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O I hefeby •. ,,rm that I am licensed under
provisions of. Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and PTofus1c,ns Code, and my license Is In
full f~~s and effect.
Loe No Class
I hereby att,rm tlllt I .,,, exempt from the Con
~lt~~;~::: ~·~f~~.:1~~r~.~ county which requires a permit to constrvct
.. ter. improve, demohsh, or repatr any structure, pnor 10 ,ts issuance also requires the applicant for such pemut to hie a signed statement that he 1s
hcensed pursu.it to the p<OYosoons ol the Con-
tractor's License uw !Chapter 9 commencing with
Sectoon 7000 of O,vos,oo 3 of the Business and Pro-
fessions Code> Of that ,s ••empt therefrom and the basts 10< the alleged exomptoon Any vt04atoon ol
Sectoon 7031 S by an "Pl)locant for a perm,t subf9Cts tne apphcant to a civil penalty of not more than f,ve
hundred dollars (S500I
a t, as owner ol the p<operty, Of my employees
'*•th wages as their sole compensation, will do the
WOik, and the structure 1s not intended or ottered for
..ie tsec 7044, Business and Professoons Code
The Contractor's LocenM I.aw does not apply to an
owner ot property who builds or improves thereon
and who does such wOf1il himself or through his own employees. provided that such ,mpmyeme:its ••
not ontende<j Of offered tor sate It. howeve< the
butld1ng or improvement 1s sold •1thin one year of
completion. the owner builder will have the burden
ol p,ovong that he dtd not build Of ,mp,ove Im the
purpose ol sale)
Cl I, as owner ot the property, am exclusively
con1rac11n9 with licensed contractOfs to construct
the p,oiect tsec 7044 Business and Proless,ons Code The Contractor·s License uw does not apply
to an owner of property who bu1tds or improves ~~~i~~ ~:nc~~:!~~ ~~~~r~~~~::.:
Locense I.aw)
a I am exempt undef Sec
tor this reason
.B &PC
C] I hereby affirm that I ha~ a cer11hcate of consent to sell insure, or a certificate ot Won<ers·
Compensation Insurance. or a cert1f1ed copy thereof
tsec 3800. lf~! 1
POLICY NO ILft..-(,V 4' 97 () I
COMPANY tt)e.s '7 ~. •
']i;.Cof>y 1$ Med woth the City
D Cer11hed copy 1s hereby furnished
CERTIFICATl OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 11 !he permit ,s t0< one hundred dollars (S tOO) or less>
D I cer1'1y that m the per1oonance of the worl< tor which this permit ,s issued. I shall not employ any
person ,n any manner so as to become sub1ect to
the WOf'kers' Compensation Laws of Cailltom,a
NOTICE TO APPLICANT II alter malon~ thos Cer,, hcate of Exemption. you shouk1 beeome sut>sect t?
the WC>f'kers Compensation provisions of the Labof Code. you must forthwith comply with such provisions or this perm11 shill! be deemed revoked
0 I hereby affirm that there 1s a construction
1eod1ng ~ency tor the performance of lhe work: for
which 1t11s permit 15 issued 1Sec 3097 C1v,1 Code)
Lendef s Nam•~-----------
Lenders Address -----------
USE BALL POINT PEN ONLY~,.;.P.;.;.RE;;,;,S..;;.S..;..;.H.....;AR.;.;.D ____________________ -:!' APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND llECLARATIONS.
CARLSBAD BUILDING DEPARTMENT
1200 Elm, Carlsbad, Callfomla 92008 (714) 438-5525 APPLICATION & PERMIT
• .&u • I _&'YE. -,r .&aao •-a.••-a.r, •••••a.&£-1 •-r•i.-r'""' VALUATION PERMIT NUMBER
ZONE }~{p7
PLAN 1.0. # BLOG USE CODE
LOT STANDARD PLAN # BUILDING SO. FOOTAGE
I ~ err ~ TZ w 9 , "!l' 1 DEs1GNu1-s ADDRESS
CENSUS TRACT GRADING f'.ERMIT ISSUED
YO ND
F/P FLR ELEV.
vO NO
REDEVELOPMENT
AREA
vO NO
NO
STORIES
TYPE
CONST
DESIGNER"$ PHONE
OCCGP EDU
occ LOAD I FIRE SPR
vO NO Not Valid Unwss Machin, wrtifild
QTY. PLUMBING PERMIT -ISSUE 01 QTY. MECHANICAL PERMIT -ISSUE SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP INSTALL FURN DUCTS iJP TO 100,000 BTU BUILDING PERMIT
EACH BUILDING SEWER OVER 100,000 BTU SIGN PERMIT ---------PlAN CHECK
TOTAL PLUMBING
;,. 1 I I BOILER/COMPRESSOR UP TO 3 HP --1 • I EACH WATER HEATER ANO/OR VENT
EACH GAS SYSTEM 1 TO 4 OUTLETS . . BOILER/COMPRESSOR 3 15 HP 1 • • .. . .
tLECTRICAL ---
MECHANICAL
MOBILEHOME
EACH GAS SYSTEM 5 OR MORE . METAL FIREPLACE • -· ----·-·.
