HomeMy WebLinkAbout1763 CAPE MAY PL; ; 79-1547; PermitMODEL NO.
BUILDING PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008 S'S3/79667l __ 190.60 BP
Applicant to complete numbered spaces only. PnOIIB 729-1181 Permit Nn /r~~ ^ ' /
1763 Cape May Place
ASSESSOR'S
PARCEL NUMBER
-LEGAL
I OESCR.89 Oarlibad QSEC72-lff 207
PAGE
312 11
MAIL ADDRESS
Dr, & Mrs. Kelvin Soottfc 1763 jGagpe May Place 92008 729 -744. Q,
CONTRACTOR CITY UIC. NO.
Severino Construction 865 Grand Ave« V729-68
OR DESIGNER MAIL AODI
Severino Construction "
ARCHITECT OH DESIGNER wlAIL ADDRESS LICENSE NO.
Robert Prater Associates 758-9144 ROE 181P1
COMPENSATION INS. CARRIER
AID(Fred Norman InsuranceS65 grand Avenue
BRANCH
Carlsbad
USE OF BUILDING
Single Family Residence NO. BDRMS.NO. BATHS.
8 Class of work: D NEW ADDITION D ALTERATION D REPAIR D MOVE D REMOVE
9 Describework:
10 Change of use from
Change of use to
11 Valuation of work: $PLAN CHECK FEE $63 2-PERMIT FEE $ / 3*1.
SPECIAL CONDITIONS:Typ
Const
e of . I
st. (/•*•
Occupancy
Group
MICRO FILM FEE
No. of
Stories
Max.
Occ. Load
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY
Fire
Zone
Use
Zone
Fire Sprinklers
Required Qves DNO
Mo. Of
Dwelling Uni
OFFSTREET PARKING SPACES:
I No.
Sq. Ft. OpenNo.Covered
NOTICE/
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB-
ING, HEATING, VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
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 THISTYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEDHEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOTPRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THEPROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATINGCONSJJIUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Special Approvals
PLANNING DEPT.
HEALTH DEPT.
FIRE DEPT.
SOIL REPORT
OTHER (Specify)
ENGINEERING DEPT.
WATER DEPT.
ATUHI Of CON TRACTOR "OR AUTHORIZED AGENT
SIGNATURE OF OWNER (IT OWNER BUILDER)IOATE)
Required Received Not Required
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK.M.O.CASH PERMIT VALIDATION CK.M.O.CASH
TOTAL FEES $.
INSPECTION RECORD
FOUNDATIONS:
SET BACK
TRENCH
REINFORCING
FOUNDATION WALL &
WEATHER PROOFING
CONCRETE SLAB
FRAMING
INT. LATHING OR DRYWALL
EXT. LATHING
MASONRY
FINAL
DATE
/& //cy??
REMARKS
•>
INSPECTOR
* .
*h*^4t^
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC.
PLUMBING PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only. PhOHG 729-1181 Permit Nn.
JO* ADDR ESS
1*^3 Capa May Placa
* LOT NO. ILK TRACT
loist.. 89 Carlebad Tract Jf®* 72-18
OWNER MAIL ADDRESS ZIP PHONE
2 3>r. * Rrs. Xalvlfc Scott 1753 Cap* *9T *la«« 729*7449
CONTRACTOR MAIL ADDRESS PHONE STATE LIC. NO. CITY LIC. NO.
3 Saw*4ii# Construction 865 Grand Ava 729*6849 301508 16703
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4 » » If « ft
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5 ' - , .
COMPENSATION fNS. CARRIER MAIL ADDRESS
6 Aid (Trad Koroac Inaoranca) 065 1
/ IJ^ Jntfcdfc*' RRANCH
;ri*id Awm* Carl abed
USE OF BUILDING
7 Stngla family Saeldaaoa
8 Class of work: D NEW OKDOITION D ALTERATION D REPAIR
9 D«cr*ework: Add SaOOBd PlOOr
SPECIAL CONDITIONS:
APPLICATION ACCEPTE D BY PLANS CHECKED BY APPROVE D FOR ISSUANCE BY .
DATE
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120DAYS.OR IF
CONSTRUCTION OR WORK ISSUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
1 HEREBY CERTIFY THAT 1 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 THEPROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
V^r •'if t.r. / J~*~ff'J.. <*•»»*•-*>• 3/J '?/'?&
SICNATURE Or>CONTRACTOR"OR AUTHORIZED AGENT (DATE)
..,, , -
PERMIT FEES
No.
-*
2
-3.
'"> Type of Fixture or Item
WATER CLOSET (TOILET)
BATHTUB
" LAVATORY (WASH BASIN)
* SHOWER :.
KITCHEN SINK <• DISP.
DISHWASHER
LAUNDRY TRAY
CLOTHES WASHER
WATER HEATER
URINAL
DRINKING FOUNTAIN
FLOOR— SINK OR DRAIN
SLOP SINK
GAS SYSTEMS: NO. OUTLETS
WATER PIPING & TREATING EQUIP.
WASTE INTERCEPTOR
VACUUM BREAKERS
LAWN SPRINKLER SYSTEM
SEWER NUMBER CLEANOirrs
CESSPOOL
SEPTIC TANK * PIT
ROOF DRAINS
ISSUANCE FEE $
TOTAL FEES $
WHEN PROPERLY VALIDATED UN THIS SPACE) THIS IS YOUR PERMIT
Fee
$ 4 &
£j
-*
i0
*&
-£
1 r*r *"
PLAN CHECK VALIDATION CK.M.O.CASH PEfiMIT VALIDATION CK.M.O.CASH
INSPECTOR
ELECTRICAL PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbered spaces only. PhOHG 729-1181 Perm it No.
