HomeMy WebLinkAbout235 PINE AVE; MULTI-PERMIT FILE; CBR2017-2365; PermitCity of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Print Date: 10/11/2017 Residential Permit Permit No: CBR2017-2365
www.carlsbadca.gov
Job Address: 235 Pine Ave
Permit Type: BLDG-Residential Work Class: P/M/E Status: Closed - Finaled
Parcel No: 2041311600 Lot #: Applied: 10/05/2017
Valuation: $0.00 Reference U: Issued: 10/05/2017
Occupancy Group: Construction Type: Finaled:
# Dwelling Units: Bathrooms: Inspector:
Bedrooms: Orig. Plan Check U:
Plan Check U:
Project Title:
Description: SMITH: GAS LINE REPAIR FOR ENTIRE BUILDING
Owner:
TRUST SMITH FAMILY
7172 Aviara Dr
CARLSBAD, CA 92011-4900
PLUMBING, ELECTRICAL, AND MECHANICAL PERMIT $170.00
Total Fees: $170.00 Total Payments To Date: $170.00 Balance Due: $0.00
Please take NOTICE that approval of your project includes the Imposition' of fees, dedications, reservations, or other exactions hereafter
collectively referred to as 'fees/exaction." You have 90 days from the date this permit was issued to protest imposition of these
fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the
protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section
3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their
i mposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection
fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this
project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the
statute of limitation has previously otherwise expired.
HE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: El PLANNING lJ ENGINEERING 0 BUILDING D FIRE EJ HEALTH i:J HAZMATIAPCD
4 City of
Cd1sbad
Building Permit Application
1635 Faraday Ave., Carlsbad, CA 92008
Ph: 760-602-2719 Fax: 760-602-8558
email: building@carlsbadca.gov
www.carlsbadca.gov
Plan Check No
Est. Value
Plan Ck. Deposit
Date tI —5-1-(
JOB ADDRESS I SUITE#/SPACE#/UNIT# APN
CT/PROJECT# LOT# PHAS NITS [BEDROOMS #BATHROOMS TENANT BUSINESS NAME CONSTR.PE OCC.GROUP
DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) 2L eyp'(- €4ht /d h7141 mA
EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE
1 YESD#. NOE
lAIR CONDITIONING
YES NO
I FIRE SPRINKLERS
YES NO
APPLICANT NAME
Primary Contact
PROPERTY OWNER
ADDRESS ADDRESS
CITY STATE ZIP CITY STATE ZIP
PHONE FAX PHONE 3/a 5-
I FAX
9-p
EMAIL EMAIL
DESIGN PROFESSIONAL CONTRACTOR BUS. NAME
ADDRESS ADDRESS
CITY STATE ZIP CITY STATE ZIP
PHONE FAX PHONE FAX
EMAIL EMAIL
STATE LIC. C STATE LIC.# CLASS CITY BUS. LiCA#
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the
applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9, commending with Section 7000 of Division 3 of the
Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a
civil penalty of not more than five hundred dollars ($5001).
0112° ®G?O®3
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
LI I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
El I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers compensation insurance carrier and policy
number are: Insurance Co. Policy No. Expiration Date
This iection need not be completed if the permit is for one hundred dollars ($100) or less.
E1Certificate of Exemption: 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. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in
addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees.
CONTRACTOR SIGNATURE [—]AGENT DATE
oO@OtQ1 ?iJ
I hereby affirm that lam exempt from Contractor's License Law for the following mason:
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 offered for sale (Sac. 7044, Business and Professions 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 offered for
sale. If, however, the building or improvement 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).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractofs License Law).
Eli I am exempt under Section Business and Professions Code for this reason:
I personally plan to provide the major labor and materials for construction of the proposed property improvement. DYes IlNo
I (have / have not) signed an application for a building permit for the proposed work.
I have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors' license number):
I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone I contractors' license number):
I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone I type of work(:
PROPERTY OWNER SIGNATURE
-
flAGENT DATE
thGU
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the
Presley-Tnnne Hazardous Substance Account Act? 0 Yes 0 No
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 Yes 0 No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 Yes 0 No
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF
EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
U]LDaø. Jc3
I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code).
Lender's Name Lender's Address
I certify that I have read the application and state that the above information is coned and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction.
thereby authorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS 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.
OSHA: An OSHA pemiti is required for excavations over 50' deep and demolition or construction of structures over 3 stories in height.
EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expireby limitation and become null and void if the building or work authorized by such permit is not commenced within
180 days from the date of such permit or if the buildi o out authorize s perm suspen at any time after work is commenced for a p rod of 180 days (Section 106.4.4 Uniform Building Code).
.APPLICANT'S SIGNATURE I DATJ/
(//
S STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE.
Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection.
'OO@ c ®AtJY ®oDa®oO 0Ifl3G ®O
Fax (760) 602-8560, Email buiIdinq@carIsbadCa.ov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008.
r0#: (Office Use Only)
CONTACT NAME OCCUPANT NAME
ADDRESS BUILDING ADDRESS
CITY STATE ZIP CITY STATE ZIP
Carlsbad CA
PHONE FAX
EMAIL OCCUPANT'S BUS. LlC. No.
DELIVERY OPTIONS
0 PICK UP: D CONTACT (Listed above) o OCCUPANT (Listed above)
CONTRACTOR (On Pg. 1)
0 MAIL TO: ci CONTACT (Listed above) o OCCUPANT (Listed above) ASSOCIATED CB
CONTRACTOR (On P. 1) ci NO CHANGE IN USE / NO CONSTRUCTION
0 MAIL! FAX TO OTHER:
CHANGE OF USE / NO CONSTRUCTION
...APPLICANT'S SIGNATURE DATE
Permit Type: BLDG-Residential Application Date: 10/05/2017 Owner: TRUST SMITH FAMILY
Work Class: P/M/E Issue Date: 10/05/2017 Subdivision: THUM LANDS
Status: Closed - Finaled Expiration Date: 04/03/2018 Address: 235 Pine Ave
Carlsbad, CA 92008-3140 IVR Number: 6796
Scheduled Actual
Date Start Date Inspection Type Inspection No. Inspection Status Primary Inspector Reinspection Complete
10/06/2017 BLDG-23 037336-2017 Passed Paul Burnette Complete
Gas/Test/Repairs
Checklist Item COMMENTS Passed
BLDG-Building Deficiency No
BLDG-Final 037337-2017 Passed Paul Bumette Complete
Inspection
Checklist Item COMMENTS Passed
BLDG-Building Deficiency No
BLDG-Plumbing Final No
BLDG-Mechanical Final No
BLDG-Structural Final No
BLDG-Electrical Final No
October 11, 2017 Page 1 of I
01
B U I L D I N G P E R N I T Permit No: CB981819
06/12/98. 09:44 Project No: A9802413
Page 1 of 1 Development No:
Job Address: 235 PINE AV Suite:
Permit Type: PLUMBING 7999 06/12/98 0001 01 02
Parcel No: 204-131-16-00 Lot#: C-PRMT 27.00
Valuation: 0 Construction Type: NEW
Occupancy Group: Reference#: Status: ISSUED
Description: EMERGENCY GAS LINE REPAIR Applied: 06/12/98
Apr/Issue: 06/12/98
Entered By: JM
Apl/Ownr : MELLANO HARRY 760 433-9550
235 PINE AVENUE
CARLSBAD CA 92008
Fees Required *Fee -.çollected&Credits -
z ------ --------------------------
Fees: ( N Adjustments: /oo r .00
Total Fees: 2'7.0U\i .00 1 BaJnc üe: . 27.00
Fee description 1 ''\. inIts\ F aak /lJn±\t Ext fee Data / --------------------------------------- Enter 'Y' for Plumb..>- - 20.00 1
-. - - - - , Gas Piping System I \ (7.00 7.00
A \ / . -'•
V /
, \INCORPORATED
\ '-- I / 1 / _'• \\._ .7
S.c • c
FL 1W
IN
JVAL
0 E
V
CLEARANCE --'
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT-APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(760) 438-1161
FOR OFFICE USE ONLY
PLAN CHECK NO.__________
EST. VAL.
Plan Ck. Deposit ,.
Validated By
1. PROJECT I TION
Address (include #1 Business Name (at this address)
Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units
Assessor's Parcel # Existing Use Proposed Use
Descri of Work SQ.Ir. #of Stories # of Bedrooms # of Bathrooms
2.....;CONTAC.TPE ON.(if:diffeiéntfrónia icant).. / H
SfET Cr) 4 us c CAL -(_ 9) 11'
Name Address City State/Zip Telephone # Fax #
3 APPLICANT 0 Contractor 0 Agent for Contractor Owner Agent for Owner
Name Address City State/Zip Telephone #
4.H PROPERTY OWNER :. ......::.. . '....
