HomeMy WebLinkAbout2541 STATE ST; MULTI-PERMIT FILE; 63-5400; PermitAPPLICATION FOR BO 11 DI I G PERMIT 5400
CITY OF CARLSBAD -BUILDING INSPECTION DIVISION
f,;;:;. ~;;~:1 ~;:•P;~~:L;:;,:;i -Morn,,
Contractor ........ ~•···························································Mailing
/
Address ;J;j}//. ... s..i;,.6.-/··········~··fi-_: .............. .
Number Strey City ·7 Phone
Address
( Please Print) Number Street City Phone
To Construct To Add O To Alter O To Repair O To Convert O To Move From ............................................................. .
Type of Cons~Kind of Foundation .... ~f. ... No. of Stories .... :Z..~To Be Usod for '4pf.~.~r···~··c·~ '¼
( Frame, Masonry, Etc.) (One f~;;,ily Dwelling, Store, Etc.)
Floor Space of Proposed Construction (sq. feet) .. .S.:='t.?.2..t.?. ............ Const. Valuation $ ....... #.:4..,-... b...f..{ .. !!!!.. .............................................. .
attached 0
Floor Space of Garage (sq. feet) ................................................. detached OConst. Valuation $ ..................................................................................................... .
LEGAL DESCRIPTION,AU2 .. ~.L~r··X..1:!!....~ .. ~Bi~µ ... ~ .......... 7. ....... ~if(-~.t. ........ ~.~.JJ ... J. ~-"
or .......................................... , .. ~······················································· .. ···············Section ..................
1
•...•...•..••... Township ............................ Range ........................ , .. .
Located at 35..t. .. t.. ..... ~~······: ................. Street, Near ..... ~~a.&.t..C.. ............................................. .
Assigned House Num ber -dJ ~--r--<~
LAND AREA ...................................... NUMBER OF EXISTING DWELLINGS ON PROPOSED BU ILDING SITE l..~ .... t ....... ~~ ........................ (INDICATE
SIZE, USE AND LOCATION ON PLOT PLAN). WILL THIS CONSTRUCTION INCLUDE ANY PLUMBING INSTALLATION, ALTERATION, OR
ADDITION? YES ... ~ ....... . NO ................ .
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
If II check is tendered for payment of the above fee an d the check is
not honored when presented for payment, your Bui lding Permit will be
immediately revoked.
SIGNATURE OF
PERMITTEE ............................................................................................... .
,? (} I Front Yard Set Back ........ ~ ..................................................... . ,
Side Yard Set Back ........ ,.~ .. .Z.. ............................................... .
I
Rear Yard Set Back .... /,2. ........ f ............................................ .
Distance Between Bldg ......... / .... 0. ........................................... .
Off Street Parking Spaces ............. / ... {J.. .................................. .
Sewage Disposal System ................... ½ .......................... .
Zone • Residential t-!f) ..................................... : ..................... .
Zone -Commercial ( ) ·························································•
Driveway Permit Required Yes (
Grading Permit Required Yes ( )
No ( Fee ..................................... .
No ( ) ....................................................... .
Sewer Disposal Plant Capital Cont. Fee .................. A/ON~ ............................. .
Sewer Pumping Station Capital Cont. Fee ................ .I.VPN..€ ............................. .
Sewer Main Line Cost ....................................................... ~<?../)/.£ ............................. .
Sewer Lateral Connection Charge ........... t$.:.K(~.T.. . .' ....... 0 ...... , .................... .
:::: ::::•:;~••~:.c:~: f;;;;;:,ii\~
Water House Service Charge ........ /.. ............................................................................ .
wfte': tfte~~~ ... ~ .. J .. ~.~······/f!q,_ .. ~ .. c~ SJ(
Sub Total ................................. ~j.!!!,,···············
Plans Approve~···0······/'r)···-r···························································Plan Check Fee ·····•··•····························5··"//····································· C ...... ~
.,,~··• by :::_._:i;::.., ... sl.. ...... ~~·······················-·-'";'•;·, ,.,.;, , .. ./.. .. 7' .. ~,·····qiFo;sc:;;···············d-I
Date ............ /fJ-f?-.. 6,,5 ............................................................ Total Charges ... ~i:i;i'.& .................. .C~./,st-:-.......... .
