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Home My WebLink About1341 OAK AVE; MULTI-PERMIT FILE; CB950933; PermitPERMiT APPLICATION City of CarLsbad BuiLding Department 2075 Las Patnms Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT TYPE From List I (see back) give code of Permit-Type: PLAN CHECK NO. q ç EST. VAL PLAN CK DEPOSIT_______________ VALID. BY DATE For Residential Projects Only: From List 2 (see back) give Code of Structure-Type: Net Loss/Gain of Dwelling Units PROJECT INFORMATION FOR OFFICE USE ONLY Address 13,41 Qfr A 'ee- Building or Suite No. Nearest Cross Street HtLiicI /1(3LcI jii1k 5 e DV. LEGAL DESCRIPTION Lck}Io. Subdivision Name/Number Unit No. Phase No. CHECK BELOW IF SUBMI Ti ED: 02 Energy Calcs 02 Strutural Calcs 02 Soils Report DI Addressed Envelope DESCRIPTION OF WORK 7 ciIXJA 4P_ e_'( '.-s i-&j \ i4P (),4,X Q_( SQ. F. # OF STORIES # OF BEDROOMS # OF BATHROOMS .). IAJF1!t'..1 rrJU-AJ1V kit uulelellu. LL(III dppICd4j ADDRESS 3 I z 5 fl NAME (lastname first)fr0j CITY (&1JLS .1 Ct 4 STATE ZIP CODE c1 2.0 DAY TELEPHONE NAME (last name first) ADDRESS CITY - STATE ZIP CODE DAY TELEPHONE PROPERTY OWNER NAME (last name first) 7oV.E ADDRESS CITY STATE ZIP CODE DAY TELEPHONE (DNTRACTOR NAME (last name first) 0 W )J Zft ADDRESS CITY STATE ZIP CODE DAY TELEPHONE STATE UC. # LICENSE CLASS CITY BUSINESS UC. # DESIGNER NAME (last name first) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE STATE UC. # WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm that I have a certificate of consent to self-insure issued by the Director of Industrial Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, lab. Q. INSURANCE COMPANY POLICY NO. EXPIRATION DATE Certificate of Exemption: 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. SIGNATURE DATE OWNER-BUILDER DECLARATION Owner-Builder Declaration: I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 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 offered for sale (Sec. 7044, Business and Professions 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 offered for sale. If, however, the building or improvement 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.). 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). I am exempt under Section Business and Professions Code for this reason: (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500]). SIGNATURE DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? DYES 0 N Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? DYES 0 N Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? DYES 0 N IF ANY OF THE ANSWERS ARE YES A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRIcr. WNSTRUCIION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(i) Civil Code). LENDER'S NAME LENDER'S ADDRESS APPLlCAN CEWIIFICATION I certify that I have read the application and state that the above information is correct. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE 10 SAVE INDEMNIFY AND KEEP HARMLESS THE CI1Y OF CARlSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CrI`Y IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA An OSHA permit is required for excavations over 5'O" deep and demolition or construction of structures over 3 stories in height. Expiration. Every permit issd-byt!-uilding Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authoriz9c!by such pçtmit is not commenced i from the date of such permit or if the building or work authorized by such permit is suspended kir abando~d at any time after wor $Ienced for a period of 180 days (Section 303(d) Uniform Building Cod,). APPUCANVS SIGNATURE / .