HomeMy WebLinkAbout2754 LA COSTA AVE; ; 82-03; Permit.. z 0 ~ "' :5 0 .. 0
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D I hereby affirm that I am licensed under
provisions of Chapter 9 (commencing with
S.Ctlon 7000) of Division 3 of the Business
and Professions Code, and my license is in
full force and effect
L,c No __ _ __ Class _
I hereby atf1rm that I am exempt from the Contrac-
!or's ucense Law for the following _reason (Sec. 7031.5
Business and Pro1ess1ons Code. Any c,ty or county which re· quires a i,erm,t to construct. alter, improve, demolish, or
repair any structure, prior to_ its 1ss_uance also requires the ap-
plicant for such permit to file a signed statement tMI he 1s
licensed pursuant to the provisions of the Contractor's
License Law (Chapter 9 commencing with Section 7000 o1
D1v1s1on 3 of the Business and Professions Code) or that Is ex· empt therefrom and tM basis for the alleged exemption Any
:~~\~t\i~ ~~~1~i~1it"1t~3c11~~ i~n;~fy~~~1:~~; fJ~rt~~ ~~~:
dred dollars ($500)
LJ I. as owner of the property, or my employees with wages
as \heir sole compensation, will do the work, and the struc·
ture 1s not intended or Offered 1or sale (Sec. 7044, Business
and Professions Code The Contractor's License Law does
not apply lo 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 intend-
ed or _o11ered for sale. 11, however, the building or Improve-
m_ent Is sold within one year of complet1on .. the owner-builder
will have the burden o1 proving lhat he did not build or im-
prove for the purpose ot sale)
0 I, as owner ot the property. am exclusrvely contracting
with licensed contractors to construct the project(Sec. 7044,
Business and Professions Code: The Contractor's license Law doos not apply !o an owner of property who builds or im-
proves thereon,. and who contracts for each pro1ects with a
contractor(s) license pursuant to the Con1ractor's License Law)
□ As a homeowner I am improving my home, and the Jollow• ing conditions exist 1. The work_ is bemg performed prior to sale
2 I _have lived 1n my home !or twelve months
prior to completion of this work
3. I have not claimed this exemption during the last three years.
lJ I am exempt under Sec ______ , B & P.C
for this reason
□ I hereby att1rm that I ha~e a cert,!1cale of consen1
to sell-insure, or a cert1t1cate o! Wofllers
Compensation Insurance, or a cert111ed copy thereo!
(Sec 311CO. labor Code)
POLICY NO
COMPANY
□ Copy ,shied W1\t, 1he city
0 Cert,!,ed copy Is hereby furnished
CERTIFICATE. OF EXEMPTION FROM
WORKERS· COMPENSATION INSURANCE
(Th,s section need not be completed of the permI1
Is tor one hundred dollars ($1001 or less!
0 I cert,!y that In the pertormance ot the won< !or
wh1cn 1h1s permit Is ,ssued. I shall not employ any
person ,n any manner so as to become subIec1 to
the Won<e,s· Compensation Laws of Cai1fo,n1a.
NOTICE TO APPLICANT 11. al1er mal<tn-;i tl11s Cert,
11cale o! Exemption. you snould become subIec1 1-,
lhe Wofllers · Compensation provIs,ons ot the Labo!
Code. you must !ortnwItn comply w,tn such
prov,s,ons or 111,s permit shall be deemed revoked
D I hereby a!!irm That !here Is a ,;onstru,;1,on
Iend1ng agency to, the performance or lhe wofl< Jo, wh•ch 1h,s pe,m,t ,s ,ssuect 1Sec 309? c,~,I CodeI
Lencte, s Name ___________ _
Lenders Address __________ _
USE BALL POINT PEN ONLY & PRESS HARO APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT
1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525 APPLICATION & PERMIT
AV. ST. j DA TE OF ~J'.I Rb.' ' VALUATION
'2---So ;::~;¾
QTY. PLUMBING PERMIT· ISSUE fl') --EACH FIXTURE TRAP
EACH BUILDING SEWER
EACH WATER HEATER ANO/OR VE~,.=-~_t_ --.
EACH GAS SYSTEM 1 TO 4_□UTLET~ ___ -+-
EACH GAS SYSTEM 5 OR MORE t----+----·--
, OWNER'S PHONE
~ □ N □
CON1RACTOR '+"
,OESl,GNfA
Ji>~~{itff,t),~~QOFIES5;
,·1·
et, FLA ELEV
YO NO
REDEVELOPMENT
AREA
vO NO
QTY.I MECHANICAL PERMIT -ISSUE
INSTALL FURN. DUCTS iJP TD 100,000 BTU
OVER 100,000 BTU
BOILER/COMPRESSOR UPTO 3 HP
---·----
BOILER/COMPRESSOR 3-15 HP
METAL FIREPLACE ----
VENT FAN SINGLE DUCT EACH \NSTA~ .. ALTER. REPAIR WATER PIPE
EACH VACUUM BREAKER . MECH EXHAUST -HOOD/DUCTS, =j -. t=vELocAnoN OF EA FURNACE/HEATER WATER SOFTNER
I EACH ROOF DRAIN (INSIDE) J_ -~---.~ TOT,t;.L MECHANICAL
TOTAL PLUMBING
TYPE
CONST
3-
BLOG USE CODE
BUILDING SQ. FOOTAGE
.... ~ ) i( ~ {
·..,,;r,, i l:·e ;_-
OCC GP
DCC LOAD J FIRE SPR
vO NO Not Valid Unless !6chine Certified
SUMMARY/ACCOUNT NUMBER
BUILDING PERMIT 0·1-00-00-8220 -SIGN PERMIT 01-00-00·8221
PLAN CHECK 01-00-00-8806 --~-
TOTAL PWMBING 01-00-00-8222
ELECTRICAL 01-00-00-8223 --.
Ml:t;HANlCAl 01-00-00-8224
MOBILEHOME 01-00--00-8225
MOBILEHOME PARK INSP
SOLAR 01-00-00-8226
STRONG MOTION 80-92-33-0519
FIRE SPRINKLERS 01-00-00-8227
PUBLIC FACILl11ES FEE 32-00-00-8923 I"' j mme,c.ceca•,-,ssoc ~ 1 ;:: _ · m so~, '""'----+-------.
NEW CONST EA AMP/SWT,18KR ___ ~--___ COLLECTORS SCHOOL FEE -DISTRICT _____ ---I-
f--+--'-'"-----____ 3 PH _ __ _· _ STO~A_GE_T_A_NK_S
BRIDGE FEE --------·
Carlsbad 80-92-21-0519
.·-----------1
----------1
EXIST BLOG EA AMP/SWT/BKR I ROCK STORAGE
1 PH ____ JPH
REMOOEL.'AL TEA PER CIRCUIT
L--'-"'"T°'EMPPOLE 200 AMPS ---+ OVER 200 AMPS
___ __j_ TE~CJ:JP~N~~ {3~_YSJ
_ ____l -------
TOTAL ELECTRICAL
PUMP
PLAN CHECK FEE
-----------+-
1
1 w.tive CARE;u~ iexAMtffEontE 'OOMP~E:r'Ett"APPUCATION AND PER~ .. -ANO oo HEl;IEBY CEfltlFV UNOEA PENALTY OF PERJURY iTHAT ALL INFORMATION HEREON INCLUDING THE
DEqt.ARATlONS ARE TRUE ANDCORRECTANOA'J'URTHER GERTfFV ANOAGREEJF A PERMIT IS
ISSUEO: TO COM Pl Y WITH ALL C1TY, 90(JNTY A.ND ST ATE LAWS GOVERNING BUILDING CON-
STRUCTION, WHETHER SPECIFIED HE;BEttil OR NOT. I ALSO AGREE TO SAVE INDEMNIFY ANO
KEEP HA~LESS THE C1TY Of:.'.CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS ANO
EXPENSES WHICH MAY IN' ANY WAY ACCFIOE AGA.1NST SAID CITY IN CONSEQUENCE OF THE ,..,,.., .. ,,., .. ,,,, nee ,.UIC" DCIJIUIT
TOTAL SOLAR
Encinitas
Sanpiegu~
San Marcos
+------jf-----
80-92-22·(!,519
80-92-23-0519 ----
80-92-24-0519
--+--
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INSPECTION TYPE DATE INSPECTOR
BUILDING -
FOUNDATION
REINFORCED STEEL
MASONRY
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME
SHEATHING
FRAME
EXTERIOR LATH lNSULATION
INTERIOR LATH & DRYWALL
PLUMBING
SEWER AND BL/CO
PLUMBING UNDERGROUND
PLUMBING TOP OUT
TUB AND $HOWER PAN
GAS TEST
ELECTRICAL
TEMPORARY POWER
ELECTRIC UNDERGROUND
ROUGH ELECTRIC
ELECTRIC SERVICE
BONDING
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 ' /I
MECHANICAL "-.A rr
GAS ' /;,/6'1' I ,
BUILDING .""
SPECIAL CONDITIONS
CERT OF OCCUPANCY ISSUED
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS
INSPECTION REQ IF INSPECTORS
CHECKED APPROVAL
SOILS COMPLIANCE
PRIOR TO
F-OUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRESTRESSED
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
PILES CAISSONS
'
: ,
•
'
~ -. . .
DATE
•
.
