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O I hereby affirm that I am licensed under
provlelone of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Profeaelons Code, and my license Is in
full force and effect.
Lie No ------Class
I hereby alflrm thal I am exempt from the Conlrac-tor's L,cense Law for the loltowmg reason (Sec 7031 5
Business and Prolessions Code Any city or county whIcn re-qutres a permll to conslruci. alter. improve, demohsh. or repair any structure, prior to its issuance also requires the ap·
plicanl for such permit to hie a stgned statement that he Is
licensed pursuant lo lhe prOYIsions of lhe COnlractor s license Law (Chapter 9 commencing wittt Secl!On 7000 ol
Dtvts!On 3 ol lhe Busmess and Pro1essIons Code} or !hat Is ex· empt lherelrom and the basis tor the alleged exempt,on Any
v10la1ton ol secI1on 7031.5 llv an apphcan1 lor a permit sub·
Iects the applicant to a crvil penalty of not more than hve hun-
dred dollars ($500)
rJ I. as owner of lhe property, or my employees w11h wages
as their sole compensation, w,11 do the work. and lhe slruc·
ture 1s 001 inlended or offered !or sale (Sec 7044, Busmess and Professions Code· The Contractor's Ltcense Law does not apply to an owner ol propeny_ who builds or improves
thereon and who does such work h1mselt or through h,s own empfoyees. provided that such improvements are no1 intend·
ed or offered for sale ti, however, the building or Improve-men11s sold within one year ot comptehon, !he owner•builder w,11 have lhe burden of proving Iha! he dKl not build or im-
prove tor the purpose of sale)
□ I, as owner Of lhe property. am exclustVely contracting
with hcensed contractors to conslruct the proIect (Sec 7044,
Business and Professions Code The Conlractor's License Law does not apply to an owner of property who buUds or •m• proves thereon, and who contracts fOf each projecls with a
conlractor(sl license pursuant to !he Contractor's Ltcense Law)
D As a homeowner I am improving my home. and the follow ing condIlIons ex1st 1 The work ,s being performed prior to sale.
2 I have lived in my home tor twelve months
3 r'~!v~ ~C:P~f~:::I It~,~ ~~puon during lhe
last three years
□ I am exempt under Sec ______ . B & P C
lor this reason ____________ _
O I hereby alt1rm tha1 I ha ... e a cert1hcate ot consent
10 self-,nsure. or a cer11!1cate ot Wor~ers
Compensation Insurance. O< a cenilled copy lhereol
(Sec 3800 LabO< Godel
POLICY NO
COMP"-NY
□ Copy IS hied With lhe c1ly
0 Certified copy Is hereoy turn,she<J
CERTIFIC"-Tl OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE
(Ttus section need not be complele<l 11 lhe oerm,1
1!i. tor one hundred 0011ars (1i1001 or less}
0 I certify that ,n the performance ot !he woni tor
wt11ch this permit Is issued I shall not emplOy any
person ,n any manner so as to beeome suo1ec1 10
!he won,;ers Compensa11on Laws ot Cahtorn,a
NOTICE TO APPLICANT 11. alter makm;» 1t11s Gerti
hcate 01 Exemption you should become sut>tec1 t'">
the WOf11,ers Compensation provIs1ons or !he La.b01
COde. you must to,tr,....,,th comoty wllh such
provIsIons or this permit shall be OeemeO revo"eo
