HomeMy WebLinkAbout2584 EL CAMINO REAL; MULTI-PERMIT FILE; CB004454; PermitCity of Carlsbad
1635 FaradayAv Carlsbad, CA 92008
11/29/2000 . Plumbing Permit Permit No:CB004454
Building Inspection Request Line (760) 602-2725
Job Address: 2584 EL CAMINO REAL CBAD St: A
.Permit Type: PLUM Status: ISSUED
Parcel No: 1670307400 Lot #: 0' Applied: 11/29/2000
Construction Type: NEW Entered By: MDP - T
Reference #: Plan Approved: 11/29/2000
- Issued: 11/29/2000
Project Title: BEAUTY FIRST Inspect Area:
GAS TEST FOR METER SET
Applicant Owner
NORTH COUNTY PLUMBING • ,-.
GREAT WESTERN BANK <LF> VANDERBURG LIVINGTRUST .
-.f-7IVV vvv- 0: . CIO WAKEN & CQ'
I'-' '"-"
3468 FAIRVIEW DR / 150.NSANTA1A NIT AAVE#645 \ '
VISTA,.CA 92085 7 ARCADIA CA9'1006 .,- 2700
619-940-1112
T0uUjt 000 \balanc:\$27.00 ,•
Plumbing Issue Fee
Fixture or
Building Sewer ( Roof Drain 1ii) :
-Gas Piping System $7.00.
Vacuum Breaker 01~: $0.00
Other Plumbing Fees $0.00
/1
Master Drainage Fee \
Install/Repair Water Line $0.00,
Water Heater and o 0 $0.00
INCORPORATED Master .,, çs000
Sewer Fee $0.00 --
.
. ..
ID TOTAL PERMIT FEES
$2700I
L
.
. ,. -., -•-•. .,4
i f
1.
FOR OFFICE USE ONLY
PERMIT APPLICATION PLAN CHECK N0.6°(-(L( ç'-
CITY OF CARLSBAD BUILDING DEPARTMENT EST. VAL.
1635 Fardäy 4e., Carlsbad, CA 92008 Plan Ck. Deposit -
Validated By_________________________
Date__________________________________
1.J PROJE tU7RMA1J1N -
Address (include Bldg/Suite #) Business Name (at this address)
Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of Units
Assessor's Parcel # . Existing Use Proposed Use
Desc ption of Wor - SQ. FT. #of Stories . # of Bedrooms # of Bathrooms
--------------------
'"' -.----- . ............ r2. .CONT.CT.PERSON(itdlffarentfrornapphcant) ..: .,. - . .. .......... . ,,. - .
Name Address - City State/Zip Telephone # Fax #
3TAPPUCANT 3actr p foont 'r OAnt.rorownr 57 3 U 37,1 6_2 C Name Xddeass City State/Zip Telephone #
PROPERTY—..OWNER'
Name Address City State/Zip Telephone #
CON 5 TRACTOR' CO11PAN NAME '
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed Statement that he is licensed pursuant to the provisions of the Contractor's License Law
[Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or that he is exempt therefrom, and the basis for the alleged
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$5001).
Name Address City State/Zip Telephone #
State License # &? IS" 7 License Class C.- City Business License # i q
Designer Name Address City State/Zip Telephone
State License # -
6 WORKERS CbMPENSATION
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
C] I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
-'l and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My worker's compensation insurance carrjr and policy number are: Insurance Company /cc..i In c'.) Policy No./'i'/V4 1178 7?2 Expiration Date
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) -
CERTIFICATE OF EXEMPTION: I 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.
WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred
thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees.
SIGNATURE DATE -
7 . OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
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 offered for sale
(Sec. 7044, Business and Professions 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 offered for sale. If, however, the building or improvement 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).
I, as owner of 'the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The
Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed -
pursuant to the Contractor's License Law).
0 I am exempt under Section Business and Professions Code for this reason:
I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES DNO
((have / have not) signed an application for a building permit for the proposed work.
I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number):
I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone
number / contractors license number): -
I will provide some of the work. but I have contracted (hired) the following persons to provide the work indicated (include name I address / phone number / type
of work):
PROPERTY OWNER SIGNATURE - DATE
COMPCETE TillS SECTION FOR NoN-AESIDENTJAcBUILDING PERMITS
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention
program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES 0 NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES 0 NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES 0 NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
8CONSTRUCTIONDINAGE.ëY
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code).
