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0 I hereby affirm lhat I am llcensed under
pro,lslons of Chapter 9 (commencing wllh
Section 7000) of Division 3 of the Business
and Professions Code, and my license is In
full force and ettec1.
lie No------ClilS
I hereby affirm !hat I am eiemp1 lrom 1ne Conirac· for s L,cense Law for 1ne lonov.,ng reason {Sec 7031 5 Busmess ana Protessians Code My t!ty or county wh1cn re quires a perm11 lo construct alter. ,mprove oemohsh or
rep.au any slructure pno, 101ls ISS\Jante also requir!S !heap
phc:ant for such permil to hie a s,oned s1a1emen1 lhal he 1s hcenstd pursuant to the pr0v1s1ons ol the Con1rac1or s License Law (Chaple< 9 commenc,ng w,1h Sect,on 7000 of O,ws,on 3 ol lhe 8usmess and Professions COde) or 11'\al 1s ex-
empt tnerefrom .antl Ille Das,s !or Ill< a11egeo uempllon Any
v1olahon of Sec.1t0n 7031 ~ by an apphtanl Joe a perm11 suo 1ec1s the app\JQnt to a c1\11l pe11a1ty ot not ITJOfe than hve hun-
dreo doriars ($500)
I as owner ol 1he: property or my employees w,11, wages
ilS lhe1r so!e compensation. w,11 do tne won,:, and 1ne s1rut·
,.:re 1s nol intended or otrered loc sale (Set 704"1 Business
and Pro,ess,ons Code Tne Contractor s license Ldw does
nol apply to an owner ot propert)' who btJ•lds oc improves
tneteon and who does sucn work h1msell or 1rirough his own
em\)iloyees. prov,ded 1hat such ,mprovements are nol intend· ed Of otlered lor sale If. however. 11'\e bu1fdtng or improve·
r,,,~1 1s sold w11n1n one year ot comp1e11on. me owner burNier w1lf hilve the burden of proY1ng lhat he did not t>u1lc.1 or 1m pr"'e Jo, Ill< purpose ot sare1
I as owner ot ihe properly am e,c1usiv,1y con1rac1ing
w11n hceosed con11acto1s 10 cons1ruc1 the proiect (Sec 70U Business and Professions Code The Contractor s License Law coes not appty 10 an owner 01 property wno builds or 1m·
proves !hereon. and who contracts !or each oro,ects with i contractor(sl ltcense pursuanr 10 lhe Coniractor s License Law)
l As a homeowner I am ompr.,...,ng my nome and Jhe lollow 1ng condltlons exist
1 The work 1s oe1ng perfOfffle:fj priot 10 sale 2 I haYe hved 1n my home tor twelve mon1hs prior 10 complelton Of 1n1s work
I have not claimed lh1s exemptlOl"I durmg Ille last 1h,ee years
J I am exempl under Sec ------
10, lhls reason -------------1-
O I ne,eby alf,rm 1ha1 I na ... e a cen,ticate 01 c sent
10 self insure or a cert1tica1e ot W rl\ers
Compensa1,on Insurance or a cert1he<J coov hereof !Sec 3800 Labo• Code)
POLICY NO
COMPANY
Q Copy 15 hied ,.,1n tne Coly ~
.P Ce1'11hecl copy is nerebv furnished
CERTtFICA fl OF EXt MPTION F OM WORKERS COMPENSA TrON INSU NCE (This sec11ori nee<J no1 be comolet~ ,1 I permit
_ •s lor one l'HJndre<J 0011a1s tS 1001 or 1ess>
0 I cen1ty 1na1 ,n 1ne i:,er1ormance 01 lhe won,. IOf
... rucn 1h15 pem·ut ,s ,ssueo I shall not emofoy anv
person ,n ~.,. manner ~ as 10 become suo1ee1 tu
1ne Wortters Compen~11on Laws 01 Calilorn,a
NOTICE TO APPLICANT If aller ma.lunJ 1n1s Cert•
ftcale ot Exempt,on yOu sflOuld become sub1ec1 ,..,
1ne WoO\.ers Compensa1ton orov,s•ons ol 1ne, Lat>o, Cc:x>e you must tor,n .... ,,n comply w,1n sucn
prov1s,ons Of 1111s perm,1 shall be aeemeo re•n1it.eo
0 I ne,eby a1t11m 1n.a1 1riere ,s a .onsiruc 1,or1 1ena,no aoencv 10, me oeno,man, P ot 1he wO"" ro1
which ttus c,erm11 ,s ,s~ue<J tSec )097 C1,..,t Cooe1
Lenaers Name ___________ _
Lenders Ado,ess -----------
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO Fft.L IN INFORMAi;t6N WITHIN SHADED AREA AND DECLARATIONS.
