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0 I hereby affirm that I am licensed under
provl1lon1 ol Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Profe11lons Code, and my license is In
lull force and effect. L,c No ______ Cl•ss
1 hereby att,rm INt I am exempt lrom the Conlr,c-lO<S Loconst L•w lor lhe lollOwmg reason (Sec 7031 5
Business and Pro!esst00s COde Any city or county which re quires I perrrul 10 consuue1. allef, 11np1ove_ oemohsh. or repau any struclure poOf to ,ts ,ssuance aiso requirts !heap-
plec:ant tor sucn permrt to h)e a SIQned statement Iha! he 1s ltcensed pursuant to the prov1s10ns ot lhe Contractor s Lunse Law (Chapter 9 comrnencmg w,11\ Sec:tlOl'I 7000 ot DMs,on 3 of lhe Business and Pl'O'ec;SIQOs Code; or lhat is ax
empt therefrom and the NSls tor lhe a11egeo e,emption Ant
vio1a11on o1 Sec:lt0n 7031.5 by Jin apphcant for a perm,t sub-1
,ects lhe apptM:ant to a crvtt penally of not more than fr11e hun-
dred doliirs (S500)
'/: J. as owner 01 the property, or my employees with wages
as their sofe compensat:on w111 do the work. anc:l lhe struc· lure lS noc mleoded or olltred I« ~e ISec 70,U Susu,ess
•nd ProlOSSIOOS Cool the Contra<;tOf·s Loa,nse L•w dOes
oot apply 10 an owner ot properly who builds or ,mproves thereon and who dOeS such "Nork himsett or through his own
emolOyees. provided lhat such tr.iprovements are not intend
ed or ottered lor sa!e II. however. lhe tM.md1ng or improve-ment ,s SOid w1th1n one year ot complellon. lhe owner•bu11der
will nave the burden ot prov111g that he dtd not build or 1m prov,, lor lhe purpose ol sa1t1
I, as owner of lhe property am exclusrveiy contractnig
wllh lteensed conuac1ors 10 construct lhe proiect 1sec 7044
BuSll\tss and Professions Code The Contracto( s lteense u .. does not apply 10 an owner ol property who llu•lds "' un• proves thereon, and who contracts tor uch pro,ects with a
f~)actOf(S) bcense pursuan1 10 the Conlraclor's license
... 4 As a hOmeowner I am smprovmg my home. and !he fotlOw mg cond1hons ex1sl 1 fhe work 1s bemg perfonned pnor 10 s.a~
2 I have k,ed ,n my home lor 1weiw months prtOf to complehon of 1hls won(
I have not clam'led 1h1s exempll()O during the '3.51 three years
I; :h~:r":a"::' UNlef Sec ------8 & P C -----------
:J. I her~by afhrm that I have a cert1l,eate of consent to
self•+nsure. or a cer11flca1e of Workers Compensation In-
surance. or a certtfled copy thereof tSec. 3800. LabOr Code)
POLICY NO
COMPANY
i.J Copy is Med with the e11y
~ Certified copy 1s hereby furnished
CERTIFICATE Of EXEMPTION FROM
WORKERS. COMPENSATION INSURANCE
(This section need not be eompJeted ,t the permit
1s tor one hundred dOllars ($100) or less)
0 I cer11ty lhal 1n the perlOfmance of the work for which
1h15 permit Is issued, I shall not employ any person in any
manner so as to bee.Orne sub1ect to the WOfkei-s · Compen-
sation laws of Calllom1a
NOTICE TO APPLICANT: If, after making this Cert1flca1e