7.30 8P
JO* ADDRESS
ARCHITECT OR DESIGNER
MAIL ADDRESS PHONE LICENSE NO.
8 Clauofwork: D NEW ADDITION D ALTERATION D REPAIR
Dncrib* work:Add 3*eoed floor
PERMIT FEES
SPECIAL CONDITIONS:SWIMMING POOL WIRING,
NO INCREASE IN SERVICE
No.Each FM
APPLICATION ACCEPTED BY PLANS CHECKED BY:APPROVED FOR ISSUANCE BV
NEW CONSTRUCTION, FOR EACH
AMPERES OF MAIN SERVICE, SWITCH,
FUSE OR BREAKER
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120OAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM
MENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THISAPPLICATION 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 SPECIFIEDHEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOTPRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THEPROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
NEW SERVICE ON EXISTING BLDG.
FOR EA. AMPERE OF INCREASE
IN MAIN SERVICE, SWITCH, FUSE
OR BREAKER
REMODEL, ALTERATION, NO CHANGE
IN SERVICE, FOR EA. AMPERE OF
INCREASE
TEMP. SERVICE UP TO AND INCLUD-
ING 200 AMP.
TEMP. SERVICE OVER 200 AMP.
PER 100
SIGNATURE OF CONTRACTOR OR* AUTHORIZED AGENT (MTE)ISSUANCE FEE
TOTAL FEES
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK.M.O.CASH PERMIT VALIDATION CK.M.O. CASH
INSPECTOR
^
MECHANICAL PERMIT APPLICATION
City of CARLSBAD, CALIFORNIA 92008
Applicant to complete numbe/ted spaces only. Phone 729-1181 Permit No..
JOB ADO ft ESS
Cape Kay Plae*
.LEGAL
IDESCR.
_ _ _ _ _ . .Carf-Bbed Tract BO*TTACHED SHEET)
MAI L ADDRESS
Br* ft Mrs. Kelvin Scott 1753 Cape Hay PI. 92008 729-7449
CONTRACTOR MAIL ADDRESS PHONE
3 Sa-rorlno Construction 865 Grand AY* 729-6849
STATE LIC. NO.CITY LIC. HO.
301506 16783
ARCHITECT ON DESIGNER MAIL ADDRESS LICENSE NO.
Construction 865 Grand AY** *
ENGINEER MAIL ADDRESS5 Hobart Prater Aaaoolatee
PHONt
758-9144
LICENSE NO.
MAIL ADDRESS
6
USE OP 1UILDINC
Single
8 Classofwork: D NEW GTADOITION D ALTERATION D REPAIR
9 Dncribi work:Add aeoood floor
Type of Fuel: Oil D Nat. Gas D LPG. D
PERMIT FEES
SPECIAL CONDITIONS:No.Type of Equipment Fee
Air Cond. Units-H.P. Ea.
Refrigeration Units-H.P. Ea.
Boilers-H.P. Ea.
Gas Fired A.C. Units-Tonnage Ea.
Forced A ir Systems—B.T.U.MEa.
APPLICATION ACCEPTED BY:PLANS CHECKED BV APPROVED FOR ISSUANCESY Gravity Systems-B.T.U.MEa.
Floor Furnaces—B.T.U.M
Wall Heateri-B.T.U.M
NOTICE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED.
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 NOTPRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THEPROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATINGCONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Unit Hefcters-B.T.U.M
Evaporative Coolers
Clothes Dryers
Ventilation Fan
Range Hood
Air Handling Unit-C.F.M.
Incinerator
s//?/>
ai«NATb*E OF CON T« AC TO* Ol^dTU THOfflZED AGENT
ISSUANCE FEE
liaNATURE OP OWNEH (IF OWNED »UILDE»I TOT At FEES
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK.M.O.CASH PERMIT VALIDATION CK.M.O.CASH
INSPECTOR
^\^x
ELECTRICAL PERMIT APPLICATI
City of CARLSBAD, CALIFORNIA 92008
Phon«
y PLTRACT tQSEE ATTACHED
MAIL ADDRESS PHONE
?29--744
CONTRACTOR MAIL ADDRESS STATFLIC. NO.CITY LIC. NO.
*t
MAILARCHITECT OR DESIGNER AIL ADDRESS LICENSE NO.
MAIL ADDRESS PHONE LICENSE NO.
COMPENSATION INS CARRIER MAIL ADDRESS
USE OF BUILDING
PAAf/LV /?£
8 CtoHofwork: DNEW (^ADDITION D ALTERATION D REPAIR
9 Oitcribt work
SPECIAL CONDITIONS SWIMMING POOL WIRING,
NO INCREASE IN SERVICE
ACCEPTED IV: *LANS CHECKED BY APPROVED FOR ISSUANCE BY
NEW CONSTRUCTION, FOR EACH
AMPERES OF MAIN SERVICE, SWITCH,
FUSE OR BREAKER
COM
NOTICE
RMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC
AUTHORWSeL^ ^am^m^mmsOf 120 DAYS AT ANY TIME AFTER WORK
D.
JBY CERTIFY THAT I HAVE READ AND EXAMINED THISATION AND KNOW THE SAME TO BE TRUE AND CORRECT.OVISIONS OF LAWS AND ORDINANCES GOVERNING THISF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEDOR NOT, THE GRANTING OF A PERMIT DOES NOTE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE. ONS OF ANY OTHER STATE OR LOCAL LAW REGULATINGRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
NEW SERVICE ON EXISTING BLD6.
FOR EA. AMPERE OF INCREASE
IN MAIN SERVICE, SWITCH, FUSE
OR BREAKER
.
, ALTERATION, NO CHANGE
IN SERVICE, FOR EA. AMPERE OF
INCREASE
TEMP. SERVICE UP TO AND INCLUD-
ING 200 AMP.