O I hereby affirm 1hal 1here ,s a cons1ruc11on
Iend1ng a,gency 101 the perto,mance ot the won,; 10, which this c,erm,1 ,s ,ssueo 1Sec 3097 C,v11 CooeI
Lenoers Name ___________ _
Lenoer s Add1ess __________ _
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA ANO DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT
1200 Elm. Carlsbad, California 92008-1989 (619) 438-5525 :;~~Eq Vi~ M-Js-} do.)AV.ST.RO. NEARESTCAOSSST. j 4 E:;:;L~asl BUSl2fs£;; ~B~~Z/ PERMIT ~:;~,b
l~/11> BLOCK _ I o/,¥~~s· I ASSESsy~;A~L ;~ ~'"" 0 O CONTAA~TOR ' i /1 ;:"CT:S PHO~E ~ ZONE : 114--.ffi
I OWNER'S NAME I OWNER'SPHONE '77,-~Jr,;., '\,"1~ (,.;Q, ""f't.Jtf...~594,,. l7)
: -rJ.,.-J-/;,,,., h L ~/") d Co. 4-..3 4--4-5 9 4 CONTRACTOR'S Ai:it')RESS LICENSE_; -, PLAN 1.0. II BLOG use CODE
OWNER'S MAIL,1"t4'1"'AOOAESS {}-::,r-/ .:5 & c::'✓ (34 ..:3 4-4-0
1 ,....,A:; r> k ~ if ltv~BB (:...::;r-/..::s b.:J_J oes1GNE.R uceNse ~ STANDARD PLAN II BUILDING so. FOOTAGE
OESCA PTION OF WORK Giv;ronn,~n~/ 7)..<.~n C!1 798 /4 9 ~
/ ~t'") .,~;;.,."), ,-..., I_._ ;,t:),,L.. .... ,-.....SQ.R DESIGNER'S ADDRESS _. DESIGNER'S PHONE ~ Jv' &,::/)j ?:c:;L~. 0 ~ NO ?:~~.L
-. ,,,, a STORIES /') / v□ "□ / ../QJ -;:, r<..3 , w;aU/buJO~I 2906.3]
CENSUS TRACT l GP LANO USE I PARKING SPACE AES UNITS I GR"-DING PERMIT ISSUED I REDEVELOPMENT TYPE occ LOAD FIRE SPP
44 I AREA CONST
· {) y O N O v O ~ )/ /'J v O ¥ Nor Valid Unless Machine Certified
QTY. PLUMBING PERMIT. ISSUE 7 ~ QTY. MECHANICAL PERMIT. ISSUE J -SUMM\f\YiACCOUNT NUMBER
: / / EACH FIXTURE TRAP ~ •i-j ""<r / INSTALL FURN DUCTS iJP TO 100,000 BTU A,,-, BUILDING PERMIT \J . 01·00·00·8220 ---~ .J... r, -
I / EACHBUILOINGSEWER (b5r. DVERI00,0008TU SIGNPERMIT 'I ,\\r()1·00·00·8221
I / EACHWATERHEATERANDDRVENT ....:;) 6r BOILER/COMPRESSORUPT03HP PLANCHECK t t.\l "\\01·00·00·8806 ,...;)_)/--
I / EACHGASSYSTEMl1040UTLETS 1 -.'J .$( 80ILER/COMPRESSOR3I5HP TOTALPLUMBI~\ ~r ~. 01·00·0~ 4<e, <..f"
EACH GAS SYSTEM~ OR MORE METAL FIREPLACE ELECTRICAi... ~ j ;'\_' 01·00·00·8223 ~ ,:? I")_
EAcHINSTAl.ALTER,REPAIRwATERPIPE _?? vENTFANSINGLEoucT Z -MECHAN1cA' 1 1 01-00-00-8224 /--<-
EACH VACUUM BREAKER ----~ MECH EXHAUST HOOD DUCTS MOBILEHOME\ j f{\ 01·00·00·8225
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER M08ILEHOME PARK INSP
EACH ROOF DRAIN fl~SIDEI SOLAR 01-00·00c·Ja'-"'oo~"---11----~-=---I
TOTi<L MECHANICAL STRONG MOTION 80·92·33·0519 4-. S<, f"l
TOTAL PLUMBING I 4-~.<.t /..3-:-FIRE SPRINKLERS 01·00·00·8227
PUBLIC FACILITIES FEE 32·00·00·89ll
QTY. ELECTRICAL PERMIT. ISSUE .,,....-_ QTY. SOLAR· ISSUE .:;?-BRIDGE FEE
I NEW CONST EA AMP SWT BKR / 00£:J _:') < -COLLECTORS SCHOOL FEE· DISTRICT ll---+-----------__,,-=-"""-L..oJ..-4--'-""'----ll---1-----------------+------+-=.:.:..:.=...c.=..._..::::::..:..:.::..::.cc...._ _______ -4 ________ ~
1 I PH 3 PH STORAGE TANKS Carlsbad LTJl:2 ,./ 80·92·21·0519
I EXIST BLOG EA AMP,SWT BKR ROCK STORAGE Encinitas 80·92·22·0519
I I PH 3 PH PUMP Sao Oieguito 80·92·23·0519 I l----+-----------------l------ll---l-----------------+-------u----==.:c..::.:.:ce.::.:.;.:...... _____ .......:c:....:.=....::.=....::.::..:.:-1--------~
