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Home My WebLink About2564 STATE ST; ; 80-206; PermitLICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provi• slons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes- sions Code, and my license Is In lull force and ef- fect. 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). 0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and lhe structure Is not Intended or of- fered lor 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). '.JI, as owner of the property, am exclusively con• tractlng with licensed contractors to construcl 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 reaso,,,__ ___________ _ Date Owner WORKERS' COMPENSATION DECLARATION I hereby afllrm 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 ~ • ~ Is filed with the city. O Certified copy Is hereby furnish, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If lhe per- mit Is for one hundred dollars ($100) or less). 1 certify that In the performance of the work for which this permit Is issued, I shall not employ any person In any manner so as to become subject to the Workers· Compensation Laws of Callfomla. NOTICE TO APPLICANT: It, alter making this Cer- tificate of Exemption, you should become subject to the Workers' 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 • • • -•• •-1 .............. IC.or 'VKl7 r.lvll Cnc:ktl. 1 I CIT Y O F C ARLSBAD-BUILDING O EPA--TMEN T ___ _ USE BALL POINT PEN ONLY APPLICATION & PERMIT 1200 ELM AVENUE (714) 438-5525 NO. J08 ADDRESS AV, ST, !°ATE OF APPLICATION k;l,67t,4t-L ~,'Ti hii g 1C::1 Ti I I I I I I I I I I I I I I I I I 7 /:). -.2.::2--~ OWNER OWNER'S PHONE PRIME CONTRACTOR ,vt H< ~ A UR.(Ef'JAJ 1: Fo u..e,e.._ '5 i ~NS OWNER'S MAILING ADDRESS CONTRACTOR'S ADDRESS >'1-/Y/€:"' ~l\ V/A '-'-~~ ;jj BLOCK J 5JZ:IVIS,.N ~ ,I, ~ ASSESSOR'S PARCEL NO, DESIGNER ~. JI_,, A ,t)1':?1 1/1~1/1 j_,,q , I , DESCRIPTION OF WORK .Jr. { f ") <JN~ Cl"' X ~ -x ~ S"l~ DESIGNER'S ADDRESS CENSUS TRACT GP LAND USE ZONING APPLlcANT TO FILL IN INFOR-MATION WITHIN RED LINES. eus. LICENSE PERMIT NUM15£R '~0~47 Ff)- STATE LICENSE ;Jo (o 3'1~<2~t) CONTRACTOR'S PHONE -,57i,9~S"' STATE LICENSE I 2/2u 180 I 0!18 -.. • 1,' .. DESIGNER'S PHONE e.; I RES. UNITS l PARKING SPACE I NUMBER OF STORIES Not V1/id Unlffl Mlchin, CMtifi«I IILDG SQ, FT. BLOG USE occ. GP I STANDARD PLAN II I PLAN ID II 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 ANO/OR VENT BOILER/COMPRESSOR UPTO 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 VENT FAN SINGLE DUCT ()ll /),, ~ ;_) -5 00 <f9 EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . I r-.·.-a ~ ,/ -, ,., ,.;J.-.,,.,,,,,,, ---,, . c.f-:---SIGN PERMIT I . I f I TOTAL PLUMBING --TOTAL MECHANICAL PLAN CHECK I I I<.. ?I ~ . CONTRACTOR CONTRACTOR ,. All INCLUSIVE PERMIT .. I I I AMT. TOTAL PLUMBING I I I QTY. ELECTRICAL PERMIT AMT. 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 A 7. • )i. /. I. , I I I REMODEL/Al TER PER CIRCUIT FENCE OVER 6' 0 I . I I I TEMP POLE 200 AMPS TOTAL MOBILE HOME MICO -FILM l . I I I OVER 200 AMPS I I I : I TEMP OCCUPANCY (30 DAYS} I I I I .-' ----~, _,,, . I I I I TOTAL ELECTRICAL TOTAL FEES PAYABLE I ;-1 v~~, CONTRACTOR I I ••• •••• """" ,S a<O"Oa<O ,oa m .. Anom OV,~r - I HAVE CAREFULLY EXAMINED THE COMPLETED ""APPLICATION AND PERMIT, AND DO HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I s·-o·· DEEP AND DEMOLITION OR CONSTRUCTION OF FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM- LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS AND /'J/? ~~ EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE ... OF THE GRANTING OF THIS PERMIT. A~S:_:T~ ~~ OWNER □ CONTRACTOR,...~ ~. V,~ ·~, .,_ .. ,. r -,,;:£.,,,,,,,., -GENT 0 BY PHONE □ ,,./ ~~, .., -I -L...,, /A r,~ .. -. ! I-~ ~ ~ ;::: ~ 0. V) ~ Cl SITE ' -M-11~1'1(.,, ADDRESS: . OWNER: PERMIT NO: FIELD INSPECTION RECORD ~ INSPECTION DATE "INSPECTOR INSPECTOR'S NOTES WOOD FLOOR FOUNDATION • FORMS• SET BACK • TOILET . UNDER FLOOR PLUMBING -" . UNDER FLOOR HEATING " .._ f ' ~ ~ ' ' ( 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 1-., FIREPLACE •· " -. DAMPER & STEEL . PLATE Tl Es/HEIGHT OF CHIMNEY OTHER TEMP POWER {POLE) SEWER GAS TEST SWLM POOL • STEEL BONDING • PRE DECK • FENCE PREPLASTER 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 7