TEMP. SERVICE OVER 200 AMP.
PER 100
crfrt*
SIONATURE OF CONTRACTOR OR AUTHORIZE* ASENT (DATE)ISSUANCE FEE
TOTAL
WHEN PROPERLY VALIDATED (IN THIS SPACE) TH» IS YOUR PERMIT
PLAN CHECK VALIDATION CK.M.O.CASH PERMIT V ATION CK.vM.0.CAS*
INSPECTOR
REQUEST FOR INSPECTION TIME:
INSPECTOR.
OWNER
.EERMIT NO.„.„.. /6-/i
ADDRESS.
BUILDING
Q FOUNDATION
O REINFORCING STEEL
O MASONRY
CD GROUT - GUNITE
CD FLOOR AND CEILING FRAME
a SHEATHING
d FRAME
a EXTERIOR LATH
CH INSULATION
CH INTERIOR LATH OR DRYWALL
a FINAL
PLUMBING
O UNDERGROUND PLUMBING
O UNDERGROUND WATER
D ROUGH PLUMBING
D TOP OUT PLUMBING
C3 SEWER AND PL/CO
D TUB OR SHOWER P,
CD GAS TEST
CD WATER HEATER
a FINAL
ELECTRICAL
ED TEMPORARY SERVICE
EH ELECTRIC UNDERGROUND
D ROUGH ELECTRIC
tD POOL BONDING
CD ELECTRIC SERVICE
CU CEILING HEAT
D G.F.I.
D SMOKE DETECTOR
a FINAL.
READY FOR INSPECTION:
SPECIAL INSTRUCTIONS.
AY
ITIONED Al
PIPING
REQUESTED BY..PHONE NO..
PERSON TAKING REPORT.
REQUEST FOR INSPECTION
iMSPFrrnp ^TO^L^^' PERMIT N0.22.t -jF *+~
OWNER
TIME:
/ /
ADDRESS
(BUfTDlNC?
CD FOUND/
CD REINFORCING STEEL
CD MASONRY
CD GROUT-GUNITE
CD FLOOR AND CEILING FRAME
CD SHEATHING
CD FRAME
CD EXTERIOR LATH
CD INSULATION
CD/MTERIOR LATH OR DRYWALL
Vf FINAL
V
PLUMBING
CD UNDERGROUND PLUMBING
CD UNDERGROUND WATER
CD ROUGH PLUMBING
CD TOP OUT PLUMBING
CD SEWER AND PL/CO
CD TUB OR SHOWER PAN
CD GAS TEST
CD WATER HEATER
CD FINAL
ELECTRICAL
CD TEMPORARY SERVICE
CD ELECTRIC UNDERGROUND
CD ROUGH ELECTRIC
CD POOL BONDING
CD ELECTRIC SERVICE
CD CEILING HEAT
D G.F.I.
a SMOKE DETECTOR
CD FINAL
MISCELLANEOUS
CD PLENUM AND DUCTS
CD COMBUSTION AIR
CD PATIO
CD SIGN
CD GRADING
CD DRIVEWAY
CD CONDITIONED AIR SYSTEMS
CD REFER PIPING
CD FINAL
READY FOR INSPECTI D MONDAY/ D TUESDAY D WEDNESDAY D THURSDAY D FRIDAY
DA.M.
apj
SPECIAL INSTRUCTIONS.
REQUESTED BY..PHONE NO..
PERSON TAKING REPORT.
JUf.
/-O
REQUEST FQtf INSPECTION
INSPECTpR.
TIME:.
PERMIT NO...DATE:.
OWNER.
ADDRESS-
reuiLDi
O FOUNDATION
CI3 REINFORCING STEEL
d MASONRY
a GROUT - GUNITE
C] FLOOR AND CEILING FRAME,
CD SHEATHING
CD FRAME
ED EXTERIOR LATH
CD INSULATION
O INTERIOR LATH OR DRYWA
a FINAL
PLUMBING
CD UNDERGROUND PLUMBING
CD UNDERGROUND WATER.
a ROUGH PLUMBING
D TOP OUT PLUMBING
D SEWER AND PL/CO
CD TUB OR SHOWER PAN
CH GAS TEST
C3 WATER HEATER
d FINAL
ELECTRICAL
PORARY SERVICE
ClfcTRIC UNDERGROUND
;OUfiH ELECTRIC
L BONDING
ELECTRIC SERVICE
AO CEILING HEAT
* D G.F.I.
SMOKE DETECTOR
FINAL
MISCELLANEOUS
O PLENUM AND DUCTS
COMBUSTION AIR
a PATIO
a SIGN
CD GRADING
D DRIVEWAY
DCONDITIONED AIR SYSTEMS
I QTft^ER MIHINU-
D FINAL
READY FOR INSPECTION: D MONDAY 0TUESDAY | D WEDNESDAY D THURSDAY D FRIDAY
DA.M.
OP.My
^SPECIAL INSTRUCTIONS
REQUESTED BY..PHONE NO..
PERSON TAKING REPORT.
REQUEST FOR INSPECTION TIME:
INSPECTOR
OWNER
PERMIT NO.
ADDRESS.77 1
CD FOUNDATION
CD REINFORCING STEEL
CD MASONRY
CD GROUT - GUNITE
CD FLOOR AND CEILING FRAME
CD SHEATHING
CD FRAME
CD EXTERIOR LATH
JZ) INSULATION
CD UNDERGROUND PLUMBING
CD UNDERGROUND WATER
CD ROUGH PLUMBING
CD TOP OUT PLUMBING
CD SEWER AND PL/CO
CD TUB OR SHOWER PAN
CD GAS TEST
a WATER HEATER
a FINAL
READY FOR INSPECTION:
SPECIAL INSTRUCTIONS
DMONDAY
0AM.
DP.M.
