HomeMy WebLinkAbout2554 STATE ST; ; 82-224; Permiten z 0 ~ IIC ~ u Ill C
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0 I hereby affirm 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
lull force and effect. lie No ______ Cl•ss _____ _
I hereby affirm that I am exempt from the eon. ~:er~!?::: ~w ~f~~:l~~~~i~
county which requires a p&rmit to construct •lter. improve, demolish, Of repair any struct.ure, prior to ,ts issuance also requires the apphcant tor
such permit to file a signed statemeot that he ,s licensed pursuant to the pr0Y1S10t1S of the Con·
tractor's Locense Law (Chapter 9 commencing with
Section 7000 of °''"""' 3 of the Business and Pro-fessions Code) or that 1s exempt therefrom and the
basis tor the alleged •~emption Any vlOlation of
Section 7031.5 by an opptocant tor a permit subjects
tne applteant to a c1111I penalty ol not more than five
hundred dollars ($500).
□ I, as owner of the property, or my employees
~,th wages as their sole compensation, will do the
WOftt, and the structure 1s not intended or offered fOJ
sale (Sec. 7044, Business and Profess,Ohs Code·
The Contractor's License Law does not apply to an owne, of property who bu:llds or improttes thereon
and who does such work. himself or through hts own employees, prOYided th.at such ,mproveme;its are
nol mtende1 or ottered tor sale. If, however, the
building or improvement 1s sold w1th1n one year of completion, the owner-builder w1II have the burden
of provmg that he dk:I not build or improve tor the purpose of safef.
□ I, as owner of the prO()erty, am exclusively
contracting with hcensed contr~tors 10 construct
the proIect (Sec. 70U, Business and Professions
Code: The Contractor's Lecense Law does not apply
to an owner of property ·who builds or improves thereon. and who contracts for each proJeCIS with a
contractor(s) license pursuant to the Contractor's
License Law).
□ lamuemptunderSec, ______ 8 &PC
tor th,sreason ___________ _
□ I hereby affirm that I ha~ a certIhcate of consent
to self-insure. or a certificate of Workers'
Compensation lnsura.nce, or a cert1f1ed copt thereof
(Sec. 3800. Labor Code)
POUCYNO __
COMPANY
O Copy IS hied wllh the city
0 Cert1hed copy ,s hereby furnished
CERTIFICATt OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
(This secttOn need not be completed 1f the permit ,s lor one hundred dOilars (S100) or less)
D I cert,ty that In the performance or the work tor which IhIs pemut Is issued. I shall not employ any
person ,n any manner so as to become subIect to
the Workers· Compensat,oo Laws of Cahforma
NOTICE TO APPLICANT. II, alter makin~ 1h15 Cert••
hcate of b:emption. you should become subIect t,:, the Workers' Compensation prov,s,ons of the Ubor
Code, you must for1t1w1th comply with sucn
provisions o, this perm1I shall be deemed revoked
O I hereby alttrm that there ,s a conslructton
lending agency to, lhe performance ot the wOf'k tor
wn,cn 1h1s perm,t 1s issued (Sec 3097. CIVIi Code)
Lender's Name ___________ _
Lender·, Address __________ _
USE BALL POINT PEN ONLY & PRE~S HARD --APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS
CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT 1200 Elm, Carlsbad, Callfomla 92008 (714) 438-5525 -JOB ADDRESS AV. ST., DATE OF APPLtCATIOflll BUSINESS LICENS,t,' 'f' lifATIOftl PERMIT NUMBER ~s-sr¥ Sr·..:,, -~~ RD. ~-,_} .F-/2, .2t.// -:·7 ft) 7-f OWNER'S NAME I OWNEll"S PHONE PRIME CONTRACTOR CONTRACTORS PHONE • ZONE i )1-~ A Al ~l I/_/ /.: J1 JI u-r PA cL 1 '('" f;;_ L.l'h,. 111!.,,-.,,d ~ 7,-1 --:1 ":l.t:7~J ,_ ... ;; ,. .,
OWNER"S MAILING ADDRESS CONTRACTOR'S ADDRESS LICENSE HO. PLAN 1.0. # BLOG USE CODE
P./"l. Br.)Y..J. I r--, (: "· ___ Jo.lf:.J f"oa ..... /J,i!.,-,AJ c r r:;7AOV 'it? 7 ~ ("-( \. . / ~-i1~·1 ,4-,J ,.-,
LOT BLOCK I SUBOI VISION I ASSESSOR PARCEL NO. DESIGNER STATE LICENSE# STANDARD PLAN# BUILDING SO. FOOTAGE
;).,_ Vt-; 1 ?~ 6/01/825 6Li DESCRIPTION OF WORK IM
DESIGNER'S ADDRESS DESIGNER'S PHONE 00016764 6/0,I / 82 ,--. . . . -IO. r,r
IVRr&" F_ .. lh· &-r~&-:~ r1-,l-Ac.._e__~J1 F/P FLA ELEV. NO OCCGP EDU
STORIES
vO NO --
CENSUS TRACT I GP LAND use I PARKING SPACE I RES UNITS I GRADING ~ERMIT ISSUED I REDEVELOPMENT TYPE OCC LOAD FIRE SPA AREA CONST
r □ ND vO NO vO NO Nor Valid Unkss Machin~ C.rtifi«J
QTY. PLUMBING PERMIT · ISSUE >'J ~(, QTY. MECHANICAL PERMIT -ISSUE SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP
, INSTALL FURN. DUCTS UP TO 100.000 BTU BUILDING PERMIT 01-Mll-42?0
EACH BUILDING SEWER OVER 100.000 BTU SIGN PERMIT 01 ·000·4221 ,,,,,...
