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O I hereby affirm that I am llcensed under
pt'OYlslone of Chapter 9 (commencing with
S.C:Uon 7000) of Division 3 ol the Business
and Profusions Code, and my license 1s in
full force and effect
1 hereby a1t1rm That I am e•empl lrom the Contrac
tors ucense law tor the 10110w1ng reaso~ 1Sec 7011 'J
Busrness and Profess,ons Code Any c,ty or wunly wh,co 'e
quires a permit 10 construe! aller ,r<iprove. de<r,ol,sh or repa,r any sTructure. or,or lo ,ts ,ssuance also requires !heap
ol1can1 lor such perm,t lo file a sI9ned s1a1ement that he ,s ,ce~sed pursuant lo the prov,s,ons of lhe Lontrac10, s
License Law (Chapter 9 commenc,ng wrlh Section 7000 of
O,v,s,on 3 ot The Bus,ness ana Prolessions Code; or that Is e,
erno: merefrorn and the basis for me allegea e,ernptIon Any
,.0Ia11on ol Sect,on 7031 S by an appl1can1 tor a permI1 sub
Iecls the appI1canl to a civil penalty o' ~ot "'Ore lhan five hu~
dred dolla!S 1$500'
1 as owner ol the properly or my emp•oyees '"'n ... ages
as the,r sole compensa1Ion w11', do The work a~d lhe STruc
ture Is not intended or o11ered lar sale !Sec 7044 Bus,ness
and Proless,on~ Code The Conir.ic10, s l1cerse Law does
no! apply to an owner of property who builds oi improves
thereon and whO does such work h1msell or lhrough hos own
employees. prov1dec that such ,mprovements are not ,ntend
ed or ottered lor sale If, however. 1he bui1d1ng or improve-
ment ,s sold w,mIn one year of comple1,on the owner-builder
w,1I ~ave the burden at prov,ng thal he d,d not build or ,rn
orove lor The purpose of saieJ
I, as owner ol the properly, am exclusively rnntraL11ng
with licensed contractors to construct The pro1ect !Sec 7044
Bus,ness and Professions Code The Con1ractor's License
Law doos not apply to an OY!ne, of properly who builds or Im
proves lhereon, and who conuacls tor each pro1ects w•th a
contractor(s) I,cense pursuant to the Con1,aclor·s License Law)
I As a homeowner I am ImprovIng "'Y home anct the lollow
1ng cond1t1ons exist
1 The work Is be,ng performed prior 10 sale
2 1 have lived In my hOme for 1welve monrhs
pr.or to comple1,on ol this work
I have no\ claimed this exemption during lhe Ias1 three years
I am exempt under Sec ______ B & P C
lo, th,s reason
I {
I
I hereby aH1rrn that, hase a certI!1cate of consent to 1 self-,nsu<e or a cer1'!,cate of Wo,Kers Compensation In
surance or a cert,hed copy the•eol 1Sec 3800. Labor Code)
POLICY NO
COMPANY
,,X Copy ,s liled w1lh \he city = Cert,1,ed copy ,s hereby lu,n,shed
CERTIFICATE OF EXEMPTION FROM
WORKERS COMPENSATION INSURANCE
(Th,s sec11on need not be completed ,! tne perm,1
1s for one hundred doHars 1$100) or le,ss1 1
/I certdy tnat In \he performance ot the work for wh,ch
~perm,t ,s ,ssued. I shall no\ employ any person In any
manner so as to become subJect lo the Workers Com pen
sa1Ion Laws of Cahlorn,a
NOTICE TO APPLICANT. 11. after ma~,ng this Cer\il1ca1e
of E<emp1Ion. you should become sub1ect to the Workers
Compensation provIs1ons of the Labor Code. you must
forthw,tn comply with such prov1sIons or 1h•s perm,\ shall
be deemed revoked
I hereby aft.rm that there ,s a construct,on lend,~g
agency for the performance ol the work lor wh,ch th,s per
m,t IS ,ssued !Sec 3097 Ci,ol Coclel
Lender s Name_
Lender s Address_
CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad, CA 92009-1915 (619) 438-1161 APPLICATION & PERMIT
JOB AOORES,S
2~5~
. , • v-. ST. RO. TttOMAS aRCS NO. J/MltS . WB~ __ OJ/J.ls.~8-40
OAT( .Of APPLICATION 1z.c1~ 8U!1¥.SS LICENSE,#
/~7:bt:7'
VALUATION
c?J
LOT SLOCk J SU~O!VISIQN f ASSESSOR ~ti[_ NO. t I ,.7 !>'-0 4S"OD co·tHRACToR ' ., --dWNtR·S PHON.E ..-_l"'i-,,,-L A A '°~
cONfAACTORS~PHONE •
.. ?2~?:?.7
ZONE(
d;JMIT NUMBER
~t)(11'4,-
BUILDING SQ. FOOTAGE ow~ s.tE/rr J CONTRACTOfl'S JoifRESS STAT~ LICENSE NO.
