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Home My WebLink About2621 ROOSEVELT ST; MULTI-PERMIT FILE; 83-123; Permitfll z 0 ~ CIC :5 u .., 0 IC i[ 0 u IC "' 0 ... 5 ~ "' z • 0 z 0 ;:: ~ z "' IL 2 0 u fll a: "' ~ CIC 0 :t; ![ O I hereby affirm lhat I am licensed under provlelone of Chapter 9 (commencing with Section 7000) of Division 3 of Iha Business and Profeaslons Code, and my license Is In full force and effect. C _,c Lie No~k._ Class I hereby affirm that I am exempt lrom 1he Contrac- lof' s License Law lor the lollowlng reason (Sec. 7031 .5 Business and Professions Code: Any city or county which r .. quires a permit to construct, alter, Improve, demoUsh, or r~tr any structure, prior to Its issuance also requires theap-- plicanr lor such permit lo file a si9ned slalemenl Iha! he is lteensed pursuant to the provisions of the Contractor's License Law (Chapter 9 commencing wnh Section 7000 ol Division 3 ot the Business and Professions Code) or !hat is e,.-2\~~~1~1~~ :~,~s~ ~~1: ~~1~~~1i s~~ jecls the appQcanl 10 a ciYH penally~ not more than five hun-dred dollars ($500). □ I. as owner of the property. °' my employees wilh wages as their sole compensation, will do the work. and the struc· Me is not Intended Of offet"ed 10< sale (Sec. 70-44, Business and Professions Code: The Conlracl0<'s License Law does not apply lo an owner of property who builds Of improves thereon and who does such WO<k himself Of through his own employees, provided that such hnprovements are not intend· ed °' ottered 10< sale. If. however. the building or imprOYO-ment is sokS within one year ot completiOn. the owner-bulkier will have Iha burden of proving lhal he did no1 build Of Im- prove !0< the purpose of sale). □ I. as owner ol the pr0pefly, am exclusively conlraclillg wilh r.censed contractors lo conslruc11he project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply lo an OWOOf 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 I am lmj)roving my home, and lhe follow-Ing conditions exist t :he~~be/;,111,:1= f~iof i!~lemooths 3. r:: :rp:~ :: :'!ption during the last three years. □ lamexet"OplunderSec. ______ , B&P.C. for this reason □ I hereby affirm that I nave a certificate of cons.eat to sell-insure, or a cert1f1cate of Workers' Compensation Insurance, Of a cert1f1ed copy thereof (Sec 3800. Labo< Code). POLICY NO C~PANY ~ Copy 1stili O Cen1f1ed copy 1s hereby turmshed CERTIFICATl OF EXEMPTION FROM WORKERS" COMPENSATION INSURANCE (This sec1Ion need not be completed ,r lhe permII 1s t0< one hundred dOllars (S11JO) Of less) D I certify that in the per1orf'Tl¥1ce ot 1he work IOJ which lhts permit 1s issued, I shall not employ any person an any manner so as to become sub1ect to lhe Workers· Compensation Laws of Cahtorn,a NOTICE TO APPLICANT It. after mak1n~ '"IS Cer1• hcate ot Exemc,11on. you should be<:ome subJect fl) lhe WOl1lers· Compensation prov1s1ons ol 11'\e Labor Code. you must f0t11'\w111'\ comply with such prov1s10ns or this permit shall be deemed revOked 0 I nereby affirm that there 1s a construction lending agency tor the performance of 11'\e work tor which th,s perm,t 1s issued {Sec 3097, c,,,.,t Code) Lender s Name ___________ _ Lender's Address __________ _ USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT 1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525 JOB ADDRESS -2 L~/ A:,,,~.,rvyL,-r OWNER'S NAME 1 OWNER'S PHONE OWNER'S MAILING ADDRESS ~ft OF mucATIONT ~r rt-3/~.1h.l t COptT..!'ACT!)R l 7 57-/Uft',1~ £"'u.,,,_.,.,_J~ CONTRACTOR'S ADDRESS 9~ S'o~.uv~~ ~,;e LOT! BLOCK I SUBOIVISION I ASSE~OR PARCEL NO -....... _.lO 6 l O I ,;1:~ z:;lc..,' 0ESIGNEA I DESCRIPTION OF WORfr~4 ~ .$~~ FIGNER'SAOORESS ~--,4.., /~ ~-~Y CENSUS TRACT GP LAND USE PARKING SPACE RES UNITS QTY.I PLUMBING PERMIT -ISSUE 7§!!.. EACH FIXTURE TRAP GRADING ~ERMIT ISSUED YO N 0 F/P FLR ELEV. vO NO REDEVELOPMENT AREA vO NO QTY.I MECHANICAL PERMIT -ISSUE INSTALL FURN. DUCTS UP TO 100.000 BTU ---m,- STORIES TYPE CONST 3- --•-LICE.,.. I VALUATION p 1--,,P /"fO•-. - -~,..,.,..,:lzoNE 7,,,22. .,~ 79 'D~EJIMITNl.lMBER /eJ-3 UCENIENO. PLAN I.D. # BLOG USE CODE --~ LICENSE. I STANDARD PLAN # BUILDING SQ. FOOTAGE BESIGNEfl'S.~ - OCCGP EDU occ LOAD I FIRE SPA vO NO Nor Valid Unlffl Machine C4rrified SUMMARY/ACCOUNT NUMBER BUILOING PERMIT 01-00-00-8220 EACH BUILDING SEWER SIGN PERMIT 01-00-00-8221 PLAN CHECK 01-00-00-8806 ----------j I I OVER 100,000 BTU J I ---··· J J EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP EACH GAS SYSTEM 1 TO 4 OUTLETS EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 3-15 HP METAL FIREPLACE TOTAL PLUM Bl NG 01·00-00-8222 ELECTRICAL 01·00-00-8223 -:z;J- EACH INSTA~ •. ALTER. REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 01·00-00-8224 . -··-····-·· MECH EXHAUST -H000/0UCTS EACH VACUUM BREAKER M0BILEHOME 01·00-00-8225 WATER S0FTNER RELOCATION OF EA FURNACE/HEATER M0BILEH0ME PARK INSP EACH ROOF DRAIN (INSIDE) v SOLAR 01·00-QQ-8226 TOTAL PLU MBING I TOTt;L MECHANICA~ STRONG MOTION 80-92-33·0519 FIRE SPRINKLERS 01-00-00-8227 QTY., ELECTRICAL PERMIT -ISSUE NEW CONST EA AMP/SWT/BKR s-=ff QTY. ~UE ~JORS ./ 1 PH 3 PH 1 7 7] s/oRArj_ Ms EXIST BLOG EA AMP/SWT/BKR ~I -y ./ ,-,J.1oc-.l'JJTr/;,.AGE -IFJ 17 1 PH 3 PH ... I l 7.::9_. D t/.>u8J IL A f)'V REMODE L/ALTER PER CIRCUIT /IJP?l~,OG ~ PUBLIC FACILITIES FEE 32-00-00-8923 BRIDGE FEE SCHOOL FEE • DISTRICT carlsbad 80-92-21-0519 Encinitas 80-92-22-0519 San Dieguito 80-92· 23·0519 San Marcos 80-92-24-0519 TEMP POLE 200 AMPS fl OVER 200 AMPS 7 \J TEMP OCCUPANCY (30 OAo/ . ~ ii: >, ~ 0 a. E ,:!. I -0 0 (!J i:: <ti .!2 0. a. <( I .