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O I hereby affirm that I am licensed under
pro,,lalona of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and ProfeHlons Code, and my license 1s In
full forca and effect.
I hereby afhrm lhat I am exempt lrom !he Conirac fo(s License Law tor the followmg reason (Sec 7031 5 Bustness and Proless,ons Code Any c11y or county wh1c.r. re
Quires a perm,, to construe!. a11er improve, demo11sh or repair any structure_ poor to its issuance also requires !heap-
phcanl tor such permit 10 t1+e a signed s1atemen1 that he ,s 1,censed pursuant to rhe prov,s1ons ol the l,;ontrac1or s
license Law (Chapter 9 commencing with Sec11on 7000 of
01v1st0n 3 ol the Business ancl Professt0ns Coaei or Iha! 1s ex empl ttlerelrom and the basis !or the aHegea e.xempMn An'/ vHlt.1t1on of Secr,on 7031 5 by an apphcanl tor a perm1! sub
1ects the app11can1 10 a c1v1I penally 01 nol more than five hun area dollars ($~)
1, as owner 011ne property or my employees w11h wages
as 1ne1r soie compensallon will do the work and the struc
ture 1s not intended Of o11ered for sa1e (Sec 7044 Business
and Professions Code The Conlraclo( s license Law does nor apply to an owner or praperty who builds or improves
thereon and whO does such work himself or through his own
employees provided lhat such improvements are not intend· eel or otlereel tor sale If however llle bU1ld1ng Of improve• menl 1s sold within one year al completion. the owner-bu,kter
will have lhe burden of proving Iha! he did not build or 1m· prove 10< the purpose of sale)
· I. as owner of the property . am exctusively contrac11ng with licensed contractors to construct lhe pro1ect (Sec 7044
Business and Professions Code. The Contractor's Lteense Law does not apply 10 an owner al property who builds or ,m
priwes thereon. and who conrracls tor each pro,ecls with a contractor(s) hcense pursuant to the Contractors License Law)
As a homeowner I am 1mprovmg my home. and the lollow mg cond1hons ex1s1
t The work 1s being pert or med prior to sale 2 I have hved ,n my home lor twelve mon1ns prior 10 comple11on of lh1s work
I have nol clamM:d lh1s exemption during lhe last three years
f1 I am exempt under Sec -------B&PC
f0t this reason -------------
I hereby affirm !hat I ha\le a cerhf1cate of consent 10 se1l 1nsure or a cerul1cate of Workers Compensation In-
surance or a certified copy thereof (Sec. 3800. Labor Code)
POLICY NO
COMPANY
Copy 1s f11ed w,th the city
:::J Cert,hed copy ,s hereby furn,sheo
CERTIFICATE OF EXEMPTION FROM
WORKERS COMPENSATION INSURANCE
(This sec1,on need not be compleled 11 the permit
,s for one hundred dollars (S100) or le,ss)
C I certify that m lhe performance ol the work tor which
this permit 1s issued. I shall not employ any person many
manner so as to become sub1ect to the Workers Compen·
sat,on Laws of Cahlorn1a
NOTICE TO APPLICANT If. after making this Cert1hcate
ol E,cemp11on. you should become sub1ect to the Workers·
Compensation prov1s1ons ol the Labor Code. you must
forthwith comply with such provisions or this perm1t shall
be deemed revoked
0 I hereby affirm that there is a cons1ruct1on tending
agency for the performance of the work for which this per-
mit IS issued {Sec 3097. C1v1I COde)
Lender's Name
Lender·s Address ~-----------
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA ANO DECLARATIONS.
JOB AOORESS
CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad, CA 92009-1915 (619) 438-1161
AV ST RO. THOMAS BROS NO.
APPLICATION & PERMIT
VALUATION PERMIT NUMBER
IDATE~~i?ONI
BUSIN~ t~.q,--, ~r,~ r"ll. I to:::>~ ~l~ g (cJJ.:l() I LOT I BLOCK I sueo1 v,s10N ---1 ASSESSOR PARCEL NO CONTRACTORS PHONE • ZONE CONTRACTOR I OWNER s NAME I OWNER'S PHONE ~ \....il ~Me-u:S ' ~ ~ BUILDING so. FOOTAGE
OWNER'S MAILING ADDRESS -cro \.11 ~ C:..""1o"31~
DESIGNER~ t:x~ c:p.l~( OESIGNER"SPHONE
OESCR>PTION OF WORK S:.J•§\\A . .;:;.,
DESIGNER'S ADDRESS
IA-.~~ Pfn--,e_ F/P FLA ELEV ,,.
