HomeMy WebLinkAbout1275 STRATFORD LN; ; 79-5336; PermitLICENSED 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
0 1 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 1, 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 proving 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 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, or a certificate of Workers'
Compensation Insurance, or a certified copy
thereof (Sec. 3800, Labor Code).
POLICY NO, ___________ _ COMPANY ____________ _
□Copy is filed with the city.
□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 ($100) or less).
I certify that In the performance of the work for
which this permit Is ls~ued, I shall not employ any
person In any manner so as to become subject to
the Workers' Compensation Laws of California.
NOTICE TO APPLICANT: If, after making this Cer·
tlficate 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
which this permit Is Issued (Sec. 3097, Civil Code).
C IT Y OF CARLSBAD-BUILDING DEPARTMEN T
USE BALL POINT PEN ONLY
APPLICATION & PE RMI T
1200 ELM AV ENUE (714) 438-5525
APPLICANT TO FILL IN INFOR -
MATION WITHIN RED LINES.
NO. JOB ADDRESS tRr 1DA'T;:1 ~~L
1
l~A~ON
BUS, LICENSE PERMIT NUM8ER
I ,2,1 ,c::., ,<:,+,i?..,u 1+1F1 0 1Q.1cl 1 I Li lt.1'(\J1-e1 I I I I I I I I I I \717-Z... v~5~ff~ !8842
OWNER OWNER'S PHONE PRIME CONTRACTOR STATE LICENSE
lJ t°Yl Cl. .w u. r {-\:t k' p 17_ ~ Lt:\-h "A--1 l ~ '\) I 11 """'' ~ ~ 24t..,q~~ .. ue v 7~
OWNER'S MAILING ADDRESS CONTRACTOR'S ADDRESS ~ CONTRACTOR'S
s 'A-{r\ p 1q()7 i_ cieue\A-nd PHONE
Sa 72Z-3=0
LOT BLOCK I SUBDIVISION I ASSESSOR'S PARCEL NO. DESIGNER ?o-P.:>o~ 414 STATE LICENSE
I I I I I I I I I I I .
' OE SCRIP TION Of rORK '11
I --0 " --?;;;· -DESIGNER'S ADDRESS DESIGNER'S PHONE
\.f'-/ ....... --, --
.. , .. .,u, .. ~..::::: CENSUS TRACT GP LANO USE ZONING I RES. UNITS I PARKING SPACE F l NUMBER OF STORIES
~ C::rr
BLDG SQ. FT. BLDG USE occ. GP I ST AND ARD PLAN # ~AN ID# I TYPE CONST--c< I occ. LOAD
I I . u //// 11
QTY. PLUMBING PERMIT AMT. QTY. MEC~PERMIT AMT. J ,1)
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP'Nl.100,000 BTU
EACH BUILDING SEWER OVER 1~00 BTU 11;
I EACH WATER HEATER AND/DR V ENT '7 .r,o BOILER/COMPRESSOR UP TD 3 HP '-....._
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP ' EACH GAS SYSTEM 5 0 R MORE BOILER/COMPRESSOR 16-30 HP I'-.....
EACH INSTAL, ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT ',. VALUATI ON
EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . I I
T~C::Tll? "LO( T~!=:110 3.00 SIGN PERMIT I . I I
TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I I I 5-oo '
CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I I
s.□~ 5 n
.
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I
AMT. TOTAL PLUMBING I I -!; l(J)l~
QTY. ELECTRICAL PERMIT AMT. QTY. MOBILE HOME PERMIT ELECTRICAL I I . I .
N~NST EA AMP/SWT/BKR AWNING MECHANICAL I I I
1 PH .25 ............... 3 PH PlmC.H MOBILE HOME I I I
EXIST BLDG EA A~/BKR SET-UP ............... SOLAR I I I I
1 PH .25 ............ 3 PH RAMADA, CABA~ I ' I I I
REMODEL/ALTER PER CIRCUIT .............. FENCE OVER 6' .......... I . I I I
TEMP POLE 200 AMPS """'-...... TOTAL MOBILE HOME ............... MICO·FILM ' . I I I
OVER 200 AMPS ............ ............ I I I ; I
TEMP OCCUPANCY (30 DAYS) -..... -i-,...__ I ' I I I
-
ISSTTE ?.fl(l I ' I I
TOTAL ELECTRICAL TOTAL FEES PAYABLE I CONTRACTOR . I I . I I S lc::r::
I HAVE CAREFULLY EXAMINED THE COMPLETED ""APPLICATION AND PERMIT. AND DD •AN OSHA PERMIT IS REQUIRED FDR EXCAVATIONS OVER
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5 '-0 " 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
CO UNTY AND ST ATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER SCHOOL FEES SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM-
LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE
OF THE GRANTING OF THIS PERMIT. APPzr~,zU~~ OWNERQ CONTRACTOR□ rPPROVED BY DATE
• • / .J' AGENT 0 BY PHONE 0 I
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SITE ' I
ADDRESS: OWNER: P ERMIT NO:
• .. -·~•· -. FIELD INSPECTION RECORD "c.. .
INSPECTION DATE INSPECTOR INSPECTOR'S NOTES
WOOD FLOOR
FOUNDATION • FORMS• SET BACK • TOILET
UNDER FLOOR PLUMBING ,. ). . ... ,. -;-.-L ..,. >-.. ., = -. -.
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 i .,,,
,,.,. ' ROUGH HEATING/VENTILATING r
FRAME OK• PLACE INSULATION
INSULATION OK • PLACE WALLBOARD .
WALLBOARD OK• PLACE TAPE . , '
EXTERIOR LATH OK• PLACE STUCCO -
FIREPLACE .•
DAMPER & STEEL '
PLATE TIES/HEIGHT OF CHIMNEY . '
'
OTHER I
TEMP POWER (POLE) --
SEWER
GAS TEST -
SWIM 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