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HomeMy WebLinkAbout2345 VIA FRANCISCA; ; 83-271-3-6; Permit' IE O I he,eby affirm that I am licensed under o f provisions of Chapter 9 (commencing with ... [. Section 7000) of Division 3 of the Business fc and ~lc.~s ~e, and my license is in ,r := full force and effect. z lie No ______ Class "' z 0 ;: ,c IIC ,c ... ~ 0 0 0 z 0 ;: ,c "' z w a.. :t 0 () "' a: w "' IIC 0 3 il I hereby alfmn thal I am exempt from !he Contrac· tor's license Law for the lollow1ng reason (Sec 7031 ~ Busmess and Prntesst00s Code Any city or county which re· qu1res a perm11 to construct, alter, improve. demolish. or repair any structure. prior to its ,ssuanee also requires ?heap-phcant !or such permit to hie a s19ned slatement lhal he 1s hcensed pursuant to the provIsI00s ol the Comractor"s License Law (ChapIer 9 commencing with Section 7000 o1 Oiv1s10n 3 of lhe Bus,ness and Profess,ons Code) or that ,sex• empt therefrom and the bas,s tor the aUegeo exemphon Any v,olallon of SecllOn 7031.5 by ao apphcant for a permit sub• Zs th applicant to a cIvt1 pel\atty ot not more than five hun- dred lars ($500). I, as owner ot the prope~. or my employees w1Ih wages as lheir sole compensatton. will do lhe work. and the struc-ture 1s not intended or offered for sale {Sec. 70-44, Business and Professions Code The ConIracIor·s LK:ense Law l10eS not apply to an owner of property who builds Of mproves lhereon and who does such work hlfflSelf or through his own empk>yees, provided that such improvements are not intend-ed or offered for sale If, ho'#ever, lhe building or improve- ment is sold within one year Of compietIon, the owner·builder will have U'le burden of provmg thal he did not build or im• prov; lor the purpose Of sale) Ol"f. as owner of the property, am exclusively contracting with licensed contracto,s to construct the project (Sec. 7Q.44. Business and Professt0ns Code The Contractor·s License Law does not apply to an owner 01 property who buitds or im-proves thereon, and who contracts tor each projects with a contractOf'{S) hcense pursuant to the Contractol's License Law). D As a homeowner I am improving my home. and the tottow-ing conditions exist: 1. The work is being performed prtOI' 10 sale. 2. I have lived in my home IOf twefw months prior to completion ot this -k. 3. I have not ciamled this e:i1:emption during the last lhree years. g :ht:r:e;:t under Sec.------. 8 & P.C. ------------- D I hereby affirm that I na..e a cen,t,cate of consent to sell-insure. or a certificate of wo,kers· CompensatK>n Insurance. or a cer1,t1ed copy thereot (Sec 3800. Labor Cooei POLICY NO COMftNY ~Co()y ,s filed with the cIly 0 Certified copy ,s hereby furnished CEATIFICATl OF EXEMPTION FROM WORKERS" COMPENSATION INSURANCE (This section need not be compleled ,t the perm11 ,s tor one hundred OOllars (1 HX>I or less) D I certify that in the per1ormance o f the wOOI tor tJWhtCh this permit Is issued. I shall no1 employ any person In any manner so as 10 beeome subIec I to the Wo111.ers· Compensation Laws ot Ca11torn1a NOTICE TO APPLICANT It, afler makinJ this Cen1 ficate of Exemp1ton, you shoukS ~ome sut>Jecl I? the Wo111.ers· Compensat,on provIs,ons of lhe l.abOr Code you must IOf'1hw1lh compl)' w1Ih such prov,s,ons or this permtt shall be c,eeme<i ,evoked 0 I hereby altirm thal there Is a cons1tuc11on lend,og ~ency tof lhe per1()fmance or the '1111'01'1!. lo, <N"h1ch lh,s permit Is issued tSec 'JIJ97 C1v1I COdel Lenders Name ___________ _ Lenoer·s Address __________ _ USE BALL POINT PEN ONLY & PRE~S HARO APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. . ,· CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT 1200 Elm. Carlsbad. California 92008·1989 (619) 438.5525 JOB ADDRESS AV. ST.AO. NEAREST CROSS ST. IT0° ,; 'i i i BUSINESS LICENSE II VALUATION PERMIT NUMBER 2345 Via Francisca Hosp 310.~~ LOT I BLOC!< 1 SUBl~;t1~.-;r? I ASSESSOR PARCEL NO CONTRACTOR -CONTRACTORS PHONE • ZONE I 83-271-3-6 OWNE R"S NAME I OW NER'S PHONE Community Resources Corp. Community Resources Corp. 483-6500 CONTRACTOR'S AOORESS LICENSE NO. PLAN 1.0. # BLOG USE COOE OWNE R"S MAILO NG AO-ESS DESIGNER LICENSE II STANDA RD PLAN # BUILDING SO. FOOTAGE 2204 Garnet Ave .. San Die9:o. Ca. 92109 ~,ry DESCRIPTION OF WORK /+-(Alvt/f't~ C"\ • DESIGNER'S ADDRESS DESIGNER'S PHONE --I 0/ ~c/~34761• 1,: ,,.. . " lL..