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O t hereby affirm that I am licensed under
provlelons ol Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Professions Code, and my license Is In
fun force and effect.
L,c No ____ _ C!a1,
I nereby alt,rm That I am exempl I,om thP. Cr,t"cc
tors L,cense Law tor the t~·lowrnq re2son ISec 703' C
Bus,ness and Profess,ors C~de A0 y :,ty or c.ou1•y ,..n,cr, ·e quires a per-11 :o wnstn,ct a ter mprove deriol1sh o·
·eoa,r any structore 0·1or to ,ts issuance also ·eaJires 'he a~
pl,cant for such ~enl<I !0 file a sIqned s·are.,,ert :~21 ~e 11
IIcensed oursuanr to ihe prov,s,ons ot toe Lonir~ctor,
ucense Law I Chapter 9 commenc-ng with Se-tion 1000 ol
D1v1s1on 3 ot :ne Bus-ness and Profess,ons Code, or Thar ,s e;:,
empt the'efrom and the bas,s tor the a-legea exe'llpi,on An·, viola!1cn of Sec·,on 7031 S ov an aopl1can1 lor 1 pe,rr,1 sub
1ects the applicant lo a c,vil per,alty of not more than love hun d'ed do'lars 1$500·,
I. as owner of !he ~,o~erty or my e"1plo·1ees w1'h wage1
as their sole compersatiQn w1I' do lhe work asd lhe struc-
ru·e ,snot intended or offered for sale 1sec 7C44 Bus,~ess
and Pro1ess,ons Code The Contraclor'~ l•cense "aw ooes
101 apply to an owner ol property who builds or ,rr;JrJ,•es
•hereon and who does su:h war, himself or thr8u;ih h,s owr
employees. provided that such ,morovemenls are noi ,n1er,d
ed or ottered for sale 11, however the bu,ld:ng or improve
ment ,s sole w,1~,n one year of comple1,on lhe owner-Dullder w,II °,ave the bu'den of proving that he did not bu,'d o, ,m
prJve lor :he pu'pcse al saleJ
I, as owner of the pro~erty, am exclusively con1rac1,ng
w1lh licensed contractors to construe! The proIecl (Sec 7044, Business and Proless,ons Code The Contracror's License
Law does not apply tu an owner of p'operty w10 bu,lds or ,rn proves thereon. and who contracts for each pro1ecls with a contractor(s) license pursuant ro the Contrac:o,·s I Icense Law)
As a homeowner I am I-iprov,ng my home. a1d the •o low ,ng cond1t1ons exist
1 The work ,s being performed prior to sa e
2 I have lived In my home for 1wel·1e '!lontis
orior to completion 01 this worK
I have not cl~1med th,s exemp' on au ring lie las: trree years
I am exempt unaer Sec -----~
'or this reason B & PC
D I hereby affirm tl1a! I ria,e a ce"1,t1c;,,t!" o! consen•
IO self insure or a cer1,f,cate o• WDrkw~
Compen~t,on lnsu•ance or a cen,!1,-d n10; r~erec•
(Se{; 38CX) LaOOr Coder
POLICY NO
COMPANY
D Copy Is !,led w,111 me uty
0 Cen,1,ed copy Is riereby lurn1s,-,e<l
CERTIFICATI:. OF EXl:.MPTION H'IOM WORKERS COMPENSATION INSURANCf:
(This sec1Ion need not b€ completec1 ,, l~P ;•P'"'''
