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Home My WebLink About2653 ROOSEVELT ST; ; 81-109; PermitLICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provi- sions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes- sions Code, and my license Is In lull force and ef- fect. OWNER-BUILDER DECLARATION D I hereby affirm that I am exempl from lhe 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 lo 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 subJecls the applicant to a civil penally 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 of- fered for sale (Sec. 70.4, 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 thal 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. 70.4, Business and Professions Code: The Contractor's License Law does not ap- ply to an owner of property t•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. _____ 8. & P.C. for this reason \ t, • / Date Owner WORKERS' COMPENSATIO~D C~ I hereby affirm that I have ill ol'con- senl to self-Insure. o• a ce · ate o orkers' Compensation Insurance, or a certified copy 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 If the per- mit Is for one hundred dollars ($100) or less). 1 certify that In the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. NOTICE TO APPLICANT: If, after making this Cer- tificate of Exemption, you should become subject Ir the Workers' Compensation provisions of the (abor Code, you must forthwith comply with such !provisions Of this permit shall be deemed revoked. • CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction len• -· , __ ...... "'-•"'""'"""•"'ro nf tho wnrlc fnr CITY OF CARLSBAD-BUILDING DEPARTMENT APPLICATION & PERMIT APPLICANT TO FILL IN INFOR- ILVU L.L..IT1 ,-,.-,-L.1.,VL. \I, .... , .,.yu-...,...,L..., ~/~7Y ~ ~~Ci~ I 1f<&1015161V16~toBIAD~RESJS I I I I I I I I I I I ~~IDif-017;1:~r :r~l-~E~s,1~ • i[,:RMITNUMBER 0J~U6 ~ vl~b« 1vf ii42-p&t:~AC{;~st. ·tc . 1Jjj;Eo~ /at 0 ~WAC:S~fZREM cffe'(ls~d CA-t,u,vA 7«f~~ ~~d ~rr;;;1 IJ_OT BLOCK ISUBDIVISION 11 A;,s~oR'S ,AR~L(NO. "I ' DESIGNER STATE LICENSE o!Rtl%'iG%1.?~7 / e i ,~ ~ ~E:RIPTION OF .l(a:.D'!JS-f ~~~u I -~~ '~ I LJ.. I I 1--------------+----,----1 ood'l5946 ·0 1 2127~ art))( -..-')~ lrMil x \.t'\di '-t'T..I Hrc;rh. ·v ".J'~1,~ DESIGNER'S ADDREss DEslGNER's PHONE • • " ---... • ,, \,t,,Jl .,J u V CENSUS TRACT GP LAND USE ZONING I RES. UNITS I PARKING SPACE I NUMBER OF STORIES Not V•lid Un/t/ss Machina c.rtifi«I 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 TO 100,000 BTU EACH BUILDING SEWER OVER 100,000 BTU • j EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UPTO 3 HP / _ , EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP / • EACHGASSYSTEM50RMORE BOILER/COMPRESSOR16-30HP V ~ EACH JNSTAL, ALTER, REPAIR WATER PIPE VENT FAN Sl~!GLE DUCT ./ / / /) -r-1 ~ -,,,,,..-- EACH LAWN SPRINKLER sYsTEM MECH ExHAusT Hooo,oucTs ./ {/ .d 0 . -, . _---;.