LENDER'S NAME - LENDER'S ADDRESS__________________________________________________________
9 APPLICANT CERTIFICATION -
I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all
City ordinances and State laws relating to building construction. I hereby authorize representatives of the Cit%' of Carlsbad to enter upon the above mentioned
property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS. 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.
OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height.
EXPIRATION: Every permit issued t a buil g ificial art provisions of this Code shall expire by limitation and become null and void if the building or work
authorized by such permit is not c me ced thin 80 d from e date of such permit or if the building or work authorized by su~1 permit i suspended or abandoned
at any time after the work is corn enc for per dot (Sec n 106.4.4 Uniform Building Code). // / APPLICANT'S SIGNATURE . DATE I I
WHITE: File YELLOW: Applicant PINK: Finance
54
0 City of Carlsbad Bldg Inspection Request OWN 1
~
For: 11/30/2000
•
.
Permit# CB004454 Inspector Assignment:
Title: BEAUTY FIRST '• '.5 -
Description: GAS TEST FOR METER SET.
Type: PLUM'Sub Type:
Phone: 1
,Job Address: 2584 EL CAMINO REAL
Suite: A • Lot -0 V :
•
Location: • • .:. 1 Inspector: -
V
APPLICANT NORTH COUNTY PLUMBING -. .
Owner. CRLSBD PLAZA/WAKEN CO
Remarks: CARD WILL BE W/TENANTL AM PLEASE' '
Total Time: •, Requested By: N/A
Entered By: ROBIN - . S
:CD Description. S.' - Act Comments
23 GaslTest/Repaurs
- *
. '• .
5
- Associated PCRs
Inspection History Date Description -. ' . Act lnsp Comments
.
0
5. 5•• - S.
S -. , 0
* S . - - 5
S S
0
-
V
0
•
. - *01 - *
S '' 0 - • f
J - . .5' - . S • .
- -
r-
-
-
V _5' -V - ' 4
-- 0 .•' 0
. . .. •0
1 . - *
-V - .
. • S
-
Vs.- '
City of Carlsbad
* 1635 Faraday Av Carlsbad, CA 92008
05104/2001 Plumbing Permit Permit No CB011651
Building Inspection Request Line (760) 602-2725
Job Address: 2584 EL CAM INO REAL CBAD St: B
Permit Type: PLUM . Status: ISSUED
—'-',Parcel No: 1670307400 , Lot #: 0 Applied: 05/04/2001 t Construction Type NEW Entered By MDP
,Reference #: Plan Approved: 05/04/2001
I issued: 05/04/2001 . •
Project Title: CARLSBAD PLAZA Inspect Area:
GAS TEST FOR METER
8486 05/04/01 '0002'01 GREAT WESTERN BANK <LF> VAN DERBURGLlVlNGrTRUST .% 44 •
C/O WAKEN & CO / c C O WAKEN & CO N
J COP . 27OO
150 N SANTA ANITA AVE #645/ /' (''91 :)T
ARCADIA CA 91006
0
ARCADIA C491006 <<
r'%
Total Fees: $27.00 Total Payments To Date:\1\$0.00 \ Balance Due: \ $27.00
Plumbing Issue Fee (oo
Fixture or Trap ,M\ \ .. :.'.... •
building Sewer 0
ZInstall/Repair Line IRoof Drain 0 ) Water Heater and/or Vent Vt.L0-.. $0.00 • 4 -
Gas Piping SYstern\ $700
Vacuum Breaker $0.00 / t
Other
Fees $0.00
-. INCORPORATED / . •J.
Master Drainage Fee 1952 •'.'$0.00 ;q.a J,i ; •
Additional Fees A $0,00
TOTAL PERMIT FEES 270
. • .
- .
4
• - . - .4
•1 -. -. .4 4• .'•... -_4_ ., • t_,_ • '. . ..•.. •; • 4
.11 ,. -
-
.' .. ,
t
V •VV •V ..._ .-,." , us,, ..U4JsI_ . . .
