HomeMy WebLinkAbout1192 LAGUNA DR; ; 81-112; 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
:::::: I hereby affirm that 1 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 Ille 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),
~
s owner of the property, or my employees
wages as their sole compensation, will do
ork, 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
imp1oves thereon and who does such work
hi1,~elf or through his own employees, provided
1:,at such improvements are not intended or of·
fered for sale. If, however, the building or improve-
ment is sold wfa't ·n one year of completion, the
c'Wner-builder w· ave the burden of proving that
he did nw_i or improve for the purpose of
sale). 1 ,
:::.1, 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·
mil 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 al California.
NOTICE TO APPLICANT: If, after 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
-·• ,ttirm that there is a construction len·
4"'e performance of the work for
~-1 (Sec. 3097. Civil r:odel.
CITY OF CARLSBAD-BUILDING DEPARTMENT
APPLICATION & PERMIT
USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525
NO. JOB ADDRESS
APPLICANT TO FILL IN INFOR-
MATION WITHIN RED LINES.
BUS. LICENSE PERMIT NUMBER
I I //9 :?1 I ~ ,19--1 "Al,{ P,/-Jr I /J ,e,' ~ I
owm/llt-J I/-£" #iG OWNER'S PHONE
,€1)-r
I I l 1 ivR~T. IDA;xfriTtoN
'~,7/LZ 7-~-. STATE LICENSE 73'1/.,, / .,., '., , , , .1,·, ;: , ,-,,,,,,,,
OWNER'S MAILING ADORES::,
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LOT fBLoc? 1suao1v1s1oii?l I ASSESSOR'S PARCEL NO,
I I l I I I I I I I
DESCRIPTION OF WORK
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J .-v..-£/ U~ J,tUUi3/ ~ -,
CE'.NSUS TRACY I iP LANO USE / ZONING
CONTRACTOR',Y ADORES S
OES\GNER
DESIGNER'S ADDRESS
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CONTRACTOR'S
PHONE
STATE LICENSE
DESIGNER'S PHONE
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C -r r;..,_':;t: •
I RES. UNITS I ""'" '"" I <>MSC," """'
Not V11h·d Unless Machine Certified
BLDG SQ. FT, BLDG USE
QTY, PLUMBING PERMIT
EACH FIXTURE TRAP
EACH BUILDING SEWER
EACH WATER HEATER AND/OR VENT
/[ EACH GAS SYSTEM 1 TO 4 OUTLETS
EACH GAS SYSTEM 5 OR MORE
EACH INSTAL., ALTER, REPAIR WATER PIPE
EACH LAWN SPRINKLER SYSTEM
WATER SOFTNER
( .!--, LU ' '
TOTAL PLUMBING
CONTRACTOR
QTY, ELECTRICAL PERMIT
NEW CONST EA AMP/SWT/BKR
1 PH .25 3 PH
EXIST BLDG EA AMP/SWT/BKR
1 PH .25 3 PH
REMODEL/AL TEA PER CIRCUIT
TEMP PO LE 200 AMPS
OVER 200 AMPS
TEMP OCCUPANCY {30 OAYSl
C,::::, _~' ._Q_,
TOTAL ELECTRICAL
CONTRACTOR
occ. GP I STANDARD PLAN ti IPLAN!D1/ I"" CONST I occ. LOAD
I
AMT, QTY, MECHANICAL PERMIT AMT,
INSTALL FURN. DUCTS UP TO 100,000 BTU
OVER 100,000 BTU
. BOILER/COMPRESSOR UPTO 3 HP
v." BOILER/COMPRESSOR 3-15 HP
BOILER/COMPRESSOR 16-30 HP
VENT FAN Sl~!GLE DUCT
MECH EXHAUST -HOOD/DUCTS -J I JLL ~~0
RELOCATION OF .E.t\ FURNACE/HEATER BUILDING PERMIT
-'3 ,oo .... ( J-<2 ---\:_")__,L~ ,3 ,<'.>-0 SIGN PERMIT
~ONTRACTOR
TOTAL MECHANICAL PLAN CHECK
ALL INCLUSIVE PERMIT
AMT, QTY, MOBILE HOME PERMIT AMT, TOTAL PLUMBING
ELECTRICAL
AWNING MECHANICAL
PORCH MOBILE HOME
SET·UP SOLAR
RAMADA, CABANA
FENCE OVER 6' ,;:-yz;;; /"rYl k= ~'YV
TOTAL MOBILE HOME 7 MIC05/'ILM
.;i.__c,D
TOTAL FEES PAYABLE l
I HAVE CAREFULLY EXAMINED THE COMPLETED ''APPLICATION AND PERMIT, AND DO
HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I
FURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY,
COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER
SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE tNDEMNIFY 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
"AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVE~ /,__,e_•,-,:::s.frc
5'•0" DEEP AND DEMOLITION OR CONSTRUCTION OF
STRUCTURES OVER 3STORIES IN HEIGHT .
OF THE GRANTING OF THIS PERMIT APPLICANT'S SIGNATU':ti' --:-;; I //_,✓ ~/ ''2} u;, £-AA
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,07-~ ~ AL.Jo'-
CONTRACTOR □ I APPROVED BY
BY PHONE 0
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SITE
%} ~ 11 -i l ADDRESS: OWNER: PERMIT NO:
FIELD INSPECTION RECORD
INSPECTION DATE INSPECTOR /NSPECTOR~S NOTE·s
WOOD FLOOR
FOUNDATION• FORMS• SET BACK• TOILET
UNDER 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
F!REPLACE
DAMPER &STEEL
PLATE TIES/HEIGHT OF CHIMNEY
OTHER
TEMP POWER (POLE)
SEWER
GAS TEST
SWIM POOL • STEEL BONDING
• PRE DECK
• FENCE PREPLASTER
SHOWN • FRAME
• PAN , I , -
FINAL INSP BY BLDG DEPT ,; / y .
A
OTHER DEPT'S REQ COMPLETED 0 '///lo I t'/ ti',.,. y
ELEC METER-PERM-TEMP I -;u I , //
: GAS METER-PERM-TEMP . V
C ! l
I I L I ' j CERT OF OCCUPANCY ISSUED L