-' ~rod _ WATER SOFTNER RELOCATION OF EA FURNA_;;t'l'HEATER BUILDING PERMIT 1 , I I /J. ~ .,,1'.,, ~,,. I j' Cl~ ./ ..A.J"J .J .i ..l ~/ / ~ .O,:;, SIGN PERMIT I , I I I TOTAL PLUMBING TOTA~HANICAL / PLAN CHECK I , I I~~ CONTRACTOR ONTRACTOR _/ t\ / All INCLUSIVE PERMIT I I I _/. -~~ TOTALPLUMBING I I I QTY. ELECTRICAL PERMIT , AMT. QTY. / MOBILE HO:;>-£T fnMIT AMT. ELECTRICAL I I I NEWCONSTEAAMP/SWT/BKR _/. I\WNING ,.,. A~ MECHANICAL I I I 1PH .25 3PH ./"' _,.,v_,' l<~RCH ( \I\/\ MOBILE HOME I J I EXISTBLDGEAAMP/SWT/BKR -.,,-f"--// (i \sET-UP / l' \ SOLAR , I , I I I 1 PH .25 3 PH / .Y . (; v RAMADA, Cf/BANA \ ~ ..,..__ .,J., ~., I I I J REMODEL/ALTER PER CIRCUIT V' "'-FENCE 0~ 6' \ ,,.;I-I , I I I TEMPPOLE 200AMPS / ._.. \ l TOTALMOBILEHOME MICO-FILM ! , I I I OVER 200 AMPS / • I , I I : I TEMP OCCUPANCY (30 DAYS) / I J I J J _ _,,, •-/ .2.llfc, I, I I I TOTAL ELECTRI CAV 11----+-----------------------ll TOTAL FEES PAYABLE I ~ CONTRACTOR / , , I I , I 'f? . ...-!"'" JI ~\L... I •t· 8 j: i ~ ~ j::: ::rl 0.. V) ~ FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION ANO PERMIT, AND 00 'AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER ~~v ti HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE ANO CORRECT ANO I 6'-0" DEEP ANO DEMOLITION OR CONSTRUCTION OF , "'I'. SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM-..._ ~ ._ ~ ~ ,1 ./ COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER ...... -~ ~ 'Y LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS ANO ')'--,c·, -_ _ .._L -~{ ~ 1/ff Ex, E NSES WHICH MAY IN AN v WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE 1~~~-= ........ ~~=-.;;;.!::.._,,.L.~::...~:::........!:e~~:......::=-~::::::::,~---==z;;;;~~~~;--:::::-1"":"::-::-::~=-=-:------::::---_:_--='7"::=--I OF THE GRANTING OF THIS PERMIT. ( "APPLICANT'S'S)GNATURE' OWNER□ ~-~~ ,.I_ORQ jAPPROVEO BY.~ DATE ---.......J ~~ I~ -,._ ~ AGENT D BY PHONED , re , ' --...-1 .,_,.. • '1-y T . . ' -SITE . • . ADDRESS: ----. --.-:--.. OWNER: . I P ERMIT NO: .. ' -I FIELD INSPECTION RECORD ~ INSPECTION DATE INSPECTOR INSPECTOR'S NOTES WOOD FLOOR FOUNDATION • FORMS• SET BACK • TOILET . l ' UNDER FLOOR PLUMBING : . I -UNDER FLOOR HEATING ' .. I . I ,, ··r: , ,,, !. ' (. ... OK TO INSTALL SUB FLOOR .. SLAB FLOOR ... UNDER SLAB PLUMBING FOOTING• FORMS• SETBACK• TOILET OK TO POUR CONCRETE FRAME i ROUGH ELECTRICAL ROUGH PLUMBING ROUGH HEAT ING/VENTILATING . FRAME OK• PLACE INSULATION INSULATION OK • PLAC E WALLBOARD . ' WALLBOARD OK • PLACE TAPE i ..... EXTERIOR LATH OK• PLACE STUCCO -' --~ .. ' FIREPLACE ' . ·-i ~-, ', _, . I DAMPER 8: ST EEL . I PLATE Tl Es/HEIGHT OF CHIMNEY ' ' I . ' 1 • L OTHER . l TEMP POWER (POLE) ' { I SEWER • •. J ' t f ? ~ . ~. '-GAS TEST I ,_ ~ SWIM POOL • STEEL BONDING j . • PRE DECK •, r • FENCE PREPLASTE R • ' I SHOWN • FRAME I • PAN -.. '• FINAL INSP BY BLDG DEPT OTHER DEPT'S REQ COMPLETED ELEC METER-PERM-TEMP GAS METER-PERM-TEMP •' . . , ' CERT OF OCCUPANCY ISSUED , . " ~ , l ~ .. .. .. ,,· ... ... , -