I I EACH WATER HEATER ANO/OR VENT .,g~ BOILER/COMPRESSOR UP TO 3 HP PlAN CHECK 01 ·000-4806 . ~-j )J
EACH GAS SYSTEM l TO 4 OUTLETS -BOILER/COMPRESSOR 3-15 HP TOTAL PLUMBING 01 ·000-4222 /1);....---I' V
EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ELECTRICAL 01 ·000-4223 ,,
EACH INSTAl .. ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 01 ·000·4224
EACH VACUUM BREAKER MECH EXHAUST -HODO/DUCTS MOBILEHOME 01 ·000-4225
' WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP
I EACH ROOF DRAIN (INSIOE) SOLAR 01 ·000-4226
. t:rfl TOTl<L MECHANICAL STRONG MOTION 65·640·0519
' . -I TOTAL PLUMBING I /LJ .£? FIRE SPRINKLERS 01 ·000·4227 I
I QTY. PUBLIC FACILITIES FEE 25·000·4933 ELECTRICAL PERMIT · ISSUE QTY. SOLAR · ISSUE BRIOGE FEE
NEW CONST EA AMP/SWT /BKR COLLECTORS SCHOOL FEE -DISTRICT
l PH 3 PH STORAGE TANKS car1sbad 65·623·0519
EXIST BLOG EA AMP/SWT/BKR ROCK STORAGE Encinitas 65-624·0519
l PH 3 PH PUMP San Dieguito 65·625-0519
REMODEL/ALTER PER CIRCUIT PLAN CHECK FEE San Marcos 65-626-0519
TEMP POLE 200 AMPS
OVER 200 AMPS
TEMP OCCUPANCY 130 DAYS) -TOTAL ELECTRICAL I TOTAL SOLAR TOTAL FEES PAYABLE /a~ J .....
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMtr AND DO HEREBY Elcp,rallon. 1:..-.ry permit i-..cl by the Bu~ding Olf1eiat unclerlheprov,s,onaof th,a * AN OSHA PERMIT IS AEQIMED FOR EXCAVATIONS OVEII
CERTIFY UNDER PENALTY OF PERJURY THAT All INFORMATION HEREON INCLUDING THE Code shall exp,re by limitation and become null and v01d II the buolding or work 5' O" DEEP ANO Dbl0U1l0N OIi CONSfflUCTION OF
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS authorized by such permit ,a not commenced within 180 days from the date of auch STRUCTURES OVEII 3 STOIIIES IN HEIGHT permit. or i~v bt.tildi:,'g or work authorized by such permct ia -pended or ISSUED: TO COMPLY WITH All CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON-abandoned time a er the work II commenced for a -ocs of 180 "-· STRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND APPLli.YGNATURE If, OWNER□ CONTRACTOR-3' APPROVED BY £U4-Dr1,li I I KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND I EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE
GRANTING OF THIS PERMIT. &1.-u.i~. ~'-a<A-( BY PHONE 0 I l f
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INSPECTION TYPE I DATE INSPECTOR ~J.-::r-:v-f I'
BUILDING t ---FIELD INSPECTION RECORD
FOUNDATION I
l REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES REINFORCED STEEL t
i INSPECTION REQ IF INSPECTOR'S DATE MASONRY I' CHECKED APPROVAL ' ,. --
GUNITE OR GROUT ! SOILS COMPLIANCE
FLOOR & CEILING SUB FRAME ~ PRIOR TO
FOUNDATION INSP
SHEATHING t STRUCTURAL CONCRETE
FRAME I' OVER 2000 PSI
PRESTRESSED EXTERIOR LATH lNSULATION } ' CONCRETE
INTERIOR LATH & DRYWALL I POST TENSIONED . CONCRETE
i ·-I PLUMBING FIE! 0 WELDING --I SEWER AND BL/CO I I •IGH STRENGTH l PLUMBING UNDERGROUND 1 BOLTS --·-
PLUMBING TOP OUT ' ! SPECIAL MASONRY
TUB AND ~HOWER PAN I
GAS TEST 1 PILES CAISSONS
ELECTRICAL I
TEMPORARY POWER l ~ '
; .
ELECTRIC UNDERGROUND ! -. -----·-·.r I -t ... '-ROUGH ELECTRIC
ELECTRIC SERVICE • . . .. I
1 ·-·-BONDING I I
G. F. I. -SMOKE DETECTOR' !
MECHANICAL I --·--I
DUCT & PLEM., REF. PIPING ·----
HEAT -AIR COND. -SOLAR SYSTEtJIS -' VENTILATING SYSTEMS
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE .
~
ITEMS ABOVE HAVE BEEN APPROVED. ~=7 ~
JOB SITE FINAL ' ' -PLUMBING I fa-?Ul-. ~ t ·---~ ---ELECTRICAL i . -.
\ -·~--~ I MECHANICAL ,,~ ·~ , -. c ~ If"";.\·"';.'~·; GAS I ~c': ~ .. '" BU ILDING I --:--... '" ' .. ·--
SPECIAL CONDITIONS ;
,l
CERT OF OCCUPANCY ISSUED -·.