HomeMy WebLinkAbout2685 STATE ST; ; 87-319; PermitIC
i[ O I tlefeby affirm that I am licensed under
provl1lon1 of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Profe1alona Code, and my license is In
0 full forca and effect.
Ur I hereby affirm that I am exempt from the Conlrac• lo<'s LJCense Law tor !he totlow1ng reason (Sec 7031 ~
Business and Profess10ns Code Any oty or county wtuc.t. re· quires a pemut 10 construct, aller, improve. demOlish. or repair any structure. prlOf to its issuance also requires !heap· plicant for suctt pe11mt 10 me a Sf9necl statement lhat he ,s
licensee, pursuant to lhe pravts,ons of the t.:ontractofs Ltcense Law (Chapter 9 commencing with Section 7000 ol Dlv1stCH1 3 of ltle Bu~ness and Protesst00s COde) or lhat 1s ex-
empt lherelrom and the bastS tor !he alleged exernp1100. Any
v1olat1on of Seclion 7031 .S by an applicant tor a perm11 sub-iecls lhe apphcant 10 a civil penalty o1 not m0(e than rrve hun-
dred dollars ($500)
at ~ as owner ol lhe property, Of my employees with wages .., eir sole compensation, w,n do the wotk, and the slruc-a lure 1s not intended or offered '°' sale (Sec 7044. Business ... and Profess.ons Code: The Contractor's license Law does 5 not apply to an owner of property wno bu1kjs or improves
I theceon and who does such work h1mseH or lhrough his own
employees, provided that wch improvements are not intend· .., ed or ollered tor sa~ If, however, the building or ImpfDve· z menl 1s sold w1th1n one year of completion. the owner-bu1kler ~ will have !he burden of proving that he did not build « im-0 prove fo, !he purpose of sale).
~. as ownor ot !he property. am exclus,vely con1ract1ng licensed contractors to construct !he proiect (Sec 7044,
Business and Pfolessions Code: The Contractor's license law does not apply to an owner or property who builds or ,m-
"' proves thereon. and who contracts tor each projects with a contractor(s) lteense pursuant to the Contractor's license z Law) 0 .: D As a homeowi:,er I am mproving my home. and ine IQ!low <C mg cond1t10ns e:,ust: a: 1 The wo,k 1s being pert«med prtOf lo sale <C ... 2 I have ltved in my home for twelve monlhs u 3 f':v: :TPi~~ot 11
~1~ :"~ption during lhe ..,
a lasl lhree years.
D I am exempt under Sec lor this reason . B&P.C
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D I hereby affirm that I have a cer11ficate ol consent to I
self-insure. or a certihcate of Workers· Compensation In• f
surance. or a certified copy thereof {Sec. 3800. Labor Code) f
POLICY NO z COMPANY 0 .: 0 Copy Is filed wilh the city <C "' 0 Certified copy is hereby furnished z ..,
A. 2 0 CERTIACATE OF EXEMPTION FROM u WORKERS" COMPENSATION INSURANCE
"' (This section need not be completed if the permit ir ~ ;, to, one hund,ed dollars fSH)O) 0< less) w " I certify that In the performance of the work for which at permit ,s Issued. I shall not employ any person in any 0 manner so as 10 become subject to the Workers· Com pen, 3 sat,on Laws of California.
NOTICE TO APPLICANT: If. after making this Certificate
of Exemption. you should become subject to the Workers·
Compensalion provisions of the Labor Code. you must
lorthw,th comply with such provisions or this perm at shall L be deemed revoked.
.jf
D I hereby affirm that there Is a construction lending
agency tor the performance of the work tor which this per·
mil Is issued (Sec:. 3097, CIVil Code)
Lender"s Name
Lender's Address
USE BALL POINT PEN ONLY & PRESS HARO
CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad, CA 92009-4859 (619) 438-1161
JOB ADDRESS
2t:8S-irA-r&
_ Av ST.RD. NEARESTCROSSST.
i -r: C ~ t{t5-'6# i> Uf. o/AJo?
LOT I BLOCK T suBD1 v•s10N l ASSESSOR l'ARCA f'/O_ (
).Q ~0..::>'-f"U, o0
~:S;A~_U
~ JI I OWNER"SPHONE fl MD t •I,. I /*33-tr'rl 'f-1 CONTRACTOR'S ADDRESS
::p,~M;L•7c}?/S (4 ~h~{s+ j) Ut . 1/.)-02 -p
CONTRACTOR
DESIGNE A
DESCAIPT•ON OF WORK '
APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
APPLICATION & PERMIT
J°i: ;:;;r1 BUSINESS LICENSE II 'VALUATION
_L::).
