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I hereby affirm that I am 11censed under
provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Professions Code, and my 11cense Is In
fu11 force and effect.
lie No ______ Clm
I hereby affirm lhal I am exempt from the Conuac-ror·s Locense Law tor the loltowIng reason (Sec. 7031 5 Business and Pro1ess1ons Code· Any city or county which re--Quires a permit to construct, alter. improve, demolish, or
repair any structure. prior to its issuance also requires !heap-phcant lor such permit 10 file a signed statement that he is hcensed pursuan1 to lhe provisions ot the Con1rac1o(s Lteense Law (Chapter 9 commencing wilh Secllon 7000 of
OlvrsM>n 3 ot the Business and ProtessK>ns Code) or that 1s ex• empt lherelrom and the basis for the allegea exemp110n Any
violation ol Sect,on 7031.5 by an applocant tor a perm,, sub·
jects the applicant lo a civil penalty ol nol moce than lwe hun-dred dollars ($500).
0 I. as owner of the property, or my employees with wages
as their sole compensatt0n. will do the wOt'k. and the strut· lure ,snot intended Of ollered for sale (Sec 70<44, Business
and Professions COde; The contractor·s license Law does
not apply to an owne, of property who buikts or improves thereon and wl'lo does such work himsett or through his own
employees, provided lhat such improvements are not intend·
ed or offered 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 dtd not build Of im-
prove tor the purpose of sal<).
D I, as owner of the Pfoperly. am exclusrvety contracting with licensed contractors to construct the project (Sec. 7044. Business and ProtesstOns Code: The Contractor's lteense
Law does not apply to an owner of properly who buik:1s or im-proves thereon, and who contracts lor each projects wilh a
contractor(s) l+cense pursuant to the Contractor's Lteense Law).
D As a homeowner I am unproving my home, and the follow· Ing conditions exist:
1. The work is being performed pnor to sate.
2. I have hved in my home lor twelve months prior to completion ot this wort<. 3. I have not claimed this exemption during the tast three years.
D I am exempt under Sec. ______ . 8 & P.C.
for this reason -------------
□ I hereby athrm that I ha.-e a cert1hca1e ot consen1 lo sell-insure. o, a cert1t1cate of Workers·
Compensahon Insurance. or a certified copy rhereot
(Sec 3800. Labo< Code!
POLICY NO
COMPANY
□ Copy IS hied with lhe city
D Cer11hed copy 1s hereby furnished
CERTIFICATl OF EXEMPTION FROM WORKERS. COMPENSATION INSURANCE
(This section need not be completed ,I the permit
1s to, one hundred dollars (S H)O) Of less)
0 I cer11ty that 1n the Pf!rlormance of !he work fOf
wtucn ttus penn,t ,s issued, I shall not emo10y any
person in Mty manner so as to become subJe<::t 10
the Wol'kers· Compen¥t•on Laws of Cahtorn,a
NOTICE TO APPUCANT II, at1er ~akinJ 1t\lS Cer11
l1ca1e ol Exemption, you shouk:1 beeome sub1ec1 l'l
ltle Workers' Compensa11on prov,s,ons or !he Labot COOe. you must lorth'Aitn comply w,1n such
p,ov,s,ons Ol 1t11s permit shall be deemed re\lOk.eCI
O I hereby altum thal lhere •S a cons1ruc11on
lend1no aoency tor the per1ormance ol the won.. to,
which ttus permit 1s issued ISec "m7 C1v1I Code1
Lenoer s Name ___________ _
Lenoe,·s AOOress __________ _
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
I CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT : 1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525 _.,..A _... I I
JOB ADOAESS AV ST.AO. NEAREST CROSS ST. I DATE OF APPLICATION' BUSINESS LICENSE # ~ Vlfl-/,uJotu:J~.--PERMIT NUMBER
2704 Via Colima, carlsba.d, CA 92008 -,L; ~~~~, --/ -._,,-,-
LOT BLOCK I SUBOIVISION I ASSESSOR PARCEL NO. LJ CONTAACTOA CONTRACTORS PHONE f ZONE
~, 237 72-21 167-350-23 ~o The Highland Ccrcpany 942-6262 OWNEA•s NAME I OWNEA·s PHONE
The Hi,...i..,, .. nr1 -942-6262 c'r9§1CT{tfiig_~5\,k way#201 LICENSE NO. PLAN 1.0.,; BLOG USE COOE
" "RES . OWNEA•s MAtLING ADDRESS Rnri ni t-:oc, r n Q?0?4 B-342407
1991 Village Pk Way #201, Encinitas, CA 92024 DESIGIIIEA LICENSE• STANOAAO PLAN# i49Z; ~zE t/. OESCAIPTION OF WOAK Envirormental Design C-1798-AIA
~ Construction oES•GNeA·s ADDRESS Encinitas,CA DESIGNER'S PHONE
50 Plan -1496 s.f. 1991 Village Pk way#201, 942-6262 ~/2UBl.j7t,S;;i l~ 11.: ~---•• -·---·---------------F/P FLA ELEV. NO OCC GP EDU
v□ N'fA.