-" ,'/ DATE: 7 //-I Ic.. 0 / - ¼ 5* CITY OF CARLSBAD INSPECTION REQUEST - PERMIT# CB950933 FOR 07/14/95 INSPECTOR AREA DESCRIPTION: REPLACE / UPGRADE EXISTING - PLANCK# CB950933 100 AMP PANEL 0CC GRP TYPE: ELEC - CONSTR. TYPE VN JOB ADDRESS: 1341 OAK-AV - STE: LOT: APPLICANT: MOZINGO, JEANNIE PHONE: 619 434-6027 CONTRACTOR: PHONE: - OWNER: PHONE: aa REMARXS: MW/JEANNIE/434-6027 INSPECTO SPECIAL INSTRUCT TOTAL TIME CD LVL DESCRIPTION - ACT COMMENTS I 34 EL Rough Electric / fi **** INSPECTION HISTORY DATE DESCRIPTION ACT INSP COMMENTS 4 5• .4 5 5. ,-• . .5 5/ - • -. 1 - I APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. -- .-4---- CALSBAD'BUILDIN'G'DEPARTMENr " 'T 'TAPPUcATION '&PERMiT 1200 Elm, Carlsbad, California 92008-1989 (619)438-5525 • - JOB ADDRESS AV. ST. RD. NEAREST CROSS ST. DATE OF APPLICATION BUSINESS LI E S VALUATION PERMIT NUMBER /3W s CiJ . ZONE LOT BLOCK SUBDIVISION ASSESSOR PARCEL NO. - CO TRACTO CONTRACTORS PHONE# I' 1cP kS:-;; Y 2?9 //7 OWNER'S NAME OWNER'S PHONE . ' . I - CDNT ACTOR'S ADDRESS ' PLAN 1.0:-S BLDG USE CODE ' L LICENSE NO. . 7fSrdf4 i/ - -' - — MAILING ADDRESS - ' ----m __ 43 - 17 C, (.bIIL' () DESIGNER LICENSE S STANDARD PLAN S BUILDING SO. FOOTAGE OESCRIP ION OF WORK - DESIGNER'S ADDRESS - DESIGNER'S PHONE -' --.- -- IVCAJ ctJLV I/l'•"'" - jJt'• F/P FLRELEV. : - NO - •1 OCCGP EDU - 'STORIES . '"'•- FIRE SPR 'CENSUS'1TRACT' "'GP LAND USE ' 'PARKING SPACE RES UNITS' - -- '-rD•O' ..... GRDING PERMIT ISSUED REDEVELOPMENT - TYPE 0CC LOAD -j- AREA,'----"- CONST' - '"• ' 'f , . • YO N 0 - ' vO NO ' -- . vD NO Not Valid Un/ens Machine Certified 0Th' I PLUMBING PERMITISSUE 7 50 QTY MECHANICAL PERMIT ISSUE SUMMARY/ACCOUNTNUMBER EACH FIXTURE TRAP ' . . INSTALL FURN. DUCTS UP TO100,000 BTU' . - BUILDING PERMIT 01-00-00-8220 - EACH BUILDING SEWER SCI - -- - OVER'lOO,OOO BTU ' , -. -. SIGN-PERMIT -, . ' -------01-00-00-8221 - ----------n- - -- - :...,iZ 4EACH WATER HEATER AND/OR VENT 1' . BOILER/COMPRESSOR UP TO 3 HP , - , PLAN CHECK - • 01-00-00-8806 -EACH GAS SYSTEM ITO'4'O6TLETS . , BOILER/COMPRESSOR 3-15 HP 1- - - • TOTAL PLUMBING - 01-00-00-8222 , '., -'-------- - 'EACH GAS SYSTEM'S OR MORE - '' - - - - -, - --i- .- - - -ELECTRICAL--- ----- -01-00-00-8223 - -• .--.-.---7--• - EACH INSTAI. ALT-ER, REPAIR WATER PIPE . - . VENT FAN SINGLE DUCT I.V • MECHANICAL 01-00-00-8224 EACH VACUUM BREAKER METAL FIREPLACE • r. -' .4. ------'-------, MECH EXHAUST HOOD/DUCTS 4 - - MOBILEHOME - - - 01-00-00-8225 - - WATER SOFTNER, - - L. - - -. ..,,..,RELOCATION O.FEA FURNcE/HEATER',j --- - - . _• -. -' - MOBILEHOME PARK INSP_ ____- -- - .. . ---------. - - - EACH ROOF DRAIN (INSIDE) ' ' ' ' - SOLAR - 01-00-00-8226 - j - . ' - - - - ' TOTAL MECHANICAL ' - -- " ' ' - - STRONG MOTION 80-9V33-051_9 TOTAL PLUMBING FIRE SPRINKLERS 01 00008227 QTY cELECTIjbAL PERMIT ISSUE r o QTY SOLAR ISSUE v- PUBLIC FACILITIES FEE 3200008933 - . • _.•.__.. - . - • ....,. •. . - - BRIDGE FEE NEW CONST EA AMP/SWT'BKR COLLECTORS SCHOOL FEE DISTRICT l'PH - 3PH , - -: - , I STORAGE TANKS - I ,• - Carlsbad 80-92-21-0519 - - EXIST BLDG EA AMP/SWT/BKR - - - ''"'' ROCK STORAGE - - - -- . - Encinilaè'' ' - - 80-92-22-0519' - -- - - - - lPH' ' 3 PH ,, -, - .. :•. - PUMP ' ' : • San Dieguilo - 80-92-23-0519 - REMOOEL.'ALTER PER CIRCUIT . PLAN CHECK FEE I • San Marcos - 80-92-24-0519 T-EMPPOLE'200AMPS'' - "-i - I ,',',, ..