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Home My WebLink About2669 MADISON ST; ; 80-130; PermitLICENSED CONTRACTOR'S DECLARATION l hereby affirm that I am licensed under provi- sions of Chapter g (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 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 g commencing with Section 7000 of Division 3 of the Business and Professions Code) or that ls ex- empt therefrom and the basis for the allegeil ex- emption. Any violation of Section 7031.5 by an ap- plicant for a permit subjects the applicant to a civil penatty of not more than five hundred dollars ($500). ~-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 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). ::: 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 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 WORKERS' COMPENSATION DECLAR~TI N I hereby affirm that I have a certifica. t.e on- sent to self-insure, or a certificate ol W rs' Compensation Insurance, or a certIf1 opy 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 il 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: 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- ding agency for the performance of the work for Which this OArmil is: is:<W<>rl /<;.,-..,-.. 'U\07 r;,,;1 r,..,,fol CITY OF CARLSBAD-BUILDING DEPARTMENT APPLICATION & PERMIT USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525 12. J .. i:,'q 1 11?\.1A-d1 l .S 0 ,iu JOB ADDRESS I I I I I I I I I I I I OWNER ~i'-k 'Al2(.l Ct-\..D, f \ OWNER'S PHONE ~R'S M~lNG ADDRESS -t C5. t:.")Dx \ \ \_l Cl\els. b11-l '" BLOCK SUBDIVISION I ASSESSOR'S PARCEL NO. l I I I I I I I I I I .OESJ:RIP~ OF wol;J J . UJ H'll"'JL. e.. (-' ,., Ke.iJ{tK:em ·' I- f _L__j_j j AV.ST. [DATE OF" APPL!CATION " I I ... PRIME CDtiA;R (? ~ JDJc t · t /,; ~lt...rr.6 , h ~ y;:;~TB✓~A~R111-J DESIGNER f DESIGNER'S AOORESS APPLICANT TO FILL IN INFOR- MATION WITHIN RED LINES. BUS. LICENSE I <g·4q'<' STATE LICENSE r ·-1 -...... :5.,,.., CONTRACTOR'S Pl12!:!.E 122 -2.COO STATE LICENSE 2-~-&: DESIGNER'S PHONE tl)M;_T NUMBER /76 CENSUS TRACT I GP LAND US£ I ZONING RES. UNITS PARKING SPACE sf NUMBER OF STORIES # Not Valid Unless Machine C.rtifitd BLDG SQ. FT. I BLDG USE I occ. GP STANDARD PLAN ft PLANID# TYPE CONST QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT EACH FIXTURE TRAP INSTALL FURN. OUCTS UP TO 100,000 BTU EACH BUILDING SEWER OVER 100,000 BTU I l I EACH WATER HEATER AND/DR VENT I 2. <t' EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR UPTO 3 HP BOILER/COMPRESSOR 3-15 HP EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS WATER SOFTNER RELOCATION OF EA FURNACE/HEATER CCC. LOAD AMT. VALUATION: BUILDING PERMIT Iss11P 3.0dl I Issue 3._ 00 SIGN PERMIT TOTAL PLUMBING CONTRACTOR QTY. ELECTRICAL PERMIT NEW CONST EA AMP/SWT/BKR 1 PH .25 3 PH EXIST BLOG EA AMP/SWT/BKR 1 PH .25 3 PH REMODEL/ALTER PER CIRCUIT TEMP PO LE 200 AMPS OVER 200 AMPS TEMP OCCUPANCY (30 DAYS) Issue TOTAL ELECTRICAL CONTRACTOR TOTAL MECHANICAL ~-,r; II CONTRACTOR AMT. QTY. MOBILE HOME PERMIT AWNING PORCH SET-UP RAMADA, CABANA FENCE OVER 6' TOTAL MOBILE HOME 2.00 PLAN CHECK ALL INCLUSIVE PERMIT AMT. TOTAL PLUMBING ELECTRICAL MECHANICAL MOBILE HOME SOLAR MICO·FILM STRONG MOTION: TOTAL FEES PAYABLE SCHOOL FEES: I HAVE CAREFULLY EXAMINED THE COMPLETED ""APPLICATION ANO PERMIT, AND DO "AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER HEREBY CERTIFY THAT ALL INFORMATION HE'REON IS TRUE AND CORRECT AND I 5"-0'" DEEP AND DEMOLITION OR CONSTRUCTION OF COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER , 1 FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY, S1RUCTURES OVER 3STORIES IN HEIGHT SPECIFIED HEREIN OR NOT. l ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM-I • j Ji.--: t/. I I I ~ I ~!f I I I I ! l. I I I I I I I I I l~P'£' ~~!!~~:sc;_:,~c 0 : iA\R1~5!~~ ~~:~N;;R:~\~:~~~~T~~~DJ~1~~~~NcT;N~~~~~~~i ) {.L-ft/1_W oF THE GRANT I NG o F TH 1s PER MIT ll-.;;'.:ee;,~,~c~,~N2T;c';.,~.i';~~".':;~~-il-""i"'"'='2~~::=:L_-;00w:;;;:Nc,cec□n-:cc0cNcT;;;e:•:ccT:0cec□nc•cea,aea0;c;cva,00caa<y~-/"81-}:,-,..Jc, 0 □ t¥f}- AGE NT □ BY PHONE □ ---· I /1 • w ... <( Cl ~ > 15 ;::: u w a. V) ~ '610-13,u SITE ADURC.S.S; OWNER: PERMIT NO: "1 3D FIELD INSPECTIC ON RECORD INSPECTION CATE INSPECTOR 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 & STEEL PLATE TIES/HEIGHT OF CHIMNEY OTHER TEMP POWER (POLE) SEWER GAS TEST SWIM POOL • STEEL BONDING • PRE DECK • FENCE PREPLASTER SHOWN • FRAME ~ , • PAN \ • l . ,IY FINAL lNSP BY BLDG DEPT ,\ \l I\" I\ ll ,. 1.1 OTHER DEPT'S REQ COMPLETED \ i ;::.LEC METER-PERM-TEMP i GAS METER-PERM-TEMP ' I i ! C~Rl" OF OCCUP~NC~I_S3UED l