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HomeMy WebLinkAbout2011 PALOMAR AIRPORT RD; MULTI-PERMIT FILE; CB132595; Permit4 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 10-23-2013 Permit No: CB132595 Building Inspection Request Line (760) 602-2725 Job Address 2011 PALOMAR AIRPORT RD CBAD Permit Type: PME Status: ISSUED Parcel No: 2130612600 Lot #. 0 Applied: 10/23/2013 Entered By: JMA Reference #. Plan Approved: 10/23/2013 PC #: Issued: 10/23/2013 Inspect Area: Project Title: GAS LEAK REPAIR Applicant Owner: R.E STEINHAUER CONSTRUCTION, INC P T CARLSBAD ASSOCIATES STE 2400 C/O GENERAL PROP MGNT 7639 MIRAMAR RD 9285 DOWDY DR #101 SAN DIEGO, CA 92126 SAN DIEGO CA 92126 858 689 0052 Plumbing Fees $158.00 Electrical Fees $000 Mechanical Fees $0.00 Other PME Fees $0.00 TOTAL PERMIT FEES $158.00 Total Fees: $158.00 Total Payments To Date: $0.00 Balance Due: $158.00 FINAL AP'RO3JAL Insoector: J' '1 Date- it./ -10 1 7 Clearance. NOTICE Please take NOTICE at ajJoval of your project includes the impositidn" of fees, dedications, reservations, or other exactions hereafter collectively actions. referred to as fees/ex" ?ou hWe 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 THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: DPLANNING DENGINEERING [--]BUILDING DFIRE DHEALTH DHAZMATIAPCD I Building Permit Application <0140> 1635 Faraday Ave Carlsbad, CA 92008 CITY OF Ph 760-602-2719 Fax' 760-602-8558 CARLSBAD email: building@carlsbadca.gov Plan Check No. c Est. Value Plan Ck. Deposit Date 10(23 / ' IswpPP 1 JOB ADDRESS SUITE#/SPACED/UNITI APN - - - Jr/PROJECT # LOT # PHASE # A OF UNITS J#BEDROOMS A BATHROOMS TENANT BUSINESS NAME CONSTR TYPE 0CC GROUP DESCRIPTION OF WORK: include Square Feet of Affected Area(s) — 6ci /e.k r'-' ,XISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE IYESD# NOI I AIR CONDONING IFIRESPRINKLERS YESENOE YESIINOII APPLICANT NAME (Primary Contact) APPLICANT NAME (Secondary Contact) ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE FAX PHONE FAX EMAIL EMAIL PROPERTY OWNER NAME — ONTRACTORAUS. NAME _ ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP PHONE FAX PHONE '- `1 FAX rf- £s -- EMAIL EMAIL Kh..cc,,-i. '— .i,RCH/DESiGNER NAME & ADDRESS STATE LIC A STATE LIC A 40 I CLASS I I CRY BUS LIC A I/2--s'7'f (Sec 7O31.5 Business and Professions Code: Any City or County which 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 jChapter 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)) ..... i...i. . '•* .. Workers' Compensation Declaration I hereby affinn under penally of pequiy one of the following declarations i:i 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 work for which this permit is issued, 91 have and will maintain workers' ompensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued My workers' compensation insurance camer and policy number are. Insurance Co 73 13 $7 Policy No. Expiration Date Thi section need not be completed if the permit is for one hundred dollars ($100) or less tn 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 to the Workers' Compensation Laws of Califomia. WARNING: Failure to secure workers' compen n cover 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 p ed 10 io bor code, interest and attorney's fees. CONTRACTOR SIGNATURE VAGENT DATE /c2 - r 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 or offered for sate (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). I, 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) [] I am exempt under Section _____________Business and Professions Code for this reason. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement Dyes [--]No 2 I (have! have not) signed an application for a building permit for the proposed work 3 I have contracted with the following person (firm) to provide the proposed construction (include name address! phone! contractors' license number) 4 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! phone! contractors' license number). 5 I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name! address! phone! type of work) ,PROPERTY OWNER SIGNATURE []AGENT DATE 77, _ 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? Yes No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Yes No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes 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. 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) Lender's Name Lender's Address I car* that l have mad the application and state thatthe above infoimation tucenectandthatthe information on the plans is accurate. l agree tocumplywlthall City ordinances and State laws relating to building construction. I hereby authorize representative of the City of Carlsbad tt up! 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..NrES WHICH MAY IN ANY WAY ACCRUE AGAJNST SAID crr INCONSEQUENCE OF THE GRANTING OF THIS PERMIT OSHA An OSHA permit is required for excavatigpover nd demolition orconslndion of structures over 3 stones a height. EXPIRATION. Every permit issued by the Burlqlhg provmons of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 180 days from the date of such pennitor if the biii rkauth 'rized bysuch permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 10644 Unitorm Building Code) .APPLICANT'S SIGNATURE DATE - 2 3 0 STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. CERTIFICATE OF OCCUPANCY (C..,ne,r i.1 Projects Only) Fax (760) 602-8560, Email buiIdingcarlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008 CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS LIC. No DELIVERY OP11ONS PICK UP: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On P. 1) ASSOCIATED CB# MAIL TO: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1) NO CHANGE IN USE / NO CONSTRUCTION MAIL! FAX TO OTHER: CHANGE OF USE / NO CONSTRUCTION APPLICANT'S SIGNATURE DATE Inspection List Permit#: CB132595 Type: PME GAS LEAK REPAIR Date Inspection Item Inspector Act Comments 10/25/2013 23 Gas/Test/Repairs - RI 10/25/2013 23 Gas/Test/Repairs PY AP 10/25/2013 29 Final Plumbing - RI Monday, October 28, 2013 Page 1 of 1 B U I L D I N G P E R M I T Permit No: CB941650 12/14/94 10:27 Project No: A8800045 Page 1 of 1 Development No: Job Address: 2011 PALOMAR AIRPORT RD Suite: Permit Type: ELECTRICAL Parcel No: 213-061-22-00 Lot#: Valuation: 0 Construction Type: NEW 9957 12/14/94 0001 01 02 Occupancy Group: Refference#: St.ff: ISSUb00 Description: REPLACE LIGHTING ON MONUMENT Applied: 12/14/94 Apr/Issue: 12/14/94 Entered By: DC Appl/Ownr : MACDONALD, KEVIN 619 546-0027 4060 MORENA BLDG #G297 SAN DIEGO, CA 92117 *** Fees Required *** Fees .Collected & Credits - ------------'-------------------------------- Fees: ; 20.00 ' Adjustments: '"..00 .' ' T- al.Credits: .00 Total Fees: 20..00 ;>' Tctal P'ayments: .00 Balance,.