HomeMy WebLinkAbout2554 STATE ST; A; 81-242; PermitCII z 0 ;::
"' a: "' ...I ~ 0
..
~ ~[ IC ... z 0 CJ
O I hereby affirm that I am licensed under
pnwlalona 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 _____ _
I he<eby aff1,m tllalt I am exempt from the Con· ¥oo~~·~:::: ~ ~t~~:1~~~~~
county which requires a p&rmit to construct
1Uer. improve, demolish, or repair any structu~.
prtor to ,ts is~e also requires the applicant tor such pe,mit to file a signed statement that he 1s
licensed pursuant to the prOY1SKM'IS of the Con·
tractor's License Law (Chapter 9 commencing with Sect10n 7(0) of Chv1sion 3 of the Business and Pro-
tesst0n1 Code) or that is exempt therefrom and the basis for the alleged exemption. Any v,olahon of
Sect,on 7031 5 by~ applicant for a pe,mit subjects ~ >l!:~ne ;;~1~ ~~-penalty of not mo,e than five
9 .~ner of the property, or my employees 5 .. 11h wages as their ~e compensatf()t"I. will do the
• • and the structure ,snot intended or offered few CC sa~ (Sec. 70rM, Business and Ptofesst<>l'ls Code Ill The Contractor's lteense Law does not aoply to an Z owner of property who builds or improves thereon
~ and who does such work himself 01 through his own O employees, provided lhal such ,mproveme;its are
not 1nlende1 or offered for sale. II, howeve<, the
building 01 improvement 1s sokt w1th1n one year of comptehon. the owner-builder will have the burden
of proving that he dtd not build or improve tor the
purpose of sale).
z 0 ;:: ~ z w IL :IE 0 u
CII a: w " a: 0 3
□ I, as owner ol the propeny, am exclusively
contract1~ w,th hcensed contractors to construct
the pro,ec.t (Sec. 70U, Business and Protesst0ns Code: The Contractor's License Law does not apply
to an owner of propeny whO builds or improves ~~::;i~ 7.~~~~!~~~ ~~t!r~~~.:::-:
License law).
0 I am exempt un<lef Sec _____ , B & PC
torth,sreason ___________ _
□ I hereby affirm thal I have a cen1fica1e of consent
to self•insure. or a cen1hca1e of Workers· Compensatton Insurance, or a cen,hed copy 1hereof
(Sec 3800. Labor Code>
POLICY NO _______ _
COMPANY
0 Copy 15 hied with lhe Ctty
0 Cen1fled copy 1s hereby furnished
CERTIFICATl OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 1f the permit 1s IOf one hundred dollars ($100) or less)
D I certify that in the performance ot the wOf'k fo,
which this pemut 1s issued. I shall not employ any
person 1n any manner so a.s to become subJecl to
the Wortte,s· Compensahon Laws of Cahlorma
NOTICE TO APPUCANT If. after makmJ this Cert• hcate of Exemp11on. you should become subject 1?
the WOf'kers' Compensation prov1s1ons of the Labof Code, you must forthwith comply w1lh such
provisions or this permit shall be deemed te\lOtl.ed
. 1[ D I ne,eby affirm that there 1s a consttuct1011
lending agency •or the performance of lhe WOOl fo1
which this permit 1s issued (Sec 'JIYJ7. C1v1I Code}
Lenoe, s Name, ___________ _
Lender's Address __________ _
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT
1200 Elm, Carlsbad, California 92008 (71-4) -438-5525
JOB~SS'-/ '# A 5-1-Ate ~ CA~ls Ad A~;_T. o~:i/:p87'0
N1t=1wl\eil:!'j[iii;!~ ~N
PERMIT NUMBER B\-:;_f~ OWNER'S PHONE
;£{-~O
OWNER'S NAME
Hel\>RY Cc,NwRY' PRIME CON;:;C~ /V e P-1
0 ~Si~7A:-As s+k s+. , CCJRlsbPd CONTRACTOR'S AOORESS 7
LOT rLOCK I SUBOIVISION I ASSESSOR PARCEL NO DESIGNER
I DESCRl~TION pF WORK \ ... )<. I DESIGNER'S ADDRESS , !Nib\:Bi \ \ ';>, N
F/P FLA ELEV.
vO NO
CENSUS TRACT I GP LANO USE PARKING SPACE AES UNITS GRADING f'.ERMIT ISSUED
YO N 0 l REOEVELOPMEN~ AREA
vO NO
QTY.
PLUMBING PERMIT· ISSUE ~ QTY. MECHANICAL PERMIT -ISSUE
EACH FIXTURE TRAP S-0 INSTALL FURN. DUCTS UP TO 100,000 BTU
EACH BUILDING SEWER OVER 100,000 BTU
EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP
EACH GAS SYSTEM l TO 4 OUTLETS BOILER/COMPR ESSOR 3-15 HP
METAL FIREPLACE EACH GAS SYSTEM 5 OR MORE ---------+------4---1-VENT FAN SING LE DUCT EACH INSTAl .. ALTER, REPAIR WATER PIPE
EACH VACUUM BREAKFR -_,,_,_,, I y I MECH EXHAUST -HDOOIOUCTS
RELOCATION OF EA FURNACE/HEATER/ WATER SOFTNER
EACH ROOF DRAIN (INSIDE)
TOTAL PLUMBING
ELECTRICAL PERMIT -ISSUE
NEW CONST EA AMPISWT /BKR ,.
l PH 3 PH
EXIST BLDG EA AMP!SWT/BKR /
l PH 3 PH II/·
REMODEL/ALTER PER CIRC~
TEMP POLE 200 AMPS
. ..1"V'-nll
--, l .t.Pl Y-1
OVER 200 AMPS
QTY.
