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~ I hereby alflrm that I am licensed under
provisions ol Cliapter 9 (commencing with
Section 70C()) of Division 3 ol the Business
and Professions Code, and my license Is In
full force~ ~ffe_ct. _ /" ~3 ~IC No 2 2-t,(,. Lia,' _c..,,_.,_
I hereby atf,•rn that am e,ernpt •,:;,,., tre Conl·ac
10r s License Law tor the follow,ng reason !Sec 7031 'i
Bus,ness ano Pro'essions C~de Aoy c,t·1 ~r ccunty wn11;c re
cuires a ;iermrt t~ corstruct al:e-,mpro·1e demoI,sh. or ·e~a1r any sln,ctwe prior :c ,:s issuance as~ ·equ,·es :heap
~l,cant lor such per01It t~ file a s,qned s:ate~ent that t>e s
,censed pursuant to The provIs1ons ol rhe Co~1,acw s ",cense Law iChao!er 9 commenc,rq w1Th Sec.Mn 71100 o'
)1•,,s,o~ 3 of the Business anc Profess,ons Code; :;r 'hat 15 ex-empt t~erefrom and !he basis for :he Jlieged e,emption Ani
·11clat1on o' Section 7031 5 by an appl,cant for a per"11T sub
1ee1s the appl,canr to a c1v1I penalty of not rll0re than ',ve ~un-dred dollars ,:S500'
I as owner ol me property, or my employees w,th wages as their sole :ompensa:,on. will do the wori ar-d 'he struc
lure ,s no1 ,n1ended or offered tor sale !Sec 70~4 Bus,ress
ano P:otess,ons Code The Contractor's License Law does not app,y lo an owner of property who burlds or 1rnpro·,es
thereon and who does such work hrmsel\ or through his owr
e'llployees. pro,idea that such improvements are not ,nte1d
ed or o'lereo for sale If, however the buold1ng or improve-
ment ,s sold w,tn,n one yea, of completion the owner-bu,lder w1il have the bu'de~ of proving thaT he did not bu,ld or 1rr-
P'0Ve for lhe purpose ol saleJ
I, as owner of the pro~erty am exclusively rnntract,ng
with 1,ce"sed contract0's to construct The pro1ec! (Sec 7044 Busmess and Pro1ess,ons Code The Contractor's L,cense
Law does not apply to an owner of property who builds or ,m-
oroves the1eon and who conrracts for each pr□Jecls w11h a contractor(s) license pursuanr to the Contractors ucense Law)
As a homeowner I am ,mprovrng ,ny home. and the 10110w 1ng cond•t10% exist
1 The ,iork ,s being performed ~rior to sale 2 ' nave i1ved 1n my home 1or twelve months pr,or to complehon ol tn,s work 1 have not cla,med this e,emp:,on during the last three years
I am exempt under Sec B&PC lor :n,s reason ____________ _
~y atfrrm I hat I ha,e a cer1,1,cale ot ccnse"t
lo self insure or a cen,t,cate of Wor~ers ~';'~':",.;,;,;s~;:;'e~e o, a[ ce,,,,,c CCC, "eceo,
POLICY NO
COMPA~'I"'
~Y ,s fried w,tr--the c,ty
D Cen,toed copy ,s heretly 'u rnshe<,l
CERTIFICA H. OF EX!::MPTION !CROM
WORKERS COMPENSATIO-. INSURANC~
(This sect,o" ~eed '101 be c()mpleted ,, ·ne r.,ern•,·
,s lor one hunCrea do•lars 1$HXl1 "' 1ess·
0 I cer1,ty that ,n lhe per1ormance o' :he "'O"' 'n< ..,h,ch lh,s perm,1 ,s ,ssued I shall no: errpruv an,
pe,so,-, ,n any mawwr so as :o t>ecc,mp 5ub·ec• 1<
lhe Worlq~rs CoMper,sat,on La..,s of Cal,to,n,a
NOTICE TO APPLICANT If alter mak,n:, •n15 CPrt
hca!e of E,emp1,on yOv stiou•d oecome ~utlJe<' v the Wor1<ers Compensation p,o,,~1ors ol me Li.Ibo'
