HomeMy WebLinkAbout2631 Galicia Way; ; 80-97; 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 lull force and el·
feet.
OWNER-BUILDER DECLARATION
C' I 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•
pHcant for a permit subjects the applicant to a
civil penally of not more than five hundred dollars
($500).
[: 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 tor 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 tor the purpose of
sale)
·.::I, 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 tor 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
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 certifiell{ copy
thereol (Sec. 3800, Labor Code).
6g~~~~v" ~ @6t~ct
::)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 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: 11, 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
• ,._._._,, ~m,m th,.t th,.,,. i!!. a construction len-
CITY OF CARLSBAD-BUILDING DEPARTMENT
APPLICATION & PERMIT USE BALL POINT PEN ONLY 1200 ELM AVENUE· (714) 438-5525
"· JOB ADDRESS AV. ST. DATE OF APPLICATION RD ?!Ll-,,ll I I ,..-. ' "'I 1 I ,: I .... 1 i ! ~ 1 1111 ! Al ,,I I 111,1 lr-lo/S1t,a, I I I 1 1-12-81
OWNER . OWNER'S PHONE PRIME CONTRACTOR
Hall, Matthew and Nancv 436-4618 Pacific Solar Desinrt
OWNER'S MAILING ADDRESS CONTRACTOR'S ADDRESS
? ~ ~ 1 r.;::ilir:i;:i W;::iv I" rn~t-;, rA Q?nnA 4422 Glacier Ave 'A1
CD• BLOCK ! SUBDIVISION I ASSESSOR'S PARCEL NO, DESIGNER San Diego 921. 21 1,6, _,fl 18101-13131 I
APPLICANT TO FILL IN INFOR-
MATION WITHIN RED LINES.
' BUS, LICt~SE PERMIT NUMBER
173\, l, '1:,0~
STATE LICENSE 97 355398
CONTRACTOR'S
PHONE
282-7644
()TATE LICENSE
DESCRIPTION OF WORK ' 'I 0
'2,/lj/1;,::-c1:.; <. ., . -Sol ;,r Hot-. Wat-Pr DESIGNER'S ADDRESS DESIGNER'S PHONE o·· I b4: ~: . /;,; / ::, ! . .--. '-.
CENSUS TRACT GP LANO USE ZONING I RES. UN\TS I PARKING SPACE ! NUMBER OF STORIES
Not Valid Unless Machine Certified
BLDG SQ. FT, BLOG USE occ. GP I STANDARD PLAN# !PLAN1D# TYPE CONST I occ. LOAD I
QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT.
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TD 100,000 BTU ---"'EA-OH &u+L-BHll&SEWE-R-Collectors 3 .00 l OVER 100,000 BI.Jr"'"
EACH WATER HEATER ANO/OR VENT 2 .00 l BOILER/COMPRESSOR UPTO 3 HIV'
EACH GAS SYSTEM 1 TO 4 OUTLETS B01 LER/COMPRESSO R 3-1§..Hf' .,,
EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOUG-30 HP ./ ~ EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SIN~ DUCT ./ U:Jd~_),{,~ EACH LAWN SPRINKLER SYSTEM MECH EX!jA'UST -HOOD/DUCTS ,
WATER SOFTNER RELM1i.TION OF EA FURNACE/HEATEV BUILDING PERMIT I I I I , . . / ( ~ .oo ./. . -/ (-<.Clo SIGN PERMIT I I I I
TOTAL PLUMBING ~/ TOTAL MECH~.r PLAN CHECK I I I 2 15(
CONTRACTOR CONTRACTOR j ALL INCLUSIVE PERMIT ' I IA
QTY. ELECTRICAL PERMIT AMT.~ ~QTY. MOB~OMEPE~~ I ~ TOTAL PLUMBING I
ELECTRICAL I I-. I
NEW CONST EA AMP/SWT/BKR ./. AWNIN,B',. -'r.i' ./ MECHANICAL I I I
1 PH .15 3 PH V _P.Ji11CH ,__ . / MOBILE HOME I I I
EXIST BLOG EAAMP/SWT/BKR ./ SET-UP __., ,,., SOLAR . ' . ' I 11V,.~
1 PH .15 µ,I( . AX RAMADA, CABANA / / .,,, /4,th,,_.,,,,,. /Y),t_/,. •~. J I I r J
REMODEL/ALTER PER CIR¢ I I •. FENCE OVER 6' / ./ . r/ I I I . I
TEMP POLE 200 AMPS/ / f'--/ .. TOTAL MOBILE HOMl'" ,, .II MICO-FILM I I I I
OVER 200 AMPS / ./ I / (' (\ £.< " I I I I
TEMP OCCUB,ll'NCY (30 DAYS)_... / I '' ' lr I I I I
.,(__,..,Y~_,,___,___.-/ ~.r.J / J I I I I
TOTAL ELECTRICAL .• /c I TOTAL FEES PAYABLE I CONTRACTOR / I I I IO. 'iln
/ "AN OSHA ,ERM" ,s R ou,Rrn ,oR EXCAVA,,ONS OVE~ ~ ]le-.,,__--/ I HAVE CAREFULLY EXAMINED THE COMPLETED '"APPLICATION AND PERMIT. ANO DO
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT ANO I 5•_0" DEEP AND DEMO ITION OR CONSTRUCTION OF _ /L_
FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 TORIES IN HEIGHT
COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION. WHETHER
SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM-
LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND '<.. -. ' / EXPENSES WHlCH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE
OF THE GRANTING OF THIS PERMIT A7iTJ;;;;;~ ~,Pft,. OWNERQ CONTRACTOR• I APPROVED BY ~ ff v/:t'/1) ~ AGENTM BY PHONE 0 .. . -. l I I
! ~ ~ >
6 ;::: ~ 0. V, ~
-.r
-r:1"'
SITE
ADDRESS: OWNER: PERMIT NO:
FIELD INSPECTION RECORD
JNSPECTION DATE INSPECTOR I INSPECTOR'S NOTES
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
SWJM POOL • STEEL BONDING
• PRE DECK
• FENCE PREPLASTER
SHOWN • FRAME
• PAN
t FINAL INSP BY BLDG DEPT
i OTHER DEPT'S REQ COMPLETED
ELEC METER-PERM-TEMP
'1 GAS METER-PERM-TEMP
i '
I CERi:-OF OCCUPANCY !SSLJ__ED