HomeMy WebLinkAbout1720 OAK AVE; ; 82-455; Permitrl) z 0 ~ a: j
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O I hereby aft111n that I am licensed under
p«>Ylalona of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Professions Coda, and my license Is In
full force and effect. Ltc No ______ Class __ _
I hereby affirm that f am exempt from the Contrac-tor's License Law for the followmg reason (Sec. 7031 5
Bus,ness and Profession, Code Any city or county which re-quires a perm1t to construct. alter, lmprO¥e, demolish, or repatr any structure, prior to its issuance also requires the ap· pt1cant for such permit to file a signed statement that he 1s licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 commencing with Sect,on 7000 of
Olv,s1on 3 of the Business and Profess1oos Code) or that 1s ex-empt therefrom and the bas,s for !he aneged exempllon. Any
Vlolation ot Section 7031.5 by an applicant for a permit sub-jects the apptlcanf to a c1~11 penalty ot not more than ltve hun-
dred dollars ($500).
D I, as owner ol the property, or my employees with wages
as their sole compensation, will do the work, and the struc-
ture Is not intended or offered tor sale (Sec. 7044, Busmess and Professions Code The Contractor·s License Law does
not apply to an owner ol property who builds or Improves thereon and who does such work hunsell or through his own
employees. provided that such Improvements are not Intend-ed or ollered tor sale II, however, the building or Improve-
ment 1s sold w1fhm one year of compleUon, the owner-builder w,11 have the burden of proving that he did not build or Im· prove tor the purpose of sale).
D I, as owner of the property, am exclus,vely contracting
with licensed conlractors to construct the project (Sec. 7044,
BuSiness and Proless,ons Code: The Contractor's License Law does not apply to an owner of property who builds or im-proves thereon, and who contracts tor each projects with a contractor(s) license pursuant to the Contractor's License Law).
D As a homeowner I am imp«wlng my home, and the follow·
Ing cood111ons exist. 1. The work Is being performed prior to sale. 2 I have lived In my home tor twolve months
3. r~~ ~:"~:::et tt~,1; -=~pt,on durmg the
last three years
D I am exempt under Sec , B & P.C. for this reason ____________ _
0 I he,eby affirm that I ~ve a cen,ticate of consent to self.insure, or a certificate ot Wonters
Compensation Insurance, or a cer1,f1ed copy thereof
(Sec 3800. Labo< Code)
POUCY NO __
COMPANY ---
0 Copy IS hied With the C1ly
0 Certtfted copy 1s hereby furnished
CERTIFICATl OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE (This section need not be completed ,t the permit
1s tor one hundred dOllars ($ 100) 0< less~
0 I certify that in the performance of the work tor
wh,ch this permit 1s issued. I shall nol employ any
person m any manner so as to become subJect to
the Workers' Compensation Laws ot Calttorn1a
NOTICE TO APPLICANT 11, alter makin;i lh,s Cer11
he.ate of Eiemphon. you should t>ecome sub1ect ,., the Workers' Compen~t1on provisions of the Labor
Code. you must forthwith comply with such
ptov1s1ons or this permit shall De deemed revoked
D I hereby affirm that lhere 1s a construction
lending agency tor the per1ormance ot lhe wo~ for wh,ch this permit 1s issued (Sec 3097. C1v1I COde)
Lenders Name•-------------
Lenders Address ------------
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT (
1200 Elm, Carlsbad, Callfornta 92008-1989 (714) 438-5525 ' APPLICATION & PERMIT
/?~ (()J 7J I/!-
AV.ST.I DATE OF APPLICATION1 RO.
