HomeMy WebLinkAbout2785 ROOSEVELT ST; ; 80-346; PermitLICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provi•
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 el·
feel.
~ OWNER-BUILDER DECLARATION
hereby affirm that I am exempt from the Con·
ctor's License Law for the following reason
(Sec. 7031.5 Business and Professions Code), Any
CITY OF CARLSBAD-BUILDING DEPARTMENT
APPLICATION & PERMIT
USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525
APPLICANT TO FILL IN INFOR -
MATION WITHIN RED LINES.
NO. JOB ADDRESS t~~ AT;;,: A;;~;;;
BUS. LICENSE PERMIT NUMBER
,2711'10! 1.e0101 S1CJ t/1~L.1fl I I ,'ST, I I I I I I I I I
?ll-3 fb OWNER OWNER'S PHONE PRIME CONTRACTOR STATE LICENSE
fa '\0t\'f (4ovAtt~ -:Jel'l(S 71-q-2210 l'JWNi:F/2.
OWNER'S MAIL ING ADDRESS CONTRACTOR'S ADDRESS CONTRACTOR'S
278S RcoSCv[LT ~ 1 111111..CJ\CllS'~A \) PHONE
LOT I BLOCK I SUBDIVISION nJ ZaSOR'S ~/o. 17g. DESIGNER STATE LICENSE
'; I i' ~cr.L1<1ni=-ILJ..JJ 1 1 1 , 1 1 /<(;l] / ,-r-,-/ tr I,
!•-J7~ , J "':..I '°'-, ) . ;
'j 1 ... n,
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 lo 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).
,~CRIPTION OF WORK 1,,1 I t-, "'--i~ /4.. '.2. -~~.J;./.. Ll ..i .. ,--1 :J.: -O-4 DESIGNER'S AOORESS ( ;;_;;,;; D
□ I, as owner of the properly, or my employees
with wages as their sole compensation, will do
the work, and the structure Is not intended or of•
fered for sale (Sec. 7044, Business and Profes•
slons Code: The Contractor's License Law does
not apply to an owner of property who bullds 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.IT C.
for this reason ~ '1 X Date 1/-f-.PQ Owner Fn-1, •Jr,-,
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).
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•
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 Callfomla.
NOTICE TO APPLICANT: II, after making this Cer·
tlflcate of Exemption, you should become subject
to the Workers' Compensation provisions of the
Labor Coder"You must forthwith comply with such
provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby aut m that there Is a construction fen·
ding agency for the performance of the work for
whlr.h thl" oarmlt Is h;~ufld ISAc. 3097. ~lvll ("'.nt1,t\
-~,. D
. :Uk., D,12. D•-II'~ 't'l-'-'1
CENSUS TRACT GP LANO USE ZONING I RES. UNITS lP~RKING SPACE# ~F STORIE;_
-ft. Not V11id Unless Machin• c.rtifi«I
BLO~ S1p BLOMl 'vi.L, J~~ STANDARD PLAN# l p?P0~1./& ITYPE,;:~
I occ. LOAD I
V ,
QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT. ---
EACH FIXTURE TRAP ~ INSTALL FURN. DUCTS UP TO 100,000 BTU / ,..J_,, ";>-
EACH BUILDING SEWER OVER 100,000 BTU ,
EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP
EACH GAS SYSTEM 1 TO 4 OUTLETS ''L !-" BOILER/COMPRESSOR 3-15 HP
EACH GAS SYSTEM 5 0 R MORE BOILER/COMPRESSOR 16-30 HP
EACH INSTAL, ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT /~/ ~</0 !!:!!
EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS VALUATION ---
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I 1CAf). 1 .
TC:C:TT'I<' 3 .• 0( ISSUE J.00 SIGN PERMIT ii., --I . f->j I
TOTAL PLUMBING TOTAL MECHANICAL /s.~ PLAN CHECK ,Slf "-f,R;O -/--r4"' ~ -.M . ,.....;... . ~·~ ie..1 I
CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT , I I
ELECTRICAL PERMIT AMT. AMT.
TOTAL PLUMBING I 1-'1 · ~ z::
QTY. QTY. MOBILE HOME PERMIT ELECTRICAL /1!:!r ·n
NEW CONST EA AMP/SWT/BKR AW~NG MECHANICAL '/11'--, JI..
