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USE BALL POINT PEN ONLY & PRESS HARD APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.
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CARLSBAD BUILDING DEPARTMENT
1200 Elm, Carlsbad, California 92008-1989 (619) 438-5525
APPLICATION & PERMIT 7/i! D I hereby alllrm that I am licensed under
provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business
and Profeoalons Code, and my license is in
full fo:MJ.~ ~ .,5~ Lie No ~~---4~-Class "'.:
------J°j;;s5o,r,/,,-~~._s-1. AV.ST.RLosN~;;;s~;~/4, D;TE;;;~TION e;;;s;ICENSE~ VALUA ION g{~MITN:::
LOT BLOCK SUBDIVIS,ON ASSESSOR PARCEL NO. CONTRACTOR CONTRACTORS PHONE• ZONE ) J
OWNERS NAME OWNER'S PHONE ~,.. ~/4 J "" 7-~s;I ,Ale~,, '-11.2 • .J'?SS CONTRACTOR"$ ADDRESS LICENSE NO. PLAN 1.0. # BLDG USE CODE
I hereby at11rm Iha! I am ex.empt from the Contrac·
tor"s License Law t01 the !allowing reason (Sec. 7031.5 Business and Professions COde. Any city or county whtCh re• quires a permit 10 construct. alter, improve. demolish. or
repair any structure. pnor to ,ts issuance also requires !heap-
phc.ant lor such oerm,t to file a si~ned statement that he is
licensed pursuant to the pcov1s1ons al the conlractor's
Ucense Law (Chapter 9 commencing with Section 7000 of Otv1s,on 3 of the Business and Prolesst0ns Code) or that iS ex-empt lherelrom and the basis tor the allegea exemption Any
v1olat10n of Section 7031.5 by an applicant !or a perm11 sub-
iects lhe apphcant to a civil penalty of not more lhan hve hun• area dollars {$500)
OWNER'S MAILING ADDRESS -2/'/9 I ,l~r .....1 J/. ¥PJ'J¥tf
-''t)~ ..s,,,., 'l'/J ,54,,, ~ • ~~~ DESIGNER LICENSE# STANDARD PLAN# BUILDING SO.FOOTAGE
IDESCV~RKA'-◄ 1,,,,. I DESIGNER'S AD-DRESS DESIGNE R;S-PHONE
I/ 0~/ Elo243J L!• F/P FLA ELEV. NO OCC GP EDU
STORIES
vO NO
GP LAND USE PARKING SPACE RES UNITS GRADING PERMIT ISSUED TYPE OCC LOAO FIRESPR
CONST
O I, as owner of the property, or my employees wI1h wages
as their sole compensation. wm do the work, and the struc-ture is not 1n1ended °' offered tor sale (Sec 7044, Business
and Profession~ Code The Contractor's L1tense Law does
not apply lo an owner of prapeny who builds or improves !hereon and who does such work himself or through his own
employees. provided that such ITT'\provements are not 1ntertd-ed or offered !or sale. II, hOwever, lhe bu tiding or 1mpr0Ye·
menl is sokt within one year ol completion. the owner-builder wm have the burden ol proving that he did not build or Im-
prove for !he purpose ol sale)
CENSUS TRACT I
v □ ND FEVELOPMENT
A
vO NO vO NO I Not Valid Unl~s Machine Certi fied
□ I, as owner of 1ne property. am exclusively contracting
with licensed contractors to construct the pro1ect (Sec 7044. Business and Protesst0ns Code: The Contractor's License
Law does not apply to an owner of property wf'IO builds°' im-proves thereon, and who contracts for each projects with a
contractorts) hcense pursuant to the Contractor's License Law)
D As a homeowner 1 am ,mproving mt home, and lhe !allow-
ing conditions exist. l. The work is being pertormed prtor to sale.
