HomeMy WebLinkAbout2374 La Costa Ave; BLDG 1; 80-705-B; 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
01 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 live hundred dollars
{$500).
t.:.· 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 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 l!censed 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)
l 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 3800, Labor Code) I_ \ ~
POLICY NO. ___ _
COMPANY ___ _
[;Copy is filed with the city.
□Certified copy is hereby furn is
CERTIFICATE OF EXEMPTION FROM
WORKERS" COMPENSATION INSURANCE
(This section need not be completed :f the per-
mit is for one hundred dollars ($100) or less).
I certify that in the performance of the work for
which this permit is issued, I shall not employ any
pf!rson in any manner so as to become subject to
the Workers' Co<;1.1pensation laws of California.
NOTICE TO APPLICANT: If, after making this Cer-
tificate-Of Exemption, you should become subject
to thEt, Workers' Compensation provisions of the
L .;or Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked
COrtSTRUCTION LENDING AGENCY
I hereby alfirm that there is a construction len-
·,.,g agency for the performance of the work for
.., thio, no,mil jc, ;.,.,,,.,.,, /C:or 1007 r.ivil r.nrl<>I
CITY OF CARLSBAD-BUILDING DEPARTMENT
APPLICATION & PERMIT
USE BALL POINT PEN ONLY
'7, /, / .J-----· ,
"°" IV I~ -~'-.-r-B ADDRESS :;23~~ 3? t, j;;,3?yY AVf?;T, l?: OF APPLICY.N -
I I .,, I -IL. . -0 , /J',,b I I ' ' ' ·, ' ' I I I ""'"",,,<_/-'c
OWNER OWNER'S PHONE PRIME CONTRACTOR
, IIAR'/21/ /-.!<IE::> 1';1.?-3133 ./ltf,<'/(y' ,/x'/e) ,
OWNER'S MAILINr{AOORESS~ cflE /), 5'1'..t-' J,f.<I(~~ /e?NTRACTOR'S AOIJ"l"IESS
• 3.3?$'"1 A :,,,-0=?:) . 'E'C~'RO f<fli,15' '(:<
"l BLOCK l.~~'z .. T ASSESSi2·'S PARCEL NO. DCS,~,</<Y '""). / I 121/ 101 , ,,! /, r,<1F7
(DESCRlPTloi; ~K-# / I A-a. G) DESIGNER'S ADD~SS
J 0 ~/ ·: -. . , . -
APPLICANT TO FILL IN INFOR-
MATION WITHIN RED LINES
BUS. LICENSE PERMIT NUMBER
;:2,J {, Y /
STATE LICENSE fl! ~70~8 -:,
J/' l/7tJ CJ
CONTRACTOR'S
17113 -:s 753
STATE LICENSE
DESIGNER'S PHONE
CENSUS TRACT GP LANO USE ZONING I RES. UNITS I P;RKING SPACE sf 1 NUM8ER OF STORIES
Not Valid Unless Machine Certifitd
'"' ry''iv? BLDG USE occ. GP I STANDARD PLAN# I PLi;: / dJ-l TYPE CONST
I OCC, LOAD
I
QTY" PLUMBING PERMIT AMT" QT-Y" MECHANICAL PERMIT AMT" §:
, .... -:, EACH FIXTURE TRAP ,. /., _,--_,, INSTALL FURN. DUCTS UP TO 100,000 BTU 1-v"-~
: EACH BUILDING SEWER /. r. /' OVER 100,000 BTU
EACH WATER HEATER AND/OR VENT {. /' BOILER/COMPRESSOR UPTO 3 HP q{" )\
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP
~ EACH GAS SYSTEM 5 0 R MO RE -l".{o BOILER/COMPRESSOR 16-30 HP •1:.) ~ --z_,~ ~ I l.r # l§ ~
,-; EACH INSTAL., ALTER. REPAIR WATER PIPE ·,~. _. Lf VENT FAN SINGLE DUCT /> . ,,, .,;b 3 ¥ "'3~ .
EACH LAWN SPRINKLER SYSTEM 5 MECH EXHAUST -HOOD/DUCTS ~-II . .--VA\1-,UATION: ..) "f r
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDllt.G PERMIT -I , f"1/,'."l,;,-
' "" '" nn T,--,,--,TT"t;' <, /HI SIGNPEctl.llT _...-41 7 .. 2..1-i "°"· ,, I I I
TOTAL PLUMBING TOTAL MECHANICAL if CL' PLAN CHEC" -# J?d-)o,;-J 111.i-r-, 1 "1
CONTRACTOR IO~-\c, CONTRACTOR r. -ALL INCLUSl~0 uIT ,~, , ' I
/AMT"
TOTAL PLUMBING -y;,~.=
QTY" ELECTRICAL PERMIT AMT" QTY" MOBILE HOME PERMIT ELECTRICAL , ....