~O SU., \,w~,i,Clo.l tt.a.M\'T ----BT<fg-3~6 --,-2 -Units--di~ ~.t..1 -F/P FLA ELEV. NO OCC GP EDU ST~ES R-1 -· -vO NO -- CENSUS TRACT I GP LAND USE I i}?i° ?CE I RE\iTS I GRADING PERMIT ISSUED I REDE VELOPMENT TYPE OCC LOAD FIRE SPA AREA 'T-l" YD ND v □ N~ .,,; v0 Nr,{_ Not Valid Un~s Machine CertifiM QTY . PLUMBIN G PERMIT -ISSUE QT Y. M EC HANICAL PERMIT -ISSUE SUMMARV ACCOUNT N UMBER n .,, EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100.000 BTU BUILDING PERMIT 01-00-00·8220 1~- EACH BUILDING SEWER OVER 100.000 BTU SIGN PERMIT 01-00-00-8221 EACH WATER HEATER ANO/DR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 01 ·00·00·8806 Ct,1.f.l)- EACH GAS SYSTEM 1 TO 4 OUT LETS BOILER/COMPRESSOR 3-15 HP TOTAL PLUMBING 01-00-00-8222 EACH GAS SYSTEM 5 OR MORE MET AL FIREPLACE ELECTRICAL 01 ·00·00-8223 EACH INSTA~ .. ALTER , REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 01-00·00·8224 EACH VACUUM BREAKER MECH EXHAUST -HOOD/DUCTS MOBILEHOME 01-00·00·8225 WATER SOFTNER RELOCATION Of EA FURNACE/HEATER MOBILEHOME PARK INSP EACH ROOF DRAIN ( INSIDE) SOLAR n1 .oo.nn.oooc TOT.l:.L MECHANICAL STRONG MOTION 80·92·33·0519 "Ll."t"" I -' TOTAL PLUMBING ~ FIRE SPRINKLERS 01-00·00·8227 - S~·ISsu y \ PUBLIC FACILITIES FEE 32·00·00·8933 I 1•-•••- QTY. ELECTRICAL PERMIT -ISSU E QTY. BRIDGE FEE NEW CONST EA AMPISWT1BKR COLLEC}6RS \. !JJI.. SCHOOL FEE -DISTRICT 1 PH 3 PH STORfo,E TANKS f lJ ' Carlsbad 80·92·21-0519 EXIST BLOG EA AMP/SWT 'BK R RO\n( STORAGE (\ (jl I\' I Encinitas 80·92-22-0519 1 PH 3 PH Pl/MP \' \ I ,\ I San Dieguito 80·92·23-0519 REMODEL ALTER PER CIRCUIT flAN CHECK F 'i\ ((I I San Marcos 80·92-24·0519 TEMP POLE 200 AMPS 'j I OVE R 200 AMPS iJ I LICENSE TAX 01-00-00-8162 TEMP OCCUPANCY 130 DAYSI I \ I CREDIT DEPOSIT TOTAL ELEClRICAL I \ TOT/OLAR TOTAL FEES PAYABLE I 8.o5'\~ I HAVE CAREFULLY EXAMINED THE COMPLETED ·APPLICATION AND PERMIT-AND DO HERES~ t~ ve,y ffllll-byltleBuildtngOffte•■tunde<theprov,s,onsofth,a * AN OSHA PERMIT IS REOUIAEo FOR tiCAVATIONS OVER CERTIFY .. UNDER. PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE ~ 1 ~ ltmttation and become null-void If the butld,ng or work 5' 0" DEEP ANO DEMOUTION 0A CONSTRUCTION Of author, by m,t IS not commenced w11htn 180 days from the dale.,, such STAUCl\JRES OVER 3 STOAIES IN HEIGHT DECLARATIONS ARE .TRUE. AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS pe,m, or ,f lfdt~ or work authorized by such pe,m,t IS suspended or ISSUED TO COMPLY WITH ALL CITY, COUNlY AND STATE LAWS GOVERNING BUILDING CON• • ,......, e, Ille wo,11 ii com-for I nenod of 180 ,._v• ----STRUCTION WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND A,Cc:Y~/l:l,UM • owNE.,;f CONTRACTOR 0 A'JVED BY _;;"-Df1J~·A KEEP HARMLESS THE CITY OF CARLSBAD "GAINST ALL LIABILITIES. JUDGMENTS. COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE BY PHONE 0 I I/ ·,~ GRANTING OF THIS PERMIT • ,!_ _ -..... ~~-A.~-.c ,., - 7 7 / -=, 2 u:: >, Ol 0 a. E Q) I- I "Cl 0 Cl §: 0 0. a. <( I ~ C: a: 0 en en Q) en en <( I ~ .2 a; >- <ti en Q) 0 0 a: <ti .; 0 ~ Q) 0 C: <ti C: u:: C: Q) ~ Cl 0 u Q) a. en C: Q) .c ~ • ... <C, - TYPE I DATE INSPECTOR BUILDING I I FOUNDATION I REINFORCED STEEL I MASONRY I I GUNITE OR GROUT I FLOOR & CEILING SUB FRAME I SHEATHING D ROOF D SHµR FRAME I / EXTERIOR LATH I '1'1,(dl... ~~ INSULATION I - I INTERIOR LATH & DRYWALL I ·- I PLUMBING I I SEWER AND BUCO DIPUCO I UNDERGROUND D WASTE D WATER TOP OUT D WASTE D WATER TUB AND SHOWER PAN I GAS TEST I D WATER HEATER D SOLAR W,4TER -- I ELECTRICAL I . D ELECTRIC UNDERGROUND D \JFFER ROUGH ELECTRIC I D ELECTRIC SERVICE D TEMPORARY D BONDING D POOL I _I I MECHANICAL I I D DUCT & PLEM., D REF. PIPl~G . HEAT -AIR COND. SYSTEMS I VENTILATING SYSTEMS ' I ~J .. -=-· ~ ~. .. . I ' - CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE ITEMS ABOVE HAVE BEEN APPROVED. FINAL I PLUMBING I ELECTRICAL I MECHANICAL I I GAS I BUILDINCY ~ I -< J SP~'CIAL CONDITIONS I I . - . ' " 1 ... \ FIELD INSPECTION RECORD v-\ ' ' ' REQUIRED SPECIAL INSPECTIONS INSPECTOR S INSPECTION REQ IF CHECKED APPROVAL SOILS COMPLIANCE PRIOR TO FOUNDATION INSP STRUCTURAL CONCRETE OVER 2000 PSI PRESTRESSED CONCRETE POST TENSIONED CONCRETE FIELD WELDING HIGH STRENGTH BOLTS SPECIAL MASONRY PILES CAISSONS ~ ! .; • ( ~. ..... . """" ' ; f . -t . 1 . ",· ;\ ... ~ DATE . . . . I .. _ ·,~ \ -\_ . ' ' 8~-'>7 , .. ~.:.?, . ' ' " ' ' .