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O I 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 1n
lull force and eflect
I hereby af•,rm 1nat am exerr>PI from 'he Cortrac
ro, s License Law •or the 'o,low,nq 'easo" iSec ?GJI J
Business a~a Professions COde Any c1r1· O' county wn,c", re quires a per,n,t 10 consiruct a11er -morove demcl,s~ or
repa,r any s1ruc1~re prior to ,:s 1s,uance als~ reaui<es !heap p·,cant lor such per,n1t to •11e a s,qned s!ate<nenr ,~at he IS
1,censed pursuant to the provisions of 1ne Coniractor, I cen1e Law ICha~ier 9 commenc,na w,tt, Sen,on rnon or
D1v1s1on 3 oi lhe Business and Protess1ons Code, or t~al IS e• e'l1pl therelrorn ,ind the bas,s 1or the a·leqen e,ernot,on An1
v,01at1or of Sec:,on 7031 S by an appl1can1 f~r a per,,,,t suP
1ec1s The app11ca~t 10 a c,v,1 pe~alty ol nol mo·e :h;;0, i,,e "un
dred dollars iS'J001
I as owner o' the property or rsy ernp a,ee~ w,t~ wages
as lhe,r sale compensat,on. w,11 do ·ne worK a~d T~e sTroc
tu'e ,s nol ,nrended or olfered for sale iSec /04~ B·us,ness
anc Profess,ono Code The Con1,actor s License Law does
nol apply to ar owner o1 proper'y who Pu1ld1 or ""P'Oves
thereon and who does sue~ wo,k ~•'llse11 or through his own emoloyees prcv,ded lhat sucn ,mprovernen11 are not ,mend
ed or Dffered for sale 11 however the bu1ld1~g or ,mo,ove ment ,s so,d w,th1r one year o! i:ornp,et1an the owner-builder
w1'I nave lhe hu'de~ of pro,ing •hat oe d,d nm bu, d or ,m
p,ove for t~e pu·pose of saleJ
, as owner 01 the oro~e'ly, am exc•us,vely contrac:,ng
with licensed contractors le const·uct the pro1ect (Sec 7044
Business ana Proless,ons Code The Contractor s License Law does not apply to an owner of properly wno bu1•ds or ,rn
proves !hereon and wno con1rJcts tor each pro1ects w,t~ a
conHactorrs) license pursua~I to T~e Contractor's .,cerse Lawl
As a homeowner I am ,,,,orov,ng nw home. and the to,lcw
,ng rnnd1t1ons ex1s1 1 The work ,s he1nq perlormed prior to sale
2 1 nave 1,ved ,n my home for twe1ve mortis
pr,or to comple1,os or lh,s wo'k
nave nol claimed •~,s exemption aurin~ t~e
las! :nree years
I am exempt u~der Sec B & PC
lor this reason ____________ _
I hereby afl11m that, ha,e a ;ertil,cate of consent to
sr1I ~sure O' a ce,1if,cate of wc,ke,s Corv,pensat,on ,n
su,ance or a cert1'1ed copy lhPrecf ,Sec 3800 Labor Code\
POLICY ",0
COVPANY
Cop, ,s •,1ea with tne c1!y
Cenif,ea mp, ,s he,eb) fu,~1shed
CERTIFICATE OF EXEMPTION FROM
WORKERS COMPENSATIO's INSURANCE
,Th,s section need ~at ~e completed 1f the permit
,s for one hundred C~l'a·s ,$'001 or 1e>ss·,
I certify that ,n the periormance of tre work 'or wh,c~
;n,s permit ,s issued. I shall nol employ ary person n any
manner so as to become sub1eC1 to the Workers Com pen
sat,on Laws of Californ,a
NOTICE TO APPLICANT II after making :n,s Ce't1frcate
01 Exemplion you should become subJect to the Workers
Compensat,on pro,is,ons of :ne Labor Code. you must
lorttiw,th comply with such pro, ,s,ons or t~,s ::,erm,t shall
De deemed revokea
I hereby affirm that There s a corstruct c~ enc,0g
age~cv •or the pe·formance o' the wcrk 'or ,,r.,c~ :r,s per
-nit 1s issued ,Sec 3097 Civil Code!