, .. :s ~/7 -7 7/
U/7l7'C/~~fl:!_ ~~qow~t77~ <fTui/W
OWNER'S MAILING ADORES$
..., ' --, CONTRACToR·s ADDRESS
...s:::.'~ e
LOT TBLOCK 1 SUBOI VISION l/~~-/3 DESIGNER l "'""""o" o, woa< ~ ~ . . .. , __J"'""'"' •ooa,~
I -~ ~ F/P FLA ELEV.
vO NO
CENSUS T RACT I GP LAND USE I PARKING SPACE I RES UN:J GRAOING ~ERMIT ISSUED l REOEV ELOPMENT AREA
y D ND vO NO
QTY. PLUMBING PERMIT -ISSUE /, .Sn II QTY. MECHANICAL PERMIT· ISSUE
EACH FI XTURE TRAP
EACH BUILDING SEWER --INSTALL FURN. DUCTS UP TO 100,000 BTU z ,5 ::.J..--OVER 100,000 BTU
EACH WATER HEATER ANO /OR VENT BOILER/COMPRESSOR UP TO 3 HP
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3·15 HP
NO
STORIES
TYPE
CONST
,?,~o
I ~ """" ., ....
I ""'"""""" .._ • "''" f' SS -
BUSINESS LICENSE # VALUATION
LIC!!NSE NO. PLAN 1.0 . # BLOG use CODE
LICENSE# STA NDARD PLAN# BUILDING SO. FOOTAGE
DESIGNER'S PHONE
OCC GP I EDU
!:'N
OCC L OAD FIRE SPR
vO NO Not Valid Unlffs Machin~ ~rtifi«I
SUMMARY/ACCOUNT NUMBER
BUILDING PERMIT 01-00-00-8220 -
SIGN PERMIT 01-00-00-8221
PLAN CHECK 01-00-00-8806 J..-
TOTAL PLUMBING 01-00-00-8222
EACH GAS SYSTEM 5 OR MORE --
r-1 l""l"Tnlf"AI 01-00-00-8223
MECHANICAL 01-00-00-8224
-----+--+METAL FIREPLACE I I CLc1.,1n11.,"L
VENT FAN SINGLE DUCT
QTY.
EACH INSTAl .. ALTER , REPAIR WATER PIPE
MECH EXHAUST -HOOD/DUCTS EACH VACUUM BREAKER -----~------1---+--~ RELOCATION OF EA FURNACE /HEATER WATER SOFTNER
EACH ROOF DRAIN ( INSIDE)
TOTAL PLUMBING I
ELECTRICAL PERMIT -ISSUE
NEW CONST EA AMP/SWTIBKR
1 PH 3 PH
EXIST BLOG EA AMP/SWT/BKR
1 PH 3 PH
REMODE L/ALTER PER CIRCUIT
TEMPPOLE 200AMPS
OVER 200 AMPS
TEMP OCCUPANCY (30 DAYSI
TOTAL ELECTRICAL -c
A II
j~v TOH,L MECHANICAL
~(JO ~ QTY. SOLAR -ISSUE
COLLECTORS
STORAGE TAN KS
ROCK STORAGE
PUMP
PLAN CHECK FEE
TOTAL SOLAR
MOBILEHOME _01-Q0-00-8225
MOBILEHOME PARK INSP
SO LAB Dl ·DD·DD-8226
STRONG MOTION 80-92-33-0519
FIRE SPRINKLERS 01-00-00-8227
PUBLIC FACILITIES FEE 32-00-00-8923
BRIDGE FEE
SCHOOL FEE • DISTRICT
Carlsbad 80-92-21-0519
Encinitas 80-92-22-0519
San Dieguito 80·92-23-0519
San Marcos 80·92-24-05_1Jl_
TOTAL FEES PAYABLE l /7~
* AN CIIM....., • NQUlll!D FOR DICAVAnota OIIIII
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1 HA.Ve CAREFUl.t.-¥ ~~ TME COM~D "'APPLl~JlQN ~W> ~-IT' AND 'i,b tlERdY'
CER'l'IFY UNDER P$W.TY OF PERJURY l'HAT ALL INFORMATION HERtoN iNCLUOING '!'HE
9ECLAAATIONS ARE TRUE AND CORRECT AND 1 FUR'l'H!R'CEA'TIFY ANO AGREE IF A PERMIT IS
ISSUED: TO COMPl.'Y WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON-
STRUCTION, WHETHER SPECIFIED HEREIM OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND
KEEP HARMLESS THE ClTV OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS AND
EXPENSES WHICH MAY IN ANY WAY ACC~UE AGAINST SAID CITY IN CONSEQUENCE OF THE
GRANTING OF THIS PERMIT.
