10561 (BLCK)Bu Iding
Arf,irasc 77- 835 Tampico
Owner
Qkw�l r4i
P.O. BOX 1504 r\ I>t, ,n i I No. 10561
Marling
Address P. O. Box 1935
Citv Zip Tel.
(Carlsbad 92008 564-4523
Contractor
Robert Tavlor Masonry
Address.
75-141 Sego Lane #D
Sta'e Lic. City
&Ctassif. C29 52336 Lic.# 124
6
Arc)., Engr.,
Designer
Adcress
City (Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION .
I hereby affjrm'that I am licensed under provisions of Chapter 9 (commencing with Section
70 OCD of Division,3 of the Business and Professions Code,'and my license is in full force and
SIGN,TURE �•^•�" ✓ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requites a
permA to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requl5s the applicant /or 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 0/ the Business and Professions Code, or fhathe is exempt therefrom, and the basis
for Me alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for permit
subJe.ts the applicant to a civil penalty of not more than five hundred dollars.($500). -
❑ I, :.s 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, Buisness and
Prolealons Code: The Contractor's License Law does not apply to -an owner of property who
bullds or Improves thereon and who does such work himself or through his own employees,
proviod 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 ofsale.)
O I, :ts owner of the property, am exclusively contracting with licensed contractors to con-
strue: the project (Sec. 7044, Business and Professions Cade: The Contractor's License Law
does not apply to an owner o/ property who builds or Improves thereon, and who contracts /or
such projects with a contractor(s)
licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
worker's Compensation Insurance,.or a certified copy thereof. (Sec. 3800, Labor Code.)
Polio No. Company
f3=Copy is filed with the city. ❑Certified copy is hereby furn
ished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 1l the permit is for one hundred dollars ($100) valuation
or les.:.) .
I certify that in the performance of the work for which this permit is issued, I shall not
empl•y any person in any manner so as to become subject to the Workers' Compensation
Laws -of California.
Date Owner
NOTICE TO APPLICANT: If, alter making this Certincate of Exemption you should become
subject to the Workers' Compensation provisloris of the Labor Code, you must forthwith
compy with such provisions or this permit shall be deemed revoked.
CONSTRUCTION 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, Civil Code.)
Lender's Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expire?ion if work thereunder is suspended for 180 days.
I cer_ify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
constriction, and hereby authorize representatives sof this city to enter the above-.
mentioned propert
y for Inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number
Legal Description
Project Description
25 1f of 6ft block ~yell trash
enc.
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolitiori ❑
stimated Valuation
y ^
925a0V
PERMIT - AMOUNT
Plan Chk. Dep. -
Plan Chk. Bal.
Const. 25.00
-Mech.
Electrical
Plumbing
S.M.I. . 1R
Grading
Driveway Enc.
Infrastructure
TOTAL 25.10
REMARKS
C4.°sr1Z
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Propert
:4 %.r`i i fi :l.t :J#
y Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
FOR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SQ. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS )
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
E PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
M/PERM
FAMPE'RES
LAVATORY
r
HEATING SYSTEM FORCED GRAVITY
SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE _ / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS )
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM �j !� `p
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
f
FINISH GRADING
FINAL INSPECTION• ' ,AA
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL