HomeMy WebLinkAbout1619 TAMARACK AVE; ; 78-4758; Permitllcf RICAt PERMIT APKltAirpsl
City of CARLSBAD, CALIFORNIA 92OO8
Applicant to compete numbered sp»ce3 only PhOM6 729-1181
JOB ADDRESS
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OWNER
CONTRACTOR '
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ARCHITECT OR DESIGNER
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ENSINEER
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BLK TRACT _(OSEE ATTACHED SHEET)
MAIL ADDRESS ZIP ",.>«*• PHONE -«*
» MAIL ADDRESS PHONE STATE LIC NO CITY LIC NO
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MAIL ADDRESS PHONE LICENSE NO
MAIL ADDRESS PHONE LICENSE NO
COMPENSATION INS CARRIER MAIL ADDRESS BRANCH
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USE OF BUILDING ~"~
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1 Clmofwork DNEW D ADDITION G ALTERATION D REPAIR
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SPECIAL CONDITIONS
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THIS PERMIT BECOM
TION AUTHORIZED 1
CONSTRUCTION OR 1
PERIOD OF 120 DA
MENCED
1 HEREBY CERTIFYAPPLICATION AND KALL PROVISIONS OFTYPE OF WORK WILHEREIN OR NOT. 1PRESUME TO GIVE iPROVISIONS OF ANYCONSTRUCTION OR
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PLANS CHfCKED BY APPROVED FOR ISSUANCE BY
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DATE
NOTICE
ES NULL AND VOID IF WORK OR CONSTRUC-
S NOT COMMENCED WITHIN 120 DAYS, OH IF
WORK IS SUSPENDED OR ABANDONED FOR A
YS AT ANY TIME AFTER WORK IS COM
THAT 1 HAVE READ AND EXAMINED THISNOW THE SAME TO BE TRUE ANO CORRECTLAWS AND ORDINANCES GOVERNING THIS
L BE COMPLIED WITH WHETHER SPECIFIED
HE GRANTING OF A PERMIT DOES NOTAUTHORITY TO VIOLATE OR CANCEL THEOTHER STATE OR LOCAL LAW REGULATINGTHE PERFORMANCE OF CONSTRUCTION
SI8N*4uRE OF CONTRACTOR OR AUTHORIZED AtENT (DATE)
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PERMIT pees
NO INCREASE IN SERVICE
NEW CONSTRUCTION, FOR EACH
AMPERES OF MAIN SERVICE SWITCH
FUSE OR BREAKER
NEW SERVICE ON EXISTING BLDG
FOR EA AMPERE OF INCREASE
IN MAIN SERVICE, SWITCH, FUSE
OR BREAKER
REMODEL, ALTERATION, NO CHANGE
IN SERVICE, FOR EA AMPERE OF
INCREASE
TEMP SERVICE UP TO AND INCLUD-
ING 200 AMP
TEMP SERVICE OVER 200 AMP.
PER 100
ISSUANCE FEE
TOTAL FEES
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WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK.M.O.CASH PERMIT VALIDATION CK.M.O.
INSPECTOR
78
INSPECTION REPORTS
DATE ITEM REMARKS INSPECTOR
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC
CITY OF CARLSBAD
BUILDING DEPARTMENT
(714) 729-1181
CERTIFICATION
I certify that in the performance of the work for which this permit is issued I shall not
employ any person in any manner so as to become subject to the workers' compensation
laws of California
If, after making this certificate, I become subject to Ihe workers' compensation pro-
visions of the California Labor Code, I will forthwith comply with Section 3700 of the
Labor Code
I understand that if I fail to comply with the workers' compensation laws, this permit
shall be deemed revoked
I further certify that if I should contract or subcontract with any person, including any
firm or company, to do all or part of the work for which this permit is issued, I shall assure
compliance by that contractor or subcontractor with Section 3800 of the California Labor
Code
SIGNED
PRINT NAME AND TITLE
JOB ADDRESS
DATED P*~ / J ~ >