I CENSUS TRACT I PARKING SPACE
QTY. PLUMBING PERMIT · ISSUE
EACH FIXTURE TRAP
EACH BUILDING SEWER
EACH WA TEA HEATER ANO OR VENT
EACH GAS SYSTEM 1 ro 4 OUTLETS
EACH GAS SYSTEM~ OR MORE
EACH lNSTAL ALTER. REPAIR WATER PIPE
EACH VACUUM BREAKER
WATER SOFTNER
EACH ROOF DRAIN l'JSIDE •
TOlAL PLUMBINL 1
QTY. ELECTRICAL PERMIT -ISSUE
7 NEW CONST EA AMP SWT BKR /(fZ)
I PH 3 PH
EXIST BLOG EA AMP SWT BKR
1 PH 3 PH
REMODEL AL TtR PER CIRCUIT
TEMP POLE 700 AMPS
OVER 200 AMPS
TEMP OCCUPANCY 130 DAYSI
TOTAL EllLTRICAt 1
RES UNITS I
7sa
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vO NO
GRAOING PERMIT ISSUED I REDEVE LOPMENT
AREA
y D ND vO NO
QTY. MECHANICAL PERMIT· ISSUE
INSTALL FURN DUCTS UP TO 100 000 BTU
OVER 100.000 BTU
BOILER COMPRESSOR UP TO 3 HP
BOILER,COMPRESSOR 3 15 HP
MET AL FIREPLACE
VENT FAN SINGLE DUCT
ME CH EXHAUST HOOD DUCTS
RELOCATION OF EA FURNACEtHEATER
DRYER VENT
TOT J;L MECHANICAL
QTY. I MOBILE HOME SETUP
CAR PORT
AWNING
GARAGE
TOTAi -
NO
STORIES
TYPE
CONST
/S~
/19/88 0001 01 r9 ,.. ~·
':"I Q~ ~ ~ IJl"t ~
FIRESPR A~ ~ ~ ~
vO NO~ ~t va"'1~achine Ctrttf1«J
ST A TE LICENSE NO
DCC GP EDU
OCC LOAD
S~RY/ej_Zo~'{~BER
BUILDING PERMIT
SIGN PERMIT
PLAN CHECK 001·
TOTAL PLUMBING
ELECTRICAL 001-81 -
MECHANICAL 001 ·810-00-00-8224
MOBILEHOME 001 ·810·00·00-8225
SOLAR 001·810-00·00·8226
STRONG MOTION 880-519·92-33
FIRE SPR,NKLERS 001·810·00·00·8227
PUBLIC FACILITIES FEE 320-810·00·00-87 40
BRIDGE FEE 360·810·00·00-8740
PARK·IN·LIEU (AREA I
TIF 312·810-00-00·8835
LA COSTA TIF 311·810·00·00·8835
FMF
LICENSE TAX 001·810·00·00·8162
MFF 880-519·92·57
CREDIT DEPOSIT
TOTAL FEES PAYABLE I 3-o /'f)
02
30.0
1 HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION AND PERMIT AND DO HEREBY
CEATiFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY ANO AGREE IF A PERMIT I~
ISSUED TO COMPLY WITH ALL CITY COUN1 Y AND STATE LAWS GOVERNING BUILDING CON
STAUCTION WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND
KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS ANO
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE
GRANTING OF THIS PERMIT
p.rehon e~e rm1t issued by ttie Bu,tdtng Offtc1al uncle, the prov,s1ons of this
de shall exp e by !lm,tat,on and become nuH and void It the bu,ld,ng o, work
thonzed by ch permit ,snot commenced within 180 days from the date ot such
rm1t. or 1f e building or work 1uthorized by such pe,m,t 1s suspended or
* AN OSHA PEMt:T IS AEOUIAIEO FOR EXCAVATIONS OIIEII
5' O" DEEP AND DEMOLITION Ofl CONSTRUCTION OJ
STAUCTUAES O\IER 3 STORIES IN HEIGHT
a ndOned a any time 1fter the work 1s commenced to, a pertOd of , 80 gavs
APP\JCANT'S\,l{lNATURE • OWNER n CONTRACTOR 0 ~ BYPHONE n
APP~~
DATE
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TYPE . DATE INSPECTOR
BUILDING
FOUNDATION . FIELD INSPECTION RECORD
REINFORCED STEEL
MASONRY
GUNITE OR GROUT
F3EOUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
INSPECTION REO IF INSPECTOR'S DATE CHECKED APPROVAL
SUB FRAME D FLOOR D CEILING SOILS COMPLIANCE
SHEATHING D ROOF D SHEAR PRIOR TO
FRAME FOUNDATION INSP
EXTERIOR LATH ' '
STRUCTURAL CONCRETE
OVER 2000 PSI
INSULATION I
INTERIOR LATH & DRYWALL ' I
PRESTRESSED
CONCRETE
POST TENSIONED
CONCRETE -
PLUMBING FIELD WELDING
D SEWER AND BL/CO D PL/CO HIGH STRENGTH
UNDERGROUND D WASTE D WATER BOLTS
TOP OUT D WASTE D WATER SPECIAL MASONRY
TUB AND SHOWER PAN
GAS TEST PILES CAISSONS
D WATER HEATER D SOLAR WATER
~ -
ELECTRICAL "'(l'"
~' ' _,
D ELECTRIC UNDERGROUND D UFFER
ROUGH ELECTRIC
D ELECTRIC SERVICE D TEMPORARY
r.~ i;._'.
