HomeMy WebLinkAbout2571 ROOSEVELT ST; ; 83-196; Permiten z 0 ~ er: ~ ~ 0
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, 'ilsrBALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. --.... -·· --·----·----···--·-
0 I hereby affirm that I am llcen.,ed under
provision• or Chapter 9 (comrnerJclng with
Section 7000) of Division 3 of the• Business
and Professions Code, and ll'IY u&ense Is In
full force and effect. , . Lie No _____ Class .._J1-----
I hereby affirm that I am' exempt Ir..-• the Conrrac-tot's License Law lor !he following reasif" (Sec 7031 5 Business and Professions Code: Any city Of:· county ~teh re--
quires a perm,t to construct, alter lmpr~· _ demol!~h, or
repair any struclure, prior to its issuance a1tr"req~.-
plocanl for such permit to file a sl?ned statement !hat he •~ licensed pursuant lo the pramoos of the Contractor's License Law (Chapter 9 commencing w,lh 5ect10n 7000 of l
Division 3 of the Business and Profess,ons Code) or that Is... I
empt therefrom and the basis fo, !he ilftegeO -,,pt,on Any vlolat10n of SectlOO 7031. 5 by an apf)locant for a permit sub-1
jects the apphcant to a civil penally ol not more than five hun-dred dollars ($500).
□ I, as owner of !he property, or 1rrf employees with wages as their sole compensation. will do the work. and the struc-
ture ,snot intended or offered 10< sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does
:r::!n: :;. r.;: s~f~O:tii;;lt :1:~~~~~~:= employ .... provided that such Improvements are not Intend-
ed or offe,ed for sale. 11, however, !he building or imp(OVO-ment Is sold within one year of completion, the owner-builder
will have the burden of proving Iha! he did not build or Im-
prove 10< the purpose of sale).
□ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044.
Business and Professions Code: The Contractot's License Law does not apply to an owner of property who builds Of im-
proves thereon, and who contracts !Of each projects w~h a contractor(s) license pursuant to the Contractor's License Law).
0 As a homeowner I am improving 1rrf home, and the follow· Ing conditions exist:
1. The worf< Is being performed prior to sale. 2. I have lived in 1rrf home lor twelVe months
3. F:v~ :;'Pc':~of ~~: :!~pUon during the
last three years.
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□ lamexemptunderSec. ______ ,B&P.C. I
to, this reason 1
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□ I hereby affirm th.I I nave a certificate of consent
to sell•insure. or ti cert1f1cate of Wonters· Compensation lnsurat,ce. or a certified copy thereof
(Sec. 3800, Labof -
POLICY NO __
COMPANY
0 Copy IS filed
D Certified copy Is hereby lurmshed
CEATIFICATl OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
(This section need not be completed 1f the permit
1s tor one hundred dOlla,s ($100) 0t less)
D I cert,ty that in the performance ot the won-. !Of
which this pemut 1s issued. I shall not employ any
person ,n any manner so as to become sub1ect 10
the. Workers· Compensatton U ws ot Ca11torn1a
NOTICE TO APPLICANT If. after mak1n~ this Cen,
ftcate of EKemption. you should t>ecome subject I? the Workers· Compensation prov1s,ons of the ~r Code. you must forthwith comply with such
prov1sIons or this permit shall be deemed rev-oke<I
0 I hereby affirm ll'lat there Is a conslructt0n
tending ~ency tor the perl0tmance of 1ne w()f1( lo, wrnct"I 1t11s oerm,1 1s issued tSec 3097. C1v1I COde)
Lender sName ___________ _
Lender's Ac,dress __________ _
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CARLSBAD BUILDING DEPARTMENT APPLIC4-TI PERMIT
1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525 •~L, .....
