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0 I lle<eby affirm 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
full force and •~t.
Loe Nn'3',.Z~~~Clm C 5'. :f
I hereby allirm lhat I am exempt from the Contrac-
tof's Locense Law fo, the following reason (Sec 7031.5 Business and Professions Code Any city or county which re-
quires a permit to construct. alter, improve. demolish, or repair any structure. prior 10 its issuance also requires ?heap--
plicanl !or such perrrnt to file a signed statement that he 1s licensed pursuant to the prOVJs1ons of the COntractor·s
Ltcense Law (Chap1er 9 commencing with Section 7000 ol Dw1s«>n 3 of the Business and Profess,ons Code} or that is ex_•
empt tnerefrom and the basis tor the allege<! exemption Any violation ol Section 7031,5 by an apphcant 10< a perm,t sub-
jects the applicant to a civil penalty of no1 "10fe than five hun-
dred dollars ($500)
D t. as owner of the propeny, o, my employees with wages
as their sole compensahon, will do the wOfk, and !he struc-ture is not Intended or offered for sale (Sec. 7044. Business
and Professions Code. The Contractor's License Law does not apply to an owner ot property who builds or improves thereon and who does such work hmself or through hts own
employees, provided that such improvemenls are nol intend·
ed or ottered for sa1e. 11, however, the butkhng or improve· ment is sold within one year of completion. the owner·buiJder will have the burden of proving that he did not build o, im-
prove for the purpose of sale).
D I. as owner ot the propeny. am exclusively contracting
with licensed contractors to construct the project (Sec. 7044. Business and Prolessions COde: The ContractOf's License Law does not apply to an owner of property who builds or im·
proves thereon. and who contracts for each projects with a contractor(s) license pursuant to the Contractor's lteense Law),
D As a homeowner I am ,mproving my home, and the follow· Ing conditions exist:
1. The work is being perto,med prior to sale. 2. t ha.,. lived in my home for twelve months
pnor to completioo or tlus work. 3. I have not claimed this exemption during the sast three years.
D I am exempt under Sec. ______ , 8 & P.C. tor this reason ____________ _
0 I hereby affirm that I ha..-e a cert1t,c~te of consent
to sell-insure. or a cer1,t1cate ot Workers Compensation Insurance. o, a cert,hed copy thereof
(Sec 3800. Labor ~e)
POLICY NO r ::36S'7 J
COMPANY ;;Z P /61 / T# y Copy IS hied with the city
□ Cert,hed copy Is hereby furnished
CERTtFICATl OF EXEMPTION FROM WORI\ERS· COMPENSATrON INSURANCE
(This section need not be compleled ,1 the pe,mIt
1s '°' one hundred dollars IS 1001 or less)
O I certify that In the per1o,-mance of lhe won. ror
which 1h1s permit ,s issued. I shall no! employ any
person In any m~nne, so as lo beCome sub1ect to
the Wor1ters· Compensation Laws ol California
NOTICE TO APPLICANT II. at1er makin;3 this Cert·,
hcate of Exemption, you shouk1 become sub1ec1 t"J lhe Workers· Compensation provisions of the LabOf
Code. you must torth""'1th comply with such
provIs,ons or this permit shall be deemed revoked
0 I hereby aftt,m 1na1 lhere Is a cons1ruc1Ion
lenchng agency tor the performance or the wOO\ for
wn1ch ttHS permit ,s issued tSec J097 C,v,1 Cooe1
Lenders Name ___________ _
Lender·s Address __________ _
USE"lALL POINT PEN ONLY & PRESS HARO APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMITf ►
l 1200 Elm. Carlsbad. California 92008-1989 (619) 438-5525
JOB AOORESS . AV. ST.RO. NEAREST cA0SS ST. .
rAT:;~;~ONI
BUSINESS LICENSE It VALUATION f7f0 :::Z.o7~ Li!!=E. C?ov2., m, Al~ ,,;;;-{ 111611 ·Cb:.J. /.?~/e) h) ~
LOT BLOC~ I SVBDIVISION I ASSESSOR PARCEL NO . .,,, i) JcONTRACTOR ' I ( . CONTRACTORS PHONE • ZOt,(E I
'7 ~ (""' 1' ",., 0 t°'\~k,7A ... 1 ~-'"' hJI"' 74'/-?.rrvJ OWNER'S NAME I ~ dwNE R0S PHONE
R1r.PJ1tRA_ a r;;::,~ '"726' .P"/'r. '?
