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Home My WebLink About2165 TWAIN AVE; ; CB043827; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 10-22-2004 Electrical Permit Permit No: CB043827 Building Inspection Requ est Line (760) 602-2725 Job Address: Permit Type: 2165 TWAIN AV CBAD ELEC Status: Parcel No: 2081801900 Lot #: 0 Applied: Reference #: Project Title: HURST RES GAS TO FIREPIT/BBQ ELEC FOR OUTLET Applicant: THE H A ELLIOTT CO 9526 CAPRICORN WY SAN DIEGO 92126 619 695-3046 Electric Issue Fee Single Phase per AMP Three Phase per AMP Three Phase 480 Per AMP Remodel/Alteration per AMP Remodel Fee Temporary Service Fee Test Meter Fee Other Electrical Fees Additional Fees TOTAL PERMIT FEES 0 0 0 0 Entered By: Plan Approved: Issued: Inspect Area: Owner: HURST MARK E&GAIL M 2165 TWAIN AVE CARLSBAD CA 92008 ISSUED 10/12/2004 KG 10/12/2004 10/12/2004 $10.00 $0.00 $0.00 $0.00 $0.00 $1 0.00 $0.00 $0.00 $27.00 $0.00 $47.00 Total Fees: $47.00 Total Payments To Date: $47.00 Balance Due: Inspector: Date: Clearance: $0.00 NOTICE: Please take NOTICE that approval of your project includes the 'Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exaction of wh r as t which the FOR OFFICE USE ONLY PERMIT APPLICATION PLAN CHECK NoC6vLt'iP il,7 CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 EST . VAL. __________ _ ~:l~d~:dD::,,4M~sc:;it1----------- Date //()-(;J. -oy 1 . PROJECT INFORMATION '.2.J 65: 'ti....,A-1/./ Av'.t, Address (include Bldg/Suite #) Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use #of Stories # of Bedrooms # of Bathrooms Address 3. APPLICANT 0 Agent for Contractor O Owner 4. PROPERTY OWNER M. Mr< J4. 1Jt.S:T Name 5. CONTRACTOR • COMPANY NAME City 0 Agent for Owner City State/Zip j,f) Fax# Telephone# (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the alleged Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). Name Ad,lress _,cense Class _C='---_Z-__ 'J ____ _ City State/Zip Telephone # City Business License # ,Af/)L-Jfli} PO/( State License # t2 6 3 I J) Designer Name Address City State/Zip Telephone State License # __________ _ 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Insurance Company______________________ Policy No. ____________ _ Expiration Date _______ _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS )$1001 OR LESS) ~ CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as 'fo ·become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($10 the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE._,_,£-:,.p..fr½~.Y.½L.----------------~::-:::::-DATE r{)-:} 2., -0 l-/ 7. I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 I, as owner of the property or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). 0 I am exempt under Section ______ Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO 2. I (have/ have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number/ contractors license number): _________________________________________________ _ 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work): ____________________________________________________________ _ PROPERTY OWNER SIGNATURE _______________________ _ DATE __________ _ COMPLETE THIS SECTION FOR NON-RESIDENT/AL BUILDING PERMITS ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES O NO Is the facility to be constructed within 1,000 feet uf the outer boundary of a school site? 0 YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CE,ntFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY 3ERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 8. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work tor which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS. __________________________ _ 9. APPLICANT CERTIFICATION I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Cit\' of Carlsbad to enter upon the above mentioned property for inspection purposes. 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 PERMIT. OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the building Otticial under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for er d of 180 ay (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 04/25/2005 Permit# CB043827 Title: HURST RES GAS TO FIREPIT/BBQ Description: ELEC FOR OUTLET Type: ELEC Sub Type: Job Address: 2165 TWAIN AV Suite: Lot 0 In spector Assignment: JM Phone: 6198053360 Location: Inspector: OWNER HURST MARK E&GAIL M Owner: HURST MARK E&GAIL M Remarks: Total Time: CD Description 29 Final Plumbing Act Comment f£ Ah I 39 Final Electrical -~- Associated PCRs/CVs Inspection History Date Description Act lnsp Comments 10/26/2004 23 Gas/Test/Repairs PA JM 10/26/2004 31 Underground/Conduit-Wiring AP JM BBQ/PIT ----- Requested By: HUDSON Entered By: JANEAN t'-<4V./ C/2A/j