HomeMy WebLinkAbout1650 OAK AVE; ; 80-621; PermitLICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provi-
sions 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 ef-
fect.
OWNER-BUILDER DECLARATION
D I 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).
C 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 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).
:JI, as owner of the property, am exclusively con-
tracting with licensed contractors 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 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. ,'lll()Q, Labol1J°de). ~
POLICY No.WC! --I -3-r •
COMPANY A<~, O · ~ 14'1 d G:·, ·P:., pf ... ~
OCopy Is filed with the city.
OCertlfled copy Is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need nol be completed If the per-
mit Is for one hundred dollars ($100) or less).
I certify that In the performance of the work for
which this permit Is Issued, I shall not employ any
person In any manner so as to become subject to
the Workers' Compensation Laws of California.
NOTICE TO APPLICANT: If, after making this Cer-
tificate of Exemption, you should become subject
to the Workers' Compensation provisions of the
Labor Codie, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
CITY OF CARLSBAD-BUILDING DEPARTMENT
USE BALL POINT PEN ONLY
APPLICATION & PERMIT
1200 ELM AVENUE (714) 438-5525
APPLICANT TO FILL IN INFOR -
MATION WITHIN RED LINES.
/6$iZ'1 ~~;,, I I I I I I I I I l I I I l I l I ~\r·11:1uP~ION1 B;s;;cJ PERMIT NUMBER JOB ADDRESS
~/t~J ow~ &--c:~ 7~~:, PRIM~NTRACTOR • -,.-,. • ~
OWNER'S PHONE STATE LICENSE
:;Ll33S-'7
f?NE0s ~ADD~S ~ q-2:.. ~otf C~T:A::::•s' P NE
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co1TRACT~RESS
{ OJ STATE LICENSE t--""
DESIGNER'S PHONE
CENSUS TRACT -u GP LANO USE ZONING
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cr-11-1 /!-I I RES. uN1TP7· l ~~t SPAtEJz>1 NUMBE:;f STORIES
Nor V•lid Unless Machin• C.rtifiad
15
TANMLAN#
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TYPEv;u rep~_, l BLOG SO. fT.
/9/t
BLOG USE
<;"'pL) I/;
QTY.I PLUMBING PERMIT AMT. II QTY. MECHANICAL PERMIT AMT.
/_3 I EACH FIXTURE TRAP ~--11 / INSTALL FURN. DUCTS UP TD 100,000 BTU -¥.-
/ I EACH BUILDING SEWER c> ~-OVER 100,000 BTU
EACH WATER HEATER AND/OR VENT BOILER/COMPRESSOR UPTO 3 HP
EACH GAS SYSTEM 1 TD 4 OUTLETS BOILER/COMPRESSOR 3-15 HP
EACH GAS SYSTEM 5 0 R MORE BOILER/COMPRESSOR 16-30 HP
~/ 71i51b/ EACH INSTAL., ALTER, REPAIR WATER PIPE _.:) --2.J VENT FAN SINGLE DUCT
EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS T
,A 'n.3.o 10 n--.J _/ ~ SIGN PERMIT I I
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I I
7.J----.,,..# ~ ~ , I I · I
I I . I TOTAL PLUMBING //. .....-11 PLAN CHECK/ u? 1 ~ ~Mtcf I 1 1 TOTAL MECHANICAL 3'f :-CONTRACTOR CONTRACTOR
QTY. ELECTRICAL PERMIT
NEW CONST EA AMP/SWT/BKR
1 PH .25 3 PH
EXIST BLOG EA AMP/SWT/BKR
1 PH .25 ~ PH
REMODEL/ALTER PER CIRCUIT
TEMP PO LE 200 AMPS
OVER 200 AMPS
TEMP OCCUPANCY (30 DAYS)
(} __ i ~ a
TOTAL ELECTRICAL
CONTRACTOR
AMT. QTY.