0 FOR OFNGEU5.ONLY
PERMIT APPLICATION 411L PLAN CHECK No._________
CITY OF CARL5AD BUILDING DEPARTMENT RST,VAL -
2075 La8.Palmtos Dr., Carlsbad CA 92009 Plan C. DWOOfr..
(780) 438.1161
Date-
city - SoV&7 T,Jiió 0
LA
Hen* AMMS Coo : 5osii10U rntir d
.5707 D
Wf
rq. 7011. Uoktui and Pte6HIMM Code Any Cl.a C.wnv sAolOfo r.00pl... om4t 10 ....t.ut% .1104, Io., Om,.t&, IrluuO 01' 0-4w, .Ui to ho lwwv j., .00. t.*.iho to. .Os.m 1w 04011 In 0. i lo.t .ulsM.t "st ho Is iwu.rnto vu. rrq.lshoo of Or .o.IWe Le. ICrn.0 p 0áu11m.ndn uu401. Ienihoo 7000 of DiThWA P of the Pu0ln*11C 1114 W*TU*ie 0*1 or thot.hq Is sumIx t1OftOffb orod 01i* b,*iu fw Uto IIlpd $Xlt$I0(. Any .'.i*Uliwo c? 5tci1.ro 7031.3 by wy a0o..* rct . pailt .44.111 tO. *malty o. joo SDGE - - - siri uiLu Lo'+ •• -
&I01$ 1k...' - -- LU..... Cim at', $uthi,pj Uto... 0•_••
0410*01 Uwe -Ad&M •0*10fp 01011111. ;tat. Un.ns.i
Waft(V Cnmuoowlor Dd.rI,n, t hmby ptn1i. 0.18410,04111001 oI' 4101 0li 118. d..O.01045' J I ll,, .nd WOO ,,.boto]o, • -W1111VA of ..,.wt to ull.O.we io o.91bw csr.pwh11n 04 p.vold.d b I..ton 3700.1 Ine.1.8*, 0.81. IWOPa Pell48111 at lii V..k to, wlclo tb's pirmO to Usoad. 0 • 0 I P40c W'd WIll fl.10111n ,..kw.Of *00040.4440, on 00104?.d by 0041100 *70001 1M L0.4 0480, tO? the pwfnuw.cq of IN welt 1w wldthi%t, oin01t I. ta&u F4V.ut'u oowpu uil.iu hot..',.. ctn#s wod 0Oic. ,40*bso Ito: • V V "Itildn Dole hr Cop -0 P01ty0h, • V
(8308 SOCTEON IlOED NOT I&IL!TI0 W TMO 11911001T IS FO9 ONE $Ur*(D DOLLAR c.iaor OR USI) • Q CIPT1FIOATI OP Ik1NPT1D* I vi$Ov 11101 In 0111 (odtnrinoo 0/114 wutk I.. t*h Wo pwm10 bliestopC I Stu.4 1104 .,. buoy p.n .00.ii mj' icor to b01orT. *i1j041 sells Work*18 COITIM611911 Letos of Cilforit.. • V • .. V WM4IN0 8.1., too...... w.U.*' •.84,, .ropo Is w-f01. 408 stopUlm" Ito to .hob.I pWi.Ono lvi 4110101 is pcI h10111 Cnitiquil ddtoy 1QO.000). 81 i.dd Ilon tOms .4% .4 Doopinet dm41.. ..poy40u8 OW 1.18.0140)104,1 110 Lw ..d. ho,.,E1u.04 .hwrW. . $I0NATU00. V PAIR 0
fls,lv *f811* toot I ito i.pt bwro40 CpcDltio. Ucino. Lay9 too Oh. f0/.wh too..., . V LII 900f1! 01100 p0104041114 "V 400410)111With W1501 04111* r011 0iup.to4tI,n. 'ill do the wk vod IPso sonuuy. U flsInton*0 at otfirod for o.I. (300. 1014, 0*11*1. .uid PT01UOI9i Cod, tlio 0movaWl Ut4itui 14W dO.. not (icili' 04 III ownof It isquait, wlso hold, o',hq*.w.., 0..qo.so uIt *11 such wcih $40110., 0ooa10 We 9040 ..plpcs.., po4010tI4l slot lu'iw4m4n1 ItO not trAmWed., 0111.18 11, wals. IT, 01. bujtohll or booprcs,mwt ii r011 WIoldo 4 j$47 It oufflodom UI. ,wo.,b440, wtl heYs (11. bwdu., Of 040111*9011db, dig net 1.184 oql.oy.cyp Our '40 pIrpS of nIl).