Cooe you mus! !onh .. ,!h ,omp'y ..,,,n 5,,,_r prov,s,ors o, This perm,t sna1 tle deer>,eC ,p.,,,1<ed
0 t,eretJy aH"m trat there s a cor,~h,, 1,,,,
iend,ng agency to, ,..,e ;,ecfo,,,-·a >',e ut w:J"' i',r ..,n,,:h th,s perm t ; ,,,ued ,Sec lO'JI ';c,,:IP
Lenoe, s Name ___________ _
lenoe, s Address __________ _
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USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS
CARLSBAD BUILDING DEPARTMENT
1200 Elm. Carlsbad. California 92008-1989 (619) 438-5525 APPL/~ TION & PERMIT
00
"];;:; Lee e,;,"o NEAREsTcRosssT f ;;;;s;;"s" ?';,;" PERMIT NUMBER
~7-3?0 LOT I aLOCK I suB01v1sioN I ASSESSOR PARCEL NO. 4;' CONTRACTORS PHONE• ZONE ~-~-~~
OWNEfl'S PHONE /;"./I-J't1.1'r OWNER'S NAME
E);w/t~ h r, S'7U,11eµ St.>..V
OWNER'S MAILING ADDRESS
,</J-l=2l'-P.Y CONTRACTOR"S ADDRESS
9/.J' e-te.STv/~
Lee ~(!)/,,t er: e;1~ls~,4/J t!11 . .f';t:1t1R OEStGNER I DESCRIPTION OF WORK A ,,, I St,t.,1MM 1A/,taL .:S-/p Ji' DEs1GNEA's ADDREss
" FLA EcLEV
YL ,c
cc Nous TRAU l Ge CANO use I SAR"NG s>Ace RCS uNm l GRADING PERMIT ISSUEO
'D ND l REOEVELOP'v1ENT
AREA
,c ... o
OTYI PLUMBING PERMIT· ISSUE l .7~! QTY. MECHANICAL PERMIT· ISSUE
EACH FIXTURE TRAP --,
INSTALL FURN DUCTS UP TO 100.000 BTU
EACH BUILOING SEWER
I -+
EACH WATER HEATER ANlJ UR VENT
I EACH GAS SYSTEM \ TU 4 0 UTLE l S
~~;1 j OVER 100.000 BTU
--Z..... }tjj_ ! BOILER·COMPRESSOR UP TO 3 HP
-z_. _ _ SOILER·COM~~E~SOR 31:1 HP
EACH GAS SYSH.M :I UR MORE
-------. -.). Mt.It.: F REP1ACE'
EACH INSTA~ ALT EH, REPAIR WATE:R PIPE 1 VENT FAN SINGLE DUCT
EACH VACUUM BREAKER ---• -_j--0 MECH EXHAUST HOOD DUCTS
'.\'ATER SOF Tr--iER RELOCATION OF EA FURNACE HEATER
FM>-1 Ril'F f:P,\ '·1 ',~ ''.,~
~ TOT i-iL MECHANICAL
fi'l>.
NO
STORIES
TYPE
CONST
3-
·----t
LICENSE NO. PLAN 1.0.;. BLDG USE CODE
_,;, t?-P ,,id~
LICENSE;. STAN DARO PLAN# BUILDING SQ. FOOTAGE
OESIGNE A'S PHONE
OCC GP EDU
OCC LOAO FIRE SPR 0032 07/15 0101 02BldPlllt 148-10
vO NO Not Vc1/id Unless Mc1ch1ne Certrf1ed
SUMMARY/ACCOUNT NUMBER
BUILDING PERMIT 01-00-00-8220 I I J o~
SIGN PERMIT 01 ·00-00-8221
PLAN CHECK
TOTAL PLUMBING
01-00·00-8805 /(;....:_ e,e
01-00-00-8222 -~~
i:, crTRICAL g LLLC. _____ o_,,_1-00-00-8223 • ,t;t)
MECHANICAL 01-00-00-822l
MOBILEHOME ----~01-00-00-8225
MOBILEHOME PARK INSP
SOLAR
STRONG MOTION /.f~-I J ,_.
I IUlAl Pt IJ!,~fllNi, I -1-,~ _Gt) c,nr C'nCJINKLERS -~7 -~~-~----~~------d.--~-------1II rim: .:irr
01 -00-00-B226
80-92-33-0519
Oi-00-00-8227 ..,._ iloTY ELECTRICAL PERMIT· ISSUE QTY. SOLAR· ISSUE ! 11 PUBLIC FACILITIES FEE 32-00-00-89ll -----I-------1
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NEW cor-.sT El', i'..MP SINI DKR
I PH \PH
EXIST blOG EA AMP SWT SKR C----+---
1 PH 1 PH
BRIDGE FEE L--
RU:> S~JR;;SE:. ---------r---• Encrn1tas ____ 8 -2-22-0519
~I.. Ii P
7. ,0. <'I)
C:l F:::H'.RS j ~ SCHOOL FEE· DISTRICT
Sl.(JRAf;E T,',J;KS . . _ C .. s UE .. .t\RE8 · 21-0519 _ --
. San D1e!iu1~ ,c ~ 80·9c_2~23'-0~5~1'-9 +--------------+-_---~~~-·-_-_--:Ii[ -SacMaliLJV 1 :r1t111r;:,2240519 ----
-I -REMDUEL AL TlR Pf R ,,,cu11 . -· uCIIJTifoMJILIIAD. ;,If..\ i':1--,::,~K f ~E.