•,,,,,,,, OVER 200 AMPS J ' - - - LICENSE TAX 01-00-00-8162 - - TEMP OCCUPANCY 130 DAYS) - " - - - 'V) F F • I ', -v -. 1C ' ..'...,. .CREDITDEPOSIT,. - TOTAL ELECTRICAL 4lV TOTAL SOLAR I TOTAL FEES PAYABLE I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY Expiration. Eve rmtt I ued bytheBuildingOfficial underth'eprovistonsofthis * AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER 'allCERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code Be comme°m° null and void If the building or work ch 50" DEEP AND DEMOLITION OR CONSTRUCTION OF from the 'eb°r DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFYAND AGREE IF A PERMIT IS permit, ' buildin r work on ad by such permit s suspen ays STRUCTURES OVER 3 STORIES IN HEIGHT ISSUED: TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON- at any tim er the w is c menced for a period of 180 days. STRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY A AP IC 1'S StG 4 0 APPROVED BY' C 'fJ ii , DATE CONTRACT " KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS ND OWNER - EXPENSES WHICH MAY IN ANY OF THIS PERMIT WAY ACCRUE AGAINST SAID CITY IN CONSEOUENCE 0 THE GRANTING BY PHONE 0 -- - -. ' -• • - - " q _g9 60 . I I USE BALL POINT PEN ONLY & PRESS HARD Q ,,lvhereby,afflrrn that am licensed underl' lalono rof rov .Chapter,9 (commencing with I ' Section 700O)'of 'DivisIon 3 of the Business .I, and Professions Code, and my license is in '.-füil fOräañd'eff I Lic,No ______ Class 36 -C 0,-,_ -I hereby athrm..that...l ,am exempt .from-the Cootrac- - tot's license Law for the following reason (Sec. 7031.5 I - Business and Professions Code: Any city or county which re- - "quires 'a permit to construct, alter; improve, demolish, or - repair any structure, prior to its issuance also requires the ap- plicant for such permit to tile a signed statement that, he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 commencing with Section 7000 01 I Division 301 the Business and Protessions Code) or that is ea-' .. , empt therefrom and the basis or the ailegee eicemption. 'Any" violationol.Section 7031 ,5hy an applicant for a permit sub-. jects the applicanttn-a civil'penally 01 nOt more lhati:tive hun-" dred dollars $5001: -- ' - •_' - 0 Iras owner of the'property, or-my employees with wages' as their safe compensation, will the work, and the struc- " •iure is not intended or offered for sale .sec. 7044. Business,. - I 'm and Professions Code: The Contractors. License Law does IT v not apply to an owner -of properly who bijitds or improves thereon and who does such work himself or through his own , omployOes..provided tat Ouch impraveme'ntOare not. intend- - U . edor dflored.torsale,.lt, however, the-building or improve- Z ment is sold within One year 01 completion.' tho'owoer-baildet ' will have the burden of priming that hedid not build or im- 0' "provA for the purposd'ol'saie). .. 0.1,-as owner 01 the property, am exclusively contracting.- I with licensed contractors to construct the project (Sec. 7044 - BOsloess and PrOtessions Cede: lheCoirtrdctor's License,,, - Law does not apply to an owner of property who builds or im- I prevesihereon, and-who contracts for each projects with.a ' e° U) - contractor(s) .license pursuant to the Contractor's -License - -- Z O As a homeowner lam improving my home,'aod the 10110w- -, - 4 - log conditions .euist:..1 -- ,r f-I 'La -_l.