J. 00 010,' of t%q .1OP1.IW 04. .lUuoolvlit pciinantb, wIt' (104148 COM'I011ft 00 uu.4I IIj pvl)aat.. 70M, lo.,b..'. prod 11o10o.Isr4 Clo.; ml 1104.11.00*0. L10000. 1010 8*01 .40 .çly 0, 40 .'iuiw of Pfcowtv *he b18d, ,,r 'rn'.... 11104...', .04 oto.t,,cl, Ow lutli 0.04.003 4481 CoaU1CVMf 0) $010114 OlI04t 000114 .Ir,ø,V. Iloero,. i...p V • 0
O -Daeorwass .08 P40114110.4 CWs for tWo .pcwo
I. 4 p.novliy 0481. s,*1140. the to.),, llblru01 ,00wotU 1w cusi.uolU. ci 0)4 t...4 p,1Y Impry000to. I 'os Orb
. I lost, I M,o .'oU llp'.d.. 1pcflstOIso Iv i bighl"Vewim 10,10s pmscod wctk. • • 11. 10or,nl40wbh uui/ I.flo.wuI5 0011,001 orowi piu44. to. 1,40,1*01 011401u0P11t' 00.0.10*4 pornO I .1*41 I Øn no..h11 ..nVrlp,, 1400.0. .o40llf!1
0. 191111A to p..vll. ooidw.s cub. wdutt. IOU) P1010 I4r.d th. 104.0104 pulot. I. c.o.8Oo04, ,'..ft10044 .0*118, V. ,.. .otn onlO.8, or.,,.. 4.88... alleviate, 04rrt01r./ ocliusotci, tyinpcoo,,vbw) 0 • -
0. 1041 proold. ow.. 05051*100*, 11JI I 40* Gordto11t*d luOd) IN f1110w10 pex.4p.l. p'ivld Oh. wt.k 001000014 Itotod. 4.0..I ,ddru. /01004. IlUr000r I yp
-- %jJ - 4 . 0 • -
Ppkgry owjqp 3I40tfl4l(
100100150*001., Mws bU1dU0 ne.iry 'siojrnd to sANt a 1.0.14%. pIsro, ..ci,l, blwdto. .v*1481s 1.$0.rs1un jorn, Ill (481 m*u11411004U uI pItY111I
- *t'VVffu 5104010,., 2850, P09)1,. 2510, .ftMP..by.Tmw.r *Itttd,bj, 5L,t,r,v* 800014111Ai07 ( Y!5 W No -
Ills. .pploato 011.1181 14I48h,05 I0CII1T Taato4 It *101. 4O.I44t Irwo *41b potid), got11705 ¶otrt a.11' gridlty .1lvsogsmlrd 4101,itlPa VU 13 110
b 114 ft.flIoy, C, .054010.0.8 wIlls 0.0001.100? 'Ii pun. buvr.dsn'cf. .nlw04 .tw ) 'Ya M NO V • II 0.10001143401*04) A'! '11U. oM?4AL 0U,iwo.Mt0t 1100UPAKOYMAY PlOT If IppUlO UNLRSO'TNP OPYUCAIIT 441 OUT 01118 M2T0N0 ml • • flIaUffiIM(lI?3 OF TII11 MCI OF INPROINCY ftOOVICE0 *440 TIM Al. POLWUON 0001TROL 010TROCT
- I M'lOt' .1 Firm 11181011,,. Ii . ..nolrootcn Iwliop igc OW 10. poofpirp,8, 04 It,. '1,1101 W1001, We 1811,dt Is I'.gØ dOoc, 30i7 CMca".'