I~ •or one hund,ed dollars ;$1001 er ,es~·
D I cer\ify that ,n the perlormance ,,, t•w work ,,,,
which th,s permit ,s issued. I shal' ~ol en,,,.r,, a~·,
person In any man~er so as to become sub,eC' 1<,
lhe Workers U,lmpensa11or-L;iws o• CaI,tc,,n,,i
NOTICE TO APPLICANT 11 al1er -na~in] •h 5 Cprr,
licale of E•ernp11or yov 5houlO t:,,>c;omp subieci'
the Workers Compensation pro-,sIons Gt 111P L<lt·,J1
Code you m~sl fo'1h,.,1Th co,.,Dly w,lh S,Lr provisions or 'h,s perm,t s~,;,,II bf' r1Pf'rr,er1 rev"lkP<J
0 I hereby ,J.'t,rcr 1iai the•e s a ',or,siru, •,:,,
IenQ1ng age.,~y lc,r thP pprf,,,. .. ,.,, ",,1 'he ,,a,, '
,..111ch this pe•m,• s <,s~ea :Ser IO'J? C" Co,J~,
Lerider s NafT1e ___________ _
Lerioer s Aoa,ess __________ _
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS
I CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT I
I 1200 Elm. Carlsbad, California 92008-1989 (619) 438-5525 . . ,~~'Sa 4-· .~ .,.___ 0 -"~AD ~ ~EA:TCRO~ OATS OF APPLICATION! 8US1NESS LICENSE # VALUATION -PERMIT NUMBER I IJ-tSC I \\9 7 0 1'?9-,r~ I
ft,5-~ r-3 I LOT BLOCK « -1-su'BDJVISION I ASSESSOR PARCEL NO. ITCONTRACTOA CONTRACTORS PHONE# ZONE ' ,._ , '..-I "i'J'fo-,I I . ' OWN£R'S NAME \ ,• k _;;;_;:"~:;, I IA. ~ J '819-vt.L <._ CONTRMCTOR"S ADDRESS UCENSE NO. PLAN 1.0. t BLOG USE CODE I
OWNER'f MAILING A:DZSS
: •7:' L(A ,u:ft.. ~<.4 ,R,,/l.--f'-/ · ,1C1.., DESIGNER LICENSE# STANDA1[;"LAN # BUILDING SQ FOOTAGE
" I, I OtSCRIPTION OF WORK / ,
I DESIGNER'S ADDRESS DESIGNER'S PHONE ti~~~~\1~~ : ,-6) ~ .. ~ <$-/4. \ -~ ~--' ' FLRELEV NO OCC GP EDU
I C\57-n --, O_..-t;:: • STORIES
y~ ,[; I
I CENSUS TRAC! I GP LANO USE PARKING SPACC RES UNITS GRADING PERMIT ISSUED I REDEVELOP'v1ENT TYPE DCC LOAD FIRESPP AREA CONST I ,□ ' □ ·C "-□ vO '<D Not Valld Unlers Machme Cert1!1ed ' I
I QTY. PLUMBING PERMIT -ISSUE 7J;:. I-CTY. MECHANICAL PERMIT -ISSUE 3-SUMMARY/ACCOUNT NUMBER I
I EACH FIXTURE TRAP , INSTALL FURN DUCTS iJP TO 100 000 BTU BUIL0ING PERMIT 01-00-00·8220 '-1 ....I ~-I -· I -~ EACH BUILDING SEWER 0 VER 100 .ODO 8 TU SIGN PERMIT 01-00-00·8221 I -' ---,--------+-------··------
I EACH WATER HEATER AND OR VENT i
1 BOILER-COMPRESSOR UP TO 3 HP PLAN CHECK Q\-00-00-8806 ------~·
' EACH GAS SYS I EM I T(J4 OiJTlfTS i [lOILER COMPRESSOR 3 15 HP ....:_ __ TOTAL PLUr-/BING 01-00-00-8222 --~· -c ----------------· --I EACH GAS SYSTEM J OR MORE I i,i:·!d F;i:lE~LACE ELECTRICAL 01-00-00-8223 1~-------------+-------------------EACH INSTA~ AL I ER. HE PA IR 1'.'A TER PIPE ---i VENT FAN SINGLE DUCT MECHANICAL 01-00·00-8224 I~ -----------
I EACH VACUUM BREAKER MECH EXHAUST HOOD DUCTS MOBILEHOME 01-00-00-8225
I 1VAlE:.R SO~TNER ' RELOCATION OF EA FURNACE HEATER MOBILEHOME PARK INSP I -.