4 \.. • CARLSBAD BUILDING DEPARTMENT ---A ;•~ICATIO~ PERMIT 1200 Elm. Carlsbad, California 92008-1989 (619) 438-5525 ~ J~;;;~ &ioMAIP rr;;/£:.D cJZSTCROSSST. I07Ji;1:0N
BVSl~LICENSE " I ifUf};; PERMIT NUMBER u::
1-t'--,1-,0 r:-
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LOT I BLOCK I SUBDIVISION I ASSE:!;SOR PARCEL NO I rT, CONTRACTOR '(~/ I -CONTR,\CTORS PHONE • ZONe' 0 a.
AfM~ :f. t.~::-rdv 7;:;a eol>7 E OWNER'S NAME I OWNER'S PHONE <l)
f1JA-/,~rfu /;,rJ" n 'l<.I ctr'NTRACTOR'S ADDRESS'" -' I LICENSE NO. I-
//7/ PLAN 1.0." BLOG USE CODE I
owi9;~<?h1nu:r . ff)3Q> <'. CL-~&JTf.1(/E //9' &.~fD() !:?
/9,qk_" /,,1 )A~ bESIGNER BUILDING SO FOOTAGE 0 LICENSE a STANDARD PLAN a (!)
I )1+(, A I+<., /Of.U A \GIii' D?'8"fT or.; OF WORK -/ D(SIGN£R'S ADDRESo/' DESIGNER'S PHONE -C u() ro
e-~T"C-TU)() ~fu}M:S ~ ci ~ F P FLR ELEV NO OCC GP EDU 711 /8bb b6 7 Q
IJA.} 5~CL>A.1.b ~,~12 STORIES • <(
vO ... o 0001'6 bii 7i'1 1 I 7 ' I
CENSUS TRACl GP LAND USE I PARl<ING SPACE I RE S UNITS GRADING PERMIT ISSUED I REDEVELOPMENT TYPE DCC LOAD FrRESPR .:.:
AREA CONST C
YO N D ,o ... o vO NO Nor Valid Unlnr Machine Cer1d1ed a:
QTY. PLUMBING PERMIT · ISSUE -,~ QTY. MECHANICAL PERMIT · ISSUE -SUMMARY/ACCOUNT NUMBER I 0 I -If)
II EACH FIXTURE TRAP /7-7.. •.. .lt-INSTALL FURN DUCTS UP TO 100 000 BTU Q-.-BUILDING PERMIT 01 ·00·00·8220 I ?-LI-I " I!.
If)
<l)
~I EACH BUILDING SEWER ~,,. OVER 100,000 BTU SIGN PERMIT 01 ·00·00·8221 • If) ,:,.~--If) ------<(
J EACH WA I ER HEATER ANO OR VENT -,__r, BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 01 ·00 00·8806 I -EACH GAS SYSTEM I IO 4 OUTL( TS BOILER/COMPRESSOR 3 15 HP TOTAL PLUM BING 01 ·00·00·8222 •"'---3 ------Yb .Q EACH GAS SYSTEM 5 OR MORE MET AL FIREPLACE ELECTRICAL 01·00·00·8223 --a>
EACH INSTA~ ALT ER. REPAIR WAT ER PIPE VENT FAN SINGLE DUCT MECHANICAL 01 ·00·00· 8224 /~ ->----------- ---t,. EACH VACUUM BREAKER L-MECH EXHAUST HOOD DUCTS -MOBILEHOME 01 ·00·00·8225
WATER SOFTNER RELOCATION OF EA FURNACE1HEATER MOBILEHOM E PARK INSP <Ii
If)
EACH ROOF DRAIN I rr~SIO[) <l) SOLAR __ 01·Q0·00·0"~ (.)