Lender 5 Name
Lenaer's Address
USE BALL POINT PEN ONLY & PRE~S HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED ARE.A ANU Ul:.GLAH.AI IUN::».
CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad, CA 92009-1915 (619) 438-1161 APPLICATION & PERMIT
J08 ADDRESS
"2 t,4<:> \\ \\..L'S.~~ STC.o ~~~OS NO.
DATE OF APPLICATION
4-\3·8'8'
/SI BLOCK S~~S~N~
M~:,;~ A "''°'G-~~ T l4l .;:.·~:;_'i
l f~~so\+-,2'.:0 7 'S C 0 CONTRACTOR
~\AJ~£h:...
CONTRACTOR'S ADDRESS
c:;.~6'
~~~L~;DtE~\.et-toC:r. 0A~•--...~
---I q;zo:,&
DESCRIPTIO"' OF WORK ,
DESIGNER
~w"elt. ~\JI cl>1NG,--).a.
I \o-n )C \\ ~ ~-noCov6l2:.. r;:~R,S
NO
STORIES 0~15...., l_,A.-.-t'\.c_E
RES uN1TS GRADING PERMIT ISSUED
FP FLRELEV
,c '.~
TYPE
CONST
BUSl.:J/AENSE #
VALUATION
1,,(,0
CONTRACTORS PHONE -ZONE
STAT~7XNO
DESIGNER'S PHONE
STAT~r-,;◊
OCC GP EDU
DCC LOAD FIRE SPF>
PERMIT NUMBER
a~'?_oq,b/
BUILDING SO FOOTAGE
I CENSUS TRACT I eAe<,NC,o"ACe
'□ ~ D I REDEVELOPMENT
AREA
·C -....C YO"□ Not Valid Unless Milchme Certified
QTY PLUMBING PERMIT· ISSUE r;so QTY MECHANICAL PERMIT -ISSUE 1Sc0 SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP INSTALi FURN DUCTSUPT □lOOOOOBfU BUILDING PERM1! ·JO 1-8 'O-CIJ-OIJ-82?0 I Cf
EACH BUI LUING SFWER OVER lOOOOOBTU SIGN PERM IT 00 · -810-G0-00-0:::21
EACH WATER HEATER ANO UH VENT BOILER COMPRESSOR UP TO 3 HP PLAN CHECK 001-810-00-00-8891 /2-
EACH GAS SYSTEM I IU·~UUTLrTS BOILER COMPRESSOR 3 1J HP TOTAL PLUMB "JG 8rJ"-S 1 D OD ,:;o 0222
EACH GAS SYST E'I J OR MORE. ME:. TA·. ~ REPLAC~ ELECTRICAL OD 1 -b 1 0-00-0~ .. 82 23
-
EACHINSTAL ALltH.HtPAIHl'\'AltHPIPt VENT ~AN SINGLE DUCT MECHANICAL OD 1-31 O-G0-00-8224
EACH VACUUM BREAKER MECH FXHAUST HOOD DUCTS MOBILEHOME 001-ssu CO-C0-8225
WATER sor TNE:.R RELOCATION OF EA FURNACE HEATER SOLAR c:1 o1Cl-0D-OC-5226
fA r Q-',n; -,;,,..,1.,, ,,;, 1:r, DRYER VENT STRUNG MUTIO', s3:,-"i' 9-92-33 I
TOH,L MECHANl[AL FIRE SPRIN:<LERS ~,c11-81 :1-:0-:0-2221
T(JlAI P! ll~Hllr--.L I PUBLIC FAC'LITIES F~E 320-S · 0-:O-CQ-.3 7.:0
QTY. ELECTRICAL PERMIT -ISSUE sco QTY
NfW [[)NST U'1 AMP SV;'l bKH
I PH ', PH
DIST fJL:JG EA AMP·SV\'T BKR
1 PH 3 PH
RE'-'00fl Al ltR PEl--l l:lf![UII
Tf'\1PP[Jlt !IJUA\H'\
0\/E:.H }[JU AMPS
TEMP IJC:CUPANCY ·JO lJAYSI
MOBILE HOME ~1~
CAR PORT /,._q,"'-_. ~
AWNING fl\" '2' I •,1
GARAGE IQ ADD 1nnn
" -·
N N ,~, WYTk;),S(IQr:,, 1'ny Si CARt..SBAl C_~PI C:::Rrtn ,,. /11, ,.,,, 7J7 ~o... l ia'v/
~e~agr,JV
BRIDGE FEE
PARK-IN-LIE:.U 1:ARE:.A
TIF
LA COSTA TIF
FMF
LICENSE TAX
MFF
CREDIT DEPOSIT
35□-s 10-00-00-s 1 ..io
312-81 0-00-00-8835