Name Address City ( State/Zip Tel phone #
S. CONTRACTOR - CQMPANY;NAME .
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$5001).
Name Address City State/Zip Telephone #
State License # License Class City Business License #
Designer Name Address City State/Zip Telephone
State License #
6 WORKERS COMPENSATION
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
C] I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My worker's compensation insurance carrier and policy number are:
Insurance. Company Policy No._____ Expiration Date___________________
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ISlOOl OR LESS)
0 CERTIFICATE OF EXEMPTION: 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.
WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred
thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees.
SIGNATURE DATE
7. OWNER-BUILDER DECLARATION .
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
El 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 offered for sale
(Sec. 7044, Business and Professions 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 offered for sale. If, however, the building or improvement 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).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code: The
Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed
pursuant to the Contractor's License Law).
0 I am exempt under Section ____ Business and Professions Code for this reason:
I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO
I (have / have not) signed an application for a building permit for the proposed work.
I have contracted with the following person (firm) to provide the proposed construction (include name / address I phone number / contractors license number):
I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone
number / contractors license number):
I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type
of work):
PROPERTY OWNER SIGNATURE DATE e2
COMPLETE THIS SECTION FOR NQ'RESIDEN77AL'BUILDING PERMITS ONL'II ( /
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention
program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES 0 NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES 0 NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES 0 NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
8.: :CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code).
LENDER'S NAME LENDER'S ADDRESS__________________________________________________________
:9. APPLICANT CERTIFICATION . .
I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all
City ordinances and State laws relating to building construction. I hereby authorize representatives of the Cit' of Carlsbad to enter upon the above mentioned
property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS 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.
OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height.
EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or
work authorized by such permit is not.çommenced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended
or abandoned at any time after the k is commence a period of 80 days (Section 106.4.4 Uniform Building Code).
kAPPLICANT'S SIGNATURE
('!2a-21??Ld/ DATE 6
/f
/
WHITE: File Y OW: Applicant PINK: Finance
B U I L D I N G P E R M I T Permit No: CB960097
01/17/96 15:13 Project No: A9600158
Page 1 of 1 Development No:
Job Address: 235 PINE AV Suite: P
Permit Type: PLUMBING 5594 )j/j,'/ 0001 0: D2
Parcel No: 204-131-16-00 Lot#:
Valuation: 0 Construction Type: VN
Occupancy Group: Reference#: Status: ISSUED
Description: REPAIR EXISTING GAS LINE Applied: 01/17/96
Apr/Issue: 01/17/96
Entered By: MDP
Appl/Ownr : WHITE, STEVE 619 434-0974
362 WALNUT AVE
CARLSBAD, CA, 92008
V V
*** Fees Required *** *** Fees collected & Credits
------------------------
Fees: 2700 •'. ". .Y' /
Adjustments: / .00 Total Credits: .00
Total Fees: "27.00 , Total Payrne?1t:'\ .00
V :Balance Due: \ 27.00
Fee description /
V ' Unite ', 'Fe'e/Unit Ext fee Data
V V - - V• VV' -?
Enter UU for Plumbing 1ue Fee- - V VV •V
V 20.00 Y
Gas Piping System 7.00
* PLUMBING TOTAL V a .)' 27.00
V
•V•
-
V / I
VV
1 N S
CLEARANCE
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
APPROVAL
- DATE
PERMiT APPUCA11ON
City of Cartsbad BuRding Departsnt
2075 Las PaLs Dr., CarLsbad, CA 92009 (619) 438-1161
PERMIT 1YPE
From List I (see back) give code of Permit-Type:
PLAN CHECK NO. G - 47_~
sr. VAL
PLAN CR DEPOSiT______________
VALiD. BY
DATE
For Residential Projects Only: From List 2 (see back) give
Code of Structure-Type:
Net Loss/Gain of Dwelling Units
PROJECT INFORMATION FOR OFFICE USE ONLY Address
, ,,
Building or Suite No.
Nearest Cross Street ...L.
LEGAL DESCRIPTION Lot No. Subdivision Name/Number Unit No. Phase No.
