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Home My WebLink About1640 OAK ST; ; 80-622; PermitLICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provl· slons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes- sions Code, and my license is In full force and el· feet OWNER-BUILDER DECLARATION 0 1 hereby affirm that I am exempt from the Con· tractor's License Law for the following reason (Sec. 7031.5 Business and Professions Code), Any city or county which requires a permit to con- struct, alter, Improve, demolish, or repair any structure, prior to its Issuance also requires the applicant for such permit to file a signed state- ment that he Is licensed pursuant to the provi- sions of the Contractor's License Law (Chapter 9 commencing with Section 7000 of Division 3 of the Business and Professions Code) or that is ex- empt therefrom and the basis for the alleged ex- emption. Any violation of Section 7031.5 by an ap- plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). r I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure ts not Intended or of- fered for sale (Sec. 70,4,1, Business and Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon and who does such work himself or through his own employees, provided that such Improvements are not intended or of- fered for sale If, however, the building or Improve- ment Is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or Improve for the purpose of sale). _ ;, as owner of the property, am exclusively con- tracting with licensed contractors to construct the project (Sec. 70,44, Business end Professions Code: The Contractor's License Law does not ap- ply to an owner of property •ho builds or Im- proves thereon, and who contracts for such pro· jects with a contractor(s) license pursuant to the contractor's License Law). I am exempt under Sec. • B. & P.C. for this reason ____________ _ Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of con- sent to self-Insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3a091 Labor Code) .. .c POLICY NO /),J<. t 71 -3 __,_-1_ .. .;..7 ___ _ COMPANY A,. ~ ( '... 'ti RS::.. :$ OCopy Is 1red~1t:f:he1 city ' ·1,j~ D Certified copy Is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS" COMPENSATION INSURANCE (This section need not be completed If the per· mit Is for one hundred dollars ($100) or less). I certify that In the performance of the work for which this permit Is Issued, I shall not employ any person In any r.lanner so as to become subject to the Workers' Compensation Laws of California. NOTICE TO APPLICANT: If, after making this Cer- tificate of Exe "'PIion, you should become subject to the Worke• ' -:Ompensatlon provisions of the Labor Code, .-6u must forthwith comply with such provisions or this permit shall be deemed revoked. rn .. ,~TDltf"Tlnht I i:NnlNG AGENCY CITY OF CARLSBAD-BUILDING DEPARTMENT APPLICATION & PERMIT USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525 APPLICANT TO FILL IN INFOR- MATION WITHIN RED LINES. JOB ADDRESS PERMIT NUMBER $/ti~ CENSUS TRACT C.r~1-J_: /t:. I BLOG USE BLDG SO. F~ 5 ~ .R ~ STANDARD PLAN II QTY.I PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT. EACH FIXTURE TRAP L INSTALL FURN. DUCTS UP TO 100,000 BTU EACH BUILDING SEWER EACH WATER HEATER ANO/OR VENT EACH GAS SYSTEM 1 TO 4 OUTLETS EACH GAS SYSTEM 5 OR MORE EACH INSTAL., ALTER, REPAIR