'OoJ
D TUESDAY
(g - ~ (a -
CD TEMPORARY SERVICE
CD ELECTRIC UNDERGROUND
CD ROUGH ELECTRIC
O POOL BONDING
CD ELECTRIC SERVICE
CD CEILING HEAT
a G.F.I.
CD SMOKE DETECTOR
FINAL
MISCELLANEOUS
a PLENUM AND DUCTS
COMBUSTION AIR
CD PATIO
CD SIGN
CD GRADING
d DRIVEWAY
CD CONDITIONED AIR SYSTEMS
CD REFER PIPING
CD FINAL
EDNESDAY; a THURSDAY a FRIDAY
REQUESTED BY.
PERSON TAKING REPORT.
INTERDEPARTMENTAL INFORMATION SHEET
BUILDING DEPARTMENT
BUILDING ADDRESS:
Received
DATE:MAR 19 1979
Gin OB
PLANNING DEPARTMENT
ZONE LOT SIZE LOT WIDTH
UNITS ALLOWED 1 UNITS PROVIDED
PARKING SPACES REQUIRED
% COVERAGE ALLOWED
BUILDING HEIGHT ALLOWED
FRONT SETBACK:
ALLOWED
PROVIDED
PROVIDED_
_PROVIDED
PROVIDED
SIDE SETBACK:REAR SETBACK:
INTRUSIONS
LANDSCAPE & IRRIGATION PLAN COMMENTS:
ENVIRONMENTAL PROTECTION
SCHOOL FEE: /V /[^DISTRICT:
ADDITIONAL COMMENTS:
ENGINEERING DEPARTMENT
R.O.W. ^r INDUSTRIAL WASTE IMPROVEMENTS
SEWER CONNECTION
GRADING PERMIT
DRIVEWAY LOCATIONS
EASEMENTS DRAINAGE
LEGAL DESCRIPTION ~j£ JF/
ADDITIONAL COMMENTS
FIRE DEPARTMENT
SPRINKLING SYSTEM
FIRE ALARMS
FIRE PROTECTION EQUIP
EXITS
FIRE HYDRANTS LOCATION
ADDITIONAL COMMENTS
<3K TO ISSUE:DATE OK TO FINAL DATE
WATER DEPARTMENT
REQUIREMENTS OF APPROPRIATE DISTRICTS MET_DATE
CORRECTION LIST
CITY OF CARLSBAD
BUILDING DEPARTMENT
SINGLE FAMILY AND MULTIPLE FAMILY RESIDENTIAL PLAN
(714)729-1181
*WARNING: PLAN CHECK FEES: Where no action is taken by the applicant in IflO days,
and no building permit is issued, all plan check fees are forfeited to the city.
Job Address:
Contractor:
Occupancy
Owner
Engineer.
Type of Construction.Valuation
Basic allowable bldg. area 1st Floor_
3rd Floor
2nd Floor.
4th Floor
Allowable Increase Due to.
REQUIRED PLANS
1.
2.
3.
4.
5.
Plot Plan
Foundation Plan
Floor Plan
General Framing
Foundation Details
6. Structural Details
7. Elevation Plans
8. Roof Plan
9. Index Sheet
TO THE APPLICANT
A. Correct Plans where corrections has been circled. Flag
Corrections.
B. Incomplete, Indefinite or Faded Drawings or Calcu-
lations not acceptable.
C. Required Engineer's or Surveyor's Calculations or
Plans shall be signed in ink.
D. Reverse Plans may not be used. Provide correct Plot
Plan, Foundation Plan, Floor Plan and Elevations.
E. The approval of plans and specifications does not
permit the violation of any section of the Building
Code'or other City, County or State Law.
GENERAL
. 1. Submit fully dimensioned Plot Plan, drawn to scale,
including all easements on property.
2. Show all existing and proposed buildings on Plot Plan.
*- 3. Show correct legal description on Plan.
4. Show all Off Site Improvements, Driveway Approach,
Light Standards, Fire Hydrants, Water Meters, Sub
Structures, Trees, etc.
5. Correct Lot Dimensions.
6. Show existing and finish contour lines.
7. Survey of Lot required.
8. Indicate all grading to be done.
9. Indicate Elevations of Garage Floor, and Street and
Driveway.
10. Indicate Centerline and Edge Profile of Driveway.
11. Slope of driveway not to exceed 15%.
12. Indicate flow lines for disposal of surface water.
13. La Costa approval required.
13aSan Diego County Health Dept. approval required.
13bShow all requirements for handicapped. U.B.C.
Section 1711. '
IScL.C.W.D. sewer receipt required.
ISdCoastal approval letter required.
14. Carry water from
.nder sidewalk through curb into street with cast
in pipe,
•ovide engineering calculations fcjr.
16. Provide engineer's moisture report.
17. Grading permit required.
18. Fire Dept. approval required.
19. Specify concrete mix d> 2000 P.S.I, minimum.
20. Dimension footing sizes and clearance from grade.
21. Show depth of footings below natural or undisturbed
grade.
22. Indicate pressure treated foundation still, or equal.
23. Show foundation bolt size, spacing and penetration
into concrete. Vi" x 17" for masonry.
24. Indicate clearance from grade to bottom of floor joists
and girders.
25. Show pier size, spacing and depth, into undisturbed
soil.
26. Show girder size, spacing and direction.
27. Show all conditions of soils report on plans.
28. Show positive drainage away from footings on site
plan. 5 "fall in 6 feet.
29. Specify minimum 18'' x 24" access opening.
30. Where expansive soils exist, planters adjacent to found-
ations are not recommended.
31. Specify underfloor ventilation equal to 2 square feet
for each 25 lineal feet of foundation plus one opening
within 3' of each corner.
32. Step footings when slope exceeds 1:10.
33.
34.