LIP*ItW0NAIuII._!L _-- 1104814111 AODRflLV..0V V
I 040IFy dot I 11..4 .00d the .8U.1144 1118 rotor lost U. s* 6vOITRII110 I 0000(01 140181111111* 1.tww.U,, .480t .4.... Ii .000510 0540*4(0 l40ty .101.01 Cloy 6.10041010 arud 11.. In.. 11ItIrog ruo 0.40010* ,t.,clov44,.,. I busty .or.anto ls 0101,1*.. 0101o. Cot. 0? Coiltld 0001110101*01110. Ibule 106014418 0.00511 ft Iato.;tiou. .80ii. I £0.50 *05191 TO 1*11. 0101 411010 MOD 0.1(4' 110.1*151 111 dIV Of 0A41L1100 £QMIIIT ML 1'*lILltlIS. • .IUD4%11'lt, COSTOIM 041104001 wiIcn MAT IN 0040 WAY ACORUt AOAW1T 0010000011111 oosoimeIo, 'WI 0*5001*0001 71410 pOstal?, 01104: 041 080.4, D...IrO it nuilr*S flr sthlollIcci *01? pV dow 1.8 drwINJo,o, .1m.1nJ%1,o. 05 slnooluur.s .OW 11 .y.du in04Irt, • • • - - V lIPIRIt1011a iwny w."tft lilisO by UI. ,0101,f 0fllç$04 noow 11w g.o61rm, .1118.01*. otiS 0, (triclMi 0.01114.404014% 5.14101111,0140880104.. wo'4 ,uohorQ.,r , soot N. .nit etmmlnf*l wIt 48 d, too.' P.* 4duto$1 soih prooWl or If 810 DqUM or w.rk .urr,0011.4W *0111 00814* ra,500vlspd w flo'.oempt II uryo.ro. lii hi Uctotronur p..toi it 050841 I11etloii 1034 Undo,,,, B40 54040U0A0or0 OIOOIATUIOI 0 oor
V FOR OWNER 1,F L0W:4,pAGEW k.0tME: PIv V
g 39116 N)1M 2.L89W.;919 t,:tt TOGZ/00/90
Request City of Carlsbad .Bldg. Inspection
For 05/09/2001
Permit# CBOI 1651 Inspector Assignment
Title CARLSBAD PLAZA
Description: GAS TEST FOR METER
Type PLUM Sub Type
Phone: 7608055725
Job Address 2584 EL CAMINO REAL
Suite: B 'Lot 0
Location: '
'
' ,
Inspector: 4 1
APPLICANT GREAT WESTERN 'BANK <LF> VAN DERBURG LIVING TRUST •'
Owner fl1i4r Oh 6,c+ SicJ o d/Idi 6c4 ~'tpp/y o
Remarks:
Total Time Requested By
Entered By:' ROBIN
CD Description Act Comments
.23 'Gas!Test/Repairs
' ' '
Associated PCRs
Inspection History
Date Description • Act Insp . Comments ' • '
-.- -•'-•,-.
£ - - . I -' •1 - - - - -
B U I L D I N G P E R N I T Permit No CB941235
09/30/9415:32 . . Project No: A9401099
Page 1 of 1 Development No
Job Address:- 2584 EL CAMINO REAL . Suite.: B
Permit Type PLUMBING
Parcel No: Lot#:. .
.
.
Valuation: - . 0 ,
Construction Type:.NEW 4 .. OccupancyGroup: B2 -. Reference#:. . . -. Status: ISSUED,
Description: RECONNECT GAS FOR HEATER FOR .. Applied: 09/30/94
SIGNSMITH . :-- Apr/Issue: 09/30/94.•
DC
Appl/Ownr : ROSEBERRY, STEPHEN . 619 941i"80FW%~Y'r/~4 SdOl 01 -.02,
1718 OLIVE AVENUE • : CPRMT 2700
VISTA, CA 92083
*** Fees Required *** ' ,*-Fees Ic.ol.'ectd & Credits ----------------------
Fe e------------ C)'
Adjustments rUU ot'_eci1ts 00
' Tota
£
l Fees: • ...00 £ #/3otal Payments:ì £ .00
'Ialance\Eue 27.00
Fee description Ext fee Data -------------
Enter "Y" for Plumb"n Issu!e Fee N>
.
.
;
PLUMBING TOTAL 27.00
INCORPORATED
Vt-
•. -: £ - CITY OF CARLSBAD . . .
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
£ I 1 £
PERMIT APPLI(11ON
City of Carlsbad Building Department
2075 Las Patinas Dr., Carlsbad, CA 92009 (619) 438-1161
I. PERMIT 1YPE
From List I (see back) give code of Permit-Type:
---------------------------------------------------------
For Residential Projects Only: From List 2 (see back) give
Code of Structure-Type:
PLAN CHECK NO. /:/,73
ESL VAL
PLAN CK DEPOSIT_______________
VALID. BY - -
DATE
Net Loss/Gain of Dwelling Units
2. PROJECT INFORMATION FOR OFFICE USE ONLY
3 (21.- u o p Building or Suite No.
Nearest Cross Street yfl IjUON tp
LEGAL DESCRIPTION Lot No. Subdivision Name/Number Unit No. Phase No.