CHECK BELOW IF SUBMIITED:
02 Energy Cabs 02 Structural Cabs 02 Soils Report 01 Addressed Envelope
ASSESSOR'S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORK
Ck. #
SQ. Fr. # OF STORIES # OF BEDROOMS # OF BATHROOMS 3: WNLFL1 PERSON (ii thiterent from applicant)
NAME (last name first) \1JJ.7Ljf 51v-A.I)DRES5 3 , z. /
CITY (Jb,4 STATE C A ZIP CODE 9 CICI '1 DAY TELEPHONE ( I 4. APPLICANT U CON IRACIUR U AGENF FOR CONTRACTOR U OWNER U AGENT FOR NAME (last name first) -y I , kg ADDRESS 1'0 cr-,,. I 00
OWNER
CITY i2 STATE ZIP CODE C) t b DAY TELEPHONE S. PROPERlY OWNER - NAME (last name first) 'YT7c' (/,V'-'o M (k c ADDRESS I /Q 0
CITY $pp... STATE C4\ ZIP CODE ')Z.66 DAY TELEPHONE WNTRAC'rOR
NAME (last name first) J )-/-,,7' 5t€- '- ADDRESS 3' t J II liv i r ,4 Cr
CITY Ci. i-'Js /7/t STATE C 3 ZIP CODE ' > ' DAY TELEPHONE -/0 r-
'T-'
.
STATE UC. # LICENSE CLASS CITY BUSINESS LIC. # DESIGNER NAME (last name first) ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. # WORKERS COMPENSATION
Workers' Compensation Declaration: I hereby affirm that I have a certificate of consent to self-insure issued by the Director of Industrial Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. Q. 12 &fq 1A 4w"
INSURANCE COMPANY flt± —/#-. POUCY NO. EXJ'IRATION DATE 'fr/'* / ?
so as to become subject to the Workers' Compensation Laws of California.
SIGNATURE ?s-- '..A.'- DATE
uwner-tsuiiaer L)eclarauon: i nereny arrirm mat i am exempt rrom me Lontractors Ucense Law tor me bollowing reason: o 1, 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 offered for sale (Sec. 7044, Business and Professions 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 offered for sale. If, however, the building or improvement 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.).
0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law).
0 I am exempt under Section Business and Professions Code for this reason:
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$5001).
SIGNATURE ))- S DATE I
COMPLETE ThIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY:
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and
prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? DYES ONO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? DYES ONO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? DYES 0 N
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUE!) AFI'ER JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLII1ON CONTROL DISTPJCr.
ereby attirm that there is a construction lending agency tor the pertormance of the work tor which this perntit is issued (Sec 3097(1) CMFCëJ.
LENDER'S NAME LENDER'S ADDRESS
10. APPLICANT CERI1F1CM1ON
I certity that I have read the application and state that the above information is correct. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection
purposes. I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID crri IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA An OSHA permit is required for excavations over 5,0" deep arid demolition or construction of structures over 3 stories in height.
Expiration. Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code). APPLICANTS SIGNATURE - , - DATE: ).
WHITE: File YELLOW: Applicant PINK: Finance - -
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT# CB960097 FOR 01/26/96 INSPECTOR AREA PD
DESCRIPTION: REPAIR EXISTING GAS LINE PLANCK CR960097
0CC -GRP
CONSTR. TYPE VN
STE: P LOT:
PHONE: 619 434-0974
INSPECT:
J
JOB ADDRESS: 235 PINE AV
APPLICANT: WHITE, STEVE
CONTRACTOR:
OWNER:
REMARKS: MW/STEVE/540-0588
SPECIAL INSTRUCT:
TOTAL TIME:
CD LVL DESCRIPTION
23 PL Gas/Test/Repairs
ACT COMMENTS
**** INSPECTION HISTORY *****
DATE DESCRIPTION ACT INSP COMMENTS
012496 Gas/Test/Repairs CO PD TENANT DIDNT KNOW
o i
I hereby affirm that I am licensed under
isions of Chapter 9 (commencing with
Section 7000) of Division '3 of the Business
and Professions Code, and my license is in
91 full
to Class
I hereby affirm that I am exempt from the Con-
tractors License Law for the following reason (Sec. 70315 Business and Professions Code: Any city or
county which requires a permit to construct
alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for
such permit to tile a signed statement that he is
licensed pursuant 10 the provisions at the Con-tractor's License Law (Chapter 9 commencing with
Section 7000 of Division 3 of the Business and Pro-fessions Code) or that is exempt therefrom and the
basis for the alleged exemption. Any violation of
Section 7031.5 by an applicant for a permit subjects me applicant to a civil penalty of not more than five
hundred dollars ($500).
