HomeMy WebLinkAbout2350 PIO PICO DR; ; 80-777; 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
QI 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 reciuires a permit to con-
struct, alter, improve, demolish, or repair any
slructure, prior to its issuance also requires the 0
applicant for such permit lo 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 tor a permit subjects the applicant to a
civil penalty of not more than live hundred dollars
($500)_
CI, 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).
:=1, 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 p./ ~J) (0 Owoe~J;..f..6,_, ( l
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 3800, Labor Code).
POUCY NO. _____________ _
COMPANY
-=copy is filed with the city.
r:::: Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the per-
mit is for one hundred dollars ($100) or less).
\ certify that in the performance of the work for
which this permit is issued, I shall not employ any
person in any manner so as to become subject to
the Workers' Compensation Laws of California
NOTICE TO').PPUCANT: If. after making this Cer-
tificate of Exemption, you should become subject
to the Worker,..· Compensation provisions of the
Labor Code, vou must forthwith comply with such
provision~ 1. t'v~ permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
CITY OF CARLSBAD-BUILDING DEPARTMENT
APPLICATION & PERMIT
1200 ELM AVENUE (714) 438-5525 USE BALL POINT PEN ONLY
,o. JOB ADDRESS
~VR~T.-1D;~ ;.:R';ION 2. ;:;,S";o ,f,L ,t"l I~ 1.r~n. I I I I I I I I I I I I
' OWNER 7z'1• ,;7i;, e,o,e '~v/:;;;_7 f1.:; t •: 0 (JnL JJ()lpf.$ A. ;;-_.h... '-,.. -
OWNER'S MAILING ADDRESS CONTRACTOR'S iDDRESS
'7AM IE. .... I ' ~ ,D~-~I~ 1n "-"--+ 1., ,..... w.J;\-. 1
lrf.T: ... BLOC{ (p.J1fe~~ .-.c.iso~~p~~EL NO.
1
~ . DESIGNER .~ ... ~ -,-.·~,J/.,1, t,,l."1. ,,0, '
DE~,:RIPTfON OF WOr,t:.. ' •, I U).4/....L_ r:; u.. '2N r1. DESIGNER'S ADDRESS
CENSUS TRACT GP LAND USE ZONING
APPLICANT TO FILL IN INFOR-
MATION WITHIN RED LINES.
BUS, LICENSE PERMIT NUMBER
STATE LICENSE 7o--1f·J
CONTRACTOR'S
PHONE
STATE LICENSE
DESIGNER'S PHONE
I RES. UNITS I PAR#ING SPACE sI j NUMBER oF sToR1Es
Not Valid Unless Machine c.rtifiBd
BLOG SQ. FT. BLOG USE
occ. GP l2~A;;~tl sfp'.' ~ '1"'1
TYPE CONST 1 OCC. LOAD I 1
~" ' UTY_ PLUMBING PERMIT AMT. UTY_ MECHANICAL PERMIT AMT. r
EACH FIXTURE TNAP INSTALL FURN. DUCTS UP TO 100,000 BTU
EACH BUI LO ING SEWER \ OVER 100.000 BTU
EACH WATER HEATER A'N.D/OR VENT BOILER/COMPRA:.SOR UPTO 3 HP
EACH GAS SYSTEM 1 TO 4 O(l'{,.LETS BOILER/COMPRE~R 3-15 HP
EACH GAS SYSTEM 5 OR MORE\ BOILER/COMPRESS~16-30 HP
EACH INSTAL., ALTER. REPAIR WATBfl PIPE VENT FAN SINGLE DUC~
VATTTATTnN t 2,q4t,; £!l__ EACH LAWN SPRINKLER SYSTEM \ MECH EXHAUST -HOOO/ObcTS
WATER SOFTNER " RELOCATION OF EA FURNACE"1HEATER BUILDING PERMIT I ') I C/ "r""'
T cc:rn: .,_ r, Teem:: 7. r, r SIGN PERMIT I I I I
TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I 1/4.~
CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I' I ' I
ELECTRICAL PERMIT AMT. TOTAL PLUMBING <t I I
UTY. AMT. UTY_ MOBILE HOME PERMIT ELECTRICAL I I I
NEW CONST EA AMP/SWT/BKR t AWNING MECHANICAL \ I I
1 PH .15 \ 3 PH PORCH MOBILE HOME 1\1 I
EXIST BLDG EA AMP/SWT/BKR \ SET-UP SOLAR I I Ii I
T PH .15 3 i>w RAMADA, CABANA \ I I ' I
REMODEL/ALTER PER CIRCUIT '\. FENCE OVER 6' '-... I I I
TEMP POLE 200 AMPS ' TOTAL MOBILE HOME MICO-FILM I I I
OVER 200 AMPS \ I I . I
TEMP OCCUPANCY (30 DAYS) \ I I I I
T .C:C:TTF ? .nn C:TLlONr~ MnTTnl,r • I I I . SI'\
TOTAL ELECTRl CAL TOTAL FEES PAYABLE I Lt:;2.~ CONTRACTOR I I
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION ANO PERMIT, ANO DO •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT ANO I 5'-0'' DEEP AND DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT
COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER SCHOOL SPECIFIED HEREIN OR NOT. 1,ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM FEE: 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'S SIGNATURE• OWNEAO CONTAACTOAO r
1
PPAOVED r. 0 DATE
AGENT 0 SYPHONED ~ ' ~~ P-)_ /-S-U
SITE
ADDRE.SS·
WOOD FLOOR
INSPECTION
FOUNDATION• FORMS• SET SACK • TOILET
UNDER FLOOR PLUMBING
UNDER FLOOR HEATING
OK TO INSTALL SUS 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 Tl Es/HEIGHT OF Cf,IMNEY ............
/ '
OTHER I /'
TEMP POWER (POLE) /
SEWER /
GAS TEST /
SWJM POOL• STEEl,..-EibNDING
• • f>RE DECK
------------· . FENCE PREPLASTER
SHOWN . FRAME
• PAN
FINAL INSP SY BLDG DEPT
I OTHER DEPT'S REQ COMPLETED
I ELEC METER-PERM-TEMP
L~ASMETER-PERM-TEM'.
i
I
f---
j CERT-oF-OCcuPA~cy is_suEo
OWNER: PERMIT NO: <?0~77 t
FIELD INSPECTION RECORD .
DATE INSPECTOR INSPECTOR'S NOTES
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