~A'ivaJ 1/.2.Y>~?.-3933
Q.WNER'S.,¥A!LING AOOfl.£$5 ''£7=? ,41.i._ 01104/89 @01 o;::t:)02
~ ·········-:::::;.,;..-:--7"A..\/;,s /,1 ILJ Of.S1GNE8 t)ESIGNE,R"S PHONE 1:•.i.w, "'r .::..2• •.:
OESCCi11PT10r'i' 2_~f4J{ j.,,Jlr"' 1./ ,-,A,<::;. ANO HL )F~,1 r. I OES1GNE.R'S",t.,OQRES;S I Sr.ATE ucENSE No. I
r-n,,,,oo; r n ~~ k'];,,,-;;;,,
·U.Nti~ .•. <A..1
~SUS TRACT
;1
PARKING SPACC RES UNITS
-j '' ;,a ecev • ~9o I · • □ ,□ .-l h,.~ ¥aRIES ace"' I EDU
GRADING PERMIT ISSUED FIRESPR
l □ ND l arne vecoeMe~"'\'i >-
AREA ____/4 1~
. ll.'
I~ l_?CC LOAD "'r _.,,. .. <0_ .. -.1.,· vO NO Not Valid Unlf!ss fthch,ne Cert1hed
~~ "')V' I I I 7· 5V I QTY. MECHANICAL PERMIT. ISSUE'.·'·
EACH FIXTUR~ TRAP INSTALL FURN DUCTS iJP TO 100 000 BTU
QTY. PLUMBING PERMIT. ISSUE
EACH BUI LUING SEWER I II ( OVER 100,000 Bl~\,.\,.11 L<--~',. -)I SIGN PERMIT 001-810-00-00-8221
• EACH WAHR HEATER ANU OR VENT BOILER:'COMPRESSOR UP TO 3 HP -~ PLAN CHECK 001-810-00·00·8891
\ EACH GAS SYSTEM l TO 4 OUTLETS 2 .<LJ BOILER·COMPRESSOR .115 HP ~~"" TOTAL PLUMBING 00; -810-00-00 · 8222 /,V -
EACH GAS SYSTEM J UR MORE METAL F1REPLACE ELECTRICAL 001-810-00-00-8223 J ,<IIC" . EACH INST AL Al TE.R. REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 001-81 0-00-00-8224
EACH VACUUM BREAKER MECH EXHAUST HOOD DUCTS MOBILEHOME 001-810-00-00·8225
WATER SOFTNER RELOCATION Of EA FURNACE,HEATER SOLAR 001-810-00-00· 8226
fACH ROOF rJRA'.r-..i 1;'JS10E, DRYER VENT STRONG MOTION 880-519·92-33
i" TOH.L MECHANICA-L FIRE SPRIN'r<.LERS 00 1-810-00 · 00-8227
TUI Al PlUMHING l 1-PUBLIC FACILITIES FEE 320-810-00·00-8740
BRIDGE FEE 360-810-00-00-8740
QTY. ELECTRICAL PERMIT · ISSUE s.oo QTY. I MOBILE HOME SETUP PARK-IN-LIEU \AREA
NEW CONST EA AMP SWl HKR CAR PORT TIF 312-810-00-00-8835 I PH .\ PH AWNING LA COSTA TIF 311-810-00-00-8835
EXIST HLDG EA AMP·SWT BKR GARAGE FMF
\ PH 3 PH LICENSE TAX 001-810-00-00-81 E2
{ REMODEL AL HR PER CIRCUIT /r. -Mff 880-519-92-57
TEMPPOLE lOOAMPS .
