HomeMy WebLinkAbout2653 ROOSEVELT ST; C; 81-349; PermitV, z 0 ~ Cl:
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USE BALL POINT PEN ONLY & PRESS HARD A, APPLICANT/ "'FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS
CARLSBA ... BUILDING DEPARTMENT A\-,JucATION & PERMIT 0 I hereby ettlrm that I am licensed under
provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Professions Code, and my license Is In
full force and effect. Lie No ______ Class _____ _
JOB ADDRESS
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OWNER'S NAME
1200 Elm, Carlsbad, California 92008 (714) 438-5525
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I hereby affirm tha1 I Mn e•empl from the Con-~~o;;-·~!~r::: ~ ~f~~l~I~~~~.(~ vt/E /!.£. 0 frJ
T, QWNE.A'S PHONE
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county which requlfes a permit to construc"t
alter. improve. demohsh, Of' ,epa1r any structure. ":) /. ~ ~
prior to its ,ssuance also requires the applicant tor ~,,;) ,::::2 53-,
AV, ST, I oA:EY. APPLZTIONI
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BUSINESS LICENSE ,t
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PRIME CONTRACTOR
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CONTRACTORS PHONE#
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CONTRACTOR"S ADDRESS LICENSE NO.
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such permit lo hie a signed statement that he 1s F--:'::--,-=------,,-:--:--------r-,===-=--c=:c----=c.-----------i ltcensed pursuanl to ltle Pf<>YISIOOS of ltle Con-LOT BLOCK SUBDIVISION DESIGNER STATE LICENSE"
VA~TI0N PERMIT NUMBER
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PLAN LO,#
STANDARD PLAN# I BUILDING SQ, FOOTAGE I
tractor's License Law (Chapter 9 commencing with · ,, 2 <ff'/ Section 7000 of 01v1s,on 3 of the Business and Pro--/ / _.. / .-l--? ,. fessions Code)or lhat Is exemplttlerefrom and ttle DESCRIPTION OF WORK \c.. , ?--L C / C::. /-:c,____, ~;~orro\ih:\a~~ a:;,=:'fo..".;':rr:::f':~ecf~ ,,,-I/~ U . S: <..../\ ;:::7 / /~✓-,; ;,-'i/'l-o....:E:;:S:.1G=N:=:Ec::Ac::,-S-A!:.o=-o..,R,::E=s::s::..:._...::::.::==.,:_::::=:::::::-----+=-----:,_..t.. __ .._ __________ ...l __________ ~
tne applic,.,'lt to a c1v1I penalty of nol mo<e lhan five --7 /_L.;>, ,'°'I JI / / hundred dollars ($500) ,/ T-V t--'~ /L-.-.,
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0 I, as owner of ttle property, or my employees .l:=L--"""'<J' 1--...:;_~~F/•P---F~L•A-E•L,;,E_V•, ,-..,:;_ __ "l'"_~N!'!!O!""_,..._;;;..:,_._..;.;.; .. ~-~l-
...,,1h wages as their sole compensa.t,on, will do the ~TORI
wC>Ol. and the structure 1s not intended or offered for sale (Sec 70-<4, Business and Professoons Code· vO NO ---
8l 1"18 17086
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46,?5 ~~ tJ S.25
The Contractor's lteense Law does not appty to an FIRE SPA owner ol prc,perty who bu_ilds or improves thereon RES UNITS GRADING PERMIT ISSUEO REDEVELOPMENT TYf I DCC LOAD
and who does such work himself Of' throuoh h1sown · A REA 10 T
employees. provided that such 1mprovemeilts are y □ N □ ND A
not mtende1 or offered for sale If, however. the I\ ,t:::J NV Not Valid Unlffs Machine Certifi!td
V' I V building or improvement 1s sold w1th1n one yNr ol ~r;;:;:=I~:'i~":°::;~:1:'.I~I~,~:~r~~ ~~~ QTY, PLUMBING PERMIT -ISSUE 7 • 5 Q QTY, MECHANICAL PERMIT -ISSUE 3.00
,,
SUMMAR~ACCOUNTNUMBER --:Z..::T. "t!) purpose ol sale) □ 1, as owner 01 ihe propeny, am excluS1vely EACH FIXTURE TRAP INSTALL FURN. BUILDING PERMIT
~~t;:o:~~ ~ "i~~u~!r:.°t~ 1~~~5~1~! EACH BUILDING SEWER _ SIGN PERMIT ~ ~°:n~~:~:~,,Lt!';: ~~d~,; '.:::~~f~r EACH WA TEA HEATER AND/0 R VENT PLAN CHECK
~':,'::;i~i ~ncs':'~~!~: ~~~~r~\~;:::;.: 1 EACH GAS SYSTEM 1 TO 4 OUT LETS TOTAL PLUMBING
L,censeLaw> EACHGASSYSTEM50RM0RE ------<-----'--~---+---ELECTRICAL
EACH INSTAl,, ALTER. REPAIR WATER PIPE MECHANICAL □ I am exempt undef Sec
torth1sreason __
____ ,B &PC ~--7
□ I hereby affirm that 1 tia·.-e a cer11t1cate of consent
~~~-~~1'::neins~~ar!:e.c:~1
~~~~ed
0~ort:~~~;
(Sec 3BOO. Lat>or Code)
POLICY NO --eJ~· _ _
COMPANY ~ c::e::;_
0 Copy IS hied with the city
□ Cen1hed copy 1s hereby lurn,shed
CERTIFICATl OF EXEMPTION FROM WORKERS' COMPENS ... TI0N INSURANCE
(This section need not be completed 11 !he permit ,s tor one hundred dollars ($100) or less)
D I certify that 1n the performance of the work tor
wh1cn this perm11 1s issued. I shall not employ any
person ,n any manner so as to become sub1ect to
the wooers· Compensation l.aws of California
NOTICE TO APPLICANT II. after makin~ this Cert,
hcate of Exemption, yOlJ should beeome sub1ect 1?
