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HomeMy WebLinkAbout2850 PIO PICO DR; MULTI-PERMIT FILE; CB091771; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 10-22-2009 Sian Permit Permit No: CB091771 Job Address: Permit Type: Parcel No: Valuation: Reference #: PC #: Project Title Building Inspection Request Line (760) 602-2725 2850 PlO PICO DR CBAD St: D SIGN Status: ISSUED 1561645500 Lot #: 0 Applied: 10/22/2009 $2,500.00 Construction Type: NEW Entered By: JMA Plan Approved: 10/22/2009 Issued: 10/22/2009 DOAN LAW: 1 NON-ILLUM SIGN Inspect Area: Applicant: Owner:-----, MACHAN SIGN DOAN LAW&PROFESSIONAL TERRACE L L C 1209 EUCLID AVE ( /T\ 2850 PlOICO LONG BEACH CA 90804 CARLSBAD CA 92008 / LJfl 562-494-8676 JBuilding Permit \$i 1 \ Add'l Building Permit Fee $0.00 Plan Check $35.17 Add'l Plan Check Fee \ 1 Electrical Fee $0.00 ) e Renewal Fee $o.00 \Z i AddI Renewal Fee so.00 T Other Building Fee $o:oo Additional Fees som TOTAL PERMIT FEES $89.28 ) \ \ / t' . .1 Total Fees: $89.28 Total Payments To Date:1 'd! $89}28 Balance JJ / Due: 1 $0.00 LI \ INCORPORATED / ©N 195 0 0 Inspector: FINAL APPROVAL Date: 12 cP 9 Clearance: NOTICE: Please take NOTICE that approval of your project includes the'Imposition' of fees, dedications, reservations, or other exactions hereafter collectively referred to as fees/exactions. You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any Building Permit Application Plan Check No. M r77 / / 1635 Faraday Ave., Carlsbad, CA 92008 -Est. ValUe CITY: OF 760-602-2717/2718/2719 iax:- (,bU:bUESDb CARLStsAD awwcarsbdcaov UIII . I.'puIL Date JOB ADDRESS / 2-g..se P,i f(c SUITE#/SPACE#/ UNiT# APN CT/PROJECT if LOT if PHASE if if OF UNITS if BEDROOMS if BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE 0CC. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) - 7 (i , d 94A tj 4 " EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) ' FIREPLACE YES 0 # NO 0 AIR CONDITIONING YES 0 NOD FIRE SPRINKLERS YES 0 NOD CONTACT NAME (If Different Fom Applicant) APPLICANT NAME ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE . PHONE FAX EMAIL EMAIL PROPERTY OWNER NAME C&/-4i ONTRACTOR BUS. NAM - frV* 4c-tp4--- ADDRESS - ADDRESS AJc( cc-t CITY STATE ZIP CITY STATE ZIP PHONE -760 3 77 EMAIL _ FAX 76Ô) PHONE L EcAT FAX - 22 V\ cz CP'T) - \1 / L vC&) ARCH/DESIGNER NAME & ADDRESS STATE LIC. A 'STATE .5 --' CLASS / I ec CITY BUS. LIC.# (V.J..O nusiness ann rroressions Lone: Any uity or county WfliCfl requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file .a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9,-commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). )43( Workers' Compensation Declaration:/ hereby affirm under penally of perjury one of the following declarations: - -. - I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the wont for which this permit is issued. have and will maintain workers' compensation, as required bX Section 3700 of the Labor Code, for the performance of th,é work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co. 7'frTc' I Policy No. a' ' _7 f _C.' -" Expiration Date I_(_-_I This section need not be completed if the permit is for one hundreddollars (S100) or less. . 