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0 I hereby affirm that I am licensed under
prOYlalona of Chapter 9 (commencing with
S.Ctlon 7000) of Division 3 of the Business
and Prof999lons Code, and my license is in
lull force and effect.
Ltc No ______ Clm
I hereby afh,m Iha! I am exempt from the Conuac-
lor"s Locense Law tor the !Ollowmg reason (Sec 7031 5 Business and Professions Code Any c11y or county wh,cn re-
qu"es a permit to construct. alter. improve. demohsh. or repair any slructure pnor to 11s 1ssuaoce also requires !heap--plant for such permit to hie a S!9neo statement 11\al he 1s ltCensecl pursuanl to lhe pr<MS""1s or the COntrac1or s
license Law (Chapter 9 commencing with Section 7000 of Qfv,s.on 3 o1 the Business and Pro1ess,ons Code} or I hat •sex-empl lherefrorn and the basis for lhe alleg,O e,emphon Any v1ofah0f'I ot Section 7031. 5 by an applicant tor a permtl sul).
jeels lhe appilcanl 10 a crvil pe,,al1y of nol more lhan 11>1&hun-
11Ted Ooll.ars ($500).
0 1. as owner ot lhe property. or my employees with wages
as lhetr sole compensahon, will do t)le work. and !he slruC· ture 1s not intended oc ottered for sate (Sec 7044. Busmess
and Professions Code The Contraclor's License Law <Joes
nol apply 10 an owner o1 property who builds or improves thereon anc:s who does ~ch work h1msett or lhroogh his own
empIDyees. provJded that such improvements are 001 intend· ed or· offered tor sale. 11. however. the building or ,mprove-
ment rs sold within one year ot completion, lhe owner·buttder :;~~;: ::: ;~;~ ~rs:r lhal he did nol build or im-
0 I, as owner ot the property, am exclus1Yely contracting
with licensed contractors to construct the prOJect (Sec. 7044. Business and Professions Code: The Contrac1or·s License Law dOeS nOI apply 10 an owner ot property who builds or im-proves thereon, and who contracts tor each projects with a contractor(s) IK:ense pursuant to lhe Contractor's L,cense Law).
D As a homeowner I am improving my home. and !he follow· ing condihons exist: 1. The work is being performed prior lo sale. 2. I haYe hved in my home for lwelve monlhs
3, rI:v~0 :;'Pc~~of t
1~i: ::;ption duri~ the last three years.
0 lamexemptunde,Sec _______ ,B&P.C. tor this reason ____________ _
□ I her~'f athrm thal I ha-,e a ce,111,cate ol consent
to selt,1nsure. or a cert,t1cate ot Workers·
Compensa1ton Insurance, Of a cerhhed copy thereof
(Sec 3800. Labo< Code)
POLICY NO
COMPANY
D Copy Is filed with the city
□ Cer111led copy IS hereby furnished
CERTIFICA Tl OF EXEMPTION FROM
WORKERS· COMPENSATION INSURANCE
(This sechon need not be complelee! 1f the perm,,
Is tor one hundred dollars (S 100) or less!
0 I cen1ty thal m the pertOfmance of the wt)(1il. ror
which this permit Is issued. I shall 001 empI0y any
person in any milnner so as to beCome subIect to the Wortilers· Compensation Laws ol Calltorn,a
NOTICE TO APPLICANT II. i!fter mak1n;i lhtS Cert,
hcale or Exemption. you should become sub1ec1 I?
