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1120 CAMINO DEL SOL CIR; ; CB051807; Permit
\o\ 05-20-2005 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No: CB051807 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: 1120 CAMINO DEL SOL CR CBAD ELEC 2062611100 Lot#: VERKLEEREN RESIDENCE UPGRADE ELECTRIC SERVICE TO 200 AMPS plicant: ALL ELECTRIC CONSTRUCTION STEM 1914 MISSION ROAD ESCONDIDO 92029 Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: N L&BARBARA A ISSUED 05/20/2005 MDP 05/2072005 05/20/2005 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 100 0 0 0 4*0.00 00 Total Fees:$35.00 Total Payment To Date:$0.00 Balance Due:$35.00 II768 05/20/05 0002 01 CGP 35-00 Inspect FINAL APPROVAL^ Date: ^#-0*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 lees/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/exactions of which vou have oreviouslv been Given a NOTICE similar to this, or as to which the statute of limitations has prevtouslv otherwise expired. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday AVe., Carlsbad, CA 92008 FOR OFFICE USE ONLY PLAN CHECK NO.. EST. VAL. _ Plan Ck. Deposit Validated By Date . 20 O V Address (Include BUg/Suite *) Legal Description Assessor's Parcel i Description of Work Business Name (at this address) Lot No. Subdivision Name/Number Unit No. Phase No. Total 9 of units Existing Use Proposed Uss SQ. FT. f of Stories * of Bedrooms * of Bathrooms Name Addrsss City Ststa/Zip Telephone *Fax * Address CrtV Stete/ZIp ??^^^ TelephorM * P Name Address city *Wj$3££$$g3ft#i State/Zip sfc*sa*a8t» Telephon* * (Sec. 7031.5 Business and Professions Code: Any City or County which reojulrae s permit to construct, altar. Improve, demolish or repair any structure, prior to Ha Issuance, aha requires the applicant for such permit to fBe s signed statement that he Is licensed pursuant to the provleions of the Contractor's License Law . (Chapter 9, commending with Section 7000 of DMslon 3 of the Business and Professions Code) or that he Is exempt therefrom, end the bssfs for the alleged \\ exemption. Any violation of Section 7031.8 by any applicant forgjprmlt subjects the appHesnt to a civil penalty of not more then five hundred doflara [tSOOD. r Name Stete License 9 •Z3ysvfc Address UcenssClsss City Stste/ZIp City Business License t hone* 3&£>j}y4-*j_~5c7Z> Designer Name State Licence * Address City State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: Q I have end win 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. JQ I have and win maintain workers' compensation, ss 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 era: Insurance Company ^V^TTS* A.**n foHcy Noi-JMaT^/STO-Z? £• Expiration O»t»_ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [*100I OR LESS) Q CERTIFICATE OF EXEMPTION: I certify that In the performance of the work for which tMe permit Is Issued, I shall not employ any pereon In any manner so as to become subject to the Workers' Compensation Laws of Caltfomls. WARNING: Fa*** to-secure workers* Dumpeneatkm coverage Is unlawful, end shall subject en employer to criminal penafttoe and civil fines up to one hundred thousand doftara (* 100,000), In addition to the cost of compensation, damages as provided for hi Section 3706 of the Labor coda, interest and attorney's fees. SIGNATURE . _ _ - DATE I hereby affirm that I am exempt from the Contractor's License Lew for the following reason: Q I, as owner of the property or my employees with wages as their sole compensation, wHI do the work and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Lew does not apply to en owner of property who builds or Improves thereon, end who does such work himself or through hie own employees, provided thst sucK improvements ere not intended or offered for sale. If, however, the buHding or improvement Is sold within one yeer of completion, the owner-builder will have the burden of proving that he did not build or Improve for the purpose of sale). Q I, ss owner of the property, em exclusively contracting with Hcenssd contractors to construct the project '(Sec. 7044, Business and Professions Cods: The Contractor's License Law does not apply to en owner of property who builds or improves thereon, and contracts for such projects with eontractor(s) licensed pursuant to the Contractor's License Lewi, O 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. 