CHECK BELOW IF SUBMITTED:
02 Energy Calcs 02 Structural Calcs 02 Soils Report DI Addressed Envelope
Gi' ru. fr4 )arl t !Ev C 7#')
SQ. FT. 2. p ' # OF STORIES ' # OF BEDROCJ6S # OF BATHROOMS
NAME (lastname first) ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
APPLICANT []CONTRACIUR U AGENT FOR CONTRACtOR DOWNER U AGENt FOR OWNER
NAME (last name first) ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE
PROPERTY OWNER
NAME (last name first) - ADDRESS
STATE ZIP CODE DAY TELEPHONE
0)yiZ''1 5,TlEve ADDRESS 17(S OLLV
CITY &MMOW V 1.5 _r01 STATE C 0 ZIP CODE Cf 2.0 ' DAY TELEPHONE Q Lt I -
STATE UC. #56- 7_3 0J UCENSE CLASS (3 CITY BUSINESS UC. #
DESIGNER NAME (last name first) ADDRESS
CITY STATE ZIP CODE DAY TELEPHONE STATE LTC. #
WORKERS' COMPENSATION
Workers' Compensation Declaration: I hereby affirm that I have a certificate of consent to self-insure issued by the Director of Industrial
Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified
by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. Q.
INSURANCE COMPANY POLICY NO. EXPIRATION DATE
Certificate of Exemption: I 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.
SIGNATURE DATE
OWNER-BUILDER DECLARATION
Owner-Builder Declaration: I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
0 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
offered for sale (Sec. 7044, Business and Professions 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 offered for sale. If, however, the building or improvement 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.). - -
o 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions
Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects
with contractor(s) licensed pursuant to the Contractor's License Law). -
0 I am exempt under Section Business and Professions Code for this reason:
(Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the
provisions of the Contractor's License Law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code)
or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars [$5001).
SIGNATURE DATE
COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY:
Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and
prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act?
DYES 13 NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
DYES 0 N
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
DYES ONO
IF ANY OF THE ANSWERS ARE YES A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT
HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
WNSTRUCI1014 LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(i) Civil Code).
LENDER'S NAME LENDER'S ADDRESS
API'UCANI CEI[flHCAflUN
I certify that I have read the application and state that the above information is correct. I agree to comply with all City ordinances and State laws
relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection
purposes. I ALSO AGREE 10 SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL UABIIIIIES, JUDGMENTS COSTS
AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMiT.
OSHA An OSHA permit is required for excavations over 5,0" deep and demolition or construction of structures over 3 stories in height.
Expiration. Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the
-- building or work authorized by such permit is not commenced within 365 days from the date of such permit or if the building or work authorized by
—such-permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code).
APPLICANT'S SIGNATURE - DATE:
Pr6fr('T. 0
5: ' .. -. ,.. .. ,_•5 . •- . .0' .
' USE BALL POINT PER ONLY & PRESS HARD . . APPLICANT ILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
1 hereby affirm thatI. am licensed under' cc provislons of Chapter 9 (commencIng With
I"-Section .7000) of DivisIon '3 of.the Business4.
and -professions Code, and my license Is in
-.a,fuii force and effect:
-- ' L' (,ic. No. ' Class i3
hreby iffirm tft iatn exempt from the Con" tractor's License Law for the following reason (Sec.
7031 5,Business and Professions Code: Any city or
,, •Couñty which requires a permit to construct - alter, improve, demolish, or repair. any structure,
prior toils issuance also requires the applicant for
Such permit to file a signed. statement that he-is
licensed pursuant to the provisions of the Cot'
tractor's License -Law (Chapter 9 commencing: with Section 7000 0f Division 3 of the Business and Pro-
c It
fessiôns ,Code( or that is exempt therefrom and,the
' basis for the alleged exemption. Any violation of
-Section 7031.5 by an applicant for a permit subjects.
tne applicant to a civil penalty of not more than five hundred dollars ($500).
1 0 tas oneof itre proerty"'or mi. ernploees ,.
5 .with wages as their sole compensation, will do the
work. and the structure is not intended or offered for
sale (Sec. 7044, Business and -Professions Code:
lxi • 'The Contractor's License Law does not apply to an Z , owner of property who builds or improves thereon
and -whodoessuchwo'rkhimsefforthroughhisown I employees. 'provided that such improvements are- -.
(not intended or ottèred'tor sale.' If, hoever,.the
.i_ '. .., ,buifding or improvement is sold within one year of.