J0e ADOR ESS AV. ST. I DATE OF APPLICATION I -.is1NESS LICENSE ft VALUATION ~AMIT NUMBER
I. 5"7/ #cCSl!.V'=.'-T
RO. '2/.; ,q 'i /7? OWIIIER"S NAME l.11,~r I OWNER'S PHONE CONTRACTOR CONTRACTORS PHONE t ZONE
~./~Ci-1l.t?~ I I,<,,C 'I 3Y -f.f.s-f,qf C ,,r,-t.l S' /ff; o E lJ. e...r l./ (. , , ,vc._ 729-1b%S-,
OWNER'S MAILING ADDRESS CONTRACTOR'S ADDRESS ttvsl/1t1-~ PLAN 1.0. # BLOG use CODE
,:5.,f-~ L /114 #'/tf-1,,U;;,tl,f l'f.UH-, C ,Ill..$"
I.OT I BLOCK I SUBDIVISION I ASS~Bi~~1EL~0000 OESIGNER LICENSE ,t STANDARO PLAN # BUILDING SQ. FOOTAGE
Ql8CRIPTION OF WORK
. . DESIGNER'S ADDRESS OESIGNER"S PHONE
//4;,f_f~~ ~-r7( __ -5/~/Blt,,wl 2m;oo 000111,,.. :e1~1 e3 F/P FLA ELEV. NO OCC GP EDU :?El.OJ'J STORIES
vO NO --OOC I; il.61 01 5/04,
CENSUS TRACT I GP LANO USE I PARKING SPACE I RES UNITS I GRADING ~ERMIT ISSUED I REDEVELOPMENT TYPE CCC LOAD FIRE SPA AREA CONST
YO N 0 vO NO vO NO Not Valid Unl#!Ss ~chine ~rtifild
QTY. PLUMBING PERMIT -ISSUE QTY. MECHANICAL PERMIT -ISSUE SUMMARTIACCOUNT NUMBER
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TD 100,000 BTU BUILDING PERMIT 01 ·00-00-8220
EACH BUILDING SEWER OVER 100,000 BTU SIGN PERMIT 01-00-00-8221
EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TD 3 HP PLAN CHECK 01-00-00-8806
EACH GAS SYSTEM 1 TD 4 OUTLETS BOILER/COMPRESSOR 3-15 HP TOTAL PLUMBING 01-00-00-8222 ...A -
EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ELECTRICAL 01 -00-00-8223 ~~"1/
EACH INSTA~ .. ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 01-00-00-8224
EACH VACUUM BREAKER MECH EXHAUST -HOOD/DUCTS M0BILEH0ME 01-00-00-8225
WATER S0FTNER RELOCATION OF EA FURNACE/HEATER M0BILEH0ME PARK INSP
EACH ROOF DRAIN (INSIDE) SOLAR 01-QO-nn.oooc
TOTAL MECHANICAL STRONG MOTION B0-92-33-0519
TOTAL PLUMBING I FIRE SPRINKLERS 01-00-00-8227
,-,?d QTY. SOLAR · ISSUE PUBLIC FACILITIES FEE 32·00·00-8923
QTY. ELECTRICAL PERMIT · ISSUE ~,<; --BRIDGE FEE
NEW CONST EA AMP/SWT!BKR .A COLLECTORS SCHOOL FEE , DISTRICT
I I PH ,.....-~ 3/J,f-/< ~-STORAGE TANKS Carlsbad 80·92·21·0519
EXIST BLDG EA AMP/SWT/BKR ROCK STORAGE _ ... Encinitas --~-i B0-92-22-0519 • I -
I PH 3 PH PUMP San 0ieguilo 80-92·23-0519 ... i.;. ~
REMODEL/ALTER PER CIRCUIT PLAN CHECK FEE ' San Marcos ,: ' 80·92·24·0519 \,
TEMP POLE 200 AMPS
OVER 200 AMPS
TEMP OCCUPANCY 130 0AYS)
--
TOTAL ELECTRICAL l P-6~ TOTAL SOLAR TOTAL FEES PAYABLE I c:2o ~
=VE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" ANO DO HEREBY Expiration E¥ery permit -by the Bullcling Official under the provt9'0M of this * AN 08HA PEflltlT 18 AEOUIREO FOR EXCAVATIONS OVER
TIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code lhall expire by llmotatlon and become null and votd II the bullding or wort< s· o-DEEP AND DBIIOUTlON OR CONSTRUCTION OF
lARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS authorized by euch permrt II not commenced w,th,n 180 day1 from the date of euch STI!UCl\lRES OVER l STORIES IN HEIGHT permit. or 1f the buildi:X: work auth.,tiad /iJfl euc:h permit II euspended or ./ =ED: TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON---at any ti-· ..,_ WOl'k · for a Denod of !An"•-.