- INSPECTOR'S NOTES . ' ,I ,-r11 : - .. -,, . . ,, ~ . .,, ; ·-.. ~4~ .. •i . \ ' f ' :l '1 _ .. ' . ·-1. ··- ..'. " k •.. I ~ .. '-17. •• l , . Y• .. ,, • ' l ,' \ ., Ill z 0 ~ C a:: C ... 0 -if'~ IC I[ 8 iii 0 ... 3 I w z 3l 0, z 0 ~ ~ z w A. :If 0 0 Ill QC w "' a:: 0 ~ il 0 I he<eby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and ~ ... 1-.,:• Code, and my license Is In full force and el'iltt . lie No ______ Class I hereby affirm that I am e,:empt from lhe Contrac· 101·s L,cense Law tor the lotlow1ng reason (Set 7031.5 Business and Professions Code: Any city or county which re- qulfes a permit to construct. alter, 1mprnve, demolish, or repalf any structure, pnor 10 Its issuance also requires !heap- pltcanl for such permit to 111e a signed statemenl that he ,s licensed pursuant 10 lhe prov1s1ons of the Con1rac1or·s LJcense Law (Chapter 9 commencing with Se<:t10n 7000 ot Oiv1st0n 3 ot lhe Business and Profess100s Code) or that 1s ex• empt lheretrom and lhe basis IOf the aUegeo exempt,on Any v,otation ot Se<:lion 7031.5 by an apphcant tor a permit sub· jects the applicant to a civ,I penalty 01 not mo,e than five hun- dred dollars ($500) \£:, as owner of the property, or my employees with wages Cstt;'eir sole compensatKtn, wiN do lhe work. and lhe struc-ture is not Intended or offered for sale (Sec 704◄, Business and Professions Code: The Contraclor's L.cense Law does not apply to an owner ot p,operty who bulds or improves thereon and who does such work n1msell or lhrough his own emp~ees. provtded that such UTiprovements are nol inlend-ed or olfered tor sale. II. however. the building or improve-ment is sold within one year of complet1011. the owner-builder will have the burden of proving !hat he did not build or Im· i fo, the purpose of sale). as owner of lhe property. am exclusively contracting ,censed contractors to consuuct the pro;ect (Sec. 7044. Business and Professions Code. The Cootractor's License Law does not apply to an owner o1 properly who builds or im· proves thereon. and who contracts for each projects wilh a contractor(s} license pursuant to the Contractor's Ucense Law). D As a homeowner I am ,mprOYing my home. and the totlow• tng condit10ns exist: 1. The wo,k is being pe~ormed p,ior to sale. 2. I have lived in my home tor twe!Ye months prior to cornptetioo 01 this WOik. 3. I have not claimed this exemption during the last three years. D tamexemptunderSec. ______ . B&P.C. tor this reason ------------- □ I hereby affirm tha1 I ha..-e a cert1t1ca1e of consent to self.insure. or a cert1f1ca1e ot Workers· Compensation Insurance. or a certified capy thereol (Sec 3800. Lat>or Code) POLICY NO COMPANY ~y IS filed w ith the Cit)' 0 Cer11hed copy 1s hereby turn,shecl CERTIFICATl OF EXEMPTION FROM WORKERS" COMPENSATION INSURANCE (This section need no1 be completed 11 the perm11 1s tor one hundred dollars ($ 100) or tess) D I cer11ty lhal 1n the performance of the w o,1( tor which 1h1s pemut 1s issued. t shall not employ any pe,son ,n ainy ma.nner so as 10 become sub1ect 10 tr\e Workers· Compensatt0n Laws of Cahforma NOTICE TO APPLICANT If. afler maktnJ this Cert• hcate ot Exemption. you shoukl become su01ec1 I'> lhe Wortters· Compens.t1on prov,s,ons ol 1he Labor Code, you must t0f1hw1th compl~ w11h such p,ov,s,ons o, 1h1s permit shall be deemed revoke<J 0 I hereby affirm !hat there 1s a cons1ruc11on lending agency tor the peri0tmance ol the won,. !or which this perm11 1s issued lSeC J097 Civil C~I Lenoer s Name ___________ _ Lender's Address-- USE BALL POINT PEN ONLY & PRE~S HARO APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. CARLSBAD BUILDING DEPARTMENT APPLICATION & PERM}~, /-.ri C,f q 1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525 JOB ADDRESS AV. ST.RO. NEAREST CROSS ST. IOATE OF Al"l'LICATIONII BUSINESS LICENSE # I ~VA.f..UATIO"" / PERMIT NUMBER .,., ~ 2345 Via Francisca Hosp 9/21/83 ........... -,, .......... ----_, . ...,_ 1ig?,'v"J I /} LOT I BLOCK I SUBDIVISION I ASSESSOR PARCEL NO. CONTRACTOR CONTRACTORS PHONE • ZONE OWNE R"S NAME I OWNE R"S PHONE Community Resources Corp. CONTRACTOR"S ADDRESS LICENSE NO. PLAN 1.0. # BLDG use CODE Communitv Resources Corooration 483-6500 OWNER'S MAILING ADDRESS c.~·1.1 ........ .., ~ 2204 Garnet Avenue. San Diego, Ca. 92109 DESIGNER LICENSE• STAN DARO PLAN J'"' -BUILDING SO. FOOTAGE~ DESCRIPTION OF WORK .. -DESIGNER'S ADDRESS DESIGNER•S PHONE Building 3-6 12 Units --------·· F/P F LR ELEV. NO OCC GP EDU FOUNDATION ONLY STORIES -vO NO -- CENSUS TRAC~ I GP LAND USE I PARKING SPACE I RES UNITS I GRADING PERMIT ISSUED I REDEVELOPMENT TYPE OCC LOAD FIRE SPR AREA CONST YO N D vO NO vO NO Not VJ/id UnMSs Machine Certifi«J QTY. PLUMBING PERMIT -ISSUE "7~ QTY. MECHANICAL PERMIT· ISSUE s-SUMMARY/ACCOUNT NUMBER I I ./ ... EACH FIXTURE TRAP , INSTALL FURN. DUCTS UP TO 100.000 BTU BUILDING PERMIT 01 ·00·00·8220 I t t t ' .-1 u EACH BUILDING SEWER OVER 100,000 BTU SIGN PERMIT 01-00·00-8221 .. - EACH WATER HEATER AND/OR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 01 ·00·00·8806 -U'-1, h.D EACH GAS SYSTEM l TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP TOTAL PLUMBING 01 ·00-00-8222 EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ELECTRICAL 01·00·00-8223 EACH INSTA~ .. ALTER, REPAIR WAT ER PIPE VENT FAN SINGLE DUCT MECHANICAL 01·00·00·8224 EACH VACUUM BREAKER MECH EXHAUST • HOOD/DUCTS MOBILEHOME 01 ·00-00·8225 WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP EACH ROOF DRAIN (INSIDE) SOLAR 01-()().QQ.A??~ ~ TOTM MECHANICAL STRONG MOTION 80·92-33·0519 I.~ TOT AL PLUMBING I FIRE SPRINKLERS 01-00·00·8227 , QTY. ELECTRICAL PERMIT -ISSUE s--QTY. SOLAR · ISSUE PUBLIC FACILITIES FEE 32·00·00·8933 ""2.D~v-. BRIDGE FEE NEW CONST EA AMP/SWT BKR COLLECTORS SCHOOL FEE • DISTRICT l PH 3 PH STORAGE TANKS Carlsbad 80·92-21-0519 EXIST BLOG EA AMP/SWT 1BKR ROCK STORAGE Encinilas 80·92· 22-0519 . l PH 3 PH PUMP San Oieguito 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 TEMP OCCUPANCY (30 DAYS) , CREDIT DEPOSIT < //, ¾ "'t TOTAL ELEORICAL I TOTAL SOLAR TOTAL FEES PAYABLE I i,,48{~. 03- I HAVEC• AREFULLY EXAMINED THE COMPLETED '"APPLICATION ANq •. '. :r -.~--. ·.!P!.91 • . . . rC...· fxpltiliol\. hay~per_,.._,.,,..._...,..Ollii:tatundtwlllepn)Vls«inSaftlUe * Mt~~ 1$ AECIWW.D f'OR £1CCAVAl'IONS 0V£R CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION . N....., ,-.C-, ..,_...,....,, . and.._llla_volel tfthe=,.ll'WOrll 5" 0-DEEP AND Dbl0UT10N CIR CONSTflUCJJON Qf DECLAAATlONS ARE TRUE AND CO.RRECT ANO I FURNER CE1n'IFY=AGREeW A~ is: =z:s~ . o,not-==='..::' ::..~ .. ~ --~o': STIIICTURESOIIEJI 3 STa.5 IN HEIOMf •. ' ISSUED. TO COMPLY WITH ALL Ctn', COUNTY AND STATE.LAWS .8UILDING.-CON--M --11 • c--.t to, a..-of 11111-. STRUCTION. WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE SAVE INDEMNIFV ANO •--7a... At. □ □ APPRO EOBY • -~ ' • ~ KEEP HARMLESS THE CITY OF CAal..S8AD AGAINST ALL LIABILITIES, ,illlllGM1:16S, COIS1$ ANO -/ %~ OWNEfl CONTRACTOR ~-t, .. EXPENSES WHICH_ MAY IN ANY WAY ACCRUE AGAINST SAID CITY •CONSEQUEN(:£ OF THE" • • ' B PHONE 0 ~ °'-~ -'--~ I r/t3-· GRANTlNG OF THIS PERMIT, -• ,_...-y ' 7 7 ~ p~ "' 0 a. E a, I- I "O ~ C co -~ a. a. <{ I .>t:. C a: 0 "' "' a, "' "' <{ I s: .Q a, >- (/) "' a, <.) 0 a: co iii 0 ~ a, <.) C co C iI: C a, a, C, 0 0 a, a. "' C ~ .c. ~ .,,_'..:-'-... , . TYPE 1 ' DATE INSPECTOR ' ' , BUILDING .: ' · ~, ~ ~ ~.,, ,;l-,7 I-~/Ill •~ FOUNDATION I FIELD INSPECTION RECORD '"-·, ft!;u-,,,t::> I REINFORCED STEEL I REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES MASON RY I -REQ IF INSPECTOR s l======;;,;,~=================-=--=====:==F'-".~, :"'. =====t GUNITE OR GROUT ! INSPECTION CHECKED APPROVAL DATE -J ~ .. FLOOR & CEILING SUB FRAMI; ; / SOILS COMPLIANCE ' : - SHEATHING □ ROOF 'fl) SHEAR 'r7_ .n «zu r ,_ PRIOR TO - " , -• FOUNDATION INSP FRAME • ' I __,, 1---.,..,....----,-----=-=-==--=-=-=-+-----t-------t------, 1---------"-----------------------i ~~i;;i~""a".a-,:i:j1 ------,,:---~~~-:;;-::i:~~:l>~;::-7I STRUCTURALCONCRETE i EXTERIOR LA TH 1 !&, '\ -. ' "ll ...., ....,-~ OVER 2000 PSI I---------+-----;--------;------, INSULATION I ~ l,.Ja!RESTRESSED ' ~~~'/ CONCRETE 1---------,-'•------------------------j INTERIOR LATH & DRYWALL ~~.~ -~Ml ";y ~l POST TENSIONED IL ' -,-r CONCRETE --------""""'."'.:---------__., __ ----ti--------t~--;----t---------t-----;------;----, 1----------------------------:----, ... -PLUMBING I I ,. FIELD WELDING t 1---------___:: __________________ ---j SEWER AND BUCO DIP UCO I ' ' HIGf-! STRENGTH :-c ~ ~--. BOLTS -' UNDERGROUND □ WASTE □ \IVATER l-----'---''------+------1r------t-------1 , TOP OUT □ WASTE □ WATER t--s P_E_c_1A_L_M_As_o_N_R_v __ t-----;------;----, : _, ~-. TUB AND SHOWER PAN 1 ·-1------------i--,---t--------i-----1 t-------· ----------------------1 GAS TEST : PILES CAISSONS ' ,. □ WATER HEATER □ SOLAR WATER 1 •• I ELECTRICAL : • 1-----------~-------+---1 I' □ ELECTRIC UNDERGROUND □ UFFER 1----------------------_-:-, --:-, -:,:;.