QTY.I PLUMBING PERMIT -ISSUE
EACH FIXTURE TRAP
7~
7
EACH BUILDING SEWER
EACH WATER HEATER ANDIDR VENT __!1 .1?',
QTY. MECHANICAL PERMIT -ISSUE I '3 -SUMMARY/ACCOUNT NUMBER
INSTALL FURN. DUCTS UP TO 100,000 BTU J ~ BUILDING PERMIT 01-00-00·8220
OVER I00,QQQ BTU "1" I u,u,. • L""'"
BOILER/COMPRESSOR UP TO 3 HP _/
<arm P,RMIT 01 ·00·00·8221
PLAN CHECK 01 ·00-00-8806
TOTAL PLUMBING 01 ·00·00-8222 2 I have lived m my home !or lwelve months pnor to comple110n of this work 3. I have not claimed this exemption during the
last three years
D I am e,empt un<Jer Sec. ______ . B & PC
EACH GAS SYSTEM 1 TO 4 OUTLETS
EACH GAS SYSTEM 5 OR MO Rf
EACH INSTAL. ALTER. REPAIR WATER PIPE
BOILER/COMPRESSOR 3 15 HP / -,I "'TRl~dl 01-00-00-8223
MECHANICAL 01-00-00-8224
L•.,Jvumunc I I I METAL FIREPLACE Z I I LLLu<n<u"L I
VENT FAN SINGLE DuS,Y'
!or tt11s reason ____________ _ EACH VACUUM BREAKER
WATER SOFTNER
EACH ROOF DRAIN (INSIDE! D I hereby affirm tha1 I have a cen,ticate ot consent
to sell ,nsure, or a cert1t1cate ol Workers
Compensation Insurance. or a cen1l1ed copy thereof 1 ~---'--------
(Sec 3800. Lat>or CodeJ __ i• ! TOlALPLUMBIN(
MECH EXHAUST ~00/0UCTS
RELOCATIONji?'EA FURNACE/HEATER z
Tt#t;L MECHANICAL
I
MOBILEHOME 01-00-00-8225
MOBILEHOME PARK INSP
SOLAR Q]·QQ·QQ-8226
I--STRONG MOTION 80-92-33-0519
FIRE SPRINKLERS 01 ·00-00-8227
PUBLIC FACILITIES FEE 32-00-00-893)
./A.t.i!:JI!)
QTY.I ELECTRI< ooinr;E FEE
SCHOOL FEE · DISTRICT
rnM,.,,.,NTTn,nc_y,-,,6 ~uc.ry, --. -. :AL PERMIT -ISSUE <:::::..., QTY. SOLAR . ISSUE I --_;:--.
V Coov <S f,led w,lh lhe C<ly ~ U llHIUb" ••• , r' NEW CONST EA AMP SWT BKR l.----COLLECTORS ./ " '
0 Cen,hec.1 copy ,s hereby furnished .../ _,,,,,,,,,,,. I PH 3 PH ./ . STORAGE TANKS ./
CERTIFICATl OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Tl'us section nee<l not be compleled 1I the perrru1
1s tor one f'\undrea dOllars IS 100) or lessJ
0 I cen11y that 1n !he per1ormance ol lhe wo~ !or
•h1ch ttus permit 1s ,ssued. I shall no1 emolo)I any person 1n any manner so as 10 become suo1ec1 lo
the Workers· Compensahon Laws ol Cahtorrna
NOTICE TO APPLICANT If, after malun~ 1t11s Cem
hcate of E.1emp11on_ you should become suo,ec1 I?
