HomeMy WebLinkAbout2425 LA COSTA AVE; F; 80-717; 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
0 1 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 cou~ty 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 five hundred dollars
($500).
, ~: as owner of the property, or my employees • N ·IwIth 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).
':JI, as owner of the property, am exclusively con•
tracting with licensed contractors to construct
the project (Sec. 7044, Business end 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. _____ 8. & 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).
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 If the per-
mit is for one hundred dollars ($100) or less).
I certify that in the performance of the work for
which this _Rermit Is Issued, I shall not employ any
person ~~ny manner so as to become subject to
the Wo..._.,,_,-Compensation Laws of California.
NOTI~ APPLICANT: If, after making this Cer·
tl~e of Exemption, you should become subject
to t:,e Workers' Compensation provisions of the
Labor ~e. you must forthwith comply with such
provisions or this permit shall be deemed revoked.
' CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction len-
ding agency for the performance of the work for
which this permit Is Issued (Sec. 3097, Civil Code).
CITY OF CARLSBAD-BUILDING DEPARTMENT --APPLICANT TO FILL IN INFOR
~438-5
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1W -I ~J~~~1~1~Dil".~~~r l0
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BUS. LICENSE PERMIT NUM8ER ja' ~. ~ l~ 0
~rv~o_~G. K~£:.rtV 4 ~,~Wft;H7E
P)ME CONTRACTOR I I STATE LICENSE ~~717 J( r.;1 Bo ii .J
owNE~~ M~LING~ooi/\-/n 't1 J'L~ ~ J ~n ~~ VCONTRACTOR'~S CONTRACTOR'S
PHONE _, L cl s F J: n ..ll ~ s. 6 ___ .,,
~/!
LO' BLOCK I SUBDIVISION ,-,., I AS,5Et,SOR'S PAR~L NO. DESIGNER -\,.../ STATE LICENSE ~ --l---'f ..;L I I I ~ 0, , _{j'C"";' I
DESCRIPT~f'~~L ~-'2Jj) if. 00 ~ ~o•vi ~::.:·~~~r.:i ..,_J DESIGNER'S ADDRESS DESIGNER'S PHONE
er, .er
CENSUS TRACT GP LANO USE ZONING I RES. UNITS I PA~KING SPACE sf I NUMBER Of STOR IES
Not V1lid Unless lhchiM CMtifi«J
8L OG SQ. f'T, SLOG USE occ. GP I STANDARD PLAN II l p9~0:7r, I TYPE CONST I occ. LOAD l
I
QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT. .
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100,000 BTU
EACH BUILDING SEWER OVER 100,000 BTU
EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP
EACH GAS SYSTEM 5 0 R MORE BOILER/COMPRESSOR 16-30 HP
EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE OUCT 3( l t£o EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOO/OUCTS VALUATION:
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I ' ~-u-,t}
ISSUE 3 .• 00 ISSUE 3.0 SIGN PERMIY .... • ,--IV~ " I ' I I I
TOTAL PLUMBING TOTAL MECHANICAL PLAN CHE«il/ /i':t;,?i # /Yf.{f 4\ I I . ...,_ ---
' ,_.i~ ...,
CONTRACTOR CONTRACTOR ALL INCwJwE Pt RM.IT J I I I
TOTAL PLUMBIN't---I I I ELECTRICAL PERMIT AMT. AMT. QTY. QTY. MOBILE HOME PERMIT ELECTRICAL I I I
NEW CONST EA AMP/SWT/BKR AWNING MECHANICAL I I I
1 PH .25 3 PH PORCH MOBILE HOME I I I
EXIST BLOG EA AMP/SWT/BKR SET-UP SOLAR I ' I I I
1 PH .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 HOME MICO -FILM I ' I I I
OVER 200 AMPS I ' I I : I
TEMP OCCUPANCY {30 OAYSI I ' I I I
ISSUE 2 •. o 0 STRm,1r, M()'T'Trn,r. I ' I I I
TOTAL ELECTRICAL ' TOTAL FEES PAYABLE I ' ~ ~ JJ-f()_ CONTRACTOR ' I I -
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5'-0" DEEP AND DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY ANO AGREE IF A PERMIT rs ISSUED; TO COMPLY WITH ALL CITY' ?t~ 3?:l! L~kf CHOOL
COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM-FEEE: 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• Cl 0WNE!'ll5r CONTRACTOR□ ~PROVED BPa DATE ,..