>t:. C a: 0 (/) (/) Cl> (/) (/) <( I 3 .2 Q) >- ui (/) Cl> 0 0 a: <ti <G 0 ~ Cl> 0 C <ti C ii: ~ I C Cl> Cl> C, 0 7 -------t-I ~ 1 ~ ~-30 , ·d-i I TOTAL SOLAR ~ TOTAL FEES PAYABLE I ~ TOTA L-11°E CTR I CAL l ~o, I I I-g . a. I HAVE CAREFULLY EXAMINED THE COMPLETED ""APPLICATION AND PERMIT" AND 00 HEREBY a ElcpiratiOn. e-yperm1tileuedt,rt11e8uilcllngOlllcilllunclarllle=ait1111 CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code ahall expire by Rrnitallon andlleccilllenulllillilwold. lftlle otwrilll DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS aut~IHd \'I' such permit le noccom ... -.s Willlln ,.,c1aplr~ltle °'-" ISSUED: TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON· :::,,~~Ille ':::;&..°"111e-=.--r:=:.:=-:--•a, 1 °' .•..... PBIMQ • ...,._, FOR EXCAVATIOMI OVS1 •ll'r'_.MID DEIIOUTION Of! 00NSTAUCl10N 011 9'IIUCIUl&OVSI lalORES IN HEIGHT STRUCTION, WHETHER SPECIFIED HEREIN OR NOT, I ALSO AGREE TO SAVE INDEMNIFY AND • KEEP HARMLESS THE CITY OF CARLSBA,D AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND APPLICA~T"S 51 ~ ~ 12 CONTRACTOR a APPROVED BY~ R DATE EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE ~:a •, "5J GRANTING OF THIS PERMIT. ~ ~ ~~:,,,!;d:E:I:____ BY flH0NE O ._.., ' : p _ ~~ -t3 -- (/) C ~ .s::. 3 --. -INSPECTION TYPE DATE INSPECTOR BUILDING I FOUNDATION REINFORCED STEEL - MASONRY GUNITE OR GROUT FLOOR & CEILING SUB FRAME SHEATHING FRAME EXTERIOR LATH lNSULATION I '· INTERIOR LATH & DRYWALL I PLUMBING SEWER AND BL/CO ' PLUMBING UNDERGROUND r' PLUMBING TOP OUT I. r TUB AND $HOWER PAN GAS TEST .. ELECTRICAL '' TEMPORARY POWER -I. , ,t_ I. ' ELECTRIC UNDERGROUND I ROUGH ELECTRIC I ' • ELECTRIC SERVICE l · . ' ; BONDING G. F. I. -SMOKE DETECTOR I MECHANICAL I - DUCT & PLEM., REF. PIPING HEAT -AIR COND. -SOLAR SYSTEMS -. VENTILATING SYSTEMS CALL FOR FINAL INSPECTION WHEN ALL APPROPlllATE ITEMS ABOVE HAVE BEEN APPROVED. JOB SITE FINAL PLUMBING ELECTRICAL MECHANICAL I GAS ... ,._--:-· ~-.,, .. :) . ,·· . .: . ; ,,_ BUILDING , SPECIAL CONDITIONS ... ~ CERT OF OCCUPANCY ISSUED FIELD INSPECTION RECORD REQUIRED SPECIAL INSPECTIONS INSPECTION REO IF INSPECTOR'S CHECKED APPROVAL SOILS COMPLIANCE PRIOR TO FOUNDATION INSP STRUCTURAL CONCRETE OVER 2000 PSI PRESTRESSED CONCRETE POST TENSIONED r CONCRETE FIELD WELDING t HIGH STRENGTH t BOLTS SPECIAL MASONRY PILES•CAISSONS i . ; • -. ~ ' . - - .. ----- -,-.J -~~·; I t • I • ., - -. . - INSPECTOR'S NOTES DATE -•' I •I , n C • • •1•; I 1 I ... ( j . - ' I .. •. :----!-I ~ ' 1 - ' ~ ., . . ' ' -. . . ~ - " ---,.,;;,-;-.-.c~ .. .. -. -. ----,,. .... I . -; -• . .,. . ' -" --· ·--. . ,. ' ,. . " -· • . ----------L--.~~~-"~'#.~'A-IV ~ JE---6 I<. $ (.I ,?"?t_/e:JC> ___ _ r.eR:...:..,m__,c_::.;e,i...;;;...~....:...;A~. k ,t~e, ~IL ,-----------------•-------,,---.......------,,t-13.~fl // JAi. L----....... --.....i..-))r;...' 3<JII /AL~. ~R,Ay t &' $ •n• ,(ii; .., . EuuM1.· 1°M,<,1t I, 1:-yc,JT -P#lftrtw oic:$0:rn-00,----- LICENSED 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 lull force and ef- fect. OWNER-BUILDER DECLARATION 0 1 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 live hundred dollars ($500). 