tne wons.:ers· Compensa11on pro>11s1ons or the Labor Cooe. you mus1 lor1h'#1o1th comply with such
pro>11s,ons or this perm,t snail be deemed re>1oke<2
r,,rt,-h,,rl 80-92-21-0519
l=nr-init:::ic: 80·92· 22·0519
c:,.n nion,,itn 80-92-23-0519
C:-:in A.A-:irrnC" 80·92-24-0519
./ ./ • II ~arisoao
EXIST BLOG EA AMP SWT BKR ./ , ROCK STORAGE / . " l PH ..., 11 C:lll,,lllllO~
.,,,., H . PUMP / • r n /. . II .:>dll Ult'YUllU
REMOOE L AL Tt R PEyt,IRCUIT . PLAN CHECK FEE /
TEMPP0LE 200 ~S . ./ . C>dllm
4
,cu,
OVER 200 A~ . • . LICENSE TAX 01-00-00-8162
TEMP OCCUPANCY 130 OAYSI . MFF 80-92-57-0519
-. CREDIT DEPOSIT
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lOTAL ELECTRICAL l TOTAL SOLAR l . TOTAL FEES PAYABLE /(!}• t)l)
I I I
· I HAVE CAREFULLY EXAMINED THE COMPLETED .. APPLICATION AND PERMIT" AND DO HEREBY Exp,rallon Every permit rssued bytheBu1ldrngOfhc,al unaertheprov,s,onsofthrs
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O I tlereoy alhrm Chat !here ,s a cons1ruc11on
tending aoency tor 1ne pertormance ot lhe won,. !or
wh,ch lh•• pe,m,I ,s AZ (Sec .l097 C,v,I CooeI
Lender s Name A (.,J
I CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code snail e,prre by lom1tat1on and become null and void If the building or work * AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER
I DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS autt>orrzed by suet, permit ,snot commenced w1tt>1n 180 d~'(S from t1Y.1a1e of such 5· O" DEEP AND 0£MOLITION OR CONSTRUCTION OF
I ISSUED TO COMPLY WITH ALL CtTY C0UNlY AND STATE LAWS GOVERNING BUILDING CON pe~r;:~or 11 th~v butldrnft or work authorrzed by such permit 15 suspended or STRUCl\JMS OVER 3 STORIES IN HEIGHT Ql
STRUCTION, WHETHER SPECIFIED HEREIN OR NOT I ALSO AGREE TO SAVE INDEMNIFY AND 8 n eel at an time a ter the work Is commenced for a oerrod ol 180 davs ~-~
I KEEP HARMLESS THE CITY Of CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. cosTi ~AND CANT'S SIGNATURE • OWNER O CONTRACTO~ APPROVED BY DATE s: Lenders Address __________ _
I EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE Q ~ . --±-,_/-. ~f .J J
I
GRANTING OF THIS PERMIT -., • BY PHONE O / 1 <._ , • .A, --... ·~ -.. -• I .,.,, v
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TYPE I
BUILDING I
OUNDATION ' . -I
~EINFORCED STEEL I
.1ASONRY I
:aUNITE OR GROUT I
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LOOR & CEILING SUB FRAME I
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HEATHING □ ROOF □ SHGAR
RAME I
I XTERIOR LATH I
INSULATION I
INTERIOR LATH & DRYWALL I
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I . , PLUMBING I ~•
SEWER AN~-'SUC'Q'-..\1!:JJPUCO ' ~-'"
UNDERGROONU, :.:t(WASTE" ,{] VVATER
TOP OUT □ WASTE □ WATER
TUB AND SHOWER PAN I
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GAS TEST I
□ WATER HEATER □ SOLAR WATER
I
ELECTRICAL ' I
□ ELECTRIC UNDERGROUND □ l!JFFER
ROUGH ELECTRIC I
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□ ELECTRIC SERVICE □ TEMPORARY
□ BONDING □ POOL I
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MECHANICAL ' I
□ DUCT & PLEM., □ REF. PIPING
HEAT -AIR COND. SYSTEMS I
VENTILATING SYSTEMS i
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DATE
...
--,.,"'"-•. ~ INSPECTOR C-• ... --,
•. .
FIELD INSPECTION RECORD
REQUIRED SPEC IAL INSPECTIONS
REO IF INSPECTORS INSPECTION CHEC KED APPROVAL
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
' OVER 2000 PSI
" PRES TRESSED " CONCRETE .
• POST TENSIONED
CONCRETE
--FIELD WELDING --HIGH STRENGTH
BOLTS
\.\:::, ~ SPECIAL MAt4'0N~'
PILES CAISSON'> ~ ' '
" .. -' : ... "
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CALL FOR FINAL INSPECTION WHEN ALL APPROPR_}}:rE
ITEMS ABOVE HA VB BEEN APPRl:>-VED,, .-. . ... 1 1,.. "''• , ....... ' FINAL I . • I/ -... '\ _/ '· -..
j)iV" . , .... ~.:,~ ,~· .. (V1 -~II~ '\ ",..., ... r-':"",--:.".I PLUMBING I ' . " :,,..-. . . . ~ . ~ ..... -.. --
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-_.._ ..
DATE
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---. MECHANICAL I t1 ·--1 / //"//'-'A
GAS 1/ A, • ,l V • f ~ •• r. .ltl,T. r "' .. --"-'-"' .. ~ ----,. ..... ~ .. " -.. . . --... -.... ' . .... . €J.. I I (,,I' BUILDING
SPECIAL CONDITIONS ;1 I
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INSPECTOR'S NOTES
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