-;,::-:-~----1 .. ~. . ROUGH ELECTRIC I t---------+-----+------+---1 .. . . _ ~ □ ELECTRIC SERVICE □ TEMPO~ARY , • ' :'_·--~-~ •. • .. ---_,"· -I I □ BONDING □ POOL I -<;,. -~ ~ '> ' ' I 1------------------------------i I MECHANICAL ) 1---------+-----r-----+---1 1----'--..:...· -----------------------1 □ DUCT & PLEM., □ REF. PIPING -' HEAT -AIR COND. SYSTEMS I VENTILATING SYSTEMS : .• l CALL FOR FINAL INSPECTlbN WHEN ALL APPROPRIATE ITEMS ABOVE HAVE BEEN APPROVED. ..-,. ,- FINAL 1 1-----------t---r------t----1 • ·_ i:: .;i, f. • : • PLUMBING 1 ELECTRICAL ; ' • MECHANICAL I 1-----------+----+----+-----i "· •• ,. : . GAS I B'♦JILDING-' ~-1 1----------+---~-----;------, • •. ,--~. ·-\ SF'ECIAL CONDITIONS : _ ' I "' z 0 ;: C a:: C ... 0 Ill 0 IC r 0 0 a:: Ill 0 ... 3 • ii Ill z 3: 0 z 0 ;: C "' z w ... :I 0 0 "' ~ w " a:: 0 3: tl O I hefeby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profeaalons Code, and my license Is In full ftlk:s and •ltec'- L,c No ______ Class I hereby afhrm lhat I am exempt lrom the Contrac-lof's License Law for the. lollowing reason (Sec 7031.5 Business and Protessioos Code Any city or county whttti re- quires -a permit lo construct. alter, ,mprOYe. dem011sh, Of repa1r any structure, pnor to 11s issuance also requires !heap· phcant for such permit to file a sI9ned statemen1 that he Is licensed pursuanl to the prCMsoos of the Contractor s Ltcense Law (Chapter 9 commencing w,th Section 7000 of Dtv,sKm 3 ol the Business and PfolesslOtls Code) or that tS ex· empl therelrom and Ine basis for the alleged exemption Any viorahon ol Sechon 7031.5 by an applicant for a perm,1 su1>-,ecIs the applicant 10 a cwil penalty of not more than hve.hun• dred dollars ($500). 0 I, as owner 01 Ule property, or my employees with wages as lhetr sole compensalK>n, will do lhe work. and lhe S!ruc· luno ,s not lnlefUled or offered for safe (Sec 7044, Bus,ness and Professions Code· The ConIractor's License Law does nol apply 10 an owner of property wtlo builds or improves thereon and who does such work himse4f or lhrough his own employees, provided that such improvemenIs are noi intend· ed or olfered tor sale. 11, howtver. the building or 1mprove--menI is sold within one year of comptetlOl'I, the owner-builder will have the burden of prOYtng that he did not build or un-• prove 10< the purpose o1 safe) 0 I. as owner ol the property. am exctus,vety contrac.llng with licensed contractors lo construct the pn:»ject (Sec. 7044. Business and ProtessJOns Code· The Contractor· s Lteense Law does not apply to an owner ol property who builds or im· proves !hereon, aod who contracts for each proiects w,th a contractOf(S) license pursuant to lhe Contrac10f·s LJcense Law) D As a homeowner I am ,mproving my home. afUI the lollow mg conditions exist: 1. The w0<k IS being pertormed prior 10 sale. 2. I have lived m my home for tweNe months 3. F~v~0 ~Pe':::;' 1~: :r!ption during the last three years. ~ /J~r:"s:' under Sec ______ . B & PC ------------- D I hereby a.II.rm that I ha-1e a cen1ftcaIe of consent 10 self-insure. o, a cen1f1caIe ot Workers· Compensation Insurance. o, a centlted coPv thereof (Sec 3800. Labor Code) POLICY NO COMPANY D Copy Is hied with the c,ty 0 Cert1f1ed copy ,s hereby lum1shed CERTIFICATl OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Th,s sechon need not be completed 1f the permit ,s tor one hunche<J dOllars 1s 100I o, less) 0 1 cer1,ty that in the performance ot the work to, which this perrmt Is issued. I shall not employ any person in any manner so as 10 beeome subJecl 10 the Worke,s· Compensation Laws ol Cahfom1a NOTICE TO APPLICANT If. after makm~ this Cen1 ltcate of Exemption. you should beeome subIecI I') the Wof1iters· Compensation provisions ol lhe l.abof Code. you must forthv.