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0 I hereby affirm that I am licensed under
provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Professions Code, and my license Is In
full force and effect.
UC No ------Class
I hereby affirm that I am exempt lrom Ihe Conlrat· 10,·s License Law 10< lhe following reason (Sec 7031 5
Business and Pfofess10ns Code Any city or counry which re• Quires a permit to construct. alter. improve, demolish, Of repair any struclure. prior to ,ts issuance also requires !heap·
phcant tor such permit 10 file a signed slalement that he ,s
(1censed pursuant 10 lhe prov,s,ons ot the Con1racto(s license Law (Chapter 9 coomencmg with Sect.on 7000 of 0rv1st0n 3 ot the Busmess and Professmns Code} or that 1s ex
empt therefrom and ll"le basis'°' the anegeo exemption Any ~~~,~~~ ~~,~~tt~3c~V~ :r!7,:~:~~ thin',:~~~~
dred dol~rs ($500)
I, as owner of the propeny, Of my employees with wages
as 1he1r S<Me compensation . .,..,11 do the wD11<. and the strut·
1ure is nor intended Of ottered for sale (Sec 7044 BuSJness and ProfesslOOs Code The Contractor's license Law does nol appfy to an owner of property who builds or improves
thereon and who does such work himself or through his own employees. prov,ded that such mprovements are not intend•
ed or offered lor sale 11, however. the building or Improve-
menIIs SOkl within one year of completion. the owner-builder w,U have !he burden of proving lhal he did not build or im-prove lo, lhe purpose ol sale)
D I. as owner of the propeny, am exclusively contracttng
wnh ltcensed conlractors to consuuct the prOJect (Sec 7044, Busmess and Profess!Ofls Gode The Conlracto(s license law does not apply to an owner of properly who builds or lffl· proves theceon. and who contracts for each prQfects wIIh a coniractor(s) hcense pursuan1 to the Contractor's lteense Law)
□ As a homeowner I am unprov1ng my home, and the lollow ing conditions exist
1 The work 1s bemg pertonned pnor 10 sale 2 I have ltved in my home for twelve months prlOf to completLOn ol this work
3 I have not claimed th,s exemptlOO dunng the last three years
□ I am exempt under Sec ______ . 8 & P C
for this reason
D I l'lereby affirm tl'lat I ha.,e a cer1tf,cate of consenl
to self insure. or a cer1,tica1e ol Workers
Compensation Insurance. or a cert,hed CoPY lhereol ISec 3800. Labo• Code!
POLICY NO
COMPANY
O Copy ,s hied wm, me c,ty
0 Cen,tied copy 1s he,eby furn,shed
CERTIFICATl OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE
(Tl'l1s section need not be completed ,, Irle perm,1 ,~ tcw one hunCred OOllars IS 1001 or less)
0 I cer11fy lha1 in the performance ol !he work to,
wtuch this perrrut ,s issued. I shall no1 employ any
pe,son 1n any manner so as 10 become sub1ec1 10
trie Workers Comperisat1on Laws ot Cahtorn,a
NOTtCE TO APPLICANT It after ma)on7 1rus Cert•
hcale ot Exemption you snould oecome sub1ect l'J me Worlil.ers Compensation prov,s,ons ol me Ut>Or
COOe. you mus! lorthv.,th comply with sucn prov1s,ons or !his perm11 shaJI be deemeo revoked
0 I hereby alfum lhat there 15 a consIructIon
1ending agency trn lhe oerlormance of the won. 10,
wn,ch lh1s permit ,s 1Ssueel !Sec 3097 C,v,1 Cooei
Lenoer s Name ___________ _
Lenoer s AOdress __________ _
1 CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT
1 1200 Elm. Carlsbad. California 92008-1989 (619) 438-5525 a,
: ~6o;s7 v✓·~ Ver~ AV.ST.RO. NEARESTCROSSST. li=~P~LssNl .SBS~~Ed ~~tssN~ B;:_T£BEZ-i
I , L.,OT .Li BLOCK J SUBDIJ;S•O~ _, I ASSESSOR PARCEL NO CONTRACTOR CONTRACTORS f't<ONE • ZONE ,A 4-0
I '4':,q.t <._ , 'I 7 ~-t:,J":"'} I 1,,,, 41~ \ 1..-, 00 . 1, L I A .A :::,,A .A.-e:J,,,; -,6 ~
I 0 \11/NERS NAME. / I . 0\11/NER'S PHONE ""7/)eM✓-n J.. .."Jr,_.y c.:o. "'1""0..,......,..-:::) 7¥-\ \_ (!:.