-Duei 20.00 Fee description ' "S. -. Units" Fee/Unit Ext fee Data Enter "Y" for Elect ic 'issue F e 9\,, > 771 ----------------- 0.00 y Enter HH for Remde ' 10.00 Y * ELECTRICAL TOTAI, 20.00 - I.\!CORPOr1ED 9FROVAL DATE - CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION '-- City of CarLsbad Building Department 2075 Las Palms Dr., CarLsbad, CA 92009 (619) 438-1161 From List I (see back) give code of Permit-Type: --------------------------------------------------------- For Residential Projects Only: From List 2 (see back) give Code of Structure-Type: PLAN CHECK NO. EST. VAL PLAN CK DEPOSiT_______________ VALID. BY DATE Net Loss/Gain of Dwelling Units PROJECT INFORMATION FOR OFFICE USE ONLY Address 67.611 Building or Suite No. Nearest Cross Street f7 i - ' P J L /- 0 2 Energy Calcs 02 Structural Calcs 02 Soils Report DI Addressed Envelope DESCRIPTION OF WORK Ad a.. ./7iL -P; x4v f r Moaiiteei"- SQ. FT. # OF STORIES # OF BEDROOMS # OF BATHROOMS WN IRLJ PERSON (it different from applicant) NAME (last name first) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE APPLICANT UUNIRACIUR DAikJ'r FUR WNTRA(JIUR DOWNER DAGENT FOR OWNER NAIVIE p J ADDRESS 4o6o fr1 4e4 3i LfD 6 7 - CITY412 e,7)) g STATE C2. ZIP CODE T// I DAY TELEPHONE 54: - _ 7 . rltl.Jrr.it I I LflYN.K- NAME (last name first) L .14 /1) A2tieS ADDRESS f'?4- 7 c.-i e j7,0 CITY (X /SAotcj STATE(24. ZIP CODE q2QV74f DAY TELEPHONE 4:3/ - 7J' "7 (_1JN1HAidLJI( NAME (last name first)Dv rjald /7J//V ADDRESS 40&7 ('4frP DIi&-t7 CITY STATE4 ZIP CODE C? /t'7 DAY TELEPHONE 5f STATE DC. #J R65- LICENSE CLASS - 1(9 CITY BUSINESS DC. # DESK.iNEK NAME (last name tirsQ ADDRESS CITY STATE ZIP CODE DAY TELEPHONE STATE DC. # 7. WORKERs' WMPENSA11ON Workers' Compensation Declaration: I hereby affirm that I have a certificate of consent to sell-insure issued by the Director 01 Industrial Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). INSURANCE COMPANY POLICY NO. EXPIRATION DATE Certiticate 01 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 to th or 'Compensation Laws of California. SIGN DATE J4J'TE Owner-Builder Declaration: I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (3 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 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 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.). E3 I, 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). 0 I am exempt under Section Business and Professions Code for this reason: (Sec. 7031.5 Business and Professions Code: Any City or County which 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, commencing 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]). SIGNATURE DATE COMPLFTE THIS SECFION FOR NON-RESIDENTIAL BUILDING PERMlTh ONLY: 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? E3 YES JZ.NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? E3 YES Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? DYES NO IF ANY OF THE ANSWERS ARE YES A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISnucr. WNSTRUCI1ON LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(1) Civil Code). LENDER'S NAME )Jc7/'..._- LENDER'S ADDRESS APPUCANI CEI[IWICA HON I certify that I have read the application and state that the above information is correct. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property 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 ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF This PERMIT. OSHA- An OSHA permit is required for excavations over 5'O" 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 become null and void if the building or work authorized by such permit is not commenced within 365 days from the date of such permit or if the building or work authorized by such permit is suspended or aba t any time after the work is comm cod for a period of 180 days (Section 303(d) Uniform Building Code). APPLICANTS SIGNATUR 4 fsE3 DATE: - 0 UNSCHEDULED INSPECTION DATE ( INSPECTOR PERMIT s(O PLANCK * JOB ADDRESS TIME ARRIVE: TIME LEAVE: Co LVL DESCRIPTION ACT COMMENTS PEPIIIT5 6/15/89 a 101— 0 I hereby affirm that I am licensed under UI provisions of Chapter 9 (commencing with I Soction 7000) of Division 3 of the Business '— and Professions Code, and my license is in L full force and effect I =affirm that I am exempt from the Contrac- tor's License Law for the following reason (Sec 7031 5 Business and Professions Code Any city or county which to- quires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires !he ap-plicant for such permit to 1110 a signed statement that he is licensed pursuant to the provisions of the Contractor License Law (Chapter 9 commencing with Section 7000 of Division 3 o the Business and Professions Code( or that is ex- empt therefrom and the basis for the alleged exemption Any violation of Section 7031 5 by an applicant for a permit sub facts the applicant to a Civil penalty of not more than five hun- dred dollars ($500) I I, as swner of the property, or my employees with wages as their sole compensation, will do the work and the struc- ture is not intended or Offered for sale (Sec 7044. Business _J 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 intend- IU ed or offered for sale It, however, the building or improve- Z mont is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or im- P prove for the purpose at sale) UI I, as owner of the property, am exclusively contracting 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 orim- proves thereon, and who Contracts for each projects with a contractor(s) license pursuant to the Contractor's License Law) II As a homeowner lam improving my home, and the tallow ing conditions exist 1 The work is being performed prior to sale 2 t have lived in my home for twelve months prior to completion of this work 3 t have not claimed this exemption during the last three years tam exempt under Sec ___________________ . B & P C for this reason 0 I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers Compensation in I surance or a certified copy thereof (Sec 3800 Labor Code) POLICY NO COMPANY Copy is filed with the city 0 Certified copy is hereby furnished a. O CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (I5 (This section need not be completed if the permit is for one hundred dollars (0100) or less) Cl29 t certify that in the performance of the work for which It this permit is issued,) shalt not employ any person in any I 0 manner so as to become subject to the Workers Compen- sation Laws of California NOTICE TO APPLICANT It after making this Certificate 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 I be deemed revoked r 0 t hereby affirm that there is a construction lending I lz agency for the performance of the work for which this per. 01 mit is issued )Sec 3097, Civil Code) zi WI Lenders Name -ii L Lender's Address_________________________________ USL BALL ?UI1 PLI1 ULT & PL55 MAU CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad, CA 92009-1915 (619) 438-1161 JOB ADDRESS 2O f AV STRO. THOMAS B OS NO. f DATE OF APPLICATION I - BUSINESS LICENSE of IO [ BLOCK SUBDIVISION OWNER'S NAME f ASSESSOR PARCEL NO CONTRACTOR i'i1ht C' CONTRACTORS PHONES r4 \ IJl('c?rL- OWNER'S MAILING ADDRESS ç1n..*\_ oWNER'S PHONE CONTRACTOR'S ADDRESS qd 01 ro AD Aç4) Ot1'O . STATE LICENSE NO 7Cfj I lot J t'A 1ç -'8c1c-z;o DESCRIPTION OF WORK DESIGNER DESIGNER'S PHONE DESIGNER'S ADDRESS 10 —-YW M60 Ix STATE LICENSE NO. F/P FLRELEV I I NO 1 STORIES OCCGP I vO ND CENSUS ItlAUt I PARKING SPACE HES UNITS I GRADING PERMIT ISSUED REDEVELOPMENT TYPE 0CC LOAD FIRE SPR AREA CONST TO N 0 O ND vO ND Not Valid Unless Machine Certified OTY F PLUMBING PERMIT - ISSUE I . 61) 1 QTY. MECHANICAL PERMIT - ISSUE f . Z SUMMARY/ACCOUNT NUMBER EACH FIXTURE TRAP , INSTALL FURN DUCTS UP TO 100,000 BTU DUILUIRb rtKMIl UUiblU'UU'UU'SZU EACH BUILDING SEWER OVER 100,000 BTU . SIGN PERMIT - . —.8J221 EACH WATER HEATER ANDrOR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN ci'k EACH GAS SYSTEM ITO 4 OUT LETS BOILER/COMPRESSOR 315 HP , TOTAL PLtBING 001-810-00-00-8222 - EACH GAS SYSTEMS OR MORE . — METAL FIREPLACE ELECTRICAL rEB - EACH INSTAL ALTER, REPAIR WATER PIPE — VENT FAN SINGLE DUCT . MECHANICAL 001-810-00'00,82 — EACH VACUUM BREAKER — MECH EXHAUST H000/DUCTS . MOB)LQJ4, ' WATER SOFTNER RELOCATION OF EA FURNACE/HEATER . SOLAR — EACH ROOF DRAIN (INSIDE) . — DRYER VENT 880-519-92-33 TOTAL MECHANICAL . FIRE SPRINKLERS 001-810-00-00-8227 TO (AL PLUMBING PUBLIC FACILITIES FEE 320-810-00'00'8740 QTY. ELECTRICAL PERMIT. ISSUE -' QTY, MOBILE HOME SETUP BRIDGE FEE 360-810-00-00-8740 PARK-IN-LIEU (AREA NEW CONST EA AMP'SWl BKR CAR PORT . TIF 312-810-00-00-8835 I PH 3 PH - AWNING . LA COSTA TIF 311-810-00-00-8835 EXIST BLDG EAAMP/SWTBKR - GARAGE . FMF 1 PH 3 PH . LICENSE TAX 001-810-00-00-8162 REMODEL'ALTLR PER CIRCUIT I no n12# MFF 880-519-92-57 — TEMP POLE 200 AMPS OVER 200 AMPS — TEMP OCCUPANCY (30 DAYS) ' CREDIT DEPOSIT ArrLII.;ArII 10 NLL IPf lNIUKIVIAlIUInd WIIMIPd I1MUtIJ AMtA AND LItt,.LAMRlIVN. APPLICATION & PERMIT VALUATION PERMIT NUMBER ZONE BUILDING SO FOOTAGE 3569 12/09/88 0001 01 02 1dPmt 30 TOTAL ELELTRICAL I HAVE CAREFULLY EXAMINED THE COMPLETED 'APPLICATION AND PERMIT" AND DO HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE DECLARATIONS ARE TRUE AND CORRECT AND) FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED: TO COMPLY WITH ALL CITY COUNTY AND STATE LAWS GOVERNING BUILDING CON- STRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT TOTAL .11 TOTAL FEES PAYp Expiration Every permit issued by the Building Official under the provisions of this * ANC Code shell aspire by limitation and become null and void If the building or work 51 01* authorized by such permit Is not commenced within 180 days from the date of such permit, or if the buIlding or work authorized by Such permit is suspended or STFA eban ad SI any time after the Work is commenced for a period of 180 days APPL ANT'S SIQ~NATUON * OWNER 0 CONTRACTOR 0 APPROVETj BY PHONE . 41, 52. 1 IS REQUIRED FOR EXCAVATIONS OVER DEMOLITION OR CONSTRUCTION OF ER 3 STORIES IN HEIGHT TYPE DATE I INSPECTOR RUILflIN FOUNDATION REINFORCED STEEL MASONRY GUNITE OR GROUT SUB FRAME 0 FLOOR 0 CEILING SHEATHING 0 ROOF El SHEAR FRAME EXTERIOR LATH INSULATION INTERIOR LATH & DRYWALL PLUMBING El SEWER AND BL/CO LI PCO UNDERGROUND LI WASTE DWATER TOP OUT 0 WASTE 0 WATER TUB AND SHOWER PAN GAS TEST O WATER HEATER El SOLAR WATER ELECTRICAL LI ELECTRIC UNDERGROUND Eli UFFER ROUGH ELECTRIC O ELECTRIC SERVICE 0 TEMPORARY O BONDING 0 POOL MECHANICAL El DUCT & PLEM., El REF. PIPING HEAT - AIR COND. SYSTEMS VENTILATING SYSTEMS CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE ITFMS ARflVF 14A VF RFFN APPRflVFfl FINAL PLUMBING ELECTRICAL - MECHANICAL GAS BUILDING SPECIAL CONDITIONS FIELD INSPECTION RECORD REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES INSPECTION - REQ IF CHECKED INSPECTOR'S APPROVAL D DATE I SOILS COMPLIANCE PRIOR TO FOUNDATION INSP OVER 2000 PSI STRUCTURAL CONCRETE PRESTRESSED CONCRETE POST TENSIONED CONCRETE FIELD WELDING HIGH STRENGTH 8OLf S SPECIAL MASONRY PILES CAISSONS _4 ••, 'I.. 0 I hereby affirm that I am licensed under . provisions of Chapter 9 (commencing with I Section 7000) of Division 3 of the Business I and Professions Code, and my license Is In full force and effect. Lic No ____________Class - 0 01 I hereby affirm that I am exempt from Inc 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 construct alter, improve, demolish, or repair any structure, prior 10 its issuance also requires the applicant for such permit 10 file a signed statement that he is licensed pursuant 10 the provisions of the Con- tractor's License Law (Chapter 9 commencing with Section 7000 of Division 3 of the Business and Pro- - fessions Code) or that is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031 5 by an applicant for a permit subjects tne applicant to Civil penalty of not more than five hundred dollars ($500) O 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 or offered for sale (Sec 7044, Business and Professions Code The Contractor's License Law does not apply 10 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 I purpose of sale) i. as owner 01 Inc property, am exclusively contracting with licensed contractors 10 construct the project (Sec 7044, Business and