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0 l hereby 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 for~ and aff_eys:= ,,. ?, L.JLJ
Lie No.,:;,~'-f Clm L--~-"""J__ /
I hereby affirm that I am exempt lrom the Contrac-
1or's License Law tor the following reason (Sec. 7031 5 Bu_smess and Pro1essions Code: Any crty or county which re-
quires a perm,t to construct, alter. improve, demolish, or repair any s1ructure, prior to ,ts issuance also requires the ap·
plreilnt for such permit to file a signed statement that he rs
licensed pursuant to the provisions of the Contractor's
License Law {Chapter 9 commencing with Section 7000 of 01v1s1on 3 o1 the Business and Professions Code) or that Is ex·
empt therefrom and the basis for the alleged exemption Any
violation o1 Section 7031.5 by an applicant lor a permit sub·
Iects the applicant to a c,vil penalty ol not more than live hun-
dred dollars ($500)
~ I as owner of the property, or my employees with wages
as their sole compensation, will do the work. and the struc-
ture Is not intended or ottered for sale (Sec 7044. Business
and Profession5 Code: The Contractor's License Law does
not apply to an owner of property who builds or improves
thereon and who_ does such work himself or through his own
employees, provided that such improvements are not m1end· ed or ottered for sale. If. however, the building or improve-
ment is sold within one year ot completion. the owner·bu1lder will have the burden ot proving that h€ did not build or im-
prove !or !he purpose of s;ile)
::::J l,_as owner of the property, am exclusively contracting
with_ licensed contr2ctors to construct the pro1ect (Sec 7044,
Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Im•
proves thereon_, and wtlo contracts !or each projects with a contractor(s) license pursuant to the Contractor's License ~w)
0 As a homeowner I am improving my home, and the follow-ing conditions exist
1 The work is being performed prior to sale 2 I have lived in my tlome for twelve months pr,or to completion ol this work 3. I have not claIme{! this exemption during the
last three years
::::J lamexemptundarSec ______ ,B&P.C
for this reason
□ I hereby af!1rm tha! I ha·•e a cer1'f1cate ol consent
lo self-insure, or a cert1l1cate of Workers
Compensation Insurance. or a cert,f,ed copy thereof
(Sec. 3800, Labor Godel
POUC, N09,. '::)C l{C\5 D~ cS ~
COMP'"V Ii J (\()._. CC(..,';µ4·
0 Copy Is filed with the c,!y
D Cert1!,ed copy Is hereby 1urn1shed
CERTIFICATE. OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
(Th,s section need not be comple1ed ,f the perm,t
,s !or one hundred dollars Is1001 o, less)
D I cert1ly that In the pertormance of the 11,orl< Jar
which this perm,t ,s ,ssued. I shall not employ ;my
person ,n any manner so as to become subject 10
the Worl<ers· Compens.111on Laws ot CaI,!om1a
NOTICE TO APPLICANT II. alter makIn;, th,s Cert,
f1cale of Exempt,on. you should become subIect 10
1he Worl<ers· Comptms.111on prov,sIons of the Labor
Code. you must torthw,th comply 11,Ith such
prov,s,ons o, th,s perm,1 shall be deemed •evoked
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARAl,~
CARLSBAD BUILDING DEPARTMENT
1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525
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APPLICATION & PERMIT(/ff'~
·JOB._flµOft£SS-
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PERMIT NUMBER r-::::R 1 IQN /l
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ZONE
$3,..
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LOT l BLOCK -l SUBDIVISION I •. SSl;ll"'l!l. , e~ceL ~o . ..,. , • ·DESIGNER LICENS~ # STANDARD PLAN# BUILDING SQ. FOOTAGE
~ ~'2) -\ C) .=>-e, '-f<
DESCRIPTION OF WORK ~~Q..r '\N;\« . \\-eciu O.ESIGNe~·s AO.DRESS
F/P FLA ELEV.
YO NO
' AREA
NO
STORIES
TYPE
CONST
,DE.SlGNEft'S PHONE
OCC GP EDU
OCC LOAD I Fl RE SPA
• ·1/i;:ij : .. ••:... o:.:~,o~, 11~0 .
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CE:sus TRACo l Ge LAND use l eARKtNG seAce I ses UNtTS I GRADING PERMIT ISSUED I REDEVELOPMENT
YO N □ -,.o .... o v□ NO Not Valid Unlffs Machine Certified
QTY. PLUMBING PERMIT -ISSUE 7E:::.. QTY. MECHANICAL PERMIT· ISSUE 3-SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP INSTALL FURN. DUCTS iJP TO 100,000 BTU -1 I BUILDING PERMIT 01-00-00-8220
EACH BUILDING SEWER . OVER 100.000 BTU SIGN PERMIT 01-00-00-8221 I---+-----------------+---------------------------------ll---------lf--~~------------
PLAN CHECK 01-00-00-8806 EACH WATER HEATER AND/OR VENT
EACH GAS SYSTEM 1 TO 4 OUTLETS
EACH GAS SYSTEMS OR MORE \
BOILER/COMPRESSOR UP TO 3 HP -----
BOILER/COMPRESSOR 3-IS HP TOTAL PLUMBING 01-00-00-8222
METAL FIREPLACE -----------'-----'----lf---~EL=E~CT~R~IC~A .• L 01-00-00-8223
EACH INSTA~ .. ALTER. REPAIR WATER PIPE 1 7 l VENT FAN s1NGLE-Duc1 MECHANICAL 01-00-00-8224
1----+-----1 1 MECH EXHAUST -HQQOIOUCTS MOBILEHOME 01-00-00-8225
.· _ _,_ __
EACH VACUUM BREAKER
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP -·-------L : EACH ROOF ORAi~ /INSIDE)
_ _J
------+--------,>-,-,.~
1 1 SOLAR -------Q1-00-00-8226 I / .\ I
TOT.l.l MECHANICAL I L ?T_~~_NG_MOTION 80-92-33-0519
---,-.