0 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or of- fered for sale (Sec. 7044, Business and 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. II, 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). '.JI, 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 reaso,n_ ___________ _ Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of cot, sent to sell-Insure, or a certificate of Work ... ' Compensation Insurance, or a certllie thereof (Sec. 3800, Labor Code). POLICY NO•~----------'~ COMPANY ____________ _ □Copy Is filed with the city. □Certified copy Is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed II 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: 11, alter making this Cer- tificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction len• dlno aaencv for the oerformance of the work for • (. - CITY OF CARLSBAD-BUILDING DEP ARTMEN T USE BALL POINT PEN ONLY APPLICATION & PERMIT 1200 ELM AVENUE (714) 438-5525 NO. £ _,d~B ADDRESS AV. ST. IDATE OF APPLICATION ~6~/. -_J-,,, ,, I R~ I I I l '1 -1 , 7 I I I I I I I I I I I I I I I I I OWNErh;~.~~ OWNER'S PHONE ~;:RACTOR ~• OWFl:E~AIL1NGARESS , !}_ ,,_· ~ ~ :>/ ,~&f¥D;E3eJ DESIGNER APPLICANT TO FILL IN INFOR - MATION WITHIN RED LINES. BUS. LICENSE PERMIT NUMBER /tf¥~/ ~bLI" STATE LICEN!I£ y,--~s~ CONTRACTOR'S PHONE ST ATE LICENSE t~ BLOCK I sz.s10 ....• i -:t: I ./ASSESSOR'S PARCEL NO. ~A-./ 'I •-I I I I I I I I I I 4/1 /6~62'3 ~7.l' DESCRIPTION OF wll"RII" DESIGNER'S ADDRESS DESIGNER'S PHONE OOUt6P23 i.i1, 11 ro p/ .. t,. Ode 162~'3 02 "' 11: CENSUS TRACT GP LANO USE ZONING I RES. UNITS I PARKING SPACE # I NUMBER OF STORIES sq. f t. Not V•lid Unless Machin, CKtifi«J BLDG SQ. FT. BLDG USE occ. GP I STANDARD PLAN II I PLAN ID II I TYPE CONST I occ. LOAD I QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT. EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TD 100,000 BTU EACH BUI LDING SEWER OVER 100,000 BTU EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UPTO 3 HP EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP ~ J s EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP EACH INSTAL, ALTER, REPAIR WATER PIPE VENT FAN SINGLE OUCT EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOO/OUCTS '\7ZI, T TlZl,'l'T{)l\T WATERSOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . I I I T~~TW. 3-00 ISSUE 3 .. oo SIGN PERMIT I , I I I TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I . I I I CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I I I ELECTRICAL PERMIT AMT. TOTA' -' ....... I I I QTY. AMT. QTY. MOBILE HOME PERMIT ( (ELECTRICAL .// .,,_ ·-~ ........ -'. I -r:1.71 c;, " NEW CONST EA AMP/SWT/BKR AWNING mcl;'ttANl!;Al l I i I 1 PH .25 3 PH . -PORCH MOBILE HOME I I I EXIST BLOG EA AMP/SWT/BKR A_v SET-UP SOLAR I , I I I 1 PH .25 3 PH /r • ('/ RAMADA, CABANA I . I I I REMODEL/Al TER PER CIRCUIT ., Jl ~ FENCE OVER 6' ~-1---,..., ........ ....,,...4--.; ,...,... I I I I T~"n nn, i:: ,nn AMPS -~ TOTAL MOBILE HOME MICO -FI LM" ' . I I I ,,........., OVER 200 AMPS --...... ,& &A I . I I : I / TEMP OCCUPANCY (30 OAYS) .ll.lTO f-111" I I I I T <;;s1t1<: --, ? on ISSUE 5 .00 I . I I I TOTAL ELECTRICAL :27~ TOTAL FEES PAYABLE I . ~17.ptt;, CONTRACTOR I I SCHOOL FEES I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DD •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I •~••ouno~ FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY, STRUCTURE VER 3 STORIES IN HEIGHT COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION. WHETHER Po J'f-~ --~~-~ SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM- LESS THE CITY OF CA RLSBAO AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND EXPENSES WHICH MAV IN ANY WAY ACCRUE AGAINST SA.ID CITY IN CONSEQUENCE ...--, ,I OF THE GRANTING OF THIS PERMIT. A_.-LICANT"S SIGN')o('tl.hle--OWNER~ACTORO r~ 4;1i-J~ AGENT BY PHONE O # ~ --. ~ ~ ~ 5 j:=: ~ c.. Vl ?;; SITE ADDRESS: . ~ OWNER: --PERMIT NO: FIELD INSPECTION RECORD -·-, -- INSPECTION DATE INSPECTOR INSPECTOR'S NOTES WOOD FLOOR FOUNDATION• FORMS • SET BACK • TOILET UNDER FLOOR PLUMBING \ '· '' ! --· -· ~ .. ,;:-.! ~ ... -;... --• i:: 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 EXT ERIOR LATH OK • PLACE STUCCO FIREPLACE DAMPER 8: STEEL PLATE Tl Es/HEIGHT OF CHIMNEY OTHER . . , ' : ' TEMP POWER (POLE) SEWER GAS TEST ' SWIM POOL • STEEL BONDING . • PRE DECK ', 1. 1,.~,. • FENCE PREPLASTER SHOWN • FRAME (-• n ', • PAN ' -. . FINAL INSP BY BLDG DEPT . ' OTHE.R DEPT'S REQ COMPLETED f ., ELEC METER-PERM-TEMP ·~ GAS METER-PERM-TEMP CERT OF OCCUPANCY ISSUED • • LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provl• slons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes,. slons Code, and my license Is In full force and ef• feet. OWNER-BUILDER DECLARATION D I hereby affirm that I am exempt from the Con• tractor's License Law for the following reason (Sec. 7031.5 Business and Professions Code), Any city or county which requires a permit to con• struct, alter, Improve, demolish, or repair any structure, prior to Its issuance also requires the applicant for such permit to file a signed state- ment that he Is licensed pursuant to the prov!· slons 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). D 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 of• fered for sale (Sec. 7044, Business and Profes• slons 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). '.JI, as owner of the property, am exclusively con• tractlng 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 reaso ~------------ Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of con· sent to self-Insure, o, a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Labor Code). ~~~!:.;>·------------ □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 per• mlt 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 Callfornla. NOTICE TO APPLICANT: If, after making this Cer• tlflcate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction ten• ding agency for the performance