FRAMING
Provide typical framing details.
Specify all lumber grades.
Specify fire blocking at floor, ceiling cove and mid-
of walls over 10' in height.
ow diagonal bracing at each corner and every 25
of wall.
Clarify bracing of wall.
Show size, direction and spacing of floor joists in
are overspanned.
39. Double floor joists or
40.
41.
42.
43.
44.
45.
46.
47.
48.
51.
52.
53.
54.
56.
58.
59.
60,
61
62
beam under parallel partitions.
Specify header size for openings over 4'. Show double
headers on edge.
Insufficient beam size at
Provide rafter ties where ceiling joists and rafters are
not parallel. 4'O.C.
Indicate rafter size, span, spacing and direction.
Show purlins on edge and indicate size. Same size as
rafters minimum.
Brace roof framing to partitions.
Indicate solid sheathing arid 2 x 6 or 3 x 4 studs on
first floor of three story construction.
Show section through
Show planter box details and water proofing, Sec.
2517 C7.
Provide typical chimney details. /
Specify 2" minimum clearance between chimney and
framing.
Specify post protection when bearing on concrete.
Provide parapet details.
Specify inspection class
required for
Provide drip screed 2" below mud sill.
Indicate how required structural and fire resistive
integrity will be maintained. Where penetration will
be made for electrical, mechanical, plumbing and
communications conduits, pipes and similar systems.
Section 301 D.
Clarify dimensions at
Show window type, sizes and locations.
Light and/or ventilation inadequate in ,
(1/10 floor area - 12 square feet min. except bath-
room).
?E IN MARGIN WHERE CORRECTIONS HAVE BEEN MADE
63. Provide^"vertical clearance and.
69.
70.
71.
72.
73.
74.
horizontal clearance from range top to combustibles,
indicate attic scuttle (22" x 30" min.)
Provide draft separation for attic area in excess of
2500 sq. ft.
Separate area between dropped ceiling and floor above
to 1000 sq. ft. max.
Specify stall shower min. width 30" minimum floor
area 900 sq. inches.
Specify wall finish in shower area not to be adversely
affected by moisture to 6' above the floor, and provide
shatterproof doors.
Water closet area minimum width to be 30".
Show material to be used under tile.
Openings closer than
to property line shall be of_
Show
_hour construction,
.ceiling height.
Show lateral cross bracing at garage plate line.
Show bedroom window as exit, section 1304.
ELEVATIONS
Sate attic ventilation per section 3205 (c)
v all eave overhangs and construction det
5imension chimney height above roof. (2'0" above
roof withing lO'O").
78. Indicate finish and natural grade to property line.
79. Show exterior wall finishes.
80. Indicate 15# felt or equal on exterior walls.
ROOF
81. Note roof pitch.
82. Indicate roofing material length & weather exposure
on wood shingles.
83. Show type, size and spacing of roof sheathing.
84. Fire retardant roof required due to location in
fire zone.
GARAGES
86. Garages not permitted to open into sleeping room.
87. Provide separation on all walls
and ceilings adjacent to living quarters.
88. Specify. J -—/..-•
.from garage/carport into.
.door/window opening
STAIRWAYS AND EXITS
de handrails as required in Section 3305 (i).
_hour walls for stairwell.
icate maximum rise and minimum
run on stair.
ovide balcony railing at 42" minimum height.I
d> 9" O.C. or equivalent
pen type balcony & stair rails.
97. Indicate 6' 6" minimum headroom clearance above
stairway.
98. Show stairway construction details.
100. Occupant load requires exits
from
101. Provide lights over stairways and public corridors.
102. Show change in floor level at doors 1" max. Sec.
3303h.
102aShow handrail extending 6" beyond the top & bottom
risers & terminating in a post or safety terminal Sec.
3305 (i).
PLUMBING
103. Indicate location of water heater.
104. Show temperature and pressure relief valves on water
heaters with discharge lines to outside. Sec. 1007.
105. Water heater not to be located in bathroom or under
stairway or landing.
106. Provide square inches of ventilation at top and
bottom of water heater.
107. Show water heater on 18 inch platform.
IPS. Provide water pressure regulator. Section 1007 (B).
110. Indicate material to be used and location of sewer
line. (If V.C.P. use flexible compression joints only.)
111. Show two way clean out in yard box with 5' of build-
ing.
ELECTRICAL
112. Provide minimum 100 Amp. service. Condos require
0 Amp. panel for each unit.
ow meter and panel location.
Show fire warnings systems centered over stairs.
Action 1310.
115.
116.
MECHANICAL
dicate furnace size, locations & registers and return
fee)
Indicate heating equipment in accordance with chapter
7 of Uniform Housing Code.
Specify heating, air conditioning and ventilating
equipment. Installations to comply with the uniform
mechanical code.
F. Ducts
G. Ladder & Light
H. Engineer's
Calcs for
Roof Loads
Access
B. Location
C. Combustion Air
D. Venting
Return AirE.
,117. Indicate location & type of fire dampers..jT \_ *g _• * .* X»l * _ /St *1 ..,
/ 119,
ELECTRIC
197gN.E.C.
nd-fault protection required fb'fji'oulctobr and
room receptacles 210-8.
least one receptical shall be installed outdoors
garages. 210-25b
electric as shown on floor plan.
Underground service is required. Show on plans.£eo,
F),
MISCELLANEOUS ITEMS
red holes and notching, show details as per Section
,10,11.
. Ft. areas of the following:
ies_
tation requirements:
A. Show 6" insulation in ceiling. (R-19)
D. Dhuw 1 x block fov inaulatian atop at venta.
C. Show 4 " insulation in walls (R-11)
D. Show exterior doors weatherstriped.
E. Place the following note on plans:
These plans comply with the requirements of the
California noise insulation standards.
