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[i?"1 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 ~Ileen In
lull for~~~. ,,
Lie No ~?F-\Clm
I hereby att,rm that I .am exempt from the Con-~~~•~~~f :':: ~w ~f~,~~~~1~
county which requires a permit to construct aliw. imp,oi,e, demolish. or repair any structure,
prlOI" to Its issuance also requires the apphcant for
:=~,:'"'~~~~et~ ~~~o~~:~:':"~t t~! ~~
tractor's License Law {Chapter 9 commencing with
Section 7000 of 01v1s10t1 3 of the Business and Pro,. fessH>ns Code) or that ,s exempt therefrom and the
basis for the alleged ea:empt10n. Any v,olation of
Section 1031.5 by an applicant for a permit SIJbtects tne applicant to a c1v1I penalty of not more than h,;e hundred dolla~ ($500) .
0 I, as owner of the property, o, my employees
-.1th wages as their so4e compensation, w,11 do the wotk. and the structure 1s not intended or offered for
sale (Sec. 7044, Business and Professions Gooe: The Contractor's License Uw does not apply to an owner of property who builds or improves the;eon
and woo does such wM himself or throooh his own employees, provided lhat such 1mproveme.its are
not 1ntende1 or offered tor sale. If, howeve,, the
building Of improvement 1s soki wtthm one year of complehon, the owner..t)u1lder will have the burden
of proving that he did not build or improve tor the
l)Ul'l)O$e ot sale)
□ I, as owner of the property, am exclusively contracli"i with licensed contractors to construct
the p,o,ect (Sec 704A, Business and Protesst0ns
Code: The Contractor's License Law does not apply
to an owner of property who butlds o, improves ~=•!t~ ~~~~~:!~~ ~~~r~~~;::-: License Law),
0 lamexemplunderSec _____ ,B &PC
f0f"th1s reason ___________ _
□ I hereby affirm !hat I haw a cen,t,cate ol consenl
to self.insure, or a cert,t1cate of Wonters·
Compensation Insurance, o, a cert1f1ed copy lhereot
(Sec. 3800, Labo< -" ·
POLICY NO IV"'. -.,, -
~-"""-
0 Certified copy 1s hereby furnished
CERTIFICA Tl OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
(This sechon need not be completed 1f the permit 1s fo, one hundred dotlars ($100) o, less)
D I certify that 1n the performance ot the w~ fo,
which this permit 1s issued. I shall not employ any
pef'SOO ,n any manne, so as to become subJect to the Worl(ers· Compensahon Laws ot Cahforma
NOTICE TO APPLICANT If, a.fter mak1n~ this Cert1
hcate of Exemphon. you should become subjec1 t'J
the WMers· Compensat10n prov1s1ons ol the labor cooe. you must forthwith comply with such
prov1s100s or this permit shall be deemed revoked
D I f\eret>y alfum lhat there 1s a construction
lending agency lo, the per1o,mance of the wont for
which 1h15 permit 1s 1=~Sec 3097. C1v1I Code)
Lenders Name-1f',-...~..yf.A--._..-------
Lender's Address _..,.... ________ _
. -•--•----• n __ _. ••••n-r r,1 I ._, __ Ii f rn~1. 11• 11•rvnm#'\11v1"1n11 n11"1 ~nMUt:U Ar1~ ANU Ut:\,;LAHAI IUN~.