UCTION, WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY ANO ·--· -,, i,//~I CONTRACTOR fl"' APPROVED BY
D:v KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND A//_),~ ~TUR "" OWNER□ //t'f~ EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE ,_ BY PHONE 0 I -;'ljl/3 GRANTING OF THIS PERMIT. ,v--._,
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-· --. ----INSPECTION TYPE DATE INSPECTOR
BUILDING
FOUNDATION f' !
REINFORCED STEEL I
MASONRY !
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME l
SHEATHING I
FRAME )
EXTERIOR LATH lNSULATION L ' ' INTERIOR LATH & DRYWALL I , ..
PLUMBING l
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SEWER AND BL/CO I , -I • :r ..
PLUMBING UNDERGROUND i
PLUMBING TOP OUT :
TUB AND ~HOWER PAN J .
GAS TEST I -
ELECTRICAL I
I
jfEMPORARY POWER I
ELECTRIC UNDERGROUND l
eoUGH ELECTRIC I ..
ELECTRIC SERVICE I
I
BONDING I •
G. F. I. -SMOKE DETECTOR ~ MECHANICAL
DUCT & PLEM., REF. PIPING
HEAT -AIR COND. -SOLAR SYSTE MS
VENTILATING SYSTEMS I
CALL FOR FINAL INSPECTION ~IVHEN ALL APPROPRIATE
ITEMS ABOVE HA VE1 BEEN-APPROVED.
JOB SITE FINAL .
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PLUMBING -~
ELECTRICAL I ,
MECHANICAL ~ -' GAS I I ... '
BUILDING l
SPECIAL CONDITIONS .
CERT OF OCCUPANCY ISSUED
... ~
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS
INSPECTION REQ IF INSPECTOR'S
CHECKED APPROVAL
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRESTRESSED
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH C ~ :r
BOLTS
SPECIAL MASONRY
·-.
PILES CAISSONS
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INSPECTOR'S NOTES
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O I hflfeby 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 effect.
Lie No ______ Class
I hereby alfirm that I am exempt from the Contra<:· tor's Ucense Law tor the tallowing reason (Sec. 7031.5
Sus,ness and Protessions Code: Any city or county Which re-quires a permit to construct, alter, improve, demolish, or r~r any structure, prior to its issuance also requires the ap·
pheant for SM!'h perm,l to file a si~ned statement that he is licensed pursuant to the provlslOf\S of the Contrac101·s L,cense uw (Chapter 9 convnencin~ with Sect10n 7000 of
Oiiision 3 of the Business and Professions Code) or that is ex-empt therefrom and the basis for the allege(I exemption. Airy
Vlolal!on ol Section 7031.5 by an applicant for a permit sub-jects the a1>11t1eant to a civil penalty ol not more tllan fr,e hun•
dred dollars ($500)
D I, as owner of the property, or my employees with wages
as their safe compensation, win do the work, and the struc-ture Is not intended or ottered for sai. (Sec. 7044, Business
and Profess!OOs Corle: The Contractor·s License Law does
not apply to an owner of property who bUllds or improves
thereon and who does such -k himself or through his own employees. prOYided that such improvements are not Intend·
ed or olfered for sale. If. however. the building or improve-ment is sold wfthin one year of completion, the owner-builder
wlll have the burden ot prOYing that he did not build or im· prove for the purpose of sale).
O I, as owner ol tho property, am e,cluslvely contracting with ficensed contractors lo construct the project (Sec. 7044,
Business and Professions Code: The Contractor's License uw does not apply to an owner of property who builds or im· proves thereon, and who contracts tor each projects wtth a
contractor(s) licanso pursuant to the Contractor·s License Law).