: -TJ>,,-> ;/-///J),/4.1/'),,.../ t?n l4-.34-4S94 CONTAACTOR'SADORESS LICENSENO PLANI.D.# ,r \\' BLOGUSECOOE I
OIIIINER"SMAILING">roORess ~r-lsh.ac:li C;.:J. l.3~4-07 ).,r <~~\. :!? 1 /0/.5 (lhe......<.lnnfltvt!!.::¢~ ~.,,-,_/_..Ji"\_/ DESIGNER LICENSE: STANO\"\f-AN~\ BUILOINGSO.FOOTAGE c3
DESCnNOFIIIIORK .L G,v,ror,menfo)rJJe.sit'Jn C1'?9_8 (\ ~.r /4-9~
/ ,.,,, ~1f1-A~L ,<_ 0L ,"' ..5n 19 R DESIGNER'S ADDRess -DESIGNER'S PHONE \ \ 1 c
G,1Ji/J/-f~s1 CA ~:i/,. _1t..<J. '-' -~
r--F P FLRELEV. NO OCCGP EDU ~
/~ STORIES /:J . . ~ v□ "'□ ' 2-"3 / I/U7/H:JrlJ'.17 n -• I
CENSUS TRACT I GP LANO USE I PARKING SPACE I RES UNITS I GRAOING PERMIT ISSUED I RE DEVELOPMENT TYPE occ LOAD FIRE SPA 9ll.ti .,,,,
4 I AREA C?NJT .S 4 D YD N D v D "~ V N v□ ,::xi Nor Valid Unlnr M~chine Cerrified a..
QTY. PLUMBING PERMIT · ISSUE ·7.? QTY. MECHANICAL PERMIT -ISSUE 3-SUMMARY/ACCOUNT NUMBER 0 V)
/ / EACH FIXTURE TRAP ~/ .r:.r / INSTALL FURN DUCTS UP TO 100.000 BTU 4,.. _,.-BUILDING PERMIT 01·00·00·8220 ~+{)-~
V) / EACH BUILDING SEWER /,. -~ Q OVE~ 100,000 BTU SIGN PERMIT 01·00-00-8221 __ :/}.
L EACH WATER HEATER ANO •OR VENT .., ..StJ BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 01-00-00-8806 ....:2..:J ,-I
1 / EACH GAS SYSTEM I TO 4 OUTLETS ,...::;J ~ BOILER/COMPRESSOR 3·15 HP TOTAL PLUMBING 01·00·00-8222 1---4'/;, L.C:,r, 3
1
EACH GASSYSTEM 50R MORE 4 METALFIREPLACE ELECTRICAL 01·00-00-8223 -.....::JO-~ 't--+---:---------------t------t--:-.-t--:::-::---:----:-~~-~--------t--~-~--..------------------7----~~--, a,
1 EACH INSTAl . ALTER. REPAIR WATER PIPE ~ VENT FAN SINGLE DUCT r,,,.. -MECHANICAL 01·00·00·8224 /,..=?.->----
1 EACH VACUUM BREAKER MECH EXHAUST • HOOD DUCTS MOBILEHOME 01-00-00-8225
1 WATER SO FTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP ::f
' a, , EACH ROOF DRAIN (INSIDE) SOLAR OJ·QO·J)l)-A??~ g
, i----~--------------.--~~.,._,.----:;;--1! TQTt;L MECHANICAL STRONG MOTION 80·92-33-0519 4,-_ ~ r,, 0::
fOIAL PLUMBING I ~ -<I'. /:3-~ FIRESPRINKLERS 01·00-00-8227 .!:! co
QT Y. E LECTRICA L PERMIT . ISSUE ~ QTY. SOLAR . ISSUE PUBLIC FACILITIES FEE 32-00-00·89:Il -----, ~ ~ -BRIDGE FEE -
NEW CONST EA AMP SWT BK R / 00 .;Q 1....,,,,2 ~ -COLLECTORS SCHOOL FEE -DISTRICT g
I PH 3 PH STORAGE TANKS Carlsbad / 7"72. i/ 80·92-21-0519 ~
EXIST BLOG EA AMP SWT BKR ROCK STORAGE Encinitas 80·92-22-0519 U::
1 PH 3 PH PUMP San D1egullo 80·92-23-0519 -
REMODEL AL TtR PEA CIRCUIT PLAN CHECK FEE San Marcos 80·92-24-0519 I
C
TE MP PO LE ?00 AMPS -------------+-----1li--------------------t----,-=--=:--.---i t
OVER ?00 AMPS LICENSE TAX 01-00-00-8162 / ~ 7 /-C,
TEMP OCCUPANCY 130 DAYS) MFF 80-92-57-0519 / (ii) 880 Baa-
CREDIT DEPOSIT o
TOTAL ELECTRICAL ~ o:::::3O __ TOTAL soLAR TOTAL FEEs PAYABLE I c::2 q 06.a0 I
C