- • completion, the ownar.büilder will have the burden a
i,5,.)'ef proving that he did not build or improve for the purpose.of-sale(. ',.,s.. ','tv'T" ?".-.j'-t"- •, as'owner of the property, am- exclusively I - "contracting with licensed contractors to construct 2
'
the: project )Sec. 7044, Business and Professions
'Code: The Contractor's License Law does not apply
' ' to owner of,propertywho builds 'or improves
< t,. ., thereon, and who contracts for each projects with -a
,.*,contractortsl license pursuant to fhe,Coptracfor'S 0 • License Law)., - -, lxi
--v' — Dlamenerpt underSeè..,.,, ,,... B. & P.C.
forth sreon
'"v'°
.'rreby affirm that I have a certificate-of consent to, 'self.insure. or a certificate of Workers'
. . ' 'Compensation Insurance, or a certified copy thereof
(Sec. 3500. Labor COde(.'
t p',- ,4''" ', • I -
— .. 'POLICY NO.
COMPANY Jp a
.ull It yjS filed with the city1.0'
z •. . - - 5,,. '
• I W : 0 Certified copy is hereby furnished.,. ,••, ' f' L. •
-: '•. CERTIFICATE'OF EXEMPTION FROM
, 4"f'i, WORKERS' COMPENSATION INSURANCE .(This section need not be completed if the permit
t:: is for one hundred dollars ($100) or less)Lul
- ' 'D I certify that in the perfoGnance 01 the work for..,.
'0 't' ' rhrch-thi5 permit is issued. I shall not employ any person in any manner so as to become Subject to
the'WOrlrers' Compensation Laws of California. c.. •' v,,,E on I . ', •..c
•' ., . NOTICE TO APPLICANT: If. after making this Cerf..,."
"c.,, of Exemption, you should become subject 10 the Workers' Compensation provisions of the Labor
'v'-r Code, you- must forthwith comply with -such -
- •\" ,provisions or this permit shall be deemed revoked.
- '-$x..
Eft- r -r
- . •'r ' , ,',.
!frereb' affrrm that there is a construction - -cc I ._ lending_agency to, e performance of the work for Lu I which this permit is issued Sec 3097, Crud Code).'
: zi - scv,. awl-_,. 'Lenders Name-- ' ._JI ' - ...... •" ' I . Lender's Address - -
- -CARLSBAUiLDING DEPARTMENT,'' '
'- ''' AJCATION & PERMIT,.: '. • 'i -' 'T'
1200 Elm Carlsbad California 92008 (714) 438-5525
JOB ADDRESS - . . . AV.'ST, DATE OF APPLICATION BUSINESS #' VALUATION ' . - PERMIT NUMBER",- ;,NSE
,,/ .
• R9.
'
":
ZONE, - CONTRACTOHONE a OWNER'S. NAME r - . r'4 OWNER'S PHONE PRIME CO TRACTOR
( / /9 OWNER'S MAILI ADDRESS C NT ACTOR'S ADORE S / /?%, LICENSE NO. . PLAN 1,0, # . . ' ' BLDG USE CODE
, ,
42t3/
.
—•• -;:.' •.
LOT I BLOCK
S
SUBDIVI ION ASSESSOR PARCEL NO.
-, . DESIGNER .
5' . .-
_______ STATE LICENSE #
• 2_,.5 91 F/
STANDARD PLAN #
u," ' .Cr. .BUILDING SO. FOOTAGE
- --r.'r '
DESCRIPTION OF WOK I / I /
DESIGNER'S ADDRESS . . . DESIGNER'S P4N E ' .' - ' '• '.
EDU ,F/P - FLR ELEV. . ' - NO -
S STORIES OCCGP"
o __________ 9/2If8J97 /08
9/2/i 700 CENSUS TRACT GP LAND USE - q PARKING SPACE, RES UNlTS- GRADING PERMIT ISSUED REDEVELOPMENT - TYPE , nr''r'1I '' -• '..
AREA 0'CONST vwv1L7 0CC LOAD FIRE SPR
,, -. , 'iD N(J 5,., ., "' '-0' •"j' . .. - , . ' • , y04j0 ' - ., YO NO , Not Va/idunle&sMachineCertified
QTY
- • ''"'
QTY
t,' • "•'f '•' -'•.--_'
MECHANICAL PERMIT SUE
--.'-..•--, ,. •_. —
SUMMARY/ACCOUNT NUMBER PLUMBING PERMIT ISSUE
,.-. EACH FIXTURE TRAP • •'s - ' ,'v' ,' rs INSTALL FURN. DUCTS UP TO 1.00,000 BTU -- ,0tJILDING PERMIT.- - ' ' . . *
EACH BUILDING SEWER - '°" '" - - - - - OVER 109,600 BTU - SIGN PERMIT "' - '-z " - '- '•- '-
EACH WATER HEATER AND/OR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK
EACH GAS SYSTEM 1 TO 4 OUTLETS I BOILER/COMPRESSOR 315 HP TOTAL PLUMBING
EACH GAS SYSTEM 5 OR MORE "S-'-' 1' METAL FIREPLACE --"40' .' _ELECTRICAL, '0'' -0' 0' ' 't ,,!r,_
"' EACH INSTAL ALTER REPAIR WATER PIPE — , VENT FAN SINGLE DUCT - MECHANICAL
-'-' EACH VACUUM BREAKER r MECH EXHAUST - HOOD/DUCTS MOBILEHOME
WATER SOFTNER — RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP
EACH ROOF DRAIN (INSIDE) - -1 SOLAR
TOTAL MECHANICAL- IV'f.....''