of the work for CITY OF CARLSBAO-BUILOING DEPARTMENT USE BALL POINT PEN ONLY APPLICATION & PERMIT 1200 ELM AVENUE (714) 438-5525 NO. JOB ADDRESS ivR~T. IDA~~J~ ;)J t,,12, I / I 1 /J n1 ni < 1 A I M'_.1 I iii ,s:;:, l C1.l.l1t I I 1'< 1-f..1A id. I I OWNER OWNER•s PHONE PRIME CONTRACTOR k / ,/ii'Tn~ ftv~e;vo. 7'l.q-P14 I APPLICANT TO FILL IN INFOR - MATION WITHIN RED LINES. BUS. LICENSE PERMIT NUMBER STATE LICENSE go/ J;:L3 OWNER'S MAILING ADDRESS CONTRACTOR'S ADDRESS CONTRACTOR'S t If r.tJ 'I, .Jp/ ;J._i ~ ( P.O. (3c>( 3S7 CA~ls644 PHONE uJ•.: 16 7.'J:J l':/?3/. IC, 1 LOT BLOCK I SUBDIVISION I ASSESSOR'S PARCEL NO. DESIGNER STATE LICENSE l J J I I I I I I I I DESCRIPTION OF WOR4~,.,✓--~ ,;, ~~ .... ~-~ -,, DESIGNER'S ADDRESS DESIGNER'S PHONE /0~;_,/_ ~'-i-/. , CENSUS TRACT --GP LAND USE # zoN'f'NG I RES. UNITS I PARKING SPACE I NUMBER OF STORIES Not V¢Unlm lbchin• c.rtifi«J BLOG SQ. FT. BLOG USE occ. GP I STANDARD PLAN II I PLAN ID II I TYPE CONST OCC. LOAD I QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT. ~o L--- EACH FIXTURE TRAP '-~ INSTALL FURN. DUCTS UP TO 100.000 BTU ' ft1 2X EACH BUILDING SEWER "--~ OVER 100.000 BTU • I EACH WATER HEATER AND/DR VENT "X' \ BOILER/COMPRESSOR UP TO 3 HP .f' V IT EACH GAS SYSTEM 1 TO 4 OUTLETS_,,,,,,,...- -----BOILER/COMPRESSOR 3-15 HP I I l EACH GAS SYSTEM 5 DR MD~ ~ BOILER/COMPRESSOR 16-30 HP ~/ 1/~ C EACH INSTAL., ALTER, ljEAAIR WATER PIPE ' -VENT FAN Sl~lGLE DUCT / EACH LAWN SPl3JNKLER SYSTEM MECH EXHAUST -HOOD/DUCTS /. , , WATER SijH"NER RELOCATION OF EA FURNACE/HEATER / ,,. BUI LOI NG PERMIT l . I I I /_ ,J#~ ••• /-s ·";:, ~_,,,;_.,, _ _. ... ,,,..,-#71 SIGN PERMIT I I I I ~ , TOTAL PLUMBING TOTAL MECHANICAL / PLAN CHECK I I I I . CONTRACTOR CONTRACTOR -ALL INCLUSIVE PERMIT I I ' I ELECTRICAL PERMIT AMT. MOB I LE ~E P~T AMT. TOTAL PLUMBING I I 1-UTY. QTY. ELECTRICAL f/1"';~-5/J NEW CONST EA AMP/SWT/BKR A -,,,., /.2.. . .5,_: ,....... AWNING y MECHANICAL i' ( I 1 PH .25 1PH PORCH / \. MOBILE HOME I I I EXIST BLDG EA AMP/SWT/BKR SET-UP / '\ SOLAR I . I I I 1 PH .25 3 PH RAMADA, CAB;rf'lA \. I , I I . I REMODEL/ALTER PER CIRCUIT FENCE ov~s· \ A,/_,, ~-= I , I I . I TEMP POLE 200 AMPS TOTALJ{oBILE HOME \ MICO-p¢WI~ ! . l I l OVER 200 AMPS / \ ... I I l l , ; TEMP OCCUPANCY (30 DAYSI / \ I I I I /_ -~ :, .J ~ -\ I I . I I -TOTAL ELECTRICAL /~~ \ TOTAL FEES PAYABLE I 1/,q,~ ...- CONTRACTOR I I , I HAVE CAAEF ULL Y E XAMINEO THE COMPLETED "APPLICATION ANO PE AMIT, ANO DO HEREBY CERTIFY THAT ALL INFORMAT ION HEREON IS TRUE ANO CORRECT AND I 5'·0'" DEEP ANO DEMOLITION OR CONSTRUCTION OF FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED; TD COMPLY WITH ALL CITY. STRUCTURES OVER 3 STORIES IN HEIGHT .. • w < 0 ~ > ~ i:= 1:d Q. V) ~ •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS 0~ ?~ COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION , WHETHER n¥/ SPECIF JED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM- LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. 