CITY OF CARLSBAD
BUILDING DEPARTMENT
729-1181 -Ext. 36
For A liea,nt to Fill In
Owner's Name E e R C. D
73-
A1pplicafion lor BUllDl1NG Permit
Building Permit F.ee
SPAID KAY 12 ·64 -cc133 3*****180.75
Meil Address s!? ~-() A t9-GUN'~ Gu?is/J.:,<tE!,-----~;...;..;.~.....;;.i;;.;.;..~~.;.;...,----.
Contractor &u h A JL,:L,_.,
Contr. Address __ .,,S:..e:....-=~=--..:__.= __ _.::,,,,~-----' To Const. □ To Add ✓ To Alter 0 Convert D
To Move From _________________ _
Type of Const. '~~
, Frame, Masonry, etc.
/~ />/fRhN¢ .Sp,-,c~s -3~
fo Be Used For C-:~ -I>;'~
Kind of Foundation ~> No. of Storie ~_'?:--___ _
Floor Space (Sq. Ft.) __,,.~ ... •'---.,_Q..c::.._£"-..,.0~--------
Attached-------~ Garage Floor Space (Sq. Ft.] , Detache0-_______ _
Legal Description /;;;-=-/6-,/"8--rf), J-/f
Lot Block
S,bdi,i,ioo ';;;Qa,.;/21? J-.,_,,,,;; 1hr }7.;z:) o,
Section Township Range
No. of Existing Building ______________ _
Will this construction include any plumbing installation or alter-
ation? Yes O No D
Signature of Applicant
I ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
COMPLY WITH ALL CITY AND STATE LAWS REGU LATING
BUILDING. , .• -
1 CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY CITY OF CARLSBAD A D
STATE OF CALIFORNIA OR THAT I AM THE
OF THE ABOVE DESC D RE ENTIA L
SIG NATURE
OF PERM ITTEE
St. Near
Set Back Bldg.
Front P.L. Main Bldg.
Side P.L. Garage
Reor P.L. Other
Group r-2-Zone c~
Contractor City Bus. Li e. No. ____________ _
Water Meter
t I I I
U/~lf /N'5
I Sewage Dispos~ ;ysfom
,&u S' / ~ / /V <i
Inspection Record
~cu..,?{; -.s;/r~/cL
Ui ility Company Noti-fied -Date ______ By ____ _
Final
check is tendered for payment for the above fee and the
chock is not honored when presented for payment, your
building permit wi ll be immediately revoked.
City of Carlsbad Building Dept.
60 days of issuance.
'
CITY OF CARLSBAD SEWER
BUILDING DEPARTMENT PERMIT • APPLICATION
l'!~Y 28-65 ~':~0 258~*******5.00
FOR APPLICANT TO FILL IN
_L_E_G_A_L ________ 9_ ... _____ t_,., __ t_t ___ --B·U-IL_D_I_N_G __ .,-~--~--/----r-----... ~-~-~:::;;,::-----
DESCRIPTION LOT NO. o'3acreas •!JS a AS ADDRESS ,,.£_~ t,j'.-(~
Unit #1 NEAREST ' BLOCK
USE OF
BUILDINGS
TRACT
Dwelling
coNTRAcToR A&R Custom Inc 1
ADDREss 2541 A State St.,
c1TY Ce'l'.'1s e.· C alifEL. No. 729 ~318
CONTRACTOR'S STATE
LICENSE NO.
CARLSBAD BUSINESS
LICENSE NO.
208302 5266
NO. DESCRIPTION OF WORK FEE
1 HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK, SEEPAGE PIT OR
PITS @ $!5.00
OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN.,
CESSPOOL, DRVWELL, MANHOLE @ $!5.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.!50
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER @ $1.!50
ALTER. REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $2.00
@ $
i.
OWNER'S PERMIT $ 2
00
00
AUTHORIZATION I TOTAL FEE 5◄00
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED BUILD·
ING TO THE PUBLIC SEWER.
SIGNED THIS -----DAY OF ---------
OWNER OR
OWNER'S AGENT -----------------
ADDRESS
CROSS ST.
