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O I herebr 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
lull force and effect. Lie No _______ Class _____ _
I hereby affirm that I am exempt from the Con•
~~0,(~~!f:':: !:; ~f~~1~1~~~~~1\~ county which requires a permit to construc1
alter, improve. demohsh, or repair any structure.
pnor to 11s issuance also requires the applicant for
such penmt to hie a signed statement that he 1s
hcensed pursuant to the provisions of the Con-
tractor·s License Law (Chapter 9 commencing with i
Section 7CXX) ot 01v1st00 3 of the Business and Pro-
fessions Code) or that ,s exempt therefrom and the basis for the alleged exemplion. Any violation of
Section 7031.5 by an applicant 10< a permit subjects
tne applicant to a civil penalty of not more than flve
hundred dollars ($500).
C I, as owner of the property, or my employees
•1th wages as their sole compensation, will do the wont. and the structure 1s not intended or offered for
sale (Sec 7044, Business and Professions Code The Contractor's License Law does not apply to an
owner of property who builds or improves thereon
and who does such wont himself or through his own
employees, provided that such improvements are
not Intende1 or offered for sale. II, however. the
building or improvement Is sold within one year of
completion, the owner-builder will nave the burden
of proving tha1 he did not build or improve tor the
purpose ot sal•l-
0 I, as owner of the propeny, am exclusively
contractinQ with licensed contractors 10 construct
lhe proteet (Sec. 704'i, Business and Profes.s1ons
Code: The Contractor's License Law does not apply to an owner of property whO builds or improves
~~~ii~ 7.~nc~n~~!~~~~ ~~c~h~r~~~;::-!
License Law)
D I am exempt under Sec
for this reason __
,8 & PC
• I hereby affirm that I have a cert1f1cate of consent
to selt·insure. or a cert,t1ca1e of Workers·
Compensation ln~ura e, Of a cer11fted copy thereof
(Sec JBOO. L.abOf •
POLICY NO -~-_ __
COMPANY __ _
• Copy IS hied wIttl the c,ty
f D Cer1Ifted copy Is hereby furnished -CERTIFICATl OF E:XEMPTION FROM . WORKERS" COMPENSATION INSURANCE • 'This section need not be completed 1f the perm11
Is tor one hundred OOl!ars ($100) or less)
0 I cer11fy that in !he performance of the wont for
which this perm11 1s issued. I shall not employ any
person In any manner so as to beCome sub1ec1 to
the Wofil.ers· Compensation Laws of ca11torn1a
NOTICE TO APPLICANT If. after maktn3 this Cert,
hcale of E•empllon. you should become sub1ec1 I'> the Wor11.ers· Compensa11on provisions of the Lat>or
Code. you must lorthw1lh comply with such
provisions or 1h1s perm,1 snall be deemed revoked
D I hereby attum Iha! !here 1s a cons1ruc11on
lending agency tor the performance ot !he wO(t,( lo• wt11ch this permit 1s issued (Sec 3097 C1v1I Code)
Lenders Name ___________ _
Lenders Address __________ _
USE SALL POINI l'tN Uit;.r.,& l'Kt:i:i NIIKU ....... ..,, .. -·-.-..·· .. -' ·--....... -· ··-·· -.. -. ---...... --------(-J ) CARLSBAD BUILDING DEPARTMENT ~ APPLICATION & PERMIT
1200 Elm, Carlsbad, California 92008 (714) 438-5525
JOB AO0RESS A~i.Trtr;;:;p~;;IONI
BUSINESS LICENSE # VALUATION PERMIT NUMBER
l/J\~ -'~~ ~ _)...01 .s-· --Zi -'f()-_..,-;If.-g.z-2a8 OWNER'S NAME I OWNER'S PHONE P~ CONTRACTOR CONTRACTORS PHONE • ZONE
-' ~0A1 n (_ ..., -• h .. -.,~ ~ •,1. AA~• 17'1-/9~7 P"""l-.• • -, :.
