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D I he<eby affirm that I am licensed under
provision, of Chapter 9 1commencing with
S.Ctlon 7000) of Dl•lslon 3 of the Business
and Profeaalona Code, and my license is in
ful I force and e!lect
I hereby altiril 1ha1 am exempt 4;orn !he Conir>1('
tm·s l1c!lnse Law 1or the fo11ow1ng reas□ri /Se( 7031 ':1
Bus.1ness. .an-d Pfofess1ons Code Any cI1y or county wn1c.r, re
QJIres a permit 10 cons1ruct alter. 1"'lpr;)lle cemol1sh or
r~p;rn an)' slruciu,-e prior t-o its iSSLJance also reQ1.wes •!'le ao
pl1can, for 5.LJCh permit IC tile a 51ci11e(J 5ti31erflen1 tr.at he 1s
l1i:.ense{l pursuart to 1he prov1s;ons 01 trie t:ontractQr •:; l1cer,s.e Law •'.Chapter 9 c.omrnenc.1rig ,.,,it~ Section 7G0n oi
;:)1.,.1s.,Dn 3 o1 the B~siries5 anrl Profess1or1cs Code·, ar that 1s e~
emp1 the-<etrom anct: me basis for Hie alleged e;:,:emot1on Ar-y
v1mat1□n □I Secl1-□n 7031 5 by an appl1ca,;t t-or a ;:ie'rt1' sub
:f'Cl5 the appIIcam to a c1v1I per,al1~ o110~ moie tha'"I ',ve 1un-dred dollar-s 1 $500
as. ow'lef -of the property or my em;:ilo·rees w1111 w.~1;ies
as rhe1r s.ole comoensa!1cin will do th,e wo,1-:: ,,rnd the stru,:
~ure Is not mlertded or of1w:d tor s.::l'e I Sec lfl44. Busin,es~
and Profess1on5 Cod-e The Conlr.!c!□-r''i License law does
"lOI apoly to an ciwn-er a! property who ou I Ids or improves
lh-ereon .a11d who does such work h1 r:,s.e,f or n,rough li1s own
emolo~ees provided tn~i such Impr-o\/emen1-s. afe r;,at 1nten~
eo ar o11ered tor sale H. ~owever. me bwlding or 1rnpra1a'1:
""ent 15 sold w1th1n one year of c.ompletion Hie owner-bl..)1lder
w,ir ha11e the burden of oroving that rie did not build or Im
:iro-,.,e ror the purpose ot sale)
I. as owri-er oi ihe properly. am e;,:clus111eIy contracting
w1in [1c.ens.ed contractors to construct th-e pro1ect 1,S.ec. 7044.
Busiries.s and Protess•ons. CMe. The c□n!racror s L!Cf!nse
law ewes nnt aooly ID ari owner at [HOO€r1'y w'1Q tJ.u,ld:s or Jr"n·
or□v~s. thereM. and wtio r.:nn1racts for e,Kh projects witr. a conl~aciorfs) lIcens,e pursu,3nl lo lhe Coni1actor s Ucens.e Lr1wl
As a homeowrier I am Im:prnvIng m~ hGme-and the lol1ow 1ng cond ItIons e;us!
, The work is be111g pe-rforme□ prIof lo sale
2 I ha11e 111,ed 111 m~ home lor lwelve "":onrris prior to comp1ehon c-1 ttm wm~
I h,a-,.,e ri□I cla1med this e-:.:emptIon dur1r'lg It,~ a,,.:\ last lllre-e ~e.;irs
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I here>b)' a•11frn !h;;it I ha>1e .a cenificate ol consent lo
sel!-1r,su•e :Jr a cer\1!1c~te o' \/';'or._,,_.;:,s· Compensal1on In
-sura,r.ce or l certil•ed cop·,· 'hereof tSec J.800. Labor Cede)
POLICY NO
C:OM~ANY
Cocy s t, lee ,-..it~ tile c,ty
Cer~1t,e-d cop1i• Is r1eretiy furnished
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE.
