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O I hereby affirm that I am licensed under
provisions of Chapter 9 (commencing with
S.Ctlon 7000) of Division 3 of the Business
and Professions Code, and my license is in
full force and effect.
lie No ____ _ Clm
1 hereby athrm thal I am exempl lrom the Conuac• tor's License Law tor the lollowmg reason (Sec 7031.5
Business and Professoos COde Any city or county whIcn re-quires a permit to coostruc1. alter. improve. demohsh _ or repair any struclure, prior to its issuance also requires ?heap-
pltcant tor such permit to 11~ a s,qned statement !hat he is
.. censed pursuanl lo the prov1st0ns of the contractor s License Law (Chapter 9 commencing with Seclt0n 7000 ol
OIV1sIon 3 of the Bu5'ness and Protess,ons COde, or that Is ex-empt therefrom and the basis tor the alleged e,cemptton Any
v1otaIIon o1 Section 7031,5 by an applicant lor a permII sub-Iects the apphcanI to a c1v1I pen.ally of not more lhan live hun-
dred dollars ($500)
r 1, as Cl'Nner of !he property. or my employees w,th wages
as lhe1r sole compensation will do the wOfk, and the struc-
ture Is not intended Of oflered !or sale (Sec 7044. Business
and Professions COde The ConIractor·s Lteense law does not ap~y to an owner o1 prC>perty who builds or 1mproves
thereon and who does such work himself or lhrough hts own employees, provided that such improvements are not mt end-
ed or ollered tor sate 11. however !he 0u,1dmg or tmprove-
menl Is sold w1ttun one year of comple11on, the owner-builder will have the burden of proving thal he did not bu1ld °' im-
prove tor the purpose ol sale)
fJ I. as owner ot the property, am exclus,vety contracting wIlh hcensed contractors to construct the protect {Sec 7044.
Business and Proless10ns Cade The Contractor's License Law does not apply to an owner ol property who builds or im-
proves thereon. and who contracts !or each pro,ecls w1Ih a contractor(s) license pursuanl to lhe Contractor's License
Law)
D As a homeowner I am improving my home, and the fo(low
1ng condItIons exist t The work ,s being performed pnor 10 sale 2 I have lived in my home !or twelve months praor 10 complehon of this work
J. I have not claimed thts exempllon during tne last three years
D I am exempt under Sec ______ . B & P C '°' !his reason ____________ _
C I hereby affirm 1hat I have a cerhf,cate of consent 10
self-Insure. or a cer1iflca1e of Workers· Compensalion In-
surance. or a cert11Led copy thereof tSec 3800. labor Code)
POLICY NO
COMPANY
:J Copy IS filed Wllh lhe c1ly
D Cer11fled copy is hereby furnished
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit
1s for one hundred dollars 1St00) or less)
:J I cerUfy that m the performance ot lhe work for which
lh,s permit 1s ,ssued. I shall not employ any person In any
manner so as to become subjec1 to the WOfkers· Compen-
sa1,on laws of California.
NOTICE TO APPLICANT: If, after making this Certificate
of Exemption. you should become subject to the Workers·
Compensation provisions of the Labor Code. you must
forthwith comply with such provisions or this permit shall
be deemed revoked.
D I hereby affirm that there is a construction lending
agency for the performance of the work for which u·us per-
mit is issued (Sec. 3097. CiYII Code)
Lende,·s Name ____________ _
Lender's Address ___________ _
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT
Carlsbad, California 92008-1989 (619) 438-5525 APPLICATION & PERMIT
008 ADDRESS AV.ST.RO. NEAREST CROSS ST.
' :J..7/o 3 l , cTn~'A -1kll.: E.Lrn
LOT I BL OCK SUBOI VISION
OWI\IE R'S NAME
~1u·w+:LiNc7r,
OWNER'S MAILING AOoJ.Ess -......... _') 7 c;, ~ v ,' c.._ --re~
DESCRIPTIOI\I OF WORK
J ASSESSOR PARCEL NO
I OWNE A'S PHONE
~<...L.T'c _k_j'-c:, 7 :J..9-Y st -;
"?
,+-/k.,e_
I DATE OF APPL.ICATION1
I -'B'-~
CONTRACTOR
/)uJ_ iJ£ (7_
co"N'l'AACTOR'S ADDRESS
DESIGNER
~ f -A-"'5,-,t.-U..--;Sc.,,J~ I I.A,) 14.-,--c..12.. l"'"G•••s.oo•m
F/P F L R ELEV. ~
STORIES
BUSINESS LICENSE • VALUATION
CONTRACTORS PHONE • ZONE
LICENSE NO PLA N 1.0 . #
OESIGNE R'S PHONE
LICENSE NO.