-1lh comoty w1lh sucn prov,s,ons o, lh1s permit shall be deemed re'IIOke<I 0 I hereby aJflrm lh.Jt there 1s a con~!fuchon lend•nQ agency ror lhe oerto,mance ot rhe wor1f for wh•Ch lhtS permll IS issued (Se<. J097 C1v1I Cooe1 Lenoe, s Name ___________ _ Lenders Address __________ _ USE BALL POINT PEN ONLY &_l__RE~S HARD --APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. -.. - CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT 1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525 JOB ADDRESS AV ST.RO. NEAREST CROSS~ST I DA~;;;:/;;TIONI BUSINESS LICENSE tt VALUATION PERMIT NUMBER .:l.3¥S-~.J~ /2 ,/2 -, ~ ~~---.,, ! 3-)..7/-~ LOT I BLOCK, I SU601VISION I ASSESSOR PARCEL NO CONTRACTOR CONTRACTORS PHONE • ZONE ~~(2.LJ ~/~--~-p;.j 'f?? ?'-'Y ~ OWNER'S NAME 16N/;;;R:s~:~ /. ~-: ~~ CONTRACTOR"S A'tl0RESS ~ LICENSE NO . PLAN 1.0. # BLDG USE CODE , ..J.tt..s,/1 ~ ~ -, . ---,. .,.,, 0:;~:;;•NG A' 1,ESS , 1.,.._ -/.Z-.h,~ ~,,..,.:.~\ DESIGNER \J LICENSE " STANDARD PLAN# BUILDING SQ. FOOTAGE r ...... DESCRIPTION OF WORK (/ DESIGNER'S ADDRESS OESIGNER'S PHONE ~?-#~j /a<~ ~ F/P FLRELEV. NO OCC GP EDU STORIES llt2,ii~~66 vO NO --ea~or CENSUS TRACT I GP L AND USE I PARKING SPACE I RES UNITS I GRADING PERMIT ISSUED I REDEVELOPMENT TYPE OCC LOAD FIRE SPR AREA CONST YO ND vO NO vO NO Not Valid Un~s Machine Certified QTY. PLUMBING PERMIT · ISSUE 7,5a QTY. MECHANICAL PERMIT· ISSUE ,_3,oo SUMMARY/ACCOUNT NUMBER '7.1.: EACH FIXTURE TRAP ,IQ/). -INSTALL FURN. DUCTS i.JP TO 100.000 BTU BUILDING PERMIT 01 ·00·00·8220 , I EACH BUILDING SEWER ;!: ·S-0 OVER 100.000 BTU SIGN PERMIT 01·00·00-8221 -/..,2 EACH WATER HEATER AND/OR VENT ?l'l . -BOILER/COMPRESSOR UPT0 3 HP PLAN CHECK 01 ·00-00-8806 EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP ' TOTAL PLUMBING 01 ·00-00-8222 ....J39,- EACH GAS SYSTEM~ OR MORE METAL FIREPLACE • ELECTRICAL 01 ·00-00-8223 EACH INSTA~. ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 01 ·00·00· 8224 ,,.:; EACH VACUUM BREAKER s .-MECH EXHAUST HODO/DUCTS MOBILEH0ME - 01 ·00-00-8225 WATER S0FTNER RELOCATION OF EA FURNACE/HEATER M0BILEHOME PARK INSP EACH ROOF DRAIN (INSIDE! SOLAR n1 .nn.nn. o,,c TOT f;L MECHANICAL STRONG MOTION 80·92-33·0519 TOTAL PLUMBING I 2.39 . -FIRE SPRINKLERS 01 ·00·00·8227 QTY. ELECTRICAL PERMIT· ISSUE I S,(){) QTY. SOLAR • ISSUE PUBLIC FACILITIES FEE 32·00-00·8933 BRIDGE FEE NEW CONST EA AMP'SWT 8KR COLLECTORS SCHOOL FEE • DISTRICT I PH 3 PH STORAGE TANKS .._/ I Carlsbad 80·92·21·0519 EXIST BLOG EA AMP/SWT 'SKA ROCK STORAGE ] ~\ Encinitas 80·92·22·0519 t PH 3 PH PUMP ,J/ I San Oieguito 80·92·23·0519 REMODEL AL HR PER CIRCUil PLAN CHECK FEE f ,v i) San Marcos 80·92-24-0519 TEMP PO LE 200 AMPS I \\ft~ . OVER 200 AMPS ,,. j I LICENSE TAX 01-00-00-8162 TEMP OCCUPANCY (30 DAYSI I -A ...... CREDIT DEPOSIT TOTAL ELECTRICAL I TOTAL SOLAR TOTAL FEES PAYABLE I J... 3 r, -- I HAVE CAREFULL y EXAMINED THE COMPLETED ·•APPLICATION ANO PERMIT" ANO 00 HEREBY E.p,ration Every perm,I issued by the Building Ott,c,11 under lhe prov,s,ons oflh,s * AN OSHA PERMIT IS REOUIAEO FOA EXCAVATIONS OVER CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code~hall by hmrtllron and become null and void If the building or work 5· 0" DEEP ANO DEMOLITION OR CONSTRUCTION Of DECLARATIO S RE TRUE AND CORRECT AND I FURTHER CERTIFY ANO AGREE IF A PERMIT IS authon by h perm~t •~ot ommenced "'1111'" I BO days !rom Ille dates>! such STRUCTURES OVER 3 STORIES IN HEIGHT N A • per . or 1f t but;"..:.i,;n r rk au1hor1zed by such pe,mIt Is suspended or ISSUED TO COMPLY WITH ALL CITY COUNl Y ANO STATE LAWS GOVERNING BUILDING CON ■ doned ■ t e work 15 commenced for a"'-flod of 180 davs STRUCTION. WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND;~c7N s,-···~ O~CONTRACTOR 0 APPROVED BY DATE KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS .. COSTS ANO h~ -' JU EXPENSES Wl1ICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE l/-LJ GRANTING OF THIS PERMIT. _...... v _,, BY PHONE 0 I -. \ / 2 u: >-.;; 0 C. E G) t- i 'O 0 (.'.) C <1l 0 C. C. <t: +- .:L C a: 0 "' "' G) "' "' <t: I ;;: .2 ai >- "' "' G) 0 0 0: <1l <O 0 ~ G) 0 C <1l C u: C G) ~ (.'.) 0 u G) C. "' C 2! .c ~ I ,I .1. TYPE I DATE INSPECTOR BUILDING I FOUNDATION I I REINFORCED STEEL I MASONRY ' I GUNITE OR GROUT : FLOOR & CEILING SUB FRAME I SHEATHING D ROOF D SHEAR FRAME I I EXTERIOR LATH I INSULATION . I INTERIOR LATH & DRYWALL ! I PLUMBING I SEWER AND BUCO DIPUCO I UNDERGROUND D WASTE D WATER TOP OUT D WASTE D W.t.TER TUB AND SHOWER PAN I GAS TEST I D WATER HEATER D SOLAR WA1ER I ELECTRICAL I D ELECTRIC UNDERGROUND D VFFER ' ROUGH ELECTRIC I D ELECTRIC SERVICE D TEMPORARY D BONDING D POOL I ' I I MECHANICAL I D DUCT & PLEM., D REF. PIPING HEAT -AIR COND. SYSTEMS I -VENTILATING SYSTEMS I I I CALL FOR FINAL INSPECTl©N WHEN ALL APPROPRIATE ITEMS ABOVE HA VE BEEN APPROVED. PLUMBING ELECTRICAL MECHANICAL GAS 84,llLDING FINAL SPECIAL CONDITIONS I ..