HomeMy WebLinkAbout2022 LEE CT; ; CB891217; Permit,,, z 0 ~ .. .. ~ 0 .. Q
0: j e J r,eret,y affirm that ! am licensed under
CJ Ions of Chapter 9 (commencing with
: [ tlon 7000) of Div. lsion 3 ol the Business
~ !"Id Protn11lor,11 Code, and my license 1s in ~ lull force and eflecl
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ne,eOy alhrm tnat I am exempt lrom the Con1•ac-
1or's License Law lor the lollow,ng reason iSec /031 5
Bus,ness and ~rofess,ons COile Any c,•y or counry w~,c~ ·e
cu,res a permit 10 rnnslruct a-ter •eip•ove cemol1sn or
<epa,r any sTruc:u,e p•,or to ,ts ,ssuance also •eoui,es 'he ao 01,canl to, sucn perm,• •o •lie a s,oned sTatemen: tna: ~e ,s
11ceesed ~ursuant to !M prov,s,ons of :ne co~"ac10, s
License Law ,Cha?ler 9 comme~c,ig wrlh Sert,o• ?OCO ot
D,v sron 3 ◊f the B-,s,ness and Professwns Code, or Thar ,sex
e"";Jl '."eretr~"" and lhe oasis to, lhe ~I1egec e,emo1-on Any
,iOlot·on ol Sec:,on 7Q31 S Oy an appIIccnt •or ;i rerm,1 wt
eels it.e appl,canl :o ~ c,-;ti penally ol 001 '11J1e inan five nun d,ea aol,ars 1$~001
as ow~er i T"e pro0€r'y or "'V er"r,·o,e~s ,.,:h w~ges
as t~e,r sole compensatI01 w•I' do the ard l"e 5''UC
!u'e ,s ~at ,rrenaea or ollereo 1D' ~a1e ,,,,g 5u"oess ao:t P'o'ess,ons -:;ode 1•.e Lonrractor, l cesse Law coe~
nor JPPlf ta ar owntlr of P'OCe'T/ who~~, ds ~r -m~ro,es
lhereor ard wh:; aoes sues ,.:;rk r,r,,sel' ~r :'rous" ~•I cwn
em:i:ovecs prcvIded t~aT o.ich ,-p-oven•eols ire no· ~te~d
ed or o'le·ec !or sa,e 1' ",oweve, roe bu,lc,ng G' ,r,iprove-
menl ,s sold w,t~,r one year Jf ~or",p'et,on t~e owne• bJ1ide,
w,I hdve rhe t-urde~ o• p,aving Iha! he d,G nJ! bu 10 J' ,m pm,e :or the Jurpcse of sa,e1
1 as owner o' the WOJertv am e,:·us,·,e'v ooinct,n~
w,:h ,,censed :cr,:rac•ors IG construct the e·o.ec:, Sec ~G~<
Business ano p,01ess1o~s Cade The Cu-1-actor s L :enstc
Law coes not app,y to an Gwner 01 ~'Gpw11 ;,he bu"ds or""
prove~ thereor and who conr,acrs lor ea:n VJ1ects w11h a
:ort'acroris) l•cense p,1rsuan: io t~e ca-t-actor's c,cense
lJWI
As a Mflleowne-I am Im;,nwIn~ my home anc The l~low
,ng coro,1,ons e<1s:
l ' The worr ,s being perto,mecJ prtor to s.aie
2 1 have ·ived In "'Y home lor lwerve months ~r,o· to complel,on o1 lh•s work
J I have not claimed 1r11s e~empt,on Guring the dSI :hree vedrs
1 am exempt ~noer Sec ______ B & P C
lor lh•s reason ____________ _
te of consent tc t I ha•e a cert,•,ca eosai,on In I hereby afflfrn,',h:a1e ol:fcSke•s s~:p aoo, Code\ ,acer,,~ =~ sel'-1~sJre o cg"'
scwce '' ac ;? • . --1-
POL,CY "'O '-< a V\....A ,-,--,MPANY
"..:: 5 'ded with e city
V' Copy
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b h1rn,shed ~ Cert,lied copy •s here Y
CERTIFICATE OF EXEMPTION FROM
WORKERS-COMPENSATION INSURANCE
1Th1s sect,on need not De ~ompleted 1f lhe perm,!