1'0 APPLICANT'S SIGNATURE• OWNERQ CONTRACTOR□ rPPROVEO BY DATE ' AGENT 0 BY PMONF n I • SITE . " .. OWNER: ADDRESS: • -,--; PERMIT NO: 1 I' . . I' .,-. .. L - ' ,· FIELD INSPECTION RECORD ~ INSPECTION DATE INSPECTOR INSPECTOR'S NOTES WOOD FLOOR .. -FOUNDATION• FORMS • SET BACK • TOILET ' UNDER FLOOR PLUMBING .. r UNDER FLOOR HEATING . . --OK TO INSTALL SUB FLOOR •. 1 ~ 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 T APE . . EXTERIOR L ATH OK • PLACE STUCCO _, ' - FIREPLACE ~ '· ~--... DAMPER & STEEL · PLATE T IES/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 DEPT'S REQ COMPLETED ELEC METER-PERM-TEMP ~ GAS METER-PERM-TEMP ~ CERT OF OCCUPANCY ISSUED LICENSED 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 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 provl• 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). 0 1, as owner of the property, or my employees with wages as their sole compensation, wlll 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 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). '.JI, 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 1•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 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. 3800, Labor Code). POLICY NO, ___________ _ COMPANY ___________ _ □Copy is filed with the city. D Certified copy Is hereby furnished. J CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If the per- mit Is for one hundred dollars (SHJO) or less). I certify that in the performance of the work for which this permit Is Issued,_! 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- tificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such previsions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I h"'ebv affirm that there Is a construction len- CITY OF C ARLSBAD-BUILDING DEPARTMENT APPLICATION & PERMIT USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525 NO. JOB ADDRESS 1C (i 1f / 1$ i;:;~0/j J i?h?N J. 1~1:J1/1 f I I .£. i/) 10 ..< 1e I Viet /, ti ,~Ci I I I I OWNER /;,6'-re~Z:-.5 OWNER'S PHONE PRIME CONTRACTOR -St-etJAeA5 ekc:#ic APPLICANT TO FILL IN INFOR- MATION WITHIN RED LINES. BUS. LICENSE PERMIT NUMBER i1?4ts- STATE LICENSE 7'1-~c; ~L/)7? ? I I J , ·-,o~.1 T},/tf//cr /4> OWNE~~~Ll~/'~A)/'~d r ),,~ /Jcr!l:llf.s'de ;;:;re:; A;R3:, U/il,d/ CONTRACTOR'S \JIJl.ll/'I ,r:;.';U I~ I t,i:' ! I 7~tt;-~,3~ LOT BLOCK SUBDIVISION I ASSESSOR'S PARCEL NO. DESIGNER STATE LICENSE I I I I t I I I I I I DE SCRIP ~;.Jc/'/~/ DESIGNER'S ADDRESS DESIGNER'S PHONE -~ ' CENSUS TRACT GP LAND USE ZONING I RES. UNITS I PARKING SPACE I NUMBER Of STORIES Not Valid Unlllss Machin, Cmifi«I BLOG SQ. fT. BLOG USE occ. GP I ST AN DARO PLAN # I PLAN I D # I TYPE CONST I occ. LOAD I QTY. PLUMBING PERMIT ~ AMT. QTY. MECHANICAL PERMIT AMT. - EACH FIXTURE TRAP ~ INSTALL FURN. DUCTS UP TO 100,000 BT'-'-""'" 7 EACH BUILDING SEWER OVER 10(U18(1"BTU EACH WATER HEM"£'R AND/OR