HomeMy WebLinkAbout2504 LA COSTA AVE; ; 80-167; Permit.....d) CONTRACTOR'S DECLARATION
--<nereby affirm that I am llcensed 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
DI 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 coutlty 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 tor the alleged ex-
emption. Any violatlon of Section 7031.5 by an ap-
plicant tor a permit subjects the appllcant to a
civil penalty of not more than five hundred dollars
($500).
DI, 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 wm have the burden of proving that
he did not build or improve for the purpose of
sale).
-..L.1, as owner of the property, am exclusively con·
~cling with llcensed 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 _____ B. & P.C.
for this reaso~
Dot• '0 p<,1\§) Owne, e0;),_ v<c;
' ~ '
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of con-
sent to self-insure, o~ 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 ($10!)) or less).
I certify that in the performance of the work for
which this permit is lss_u!.Q,. I shall not employ any
person in any manner so as to become subject to
the Workers' Compensation Laws of Callfornia.
NOTICE TO APPLICANT: If, alter making this Cer-
tificate 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.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction len•
dlng agency for the performance of the work for
which this permit Is Issued (Sec. 3097, Civil Code).
" r CITY OF CARLSBAD-BUILDING DEPARTMENT
USE BALL POINT PEN ONLY APPLICATION & PERMIT
1200 ELM AVENUE (714) 438-5525
NO, J08 ADDRESS
z... i),t),4, ,L .... c,o,:s;--r,A, ,.«.,IJ", , I I I I I I I I I I I I
r ~ APPLICANT TO FILL IN INFOR -
MATION WITHIN RED LINES.
AV. ST. IOATE OF" APPLICATION BUS. LICENSE PERMIT NUMBER
RD f6.l6 1 , 11,80
ftJ--/(, 7 OWNER OWNER'S PHONE PRIME CONTRACTOR / ST ATE LICENSE ,Sw831JS-y ,AwDfU:i.v T q-4'2.. -l.{,co
OWNER'S MAILING ADDRESS
r
CONTRACTOR'S ADDRESS/ CONTRACTOR'S
2-Sc) 4: ~ C:oS'T-f,, Av PHONE 2/~'5/AfJ2S7!.: ~c .. : o: !!2(;7L: ?:l'.1 £il EFJ :j~ II I _.
~ BLOCK ~~·".#-/ I 1'i.':t.••·:r.t:·;,,•· , I, "I, , DESIGNER_/ ST ATE LICENSE
OES ~JON OF" WORKP-n ~K-
.
~,'A-/,;.i-500 7n'S ADDRESS DESIGNER'S PHONE
,
CENSUS TRACT GP LANO USE ZONING I RES. UNITS I P;KING SPACE sf I NUMBER OF" STORIES
Not V•lid Unlm M«:hiM c.rtifild
BLOG i?J d 1!I BLOG USE acc. GP I STANDARD PLAN 11 IPLANI011 I TYPE CONST I occ. LOAD I -QTY. PLU,..INu PERMIT AMT. QTY. ME9""NICAL PERM'IT AMT.
EACH FIXTUffE TRAP INSTALL FA.JRN. DUCTS UP TD 100,000 BTU
EACH BUILDIN.G SEWER OVER 100,000 BTU
EACH WATER HEA""-fill_O/DR VENT BOILER/C OR UPTO 3 HP
EACH GAS SYSTEM 1 TO 4 DUl'l,ETS BOILER/COMPRESSOff'l,.15 HP
EACH GAS SYSTEM 5 OR MORE '-BOILER/COMPRESSOR 16-1ll HP
EACH INSTAL., ALTER, REPAIR WATER PIPe. VENTFAN SlllGLE DUCT \ _:2;;~s-o EACH LAWN SPRINKLER SYSTEM '\. MECH EXHAUST -HODO/DUNS VALUATION:
WATER SOFTNER RELOCATION OF EA FURNACE/iffcATER BUILDING PERMIT I . 1..21.V.""'t'O
Issue 3.00 Issue 3 .• 00 SIGN PERMIT I I I I
TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I I~.,.,,
CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I I I
ELECTRICAL PERMIT AMT. TOTAL PLUMBING I I I QTY. AMT. QTY. MOBILE HOME PERMIT ELECTRICAL I I I -.
