HomeMy WebLinkAbout2564 STATE ST; A; 84-132; PermitCl) z 0 ~ a: C ..,
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0 I hereby alllrm that I am licensed under
provision• of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and ProfesalOns Code, and my license Is In
full force and effect.
lie No ------Clm
I hereby affirm that I am exempt from the Contrac· 1or·s License Law lor lhe lollowmg reason {Sec 7031 5 Bus,nes, and Prat.....,, Code Any Clly or county wnlth rt-qwres a perrn,1 to construct. alter, ,mpnwe, demoLlsh. er
rep,tf any slructure. poor 101ls issuance atso requires !heap-
pttca,nt to, such perrNI to tile a StQned statement that he is hce.nsed pursuant 10 the pr0Vtst00s of the COnuaclor · s License Law (Cnapler 9 commencmg w11h Sect10n 7000 al
o,v,s,on 3 at the Bus,ness and Prolessoons Cade) or thal ,sex-
effll>I thefelrom and the baslS lor tne atlegeo exempt""' Any
-•"'" al Sect,on 703 t 5 by an applocant for a ""'""' sub iects 11'-Jpplocanl lo• CMI penalty at not more than,..., ll<Jn-
dred dollars (SSOO)
D I, as owner of the property, am exclusrvely contracting with licensed contrac1ors to construct Ille project (S.C 7044.
Bus,ness and PratesSIOOs Cade TM Contractor's license Law does not apply to an owner ol property wllo l>u11ds or Mn·
proves thereon .• and who contracts 101' each projects with a ~1actor(s) license pu,suanl to the Contractor's License
O As• homeowne, I am improving my home. ana tne lollow· ing condillons exist 1 TM WOl1< ,s llemg per!ormed pno, to sale
2. I nave loved on my home for twelve months
3. r~v'." =p~at t
1
~: ~-during the last tllfee years
0 I am exempt unde< S.C. ______ . B & P C for this reason ____________ _
□ I hereby athrm tha1 I hao1e a cert1hca1e ol consen1
10 self insure. or a cen1l1cate ot Workers Compensat10n Insurance. Of a cen•h~ copy thet'eot
(Sec 3800. Labo< Code)
POLICY NO
COMPANY
□ Copy IS filed w1lh lhe city
Q Certthed copy is hereby lumishec:J
CEATIFICATl OF EX~MPTION FROM WORKERS" COMPENSATION INSURANCE
(This sect,on need not be completed ,t 1ne oe,.m,1
,s fOf one hundred ~lars (S H)O) Of less1
O I certify that ,n the per1ormance of ll'le wont tOf
wtuch this permit ,s issued I shall not employ any
P8f$0n 1n any ~ner so as to t>ecome sub tee 1 10
the Workers· Compensation Uws of Callto,n,a
NOTICE TO APPt.lCANT If after mail ,n~ lh1s Cen
hcale of E•emPttOn you shOukS t>ecome sub1ec1 ,,, lhe Wonte,s' CompenSit1on pro,..,s,ons of !he LabOf
Code you must lorth-.1lh compty w,1r, such
P,CWIStOnS Of Ult$ p,ennll sl"lall be deemed revoke<>
0 I hetet>y atftrm 1~1 mere ,s a cOMlructi<>n
1end1og agency '°' ,,.._ perto,ma"Ce ot 1r,e ~ '°' W'hlCh lhlS pem111 IS 1ssueo (Sec )097 c, .... 1 Code1
LendersNa,-ne ___________ _
LenOer s AOOress __________ _
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT
1200 Elm, Carlsbad. California 92008-1989 (619) 438-5525 APPLICATION & PERMIT
JOBAODR£SS AV ST AD. NEARESTCROSSST ').~~v-Aa R:. ~ H' IDATE 77~?1 8USINESS LICENSE " (~~ON PERMIT NUMBER ~,3~ LOT BLooC:;,, I sueo,v,s•ON I ASSESSOR PARCEL NO
~0~101~a0 -OWNE A"S PHONE
?C31/-53
CONTRACTOR z /
Ous \j 'l:-C2--
CONTRACTOR'S ADDRESS
0::i~t:YNU~, Ai :..£~ n-DESIGNER
DESCRIPTION OF WORK
l=:::==,---~~:,-j~...8:~Z,_-.-----1 DESIGNER'S ADDRESS
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CENSUS TAAC1 I t LANO USE PARKING SPACE I RE S UNITS I
QTY.I PLUMBING PERMIT -ISSUE 7.So
EACH FIXTURE TRAP
EACH BUILDING SEWER
EACH WATER HEATER ANO /OR VENT
EACH GAS SYSTEM 1 TO 4 OUT LETS
EACH GAS SYSTEM 5 OR MORE
EACH INSTAl . ALTER . REPAIR WATER PIPE
EACH VACUUM BREAKER
WATER SOFTNER
EACH ROOF DRAIN !INSIDE)
TOT Al PLUMBING T
QTY. ELECTRICAL PERMIT -ISSUE ~
NEW CONST EA AMP'SWT BK R
I PH 3 PH
