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1 :ISTRUCTION WHETHEH SPECIFIED HEREIN OH NOT 1 ALSO AUHtt IO SAVb INUtMNIf-t ANU .__. ,r «.JT j-SSfiuiTi ./n/i. */ nKEEP HARM LESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES JUDGMENTS COSTS AND APPUCAN^BrtSNATyfty^ OWNER^ CONTRACTOR^!APPROVE/Bfr , DATE .7 Jr i 7 / .i i
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gSSicog>(E CAREFULLY EXAMINED THE COMPLETEDIFY UNDER PENALTY OF PERJURY THAT AARATIONS ARE TRUE AND CORRECT AND 1 FED TO COMPLY WITH ALL CITY COUNTY ANAPPLICATION AND PERM!LL INFORMATION HERECURTHER CERTIFY AND AGD STATE LAWS GOVERNCDmz§
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TOTAL FEES PAYABLEf CREDIT DEPOSITTEMPOCCUPANCY (30 DAYS)MFF 80 92 57 05190
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DESIGNER S ADDRESS1 DESIGNER S PHONEr
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IPTION OF WORK / |-?DESIGNERLICENSE <FSTANDARD PLAN #M 4 , ,-H
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BLDG USE CODECONTRACTORj ^/^^-/eI
CONTRACTORS PHONE «s
m 11Q] 1 hereby affirm that 1 am licensed under_ provisions of Chapter 9 (commencing withSection 7000) of Division 3 of the Business 1and Professions Code and my license s n 1full force and effect .1 r N Cl <,1OB ADDRESS AV ST RO NEAREST CROSS ST/3$LO "flffW&Sj- Ul^ <^s Pt*A*jo
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BUSINESS LICENSE #tj
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V CARLSBAD BUILDING DEPARTMENT APPLICATION & PEF1200 Elm Carlsbad California 92008 1989 (619)4385525H
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SPECIAL CONDITIONS.
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PLAN"CHECK NUMBER ADDRESS
PLANNING TYPE OF STRUCTURE
SCHOOL FEES SAN DIEGUITO_
CARLSBAD
% COVERAGE
BUILDING HEIGHT_
FENCES/WALLS
TWO CAR GARAGE
COilMENTS
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LANDSCAPE PLAN COMMENTS
DATE
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DRAINAGE
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DATE TO FINAL DATE
***** ****************
LEGAL DESCRIPTION VERIFIED?.
_ PARK IN LIEU
IMPROVEMENTS
A P N CHECKED?.
E D U
DRIVEWAY
ADDITIONAL COMMENTS
17
/^^DATE /
ENGINEERING INSPECTION REQUIRED
PUBLIC V'ORKS INSPECTOR
FINAL OK DATE
IF THIS ITEM IS NOT CHECKED, BUILDING DEPARTMENT WILL MAKE ALL INSPECTIONS
(DRIVEWAYS, CURB CUT, DRAINAGE, ETC )
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ATTENTION PROPERTY OWNER"
An "owner-builder" building permit has been applied for 1n your name and bearing your
signature
Please complete and return this Information In the envelope provided at your earliest
opportunity to avoid unnecessary delay 1n processing and Issuing your building permit
No building permit will be Issued until this verification 1s received
1 I personally plan to provide the major labor and materials for construction of
the proposed property improvement (yes or no)
2 I (have/have not) /L&SI/-+ -- signed the application for a building permit
3 I have contracted with the following person (firm) to provide the proposed construction
Name _ // _ Phone _
Address _ /[// jC\^^ _ Contractors License No
City 7
4 I plan to provide portions of the work, but I have hired the following person to
coordinate, supervise and provide the major work
Name _ / / _ Phone _
Address _ /I/ / / " Contractors License No
I will provide some of? the work but I have contracted (hired) the following persons
to provide the work indicated
Name Address Phone Type of Work
Signed Property Owner ^f£*££/?£Ttf£L J>T£.U£(U
Social Security Number /4-f ~ "2- 4 ^ 6"£ &
Date
EACH SUBCONTRACTOR WILL BE INSTRUCTED TO OBTAIN A CITY OF CARLSBAD BUSINESS LICENSE
AND FURNISH A CERTIFICATE OF WORKMAN'S COMPENSATION TO THE CITY OF CARLSBAD
Initials