II/
TDT.t,LMECH/
~R-ISSUE
Ui(l1'.'LECTORS
STORAGE TANKS
ROCK STORAGE
PUMP
PLA'1C~E
U"~
./
y
NO
STORIES
TYPE
CONST
7
CONTRACTORS PHONE •
LICENSE NO.
STATE LICENSE #
~
DESIGNER'S PHONE
OCCGP EDU
DCC LOAO FIRE SPA
vO NO
ZONE
PLAN 1.0. # BLOG use COOE
STANOARD PLAN# BUILDING SO. FOOTAGE
5 / I I /B I 1383
QtJll::IR::I Fi/l L/~1.. Not Va1i81JnwsF'Mhtne C!l!t'tdtld
10~0
10 .c
SUMMARY/ACCOUNT NUMBER
BUILDING PERMIT
SIGN PERMIT
PLAN CHECK
TOTAL PLUMBING
ELECTRICAL
MECHANICAL
MOBILEHOME
MDBILEHDME PARK INSP
SOLAR
STRONG MOTION
FIRE SPRINKLERS
PUBLIC FACILITIES FEE
BRIDGE FEE
SCHOOL FEE · DISTRICT
Carlsbad
Encinitas
San Diegu1to
San Marcos
A ./,tJ ~
TOTAC SOLAR I TOTAL FEES PAYABLE I I ,--1r !!!--I =---.. ' REBV E><p<r1tion Everypermi1-bytheBu1ldtngOff1c11lun-thep<oV1StOn9ofth19 I HAVE CARE AMINED THE COMPLETED "APPLICATION AND PERMIT AND DO HE Code shall exptre by llm1tat1on and become null and void If the building or work
CERTIFY UNO LTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE authorized by such permit it not commenced w1lhm 180 days from the date of such
* AN OSHA PU .. IT IS REOUlffED FOR EXCAVATIONS OVEfl
5' O" DEEP ANO DEMOUTION Ofl CONSTIM::TION OF
STRUCTUflES OVER 3 STORIES IN HEIGHT
~
u:::
>-iii 0 a.
E Q)
f-
l
'O 0 C,
C: co E a. a.
<(
I ~ Tlf:
0 (/) (/)
Q) (/)
(/) <(
I
~ ,Q
ai >-
ui (/)
Q)
0 0 a:
co
ai Cl
€
Q)
0 C co C u:::
C Cl)
Q)
<5
0 0 Cl) a. (/)
C
~ DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS permit or 11 the b<uldu111 or work 1uthoriZed by auch pe,m1t 11 -pended or
ISSUED TO COMPL V WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON· l,!aban!!!!!!do!!!!!ned!!!_,!ll!_;an!!!)(..!l!!!1me!!!_!lfl!!e<!!Jllle!!!,_!W!!!ork!!!_!!•SJC,!!O!!!ml!:men!!!!!!:C:!:ed!!..!lfo~r..!!i~r~1od~o!!.f.,!l3!!!.,!!daWL-:::-,1'":=~~~:::"'---~:-------:::°:"::'°,,,-----,
STRUCTION: WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND ?7.PPLIC i•s fGNATU CONTRACTOR O APPROVED BY ~
.r:. ~
KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS, COSTS AND
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE IWN'VI-.,,, BY PHONE O I
GRANTING OF THIS PERMIT. ,
I ,
INSPECTION TYPE DATE INSPECTOR
" BUILDING
FOUNDATION
REINFORCED STEEL
MASONRY
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME
SHEATHING
FRAME
EXTERIOR LATH lNSULATION
INTERIOR LATH & DRYWALL
PLUMBING
SEWER AND BL/CO
PLUMBING UNDERGROUND
PLUMBING TOP OUT
TUB AND ~HOWER PAN
GAS TEST
ELECTRICAL
TEMPORARY POWER
ELECTRIC UNDERGROUND .
.. . . ROUGH ELECTRIC
ELECTRIC SERVICE
BONDING
G. F. I. -SMOKE DETECTOR
MECHANICAL
DUCT & PLEM., REF. PIPING
HEAT 7 :AJR COND. -SOLAR SYSTEMS
VENTILATING SYSTEMS
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAVE BEEN APPROVED.
JOB SITE FINAL :,-a,f
I .. " --,
PLUMBIN"G
ELECTRICAL .. '\
MECHANICAL
GAS . , I -BUILDING -. . . ,
SPECIAL CONDITIONS
CERT OF OCCUPANCY ISSUED
.
~. •r-• {' .. .. ,
/
< -
FIELD INSPECTION RECORD ,
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
INSPECTION REQ IF INSPECTORS DATE CHECKED APPROVAL
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRESTRESSED
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
PILES•CAISSONS .
C -I
.
-•
,, I j" LJt1 r, ~ ,, : .'
-c--\1 \i..: J~·
--
,
t;~: ~--~~·
-. -· .
,:,..,
I . . . ' .. ~· -,:-. ~ 1 --.-:...~.
I
-
I