STORIES 7'?-~ I ' --
CENSUS TRACT I GP L ANO USE rARK ING SPACE
1 447
d
1
GRADING PERMIT ISSUED I AEOEVELOPMENT TYPE OCC LOAO Fl AE SPA
AAEA ~ CONStJ
vO ~ y D ND vO Y-LIO Noc Valid Un~s Machine Certified
QTY. PLUMBING PERMIT · ISSUE 7-~-QTY. MECHANICAL PERMIT· ISSUE ,3"-SUMMARY/ACCOUNT NUMBER g_c,o -II EACH FIXTURE TRAP .... -; 7 .""V': I INSTALL FURN. DUCTS UP TO 100.000 BTU 4-.l"'Y": BUILDING PERMIT 01·00·00·8220 -' .,
I EACH BUILDING SEWER ~Sr OVER 100.000 BTU SIGN PERMIT 01·00·00-8221 ,.,~, ,....,..,_
I EACH WATER HEATER ANO/OR VENT ..:2_.<r. BOILER/COMPRESSOR UPTO 3 HP PLAN CHECK 01 ·00·00·8806 ..... ,, ., =--
I EACH GAS SYSTEM 1 TO 4 OUTLETS -"-~ BOILER/COMPRESSOR 3-15 HP TOTAL PLUMBING 01 ·00·00·8222 4.£..<n
EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ELECTRICAL 01·00·00·8223 '-~n. r){")
EACH INST Al . ALTER. REPAIR WATER PIPE ~ VENT FAN SINGLE DUCT ~ /Jr) MECHANICAL 01·00·00·8224 A-? nr,.,
EACH VACUUM BREAKER MECH EXHAUST -HOOD/DUCTS MOBILEHOME 01·00·00·8225
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP
EACH ROPF DRAIN (INSIDE) SOLAR n1 .nn.nn.oooc i ,.., .....
TOTJ;L MECHANICAL STRONG MOTION 80·92·33·0519 ld'...,r, ----L'"\
TOT AL PLUMBING I ~ Sc /..3.oc FIRE SPRINKLERS 01-00·00·8227 --~ PUBLIC FACILITIES FEE 32·00·00·8933 QTY. ELECTRICAL PERMIT · ISSUE QTY. SOLAR -ISSUE
BRIDGE FEE
1111? NEW CONST EA AMPISWT.1BKR COLLECTORS SCHOOL FEE • DISTRICT
AAlt. (1 PH ) 3 PH ....?.< rr.. STORAGE TANKS Carlsbad 80-92·21·0519
EXIST BLOG EA AMP/SWT /BKR ROCK STORAGE Encinitas 80·92·22·0519
1 PH 3 PH PUMP San Dieguito 80·92·23·0519
REMOOEL'ALHR PER CIRCUIT PLAN CHECK FEE San Marcos 80-92·24·0519
TEMP POLE 200 AMPS
OVER 200 AMPS LICENSE TAX 01-00-00-8162
fEMP OCCUPANCY (30 OAYS) /HF~ 4.nn_nr
' CREDIT DEPOSIT ~----
TOTAL ELECTRICAL I '-30 TOTAL SOLAR TOTAL FEES PAYABLE I :. .... Jr..£:..::--~ .oc
t HAVE CAREFULLY EXAM.INED THE COMPLETED '·APPLICATION AND PERMlr AND DO HEREBY Exp,ra11011 Every perm,t -by the Buildir19 OffiClal under -prov,s,ons of this * AN OSHA PENttllT IS AEQUtAED FOfl EXCAVATIONS OYER
CERTIFY'UNDffi P~TY--OF-PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall exp,re by hmotation and become null -vOHI If the budding or worl< s· 0 .. ~MOI..ITION OR COftSTAUCTION OF
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS authorlZed by such _m,t ,s not commenC<td with111 180 o■ys from the date of such STIIUC A 3 STORIES IN HEIGHT ~rrlllt, or 11 the bu1ldrl or worll au1hor...cl by sue~:• suspend..r or ISSUED· TO COMPLY WITH ALL CITY. COUNlY AND STATE LAWS GOVERNING BUILDING CON· abandoned at anv llme • er the worll is c~ of 110 "•v•
STRUCTION. WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND~PPLICAN. ~~~RE• ~ CONTRACTOR 0 APPROVEDr b...-----
l~~t,L
KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS AND R
EXPENSES WHICH MAY IN.ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE BYPHONE 0 GRANTING OF THIS PERMIT _ -;/
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TYPE I DATE INSPECTOR
BUILDING I /
FOUNDATION I ....... /l .1 1 ./21JI /
I . \..A'JlI
REINFORCED STEEL I ~ ' ,, v-, . -v
MASONRY I/
GUNITE OR GROUT /i
FLOOR & CEILING SUB F.,E:AME I
SHEATHING ~RO_Qe.) ~ SHEAR /
FRAME ,, "Jl!-1/ I ?,)/,,~ 'YYAJ I
EXTERIOR LATH I .--
INSULATION ! -:::,. . 1 -::,. ........ ~ /
INTERIOR LATH & DRYWALL I ~~~ ~-I "' I -.