1 PH .25 3 PH PORC~ MOBILE HOME I I
EXIST BLOG EA AMP/SWT/BKR SET-UP \ SOLAR I . I I I
1 PH .25 3 PH RAMAOA,QABANA ~trnnn-motion I , I ✓ .>'1J
2. REMODEL/ALTER PER CIRCUIT /0. V • FENCE OVE"R,§' I , I /1 I
TEMP POLE 200 AMPS TOTAL MOBILE H~ MICO-FILM I , I I I
OVER 200 AMPS } I , I I ; I
TEMP OCCUPANCY (30 DAYS) ( I I I I
ISSUE 2.00 ISSUE '--5.00 I . I I I
TOTAL ELECTRICAL /d-.CP TOTAL FEES PAYABLE I ./1/1~.~.,.. CONTRACTOR I I
I HAVE CAREFULLY EXAMINED THE COMPLETED .. APPLICATION AND PERMIT, ANO DO 'AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER SCHOOL FEES
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5•.o .. DEEP AND DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY, STRUCTURES OVER 3STO~/T
COUNTY AND ST ATE LAWS GOVERNING BUILDING CONSTRUCTION. WHETHER -7~ SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM,
LESS 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. APPLICANT'S SIGNATURE• OWN~ CONTRACTOR□ I APPAOVEO BY DATE
AGENT D BY PHONE O /..1 ./,__ ,72 ~ ~-;.lt-:l<
./
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~
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SITE
ADDRESS: OWNER: PERMIT.. NO: 8D r3 t/'Ca
~ FIELD INSPECTION RECORD -
INSPECTION DATE INSPECTOR INSPECTOR'S NOTES
WOOD FLOOR .ta FOUNDATION• FORMS• SET BACK• TOILET
''. ,: ~_ '\. UNDER FLOOR PLUMBING
~ --. .--::::-..::;. --i-,; .. : 0 -• UNDER FLOOR HEATING ~
' ~""" ' . ' OK TO INST ALL SUB FLOOR • C . . -,,-..,, 'I. -,\ ·-· ·-SLAB FLOOR
I UNDER SLAB PLUMBING '
FOOTING• FORMS• SETBACK • TOILET . ~ ', "'·. 'l, ... , < ..... . ' --• \..~' ' I • . OK TO POUR CONCRETE ' .,• I . '
' FRAME '
ROUGH ELECTRICAL
ROUGH PLUMBING .
ROUGH HEATING/VENTILATING
FRAME OK • PLAC E INSUL ATION
INSULATION OK• PLACE WALLBOARD
WALLBOARD OK • PLACE TAPE
EXTERIOR LAT H OK• PLACE STUCCO "
FIREPLACE "
DAMPER & STEEL -
PLATE Tl Es/HEIGHT OF C HIMNEY
OTHER
TEMP POWER (POLE)
SEWER
GAS TEST
SWIM POOL • STEEL BONDING
• PRE DECK
• FENCE PREPLASTER
SHOWN • FRAME t
• PAN ..4 I , / A / _, ..
FINAL INSP BY BLDG DEPT '1!/ ti/ YO r;vr ,,r
OTHER DEPT'S REQ COMPLETED ( {' V
ELEC METER-PERM-TEMP
GAS METER-PERM-TEMP
..
CERT O F OCCUPANCY ISSUED
/ _ (~.Jt, /J-P/V '2 D3 -;f:/-D7 i1f',1r y . _I_N_T_E_R_D_E_P_A_R_T_M_E_N_T_A_L_I_N_F_O_R_M_A_T_I_O_N_S_H_E_E_T
o,~ILDING DEPARTMENT DATE: ---------
, BUILDING ADDRESS: RECEJ,TET)
_-PLANNING DEPARTMENT r1, Cll'.V Of. CARLSBAD.
z oNE __ .....,,e,~d_-____ Lo T s I z E_~$_o/~/.._o __ , ___ LoT wI DTH sr lulldlna ••••nt
UNITS ALLOWED UNITS PROVIDED ------------------------
PARKING SPACES REQUIRED J PROVIDED i __ ......;_ _______ _
% COVERAGE ALLOWED PROVIDED
BUILDING HEIGHT ALLOWED _____ 3~_§ ____ PROVIDED
FRONT SETBACK: SIDE SETBACK: REAR SETBACK:
ALLOWED 0 0 (j -------
PROVIDED -------
INTRUSIONS
LANDSCAPE & IRRIGATION PLAN COMMENTS:
ENVIRONMENTAL PROTECTION REQ:
FINAL DATE --------·-----
,, ENGINEERING DEPARTMENT ~3,, ll {) =--
R.O.W. ______ INDUSTRIAL WASTE IMPROVEMENTS ---------------
SEWER CONNECTION
GRADING PERMIT
DRIVEWAY LOCATIONS ---------------------
EASEMENTS DRAINAGE ---------------------
LEGAL DESCRIPTION ____________________________ _
ADDITIONAL COMMENTS __________________________ _
OK TO ISSUE~ DATE lf· ~, 'i§j PWI OK TO FINAL DATE ------------
ti
FIRE DEPARTMENT
SPRI~KLING SYSTEM -~~ ________ FIRE
i FIRE ALARMS
FIRE HYDRANTS ------------=~ ~ ADDITIONAL COMMENTS
oK To IssuE: ~,-Yo
WATER DEPARTMENT
REQUIREMENTS OF APPROPRIATE DISTRICTS MET ________ DATE ________ _
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1200 ELM AVENUE
CARLSBAD, CALIFORNIA 92008
Building Department
cteitp of ctearlsbab
. . . .