BY PHONE 0
APPROVED CT ~wr~µ
.. ! : -~--1°716!: 3
-. I r
INSPECTION TYPE DATE INSPECTOR
BUILDING
FOUNDATION
I
REINFORCED STEEL '-__ , J,_; . -
MASONRY ~
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME . .
SHEATHING '
FRAME
EXTERIOR LATH lNSULATION
INTERIOR LATH & DRYWALL
PLUMBING -r
SEWER AND BL/CO , I . ..
PLUMBING UNDERGROUND
PLUMBING TOP OUT I -
TUB AND ~HOWER PAN
GAS TEST I
ELECTRICAL
TEMPORARY POWER •
ELECTRIC UNDERGROUND
ROUGH ELECTRIC ~
ELECTRIC SERVICE I -~
BONDING I
G. F. I. -SMOKE DETECTOR ~
MECHANICAL e
DUCT & PLEM., REF. PIPING
HEAT -AIR COND. -SOLAR SYSTEMS
VENTILATING SYSTEMS "
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAVE BEEN APPROVED.
JOB SITE FINAL I ,,,---
PLUMBING '-•7, PT"". Q_k\
ELECTRICAL \
MECHANICAL
GAS
BUILDING
SPECIAL CONDITIONS --
CERT OF OCCUP"-IIICY ISSUED
0
... ~ ~-;;...,_'j'6b .
' . . --" !!' .. .. FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS INSPECTOR"S NOTES
REQ. IF INSPECTOR'S 1. INSPECTION CHECKED APPROVAL DATE .
--' ·--
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP I
STRUCTURAL CONCRETE I I, OVER 2000 PSI
PRESTRESSED
CONCRETE I
POST TENSIONED
CONCRETE
FIELD WELDING -I
HIGH STRENGTH ~ ' ,,
BOLTS .. I
SPECIAL MASONRY •
-
.
PILES CAISSONS ·,,
•
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APPLICATION FOR PERMIT TO CONNECT TO CITY SEWER SYSTEM
CITY OF CARLSBAD
ENGINEERING DEPARTMENT
438-5541
FOR APPLICANT TO FILL IN
BUILDING
ADDRESS
OWNER
MAILING
ADDRESS
CONTRACTOR
CONTRACTOR'S
ADDRESS
NEW BUILDING
LEGAL DESCRIPTION
REMARKS:
EXISTING BUILDING
LATERAL LOCATION
ST.
t-= Cl)
LATERAL NO. _______ INSTALLATION DATE---------.
SE
ISSUED BY -------------------
DATE ISSUED------------------
VALIDATION
LATERAL CHARGE COMPUTATION
OVER 30' H. ___ @~ ___ FT·--..--------
OVER 10' V. @ FT. _________ _
OVER 30' H. ___ @ ____ FT,----------
OVER 10' V. @ FT.----------
TOTALCONSTRUCTIONCOST----------
SERVICE CHARGE (REPAVING ETC.) _________ _
TOTAL LATERAL CHARGE----------
LINE COST DATA
ASSESSMENT DIST. NO.
FRONTAGE ____ COST PER FT. ____ TOTAL __ _
OTHER--------------------
I CONNECTION FEE
NO. UNITS ___ COST PER UNIT---TOTAL----
PUMP STATION FEES
NO. UNITS ___ COST PER UNIT ____ TOTAL---
TOTAL CHARGES (LATERAL ETC.) _________ _
WHITE: Engineering GREEN: Finance YELLOW: Sanitation PINK: Building GOLDENROD: Permitter