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u:.t tlRLL ru1111 rt11 u11u & nlt.~;l n,u,u 1-\t't'LIVI-\N I IU rlLL IN INt-UHMAI IUN WIIMIN ::,iMAUl:.U AHl:.A ANU Ul:.\.iLAHAI IUN::,i
CARLSBAD BUILDING DEPARTMENT
1200 Elm, Ca~lsba~.~~lifornia 92008-1989 (619) 438-5525 APPL~~~N & PERMIT ri'i hereby affirm that i am iicensea 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:_t,.~d e!.fpct...., /' .. 2 ~
Lie No ~10(.'{;;~{)' I Class ~ __
'7:;'io K, ,_ k Place_ : VACUAT,ON 3EAMIT NUMBER
I hereby affirm that I am exempt from the Con1rac-
tor's License Law lor the following mason (Sec. 7031 5
Business and Professions Code· Any city or county which re-quires a perm,t to construct alter. improve, demol,sh, or
repair any structure, prior to I1s issuance also requires the ap-plicant for such permit to Me a signed statement that he ,s
licensed pursuant to the provisions of the Contractor's
license Law (Chapter 9 commenc1ng with Section 7000 of
DIv1sion J ol the Business and Professions Code) or that ,sex·
empt there1rom and the basis for the alleged exemption. Any
v1olat1on ol Section 7031_.5 by an applicant tor a permit sub-1ec\s the appl,can1 to a c1v1I pMalty of no! more than five hun-
dred dollars {$500)
0 h14~rd l-/at1S€,h COHw7Jn' ZONE cR S-lJ
0 t.:;/~'x,;k~ fla<e, ..l01-¼0 SC,00 ='-"'=-....:::..-'?"..1d✓t?? I eLANLO# 1 BCOGUSECODE
LOT l BLOC:: ,J ASSESSO~ PAR'fiL NO-, Q,._, nl ? / _
Ht'."'2.D 1 ra "' ~r~--~~ SUBDIVISION DESIGNER (/ ~ LIC£NSE # STANDARD PLAN# BUILDING SQ. FOOTAGE
-" "'"' /ll'!f801'
= I. as owner of the property, or my employees with wages
as their sole compensation. will do the work, and the struc-
ture is not intended or oflered for sale (Sec. 7044. Business
and f'rolessions Code: The Contractor's license Law does
no1 apply to an owner ol property who builds or improves thereon and who does such work himself or through his own
employees. provided that such improvements are not intend-
ed or offered for sale 11, however, 1he building or rmprove-m_ent Is sold within one year of completion,_ th-e owner-builder
will have the burden of proving that he did no1 build or 1m· prove for the purpose o1 sale)
0••c•"7;r,~1a 1/o.ltJrn 6f bJafv So71.rthir DEStGN'ER'&,-AODRESS DESIGNER'S PHQKE', t)cC"'8Gf 51t3 '~3
u, FLA ELEV.
vD NO
GP LAND use GRADING J".EAMIT !$SUED
NO
STORIES
TYPE
CONST
ace GP
ace LOAD
EDU
FIRE SPA CENSUS TRACT I I eAAKINGSeACEl AESUNITS I
y D N □ I REDEVELOPMENT
AREA
vO NO vO NO Not Valid Unkss M.chine Certified
C 1,_as owner of the property, am exclusively contracting
with licensed contr~ctors to construct the project (Sec. 7044,
Business and f'rofess1ons Code: The Contractor's license
Law does not apply to an owner of property wllo builds or im-proves thereon, and who contracts lor each proiects with a
contractor(s) license pursuant to the Contractor's License ~.,
QTY.I PLUMBING PERMIT -ISSUE 7~ QTY. MECHANICAL PERMIT -ISSUE _-5-SUMMARY/ACCOUNT NUMBER
EACH FIXTURE TRAP 7 / INSTALL FURN. DUCTS iJP TO 100,000 BTU • BUILDING PERMIT 01·00·00·8220
□ As a homeowner I am improving my home, and the follow-mg condrt1ons exist
1 The work_ is be_ing performed prior to sale
EACH BUILDING SEWER _ I . OVER 100,000 BTU • SIGN PERMIT 01-00·00·8221 I
EACH WATER HEATER AND/OR VENT --L~ ____ ~--~ :_---sOILE~C~M~~soR UP TO 3 HP • PLAN CHECK 01-00-00-8806 I I
EACH GAS SYSTEM 1 TO 4 OUTLETS j BOILER/COMPRESSOR 3-15 HP • TOTAL PLUMBING Oi-00·00-8222 1 1 2 I have lived in my home !or twelve months prior to completion of this work
I have no! claimed this exemption during the last three years
□ lamexemptunderSec ______ ,B&P.C
for lh1s reas.on
I
EACH GAS SYSTEM 5 OR MORE _______ --4----. ____ ,_ ____ METAL FIREPLACE • ELECTRICAL _ _ __ Oi·00·00·8223
VENT FAN SINGLE DUCT MECHANICAL 01-00·00·8224 EACH INST AL .. ALTER, REPAIR WATER PIPE
EACH VACUUM BREAKER
WATER S0FTNER