-
~-
. 75).-03 ~
INSPECTOR"S NOTES
I• K.--,, //,1./,1'1"._S!,,l. /.JttuV SYA.1U /f /11.t.1.."t'.1i..e; .,-
A, • ·~ /!,J1a.-Le/~Au /,v,teAu. 4'Lt~-v."· -.AN --A7)~Al IS' STAAL#.
... -.VNJf~ /J ~ ~•~A Ail'lTt C I zg ..t//~_
• / L/f ~ ,I/If',,,,, -. ------,n. ----.... L-.,I
I ;u;u,...L#n»u----,,,,eAV .4r L ~
...... ,J.>. 1ec6AA 6/& ..f'~N,.,, ,,,ur,. ... ~ • ..h ---ll -
• -A . ,-I--,Ji) .Rt!~,CO Al' I(,)() ... f,.H~.IJ:'1•,. All,,-1f(.._
I
..... ..VN/,r _.-MH A4,1µ41,p ,4,v4? dlftTA,1~__#? ~,✓_,.) .,
A.~ • .,,,,.J_, r,,.• . ,,, ~.-.i~,.., ~Go.1!'4ttt:rlq.,,.,l.j --.. ---· ... ~ .....
--.. •' : --. 4'i-'"-~
----
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O I hfl affirm I licensed under
provisions of Ch~ ,mmenclng with
Section 7000) of Div,~ ., of the Business
and Professions Code, and my llcense Is In
full fOf'Ce and effect.
Lie No ____ Class
I hereby alfmTl th.it I am exempt from the Con• ~~ts~~~:::~; ~,~~.~~1~~'.~~i~
county which requires a permit to conslrvct alter. improve. demohsh, or repair any strvcture,
pnor to its issuance also requires the applicant for such permit to tole e s1gMCI slatement that he ,s
licensed p1Jrsuant to the prov1smns of the Con-
tractor"s License Law (Chapter 9 commencing with
Section 700) of Div1s1on 3 of ttle Busine,ss and Pro
fessions Code) or that 1s uemp1 therefrom and the
t,asis tor the iilleged exemption Any v1otat100 of
Sect101'1 7031 5 by an applicant for a perm,! subjects
tne applicant to a civil penalty of not more lhan five ~ ~dff!d dolla~ ($500) 9 I, as owner of_ the property, or my employfles 5 h wages as \heir sole compensat,on, will do the II . an-d the struC!ure 1s not intended or offered tor if sale (Sec 7044, Business and Profess1ohs Code w The Contractor's license Law does not apply to an
Z owner ol property who builds or improves thereon J: and who does such woril htmsel! or through his own
0 employees, provided that such improvements are
nol ,ntende1 or olfered !or sale. If, however, the
building or improvement 1s sold within one year of
completion, !he owner•builder will have the bul'Oen
ol proving that he d1~n(}I au,ld or improve for the purpose of w!e)
z 0 s z w .. 2 8
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if
Q I, as owner of
contractm; with llcelfsed ccintrai:tors to construct
~-r~~ac~~· L~~s~~:sea:n:;:~1i,5~op~:
to an owner of property who builds or improves
~~~~ii;~ ~~~nc~n~~~!~~~; ~~~h~,1!~\~i.~;~~.~
License Law)
0 I am eiemp1 ul'lde• sec
for !h1s reason
B & PC
□ I hereby affirm I hat I ha•e a cert,t,cate al consent
to self-insure, or a cert,t,cate of Workers Compensatmn Insurance, or a cert1f1ed copy thereof
!Sec 3800, Labor Code)
POLICY NO
COMPANY
D Copy ,s hltKI w11h the city
D Cert,1,ed copy ,s hereby turnished
CERTIFICATE. OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(Th,s sectoon need not be completed ,t the permit
,s tor one hundred dollars ($100) or less)
D I cert,!y 1ha1 ,n the pertormance ot the worl<. for wh,ch 1h,s perm11 ,s issued, I shall not employ any
person ,n any manner so as to become sub1ect 10
1he Worl<.ers· Compensa1,on Uws of Cai.forn,a
NOTICE TO APPLICANT If_ alter mak1n;i this Ceri,
1,cate 01 Exemp1•on. vou should become sub1ect t'J 1he Worllers · Compensat,oo provos,ons ol the Labor
Code. you mus! tor1hw,th comply ,,nth sue~ prov,s,ons or th,s perm11 shall be deemed revoked
O I hereby attorm that there ,s a construct,on
lend,ng agency lor the per1ormance of the worl<. for which 1h,s perm,1 ,s ,ssued (Sec 3097. c,v,1 Codel
Lenders Name, ___________ _
Lendefs Address __________ _
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TC' ,."ILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. ------------------------
QTY.
CARLF
1200 Elm, l
, -
PLUMBING PERMIT· ISSUE
EACH FIXTURE TRAP
EACH BUILDING SEWER
EACH WATER HEATER AND/OR VENT
EACH GAS SYSTEM 1 TO 4 OUTLETS
,UILDING DEPARTMENT
,, California 92008 (714) 438-5525
VO N 0
vO NO
REDEVELOPMENT
AREA
,□
MECHANICAL PERMIT· ISSUE
INSTALL FURN. DUCTS UP TO 100.000 BTU
OVER 100,000 BTU
V"'~ I BOILER/COMPRESSOR UP TO 3 HP
--" BOILER/COMPRESSOR 3-15 HP -----
EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE
EACH INSTA~ .. ALTER. REPAIR WATER PIPE ,-------..,-.-t-VENT FAN SINGLE DUCT
EACH VACUUM BREAKER
WATER SOFTNER
EACH ROOF DRAIN (INSIDE)
TOTAL PLUMBING
NEW CONST EA AMP:SWT-BKR
1 PH 3 PH
EXIST BLOG EA AMPISWT,'BKR
1 PH 3 PH
MECH EXHAUST -HOOOIOUCTS ---+-----------+-
C
OTY.
RELOCATION OF EA FURNACE/HEATER
TOT.C..L MECHANICAL
SOLAR· ISSUE
COLLECTORS
STORAGE TANKS
R6CK STORAGE
PUMP
AF-. .ICATION & PERMIT
VALUATION PERMIT NUMBER I ..so -u;"l,,,,/
i--v-O?
BLOG USE CODE
""3'~SQrr
: I:.,,·':'! I <"Jr=-·
FIRE SPR
vO NO Not Valid Unkss Machine <Artified
;,..::; ft,~·,:
SUMMARYIA§COYN;E,~M~
PLAN CHEC
TOTAL PLUMBING
ELECTRICAL
MECHANICAL
MOBILEHOME
MOBILEHOME PARK INSP
SOLAR
STRONG MOTION
/" I FIRE SPRINKLERS
PUBLIC FACILITIES FEE
BRIDGE FEE
SCHOOL FEE · DISTRICT
Carlsbad
Encinitas
San Oieguito
San Marcos
01-000·4220
01·000·4221
01 ·000·4B06
01 ·000-4222
01·000·4223
01 ·000-4224
01·000·4225
01-000-4226
65-640·0519
01·000·4227
25·000·4933
65·623·0519
65·624·0519
65-625·0519
REMOOEL:'ALTER PER CIRCUIT
TEMP PO LE 200 AMPS , f..--------= --· -----,' ..... --+--------!
OVER 200 AMPS
TEMP OCCUPANCY {30 DAYS)
TOTAL ELECTRICAL . ..re
' ~, 1,ttA VE ~JJLJ."Y
OEmlFY ~
lll;!ljARA11 ,'iS$Qen: to
~
11Nio THE ~tED,"~!CAttON AND PERMIT" AND oo t'JeRe,Elv
t 0P PERJURY T}-iAT ALL fNFO~TION H~EOM-,J@LUOJNG' THE'.
"-.~QCOfUlECtAND ! FtlRTHe!~ll'flFY ANO-AGRfl,1!'. APE.Rl,IIT.11,s ."'IJ, CIT'l; COlm!'Y J~O STP,TE LAWS GOVERNlN!>B01l.1'1NQ (1() ..
--·teO HEREIN Q~ NO'f. l ALSO A(.lREE TO $,AVE lNDEMN\fV "iND
C/181£BA0. JIGAI.NS'f .ALL LIABILITIES, JUOGM. EN. "'."' (;QSl1\ ~ IV WAY .""¢RUE ~AINST SAIO CITY IN COll~.ENCl ()~. ""'1:
'L'
APPRovrn \Y
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INSPECTION TYPE DATE INSPECTOR
l BUILDING '
ROUNDATION "-,._ .
REINFORCED STEEL "'-2-$°-f'2 1'1
MASONRY
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME
SHEATHING \,
FRAME :5~$2.. 1-f
EXTERIOR LATH lNSULATION .S";C)S'£) I
INTERIOR LATH & DRYWALL l.r..J~_o, 'f
PLUMBING I
-\, ! SEWER AND BL/CO /l
PLUMBING UNDERGROUND '\. ~-~-.rZ. 11"
PLUMBING TOP OUT 1.-;--s:sz.. If
TUB AND SHOWER PAN NO u,.r~ e, oln<'~
GAS TEST e:.r-s :z. ..p
' ELECTRICAL .
