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USE BALL POJNT PEN ONLY & PRESS HARD ___________________ _;_Ac.P.c.P.=L:..:ICc:.A.c.N:..:T_Tccc.O Pi,\ IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD ILDING DEPARTMENT
(714) 438-5525
AV.SJ. ""·
APPL,~ATION & PERMIT
O_~f:' ,4.Pflt,IC.ffTlON B\.l:$tf"ESS LICE.HS¢ # PERMIT NUMBER
Ji!!: I hereb) _,,,rm 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
foll fo,q '1'~,cJ.._ ~,,. <l l • Lie No...:C/' ~ __ Class_,2.~ 7__7
I hereby ;ilflrm tha! I am exempt from the Con•
PRIMECONTRACTC:,R
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2~:!'f'l .
CQf't"TRACTORS PHON6-#
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~~o;·~~~~i;:: !;; ~~,~~.~~~•~-~~/8:~~i~r
county which requires a IM:lrTnil lo construci
;alter, improve, demolish, or repair any structure. pnor to ,ts issuance also requires the applicant tor
such permit to hie a s,gned statement 1hat he ,s
hcensed pursu-ant lo 1he provisions of the Con•
trac!Of's License Law (Chapter 9 commencing with Sect10t1 70'.Xl ot D1v1s1on 3 of the Business and Pro
fessions Code) or that ,s exempt therefrom and the
b,1s1~ !or the a,lleged exemption Any v1olat1on of
S&ct1on 7031 5 by an apphcant for a perrmt sub1ects
trie apphcant to a civil penalty ot not more than five
hundred dollars ($500)
OESIGJ\fEJJ•s AOORESS
,1, FLA ELEV.
YO r-.0
AEOEVELOPMENT
AREA
~
NO
STORIES
TYPE
CONST
PLAN 1.0. # BLOG USE CODE
STANDARD PLAN# BUILDING SO. FOOTAGE
OCC GP EDU
OCC LOAD I FIRE SPA '
□ I, as owner o! the proper1y, or my employees
.,.,1h wages as their sole compensat•on. will do the
w0<1<, and the structure ,snot intended or offered for
sale (Sec. 704-4, Business and Protess1ohs Code
The Contractor's L,cense Law does not apply to an
owner of property who t>u1lds or improves thereon
and who does such WOO: himself or througr: his own
employees. provided that such ,mproveme;1ts are
not ,ntende'I or offered for sale. II, however. the
building or improvement 1s sold within one year of
comple11on. the owne,-builde1 w,11 hil'le the burden
ot proving that he did not build or ,mprove for the
purpose of sale)
GRACING f'.ERMIT ISSUED
YO ND YO NO vO ND Notiilid 'gd/es.-,.riPi.P'. ~,tified
QTY. PLUMBING PERMIT· ISSUE !!-QTY. MECHANICAL PERMIT· ISSUE ~ SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP I INSTALL FURN. DUCTS UP TO 100,000 BTU BUILDING PERMIT □ I, as owner ot the property. am e~clus,vely
contracting w,th licensed contractors to construc1 the pro1ect (Sec 704-4. Business and Profess,ons
Code The Contractor's License Law does not apply
to an owner of property who builds or improves
thereon, and who contracts for each prOJects w,th a
contraclor(S) license pursuant to the Contractor's
License Law)
EACH BUILDING SEWER ----J OVER 100.000 BTU
EACH WATER HEATER ANO/OR VENT ____ : _l _ BOILER/COMPRESS□! UP TO 3 HP-----+----.:....---t,-'n·"" '-'"L'-'"
SIGN PERMIT
DI A~, r,ucr,v
TOTAL PLUMBING C---1--"E"A-"'C H ~~ SYSTEM 1 TO 4 0 UTLE_T_S _ __ --t-1
_ _ BOILER /CO~!:_R ESSO A ::.3_1 ::.S .:.H_P ______ -+-----'--1-..C.
