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I hereby alllrm that ! am licensed under 1
p~lslona of Chapter 9 (commencing with
Section 7000) ol Division 3 of the Business
and Professions Code. and my license is in
full force and effect
I hereby a1hrm that I a<n e,emol trom i"e (,~ntric
tors L,cense Law tor the tollow,ng 'eason !Sec 7031 5 'Business and Pro1ess,ons COde Any c1t1 o, county wn,c,, re
qu,res a perm,t to consl'uCI. alter ,mprove. Cemol,sr ~r repa,r any struc\u·e pr,or lo 11s issuance a.sD requ,·es !heap
pl1cant for such permit to J,je a s,qned s1are.o,en1 Th.it he ,s
licensed pursuant To t~e pro~1s1ons ot t~e Lonrracror ;
License Law ,:Chapter 9 commencrng w,th Se:.t,on 7000 of D1·11s1on 3 o1 the Busrness and Professions Code, ~r thdl is ex
empt therefrom and tM basis lor the allegea exempl,on A~·1
·,1c1at,on 01 Sect.on 7031 5 by an appl1can1 lor a permit sub
;ects t~e appl,canl to a c1v11 penalty of ~ot more t'"ar f,·,e ru~
drea dollars 1S5001
I, as owner ot lhe property. or my employees H1th mge~
as Their sole compensation. w,I' do the ,iork end The slruc
ture ,snot intended or oflered for sale iSec 10~4 Business
and Protess,on~ CO<le The Contractor's L1cerse Law does
not apply 'a an owner ot property .,ho builds or ,rnproves
!hereon and who does such work ~1mselt or thr~uqh h,s own employees. provided thar such irrprovernents are nol rnlend-
ed or olfered for sale If however. the bu1ld1ng or ,mprove-
me~t ,s sold w,th,n one year of completion. the owner·bu,laer
w•II have the burden of proving Iha! he did no! build or •rr
orove 'or the purpose of sale1
I. as owner ol me oroperty, am e,clus,veiy contrac1,n~
w1m licensed rnn1ractors lo construct the pro1ec11sec 7044
Busmess and Profess,ons Code The Contractor's License
Law does not apply to an owner o1 property who bu,ids or ,m proves !hereon and who comracts for each pro1ects w•th a
cor.tractor{sl 1,cense pursuant to tre Contractor's L ,cense
Law)
As a homeowner I am 1mprov,ng my home. and the follow ,ng cond1t1ons e,1st
1 The wor~ 1s bemg oerlorrneo pr,or 10 sale
2 I ~ave lived 1n my home lor twelve '110nths
prrn lo completion of th,s work
I ~ave nol claimed th,s exempt,or, durir,g the
loot lliree yeors
for ;h~: ,:~~~;;1 under Sec _____ _ B & PC
I 'lereby aft.rm that I ~ave a cert1•1cate ol consent 10
se~~re o, a certd1cate of \';'orkers Compensation In
su nee. or a ce-t1f1ed copy the·eo' (Sec 3800 Labo• Code)
PO ICY NO
COMPANY
Copy ,s l<led with ltle city
Cert1f1ed copy ,s hereby furnished
CERTIFICATE OF EXEMPTION FROM
WORKERS COMPENSATION INSURANCE
1Thts section need ~ot be completed d the permit
' 1s 'or one hundred dollars ($700i or lf'S5l
I certify that ,n the performance of the work for wh1c~
mis perm,t 1s issued. I shal, not employ any person ,n anr·
manner so as to become sub1ect to the Workers Campen
sat,an laws or Cal,Jorn,a
NOTICE TO APPLICANT. I!, arter making this Certificate
ol E,emption. you should become sub1ect to the Workers
Compensai,on p,ov1s1ons of the labor Code. you must
forthwith comply wrth such prov1s1ons or this permit shall
be deemed re,oked
I hereby affirm that there 1s a canstruct,on lerd1ng
agency for the performance ol \he work for which 1h1s ~er
m,t >s issued ,Sec 3097. C1v1 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 APPLICATION & PERMIT
-::\ 2075 Las Palmas Dr., Carlsbad, CA 92009-4859 (619) 438-1161
JOB AO DRESS AV. ST.RO, NEAREST CROSS ST.