AGENT D BY PHONE D -~~Al~ .. ·--· .?,-'1J .. 9 r-., . .
• .... < 0 ~ >
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,., ~-
SITE
PERMIT NO: 8:?-/ / / ADDRESS: I OWNER: ·•
... ' ~ . ..
\·" FIELD IN SPECTION RECORD ' . \ .
INSPECTION DATE INSPECTOR INSPECTOR'S .NOTES
WOOD FLOOR
FOUNDATION • FORMS • SET BACK • TOILET .,
UNDER FLOOR PLUMBING ' .. -· -. -· -UNDER FLOOR H EATING .
OK TO INSTALL SUB FLOOR
-..
SLAB FLOOR
UNDER SLAB PLUMBING
FOOTING • FORMS• SETBACK • TOILET
OK TO POUR CONCRETE -·
. FRAME
ROUGH ELECTRICAL L
ROUGH PLUMBING
ROUGH HEATING/VENTILATING '
FRAME OK • PLACE INSULATION
INSULATION OK • PLACE WALLBOARD
WALLBOARD OK• PLACE TAPE
EXTERIOR LATH OK• PLACE STUCCO
'
FIREPLACE 0
DAMPEB &STEEL
PLATE TIES/HEIGHT OF CHIMNEY
OTHER
T EMP POWER (POLE)
SEWER
GAS TEST
SWIM POOL • STEEL BONDING
• PRE DECK
• FENC E PREPLASTER
SHOWN • FRAME
• PAN
FINAL INSP BY BLOG DEPT .. lrhl I / ,A
OTHE~ DEPT'S REQ COMPLETED If IL 'Ir' • I o rl
ELEc--MErER-PERM-TEMP ' I
GAS METER-PERM-TEMP ~
'111'1" ~
.,
CERT OF OCCUPANCY ISSUED ~ ....... , ·• .. '\_.,., ... .~.,.;.-1 .. ., \ .r,~. '
)
INTERDEPARTMENTAL INFORMATION SHEET El'VE D
DEPARTMENT flC BUILDING
BUILDING ADDRESS: ,,,!1/ ,;;_ >" d ~ ~ -.,u-1.. i-s-=•--
PLANNING DEPARTMENT
ZONE LOT SIZE LOT WIDTH ----------------------------
UNITS ALLOWED ___________ UNITS PROVIDED ____________ _
PARKING SPACES REQUIRED PROVIDED
% COVERAGE ALLOWED _____________ PROVIDED
BUILDING HEIGHT ALLOWED PROVIDED
FRONT SETBACK:
ALLOWED
PROVIDED -------
SIDE SETBACK:
-----------
REAR SETBACK:
' INTRUSIONS
LANDSCAPE & IRRIGATION PLAN COMMENTS:
/
I
ENVIRONMENTAL PROTECTION REQ:
1CHOOL nu, f
ADDITIONAL COMME , , ....
OK TO ISSUE:
ENGINEERING DEPARTMENT ~f?ft'•_;, f'/$ .3 ~'fo /
R.o.w. ______ INDUSTRIAL WASTE _______ IMPROVEMENTS _______ _
SEWER CONNECTION DRIVEW~LOCAT1NS--;
GRADING PERMIT -===========~-E.-A-SEMENTS ':1&~/4DRAINAGE ____ _
LEGAL DESCRIPTION~&-r~~-4-/ ___ · _C...~7~• __ 7 __ -_
1
r-7 ____________ _
, • nu,
FIRE DEPARTMENT
SPRINKLING SYSTEM ___________ FIRE PROTECTION EQUIP._· ______ _
FIRE ALARMS EXITS ----------------FIRE HYDRANTS LOCATION _________________ _
'ADDITIONAL COMMENTS
OK TO ISSUE: _____ DATE _______ OK TO FINAL ______ DATE ____ _
WATER DEPARTMENT
REQUIREMENTS OF APPROPRIATE DISTRICTS MET __ ~ _____ DATE ________ _
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