Professions Code The Contractor's License Law does not apply 10 an owner of property who builds or improves Ihereon, and who contracts for each projects With a contrsctoilsl license pursuant 10 the Contractor's License Law) O lam exempt under Sec - _______,B & P C for this reason I hereby affirm that I have a certificate 01 consent to self insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec 3800, Labor Code) POLICY NO GL333it±i3. COMPANY O Copy is tiled with Inc City 0 Certified copy is hereby furnished CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 90 (This section need not be Completed if the permitIX i is for one hundred dollars l$1001 or less) UJI 0 I Certify that in the performance of the work for - O whiCh this permit is issued. I shall not employ any I person in any manner so as 10 become subject to I the Workers Compensation Laws of California NOTICE TO APPLICANT if, after makin3 this Certi ficate of Exemption, you should become subleci to - Inc Workers Compensation provisions of the Labor Code, you must forthwith comply with Such provisions or this permit shall be deemed revoked I 0 I hereby affirm that there is a construction I lending agency 10, the performance of the work for UJI which this permit is issued ISec 3097, Civil Code) Lenders Name L Lender's Address U' 0 -I cll U' 0 APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT 1200 Elm, Carlsbad, California 92008 (714) 438-5525 - JOB ADDRESS AV. ST. I DATE OF APPLICATION BUSINESS LICENSE # RD. // 7/bn29,e /b,2a24'1' ,4/ k 'PRIMECONT 3JJJ' I fC / 0 IO7 TOR NTRACTORS PHONE a OWNER'S NAME OWNER'S PHO E &a-zh ex W3 -t-"qSl )jZc VALUATION PERMIT NUMBE ZONE OWNER'S MAILING AODIESS )21&z,1q,e A,,e/ 'V lOS' CONTRACTOR'S ADDRESS LICENSE q/e,rAe, NOe/ PLAN I.o.# BLDG USE CODE I LOT _BLOCK SUBDIVISION I ASSES,OR PARCEL NO / -_/_- DESIGNER 2Qf STATE LICENSE # ' Ot)3 STANDARD PLAN # 003003/fl0101OB1diit14x00 BUILDING SO FOOTAGE DESCRI?TIOI4OF WORK /1UdL)(1Z,f/ DESIGNER'S ADDRESS _______________ DESIGNER'S PHONE Not Valid Unless Machine Certified - sJE_I'&_ F/P FLRELEV YO NO NO I STORIES OCCGP EDU I CENSUS TRACT I GP LAND USE PARKING SPACE RES UNITS GRADING PERMIT ISSUED 0 N 0 _Y O AREA I REDEVELOPMENT NO I I TYPE CONST i 0CC LOAD I FIRE SPR I YO NO QTY. PLUMBING PERMIT - ISSUE QTY. MECHANICAL PERMIT - ISSUE SUMMARY/ACCOUNT NUMBER EACHFIXTURETRAP , INSTALL FURN_ DUCTS UPTO100,000BTU BUILDINGPERMIT EACHBUILDINGSEWER OVER100,000BTU SIGN PERMIT EACHWATERHEATERAND/ORVENT - - BOILER/COMPRESSORUPTO3HP PLAN CHECK EACH GAS SYSTEM 1TO 4 OUTLETS BOILER/COMPRESSOR3.15HP TOTALPLUMBING EACH GAS SYSTEM 5 OR MORE - METAL FIREPLACE ELECTRICAL EACH INSTAL _ ALTER, REPAIR WATER PIPE . VENT FAN SINGLE DUCT MECHANICAL EACHVACUUMBREAKER - MECH EXHAUST -H000/OUCTS MOBILEHOME WATERSOFTNER . RELOCATION OFEAFURNACE/HEATER MOBILEHOME PARK INSP EACHROOFDRAIN(INSIDE) - - SOLAR TOTAL MECHANICAL ',. STRONG MOTION TOTAL PLUMBING )_4_-- FIRE SPRINKLERS QTY. ELECTRICAL PERMIT - ISSUE QTY. SOLAR -ISSUE PUBLIC FACILITIES FEE BRIDGE FEE NEW CONST EA AMP/SWT/BKR COLLECTORS SCHOOLFEE -DISTRICT 1PH 3PH , STORAGE TANKS Carlsbad EXIST BLDG EA AMP/SWT/BKR ROCK STORAGE Encinilas 1 PH 3 PH - PUMP • cimr-R SanDieguito REMOOEL/ALTER PER CIRCUIT . PLAN CHECK FEE RS8,t' _ Co.San Marcos TEMPPOLE200AMPS - -' OVER 200 AMPS TEMP OCCUPANCY (30 DAYS) TOTALELECTRICAL TOTAL SOLAR TOTAL FEES PA _— all exire limitation and become null and void If the building or work rmlt IS not commenced within 180 days from the date of such I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THEruthortzedby tiuch ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS or tf the author' ed by such permit is suspended or TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON-ed ata_imeafter the mencedr 5perIodof180days, ii STRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND CONTRACTOR, KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE IGNA BY PHOfD GRANTING OF THIS PERMIT, * AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER ISSUED APPROV DECLARATIONS 5 0" DEEP, AND DEMOLmON OR CONSTRUCTION OF STRUC'WRES OVER 3 STORIES IN HEIGHT (_ - USE BALL POINT PEN ONLY & PRESS HARD FIELD INSPECTION RECORD REQUIRED SPECIAL INSPECTIONS INSPECTION REQ IF INSPECTORS DATE CHECKED APPROVAL SOILS COMPLIANCE PRIOR TO FOUNDATION INSP STRUCTURAL CONCRETE OVER 2000 PSI PRESTRESSED CONCRETE POST TENSIONED CONCRETE FIELD WELDING HIGH STRENGTH BOLTS SPECIAL MASONRY INSPECTOR'S N IIJSPCTIOM TVPF DATE INSPECTOR BUILDING FOUNDATION REINFORCED STEEL MASONRY GUNITE OR GROUT FLOOR & CEILING SUB FRAME SHEATHING FRAME EXTERIOR LATH INSULATION INTERIOR LATH & DRYWALL PLUMBING SEWER AND BL/CO PLUMBING UNDERGROUND PLUMBING TOP OUT TUB AND SHOWER 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 HAVE BEEN APPROVED. JOB SITE FINAL PLUMBING ELECTRICAL MECHANICAL GAS BUILDING SPECIAL CONDITIONS CERT OF OCCUPANCY ISSUED PILES'CAISSONS tic I hereby affirm that I am licensed under p lelone of Chapter 9 (commencing with Soc on 7000) of Division 3 of the Business I end professions Code, and my license is in L full force and effect. Ci U'— I hereby affirm that I am exempt from the Contrac-tors License Law for the following reason (Sec 7031 5 I Business and Professions Code Any city or county which re-quires a permit to construct, alter, improve, demolish. or repair any structure, prior to Its issuance also requires the ap-plicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor License Law (Chapter 9 commencing with Section 7000 DI I Division 3 of the Business and Professions Code) or that is ex-empt therefrom and the basis for the alleged exemption Any violation of Section 7031 5 by an applicant for a permit sub- I lectn the applicant to a Civil penalty of not more than five hun- dred dollars ($500) I I, as owner of the property, or my employees with wages as their sole compenoation, 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 I not apply to an owner of property who builds or improves thereon and who does such work himself or through his own emp)oyeoo, provided that such improvements are not intend- I ed or offered for sale it, however, the building or improve- ment is said within one year of completion, the owner-builder will have the burden of proving that he did not build or im-prove for the purpose of sale) f, 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 