0 Certificate of Exemption 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 lathe Workers Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars &100,000), in addition to the cost of compensation, damages as provided for in Section 2706 of the Labor code, interest and attorney's fees. - CONTRACTOR SIGNATURE ,f' ')ENT DATE / -' 67 ®QU Oiçu L)i ( I hereby affirm that lam exempt from Contractor's License Law for the following reason: 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 oroffered for sale (Sec. 7044, Business and Professions 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 offered for sale. If, however, the building or improvement 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). t, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). t am exempt under Section ' Business and Professions Code for this reason: - I personally plan to provide the major labor and materials for construction of the proposed property improvement. C3 Yes, 0 No I (have / have not) signed an application for a building permit for the proposed work. I have contracted with the following person )firm) to provide the proposed construction (include name address I phone / contractors' license dumber):'- I plan to provide portions of the work but I have hired the following person to coordinate supervise and provide the major work (include name! address I phone / contractors license number) I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name I address! phone / type of work): PROPERTY OWNER StGNATUR5,/1J"" 17a ENT DATE / - 07 Is the applicant or future building occupant required.to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 Yes 0 No Is the applicant or future building occupant required to obtain a permit from the air 'pollution control district or air quality management district? 0 Yes 0 No Is the facility lobe constructed within 1,000 feet of the outer boundary of a school site?. 0 Yes 13 No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. Af ' I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lenders Name . Lender's Address '& J I certifyttiat I have read the application and state that the above infomialion is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relabng to building construction. I hereby authorize representative of the City of Carlsbad to enter upon the above mentioned properly for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANYWAY ACCRUE AGAINST SAID CITY INCONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA M OSHA permit is required for excavations over 50' deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and beccime null and void tithe building or work authorized by such permit is not commenced within l8o days from the date of such perm itorif the building or work authorized by such permit is suspended orabandoned at any time after the work is commenced fora period of 180 days (Section 106.4.4 Uniform Building Code). .APPLICANT'S SIGNATURE ..-i 4 J - ' . ' fleiF' City of Carlsbad Bldg Inspection Request For: 12/07/2009 Permit# C13091771 Inspector Assignment: Title: DOAN LAW: 1 NON-ILLUM SIGN Description: Type: SIGN Sub Type: Phone: 5624948676 Job Address: 2850 PlO PICO DR Suite: D Lot 0 Location: Inspector: OWNER DOAN LAW&PROFESSIONAL TERRACE L L C Owner: DOAN LAW&PROFESSIONAL TERRACE L L C Remarks: Total Time: Requested By: AMALEA Entered By: JANEAN CD Description Act Comments 19 Final Structural fTr 39 Final Electrical Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 2r' hereby affirm that am licensed under I , i 0 felons of Chapter 9 (commencing with If Section 7000) of Division 3 of the Business and Professions Code, and my license is in L full force and effect. I hereby affirm that i am exempt from the Contrac- tors License law for the following reason (Sec. 7031.5 Business and Professions Code: Any city or county whicr, re- 'quires a permit to Construct, alter, improve, demolish, or repair any structure. prior to its issuance also requires the