OCC GP EDU
11 '/ C6'/B69£18T
PERMIT NUMBER 3/t'
I rt
BUILDING SO. FOOTAGE
~ GAc-1 L, ~ ID ~~ :;S,.,-v:t>J/J
CENSUS TRACT GP LANO USE l PARKING SPACE RES UNITS GRADING PERMIT ISSUED
v□ "□ rEOEVELOPMENT
REA
TYPE
CONST
OCC LOAD FIRE SPR l:lO'Gl 9ii8l 1/08/ !I
1,:00
19;00
y O N 0 vO "-'O vO NO Nor Valid Unless M~chine Cerrd,ed
QTY. PLUMBING PERMIT -ISSUE
EACH FIXTURE TRAP I , . .; I __..I INSTALL FU RN DUCTS UP TO 100.000 BTU I I BUILDING PERMIT 001·810·00-00-8220
1~ QTY. MECHANICAL PERMIT -ISSUE 3-SUMMARY/ACCOUNT NUMBER
EACH BUILDING SEWER I OVER 100,000 BTU SIGN PERMIT 001·810-00-00·8221
EACH WATER HEATER ANO OR VENl BOILER/COMPRESSOR UPTO 3 HP PLAN CHECK 001·810-00-00-8806
EACH GAS SYSTEM I TO 4 OUTLETS BOILER/COMPRESSOR 3 15 HP TOTALPLUMSING 001-810-00-00-8222 I 7q -I
EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ______ ELECTRICAL 001-8-10-00-00·8223
EACH INSTAl . ALTER. REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 001-810-00·00·8224
EACH VACUUM BREAKER MECH EXHAUST HOOOIOUCTS MOSILEHOME 001-810-00·00·8225
WATER SOFTNER I . , U I RELOCATION OF EA FURN ACE/HEATER I II MOSILEHOME PARK INSP ~
SOLAR 001-810-00·00·8226 I I
r -+.:=.:....:.:.:~~:iiFjt,t ;;~;;gc~!!:~]&{l(-J~!~::!:~:~~~~l ,f,tt!-=::L.-,T'oOiTT~!;LL MMIEECCHH.Aii'iN~ICCAALL ----T--1..-----.~S~TR~O~N;;-G ~M;:;:OT;:-;IO;N '(1 :Q 880-519-92-33
FIRE Sl',lllNk_E~ ~ 001 ·810-00-00-8227
'QTY. ELECTRICAL PERMIT -ISSUE -5-II QTY. SOLAR -ISSUE
NEW CONST EA AMP SWT BKR 1 11 1 COLLECTORS I 8 SCHOOl.--f~ -vislrnicr -d.~o ,t
lcfl(JBL~llEs FEE X) 332-810·00-00-8930 I I
.>v ,.,. ,o.<o
1 1 1 PH 3 PH . STORAGE TANKS • Ca~acl ~\,.'='-~ ~~ I I I I EXIST BLDG EA AMPISWT SKA ROCK STORAGE • Enc1rn1as -t ij,.-~<:,~
3 PH . I PUMP • ft\\~u~'\ l~ 1 PH
REMODEL AL HR PER CIRCUIT PLAN CHECK FEE I II 's:ia "9~"'
TEMP PO LE 200 AMPS ~'(.'C"
OVER 200 AMPS LICENSE TAX 001-810·00-00-8162
TEMP OCCUPANCY (30 DAYSI MFF 880-519-92-57
CREDIT DEPOSIT
TOTAL ELECTRICAL l TOTAL SOLAR TOTAL FEES PAYABLE l It/,--
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION ANO PERMIT· ANO 00 HEREBY Ex1>1rat,on Everyper1'11t111uedbyt.,.Bu1ldtng0fhc1alundertheprov1s,onsoftn,s
CERTIFY UNDER PENAL TY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall exptre by llm1tatIon anO t>ecome null anO void II the bu1ld1ng o• work
DECLARATIONS ARE TRUE ANO CORRECT ANO I FURTHER CERTIFY ANO AGREE IF A PERMIT IS auinor,zed l>y such perm,r II not commenced within 180 days f,om the date o• suet\
ISSUED TO COMPLY W►TH ALL CITY COUNlY ANO STATE LAWS GOVERNING BUILDING CON permit. or ,f Ille bulldt~ or work aulhortZed by suet\ permit 1• suspended or
STRUCTION. WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY ANO abandoned at an time a er the work 11 commenced for I nod of t80
KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS ANO APPLICANT'S SIGNATURE • OWNER iw--coNTRACTOR 0
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE~
GRANTING OF THIS PERMIT /2... . \ Q \ BY PHONE 0 • \1 ""'\ .l • ' • ...2......