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) As a homeowner lam improving my home. and the follow-ing conditions exist 1 The work is being performed prior to sale 2 I have lived is my home for twelve months prior to completion of this work 3 I have not claimed this exemption during the last three years iam exempt under Sec , 95 PC for this moons I hereby affirm that I have a certificate of consent to I insure or a certificate of Workers Compensation In. I rance, ora certified copy thereof (OeC 3800 Labor Code) I ICY NO O PANY Copy is filed with the city Certified copy is hereby furnished CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (5100) or less) 0 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 cots become subject to she Workers Compen- sation Laws of California NOTICE TO APPLICANT If, after making this Certificate 01 Exemption you should become subject to the Workers Compensation provisions of the tabor Code, you must forthwith comply with such provisions or this permit shall I be deemed revoked [' 0 I hereby affirm that there is a construction lending agency for the performance 01 the work for which this per. O mit is issued (Sec 3097, Civil Code) l&l Lender's Name___________________________________ -j Lender's Addreas_________________________________ I', 0 I-. V., w 0 19 0 .J I '0 0 USE BALL POINT PER ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. CARLSBAD BUILDING DEPARTMENT APPLICATION It PEROT 2075 Las Palmas Dr., Carlsbad, CA 92009.4859 (619) 438-1161 JOB ADDRESS AV ST. AD. NEAREST CROSS ST. LL • DATE OF APPLI"ATIONI BUSINESS LI # 7 I CONTRACTOR CONTRACTORSPH# —i OWNER'S PHONE VALUATION PERMIT NUMBER LOT BLOCK J SUBDIVISION SOR PARCEL NO. ZONE OWNER'S NAME I CONTRACTOR'S ADDRESS ________________ ______________________________________ STATE LICENSE NO. - " . l' BUILDING SO FOOTAGE OWNER'S MAILING ADDRESS 1 DESIGNER 'StGNE A' SPHONE ' tJt EJuITPROCE D SSIJG SERVS 0013 o3i31 0101 021dPDt 300 Not Valid Unless Machine Certified - DESCRIPTION OF WK 4/fl417 rT3{2- DESIGNER'S ADDRESS STATE LIcENEYMR 10F - ••__f •y;7',. -- - ______-- F/P FLR ELEV vO ND I I NO STORIES DCC GP EDU I I I PARKING SPACE RES UNITS GRADING PERMIT ISSUED Y 0 N 0 J_Y O I REDEVELOPMENT AREA NO I I J TYPE I CDNST DCCLOAD I_FIRESPA I YO NO CITY PLUMBING PERMIT - ISSUE .770 QTY. MECHANICAL PERMIT - ISSUE 3_ CP SUMMARY/ACCOUNT NUMBER - EACHFIXTURETRAP - INSTALLFURNDUCTSUPTO100,000BTU BUILDING PERMIT 001-810-00-00-8220 EACH BUILDING SEWER . OVER 100.000 BTU SIGN PERMIT 001-810-00-00-8221 EACHWATERHEATERAND/ORVENT . BOILER/COMPRESSORUPTO3HP PLAN CHECK 001-810-00-00-8821 EACH GAS SYSTEM )TO4OUTLETS . BOILER/COMPRESSOR 315HIP TOTALPLUMBING 001-810-00-00-8222 EACH GAS SYSTEMS OR MORE METALFIREPLACE ELECTRICAL 001-810-00-00-8223 _'C) EACH INSTAL. ALTER, REPAIRWATERPIPE - . -- VENT FAN SINGLE DUCT . MECHANICAL 001-810-00-00-8224 EACHVACUUMBREAKER MECHEXHAUST - HOOD/DUCTS - MOBILEHOME 001-810-00-00-8225 WATERSOFTNER . RELOCATION OFEAFURNACE/HEATER . SOLAR 001-810-00-00-8226 EACHROOFDRAIN(INSIDE) - DRYER VENT - STRONGMOTION 880-519-92-33 TOTAL MECHANICAL I FIRESPRINKLERS 001-810-00-00-8227 TOIAL PLUMBING PUBLICFACILITIESFEE320-810-00-00-8740 OTY. ELECTRICAL PERMIT - ISSUE .uvç" 00 QTY. MOBILE HOME SETUP BRIDGEFEE 360-810-00-00-8740 PARK-IN-LIEU (AREA NEW CONST EA AMPISW1 iBKR CAR PORT . TIF 134-810-00-00-8835 1PH 3PH AWNING LA COSTA TIF 133-810-00-00-8835 EXIST BLDG EA AMP/SWT/BKR A If______ ___________ GARAGE _________________________________ FMF 1 PH 3 PH . LICENSE TAX 001-810-00-00-8162 REMOOEL.ALTER PER CIRCUIT MFF 880-519-92-57 TEMPPOLE 200AMPS - - OVER 200 AMPS - TEMP OCCUPANCY (30 DAYS) - - - - - CREDIT DEPOSIT TOTAL ELELIRICAL F7 TOTAL TOTAL FEES PAYABLE 30 - = 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 CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE I Code shall expire by limitation and become null and void If the building or work authorized by such permit is not commenced within 180 days from the dale of Such DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS permit, or if the building or work authorized by such permit IS suspended or ISSUED: TO COMPLY WITH ALL CITY COUNTY AND STATE LAWS GOVERNING BUILDING CON- I_abandoned at any time after the work is commenced for a period of180 dsys. STRUCTION. WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND APPLICANT'S SIGNATURE OWNER CONTRACTOR 0 KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT, BY PHONE 0 * AN OSHA PET IS REQUIRED FOR EXCAVATIONS OVER 5'0" DEEP AND O7x1O0JTlON OR CONSTRUCTION OF STRUCTURES OVER 3 STORIES IN HEIGHT APPROVED BY DATE 0 0 _1 TYPE DATE INSPECTOR BUILDING FOUNDATION REINFORCED STEEL MASONRY GUNITE OR GROUT SUB FRAME El FLOOR El CEIJNG SHEATHING El ROOF 0 SHEAR FRAME EXTERIOR LATH I INSULATION - INTERIOR LATH & DRYWALL PLUMBING 0 SEWER AND BL/CO 0 FL/CO UNDERGROUND 0 WASTE D WATER TOP OUT 0 WASTE El WATER TUB AND SHOWER PAN GAS TEST 0 WATER HEATER 0 SOLAR WATER ELECTRICAL El ELECTRIC UNDERGROUND LII UFFER ROUGH ELECTRIC El ELECTRIC SERVICE 0 TEMPORARY El BONDING El POOL MECHANICAL El DUCT & PLEM., El REF. PIPING HEAT - AIR COND. SYSTEMS VENTILATING SYSTEMS CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE FINAL PLUMBING ELECTRICAL MECHANICAL GAS BUILDING SPECIAL CONDITIONS FIELD INSPECTION RECORD REQUIRED SPECIAL INSPECTIONS INSPECTORS NOTES INSPECTION REQ IF CHECKED INSPECTORS APPROVAL ATE SOILS COMPLIANCE PRIOR TO FOUNDATION INSP OVER 2000 PSI STRUCTURAL CONCRETE PRESTRESSED CONCRETE POST TENSIONED CONCRETE FIELD WELDING HIGH STRENGTH BOLTS SPECIAL MASONRY PILES CAISSONE -- C\2 CT Goya CD USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS I hereby affirm that I am licensed under C.) I. e of Chapter 9 (commencing with fic Soctlon 7000) of Division 3 of the Business - and Profession. Code, and my license is in full force and effect U- I hereby affirm that I am exempt from the Contrac-tor's License Law for the following reason (Sec 7031 5 I Busineso and Professions Code Any city or county which re-quires a permit to conStruct, alter, improve, demolish, or repair any Structure, prior to its issuance also requires the heaps I pilcant for Such permit to tile a Signed statement that he is licensed pursuant to the provisions of the Contractor License Law (Chapter 9 commencing with Section 7000 of Division 301 the Business and Professions Code) or that is ex-empt