0 As a homeowner I am Improving my home, and the follow· ing conditions exist 1. The work Is being perlormed prior to sale. 2. I have liYed in my home for twelve months
3. rt: :;1P~ol :~ ::~PIM>n during the
last thrae years.
0 I ame,empt under Sec. ______ , 8& P.C.
for this reason ____________ _
D I hereb¥ athrm that I ha-.e a cen1t1cate or consent 10 self.insure. or a cen,t,cate of Workers·
Compensation Insurance. or a cert1tIed copy thereof
(Sec 3800. L.at>or Code)
POLICY NO ____ _
COMPANY
□ Copy IS hied With the c,ty
O Cert,hed copy Is hereby furnished
CERTIFIC ... Tl OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE (This section n,eed not be completed ,t lhe permit
Is for one hundred dOllars (S1001 or less)
0 I certify that ,n the performance of the work lor
which this permit 1s issued. I shall not employ any
pe,son m any manner so a.s 10 become sub1ect to
the Wot1ters· Compensation Laws ot California
NOTICE TO APPUCANT 11. after mak1n;i this Cert•
llcate of Exem.Pt•on. you should become sub1ec1 I?
!he Workers' CompensaI,on provIsIons of the labor
Code. you must for1hw1th comply with such
p,rovIsIons or this perm,1 shall be deemed revokeo
0 I hereby afltrm 1na1 there Is a cons1<uc11on lending agency lor the perlormance of the wo~ tor
which lh•s permit ,s issued (Sec 3097. C1v1I Code)
Lenoer s Name ___________ _
lender's Address __________ _
USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS ----
r CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT 1~ Elm, Carlsbad, California 92008-1989 (619) 438-5525
JOB AODRESS /4: :1 ~A.,J J;f AV, ST., DATE OF APl'I..ICATIONI BUSINESS LICENSE # VALUATION PERMIT NUMBER
h? ,c;-71
RO.
/l6/iJ OWN:JlE-;1; • I OWNER"S PHONE CONTRACTOR CONTRACTORS PHONE • ZONE ~,,~AL n __,J dJ:-;,/-/JMr, J -
OWN~;,MAILING AODRE.d; CONTRACTOR'S ADDRESS LICENSE NO. PLA N 1.0. # BLDG use cooE1
LOT I BLOCK I SUBDIVISION I ASSESSOR PARCEL NO. DESIGNER LICENSE It STANDARD PLAN# BUILDING SO. FOOTAGE
DESCRIPTION OF WORK
,I DESIGNER'S ADDRESS DESIGNER'S PHONE .
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NO
. . . 7 --F/P F LR ELEV. OCCGP .EDU
STORIES L -..o;~ C.Miol
vO NO --
CENSUS TRACT I GP LANO USE I PARKING SPACE l RES UNITS I GRADING ~ERMIT ISSUED I REDEVELOPMENT TYPE OCC LOAD FIRE SPA
AREA CONST
YO N □ vO NO vO NO
-7.£!-3..41!) ~~ GQ8~~t '~S! ! .(
QTY. PLUMBING PERMIT · ISSUE QTY. MECHANICAL PERMIT · ISSUE SUM AC ~'--~-:~ iJ:!/[ J/ :::-, '. 1
EACH FIXTURE TRAP
., INSTALL FURN. DUCTS UP TO 100,000 BTU BUILDING PERMj.v 01 ·00·00·8220 -~
EACH BUILDING SEWER OVER 100.000 BTU SIGN PER~ 01 ·00·00·8221 -
EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP PW/'CHECK 01 ·00·00·8806
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3-15 HP l_,,.....,.OTAL PLUMBING 01 ·00·00·8222
