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i i hereby affirm that I am licensed under
lalona of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Professions Code, and my license Is In
full force and affect. ¼
Lie No~1----c1ass C-
l hereby affirm that I am exempt from the Con-
~~0;°8~~~=:: ~ ~f~~l~l~~~~I~
county which requires a permit to construc1
alter, improve, demohsh. °' repair any structure. pnor to its issuance also requires the ~hcant tor
such pemut to file a signed slatement that he ,s
lteensed pursuant to the prov,s1ons or the Con· tractor·s License Law (Chapter 9 commencing wl1h
Sect10n ,ax, of Or"1st0r'I 3 ot the Business and Pro-fessions Code)°' that Is exempt therefrom and the b&s•s for the ,:lleged exemptt0n Any YK>latIon of Sectt00 7031 5 by an ~phcant fOf a permit subt9Cts
tne IIPPhe&nt to a c1v11 penalty of not more than hW!
hundred <1011"'5 (S500)
Q I, as owner ol lhe property, Of my employees .
,.1th wages as thtm sofe compensation. will do the
wo,k, and the structure 1s not intended or offered fOt'
sale (Sec TOW, Busmess and Professions Code:
The Contraclor's License Law does not apply to an owner of p,operty who builds or improves thereon and who does such wonc: himself Ot througl"l his own employees, provtded that such ,mproveme:its are
no1 intende1 or offered tor sale 11, hOwever, the
building or 1mp<ovement ,s sold w1th1n one year of completion, the owne,~1lder will have the burden
of proving that he did not build or improve tor the
purpose of sale).
□ I, as owner of the property, am exclusively
contracting with licensed contractOfs to construct
the proJect (Sec 70M, Business and Protess10ns
Code: The Contractor's License Law does nol apply
to an owner of property who builds Of improves
thereon, and who contracts fOf each pro1ects w1lh a contractor(s) hcense pursuant to the Contr&ctor's.
lteense Law)
0 I am exempt under Sec ____ ,B &PC
tor th,s reason ___ _
'4. • hereby affirm that I have a cer1'11cate of consent
~elf-insure, or a cer11ftcate at Workers'
Compensahon Insurance. Of a certified copy thereof
(Sec 3800. Labo< Code)
POLICY NO ----333\ 1 __ _
COMPANY --s-~fvJ
~Copy IS filed With the: City
0 Certified copy 1s hereby turn,shed
CERTIFICAT~ OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
(This section need not be completed 1t the permrl
Is fOf one hundred OOllars CS H)0) or less)
0 I certify that in the performance ot the wcw1t for
which this permit 1s issued. I shall not emplOy any person in any manner $0 as to become sut>1ect 10
tne Workers· Compensation Laws o1 Cahlorn,a
NOTICE TO APPLICANT If. after maktn1 ttus Cen1
he.ate ot Exemption. you should become SUble<:I I':> lhe Workers· Compensation prov1s1ons of the Labor
Code, you must forthwith comply w11h such
p,ov1s1ons Of this pe,m,1 shall be deemed revoked
O I hefeby affirm that there 1s a construct,on
1end,ng agency tor the performance ol the wono. lor
which 1h15 permit 1s issued (Sec 3097 C,v,1 Code)
Lenoe, s Name ___________ _
Lenders Add,ess __________ _
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT
1200 Elm, Carlsbad, California 92008 (714) 438-5525
VALUATION PERMIT NUMBER l1lli J =-· 2,~/ ~ • Lq
._J\} \\€, 0 Cl~
dQ~~ ~
PRI CONTRACO/" b ~ ZONE 'f::/f 0 )./J-
______.._,.__....,:_O'~-=--t f{ vltt l >t~ . ::CML
ow~rttLIN~:REC{o.v-'l-2, ~u~iJ q~o</ CONTRACTO~A~W>: I k ~ I i SENO.
PLAN 1.0. # BLOG USE CODE
LOT BLOCK SUBDIVISION R ELN0.1<,72,lQ oc;·{;)C) DES~ s~rz:E it STANDARD PLAN# BUILDING SO. FOOTAGE
DESCRIPTION OF WORK /d 3
OESIGNER"S ADDRESS DESIGNER'S PHONE 1---N'----------,---------------------tl
lrftlL-~.-.. .... 1.\1' J {,f,~
CENSUS TRACT GP LANO USE PARKING SPACE RES UNITS
-
GRADING ~ERMIT ISSUED
YO ND
F/P F LR ELEV.