I REMOOE LAL HR PER CIRCUIT PLAN CHECK FEE San Marcos 80·92·24-0519
t TEMPPOLE 200AMPS
I OVER 700 AMPS -LICENSE TAX 01-00-00-8162 /,.E 7/-
: TEMP OCCUPANCY 130 DAYSI MFF 80·92-57-0519 / r.J A~("'\ 8 8 Q -
t CREDIT DEPOSIT
: TOTAL ELELlRICAL I \:.:?o _ TOTAL soLAR TOTAL FEEs PAYABLE _;z 90~_...:?o
I
I I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY Expiration Everypermit,ssuedbytheBuildingOff,cialund"ttheprovisionsofth1s * "-N OSHAP~:T l REQUIRED FOA EXCAVATIONS OVER
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall exl)lre by hmllahon and become null and void If the building or work ~· 0" DEEP 1'~MOLITION OR CONSTRUCTION OF' I . authouzed by such perm,t ts not commenced within 180 days from the date ~f such I DECLARATIONS ARE TALIE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS pe,m,t. or if the building 0 , wo<k authorized by such permit 15 suspended or STRUCTURES EA J STORIES IN HEIGHT
ISSUED TO COMPLY WITH ALL CITY. COUNlY AND STATE LAWS GOVERNING BUILDING CON L,!;•b~•~n~do:!!n!!ed~a!...:t •~n!.l.,!Yh~m!!e..!a!!!fte!!r:..!t~h•~w~o~r~k_:!,S~C,!!O~m!!!m!!e~nc!:!ed~fo~r:...!a!Joe~ri!!!od!!J!!Ofc,;1LJ!8!L0,!!;d8!!,l••~•-~,.,.------""'---------,-----1
I STAUCTION, WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND p CA • 0 ,'!ii! APPROVED BY ( I~ I KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS AND A Pll NT S SIGNATURE • OWNER CONTRACTOR F" • \ ~
1 EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE ~~ ~ ~ ~ .-,,2 --BY PHONE □ ~ I "'l,,,-' 'G __.
I GRANTING OF THIS PERMIT ~ / /~n -"Z,.'i' -----, n -a'J
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TYPE I DATE INSPECTOR
BUILDING I
I
FOUNDATION I
REINFORCED STEEL I
I
MASONRY •I
GUNITE OR GROUT I
FLOOR & CEILING SUB FRAME I
SHEATHING □ ROOF □ SH~AR
FRAME I
EXTERIOR LA TH I
INSULATION I
INTERIOR LATH & DRYWALL I
I
PLUMBING I
SEWER AND BUCO DIPUCO I
UNDERGROUND □ WASTE □ WATER
TOP OUT □ WASTE □ WATER
TUB AND SHOWER PAN I
GAS TEST I
□ WATER HEATER □ SOLAR WAil"ER
I
ELECTRICAL I
□ ELECTRIC UNDERGROUND D l!JFFER
ROUGH ELECTRIC I
□ ELECTRIC SERVICE □ TEMPOAARY
□ BONDING □ POOL I
I
MECHANICAL I
D DUCT & PLEM., □ REF. PIPll'-IG
HEAT -AIR COND. SYSTEMS I
VENTILATING SYSTEMS I
I
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAVe BEEN APPROVED.
FINAL
PLUMBING
ELECTRICAL
MECHANICAL
GAS
BUILDING
SPECIAL CONDITIONS
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS
INSPECTION REO IF INSPECTORS DATE CHECKED APPROVAL
SOILS COMPL ,ANCE
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 .
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Blown: Type Manufacturer Thickness R-Value ------------~-----3½" EXTERIOR WALLS Owens/Coming
Certain Teed
Type Fibergl ass Manufacturer Manville
3}"
Thickness 4" R-Value 11
FLOORS Type _____ Manufacturer _______ Thickness ___ R-Value __ _
General Contractor License# I",
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By • Title Date \I) %z
Schmid Insulation Contractors, Inc. License # ~1'-~I 221517 C-2 ,1.
« t(~ By{c_J;o~ b. 8%4-u Title Vice President Date ________ l_,
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