0
.1/7/~
TOT I.L MECHANICAL STRONG MOTION 80·92·33·0519 /~"-ct
I ,1 . .r' TOTAL PLUMBING -FIRE SPRINKLERS 01 ·00·00·8227 ro 7, iii ~--PUBLIC FACILITIES FEE 32·00·00·8930 0
QTY. ELECTRICAL PERMIT · ISSUE QTY. SOLAR · ISSUE ~ BRIDGE FEE
NEW CONST EA AMP SW 1 HKR COlLECTORS <l)
SCHOOL FEE • DISTRICT (.) -C
I PH 3 PH STORAGE TANKS Carlsbad 80·92·21 ·0519 ro
C
EXIST BLOG EA AMP SWT BKR ROCK STORAGE Enctnllas 80·92· 22·0519 u:: -I PH 3 PH ~
~ PUMP San 01egu110 80·92·23·0519 -
REMOOE L AL Tt R PER CIRCUIT ~ ~
PLAN CHECK FEE San Marcos I 80·92·24·0519 C
TEMP POLE 200 AMPS <l)
~
OVER 700 AMPS LICENSE TAX 01-00-00-8162 ~~o -(!)
TEMP OCCUPANCY 130 DAYSI MFF 80·92-57·0519 --
CREDIT DEPOSIT LC-fl, ~J9> £
IOIAL EULIRICAl l TOTAL SOLAR I ..f'7f, ,~ (.)
//) TOTAL FEES PAYABLE <l) -a. If)
C
Expirallori Every perm111s.sued by the Bu1ld1ng Off1c1a1 under ll'le pl'ov1s1ons of Ul1s , -I HAVE CAREFULL '( EXAMINED THE COMPLETED APPLICATION ANO PERMIT ANO DO HEREBY * AN OSHA PERMIT IS REQUIRED FOR EXCAV-'TIONS OVER I CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE COde shall expire by hm1tat1on and become null ano void It the bu,ldmg or work S' O" DEEP ANO DEMOUTIOH OR CONSTRUCTlON OF
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY ANO AGREE IF A PERMIT IS authorized by such permit,, not commenc.ed w1lhm 1800ays lrom the oatet>f sucn STRUCTIJR£S OVER 3 STORIES IN HEIGHT ~ permit or 1f the bu1ldinPi or ¥¥Ork authonzed by .such permit ,s suspen~-:\. or /\ ISSUED TO COMPLY WITH ALL CITY COUNlY AND STATE LAWS GOVERNING BUILDING CON abandOnecl al anv lime a 1er lhe work ,s commenceo tor a oenod ol 180 davs .c
STRUCTION WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND X: ~rs SIGNATURE • ·L OWNERD CONTRAC:~
APPRO D BY 07r;// I s: 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 L, ,__,,, ,.,.-~,, GRANTING OF THIS PERMIT ~ .... .,. ... , --BVPHO 0 ~ I :'_J. ~ ~ . I .. ' rr --" ,_ -~,-~ ....
\ -'-<.,/ .../
TYPE DATE INSPECTOR r ~ I -&S-L/AU BUILDING •• I
FOUNDATION .. I
FIELD INSPECTION RECORD I
REINFORCED STEEL . '~ .. ,\ '-·-.. I'
REQUIRED SPECIAL INSPECTIONS INSPEC TOR'S NOTES I --MASONRY -,.
REQ IF INSPECTORS I " INSPECTION DATE GUNITE OR GROUT ~-,. ) CHECKED APPROVAL I
\. -' . I FLOOR & CEILING SUB FRAME ~ . I SOILS COMPLIANCE I. .. '-' --. .,
.'.'i ~\ SHEATHING D ROOF D SHEAR PRIOR TO ,, I --J \ FOUNDATION INSP I FRAME -. "' ... " ' I \' ~\"' ' .. ,: ''..,'I ' ' STRUCTuRALCONCRET~ I EXTERIOR LATH ....l • OVER 2000 PSI ,,-I
INSULATION PRESTRESSED I
CONCRETE .. . ~. ' . -....... ' I INTERIOR LATH & DRYWALL ' ' . "i -' -· -I . POST TENSIONED
CONCRETE I I . ,. ~-~-
' . \ \ . -'\ I
PLUMBING FIELD WELDING .. l i
DIP UCO -SEWER AND BUCO HIGH STRENGTH I BOLTS I UNDERGROUND D WASTE D WATER I
D WASTE D WATER SPECIAL MASONRY I TOP OUT . I -.