,s lor one hundred dollars 1$1001 o, Iess1
__ I cert,ly lhal ,n t~e performance of the work for wh•ch
lh1s permit Is issued I sr,aII not employ any person ,n any
man~e, so as to became sub1ect 10 the Workers' Com pen
sa1Ion Laws of Cal,lorn,a
NOTICE TO APPLICANT 11. alter making this Cert·licate
of Exempt,on. you should become sub1ec1 to the Workers
Ccmpensat,on prov,s,ons of IM Labor Code. you must
forthw,th comply v,,th such proa,s,ons or this perm,! shall
oe deemed re•oked
i[ I "e•eby affirm !ha! there Is a construction -end,o,;
agency fo, the oerlo,mance of the work for wh,ch th,s per
m,1 ,s •.ssued 1Se\f°\7 f;4-,v,I . oe,
Lenders Name J t _
Lenders Address
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USE BALL POINT PEN ONLY & PRE~S HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS
CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT 2075 Las Palmas Dr., Carlsbad, CA 92009-1915 (619) 438-1161
JOS/AODAESS Ir AV.ST.AO. THOMAS BROS NO, DA TE OF APf>UCA TION BUSINESS LICENSE # l'tf~" PERMIT NUMBER
/"l I A ") ".) t,, ,,.., ,i-1}-~0i 1 COT BLOCK I susb1v1s10N Ac:;SESSOA PARCEL NO. -,"\ CONTRACTOR ;.ON;~AC:~~l ZONE n l /; I/ 11----' ? ":5' ~ .,.__.,., . ):'vi ~,' {)..,,,'b; "" < 7 ,~
0 ~~l;~b I OWNER'S PHONE
CONTRACTOR'S ADO.ESS ( fA -i,f} STATE LICENSE NO. BUil NG SQ FOOTAGE
L Irr "' J'Y'\· --.I~ /::..,ivr--C 0 { 1/1,/l A/ OWNEFl'S MAILl!'llG ADDRESS •
---~;"_rt('\ t_.., DESIGNER l DESIGNER'S PHONE
\ <:..DO 3t../.? l .p DESCR,PT10N OF WORK -~ 'l· i-r 'C\ tO ('\(\ I rt::.. I ~ A t .,,.., DESIGNER"$ ADDRESS STATE LJCENSE NO .
\ Q~Hl'" ' ~.., _,,, r -l /"' -.'-:• '.;<:: ;",' -. ' ' ' L '1 ,: LEV l NO OCC GP EDU -. 'J,'.•;,-,~. STORIES
y ,, •,-= I ---l CENSUS TRACT [ f'Af'lP< ,N(, SPACE ) HES u';,T'~ 3<'iACl1'G PERM•T ISSuEO ! RE DEV[ _::_;pr, E'-T
I
TYPE DCC LOAD FIRE SPFI
Ai"E A CONST I I I -Nor Vi1/1d Unless Milchine Cerrd1ed i I . [' ' D ,c YO "<D
I '7 .)--0 i I /'j ----QTY PLUMBING PERMIT -ISSUE QTY.I MECHANICAL PERt,,,~IT · iSSUE SUMMARY/ACCOUNT NUMBER -.
EACH f IX. fURE rRAP -I iNSTALL FUR~ i;L·CTS -JP TO iOO Ot,O ElTU tlU1'-ll'''" f-'~-.,v,' ,Ju1 c·u-c,.,-,::c· tL:iD ~,
EACH flUILLJING S~WER / cvt.R 100:J_oosrn . S G'.J PER\W OJ· -21 rJ-[rJ-CD-iL 2 ·
t.ACH°'NATER HEATEfi Ar-.lvrfR VENT 601LER COMPRESSOR UP 1o,.,a,1'ip PLA~ CHECK 001-s 10-00-00-8891 l,dA
EACH GAS SYSTEM I ;.<f',1 OUT LFTS BOILER COMPRESSOA..-r1'5 HP T\YAl ilLLJMBl"lG uo· o· ,.-c,:.-,~o-s21;: ,
EACH GAS SYSTFA~ OR MURE. ~UAL F'flfPLAO:.V ELECTl=l!CAL 00' J 1 ~,-Q:J-0~•-8223
EACH INSTAl/ALTER. 8EPAIR ,';ATER PIPE VENT ~A~GlE ill.JCT v1ECHANICAL GC 1 C10-=0-'J0-8224
EACH vA'cuuM BREAKER MECHE XHAUST HOOD DUCTS '.rnBILEHOME 0:J 1-8 I 0-:}0-00-8225
WATER SUFTNU: RELOCATION OF EA FURNACE HEATER SOLAR :JO 1 -3; :J-0:J-OC-82 26
FAU .. P()I_H ''RM 'j 'F1't DRYER VENT c;T;J;ONG M(JTIG\ 28:J-J' 9-92-33 I
I TOH.L MECHANICAL I F'RE SPR,IJ:-.'"ERS GO 1 -8 ~ 0-SO-C•0-22 27