EACH GAS SYSTEM 5 0 R MOR E METAL FIREPLACE " ~ ./ ELECTRICAL 01-00·00·8223 .A
EACH INSTAL .. ALTER, REPAIR WATER PIPE VENT FAN SINGLE DUCT -ll iJ / . ..JJ i--MECHANICAL 01-00·00·8224 ;;,;~
EACH VACUUM BREAKER / MECH EXHAUST • H0 00/0 JCTS 1J / ::-s ~.,, MOBILEHOME 01 ·00·00·8225
WA TEA SOFTNER RELOCATION OF EA FW!Jl1 CE/HEtfER ,,,/ MOBILEHOME PARK INSP
EACH ROOF ORAIN (INSIDE) V / SOLAR 01-M-00-112?~
TOT.t.L MECHA:7i 1/ 6 r;--I,, STRONG MOTION 80·92·33·0519 . I TOTAL PLUMBING FIRE SPRINKLERS 01-00·00-8227
S-:!!!-SOLAR -~
PUBLIC FACILITIES FEE 32-00-00-8923
QTY. ELECTRICAL PERMIT · ISSUE QTY. -BRIDGE FEE
NEW CONST EA AMP/SWT /BKR COLLECTORS / SCHOOL FEE • DISTRICT
1 PH 3 PH STORAGE TA¢ Gar1sbad 80·92·21·0519
EXIST BLOG EA AMP/SWT /BKR -ROCK ST9AAGE Encinitas 80-92-22·0519
1 PH 3 PH PUMP ( i San Oieguito 80·92-23-0519
REMODEL/ALTER PER CIRCUIT PLAN CHECK FEE . ' San Marcos 80·92·24·0519 .
TEMP POLE 200 AMPS -
OVER 200 AMPS C
TEMP OCCUPANCY (30 DAYSI ' -
TOTAL ELECTRICAL I I .
TOTAL SOLAR I I 6 C--TOTAL FEES PAYABLE
\.
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERM!r' ANO 00 HEREBY ExpirallOn. Ew,y penM iMliedbyllleBuilcllngOfflllialunderlhepn,wlaioneo/tlws ~ .Nf QISHA PENffl IS REQUIIED FOR EXCAVATIONS OYER
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code 1111111 expire by -tlon -beCOllle flu8 and VOICS1f n.·~ a,_. .... O" DEEP AND OBr10UTl0N 0111 CONSTRUCTION OF
DECLARATIONS "RE TRUE AND CORRECT AND I FURTHER CERTIFY ANO AGREE IF A PERMIT IS aulllonzed by IUCII permit ia IIOI com--,., .. from the OI MICII snumlRES OYER 3 STORIES IN HEIGHT permit, or rt 111e builcll:i'L.°' work aulllOriMd by IUClt _ii! a•.,. = or ISSUED: TO COMPLY WITH ALL CITY, COUNTY AND STATE LAWS GOVERNING BUILDING CON--•cloned al -time Ille work Is tor a ,..,
STRUCTION. WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND
A~Tu(• OWNE/1 CONTRACTOR□ APPROVED BY p I~~ KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND ~ A -EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE BVPHONE 0 GRANTING OF THIS PERMIT. -~.,~ ... /
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INSPECTION TYPE .. DATE -···-INSPECTOR ... _. _ _.._. ..
BUILDING I
I
FOUNDATION I FIELD INSPECTION RECORD
..
REINFORCED STEEL l --REQUIRED SPECIAL INSPECTIONS
MASONRY ' I INSPECTION REQ. IF INSPECTOR'S
CHECKED APPROVAL
GUNITE OR GROUT l ' SOILS COMPLIANCE
FLOOR & CEILING SUB FRAME PRIOR TO
I FOUNDATION INSP
SHEATHING -. I FRAME
STRUCTURAL CONCRETE
OVER 2000 PSI
EXTERIOR LATH lNSULATION I PRESTRESSEO
CONCRETE
INTERIOR LATH & DRYWALL I
POST TENSIONED
CONCRETE
PLUMBING I
-FIELD WELDING
SEWER AND BL/CO I HIGH STRENGTH
PLUMBING UNDERGROUND I BOLTS
PLUMBING TOP OUT SPECIAL MASONRY
---TUB AND $HOWER PAN
GAS TEST ' PILES•CAISSONS ' < ELECTRICAL •
TEMPORARY POWER
ELECTRIC UNDERGROUND
ROUGH ELECTRIC '
.