therefrom and the basis for the alleged exemption Any violation 55 Section 7031,5 by an applicant for a permit sub-jects the applicant to a civil penalty of not more than five hun- dred dollars ($500) I I, as owner of the property, or my employees with wages 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 thereon and who does such work himself or through his own emptsyees. provided that such improvements are not intend- Ill ed or uttered for sale If, however, the building or improve- ment is sold within one year of completion, the owner-builder 3 will have the burden 01 proving that he did not build or rn- I prove for the purpose of sale) fl I, as owner of the property, am exclusively contracting I with licensed contractors to construct the project (Sec 7044, Business and Professions Cede The Contractor's License Law does not apply to an owner of property who builds or im-proves thereon, and who contracts for each projects with a - to contractor(s) license pursuant to the Contractor's License Law) 0 As a homeowner lam improving my home, and the fallow- I ing conditions exist 19 1 The work is being performed prior to sale 2 I have lived in my home for twelve months I prior to completion of this work 155 3 I have not claimed this exemption during the O last three years tJ lam exempt under Sec - B & P C for this reason I hereby affirm that i have a certificate 01 consent to I If insure or certificate of Workers Compensation in I ance or a certified copy thereof (Sec 3800 Labor Cadet POL NO COMPANY 0 Copy is filed with the city go - Certified copy is hereby tarnished 0 21 CERTIFICATE OF EXEMPTION FROM C) WORKERS COMPENSATION INSURANCE U) (This section need not be completed if the permit is for one hundred dollars 151001 or less) ke 0 1 certify that is the performance of the work for which It this permit is issued. I Shall not employ any person in any 0 manner so as to become subject to the Workers Compen- $ satios Laws of California NOTICE TO APPLICANT If. utter making this Certificate 01 Exemption you should become subject to the Workers Compensation provisions at the Labor Code you moot I forthwith comply with such provisions or this permit shall he deemed revoked fic r 0 I hereby affirm that there is a construction lending agency for the performance of the work for which this per 01 mit Is issued (Sec 3097, Civil Code) WI Lender's Name -a' Lender's Address_________________________________ 7 CARLSBAD BUILDING DEPARTMENT IPPLOCATOO 2075 Las Palmas Dr, Carlsbad, CA 92009-4859 (619) 438-1161 JOB ADDRESS AV ST RD NEAR LI9ATION1 BUSINESS L,ICENSE # CONTRACTORS PH ' OWNER'S PHONE VALUATION PERMIT NUMBER LOT I BLOCK SUBDIVISION OWNER'S NAME T5J ,!Fkc? AbSESSOR PARCEL NO CONTRACTOR ZONE ____________________________ ________________________________ CONTRACTOR'S ADORES ,2ç MAILING ADDRESS STATE LICENSE NO. 155] BUILDING SO FOOTAGE DESIGNER DESIGNER'S PHONE %013 03/31 0101 O211dpt 30 Not Valid Unls Machine Certifi& - DESCRIPTION OF WORK DESIGNER'S ADDRESS STATE LICENSEtO. F/P FLRELEV vD NO REDEVELOPMENT AREA J YO NO NO STORIES I J CONST OCCGP © LQJ yD NO PARKING SPACE RES UNITS GRADING PERMIT ISSUED YOND QTY PLUMBING PERMIT - ISSUE OTY. MECHANICAL PERMIT - ISSUE 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 ].TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP . TOTAL PLUMBING 001-810-00-00-8222 EACH GAS SYSTEMS OR MORE . METAL FIREPLACE . ELECTRICAL 001-810-00-00-8223 EACH INSTAL ALTER, REPAIR WATER PIPE -- . . VENT FAN SINGLE DUCT MECH EXHAUST - HOOD/DUCTS . . MECHANICAL 001-810-00-00-8224 MOB(LEHOME 001-810-00-00-8225 EACH VACUUM BREAKER 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 PUBLIC FACILITIES FEE 320-810-00-00-8740 QTY, ELECTRICAL PERMIT - ISSUE QTY.BRIDGE MOBILE HOME SETUP FEE 360-810-00-00-8740 PARK-IN-LIEU (AREA NEW CONST EA AMP/SWI'BKR CAR PORT ' hF 134-810-00-00-8835 1 PH 3 PH AWNING LA COSTA TIF 133-810-00-00-8835 EXIST BLDG EA AMP/SWTIBKR GARAGE FMF 1PH 3 P LICENSE TAX 001-810-00-00-8162 REMODEL'ALTER PER CIRCUIT MFF 880-519-92-57 TEMP POLE 200 AMPS OVER 200 AMPS TEMP OCCUPANCY (30 DAYS) CREDIT DEPOSIT TOTAL ELECTRICAL E TOTAL 1' TOTAL FEES PAYABLE j I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY Expiration Every permit issued by the Building Official under the provisions of this CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall expire by limitation and become null and void lithe building or work authorized by such permit is not Commenced within 180 days from the date of such DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS permit, or if the building or work authorized by Such permit is suspended or 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 days STRUCTION, WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND I KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES JUDGMENTS, COSTS AND APPLICANT'S SIGNATURE OWNER 0 CONTRACTOR 0 EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE BY PHONE 0 GRANTING OF THIS PERMIT APPROVED BY DATE = * AN OSHA PER.'T IS REQUIRED FOR EXCAVATtONS OVER 5'O" DEEP AND DEMOLITION OR CONSTRUCTION OF STRUCTURES OVER 3 STORIES IN HEIGHT 4' 1/17 0 us 0. U) C us r TYPE DATE INSPECTOR BUILDING FOUNDATION REINFORCED STEEL MASONRY GUNITE OR GROUT SUB FRAME D FLOOR E CEILING SHEATHING 0 ROOF 0 SA EAR FRAME EXTERIOR LATH INSULATION 1 INTERIOR LATH & DRYWALL = PLUMBING 0 SEWER AND BL/CO 0 AL/CO UNDERGROUND 0 WASTE 01 WATER TOP OUT 0 WASTE 0 'VATER TUB AND SHOWER PAN GAS TEST O WATER HEATER 0 SOLAR WATER ELECTRICAL O ELECTRIC UNDERGROUND Ei UFFER ROUGH ELECTRIC o ELECTRIC SERVICE 0 TEMPORARY O BONDING 0 POOL MECHANICAL 0 DUCT & PLEM., 0 REF. PIPING HEAT - AIR COND. SYSTEMS VENTILATING SYSTEMS CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE ITEMS ABOVE HAVE BEEN APPROVED FINAL PLUMBING ELECTRICAL MECHANICAL GAS BUILDING SPECIAL CONDITIONS t7 Jac/ FIELD INSPECTION RECORD REQUIRED SPECIAL INSPECTIONS INSPECTORS NOTES INSPECTION REQ IF CHECKED INSPECTOR'S APPROVAL DATE SOILS COMPLIANCE PRIOR TO FOUNDATION INSP STRUCTURAL CONCRETE OVER 2000 PSI PRESTRESSED CONCRETE POST TENSIONED CONCRETE FIELD WELDING HIGH STRENGTH BOLTS SPECIAL MASONRY PILES CAISSONS - ;.. 