NEW CONST EA AMP/SWT KR AWNING -MECHANICAL I I I
1 PH .25 3 PH PORCH I MOBILE HOME I I I
EXIST BLOG EA AMP/SWT/ 111(:R 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 DAYSI '\ I ' I I I
T--.. -?.nn ·-,....,...,._.;,... .... I I I ./17
TOTAL ELECTRICAL TOTAL FEES PAYABLE I .
CONTRACTOR I I ,L, ,I r1
•
I HAVE CAREFULLY EXAMINED THE COMPLETED "'APPLICATION AND PERMIT, ANO DO •AN OSHA PERMIT 1S REQUIRED FOR EXCAVATIONS OVER
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE ANO CORRECT ANO l 5'-0" DEEP ANO DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUEO;TO COMPLY WITH ALL CITY. STRUCTURES OVER 3STORIES IN HEIGHT school fees: COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION. WHETHER
SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM-I LESS THE CITY OF CAR LS BAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS ANO -I EXPENSES WHICH MAY JN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE
OF THE GRANTING OF THIS PERMIT. APPLt?Jrut·~RP OWNE:,C:,,-... CONTRACTOR□ AP ~-/3-fllATE
AGENT D BY PHONE 0
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INTERDEPARTMENTAL INFORMATION SHEET
BUILDING DEPARTMENT
BUILDING ADDRESS:
PLANNING DEPARTMENT
RECEIVED
DATE: _.,....FE'"""'B-· -1 -1 ~i --~,:3-" --
CITY OF CARLSBAD
Buifding Department
ZONE _________ LOT SIZE _________ LOT WIDTH _________ _
UNITS ALLOWED UNITS PROVIDED --------------------------
PARKING SPACES REQUIRED PROVIDED ----------------------
_____________ PROVIDED % COVERAGE ALLOWED
BUILDING HEIGHT ALLOWED
FRONT SETBACK:
ALLOWED
PROVIDED --------
INTRUSIONS
___________ PROVIDED
SIDE SETBACK: REAR SETBACK:
~LANDSCAPE & IRRIGATION PLAN COMMENTS:
ENVIRONMENTAL PROTECTION REQ:
ADDITIONAL COMMENTS:
OK TO ISSUE, ~~ DATE*~ OK TO FINAL _______ DATE ___ _
ENGINEERING DEPARTMENT
R.O.W. INDUSTRIAL WASTE IMPROVEMENTS ---------------------
SEWER CONNECTION
GRADING PERMIT
LEGAL DESCRIPTION_(Z::.2'.J~_!_.L-_.£.~~2t.~.__Jil..!..._ _ __:__+-------------
PWI OK TO FINAL DATE _,_...,........,...___ ------------
FIRE DEPARTMENT
SPRINKLING SYSTEM ____________ FIRE PROTECTION EQUIP. _______ _
FIRE ALARJl!S 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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BUILDING DEPARTMENT ::, '
COMPLAINT AND/OR REQUEST FORM
Complaint and/or Request: :J .>dz' ~ ~,c.., ~--
~~a~{rrhzfp,~JP1·~+/4k
Name of Complaintant:7d':~ ~_,..... . _ .
Address: £,;lf }J,-a:L . ~ ;e;;..f 5. ~ c.l-
Phone: ~::J{-F 9 ti I
Date Received: __ ~'/4~:;g~,/4u',l"~~g--By Whom:_~/44.,--'-"~~'-=·-----------, 7
Referred to:_-J.--='""'-------------------------
Action Taken:
1
/
-~c/J)_ y/;JP.
JVJTt/JN
Nature and Date of Notification of ·
Action to complaintant or Petitioner: ------------------
PLEASE RETURN THIS COPY TO THE BUILDING DEPARTME?lT, WITH NOTATION AS
TO ACTION TAKEN.