"'7 * AN OSHA PEMIIT IS AEOUIAEO FOR EXCAVATIONS OVER
5· o·· DEEP ANO DEMOUTION OR CONSTRUCTION Of
STRUCTURES OYEA 3 STORIES 1H HEIGHT .. .......
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[] 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.
Ltc No ______ Class
I hereby affirm !hat I am exempt lrom lhe Conlrac· IOf s License Law tor the following reason (Sec 7031 5 Business and Professions COde Any city or county whIct1 re-
qutres a permit lo construct, alter. 1mpr0\le demolish, or repair any structure prior to its issuance also requires !heap-
phcant for such permit 10 file a s,gned statement that he Is
lteenset1 pursuant 10 lhe proVJSIOOS OI lhe Comractof°s lttense Law (Chapter 9 convnen~ng with Sect10n 7000 of
Oiv1st0n 3 ol the Business and PtolesslOOS CodeJ Of thal Is ex-empt therelrom and !he basis for lt\e allegeo exempllon Any
viOlalion of Sectoon 7031.5 by an applicant tor a permit sub· Jecls the appheant to a CM\ penalty of not more than five hun-
dred dollars ($500) ✓, as owner ol lhe property, or my emplO)'ees with wages ffi t~1he1r sole compensa11on. w1t1 do the work. and !he struc• o Iure Is not intended or offered for safe (Sec 7044 Busmess
_, and Profess,ons Code The contractors lltense Law does 3 not app!y to an owner of proper1y who builds or improves
• !hereon and whO does such work himself Of through his own ii employees. provided that such improvemenis are not intend· w ed or ottered tor sale It, however. lhe budding or 1mprove-z men1 1s sotd w11hIn one year of compfehon, the owner-bu11der ~ will have !he burden ot provmg that he did not bulld Of 1m• 0 prove tor the purpose of s.a!e)
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~ I, as owner of lhe proper1y am exc/us,vely contraclmg (h ilcensed contraclors to construct the profeel {Sec 7044
;mess and Proless,ons Cooe The Contrac.lor's License Y does nol apply 10 an owner of property who builds or 1m-~itives thereon_, and who contracts for each proiects w11h a
lntractOf{S) hcense pursuant to the Contractor's License IW)
I As a homeowner I am unp(oving my home. and the follow·
ing condI1tons exist· 1. The work Is being per1ormed prior to sale
2 I have hved m my home !or twelve months
3 rr:v~ ~:'p~~~~I t~1Ii :1!phon duung the
last lhree years
C' I am exempt under Sec ------· 8 & P C for this reason ____________ _
0 I hereby affum that I have a cert1!1cate ot consent to
se1f-msure. or a cert11!cate ot Workers Compensa11on In•
surat1ce. or a cer11f1ed copy !hereof tSec 3800. Labor Code)
POLICY NO
COMPANY
r--, Copy 1S filed with tne City
.......J Certified copy 1s hereby furnished
CERTIFICATE OF EXEMPTION t'ROM WORKERS' COMPENSATION INSURANCE
(This section need no! be compleled II the permit
,s for one hundred dollars ($ 11)0) or less)
0 I certify that m the performance of lhe work lor which
this penn,1 ,s ,ssued. I shall not emp!Oy any person in any
manner so as to become subJect to lhe Workers Compen-
sation Laws of California.
NOTICE TO APPLICANT; If, after making this Certificate
of Exemplion. you should beeome sub1ec1 to the Workers'
Compensation provisions of the Labor Code. you must
forthwilh comply with such provIsIons or this permit shall
be deemed revoked
D I l'tereby allirm that there 1s a construction lending
agency tor the perfom-tanceof lhe work for which this per-
mit Is issued {Sec. 3097. C1vO Code)
Lender"s Name _____ _
Lender s Address _ ---~~
USE BALL POINT PEN ONLY & PRE~S HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT
Carlsbad, California 92008-1989 (619) 438-5525 APPLICATION & PERMIT
JOB ADDRESS
27t~ 1/1~'11)/J.JA 1/vPv'//L-T.RD
NEAREST CROSS ST LL>! -I 17}11,11)/UtCL. l°~izLICATIONI
BUSINESS LICENSE # VALUATION
LOT BLOCK l suB01v,s,oN I ASSESSOR PARCEL NO
o~~~; (/'~/4' 1729:;t;i_H7NE
CONTRACTOR
OW#EIZ_
CONTRACTORS PHONE • ZONE
PERMIT NUMBER '61rl
CONTRACTOR'S ADDRESS LICENSE NO PLAN 1.0. # BUILDING SO. FOOTAGE
OW"lER'S MAILING ADDRESS
Z7t~ }Acn;L/~ IM:.. DESIGNER DESIGNER'S PHONE
DESSf•~~O!".,Q,;_.w~'}f/j I l...H71/V~l#C: I DESIGNER'S ADDRESS LICENSE NO.