ap pucant for,such permit to bin a signed statement that he is licensed pursuant In the provisions 01 ike Contractors I License Law (Chapter 9 commencing with Section 7000 of Division 301 the Business and Professions Code) or that is no-' - enrpr thetetrom and the basis for the alleged exemption. Any I violation 01 Section 7031.5 by an applicant tar a permit Sub- jects the applicant too civil penalty 01 not more than tine hun- dred dollars ($500). I I, as owner of the property, or my employees with wages I as their sole compensation, will do the work, and the struc- ture is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves I thereon and who does Such work himself or through his awn employees, provided that such improvements are not intend- ed or offered for sale. .11. however, the building or improve• merit is sold within one year 01 completion, the Owner-builder will have the burden of proving that he did not build or im- prove for the purpose 01 safe). ' 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, I Business and Professions Code: The Contractors License p Law dons not apply loan owner of property who builds or im- proves thereon, and who contracts for each projects with a contractor(s) license pursuant to the Contractor's License Law). 0 As a homeowner lam improving my home, and the tollow' ing conditions exist: - The work is being performed prior to sale. - I I have lined in my .home for .twelve months prior to completion 01 this work. I have not claimed this exemption during the last three years. - I 0 tam exempt under Sec. ___________________ - B & P.C. - to this reason o I hereby affirm that I have a certificate 01 consent 101 oell.insure, or a certificate 01 Workers' Compensation In. surance. era certified copy thereof (Sec. 3800. Labor Codel POLICY NO. 'I COMPANY - 0 'Copy is tiled with the city 0 Certified copy is hereby furnished - UI 0. O CERTIFICATE OF EXEMPTION FROM C) WORKERS' COMPENSATION INSURANCE U) (This section need not be completed it the permit cc is for one hundred dollars 151001 or less) UI Ic I certify that in the performance 01 the work for which Ix this permit is issued. I shall not employ any person in any 3 manner so as In become subject to the Workers' Cempen. - 'sation Laws of California, - NOTICE, TO APPLICANT: if, after making this Certificate 01 Exemption, you should become subject to the Workers' Compensation provisions 01 the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. cc [" 0I hereby affirm that there Is a construction lending UJ agency for the performance 01100 work for which this per. ol mit is issued (Sec. 3097. Civil Code) ZI .- ' ' - Mi I Lender's Name _1I L Lender's Addreoo hill L_ __________________________________ USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS CARLSBAD BUILDING DEPARTMENT 2075 Las APPLICATION & PERMIT Palmas Dr., Carlsbad, CA 92009.4859 (619) 438-1161 , . . ... -. -. (JOB ADDRESS r AV. ST. RD. NEAREST CROSS ST. DATE OF APPLfCATlONI BUSINESS LICENSE A '. VALUATION .?/.PP MIT NUMBER 7fo Fio I ii —' --r I _________ LOT BLOCK SUBDIVISION ASSESSOR PARCEL NO. CONTRACTOR J ________ CONTRACTORS PHONE g ZONE I I OWNER'S NAME ASC E4r ~ RACTOR'S ADDRESS 9 O—' OWNER'S PHONE L3q STATE LICENSE NO. BUILDING SO. FOOTAGE OWNER'S MAILIN ADDRESS DESIGNER C. DES fG NE AS PHONE TION OF WORK DES 3 f:•_..trDz;R. DESIGNER'S ADDRESS STATE LICENSE NO. ÜU.jã UUJ. li/i7/.,RiiT lU. F/P FLRELEV,I I NO OCCGP EDU STORIES I YO NO ' PARKING SPACE RES UNITS GRADING PERMIT ISSUED I REDEVELOPMENT I I TYPE 0CC LOAD r FIRE SPA AREA I !CONST 0 u 0 vD NO vI( ND Not Valid Unless