HomeMy WebLinkAbout2813 JACARANDA AVE; ; 81-253; 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 full force and ef-
fect.
OWNER·BUILDER DECLARATION
01 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-
plicant for a permit subjects the applicant to a
civil penalty of not more than five hundred dollars
($500).
r:_· l, 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 tor 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 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).
:.:.1, 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. & PC
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 certified copy
thereof (Sec. 38 ab r o / _
PO~!~:~. k2_____~-
CO~T-~
opy is filed w t i y.
~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 'li:Jrkers' Compensation laws of California.
NOTh.1E TO APPLICANT: If, after making this Cer-
tificate of Exemption, you should become subject
to the Workers' Compensation provisions ol the
Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked
CONSTRUCTION LENDING AGENCY
CITY OF CARLSBAD-BUILDING DEPARTMENT
USE BALL POINT PEN ONLY APPLICATION & PERMIT
1200 ELM AVENUE (714) 438-5525
APPLICANT TO FILL IN INFOR -
MATION WITHIN RED LINES.
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ow,~1~1~0 A\' s) 'l.Y/1YYYA . -✓ ~T\"1'i::t\°ffim m~c\ ;~_;;1?:1
I '1~1j BLOCK ~ 1?1V_t-i,_l!)N f".tl'\ ~wf~~EJ,SO?~RCEL\NOd A _. A / DESIG ER (_ ___,,/ _ STATE LICENSE •
1£1-111 T-1:'. rY-YV'I l::(A~·1,ff)1"1 ,"1,rJ, ,/~VI -1\lf\,~,IV\~Jl .. ;,-,,J/ -,-"'•10 ,
DEs"CRIPTl~ ..... w.f'p... _,, --~ ,, I \\r l/Til l.,A l fl .LJ \.:::) -lA i w · 1 ·-· 1 .', -l . -~,,: . ~
'J--'1YFJV!rf1f) (lAJA ?:,":Z.,1./l DESIGNER'SADdRESS t DESl,rnc.R'SPHONE ' -., ;~
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CENSUS TRACT GP LAND USE ZONING I RES. UNITS I PAR~ SPACE NUMB.ER OF STORIES
Not Valid Unless Machine Cartified
"" so. n. "'° "" occ. " I STASOASO "'" • I "'"f (,,,..., 7 1 I"" cossT I occ. cOAO I
(!TY. PLUMBING PERMIT AMT. QTY. MECHANICAL PEJMIT AMT.
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100,000 BTU
EACH BUILDING SEWER . / OVER 100,000 BTU
I EACH WATER HEATER AND/OR VENT /', BOILER/COMPRESSOR UPTO 3 HP
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP
EACH GAS SYSTEM 5 OR MORE y. BOILER/COMPRESSOR 16-30 HP
EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT t j jJ -tt-' , _ /. / / ~
EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS I/~ / l,,/ (_) /) --J c.·.----4
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT ! , ...t-. --! Y ./
., -~ ,. .. c::, Ch) ,. -,. , '"' 0-0 SIGN PERMIT ;] --I I I l
TOTAL PLUMBING 1 TOTAL MECHANICAL PLAN CHECK,1);,:/ t /5 :JU I I I I
CONTRACTOR CONTRACTOR ALLINCLUSWE PERMIT I I I
TOTAL PLUMBING I I /-.1--i--QTY ELECTRICAL PERMIT AMT. QTY MOBILE HOME PERMIT AMT. ELECT ,,_; . -. RICAL I I /· I
NEW CONSTEA AMPISWT/BKR -') / AWNING MECHANICAL I V . 1
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 .25 3PH RAMADA.CABANA -1 -.,1"'>l..,,,i., .L • n J I I I • I
REMODEL/ALTER PER CIRCUIT FENCE OVER 6' /"/ I I I . I
TEMPPDLE 200AMPS TOTALMOBILEHDME MICO-FILM I I I . I
OVER 200 AMPS I I I I
TEMP OCCUPANCY 130 DAYSI I I I 1
., __ .,.~ ..... I JI I
TOTALELECTRICAL /7 o,--U -TOTALFEESPAYABLE I '7 c7 ~