I HAVE CARE FULL y EXAMINED THE COMPLETED APPUCA TION AND PERMIT" ANO DO HEREBY Exporallon Every permit issued by the Building Ofllc1al under !he prov1s,ons of lh,s * AN OSHA ~:T IS REQUIRED FOR EXCAVAT~S OVER -, CERTIFY UNDER PENAL TY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall ox pore by hmitallon and become null and void II lhe bu,ldong or ..,.o,k 5· O" ng'll'1[Nil OEMOt.lTION OR CONSTRUCTION OF . authorized by such permit Is nol commenced w1tn1n 180 days trom Ihe date of such ----;·,ro a, DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY ANO AGREE IF A PERMIT IS petmit or ii the building or wori. auiho.,zed by such pe,m,I 15 suspended or STRUCT\J OVER 3 STORIES IN HEIGHT
ISSUED TO COMPLY WITH ALL CITY. COUNTY AND STATE LAWS GOVERNING BUILDING CON abandOned al any llme after !he work 1s commenced to, a penod of 180 davs .c
STRUCTION, WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND . APPROVED (p ;; :!:
KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND APPLICANTS SIGNATU~E ... . OWNER O CONTRACTOR~ J ~ or, '/4
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE ~ -:z::!':::. ~,;,?/-LL ~ BY p o E O 7 •~ ,~ -
GRANTING OF THIS PERMIT --;,,,,,... /~ 14-~ H N I h-.\
--, I
\_ ~-"'~ r ·
TYPE I DATE INSPECTOR \ \ l i \, I
BUILDING I 34 -515d--4'-ot-l, . \
FOUNDATION I FIELD INSPECTION RECORD
' REINFORCED STEEL I
MASONRY I
I
GUNITE OR GROUT I
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES·
INSPECTION REO IF INSPECTOR S DATE CHECKED APPROVAL
FLOOR & CEILING SUB FRAME I
SOILS COMPLIANCE
SHEATHING D ROOF D SHBAR PRIOR TO -
FRAME I
I
EXTERIOR LA TH i
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
INSULATION I
I
PRESTRESSED
CONCRETE INTERIOR LATH & DRYWALL i
I POST TENSIONED
CONCRETE
PLUMBING I FIELD WELDING
SEWER AND BUCO DIPUCO I
UNDERGROUND D WASTE D WATER
HIGH STRENGTH
BOLTS
TOP OUT D WASTE D WATER SPECIAL MASONRY
TUB AND SHOWER PAN i
GAS TEST I
PILES CAISSOl\iS
D WATER HEATER D SOLAR WATER
I
' ELECTRICAL I
D ELECTRIC UNDERGROUND □ ~FFER
ROUGH ELECTRIC I
D ELECTRIC SERVICE D TEMPOijARY
D BONDING D POOL I
-
'\. '
I
I '
MECHANICAL I
D DUCT & PLEM., D REF. PIPINµ
HEAT -AIR COND. SYSTEMS I '
VENTILATING SYSTEMS I
I .
I
CALL FOR FINAL /NSPECT(iN WHEN ALL APPROPRIATE ITEMS ABOVE HA V BEEN APPROVED.
...
' I ..
FINAL I -PLUMBING I "" C -
ELECTRICAL I -\ .. 7\-' .
MECHANICAL I I.A ;~ \ I -' GAS I 1-L (V'V
BUILDING I ·~ ~ --,.
SPECIAL CONDITIONS I -
' I
'.
. , . .. . . -.. . ~. ,;, ,/ ,,,/ '•/ .. ./
'J11js js to ccrtjfy that j11~uJ;iU0n lias b<:cn jnst;iJJed jn confornnncc ,,:jth the
cuncnt energy rq_;ulntion, C;➔Jjfornia Acl111jJ1istratjvc Cocle , 'fjt]e 25 , State o f
CaJjfornia, jn the bujJcJjng J ocatcd at :
Via Vera , Cg_rlsbgc!, CA ___________ _
M,nuf ac tu1 er
01vcn s/Corn j ng
Ccrt :.inTccd
0h1c ns/Corn i ng-
Ccrt c1 inTccd
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License #
Date
6a "
6 II
.<H~-
3 II
3 II
4 II
R-Va Jue
R-Value
R-Va)ue
R-Value
19
11
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