HomeMy WebLinkAbout2301 Hosp Way; ; 81-360; PermitII) z 0 ~ a:: C .... u w C
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0 I hereby affirm that I am licensed under
provlalona of Chapter 9 (commencing with
Section 7000} of Division 3 of the Business
and Professions Code, and my license is in
full force and effect
l•c No_ ___ Clas~
I hereby attirm that I am ex:emp! trom the Con
~roi~·~;~~~;:: ;;; ~~t:~.~~~0~/6:~~~1\~~
county which f9Qu1res a perrmt lo construe 1
a.ltet, 1mpro'fl!, demolish, or repa~r any structure,
prior to ,ts issuance also reqw res the appl 1cant for
such peinY'nt to h fe a signed statement that he 1 s
hcensed pt.1rsuar,t to the pro.,,1s1ons of the Con
! ractor's License Law (Ctlapfer 9 commencing ,111t~
Section 700Ci o1 D1Y1S-1on J of the Business and Pl'C-fess,ons Code) or that Is exempt !here from and the
ti,as,:r,, tor the alleged exem pt,o-n Any v1oialmn-of
Section 7031 5 by an applicant to,r a pe.,--m11 subiects tne a,pphcant to a C11i1I penalty ol nol more than 11...-e
hundr6d doHars {S500}.
D !. as Owr"\ef ol the pmper1y. or my employe-es
l'tiih w.aiges as their sole compens.at•:::m. will d-o the
woni:., and the s1rucrure ts no~ intended or offered for
sale {Sec. 7D44, Business and Professions Code
The Con1rac1or·s Ucense Law does not apply lo an
owner of prnpeffy who builds or improves there-on
anO wtio does such woni. him-self or 1hrougr: his own
employees, prm11ded that such 1mproveme,1ts are
not mtende1 or offered tor sale If, however the
building o-r 1mprovt"men1 1s sold w1thm one year of
completion the owner-builder will ha,,,e the buraen
ol pro11m-g that he did-not build or 1mprolt'e tor the
purpose of sale)
D I, as owner ot tt,e pror,€rty am excluswel~
con~ractmt; with 11cen'SOO contractors to construct
the pmJect 1sec. 7'044, Bus.mess and Protessmr.s
Code-Th-e Contractor's L,cense Law does not app1,.-
10 an owner ol property wt.o bu I Ids Of improves
1hereon. and who contracts fa, each proiec1s with a
contrac10-r(S) license pursuant 10 lhe Co11tr.;clor's.
License l..i,Hw►.
D I am e._ernpt under Sec
tor lh1s reason
B & PC
D ~ hereby aftrrm !hat I ha·o1e a cemt1cate of consen1
to self-insure -Or a cert1f1cate of Worker5
Compensation 1nsurar.ce, or a cen1hed copy Hiereot
(Se< 3800. Labor Codei
POLICY NO
COMPANY
0 Gopy IS tiled w11t1 the CI ly
0 Ce-rt1hed copy 1s hereby turn1s'1ed
CERTIFICA n OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This se-ct1on. need not be completed 1f !he permct
1s for one hundred dollars ('StOO) or jessj
0 1 cerilfy u-.a! 1ri !he performance of the worl-: for
which. this peon1l 1s issued. l shall no1 employ any
person 1n any manner so as 1 a become-subJect lo
the Workers· Compensa11on Laws of Ca11fom1a
NOTICE TO A,PPUCANT It. afler mak1n;i this Gerti
hcale of Exemptmri. you should become subJe-Cl ,-'J
the Wol'kers· Compensatron pro1r1s1ons of the Labor
COOe. you must forthw,tri comply w11h su-ch
provisions or lh•S permrt shall De deemed re,..i;:11<.e(]
D I r-.ereby "°!l1rm th.al ttiere 15 a, cor1struct,an
~endmg agerr-cy for 1he perl[Jrr,,ance c,1 !he won,: tor
wr-111::h th-,~ perm,,: 1s 1'.5-su-ed (Sec 3097 c,·,i11 Code1
Lend-er -s Na.me ___________ _
Lender·s ACIOress __________ _
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT T'"' FILL IN INFORMATION WITHIN SHADED AREA ANO DECLARATIONS -------------------------CARLSBA_ BUILDING DEPARTMENT
1200 Elm, Carlsbad, California 92008 (714) 438-5525 At-"r'LICATION & PERMIT
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PERMIT NUMBER
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COITTRACTOR~OAESS
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CONTRACTORS PHONE # ZONE
SLOG USE CODE
I ASSESSOR Pf.Act.L NO. OESIGNER STATE LICENSE If STANDARD PLAN ti SUIL~~G 50 FOO~.· E
oe c710N OF WORK -OESIGNE R'S ADDA ESS DESIGNER'S PHONE
;, ,/ ';{7-y /J-.',r,.