CONTRACTOR'S ADOREsl -LICENSE NO. PLAN 1.0. # BLOG USE CODE
OWNER"S MAILING ADDRESS -_s-"~ /J.J ..... JIIIIJ'Q._<;.1-~) ,,,,,/.-~ '7 c-c:, 't I')
<l~--DESIGNER -LICENSE. STANDARD PLAN It BUILDING SO. FOOTAGE
OESe:rnn.ON OF WORK 1.t::, ~ .... / 0.D.14 I
Ifr ·i:"':_..
.-J/,V,,.,, J~}, L'lL..11'. .. 0~19.!f!:!f'S ~lS.S _ .., DESIGNER'S PHONE -r -~ -~-----·---~·---F/P F LR ELEV. NO OCC GP EDU
J STORIES
vO NO --0008 02/'15 010102BldPat 93.5:•
CENSUS TRACT I GP LANO USE I PARI\ING SPACE
1
RES UNITS 1 GRADING PERMIT ISSUED I REDEVELOPMENT TYPE OCC LOAD FIRE SPA
AREA CONST
YO ND v O NO vO NO Not Valid Unkn lhchine Certifitd
QTY. PLUMBING PERMIT -ISSUE 7.i;!-QTY. MECHANICAL PERMIT -ISSUE 3--SUMMARY/ACCOUNT NUMBER.-/ -.,
EACH FIXTURE TRAP
, INSTALL FURN. DUCTS UP TO 100,000 BTU BUILDING PERMIT 01-00-00-8220 ()lit'...,) V
EACH BUI LO ING SEWER OVER 100,000 BTU SIGN PERMIT -01-00-00-8221
I EACH WATER HEATER ANO/OR VENT .z.50 BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 01-00-00-8806 ·"' L .~
I EACH GAS SYSTEM 1 TO 4 OUTLETS ,-("o BOILER/COMPRESSOR 3-15 HP TOTAL PLUMBING 01-00-00-8222 ,c:-.o-,;>
EACH GAS SYSTEM~ OR MORE METAL FIREPLACE I ELECTRICAL 01-00-00-8223 ·, ~ .. ~,
EACH INSTAl .. ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL-.'{ l 01-00-00·8224
I EACH VACUUM BREAKER j..5 l> ME CH EXHAUST -HOOD/DUCTS MOBIL~E~7 01-00-00-8225
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MMIIL~PARK ltlSP -
EACH ROOF DRAIN I INSIDE) ' -( .,,u,. • <'1.9-. I n1.nn.nn.oooc
-TOTJ.L MECHANICAL 'l ~ '>'srnoNG MOTION ' -_._,yBO-Ql..13-0519 _/7 ..
I TOTAL PLUMBING I /j .00 r F1AEti>°it1NKLERS -'-,.-,,, ~0-00-8227
I PU~LIC FACJU~l°E~c..,<,W-I ELECTRICAL PERMIT -ISSUE ~-QTY. SOLAR -ISSUE
32-00-00-8933
1 QTY. BRIDC FO' -Yl~cv
I NEW CONST EA AMP/SWT 1BKR COLLECTORS .... ~, ~blSTRICT I
I 1 PH 3 PH STORAGE TANKS -All d 80-92-21-0519
I EXIST BLOG EA AMP/SWT/BKR I ROCK STORAGE V"' Encinitas 80-92-22-0519
1 PH 3 PH PUMP San Dieguilo 80-92-23-0519
J-REMOOEL'ALTER PER CIRCUIT I ltrrro PLAN CHECK FEE San Marcos 80-92-24-0519
TEMP POLE 200 AMPS
OVER 200 AMPS LICENSE TAX 01--00-00-8162
TEMP OCCUPANCY 130 DAYSI -//7F-,-/ ... --CREDIT DEPOSIT <..... b o. &V/
TOTAL ELECTRICAL I ·tr f1t> TOTAL SOLAR TOTAL FEES PAYABLE 93~.S-2._ -...