0 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 Professions 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 offered for sale. If, however, the
building or improvement 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
O I, as owner of the property, am exclusively contracting with licensed contractors to construct
the project (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply
to an owner of property who builds or Improves
thereon, and who contracts for each protects with a contractor(s) license pursuant to the Contractor's
License Law).
O lam exempt under Sec. - -, B. & P.C.
for this reason
a
UI Z
0
USE BALI POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CAR LSBAD BUILDING DEPARTMENT APPLICATION & PERMIT 1200 Elm, Carlsbad, California 92008 (714) 438-5525
JOB ADDRESS AV, ST, DA S OF APPLICATION BUSINESS LICENSE # VALUATION PERMIT NUMBER
3 S , N SEAsiA 4h IsA bE~
RD.
CON ACTOR'S I ORSPHONE# ZONE OWNER'S NAME J OWNER'S PHONE P 5 CONTRACTOR
1- ALi3eT I(1441 I .
VeSLé7
OWNER'S MAILING ADS CONTRACTOR'S AL33RESS LICENSE NO. PLAN I.D. #qLDG USE DE
2 3 5 Pi A-' % P ?Vé Ti'! V
LOT BLOCK
J
SUBDIVISION ASSESSOR PARCEL NO. DESIGNER STATE LICENSE # STANDARD PLAN # BUILDING SO. FOOTAGE 77
DESCRIPTION OF WOR)C# JO 73
A p ,4fc-tlj L. LCj /14 c7L,C DESIGNER'S ADDRESS DESIGNER'S PHONE 4 /2 /823I 700
(Al' Af' i1Jl vO ND
' STORIES
FLA ELEV. NO OCCGP EDU OI,T1, 82 27.00
&I5ISUS TRACT GP LAND USE I PARKING
SPACEt
RES UNITS I GRADING PERMIT ISSUED I REDEVELOPMENT I TYPE 0CC LOAD' FIRE SPR AREA I I CONST I
0 N 0 v D NO J J YO NO Not Valid Unless Machine Certified
-
QTY. PLUMBING PERMIT - ISSUE 7.501 QTY. MECHANICAL PERMIT - ISSUE 3 SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP . INSTALL FURN. DUCTS UP TO 100,000 BTU BUILDING PERMIT 01-000-4220
EACH BUILDING SEWER OVER 100,000 BTU SIGN PERMIT 01-000-4221
EACH WATER HEATER AND/OR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 01-000-4806
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3.15 HP TOTAL PLUMBING 01-000-4222 ___________
EACH GAS SYSTEM 5 OR MORE - METAL FIREPLACE ELECTRICAL
, 01-000-4223 ', ____j t 0
EACH INSTAL.. ALTER, REPAIR WATER PIPE - VENT FAN SINGLE DUCT MECHANICAL 01-000-4224
EACH VACUUM BREAKER . MECH EXHAUST - HOOD/DUCTS MOBILEHOME 01-000-4225
WATER SOFTNER , RELOCATION OFEAFURNACE/H MOBILEHOME PARK INSP
EACH ROOF DRAIN (INSIDE) SOLAR 01-000-4226
: TOTAL MECH2 STRONG MOTION 65-640-0519
TOTAL PLUMBING I - FIRE_SPRINKLERS 01-000-4227
11 BRIDGE FEE QTY. ELECTRICAL PERMIT - ISSUE QTY. 0(- ISSUE
PUBLIC FACILITIES FEE 25-000-4933 ,
NEW CONSTEAAMP/SWT/BKR C0TORS
SCHOOL FEE - DISTRICT
VT EXIST BLDG EA AMP/SWT/BKR IOIK STORAGE /
1 PH 3 PH ORAGE TANKS 4
-
-Carlsbad 65-623-0519
Encinitas 65-624-0519
3 PH PUMP IV
San Dieguito 65-625-0519
REMODEL/ALTER PER CIRCW" PLAN CHECK FEE San Marcos 65-626-0519
TEMPPOLE 200AMPS
OVER 200 AMPS
TEMP OCCUPANCY (30 DAYS)
TOTAL ELECT L 7o - TOTAL SOLAR TOTAL FEES PAYABLE
I HAVE CAREFULLYINEO THE COM TED "APPLICATION AND PERMIT' AND DO HEREBY Expiration. Every permit issued bythe Building Official uncferthe provisions ofthis * AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER Code shall expire by limitation and become null and void. If the building or work -5'0" DEEP AND DEMOLITION OR CONSTRUCTION OF CERTIFY UNDEWENALTY OF PERJUli'THAT ALL INFORMATION HEREON INCLUDING THE authorized by such permit is not commenced within 180 days from the date of such STRUCTURES OVER 3 STORIES HEIGHT DECLARATION ARE TRUE AND CORF1T AND i FURTHER CERTIFY AND AGREE IF A PERMIT IS permit, or if the building or work authorized by such permit is suspended or ISSUED- COMPLY WITH ALL C(TY"ItOUNTY AND STATE LAWS GOVERNING BUILDING CON- abandoned at any time commenced for a period of 180 davy
DATE STRU&1'iON, WHETHER SPECIFIED I.t/IEIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND CA 'S SIGNAT KEEP HARMLESS THE CITY OF CARS' BAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND
EXPENSES WHICH MAY IN ANY WA
GRANTING OF THIS PERMIT. 4 ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF TH BY-PHON ij;;~ .4
I
0 I hereby affirm that I have a certificate of consent
self-insure, or a certificate of Workers
Compensation Insurance, or a certified copy thereof
(Sec. 3800. Labor Code),
POLICY NO.