TOTAL PLUMBING I -
FIRE SPRINKLERS 01-00-00-8227
QTY.I
I
ELECTRICAL PERMIT· ISSUE 32-00-00-8923 ..5--;_ QTY. SOLAR · ISSUE PUBLIC FACILITIES FEE
BRIDGE FEE ·----
1 NEW CONST EA AMP.'SWT·BKR COLLECTORS SCHOOL FEE -DISTRICT -t----------
1 PH 3 PH Carlsbad 80-92-21-n..,1q
Encinitas 80-92-22-0519 EXIST BLDG EA AMPISWT,'BKR --t-111 I ::~:A~ I I
1 PH 3 PH PUMP _ ,j .:::,,:111 v1t:yu1w l----+--R-E-M□□EL,ALTER-PER CIRCUIT ----PLAN CHECK ~EE j
<'~-n, __ 80-92-23-0519 ___ .,_ ---
--·
TEMP POLE 200 AMPS
OVER 200 AMPS t--+-------
TEMP OCCUPANCY (30 DAYS) -------
' TOTAL ELECTRICAL
--·---,f------------
-+-------
San Marcos 80-92-24-0519
-
-
--·-
TOTAL SOLAR ~· . I I I j TOTAL FEES PAYABLE Is------
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" 0. w C · · · ' " · .. · : · · : E expinlttofl E m".littGUedt,yth Buitdi Ottk:ia:iuttclefthe· · 1 o{tf'its •, ·~ 0 I hereby affirm H'lat lllere ,s a coristruct,ori ·1 HAVE"~EFUL1.V DAM'INE~THE COMPIJ~TE0 ,;APPUQA"IJON ANO PERMIT" ANO DC) ti-ER 8Y Code shall ex;!YJ;'iitnital:foh an(f ti!com6 ~tarid void' .. ff the~:~, w6rk * '~.tt. f'EMi!IJ~AEa:UJREO FOfl ~VATIONS-~
1ending-agency tor t~e perto,man.ce or.'".' we. n,; Jar ~CE .. ~ .. TIF'f Ul'+OE. R ·PEN-AlTY OF P.ERJUAY :THt\T .. A. L. l INF·. OA·>,<.ATION HE. RED. N tNCllJDING THE authoriled by.suell permit is not commenced wit.hin ·i30day$fr'om tned.llteof sifoh -.51:0 -~ OR CONSTRUCTIOH OF QJ wh,cll 1111s perm,! ,s ,ssued ISec .m1,c1,,1 Co<leJ, OEOLARAT10NS'AA£ TAU€ ANO CORRECT AND·f FURTHER.CERT1F'f AND AGREE IF A PERMIT IS , permit. or if the building ('J( \lWOrk.&ulhorwad by such permit ii suspef'lded or . $TR(JC1UFIES-OYER 3'STONES tN HEIGHT ;:::
C "'' \'\./ _ ~;-.,~ --( ( iSStJEO: "lO .COf\4PJ;Y Wl"ft{ <ALL CtTV:, CQUNTY·AND STAfE.LAWS GOVERN-ING BUILDING CON· ablUfdOned at Jin me after the WOfk·fl commMNCI tor & "riod of · · .t=.
Lende•sName_i \\lr,....'.\l~, \1"N: \ .( $TFHJGTK>N,WftE1'14ER.SPECIFIEOHEREJNORNbT. !ALSOAGREETOSAVEINDEMNIFYANO , DATE ~
Lende•sAddress -. \. _ ·t<f.EPJ-tA"f,t~LE$STH~~.:t:)F.CA.ffl.$8,!!;QAGAlNSTALt,.UABIUT!ES,JUOGMEt,ITS.COSTSAN0 ICANT.SSIGNATLJRE: .If,,. ER □ ,CONTAAC c>Z:J. ,,..,.,..--t::-~ (C-hcw-lo . . ExPaiSEs wtttctt MAY iii ·ANY wAv ACCRue AGAI_Nsr sAm c1TY 1N coNsEOUENce M rHe ----/ ..... --; .....,
',,_ .GRAt+Tt!4G QF Tk!S ~ft}4J:f'-" : · · , · .J I -t----' ,-
INSPi::CTION TYPE DATE INSPECTOR
BUILDING
FOUNDATION
REINFORCED STEEL
MASONRY
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME
SHEATHING
FRAME
EXTERIOR LATH lNSULATION
INTERIOR LATH & DRYWALL
PLUMBING
SEWER AND BL/CO
PLUMBING UNDERGROUND
PLUMBING TOP OUT
TUB AND $HOWER PAN
GAS TEST
ELECTRICAL
TEMPORARY POWER
ELECTRIC UNDERGROUND
ROUGH ELECTRIC
ELECTRIC SERVICE
BONDING
G. F. I. -SMOKE DETECTOR
MECHANICAL
DUCT & PLEM., REF. PIPING
HEAT -AIR COND. -SOLAR SYSTEMS
VENTILATING SYSTEMS
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HA VE BEEN APPROVED .
JOB SITE FINAL ./
PLUMBING ..:.: ..L .. )(_-<,_ '\
ELECTRICAL -
MECHANICAL
GAS
BUILDING
SPECIAL CONDITIONS
CERT OF OCCUPANCY ISSUED
-
-
-
-
-
-
-
-
-
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS
INSPECTION REQ IF INSPECTORS
CHECKED APPROVAL
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRESTRESSEO
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
! PILES CAISSONS
. ~
INSPECTOR'S NOTES
DATE
St'~ -3(od-
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