: P.i":Y RDUf 111.;:.,•, 1 ';'; :>:
SOLAR I 01-00-00-_8_2_2_5_ --------I ' TOT.C.L MECHANICAL STRONG MOT:QN 80-9?-33-0519 I t---•------·· -------r-------I TOI Al Pi \JMfllN(; FIRE SPRINi<.LERS 01-00-00-8227 I ~---PUBLIC FACILITIES FEE 32-00·00-893:J I QTY ELECTRICAL PERMIT. ISSUE QTY. SOLAR -ISSUE ---------~ -------
BRIDGE FEE I --I NEW CONST EA AMP S',Vl bKR 'CCL ~p,:ir:s SCHOOL FEE -DISTRICT -~·----I I PH l PH u sT1JRAl:F r:.r,r's Carlsbad 80·92-21-0519 I ----.. ~XIST tllUC E:A AMP SWT SKR
' I RO\, S (JR,\.'.,~ Errc,n•tas 80-92-22-0519 I
I PH J PH ---r---· ---~----------I 1: PU •,1cJ ' San D1egu1to 8:J-9?-23-05'.9 -------------· --~-I REr,JQQFI Al HR P[el (!R[UIT P .'\', ,-.i~'.;, "F~ _l San Marcos 80-92-24-0519 I -~---·--· -----------· ---TH,1P POI t ?IJU A \iPS I ------------~----------..
I OVl:.H )UU AMPS LICENSE TAX 01-00-00-8162
·-I TEMP OCCUPANCY ,30 CAYS1 MFF 80-92-57-0519 ~----I ---f------------1 i CREDIT DEPOSIT 1,----------------,-------. . --
I l [)IA I EL["(, 1 HI(, A I
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TOTAL FEES PAYABLE I q.:) I I -I I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT' AND DO HEREBY E~p1rat1or, Every permit issued by the 81J1ldmg Oftic,al under the prov1s,ons of !his * AN OSHA PERMIT IS REQUIRED FOR EXCAVATtONS OVER I CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall e~pire by hm1tat,on and become null and void ti the bu,ld1ng or work 5' 0 .. DEEP AND DEMOLITION OR CONSTRUCTION 01" I DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS author1zed by such permit ,snot commenced w1th1n 180 days from !he date ot such
STRUCTURES OVER 3 STORIES IN HEKitH permit or if the buildm~ or work authorized by such permit 1s suspended or I ISSUED TO COMPLY WITH ALL CITY. COUNTY AND STATE LAWS GOVERNING BUILDING CON-abando--" a• -time a er the work IS commenced tor a penoo of 180 da s
STRUCTION. WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND ~ OWNER □ CONTRACTOR' AP(ROVEO BY DATE I KEEP HARMLESS THE CITY Of CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND APPLI 1~£,, I EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE
BY PHONE n 0_ _ 7Y\_ ( ~O. I l, foe-I GRANTING OF THIS PERMIT -Ad--,, -I
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TYPE I DATE INSPECTOR
BUILDING '
---s-s--34q~3
~-
FOUNDATION I FIELD INSPECTION RECORD
REINFORCED STEEL ' REQUIRED SPECIAL INSPECTIONS INSPECTOR"S NOTES
MASONRY '
GUNITE OR GROUT I INSPECTION RED IF INSPECTOR s I
CHECKE D APPROVAL DATE
FLOOR & CEILING SUB FRAME I
SHEATHING □ ROOF □ SHEAR
FRAME I
EXTERIOR LATH I
INSULATION '
INTERIOR LATH & DRYWALL '
I
PLUMBING '
SEWER AND BL/CO □iPL/CO I
UNDERGROUND □ WASTE □ WATER
TOP OUT □ WASTE □ WATER
TUB AND SHOWER PAN '
GAS TEST '
□ WATER HEATER D SOLAR WATER
I
ELECTRICAL I
□ ELECTRIC UNDERGROUND □ WFFER
ROUGH ELECTRIC I
□ ELECTRIC SERVICE □ TEMPOli!ARY
□ BONDING □ POOL I
SOILS C:.)MP' IANCE
PR'OR TO To: ENGINEERING, FIRE, PLANNING, UTILITIES
F-OUNDA ii ON iNSP F L •· •
N0~eOTIC~k~ STRUCTURAL 6:5N-CRETE: '"""' c'-i r
OVER 2/l!JO PSI ~ PRESTRESSEO
I
CONCRETE .;?3 ~ _,.J ... &.i/-,;.,4 N
POST TfNSIONED Plan# ,fs-5;j9,3
CONCRETE
Addr~ ss ,, t/S. ~ s ,
---S;,,,, -f,, Ll, -·
p
FIELD WELDING
r11GH STRENGTH --;z;-E
BOL Ts Type of Construction r, C
<f-'ECIAL MASONRY
Person to Contact ~~ Ph. No.