'r.",~-
< 0 •;. ,-,_ ~--:• 1"'
D BONDING D POOL
, .... , . . •' ...... ~"" 'c ...... , ("' <t c;._,
MECHANICAL
D DUCT & PLEM., D REF. PIPING
·~ ....... -...:. "(':.:i ...... :. ,-~~ ··~~ .:.-_ ,-~ ~ "P ~ ~ ~ ~->-
HEAT -AIR COND. SYSTEMS -.A -<) 'Ci--, •, . 't,,...; :;..)_
VENTILATING SYSTEMS ; ..,...-. ,J -
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE ..--.,. -·' ITEMS ABOVE HAVE BEEN APPROVED. __ _
FINAL -, ' '
PLUMBING I /J '
ELECTRICAL ; J'/J/n-r
MECHANICAL j I I / .... '
GAS ; , . -..
BUILDING
SPECIAL CONDITIONS
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O I hereby affirm that I am licensed under
provlalona of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Profaulona Code, and my license is In
full force and effect
hereby affirm lhat , am exemp1 from the Contrac
tor's license Law tor the following reason {Sec 7031 S Business and Professions COde Any city or county wh,c.r, re
Quires a permit 10 construct. a11er improve demohsh. or
repair any structure ph()( lo ,1s issuance a1so requires !heap-p11un1 tor such permit to Ille a stQned statemenl Iha! he ,s
hcensed pursuanr to the provisions ol the ton1rac1or s License Law !Chapter 9 commencing with Ser.hOn 7000 ot
01v1s10n 3 ol the Busmess and Proless,ons COde, or lhat ,s e,:
empt lherelrom and the bas,s tor rhe a11egea e.-<empllon Any v101a11on o1 Section 7031 .5 by an app11cant lot a permit sub
Jecls the applicant to a c1v1I penalty ol no1 more than live hun
dred dollars ($500)
I, as owner ot the properly. or my employees wilh wages
as their soie compen5c111on will do !he work, and lhe slruc-
ture ,is not intended or offered tor sate I Sec 7044. Business
and Proless1on5, Code The Contractor s License Law does
nol apply to an owner of properly who builds or improves
!hereon and whO does such work h1msell or lhrough his own
emoioyees. provtded tna1 such 1mprovemen1s are no1 mrend•
ed or olfered lor sate It. however, the building or improve, ment 1s sold w1thm one year ol completion. lhe owner but1der
will have the burden of proving Iha! tie did not build or 1m·
prove tor the purPoSe ot sate)
{ i I as owner al the property. am tJCclus1vely contracting w,th lteensed contractors to construct the pro1ec1 rsec 7044 Business and Protess,ons Code The Contractor s license
law does nol dop1y to an owner of property who builds or im-
proves I hereon. and who contracts for each proiects with a
contractor(s) license pursuanl to lhe Contraclor's License law)
As a homeowner I am 1mpf0vmg my heme. and the lollow mg condilions ex1s1
1 The work 1s being per1ormed prior to saie
2 I have lrved ,n my home for lwelve monlh~ prior to comp1et1on ol thts work
I have not claimed this exemption during lhe
.iast three years
I am exempt under Sec -------for this reason B&P C
I hereby allum that I have a certificate of consent to
Se1f-,nsure or a cett1!1cate of Workers Compensat,on In
surance or a cert1f1ecl copy thereot 1Sec 3800. LabOr Code)
POLICY NO
COMPANY
Copy is 1,led w,1h 1he city
:......i Certified copy 1s hereby furnished
CERTIFICATE OF EXEMPTION FROM
WORKERS COMPENSATION INSURANCE
fTl"us section need not be completed 1f tl"le permit
is for one hundred doilars 1$1001 or less)
~ .._., I cer11fy tnat in lhe perfOfmance ot the work for which
this permit 1s issued. I shall nol employ any person in any
manner so as to become sub1ect to the WOfkers Compen.