- ,'
'STRONG MOTION ''" ""*•• • ' -• ''•
'TOTAL PLUMBING - FIRE SPRINKLERS -
QTY
v,r •_,, "-v ,0' '
ELECTRICAL PERMIT,.. ISSUE
. '
QTY
r - -• . ' '-
' SOLAR ISSUE
- ' PUBLiCFACILITIESFEE -
"'- BRIDGE FEE
NEW CONST EA AMP/SWT/BKR ' ' I CO LLECTORS SCHOOL FEE DISTRICT
1 PH ' ' 3 PH " STORAGE TANKS t Carlsbad
— EXIST BLDG EA AMP/SWT/BKR'\ "s ' ROCK STORAGE - ,v ' 0" Encinitas 0' 0'-
L 1 PH _3 PH 'r PUMP San Diegullo
REMODEL/ALTER PER CIRCUIT 'a PLAN CHECK FEE Sat Marcos
TEMP POLE '260 AMPS 0' '- '- '' - 4
OVER200AMPS
TEMP OCCUPANCY (30 DAYS) -"
t. 1'
I TOTAL ELECTRICAL I a - v" TOTAL SOLAR I "1 TOTAL FEES PAYABLE __? ..-
- _'•_•7•__ ' - '-' v t-" , "''v.v''4,-. .- -.'j,. -"ra- '5 • ,*,-n -.•-',-. f .'.-'_*v"'
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY E xpiration. Every permit issued by the Building Official under the provisions o(this * AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER
CERTIFY UNDER'PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE d shall expire by limitation and become null and void. If the building or work .
5'0" DEEP AND DEMOLITION OR CONSTRUCTION OF authorized by Such permit is not commenced within 180 days from the date of such DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS permit, or if the building or work authorized by such permit is suspended or STRUCTURES OVER 3 STORIES IN HEIGHT
ISSUED: TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON abandoned at any time after the work is commanced.for a periodof.180 days. ' ' •
STRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY ANU APPLI IGNATURE OWNER CT__CL(~NTF~'A0_T9_!,'b,. OVED BY
KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND
CONSEQUENCE OF EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN '' - BY PHONE , 0 GRANTING OF THIS PERMIT 5'f?•
I
INSPECTION TYPE DATE INSPECTOR
BUILDING
FOUNDATION
REINFORCED STEEL
MASONRY
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME
SHEATHING
FRAME
EXTERIOR LATH INSULATION
INTERIOR LATH & DRYWALL
-
PLUMBING
SEWER AND BL/CO
PLUMBING UNDERGROUND
PLUMBING TOP OUT
TUB AND SHOWER PAN
GAS TEST
ELECTRICAL
TEMPORARY POWER
ELECTRIC UNDERGROUND
ROUGH ELECTRIC
ELECTRIC SERVICE
BONDING A
G. F. I. - SMOKE DETECTOR. . *
MECHANICAL
DUCT & PLEM., REF. PIPING
HEAT - AIR COND. - SOLAR SYSTEMS
VENTILATING SYSTEMS
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE 'HA VE BEEN APPROVED.
JOB SITE FINAL
PLUMBING
ELECTRICAL -
MECHANICAL 11i4f,l ? ef
GAS
BUILDING
SPECIAL CONDITIONS
CERT OF 0CC PANCY ISSUED
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS . . INSPECTOR'S NOTES
-
INSPECTION REQ. IF
CHECKED
INSPECTOR'S
APPROVAL D ATE
SOILS COMPLIANCE
FOUNDATION INSP
PRIOR TO
STRUCTURAL CONCRETE
OVER 2000 PSI
PRESTRESSED
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING . .
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
PILES'CAISSONS
AMC --- w