CONTRACTOR ( • I I :11 I/, ) (
/~~ -/
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION ANO PERMIT. AND DO "AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER~ T ~
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5'-0"' DEEP AND DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUEO;TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT
COUNTY AND ST ATE LAWS GOVERNING BUILDING CONST AUCTION, WHETHER
SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM
~~!!~~is c~:~c
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OF THE GRANTING OF THIS PERMIT APPLICANT'S SIGNATURE·... ,/ / ,_ OWNERn CONTAAC:Tni::in IAPPAnvi=n RY n.o.Ti=-
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SITE Sl: I ~ ,;i.$ 3
ADDRESS: OWNER: ' PERMIT NO:
FIELD INSPECTION RECORD
INSPECTION INSPECTOR '' INSPECTOR'S NOTES DATE
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
Fi REPLACE
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
FINAL !NSP BY BLDG DEPT
OTHER DEPT'S REQ COMPLETED I \ ' ELEC METER-PERM-TEMP •1.~P\\\ AL~"'
I
GAS METER-PERM-TEMP \ .
1----------~--
r~-~RT OF OCCUPANCY ISSUED
I I
------------------' . , ...
1200 ELM AVENUE
CARLSBAD, CALIFORNIA 92008
TELEPHONE:
(714) 729-1181
his document will certify that I am aware of the provisions of the
California Administrative Code, Title 24, Section T20-1406(c),
"Swimming Pool Heating", as shown on form DPL #297. I understand
that neither a swimming pool building permit using a fossil-fueled
heater nor a plumbing/electrical permit for a new or replacement
fossil-fueled heater will be issued until this certification is
executed.
1. Outdoor pools shall be equipped with a pool cover.
2. ON-OFF switch on outside of heater to allow shutdown without
adjusting thermostat and start-up without relighting pilot light.
3. 36" minimum length of plumbing provided between filter and
heater to allow future. solar in:;,;tallation.
4. After January 1, 1982, new heaters installed must have 75%
thermal efficiency.
5. Time clocks installed to allow pump operation during off-peak
demand periods (unless pump used for active solar).
6. Directional water inlets in pool for good mixing.
Print Owners Name:
Owners Signature: Date:
Contractors Signature:
Address:
INTERDEPARTMENTAL INFORMATION SHEET
~UILDING DEPARTMENT
BUILDING ADDRESS:
PLANNING DEPARTMENT
DATRECEIVED
tZA.-~
ZONE _________ LOT SIZE _________ LOT WIDTH. ________ _
UNITS ALLOWED ___________ UNITS PROVIDED ____________ _
PARKING SPACES REQUIRED PROVIDED __________ _
% COVERAGE ALLOWED _____________ PROVIDED __________ _
BUILDING HEIGHT ALLOWED PROVIDED __________ _
FRONT SETBACK: SIDE SETBACK: REAR SETBACK:
ALLOWED -------
PROVIDED ______ _
INTRUSIONS
LANDSCAPE & IRRIGATION PLAN COMMENTS:
ENVIRONMENTAL PROTECTION REQ:
ADDITIONAL COMMENTS:~~==-=--=-li~:;l:::!""="2::::_ _______________ _
OK TO mu,,qe '?tL. ;s:,,..✓ilio ,,.,, _______ .DATE, ____ _
ENGINEERING DEPARTMENT
R,O,W. INDUSTRIA ------_______ IMPROVEMENTS _______ _
SEWER CONNECTION ________ DRIVEWAY LOCATIONS ___________ _
GRADING PERMIT __ _,-= ___ EAS,:ENTS ______ ~~-DRAINAGE ~:::~,:::~•:::::µ~~ . ;f"S'"-;;i' O'--
\K TO ISSUE:J.fl( DATE 5•1).,[j( PWI ____ OK TO FINAL ____ .DATE __ _
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. _______ _