ELECTRIC SERVICE I
BONDING I . "
G. F. I. -SMOKE DETECTOR '
MECHANICAL •
DUCT & PLEM., REF. PIPING
HEAT -AIR COND. -SOLAR SYSTEMS ,
I .A
VENTILATING SYSTEMS -c(/q // 1//lJ • " -
CALL FOR FINAL INSPECTION WHEN dLl APP {dPRIATE
ITEMS ABOVE HA VE BEEN APPROVED.
(
JOB SITE FINAL ' PLUMBING
ELECTRICAL .,
MECHANICAL -\
' GAS '
BUILDING I
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SPECIAL CONDITIONS --,, ... CERT OF OCCUPANCY ISSUED ..
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INSPECTOR'S NOTES
DATE
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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 In
full force end effect.
L,c No ______ Class
I hereby att1rm that I am exempt from the Cootrac·
!or's l,cense Law for the lollowmg reason (Sec. 7031.5 Busmess and ProfesslOfls Code Any c,ty Of counly which re-quires a permit to conslruct, alter, tmprove, demotish. Of
repair any structure. prior to ,ts ,ssuanc.e also requires !heap-
plicant !or such permit to file a ~~oed statement that he 1s ltcensed pursuant 10 the prov1st00s of 1he Contractor"s
ucense Law (Chapter 9 commencing with Section 7000 of D1v1st0n 3 of the Busmess and ProfesSK>ns Code, Of' thal lS ex-
empt lherelrom and lhe basis tor the allege<J exemphon A.rry vt0fat10n of Secoon 7031 .5 by an applicant 101 a perm,1 sub-
,e<:ts the appl1can1 to a c1v11 penalty ot not mOfe than hve hon-
dred dollars ($500)
O I. as owner of the property. o, my employees with wages
as their sote compensation, wih do lhe work, and the struc-
ture 1s n01 intended or olfered tor sale (Sec 7044, Business
and Professions Code: The Contractor's License Law does nol apply to an owner ol property who builds or unproves
!hereon and who does such work htmselt or lhrough his own employees, provMled that such improvements are not intend-
ed Of ottered tor sale. 11, however, the bu1fdmg or improve-ment is 5'Hd w1th1n one year at comptetion, the owner-bu,tder
will have the burden of proving that he did nol build DC im-prove for the purpose ol sale).
O I, as owner 01 the property, am exclusively contracting with ltCensed conlfactors to construct the pro,ect (Sec. 7044,
Business and PfolessfOns Code: The Con!ractor·s License
Law does not appty to an owner of property who builds or im-proves thereon, and who contracts lor each ptojects with a contractOl'(s) license pursuant to the Contractor's License Law).
O As a homeowner I am improving my home. and the tollow· Ing condmons exist:
1. The work is being performed prior to sale.
2. I have lr\led in my home lor twtl.ve months prio< to completion ol !his -k. 3. I have not claimed this exemption during lhe
last three years.
D I am exempt under Sec. ______ . 8 & P.C.
lor this reason
□ I hereby affirm tllal 11\Ch'e a cert1hcate of consent
10 self-insure, or a cer11t1ca1e ot Work.ers· Compensation Insurance. or a cerr,tie,c, copy thereol
(Sec 3800. l.al>O• Code)
POLICY NO
COMPANY
□ Co()y IS filed with the City
□ Cert1t1ed copy 1s hereby furnished
CERTIFICATl OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This sec11on need not be completed ,t the perm11
1s tor one hundred dollars ($100) OI less}
D I cert1ly that m the performance or the woo lo,
which this permit 1s 1ss~. I shall no1 employ any
person 1n any manner so as to beeome sut>1ec·1 10
the Workers· Compensation U ws of Caltforn.ai
NOTICE TO APPLICANT If. after mak1n7 ttus Cert,
heate of Exemption. you should t>ecome sub1ec1 ,,,
lhe Wor'kers· Compens.it1on pt~1s1ons ol lhe ut:,o, Code. you musl forthw1lh comply w1lh such
provisions or tt11s permit shall be oeemed ,evoked
D I hereby affirm Iha.I there ,s a cons1ruct1on
lending agency tor !he per\orma.nce ot the ~one: tor which this perm,t ,s ,ssue<J (Sec Y:137 C•v1I Codel
Lenoer s Name ___________ _
Lender·s AOOress __________ _
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CARLSBAD BUILDING DEPARTMENT APPLICATION & PERMIT
I " . 1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525
JOB ADDRESS Ro,.,< s: VE LT'
AV.ST.RO. NEAREST CROSS ST.