TEMPORARY POWER 7-<i'-f? -f'
ELECTRIC UNDERGROUND I
ROUGH ELECTRIC ,;-"-<:""-QJ 4'
ELECTRIC SERVICE I
' BONDING :,,
G. F. I. -SMOKE DETECTOR
MECHANICAL
DUCT & PLEM., REF. PIPING 1.r:--5-BZ r .:P
HEAT -AIR COND. -SOLAR SYSTEMS I
VENTILATING SYSTEMS
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAVE BEEN APPROVED.
JOB SITE FINAL
PLUMBING
ELECTRICAL
MECHANICAL
GAS
BUILDING
SPECIAL CONDITlr
CERT OF OC -'"AN'. JED
... .s,.;t ~o 3 . . '
. .
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES .. REQ IF INSPECTORS INSPECTION CHECKED APPROVAL DATE
--·-
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
.
STRUCTURAL CONCRETE
OVER 2000 PSI
PRES TRESSED .
CONCRETE -~ POST TENSIONED
CONCRETE ..
I FIELD WELDING :_
. ------HIGH STRENGTH
BOLTS .. ~·--·· -------· . .
I SPECIAL MASONRY
',
f----.-----··".
! PILES CAISSONS r . . ----
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ctcitp of <lrarlsbab.
REQUEST FOR INSPECTION RECORD
INSPECTOR ~ PERMIT NO.
OWNER . -
TIME: ~~~--,'~-
________ DATE: ffJ/1.3
7
ADDRESS c2 2 ~??.' ~
REQUESTED BY --~-=---,t,,<,,-~"'-=-------PHONE NO. --------~---=+---
PERSON TAKING REPORT m 7
BUILDING
□ FOUNDATION
I_J REINFORCING STEEL
D MASONRY
n GROUT -GUNITE
□ FLOOR AND CEILING SUB FRAME
□ SHEATHING □ ROOF n SHEAR
□ FRAME
□ EXTERIOR LATH
□ INSULATION
□ INTERIOR LATH OR DRYWALL
U FINAL
PLUMBING
lJ UNDERGROUND PLUMBING
□ SEWER AND PL/CO
LJ TOP OUT PLUMBING
□ TUB OR SHOWER PAN
□ GAS TEST
n WATER HEATER
□ SOLAR WATER
D FINAL
□ A.M. □ P.M.
D Tuesday
ELECTRICAL
□ TEMPORARY SERVICE
n UFFER GROUND
I~ ELECTRIC UNDERGROUND
□ ROUGH ELECTRIC □ POOL BONDING #""'1'~ □ ELECTRIC SERVICE ,_~Aeri
D FINAL ,._, -or
MISCELLANEOUS
□ CONDITIONED AIR SYSTEMS
□ SOLAR HEAT
□ PATIO
n POOL □ SPA
□ SIGN
n GRADING
□ DRIVEWAY
n FINAL
□ Wednesday □ Thursday D Friday
.. ·---------. -----------
<?~-06
r
ESGILCORPORATION
OB~() C'HJ<;MAPRAKR nn .. !o.l"JTR lllll
MAN l>JJ<;c,;o, ('A O~lllB
(Tl•O noo-t,f.Olol
h 'A-~ ... ~ A-vQ..,. J~, ~<., 19 82,.
I
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"C¼) ~ ~ : ~ $\-J--~ ~ k--.--\ii Le~"-½ ~ ~ ~--'J'V'-~~
io ..,..,,._.,._-"-"-<.~~ b~,,~ ~'""' -¥2J ·l-v -~ ~~, ~~u-.~ +1:i
~O .~ c,__, 5 ' R-1-, r-cJ4 'V: ~ .~ C\-<. ,....,. J,...,,,,, b
.21•,.u -~~~J,,/ ~~ ~ hj I, Q....,,_ 1 i • ~/"\--"v , J:.{c ~ 8-.,...,_,_
~~ /J (l,,1.9--t,1..., ~ .,, ' -~ ~ ~
c......._, 9 <~ ~-~ ee,...,...,..c...{,; ~"""'-1 J G, ,_ C. ".
-----•~ .. -·
Prepared by,
~
Jurisdiction '• : I' t '.: ,._, h L,
VALUATION AND PLAN CHECK FEE
/4dg, Dept,
tJ (.:-,~(,-ll.,..
PLAN CHECK NO, 81-· 03
BUILDING ADDRESS t . :
APPLICANT/CONTACT ✓, S f'11l1;;•1 (,),1c,, · ~ \ PHONE NO . _____ ...c.. __ _
BUILDING OCCUPANCY R • -~ DESIGNER PHONE ------TYPE OF CONSTRUCTION -~V_-~-u"-----CONTRACTOR PHONE ____ _
BUILDING PORTION BUILDING AREA VALUATION VALUE
MULTIPLIER
.' ' '/ . ' :,.. . -, 7 ~ i:: ;t·, .. -· llf2.2~~.-~ -' '
c.41'.<1<r ( '/ I. :f I // --; /,;; " . -
r• :" I ( c>~t:)Z "J ') ,9t>d pc,o, -
(;;, n)IJ~'""•1 :: n1c:·nn l
Air Conditionin.e-
Commercial
Residential
Fire Snrinklers
Total Value I, ., 2 ~
Building Permit Fee ------'•~.-S-.~0~•-•:~,_'--~_,· ______ _
Plan Check Fee
,r :(.,_.,tf.·-·-
COMMENTS , _____ __;f:....;.••c:;;.·· ~---'----'-· _•·--...:..'_, _....:.,2_Cf'--'/"-'._'_I._;; ______ _
~
Citp of Qtarl~bab 116 Jt,
,rf'r" el' ,~
JURISCICTI0:,' ,£..9,l2L.S BAD DATE S/3/C 114 !~
C.O $:Pc err;;:( P~'..J"E:': A:lDRE::i~1 La:_
TO, Ar P lw\!!::::A::NT
c::;
SHEET
□ Cl
'O
APi :.:-;.•-........ r·.-
C:7':' $>
PLA~i CHE::r=.: cc r·:·
SI~OC!..!: FA.~ILY AND QUPLEX DWELLINGS
Plan Check t,c. gz-c3 Stories~ Area(a)
Date 1'~31\S received by jurisdiction )61£7' \l'5ie, ty cs;, '
Date r:.a:-.s received ty ~'-~ 'l"-1e.1
Date ~~itial ;::an check conpleted 'SAT:· \\C\\~\ ty ~ ~c--a~C P_a: ,,.._ -----t"""
, ~ ) Plan check is li"i ted to E:"::
techr.ical require~ents contained in the Unifonn Building Code.
Uniter: Plu.:::.bir.g: Code. Uniform Mechanical Code. :,ational Elec-
<;rical Code a."',d state laws regulatin& energy conservation. nol■e
attenuation ar.d access tor the handicapped,The plan check la
based en regulat!ons enforced by the Building Inspection Depa.rt-
aent, You cay have other correctlona baaed on laws ar.d ordin-
ances enforced by the Planning Department, Engineerir.g ~epart-
ment or other departments.
The item■ circled below need clarification, aodification or
ch&nae• All circled items have to be ■atisfied before tn■
plan■ •111 be 1n conronnance with the cited code■ and regu-
lation■• Per s,c. )0) (c), 1979 Unirona 8ulldlng Cod,. tho
approval or the plan■ dot■ not pt:Blt th• violation of &11,7
■tai., cov.ntJ or c1tJ la■•
,. p .fl&§
Please mlie all correction■ on the original tracings and
submit two new ■eta of prints, and any original plan ■eta
that may have been returned to you by the Jurisdiction,
to , :::%ur,., . W<&'r a _ ~-e, w I e f? MYl Q --'' ~a esc,:;1 l,,, L '5Cd:; -1 ':\ le 'b) R> Q,. I'\: f Bi ' Yl ½§&A
Q To facilitate r-echecking. J:lease identi!:,·, r.ex! tc each
~ circled ite~. the sheet cf the :r:lans upcn w!".ic!":. eac!":
correctic:-. or:. this Sl",ee":: :-.as beer. made a:::!. ::--et".J?7: this
check shee-:: with the re·.-ised plans;,·---,,--, __ ~ lr.dicate o:-. plans the r.a.~e of tilye;~ o:-.e~
/ of person responsible ~or the prepara =-zt •~
See. J02{:)
d na.'lle
G') 5';.lb!o:i t f';.111:, di:ner.sior.ed ;lot plar. draW'!":. to scale ,? s!":cwir.g location size, ar.d use o~ al! existi~£ ar.!
p:·oposed st:--.1ctures or. the lo-::. Ider.ti:!':,· :r;::--::r;e::--t:
lir.es ar.d s~.ow let di:!!.er.sic:-.s ar.d all ease:"".ec.ts. ~
/ y.
lccatior. cf all cu-:: or fi!! slop_es a.'"ld _a rcx:.-a.te
!"i:-. .:.s:--. !'J.cc::--eleva'::::.or.s !"o::-all st::-uc't".Jres a::::. s:--.ow
eleva-::::.~:-.s a~ all lot cor:1ers. (Sec. JC2:t'._,,_
:ndica~e distance from ce~ter-line of stree~ er alley
to property line and dis-:.a.nce from curt to :r;::--cfert:,
line. {Sec. J02{b)i).
Plans, specifications and calculations shall te signed
by a California State licensed engineer or architect.