Machine Certified - QTY. PLUMBING PERMIT- ISSUE 7- QTY. MECHANICAL PERMIT- ISSUE 2 OV SUMMARY/ACCOUNT NUMBER EACH FIXTURE TRAP , INSTALL FURN. DUCTS UP TO 100.000 BTU , BUILDING PERMIT 001-810-00'00-8220 EACH BUILDING SEWER . OVER 100,000 BTU - - SIGN PERMIT 001-810-00-00-8221 EACH WATER HEATER AND/OR VENT - . BOILER/COMPRESSOR UP TO 3 HP - - PLAN CHECK 001-810-00-00-8821 — EACH GAS SYSTEM 1 TO 4 OUTLETS . BOILER/COMPRESSOR 316 HP , TOTAL PLUMBING 001-810-00-00-8222 EACH GAS SYSTEM S OR MORE - , METAL FIREPLACE - ' ELECTRICAL ' 001-810-00-00-8223 - — EACH INSTAI,., ALTER, REPAIR WATER PIPE - VENT FAN SINGLE DUCT . MECHANICAL 001-810-00-00-8224 - EACH VACUUM BREAKER MECI-I EXHAUST - HOOD/DUCTS ' MOBILEHOME 001-810-00-00-8225 WATER SOFTNER , RELOCATION OF EA FURNACE/HEATER - . SOLAR ' 001-810-00-00-8226 EACH ROOF DRAIN (INSIDE) . DRYER VENT . STRONG MOTION 880-519-92-33 - TOTAL MECHANICAL I FIRE SPRINKLERS 001-810-00-00-8227 TOTAL PLUMBING I PUBLIC FACILITIES FEE 320-810-00-00-8740 QTY. - ELECTRICAL PERMIT - ISSUE S- QTY. MOBILE HOME SETUP BRIDGE FEE 360-810-00-00-8740 PARK-IN-LIEU (AREA NEW CONST EA AMP/SW1 18KB CAR PORT . - TIE 134-810-00-00-8835 I 'PH 1 3 PH . ' AWNING . LA COSTA TIE 133-810-00-00-8835 EXIST BLDG EA AMP/SWTIBKR GARAGE - EMF 1 PH 3 PH . - LICENSE TAX 001-810-00-00-8162 - REMOOEL,'ALTER PER CIRCUIT ' - MFF 880-519-92-57 TEMP POLE 200 AMPS OVER 200 AMPS TEMP OCCUPANCY (30 DAYS) F.h1L /W -'LPs1 S 0 . . ' CREDIT DEPOSIT DIAL ELECTRICAL TOTAL FEES PAYAB LE JOTAL - - - I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY I Expiration Every permit issued by the Building Official under the provisions of this * AN OSHA PRMT IS REQUIRED FOR EXCAVATIONS OVER Code shall expire by limitation and become null and void if the building CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE authorized by is 1prk 50' f' DEEP AND DEMOLITION OR CONSTRUCTION OF DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER such permit not commenced within 180 days from the date CERTIFY AND AGREE IF A PERMIT I permit, or if the building or work authorized by Such permit is suspenis STRUCTURES OVER 3 STORIES IN HEIGHT ISSUED: TO COMPLY WITH ALL CITY. COUNTY AND STATE LAWS GOVERNING BUILDING CON, abandoned at any time after the work is commenced for a period of 180 d STRUCTION. WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND TS SIGNTUR A 0 KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND DATE — VIED BY C EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE BY PHONE 0 GRANTING OF THIS PERMIT, / TYPE DATE INSPECTOR BUILDING FOUNDATION REINFORCED STEEL MASONRY GUNITE OR GROUT SUB FRAME El FLOOR El CEILING SHEATHING El ROOF El SI1EAR FRAME EXTERIOR LATH I INSULATION INTERIOR LATH & DRYWALL PLUMBING El SEWER AND BL/CO El FL/CO UNDERGROUND El WASTE E3 WATER TOP OUT El WASTE El VATER TUB AND SHOWER PAN GAS TEST O WATER HEATER 0 SOLAR WATER ELECTRICAL El ELECTRIC UNDERGROUND Ei UFFER ROUGH ELECTRIC O ELECTRIC SERVICE 0 TEMPORARY O BONDING 0 POOL MECHANICAL o DUCT & PLEM., 0 REF. PIPING HEAT - AIR COND. SYSTEMS VENTILATING SYSTEMS CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE ITEMS ABOVE HAVE BEEN APPROVED. FINAL I I I PLUMBING ELECTRICAL MECHANICAL GAS BUILDING L IAL CONDITIONS FIELD INSPECTION RECORD REQUIRED SPECIAL INSPECTIONS INSPECTORS NOTES INSPECTION - REQ. IF CHECKED INSPECTORS APPROVAL DATE SOILS COMPLIANCE PRIOR TO FOUNDATION INSP OVER 2000 PSI STRUCTURAL CONCRETE PRESTRESSED CONCRETE POST TENSIONED CONCRETE - FIELD WELDING HIGH STRENGTH BOLTS SPECIAL MASONRY PILES CAISSONS flT! 