OWNER Jo oph Wood
MAIL
ADDRESS
CITY TEL. NO.
CONNECTION DATA
Lateral Charge Computation
30' H., 10' V. @ 4" = __ 6" ---
Add. Horiz. @ 4" ___ 6" ----
Add. Vert. @ 4" = ___ 6" ---
Total Construction Cost
10% Service Charge
Total Lateral Charge ____ _
Lat. No.: Logged in Plat:
LINE COST DATA
A. D. & Assmt. No. _______________ _
LINE COST: ________________ _
C. C. @ __ I dwelling --------____ _
P. S. @ __ I dwel ling ______________ _
OTHER
TOTAL
Grand Total, Loteral, etc.
FOR SEWER LOCATION
NORTH
Permit When Properly Filled Out, Signed end Validated
luued By __________________ _
PERMIT VALIDATION
-· . ' . .;: ... . • I -~ tar·
'i '• •
'i BUILDING PERMIT APPLICATION
Pi .,1 I ,, I City of CARLSBAD, CALIFORNIA 92008
" Perm it No. I.. ' ' Applicant to iomplete numbered spaces only. Phone 7 29-1181 . ..
~-J08 ADDRESS 0 L..
I t, ::, 0
25 1 ,tata 'Street Carlsbad z {J)
f1l )>
coT •~8 Portion I m
I TRACT ll 0
1 LE GAL I tOst, ATTACHED SHEE.T) 0 1 DESCR, !l~Afd... r --.a-ll ,. -f1l
OWNE" MAIL AOD,.£55 ZIP PHONE IJI IJI
'I 2 Dl"'ln_l",, 550 Lal'ft1na Dr. c.tr 1 Ahrl.il C'.!1111 f. 92009 71• '729-llS8 I'• CON T .. AC: TOR MAIL ADDRESS PHON [ LICENSE. NO. ' ~ 3 owner ~
; AIIIICHITtCT OR OE.SIGHER MAIL AOOR£S5 PHONE LICENSE NO. .. ...
4 l"'lw-na 'r' :,
ENGIN££R MAIL ADDRESS PHONE LICENSE NO.
5 JA -.
I~ L£NDIER MAIL AOOfH.SS BfllANCH ~ lt 6 !lA t USE OF' l&UII..OING
[) 7 ..;~or.aon .~ !i,, -u
Cl)
1, 8 Class of work: □NEW ~DDITION □ ALTERATION □ REPAIR □ MOVE 0 REMOVE -3 -· --z
I : 9 Describe work: ?
PRAME -'""' ... ,..1~ ii77-& ~T.l'llt ....... ~ :LI
/
l , 10 Change of use from
I Change of use to r,
1, 11 Valuation of work: $ I PERMIT FEE 11,960. PLAN CHECK FEE 7S.00
SPECIAL CONDITIONS: Type of Occupancy
Const. VN Group Division --
Size of Bldg. No. of Max.
(Total) Sq. Ft. 19 ,o Stories l Dec. Load -
~ Fire Use Fire Sprinklers j
1 APPLICATION ACCEPTED BY, PLANS CHECKED BY APPROVED FOR ISSUANCE BY zone 2 Zone c-;4 Required □Yes ~o
' I ' .!:.. (,;, No. of OFFSTREET PARKING SPACES:
1 ... \. I Uncovered ~-\· -Dwelling Units -Covered ---
k NOTICE Special Approvals Required Received Not Required
\ SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB-ZONING
ING. HEATING, VENTILATING OR AIR CONDITIONING. HEALTH OEPT.
) THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
~ TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF FIRE DEPT.
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A SOIL REPORT •' PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM·
MENCED. OTHER (Specify)
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS
" APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. .. ALL PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS
(!. TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT ·, PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING
•• CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. -,. ,7 ~ 1· /",,. ' ... .,,. ~ , ....