OWNER'S MAILING AOORESS ,-~' ~ CONTRACTOR'S ADORES$ ~ ,. 3E;;;j<lt3 PLAN 1.0. # BLDG USE CODE
~~'6,f; /"_,,1Lf4,JJFf'E. 1"2 •~ (tlAf.f,r, \I\~ f)}_-., S-?tJ 'l ~ P£J..J ~. Poot--
LOT BLOCK SUBDIVISION I ASS~~ACEL l'lO. ¢ 0ESIGNER STATE LICENSE# STANOAR0 PLAN# BUl~b•F~ ~" •f'"I-/ -s ,-,, .,. --~
0ESCRIPTtON OF WO~ ~-~~-
I~._~~ . -.. ' rr _,. JI ~ ---DESIGNER'S ADDRESS DESIGNER'S PHONE ·, -
Irr l'.nMOO CM-~~ -·-. -. F/P FLA ELEV. NO ace GP EDU
STORIES
vO NO --
CENSUS TRACT I GP LANO USE I PARKING SPACE I RES UNITS I GRA0ING ~ERMIT ISSUE0 I REDE-VELOPMENT TYPE OCC LOAD FIRE SPA 5ID,1/~?.£?~9tS C'l,.~m; AREA CONST
YO N 0 vO NO vO NO • Q r!d,t'r,Jlp'.J/nler[J,flf_"f,I('/ ~(tifi,d 9,1 ... nr.
QTY. PLUMBING PERMIT -ISSUE -1..~ ;QTY. MECHANICAL PERMIT· ISSUE ('1tJtJ SUMMARY/ACCOUNT NUMBER . -
EACH FIXTURE TRAP • INSTALL FURN. DUCTS iJP TO 100,000 BTU BUILDING PERMIT 01-00fi-4220 / ,,_Y,, I,... n --
EACH BUILDING SEWER OVER 100,000 BTU SIGN PERMIT 01 ·000-4221
J EACH WATER HEATER ANO/OR VENT 7_. &;l BOILER/COMPRESSOR UP TO 3 HP PLANCHECK44-Cl:.. Ot!JI" ··01--~ -r,, ... -
I EACH GAS SYSTEM 1 TO 4 OUTLETS "'7 .CJ.. BOILER/COMPRESSOR 3-15 HP TOTAL PLUMBING• 01-000-4222 /,4. ,0 /} . --ELECTRICAL 01-000-4223 7 ,0 o EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE
EACH INSTA~ .. ALTER, REPAIR WATER PCPE VENT FAN SINGLE OUCT MECHANICAL 01-000-4224
I EACH VACUUM BREAKER ./I. ,t:;O MECH EXHAUST -HOOD/DUCTS MOBILEHOME 01-000-4225 . WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP
EACH ROOF DRAIN (INSIDE) SOLAR 01-000-4226
TOTJ;L MECHANICAL STRONG MOTION 65·640-0519 • J.i~
~ i-,,.., 00 TOTAL PLUMBING FIRE SPRINKLERS 01-000-4227
_J,t;() QTY. SOLAR · ISSUE
PUBLIC FACILITIES FEE 25-000·4933
QTY. ELECTRICAL PERMIT -ISSUE BRIDGE FEE
NEW CONST EA AMP/SWT BK R COLLECTORS SCHOOL FEE • DISTRICT
1 PH 3 PH STORAGE TANKS Carlsbad 65-623-0519
EXIST BLOG EA AMP/SWT/BKR ROCK STORAGE Encinitas 65-624-0519
1 PH 3 PH PUMP San Dieguito 65-625-0519 .
I REMODEL/ALTER PER CIRCUIT ,:; Orl PLAN CHECK FEE San Marcos 65-626-0519
TEMP PO LE 200 AMPS
OVER 200 AMPS
TEMP OCCUPANCY (30 DAYS)
.