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F/P FLR ELEV. NO OCC GP EDU
STORIES
<J ,□
CENSUS TRACT GP LAND USE PARKING SPACE RES UNITS GRADING PERMIT ISSUED I REDEVELOPMENT TYPE OCC LOAD FIRE SPA AREA CONST
,o "'□ YO ND Not Valid Unless Machine Certified
i QTY., PLUMBING PERMIT· ISSUE 7.50 QTY MECHANICAL PERMIT -ISSUE 3,00 SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP ---------· __ ,_ ____ . · ____ '--
EACH BUILDING SEWER
~--➔------
EACH WATER HEATER AND DR VENT
---t
---.L_
1----+--EA_CH_G_A~ SYSTEM~.~_9UTLETS ·----j.
1----+-E_A_C __ H _G_~YSH~ 5 0 R MORE j -----
EACH INSTA~. ALTER, REPAIR WAT-ER ~!~E_ ~·~-~--__ _
___ . --'---
EACH VACUUM BREAKER 1----+----
BUILDING PERMIT INSTALL FURN. DUCTS uP TO \00,000 BTU
OVER 100,000 BTU
-+---------1--------·-
SIGN PERMIT -----+---------~-
BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK -------
801LEAICOMPRESSOR 3 15 HP TOTAL PLUMBING --------+--------..---
METAL FiREPLACE ELECTRICAL + ·-----·----·--·------·-~-4----=----1--
VENT FAN SINGLE DUCT MECHANICAL --------+---------n-----------
MECH EXHAUST HOOO-'OUCTS MOBILEHOME ~--
RELOCATION OF EA FURNACE1HEATER MOBILEHOME PARK INSP WATER SOFTNER I----<--__ _J._ _______ ,._ ____ i-------. -------·-----------+--------la.--------·----·-----------SOLAR
~---'---~==-,--==~==-,--------~--'---------ll--------TOT M MECHANICAL STRONG MOTION
,,, _____ _
FIRE SPRINKLERS ------
~ ~rRO:~ DRAlt. {1NSIDE) ~-~------
~=-===T=D=l=A=L=Pl=U=M=B=I N=G=====----....,,_I~~=~=-·'·--· ,====l!,-ac=~p-====-..
PUBLIC FACILITIES FEE
QTY. ELECTRICAL PERMIT -ISSUE ------
BRIDGE FEE 2.00 QTY. SOLAR -ISSUE
1----1-------------------------! NEW CONST EA AMP 'SWT BK R
------------+,-----~·-
COLLECTORS SCHOOL FEE -DISTRICT ------------+--------+----------·--------------~--------1---------fll---
I I PH 3 PH STORAGE TANKS C a r Is tJ ad 1---t------------------------~· ---1-------------------------+-··· --------
EXIST BLOG EA AMPiSWT'BKR
1---1-------------~-
1 PH 3 PH ,__ _ _, _________ ---------------
REMODEL ALTER PER CIRCUIT ---+--------------·--
TEMP PO LE 200AMPS
~ -+OVER 200 AMPS
TEMP OCCUPANCY 130 DAYSI ---t ··----·----
ROCK STORAGE Encinitas
PUMP --------------+-----------------=----+-------II--San D1eguito
San Marcos PLAN CHECK FEE ----------·~· -------------1~--
_,_ ______ _.. ----..
_.___-;:r-3'.1 ·z~-
-·-------;:i., -,~~n-
I
•-t---------
-~----~
----~
----·-
------+-------·
------
-----
-l __________ _
f------------ilt------------------.--..i..---------1
I ~.(3, 10 TOTAL ELECTRICAL
I HAVE CAREFULLY EXAMINED THE COMPLETED ·'APPLICATION AND PERMIT'; AND DO HEREBY
CERTIFY UNDER PENALTY OF PERJURY THAT A.LL INFORMATION HEREON INCLUDING THE
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS
ISSUED: TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON-
STRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND
KEEP HARMLESS TH£ CITY OF CARLSBAD AGAINST ALL UABIUTIES, JUDGMENTS, COSTS AND
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE
GRANTING OF THIS PERMIT.