COMPANY
Copy is filed with the
0 Certified copy is hereby lurni
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit
is for one hundred dollars ($100) or less)
0 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 10 the Workers' Compensation Laws of California
NOTICE TO APPLICANT: If, after making this Certi-ficate 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
r 0 I hereby affirm that mere is a conslruclion
I lending agency to, the performance 01 the work for Lu which this permit is issued (Sec 3097, Civil Code).
Lu Lender's Name______________________________
L Lender's Address
INSPECTION TYPE DATE INSPECTOR\
BUILDING
FOUNDATION
REINFORCED STEEL
MASONRY
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME
SHEATHING
FRAME
EXTERIOR LATH INSULATION
INTERIOR LATH & DRYWALL
PLUMBING I
SEWER AND BL/CO
PLUMBING UNDERGROUND
PLUMBING TOP OUT
TUB AND SHOWER PAN
GAS TEST
ELECTRICAL
TEMPORARY POWER
ELECTRIC UNDERGROUND
ROUGH ELECTRIC
ELECTRIC SERVICE
BONDING A
G. F. I. - SMOKE DETECTOR
MECHANICAL
DUCT & PLEM., REF. PIPING 4 ' '
HEAT - AIR COND. - SOLAR SYSTEMS
VENTILATING SYSTEMS
- -' S' -
CALL FOR FINAL INSPECTION WHENALC.-APPROPRIATE
ITEMS ABOVE HAVE BEEN APPROVED.
JOB SITE FINAL
PLUMBING
ELECTRICAL
MECHANICAL
GAS
BUILDING
SPECIAL CONDITIONS
CERT OF OCCUPANCY ISSUED
\\r
' ,_..
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS INSPECTORS NOTES
INSPECTION., REQ. IF
CHECKED
INSPECTORS
APPROVAL DATE
SOILS COMPLIANCE
FOUNDATION INSP
PRIOR TO
OVER 2000 PSI
STRUCTURAL CONCRETE
CONCRETE
PRESTRESSED
POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
PILES CA ISSONS
\' -
\\•\ -____________________ ____
V ' V •• - ' - ____ _______ .
-
C El I herw.,y affirm that I am licensed under
o provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Professions Code, and my license is in
I full force and effect.
Lic. No. ___________ ,_ Class
0 U —
hereby affirm that I am exempt from the Con-
tractors License Law for the following reason (Sec.
70315 Business and Professions Code. Any city or county which requires a permit to construct
alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for
such permit to file a signed statement that he is
licensed pursuant to the provisions of the Con. tractor's License Law (Chapter 9 commencing with
Section 7000 of Division 3 of the Business and Pro-
fessions Code) or that is exempt therefrom and the -
basis for the alleged exemption. Any violation of
Section 7031.5 by an applicant for a permit subjects the applicant to a civil penalty of not more than five
IC hundred dollars ($500).
0 I, as owner of the property, or my employees
5 with wages as their sole compensation, will do the
0 work, and the structure is not intended or offered for
sale (Sec. 7044, Business and Professiohs Code:
W The Contractor's License Law does not apply to an Z owner of property who builds or improves thereon
and who does such work-himself or through his own o employees, provided that such improvements are
not intended or offered for sale, If, however, the
building or improvement 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),
Q I, as owner of the property, am exclusively Z
2 contracting with licensed contractors to construct
the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply
Ix to an owner of property who builds or improves thereon, and who contracts for each projects with a
—I contractor(s) license pursuant to the Contractor's
License Law).