ilJ!Al PllJMl-i,~L I PUBL!C FACILITIES Ff:.~ 320-6 · ;:,-C•O-,J0-2 7 ~o
!:J BRIDGE FEE 360-810-00-00-8 7..J0
QTY ELECTRICAL PERMIT -ISSUE _,,. QTY. MOBILE HOME SETUP PARK-'h'EU AREA
NE:W CONST EA AMP s·,1n OKR -CAR PORT -F 312-810-00-00-8835
' PH j,!'H AWNING LA COSTA TIF 311-810·00·00·8835
EXIST HLDG EA AMP sw_0KR GARAGE ;:MF
I PH / 1 PH LICENSE TAX ::,o· s10-co-:o-s·:;~
RE"'100fl Al~ PEH ( H[Ud MFF sso-s19-92-s;-
TE'v1PPOL~ )UU>l~PS
()V~R 2lJll A\<\PS
TtMP OCCUPANCY 30 DAYS1
. CREDIT DEPOSIT
J,:11AL Ull.P-llt:Al I TOT Al TOTAL FEES PAYABLE /'1 1J ,,--
Ellp1ratioo. Every perm1_1 issued by the Buildtng Ofl1c,al under tt,e prov1s,ons ofth1s * AN"~," IS REQUIRED FOR EXCAVATIONS OVER I HAVE CAREFULL y EXAMINED THE COMPLETED "'APPLICATION ANO PERMIT ANO DO HEREBY
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall u:pire by hm!l&llon and become null and vo,d II the building o, work 5' 0.. EP. NO DEMOLITION OR CONSTRUCTION OF
DECLARATIONS ARE tAUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT!~ aulhonzed by suet, _permit 1s not commen~~,withm 180 days from the date ot sue ti STRUC S OVER 3 STORIES IN HEMlHT permit, or if the bulld1l or work aulho ed by such perm,t 1s suspended or ISSUED: TO COMPLY WITH All CITY. COLINlY AND STATE LAWS GOVERNlNG BUtUJ!NG CON-abendone<I at anv time a ter the work ,s co 8flced tor .i =nod ot 180 da"S
STRUCTION. WHETHER SPEC\FlED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY ANO ·s""! IGNATURE' • OWNER □ APPROVErY --1. 1D3/1~/1;1 KEE(;' HARMLESS n·iE CITY OF CARL.SBAD AGAINST ALL LIABllmES. JUDGMENTS, COSTS AN~~ /c:( ~ CONTRAC~
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE 1,-') / J ,..'7lA. BY PHO fJ -~AANT!_NG Q-F THIS ~~RMl".f-. . --,-...:r---, ,
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TYPE I DATE INSPECTOR
BUILDING I
FOUNDATION I
REINFORCED STEEL I
MASONRY ' I
GUNITE OR GROUT I
SUB FRAME □ FLOOR □ CEILING
SHEATHING □ ROOF □ SHEAl;l
FRAME I
EXTERIOR LATH I
INSULATION I
' INTERIOR LATH & DRYWALL I
PLUMBING '
D SEWER AND BUCO □ PL/CO
UNDERGROUND □ WASTE □ WATER
TOP OUT □ WASTE □ WATER
TUB AND SHOWER PAN I
GAS TEST I
□ WATER HEATER □ SOLAR WATl;R
I
ELECTRICAL ' I
□ ELECTRIC UNDERGROUND □ U~FER
ROUGH ELECTRIC I
□ ELECTRIC SERVICE □ TEMPOR,l\RY
□ BONDING □ POOL I
'
I
MECHANICAL ' I
□ DUCT & PLEM., □ REF. PIPING'
HEAT -AIR COND. SYSTEMS '
VENTILATING SYSTEMS '
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I
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAVE BEEN APPROVED
FINAL I
PLUMBING I /1\ . n.
ELECTRICAL I
·~ \\1'
MECHANICAL ' ""
.
' ' GAS I ' ... ~
BUILDING I 'v ' SPECIAL CONDITIONS ' " '
'
c.e, 8q I :;) I 7
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
INSPECTION RED IF INSPECTORS DATE CHECKED APPROVAL
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRES TRESSED
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH
BOL Ts
SPECIAL MASONRY
PILES CAISSON~
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