lhe Wonte,s· Compensation provIsIons of !he Ult>Or
Code. you mus! lonh'lltlltl comply wllt1 such
provIs,ons or this perm,1 shall be deemed revoke<J
O I hereby afl11m Inat there js a con!trvc11on
lencl1no aoency IOf me pertorn,ance or the wo"'-Ior
which 1h15 perm,I ,s issued tSec )097 C1v1I C-odeJ
lenders Name ___________ _
lenders Address __________ _
1; '
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. --• --,u
CARLSBAD BUILDING DEPARTMENT -APPLICATION & PERMIT
' 1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525
JOB ADDRESS AV ST.RO. NEAREST CROSS ST I DATE OF APPLICATION I BUSINESS LICENSE • VALUATION PERMIT NUMBER •
2504 Via. Jbjo !IQ76±6 69,70" 83-34 -
LjGsl BLO~K I ~ueo,1'/4•2~5 I ASSESSOR PARCEL NO O D CONTRACTOR CONTRACTORS PHONE • ZONE 5~ · 1~7'-t \ l OY
OWNER"S NAME I OWNER'S PHONE '1"'h.:> u;,..J,,,1.,...-v1 -,. O A 'l .C"l£:')
The Hi.ghlaoo Catpany 942-6262 CONT1~r-Vi'icr!ge Park Way #201 LICENSE NO. PLAN 1.0. ;t BLDG use CODE
RES . QWNER"S MA'~'NG ADDRESS -s.-rv,.; ni t-:11:,. rA 92Q?A R-"M?.1.n7
1991 Vill.2'<;ie Park Way #201, Encinitas, CA 92024 DESIGNER LICENSE# STANDARD PLAN# BUILDING SO. FOOTAGE
OESCRIPT•ON OF WORK Environmental Desian C-1798 AIA 1760 s .f. LIV . DESl~9'rvn.tage Park way #201 DESIGNER'S PHON E -
New Construction Encinitas, CA 92024 942-6262
~ ---• ---~ --· F/P FLR ELEV. NO ace GP EDU
STORIES 60 PIM 1760 s.f . vO ~ --R.--3 1 B~ I /63 1,k20 ----·· .~ --·,-._ •• -u7.S~Li3
CENSUS TRAC1 I GP LANO USE I PARKING SPACE RES UNITS I GRADING PERMIT ISSUED I REDEVELOPMENT TYPE ace LOAD FIRE SPA
441 s,;f. AREA CONST
YO ND vO NG] V -N v□ Nlijl Nor Valid Unkss Machint Certified
QTY. PLUMBING PERMIT · ISSUE 7.50 QTY. MECHANICAL PERMIT · ISSUE 3.00 SUMMARY/ACCOUNT NUMBER
, , EACH FIXTURE TRAP LI ._50 l INSTALL FURN. DUCTS iJP TO 100.000 BTU 4 _.00 BUILDING PERMIT 01 ·00·00·8220 343.UU
, EACH BUILDING SEWER o ,-:SU OVER 100.000 BTU SIGN PERMIT 01 ·00·00·8221
.,_ , EACH WATER HEATER ANO/OR VENT 2,50 BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 01 ·00·00·8806 246 .35
.,_
EACH GAS SYSTEM I TO 4 OUT LETS 2.50 1 BOILER/COMPRESSO R 3-15 HP TOTAL PLUMBING 01 ·00·00·8222 46.50 .,_
EACH GAS SYSTEM 5 OR MORE MET AL FIREPLACE ELECTRICAL 01 ·00·00·8223 30 .00
EACH INSTA~. ALTER, REPAIR WATER PIPE 3 VENT FAN SINGLE OUCT 6,.00 MECHANICAL 01 ·00-00·8224 13.00
EACH VACUUM BREAKER MECH EXHAUST -HOOD/DUCTS MOBILEHOME 01 ·00·0()·8225
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP
EACH ROOF DRAIN I INSIDE) SOLAR n1.m.nn.oooo
TOT .t;L MECHANICAL 13.00 STRONG MOTION 80·92·33·0519 4 .~7
TOTAL PLUMBING I M, _ r;n FIRE SPRINKLERS 01 ·00-00·8227
QTY. SOLAR • ISSUE PUBLIC FACILITIES FEE 32·00·00·8933
QTY. ELECTRICAL PERMIT · ISSUE t:; ()() BRIDGE FEE
, nr NEW CONST EA AMP/SWT •BK R COLLECTORS SCHOOL FEE -DISTRICT
;unr 1 PH 3 PH ? r; ()(\ STORAGE TANKS ~ ~ ........ Carlsbad 80-92·21-0519
EXIST BLOG EA AMP/SWT/BKR ROCK STORAGE / I\ "' Encinitas 80·92·22·0519
1 PH 3 PH PUMP I tr, \ . San Oieguito 80·92·23·0519
REMOOEL 'ALTER PER CIRCUIT PLAN CHECK FEE I ,... u,.,.,, ([~ l . San Marcos 80·92·24·0519
TEMP POLE 200 AMPS V 'h -I .