- .,The work is being performed. prior to sale. - - I have lived in 'My 'home Or' twelve months prior to completion of this Jork. ' - I haoe n0t ctaimedthis' exemption doriog the" O last three years. - - 0 lam empt under Sec _________________ B EP C . br this reason a - - • r 'j thereby affirm that I have a certificate or consent I ) to selfmsure, or a certificate of Workers' - Connpe'nsatron Insurance, or a cArtifred copy thereof Sec, 3800, Labor Codel. 1 -1 e:_il':'1.j POLICY NO ' •. Copy s wrth'tfre cIty. - COrj - z -. -------.-'----- _ LU 0 Certified copy is hereby furnished - I' o ' "' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE cr -. I - .ul'This bectron'need not be completed lithe permit -- - is for one hundred dollars 111109l or less) - _ 0 I certify that in the performance 01 the work to, .0 ,which this Permit is Issued. I shall not employ any !person ,n any manner so as to become subject to I - the Workers' Compensation -Laws 01 California - L 'a ') ' NOTICE TO APPLICAN,T If, after m-akto3 thtsCerl,-_ I' , trcate of Eremphon, you. should become subtecl t' L_. -Ihe Workers' Compensaton provisions ol.trte Labor Code p.' you "must forthwith comply' 'with " Such I' ('5 c ' prornsonO.ot trvs permit Shalt be deemed revoked -- '0'i hyreby_ aff,rrn"ttrat 'there is acousiruchon I. ,- lending agency,'or the perlorrrravce bir the work to, .1.161 .i, kr'ircir.tns permit is Issued ISeC 3097, Civil Code) I w1 Lender's Name f,'r ., • ..... inde ... r.. Addre ....-. - I s's L_. . • - •'••-•--••_ - — - — .-.- -. -'-- * -*- -. - - TYPE . DATE INSPECTOR BUILDING FOUNDATION REINFORCED STEEL MASONRY GUNITE OR GROUT - FLOOR& CEILING SUB FRAME SHEATHING E ROOF DSH.AR FRAME EXTERIOR LATH - INSULATION INTERIOR LATH &DRYWALL ! PLUMBING SEWER AND BL/CO DIPLICO h-2 -• UNDERGROUND 0 WASTE 0 ATER TOPOUT 0 WASTE 0 YYATER TUB AND SHOWER PAN GAS-TEST - -• _______ - - 0 WATER HEATER 0 SOLAR WATER ELECTRICAL . - • ________ 0 ELECTRIC UNDERGROUND D'UFFER ROUGH ELECTRIC i . '• ' D ELECTRIC SERVICE -'D TEMPORARY'. D BONDING 0 POOL MECHANICAL 0 DUCT & PLEM., 0 REF. PIPING HEAT - AIR COND. SYSTEMS VENTILATINGSYSTEMS CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE. ITEMS ARUVF HA VF BFN APPRQVEt FINAL • I PLUMBING ELECTRICAL MECHANICAL GAS.7--- BUILDING. SPECIAL.CONDITIONS S., S..- -• .•••S1_.' .4 . .. 5__ -r . . . * . . - . . \\ '--.--•. . 4,;,, -i-:.- - FIELD INSPECTION RECORD "P •. . • - •••• .- • . S " - • s ',. . . . . . - . - . . . - REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES INSPECTION REQ. IF INSPECTOR'S E D ,.. *•S S J. . • - CHECKED APPROVAL — - - - _ SOILS COMPLIANCE PRIOR TO - - . ..-*- -S - - •-- FOUNDATION INSP . - ' . . -. STRUCTURAL CONCRETE. . • . . - - OVER 2000 PSI '••. , • PRESTRESSED CONCRETE POST TENSIONED CONCRETE . • . FIELD WELDING HIGH STRENGTH BOLTS SPECIAL MASONRY - 5 - 0- • I - ~_4•. S S - S -S.- - fJ •- -•'•- _L_L PILES CAISSONS t .--5 .. 4k -- - . I 5 5 S. • . . S •I ' ' . - -. - • :- -•S_ --: - _ i • - 5__• k.. i .'.••a ; . S I . 5 . 'S '• ._•_•_,_ .' - I - ____. * .. -- ..-- •••_-I- 5 • __________________ ___________ ---5 \S•3S \ .55 5 . S _______________ ______ 10 1 . .—t\ A.- . - S 5• -- '- \ .•l •" •' 5 . 5 - - -' tr - --- S -. •'_ - -, . '45 - 54 • , t.-•.' .-4j, APPLICATION FOR PERMIT TO CONNECT TO CITY SEWER SYSTEM. CITY OF CARLSBAD %T?-SE 2.167 ENGINEERING DEPARTMENT 438-5541 ISSUED BY FOR APPLICANT TO FILL IN DATE ISSUED BUILDING J 2L/1 ADDRESS OWNER co MAILING ADDRESS (/(/bf4ci. L, '72Oof CONTRACTOR Jevv ,' c.e., ( a CONTRACTOR'S ADDRESS , (, /1-f /'J L NEW BUILDING EXISTING BUILDING LEGAL DESCRIPTION REMARKS: I VALIDATION Ui$j /(../4,(4 LATERAL CHARGE COMPUTATION 1- STANDARD 4"/(Max. H. 30', V. 10') OVER 30' H. _____ _______FT._________________ OVER 1O'V. _____ @- FT. STANDARD 6" (Max. H. 30', V. 10') OVER 30' H. ______ _______ FT.'