sat,on Laws of Cahforn,a
NOTICE TO APPLICANT If. after making this Cer11flcate
of Exemption. you should become sub1ec1 to the Workers
Compensation provisions of 1he labor Code. you· must
forthw11h comply with such p,ov,s1ons or 1h1s permit shall
be deemed revoked
t..""' I hereby affirm that the,e 'lS a construction lending
agency for the performance of the work tor wh1et, this pet"
m•t Is Issued (Sec. 30971 C1vU Code) ·
Lender s Name
Lender s Address
IJ~_All 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 J/ ;;~ /}1 /t{4q D J1J }/iJ/t;v ~/~l) THOMAS BROS NO. 1:;;~~o; :;;;TIONI BUSINESS LICENSE# VALUATION PERMIT NU:;
LOT I BLOCK I suB01v,s,oN ASSESSOR PARCEL NO. co,..TRACTOR CONTRACTORS PHONE• ZONE ~g O 8
OWNER'SNAME I OWNER'S PHQNE -r'AN _':;,;:.IQ$0A1 Ftt-Tf./"'-l-~cJ-23"!-3:Jt,r ,-rli:.'f\Ll"l"'1)n,-. "'~· F/2.l"f-,vl< 11 , /lt,1,1,,uoN.fucJ 7 -i.c,,-:is?i CONTR::OR'SADDRESS STATELICENSENO :id'?LDINGSOFOOTAGE
OWNER'Sl\AA,UNG ADORESS "'2&>~ u_;, Al/If-~/:-{ s-.2), ... ~~~~...c....::.___;c.....::~~'--~~~~~~~-1~--~~~~~~--4~~~~~~~~~-'-~~~~~~~~---< L..J-;..11 Lla11wc.11-l.tLv,.::-,-; AD-<t-;)...c7o~ OES•GNER OESIGNER'SPHONE
Df}C,R...!fT•Oi. OF WORK
/Vfz/l !> -,-£Mt /<.#,lit'-/ )::?(JJAJJ1.A! ,Cl'/..0/l(.fl)~T"£ OESIGNERSADDRESS STATELICENSENO
I ,
1z;J 1'IJ£a,;,.; Tm -4A..ol/C m~w;-..S F,P FLR ELEV No occ GP Eou
STORIES
vO i.O ---
'
CENSUS TRACT I PARKING SPACE I RES uN1Ts I GRADING PERMIT 1ssueo 1 REDEVELOPMENT TYPE ace LOAD FIRE SPP
AREA CONST
YD N D , 0 "O vO NO Not Valid Unlf!fr Mach,ne Certtfted
QTY. PLUMBING PERMIT . ISSUE r/ 5-0 QTY MECHANICAL PERMIT . ISSUE IS OC> SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP INSTALL FURN OUCTS UP TO 100 000 BTU ~UILUINt, rtMMII UUl HlU·UU·UU·HUU
EACH BUILDING SEWER OVER 100.000 BTU SIGN PERMIT 001810·00·00·8221
EACH WATER HEATER ANO OR VENT BOILER COMPRESSOR UP TO 3 HP PLAN CHECK 001-810-00-00·8891
EACH GAS SYSTE M 1 TO 4 OUT LETS BOILER COMPRESSOR 3 15 HP TOTAL PLUMBING oo;-810·00·00·8222
EACH GAS SYSTEM~ OR MORE METAL F1REPLACE ELECTRICAL 001·810·00·00·8223 ,r-
EACH INSTAL Al TER. REPAIR WATER PIPE VENT FAN SINGLE OUCT MECHANICAL 001·810·00·00·8224
EACH VACUUM BREAKER MECH EXHAUST HOOO OUCTS MOBILEHOME 001·810·00·00·8225
WATER SOFTNER RELOCATION OF EA FURNACE HEATER SOLAR 001·810·00·00·8226
fACH ROOF IRAIN 1 ... s,or I DRYER VENT STRONG MOTION 880 519·92·33
TOT /;L MECHANICAL FIRE SPR1Ni<LERS 001 810·00-00-8227
TOI Al Pl UMBINL [ PUBLIC FACILITIES FEE 320·810·00·00·8740
ot) BRIDGE FEE 360·810-00-00·8740 QTY. ELECTRICAL PERMIT. ISSUE ~ QTY. MOBILE HOME SETUP PARK N·LIEU (AREA l
NEW CONST EA AMP SWl IJKR CAR PORT TIF 312·810·00-00-8835
I PH 3 PH AWNING LA COSTA TIF 311·810·00·00-8835
fX IS I ll l DG EA AMP SWT BK R GARAGE FMF
I PH 3 PH LICENSE TAX 001·810·00·00·8162
REMODEL Al Tt R PER CIRC UIT MFF 880·519·92·57
TE MP PO l f JOO AMPS
OVER 700 AMPS
TEMP OCCUPANCY 130 DAYSI
CREDIT DEPOSIT
TOIAL ELU.TRICAL I /5"'~ TOTAi TOTAL FEES PAYABLE l /.5 ,__..