~o7J L£c &er ~---... l),e_ LB I BLOCK I SUBDIVIS10N
BS-31':. I ASSESSOR PARCEL NO. c0 ,).f)S ~ t.D !> s
OWNER'S NAME .IM. C. ,M<J/(Abb t O't'.!'!R"S eHONE /1,.,M,, _,,_,.,_SJ◄ I
.tx ,4j81'-109
OWNER'S MAILING ADDRESS
~071 L.~e &c,i,?_7
DESCRIPTION OF WORK
DATE Of APPLICATION
3-/1,-87
CONTRACTOR
.f=xp~J),,,' l-/o,e,2c,J.S
CONTRACTOR'S ADDRESS
993c ;;,, .5"AN7>1 Ii l,{.srl'\
DESIGNER
DESIGNER'S ADDRESS
•us,[JqJ~ nlJ VALUATION
CONTRACitJ.RS PHONE 11 ZONE
91/J -•54So
STATE LJCENSE NO.
[353 7 ~7
DESIGNER'S PHONE
STATE LICENSE NO.
PERMIT NUMBER
o~ilfD
BUILDING SQ FOOTAGE
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0 0. / A/57711uA-r/<>~ oF ~.s L.(,vec ~
;:::-vr(,l,,e e S;'A
r-------FP ~LA ELEV NO
STORIES
~-<l
DCC:~~>'
0001 03/24 0101 02BldPat E
10-t~
l I eAe, "'' SSACC
QTY PLUMBING PERMIT -ISSUE
EACH f IXTURE TRAP
EACH 6UllllING SEWER
•C '--C
ReS U"Vi l GRADING PERMIT ISSUED
I
REDEVELOP~~t-,.T
AREA
YO N 0 ,'.] -,□
750 ;I QTY. MECHANICAL PERMIT· ISSUE
~ INST AL l FURN DUCTS UP TO 100 000 BTU
-.II-OVER 100,000 BTU
TYPE d"cc_ CONST .V
}
Fl R&. SPfl_
j:-:□ "-0 'o.-...;' Not Valid Unless Machine Certified .::.."-
3o<> '(;'f.1M,AR'.\'IACCOUNT NUMBER
-8Ul1_DING ~ T ,::,::_.J· 001-810-00-00-8??8 ____ ,.,\ --·' :il~ft't~4!;_.~~ 001-81".J-OC-OC-8221 +-
EACH WATFR HEATFR ANIJ DR VENT
~
A~H-(As SYS TE_~_ 1 ~~TLETS-
ACH GAS SYSTEMS OR '-i10Rt --------
BOI LE R,CUMPRESSO R UP l O 3 HP -----'----' PLAN~ 001-810·00·00·8821 :-_--~-T5-_ fs-UILERCoM~RE·sso~ ~ ___ 1_:1 __ ~P ---~ ]___ ··•fi1A't~·LuM-Bl~JG 1O1-s1O-0O-oo-s222 j / () ~---
t ME~Al ~:REP'~A.CE ELECTR1CAL ----. ---+ ------------------'---~-oc 1-810-00-00-8223 ---+----------{
' 1 VENT FAN SINGLE OUCT . MECHANICA; OD 1 -21D-00-00·822J EACH INST Al. ALTER. REPAIR WATER PIPE r-EACH vAcuuM BREAKER -t --t M-E-cH_t_x_HAu~1 HO □o oucTs ___ , ---MD!m.-EYo~,1~ 001-810 oo oo-s225
RELO[A~ION OF EA FURNACE HEATER ---------'--' SOLAR G01-8 1 0-00-00-8225 WATER SOFTNER ' _, --L---_7, f"-C"-I R~-,•:1-· "~ ··,r, I DRYER VE.NT
TOU,L MECHANICAL
I----
srnmK; Mo:I0~ ss,:-5-19-92-33
F'8E SPR',\i'\LfRS 001-810-,JC,-OC-8227
PUBLIC FACILITIES FEE 320-810-00-0C-87J0 T(jlAI Pi iJ'vHllN(. r-~~-+-c..c,--~~,~----~-~-~~, -+-----------{
QTY I ELECTRICAL PERMIT -ISSUE ::[oo 1: QTY.
NE:W CONST EA AMP SIJ.J bKR CAR PORT
I PH ', PH AWNING
FXIST blOG EA AMP SW! !lKR :i ---+-GARAGE
I PH J PH :,
REMODEL AITtR Pf9 CIRCUIT 'I t
MOBILE HOME SETUP
------1-------
--+--------
BRIDGE FEE
PARK-l[h,ELJ !AREA
ilF
LA COSTA TIF
FMF
J LICENSE TAX
MF~
-
360-810-00-00-8740
--+--------!