CONTRACTORS PHONE t ZONE
iiR~IT NUMBER
3/1
STATE LICENSE NO. BUILDING SO. FOOTAGE
~
u.. DESIGNER'S PHONE >,
oi
0 I £)EA4hn•,;7 rESIGNER"SADDRESS
STATE LICENSE NO. 0033 04/13 0101 02BldP1llt 30.io[
6 t/#/-1-#///P£/ /II e Alt.'-
F/P F LR ELEV.
vO NO
REDEVELOPMENT AREA
~ I occ GP I EDU STORIES
TYPE I occ LOAD I FIRE SPA
CONST 1 PARKING tPACE l RES UNITS l GRADING PERMIT ISSUED
1 □ N 0 vO NO vO NO Nor Valid Unlns Machine Certified
QTY. PLUMBING PERMIT· ISSUE .:J_<lJ II QTY. MECHANICAL PERMIT -ISSUE -~00 SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP INSTALL FURN DUCTS iJP TO 100,000 BTU BUILDING PERMITJj:,,r,#{j' 001·810·00·00-8220 -ZO!!::-
EACH BUILDING SEWER OVER 100,000 BTU SIGN PERMIT 001 ·810·00-00-8221
EA CH WATER HEATER ANO OR VENT BOILER/COMPRESSOR UP TO 3 HP
EACH GAS SYSTEM I TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP
PLAN CHECK 001 ·810·00·00-8821
TOTAL PLUMBING 001-810-00-00-8222 I /o~v-
EACH GAS SYSTEM 5 DR MORE METAL FIREPLACE ELECTRICAL 001-810·00·00-8223
EACH INSTA~. ALTER, REPAIR WATER PIPE MECHANICAL VENT FAN SINGLE DUCT ,.,__"""·~~, 001·810·00·00-8224
EACH VACUUM BREAKER MECH EXHAUST · HOOD DUCTS MOBILEHOME 001-810·00-00-8225
WATER SDFTNER RELOCATION OF EA FURNACE/HEATER SOLAR 001·810·00-00-8226
EACH ROOF DRAIN (INSIDE) ~ DRYER VENT / C:::-:AA'J /7,h ~ ./ 3--TOTl:.L MECHANICAL
STRONG MOTION 880-519-92-33 -FIRE SPRINKLERS 001-810-00·00-8227 -vrn r AL PLUMBING I /O.!!--PUBLIC FACILITIES FEE 320·810-00-00·87 40
QTY. ELECTRICAL PERMIT -ISSUE _-S---t)t) II QTY. MOBILE HOME SETUP BRIDGE FEE 360-810-00-00·87 40
PARK·IN·LIEU (AREA )
NEW CONST EA AMP'SWT BKR CAR PORT TIF 134-810·00-00-8835
1 PH 3 PH AWNING LA COSTA TIF 133-810·00·00·8835
EXIST BLDG EA AMP'SWT 'BKR GARAGE FMF
1 PH 3 PH LICENSE TAX 001 ·810·00-00-8162
REMODEL ALHR PER CIRCUIT MFF 880·519·92·57
TEMPPOLE 700AMPS
OVER 200 AMPS
TEMP OCCUPANCY 130 DAYSI
CREDIT DEPOSIT
TOTAL ELELTRICAL l TOTAL TOTAL FEES PAYABLE 1 ~d§3Z.
y Exp,rat,on Every permit 1ssu&d by the Bu,ldmg Offlc11J under the prov,s1ons of th,, I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION ANO PERMIT" AND DO HEREB Code shall expire by t1m,tat,on and become null and void ti !he bu,ld,ng or work
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE author,zed by such permit"' no! commenced w,th,n 1B0 days from the dale of such
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS permit. or ,f the bu1td1ng or work authorLZed by such permit 1s suspended or
ISSUED TO COMPLY WITH .ALL CITY COUNlY AND STATE LAWS GOVERNING BUILDING CON aban at an lime after the work 1s commenced for I nod ol 1BO da s
STRUCTION WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND~~-IGNATURE ~ OWNER CONTRACTOR 0
KEEP HARMLESS THC crry Of CARLSOAD AGAINST ALL LIABILITIES, JUDGMENTS .. COSTS .O.ND c/ ~ .