(California Business & Proteaaions Code)
!. FIRE PRO':'P:CTICN
~Walls closer than J teet to property lines stall be
-o~ hour fire rated construction. (Table 5-A' • fl il'alls closer than ) feet to property lines S!".all have
/-
r.o openings. (Table 5-A).
il'alls closer than) feet to property lines s!":all have
)O inch parapets when the building floor area exceeds
1,000 square feet per floor. y' Projections, including eaves, may not exten~ nore than
12 inches into the J foot setback from the property
/lino. (Soc. 1710 and Soc 504(b) ).
_.,,)16. Projections, including eave■ shall be one hour fir•
rui■tive construction, heavy timber or of non-combuatible
.. terial if they project into th• J" ••tback area froa
the property line, Section 1710.
/. Show location of emoke detector, Smoke detectors ahall
not be battery operated. in new eon■tniction.Pennanent
electrical power supply r~quired.(Sec. 1210).
C, ROOM SIZE:; LIGHT, VENTILATION AND GU.ZING
fi-one room must contain a minimum of 150 square feet of
_/ superficial floor area. (Sec. 120?(b)).
.,,/°· Habitable rooms, other than kitchens, shall contain at
/
least ?O square feet of floor area. (Sec. 120?(b)).
Window area ~ust be at least 1/10 o! the floor area and
a ~inimum of 10 square feet per Sec. 12C?(a). Appears
/
/.
to be deficient in _________________ _
Openable window area must be 1/20 of the floor area,
and a minioum of 1 1/2 square feet i~ t:at~rco~s. la-.mdry
rooms, and similar rooms. (See. 1205(a)).
Cne-half ot' all required window area :o-.'..1.st be oper!.able i:-.
/ Frovide ~echanical ventilation capat:le ::!f providing
five air changes per hour in ba"t~.roo=.s. water clos•1 t
compartnen-::.s. laundry rooms and sb.!.lar roo3s if
required windows are not provided. ( Sec. l205(a)).
/.
/
7·
No habitable room, other than a kitchen, shall he less
than ?'0" in any dimension, ( Sec. 1207(e)).
Show that ceiling height for habitable rooms is a
minimum or ?·-6•. ( Sec, 120? (a)l-
Show ceiling height :for laundry rooms, hallways, corri-
dors, and bathrooms ia a minimum of 1•-0•. ( Sec. 120?(a)). 7" Provide )o• clear width for water closet-compartments
_/and 24• clearance in :front of water closet. ( Sec.l?ll(b)).
,,,75• No cooking room shall be u■ed for aleepir.g purposes,
~eaa complying as an efficiency llvir.g unit. ( Sec.1208 ). 1'6• Specify safety glazing for glazing in l"'.at.ardous locations
such as glass doors, glazing adjacent to such doors and
glazing adjacent to walking surfaces. ( Sec. 5406).
/.sieepin~ !'"OO!!!S :,ust have a ·lfindow er ex-:er-:.or ::loor :·or
e!llergenc:, exit. ::::111 height shall ~o"t be over ~4"
above the floor with 5.7 sq. ft. ~inbum openable area
minimum, with net height o~ openir.g 24· and minimum
_,.~et width of opening 20". { Sec. l2C4).
;J"" Eaves and cornice• may not project into a required
yard aore than 2 inch•• for each toot or Yard width
ir rtqulrtd wirdowo open Into th• 1ard, ( Sec, 1206(d)),
-•
/ A ~•11anlne 1• an lntennediate floor and ~•Y nnt havp
a floor area exceeding)) 1/) percent of thP total
floor area in the room below, and thP mezzaninP florr
~uat have a clear height of? feet. abovp and bPlow,
and must have 65~ of the long aide open to thP rco-
/b•low.
.)""• Tt-.e loft you ahow doea not comply aa
and ia, by Building Code definition,
a mezzanine floor
a atorJ
D. ==.'tITS, STAIRWAYS, AND RAILINGS Y, ?loors above the second story shall have not less than
2 exi'ts. ( Sec. ))C2{a)). (4"J ~~q·~::~.: •:it d:orways shall 0be _not le~s tha?": )6" 7 -·· w_ ...... a:.d r.o .. less than 6 -8 in height. No door
:ea~ s~a. :1 exceed 4• in width. (Sec. ))O){e) a:-.~
f> r e
JJOJ(~! • (~ c,,,e e..rt~@,"3,'l<C.8':)
:=:-ovide )5" high protective railir:g for porches, balco-
~:..es, a:-.1 ope?": sides of landings. Maximum oper.ir.g
·:etwee:-:. railings is 9... (Sec. 1716}.
Stow~~• guardrail connection details are adequate to
s:;.ppor~ 20 po'.lnds per lineal foot at a right ar.gle to
-:!-.e top ra!.l. l ":'able 2)-B
Provide stairway and landing details. (Sec. J)05(b) & (c)).
a. lf..ax~um rise B" and ·minimum run is 9'"• Q Min~um. head room is 6•-6•.
c. Mini:num width is 30•.
P ✓." frovide r.ar.drails for all stairways with two or r· more risers. (Sec. ))05 {j)).
r/ Provide har.drails for stairways over JO" !'".ic~.
/" when ser·✓:.~.f"" a s:.ne-le dwellir.e-. (Title ?~,
3ec. T2'5-22(t:).
@ f-rivate stairways shall t:ave an 8" r.iaximur-. risP ,tr./ ar.d 9" l"'"!ir.i.,.:;.:--. r;.r.. (Sec. JJ05 (c)).
/. Handrail shall be )0'" to J4" above the nosin£T of
treads. (Sec. J)OS (j)).
(j)
e
Handrails projecting from a wall shall have a
space not less than 1;• between the wall and the
handrail. (Sec. JJ05(j)).
The hand J;rip portion of handrails shall be not less
than 1¼• nor more than 2 .. in cross-sectional
dimension, (Sec. ))05 (j)).
y. !'Very atalrway landln~ ehall have • dlmenalon, ••••ured
ln the direction of travel, at lea■t equal to thft
otairway width. (Sec. )JOS(g) J.
/. A door owinging over a landlng ■hall not reduce the
width or the landin, to l ■aa than 1/Z th■ required
width in any poaltion nor by more than? inchee when
fully open. (Soc. ))OS (g)J • _y.' Provide details of winding atair•Y•
/.
a. Minimum tread is 6 inchea at any point and minimuri
9 inchee at a point 12 inches from the aide of
the stairway.
b. ff.axim.UJ:1 rise is 9 inches.
c. Minimum width la )0 inches.
(Sec. ))05 (d)).
Provide spiral stairway details,
a. Minimum run is 7 1/2 inches at a point 12 inches
from where the trea1 is the narrowest.
b. Maxi.mum rise is 9 1/2 inches.
c. Minb~ headroom is 6 feet 6 inches.
(Sec. JJ05(f)).
/. Spiral stairways may not be used for re::;_'..lire:. ex::. ts
wher-. the area served is greater thar. 4CC sq. ~:.
/ Sec. JJ05(f)
/-6, Spiral stairways must have a clea:-walking space of 26
.. / inches between the column and handrail. (Sec. ))05(!)}.
//· In buildings over 2 stories in height, provide J/4
hour fire rated assembll-ea for all openir.gs i:-. the
exterior wall below or within 10 feet hori:or."tally ot an
exterior S'2.irway. An exit balcony with 2 separated
stairways is exempt. (Sec. JJ05(L)). ~✓ Exterior stairways shall not project ir.to the J !oot
/~etback from the property lines. {Sec. ))05(!".~).
.)IT• The walls and sottita of the enclosed useable space
under interior stairs shall be protected or. tr.e enclosed
side as required tor one hour fire-resistive cc~struc-
tion, (Sec. )J05(mJJ.
E. ROOFING
A Specify root pitch. 7-Root pitch la not adequate tor root type ■peci!ied.
~ Specify minimum. pitch of
\!3/ Specify root material and application,
/ Speclty JCBO approval nwnber tor roof 1HtPrhln not
covered in UBC.
/ Sp,.cify root elope for draina,e or df'Dl,:n to support
~ accumulated water. (Spc, )20?(a}).
Show roof drains and overflows. (Sec. J207(c)).
Provide skylight detaila to show compliance with S ectior,s
)401 or 5207 or(!.!i.vlde IC@ anproul m.imbe;:--)
/ Provide plastic roof panel details to show co:--.pliance
with section 5206 or provide ICBC apprc:val r.'.1.~ter-.
7-show attic ventilation. Minimum vent area is 1/150
of attic area or 1/)00 of attic area i! at least 50~
ot the required vent ia at least J feet above ceiling
joists. (Sec. J205(c) ).
H.
~ /JC
~
MASONRY
Provide fireplace constructior. details. (Se=• J7a7),
Show veneer support ar.d specify ver.ee:-cc:-:.:-:.ec~ic~s.
Sec, )CO2, 4, 5, 6 and Sec. 2516(a).
Provide veneer anchor ties fo!' ever--/ t"N~ s::pa:-e fee"";
of veneer and No. 9 horizo:-.tal :oi:-:.: re:..:-:.:::-::e:-.<?:-:.t
wire for all anchored ver.ee:-in seis=i: z::-:.es !!: a:-.!
n·. (UBC Standard )0-1), y Show height and constructior. details cf al! =asor.r--J
walls. (Chapter 24),
yNote tl".at cleanout openings shall be provided at the
bottom of all cells to be grout filled over 4• in a
single pour, Cleanout shall be sealed before grouting,
after inspection. (Sec. 2415). y." Provide engineering calculations for ::iaso~.ry wall design
and connections. (Sec. 2417,18,19,20).