T 7;-3-7r,e,9 I I
Engineering
0
P•c_ES CAISSO!\,c' Department Date Approved N
--~-----~----~-({;"• a) Date yz-v0oroved @d i::~~1~,'.;" .. R
r'epartment Dijle }-( L Ap~ed E
Utilities / V i .1. Q ,,
/ Sa I vJf A / fc,A-i Appr ed Department u
( IL I I I /' E
--Comments: s
,. --'---_,.,-T
I
MECHANICAL I IF A RESPONSE IS NOT RECEIVED WITHIN 24 HOURS, IT WILL BE ASSUMED IT IS OKAY TO FINAL.
□ DUCT & PLEM., □ REF. PIPING ' ---
HEAT -AIR COND. SYSTEMS I
-
VENTILATING SYSTEMS ' I
.
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HA ll_li_ BEEN APPROVED .
FINAL ,,
PLUMBING \'
ELECTRICAL I },t
MECHANICAL I './Af Jg V, ' AT -
' GAS I 7 I r,J vr· , '
, BUILDING ! /]/// ' ' -
SPECIAL CONDITIONS /' I -.
/, •
"1:it_p of "1:arlsbab
REQUEST FOR INSPECTION RECORD
INSPECTOR-~-~~----,---,--,--PERMIT NO.
OWNER /lh!/n514A-'L-BAI,)/('.
ADDRESS :;t3 M L.A-C.O.S-rA AW
REQUESTED BY ~ ~s
BUILDING
D FOUNDATION D FOOTING D SLAB
□ REINFORCING STEEL
n MASONRY
D GROUT· GUNITE
□ FLOOR AND CEILING SUB FRAME
□ SHEATHING D ROOF □ SHEAR
C FRAME
D EXTERIOR LATH
□ INSULATION
□ INTERIOR LATH OR DRYWALL
D FINAL
PLUMBING
D UNDERGROUND PLUMBING
D SEWER AND PL/CO
D TOP OUT PLUMBING
C TUB OR SHOWER PAN
□ GAS TEST
D WATER HEATER /, ~
D SOLAR WA~/'·-'
D FINAL ~#
TIME· A •
_______ DATE; &7i7/r?f ( l
A Fl. • .J-~ -. ' PHONE NO.
PERSON TAKING REPORT ____ _
ELECTRICAL
D TEMPORARY SERVICE
D UFFER GROUND
□ ELECTRIC UNDERGROUND
D ROUGH ELECTRIC
MISCELLANEOUS
n CONDITIONED AIR SYSTEMS
n SOLAR HEAT
□ PATIO
□ POOL C SPA
D SIGN
C GRADING
;t,) □ DRIVEWAY
D FINAL
SPECIAL INSTRUCTIONS ___________________________ _
Ready For Inspection: □ Tuesday □ Wednesday □ Thursday D Friday
D A.M. D P.M.