EXIST BLOG EA AMP/SWl 'BKR
I PH 3 PH
REMODEL ALTER PER CIRCUIT
TE MP PO l E 200 AMPS
OVER 200 AMPS
TEMP OCCUPANCY 130 DAYSI
TOTAL ELECTRICAL l
-. F/P FLA ELEV
vO NO
~G PERMIT ISSUED
YO ND
REDEVELOPMENT
AREA
vO NO
I QTY.I MECHANICAL PERMIT -ISSUE
INSTALL FU RN. DUCTS UP TO 100.000 BTU
OVER 100.000 BTU
BO I LE R/COMPR ESSO R UP TO 3 HP
BOILER /COMPRESSOR 3 15 HP
METAL FIREPLACE
VENT FAN SINGLE DUCT
MECH EXHAUST HOOD/DUCTS
RE LOCATION OF EA FURNACE/HEATER
larvl
TOT.t.l MECHANICAL
SOLAR -ISSUE
COLLECTORS
STORAGE TANKS
ROCK STORAGE
PUMP
PLAN CHECK FEE
TOTAL SOLAR
7
----,;,a-
STORIES
TYPE
CONST
3~,,
CONTRACTORS Pl-fONE • ZONE
LICENSE NO. PLAN 1.0. # BLDG USE CODE
LICENSE • STANOARD PLAN # BUILDING SO. FOOTAGE
OE SIGNE R'S PHONE
OCCGP EDU
ace LOAD I FIRE SPR
vO NO Not Valid Unlffs Machine Certififtl
SUMMARY/ACCOUNT NUMBER
BUILDING PERMIT 01-00-00-8220 //, -l 0
SIGN PERMIT 01-00-00-8221
PLAN CHECK 01-00-00·8806 7 ..... ,o
TOTAL PLUMBING 01-00-00-8222
ELECTRICAL 01-00-00-8223
MECHANICAL 01-00-00-8224
M0BILEH0ME 01 ·00-00-8225
M0BILEHOME PARK INSP
SOLAR Q]-!!Q-QQ-8226
STRONG MOTION 80-92-33-0519 ,JO
FIRE SPRINi<LERS 01-00-00-8227
PUBLIC FACILITIES FEE 32-00-00-8933
BRIDGE FEE
SCHOOL FEE -DISTRICT
Carlsbad 80-92-21-0519
Encim!as 80-92-22-0519
San Oieguito 80-92-23-0519
San Marcos 80-92-24-0519
LICENSE TAX 01-00-00-8162 -rL....--
CREDIT DEPOSIT
TOTAL FEES PAYABLE 1 3/, Jo
* AN OSHA P£MIIT 1$ ~ FOR EXCAVATIONS OVER s· o· DEEP ANO 0QIOLJTlON OR CONSTIIUCTION OJ
STAUCl\lRES OVER 3 STONES IN HEIGHT
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY
CERTIF'I' UNDER PENALTY OF PERJUR'I' THAT All INFORMATION HEREON INCLUDING THE
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS
ISSUED TO COMPLY WITH ALL CITY COUNl'I' AND STATE LAWS GOVERNING BUILDING CON•
STRUCTION WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AN L..;:~~7:.ao.._f-!:=.!:!:!!:..:==:.!..!~ic_!=~~=!.1!!~!!..l!~l!!WIUL..-
KEEP HARMLESS THE CITY Of CARLSBAD AGAINST All LIABILITIES. JUDGMENTS. COSTS AN -'\.-• • . . 111/t<f 1 EXPEIIISES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF TH
GRANTING OF THIS PERMIT
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TYPE ! DATE INSPECTOR
BUILDING I
FOUNDATION ' I
~ -. -' ., ' ,. --,---.. ·. "\<....,. ·r . ' •i1u·--~ i, ';l . . ' ' . !I ' ~ -.,.....-----'\" -FIELD INSPECTION RECORD
REINFORCED STEEL I '
MASONRY !
GUNITE OR GROUT I
l
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
REQ IF INSPECTOR S . . INSPECTION CHECKED APPROVAL DATE
~
FLOOR & CEILING SUB FRAME I
' SOILS COMPLIANCE
SHEATHING D ROOF D SHEAR PRIOR TO
FRAME I
I
EXTERIOR LA TH I
I
FOUNDATION INSP \ -
T • STRUCTURAL CONCRETE
OVER 2000 PSI
INSULATION I
INTERIOR LATH & DRYWALL I
I
PRESTRESSED
CONCRETE
POST TENSIONED
J CONCRETE
PLUMBING I I FIELD WELDING
SEWER AND BUCO DIPUCO I
I
UNDERGROUND 0 WASTE D WATER -
TOP OUT 0 WASTE D WATER
HIGH STRENGTH . BOLTS
~ i I SPECIAL MASONRY
TUB AND SHOWER PAN : . , . . . ' ...
GAS TEST I PILES CAISSONS I . .
D WATER HEATER D SOLAR WATER
I
I
ELECTRICAL I I. ,.
D ELECTRIC UNDERGROUND D WFFER
ROUGH ELECTRIC I
I
.. --.-~ .-... . ' .
D ELECTRIC SERVICE D TEMPOAARY Ji -.
D BONDING D POOL -I
I
"
I> .,
• -
MECHANICAL I \
D DUCT & PLEM., D REF. PIPlf\,(G -.. .. ' -···
HEAT -AIR COND. SYSTEMS I . I
l '· ~ }-~
I -. . "'·v , ... • .... --• .
VENTILATING SYSTEMS I ~-" ·-1-,-, I I
..
I
-.. : • . ' \ .--•. i
I
CALL FOR FINAL INSPEcr:iN WHEN ALL APPROPRIATE
ITEMS ABOVE HA V BEEN APPROVED.
FINAL I ~
-·' ' --
,. ..
PLUMBING I
' .
ELECTRICAL I
MECHANICAL I A1 .
GAS ~ """X> \"\\
BUILDING (A.~-f n•"" lJ V
~
I -. ' . \ ' •-. -=---~--. •. I ...:·· '
' , .... I . ~-
' SPECIAL CONDITIONS "', -
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