CARLSB"'J BUILDING DEPARTMENT APPLICATION & PERMIT 1200 Elm, Carlsbad, Callfornla 92008 (71-4) 438-5525
JOB ADDAEl1~ ~flt\ (~ A~i.Tj (f ,\,;;\~\ION'
BUSINESS LICENSE IF l v~M PERMIT NUMBER ~CA-YI-J4 OWNEA'S~{\\\nr{\ J ?ui~ 1~101 PNBtilY~ >t:en'h CONTRACTORS PHONE# ZONE JAf)-117 __ 1
OWNER'SMA\~A~ ~(t) , --CO;z\yTir?~ti~~ t::>,<1i, ~\O\ PLAN 1.0. # BLOG use CODE C-:\ i3 /-J-8 '1 LOT BLOCI<: l SUBDIVISION I Ass-7~\f'\ ~E~ \l ,o -\ 7 _ OESl~NER U •'r!:ra is ~~\'1 STANOARD PLAN# BUILDING SO. FOOTAGE
~l.;,\linr oEsc~'r;R~ 4'')V\
OE~~~f ,\'AIT CJly ,Y\ ~rtiJo DESl..,.,.tR'S PHONE ' -' MfJ~1171 7h I /815498 ----F/P F LR ELEV. u " NO EDU fD.ac OCC GP STORIES
vO NO --
CENSUS TRACT I GP LANO use PARKING SPACE I AES UNITS GRADING ~ERMIT ISSUED I REDEVELOPMENT TYPE OCC LOAD FIRE SPR AREA CONST
YO ND vO NO vO NO Nor Valid Unwss Machine ~rtifif!d
QTY. PLUMBING PERMIT-ISSUE 7~ QTY. MECHANICAL PERMIT -ISSUE SUMMARY/ACCOUNT NUMBER ~~ EACH FIXTURE TRAP INSTALL FURN. DUCTS UP TD 100,000 BTU BUILDING PERMIT .::J. ~ -~ EACH BUILDING SEWER /D OVER 100,000 BTU SIGN PERMIT ~ I --~ / EACH WATER HEATER ANO/OR VENT )/"'.' BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK .,,~~-
EACH GAS SYSTEM 1 TO 4 OUTLETS . ..A'J BOILER/COMPRESSOR 3-15 HP TOTAL PLUMBING /~~ fl1-"' --/ EACH GAS SYSTEM 5 OR MORE "),/_7.,, METAL FIREPLACE ELECTRICAL _, 17....,;;,,,,-/ EACH INSTAl .. ALTER, REPAIR WATER PIPE ,,.,s VENT FAN SINGLE DUCT MECHANICAL r
EACH VACUUM BREAKER ,
~ MECH EXHAUST -HOOD/DUCTS MOBILEHOME ..
WATER S0FTNER RELOCATION OF EA FURNACE/HEATER MOBILEHOME PARK INSP
EACH ROOF DRAIN (INSIDE) A SOLAR
~ _,,,,:v_./ TOTI.L MECHANICAL STRONG MOTION
TOTAL PLUMBING I /,5 .,
FIRE SPRINKLERS
QTY. ELECTRICAL PERMIT -ISSUE -~
..,,,,t)_.,, QTY. SOLAR -ISSUE PUBLIC FACILITIES FEE
BRIDGE FEE /' NEW CONST EA AMP/SWT/BKA b -COLLECTORS SCHOOL FEE -DISTRICT
1 PH 3 PH STORAGE TANKS Carlsbad
EXIST BLOG EA AMP/SWT/BKR ROCK STORAGE Encinitas
1 PH 3 PH PUMP San D1eguilo
REMODEL/ALTER PER CIRCUIT PLAN CHECK FEE San Marcos
TEMP POLE 200 AMPS
OVER 200 AMPS
TEMP OCCUPANCY 130 DAYS) ---,--.A .. Yr/ ,.,
TOTAL ELECTRICAL 1 ~1/ ,,,.
TOTAL SOLAR l htfv TOTAL FEES PAYABLE n
I HAVE CAREFULLY EXAMINED THE COMPLETED '·APPLICATION ANO PERMIT" ANO DO HEREBY Exp,ratton Every permit 11oued by the Bu1td1ng Olfic1al under the provisions of this * AN OSHA PERMIT IS RE0UIAED FOA EXCAVATIONS OVER CERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE Code shall expire by hm1tat1on and become null and void If !he building or work 5' O" DEEP ANO OEMOUTlON OR CONSTRUCTION Of' DECLARATIONS ARE TRUE ANO CORRECT AND I FURTHER CERTIFY ANO AGREE IF A PERMIT IS authorlZed by such pe,:m,t 11 not commenced w1tt,in 180 days from the date of such 3AUCTVAES OYER 3 STORIES IN HEIGHT permit or ii ":8~1~ o, work authorl28d ~ouch permit 11 suapended or ISSUED: TO COMPLY WITH ALL CITY. COUNTY ANO STATE LAWS GOVERNING BUILDING CON-abandoned at a ,me a er the work 1s commen for• penod of 180 dav• STRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY ANO
APr~.:GNATU • ~~;/,RO CONTRACTOR IJ.-,APPROVED BY DATE 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 7~/L -L 17-::Ll-,r I GRANTING OF THIS PERMIT. ~ ,,,._. ~ -., BY PHONE 0
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INSPECTION TYPE DATE INSPECTOR
BUILDING
FOUNDATION n
REINFORCED STEEL 7-1j1-f1 ti'
MASONRY
GUNITE OR GROUT
FLOOR & CEILING SUB FRAME
SHEATHING
FRAME
EXTERIOR LATH lNSULATION
INTERIOR LATH & DRYWALL
PLUMBING :
SEWER AND BL/CO '-1, n
PLUMBING UNDERGROUND 1-, '1-rl r3'
PLUMBING TOP OUT
TUB AND $HOWER PAN ,.,.