loj?;:r:;T~
BUSINESS LICENSE # VALUATION PERMIT NUMBER
2r7/ -:Yr'.trrt= S-os-7 /-Z.ocJ,# _!!.!.... F020-~ LOT BLOCK I suBo• vIsI0N ' I ASSESSOR PARCEL NO. CONTRACTOR CONTRACTORS PHONE• ZONE
OWNER'S NAME b2;:;·~;; ,:::;~ ~tJ~(,{ ~ 9Zc: . ..+\ S l4S?-7·;;;
C!Aii!. Co.A. ,-LJC.
CONTRACTOR'S ADDRESS / LICENSE NO PLAN 1.0. # BLOG USE CODE
~/tJZ, I A ~~jlt1~ .P1ic Ir'# ~ots-5o OWNER'S MA, LING ADDRESS
"2. s-, I ~ ~.:l.Se vet... -r DESIGNER . LICENSE • STANDARD PLAN# BUILDING SO. FOOTAGE ~-L.c#:A.AS OESCRIPT1DN OF WORK ..4.-n~ -F"i.AE ~..L ;~Jit"l ~~ ""
_ ... _, ...
DESIGNER'S ADDRESS DESIGNER'S PHONE Utf~1 It rt. 7 .
. ~ ' ~~E"' ~i:· ;.r~
•-;;:. F77 #;lltl~ --'~-1-$,v~~ --C ~------F/P F LR ELEV. NO OCC GP EDU
STORIES
vO NO --
CENSUS TRACT I GP LANO USE I PARKING SPACE 1 RES UNITS I GRADING PERMIT ISSUED I REDEVELOPMENT TYPE OCC LOAD FIRE SPR AREA . CONST
YO N 0 v O NO vO NO Nor Valid Unkn ~chine Cerrifi«J
QTY. PLUMBING PERMIT · ISSUE QTY. MECHANICAL PERMIT· ISSUE SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TO 100.000 BTU BUILDING PERMIT 01·00·00-8220
EACH BUILDING SEWER -OVER 100,000 BTU SIGN PERMIT 01 ·00·00·8221
EACH WATER HEATER ANO/OR VENT BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 01 •00·00-8806 /~.2....<
EACH GAS SYSTEM 1 TO 4 OUTLETS BOILER/COMPRESSOR 3·15 HP TOTAL PLUMBING 01·00-00-8222
EACH GAS SYSTEM 5 OR MORE METAL FIREPLACE ELECTRICAL 01-00-00·8223
EACH INSTAl .. ALTER. REPAIR WATER PIPE VENT FAN SINGLE DUCT MECHANICAL 01·00-00-8224
EACH VACUUM BREAKER MECH EXHAUST -HOOD/DUCTS MOBILEHOME 01 ·00·00·8225
WATER SOFTNER RELOCATION OF EA FURNACE/HEATER MOBlLEHOME PARK INSP -
EACH ROOF DRAIN (INSIDE) SOLAR n1.nn.nn.o,,c
TOTI.L MECHANICAL STRONG MOTION 80·92-33-0519
TOTAL PLUMBING I FIRE SPRINKLERS 01 ·00·00·8227 7-0, ~D
QTY. ELECTRICAL PERMIT· ISSUE QTY. SOLAR· ISSUE PUBLIC FACILITIES FEE 32·00·00·8933
BRIDGE FEE
NEW CONST EA AMPl SWT BKR COLLECTORS SCHOOL FEE • DISTRICT
I PH 3 PH STORAGE TAN KS Carlsbad 80·92·21-0519
EXIST BLDG EA AMP/SWT/BKR ROCK STORAGE Encinitas 80·92-22-0519
I PH 3 PH PUMP San Dieguilo 80·92-23-0519
REMODEL'ALTfR PER CIRCUIT PLAN CHECK FEE San Marcos 80·92·24·0519
TEMP POLE ]00 AMPS
OVER 100 AMPS LICENSE TAX 01-00-00-8162
TEMP OCCUPANCY (30 DAYSI
CREDIT DEPOSIT
TOTAL ELECTRICAL l TOTAL SOLAR TOTAL FEES PAYABLE I ~R.S
