HomeMy WebLinkAbout2641 LA GRAN VIA; ; 80-750; PermitLICENSED CONTRACTOR'S DECLARATION
l hereby affirm that 1 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 el•
feet.
OWNER·BUILDER DECLARATION
&"1 hereby affirm that I am exempt from the Con·
i'r1.ctor's License Law for the following reason
(Sec. 7031.5 Business and Professions Code), Any
city or county which requires a permil 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).
'-'i, as owner of the property, or my employees
Clih wages as their sole compensation, will do
the work, and the structure is not intended or of·
fered for sale (Sec. 7044, Business and Proles·
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).
)G, 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.
~--I~ ~<-f,-~-~ for this r~on .,~. t , I ;-;----
Da<e 1/Ml6 {ii~ Owoec T=-·-
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of con-
sent to sell•insure, or a certificate of Workers'
Compensation Insurance, or a certified copy
thereol (Sec. 3800, Labor Code).
POLICY NO. ___________ _
COMPANY ____________ _
CCopy 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 tor one hundred dollars ($100) or less).
I certify that in the performance of the work for
which this permit is issued,_I shall not employ any
person in any manner so as to become subject to
the Workers' Compensation Laws of California.
NciTJCE TO APPLICANT: 11, after making this Cer-
tificate of Exemption, you should become subject
to the Workers' Compen~~ion provisions of the
Labo1 Code, you must forthwith comply with such
pro·a,.,ons or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction len· --· •--. ____ ,. , __
CITY OF CARLSBAD-BUILDING DEPARTMENT
APPLICATION & PERMIT
USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525
,o. JOB ADDRESS AV,ST. IOA?½F ;;LICATlON 2 b,'/,1 , ,L,tl, IC R, t-1, ,t', I~ I I ,H I ,(·, ti, R.,L, ,·. ,R, A, i), I I I I I ',0 8 13 & C
OWNER ~OWNER'S•~ PRIME CONTRACTOR
1·;, .-I i>. <lvhr;._~,,-.... ~v -~ ~ ·-'31,,,(,, I . 4--1. -
OWNER'S MAILING ADDRESS C!Q(__ ,)..3S-? <p¥ CONTRACTOR'$" AO~ ~
(: ...
..:;.."=1,t£..o,Y, -r-'
td1 BLOCK [ suaoivrs10N c _ I ASSESSOR'S PARCEL NO. DESIGNER
4-.,(<;;<t.. --c,.t~ r, Z,i ,fr,-,2~~.<', -,3,.:-·; I
DESSIP_TI_ON OF WORK , <ld·+;,,_ 4.-, G,f.: . iel_ .--*''·-c..":, tt;;· t _.., Lb . DESIGNER'S ADDRESS
34-.!Xl,. ~" .
,j
CENSUS TRACT GP LANO USE ZONING sf
APPLICANT TO FILL IN INFOR-
MATION WITHIN RED LINES.
BUS. LICENSE PERMIT NUMBER
STATE LICENSE '10-1~
CONTRACTOR'S
PHONE
STATE LICENSE
DESIGNER'S PHONE
I RES. UNITS l P:RKING SPACE I NUMBER OF STORTES
Not Vah'd Unless Machine Cartified
BLDG SQ. FT. BLDG USE acc. GP ! STANDARD PLAN# I ''-;~0:_Jso I TYPE CONST I acc. LOAD I
UTY. PLUMBING PERMIT AMT. UTY. MECHANICAL PERMIT AMT.
EACH FIXTURE TRA~ INSTALL FURN. DUCTS UP TD 100,000 BTU
EACH BUILDING SE1 ER OVER 100,000 BTU
EACH WATER HEAl R ANO/OR VENT BOILER/COMPRESSOR UPTO 3 HP
EACH GAS SYSTEM 1 flN.oUTLETS BOILER/COMPRESSOR 3-15 HP
EACH GAS SYSTEM 5 0 R MO Ji1 BOILER/COMPRESSOR 16-30 HP
EACH INSTAL., ALTER, REPAIR V MER PIPE VENT FAN SINGLE DUCT /, J60, ~
EACH LAWN SPRINKLER SYST "' MECH EXHAUST -HODO/DUCTS VALUATION: ~
WATER SDFTNER .... RELOCATION OF EA FURNACE/HEATER BUILDING ~ml I ~ I ' I 4,--r:;;;;¥
I ::,SUE 3.0 ISSUE 3 .00 SIGN PEtMIT I 2-/.Z-~0 ' I I' I ' . I
TOTAL PLUMBING TOTAL MECHANICAL PLAN CH(Wt,I j,_,, #IVJ,'7 I) I 1-r-. I
CONTRACTOR CONTRACTOR ALL lNCLUSIVE'-P.ERMIT ~ I I I
ELECTRICAL PERMIT AMT. TOTAL PLUMBING I I --'
UTY. AMT. UTY. MOBILE HOME PERMIT ELECTRICAL I I 7..,,.
