HomeMy WebLinkAbout1560 SANDALWOOD LN; ; 80-729; 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
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 life 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 five 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 slructure 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 \•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.
□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).
I certify that In the performance of the work for
which this permit Is Issued, I shall not empl9y 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-
tlflc;ll'e of Exemption, you o I ome subject "'l"\he Workers' pens i provisions of the
Jj .t r Code, Y.O comply with such
projslon~//J:Mlli'!l(ril,J~~ii'lleemed revoked.
COi:lSTRUCTION LENDING AGENCY
r hereby affirm that there Is a construction len•
ding agency for the performance of the work for
whlr.h thl~ nArmlt i~ ,~~11A<1 l~Ar:. :l097. Civil Code).
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
l 1,l,c, ~rAv/J:Jr/1-tL,Wio1e~, 1J..,11,J,a.,, 1, 1 1 1
OWNER'S PHONE OWNER
~oMWJc.K J, .So /<-Jl°Jo 7 7.. 9-o/ot.,
O~E~S/#E
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N:ADDRECll:lf is Bll-jr GA, 9.Ao(JY
11dl/' BLOCK I SUBDIVISION T-AiSESSOR'S PARCEL NO. ~I
l~1n 1S 1 , t131n1 1¥1 ~1 1
I I I I tRt 10~/i;ATIONI ~L~:;~
PRi<.oci~et BJJ i'th~s le:/E3~~~::;~
c°/-rz'r'f'P&~5Ff,,./a JS/(, ~
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DESIGNER ~ -I 0'tYd';J:S'~f,{})c1 d6-w IFITA<:&P DaJ/Blc f/4{!lvtf:. I DESIGNER'S ADDRESS
7;., ~f.s1b.E.NC£.
DESIGNER'S PHONE ---
CENSUS TRACT GP LAND USE ZONING
PERMIT NUM9ER
/'tJ✓ 7 .2 ;?
,,21 17 .75 I RES. UNITS 1 PARK~HG SPACE sf I NUMBER oF sToR1Es
Not V11id Unless M,chin, Clrtifild
BLDG SO. FT. BLOG USE occ. GP I STANDARD PLAN # I Py;~ 7 ~ r TYPE CONST l occ. LOAO l -
CHY. PLUMBING PERMIT AMT. QTY. MECHANICAL1ERMIT AMT.
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100,000 BTU
EACH BUILDING SEWER OVER 100,000 BTU
EACH WATER HEATER AND/DR VENT BOILER/COMPRESSOR UPTO 3 HP
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP
EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP
EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT
EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HODD/DUCTS VALUATICN: _J JO tJ. -
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PE~ ------
T~C:TTR ~.nn TC:C:Tlk' ~_.{){) SIGN pifa,l_g.,J 3--.> At?(>
TOTAL PLUMBING
CONTRACTOR
TOTAL MECHANICAL PLAN 41fl/V.-it ;<;Z,3/ " )
CONTRACTOR ALL INC~IVE PERMIT /
QTY. ELECTRICAL PERMIT AMT. QTY. MOBILE HOME PERMIT AMT. TOTAL PLUMSlffG.
ELECTRICAL
NEW CONST EA AMP/SWT/BKR AWNING MECHANICAL
1 PH .25 3 PH PORCH MOBILE HOME
EXIST BLOG EA AMP/SWT/BKR SET-UP SOLAR
1 PH .25 3 PH __ 1 , -· 1, RAMADA, CABANA
14-REMODEL/ALTER PEA CIRCUIT ;10 ~ f1J:i, ., TEMP PO LE 200 AMPS ~ -
S(' , 7!,
-a'
FENCE OVER 6'
TOTAL MOBILE HOME MICO-FI LM
OVER 200 AMPS
TEMP OCCUPANCY (30 DAYS)
J / 2~00 SI'R:NG MJI'ION: ISSUE
TOTAL ELECTRICAL
CONTRACTOR ~IO 7~1,----------+--_____,JII TOTAL FEES PAYABLE l .
•AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER
5'•0 .. DEEP AND DEMOLITION OR CONSTRUCTION OF
STRUCTURES OVER 3 STORIES IN HEIGHT
8SiooL FEE: I
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I :~ilst
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-:yi 7-;r -I HAVE CAREFULLY EXAMINED THE COMPLETED .. APPLICATION AND PERMIT. AND DD
HEREBY CE8TIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I
FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED; TD COMPLY WITH ALL CITY,
COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
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.
_,..
APPLl~NAK~ /
OWNER□
AGENT D
coNTAACToRiil IAPPR~ ~./
SYPHONE D er~~ ~¼
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SITE <
P.j:::RMIT NO: _,80 --J;).._9 ADDRESS: ' .. OWNER: ,,
,. FIELD INSPECTION RECORD ~ ,
'
INSPECTION DATE IN5PECTO'R INSPECTOR'S NOTES
WOOD FLOOR '. --.
FOUNDATION• FORMS• SET BACK • TOILET
UNDER FLOOR PLUMBING r 1 --, ' -----. ''"' ' '" :~ .• ~ .,
UNDER FLOOR HEATING . ' ' . I .. ..,-41.o .,_ , L•, . ' . ' . ' .__ -:'.\ ', . ,, OK TO INSTALL SUB FLOOR ~ -. . . --. ~\ -:c .•. , -..
SLAB FLOOR
UNDER SLAB PLUMBING
FOOTING• FORMS• SETBACK • TOILET r
OK TO POUR CONCRETE
FRAME
ROUGH ELECTRICAL '
ROUGH PLUMBING
ROUGH HEATING/VENTILATING
FRAME OK • PLACE INSULATION
INSULATION OK • PLACE WALLBOARD
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 • A .. -• PRE DECK .,. ' . --..
• FENCE PREPLASTER .
SHOWN • FRAME
• PAN 1...1 I -J J v
FINAL INSP BY BLDG DEPT f,f
"-'--" I _r·J
OTHER DEPT'S REQ COMPLETED I • ' ' ,,_ I
ELEC METER-PERM-TEMP .
GAS METER-PEl'tM-TEMP
.. " \ . .·
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CERT OF OCCUPANCY ISSUED -{ . '