/. Show floor and roof cor.nectior.s to ::iaso!".!'""J walls.
Connection shall resist 200 pound per foot or the ac~~al
design loads,whichever is greater. (Sec. 2)1C). 0 Provide oaterial apecificatior.s for oor·..ar, g:-o~t.
/ o'V" masonry and rein!orcir.g steel. (Sec. 2~CJ), Y, Show how masonry house walls ret:air.ir.g ea:-::-. are -:o ~e
-~terproofed.
/• ~ote that special inspection of the ~asc!".!"'J will be
required tor __________________ _
...
G. ~"ote on th• foundation plan that •Prlor to th• Contrac-
tor reque■tlng • Bulldlng D1partznent foundation
C1r■g1 require■ one-hour tlr• prot1ctlon on thP g■ragA ln■pectlon. the ■oll■ engineer ■hall advl■e the
■lJ1 ot wall■ and celllnp c0111mon to the dwelling, Building Ottlclal ln wrltln« that,
_ _/ (Tabla S-B, Sac. SO)(b)). 1. the building pad wa■ prepared in accordance wit~ y~• All ■lelllente aupportlng floor above garage to have the eoll■ report1
one-hour tlr■ re■l■tiv■ protection on th■ garage ■lde. 2, the utility trenches have been properly backfilled
(Sec. SO)). and compacted, and 1
/ Show l )/B• aolld core ■elt-closlng door for opening J. the foundation excavations. for.:iing a:-.j rei~force-
.-./ between garage and dwelling. (Sec. 50J(d)i, ment comply with the ao1ls report a:.= ar~rove.!
_,)J'J• Garages are not pendtted to open into a roe: used plar,. •
/ for sleeping purposes. (Sec. 1104). / frovide spread footir.gs for concentrate::! !..::a.!s :tesig.e.!
~• Cper.ings between car port and residence require sel!-for 1000 PSF soil bearing or ~er bearing val~e as
f closing doors and stationary windows. (Sec. l2lt...), determined by an engineer or architect. (Cr.apter 29).
• Show garage framing aection1 size ot header ove:-garage 2 • Show height ct all four.dation walls. {Cr.apter 2)).
opening, lateral cross bracing at plate line a:-.d methoQ #-Show height o! retained earth on all four.oa,1cr. walls •
o! bracing_prage !~n;. (Chapter 2))<:_'5>\;,;,.,~•~ ( -__,,.-<Chapter 2) ),
N::":'E, Minbum plywood diaphragm ratio is J 1/2 to 1 _;.zg. S!-.ow distance of foundation to ed~e o! ::..t ::-!"i!.l
;::::f'or 2"-4", (Table 24-I). slopes a:-.d show steepness ar.d he:g~.ts :!' ::..ts a:::
/ ~ fol~s. ,:hapter 29 ),
/~
~ote =~ plans that wco::S shall
g-:-a=e .. ~e=. 2417{c)-1.
te '5" ate·:"' !":.:-.:.:;~
G';:)Sho• tound■tlon 11111 to be pr•••ure treated, or ~ ■qual. (Soc. 2517 (c))), ~ Show foundation bolt ■lte, ■pacln~ and penetr■tlon.
/ C,ec, 2907(0)),
_.k".f... 5pec1!y ■lt•• ICBC number and manufacturer or power
driven pine. Show edge and end distances and spacing.
(:iec. )06(!)). Y, ~how •l~e, lmbedment and location of hold doW!"'l. n.~chora
on foundation plan. (Sec. 2Jl2(!),♦ ~ Note on pla.~ that hold dowr. ar.chors ::i~st be '::aj i:-:.
lace prio!' to foundatiori ir:.spectior.. (Sec. 2)121 !) '.
0how adequate footings under all shear walls. ,Seo.
2)ll(e)) • @ Show steppej footir:.gs for slopes steeper t~a.--:,1~ . r ~ 1Se::. 290",c)),
~/ Show !!lir.L~~ is· clearance fr:~ ~a~e to::.:~~=-=::~==~
/
7
" ;ois!s and minim~ 12" clearar:ee tc to-::::::. =~ g-:r~e:-s.
• ~Sec. 251").
/.;,· Show pier size, spacing ar.d depth i::!o '£"1:s~Jrte~
~
oil. 1 l'able 29-A)
!"'i.ow ::animum under floor access cf 13" x 2 ... ~. , :ec.
" ..
:::•~~:;.. :-::s ?::::;-.:IR:Y.E:i":'S
/. Note Cl". ~la:-.s that a soils englr:.eer shall eval·.iate
any -.manti:ipated uncompacted !ill or expa.~sive soil
? :,cte on plans that surface water w::.l ... :!:-a.:-. away ~r=~
t:.1!.ldir.g and ah ge ~ttern ar.d £ey elevatior. •
,Sec, 2905(!1.:_ '?es.,-\lve. ~ Co' f-01 \.u,~s.. \"'lf•~j
Y,~imension founch.:tidn ~•r Ti.bi-201.
~
,_,
. ow !"'.i:-:.i!!lu::i under floor ventilatio!"'. equa: ':::.: : :;~
sq. ft. !or each 25 lineal !ee! of exterior !°:.:·.,;.:-:1at!.ol".
with openings as close to cor:-iers as practicatle to
provide cross ventilation on at least two approx!=iately . _/or o!her
_;,A• Sub:!t a
englr.eer
soil problems disclosed durir.g cor.s::-.i:tion •
soil claasitication deter.!lir.ation ty a licensed
or architect baaed or. obser-✓ation, tests.
f>
r
torir:.gs, or excavations1 and eontai~ing co~::e~:s on the
~egree ot expansiveness, compressibility ar:.1 :eari?":.g
value, (Sec. 2905).
/Note on the plan the aoil claaaification. whether or
not the aoil 1B expansive.and note the allowatle
bearir-& value, or have the foundation confer:,, to
Table 29-A. (Sec. 2905).
The foundation plan doe■ not comply with the 1011
report recommendationa for thia project ______ T :z~A; m?Z~tZenl~
Provide note■ on the foundation plan listing the 1011
report recomaendatlona tor foundation■, ■lab and
bulldlng pad preparation.
Number
C! Stories
l
2
J
TABLE NO. 29-A -POUNDAT::CN FOR s:-.::; BEARD'<~
WALl.S MINIMUM R"EQU!!H)!~':'S
Thickness or Foundation Wall
( Inches)
unlt Concrete Masonry
6
8
10
6
8
10
Width
0!
Footing
( Inches)
12
15
18
Thickness
~!
Footing (Inches)
6 ,
8
~epth C!°
:°O'.Jr.datiO?":. Eelow
'ia t'.ira::..
:-..r!ace
: !° :;round
i..r.d Finish ';rade
( Inches)
12
18
24
opposite sides. (Sec, 2517).
:. FRAMl~G
·✓Show all jol!lts. rafters, bea.'!ls, and pests 2· '::o 7~· thick to be No. 2 Grade nouglas Flr-~arch or :etter.
All posts an:1bea.•ns 5· and thicker shall !:le No. l Grade
• ;~ouglas Fir-Larch or better. (':'able 25-A-l). 7~• :how wall bracing. Every exterior wood s-:-u.d wall ar:1
main cross partition shall be braced at each er.d a.r:d
at least every 25 feet of length with l x ... diagonal r:•t-in brace or equivalent. (Sec. 2518(g)5) :, •
ote cross bridging or blocking.Floor jo~sts ar.d rafter5
more tr.an 12• in depth and spanning ~ore than 8 feet
shall be supported laterally by bridging at intervals
not exceeding 8 f11t. (Sec. 2506(g)) ,
' '
~ Show blockln« at ende and at ■uiportR ~, f!o~r J,t•tn,
and for ratter■ at exterior wall ■• (SM, 2~0't,J >. r-Show ■olld blocking at rldg■ lln• and at exter!or
~J.·"~ Uy n•tl •h• and epac1r, tor •11 •hHr .. 11 ■. floor
and roof di•phr•,:zn•. Indicate required blocklr~.
g /' .
Maintain maximWII dlaphra,r;,n dimen■lon r•tlo■• (t•t••e
_ _/ I, J. K.). wall■ on tru.■■■d roor■• (Sec. 2506(g) J •
Show double jol■t■• Ploor jol■t■ ■hall be doubled
under bearing partltlona running parallel wlt~ th~
Jol■t■• (See. 2518(d)S).
Show rafter purlin braces to be not leaa tha:: ~s degrees
to the horizontal. CSec. 2518(h) ).
~
yL
yr. Show rafter tlea. Ratter ties ahall be spaced r.ot more
tr.a:-. i.t feet on center where ra:fters ar.:1 ceillr.l' ,10ists
__ / are not parallel. ( Sec. 2Sl8(h)). ye, Show 1/2· minimum clearance between top plate o!
interior partitions and bottom chord o! trusses.
l To:: e~sure loa~ing will be as designe::!, '.
:;
S~cw j~uble top plate with minimum
s.:. 2518(g)~
4E"' lap splice.