TOT Al SOLAR TOTAL FEES PAYABLE
E•piration. Every permit issued by the BuildingOfllcial under the pro•isions of this Code shall expire by lim,tation and become null and •oid fl the ou,ldmg o, •or1'
authorized by such permit is not comlll9flced within 180 days from the date of such
permit, or if the building or work authoriziid by .such permil is suspended or
abandoned at eny tune after the work i!!i commenced lor a m>riod of 180 d"''".
APPLICANT'S SIGNATURE Jf-OWNER □ CONTRACTOR 0
BYPHONE 0
* AN 06ttA PEF!Mll IS REOUIAED FOFI EXCAVATJONS.OV£FI 5· O" DEEP ANO OE.MOLrnot,1 OR C0"1$TRUCTION OF
S~l\lMS OVER 3 STOAIE.S IN HEIGHT I
APPROVE'jt} BY ISRE , v,z,..7,: l . /8/
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INSPECTION TYPE DATE INSPECTOR 0 ---
BUILDING FIELD INSPECTION RECORD
FOUNDATION
REINFORCED STEEL REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
MASONRY INSPECTION REO. IF INSPECTORS DATE CHECKED APPROVAL
GUNITE OR GROUT SOILS COMPLIANCE
FLOOR & CEILING SUB FRAME PRIOR TO
FOUNDATION INSP
SHEATHING STRUCTURAL CONCRETE
FRAME OVER 2000 PSI
EXTERIOR LATH lNSULATION PRESTRESSED
CONCRETE --~-----·--
INTERIOR LATH & DRYWALL POST TENSIONED
CONCRETE
PLUMBING -
-
FIELD WELDING
SEWER AND BL/CO ~
HIGH STRENGTH ·-•-• ---------------··
PLUMBING UNDERGROUND
PLUMBING TOP OUT
BOLTS
i
+--------~-----------·----· ------
I SPECIAL MASONRY
-TUB AND ~HOWER PAN I
I
~------···· -----~ I ---·
GAS TEST ! PILES CAISSONS
ELECTRICAL !
TEMPORARY POWER I
I
ELECTRIC UNDERGROUND -----------
ROUGH ELECTRIC
ELECTRIC SERVICE
BONDING A ------------
' G. F. I. -SMOKE DETECTOR. --· .
MECHANICAL .. -------~-------
DUCT & PLEM., REF. PIPING -------·------~-
HEAT -AIR COND. -SOLAR SYSTEMS
I
VENTILATING SYSTEMS
----
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS. ABOVE HAVE BEEN APPROVED ,, -----
JOB SITE ANAL
PLUMBING " ELECTRICAL "' . '
MECHANICAL "' A .'l'J ' ---------
GAS ' 1")_✓7
BUILDING '-.... .. -----
SPECIAL CONDITIONS ·---~-~
CERT OF OCCtJPANCY ISSUED
J of Carlsbad
J ELM, CARLSBAD, CA 92008 • TEL. (714) 438-5525
Job
Address
Address
City
State Lie. ~ s. Classil. o<..
.
Tel.
City r'] h~
Lie. NoO(l'.? / °'-.:)
COMPLETE FOR PLAN CHECK ONLY
LEGAL DESCRIPTION
ASSESSORS PARCEL NO
DESCRIPTION OF WORK
PLAN ID NO. CJ
DESIGNER ADDRESS
PHONE
CONTACT PERSON
MISCELLANEOUS
RECEIPT
MISCELLANEOUS FEE RECEIPT
□ • PLAN CHECK FEE
□ VALUATION
□ DEMOLITION
□ HOUSE MOVING
□ PARKS ANO RECREATION FEE
□ PUBLIC FACILITIES FEE
□ SCHOOL FEE -DISTRICT
□ Carlsbad
□ Encinitas
□ San Diego
□ San Marcos
□-----------------+-------t
□-----------------+-------t
□-----------------+-------t
□-----------------+-------t
□------------------+--------
□-----------------+-------t
TOTAL FEE $
*WARNING: PLAN CHECK FEES. WHERE NO ACTION IS TAKEN BY THE
APPLICANT IN 180 DAYS AND NO BUILDING PERMIT IS ISSUED, FEE ARE
FORFEITED TO THE CITY.
COMMENTS: ______________________ --t
White -Applicant Yellow -File Pink -(1) Finance (2) Data Process Gold -Assessor
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