SIGNED
DATE
TITLE
Show details of party wall and floor system and
S.T.C. or I.C.C. rating of each.
Have designer sign and date plans.
ECKED
RECHECKED
(DATE)
THE FOREGOING CORRECTIONS HAVE BEEN MADE
AND ARE UNDERSTOOD BY THE UNDERSIGNED:
(DATE)
OWNER^DR HIS" AUTHORIZED AGENT
DATE
I
JOB ADDRESS PLAN CHECKER
CITY OF CARLSBAD BUILDING DEPARTMENT
, (729-1181 ex.48)
C)2g . ROOM ADDITIONS CORRECTIONS LIST
. CORRECTIONS CHECKED BELOW ARE TO BE MADE-ON PLANS
Two (2) identical sets of plans drawn to scale with the following information are required.
feck
) A. Dimensioned plot plan showing all existing and proposed buildings, setbacks,.
lot dimensions, legal description, earth slope and job address.
clean sand, vapor barrier, and
Foundation plan and foundation details.
1. Show foundation plans and foundation details.
Provide 6 X 6 - 10 X 10 wire mesh in slab, 4"
(2) #4 rebars continuous in footings.
Exterior Elevations. .
1. Show all exterior elevations.
Show window sizes, doors sizes, and locations.
Show materials used on exterior,
how roof pitch and roofing materials used.
Show adequate bracing. ' '
Framing Sections. *. ' , '
1. Show complete structural framing details, material sizes, and connection
to existing building (header sizes, rafter sizes, joist sizes).
Show materials used on the interior - floors, walls, ceiling..
Show thermal insulation values as per State law. '-£•'
Provide R-20 insulation in attic of existing building.ff >•?<>%
Two story additions require structural calcs for vertical and horizontal
loads.
E. Floor Plan. '-"'".
1. Show use of new addition and existing adjacent room(s).
2.. Show heating provided for new addition. ,
Show adequate light and ventilation for adjacent room(s) .
ireplace: type, clearances required and ICBO approval number.
Show dimensions and square footage for room addition(s) and adjacent room(s)
Provide exterior .lighting at exterior doors. . '...-.
Provide adequate electrical receptacles.
Provide GFI at all outside and bathroom electrical receptacles.
how room ceiling and passage way heights.
Provide adequate emergency exiting from sleeping rooms.
Provide smoke detectors adjacent to new bedrooms .,
C 1 F. Chgfk with La Costa, Ponderosa Homes, or Costal Commission for their requirements
&+-&*<* lAr ^Z^/^^S^*&- ,_ -_-
,
PURCHASE AGREEMENT
SHORT FORM
CATEGORY 2 DESIGNS
JOB NAME: J^COTT
DELIVERY ADDRESS:
REQUESTED DELIVERY DATE:.
GOVERNING CODE:..JOB NUMBER (Assigned 0 Plant)
Trus Joist Type Identification ("A" -
Lumber Stress Level
Series (TJL - TJM -
(100% -115%-
"B"-"B1"etc.)
125%)
• TJH - TJS)
Total uniform load
Live uniform load
PSF
PSF
Camber (mark "P" if per policy) other at inches at center of span
Number required this type
•
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TRUS JOIST DESCRIPTION
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All bearing
All clear si
All centile
All depths
Roof slop*
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FRAMING PLAN - O " CtEAJL SfAM SECTION
(See also Form No. OP44A attached)
TRUS JOIST ACCESSORIES
Prentchd.
Prentchd.
Prentchd.
Blocking
Blocking
Blocking
Bridging
Bridging
Other:
plate x
plate x
plate x
x
x
x
x
x
k*f
Prft-A
o.c.o.c.
O.C.
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By: Y(
TRUS JOIST CORPORATION
£/.xa h<^
Price(s) for TRUS JOISTS and Accessories subject to the TERMS AND CONDITIONS
OF SALE on reverse hereof:
3^ i\yr6- « TA^Ct r TKf*£ A AKI^ /VVLK.C.
Alsi^ LOCATE Z.Jb"^ fV£A6££_ UJHCR£ SWOt*>K>
^fi>ON/£. ' (*/ d>/tM\
T«t.l tilling Prle. $ / ° V -? - O d)
Above prices FOB truckbed jobsite. Sales and use taxes not included unless listed above.
TERMS: ADF 2% 10; Net 30 ADI. Subject to approved credit
1 have checked all the dimensions, quantities and loadings and warrant that they are correct
Accepted?
PURCHASER: '* n*t»:
By: TUta:
TERMS AND CONDITIONS OF SALE
THIS AGREEMENT, between Purchaser and TRUS JOIST COR-
PORATION, hereinafter called TRUS JOIST, Is subject to the
following terms and conditions:
1. TRUS JOIST warrants that the products delivered will be free
from manufacturing errors or defects in either workmanship or
materials and will correct any such errors or defects, but only if
given adequate notice and opportunity to investigate and make
such necessary corrections. TRUS JOIST members are structural
and cannot be cut, notched, drilled, or in any way altered without
prior written approval of TRUS JOIST. If after manufacture
TRUS JOIST members are cut, notched, drilled, or in any way
altered, without prior written approval TRUS JOIST disclaims all
warranties, express or implied. If such unauthorized cutting,
notching or drilling occurs, then the TRUS JOIST members are
purchased by the Purchaser "as is," and TRUS JOIST does not
warrant that they are of merchantable quality, or that they can be
used for any particular purpose.
2. The Purchaser agrees to check immediately upon delivery the
quantities delivered with the shipping notices and bills of lading.
TRUS JOIST agrees to fill any shortages only if notified within
five (5) days of the delivery of the material.