SIGN7••: ... ::::t.T''d,CTO' OR,z t'J~IZED AGENT (DATE) _/,i _,,· ;y --l~/ [i ,-~ ,--,..... TJ d' 1 l ·r-, ; I ? ~ l~Ja ·•I~ _/_ r;n lj SI-ATUIII:£ 0,-OWN£A IF' OWNEPI BUil.DEA) . . -
WHEN PROPERLY VALIDATED UN THIS SPACEI THIS IS YOUR PERMIT \' i, -,,
t:-·,
r{ PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
;~
iif.:.a.:.._~
INSPECTOR
LICENSED 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 full force and el·
feet.
OWNER-BUILDER DECLARATION
D I 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 file 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).
□ I, as owner of the property, 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-
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 prov! ng 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 2nd Professions
Code: The Contractor's License Law does not ap-
ply to an owner of property I•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 reaso .. ._ __________ _
Date Owner
WORKERS' COMPENSATION DECLAR ION
I hereby affirm that I have a certificate f Cll ·
sent to self-Insure, o, a certificate of
Compensation Insurance, or a certifl
thereof (Sec. 3800, Labor Code).
POLICY NO _____ -_-_-_-_-_-_-_-_-_----fll-!'.l.-.. -
7
_ -.-4-1--,~I-t__JL COMPANY
~Copy is filed with the city.
D Certified copy Is hereby furnls
CERTIFICATE OF EXEMPTION FRO
WORKERS' COMPENSATION INSURA
(This section need not be completed If the per-
mit Is for one hundred dollars ($109) or less).
I certify that In the performance of the work for
which this permit is issued, I shall not employ any
pc~on In any manner so as to become subject to
the Workers' Compensation Laws of California.
NOTICE"JO APPLICANT: If, after making this Cer·
tlflcate of Exemption, you should become subject
to the Workers' Compensation provisions of the
Labor Code, you must forthwith comply with such
provision~ or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction len-
CITY OF CARLSBAD-BUILDING DEPA RTMENT
USE BALL POINT PEN ONLY
APPLICATION & PERMIT
1200 ELM AVENUE (714) 438-5525
NO. JOB ADDRESS AV, ST,
215:41 l1 1S11i41r;~ 1 s;-r1e1 €i&i"'i, I I I I I I I I I I I I R~
OWNER OWNER'S PHONE PRIME CONTRACTOR AU,O SPOt2T ? Z'1-13tRI 61lAOSHAW
APPLICANT TO FILL IN INFOR -
MATION WITHIN RED LINES.
DATE Of' APPLICATION BUS. LICENSE PERMIT NUMBER
I ·-27-8/ 2,·z.q4 fyi~ E AJ(:, , G-c n , STATE LICENSE
383:,~0
OWNER'S MAILING ADDRESS CONTRACTOR'S ADDRESS CONTRACTOR'S
<oAJVf Et. 44-5'5 1t()_AI~ AvE. i~~-~'1'1(p qdrf.~~"P.~,,a 1 LOT BLOCK l SUBDIVISION I ASSESSOR'S PARCEL NO. DESIGNER ..;>H ,V Vie:,-..,,.;) ..,,_.11,/,-. STATE LICENSE I ,R b
I I I I I I I I I I I
DESCRIPTION Of WORK SPt-ZLV/< I €.R.S ~
ltJSrA-LL /qJG~ JA) A DESIGNER'S ADDRESS DESIGNER'S PHONE
PAtl.JT 5Pl<P\ ~ l!:> oorH-
CENSUS TRACT GP LAND USE ZONING I AES. UNITS I PARKING SPACE # I NUMBER Of' STORIES _., -/7,(' /.,..., Not Valid Unless Machin, c.rtifild
BLDG SO. fT, BLDG USE occ. GP I ST AND ARD PLAN II I PLAN ID II v; TYPE CONST I occ. LOAD I
QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT AMT.
EACH FIXTURE TRAP 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 1 TO 4 OUTLETS • BOILER/COMPRESSOR 3-15 HP ..,
I-
EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP ( < Q
EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT ; /4 d J-r..;.,. ) ~
~ EACH tlf.WYrSPRINKLER SYSTE~"',.,, 4 _cn:, MECH EXHAUST -HOOO/OUCTS t 1.000 >
WATERSOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I 111/J.< ~ IA' --. . ~ /._---""-,, ? (T."T/ SIGN PERMIT I , il l
TOTAL PLUMBING /tff!:!-
TOTAL MECHANICAL PLAN CHECK I , ~-o ~ 0..