I HAVE CAREFULLY EXAMINED THE COMPLETED '"APPLICATION ANO PERMIT" ANO 00 HEREBY E•pirellOn E--, permit -bylhe BulklingOfficlef under the p,ovt910IIS oftl111 * AN OSHA PEflMfT IS AEOlMEO FOR EXCAVATIONS OIIEfl
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code -••Pl,. by !imitation and become null -•oid II the building or worl< S' O"' DEEP ANO DEMOUTION OR CONSTAUCTION OF
DECLARATIONS ARE TRUE ANO CORRECT AND I FURTHER CERTIFY ANO AGREI! IF A PERMIT IS autllOrizeo by such permit ,. not commenced Within 180 days from lhe date ol such STIIUCl\JAES OIIER 3 STORIES IN HEIGHT permll or of the buoldt::X or work aulhonud by such perm11 ,. •--or ISSUED· TO COMPLY WITH ALL CITY, COUNlY ANO STATE LAWS GOVERNING BUILDING CON--cloned at •nv bme a er 1118 worti II COln,-,cad tor• -oc1 ol 1Ril "-•
STRUCTION, WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND
~/T'S ~ OWNER□ CONTRACTO'r <:'-/ --/ ~ DATE KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS. COSTS AN
1-J2~ EXPENSES WHICHCMAY IN ANY WIC't ACCRUE AGAINST SAID CITY IN CONSEQUENCE OFT ~ ~ ~~~.I ... BY PHONE 0 --r:-tvr~ ,GRANTING OF THIS PERMIT, ,..... -,
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TYPE .1. DATE INSPECTOR
BUILDING I
FOUNDATION I
REINFORCED STEEL I
MASONRY I
GUNITE OR GROUT I
FLOOR & CEILING SUB FRAME '
SHEATHING D ROOF □ SHltAR
FRAME I
I
EXTERIOR LATH I I
INSULATION I
INTERIOR LATH & DRYWALL ;
I
PLUMBING I
SEWER AND BUCO □IPUCO I
I
UNDERGROUND □ WASTE □ WATER -
TOP OUT □ WASTE D WATER
TUB AND SHOWER PAN :
GAS TEST I ,,
□ WATER HEATER D SOLAR WATER " C
:
ELECTRICAL I
□ ELECTRIC UNDERGROUND DUFFER
ROUGH ELECTRIC I
I
□ ELECTRIC SERVICE □ TEMPORARY ' -
□ BONDING □ POOL I
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MECHANICAL I
□ DUCT & PLEM., □ REF. PIPING
HEAT -AIR COND. SYSTEMS I
VENTILATING SYSTEMS I .. _
' -'·
I -CALL FOR FINAL INSPECTION WHEN ALL APPROPRIATE
ITEMS ABOVE HAVE BEEN APPROVED.
FINAL
PLUMBING
ELECTRICAL
MECHANICAL
GAS
BUILDING ·,
SPECIAL CONDITION _/ I ..,,...
/
" . ---. ... ~ ' ~ -. ; .· •
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS INSPECTOR"S NOTES
INSPECTION REO IF INSPECTORS DATE CHECKED APPROVAL
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRES TRESSED
CONCRETE
POST TENSIONED II a, CONCRETE ,,
FIELD WELDING I
HIGH STRENGTH '~
BOLTS --
SPECIAL MASONRY ,. • .• ':!. . --'-"
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PILES CAISSONS "
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