HomeMy WebLinkAbout2455 UNICORNIO ST; ; 80-243; 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
D I hereby affirm that I am exempt from the Con•
tractor's License Law for the following reason
(Sec. 7031.5,Buslness 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 lo the provl•
slons 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·
pllcant for a permit subjects the applicant to a
civil penalty of not more than five hundred dollars
($500).
D 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 1:1™! 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 ln~ra certified copy
thereof (Sec. 3800, [a
POLICY NS.-4,J,..Jl'----------
COMP~-----------
□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 Issued, I shall not employ any
person In any manner so as to become subject to
the Workers' Compensation Laws of California.
,_.,QTICE TO APPLICANT: If, after making this Cer·
t~a1e 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
CITY OF CARLSBAD-BUILDING DEPARTMENT
USE BALL POINT PEN ONLY
APPLICATION & PERMIT
1200 ELM AVENUE (714) 438-5525
APPLICANT TO FILL IN INFOR-
MATION WITHIN RED LINES.
12° .St --2hiz ~/?
JOB ADDRESS
tRr· ~-
0
/]~lf :r~L5'~(}
PERMIT NUMBER
.A.A,, ~
I S-r-5 I I ,-~ T 'f T 'i -r--1 I I I I I I I I I I I go-~ </3
OWNER,#µ<.)~' 3~o.J
OWNER'S PHONE"
l~A¼ p' ,/;7~ /
STATE LICENSE
3 7 .:fjc)._J I
077/:IsNW~ tEv-e-0 0jj6Ty'sg;:;~ ~t
CONTRACTOR'S
=3rJ-Y~7~
77 BLOCK f/l2..5tf'll,";a_tl, tr; I ;;:;/
ASSESSOR'S PARCEL NO. ,:J ,R, DESIGNER STATE LICENSE
I /1Si' 1.11~ ,t) I ' I
(DESCRIPTION OF WORK j'(.-r:. v..,,.. Oo 3/1J/8L4~182
DESIGNER'S ADDRESS DESIGNER'S PHONE
CENSUS TRACT GP LANO USE ZONING sf
3~.~)
I RES. UNITS I P;RKI NG SPACE I NUMBER OF STORIES . ' .
. . J Not Valid Unless Machin• c.rtifi«J . F."'--~ '5 BLOG USE occ. GP l STANDARD PLAN" I PLAN I D " I TYPE CONST I occ. LOAD I~ It-' -1/-,dfl
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/OR VENT BOILER/COMPRESSOR UP TO 3 HP
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP
EACH GAS SYSTEM 5 DR MORE BOILER/COMPRESSOR 16-30 HP
EACH INSTAL., ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT 3 µ-u ,
EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS VALUATION: /' . , / -
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . ir-;1. y-,.-
I ssue 3 .. 00 Isc::::110 3.on SIGN PERMIT I . ,-I I .
TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I . I 1/~1_.........
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 BLDG EA AMP/SWT/BKR SET-UP SOLAR I . I I I
1 PH .25 3 PH RAMADA, CABANA 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
Issue 2.0C .STRONG MOTION: I . I I . .µ ,,
! < a ~ >
5 i= ~ 0. V')
~
TOTAL ELECTRICAL TOTAL FEES PAYABLE I . ~ 6., $< I I k?
CONTRACTOR .
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT. ANO DO 'AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER School fees :
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE ANO CORRECT AND I 5'-0" DEEP ANO DEMOLITION OR CONSTRUCTION OF
FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED;TD COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN HEIGHT
COUNT Y ANO STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
;; J / SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM-
LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS ANO /") ./7 EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE .
OF THE GRANTING OF THIS PERMIT. APPLIO>f!P''C/~ 6 OWNER□ CONTRACTOFf
~
IAPPROVE•X? DATE
AGENT D BY PHONE O '/l.l.LAv--•13-(3-1, ,itJ
,,,.
SITE
ADDRESS: OWNER: -,~' ' PERMIT NO: '30--~? -•
FIELD INSPECTION RECORD
INSPECTION DATE INSPECTOR INSPECTOR'S NOTES
WOOD FLOOR .
FOUNDATION • FORMS• SET BACK• TOILET
~ ' UNDER FLOOR PLUMBING r -., -.-' -
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 TIES/HEIGHT OF CHIMNEY
OTHER
TEMP POWER (POLE)
SEWER
GAS TEST ..
SWIM POOL • STEEL BONDING
• PRE DECK
• FENCE PREPLASTER
SHOWN • FRAME j r )
• PAN I //,,. \.. J
FINAL INSP BY BLDG DEPT 1111"1 «« r/
OTHER DEPT'S REQ COMPLETED r /
ELEC METER-PERM-TEMP
G AS METER-PERM-TEMP
"'
CERT OF OCCUPANCY ISSUE[? \ .
•. -