CONH!ACTOR CONTRACTOR All INCLUSIVE PERMIT I I I V) ~
ELECTRICAL PERMIT AMT. AMT. TOTAL PLUMBING I I I
QTY. QTY. MOBILE HOME PERMIT ELECTRICAL I I I
NEW CONST EA AMP/SWT /BKR AWNING MECHANICAL I I I
1 PH .25 3 PH PORCH MOBILE HOME I I I
EXIST BLOG EA AMP/SWT/BKR SET-UP SOLAR , -I . I I I
1 PH .25 3 PH RAMADA, CABANA " /1Z1~ -"k. -/. -) I , I I I
REMODEL/ALTER PER CIRCUIT FENCE OVER 6' \ I • d I . I I I
TEMP POLE 200 AMPS TOTAL MOBILE HOME ~ \. MICO-(ILM ! . I I I
OVER 200 AMPS I . I I ; I
TEMP OCCUPANCY (30 DAYS) ·-
["_ I . I I \. I
_, __ ~.,,,_a ") ,h-I ~ ... \(If} z -_.,,v I .
TOTAL ELECTRICAL TOTAL FEES PAYABLE
I 1/l.i rt CONTRACTOR , I I .
".:!:, !-1--L./ T ~ -
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION ANO PERMIT, ANO 00 •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE ANO CORRECT ANO I 5'-0 " DEEP ANO DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED;To COMPL Y WITH ALL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT
COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER C._..J) i'1ri 41~ SPECIFIED HEREIN OR NOT. l,ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM-;\ 1/ LESS THE CITY OF CAR LS BAO AGAINST ALL LIABILITIES, JUDGMENTS, COSTS ANO ;
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE .
OF THE GRANTING OF THIS PERMIT. APPLICANT'S SIGNATURE• t),. OWNER□ CONTRACTO';P( rAP~O BV ~·t AGENT D BY PHONED
SITE ~1 ---t.t oL-ADDRESS: ' , . OWNER: PERMIT NO:
FIELD INSPECTION RECORD
~ I
INSPECTION DATE INSPECTOR INSPECTOR'S NOTES
WOOD FLOOR -
FOUNDATION • FORMS• SET BACK • TOILET -
UNDER FLOOR PLUMBING _ __,,
~ •-c~ ~ .
UNDER FLOOR HEATING -~;
OK TO INSTALL SUB FLOOR
SLAB FLOOR
UNDER SLAB PLUMBING .
FOOTING• FORMS• SETBACK• TOILET
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
DAMPE'R &,STEEL
PLATE Tl Es/HEIGHT OF CHIMNEY
OTHER
TEMP POWER (POLE)
SEWER
GAS TEST (,_; SWIM POOL• STEEL BONDING
• PRE DECK :., IAVl'
• FENCE PREP LASTER II i /JJ [V l
SHOWN • FRAME 11 I " ~v,.,
• PAN VJL. A I AMff' AJ ~
FINAL INSP BY BLDG DEPT 1171 VI Ill ~, /"
OTHER DEPT'S REQ COMPLETED I I, r , /JV
ELEC METER-PERM-TEMP I r
GAS METER-PERM-T EMP ..
A
' .
C ERT OF OCCUPANCY ISSUED
LICENSED 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 full force and ef-
fect.
OWNER-BUILDER DECLARATION
01 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 lo file 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
ciYII penalty of not more than live hundred dollars
($500).
O I, as owner of the property, or my employees
with wages as their sole compensation, will do
I/le work, and the structure 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).
:11, as owner of the property, am exclusively con•
tractlng 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, 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.
O 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 ($1Cl0) or less).
l~ertlly that In the performance of the work for
whi,ti this permit Is issued, I shall not employ any
perso,9in any manner so as to become subject to
the Workers' Compensation Laws of California.
11:!0TICE TO APPLICANT: If, alter making this Cer-
tlflcate of Ex.emption, you should become subject
to the WOl}<ers' Compensation provisions of the
Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction len-
ding agency for the performance of the work for
whlr.h thl• nArmlt is Issued (Sec. 3097, Civil Code).