I HAVE •~AREhJL l y EXAMINED ~Hf COMF-, E TF'.J APPL r.AT ON ANO PERMIT AN~ :JO HEl-11:BY Expirat,on Every perm,t JSsued by the Building Ott,c,al under the prov,s1onsolth1s * AN OSHA PERM:T <S REOUtREO FOR EXCAVATIONS OVER
C.ERTIFY NOEF, FE "Al ry c,, F"' '1 JAY THAT ALL INF( RMATION HEREON 'IIClUDING 't-<~ Code snail expire by l1m1tat1on and become null and vo1~ 11 t~e bu1ld1ng o• work 5 0" DEEP ANO DEMOLITION OR CONSTRUCTION Of ~ c .'-.. ~ . . . . . au•hor,zed by sucn permit 1s not comrnericed w1tt11ri 180 days from the date""' suci"\ DECl_A''lA •ON, ARf rnur AND(ORREr..T ANO Fl'1THER C,E'l-lT<FY Ml_) AC.,lEE l· A J., ;:JMl1' , perm,!, c,r ,1 the building or .. ork aulhor,zed by such perm,t IS Suspended or STRUCT\JR£S OVER 3STORIES IN HEIGHT 1< ,u,·" Tl.) COM~l Y V.,TH ALL ( ITY COLN Y ANO STA'I LAW'l GOJ•· lNIN.., l1L ')l~G CON ~ned ~any time •!~er the work ,s commence~_IC>r o ~od of 1!!l1..!!!tl....-:-jr"'!'~~"."!'!~~--~~--------"'7---"""'<!
<;TRl)< TION WHF. HtH 'lPE-<,IFfr l HfR"IN OR "<aT I AL'lO AGREE TO SAVE INOEMN.FY ANO APPLICANTS SIGNA~U E If. ( AP~EO BY ,~ OAT'ln' KEEP HARMi.EGS THE C.ITY o: CAR:.'lBAO AGAINST AL~ ~1A8._ITIES ,JDL.~E,,.,~'l. COSTS AN~~ OWNER , C vNTRACTOR , , (I. ~
EXPEN<;f·,WH fH MAY IN ANY WAY AC.CRUE AC...AINST '>A'O ( TY IN C.ONSLC..;JEIIICE OFT~. ~ L •~ BY PHONE J ) ~ • ~ -
(;RA"<T,'ll(;r·F·,;':,PER'iT _.. AP> Z, ..-, ·"' .../'rJ----._. •• ~. 1 I ..,-~ -1!'.11rriC.... ~~ ":/ -
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TYPE . DATE INSPECTOR
BUILDING •
FOUNDATION .
REINFORCED STEEL . . MASONRY •
GUNITE OR GROUT
SUB FRAME D FLOOR D CEILING
SHEATHING D ROOF D SHEAR
FRAME
EXTERIOR LA TH '
INSULATION . .
INTERIOR LATH & DRYWALL '
PLUMBING
D SEWER AND BUCO D PL/CO
UNDERGROUND D WASTE D WATER
TOP OUT D WASTE D WATER
TUB AND SHOWER PAN
GAS TEST
D WATER HEATER D SOLAR WATER
ELECTRICAL
0 ELECTRIC UNDERGROUND D UFFER
ROUGH ELECTRIC
D ELECTRIC SERVICE D TEMPORARY
D BONDING D POOL
MECHANICAL
D DUCT & PLEM., D REF. PIPING
HEAT -AIR COND. SYSTEMS
VENTILATING SYSTEMS .
'
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAVE BEEN APPROVI;_[)_
FINAL
PLUMBING .
ELECTRICAL '•
MECHANICAL ' I-' .
GAS ; \
BUILDING :
SPECIAL CONDITIONS .
'
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES ·/"\
REO IF INSPECTOR S . .l/Et/t!5L I.ff GI? ,,.t:Jc~ff'l Tl 10/b~
.
INSPECTION CHECKED APPROVAL DATE
-I I SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRESTRESSED
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
I
i
PILES CAISSONS i
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