of Exemplton. you should become subject to the WOfkerS
Compensa110n pr0YiS1ons of the LabOf Code you must
forthwith comply with such pr0'<11s1ons or this permit Shall
be deemed revoked
D I hereby affirm that there 1s a construct10n lending
-oency tor the perform,nce of the work !or whteh this per-
mit is issued (Sec. 3097, Clvil Code)
Lenders Name ___________ _
Lender's Address, ____________ _
' USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT & RMIT
Carlsbad, California 92008-1989 (619) 438-5525 APPLICATION PE 10i~o¥Y P/tL/~$P0£$ Av ST.Ro. ~;::~~ lo/~o:3P;1CATtONI eus1NESSL1CENSE# ;:~;;N ~)RMITNUMBEA
LO:,e_ BLOCK I SUBDI v,s ON I ASSESS~R PARCEL NO CONTRACTOR CONTRACTORS Pl<QNE. ZONE (!/ 01 9'.;;7 ol07. ~'is"! t l OU A\ _ t) '
OWNER NAME I OWNE R'S PHONE 1--.i<..,L. "'Y-f=t.t1.,.-4C-~n~-~::::::---------+--:-----:--:-----.J-.---------~--...!...------l 7b /")I') 72 'j~/t/!l (; CONTRACTOR"$ ADDRESS LICENSE NO PLAN 1.0 . • BUILDING SO F~TAGE
'WNEA'S MA, •NG AOOAESS ~M l8Lftf PALI<; 11 n e~ DIZ, DESIGNER DESIGNER'S PHONE ,
DlSCR•PT•O" OF f.lORK
OES•GNEAS ADDRESS LICENSE NO o~ti,Vs\\1%'ilr
1
,_tf~js
V,tJ77o ~1v'e/4<?><°/Z--t-----------~~-------"! .. ··-_,._ ... _,_ e! a,!,~ ,_rr (.'-(;:: (-· Fi P FLRELEV NO OCCGP EDU -• •
~ r STORIES
· / V /'./ ~-I./~_... 1 -v□ ..,o
CENSUS TAACt GP u (No usiV PARKING SPACE I AES uNITs I GRADING PERMIT ISSUED I REDEVELOPMENT TYPE occ LOAD FIRE SPP , AREA CONST
1 D N O , D -..□ v□ NO Not Valid Un~s Machme Cemt.ed
QTY. PLUMBING PERMIT -ISSUE . / _51) QTY. MECHANICAL PERMIT -ISSUE 3 / SUMMARY/ACCOUNT NUMBER _...
EACH FIXTURE TRAP ' INSTALL FURN DUCTS UP TO 100.000 BTU BUILDING PERMIT 001-810-00-00-8220 /~ !:--
EACH BUILDING SEWER OVER 100.000 BTU SIGN PERMIT 001·810-00-00-8221 • __.
EACH WATER HEATER ANO OR VENT BOILER/COMPRESSOR UPTOJHP-PLAN CHECK 001-810-00-00-8806 V ' .,...~ -
EACH GAS SYSTEM 1 JO 4 OUTLETS __ --~· _ _____ BOILER/COMPRESSOR 3 15 HP TOTAL PLUMBING 001·810-00-00-8222_._ -_ _
EACH GAS SYSTEM 5 OR MORE -~-----1--METAL FIREPLACE ELECTRICAL 001-810-00·00·8223
EACH INSTAl. ALTER REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 001-810-00·00·8224 1-----+------------------ell------+-------EACH VACUUM BREAKER ME CH EXHAUST HOOD DUCTS M0BILEH0ME 001-810-00-00-8225
WATER S0FTNER RELOCATION OF EA FURNACE HEATER M0BILEH0ME PARK INSP
EACH ROOF DRAIN (l'J$10Ei SOLAR 001-810-00-00-8226-4----------l
TOTM MECHANICAL STRONG MOTION --880-519-92-33 _ 5l>
TO I AL Pl UMBING I ---FIRE SPRINi<LERS 001-810-00-00-8227 ,_
t:: PUBLIC FACILITIES FEE 332-810-00-00-8930 QTY. ELECTRICAL PERMIT -ISSUE ~ ../ QTY. SOLAR -ISSUE -----------·-=c=-=c=-== -
NEW CONST EA AMP SWl BKR COLLECTORS SCHOOL FEE -DISTRICT _
I PH 3 PH STORAGE TANKS Carlsbad
EXIST BLOG EA AMP•SWT BKR ROCK STORAGE Encinitas
1 PH 3 PH PUMP San Oiegu1to
REMODEL AlltR PER CIRCUIT PLAN CHECK FEE San Marcos
TE MP PO l E lOO AMPS
OVER 200 AMPS LICENSE TAX 001-810-00-00-8162
TEMP OCCUPANCY !30 DAYSI MFF 880-519-92-57