vO NO
1 REDEVELOPMENT
AREA
vO NO
NO OCC GP EDU
STORIES
TYPE I occ LOAD • FIRE SPR
CONST
vO NO
5024 02/27/89 0001 01 02
Bldf'mt
I Nor Valid Un~s ~chine <Artifi«I
QTY. PLUMBING PERMIT· ISSUE I. ,.«J QTY. MECHANICAL PERMIT· ISSUE SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP I I I INSTALL FURN. DUCTS UP TO 100,000 BTU I I BUILDING PERMIT
EACH BUILDING SEWER I OVER 100,000 BTU SIGN PERMIT
EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK
•. EACH GAS SYSTEM I TO 4 OUTLETS j ? ,a:, I I BOILER/COMPRESSOR 3-15 HP I I TOTAL PLUMBING toioo
EACH GAS SYSTEM 5 OR MORE i I I METAL FIREPLACE I I ELECTRICAL
EACH INSTA~ .. ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL
10.00
I j EACH VACUUM BREAKER MEC~XHAUST -HO00/0UCTS MOBILEHOME
WATER S0FTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP I
EACH ROOF DRAIN (INSIDE) SOLAR .--r T:' f\ .,n..----11-----------11
STRONG ~Tj)L, £i l"" .I-' TOTJ;L MECHANICAL
~ TOTAL PLUMBING l t,o,.c,:> FIRE SPRINKLERS -_ •"'"''"'
QTY. ELECTRICAL PERMIT· ISSUE QTY. I SOLAR · ISSUE
PUBLIC FACILITl(!iF,E~B Z 8 \'3tj::J
BRIDGE FEE ---n&.D
NEW CONST EA AMP/SWT/BKR COLLECTORS
1 PH 3 PH STORAGE TANKS
SCHO~
C I
ifYRial c1u<--· _
ar st»rl __ m nou~Ml pQ.Q(ESS\'MG-S-cD\IC
EXIST BLOG EA AMP/SWT/BKR ROCK STORAGE ~wv
1 PH 3 PH PUMP San 0Iegu1to
REMODEL/ALTER PER CIRCUIT PLAN CHECK FEE San Marcos
TEMPPOLE 200AMPS
OVER 200 AMPS
TEMP OCCUPANCY 130 DAYS)
TOTAL ELECTRICAL 1 TOTAL SOLAR TOTAL FEES PAYABLE Li /0,o:::>
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY Expiration Everyperm1ttssuedbylhe8ulld1rn;iOfllc1alundertheprov1s1onsofth,s
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall exp, on and become null and void If the building or work
* AN OSHA PERMIT IS AEQUtAEO FOR EXCAVATIONS OVER
S' O" DEEP ANO DEMOLITION OR CONSTRUCTION OF
STAUCT\JA£S OVER 3 STORIES IN HEIGHT DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS aulnomed by I commenced within 180da sfromthedateof such
ISSUED, TO COMPLY WITH ALL CITY. COUNT'( AND STATE LAWS GOVERNING BUILDING CON-~r STRUCTION, WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND "-;=,~';;;:;;;;;;;;~:;:7.:'"-'7!-"?;,.::.it-7====~~~!!..!!:!...l!!!!LJ!!:£L.-:::-:t,!~~~~~-----,,-------,---,,--~
KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS, COSTS AND APPROVED BY
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE '<?(}
GRANTING OF THIS PERMIT -,.~----.;....,;~~ .. ~ .. ,.&,,;;;., ___ .;..;;....,J.;,... ______ ..JL _____ J_--'::..._...1._ • l () 6
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INSPECTION TYPE ··--·--··-. ···-DATE INSPECTOR
BUILDING I
FOUNDATION
REINFORCED STEEL
MASONRY I
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME
SHEATHING
FRAME
EXTERIOR LATH lNSULATION
INTERIOR LATH & DRYWALL
PLUMBING l -
SEWER AND BL/CO '.'-(. I
I
PLUMBING UNDERGROUND I
PLUMBING TOP OUT I
TUB AND ~HOWER PAN I
GAS TEST I
ELECTRICAL -I
TEMPORARY POWER
ELECTRIC UNDERGROUND •
ROUGH ELECTRIC
ELECTRIC SERVICE
BONDING A l
G. F. I. -SMOKE DETECTOR .
MECHANICAL I
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
PLUMBING
ELECTRICAL
MECHANICAL
GAS ""
BUILDING
SPECIAL CONDITIONS
CERT OF OCCUPANCY ISSUED
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-
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS
INSPECTION REQ IF INSPECTOR'S
CHECKED APPROVAL
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRES TRESSED
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH
BOLTS
SPECIAL MASONRY \
PILES CAISSONS
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INSPECTOR'S NOTES I. -
DATE
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