0 0 lam exempt xnder Sec _. _______._, B.& P.C.
for this reason
I hereby affirm that t have a certificate of consent to self-insure, or a certificate of Workers'
Compensation Insurance, or a certified copy thereof
(Sec 3500, Labor Code(
POLICY NO.
COMPANY
Copy is filed with the city.
Certified copy is hereby furnished
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit cc is for one hundred dollars ($100) or less) Lu it cc 0 1 certify that in the performance of the work for
which this permit is issued, t shall not employ any person in any manner so as to become subject to
the Workers' Compensation Laws of California.
NOTICE TO APPLICANT: It, alter making this Certi-
ficate 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
r 0 I hereby affirm that there is a construction
I lending agency for the performance of the work for Lu which this permit is issued (Sec 3097, Civil Code(
Lender's Name
L Lender's Address
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT hILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBA-UILDING DEPARTMENT AI4ICATION
1200 Elm, Carlsbad, California 92008 (714) 438-5525 & PERMIT
JOB ADDRESS 1ST. DATE OF APPLICATIONj
RD. / 1 I
OWNER'S NAME OWNER'S PHONE PRIME
% I
BUSINESS LICENSE #
CONTRACTORS PHONE 4
VALUATION PERMIT NUMBER
~'7 ZONE 3
OWNER'S MAILING ADDRESS A CON CTORS A ?
SS LICENSE NO. PLAN .0. # BLDG USE CODE
LOTLOCK
T-5
SUBDIVISION ASSESSOR PARCEL NO DESIGNER STATE LICENSE #
047 1
STANDARD PLAN # BUILDING SO. FOOTAGE
fyflri ________ ________________ DESCRIPTIONfOF WORE
. DESIGNER'S ADDRESS DESIGNER'S PHON 8/3=..,/8 73 ____ _________
00017933 8/1 /8 1 I0.0
Not Valid Unless Mac/tine Certified
-
- F/P FLRELEV.I
YDNO I
I NO
STORIES I
OCCGP' EDU
I
CENSUS TRACT I GF LAND USE I PARrINGSPACE I RES UNITS I GRADING PERMIT ISSUED
0 N 0
I REDEVELOPMENT AREA
YO NO
I I I
I TYPE '
CONST
0CC LOAD FIRE SPA
vD NO
QTY. PLUMBING PERMIT - ISSUE. 7. 5'd QTY MECHANICAL PERMIT - ISSUE SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP . INSTALL FURN. DUCTS UP TO 100,000 BTU - BUILDING PERMIT
EACH BUILDING SEWER OVER 100,000 BTU - SIGN PERMIT
EACH WATER HEATER AND/OR VENT -' ._.'C BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK
EACH GAS SYSTEM 1 104 OUTLETS . BOILER/COMPRESSOR 3-15 HP ' - TOTAL PLUMBING
EACH GAS SYSTEM 5 OR MORE - . METAL FIREPLACE ELECTRICAL
EACH INSTAL,, ALTER, REPAIR WATER PIPE . VENT FAN SINGLE O "
'
MECHANICAL
EACH VACUUM BREAKER - MECH EXHAIJSj,u.'600/OUCTS MOBILEHOME
WATER SOFTNER , MOBILEHOME PARK (NSP
EACH ROOF DRAIN (INSIDE) .