::) NEW CONSTEA AMP/SWT/BKR / 0 0 k -1., ·---AWNING / MECHANICAL ,I,;-, ✓,_.,
1 PH 25 3 PH ' PORCH / MOBILE HOME 1' I I
EXIST BLOG EA AMP/SWT/BKR SffUP / SOLAR I I I I
lPH 25 3 PH RAMADA, CABANA / I I I I
REMODEL/ALTER PER CIRCUIT FENCE OVER 6' / I I I I
TEMP POLE 200 AMPS TOTAL MOBILE Hfil'IE MICO-FI LM I I I I
OVER 200 AMPS / I I I I
TEMP OCCUPANCY (30 DAYS) / I I I I
ISSUE 2 .• 00 / STRONG MOTION: I ,;,Ci_ll,.{"
TOTAL ELECTRICAL 17~ / TOTAL FEES PAYABLE
I
;
CONTRACTOR I I JJ-,,:;"1~" /~
I HAVE CAREFULLY EXAMINED THE COMPLETED ""APPLICATION ANO PERMIT, AND DO "AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER r~~;,:,O ;2//tJ() ':!?-
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5" O"" DEEe AND DSMDUTION OR CONSTRUCTION o, o/4 ~ • ..d, ~ FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUE□;TO COMPLY WITH ALL CITY, STRUCTURES OVER 3STORIES IN HEIGHT 7"v,' /~ • 'I ?41"6' COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM-v SCRO FEES:
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 SIG fl£ OWN:;t CONTRACTOR□ IA~EO BY 11/l1/, ,. ,~ AG E N 8 Y PHO NE O ~
! < Cl ~ >
15 i= ~ 0.. V, ~
SITE
ADDRESS: OWNER: PERMIJ NO: NI -'"7D<-: ..If!.-..
FIELD INSPECTION RECORD
INSPECTION DATE INSPECTOR r INSPECTOR'S NOTES ' WOOD FLOOR
FOUNDATION• FORMS• SET SACK• TOILET
UNDER FLOOR PLUMBING
UNDER FLOOR HEATING
OK TO INST ALL SUB FLOOR
SLAB FLOOP
UNDER SLAB PLUMBING
FOOT\ NG • FORMS• SETBACK • TOILET
OK TO POUR CONCRETE
FRAME
ROUGH ELECTRICAL
ROUGH PLUMS I NG
ROUGH HEATING/VENTILATING
FRAME OK• PLACE INSULATION
INSULATION OK • PLACE WALLBOARD
WALLBOARD OK• PLACE TAPE
EXTERIOR LATH OK• PLACE STUCCO
FIREPLACE
DAMPER 8: STEEL
PLATE TIES/HEIGHT OF CHIMNEY
OTHER
TEMP POWER (POLE)
SEWER
GAS TEST
' SWIM POOL • STEEL BONDING
I • PRE DECK
! • FENCE PREP LASTER
SHOWN • FRAME
i • PAN I .
I FINAL INSP BY BLDG DEPT r/lYI , ,. -
! OTHER DEPT'S REQ COMPLETED I ' t
i E!....EC METER-PERM-TEMP '
, GAS METER-PERM-TEMP
~
' i ... , ___
L_:-:ERT OF OCCUPANCY ISSUED -i . .
SEE
2376 LA COSTA AVE
FOR MORE INFO
ON
80-705
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-CITY OF CARLSBAD ~
This Certificate issued pursuant to the requirements of Section 306
of the Uniform Building Code certifies that at the time of issuance
. this structure complies with app Ii cable ordinances of the City 3 regulating buildi~g const~u.ction use.
3 Use Classification 3 urut COn:ianinilrun. . Bldg. Permit No. 80-705
Group ______ Type Construation _____ fire Zone ______ Use Zone _____ _
Occupant Load ~., 1i:"">•
~ Owner olBuildin\'.'";''T~ ~es--✓;·::,, , ;Address 33751 Paseo De Ilecorc>~ capistrano ~ Building Address j~1i;;mQ,t23sb J'.'! ·fp:ltatAv,it.•~•hty carlsbad, 9,A• 92008, ··;" j . . . l••,--;..Jt,l'.e ,;,:: • . •,.. 8-26-81
~ NOTE: Altorotions, chan9H, additions or chan·ges of occupancy nullifies this certificate. ~ (Post In conspicuous place)
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