3. TRUS JOIST will furnish all items specifically listed in this
agreement Bridging, bracing, blocking, bolts, etc. will not be
furnished unless specifically listed. TRUS JOIST will not be
responsible for loss or damage arising from delays caused by lack
of correct or complete data to be furnished by Purchaser; by
changes or revisions; by fires, floods, earthquakes or other causes
beyond TRUS JOISTS control or by inability to obtain raw
material.
4. TRUS JOIST warrants the adeqgacy of design and fabrication of
TRUS JOISTS to carry the loads and to fit the dimensions shown
on this Purchase Agreement, provided that the specified data is
within the current published TRUS JOIST Design Manual limits.
Approval of all dimensions and quantities with relation to the
building dimensions and all loadings to be imposed on the TRUS
JOISTS by the Purchaser is an essential condition of this Purchase
Agreement, TRUS JOIST standard design and manufacturing
specifications will apply unless otherwise noted.
5. TRUS JOIST and the Purchaser mutually agree that because the
material which is the subject of this agreement will be custom
made, this agreement may be cancelled only by consent of all
parties, except that if Purchaser is or becomes delinquent in
payment for materials shipped under this or prior orders, or
Purchaser's credit standing is not maintained satisfactorily to
TRUS JOIST, TRUS JOIST may withhold further shipment, or
may cancel the uncompleted portion hereof, and will, in that
event, be entitled to compensation for the full portion of
performance by TRUS JOIST prior to cancellation. It is agreed
that such performance shall include all costs incurred by TRUS
JOIST, including engineering detailing, purchase of special stock,
manufacturing and fabrication and a reasonable allowance for
overhead and profit
6. TRUS JOIST and the Purchaser mutually agree that no retainage
or subcontractor agreements will be accepted by TRUS JOIST or
become part of this agreement In no event will any penalty
clause, of any nature whatsoever, be binding upon TRUS JOIST,
unless agreed to by TRUS JOIST in writing.
7. TRUS JOIST and the Purchaser mutually agree that the price set
forth in this agreement is guaranteed by TRUS JOIST for
months but in no case more than six months from date of
acceptance. After this period of time has expired this price is
subject to change to reflect increases in the standard TRUS JOIST
price list
8. TRUS JOIST and the Purchaser mutually agree that discounts as
set forth on the front of this agreement will be allowed only on
invoices that are timely paid. Partial order shipments will be
invoiced and the values estimated by TRUS JOIST. Interest will
be charged at twelve per cent (12%) per annum on all past due
accounts and'the Purchaser agrees to pay all costs of enforcing
this agreement, including charges for reasonable attorneys' fees.
9. TRUS JOIST and Purchaser agree that the written and printed
provisions hereto embody all of the parties' agreements, condi-
tions and representations; and no oral or written agreements,
between the parties or their agents not herein contained shall be
of any effect Subsequent modifications must be in writing and
accepted by TRUS JOIST.
Job Superintendent.
Purchaser
Architect.
ORDER DATA FOR SALESMAN AND MANUFACTURING PLANT INFORMATION ONLY
- 1_ Phone
Phone
; Phone
Address.
Ship to D Same as job address O Other.
Special delivery instructions
Purchaser mailing addr
1. Calculation Sheet (Form No. OP4) D Enclosed
2. Special Pricing Information (Form No.OPS) D Enclosed D None
3. Credit Information (Form No. OP6) D Enclosed D None Territory sold by
4. Salesman's Split Commission Advice (Form No. OP7) d Enclosed O Nona
5. Are copies of Truss Calculations required? D Yes D No Territory delivered in
Fen* No. OP 44 Rw. (00-71) 4
PURCHASE AGREEMENT
ATTACHMENT
Form No. OP 44 A Or*. (0949)
TYPICAL" DETAILS
Inverted taring dip
2-2x4*by Mfr.field
installed by other*.Inverted bearing
dip turned up
LOADS ON CANTILEVERS
Head* hanger by MfrDouble 2 x as req'd
by Others Mex. toed par hanger
Outrigger Mock by Mfr.
5/8 Bolts
by others
HEADER DETAIL
Double 2 x
(Spaced 1/4" apart)
across corridor
Care required to assure
full bearing of the
bearing dip.SECTION A-A
CORRIDOR FRAMING
1973 Trut ,lr*4M Cwporatiotl
BRIDGING
CROSS BRACING
BLOCKING
DECK NAILING
(For strut bracing and bottom chord restraint see page O-14 ft D-151
Blocking
Prtcut blocking
available from Mfr.NOM:
Special thickness blockingmay bt required by others
with loads bearing from
1/0-2) BLOCKING
dips available
ing with
• from Mfr.
EDGE BLOCKING
NOTE: Cross bracing is mandatory
at all bottom chord bearing
conditions.
Continuous Cross
Bracing with nails
furnished by Mfr. .
Maximum lateral load
BOO Ib. par Trus Joist
Sheethlng
Materiel
Nailing pattern to be per
plans end specification*. In
no case shaH nail spacing
be more than 32" o.c. in
each chord member. Nells
shell not be lea* then 84
or greewr than 1M.
ALLOWABLE FOR NAILS IN A ROW
NAIL»IZE
8d
10*
NAILTYPE
BoxCommon
Box
Common
Box
Common
Box
Common
NAILDIA.
.113".131"
.128"
.148"
.128"
.148"
.135"
.162"
TJL
4" o.c.6" o.c.
6" o.c.«" O.C.
6-o.e.6"o.c.
V D.C.
8"o.c.
lote: If more than one (1) row is used
the rows must be offset at least 1/2".
* 14 gauge staples may be a direct
substitute for 8d nails whan having
a minimum penetration of 1 inch
into the main member.
SHEATHING NAILING PATTERN
SPAN
NO. OF ROWS
15-28 28-42 42+
•J
Lap approximately 12"
transfer 600 to.