,OCA1).Ø(IFEAFURNACE/HEATER
SOLAR
TOTAL MECHANICAL STRONG MOTION
TOTAL PLUMBING 'I FIRE SPRINKLERS
QTY. ELECTRICAL PERMIT - ISSUE CITY. SOLAR - ISSUE
PUBLIC FACILITIES FEE
BRIDGE FEE
NEW.CONSTEA,AMP/SWT/BKH COLLECTORS SCHOOL FEE DISTRICT
- 1 PH 3PH/j STORAGE TANKS . ' Carlsbad
EXIST BLDG EA AMP/S WT/BKR' ROCK STORAGE . . Encinitas
(PH 3 P PUMP San Oieguito
REMODEL/ALTER PER PLAN CHECK FEE - San Marcos -
TEMPPDLE 200 AMPS
TEMP C UPAN CVA 'YSI
OVER 200AMPS
TOTAL SOLAR
"fOTAL ELECTRICAL ' TOTAL FEES PAYABLE
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND 00 HEREBY Expiration. Every permit issued by the Building Official under the provisions ofthis AN OSHA PERMIT IS REQUIRED FOR EXCAVATIO14S OVER
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE I Code shall expire by limitation and become null and void. It the building or work -5'0" DEEP AND DEMOLITION OR CONSTRUCTION OF authorized by such permit is not commenced within 180 days from the date of such DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS I permit, or if the building or work authorized by such permit is suspended or STRUCTURES OVER 3 STORIES IN HEIGHT
ISSUED: TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON- I abandoned at any time after the work is commenced for a period of 180 dpys,
STRUCTION, WHETHER SPECIFIED HEREIN OR NOT, (ALSO AGREE TO SAVE INDEMNIFY AND DATE KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND APPLICAN 'S SIGNAT
EXPENSES WHICH MAY IF't ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF
OWNERD CONTRACTOR APPROVED BY
BY PHONE 0 GRANTING OF THIS PERMIT, fl
L!d
RFA
ai
C)
0. 0.
C
'3-
0 U) U) a) U) in
INSPFCTION TYPE DATE INSPECTOR
I BUILDING
FOUNDATION
REINFORCED STEEL
MASONRY
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME
SHEATHING
FRAME
EXTERIOR LATH INSULATION
INTERIOR LATH & DRYWALL
PLUMBING
SEWER AND BL/CO
PLUMBING UNDERGROUND
PLUMBING TOP OUT
TUB AND SHOWER PAN
GAS TEST
ELECTRICAL
TEMPORARY POWER
ELECTRIC UNDERGROUND
ROUGH ELECTRIC
ELECTRIC SERVICE
BONDING
G. F. I. - SMOKE DETECTOR:
MECHANICAL
DUCT & PLEM., REF. PIPING
HEAT - AIR COND. - SOLAR SYSTEMS
81-
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS
INSPECTION REQ IF INSPECTOR'S
CHECKED APPROVAL DATE
SOILS COMPLIANCE
PRIOR 10
FOUNDATION IN
STRUCTURAL CONCRETE
OVER 2000 PS
PRESTRESSED -
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
INSPECTOR'S NOTES
5_.
PILES'CAISSONS
VENTILATING SYSTEMS
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAVE BEEN APPROVED.
JOB SITE FINAL
PLUMBING
ELECTRICAL . • s
" -. -
MECHANICAL
GAS * .
BUILDING
SPECIAL CONDITIONS
CERT OF TC~ANCY
.
ISSLIED
0
1
0 ELECTRICAL PERMIT APPLICATION
Permit No. City of CARLSBAD, CALIFORNIA 92008
Applicant to complete nymbered spaces only. . Phone 729-1181 - p
JOB ADDRESS
M //ti Age- (:4 900f
- LOT NO. r BLK TRACT LEGAL I (cJSEE ATTACHED SHEET)
OWN -
2
AIL M ADDRESS ZIP PRONE
CONTRACTOR
or
V
MAIL ADDRESS PHONE LICENSE NO.
ARCHITECT OR DESIGNER MAIL ADDRESS. PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRESS BRANCH
6
USE OF BUILDING
7
8 Class ofwork: El NEW DADDITION )LTERATION DREPAIR
9 Describe work:-
PERMIT FEES
I No. I Each Fee
ISPECIAL CONDITIONS: I
ISSUANCE OF EACH PERMIT
NEW CONSTRUCTION, FOR EACH
APPLICATION ACCEPTED BY: PLANS CHECKED BY: APPROVED FOR ISSUANCE BY: AMPERES OF MAIN SERVICE, SWITCH,
FUSE OR BREAKER
v6111 - NEW SERVICE ON EXISTING BLDG. —
FOR EA. AMPERE OF INCREASE / NOTICE IN MAIN SERVICE, SWITCH, FUSE -t
, THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- OR BREAKER , 5 '— TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF - —
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM- REMODEL, ALTERATION, NO CHANGE
MENCED. IN SERVICE, FOR EA. AMPERE OF
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS INCREASE
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE TEMP. SERVICE UP TO AND INCLUD-
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING ING 200 AMP. CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
TEMP. SERVICE OVER 200 AMP.
PER 100
.' — SIGNATURE OF CONTRACT (DATE)
MINIMUM PERMIT
SIGNATURE or OWNER (IF OWNER BUILDER) (DATE) T2
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT -
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. - CASH
INSPECTOR