CREDIT DEPOSIT
lnlAL ELECTRICAL i TOTAL SOLAR TOTAL FEES PAYABLE I ;i...1 J£--
I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION AND PERMIT ANO DO HEREBY Exporat,on Eve,y permot ossued byt~eBu,ld,ng Ofloc,al under 1h9P•O_,s,onsoflh•• 1t AN OSHA PERM:T IS REQUIRED FOR EXCAVATIONS OVER
CERTIFY Ur,,OER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code sllall expore by lom,lat,on and become null •nd vo,d II the buold,ng or work ~· o· DEEP ANO 0£MOUTION OR CONSTRUCTION OF authorized by such permit ,snot commenced t«tthm 180 days lrom the date ot such DECLARATIONS ARE TRUE ANO CORRECT ANO I FURTHER CERTIFY AND AGREE IF A PERMIT IS perm,t or ,f the buoldong or work authonzed by such perm,t ,s suspended or STRUCT\IR£S OVER 3 STORIES IN HEIGHT
ISSUED TO COMPLY WITH ALL CITY. COUNlY AND STATE LAWS GOVERNING BUILDING CON, l..!;ab~a~n~do~n!!ed2_!1!._:l •i!!:n!l'Y..!!h!!!m!!e..!a!!!fle!!r:..!l!!!he!._W~O!!!r!.k_!!IS!JC:5!0!!!m!!!m!!e~nc!:!e!2d..!!fo!!!r..!a!-l°"~"°"2!!.02!lc..!1~80!Ll!;d•!lllu• __ -+~~~~--------"-----~----1 STRUCTION WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE. INDEMNIFY ANO Ri'1' Q APPROVED BY · TE~ / KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS COSTS ANO APPUCANT·s SIGNATURE • ..-.OWNER CONTRACTOR DA .r
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEOUENCE OF THE ~ :_t!. '__,/ '/ B PHO O / / ./ /0 "!)/ ,~
GRANTING OF THIS PERMIJ ~ _ /,, 1 d.-t ...-;./7 _ 7 /4 _, , v NE /-d"" I
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TYPE I DATE INSPECTOR ' BUILDING I
~ -~~--1(01 ' \·,
. ·~-... " .
FOUNDATION I -. -FIELD INSPECTION RECORD
REINFORCED STEEL I
MASONRY !
GUNITE OR GROUT I
I
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
INSPECTION REO IF INSPECTORS DATE . '· CHECKED APPROVAL
SUB FRAME D FLOOR 0 CEl~ING .
SOILS COMPLIANCE
SHEATHING D ROOF D SHEAR
FRAME T
I
EXTERIOR LA TH I
'
PRIOR TO
FOUNDATION INSP
~ ,-.
STRUCTURAL CONCRETE:
OVER 2000 PSI
INSULATION I PRES TRESSED
CONCRETE
INTERIOR LATH & DRYWALL I POST TENSIONED
I CONCRETE
PLUMBING I ~IELD WELDING
D SEWER AND BUCO o P1]co
UNDERGROUND D WASTE D WATER
HIGH STRENGTH
BOLTS
TOP OUT D WASTE D WATER SPECIAL MASONRY
TUB AND SHOWER PAN I
I
.;
GAS TEST I PILES CAISSOr-.$
0 WATER HEATER D SOLAR WATER
7
I
ELECTRICAL I
D ELECTRIC UNDERGROUND 0 1 UFFER ' ROUGH ELECTRIC I
I '
D ELECTRIC SERVICE D TEMPC)RARY ~
~ . ---.
D BONDING D POOL I
I
I
MECHANICAL I
D DUCT & PLEM., D REF. PIPING ' ~ -
HEAT -AIR COND. SYSTEMS I
I
.
VENTILATING SYSTEMS I ' I
I
t::"'r-:-;{1··.~:'t'.I~~ SJ ~,•.p. t4 '_, !, ,I -, ....., ·-. .,_ tFrt ... , i
.-,1i,..r~...).f ~~_.__,._,) ,_..~~'l!!!l'-J ·-·
CALL FOR FINAL INSPECUON WHEN ALL APPROPRIATE
ITEMS ABOVE HA E BEEN APPROVED. J
FINAL I I -. -
PLUMBING I i JI I
-, ..
ELECTRICAL I I ,IL-.. I
MECHANICAL I t : I l " /
GAS I \ u /rllY.) I
•.. ~,
,\
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BUILDING I -v,v
SPECIAL CONDITIONS I I
I V