PLUMBING I /
SEWER AND BUCO DIPUCO I n . L -C'..tt -/
I ,..__ ~-
UNDERGROUND D WASTE D WATER"' ' u,, ..... . -
TOP OUT D WASTE D WATER -:,. /JA .><11_ .
~
TUB AND SHOWER PAN I I -....
GAS TEST I (
D WATER HEATER D SOLAR W~TER
I
ELECTRICAL I
D ELECTRIC UNDERGROUND 0 1UFFER
ROUGH ELECTRIC I ?.f/_.c,f{ .-~
--¥'
D ELECTRIC SERVICE D TEMPORARY ~ . --
D BONDING D POOL I
I
MECHANICAL I
D DUCT & PLEM., D REF. PIPING r" 7-/ I,.., s::;::a,.., 1 ::--
HEAT -AIR COND. SYSTEMS I ,-.
VENTILATING SYSTEMS I
I
I
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITE_M_5_ ABOVE HAVE BEEN APPROVED.
FINAL
PLUMBING
ELECTRICAL
MECHANICAL
GAS
BUILDING
SPECIAL CONDITIONS
• ► . ----
'8~-~;4,J.,.)..,37
-.. , ..... . -'· I ~ -. "
FIELD INSPECTION RECORD -
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
~ali
--REO IF INSPECTOR'S 4 · l 8 , &4. -INSPECTION CHECKED APPROVAL DATE ....... . . .., ~'-
' '>
SOILS COMPLIANCE ~ _,. ,. or'
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRES TRESSED
CONCRETE
POST TENSIONED <
CONCRETE
FIELO WELDING
HIGH STRENGTH
BOLTS ..
SPECIAL MASONRY \•-:.--. _,..
. _-:__. ~
PILES CAISSONS
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, ,#;;-✓=-~~~~-~✓-~":-;~ ·~~~~~~;_~~ " -,~~~~~!,~~--,t~~v~~~v~, /~~i"~i~ . r:,"'J/'-~··.;J,~~:-,-~=::"-tt~:-~ .. tfl'r -,,. G,.__,\.."ll'~'o/.,"f:. • "-~~i'~,-:A,~,~~J~ ':·~',-~-:,·:,,,=.';~./,,, ~ • --'· • ·, ,.. t • -,-. . ;-, . --"... . .... _ . :-,.... ~"'tf~~,~-~-~~~~~ , ~. _..,..
INSULATION CERTIFICATION '
This is to certify that insulation has been installed in confonnance with the
current energy regulation, California Administrative Code, Title 25 , State of
California, in the building Jocated at:
SITE ADDRESS d.701./ Via_ Cardel, Carlsbad, CA
61 11 CEILINGS Owens/Coming
CertainTeed
Batts: Type Fiberglass Manufacturer ·Manville
6 11
Thickness 6½" R-Value 19
Blown: Type _____ Manufacturer ----:----,--Thickness ___ R-Value __ _
EXTERIOR WALLS Owens/Corning 3½" Certain Teed 3 ½ 11
Type Fiberglass ~1anufatturer Manville Thiclmess 4 " R-Value ---11
FLOORS Type _____ ~1anufacturer _______ Thiclmess ___ R-Value __ _
General Contractor License# ----------------
By Title . Date ----------------------------------
Schmid Insulation Contractors, Inc. License# 221517 C-2
By
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