GAS TEST i-1_'1-H rd/
ELECTRICAL
TEMPORARY POWER
ELECTRIC UNDERGROUND ,.
ROUGH ELECTRIC 7-J..7-r/ ;,f/
ELECTRIC SERVICE /)
BONDING ?-'J.7-A'/ z.f/
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 HAVE BEEN APPROVED.
JOB SITE FINAL
PLUMBING
ELECTRICAL
MECHANICAL:
GAS
BUILDING
SPECIAL CONDITIONS
CERT OF Qrl';UPANCY ISSUE_p
FIELD INSPECTION RECORD
REQUIRED SPECIAL INSPECTIONS
INSPECTION' REO. IF INSPECT08'S
CHECKED APPROVAL
SOILS COMPLIANCE
PRIOR TO
FOUNDATION INSP
STRUCTURAL CONCRETE
OVER 2000 PSI
PRESTRESSED
CONCRETE
POST TENSIONED
CONCRETE
FIELD WELDING -~
HIGH STRENGTH
BOLTS
SPECIAL MASONRY
PILES CAISSONS
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INSPECTOR'S NOTES
DATE • ..
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INTERDEPARTMENTAL INFORMATION SHEET
BUILDING DEPARTMENT ,,1~CEIVED
BUILDING ADDRESS:
PLANNING DEPARTMENT
JUL 151981
CITY OF CARLSBAD
8ulldlng Department
ZONE LOT SIZE LOT WIDTH ----------------------------
UNITS ALLOWED UNITS PROVIDED ------------------------
PARKING SPACES REQUIRED PROVIDED -----------
% COVERAGE ALLOWED PROVIDED
BUILDING HEIGHT ALLOWED PROVIDED ----------
'FRONT SETBACK: SIDE SETBACK: REAR SETBACK:
ALLOWED -------. PROVIDED ______ _
INTRUSIONS
LANDSCAPE & IRRIGATION PLAN COMMENTS:
ENVIRONMENTAL PROTECTION REQ:
ADDITIONAL COMMENTS:
1:E_~ /
OK TO ISSUE: /l?/ ~ATE '?-I [ OK TO FINAL DATE 11-~ ---·--
ENGINEERING DEPARTMENT J:o4L.
R.O.W. ______ INDUSTRIAL ~ASTE IMPROVEMENTS ---------------
SEWER CONNECTION ________ DRIVEWAY LOCATIONS ___________ _
GRADING PERMIT EASEMENTS DRAINAGE ---------------------
LEGAL DES CR IP TI ON ______ :J~J_.5_,.._----'S:=-----<-/......::t=-------/<---=2.---___________ _
ADDITIONAL COMMENTS ----------------------
OK TO ISSUE:W DATE -'1-1~'~ PWI ____ OK TO FINAL ____ DATE ___ _
FIRE DEPARTMENT
SPRI~KLING SYSTEM FIRE PROTECTION EQUIP. -------------------
FIRE ALARMS EXITS _______________ _
FIRE HYDRANTS LOCATION _________________ _
ADDITIONAL COMMENTS ____________________________ _
OK TO ISSUE: DATE OK TO FINAL DATE -----------------------
WATER DEPARTMENT
REQUIREMENTS OF APPROPRIATE DISTRICTS MET ________ DATE ________ _
\
1200 ELM AVENUE
CARLSBAD, CALIFORNIA 92008 TE Le PHONE:
(714) 729-1181
er:itp of etarl.sbab
This document will certify that I am aware of the provisions of the
California Administrative Code, Title 24, Section T20-1406(c),
"Swimming Pool Heating", as shown on form DPL #297. I understand
that neither a swimming pool building permit usinq a foss::.1-fueled
heater nor a plumbing/electrical permit for. a new or replacement
fossil-fueled heater will be issued until this certification is
executed.
For the swimming pool located at Q:::P\ ~it~ ex
(site address) I certify that all o the :folowing requirements for
fossil-fueled (or electric) swimming pool heaters will be met:
1. Outdoor pools shall be equipped with a pool cover.
2. ON-OFF switch on outside of heater to allow shutdown without
adjusting thermostat and start-up without relighting pilot light.
3. 36" minimum length of plumbing provided between filter and
heater to allow future solar installation.
4. After January 1, 1982, new heaters installed must have 75%
thermal efficiency. . ,
5. Time clocks installed to allow pump operation during off-peak
demand periods (unless pump used for active solar).
6. Directional water inlets in pool for good mixing.
Print Owners Name:
owners Signature:
Contrac~ors Signature:
Address:
'" •:,,.•' J;:~;;::
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