^^/D-21 BRIDGIN
IK" 10Ga.
nails by Mfr.
ESIZE OF BRIDGING USING NO. 2 OR CONSTRUCTION GRADE
. . , „ -, ., ... .
TRUS JOIST SPACING
12-1 6 inches
18-32 inches
34-48 inches
SIZE OF MEMBER
2 x 4 (t)
2x6
2x8
SIZE OF BRIDGING USING STRESS GRADED LUMBER
TRUS JOIST SPACING
12-24 inches
25-48 inches
SIZE OF MEMBER
2x4 (Set. Str. or better) <11
2x6 (No. 1 or better)
1. For floors use 2 x 6 min. bridging.
2. For intermediate nailer use 2x6 min. bridging at 8* on center.
3. Bridging required in cantilevers whan the length of cantilever
exceeds 3 times the depth of the Trus Joiat.
I Corporation 6A
JOI Jo* No.
•MEKT_Z or_
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CHARLES H. RICE
•TRUCTURAL KNOINCKM
jom-.Jom No.
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verx /'&—
CHARLES H. RICE
STRUCTURAL CKOINKKR
JOBt Jo.
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MAX. WML
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( I
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CHARLES H. RICE
STRUCTURAL KNOlNKCft
JOB:.JO. NO.
DATE.
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1
ROBERT PRATER ASSOCIATES
Consulting Soil, Foundation & Geological Engineers
March 15, 1979
900-28, 2643
Sever! no Construction Company
865 Grand Avenue
Carlsbad, California 92008
Attention: Mr. Joe Spano
Re: Proposed Second-Story Addition
1763 Cape May Place
Carlsbad, California
Gentlemen:
In accordance with your request we have inspected the footing foundations of the
subject existing single-story residence. It is our understanding that it is proposed to
construct a second-story addition to the southern portion of the existing residence. The
purpose of our investigation was to determine whether the existing footing foundations
will provide safe support for the proposed addition.
On February 26, 1979, our soil engineer was present at the site to inspect the footings
exposed in excavations at three locations around the southern portion of the residence
and to inspect and obtain samples of the foundation soils. The exposed perimeter foot-
ings were approximately 12 inches in width and were founded approximately 12 inches
below the adjacent ground surface. The soils exposed in the excavations consisted of
dense silty sands. The results of a laboratory direct shear test performed on a relatively
undisturbed representative sample of the foundation soils obtained from one of the test
pits is attached.
J0505 Roselle Street, Son Diego, California 92121 • (7U) 453-5605 / 630 A/fa Vista Drive, Suite 105, Vista. California 92083 • (714) 758-9144
March 15, 1979
900-28, 2643
Page 2
Based on our observations, engineering analyses, and the attached test results, it
is our opinion that the existing footings will safely support the proposed second-story
addition. We estimate that the applied bearing pressure at the base of the footings
will be less than 2,500 pounds per square foot with the addition of the second story.
Our services consist of professional opinions and recommendations made in accordance
with generally accepted soil and foundation engineering principles and practices.
This warranty is in lieu of all other warranties either express or implied.
If you have any questions, please call.
Very truly yours,
ROBERT PRATER ASSOCIATES
John LaBar, RCE No. 22,385
JLBrjsr
Attachment
Copies: Addressee (3)
3.5
3.0
2.5
ii-cn
(OCOUJcc
cc
uj 2.0
OT
1.0
0.5 1.0 1.5 2.0
NORMAL PRESSURE (KSF)
2.5 3.0
SAMPLE DATA
DESCRIPTION: $ILTY SAND (SM), brown
BORING NO.:
DEPTH (II.): FG-2'ELEVATION (ft):
TEST RESULTS
APPARENT COHESION (C): 1 .98
APPARENT ANGLE OF INTERNAL FRICTION (0): 26°
TEST DATA
TEST NUMBER
NORMAL PRESSURE (KSF)
SHEAR STRENGTH (KSF)
INITIAL HjO CONTENT (%)
FINAL H;0 CONTENT (%)
INITIAL DRV DENSITY (PCF)
FINAL DRY DENSITY (PCF)
1
0.50
2.18
14.1
22.1
116.9
—
2
1.50
2.78
14.1
22.1
116.9
—
3
2.50
3.16
14.1
22.1
116.9
—
4
STRAIN RATE: 0.02 inches/minute (approx.)
Note: Test was performed^jn a relatively undisturbed tube sample allowed
to saturate before shearing.
ROBERT PRATER ASSOCIATES
Consulting Soil. Foundation & Geological Engineers
DIRECT SHEAR TEST DATA
PROPOSED SECOND-STORY ADDITION
Carlsbad, California
PROJECT NO-
900-28
DATE
March 1979 Figure 1
1200 ELM AVENUE • ^^^ • TELEPHONE-
CARLSBAD, CALIFORNIA 92008 •tOTjM (714) 7290181
Building Department
of Cartebab
RESIDENTIAL ENERGY DESIGN CERTIFICATION
Permit No.Tfr
Issue Date,
CERTIFICATE .OF OTLIANCE WITH ENERGY (HSERVMIOH DESIGB EQUIREfBfTS
COMAINED IN ARTICLE 1, PART 6, TITLE 24, CALIFORNIA AEM, CODE
I, *=fi/en,ssJd xK>>J7^^cy7^a hereby certify that I am familiar
with the state energy. conservation standards mandated in
CAC Title 24, Section T20-1401 through T20-1406, and that the
plans and other documents submitted in support of the application
for a building permit at /74 B
Address
^7-3/2- - // _ _ .
Assessor's Parcel No. Dated
comply with all current requirements of these regulations.
Signature
Ti tie
( Architect, Engineer, Contrctor, Other.)
State License or Certificate No. 3o/ S&/
Date
Submit to the Building Department with permit application.
Form 78-101