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Home My WebLink About256 JUNIPER AVE; B5; 81-75; PermitLICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that ! am licensed under provi- sions of Chapter 9 (commencing with Section 7CXXl) of Division 3 of the Business and Profes- sions Code, and my license is in full force and ef- fect OWNER-BUILDER DECLARATION ~-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 county which reQuires a permit to con- struct, alter, improve, demolish, or repair any structure, prior to its issuance also requires ttie 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 Seclion 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). r 1 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 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. H, however, the building or improve- ment is sold within one year al 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 Owner -------y-- WORKERS' COMPENSATION OECLA I hereby affirm that l have a certifica sent to self-insure, or a certificate of Compensation Insurance, or a certif' thereof (Sec. 3800, Labor Code). POLlcv No. 1 i:>Cv\l'.(c,c - COMPANY~\ t,) ~9<4_'J -:'Yr:opy is filed with the city. OCertified 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 APPLICANT: If. after 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- ding agency for the performance of the work for ..... ,_ .. ,._;D n<>rn"lit ic, ;,.,,,,u,d (Sec. 3097, Civil Code). CITY OF CARLSBAa-auu ... ....,.,,_. ........ APPLICATION & PERMIT At't'L.1\,.,1-\l'l I I...,' ·--••• USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525 M9,ION WITHIN RED LINES. ~/.5'7 "'· .fl.Kl,, JOB ADDRESS ,\,lJJ n 11P1~1R.i #iB6-: , , , I I I I I I AV. ST. DATE OF APPLICATION " \ I I I I I I -:,,,,, \ <;; I OWNER ~ tt, , ·-; ; ,.---. :;, ;;i._ '1 11 1+- OWNER'S PHONE ,.'.:l.Cl-?4:;,.,:::i OWNER'S MAIL~ ~OORESS d-s6l;> J 1....,,1 Pti:"R PRIME CONTRACTOR ' l I STATE LICENSE \_{\, ,-...--P,,,v; Lh::mr> "q'§-':\_i.))-0,; \~ 86 (\ n.01" .-.. - '" BLOCK l SUBDIVISION I ") ASS_ESSOR'S PARCEL NO.,.--_ -o<,oti:1j.,4-,u,:,.~ 0~ , CONTRACTOR'S ADDRESS lo lr.';,5_tfls.I[1_,l"lrn-v\ CONTRACTOR'S I PHONE --,, H-N" 11 DESCRIPTION OF WORK :s·,aoh::, e)-ea_+,;<!-_("g_[I D n~.a?.Q n, 14-1 •T ,------- -r:;.. ...... ..-l"l(\.(",.-ln,:; r\rv,< ,.,...,,_,~~t\\,cr OE SIGNE-~---[~LICENSE DESIGNER'S ADDRESS ~ DESIGNER'~ '?~ --~ .-,..,_,. o. ·""1 ~:.~ CENSUS TRAC,\ -=, I GP LANO USE \ ZONING UNITS ~)t-5;.,/ ~ f,, l '"· l PARKING SPACE l e,Mse, " sTorns Not VaHd Unlllss Machine Ctrtified BLDG SO. FT. BLDG USE QTY. PLUMBING PERMIT EACH FIXTURE TRAP EACH BUILDING SEWER EACH WATER HEATER ANO/OR VENT EACH GAS SYSTEM 1 TO 4 OUTLETS EACH GAS SYSTEM 5 0 R MORE EACH iNSTAL, ALTER, REPAIR WATER PIPE EACH LAWN SPRINKLER SYSTEM WATER SDFTNER TOTAL PLUMBING CONTRACTOR QTY. ELECTRICAL PERMIT NEW CONST EAAMP/SWT/BKR 1 PH .25 EXIST BLOG EA AMP/SWT/BKR 1 PH .25 7 REMODEL/Al TER PER CIRCUIT TEMP PO LE 200 AMPS OVER 200 AMPS TEMP OCCUPANCY (30 DAYS) -C, __ . A - TOTAL ELECTRICAL CONTRACTOR 3 PH 3PH occ. oe l sTAsoAeo "" • lPLANID# l "" CONST l OCC, LOAD l AMT. QTY. MECHANICAL PERMIT AMT. INSTALL FURN. DUCTS UP TO 100,000 BTU OVER 100,000 BTU BOILER/COMPRESSOR UPTO 3 HP BOILER/COMPRESSOR 3-15 HP BOILER/COMPRESSOR 16-30 HP VENT FAN Sl~!GLE DUCT MECH EXHAUST -HOOD/DUCTS RELOCATION OF EA FURNACE/HEATER TOTAL MECHANICAL CONTRACTOR AMT. QTY. -~ ..,~u_ 7,CO MOBILE HOME PERMIT AMT. AWNING PORCH SET-UP RAMADA, CABANA FENCE OVER 6' TOTAL MOBILE HOME •AN OSHA PERMIT \S REQUIRED FOR EXCAVATIONS OVER 5'-0" DEEP AND DEMOl.lT!ON OR CONSTP.UCTlON OF STRUCTURES OVER 3 STORIES IN HEIGHT BUILDING PERMIT SIGN PERMIT PLAN CHECK ALL INCLUSIVE PERMIT TOTAL PLUMBING ELECTRICAL MECHANICAL MOBILE HOME SOLAR M!CO-FILM TOTAL FEES PAYABLE \..._,,..._ \ • ~ A • l •"-,,-, l ~) ¼~o 1 l HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO HERESY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED'.TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER SPECIFIED HEREIN OR NOT. 1,ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM LESS THE CITY OF CA A LS BAO AGAINST ALL LlABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. APPLICANT'S SIGNATURE• OWNERQ,- AGENT D CONTRACTO~.tl(",APPROVED aY av PHONE □ I I I I I . I I I I . I I I I . I I I I . I I I . I I I I , I I I I . I I I I :fZbr I a •'='-I < \1 ~,ii';t\ v1p1 "• ~:- ! '< 0 ~ > 5 ;= u = 0. .,, ~ SITE ADDRESS: INSPECTION WOOD FLOOR FOUNDATION• FORMS• SET BACK• TOILET UNDER FLOOR PLUMBING UNDER FLOOR HEATING OK TO INSTALL SUB 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 8: STEEL PLATE TIES/HEIGHT OF CHIMNEY OTHER TEMP POWER (POLE) SEWER GAS TEST SWIM POOL • STEEL BONDING • PRE DECK • FENCE PREPLASTER SHOWN • FRAME . PAN FINAL !NSP BY BLDG DEPT OTHER DEPT'S REQ COMPLETED ELEC METER-PERM-TEMP i GAS ,',1E.TER-PERM-TEMP 1--- I I CERT OF OCCUPANCY JSSLJED OWNER: PERMIT NO: FIELD INSPECTION RECORD DATE INSPECTOR INSPECTOR'S NOTES