TUB AND SHOWER PAN ,,
~ ' I ' I ' GAS TEST • ') ,,. ~ I PILES CAISSONS I
D W_ATER Ii EATER D SOLAR WATER "• ~·· . I
I
I -ELECTRICAL I
D ELECTRIC UNDERGROUND D UFFER ' I , i ROUGH ELECTRIC I
D ELECTRIC SERVICE D TEMPORARY j
D BONDING 0 POOL ~ "·,\ I .
I
I MECHANICAL I
D DUCT & PLEM., D REF. PIPING I
I ~ HEAT -AIR COND. SYSTEMS I
VENTILATING SYSTEMS I
I
I .,,
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE I . _ITEMS ABOVE HAVE BEEN APPROVED. 1 I
FINAL ~ ) ., I . r / I PLUMBING II -/' / I j
ELECTRICAL . . .... II ~ 111 / J ~/
I
I
l //~Jr ~ !tt.f/ /_,; MECHANICAL LI. ' -. \ I GAS . ///{/' rt> rJ/1 /Y
.~ '/ /, I . G:: t ,/? I BUILDING I
SPECIAL CONDITIONS II / . /J YV I
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• 1200 ELM AVENUE
CARLSBAD, CA 92008-1989
~itp of Carl.sbab
FIRE DEPARTMENT
TELEPHONE
(619) 438-5523 APPROVED
DISAPPROVED
PLAN CHECK REPORT
PROJECT ----"Tl%-~~"'=-===---r-:--CP.f_~(k_
1
_, ~--A~~S / Cj ~ ~ {'
p~oA. 6-.~4!-
ARCHITECT --------------'----ADDRESS -r OWNER ADDRESS
__ ______c-'-------PHONE ~
---------PHONE
OCCUPANCY CONST. ...;;;_ _____ TOTAL SQ. FT. ------STORIES
D SPRINKLERED D TENANT IMP.
__ 1.
__ 2.
__ 3 .
__ 4_
--5.
__ 6.
__ 7 . •
r __ 8.
__ 9 .
__ 10.
...
APPROVAL OF PLANS IS PREDICATED ON CONFORMING
TO THE FOLLOWING CONDITIONS AND/OR MAKING
THE FOLLOWING CORRECTIONS:
PLANS, SPECIFICATIONS, AND PERMITS
Provide one copy of: floor plan(s); site plan; sheets
Provide two site plans showing the location of all existing fire hydrants within 200 feet of the project.
Provide specifications for the following:
Permits are required for the installation of all fire protection systems (sprinklers, stand pipes, dry chemical, halon,
CO2, alarms, hydrants). Plan must be approved by the fire department prior to installation .
The business owner shall complete a building information letter and return it to the fire department.
FIRE PROTECTION SYSTEMS AND EQUIPMENT
The following fire protection systems are required:
D Automatic fire sprinklers (Design Criteria: ------------------------
0 Dry Chemical, Halon, CO2 (Location: -------------------------
0 Stand Pipes (Type: -------------------------------
0 FireAlarm(Type/Location: -----------------------------
Fire Extinguisher Requirements:
O One 2A rated ABC extinguisher for each ____ sq.ft. or portion thereof with a travel distance to the nearest
extinguisher not to exceed 75 feet of travel.
D An extinguisher with a minimum rating of ___ to be located:
D Other:----------------------------------=--=-~
Additional fire hydrant(s) shall be provided -----------------------===
EXITS
Exit doors shall be openable from the inside without the use of a key or any special knowledge or effort.
A sign stating, " This door to remain unlocked during business hours" shall be placed above the main exit and doors ___________________________________ ~
EXIT signs (6" x 3A" letters) shall be placed over all required exists and directional signs located as necessary to
clearly indicate the location of exit doors.
GENERAL
Storage, dispensing or use of any flammable or combustible liquids, flammable liquids, flammable gases and
hazardous chemicals shall comply with Uniform Fire Code.
Buildlng(s) not approved for high piled combustible stock. Storage in closely packed piles shall not exceed 15 feet
in height, 12 feet on pallets or in racks and 6 feet for tires, plastics and some flammable liquids. If high stock pil-
ing is to be done, comply with Uniform Fire Code, Article 81 . {)-
Additional Requirements. ----------~-A-,~1.£::...-----------------:'
f I
•
Comply ~ns on attached sheet(s).
Plan Examiner ~~ Dale---....~-,,_ g_s_C---_
Report mailed to architect ___ Met with -------------~ Attach to Plans