1 (have / haw not) signed an application for s 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, superviss and provide the major work (include name / eddress / phone number / contractors license number): 5. i wW 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): . .... . DATEPROPERTY OWNER SIGNATURE Is the applicant or future building occupant required to submit a business plsn, acutely hazardous materials registration form or risk management end prevention program under Sections 26506, 25533 or 26534 of the Presley-Tanner Hazardous Substance Account Act? Q YES Q NO Is the sppHeant or future bufldmg occupant required to obtain a permit from the sir pollution control district or sir quality management dtarict? -Q YES Q NO Is the facility to be constructed within 1 ,OOO feet of the outer boundary of a school sits? O YES O 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 construction landing agency for the performance of the work for which this permit Is issued (Sec. 3097(1) Civil Coda). LENDER'S NAME . LENDER'S ADDRESS I certify that I hsve read the application and state that the above information Is correct and that the Information on the plans is sccurate. I agree to comply with ell City ordinances end State laws relating to bunding construction. I hereby authorize representatives of the City of Csrisbnd to enter upon the above mentioned property for Inspection purposes. I ALSO AQREE 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 end demolition or construction of structures over 3 stories In height. EXPIRATION: Every permit issued by the buikflng Official under the provisions of this Code shaft expire by Hmttation end become null and void if the bunding or work authorized by such permit Is not commenced within 180 days from the date of such permit or H the bulkfing or work authorized by such permit is suspended or abandoned at any time after the work Is commencedWor *P«4fcf flf 180 days (Section 106.4.4 Uniform BuHding Code). ^APPLICANT'S SIGNATURE ^zfff ' WHITE: Ffle YELLOW: Applicant PINK: Finance DATE City of Carlsbad Bldg Inspection Request For: 05/27/2005 Permit* CB051807 Title: VERKLEEREN RESIDENCE Description: UPGRADE ELECTRIC SERVICE TO 200 AMPS Inspector Assignment: PD 1120 CAMINO DEL SOL CR Lot 0 Type: ELEC Sub Type: Job Address: Suite: Location: OWNER VERKLEEREN JOHN L&BARBARA A Owner: VERKLEEREN JOHN L&BARBARA A Remarks: Phone: 7606440347 In spec Total Time:Requested By: JOSH Entered By: KAREN Act . CommentCD Description 39 Final Electrical Associated PCRs/CVs Inspection History Date Description Act Insp Comments 05/24/2005 33 Service Change/Upgrade AP PD License Detail Page 1 of2 California Home License Detail Contractor License # 771386 CALIFORNIA CONTRACTORS STATE LICEN DISCLAIMER A license status check provides information taken from the CSLB license data base. Before on this information, you should be aware of the following limitations: • CSLB complaint disclosure is restricted by law (B&P 7124.6). If this entity is subject tc complaint disclosure, a link for complaint disclosure will appear below. Click on the lin button to obtain complaint and/or legal action information. • Per B&P 7071.17. only construction related civil judgments reported to the CSLB are disclosed. • Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration. • Due to workload, there may be relevant information that has not yet been entered ont Board's license data base. Extract Date: 05/20/2005 * * * Business Information * * * TODD F SHIFFLETT & ASSOCIATES INC DBA ALL ELECTRIC CONSTRUCTION SERVICE 1914 MISSION RD STEM ESCONDIDO, CA 92029 Business Phone Number: (760) 740-5070 Entity: Corporation Issue Date: 11/12/1999 Expire Date: 11/30/2005 * * * License Status * * * This license is current and active. All information below should be reviewed. * * * Classifications * * * Class C10 Description ELECTRICAL * * * Bonding Information * * * CONTRACTOR'S BOND: This license filed Contractor's Bond number 10105379 in the an http://www2.cslb.ca.gov/CSLB_LIBRARY/License+Detail.asp 05/20/2005 License Detail Page 2 of2 $10,000 with the bonding company AMERICAN CONTRACTORS INDEMNITY COMPANY. Effective Date: 01/01/2004 Contractor's Bonding History BOND OF QUALIFYING INDIVIDUAL(I): The Responsible Managing Officer (RMO) T FITZGERALD SHIFFLETT certified that he/she owns 10 percent or more of the voting stoc of the corporation. A bond of qualifying individual is not required. Effective Date: 11/12/1999 * * *Workers Compensation Information * * * This license has workers compensation insurance with the STATE COMPENSATION INSURANCE FUND Policy Number: 1590292 Effective Date: 07/01/2001 Expire Date: 07/01/2005 Workers Compensation History * * * Miscellaneous Information * * * Date 11/12/1999 Description SERVICE Personnel listed on this license (current or disassociated) are listed on other licet ISalesperson Request ISalesperson Name Request © 2005 State of California. Conditions of Use Privacy Policy http;//www2.cslb.ca.gov/CSLB_LIBRARY/License+Detail.asp 05/20/2005