11---+1-E-A-CH-INSTA~. ALTER. REPAIR WATER PIPE . . VENT FAN SINGLE DUCT :
EACH VACUUM BREAKER • MECH EXHAUST -HOOO/OUCTS ---------
WATER SOFTNER . RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP ---·------EACH ROOF DRAIN (INSIDE)
TOTAL PLUMBING
QTY. I ELECTRICAL PERMIT · ISSUE
NEW CONST EA AMP/SWT BKR
1 PH 3 PH
EXIST BLOG EA AMP/SWT/BKR
1 PH 3 PH
REMOOEL/ALTER PER CIRCUIT ~---,f----------
TEMP POLE 200 AMPS
OVER 200 AMPS 1----+---TE MP OCCUPANCY (30 DAYS)
TOTI.L MECHANICAL
--SOLAR
STRONG MOTION -
FIRE SPRINKLERS
PUBLIC FACILITIES FEE
BRIDGE FEE
SCHOOL FEE • DISTRICT ---
car1sbad -Encinitas
San Diegulto
S.1n Marcos
01·000-4220
01 ·000-4221
01-000-4806
01 ·000·4222
01·000·4223 ---
01 ·000-4224
01·000-4225
OHl00-4226
65-640-0519 --
01 ·000·4227
25-000-4933_
---
65-623·0519
65-624·0519
65-625·0519
65-626-0519
TOTAL ELECTRICAL TOTAL SOLAR TOTAL FEES PAYABLE
,a.
~ ,, ........... ....,. ..... ._...bytlle ...... OfllcNIUIICllrlle=oftllla * ANOIM WI' ·MQl-flOIIIJICAVAllONSOWIII I HAVE CAREFULLY EXAMINEOlH& ,06lt 1111111 _,..by ......... end.._ null end YOld. H Ille orworll .5•0-IIIIPAND ~.::OONSTil,ICTION OF C&RTIFY UNDER PENALTY OF -WMlorlzecl by IUCII pemill II not com-*Cl wllhln 180 dar9 from Ille of-" slllUCftlla Olla I •tmaHT DECLARATIONSAAETRUEANDC0ARECTANDll'URTHERCEn,jll'"o . pennlt. or If ........ or worll autllorlmd by auch permit ta or
ISSUED: TO OOMPL Y WITH AU CffY, COUNr( 1tND STATE LAWI ........ • 111119 lier the worll II tor• 1 _. __ ,.
STRUCTION, WHETHER SPECIFIED HEREIN OR. NOr. I AL.SO AGREE 1'() AND N'f'UCANT"S SIGNATUM • OWNER O CONTRACTOR O APPRO\IED~BY ~ KEEP HARMLESS THE CITY OF CARlS8AD AGAINST ALL UABIUTIES, JUOGMENT8, OOS'8 AND ~
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN ~ OIF THE BY PHONE 0
GRANTING OF THIS PERMIT. ~ ·
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INSPECTION TYPE DATE INSPECTOR
BUILDING I
I
FOUNDATION I
REINFORCED STEEL I
I
MASONRY I
I
GUNITE OR GROUT I
FLOOR & CEILING SUB FRAME r .
SHEATHING I
FRAME I I
EXTERIOR LATH lNSULATION I r
INTERIOR LATH & DRYWALL I
PLUMBING
SEWER AND BL/CO
PLUMBING UNDERGROUND
PLUMBING TOP OUT -TUB AND ~HOWER PAN
GAS TEST
ELECTRICAL '
TEMPORARY POWER ,,
I
ELECTRIC UNDERGROUND I
ROUGH ELECTRIC I
I \
ELECTRIC SERVICE I
I
BONDING ' I
G. F. I. -SMOKE DETECTOR I
MECHANICAL I
I
I
DUCT & PLEM., REF. PIPING
HEAT -AIR COND. -SOLAR SYSTEMS
VENTILATING SYSTEMS
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAVE BEEN APPROVED.
JOB SITE FINAL
PLUMBING
ELECTRICAL
MECHANICAL
GAS
BUI LOIN ...