Stow ~ailing will be ln compliar.ce wi~t :a~!e 25-F,
f:-:v;.:!e fire stops between stories. :e:wee~ ::;:: s::~:
anj roof space. at ceilings ar.d floe:-:eve:s ;.~ ;.~terio:-
ar.j exterior walls, in mansard roof or eye:ro• sc r.o
cor.cealed or rurred space la greater thar. 1c• ~cri:on-
tally or vertically, between stair strir.gers at top and
bottom and between studs along and in line with stair
:nm adjoining stud walls and partlt!or.a, at perimeter
o! eliding door pockets, between chi::..~ey ar.d wood
)"'e• Show 3• X 4• or 2• X 6• etud■ 1n fir■t ■tory of thr■e
etory building. (See. 251B(f)). ~ Provide tru■a detaila and truaa calculations.
~Provide a root framing plan. ( Sec. )02(a)7,. 7'7· Provide framing aections through _________ _
____________________ _.·Se:. )02(a)?J. 7" Specify all header sizes for openir.g over .. • w:.:e-.
1e:.
fl
Sec. 2518(g)?.
Frovide calculatiofts for<:i>
S•e· )02(al;,;.___-G-v--~c& 1
'o]e~ In areas su'ojec • sp .:: ex!er:cr locatior.s,
wocd columr.s a.~d posts shall 'oe s-.i~t-:::---;e:: ::,' ;:::e:::-'.:"
pro:e=ting at least 2" above tr.e f:r.:.s~.e:: g:-:-a=.'°' a::-.-::
shall tear on a metal base plate er t:-eate=. w-:::=. Jc.!ess
t~e =c:.:J!"".r.s or posts are foundatio!". gra:e :-e=.w-:::= cr
eed.a:-. ,.Se:, 251.,\C) .. ,.
/ S:-:ow lo.:atior. of attic scuttle wit:-:.=:.:-:.-...;..~ s:.-:e ::M x
3c··. ,See. 3205). y-_ Show draft separation for attic areas ir: ex:ess cf
/ 3000 sq. rt. (See. 3205).
~. Show draft sei:aration for space betwee:-. :!r=;:;:e"! ceilir.gs
and !loor ln ezcess of 1000 sq. !t. ( Se=. 2~1-
J. "P'~HANJCAL
All heatln~, vent1l ■t1ng, and cooling ■yeteme and appll•nceR
■hall comply •1th th• Unl~onn Mechanical Code. (iiia:t Speclty BTU raUnc of the heating appliance.
~ Show the loea tlon and typo ot all hea t~&•i.n4d-e•"""~~
appliances or systems, --== ~-GAS;__.,; e> Every dwelling unit shall be provided wit~-heating
facilities capable of maintair.ing a roo::-: te:.-.perature
ot ?0° F. at) feet above ~he !loor !~ all ~.ahitable
rooms. $how basis tor complia:-.ce. ~S: Se:. 1211 ~ Show mini.!:iu:n )0" deep ur.obetr:aeted wcrkir.g space i?":.
~ront ot furnace.
~-Show furnace space minimu::i 12" •:::le:-!:0-:a.::. ! ..:::--:-.a:P c:-
~ _ _/per listing. C Se:. ?0~L"?C:.
ji>'5• Stew ::-:ini::':1.1:!: J" :lear wcr~:.;.? s;a:e a::-;:-:-~$:~~:,
ha:k a.-.1 top
~e:. -:-,.,<:
,.Y-• Far:-.ace shall
Se::. -: .. :."Y.:
o! !"...mace c::-:lea:=-a:-:i;,
:-.::! be i:-:s~a!:e::
:. : =-:: :-.~.
::.:.· :-:.a:,· ... :?":
Y, F\.ir:-.aee shall :-.ct he i:-:s"tal:e:: ::-. a.-.::·:.,:!,::-, ~a~:---·::-.
close!, or in confined si::ace 11:!:: a::es: :-.::: !~..!"o-....:~
such rooo, unless specified as :::::-e:-: ·1e:-;--; a;:pl::.a:-:c,;,,
enclosed furnace or electric hea~::-:f a;;::.a::::e. __.sec. iCl.t,,,.;::
r
frame using meu1·0r incombustibles tor the tire atop
and at other places that could afford ~assage o! flee.
See. 25l?(f)
Show studs. !none or two story buildings. s~~ds fer
exterior walls and interior bearing walls s!':a:::.
7"_ Speci!"y plywood grade and panel ider.ti!i::a!:.::-. i:-:t!ex.
_ L ( Table 25-J). r-• When· roof pitch is less than J112, desi~. r:.!ge as a
/-vertical load earcyir.g me:nber. ( S•c· 25:: •
,,)/'€· Atti: !-.irnace installed in a s;ace :.ess !~a:: 5• hig~ s~.a!:.
be listed for such ir.stallat1or .• ~e:. -,::;::~:;. <® ~
Show IC:S0 approval for prefab !'i:-e;:lace a.--~ ;:ro·1ide
approvej installation lnst~.oc!ioc.s.
Shew aecess to the attic f'.:...~.a:e !:: :e :a::-ge e;.~:.:g: .. :..
the largest piece of f•.:r.-.ace a:.:! i:-. :-.: case !ess
JO !..nches by )O inches,: Sec, ':3::!':,.
,r
,y·
be not less than 2 x 4 at 16· o.c. S4:uds !cr
nonbearing partitiona may be 2 x) at 16 o.c.
2• to 4• thick and 2• to 4• wide ar.d ~ot =ere
:~-:ericr
S't'.ods
!r.a:-. :
feet long sr.all be •stud grade· Douglas Fir-:.arc~ or
better when supporting not more than one floor ar:.d a
roof. ( See. 2518(g) ).
Note an A.I.T.C. Certificate of Compliance for glued
laminated woc:dmembers ahall be given to the !uilding
Inspector prior to erection. ( See. )06( r) l •
Detail all poat to beam and post to footing connections.
s,e. 25l?(c)4
:✓. 7·
~
~ ~
ftood shear walls sr.all not be use-:! !:: !'"es:.s-: !".:riio:-.ta!
fo:-ces contrH:uted 't:y ~ascr.ry ir. ~-..i!!i:-.gs :·.·e:-::!"P
story in height, (Sec. 2516(b)~.
~ypsu:: lath and plaster, gypsum shea-:~:r:g ~ca:-"! c-.d gyJ)s·:
wallboard shall not be used in vert:ca:. ::.:.a;::-:-a~s to
resist forces imposed by masonry :r :cc.::-e:e
':"able L,?-I.
:-:::-.str-.1ctic:-:.
If cripple wall atuda are leas than 1~•. !ra:i.ing shall
be solid blocking. (See. 25l8(g)6).
Cripple wall atuda exceeding 4 feet in height
) inch by 4 inch or 2 inehea by 6 inches when
2 atori••• (Soc. 25l8(g)6),
ahall be
aupporting
Show plywood aheathll\l OTer expo■ed e&Te■, or other
weather 01po1o4 U'IU, 11 11t1rior crd•• (Soc. 2517(1))).
pass
tha::. ~ Note tnat passageway to the attic !':;.."";.ace s:-.a!l t:e
unobstr.1eted and have eontir.-..o·Js sc:.:..-: !::::::-:.:-.g r:ct
..,,/ less tr.an 24 inches wide, (Sec. 1-:e·.~:;. r~• Show a per::ianent electrical o•.1tle! a:-.d ::.:.g:-.:::-:g fix:-.J:-e
controlled by a switch for tr.eat!~: !-:..r:-.a:e, 3ec,
?08UMC r-Show detaila to comply with Section 709 !er furnace
?
under the floor, Section ?08 tor attic fur:-.ace, or
Section ?10 for root or outside tur.-.ace.
Note on plan, gaa vent■ and non-coe~ustiblt piping
paaaing through three floor■ or le■s shall be ,rt,ctively
draft ■Upped at each floor or ceilJ.nc. lu.1.c.soe •
l?06(a)6).
• •
K. ELECTPICAL ("ATIO"AL EL£CTRICAL COD?)
~
•lrln& ■hall comply with the National Electrical Code.
~Note on the plan the amperage ot electrical ■ervier. r~• It the electrical inatallatlon le more than 20C acperea.
■ho• panel location and provide a ■lngle line dlagrL~
ar . .1 load calculations including,
•· Wlrir.g method employed.
t. Sizes ot all conductors, switches. circuit treakers,
!uses, and conduits.
c. A~proximate length ot service and reeders.
••
F:-ovide plot plan showing services, all r,a:-.e:
l~eat10~s. circuit arrange:e~t and load distribu-
tic~ en panel busses.
F:-~vide typical panel sche~~le(s).
:-we:: :'."".~s a!".::i condo!'tiniuas requ:.:-e 100 a~p se:-•.ri:e.
S!".:w :.=cation o! all electrical receptacles.
,~.;:.:. A!'t. 2!0•25(b)),
oeatior.s and/er spaci~g is ~o~
a a; ·°' e i,: , !<-t ::l:c:::!D 0v'--\,;""\;!½ Ju\ , <;, • 02. OS.. S ,:n ¥--z ee. i:, G:: y., A~ :east or.e receptacle shall 'be instalied o"..lt:1ccrs, in base-
-~~ta &::.d attached garages other ~ha.~ law-:.~ry outlets.(See 22~).