TOTAL ELECTRICAL I ,_oo TOTAL SOLAR I 11 os----TOTAL FEES PAYABLE
I HAVE CAREFULLY EXAMINEO THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY Expiration. Every permit issued by the Building Off1c1aJ under the provisions ofth1s * AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall expire by lim1lation and become null and void If the building or work 5' O" DEEP ANO DEMOLITION OR CONSTRUCTION OF
DECLARATIONS ARE TRUE ANO CORRECT ANO I FURTHER CERTIFY AND AGREE IF A PERMIT IS authorized by such permit 1s not commenced within 180 days from the date of such STRUCTUR£S OYER 3 STORIES IN HEIGHT
ISSUED: TO COMPLY WITH ALL CITY COUNTY AND STATE LAWS GOVERNING BUILDING CON-:~r;;~n~ 1!, t~~y ~~~~':He~~h=~~r:':!hi~~~e~le~~~ rn:~~1~?¥:C-cI'a~ or
STRUCTION, WHETHER SPECIFIED HEREIN OR NOT. 1 ALSO AGREE TO SAVE INDEMNIFY AND , ,. t>J'/jEl!O CONTRACTOR 0 APPROVEDB~ OATr --KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND APPLICANTS SIGNATURE Jf, a. ~ ...... ,. . -.
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF TH~ J ~ ---~ ..... ~,.,,-/'---
GRANTING OF THIS PERMIT A;,,~ •-/P_ BYP~"'-'
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! INSPECTION TYPE I DATE INSPECTOR , ,. J • "7r ;i: '3 i 1{
BUILDING 1
I FIELD INSPECT ION RECORD
FOUNDATION : 1------------------------,--r-----------------------------~
I REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES REINFORCED STEEL F===================--~=====~=====~ ..'...!.!~~~=~~'--'=-"'----------;,--t------r------' ' REQ IF INSPECTOR'S
MASONRY l INSPECTION-CHECKED APPROVAL DATE ~ U.cJlJ_.,"'fH ~~rf' .. ~ •,\.'I ~O'l
I !==========jp=====t======j===9 . GUNITE OR GROUT l SOILS COMPLIANCE
FLOOR & CEILING SUB FRAME I PRIOR TO
FOUNDATION INSP
SH EA TH I NG I r--=csT=R:--:-uc::c-=-T:---:-uR=-A,-L-c::-:o::c-N-,--:CA=-=E-=-TE::-t----t--------1--------1
FRAME OVER 2000 PSI ~ •
t-=-P=-RE:-S-T-R-ES,-S_E_D--------1r-----t------1------1
EXTERIOR LATH lNSULATION ! CONCRETE
t-=-::-::-:=-=::--:--::-::,-------1r----t------1------1 INTE.fi!IOR LATH & DRYWALL j POST TENSIONED
CONCRETE •
., PLUMBING I FIELD WELDING 1--------------------------------,
SEWE R AND B LICO I I--H::--:IG::-cH-:-S:::T:-::R:-=E..,..,N-=-G-=-TH------t----1------;------1
P LUMB I NG UNDERGROUND ! ,__s_o_L T_S ___ ~, ---.-.-----=--t----t--------+-----;
PLUMBING TOP OUT ; SPECIAL MASONRY'... '-' J ""'\
TUB AND SHOWER PAN I r----------1----t---------1-------t ·-I
GAS TEST i PILES CAISSONS
ELECTRICAL I
TEMPORARY POWER ! -----------------,-,---r-------r------(-.. ·-
ELECTRIC UNDERGROUND I -t---------------;--:-------,------=,-----------------1 _.:.._~-------------;,--+---;------. ~ C '>t-" t:'~' I . , __ ' .. .. ~ ROUGH ELECTRIC I .._ . ~.
