The URL can be used to link to this page

Home My WebLink About2621 UNICORNIO ST; ; CB032662; Permit~~ ~ 09-26-2003 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Mechanical Permit Permit No: CB032662 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Reference #: Project Title: 2621 UNICORNIO ST CBAD MECH 2152806000 Lot#: $0.00 BREAKFIELD RES REPLACE FURNACE 0 Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 09/26/2003 SB 09/26/2003 09/26/2003 Applicant: BANNER REFRIGERATION CO. INC. PITTFIELD JOSEPH L&BREAKFIELD HEDY T 7322 MUSLOW LN. 92009 632-7877 Mechanical Issue Fee Install/Furn/Ducts/Heat Pumps Fee Fireplace Installation Fee Exhaust Fan Fee Installation/Relocation Vent Fee Hood Fee Boiler/Compressor to 15HP Fee Other Additional Fees TOTAL PERMIT FEES 1 0 0 0 0 0 3691 MORRIE DR SAN JOSE CA 95127 $15.00 $9.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $24.00 Total Fees: $24.00 Total Payments To Date: $0.00 Balance Due: $24.00 5126 09/26/03 0002 01 02 CGP 24-00 . FINAL APPROVAL :{ ----INSP.-dfA✓ DATE /olf'/tl CLEARANCE _______ _ PERMIT APPLICATION ' CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 1. PROJECT INFORMATION Lot No. Subdivision Name/Number Existing Use 0 SO. FT. ~--cJ;iNIAC.T fgR§9,.t-4 (If different from applicant! • J)fl Ve 1.6/2-tfl cctJ I.(, r.3;;1.d-r,{u slo Name Address ;□• ContraotOL• Name Address #of Stories City Q :'Agent-fo.t Owner'. City (6., .CON°t~CTQfl~C..QMPANY llf~M~ _.;........,,,,......., '" FOR OFFICE USE ONLY PLAN CHECK NO.e ]5n;) 7-(!)f!Jz_ EST. VAL. __________ _ Plan Ck. Deposit~~------- Validated ::a:? Date 9/_~ Unit No. Phase No. Total # of units Proposed Use s # of Bedrooms # of Bathrooms c~ 9'7/J~? <1~Yft1-i517f-s~ State/Zip Telephone # Fax # State/Zip Telephone# S.tate/Zip 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 exe tio;:; ;e:,iol~ection;o3 ... 1; :J an(:alicant for a permit subjects the appt~(µivil pen~ahan f'velundred do ~a 500f-1-il-- Name Address City State/Zip Telephone # State License# 5,;2..f!/J.( License Class c-~o e,,-:,r City Business License# /,i?I) 7-3SY Designer Name Address City State/Zip Telephone State License # _________ _ {i •. ,WQRKE~S' COMPEN_S'ATI.ON ", • . •;. • , "" ;~ ·"" ·" ; Worke~• Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: lkI.-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) 0 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 to 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 ($100,000), In addition to the cost of compensation, damagas aa provided for In Section 3706 of tha Labor code, interest and attorney's fees. DATE I ~~ -,;;;;;;;:;;::;;;;::;;;:-;::;:::;:;;;;;;:;;: ,,_ I hereby affirm that I am exempt from the Contractor's License Law for the following reason: O 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). O 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 ______________________ _ tC9MPLETE THIS 'Sl;CTiO!'! FOR NON-RESIOENnAL BUJLQINQ PERMITS ONLY.,..,_., _ _,._ ' ,), ~-ti 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 25634 of the Presley-Tanner Hazardous Substance Account Act7 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 of the outer boundary of a school site7 0 YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUEO UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. (B. ~NSTRUC"fJON"LENDII\IG AGENCY, ;t •• • ' " iL' • ~ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(1) Civil Code). LENDER'S NAME ______________ _ •9,; ae~OCANT QERTIFICATION 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\t 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 SAIO 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 th • ding Official under the provisions of this Code shall expire by limitation and become null and void If the building or work authorizerl by such permit Is not comm i in 180 days fro the date of such permit or if the building or work authorized by such permit is suspended or abandoned :~~~:: '1e;,:~:;~:is of 1 0 (Section 106.4.4 Uniform Building Code). DATE i,/;;z sftl 3 WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 1 0/03/2003 Permit# CB032662 Title: BREAKFIELD RES REPLACE FURNACE Description: Type: MECH Sub Type: Job Address: 2621 UNICORNIO ST Suite: Lot o Location: APPLICANT BANNER REFRIGERATION CO. INC. Owner: PITTFIELD JOSEPH L&BREAKFIELD HEDY T Remarks: DID NOT SAY WHAT WAS NEEDED Total Time: CD Description Act Comment Inspector Assignment: Phone: 7604311794 Inspector: R Requested By: NA Entered By: CHRISTINE 43 AirConcl/Furnace Set £_ _______ _ ..!:f+_ ______ /2/ Associated PCRs/CVs Inspection History Date Description Act lnsp Comments POLICYHOLDER COPY . !t.t~1T,5 P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 INSUR A t•J'C E FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-01-2002 GROUP: 000229 POLICY NUMBER: 0007183-2003 CERTIFICATE ID: 24 CERTIFICATE EXPIRES: 01 -01-2004 01-01-2003/01-01-2004 STATE CONTRACTORS LICENSE BOARD-WORKER'S COMP. BOX 26000 LICENSE NU~ER: LICENSE #521181 INCEPTION DATE: 01-01-2003 SACRAMENTO CA 95826 0.0.: SD This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance· may b'e issued or may ·pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. ~~ AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER 'S LIABILITY LIMIT INCLUDING DEFENSE CdSTS: $1,000,000.00 PER OCCURRENCE . ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTlVE 01-01-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY . EMPLOYER BANNER REFRIGERATION CO ., INC PO BOX 9000-639 CARLSBAD CA 92018 12-13-2002 PRINTED: PO409 THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND sc1F ,om (REV 2-01) SD