OVER 200 AMPS lo r \i ,A, I LICENSE TAX 01-00-00-8162
TEMP OCCUPANCY (30 DAYSI .J\ ~ /
\ / CREDIT DEPOSIT {:,W8.LY
TOTAL ELECTRICAL f TOT AL SOLAR~ / TOTAL FEES PAYABLE I 475 .43 30.00
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT"' AND DO HEREBY Exp,rabon Every permit ,uuec.t by tl'le Bulldt~~Off1c1al un PfOV1sIoos of this * AN OSHA PERMIT IS REOUIAED FOR EXCAVA½IONS OVEII
CERTIFY UNDER PENALTY OF PERJURY THAT All INFORMATION HEREON INCLUDING THE Code shall expire by hm1ta1ton and become null and If I bu,ld,ng or wor• !>. _°L!9_P AND DEMOLITION 0A CONSTIIUCTION <>" authorized by such perm,t II not commenced with, days fr m the date of S\JCh DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS =~~ '!t t~y t;:'~•~:.r.:':!,:~!h~ed ced~~~ r' ~•~,•~:r:~ or
ST / • ---OVER 3 STORIES IN HEIGHT
ISSUED., TO COMPLY WITH ALL CITY. COUNlY AND STATE LAWS GOVERNING BUILDING CON•
STRUCJION WHETHER SPECIFIED HEREIN CR NOT I ALSO AGREE TO SAVE INDEMNIFY AND ~ APPROVl~v•/~ ·;'
l
~c J KEEP HARMLESS THE CITY OF CARLSB. AD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS ~ND APPL! S SI RE OW i CJ'"" CONTRACTOR 0 ;. "\ ..,,
I ~1/8~ EXPENSES WHIC'i MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF f ~ _. . BY PHONE 0
GRANTING OF THIS PERMIT. =...----.
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TYPE I DATE INSPECTOR I
BUILDING I -' . -~·
..
-........::.. ' ¥:'3 -.! l/J -3~ ~ .. • -·
FOUNDATION r"-A.QA~ --t}J1 FIELD INSPECTION RECORD
REINFORCED STEEL V"\•l~ .~ ;Dest
MASONRY 1 ---·
GUNITE OR GROUT .1
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
INSPECTION REQ IF INSPECTOR S DATE CHECKED APPROVAL
FLOOR & CEILING SUB FRAME I
I
SHEATHING D ROOF D SHf;AR
FRAME ' ~~-~ ,.f'"~
EXTERIOR LA TH I -.~
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP -
STRUCTURAL CONCRETE
OVER 2000 PSI
INSULATION "J. (") • ~.Y""~ \ /
INTERIOR LATH & DRYWALL ~ q..,l.J"'i -I 1 ../C ~ _i
PRESTRESSED
CONCRETE
POST TENSIONED -
' CONCRETE
PLUMBING ' ./ FIELD WELDING
SEWER AND BUCO DIPUCO ' 0"11 . Qj ~ I
UNDERGROUND D WASTE D V'!ATER,. I YI>' V 1 V r
TOP OUT D WASTE D WATER '"2 -6-'xAI: ~ -...
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
TUB AND SHOWER PAN --I
.
.'
GAS TEST I
1 PILES CAISSONS
D WATER HEATER D SOLAR WATER .
I
ELECTRICAL I , ' ~
I
J
D ELECTRIC UNDERGROUND D l!JFFER
ROUGH ELECTRIC ' ~-~-~ '{ ,;-v,} I
D ELECTRIC SERVICE D TEMPO~ARY -.
D BONDING D POOL I
I, ,_ ' .
I -. ,·
MECHANICAL I
I
D DUCT & PLEM., D REF. PIPING ·t2~-~ -~
HEAT -AIR COND. SYSTEMS .,
I
. r\., u' ~"' I L •
VENTILATING SYSTEMS ' I
I
CALL FOR FINAL INSPECT{jN WHEN ALL APPROPRIATE ITEMS ABOVE HAV BEEN APPROVED.
-
FINAL I -~
PLUMBING I ,......, ~
ELECTRICAL I -,t)~ ~/ I
MECHANICAL I ,nl,l., ...-~A'") ~ ' . . ' -.... -•-,_:..;:,~~
GAS I '-'/ ...,~-o~
BUILDING ,, I r I ~ \
SPECIAL CONDITIONS I --,
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