• \ . i~" ,-, l ..-3~ -/-"tL,. ~ 1 FIELD INSPECTION RECORD REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES INSPECTION REQ IF INSPECTOR S DATE CHECKED APPROVAL SOILS COMPLIANCE PRIOR TO J "c,. It, I FOUNDATION INSP .... STRUCTURAL CONCRETE OVER 2000 PSI ~ PRES TRESSED CONCRETE POST TENSIONED CONCRETE FIELD WELDING HIGH STRENGTH BOLTS SPECIAL MASONRY I PILES CAISSONS -' . ' - " .. -~ () . : <... .:.._, -. --~ , . =-.,.. __ ..... ......_ ' , L ....... ~ ..... ~ . .. -: ... • . -' ' .. --" --. -.. - \y(/IC ,<il ![ .,, z 0 ~ a: C -' () 11,1 a 0 () a: 11,1 a -' 5 • ii 11,1 z 3 0 z 0 ;::. C .,, z 11,1 A. ~ 0 () .,, a: 11,1 " a: 0 3 il 0 I hereby affirm that I am licensed under provlalona of Chapter 9 (commencing with S.Ctlon 7000) of Division 3 of the Business and Profaaalons Coda, and my license is In full force and affect. Loe No ______ Class I hereby alhrm !hat I am exempt from the Con1rac· tor's LIC8'1se Law for Ille lollowong reason (Sec 7031.5 Business and Prolessions Code Any c11y Of county whtdi re· quires a perm11 to construct. alter. improve, demohsh, or repair any structure. prior to ,ts issuance also requires !heap-phcant tor such permit to file a s1Qned statement that he ,s licensed pursuant lo lhe provisions ol lhe Contract0t's License Law (Chapter 9 commenc.ng w11h S!ctJOn 7000 ol Dw1s10n 3 ot the Business and Protesstons Code) Of thal ts ex-empt therefrom and the basis tor the allegeo e,cempt1on Any V1olal10n ol Se<:t1on 7031.5 by an applicant IOt' a permit sub· 1ects ttle apphcant to a c,vit penalty of not more than hve hun· dred dollars 1$500) 0 I. as owner ol the property. Of my employees w1lh wages as their sole compensation. w1tf do the work, and the struc· lure Is not intended or ottered tor sale {Sec 7044, Busmess and Professions Code The Contractor's license Law does not apply lo an owner ol prc,perty who builds or improves thereon and who dOes such work h1msel1 or through h1s own emptoyees. prcr/Mjed that such improvements are nol mlend· ed or ottered tor sale II, however. the building or improve- ment is sold wIth1n one year of completion, the owner-builder w,11 have the burden ol provrng that he dod nol builo CK im· prove l0< the purpose of sale). D I. as owner of lhe property. am exclus,veiy contracting Wlth licensed contractors to construct the prqect (set. 7<M4. Business and Profess10ns Code: The Contractof's License Law does not apply to an owner ol property who builds Of im-proves thereon. and who contracts tor each pn>,ects wi1h a contractor(s) hcense pursuant to the Contractor's License Law). D As a homeowner I am improving rrry home, and the follow~ ing condllions exist: 1. The wor1< is being performed prior to sale. 2. I have lived in my home IOI' twelve months prior to cornpieUon o1 thIs work. 3. I have not claimed this exemption during the last three years. D I am exempl under Sec. ______ . B & P C. for this reason ~ -. 0 I hereby affirm that I t\a'le a certificate ol consent 10 self insure. or a cer11hca1e ol Workers· Compensat,on Insurance. or a cert1hed copy 1hereot (Sec 3800. Labo< Codel POLICY NO COMPANY D Copy ,s hied with the city 0 Cer11tied copy is hereby turn1shed CERTIFICATl OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed 11 the permit 1s to< one hundred dollars ($100) 01 less) O I cer11ry 1na1 In lhe pertormance ot lhe wor1t to, which lhts permit Is issued. I shall nol employ any person In a.ny manner so as to become sub1ect 10 the W()O(ers· Compensahon Laws ol Cahlornia NOTICE TO APPLICANT II. after mak1n1 this Cert, hcate of Exemption. you should become subIecI I? the W()O(ers· Compens.a1ton prov,sIons of ltle Ubor Cooe. you must l0t1hw1tn comoly wllh such prov1s,ons 01 this permit shall be oeemed revoll..ed O t hereby affirm thal lhere ,s a construchon 1end1ng agency tor the performance ol the wr.iork lor which lh,s perm,1 Is ,ssue<l ISec 3097 C1v1I Cooe1 Lenders Name ___________ _ Lender's AOdress __________ _ USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT 1200_El111._Carlsbad, California 92008-1989 (619) 438-5525 J2 ~RZ/(£ U ~ ~ f rAvtJi,;;_; NEAREST CROSS ST. BUSINESS LICENSE It ,&"j ))'/ SUBOI VISION ASSESSOR PARCEL NO. OWNER'S PHONE VALUATION ZONE k~;1t:i i t--PLAN I.O. It BLOG USE CODE r?:~~;;~~~pc>~-:,~-i~~~~ij_~~~~_JL ________ _J CONTRAC ·s ADDRESS '7:hJ-,/ _ .iT A,,.. ' 3/./'1 ,4JYL,'-.