~r.'-
~
~7--
All INCLUSIVE PERMIT
AMT. TOTAL PLUMBING
MOBILE HOME PERMIT ELECTRICAL
AWNING MECHANICAL
PORCH MOBILE HOME
SET-UP .,.... "" SOLAR
RAMADA, CABANA / '\
FENCE OVER 6' ~
TOTAL MOBILE HOME J -I MICO -FILM
r-,._ VtlL .(l\ //-/M 22~///d~ T ..l.. Vl:K"' c.v 1° \J"'7v~ J L,,,,...... V i,,7
'11 / I 1 TOTAL FEES PAYABLE \ \ ~J I
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT. ANO 00
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I
FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY,
COUNTY ANO 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 LIABILIT1ES, JUDGMENTS, COSTS ANO
EXPENSES WHICH MA'( IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE
•AN OSHA p 5'-0'' EA TIS
I
S~~:EP ANDO RE IRED FOR ,1/;;;. o~ea, ,\~~~.~:. c::i.~':Ja;,';,~;~~·g,ove;,./ ~ ~
7/'rJ~~../ ~
-o-
OF THE GRANTING OF THIS PERMIT.
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'D lPPLICANT'S SIGN/f ~ OWNE~ CONTAACTOAQ lAPPAOVED BY
AGENT D BY PHONED I ___ -_I .n ----
SITE ..
ADDRESS: ~ OWNER: PERMIT NO: • :c.-' ' ·----
-FIELD INSPECTION RECORD \ I \
INSPECTION DATE INSPECTOR INSPECTOR'S NOTES ,, .
WOOD FLOOR . . . . ' l ( ;
FOUNDATION• FORMS• SET BACK• TOILET -
' _,, \' '. UNDER FLOOR PLUMBING .., ' ' <,.
' -__). . -. -
UNDER FLOOR HEATING ' --" ""':, :-. 1 .. J
OK TO INSTALL SUB FLOOR C ~ ---. 'i ,-~I . -.• ~ ' . •-• "l ..,
SLAB FLOOR ~ ' " ~ ' ~. i, "'" .. -. r-• UNDER SLAB PLUMBING • y " ' C
FOOTING• FORMS• SETBACK• TOILET -~
' '· . ,·' . ' >. , .. ' ·~ . OK TO POUR CONCRETE ' ' -"I;· -. ' C '· ~ ' "
FRAME
ROUGH ELECTRICAL " '.J."' '
ROUGH PLUMBING -~ •' '
ROUGH HEATING/VENTILATING ' '
FRAME OK• PLACE INSULATION
INSULATION OK • PLACE WALLBOARD '
WALLBOARD OK• PLACE TAPE . ,--. .
EXTERIOR LATH OK• PLACE STUCCO
' --.. , .. r-~·~ ; ,,. ~'.-.• ..t,,, .1 FIREPLACE .-, .. _,,_.....,.
-DAMPER &STEEL .... ----\ .. ('
PLATE Tl Es/HEIGHT OF CHIMNEY . \
' . I I '
OTHER
TEMP r:>OWER (POLE) ..... l .............. ,~ . ,,..
SEWER I
GAS TEST
SWIM POOL • STEEL BONDING '. '
• PRE DECK
• FENCE PREPLASTER
SHOWN • FRAME
• PAN ~
' -FINAL INSP BY BLDG DEPT ---,._ ,-
OTHER DEPT'S REQ COMPLETED -'. -
ELEC METER-PERM-TEMP '
GAS METER-PERM-TEMP .
; ~ ..:, · ... _;. '
,,..-". d ' ,-. ,( ~ ~)-. ;-~ .)~--) '-. '
CERT OF OCCUPANCY ISSUED " ..--T..1t. ._ .• --.
COMPLETE IN DUPLICATE AND POST WITH THE INSPECTION RECORD CARD
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 \ lo5t) 0.\ k-W Cclr /6~J , CA.
Number Street City
EXTERIOR WALLS
Manufacturer OWENS CORNING Thickness/Type 3¥2" 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 Va~ue __ _
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 NSULAJ;Or. CONTRACTOR DANA JOHNSON INSULATION,INC. LICENSE NUMBER 306493
BY k::X-TITLE Authorized Representative DATE :3 /;:)./8/
Bl Form #121
22175