NEW CONST EA AMP/SWT/BKR AWNING MECHANICAL I I '-'."°I
1 PH .15 3 PH PORCH MOBILE HOME I I • I
EXIST BLDG EA AMP/SWT/BKR SET-UP SOLAR I I I I
1 PH .15 3 PH RAMADA, CABANA I I I I
REMODEL/ALTER PER CIRCUIT ,;: . •v FENCE OVER 6' I I I . I
TEMP POLE 200 AMPS TOTAL MOBILE HOME MlCO-FILM I I I . I
OVER 200 AMPS I I I I
TEMP OCCUPANCY (30 DAYS) I I I I
ISSUE 2.00 STRONG M1D1DION: I I I ~"1
TOTAL ELECTRICAL 7 ,-p_ TOTAL FEES PAYABLE I ,,JJ~ CONTRACTOR I I
•
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND 00 "AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I S'-0" DEEP AND DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUE□;TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT
COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER SCHOOL ~FE: SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM
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 Ac::Jf.1~ /
OWN~ CONTRACTOR□ lt.p:~~V~O BP.,;;, OAT~"'"'JI. ~-AGENT D BY PHONE O • ,~
! < Cl ~ >
6 ;::: u w 0. V,
~
i--fi)
SITE ~/J-7S-U ADDRESS: OWNER, PERMIT NO:
FIELD INSPECTION RECORD
INSPECTION DATE INSPECTOR INSPECTOR'S NOTES
WOOD FLOOR
FOUNDATION• FORMS• SET SACK • 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 PREP LASTER
SHOWN • FRAME
• PAN '
FINAL INSP BY BLDG DEPT /nl /~ l
OTHER DEPT~S REQ COMPLETED I .: ;t/,..,, :'.',if,
: ELEC METER-PERM-TEMP r
! GAS METER-PERM-TEMP
I
!
r j CERT OF OCCUPANCY ISSUED ---,
REQUEST itOR INSPECTION TIMEc_· _____ _
l~SPEC~OR __________ PERMIT Na:EY-/ J 0 DATE: /0-9-~0
0WNER ____________ ,-.,,,1'--------------~-_,,_..,,._ ___ _
ADDRESS_---=2~G=--/./.__/ -~Z<---.>.~---'Cd1~-,;.~~"----__...1L...½"-""ik"-''::....-..,,c,__ __
BUILDING
0 FOUNDATION
CJ REINFORCING STEEL
L"'J MASONRY
C GROUT -GUNITE
0 FLOOR AND CEILING FRAME
C:J SHEATHING
C, FRAME
D EXTERIOR LATH
0 INSULATION
0 IN!!JII0R LATH OR DRYWALL
er-FIN AL
PLUMBING
0 UNDERGROUND PLUMBING
0 UNDERGROUND WATER
0 ROUGH PLUMBING
0 TOP OUT PLUMBING
0 SEWER AND PL/CO
0 TUB OR SHOWER PAN
If)
.......
':'..I
'/
ELECTRICAL
D TEMPORARY SERVICE
0 ELECTRIC UNDERGROUND
0 ROUGH ELECTRIC
0 POOL BONDING
0 ELECTRIC SERVICE
0 CEILING HEAT
D G.F.J.
~E DETECTOR
NAL
MISCELLANEOUS
0 PLENUM AND DUCTS
0 COMBUSTION AIR
0 PATIO
0 SIGN
0 GRADING
0 DRIVEWAY
0 GAS TEST D CONDITIONED AIR SYSTEMS
0 ~TEA HEATER
CV FINAL
READY FOR INSPECTION:
~ER PIPING
FINAL
./
D MONDAY □TUESDAY □WEDNESDAY HURSDAY
DA.M. v-
() 0
D F !DAY R
DP.M. a
SPECIAL INSTRUCTIONS, _________________________ _
REQUESTED BY ~ 9±;; PHONE NO, 1JJ._-;zb:-
PERS0N TAKING REPORT/j
Building Department
1200 ELM AVENUE
CARLSBAD, CALIFORNIA 92008
•
RECEIVED
Aue 1 s 1980
CITY OF CARLSBAD
Cuilding De 1 · etitp of etarl~bab par mcnt
TELEPHONE:
17141 438-5525
Dear Property owner: I?.... : (o. c, #--Jo-)So
J.1n o;'.)pJ ication for a buildinq perr.,it has been submitted in your name listing your-
S'-".!lf as the Luildcr of the property irnprovemer..ts .specif!e:1.