CITY OF CARLSBAD-BUILDING DEPARTMENT
USE BALL POINT PEN ONLY APPLICATION & PERMIT
1200 ELM AVENUE (714) 438-5525 -
i-Z-r?½-1, I ~ 1/-___IO_iJ tr:-J. I
~8 ADDREr·. /)J. ,~;;;>le.), iyRr· 1DF;,. 7r7iv o~u.,.-,-r-I fil 1 -1 • l I
OWNElLLu~~ L1 _. OWNER'S PHONE pn, CONTRACTOR , IM
j 1 -i.-4 -r=i,. In I 1\~~ .r.l~ OWNER'~AILING ADDRESS I CONTRACTOR'S ADDRESS
,...., /ltc-t---4~
LOT I BLOCK I SUBDIVISION I ASSESSOR'S PARCEL NO. OESIG NER
I I I I I I l I I I I
.-l,KCRIPTION OF WORK ,1{'1 J__I.J~~ D ~ L-F I l.J/2. w~ DESIGNER'S ADDRESS
.+=r>f2.. /' ..:; C::-Ji::114..n A r1 ~"}
CENSUS TRACT GP LAJ'O USE ZONING RES, UNITS
APPLICANT TO FILL IN INFOR-
MATION WITHIN RED LINES.
BUS. LICENSE PERMIT NUMBER
STATE LICENSE io-!Jo ,......
CONTRACTOR'S
PHONE
ST ATE L ICENSE
12/0 I
OESIG NER' S PHONE 0 f978w
'
7
J I I
I PARKI NG SPACE I NUMBER OF STORIES
Not V•lid Unless Macltin• Cartifi«I BLDG SQ. FT. BLDG USE occ. GP I ST AND ARD PLAN II I PLAN ID If I TYPE CONST I occ. LOAD I
QTY. PLUMBING PERMIT AMT. QTY. MECHANICAL PERMIT 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 UP TO 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 -"'1....--VENT FAN SINGLE DUCT ~v
~: (poo~ EACH LAWN SPRINKLER SYSTEM I MECH EXHAUST -HOOD/DUCTS _.,,,..,,..--L.1--' WATER SOFTNER RELOCATION OF EA FUR~EATER ,
BUILDING PERMIT I lhnlr, -~ J . 1/-A JJ g -::,_,u-'>l/1 _A j .L.R ~ -----~~ SIGN PERMIT I I I I ~,. . -TOTAL PLUMBING r ~ MECHANICAL PLAN CHECK -I I I I CONTRACTOR .._j_-CONTRAC 7-~ ALL INCLUSIVE PERMIT I I ·-I
ELECTRICAL PEl(J!_IT AMT. ~ AMT. TOTAL PLUMBING I l J.Of,f) QTY. j ..,,. MOBILE HOME PERMIT ELECTRICAL I I I NEW CONST EA AMP/SWT/8~ AWNl~G , MECHANICAL I l/.~ln 1 PH .25 / / 3 PH I ~~ ., -PORlH / MOBILE HOME I I / I EXIST BLOG EA AMP-T/j1 R t ,,Pr/ , y SET-l P L SOLAR l I I I . 1 PH .25 I n3%" I i RAMi ~ I CABANA '1t.c-~/7-, I I I I REMODEL/ALTER .J!Ji4'yl"R ~ ( f) " I ' ~ N VER 6' _4/-t.-.:Lo.l "4 ';i;,''.Z, ,,.-_ ! I I ./'Yi" -,-I TEMP PO LE ...26lf AMPS_P" -I ~, Ol"AL MOBILE HOME GMICO·FILM I . I I I OVER.lll(J" AMPS// j \, I IV I I I I . ; ~p OCC~CY (JQ DA)'S} / I . I I I ~1,fil -,,-,;Z.~ I I I . I ~TOTAL ELECTRICAL TOTAL FEES PAYABLE l I /1 ~;?JI l CONTRACTOR " . l 1 .