2 i" 1' I hereby affirm that I am licensed under I ul VióvleIona of Chapter 9 (commencing with '6oction 1000) of DIvIsion 3 of the Business I and Professions Code, and my license is in L full force and effect U I hereby affirm that I am exempt from the Contrac- I tors License Law to, the following reason (Sec 7031 5 Business and Professions Code Any city or county which re- quires a permit is construct, alter, improve, demolish, or I repair any structure, prior toils issuance also requires the ap- plicant to, such permit to tile a signed statement that he is licensed pursuant to the provisions of the Lontractor 5 I 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 exemption Any I violation of Section 7031 5 by an applicant for a permit sub- jects the applicant to civil penalty of not more than five hun- dred dollars ($500( II I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the struc- I o lure is not intended or offered for sale (Sec 7044. Business .J and Professions Code The Contractor's License Low does not apply to an owner of property who builds or improves I thereon and who does such work himself or through his own employees, provided that such improvements are not intend- UI ed or offered for sale If, however, the bailding or improve- I Z ment is said within one year of completion, the owner-builder will have the burden of proving that he did not build or rn- o prove for the purpose of said fl I. as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec 7044. I Business and Professions Code The Contractor's License Law does not apply to an owner of property who builds or im- proves thereon, and who contracts for each projects with a I U) contractor(s) license pursuant to the Contractor's License Law( 0 As a homeowner lam improving my home, and the follow- ing conditions exist 1 The work is being performed prior in sale 2 I have lived in my home for twelve months U tat 0 prior to completion of this work 3 I have not claimed this exemption daring the last three years for this reason •• ,tf I hereby all irm that I have a certificate of consent to oelf.issure ore certiiicate of Workers Compensationin. surance or a cerlified co y lb reoi lSys 3800 LAb Cadet POLICY N0VJC..dL&q #( COMPANY 7-1- " 0 Copy is filed with the city 0 Certified copy is hereby furnished UI all. o CERTIFICATE OF EXEMPTION FROM U WORKERS COMPENSATION INSURANCE (I) (This section need not be completed it the permit IC is for one hundred dollars ($100) or must 0 i certify that in the performance of the work for which IC 0 this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers Compen- sation Lawn of California NOTICE TO APPLICANT If. alter making this Certificate I 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 he deemed revoked [" 0 I hereby affirm that there is a construction lending $ I agency for the performance of the work for which this per. I mit is Issued (Sec 3097, Civil Code( tail —ii Lender's Name L Lender's Address USE ,BALt-POINTPENOY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad, CA 92009-4859 (619) 438-1161 APPLICATION PEROT JOB SS AV. ST.RD. NEAREST CROSS ST. b DATE OF APPLICATION I BUSINESS LICENSE # VALUATION 1PERMiT NUMBER P-LOtt J3%7 I LOT J BLOCK J SUBDIVISION ASSESSOR PARCEL NO CONTRACTOR CONTRACTORS PHONE A ZONE OWNER'S NAME PHONE i c,.. cLo. BUILDING SO FOOTAGE \.&) LA -j — i 17 CONTRACTOR'S ADDRESS STATE LICENSE NO OWNER'S MAILING ADDRESS s-ô1a rE./JrH q £4 DESIGNER V/O Miis -wue Pt.ac, 'CA 9 P. 1 DESIGNER'S PHONE DESCRIPTION OF WORK fN p DESIGNER'S ADDRESS STATE LICENSE NO. 001103/20 0101 O2B1dPt 5Ti..-ir-t Av e.-, 105e0 F/P F LR ELEV, I NO DCC GP EDU I STORIES YO NO I PARKING SPACE RES UNITS GRADING PERMIT ISSUED i REDEVELOPMENT I TYPE 0CC LOAD I FIRE SPP 1 AREA I0'' I T 0 N 0 vD NO YO NO Not Valid Unless Machine Certified — OTY PLUMBING PERMIT - ISSUE QTY. MECHANICAL PERMIT- ISSUE 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 315 HP , TOTAL PLUMBING 001'810-00-00'8222 EACH GAS SYSTEM 5 OR MORE . METAL FIREPLACE , ELECTRICAL 001-810-00-00-8223 / 0 EACH INSTAL ,ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT . MECHANICAL 001-810-00-00-8224 EACH VACUUM BREAKER , MECH 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 PUBLIC FACILITIES FEE 320-810-00-00-8740 QTY ELECTRICAL PERMIT- ISSUE QTY.BRIDGE MOBILE HOME SETUP FEE 360-810-00-00-8740 PARK-IN-LIEU (AREA NEW CONST EA AMP/SWI 'BKR CAR PORT . TIF 134-810-00-00'8835 1 PH 3 PH AWNING LA COSTA TIF 133-810-00-00'8835 EXIST BLDG EA AMP/SWT/BKR GARAGE . FMF 1 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) CREDIT DEPOSIT TOTAL ELELTRICAL TOTAL TOTAL FEES PAYABLE = I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY I Expiration Every permit issued bytne$uiIdtng Official under the provisions ofth CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall expire by limitation and become null and void it the building or work = * AN OSHA PEIT IS REQUIRED FOR EXCAVATIONS OVER I authorized by such permit is not commenced within 180 days from the date of such DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT 15 I permit, or if the building or work authorized by such permit is suspended or 5'0" DEEP AND DEMOLITION OR CONSTRUCTION OF ap, srTTuREs OVER 3 STORIES IN HEIGHT ISSUED TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON- I abandonod Ving4ifris after the work is commenced for period of 180 days STRUCTION, WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS A APPLI GNATUREJ OWNER coNTAACTopX APPROVED BY DATE EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF GRANTING OF THIS PERMIT _____________________ __________ By PHONE 0 - TYPE DATE INSPECTOR BUILDING FOUNDATION REINFORCED STEEL I MASONRY GUN ITE OR GROUT SUB FRAME U FLOOR U CEILING SHEATHING U ROOF 0 SHEAR FRAME EXTERIOR LATH INSULATION - INTERIOR LATH & DRYWALL PLUMBING U SEWER AND BL/CO U FL/CO UNDERGROUND U WASTE 0 WATER TOP OUT 0 WASTE U WATER TUB AND SHOWER PAN GAS TEST U WATER HEATER U SOLAR WATER ELECTRICAL 0 ELECTRIC UNDERGROUND di UFFER ROUGH ELECTRIC U ELECTRIC SERVICE U TEMPORARY I/f U BONDING U POOL MECHANICAL U DUCT & PLEM., U REF. PIPING HEAT - AIR COND. SYSTEMS VENTILATING SYSTEMS CALL FOR FINAL INSPEC!ON WHEN ALL APPROPRIATE ITEMS ABOVE HAVE BEEN APPROVED FINAL 1 PLUMBING ELECTRICAL MECHANICAL GAS BUILDING SPECIAL CONDITIONS FIELD INSPECTION RECORD REQUIRED SPECIAL INSPECTIONS INSPECTORS NOTES INSPECTION REQ IF CHECKED INSPECTORS APPROVAL DATE SOILS COMPLIANCE PRIOR TO FOUNDATION INSP STRUCTURAL CONCRETE OVER 2000 PSI PRESTRESSED CONCRETE PCs TENSIONED CONCRETE FIELD WELDING HIGH S1RENGTH BOL 