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Home My WebLink About2562 STATE ST; A; 80-14; 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 01 hereby affirm that I 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 file 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). O 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 Contlector'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 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 1•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 reaso,~------------ 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- mit IJ for one hund{ed dollars ($1()0) 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. NOTICE TO APPLICANT: If, after making this Cer- tlflcat& 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. CON~TRUCTION LENDING AGENCY I hereby affirm that there Is a construction len- ding agency for the performance of the work for which this permit Is Issued {Sec. 3097, Civil Code). CITY O F C ARLSB A D -B UILDI NG DEPA R TME NT USE BALL POINT PEN ONLY APPLICATION & PERMIT 1200 ELM AVENUE (714) 438-5525 APPLICANT TO FILL IN INFOR- MATION WITHIN RED LINES. NO, 14~~ JOB ADDRESS AV. ST. ,DATE OF APPLICATION eus. LICENSE PERMIT NUMBER ~,<ii:~, I I , 1S77'1A-17ie, 1Sir, I I I I I I I I I I I I I I I R~ lirt'JCJ/ eo-11 OWNER OWNER;;;;)) PRIME CONTRACTOR STATE LICENSE Afo()U ~Le~ r.1t=P1W.n': . --~ Ff..A i~Stc::.JJ5' -~,,'J7r1L OWNER'S MAILING ADDRESS CONTRACTOR'S ADDRESS CONTRACTOR'S 00·01 f-1),1,,J,s VI-Aa.~ PHONE "5/f t,S-, 69~!:: ' LOT BLOCK I SUBDIVISION I ASSESSOR'S PARCEL NO. DESIGNER STATE LICENSE I I I I I t I I I I I DESCRIPTION OF WORK 'tC:A,/ IA/A/, </ DESIGNER'S ADDRESS DESIGNER'S PHONE CENSUS TRACT GP LANO USE ZONING ,,.~ ~ - 1/06/8:) 7 . I RES. UNITS I ~ARKING SPACE sf. I NUMBER OF STORIES Nat Valid Un'-ss Machin, c.rtifi«I BLDG SO. FT. BLDG USE occ. GP I .ST AND ARD PLAN II I PLAN ID II I TYPE CONST I occ. LOAD I 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 ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP ' EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP EACH INSTAL, ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HODO/DUCTS VAIDATION: WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . I I I T C!C!TW i .nn Issue 3 • .00 ( SIGN PERMl'Tl .-I , I I '.7 -,,s TOTAL PLUMBING TOTAL MECHANICAL L"" .,,,~CK I I I I . CONTRACTOR CONTRACTOR ALL INCLUSIVE PERMIT I I I ELECTRICAL PERMIT AMT. AMT. TOTAL PLUMBING I I I QTY. 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 BLOG EA AMP/SWT/BKR SET-UP SOLAR I I I I 1 PH .25 3 PH RAMADA, CABANA I I I I REMOOEL/ALTE.A PER CIRCUIT FENCE OVER 6' I I I I TEMP POLE 200 AMPS TOTAL MOBILE HOME MICO-FILM I I I I OVER 200 AMPS I I I ; I TEMP OCCUPANCY (30 DAYS) I I I I -?.nn I . I I I TOTAL ELtt.:TRICAL TOTAL FEES PAYABLE I I 1/1~ CONTRACTOR I I .,. ·'"" """" ""'°""'" ,o, ~'" SQIOOL FEES: I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION ANO PERMIT, ANO 00 HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE ANO CORRECT ANO I 5'-0" DEEP ANO DEMOLITION OR CONSTRUCT! 0 FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED;TO COMPLY WITH ALL CITY, ST~SOVER 3STORIES IN HEIGHT COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION, WHETHER &-----U~ SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY ANO KEEP HARM- LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS ANO EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. Apjl"LICANT'S SIGNATUR7 ---OWNERQ CONTRACTOR~PPROVED BY DATE AGENT D BY PHONE 0 I '-.,I r: ' ! ~ • u., I--c( 0 ~ > 5 j:; ~ a.. ..,, ~ ;i,.. SITE w-0O14 ADDRESS: OWNER: :... PERMIT NO: • .. '· FIELD INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTOR'S NOTES WOOD FLOOR FOUNDATION• FORMS • SET BACK• TOILET UNDER FLOOR PLUMBING ,, --~--C -. . ~ UNDER FLOOR HEATING OK TO INSTALL SUB FLOOR . . --- I . - SLAB FLOOR UNDER SLAB PLUMBING FOOTING• FORMS• SETBACK • TOILET OK TO POUR CONCRETE - F~AME I - '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) ~WER GAS TEST SWIM POOL• STEEL BONDING • PRE DECK .. • FENCE PREPLASTER SHOWN • FRAME .. • PAN FINAL INSP BY BLDG DEPT OTHER DEPT'S REQ COMPLETED ' .. ELEC METER-PERM-TEMP G AS METER-PERM-TEMP .. . . . CERT OF OCCUPANCY ISSUED - LICENSED 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 I 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). DI, 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. 