l---+'::.A.:.C::.H~G.AS SYSTEM 5 OR MORE METAL FIREPLACF 1:LECTRICAL
O I am uempt under Sec
for this reason
,8 &PC
lill1 hereby a!f,rm that I have a cert1f,ca1e ot consent 1o-self-1ns,,re. or a cert,t,cate of Workers
Compensat,on Insurance. or a cert,!,ed copy thereof
(Sec 3800, Labor Code)
<--+-E_A_CH INSTA~ .. ALTER, REPAIR WATER PIPE
EACH VACUUM BREAKER
C---l-.:..WATERSOFTNER
EACH ROOF DRAIN (INSIDE) ---------
TOTAL PLUMBING
F'Ouc,NO '9'{,6y 7 /-··· COMeAN,kNt!.4'-/4Jll.,_.,...,,-;y QTY. ELECTRICAL PERMIT· ISSUE ;;_t!;!-
VENT FAN SINGLE DUCT MECHANICAL
M0BILEH0ME
M0BILEH0ME PARK INSP
MECH EXHAUST -H000/OUCTS REL□CATtClN oFEA F-uRNACE/HEATER ~
SOLAR
TOTAL MECHANICAL STRONG MOTION
FIRE SPRINKLERS
QTY. I SOLAR · ISSUE • PUBLIC FACILITIES FEE
BRIDGE FEE
]11.c,opy 15 hied w1!h the c,ty ~ NEW CONST EA AMP/SWT.,-BKR ___ COLLECTORS y vv,ouv'-
0 Cert,hed copy ,s hereby tum,shed l PH 3 PH STORAGE TANKS ------
CERTIFICATE. OF EXEMPTION FROM EXIST BLDG EA AMP/SWT/BKR ROCK STORAGE
<:f'i.mrn i:EE -DISTRICT
Carlsbad
Encinitas
WORKERS-COMPENSATION INSURANCE -----
(This section need not be completed,! the permit 1 PH 3 PH PUMP f---------1-------<1'
1s to1 one hundred dollars ($100) or less) --r REMODEL/AL HR PER CIRCUIT --lf---.+PLAN CHECK FE O I cert,ty that in the pertormance of the work fo1 r------I-------------
wh,ch lh1s permit ,s ,ssued. I shall no1 employ any TEMP PO LE 200 AMPS
San Dieguito
San Marcos
person m any manner so as 10 become sub1ec1 !O -----
the Workers· Compensation Laws of Cal1forn,a OVER 200 AMPS
TEMP OCCUPANCY 130 DAYS)
01-000-4220
_Q:1 ~0@.-4221
01-000-4806
01-000-4222
01-000-4223
Q..!_~000-4224
01-000-4225
01-000-4226
65-640-0519
01-000-4227
25-000-4933
--·--
65-623-0519
65-624-0519
65-625-0519
--65-626-0519
K r-
NOTICE TO APPLICANT II. alter makm;i this Geri,
t,cate ol bemp11on. yoo should tlecome sub1ect t0
the Workers· Compensat,on prov,s,ons of the Labor
Code. you must forthwith comply with such
prov,s,ons o, tn1s perm,t shall tie deemed revoked TOT AL SOLAR -+ ,,r•fj ----·· If fr 7'f-----------,---'--,-"'7'~""7'"'----t
0 1 ne,eby att,rm tnat lhere 1s a construct,on
:ending agency tor me performance ot !he work for
wh,cti th•S perrn,1 ,s ,ssued (Sec 3097, C,vrl Code1
Lenders Name ___________ _
Lenders Address __________ _
TOTAL ELECTRICAL TOTAL FEES PAYABLE
1'1"1(-RERJl;!,'/,~;E-PL~~ CERTIFY lJNOER,JS5.NALTfs~~ ' ,T-HAT'AU. ltflh __ ·---' -,
OEGt'.ARATIONS ARE TRUE AND CT ANO t FURt~ -"ND AGREE IF A PERMIT ts
ISSUE~ TO COMPLY WITH All CITY. COUMJY AMO STAtE t.AWS·'G'OVERNING BUILDING CON• -
STRUCTIQN, WHETHER SPE~FIED HEREtN 0A NOT. J ~ A(i6EE TO SAVE INDEMNIFY ANO APPRO ED BY
KEEPHARMLESSTHECfTY,QFCARLSBAOAOAIN.STAU.LJA. -.--' S,-JUOGMENTS,COSTS-ANO _..,,,§,,,._ v u D EXPENSES WHICH t,fAY IN ANY,WAY AGCRUI: AGAiNST-$.AIO,otrY lbl CONSEQUENCE OF THE I '
GRANTING OF 1HIS PERMIT.-v , " 'J{ y./
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INSPECTION-TYPE
BUILDING .
FOUNDATION
REINFORCED STEEL
MASONRY
GUNITE OR GROUT
•
FLOOR & CEILING SUB FRAME
SHEATHING
FRAME
EXTERIOR LATH lNSULATION -
INTERIOR LATH & DRYWALL
PLUMBING --
SEWER AND, BL/CO
PLUMBING UNDERGROUND
PLUMBING TOP OUT --·
TUB AND SHOWER PAN
GAS TEST
ELECTRICAL
TEMPORARY POWER
ELECTRIC UNDERGROUND
ROUGH ELECTRIC
ELECTRIC SERVICE
BONDING '
G. F. I. -SMOKE DETECTOR
MECHANICAL
DUCT & PLEM., REF. PIPING
HEAT -AIR COND. -SOLAR SYSTEMS
VENTILATING SYSTEMS
DATE INSPECTOR
r-;
/ti~ I
0
.• ' CALL FOR FINAL INSPECTION WHEN ALL AF'PROPf/lA TE
ITEMS ABOVE HAVE BEEN APPROVED.·
JOB SITE FINAL -A
PLUMBING ..s:o ✓--.::z ./". $-J 'T
ELECTRICAL /· . .
MECHANICAL
GAS -
BUILDING
SPECIAL CONDITIONS
CERT J)F OCCL•0 <NCY ISSUED
.
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS
INSPECTION REO IF INSPECTORS DATE CHECKED APPROVAL
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRES TRESSED
CONCRETE ----POST TENSIONED
CONCRETE
FIELD WELDING
. -HIGH SlRENGTH
,' BOLTS
----
i SPECIAL MASONRY
' -----· --·---
1 P1~ES CAISSONt·
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INSPECTOA"S NOTES
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