311-810-00-00-8835
,Jo, _s, o-co-,~o-o, r~
880-519-92-57
-l '.1 TA I FI f I, l HI( A! I ·cp A TOTAL FEES PAYABLE l 3:1
I HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION AND PERMIT'. ANO DO HEREBY EJ(p,ral!on Every perm,t issued byttieBwldong Oll1c1sl under 1he prov,s,onsolth1s
CERTiFY UNDER PENAL TY OF PERJURY THAT ALL INFORMATION rlEREON INCLUDING THE Code shall expore by t,m,!at1on and become null and vo,d It the build,ng or work
DECLARATIONS ARE TRUE AND CORRECT ANO I FURTHER CERTIFY ANO AGREE IF A PERMIT 1::, au!horized by such permit 15 not commenced within 180days from ttie dale or such
* AN OSHA PERM:T IS REQUIRED FOR EXCAVATIONS OVER
5· O" DEEP AND DEMOLITION OR CONSTAUCTK)N Of
STRUCTURES OVER 3 STORIES IN HEKiHT
ISSUED TO COMPLY WITH ALL CITY COUNlY AND STATE LAWS GOVERNING BUILDING CO"l ~~~n~1~te buil 1~fle~rth:~~r:~tco~~~ ~y s~c7 perm,t '5 suspended or
STRUCTION. WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND '--;tc:c:c'::":":-'J'',"'i'tf"'""-"'"-"'-"'"-''-""""""e!S'S8Sd2"-oC-',ae_•~"£0Sd.;octa,,asOad••ll.---j,-.,,, ... -----------------------,11
KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND OWNE CONTRACTOR O APPROVED BY ~ o,1,e
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE \JiC\<'P,,,,!i~'\.<A. ~ n _ ' J./ / t"/
GRANTING oF TH1s PERMIT ~~, av PHONE n •-~~"-----"-l 7// 3/t'"
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TYPE DATE INSPECTOR
BUILDING
FOUNDATION
REINFORCED STEEL
MASONRY
GUNITE OR GROUT
SUB FRAME □ FLOOR □ CEILING
SHEATHING □ ROOF D 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
□ ELECTRIC UNDERGROUND □ UFFER
ROUGH ELECTRIC
□ ELECTRIC SERVICE D TEMPORARY
□ BONDING □ POOL
MECHANICAL
□ DUCT & PLEM., □ REF. PIPING .
HEAT -AIR COND. SYSTEMS ' ' VENTILATING SYSTEMS
CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
___ ITEMS ABOVE HAVE BEEN APPROVED
FINAL ... . .
PLUMBING . .
" ELECTRICAL .. ~
MECHANICAL • • .
GAS ~\l. "-
BUILDING ' " "-" ........ SPECIAL CONDITIONS \ ~
-✓ -
.
<!.8~~04"''
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
INSPECTION REQ IF INSPECTORS DATE_. ·-CHECKED APPROVAL ~ 1, ":;· . -''·· .. --.,
SOILS COMPLIANCE , '
PRIOR TO . . .
FOUNDATION INSP
'-..
STRUCTURAL CONCRETE . •. ' , OVER 2000 PSI ' PRESTRESSEO ; . .. ,~.j . ,. .
CONCRETE .. ~/ .-,
POST TENSIONED ' , "' . . , . ,,.V·:' CONCRETE ·, .;•
FIELD WELDING ' ~f!fJJJ Jh
,--;,',-:/
~ _1 /
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
PILES CAISSONS
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