_,J,,2'?• ~~o• :!n!.=1..:1 dwelling lighting \N.E.C. Art.210-26(a) and
~ ~!!"s !r. garage, baths and outdoors.(~.E.C. Art.210-S(a}),
228J Sr.ow kitchen electrical receptacles are located 1~
co:plia:-.ce with code. (N.E.C. Art. 210-2.S(b)).
L. r:.: . .-~s=~~ (U'NIPOR.~ P!.UMBI~G CODE)
All plui::ti~g shall comply with the Uniform Plumbir.g Code,
y.'Provide adequate barrier to protect water h•at•r trOIJI
vehicle damage. (Sec. 1)10). § Show T and P valve on •t•r h•ater ar.d ■how route or
dhcharge line. (See. 100? {e)). e Note on plane that a water presa~re rerjlater 1s req~1re1
~ if serving pressure le over 80 p.s.i, ::;ec, 1CC7).
Provide dryer vent to outside. t:.~ecr •• :~de, .-:iec. 1q~J,
Note on the plan that hose bibts a:-.1 la-.. s.-r::.r.kle~
syster.:.s sr.all have approveoj bacit!::w r;r .. ver.--_: --
devl.ces. ( Sec. 100),.
"'. NCISE INSUIATION (DUPLEXES)
/."' Show details of duplex comm.en \pa:--::,·) walls ~-= !lo::-/
ceillr.g asse:nblies to achieve a So~.:1 -:'rar.s=issior.
Class (STC) rating in walls o! !: :1ecibels a:-.: a:-.
~ Extra window area tor ■outh-!aeing walls la permitted
it ju■titied by a pu ■iv• ■olar credit a.naly■1a.
yo-1•0J.
~ In cooled bulldlnp. provide tinted gladr.g !or
glazing areas ln exeesa or 16~ or the floor area.
~he glazing area on walls oriente:1 •ithin 22 1/2
degrees or North need not be 1r.cluded in tr.e total
calculated glaied area. (~T20-1L.OJ). _r-Frovide energy analysis to ehow that the bor:.et ea;;a:it-.,.-
of the gas central f~rnace does r.ot
design heat loss by more than JC<,
excee1 t!':e buil:!ir.g
( Exceptio:-:.s,
c! 5c 1eeibela.(Title 25}. 2"." •
!~pact Insulation Class (ITC) rati~g or. !loor/eeilir.g f
/ S!'low !'.ow per.etratio:-.s o! asse:-::::es !":::-;::r::-. .;-, ele:~ical
:1evices, recessed cabinets, :at~~~:s, s::!"!":t3, c:-
48,000 BT'J/P.r. o"Jtput furnace. See also Ca!ifo:c.ia
Seas or.al E!f!ciency Adjusbe:-:.t.) ( :-2 ... -14:;.,.;,
~ote or. pla..,_ that all tra:-.sve?"se ::.Jets, ple~:.:..-.s, a~.:!
!ittir.g ;oints o! H"-IAC syste= s!".al: te sea.le:. wit~.
pressure sensitive tape or mastic <:.:::. ~:-ever.t ai:-::ss.
:2c-11.oc ... :-:eati!"'.g, ve!":.tilating, or ex!"'.a:;.s'"; :.·.;:--;::; ~~.a:: :e aea:e=,
:.:..=:e:i, ::r :.:-.sulate1 to nair.ta::.~. ~e:r.-.:~e:. sc·..:.:::. trar.s-
--~:ss::.::-. ratings. , ':i tle 2;,.
'},'!Z• ?:-:>vi:ie ir.sulatior. in walls ar.:. :e::..:~ . ..: t:: a:~.:eve
... s:: c!" 50 between garage and li·.-:~g area :!" ..a=-age ..;.se
is r.ot controlled by the resider.t., ::.. t:e ,5
s. ~~~y CONSERVATION
?-All additions to existing resider.tial ~uildi.::gs ~ust
comply with Title 2~ energy re~..;.!..atior.s. Additior.a
exceeding )Oi of the existing t~:.:1:.r.g requires t~e
existing and ad~ition to have?-:; :ei:i=:g :.r.sulati:r.
!"::?" ir.s'..i.:a-
(,2) ~ r ~ote or. pla."'l that ir.sulatio~ ::!"
·."'V: Section 1co5. (-:20-lL4-Q .. ,.
.:!:..cts s~.a!! .:::r.!":::-!:-
~;ote er. pla."'l th.at all doors a~.:! wir.:!o·.tS ~o --;:-:e exte:-ic:-
er to -..;..-i.conditioned areas sl-.a!l ::e !"·.;,Uy wea!!"'e:-
striped pPr "ANSI Standard. (':'20-1:.+C),. ~ Note on plan that back draft :!ar.ipers a:e requi:-e1 O!":
all !ar. systems exhausting air !roo the bu!ldi:-:.~.
~20-140).
•~cal resistance apace heatir.g st-.all r.ot !Je used
o! heating/coolir.g is S"..1pplie1 >;y a :"":.cr.depletat::<:>
~ Pilots, 'burners, heating elemen:ts and swi tct-.es o! -water l=At.J ~ -neat era shall be 10• above garage floor. ( Sec. 1)10). (\)()l9"-@
?/how water heater type and location on plans •
,J!Yf• Stow ~ethod ot providing combustion air to tuel burning
.. /water heater. ( Sec. l)O?).
i! the existing ceiling area is a::essitle
tier. 1nstallation.(T20-1*01(c,1. r 3pec1!y the insulation R values !er walls, roof,~~
ceiling. (R-11 tor -.lls; R-19 !:::-:eilir.gs, or
provide details and analysis fe:-ar: alternate desig:-:.)
__ /IT20-140),Tablo A and (2)(B)).
supplements a heat pump syste~.
c. less than 10~ or total heating syste::t,
d., li!e cycle cost analysis justifies. ,:2c-1 ... c1.o: •
~ Note on plan that all heating ar.d cooling equipment
efficiencies shall conform to Title 20-~hapter 2, r• Show water heater clearance trom combustible wall.
~
ec. 1)08
2 • Fuel combuation water heater ■hall not be installed in
bath or bedrooa or in clo■et opening into bath or
bedroom. (Soc, 1)09),
__,YJ• Specify the gross floor area o! ~eated portior.s or t~e
dwelling, and the area or glaze~ o;enings on the plan.
(T20•l40)). r) Provide an analyal■ ju1tifying !:':~teasing the single
glazed area beyond 16~ of the c-:ss floor area. S~o•
method to reduc• heat lo■■ to t?·.at which
with ba■io cla&ing, (T20-1402, de!. l
would occur
? Suber.apter 4, Article 4 (75~ for forced air !"urnaces},
Note on plan that no r.atural gas, central heating plant
may be installed without an Inter.nittent Ignition
,/Device, ( T20•1•05).
.,,,}!!b• Note on plan that th• hot •ter pipe recirculating ayatems
in attic,. garage, or unheated ■pace■ ■hall be insulated
to provide uziaum loea ot 50 B1V/hr per linear toot,
T20-l406,
• •
/. Eloctrlo roolotanco .. tor hNtlnc lo not pon,lttod ~nlooo
••rlfled a■ co■t effectl•• by a llf• cycle co■t analy■l■,
~
20-1406,
Outdoor pool ■ with fo■■ll tuwl heater■ r•q~lr■ pool
cover■ a■ wall•• other ■n■ra ■avlns devlc■■ ■uch ••
tlaa clock■, ate, (T2O-1406),
O. )IIIJSC£LLANEOUS
Ao• minimum 2" wide air apace and flashing between
"--~anter and building wall■, (Sec, 2Sl?(c)J. r• __:~ow a weep acreed at the foundation plate line on all
~
xterlor atud walls to be stuccoed■ (Sec. 4?0C(e)j.
hower stall shall be mlnlmu::1 width 30• with a minimu=:
~100r area ot 900 aq. in. (U.P.C. 909(4)). @. Specify material to be used w,,der the Bl",ower tile.(Sec. 1?0?(a}).
~Speei!y lath and plaster to comply with Chapter 47, UBC.
,;c:• Frovlde an approved waterproof buildlng paper under woo~
~ r
siding. (Sec. 1?07(a)~.
Specify a.~ approved !lashing tor ex~erior openings and
;a~apet walls.(Sec. 3208).
'Iwc J/..-" c:::pper pipes !"'.'..1st be installed :·rc-
wace:c l".ea-:e!"" locatior. to cor,ver.ier.t locatio:-.
!ut·-1re solar panels (City Crd. 809)).
~
/.
·?
frvvide sleeves (roof jacks) i~ roof for twc
future J/~" copper pipes to convenient locaticn
o~ f~ture solar panels {City Ord. 8093).
Note that solar water p1p1ng is to be insulatej
ir. areas t!'i.at are not heated or cooled.
(C'. -:-; Crd. 809)).
A Class C roof covering, complying with U.B.c.
