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HomeMy WebLinkAbout1055 AVIARA PY; TP; CB063379; Permitf" 03-08-2007 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No CB063379 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Reference # Project Title 1055 AVIARA PY CBAD St TP ELEC 0000000000 Lot# 24 HR FITNESS- TEMP POLE (NEW LOCATION DUE TO POWER LINE BURIAL) Status Applied Entered By Plan Approved Issued Inspect Area Applicant LUSARDI CONSTRUCTION COMPANY 1570 LINDA VISTA DRIVE SAN MARCOS, CA 92069 619-744-3133 Owner ISSUED 11/29/2006 LSM 11/29/2006 11/29/2006 TP 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 $1000 $000 $000 $000 $000 $000 $1000 $000 $000 $000 TOTAL PERMIT FEES $2000 Total Fees $20 00 Total Payments To Date $20 00 Balance Due.$000 Inspector ^ FINAL APPROVAL Date ,yW Clearance 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 nght 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/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 FOR OFFICE USE ONLY PLAN CHECK NO. BST. VAL. 9 Plan Ck Deposit Validated By _ Date 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 SO FT ffof Stories # of Bedrooms # of Bathrooms Name Address State/Zip Telephone #Fax* (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 exemption 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 [5500]) N*me 7/v77P>7 Address A-State License # a^(S / ~*Q 1 License Class /^ ' Xf /4 /Designer^m!) * ^ Address State License ff ^" */ r*\- t *^2 ' ' City ""' "^ State/Zip "Telephone # *- / J^ City Business License # City State/Zip Telephone I hereby affirm under penalty of perjury one of the following declarations „! Vf&jl £!< tfiS^SiiiKil* ™^ 4rf|Hf If i"rf i m»f i. ''•'< •', Stay Workers' Compensation Declaration Q 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 AST**""*JQ\ 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 _/^.~** U t^~) /&-*—( (-"? f C-fc^ Policy No /'C/C- /?^ t iLs / Expiration Date_ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) ' Q 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 19 unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred ie cost_pf Jeflmper»sation, damages as provided for in Section 3706 of the Labor code^ Interest apd attorney's fees DATE thousand dollars ($100 000), in SIGNATURE _._ . trr^WNtfP5!&^&AS^ I hereby affirm that I am exempt from the Contractor's License Law for the following reason Q 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 sate (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 tha burden of proving that he did not build oc improve for the purpose of sale) Q 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) Q 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 Q YES QNO 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 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? Q YES Q NO Is the applicant 01 future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES Q NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school sue? D YES Q 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 I hereby affirm that there is a c LENDER'S NAME re is a construction ^H/ /^C' struction lending agency for the performance of the work for which this p>rmi£js issued (Sec 3097(i) Civil Code) _ LENDER'S ADDRESS A-^ I certify that I have read the application and state that the above information is correct and that the information on tha plans is accurate I agree to comply with ell City ordinances and State laws relating to building construction I hereby authorize representatives of the City 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 OS HA 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 Official under, the pvovravons rjf this Code shall expire by limitation and become null and void rf 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 commpBeso! fqr_a penod'o) 180_days (Sectjep 106 4 4 Uniform Building Code)-oAPPLICANT'S SIGNATURE DATE YELLOW Applicant PINK Finance City of Carlsbad Bldg Inspection Request For 03/08/2007 Permit# CB063379 Title 24 HR FITNESS-TEMP POLE Description (NEW LOCATION DUE TO POWER LINE BURIAL) Inspector Assignment 1055 AVIARADR TP Lot 0 Type ELEC Sub Type Job Address Suite Location APPLICANT LUSARDI CONSTRUCTION COMPANY Owner Remarks Phone 7608025133 Inspector Total Time CD Description 32 Const Service/Agricultural 39 Final Electrical Act Comment Requested By JOHN Entered By CHRISTINE Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments \f AgQgQ. CERTIFICATE OF LIABILITY INSURANCE "iT/'zT/Toos' 'RODUCER (858)642-0010 FAX (358)642-0388 G A Pearson and Associates License #OA91092 62?5 Lusk Boulevard, Suite B £ Olego, CA 92121 NSURED Lusardi Construction Co 1570 Linda Vista Dr. San Marcos, CA 92078 THiS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLfCtES BELOW INSURERS AFFORDING COVERAGE INSURERA American Int'l Specialty Lines Ir INSURERS National Union Fire Ins. Co. of H INSURERC American Home Assurance Company INSURER D INSURER E NAIC# LS. CO 'itt , PA COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS •JSR .TR A B ir 4DDL NSRC TYPE OF INSURANCE GENERAL LIABILITY X ~X~~ COMMERCIAL GENERAL LIABILITY 1 CLAIMS MADE | X | OCCUR $10,000 SIR GEN L AGGREGATE LIMIT APPLIES PER ~~] POLICY [TIE | |LOC AU1 X* OMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS • GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY _J OCCUR j ~| CLAIMS MADE DEDUCTIBLE RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes dsscritw under SPECIAL PROVISIONS below OTHER POLICY NUMBER CL 17S711S CA 8262244 -INSURER B. WC 1359707 (CA) * INSURER C. WC 1359708 (AOS) POLICY EFFECTIVE DATE IMM/DO/YYI 01/01/2006 01/01/2006 01/01/2006 01/01/2006 POLICY EXPIRATIONDATE fMM/nn/YY) 01/01/2007 01/01/2007 01/01/2007 01/01/2007 LIMITS EACH OCCURRENCE DAMAGE TO RENTEDPRFMIRFR (Fo nrnirnnnp] MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS COMP/OPAGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Par accident) PROPERTY DAMAGE (Per atadent) AUTO ONLY EA ACCIDENT OTHER THAN ^ ACC AUTO ONLY AGG EACH OCCURRENCE AGGREGATE Y WC STATU OTHA TORY LIMITS FR EL EACH ACCIDENT EL DISEASE EA EMPLOYEE EL DISEASE -POLICY LIMIT $ 2,000,000 $ 100,000 s 5,000 s 2,000,000 s 4,000,000 s 4,000,000 1,000,000 s s J s s s S s s s $ s 1,000,000 5 1,000,000 3 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED SY ENDORSEMENT / SPECIAL PROVISIONS IE: Job #2794 - VCC Oceanside OCATION- Oceansnde, CA ertificate holder is named as additional insured with regards to the above-mentioned Job/Location, per 'orm CG2010 0704 attached 10 Day Notice of Cancellation in the event of non-payment of premium CERTIFICATE HOLDER CANCELLATION City of Oceanside 300 N. Coast Highway Oceanside, CA 92054 SHOULD AMY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER V/ILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 70 THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSU^R ITS AGENTS OR R£ PRESERVATIVES AUTHORIZED REPRESENTAJWlX ,/ ff^~'^'^~~^— /^fS ^<r J^^^'f^^^^~^^ ' ACORD 25 (2001/03)©ACORD CORPORATION 1988