____________________ OVER 10'V.-@-L- FT. TOTAL CONSTRUCTION COST SERVICE CHARGE (REPAVING ETC.) , TOTAL LATERAL CHARGE - LINE COST DATA ASSESSMENT DIST. NO. - FRONTAGE -'" COST PER FT. _______TOTAL_______ OTEE R LATERAL LOCATION 1 . CONNECTION FEE NO. UNITS COST PER UNIT_ H / ST. LATERAL NO. _____________ INSTALLATION DATE_______ I •.. WHITE: Er gineerIng GREEN: Finance YELLOW: Sanitation PINK: Building GOLDENROD: Permitter PUMP STATION FEES NO. UNITS - COST.PER UNIT_ TOTAL CHARGES (LATERAL ETC.) -TOTAL- -TOTAL- JOB ADDRESS 4- 0 z P1 '- 0 w LEGAL 1DESCR. LOT NO. I BLK'.. i I I TRACT I cJSEE ATTACHED SHEET) 0 MAIL ADDRESS OWN;~ /" 2 ZIP PHONE CONTRACTOR MAIL ADDRESS 3 PHONE LICENSE NO. ARCHITECT OR DESIGNER MAIL ADDRESS 4 PHONE LICENSE NO. ENGINEER MAIL ADDRESS 5 PHONE LICENSE NO. LENDER MAIL ADDRESS 6 — BRANCH USE OF BUILDING 7 . 8 Class ofwork: El NEW El ADDITION El ALTERATION D REPAIR 9 Describe work: PERMIT FEES — — No. Type of Fixture or Item Fee SPECIAL CONDITIONS: - WATER CLOSET (TOILET) $ - BATHTUB LAVATORY (WASH BASIN) SHOWER KITCHEN SINK & DISP. DISHWASHER APPLICATION ACCEPTED BY: PLANS CHECKED BY: APPROVED FOR ISSUANCE BY: LAUNDRY TRAY - CLOTHES WASHER WATER HEATER NOTICE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC- TION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM- I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. • URINAL - - DRINKING FOUNTAIN - - CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A FLOOR—SINK OR DRAIN SLOP SINK MENCED. GAS SYSTEMS: NO. OUTLETS WATER PIPING & TREATING EQUIP. - - - WASTE INTERCEPTOR - VACUUM BREAKERS LAWN SPRINKLER SYSTEM SEWER 22 CESSPOOL SEPTIC TANK & PIT SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) - - PERMIT $ TOTAL FEE $ , SI:GNATUREtO OWNER (IF OWNER BUILbER) (DATE) 0 CD 2 Q y PLUMBING, PERMIT APPLICATION' City of SBAD, CALIFORNIA Applicant to complete numbered spaces only. 01 WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT - PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION I CK. M.O. CASH INSPECTOR INSPECTION REPORTS DATE ITEM REMARKS INSPECTOR USE SPA CE BELOW FOR NOTES, FOLLOW-UP, ETC. - 4 1 172 :'" 'S P 25. •' 'S ? - 7; .% 5 2. r . r' APPLICATION FOR PERMIT TO CONNECT TO CITY SEWER SYSTEM CITY OF CARLSBAD . . ENGINEERING DEPARTMENT N? s 1153 .. BUILDING' DEPT . 729-1181 EXT. 35 . S FOR APPLICANT TO FILL IN . ISSUED BY .- . DATE ISSUED BUILDING ADDRESS . I 4[ 1'V 2.(Jf VALIDATION . ,S OWNER (e-& ' • #'% .t/() . . , . MAILING ADDRESS - . .. LATERAL CHARGE COMPUTATION - •' .• STANDARD..4" (Max. H. 30', V. 101_' ' OVER 3OH. !' @ ..4!S! FT. CONTRACTOR . ('Ci - CONTRACTOR'S - • OVER 'V _____ _____ S 1 . ______ _______ T. . .... ADDRESS STANOARD 6" (Max. H 30', V. 101 S. OVER 30' H. _______ ________ FT... OVER 10'V. _____ ______ FT. eq TOTAL CONSTRUCTION COST NEW BUILDING F_EXISTINGBUILDING . LEGAL DESCRIPTION . . . . 0 ' o I 7 SERVICE CHARGE (REPAVING ETC)___________________ _S 'S TOTAL LATERAL CHARGE REMARKS:'oco S . . LINE-COST DATA C ASSESSMENT DIST. NO. '_TOTAL______ FRONTAGE - COST PER FT. /ATs2..AL 40 OTHER_______________________________ LATERAL -LOCATION S . CONNECTION FEE - 7 ; (/) . - . NO.- UNITS _• !- COST PER UNIT._- '.-'TOTAL S S • 5 .5 5 . I - PUMP STATION FEES NO. UNITS -COST COST PER UNIT' . - TOTAL - ST. ' . T. TOTAL CHARGES (LATERAL ETC.) • -L.I . LATERAL NO. INSTALLATION DATE