ELECTRIC SERVICE ,: t----------t----+-----+-----, i••,. ~ ~ c_.•
BONDING I . \. . . G. F. I. -SMOKE DETECTOR I ~-------+-----t-----·---t-----;
MECHANICAL {
DUCT & PLEM., REF. PIPING
HEAT -AIR COND. -SOLAR SYSTEMS . , ._,
I • ' I VENTILATING SYSTEMS ·
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE :,.., '/ '
1 ~ t-----------------------:~ ~
ITEMS ABOVE HAVE BEEN APPROVED. J!r,, , ) •. . , -.,_,~ .'""''· t
0 TE FINAL . 1 / -! , I I I , -,-, '•• 1 _ J B SI )I'_,;, i----' V ,, . .. • ,,., . ' ,I i.., -,.
PLUMBING ~ J'II~ ~A -"' • i • ~ , t-------------~--------------ELECTRICAL ; , ~ %"\ t,J'{ -1 • ._, '1_ ~: • '
MECHANICAL I -• l, ./. \""" · • , . I
GAS I 1 7 /. \ I , , . , • 'r'-...S \ ' _ -,
BUILDING ...,e/) V ,., r--c • ' '~ -.,1 '•' • e=-' •
SPECIAL CONDITIONS I 1../
CERTOFOCCIIPANCYISSUED ___ ~-------~---~----~---, f
r I l -'-'·
'
.llilERDEPARTMEN"I AL INFORMATION SHEET :E(;EIVED
BUILDING DEPARTMcNT DATE:_,_,~,ic--r--,-r---""""'-fn:~--0 ·11 t12 1982
BUILDING ADDRESS: /65 ~,,,..~,.,,, e,r··
r.),.11 ~ .vz-=-Y 01 CARL A. p. N: ,:/-U L -.2st -/d C. T: . Boi/djnr, e SBAD
f-.. c11cirtme L
li.lils.ld:. * * * t, * t; * * * * * * * * * * * * * t ti;* ;1; * * i'; * * * * * * * * * * * ;~ * * * * * * * ti.1i.1iJi * * * * t t * * * * * * * 2* *
PLANNING DEPARTMENT
,ZONE: SCHOOL FEES: SAN DIEGUITO SAN MARCOS --------------ENCINITAS ____ CARLSBAD _____ _
·0NITS REQ'D: __________ PROVIDED: ___________ _
% COVERAGE ALLOWED: ________ .PROVIDED: __________ _
PARKING SPACES REQ'D: PROVIDED: ------------------BUILDING HEIGIIT REQ'D: PROVIDED: ---------
FRONT SETBACK SIDE SETBACK REAR SETBACK
ALLOWED:
PROVIDED-: --,-r-,~c---+t)"TT"\ ____ _
a[Z L
INTRUSIONS: ------
RE-DEVELOPMENT APPROVAL REQ 'D: NA
LANnscAPE & rRRIGArioN PLAN coMMENTs: 1 EY.. eNi. PT ~~--------------
ENVIRONMENTAL PROTECT I ON REQ : __ E_;;-_.)(.....:.e:;_-_~-""-.p-__ 1 ____________ _
ADDITIONAL COMMENTS: ----------------------·--
OK TO ISSUE: $ DATE: ~3Jlf;;)--oK TO FINAL: DATE: ·------
' '
..i.:t.:Ji.~"< * ,; * * * * * "i: :k.:};,_j;_ ·• .,. ~-* * t: * * * 't * * * * * * * * * t * t: ti,:\~****:';******«* ;d; * * * * ;~ * * tT:F*.
ENGJ.NEER I NG DEPARTMENT ,. ., ~ U.-
R.O.W: IMPROVEMENTS: -----------------
·----·---··----
PUBLIC FACILITIES FEE: SEWER CONNECTION: ---------------
DRIVEWAY LOCATION(S) : ____________________ _
GRADING PERMIT: -------------------------EASEMENTS: DRAINAG E: -----------------------\/ LEGAL DESCRIPTION: _________ , ______________ _
ADDITIONAL COMJ\IENTS : ______________________ _
*CHECK rr EN I EQ'D . ON FINAL: ----------OK TO ISSUE \::::r--'---~,...._-+-"-PWI:-,--___ OK TO FINAL: _____ _
DATE:
* IF TIITS ITEM JS NOT Cl!ECKED, BUILDING DEPARTMENT WILL MAKE
PINAL IN SPECTION.
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