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION ANO PERMIT, ANO 00 •AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE ANO CORRECT ANO I 5'-0" DEEP ANO DEMOLITION OR CONSTRUZ
/dwl/4:
FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH A LL CITY,
XST~PSIN 4 ~]
COUNTY ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM-
,~/.. ' LESS THE CITY OF CA RLSBAO AGAINST ALL LIABILITIES, JUDGMENTS. COSTS ANO
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE ' OF THE GRANTING OF THIS PERMIT. APl'"LICANT'S SIGNATURE" ~WNERO CONTRACTOR□ l~ED B'I' ,Y½~ AGENT J!!/ BY PHONED .... J> ~
/
\
SITE
ADDRESS: OWNER: -. ) PERMIT NO:
✓ FIELD INSPECTION RECORD
INSPECTION DATE INSPECTOR INSPECTOR'S NOTES
WOOD FLOOR
FOUNDATION• FORMS• SET BACK• TOILET .
UNDE"1 FLOOR PLUMBING .
UNDER FLOOR HEATING ,..
OK TO INSTALL SUB FLOOR
SLAB FLOOR
UNDER SLAB PLUMBING
FOOTING• FORMS • SETBACK• TOILET
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 !
t
OTHER
TEMP POWER (POLE)
SEWER
GAS TEST .
I
SWIM POOL• STEEL BONDING
• PRE DECK • . • FENCE PREPLASTER I
SHOWN . FRAME
• PAN
FINAL INSP BY BLDG DEPT
OTHER DEPT'S REQ COMPLETED
ELEC METER-PERM-TEMP • GAS METER-PERM-TEMP
CERT OF OCCUPANCY ISSUED
1200 ELM AVENUE
CARLSBAD, CA 92008-1989
Olflc• of the City EnglnHr
DATE: #19RCI/ t'lfdG
Dave Sautter
Citp of Carlsbab
Encina Water Pollution Control Facilities
P.O. Box 1005
Carlsbad, CA 92008
INDUS TR I AL WAS TE PERM I T APPL IC AT ION NO • 2 77
TELEPHONE
(619) 438-5541
~ .~ ,•. .. ;. 0 0'. o. 0 •: • • .. • 00 ,• .-:.' 0 . :.:.:, ,: 00 ": ! •·•· ••-:·.,. O M'\ ·•• •• • ~ ~·• ' ... , ....
Enclosed is a copy of the application for· an Industrial Waste
Discharge Permit from the subject applicant.
Your review and recommendations on this application will be
appreciated prior to the issuance of a waste disposal permit.
~~--z:r---
fi-~: DONALD E. DONO VAN
City Engineer
Enc 1 o sure : Appl i cat ion No • 2 71
C: u atng Departmen
Jack Thomas, Dept. of Public Works
Linda Pratt, Dept. of Health Services
DED:JM:lch
~' ,.
APPLICATION FORM FOR INDUSTRIAL WAST2 DISCHARGE PERMIT
CITY OF CARLSBAD
Applications
(Check one)
-✓ sew. ______ _ Applica'tion No. 217 -------
Indu■trial Cla■■ 0 '-/ Revised. ____ _ ------
Date ----i~,._/.,.r./2._'8._6 __
ature of City R•p~e•antative ·----------------------------------.. --------------------------------------------.----------
APPLICATIOII FOR DJDUSTRIAL WASTB DISCBARGB PERMff
A.
.
r &171f rr ./-' ,. ~ ,,& ,; A--'f 1
8. INDUSTRIAL WASTES ARD PROCESS mG:
General de•cription of chemical and physical characteristics of existing
General de■cription of proc•••• (If applicable) <f&?/,,a: ,G ., ?C:.L-
1"7A.;~ 6....., -,.~ /dp,-,IJ 7-°Ae rv",e"" ~ 6 <-;fc:.p ~.lfnJ:> ~,tf,ild°,f /;f~,
C. WASTES TO BB DII.CURGED TO SEWER 1
.. 4 ....
Waste
(Check One)
Treated. ____ _
Untreated. ___ _
Quantity: Averaqe ____ GPD
(Daily)
Maximum GPO ·----
Applicant or Repreaentative of Firm.__ ...... ~..u,_u ___ c_c_.....;;;f._~ __ A_""-' _________ _
(Print)
· Oate1 __ -z~/.;,.i.:;.f .1../_e_, _______ _