S"ta:-.dard 32-7. is required on all of the
si:-.ele fa~ily or duplex dwellings that are r.c--:
~.ore t!'i.B!". two stories, are not more than 6,oco
sq'..lare feet i~ area and have at least ten feet
of =.isc.a.r.ce from the roof extrer.ii ty to all c:
t!",e property lines except property lines that
arEc adjace:-.t to public ways (City Ord.),
A fire retardant roof, complyin~ with Chapter J2
cf the 19?9 U,B,C,, is required unless all
three of the elements in Jll have not been
satisfied (City Ord,),
tr you have any queetlon■ •~~•rdlng thl■ plan chec~. pl••••
coll ,;;;:r NY) ot 1714) S60-1~6a, Wo
would alao be pl ■■aed to Meet •1th you, at no char«■, tr
addltlonal •••••tance lr. needed.
ADDITIONAL REMARKS
t,.. ~
~
~ C
(:T
INTERDEPARTMENTAL INFORMATION SHEET
•
BUILDING DEPARTMENT
BUILDING ADDRESS:
?1 ~if "'.EG&IVED -t9 '} t''"/1 -L /6 ,I ---
7 ..-oL~a:-i.---JAN 6 5 1982
PLANNING DEPARTMENT
CITY Of1 CARLSBAD Bulldiii& D1part111e1 ■t
•ZONE R-( fl:fO O LOT s I ZE,_~,w~~A.{+,lli,u ___ LOT WI DTH _ _.g.,__3""---')'~{,_'fL-L..:/ oe..._
UNITS ALLOWED ___ ____.,. _______ UNITS PROVIDED . -~----------
PARKING SPACES REQUIRED A PROVIDED ___________ _
% COVERAGE ALLOWED _____ Lf+~~~~7'()_· _____ PROVIDED _________ _
BUILDING HEIGHT ALLOWED 1;2 PROVIDED
FRONT SETBACK: SIDE SETBACK: REAR SETBACK:
ENVIRONMENTAL PROTECTION REQ:
,ADDITIONAL COMMENTS:
• OK TO ISSUE:
ENGINEERING DEPARTMENT ) y\)-
R. O. W . _____ INDUSTRIAL WASTE ______ IMPROVEMENTS _____ ~~~'\-
SEWER CONNECTION _______ DRIVEWAY LOCATIONS ___________ ~~VAJ
GRADING PERMIT ______ _
LEGAL DESCRIPTION_~~~!=§~~-----<~77':......!!~~~~::!:::::.__.~::;------:-----:---
ADDITIONAL C
FIRE DEPARTMENT
SPRINKLING SYSTEM ___________ FIRE PROTECTION EQUIP. ______ _
FIRE ALARMS EXITS ______________ _
FIRE HYDRANTS LOCATION ________________ _
ADDITIONAL COMMENTS ___________________________ _
' OK TO ISSUE: _____ DATE, _______ OK TO FINAL, ______ DATE. ____ _
..
WATER DEPARTMENT
REQUIREMENTS OF APPROPRIATE DISTRICTS MET ________ DATE. _______ _
..
•
LEUCADIA COUNTY WATER DISTRICT
APPLICATION FOR SEWER SFRVICE
Owner 's Name __ R.,.a,_,y'-"'Dccl ,uve""rk"'-------------
Mailing Address _ p a .8.ruL.5.14...
Phone Nn. lli.:-Jlll."------
753-5073
SEWER PERMIT ISSUED U?ON
ice Address:
Foci a i ta s , .f.A~9:u2:..cDu.2..'t4 ______ _
RECEIPT 01' BUILDING PcRM:T. _____ ___,_.a,._L.o.5.taberu..ie_,___
•·t D · t · BUILDING PEfH-AIT ~AUST OE ~ ., ... -.; escrip ion: Jot 35D, So11th #5 -· _
Assessor's Paree l No. 2] 6-28D-2] APPLIED FOR BY -ii!@ 1
Type of Building-----''-'------No. Units_...__ Connection Fee
Lateral Size: 4" 6" 8" Saddle Easement Connection(pre-pd
Extra Footage: __ @ $ Extra Depth: ___ @ $ __ _
Lateral Fee
Prorated Sewer
Service Fee
$ 500 aa
200.00)
.1..\ :co -Q'.)
Amount Rec'd $J_\CX).m
Ck. No/Cash ~ QQ\ nl.P
Date ~-C\ Rec'd Byi) Total ~cCCJCO
The application must be signed by the owner (or his duthorized representative) of
the property to be served. The total charges must be paid to the District at the
time the application is submitted.
If a service lateral is required, it will be installed by the Leucadia County Water
District. The service lateral is that part of the sewer system that extends from
the main collection line in the street (or easement) to the point in the street (at
or near the applicant's property line) where the service lateral is connected to
the applicant's building sewer. The applicant is responsible for the construction,
at the applicant's expense, of the sewer pipeline (building sewer) from the appli-
cant's plumbing to the point in the street (er easement) where a connection is made
to the service lateral.
The connection of the applicant's building sewer to the service lateral shall be
made by the applicant at his expense. The connection must be made in conformity
with the District's specifications, rules and regulations; and IT MUST BE INSPECTED
AND APPROVED BY THE DISTRICT BEFORE THE SEWER SYSTEM MAY BE USED BY THE APPLICANT.
THE APPLICANT, OR HIS AUTHORIZED REPRESENTATIVE, MUST NOTIFY THE DISTRICT AT THE
TIME INSPECTION IS DESIRED .. ANY CONNECTION MADE TO THE SERVICE LATERAL OR COLLEC-
TION LINE WITHOUT PRIOR APPROVAL AND INSPECTION BY THE DISTRICT WILL BE CONSIDERED
INVALID AND WILL NOT BE ACKNOWLEDGED.
The prorated sewer service fee is based upon the date the District estimates that
service will begin and covers the balance of the fiscal year. There will be no
additional fee or refund if service actually co111Tiences on a different date. For
succeeding fiscal years, the sewer service fee will be collected on the tax roll
in the same manner as property taxes.
The undersigned hereby agrees that the above information given is correct and agrees
to the conditions as stated.
\ ()(.o-lB
Date Account No.
1200 ELM AVENUE
CARLSBAD, CALIFORNIA 92008
Dear Property o..mer:
Qtitp of Qtad~&ab
TELEPHONE:
714-438-5525
An application for a building ,:ermit has been sul:mitted in your name listing yourself
' '
as the builder of the propert:'.f. foprovements specified. i:'or your protection you should be
aware that as "owner-builder" you are the responsible party of re=ord on such a permit.
Building permits are not :cequired to be signed by the property owners unless they are
personally perfo:anin.g their own ;.ork. If your v.0rk is being performed by saneone other
than yourself, yo1.~ may protect yourself from possible liability if that person applies for
the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and
to have a business license from the City of Carlsbad. They are also required by law to
put their license number on all permits for which they apply.
If you plan to do your own ;.ork, with the exception of various trades that you plan to
subcontract, you should be aware of the following infonration for your benefit and pro-
tection. If you errploy or otherwise engage any persons other than your imnediate family,
and the ;.ork (including material and other costs) is $200 or rrcre for the entire project,
and such persons are not licensed as contractors or subcontractors, then you may be an em-
ployer. If you are an errployer, you must register with the state and federal governrrent
as an errployer and you are subject to several obligations including state and federal
incane withholding, federal social security taxes, ;.orkers' corrpensation insurance, dis-
ability insurance costs, and unerrployrnent contributions. There may be financial risks
for you if you do not carry out these obligations, and these risks are especially serious
with respect to ;.orkers' canpensation insurance.
For specific info:anation about your obligations under federal law, contact the Internal
Revenue Service (and, if you wish, the U. S. Snail Business .lldministration). Fbr more
specific information about your obligations under state law, contact the Department of
Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are oot licensed contractors
are allowed to perform their ;.ork personally or through their own errployees, without
a licensed contractor or subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an
"owner-builder" building permit, erroneously implying that the property owner is providing
his or her own labor and material personally. Building permits are not required to be
signed by property owners unless they are perfonning their own ;.ork personally. Info:ana-
tion about licensed contractors may be obtained by contacting the Contractors State
License Eoard in your corrmunity or at 1020 N Street, Sacramento, CA. 95814.
PLEASE CTM>IEI'E AND RETURN THE ENCLOSED OWNER-BUILDER VERIFICATION FORM SO THAT WE CAN
CONFIRM THAT YOU ARE AWARE OF THESE MATI'ERS. THE BUIIDING PERMIT WILL NaI' BE ISSUED
UNTIL THE VERIFICATION IS RETURNED.
Very truly yours,
Building Department
City of Carlsbad
ATTENTION POOPERrY OWNER:
' ' '
An "o;ir=-builder" building permit has been applied for in your name and bearing your
signature.
Please ccmplete 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.
1.
2.
3.
I personally plan to provide the major lab:>r and ma~~for construction of
the proposed property improvement (yes or no) ~ :
I (have/have not) ~ signed the application or a wilding permit.
I have contracted Gf th the following person (fitm) to provide the proposed construction.
Name Phone --------------------------
Address Con tractors License No. ----------------
City -------------
4. I plan to provide portions of the v.Urk, but I have hired the following person to
ccordinate, supervise and provide the major v.Urk.
Name -------------Phone -------------Address -----------Con tractors License No. -----
City -------------
5. I will provide some of the v.Urk but I have contracted (hired) the following persons
to provide the v.Urk indicated:
Name Address Phone
Signed: Property Owner · ~ ~ ~ 4('.'.'.'
Social Security Number 5'""2-<Z -?~ -~ 5'7 ?
Date: c2:2 ~ ~
Type of Work