lTr11:,; section need ,ot be -::ompleted 11 the permit
Is f:ir one hundred dollars :.'S,1001 or !e-ss)
I certtfv that 1n ltu::i performance o! the work for ..,...h.,:-ti
l-'1I5 ,:iermI11s issued, l stial' nol employ an)' person,..., an~
'T7ar'l11er sc as to become sub1ect 10 1t'le Wrnkers Compen-
-sat1on Laws of Ca1dor111a
NOTICE TO APPLICANT. IL ::.her making tl"lis Cert1f1c3te-
of Exern p!1on. you should become subJect to ttie Worf<..ers
Compensa11on i::rov1s1or.s of tile Labor Cade you mJSt
fo,thw11n corn pl)' with suet, provisions or 1ll1s ~errnil shp.II
be (l,e-emed ~evoi.;ed
I !1eretiy affirm 1ti1:1t 1here 1s;; ::onstrucl1011 le0C1111J
agency lortlle perlormarce of the work. 'or wilier. tt1Is pe,
m1t ,., issued (Sec 3097 Cml Code)
Lender" s Name
Lender s Aodres.s
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT 2075 Las Palmas Dr., Carlsbad, CA 92009-1915 (619) 438-1161
J00 AODRESS p/ A\/. ST.RO. THOMAS BROS NO. j°;~, ~818T10NI
BUSINESS LICENSE It
v~
PERMIT NUMBER
I ~Bo Jp~..-, r'II!. ~~~ LOT I BLOCK I SUBDIVIStQN I ASSESSOR PARCEL NO. y, CONTRACTOR CONTRACTORS PHONE • ZORE 2.~?-1Ja-.6 IJ//}-OWNE R"S NAME I 1~9 :;3R12.NE Kev,,,, E~ 11 [_( ~...,-. CONTRACTOR'S ADDRESS STATE LICENSE NO. BUILDING SO FOOTAGE
OWNE R"S MAI LI NG ADDRESS
/580 Jp~,,,,,.. fl. (' _j,.-J~J ..)/ j rA-9~f-' DESIGNER OESIGNl;Fl'S PHONE
DESCRtPTION OF WORK /
r.Ir;.t;.,,f .f /4.r IVI ~,f;Jj ~/1 ~A?L> DESIGNER"S ADDRESS STATE LICENSE NO.
fJrJ rh II f e-5h; II'/~ h J/iJ ha-.. F p FLR ELEV. NO OCC GP EDU • r STORIES ,c '-u ---I CENSUS TRACT I PAR< l"JG SPACf RESUN!TS
I
GRADING PERMI' ISSUED I RE DEVELOPMENT TYPE OCC LOAD FIRE SPP
ARE A. CONST
I ,□ ~ D ,0 ·,□ ,□ '-0 Not Valid Unlers M~chine Cemf,ed
_, ._, .. !J,So ~00 --
QTY. PLUMBING PERMIT· ISSUE QTY. MECHANICAL PERMIT· ISSUE SUMMARY/ACCOUNT NUMBER
EArn flXTUR, TRAP INSTALL FURN DUCTS uP TO 100 000 BTU BUllOINGt·t~MII uu·-~·u uO-JD-2,,,·o