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF lHE , /.: ::r, ~/ , ' BY PHONE 0
GRANTING OF TtilS PERMIT t,V &C{ •
* AN OSHA Pf:RMIT IS REQUIRED FOR EXCAVATIONS OVER s· o· DEEP AND 0£MOI..ITION OR CONSTRUCTION OF
STRUCTURES OVER J STORIES IN HEIGHT
APPROVED BY p 1%,11
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TYPE ' I DATE INSPECTOR
1-,l BUILDING ;
FOUNDATION 1 FIELD INSPECTION RECORD F
.. ~ REINFORCED STEEL
\AASONRY
I REQUIRED SPECIAL INSPECTIONS 1 REO IF INSPECTORS GUNITE OR GROUT I INSPECTION CHECKED APPROVAL
SUB FRAME □ FLOOR □ CE~LING SOILS COMPLIANCE
SHEATHING □ ROOF □ St,IEAR PRIOR TO
FOUNDATION INSP FRAME I
STRUCTURAL CONCRETE EXTERIOR LA TH ' OVER 2000 PSI
INSULATION : PRESTRESSED I CONCRETE INTERIOR LATH & DRYWALL l POST TENSIONED
CONCRETE
PLUMBING l FIELD WELDING
□ SEW ER AN D BUCO □ UCO HIGH STRENGTH
UNDERGROUND □ WASTE [ WATER BOLTS
TOP OUT □ WASTE D WATER SPECIAL MASONR'I'
TUB AND SHOWER PAN J !
GAS TEST t PILES CAISSONS
□ WATER HEATER D SOLAR \1'ATER .
I
ELECTRICAL
□ ELECTRIC UNDERGROUND [~ UFFER
ROUGH ELECTRIC I
D ELECTRIC SERVICE □ TEMfPRARY ,
I -; □ BONDING □ POOL I
I
MECHANICAL , □ DUCT & PLEM., □ REF. PIP,ING ' '
HEAT -AIR COND. SYSTEMS l ;,-...._, ' ' ...
VENTILATING SYSTEMS : ' / ~ \\ ..,,,, ~ ' . .. . • ' '\z--,
l
CALL FOR FINAL /NSPEC7ION WHEN ALL APPROPRIATE
ITEMS ABOVE HA1VE BEEN APPROVED.
FINAL : .
PLUMBING I .
ELECTRICAL I "I J .. ,Jr ✓ lL7 MECHANICAL : . I I / J er / p{J,.v
GAS I \I J;v-I ., ~~~ ~ • /lJ l.,. BUILDING I ~-Jl "6'1l Vtv"' "~ r
SPECIAL CONDITIONS l -V V \ I nJlit'v _j ~ • \ ,-0 0
l !'I -n~"-f 1, /1,,
51, ... 3/°t
INSPECTOR'S NOTES
DATE
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00'.u O\t\Tl oror OSEI~~+ 10·~
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ATTENTION PROPERTY OWNER:
An "owner-builder" building permit has been applied for in your name and bearing your
signature.
Please complete and return this information in the envelope provided at your earliest
opportunity to avoid unnecessary delay in processing and issuing your building permit.
No building permit will be issued until this verification is received.
l. I personally plan to provide the major labor and materials for~struction of
the proposed property improvement (yes or no) '/f:> . .
2. I (have/have not) ;JJJ-tJ(, signed the application for a building permit.
3. I have contracted with the following person (firm) to provide the proposed construction.
Name ---------------Phone ------------
Address Contractors License No.
City ______________ _
4. I plan to provide portions of the work, but I have hired the following person to
coordinate, supervise and provide the ,ml(jor work.
Name /1.()(3ry.2-r A UJy,{, / a) /Phone 9/4 37572
Address ~SJ/ 3@ 9": / <[i;O r// Contractors License No. 4f.i:912i>
City &N&N)rflj L _,,,/
5. I will provide some of the work but I have contracted (hired) the following persons
to provide the work indicated:
Name Address Phone Type of Work
Signed: Property Owner --=-0/-1-/---'~~c.=.::~c.::.::z_--<-£--"-'---,+-;;z,e;= _____ _
Social Security Number _ ______cS,=-.:~'-7-'--,-'-~-6_-_,9'--'-(J(-O_b ______ _
Date:
EACH SUBCONTRACTOR WILL BE INSTRUCTED TO OBTAIN A CITY OF CARLSBAD BUSINESS LICENSE
AND FURNISH A CERTIFICATE OF WORKMAN'S COMPENSATION TO THE CITY OF CARLSBAD.
Initials
~ SAN DIEGO GAS & ELECTRIC
, -~' P.O. BOX 1831, SAN DIEGO, CALIFORNIA 92112
Notice of Service Discontinuance
PERMIT DEPARTMENT
CITY OR COUNTY OF
@'R1c@/o@ SERVICE TO
ct-lo 3S S~{.,\,-\-c.. Co..rMA:D
ADDRESS
WILL BE DISCONTINUED, AND ALL SERVICE LINES WILL BE REMOVED
BY '-I -~ -'b 7
DATE
THIS BUILDING CAN BE MOVED OR RAZED AFTER THE ABOVE DATE.
FORM l06-2152A
SAN DIEGO GAS & ELECTRIC
BY l)\\~ ~[Mt1rGo)
DATE Lf -7 -9:. I
TELEPHONE ½J!l.' (oQl..f&