VENT BOILER/COMPRESSOR UP .l8"'3' HP EACH Gi\S,,a'f'STEM 1 TO 4 OUTLETS BOILER/COMPRESjl>fl'"3-15 HP ' . EA,llf('GAS SYSTEM 5 OR MORE BOILER/COJW11'ESSOR 16-30 HP • /EACH INSTAL., ALTER, REPAIR WATER PIPE VENJ;,1'1iN SINGLE DUCT / EACH LAWN SPRINKLER SYSTEM .A'ECH EXHAUST -HOOD/DUCTS WATER SOFTNER 7tnOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . I I I SIGN PERMIT I . I I I TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I . I I I CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I I I 1 TOTAL PLUMBING I I I QTY. ELECTRICAL PERMIT AMT. QTY. MOBILE HOME PERMIT L..o AMT. ELECTRICAL / It> 12 .I) It) / NEW CONST EA AMP/SWT /BKR ~ ---" /JIit .-AWNING _/"' MECHANICAL I I I • I 1 PH .25 3~-. PORCH ./ MOBILE HOME I I I EXIST BLOG EA AMP/SWT/BKR SET-UP _/ SOLAR I . I I I 1 PH .25 3 PH RAMADA, CABAfilll"" I . I I I REMODEL/ALTER PER CIRCUIT FENCE 0Yff'6' I I I I TEMP POLE 200 AMPS TOy'!(MOBILE HOME MICO-FILM ! I I I OVER 200 AMPS / I . I I : I TEMP OCCUPANCY (30 DAYSI ,/ I . I I I ~--c.... I j j I TOTAL ELECTRICAL /d,.~ TOTAL FEES PAYABLE I CONTRACTOR . I I , ./IA 1..2 ,d 10 I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO "AN OSHA PERMIT IS REQUIRED FOR E XCAVATIONS OVER 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 ISSUED; TO COMPLY WITH A LL CITY, STRUCTURES OVER 3 DRIES IN HEIGHT COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER ../. -SPECIFIED HEREIN OR NOT. l,ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM- ~.J 11 LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS AND ~ ...,,,,, __ ,..., I EXPENSES WHICH MAY IN ANY WAY ACCRUE A GAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. APPLICANT'S SIGNATURE"/ OWNER□ CONTRACTORN 'APPROVED BYO, lt9Jj,~ AGENT n BV PHONE n ~ I ~ ~ ~ i== l:rl a. V, ~ ( .. SITE ADDRESS: , • . \ OWNER: • PERMIT NO: . • --FIELD INSPECTION RECORD - INSPECTION DATE INSPECTOR INSPECTOR'S NOTES WOOD FLOOR FOUNDATION • FORMS• SET BACK • TOILET UNDER FLOOR PLUMBING __ ._ UNDER FLOOR HEATING t--------------------------------------------------i OK TO INSTALL SUB FLOOR t---------------------------------------------------i SLAB FLOOR UNDER SLAB PLUMBING FOOTING• FORMS• SETBACK • TOILET O ' OK TO POUR CONCRETE .... FRAME , ... i ' ROUGH ELECTRICAL ~--.. • --.. . ...... ~ .... ROUGH PLUMBING . .__ • • ~ ~ ROUGH HEATING/VENTILATING " • '· FRAME OK• PLACE INSULATION • '-., INSULATION OK • PLACE WALLBOARD ' ~, 1 "-,..,_ . .. " WALLBOARD OK• PLACE TAPE ' EXTERIOR LATH OK• PLACE STUCCO ·· FIREPLACE DAMPER &STEEL PLATE Tl Es/HEIGHT OF CHIMNEY , OTHER ,---.,._ , ..... ~•· , . TEMP POWER (POLE) '·...__ •.:;•.' ~.._-~ ': '.. ..._ SEWER ·•~ ._ GAS TEST SWIM POOL • STEEL BONDING "'-.. • · t-----------------------------------------------i • PRE DECK , • FENCE PREPLASTER ._ SHOWN • FRAME • PAN __ f,,_ FINAL INSP BY BLDG DEPT , .l. OTHER DEPT'S REQ COMPLETED ' :"' ;... °' ELEC METER-PERM-TEMP -• GAS METER-PERM-TEMP CERT OF OCCUPANCY ISSUED ~