ITIONS
ANCY ISSUED
.
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS
INSPECTION REO IF INSPECTORS
CHECKED APPROVAL -.
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRES TRESSED
CONCRETE --POST TENSIONED
CONCRETE -,___
FIELD WELDING
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
PILES CAISSONS
I
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INSPECTOR·s NOTES
DATE ----
-· ·-
--~-~ -
·--------~ -·------·-.
---·-
-
---
-
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,!\ . ,. t \_\.· " ~r; r· --, ~ . , ,.,· · •. •.._i
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ELECTRICAL PERMIT APPLICATION I 7
City of CARLSBAD CALIFORNIA 92008 ' 11 (,7, I Applicant to complete numbered spaces only. Phone 729-1181 Permit No. I
JOB ADDRESS
t l 1' 1 (.1 q ,<: -j\v
LOT NO. I BLK. I TRACT (0SEE ATTACHED SHEET) LEGAL I 1 DESCR.
OWNER MAIL ADDRESS ZIP PHONE -, !~ '•''fl. .... 2 t,-p It:. J< r .. ~. 4 """'..5 t J. ...,.., 0 I\ 1< ~J GJ 1. 0~ :? r&-5 -, ,·1 El !;J'"
CONTRACTOR MAIL ADDRESS PHONE STATE LIC, NO, CITY LIC. NO.
3 I 1,:1.vS I l. '13 )Al '\ " , 1. Ci "i O lf \,
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
COMPENSATION INS CARRIER MAIL ADDRESS BRANCH
6 "\, 'i \
.
\ .. ., l
USE OF BUILDING
1
8 Clw of work: ONEW (S.AODITION )(ALTERATION 0 REPAIR
,
9 Describe work: ~\.r..t~ ~:..o <l,~ "). (.2--~ t 3 ~~
I, "
PERMIT FEES
No. Each Fee
SPECIAL CONDITIONS: SWIMMING POOL WIRING,
NO INCREASE IN SERVICE '
'
-NEW CONSTRUCTION, FOR EACH
Al'rLICATION ACCEPTEO BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY AMPERES OF MAIN SERVICE, SWITCH, ~
FUSE OR BREAKER
I-J. ... r f '-L DATE NEW SERVICE ON EXISTING BLDG.
FOR EA. AMPERE OF INCREASE NOTICE IN MAIN SERVICE, SWITCH , FUSE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC· OR BREAKER
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS.OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A REMODEL, ALTERATION, NO CHANGE PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COM I ,. r; ..,
I-MENCED. IN SERVICE, FOR EA. AMPERE OF (:) /J 7J I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS INCREASE -.:, ---APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. J ALL PROVISIONS OF LAWS AND ORDINANCE~ GOVERNING THIS •"1 ~ -.
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED / ,,.
HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT TEMP. SERVICE UP TO AND INCLUD· PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING ING 200 AMP. CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
TEMP. SERVICE OVER 200 AMP.
PER 100
SIG~r;:;;;ACr O:~r;;l,[;GENT
(DATE) ,...
7f-ISSUANCE FEE ..,) --., ,..,.,. --TOTAL FEES .... ;J ' ~l•NATIIRE: OF OWNER IF OWNER BUILDER AOATE ..I
WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
1?--t I
INSPECTION REPORTS
DATE ITEM REMARKS INSPECTOR
.
USE SPACE BELOW FOR NOTES, FOLLOW-UP, ETC.
'
•
CITY OF CARLSBAD
BUILDING DEPARTMENT
(714) 729-1181
CERTIFICATION
I certify that in the performance of the work for which this permit is issued I shall not
employ any person in any manner so as to become subject to the workers' compensation
laws of California.
If, after making this certificate, I become subject to the workers' compensation pro-
visions of the California labor Code, I will forthwith comply with Section 3700 of the
labor Code.
I understand that if I fail to comply with the workers' compensation laws, this permit
shall be deemed revoked.
I further certify that if I should contract or subcontract with any person, including any
firm or company, to do all or part of the work for which this permit is issued, I shall assure
compliance by that contractor or subcontractor with Section 3800 of the California Labor
Code. /) l/ _ 1 C "'l '() 1
SIGNED:~~L,o.{j--=~'f""<,1,.~-'-'--~~--:J-~~~~~~~~~~~ P~,c.\, PRINT NAME AND TITLE:
JOB ADDRESS: _l_"L_s_3_cJ_A-_<_<_A-v _______ _
DATED: __ J.-_~4-'Afv-'--_1_8 ________ _