MECH EXHAUST -H000i0UCTS M0BILEH0ME 01·00·00·8225
----------+1---.::}~•-.5i=t1+---1t-R-E-LOCATION OF EA FURNACE/HEATER M0BILEH0ME PARK INSP
"
I EACH ROOF DRAIN (INSIDE) ' I I -SOLAR 01·00·00-8226 \ hereby atl,rm that I ha;e a cer'!ll,ca!e ot consent
sel!-msure, or a cert1f1cate of Workers LJ . TOT.!.L MECHANICAL I STRONG MOTION 80·92-33-0519 I Compensation Insurance, or a cert,f1ed copy thereof 7 ~ I
(Sec 3800.LabofCodeJ l't ~J TOTAL PLUMBING -··-~-----'(; ·"-''1 . FIRESPRINKLERS 01·00·00-8227
POUCYNO /lJ_j}/ lf_J __ /l/v-t _ __,_ -----PUBLIC FACILITIES FEE 32-00-00-B923
COMPANY b('llJP4h~ ir-i..{_l')U QTY. ELECTRICAL PERMIT-ISSUE .s--QTY. SOLAR -ISSUE BRIDGE FEE---+------
ri"eopy ,s !lied w•th the c,ty NEW CONST EA AMP:'SWT ,8 KR --COLLECTORS SCHOOL FEE • DISTRICT
D Cert,t1ed copy 1s hereby fllrrnsh 1 PH 3 PH STORAGE TANKS Carlsbad
CEATIFICATlOF EXEMPTION,N OM EXIST BLDG EA AMP.'SWT:'BKR ROCK STORAGE Encinitas 80·92·22·0519 1
(Th,~~~.~~~~~:tE::es:i~~~e:~s~ 1~:f!rm,t 1 PH 3 PH ~---PUMP San Oieguito 80·92·23·0519 T
80·92·21·0519
___________ _,
1s !or one hundred dollars 1s1001 or less) ------__ L ___ -1
D I cert,fy that ,n the performance of t~e won< tor RE MO DE L.'A LT ER PER C !~C~---·-----I --~L-~N CHECK i=EE • ~a~ Marcos 80·92·24·0519
wh,ch th,s penTI1t 1s ,ssued. I shall not employ any TEMP PO LE 200 AM PS person ,n any manner so as to become sub1ect lo --------
the Workers· Compens.at,on Laws of Caldorri,a OVER 200 AMPS
-----------------
TEMP OCCUPANCY {30 DAYS) -----+-----
-------t-------tJ---
-+-NOTICE TO APPLICANT If. a'1er makm;i tn,s Cert,
1,cate o! Exemption. you stiollld become subject 10
trie Workers· Compensation prov,s,ons o! tne LabOr
Code. you must torthw,tn comply w,th SllCh prov,s,ons or 1h,s perm,! Sh<1II be deemed revoked TOTAL ELECTRICAL l -----
-----t--TOTAL SOLAR I t TOTAL FEES PAYABLE /.#/ti,_ /1 C, I
D I hereby at11rm that there ,s a conslrlJCllon
Iendmg agency to, the per<o,mance 01 The wof\o. to,
wh•ch th,s perm,t ,s ,ssued (Sec 3097, c,v, Cooe,
Lenders Name ___________ _
Lender's Address __________ _
I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION ANO PERMIT" AND DO HEREBY
CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE
DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS
ISSUED: TO COMPLY WITH ALL CITY, COUNTY AND STATE tAWS GOVERNING BUILDING CON-
STRUCTION, WHETHER SPECIFtEO HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND
KEEP HARMLESS THE CITY'OF CARLSBAD_AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND
EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE
GRANTING OF THIS PERMJT.
Expiration. Every perml_t ~ by the Building Offk:ial under ttie provisions of Utt$
Code shall expire by fimitl!ltion and become null and void. If lhe butldil'lg" or work authorized by such permit is not commenced within 180 days from the date of suet,
permit, or. if the building Of work a_uthol'ited by_ such permit is suspended or
· at any time after the work is commenced for a period of 180 da'
-.
fiOSttAPEAMIJ ISIIEOI.PRED FOR EXCAVATIONS OYEFI
O" 0EEP AND OEMOt.fTION OR CONSTRUCTION OF
flJCl\JR9 OVER 3 STORIES tN HEIGHT -CONTAACTOA: APPROVED BY l n· ~----
BV PHONE O WW--
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INSPECTION 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
PLUlll!BING TOP OUT
TUB AND SHOWER 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 I , .,,,,
PLUMBING f,WAf'M vu\
ELECTRICAL I i
MECHANICAL
GAS
BUILDING
SPECIAL CONDITIONS
CERT OF OCCUPANCY ISSUED
'
. •_:·-
8"3~;;:is)
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS INSPECTOR'S NOTES
INSPECTION RED IF INSPECTORS DATE CHECKED APPROVAL ---
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRES TRESSED
CONCRETE -POST TENSIONED
CONCRETE
FIELD WELDING
HIGH STRENGTH
BOLTS --
SPECIAL MASONRY
PILES CAISSONS
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