70«, Business and Profes- sions Code: The Contractor's Ucenle 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 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 ha 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. 70«, 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 contractorjs) license pursuant to the contractor's License Law). I am exempt under Sec. ____ ~ B. & P.C. for this reaso,,._ ___________ _ 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 --~ Is filed with Iha city. □Certified copy is hereby furnlsha CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed If the per- mit Is for one hundred dollars ($100) or lass). 1 certify that In the performance of 1he 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. NOTICE TO APPLICANT: If, after making this Cer- tificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Coda, 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 whl~h thl• rM1rmlt Is Issued (Sec. 3097, CIYII Code). ~ I CITY OF CAR L SBAD-BUILDING DEP,...,TMENT APPLICATION & PERMIT USE BALL POINT PEN ONLY 1200 ELM AVENUE (714) 438-5525 APPLICANT"iU t-lLL IN 1r1rv~- MATION WITHIN RED LINES. NO. JOB ADDRESS tRr l1;i: ;i:~A~~ BUS. LICENSE PERMIT NUMBER ~1~t14i L t;°1Tt h /I '5° 1<11i I I I I I I I I I I I I I I I I ~OB.47 Ff)- Co ;;J 0 OWNER OWNER'S PHONE PRIME CONTRACTOR STATE LICENSE ..vllk~ A UR ( € fJ NE" FU u..e,e._ '5 I ~NS 3'1~ <i?'" OWNER'S MAILING ADDRESS CONTRACTOR'S ADDRESS CONTRACTOR'S t::''?/-fr'lc ~ll V/A~L<:.e:AfT°NJ PHONE ,~ / 6"'1-YS' ;).Tl SLOCK J 5JZ,:1v1s~1N ~ ,I__ l1 ASSESSOR'S PARCEL NO. DESIGNER STATE LICENSE 12/2l.i/8010~8 ,1, .,, .A ,I),-=?, 1/1~1/1 1..71 9 1 I -..:, .• t'. - DESCRIPTION OF WORK .Jr. , { (' (J Nt:! q_,.x~-x ~ S"'l~ DESIGNER'S ADDRESS DESIGNER'S PHONE CENSUS TRACT GP LAND USE ZONING ·e.,~ I RES. UNITS I PARKING SPACE I NUMBER OF STORIES Not V•lid Unlttss MachiM CKtifi,d BLDG SO. FT. BLDG USE occ. GP I ST AND ARD PLAN ,, I PLAN ID II I TYPE CONST I occ. LOAD I 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 ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP EACH GAS SYSTEM 5 OR MORE BOILER/COMPRESSOR 16-30 HP ~ EACH INSTAL, ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT r )11 /), I /'J-r; ~ $" 00 '/9 EACH LAWN SPRINKLER SYSTEM MECH EXHAUST -HOOD/DUCTS WATER SOFTNER RELOCATION OF EA FURNACE/HEATER BUILDING PERMIT I . I 1<:,.--:;'"a-c, ~_,._,. ,;; .-_; ... . ... t:J-:---SIGN PERMIT I . I I I TOTAL PLUMBING TOTAL MECHANICAL PLAN CHECK I I R 71c; . CONTRACTOR CONTRACTOR ,. ALL INCLUSIVE PERMIT ·-I I I AMT. TOTAL PLUMBING I I I QTY. ELECTRICAL PERMIT AMT. QTY. MOBILE HOME PERMIT ELECTRICAL I I NEW CONST EA AMP/SWT/BKR AWNING MECHANICAL I I I t PH 15 3 PH PORCH MOBILE HOME I I I EXIST BLOG EA AMP/SWT/BKR SET-UP SOLAR -, I I I I 1 PH .25 3 PH RAMADA, CABANA A 7~~--}., ,/,, I . I I I REMOOEUALTER PER CIRCUIT FENCE OVER 6' // I I I I TEMP POLE 200 AMPS TOTAL MOBILE HOME MICO-FILM I I I I OVER 200 AMPS I . I I : I TEMP OCCUPANCY (30 DAYS) I I I I _; ...... ., ~-I . I I I TOTAL ELECTRICAL TOTAL FEES PAYABLE I :-1 v~~~ CONTRACTOR . I I I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT, AND DO ••• ""' """"" "'""'"'" '°" "=v.nom ovo~~ HEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND I 5"-0 " DEEP AND DEMOLITION DR CONSTRUCTION OF FURTHER CERTIFY ANO AGREE IF A PERMIT IS ISSUED; TO COMPLY WITH ALL CITY, STRUCTURES OVER 3 STORIES IN H EIGHT COUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION. WHETHER SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARM- LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND ...., .,,.., .,,,c)_~ -EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. A~SIGNAT~ ~_/$,_ OWNERQ CONTRACTOR~~ -- 1 :, -;,i~ ~ ~ -~ -GENT □ BY PHONE □ r..,m I .. , I '). , ., r ,__,_ -.,,. I I ,.,,,,, / .A T,11.L~J 1,r~l'IC. .1"1. ! I-< 0 ~ ~ j::: ~ a. V) ~ !:I \ ,,,., SITE ', -. M-();v-J e,., ADDRESS: . OWNER: PERMIT NO: FIELD INSPECTION RECORD - INSPECTION DATE "INSPECTOR INSPECTOR'S NOTES WOOD FLOOR FOUNDATION• FORMS • SET BACK • TOILET UNDER FLOOR PLUMBING C -. UNDER FLOOR HEATING '/.. I ' , --' ... ~ ~ ~· OK TO INSTALL SUB FLOOR ' '• SL AB 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 WALL BOARD OK• PLACE TAPE . ... -EXTERIOR L ATH OK • PLACE STUCCO . .. FIREPLACE C ' - DAMPER & STEEL PLATE Tl Es/HEIGHT OF CHIMNEY OTHER TEMP POWER (POLE) SEWER GAS TEST SWIM POOL • STEEL BONDING • PRE DECK • FENCE PREPLASTER SHOWN • FRAME • PAN FINAL INSP BY BLDG DEPT OTHER DEPT'S REQ COMPLETED ELEC METER-PERM-TEMP GAS METER-PERM-TEMP -. CERT OF OCCUPANCY ISSUED