:E'er yom: pr.ol:cction you should be aware that as "owner-bu.ilder" you are the resp:>n-
ai))l.t=? p,-.rty of record on such a permit. Building permits a.re. not required. to be
sig:ne-d t!y pto~H!r.ty owners unless they are personally performlng their own work. If
yo•.1:a:.· wud·:. is he.i11g per.formed by someone other than yourself, you may protect your-
self :trorn pos~::iblc liability if that person applies for the prop.er permit in his or
her nama. ·
Contractors nrn required hy la\., to be licensed and bouded by the State of California
ar.d to have ,, business liceu:,e from the city or county. They arc a1so requirt::d by
i.e:w to put: th~:!it:: licens,:3 nu~b .. -.!r on all permits for which they apply.
If: y0u plan to do your own work, with the exception of various trades tl1at you p,lnn
to subcontt·act, you should be aware of the following information for your benefit
and protecti0n.
I.E yo1J employ or otherwise engage any persons other than your immediate far.d.ly r ~nrl
the work (including materialE; and other costs) is $200 or more for the entire pro-
ject, and s\lch persons are not licensed as contractors or subcontrac-t:or~, then you
1na~l i;t c1,1 employer.
J.f you are an employer, you must register with the state and federal gov?rnir.!':nt as
an e!":"1ployer o.nd you are subject to several obligations including stc~te nnd fcder:~l
incom,.2 tax withholding, federal social security taxes, workers 1 cvmpeusetion insur-
anci;:, disability insurance costs, and unemployment compensation contributicr..s.
There may be financial risks for you if you do not carry out these obligatio~s, and
these risk a i:.re especiallj'" serious with respect to workers• compensation insurance.
Fol:' more s~<ic.lfic inforro.3.t:.·:'.}:1 about your obligations under federal law, contact the
Internal r-:ev..: ... nue Serv.i..:-e :..-:.;i.d, if you wish, the U.S. Small Business Mmi11ist.ra-t;.i.or1).
For mo::-,.. ,3-t-\e,::if.ic infor"t.:;.1.t.::.::i:i about your· obligations under ·state law, contact the
D~p.:-rt::-'--c':::: o! Ben~fit f.)f":;~.,}.11ts and the Division of Industrial Accidents.
If tt-.-:· 3t.t.'t.:.Ct.urc is in:.e;-1,J,e-:i for sale, property owners who are not licensed con-
tr~ct.c.•·:-:-:: nra1:, allowed t~) pe::-.:.c:.:::-";.l their work personally or through their own cmph:,yees,
wit.he-.:.:: :'l. lic-en!led cont:-ac ... _;~:: :ir subcontractor, only under limited conditions.
I\ fr<'~'>-·:.t practice of. un::.:.:::-~~:-::sed persons professing to be contrc1cto-rs is 4;:o secur~~
-?11 ":·-·· -·.··r--~uildcr11 hu.i.1,:Ji~,; ::::,.:::r:rd.t, erroneously implying ·that the pr.operty owner is
prcn".::.~·q his or hC!l." o\m labor and :nateria.l l-'trsonalJ.y. Building pei::-mi.t!t r.rc not
rcqui 1.·;_•,:l to be signf..:d hy property owners unless they are performing their own ,x,rk
persc,rwlly.
InfcJrn"'!at.ion about lic<mscd contract.orn may be obtained by contacting the Contractors
Sb,te .T.Lcensc. Board in your cornmunity or at 1020 N St.ccct, Sacramento, California
95011.
Plea.Ho 1.•t~mplctc and return the cnclo!?ed owner-builder verification form r.o that we
c;:.n co11 t." lrrn lhu.t you nrc aware of these r,,a tters. 'l'he building pc!rmi t will. not b(?
.. ¼~LHPLil .th,,~~ot~f ~.c<;.t,,i_9~. f ~;\' .. E~:urne_a.
Vc.ry trl\l~• yours,
('J~·y OP CARl,SBAD
lJUtLTlIHG DEPAHTMEN'l'
Attention Property Owner:
An "owner-builder" building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest
opportunity to avoid unnecessary delay in processing and issuing your building permit.
No building permit will be issued until this verification is received.
l. I personally plan to provide the major labor and m'lt:Jo,ja!s for construction of
the proposed property improvement (yes or no) fl.::::6
2. I (have/have not) . htt:v:<.
for the proposed work.
signed an application for~ building permit
3. I have contracted with the following person (firm) to provide the proposed con-
struction:
Name _____________________ _
Address
City __________________ _
Phone -------------------
Contractors License No.
4. I plan to provide portions of the work, but I have hired the following person to
coordinate, sup~rvi1:=e and provide the major work:
Name ____________________ _
Address
City
Phone------------------~---
Contractors License No.· __________ _
s. I will provide some of the work but I have contracted (hired) the following per-
sons to provide the work indicated:
Addres-s Phone Type of work
Signed:
C".~ Property Owner ~
Social Security-N~u~m~b~e~r-4~+-..<'--.-~'---'-~_--,,L_-+/-7-'i/{f
Cb;;✓ /1} (9N Date
...