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Home My WebLink About2687 WATERBURY WAY; ; CB163421; PermitJ 09-06-2016 Job Address: Permit Type: Parcel No: Reference #: PC#: Project Title: Applicant: City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit Permit No: CB 163421 Building Inspection Request Line (760) 602-2725 2687 WATERBURY WY CBAD PME 1674412000 Lot#: 0 FORTNER: 125A PANEL UPGRADE Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 09/06/2016 SLE 09/06/2016 09/06/2016 TC B ELECTRIC & LIGHTING SERVICES SCOTT FORTNER PO BOX 730 ALPINE CA 91903 619-264-2941 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES 2687 WATERBURY WAY CARLSBAD CA 92010 $0.00 $163.00 $0.00 $0.00 $163.00 Total Fees: $163.00 Total Payments To Date: $163.00 Balance Due: Clearance:------. $0.00 I\OTlCE Aease ta<e l'OTlCE ~~u..ial ci >OX p-tjed irdudes tre "lrrpa;itioo" ci fees. ocdc:aia,s, reservctia,s, cr ctra-exa::tia,s rera:tter roledively ra'erred to as "fees'exadims." Yoo rave 00 days frcrn the elate tns p:mit = iss..ed to J'.)ctest illlX)Sitioo ci these fees'exadims. If~ J'.)ctest tt-an. ~ rrust fcilON Ire J'.)ctest p-oced.res sE( forth in <?i:NanrErl Oxle Sadia, 60020(a), a-d file Ire J'.)ctest a-d My ctre-recµred irtooraia, Y.ith the Oty ~ fcr ~rg in cn:ada oi Y.ith Ca1sbad M.ricipa Oxle Sadia, 3.32.cro. FailLre to tirrely fcilON !ha p-ocedre Y.ill ta-any Slbseq.Jert le;p octia, to atta:i<, review, sa aside, l.tid, cr annJ th:ir illlX)Siticn Yoo ere re-et,,, R.RTI-ER I\OTlRED tt-at >OX rigt to J'.)ctest tre specified fees'exa:tia,s lXl:S f\Or .APPLY tov.aEJ" a-d-a:rnedia, fees a-d ~ c:t-a,g.;Js, rcr plcrrirg, zairg, gadrg cr ether sirrila-~ic:aioo ~rg cr service fees in a:rnedi01 Y.ith tns p-tjed. I'm lXl:S IT .APPLY to an; f w-i • • "rril t ·s ast w-i 11 cilirrit i • • • C cityof Carlsbad JOB ADDRESS 2(:, Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-271.9 Fax: 760-602-8558 email: buildlng@carlsbadca.gov www.carlsbadca.gov SUITE#/SPACE#/UNIT# Plan Check No. Est. Value Plan Ck. Deposit TENANT BU INESS NAME 342.f SWPP C NSTR. TYPE OCC. GROUP GARAGE (SF) PATIOS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES □ # __ NO □ YES □ NO □ YES □ NO □ AD ZIP tr2//Cf DESIGN PROFESSIONAL NAME ADDRESS .s: CITY STATE ZIP STATE ~ PHONE FAX FAX EMAIL STATE LIC. # STATE LIC.# CLASS ltJO? ~~ e-10 (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 fChafter 9, commending with Section 7000 of Division 3 of the Business and Professions Code} or !hat he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 703 .5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). Workers' Compensation Declaration: I hereby affirm under penalry 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 workers' compensation insurance carrier and policy number are: Insurance Co. Policy No. _______________ Expiration Date _________ _ This section need not be completed ~ the permitis for one hundred dollars ($100) or less. ~ertificate 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, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. ,/iS CONTRACTOR SIGNATURE -r:::----□AGENT DATE I hereby affirm Char I am exempt from Conuacror·s License Law for the following reason: □ I, as owner of the property or my employees with wages as their sole compensation, will do the work and the suucture is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contracto(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). □ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contracto(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). □ 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. □ Yes □ No 2. I (have / have not) signed an application for a building permit for the proposed wor1<. 3. t have contracted with the following person (firm) to fl(Ovide the proposed constnuction (include name address I phone I contractors' license number): 4. I plan to provide portions or the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address/ phone/ contractors' license number): 5. I v,;11 provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address/ phone I type of work): ,/i5 PROPERTY OWNER SIGNATURE □AGENT DATE Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and p,evention p,ogram under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? D Yes D No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? D Yes D No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D Yes D No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. f the work this permit is issued (Sec. 3097 (i) Civil Code). r's Address 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 representative of the City of Car1sba'.J to enter upon the above mentioned property br inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CAALSE'AD 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 M OSHA permit is required br excavations over 5'0' deep and demot«ion or construcoon of structures over 3 stores in height. EXPIRATION: Every permit issued by the Building Official under the provisions of lhis Cooe shall expire by imitation and become nul and vod if the building or v.orl< authorized by sudl permit is not commenced wilhin 180 days from the date of such permit or if the buildi orv.orl< authorized by sudl perm« is suspended or abandoned at any time after the v.orl< is oommenoed bra period of 180 days (Section 100.4.4 Uniform Building Cooe). ~ APPLICANT'S SIGNATURE ~<--DATE Inspection List Permit#: CB163421 Type: PME Date Inspection Item ____ _ 09/07/2016 33 Service Change/Upgrade 09/07/2016 33 Service Change/Upgrade 09/07/2016 39 Final Electrical Thursday, September 08, 2016 Inspector Act PY PY RI AP AP FORTNER: 125A PANEL UPGRADE Comments BEFORE NOON/DISC RECON Page 1 of 1