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CENSUS TRACl I GP LANO USE I PARKING SPACE I RES UNITS I GRADING PERMIT ISSUED
F/P F LR ELEV.
vO NO
f
REDEVELOPMENT
AREA
~
STORIES
TYPE
CONST
OCC GP EDU
OCC LOAD FIRESPP
6/ 'l E '/ B66652
DOOH:!682 5'lT21' 8!:i
[ln"T PC~!? rf
·,~~Oi l ~p
1.0 ~TL.
siia a1
YO N □ YO ... o vO NO Nor Valid Unless Machine Certd1ed
QTY. PLUMBING PERMIT -ISSUE 15/J QTY. MECHANICAL PERMIT· ISSUE ..s--SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP I I I INSTALL FURN. DUCTS UP TO 100.000 BTU BUILDING PERMIT 001·810·00·00·8220
EACH BUILDING SEWER I OVER 100,000 8TU SIGN PERMIT 001·810·00·00·8221 -
EACH WATER HEATER AND OR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 001·810·00·00·ans
EACH GAS SYSTEM 1 TO 4 ouTLETS ___ I I BOILERICOMPREssoR J 15 HP TOTAL PLUMBING 001-81 -o~L ~
EACH GAS SYSTEM 5 0 R MORE I . METAL FIREPLACE ELECTRICAL . ~l 00·8223 /tJ 7'
EACH INSTAl . ALTER, REPAIR WATER PIPE _L -! I VENT FAN SINGLE OUCT _ MECHANICAL
EACH VACUUM BREAKER -] MECH EXHAUST HOOD'DUCTS MOBILEHOME
WATER SOFTNER I II I RELOCATION OF EA FURNACE,HEATER I II MOBILEHOME PARK INSP c...\.. '(' .. a.:\.,~~L~~ ...
\t~<t ~'>" I SOLAR 001·810·00~0 6 £
EACH ROOF DRAIN !INSIDE) TOTAL MECHANICAL STRONG MOTION \l\.1fl0~1~12~;:.. --------i
FIRE SPRINi<~R.§._ ~H,\,'t~~0-8227 TOTAL PLUMBING 1
QTY. ELECTRICAL PERMIT· ISSUE s"
NEW CONST EA AMP SWl BKR
QTY.I S91::AA l~~Uc
COLLECTORS
PUBLIC FACILITIES FEE ..... d\..'nYo-oo-oo•B93o
V
SCHOOL FEE • DISTRICT
I PH 3 PH STORAGE TANKS Carlsbad
EXIST BLOG EA AMP1SWT BKR ROCK STORAGE Encinitas
l PH 3 PH PUMP San 01egu110
/ REMOOEL A LTfR PER CIRCUIT 5--
TEMPPOLE 200AMPS
OVER 200 AMPS
TEMP OCCUPANCY 130 OAYSI
PLAN CHECK FEE ""~~~ ¢>0&7 q;
San Marcos
LICENSE TAX 001-810·00·00·8162
MFF 880·519·92-57
T /t1f:!!--
CREDIT DEPOSIT ..f vcii.t. ,,.,,,..,it*/T <~~>
lOTAL ELECTRICAL TOTAL SOLAR TOTAL FEES PAYABLE 1 /~
I HAVE CAREFULLY EXAMINED THE COMPLETED ··APPLICATION AND PERMIT" AND DO HEREBY Expirarron. Every permrr ,ssued b !he Bulld1n Otflcral under rhe prov1sronsol this CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code sha II and vo,d 11 !he bu11d,ng or work * A.N OSHA PEAM:T IS REQUIRED FOR EXCAVATIONS OVER
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS aulhorr ....,.,,.,;-;,,,_. h1n 180 days from theda1e of sucn 5 0 DEEP AND DEa.lOUTION 0A CONSTRUCTION OF
ISSUED TO COMPLY WITH ALL CITY COUNlY AND STATE LAWS GOVERNING BUILDING CON ~r ,s suspended or STRUCT\JRES OVER 3 STOAIES IN HEIGHT
STRUCTION, WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND ~~~~7'~~;,;~~~'!J7~.£!1~~~!l..!!~~~!!L!O~fJl18QO.Jld!!•k:l•L-;:::-~~~~~~------------------.J
KEEP HARMLESS THE CITY OF CARLSBAD A.GAINST ALL LIABILITIES. JUDGMENTS COSTS AND ro...,.,.~~J,~,A;ii~=-=+-, CONTRACTOR O APPROVED BY
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE , LL,-,,
GRANTING oF THIS PERMIT v 2 ~~:::,,,-7f'/ ·n:A:-t.,'9.... BY PHONE o /'f
DATE r-/-v-16
7~ -7
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