=...£........:=-,...~Z!'..4~,Lc;~ [ '5Es1lN{R 1 LICENSE• STANOARO PLAN# BUILDING SO. FOOT AGE OESCRIPTtoli' ~RIC f-- 7 ..{_ I e. (.,.,jf' ~ C--DESIGNER'S ADDRESS F/P F LR ELEV. vO NO CENSUS TRACT GP LANO USE PARKING SPACE RES UNITS GRAOING PERMIT ISSUED I REDEVELOPMENT AREA y O N 0 vO NO QTY.I PLUMBING PERMIT -ISSUE 71J-QTY.I MECHANICAL PERMIT -ISSUE EACH FIXTURE TRAP 7 INSTALL FURN. DUCTS iJPTO 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 I TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE EACH INSTAl . ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT EACH VACUUM BREAKER MECH EXHAUST -HOOD/DUCTS WATER SOFTNER RELOCATION OF EA FURNACEJHEATER EACH ROOF DRAIN (INSIDE) TOT ,l;L -MECHANICAL TOTAL PLUMBING T QTY. ELECTRICAL PERMIT -ISSUE ~ QTY. SOLAR -ISSUE NEW CONST EA AMP/SWT BKR COLLECTORS 7 lPH 3PH~A ~ .-+-STORAGE TANKS EXIST BLOG EA AMP/SWT/BKR --, ROCK STORAGE 1 PH 3 PH PUMP REMOOEL'ALTER PER CIRCUIT PLAN CHECK FEE TE MP PO LE 200 AMPS OVER 200 II.MPS TEMP OCCUPANCY 130 DAYSI NO STORIES TYPE CONST 3- ----DESIGNER'S Pt<ONE DCC GP EDU OCC LOAD Fl RE SPR YO NO Not ValitJ Unkss Machine Certifi«J SUMMARY/ACCOUNT NUMBER BUILDING PERMIT 01-00-00·8220 SIGN PERMIT 01-00-00-8221 PLAN CHECK 01-00-00-8806 TOTAL PLUMBING 01-00-00-8222 ELECTRICAL 01-00-00-8223 I ~r --MECHANICAL 01 ·00·00· 8224 MOBILEHOME 01-00-00·8225 MOBILEHOME PARK INSP SOLAR QJ-O!l·Q{Hl226 STRONG MOTION 80-92-33-0519 FIRE SPRINKLERS 01-00-00-8227 PUBLIC FACILITIES FEE 32-00-00-8933 BRIDGE FEE SCHOOL FEE -DISTRICT Carlsbad 80·92-21-0519 Encinitas 80-92-22-0519 San Oieguilo 80-92-23-0519 San Marcos 80-92-24-0519 LICENSE TAX 01-00-00-8162 CREDIT DEPOSIT TOTII.L ELEClRICAL l ~--- TOTAL SOLAR TOTAL FEES PAYABLE A "'u). r ____,... i HAVE CAREFULLY EXAMINED THE COMPLETED ~APPLICATION AND PERMIT" AND DO HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS Expiration Ew,yparmtt ilauadbytheBulldingOfficialunde<tttaprov,s,onsolltus * IS AEOUtAED FOR EXCAVATI0"5 OVER Coda shall exp,re by lim1tat1011 and become null and YOld II 11,e bu1td1ng or work DEMOUTION OR CONSTRUCTION OF authorized by auch penM ,. not commenced -180 days from Itta data o1 soc~ 'A.Jr.Tii,11111~ OVER 3 STORIES IN HEIGHT permit or 11 the bu1ld1ng or work euthorwtd by IUCh permit II suspended or ISSUED· TO COMPLY WITH All CITY, COUNlY AND STATE LAWS GOVERNING BUILDING CON L!aban!!!!!!1doned!!!!!!!!!,!•!!1..!a!!!nl.J!bme!!!!,.!•!!fter!!Jthe!!!!,,!•!!!ork~l8!.£COffl2!!!!!!mel!!!!oced,!!!_?fo<!!!.,!a!...1!!~nod!!J. ~o!!,_l..!J1!!!!..J~L----:z.~~~~~~""'r---------~~,--:r---"1 STRUCTION, WHETHER SP.ECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDE. MNIFY AND~·ssRE 1f OWNER□ KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS AND , EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF TH L. ·~ ~ ~ BY PHONE D I GRANTING OF THIS PERMIT. ,... ff ,T. ~ Vf 7 7 'O 0 (.9 C <O u a. a. <t I ~ C a: 0 (/) (/) Q) (/) (/) <t I ~ .Q 'ai >- (/) (/) Q) u 0 ct <O ni Cl ~ Q) u C <O C u: C Q) Q) <5 0 0 Q) a. (/) C ~ .c. ~ City of Carlsbad APPLICATION FOR CERTIFICATE OF OCCUPANCY BUILDING DEPARTMENT 1200 ELM 438-5525 Address where Business will be conducted Name of Occupant Address of Home Office of Occupant if different from above Owner of Building ttJ Type of Business Previous use of Building ,.(/ /Tl E $If) tl y" C 1.:,-$ Address Type of flammable or explosive liquids to be used, if any G VALIDATION Building Permit No. Home Office Phone Phone 'f/5-b5()0 I certify that I have read the statements contained In this application; that they are true and correct, and that I make this statement under penalty of perjury. Dated this Signature of Applicant Use Zone !.c_ Planning ~ n Department 1::-M'--' Engineering l'J. Department ,,;ll(f,( Fire Prevention Health Department Building Department Date Date , 19 In the City of Carlsbad, State of California Signature of Building Official FOR DEPARTMENTAL USE ONLY Occupancy Group Type of Construction Disapproved By Disapproved By Disapproved By Disapproved By Disapproved By White -Bulidlng Dept. Yellow -Applicant Pink -Finance Gold -Fire Dept.