EACH eu1LOING SEWER OVER 100 000 BTU SIGN PERMIT l](J 1 8' 0·00 00 8221
EACH WATER HEATER ANO IIR vrnT BOILER.COMPRESSOR UP TO 3 HP PLAN CHECK 001-810-00-00-8891
EACH GAS SYSTEM 1 lU 1\ l)UTLETS 801LER COMPRtSSOR JI~ HP TOTAL PLUMBING DO" B1 0-GO-OO-E:222
EACH GAS SYSTEM a OR MOK[ MET AL FIRECLACE ELECTRIC,~L OD' -o, o-□o o□-8223 /-c;--
EACH INSTAL. AlltR_ REPAIR ',';ATER PIPE VENT FAN SINGLE DUCT MECH.AN I CAL 001i111] 00·00·8224
EACH VACUUM BREAKrn MECH EXHAUST HOOD DUCTS MDBILEHOME 001 8 1 0 00-00-82 25
WATER SOF TNER RELOCATION OF EA FURNACE-HEATER SOLAR ~lrJ 1 ·810·00-00 8226
t.A:":H RUOf r1i:i,.:i.,\ ' '' -,[ DRYrn VENT STRONG MO:ION 86D·5"9 92-33
TOT/;l MECHANICAL F'RE SPRll•Ji<LERS :o 1 810-00-00·8227
l U I Ai Pl IJMBll'.i, I PUBL'C FACILITIES FEE )2Cl 810·00 00-514:,
c;co BRIDGE FEE 360810-00 00 8740
QTY. ELECTRICAL PERMIT· ISSUE QTY. MOBILE HOME SETUP PARK IIH EU (AREA
r..EW CONST EAAMPSWI HKR CAR PORT ...,..-:;..-1-:,i--::;-...._ TIF 312·810·00-00-8835
I PH :J PH AWNING /4''9.,--v:.~'-...__ LA COSTA Tl F 3 i 1-810-00-00"8835
t x IS T BLOG EA AMP Sl:IT HK R GARAGE /..ti,v v.:,.':,.._ FMF
1 PH I PH tr:-.· ✓6 ~ ":"'o\ LICENSE TAX DO 1 S 1 c1 ,::iJ GQ-515?
~E'IIOIJEI Al HR PE H ,:: IR CU IT J() '!ti 4,f1'l, ·r )Y .7-. -;:; MFF 880·519 ,:12 5~
TtMP Pf1 If )170 AMP~, Ill c4;-o,..'1¼~ ~..w, ....
OVERi(JUAMPS :,; <,J,'-9~-"1,9/&,., ;:::;
HMP O[CUPANCY 'JO DAYS) \"~ .'!C'~~',,1' i;:;
~~ _ .. ,(_ CREDIT DEPOSIT
HlTAI lllL'fllUd I 1< ~~ (\,' --___ 6t £t 1,\ <?i --
TOTAL FEES PAYABLE I /~-
I HAVE CAREFULLY EXAMINED THE COMPLETED ""APPLICATION AND PERMIT"" AND DO HEREBY Exp1rat1on. Every pernl1t issued by the 8u1ld-1ng Ottida~ undef the prov1s1ons of thts * AN OSHA PE!WtT IS REQUIRED FOFI EXCAVATIONS OVER
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code stlal! expire by timUat,on and become null and ¥01d 11 !he bu1ldmg or work 5· O'" Of.EPA.NO OEMOllTION 0A CONSTRUCTION Of
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE lf A PERMIT IS authonzed by such permit 11 not commenced wtthm 180 days from the date of such ST~T\JRES OVER 3 STORIES IN HEIWIT
ISSUED· TO COMPLY WITH ALL CITY COUNlY AND STATE LAWS GOVERNING BUILDING CON-:~~::or:., '~t t=~v ~~~~i~-~~h:C:~r:~!hcoi~~.!le~~~~ ro~~~d1~fsrer:a~~ or
STRUCTION. WHETHER SPECIFIED HEREIN OR NOT f ALSO AGREE TO SAVE INDEMNIFY AND
AP~~
OWNE~CONTRACTOR 0 APPROVED BY Pf 1°ill~/r1 KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS, COSTS AND
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE BY PHONE [] ~,...,, .. , ... , .. ~ ~~-,,,,.._ ................
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TYPE DATE INSPECTOR {!/J8~0'·f33
BUILDING
FOUNDATION FIELD INSPECTION RECORD
REIN FORCED STEEL REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES MASONRY REO IF INSPECTOR s GUNITE OR GROUT INSPECTION CHECKED APPROVAL DATE
SUB FRAME □ FLOOR □ CEILING SOILS COMPLIANCE
SHEATHING □ ROOF □ SHEAR PRIOR TO
FRAME FOUNDATION INSP
EXTERIOR LATH STRUCTURAL CONCRETE
OVER 2000 PSI ·,.
INSULATION PRESTRESSEO
CONCRETE -INTERIOR LATH & DRYWALL POST TENSIONED -.. ,--""'
CONCRETE -..
PLUMBING FIELD WELDING
□ SEWER ANO BUCO □ PL/CO --HIGH STRENGTH
UNDERGROUND □ WASTE D WATER BOLTS
TOP OUT □ WASTE □ WATER SPECIAL MASONRY
TJJB AND SHOWER PAN
GAS TEST PILES CAISSONS
□ WATER HEATER □ SOLAR WATER -.
ELECTRICAL
□ ELECTRIC UNDERGROUND □ UFFER
ROUGH ELECTRIC
□ ELECTRIC SERVICE □ TEMPORARY
□ BONDING D POOL ~-
MECHANICAL --,...._ -~
□ DUCT & PLEM., □ REF. PIPING
HEAT -AIR COND. SYSTEMS
VENTILATING SYSTEMS
-
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE J ___,
ITEMS ABOVE HAVE BEEN APPROVED. r, l// FINAL I ./
PLUMBING I I ~I J 1.IO ,./
ELECTRICAL tlJ r-7)0 ~,...., ,.,,~ '
MECHANICAL 1 . ,/;, .
GAS /
BUILDING r
SPECIAL CONDITIONS