1S SPECIAL MASONRY PILES CAISSONS OTT 02\0 TO 0 I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Soctlon 1000) ofDivlsion 3 of the Business and Professions bode, and my license is in full force and eff44 I hereby affirm that I am exempt from the Contrac tsr's License Law for the following reason (Sec 7031 Business and Professions Code Any city or county which re-quires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the ap-plicant for such permit to file a signed statement that he in licensed pursuant to the provisions of the Contractor License Law (Chapter 9 commencing with Section 7000 of Division ant the Business and Professions Code) or that is ex-empt therefrom and the basis for the alleged exemption Any violation of Section 7031 5 by an applicant for a permit sub-lects the applicant to a civil penalty of not more than five hun- dred dollars ($500) II I, as owner of the property, or my employees with wages 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 properly 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 offered 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 im-prove for the purpose of sale) 11 I. 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 loan owner of property who builds or im-proves thereos, and who contracts for each projects with contractor(s) license pursuant to the Contractor's License Law) 0 As a homeowner lam improving my home, and the follow-ing conditions exist I The work is being performed prior to sale 2 I have lived in my home for twelve months prior to completion of this work 3 I have not claimed this exemption during the last three years o lam exempt under Sec , B & P C for this reason EC (p 0- 0 I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers Compensation In. I surance ore certified copy thereof (Sec: 3800, Labor Code) POLICY NO COMPANY I 0 Copy is filed with the city 0 Certified copy is hereby furnished CERTIFICATE OF EXEMPTION FROM I WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars 151001 or lens) 0 I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any I manner so unto become subject to the Workers Compen. nation Lawn of California NOTICE TO APPLICANT If, after making this Certificate I of Exemption you should become subject to the Workers Compensation provisions of the Labor Code, you mast I forthwith comply with such provisions or this permit shall be deemed revoked El I hereby affirm that there is a construction lending agency for the performance of the work for which this per. mit is issued (Sec 3097, Civil Code) $ Lenders Name___________________________________ Lender's Addrens_________________________________ I USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS CARLSBAD BUILDING DEPARTMENT APPLUCATOOI?!1 A PERMIT 2075 Las Palmas Dr., Carlsbad, CA 92009-4859(619) 438-1161 JOB ADDRESS AV. ST. RD, NEAREST CROSS ST. 2:0/f 414409T X40 DATE OF APPLICATION BUSINESS LICENSE # /10 CONTRACTOR CONTRACTORS PHONE of ~dO/ /r C b 74J 'Z' CONTRACTOR'S ADDRESS STATE LICENSE NO. 157 bis%4 P o1&ø7 VALUATION PERMIT NUMBER 11'57 LOT BLOCK SUBDIVISION ASSESSOR PARCEL NO ZONE OWNER'S NAME OWNER'S PHONE BUILDING S0 'FOOTAGE OWNER'S MAILING ADDRESS z ' DESIGNER - DESIGNER'S PHONE UUU( ÜU.L 1ü/3i/6jiT 25. Not Valid Unless Machine Certified DESCRIPTION OF WORK -7~-r DESIGNERS ADDRESS STATE LICENSE NO. j F/P FLRELEV 'D NO REDEVELOPMENT 1AREA V 0 NO I j I NO STORIES TYPE 1CONST OCCGP DCC LOAD EDU I I FIRE SPR I vD NO PARKING SPACE RES UNITS GRADING PERMIT ISSUED V 0 N 0 QTY PLUMBING PERMIT - ISSUE 7 '- QTY MECHANICAL PERMIT - ISSUE 0-0 3 SUMMARY/ACCOUNT NUMBER - — EACH FIXTURE TRAP - INSTALL FURN DUCTS tiP 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 I 104 OUTLETS . BOILER/COMPRESSOR 3 15 HP , TOTAL PLUMBING 001-810-00-00-8222 ELECTRICAL 001-810-00-00-8223 EACH GAS SYSTEMS OR MORE METAL FIREPLACE . 'Z15''j!,j' EACH _INSTAL ,ALTER, REPAIR WATER PIPE - -- VENT FAN SINGLE DUCT . MECHANICAL 001-810-00-00-8224 EACH VACUUM BREAKER . MECH 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 FIRE SPRINKLERS 001-810'00-00-8227 TOIAL PLUMBING I PUBLIC FACILITIES FEE 320-810-00-00-8740 QTY. ELECTRICAL PERMIT - ISSUE QTY MOBILE HOME SETUP BRIDGE FEE 360-810-00-00-8740 PARK-IN-LIEU (AREA NEW CONST EA AMP/SWI BKR 0 CAR PORT TIF 134-810-00-00-8835 1 PH 3 PH AWNING . LA COSTA TIF 133-810-00-00-8835 EXIST BLDG EA AMP/SWT/BKR GARAGE . FMF 1 PH 3 PH . LICENSE TAX 001-810-00-00-8162 REMODEL'ALTER PER CIRCUIT 880-519-92-57 TEMP POLE 200 AMPS OVER 200 AMPS TEMP OCCUPANCY (30 DAYS) . kCREDIT — . DEPOSIT 1TAL ELELTRICAL TOTAL TAL FEES PAYABL — - I I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY f Expiration Every permit Issued by the Building Official under the provisions of this CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall expire by limitation and become null and void If the building or work authorized by such permit is not commenced within 180 days from the date Of such DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMITS I permit, or if the building or work authorized by such permit IS suspended or 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 ¶80 dave WHETHER SPECIFIED E INDEMNIFY AND APPLICA 'S KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS.APPROVED COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. NE 0 * AN OSHA PERT IS REQUIRED FOR EXCAVATIOPitS OVER I 5O DEEP AND DEMOLITION OR cONSTRUCTION OF STRUCTURES OVER 3 STORIES IN HEIGHT I BY DATE - '• \• . • -. - •''-. ._.•• \ FIELD INSPECTION RECORD REQUIRED SPECIAL INSPECTIONS INSPECTORS NOTES INSPE TION REQ IF INSPECTORS D - - CHECKED APPROVAL ATE -- SOILS COMPLIANCE PRIOR TO FOUNDATION INSP STRUCTURAL CONCRETE OVER 2000 PSI PRESTRESSED CONCRETE POST TENSIONED CONCRETE FIELD WELDING HIGH S1RENGTH BOLTS SPECIAL MASONRY PILES CAISSONS L1ARZED - -I nv p51 Oy ©fl Jb1 DEVE - LOMk1 Me im £IEtG 7'\- TYPE DATE INSPECTOR BUILDING FOUNDATION REINFORCED STEEL MASONRY GUNITE OR GROUT SUB FRAME 0 FLOOR 0 CEI)JNG - SHEATHING El ROOF El S!EAR FRAME EXTERIOR LATH INSULATION INTERIOR LATH & DRYWALL PLUMBING Li SEWER AND BL/CO LI FL/CO UNDERGROUND 0 WASTE L WATER TOP OUT 0 WASTE 0 WATER TUB AND SHOWER PAN GAS TEST LI WATER HEATER 0 SOLAR WATER ELECTRICAL 0 ELECTRIC UNDERGROUND [U UFFER ROUGH ELECTRIC 0 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 PLUMBING . ELECTRICAL ) MECHANICAL GAS BUILDING SPECIAL CONDITIONS