WATER PIPE EACH LAWN SPRINKLER SYSTEM WATER SOFTNER CONTRACTOR QTY.I ELECTRICAL PERMIT NEW CONST EA AMPISWT/BKR 1 PH .25 EXIST BLDG EA AMP/SWT/BKR 1 PH .25 REMODEL/ALTER TEMP PO LE 200 AMPS OVER 200 AMPS TOTAL ELECTRICAL CONTRACTOR ~ ~1..,, I HAVE CAREFULLY EXAM_j,l(ED.U+t! COMPLETED "APPLICATION ANO PERMIT, ANO 00 HEREBY CERTIFY THAT ~-INFORMATION HEREON IS TRUE ANO CORRECT ANO I FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUEO;TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION. WHETHER SPECIFIED HEREIN OR NOT !,ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT OVER 100,000 BTU Ii .-- MOBILE HOME PERMIT AMT. 'AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER S' O" OEEP ANO DEMOLITION OR CONSTRUCTION OF STRIJ.CTURES OVER 3 STORIES IN HEIGHT --........ BUILDING PERMIT SIGN PERMIT PLAN CHECK ALL INCLUSIVE PERMIT TOTAL PLUMBING ELECTRICAL MECHANICAL MOBILE HOME SOLAR MICO -F ILM TOTAL FEES PAYABLE ~~,-6--- CONTRACTORQ !APPROVED BY AGENT D BY PHONE 0 DATE • .... < 0 ~ ~ i== lrl 0. V> ~ ,.,.,. SITE c:<n -~ ?-?-ADDRESS: '1~ -. ' OWNER: PERMfT NO: ' ' FIELD INSPECTION RECORD C .. INSPECTION DATE INSPECTOR INSPECTOR'S NOTES~ . . -· : WOOD FLOOR . ., }'"'.9 1 J I -~ . ) -,: FOUNDATION• FORMS• SET BACK• TOILET . -' UNDER FLOOR PLUMBING ' ' • ' •,_, . '' -Ir;_ ~tr I • t j . ,._ ... i .. -1.-, \ .. -. ( ~ 1,1 ,_ - UNDER FLOOR HEATING I 'r---. ' . . ~ '..r : ~ OK TO INSTALL SUB FLOOR ... -~ ' ,. -r ., "' ' \ .. t· . ' ' SLAB FLOOR ' . . , ... ' ~ >---f UNDER SLAB PLUMBING "\ I --.._ ... ' ' ;" \ ,, FOOTING• FORMS• SETBACK• TOILET ' "' ~ ~ .. .. -. OK TO POUR CONCRETE ,\ . ~ -· -. --C FRAME ROUGH ELECTRICAL ' r -ROUGH PLUMBING . ROUGH HEATING/VENTILATING FRAME OK • PLACE INSULATION INSULATION OK • PLACE WALLBOARD WALLBOARD OK• PLACE TAPE.. EXTERIOR LATH OK• PLACE STUCCO ' ' FIREPLACE ,--·-.. . . ~ !. ; DAMP.ER &STEEL ---~ . PLATE Tl Es/HEIGHT OF CHIMNEY OTHER TEMP POWER (POLE) .. I SEWER I GAS TEST , I SWIM POOL • STEEL BONDING I • .. -I • PRE DECK ' ~ ... • FENCE PREPLASTER ' SHOWN • FRAME .. -. . • PAN ;'C. . FINAL INSP BY BLDG DEPT -~- OTHER DEPT'S REQ COMPLETED I ELEC METER-PERM-TEMP .... GAS METER-PERM-TEMP ·- ~ ,,.-~-~~ ~ . ~-' __ ...,.. ... ~-;~. . ,' '"' ~ CERT OF OCCUPANCY ISSUED I -...:, -,. f: '-_,)-\..~' )\ -- ' ../ , COMPLETE IN DUPLICATE ANO POST WITH THE INSPECTION RECORD CARO THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT ENERGY REGULATIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 25, STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT : SITE ADDRESS \ W-0 Ocl {M_, Car l~ba~t C..A- Number Street City EXTERIOR WALLS Manufacturer OWENS CORNING Thickness/Type 3%" R Value 11 CEILINGS Batts: Manufacturer __ ow_EN_S_C_O_R_N_IN_G __ Thickness/Type __ 6'_' _ R Value __ 19_ Blown: Manufacturer ---------Thickness/Type ___ _ No. Bags Wt ./Bag --------Sq. Ft. Covered ------R Value --- FLOORS Manufacturer---------Thickness/Type-----R Value ___ _ SLAB ON GRADE Manufacturer----------Thickness/Type-----R Value ___ _ Width of Insulation ____ Inches FOUNDATION WALLS Manufacturer ----------Thickness/Type -----R Value ___ _ GENERAL CONTRACTOR---------------LICENSE NUMBER----- BY ____________ TITLE----------DATE-------- I NSULAP)Of 1 CONTRACTOR DANA JOHNSON INSULATION,INC. LICENSE NUMBER 306493 BY 1~ TITLE Authorized Representative DATE 3/Jd I~) Bl Form #121 22175