the Workers· Compensation provisions of the Labor
Code. you must forthwith compfy with such prov1s1ons or lh1s permit shall be deemed revoked
D I hereby alhrm thal !here ,s a cons1ruct100
lendmg agency tor the performance ot lhe wont lo,
which this perm11 1s ,ssued (Sec 3097 C1v11 Godel
Lenders Name ___________ _
Lender s Address __________ _
QTY,
EACH VACUUM BREAKER
1
! rH E XHAUST _ HOOD/DUCTS MDBILEHOME
WATER SOFTNERRELDCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP
EACH ROOF DRAIN (INSIDE) 1 fl. II 7 I / 1 1 SOLAR
TOTAL PLUMBING
./ 7
Tf{r.L M_;.efiANICAL l STRONG MOTION
I V FIRE SPRINKLERS
ELECTRICAL PERMIT -ISS~E ~7oo QTY, A ~LAA , ISSUE I PUBLIC FACILITIES FEE
BRIDGE FEE
~y \ r /\ 11 11x:011Lt cTORs NEW CONST EA AMP/SWT/BKR /
1 PH 3ij7'
EXIST BLOG EA AMP/SWT/BKR
.,.p;n \l,1 II / ,~RIGETANKS V n ...J) I =:I-=:J I RdcKllTORAGE
SCHOOL FEE · DISTRICT
Carlsbad
Encinitas
1 PH 3 PH /Y I i'hl , I ,_ 71~7 !PUMP
REMODE L/ALTER
TEMP PO LE 200 AMPS
San D1eguilo
PER CIRC~=L T\ ,r ..-11 , 1 PLAN ~HECK FEE 1 ~u .... <:,n Marcos
OVER 200 AMPS 7 -
TEMPOCCUPANCY?~Sl
TOTAL EfECTRICAL l 7 .,,, TOTAL SOLAR TOTAL FEES PAYABLE I ~,vi
7 ., E Expiration Every permit ouued by the Building Off1c1al under the provIsIons oflhos I HAVE CAREFULLY EXAMINED THE COMPLETED 'APPLICATION AND PERMIT AND DO HER BY Code shall exp,re by timotaloon and become null and void If the bu1ld1ng or work
CERTIFY UNDER PENALTY OF PERJURY THAT "LL INFORMATION HEREON INCLUDING THE authOrized by such permit as not commenced with 180 days from the dale ofsuch
* AN OSHA PEAMIT IS FIE0UIIIED FOR EXCAVATIONS OVER
~• O" DEEP ANO otMOUTION OR CONSTI!UCTION OF
STAUCTUAES OVER 3 STORIES IN HEIGHT DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS permit, or of the building or work authonzed by h permit II suspended or
ISSUED: TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON-l_!a~ban~do~ned!!!!__!a!_I !!•n!!l_t!!,!1me~.!•,!!lte~r~t~he!_!w~o!!rk~1s!_!c~o!_!!m!!_!m!!:en!!!!!c:!ed~fo2!:i~;¥-!J1od~o~fJ1l!!B02.J!da!n!L-;:::-r':~~~~::::"-----------:t!l~--'j"---,
STRUCTION. WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND APPLICANT'S SIGN~TUA OWNER CONTRACTOR O APP]EO BY
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE ~ BY PHONE O _ _ 1 ~ KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AN~ ~
GRANTING OF THIS PERMIT _ _ ~ -I -,
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INSPECTION TYPE DATE INSPECTOR
BUILDING ,/'
FOUNDATION '
REINFORCED STEEL l '
MASONRY :
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME
SH EATHING
FRAME
EXTERIOR LATH lNSULATION
INTERIOR LATH & DRYWALL
PLUMBING I
I --
SEWER AND BL/CO 'a I
PLUMBING UNDERGROUND I I
PLUMBING TOP OUT I I
TUB AND ~HOWER PAN I
GAS TEST I
I
ELECTRICAL l I
TEMPORARY POWER I
ELECTRIC UNDERGROUND i
ROUGH ELECTRIC I
ELECTRIC SERVICE I
BONDING A I
G. F. I. -SMOKE DETECTOR. I
I
MECHANICAL I
DUCT & PLEM., REF. PIPING i ..
HEAT -AIR COND. -SOLAR SYSTEMS '· -
VENTILATING SYSTEMS
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HA VE BEEN APPROVED.
JOB SITE FINAL
PLUMBIN.G
ELECTRICAL .
MECHANICAL
GAS ' .
BUILDING
SPECIAL CONDITIONS
CERT OF OCCUPANCY ISSUED
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS
INSPECTION REQ IF INSPECTOR'S
CHECKED APPROVAL
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRES TRESSED l CONCRETE • POST TENSIONED !' CONCRETE
FIELD WELDING
HIGH STRENGTH
BOLTS ~·,
V SPECIAL MASONRY •
PILES CAISSONS
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INSPECTOR'S NOTES
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