eTRAKiT Permit

CITY OF OCEANSIDE
DEVELOPMENT SERVICES
300 N COAST HIGHWAY, City of Oceanside CA 92054
BUILDING INSPECTIONS (760) 435-3925

Applied Date:	7/17/2017
Expiration Date:
Permit No:	BLDG17-1655
Permit Type:	BLD ROOM ADDITION

Site Address:

3760 VISTA CAMPANA S 26 OCEANSIDE

Site APN:

1602102600

Subdivision:

OCEANA UNIT#05

Site Block:

Site Lot:

Valuation:

$20,000.00

Site Tract:

Permit Status:

FINALED

Description of Work:

207 SQ FT LAUNDRY & BATHROOM ADDITION


Contractor:	JACKSON DESIGN & REMODELING INC
Address:	4797 MERCURY STREET, SUITE B SAN DIEGO CA 92111
Phone:	(619) 442-6125

Technical Information:

Caption	Value
PLAN ID #
PERMIT #
BIN #	Q-6
SPRINKLER
REDEV AREA
HOT WATER CONSERVATION
FLOOD ZONE	X
COASTAL ZONE
OCC GROUP	R3
TYPE CONST	VB
USE CODE	021
EXISTING BLDG SF
OCC LOAD
UNITS	0
STATE CODE EDITION	2016
BLDG SF	207
NO STORIES	1
ELECTRIC RELEASED BY
NOTIFIED SDGE BY
DATE ELECTRIC RELEASED	12:00:00 AM
ELECTRIC RELEASE TYPE
TYPE OF BUILDING
GAS RELEASED BY
NOTIFIED SDGE BY
DATE GAS RELEASED	12:00:00 AM
GAS RELEASE TYPE
WDID #


Owner:	TADLOCK PAUL C
Address:	3760 VISTA CAMPANA S #26 OCEANSIDE CA 92057
Phone:

WORKERS COMPENSATION DECLARATION

WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
____ I have and will maintain a certificate of consent to self-insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
Policy No.
____ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are:
Carrier: Policy Number: Expiration Date:
____ 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, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.

LICENSED CONTRACTOR'S DECLARATION

I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
License No: Expiration Date: Contractor: Class:

Inspections:

Type	Result	Date	Inspector
495 PLB UNDERGROUND	NO INSPECTION	6/8/2018	DAVID GANS
495 PLB UNDERGROUND	PASS	6/12/2018	DAVID GANS
495 PLB UNDERGROUND	PARTIAL	5/15/2018	TOM LOPEZ
305 FRAME (W/M,P&E)
320 DIAPRAGM NAILING
605 INSULATION
705 WALL BOARD
485 GAS TEST
550 METER RELEASE
**905 FINAL SFR	NO INSPECTION	6/28/2018	DAVID GANS
495 PLB UNDERGROUND	NO INSPECTION	6/1/2018	MICHAEL TROSTRUD
305 FRAME (W/M,P&E)	PASS	7/12/2018	DAVID GANS
**905 FINAL SFR	PASS	12/13/2018	DAVID GANS

Fees:

Description	Amount	Receipt #	Paid Date
PLN-REVIEW OF BUILDING PERMIT	$158.00	754073	03/27/2018
ROOM ADDITION <250	$372.75	754073	03/27/2018
SMIP - RESIDENTIAL	$2.60	754073	03/27/2018
PERMIT IMAGING SURCHARGE	$5.00	754073	03/27/2018
PLAN IMAGING SURCHARGE	$33.00	754073	03/27/2018
PERMIT TECHNOLOGY SURCHARGE	$7.46	754073	03/27/2018
GENERAL PLAN SURCHARGE 10%	$37.28	754073	03/27/2018
RES. REMODEL/REPAIR NON-STRUCT 251-499SF	$459.42	555827	07/17/2017

TOTAL FEES:	$1,075.51
TOTAL FEES PAID:	$1,075.51
TOTAL FEES DUE:	$0.00

*BLDG17-1655*