HomeMy WebLinkAbout1643 MAGNOLIA AVE; ; 80-238; 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•
feel.
OWNER-BUILDER DECLARATION
D I hereby alfirm that I am exempt from the Con•
tractor's License Law for the following reason
(Sec. 7031.5.Business and Professions Code), Any
clly or county which requires a permit lo con-
,iltruct, alter, Improve, demolish, or repair any
structure, prior to Its Issuance also requires the
applicant for such permit to file a signed state-
~ent that he Is licensed pursuant to the provl·
~on3 of the Contractor's License Law (Chapter 9
'tommencing wllh 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•
pllcant for a permit subjects the applicant to a
civil penally of nol more than live hundred dollars
($500).
D I, as owner of the property, or my employees
with wages as their sole compensation, will do
the work, and the structure Is not Intended or of•
fered for sale (Sec. 7044, Business and Profes·
sions Code: The Contractor's License Law does
not apply 10 an owner of property who builds or
Improves thereon and who does such work
himself or through his own employees, provided
Iha! 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).
'.JI, as owner of the property, am exclusively con•
tracling with licensed contraclors to construct
the project (Sec. 7044, Business and 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 conlraclor(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, o• a certificate of 'A(orkers'
Compensation Insurance, or a certifi~opy
thereof (Sec. 3800, Labor Code).
~~~~:.;>_____ ~ ~," ..
□Copy is filed wllh the city.
□Certified copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed II the per•
mlt 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 manner so as to become subject to
the Workers' Compensation Laws of California.
NOTICE TO APPLICANT: If, after making this Cer•
tlficate of Exemption, you should become subject
to the Workers' Compensation provisions of the
Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction len•
dlna aaencv for the performance of the work for
CITY O F CARL SBAD-BUILDING DEPARTMENT
USE BALL POINT PEN ONLY
APPLICATION & PERMIT
1200 ELM AVENUE (714) 438-5525
/i Ho. /./#'b#tPJ-/19 ,#~JOB ADDRESS AV, ST. IDATE OF APPLICATION RO ,?.3, I 'I I I I I i I I I I I I I I I I I I I I I I I I I I
OWNEr,61te L..rs;' 0,1])· C 4~ Lfc U (SL a
0::57.Jf '9.;i;
PRIME CONTRACTOR
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OWNER'S MAILING ADDRESS
d I c) -S----cf ie ~ /~so.._j -11 CJ e_ 41 7 CONTRACTOR; iDDR SS "v
LOT BLOCK I SUBDIVISION I ASSESSOR'S PARCEL NO. ' DESIGNER IV I I I I I I I I I I I I
DESCRIPTLON OF WORK Pa¼..1~ -~ J;,;::::.-, ,~ t L t•f"71· .,......._. I nF DESIGNER'S ADDRESS \
fY\€'r€~
CENSUS TRACT GP LAND USE ZONING
APPLICANT TO FILL IN INFOR -
MATION WITHIN RED LINES.
BUS.(\Lr NS,. PERMIT NUMBER
I,
STArl/ L 1,!i4<SE J !o-'V3Y
CONTRAC OR'S
PHONE
STATE LICENSE
OESIGNER•s PHONE
ti!""U. I! -7 ,.. ,
--. C •
.....
I RES. UNITS I PARKING SPACE I NUMBER OF STORIES
Not V•lid Unless Machin, C.rtifi«J
BLOG SO, FT, BLDG USE occ. GP I ST AND4RD PLAN 11 I PL4N I D 11 TYPE CONST I occ. LOAD I .
'
QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT.
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TD 100,000 BTU
EACH BUILDING SEWER OVER 100,000 BTU
EACH WATER HEATER AND/DR VENT BOILER/COMPRESSOR UP TO 3 HP
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP
EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP
EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT
EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS -..,___
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . I I I
SIGN PERMIT I . I I I
TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I I I I
CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I I I
ELECTRICAL PERMIT AMT. AMT. TOTAL PLUMBING I I I
QTY. QTY. MOBILE HOME PERMIT ELECTRICAL I 'l,'7. LH1)
/(k NEW CONST EA AMP/SWT/BKO ~ -z,,.;:_ 7TJ!, AWNING MECHANICAL I I I
1 PH .25 3 PH PORCH MOBILE HOME I I I
EXIST BLDG EA AMP/SWT/BKR SET-UP SOLAR I . I I I
1 PH .25 3 PH RAMADA, CABANA I . I I I
REMODEL/ALTER PER CIRCUIT FENCE OVER 6' I I I I
TEMP POLE 200 AMPS TOTAL MOBILE HOME MICO -FI LM I I I I
OVER 200 AMPS I . I I I
TEMP OCCUPANCY (30 DAYS) ~-I . I I I
I ....,_ ,JO 'v:'./ .
I . ~
TOTAL ELECTRICAL /7 :::::-'-TOTAL FEES PAYABLE
I
,
CONTRACTOR I I i217 /) 'd . .
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5'-0" DEEP AND DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY,
STACI:EA 3STOA~E~: _ /_ COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
SPECIFIED HEREIN QA NOT. l,ALSO AGREE TO SAVE INDEMNIFY AND 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. APPLICANT'1 IGNATUAE • cJ () OWNER□ CONTRACTOR□ 'APPROVED BY DATE
AGENT lo B Y PHONED I
.
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SITE W ... /3<e; ADDRESS: OWNER: PERMIT NO:
FIELD INSPECTION RECORD
INSPECTION DATE INSPECTOR INSPECTOR'S NOTES
WOOD FLOOR
FOUNDATION• FORMS• SET SACK• TOILET •
UNDER FLOOR PLUMBING
UNDER FLOOR HEATING
OK TO INSTALL SUB FLOOR
SLAB FLOOR
UNDER SLAB PLUMBING
FOOTING• FORMS• SETBACK• TOILET
OK TO POUR CONCRETE
FRAME
ROUGH ELECTRICAL
ROUGH PLUMBING
ROUGH HEATING/VENTILATING
FRAME OK• PLACE INSULATION
INSULATION OK • PLACE WALLBOARD
WALLBOARD OK • PLACE TAPE
EXTERIOR LATH OK • PLACE STUCCO
FIREPLACE
DAMPER &STEEL
PLATE TIES/HEIGHT OF CHIMNEY
OTHER
TEMP POWER (POLE)
SEWER
GAS TEST
i SWIM POOL• STEEL BONDING
• PRE DECK
• FENCE PREP LASTER
SHOWN • FRAME ,
• PAN I • I /: ,.
FINAL INSF'> BY BLDG DEPT tfl✓Fff1<, ·;pJV"V
OTHER DEPT:S REQ COMPLETED 'I ' ( fl
ELEC METER-PERM-TEMP ~
j GAS METER-·PERM-TEMP
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L.'.::..1:_:T OF OCCUPANCY ISSUED ~ i
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