134·81 O ·OO-iJ0-8835
133·81 0-00-00-8835
---------+--0'.l 1 -S 1 0-~,,J-~0-S 1 ~2
880-519-92·57
lE'\o1PPOlE )00 A MPS ~--------i ~-------
(]VE:.R 2UU AMPS ,,
----------
II TEMP OCCUPANCY ,]U DAYSI --+---11-----------+---CREDIT DEPOSIT .
TOTAi f"IELTHII.AI , -+--II
II i
-mM TOTAL FEES PAYABLE I /01/
I HAVE CAREFULLY EXAMINED THE COMPLETED ··APPLICATION AND PERMIT AND 00 HEREBY Expiration Every perm!! issued byt'le8u1ldmg Otf1c1al under the prov,s,onsolth1s
CERTIFY UNDER PENAL TY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall expire by hm,tat,on and become null and vrnd lf the building or work
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERM!T I'-aulhonzed by such permit 1s not commenced within 180 days from the date ut such
tSSUEO. TO COMPLY WiTH ALL CITY. COUNTY AND STATE LAWS GOVERNING BUILDING coN'-~~~~t()n~:/~i'=~ ~:;;!~1~Pte~;h:~~r:~tcoi~ed by such permit 1s suspen(]&d or•
STRUCT10N. WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND menced for a eriod of 160 da s
KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIAB1LITIES. JUDGMENTS, COSTS A~O APPLICA7/1T' SI ~N~TUAE Jf-OWNER CONTRACTOR [J
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID C!TY IN CONSEQUENCE OF HE
GRANTING OF THIB PERMIT ~ BY PHONE rJ
I ~
* AN OSHA PERM:T IS REOUIREO FOR EXCAVATK>NS OVER
5' O" DEEP AND DEMOLITION OR CONSTRUCTION OF "'°' STRUCTURES OVER J STORIES IN HEIGHT
APPROVED BY <77· TI ;!i{/r1
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TYPE
BUILDING I
FOUNDATION I
REINFORCED STEEL
MASONRY
GUNITE OR GROUT
SUB FRAME □ FLOOR □ CEILING
SHEATHING □ ROOF □ SHEAR
FRAME
EXTERIOR LATH
INSULATION
INTERIOR LATH & DRYWALL
PLUMBING
□ SEWER AND BUCO D PL/CO
UNDERGROUND □WASTE □'WATER
TOP OUT □ WASTE □ WATER
TUB AND SHOWER PAN
GAS TEST
□ WATER HEATER □ SOLAR WATER
ELECTRICAL
' _J_
D ELECTRIC UNDERGROUND ul UFFER
ROUGH ELECTRIC ~
D ELECTRIC SERVICE D TEMPORARY
□ BONDING □ POOL
' ..l
MECHANICAL 1
□ DUCT & PLEM., D REF. PIFIING
HEAT -AIR COND. SYSTEMS 1
VENTILATING SYSTEMS
DATE INSPECTOR
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAYE BEEN APPROVED
FINAL I
PLUMBING '
ELECTRICAL I " J
MECHANICAL ' .".11 I,_
GAS I ., • ~I/ I
BUILDING ' I ~-
SPECIAL CONDITIONS ' 'J '
I
1-2½0
FIELD INSPECTION RECORD . ..
REQUIRED SPECIAL INSPECTIONS '-=====~IN;:S;;P;:E;:C;;T;:Oc;,R~·s;;N;:0"=',T,"E,"S=====--============~ ~-~~~~--~~---T"'----,------,----1 ,-REQ IF INSPECTORS INSPECTION CHECKED APPROVAL DATE
-----
SO I LS COMP•_:AN'.~E
PRIOR TO
FOUNDA-:-ION INSP I
STRUCTUF1AL co--,-C-R-,-T-,--+------------------1;-------1
OVER :?000 PSI -----1 ,--------__
PRES TRESSED
CONC::iETE
POS r TfN~<IC>NED
CCNCRE"'T ,-------------------,---------+-------1
f-lFLD WELDING
I---~=~~------,------,-----~-----------------------------------------, HH_1H SlRENG-:-f~
HOL fS
SPECIAL MASONPV
r------------. r--------i--------+-----
PILES CA~::,:so~------;----+------------
1 -
i I
------+---------~
r----------------+-------t--------·---+----
---.----------.----------·
OOOT 03\:)'# OTOT ~JCV+ JO•OO
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