OONRESIIINfIAL ENERGY IISIGN CERTIFICATION
TELEPHONE:
(714) 729-1181
Permit.No. ------
Issue Date ------
CERTIFICAlE OF C0'11PLIANCE WITH ENERGY CONSE~ATION DESIGN REQUIREMENTS
CONTAINED IN ARTICLE. 2,· PART 6," TillE 24,· CALIFORNIA AD~·. CODE.
I, C,.E,/3vk,(00vlfi her eby .c-~rtify that I
Des i gn ~r
am familiar with th e stat e energy con s er vation s tanda rds mand a ted
in CAC Title 24 , Section 120-1451 thro ugh T20-1542, and that t he
plans and . other doc~ments submitted in support of the application
fof a Building -permit at ·
'i1 . 7 IJ~ -r•· ,.../f --------~---'-----------'------...,_-------. y ·P ,JP,
Address Ass essor's Pa r ce l No. :. Da ted
comply with all curr~nt requi!ements of these r egulations.
Indicate method of .compliance :
A: B Component Performance (Stand ard Des ign)
. .
B. 0 Energy Bu dge t Ana l y s is (Al t ern ative Design)
C. 0 Non-deplet~bl e Energy Analysi s (Al_ternativ e Desi gn)
D. 0
Other (specify) / ~ ¾~p Si gna ture~ __ __._-_· __ .....,..~"-1---·~~-------------~------
Ti t l e ___ c»_l"--=---~-'~A-·~--' L----==--~----=--·-=---Ar chitect, Engineer , Contr a ct or
s t a t e L i C e n s e O r Ce r t i f i C a t e NO • ~z 9; t, 1------------------
Date_-=c,_·_/..,;,_9 _·~_0 _____ _
Submi t t o th e Bu i l ding De partment with permit appl i ca t ion.
~
' DOCUMENTATION F.ORM ~ ' r-orm 5
• BUILDING LIGHTING COMPLIANCE
\_, Project Title n:'(W #~Po---0~ ~/7C.Z:::-~;' Documented by __ _
. Location __ Ok:=-.::~~='2'5:::....(..c/S1P:z..a::: ____ _
Project Designer ...,,f:J//(/ ~ ~~
Room Room RCA
No. Sq. Ft. Task Areas Note
Appl.
Sq. Ft.
/Occ.
No.
0cc.
Date tj,, /,f• '50
Sq, Ft. Total Watts Allotted Design
Watts ---..---... --
K,o:Jtlll7#f} ~
/Task Sq. Ft. /Sq. Ft. Watts
/{}/ /.53 5-1-r / I 50 ~ 50 !150 (P 900 qc?o I
IVt?N-T~ I I ~ 2 ~ I I . I I I I
/()~ 2/0 0 5 A~Ml/41& I !SO -1-50 !200 5 /COO /t?~")O
!Vt?/V-~ I I ;o /, 7 17 I
I I
I I
/()3 153 5 -r Aa:::a:l'M" ~ I ! 6 0 B 50 1160 I rJ 900 <?tJt}
;Vo;VrASJt:-I 18 2 •' ~ ,• I
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;J A/j_a 2 t(}() V Page Totel ....;.v-.....;U;...._L.._ __ _
) • ...
To: Current Development
I.es Evans, City Engineer
From~ Pat Cratty, Development Coordinator
r,nte: //;;. 3/!o .
!",•,J e<ot: Application for ~-L...t:.t.~~~1.&.::~r.lJ'.J~
: )r~se n ,view the atr.ached application for uete1mination of acceptance
m,d re tu1:u with your c.or,1men t s.
::'•. ·. ·:·:·:·.'. Dcw!lopment:
--__ I __ ~ .... ~_1-~_;_-'Jt._--,---·'-;v
U-:..r~ (Date ) ·
,':1.ty Eng.lt:cer:
-'ill c;;_,__· __ .. -+--·¼ ~
(S!.gna 1 .. ure) (r/a t ~-