---·------
.. __.""""" """'" . ·-~"'"" ""''· Q,;.•J OVt R /01) AMPS , j CREDIT DEPOSIT I b
I I ,,,-! rrrA.2\)11<'-' ' "" "" """' "" •• . .. ' I . .. ·-""""' '"'"'' I f'lq, ' ~ I TilTAL Utl,THil:A·. /s C[)
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I HAVE CAREFULLY EXAMINED THE COMPLETED ··APPLICATION AND PERMIT'" AND DO HEREBY Expiration. Every per_m,t issued by the Butld1ng Olf1c1111 under !he prov1smns oflh1s * AN OSHA PERM:T IS REQUIRED FOR EXCAVATK)NS OVER
5' o·· DEEP ANO DEMOLITION OR CONSTAOCTION OF
STRUCTURES OVER 3 STORIES IN HEIGHT
I CERTiFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall expire by hmitahon and become null and void If the bu1!d,ng or work
DECLARATldNS ARE"TRUE AND CORRECT AND I FURTHER CERTIFY ANO AGREE IF A PERMIT IS aulho ized by such permit tS nol commenced Within l80days lrom !he date of such
ISSUED: TO c◊MPLY WtTH ALL CITY. COUN1Y AND STATE LAWS GOVERNING BUILDING CON :r n:/~/=~ ~~1;r. ~t~k authonzed by such permit is suspended or
STRUCTION. WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND '-;';;';'/';,r,:::;:;;';::'.':,ac:",'f:-.!:'''-'!S0~'k!..!!"'.!'eo,m~m'!'!'0"'S•SdL!!lo,,J•~•~'S'°""1.021'-"180"'-dS•msc_-::::;;;f"~~~~~::""-1._ _________ ... _, ______ -1
KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND OWNER □ CONTRACTOR APPROl1VED BY DATE I
EXPENSES WHICH MAY 1N ANY WAY ACCRUE AGAINST SAID CITY IN CONS€QUENCE OF THE --.,,_.*_ 7 /1. ..... ,
GRANTING OF THIS PERMIT BY PHONE O ,. j -_, ... u
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TYPE DATE INSPECTOR
BUILDING
FOUNDATION l-'7·Z.9-b7 I ,, • /4
REINFORCED STEEL ,.------I, -
MASONRY
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME
SHEATHING □ ROOF □ SHEAR
FRAME
EXTERIOR LATH
INSULATION
INTERIOR LATH & DRYWALL
PLUMBING.
SEWER AND BL/CO □IPL/CO
UNDERGROUND □ WASTE C WATER
--~--~~1-3 <"J{)
t--------------------------------------~--------------4
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS
INSPECTIO'N
S01LS COMP1_:ANr_-E
P910R TO
FC·U~0/1.TIO'\J ,NS~'
REO IF I !NSPECTOR s
CHECKED APPROVAL
I
STPUCT1;PA.1_ C(1NCRETE I -------4-
OVER :?0::J0 ~'SI
PRESTRESSE'J
CONG1'.:TE
POST TEN~.IO~E'.;
cor--..CPEH.
FIEL.[J WEL ~1r-...·G
Hl'.]H ST ,,ENC3TH
DATE
riOL TS --------+-----~---------t-----
INSPECTORS NOTES
f".., .. . . ~;. --.-,;'-
~:ti A (l ~ ;., d ;.ii ;,? \! (';
~ ~ \ , I
~ ·~ ' -; ,-... i-'c .. J' ;~ ;.: J )
TOP OUT □ WASTE □ WATER I I f---------------
>-'C·--.: ,1~ 1/A'.~'..l~H-t'
----+------+-----
TUB AND SHOWER PAN ~
GAS TEST <;;-1 'l--'i. ') t;Jtl. -t"':J CAl:~sor-..~-
□ WATER HEATER □ SOLAR WA'rER i------------j-------j-----------t---
--------ELECTRICAL
□ ELECTRIC UNDERGROUND □ lJFFER 'i,-11-c,, 11¼tlee_
ROUGH ELECTRIC
□ ELECTRIC SERVICE □ TEMPOfi!ARY I-----< .
□ BONDING □ POOL A.!114-<7 1,M..U,,
' ~---------t---· +----. +------, f----------------------------j
MECHANICAL ' □ DUCT & PLEM., □ REF. PIPING
~---·;c1:: . ,L
HEAT -AIR COND. SYSTEMS 1
VENTILATING SYSTEMS
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HA V§ BEEN APPROVED
FINAL I I
PLUMBING I /.....\ \ IA
ELECTRICAL I '\\
MECHANICAL I ,\ ~
GAS I ,, ' j_
BUILDING I \ i
SPECIAL CONDITIONS I
~----~
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