t HAVE CAREFULLY EXAMINED THE COMPLETED 'APPLICATION AND PERMIT" AND DO HEflEBY · ~,·e-ypernllt ..... !lrtlle&,ildingOfftctat under the prov1s1onsofthrs * AN OSHA PERMIT IS ~~~VATIONS OVER Code.._.....,. llp llmillllan and'll9come null and vOtd 11 lhe bu1tdtng or work CERTIFY UNDER PENALTY Of PERJURY THAT ALL INFORMATION HEREON INCLUDING THE 5· O" DEEP_ANO ll •MOUTION .. ~TION OF
DECLARATIONS ARE TRUE ANO CORRECT AND I FURTHER CERTIFY ANO AGREE IF A PERMIT IS aulllclriad~---wittun 180daysfrom trie date of such /". ·r .7r OVI IA 3 ST "ifll¥4r ...,..._ ._ -'< aulhorlZ-«I by such permit 1s suspended or ISSUED TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON, •-.__..,._,._11:edtoraoenodof t110~----
STRUCTION, WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND ·-~r:zw OWNER□ CONTRACT~~ 1A5t.-_/ 1 f {//1 D2~21,8? KEEP\iARMLESS THE CITY OF CARLSBAD AGAINST All LIABILITIES. JUDGMENTS. COSTS ANO
EXPENSES WHICH MAY IN ANY WA.Y ACCRUE AGAINST SAID CITY IN C0NSE0UENC£ Of'Tl'IE BY PHONE GRANTING OF THIS PERMIT, --,.. T , ...
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I . -~ TYPE DATE INSPECTOR -. •
BUILDING I
FOUNDATION I ~ ~ FJELD INSPECTION RECORD
REINFORCED STEEL I ?>-d•YI t'i,'1'1. j REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
MASONRY I .. REO IF INSPECTORS GUNITE OR GROUT INSPECTIO-N CHECKED APPROVAL DATE I
FLOOR & CEILING SUB FRAME I ·-. SOILS COMPLIANCE
SHEATHING D ROOF □ SHEAR PRIOR TO
FOUNDATION INSP FRAME I
I 6t.~ /J,l ~ ~UCTURAL CONCRETE EXTERIOR LATH I ER 2000 PSI .
INSULATION I '(!,{~) _;L,/;,,,,. v PRESTRESSED
CONCRETE INTERIOR LATH & DRYWALL I
I POST TENSIONED
I CONCRETE ~
, .
PLUMBING I FIELD WELDING I/.·~
SEWER AND BUCO □IPUCO ' HIGH STRENGTH I .•
□ WATER BOLTS UNDERGROUND D WASTE
TOP OUT □ WASTE □ WATER SPECIAL MASONRY. ; ...... ' ' ' TUB AND SHOWER PAN ' . ., .,/
I .'
GAS TEST I .. PILES CAISSONS
□ WATER HEATER □ SOLAR WATER -· ' ,
I
ELECTRICAL I
, .
□ ELECTRIC UNDERGROUND DUFFER 3-0-&i ... ..k~ .•
ROUGH ELECTRIC I
□ ELECTRIC SERVICE □ TEMPO~ARY A .I
D BONDING □ POOL I 1.cl•ff) ft/''a
I
I
MECHANICAL I
□ DUCT & PLEM., □ REF. PIPING 0008 OS\'O or vI r'!,e;;irOJ..lil+ >/~-~~
HEAT -AIR COND. SYSTEMS I
I
VENTILATING SYSTEMS I
I -..
CALL FOR FINAL INSPECT~~N WHEN ALL APPROPRIATE
ITEMS ABOVE HA V BEEN APPROVED.
FINAL I
PLUMBING I
ELECTRICAL I
I
MECHANICAL I ' .
GAS ·, I ' BUILDING I t--5 47>1 .A.AW I
SPECIAL CONDITIONS I -
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