OVER 200 AMPS
TEMP OCCUPANCY 130 DAYSI
CREDIT DEPOSIT
lOTAL Fi~LTRICAt I /,~w TOI Al TOTAL FEES PAYABLE I ..,,?~~
" . ' ,. J -HAVE CAAEFULL Y EXAMINED THE COMP~TED ·APPUCAT!QN ANO PERMIT"' ANO D0 tl.,l:REBY E,:J)tratioti. Eym-yper,Missuldbf1t\eSundingOfficie_hmderfheP«N~$0lth!S
CERTIFY ,UNDER PENALTY OF PERJURY THAT ALL JNE'O~MA,TJON 1:i~EON JNC!,.UOtNG THE ~~all expire by lli:rt.1tat1on and beeormt nuttand vOid 11 the budding or WOTk
OECLARAT!ONS AR& TRUE AND CORRECT AND I.FURTHER CERTIF.Y ANO,AGREE IF A PERMlt f& autt\~r~ect ~y auch ~':"•1 ts noteommenced ,w1tt11n 1~daysfrom th&ciateotSUch
l~UE_O: :ro COMPLY W1TH ALL CITY. CQUNlY AND $TATE LAWS GOVERNING dUlLDING CON· ~~~ «: ~·::a Of Work auil'\QflZed b'J:"'SU~ permit IS , •. Of'
* ""OSHA PERM:r IS REOUIA£0 FOIi UCAV.t.TiONS 6vEA
5· er· DEEP 'dtD DEMOLITION OR CONSTRUCTION OF
STftUCTURE&OVER.J STORIES IN HEIGHT
"5.IFIUCT!Gtt. WHETHER SPE,ClFIEQ.11E~ OB.NOT. f At.SQ AGREE TO.SAVE INDEMNIFY ANO a. Im& er lh~ Wot:k II commenced for a nod of . "t
Kf;.ER H~Ml6SS:TH£ crry qF,~sBA~P/INST ALL U.AstU'tlEs.~ ~EN'TS: CQ'STS •A,fffi; • ~c $1GNATURE • •. · ~~l~
;~~MSE&l/VbllCH W:Y ill ~,;,Kl ~G••M•• SAIO rnr.r ll'I. ll!>NS-®ENCE Of.,... ·. ', ,~i.,'.. · +~RAflrffNGQF~"PERMi.T. " ·.•'; • '·. · '>-••,,-t-,1.•,·,•.;. • ., •. ,..., • •~~.t, .·, {..,;:__•,······-: _ ___,.::_ __ ._, ___ ,_ ..... ~-,,/' • •,}',;, •. ,, ,,,_'v*W..'*•,•
APPROVE:Pr 0/'1/1/Yi I { -I ,,
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TYPE ' DATE INSPECTOR ' BUILDING ' . Cf, S'j OC O Ca
FOUNDATION I FIELD INSPECTION RECORD
REINFORCED STEEL .
MASONRY '
GUNITE OR GROUT I
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
REO IF INSPECTORS . INSPE'.CTION CHECKED APPROVAL DATE
SUB FRAME □ FLOOR □ CEl~ING SOILS COMPLIANCE
SHEATHING □ ROOF D SHEAR
FRAME '
PRIOR TO
FOUNDATION INSP
EXTERIOR LATH I
STRUCTURA~ CO_NCRETE
OVER 2000 PSI
INSULATION ' ' INTERIOR LATH & DRYWALL '
PRESTRESSEO
CONCRETE
POST TENSIONED
CONCRETE ' PLUMBING ' ' FIELD WELDING
□ SEWER AND BUCO □ PUCO
UNDERGROUND □ WASTE □;WATER
TOP OUT □ WASTE □ WATER
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
TUB AND SHOWER PAN I fl
GAS TEST ' I /~-'>I V\'\ l.\ I PILES CAISSONS
□ WATER HEATER □ SOLAR W/!ITER
I
ELECTRICAL .
□ ELECTRIC UNDERGROUND □'.UFFER ' ROUGH ELECTRIC .
□ ELECTRIC SERVICE D TEMPORARY .
□ BONDING □ POOL '
. ' .. ...
MECHANICAL ' ' " □ DUCT & PLEM., □ REF. PIPING
HEAT -AIR COND. SYSTEMS I
VENTILATING SYSTEMS :
I
ITEMS ABOVE HAIJE BEEN APPROVED
FINAL I
PLUMBING ' ~,
ELECTRICAL I 1:..1... \ ' MECHANICAL : , "' f\"-~
GAS I ,'! .\'-'\.
BUILDING . ~· \ I
SPECIAL CONDITIONS I • .
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