'r A - CITY OF CARLSBAD— BUILDING DEPARTMENT APPLICATION & PERMIT *F USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525 NO, JOB ADDRESS AVR. ST. D Z815'01 iii i9iic.1a I I I I I I I I I I I I I I I I I i IDATE OF APPLICATION I/Z-Z/ A56 BUS. LICENSE -oii PERMIT NUMBER 3 I I OWNER OWNER'S PHONE PRIME CONTRACTOR STATE LI5&NSE OWNER'S MAILING ADDRESS /0 7ô &D. S7 ir Ut th4 . 2 / 1 N"IRACTOR'S ADDRESS - CONTRACTOR'S PKONE 3&/ 22' Not Valid Unless Machine-lertifietl DESIGNER'S PHONE LOT I BLOCK SUBDIVISION ASSESSOR'S PARCEL NO. DESIGNER STATE LICENSE DESCRIPTION OF WORK 4_,_ cb DESIGNER'S ADDRESS \c \ CENSUS TRACT GP LAND USE , ZONING / 'V '" ''-.- I RES. UNITS I PARKING SPACE I I I NUMBER OF STORIES BLDG 50. FT. BLDG USE 0CC. GP STANDARD PLAN # PLAN ID S TYPE CONST 0CC. LOAD AMT. QTY. MECHANICAL PERMIT AMT. . INSTALL FURN. DUCTS UP TO 100.000 BTU . OVER 100.000 BTU . BOILER/COMPRESSOR UPTO3HP . BOILER/COMPRESSOR 3-15 HP . BOILER/COMPRESSOR 16-30 HP . VENT FAN SINGLE DUCT . MECH EXHAUST - HOOD/DUCTS UTY. PLUMBING PERMIT EACH FIXTURE TRAP EACH BUILDING SEWER EACH WATER HEATER AND/OR VENT EACH GAS SYSTEM 1 TO 4 OUTLETS EACH GAS SYSTEM 5 OR MORE EACH INSTAL, ALTER, REPAIR WATER PIPE EACH LAWN SPRINKLER SYSTEM WATER SOFTNER . RELOCATION OF EA FURNACE/HEATER . BUILDING PERMIT a6 'da SIGN PERMIT TOTAL PLUMBING CONTRACTOR . TOTAL MECHANICAL CONTRACTOR PLAN CHECK .4. - ALL INCLUSIVE PERMIT UTY. ELECTRICAL PERMIT AMT. QTY. MOBILE HOME PERMIT AMT. TOTAL PLUMBING ELECTRICAL NEW CONST EA AMP/SWT/BKR . . AWNING . MECHANICAL 1 PH .25 3 PH . PORCH . MOBILE HOME EXIST BLDG EA AMP/SWT/BKR . SET-UP . SOLAR 1 PH 15 3 PH . RAMADA, CABANA REMODEL/ALTER PER CIRCUIT . FENCE OVER 6' TEMPPOLE 200AMPS . TOTAL MOBILE HOME . MICO-FILM OVER 200 AMPS TEMP OCCUPANCY (30 DAYS) TOTAL ELECTRICAL TOTAL FEES PAYABLE I CONTRACTOR I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT ANfl FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUEDTO COMPLY WITH ALL CIT?\ COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER HEREIN OR NOT. ].ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM- "IIEC"JY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THIS PERMIT, AN OSHA PgWAJ IS REQUIRED FOR EXCAVATIONS OVE 5.0" DE AND E LITtON OR CON TRUCTIO STRU APPLICANT'S SIGNATURE' OWNERD CONTRACTOR AGENT 0 BY PHONE 0 APPROVED BY DATE LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provi- sions of Chapter 9 (commencing with Section 1000) of Division 3 of the Business and Profes- sions Code, and my license is in full force and ef- fect. OWNER-BUILDER DECLARATION Di 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). - Dl, as owner of the properly, 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 for safe. 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). Dl, 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 DECLAILAJION I hereby affirm that I have a certi caj con- sent to self-Insure, or a certificate %) r Compensation Insurance, or a ce fi thereof (Sec. 3800, Labor Code). POLICY NO. COMPANY OCopy is filed with the city. OCertitied copy is hereby furnishe 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: If, after making this Cer- -JlticaLe of Exemption, you should become subject n'nvisiOflsof the APPLICANT TO FILL IN-NFOR- MATION WITHIN RED LINES. ITE ADDRESS: OWNER: At FIELD INSPECTION RECORD INSPECTION DATE INSPECTOR WOOD FLO@R FOUNDATION • FORMS -SETBACK * 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 - FINAL INSP BY BLDG DEPT OTHER DEPTS REQ COMPLETED ELEC METER—PERM—TEMP GAS METER—PERM—TEMP - - - -. - - - CERT OF OCCUPANCY ISSUED - - PERMIT NO: INSPECTOR'S NOTES