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HomeMy WebLinkAbout1145 CARLSBAD VILLAGE DR; ; CB100142; Permit01-22-2010 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No: CB100142 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC#: Project Title: 1145 CARLSBAD VILLAGE DR CBAD ELEC 1561802600 Lot#: SHELL STATION-REPLACE ALL FUEL DISPENSERS Status: ISSUED Applied: 01/22/2010 Entered By: RMA Plan Approved: 01/22/2010 Issued: 01/22/2010 Inspect Area: Applicant: FUELING & SERVICE TECHNOLOGIES STED 7050 VILLAGE DR BUENA PARK, CA 90621 714523-0194 Owner: ZANDER ARDIS P 0 BOX 222 NACOAZ 85620 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 0 0 0 0 $10.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $55.00 $0.00 TOTAL PERMIT FEES $65.00 Total Fees:$65.00 Total Payments To Date:$65.00 Balance Due:$0.00 Inspector: FINAL APPROVAL Date: 0//PJ/W0 Clearance: NOTICE: Please take NOTICEmat 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/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. € C S T'Y OF CARLSBAD Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 760-602-2717 / 2718 / 2719 Fax: 760-602-8558 www.carlsbadca.gov Est. Value Plan Ck. Deposit Pate (0 JOB ADDRESS PHASE* I # Of UNITS I S BEDROOMS SUITE#/SPACE*/UNIT# CT/PROJECT ## BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION Of WORK: Include Square Feet of Affected Area(s) EXISTING USE PROPOSED USE GARAGE (SF)PATIOS (SF) DECKS (SF)FIREPLACE YESD #NOD AIR CONDITIONING YES D NO D FIRE SPRINKLERS YES D NOD CONTACT NAME (If Dlfl APPLICANT NAI ADDRE 17 ADDRESS CITY PH6NE STATE ZIP 2V. STATE ZIP FAX PHONE FAX EMAIL EMAIL PROPERTY OWNER NAME . (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 theBusiness 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 acivil penalty of not more than five hundred dollars ($500)). Workers' Compensation Declaration: / hereby affirm under penalty of perjurywle^ithe following declarations: I have and will maintain a certificate of consent to self-insure for workers' compensafiBrrs^proyided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workecrffcgQwensaiJBn, as required by Section 3700 of the Labor Code, forThe^jerformanpe/yfee wBAJQ^wWchthj^ermit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co. /•f'*--C)/*ff) Policvfob.-$ £j*-$~7/~t''O&-'%Ot> Expiration Date /»* •— / /~//—r— --^ ^_—-r*^ T * ' ~~**~^ This section need not be completed if the permit is for one hundred dollars ($100) or less. O Certificate of Exemption: I certify that in the performance of the work for which thisjjafmfris issued, I shall not employ any p&rspn in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' comp«ft§atjpn covera^wtfruawful, and shall subject an employer to crimihXpenalties and civil fines up to one hundred thousand dollars (&100.000), in addition to the cost of compensation, damages^ffovi^ed ftinn£egp6njn06 of the Labor code, interest and attorney's fees. V DATE-CONTRACTOR SIGNA AGENT / nereoy affirm that I am exempt from Contractor's License raw for the following G t reason: 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). 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). I am exempt under Section _ Business and Professions Code for this reason: 1 . 1 personally plan to provide the major labor and materials for construction of the proposed property improvement. O Yes D No 2. 1 (have / have not) signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors' license number): 4. 1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (incl ude name / address / phone / contractors' license number): 5. 1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work):owing persons ti77 >eTpROPERTY OWNER SIGNATURE/^ 4- \AGENT Is the applicant or future building occupant required to submit a business dan, 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? d Yes WNo1 Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air Quality management district? n Yes )^No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? DYes XNO ' 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 lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender'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 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 Official 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 ) APPLICANT'S SIGNATURE DATE <lw?y Building Permit A ^b±\Jr ' 1635 Faraday Ave., Carlsba ^T CITY OF 760-602-2717/2718 /** A PI 1 f* O A F*V Fax: 760-602-85 CAKLbDAU www.carlsbadca., JOB ADDRESS CT/PRC-JECT* L6T# 1 PHASE* # OF UNITS # BEDROOMS Dnlicatian Plan Check N°' ^ /^ / ^ ^~PpllCQEIOn v_7 ' d, CA 92008 Est. Value / 2IV4 58 Plan Ck. Deposit <. m Date SUITE#/SPACE#/UNIT# APN # BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: Include Square Feet of Attested Ant(*) EXISTING USE PROPOSED USE GARAGE (SF) CONTACT NAME (If Different Fom Applicant) ADDRESS * CITY STATE ZIP PHONE FAX EMAIL PROPERTY OWNER NAME ADDRESS CITY STATE ZIP PHONE FAX EMAIL ARCH/DESIGNER NAME & ADDRESS STATE LIC. # PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES D # NO D YES D NO D YES D NO O APPLICANT NAME ADDRESS CITY STATE ZIP PHONE ' FAX EMAIL CONTgACTOR BUS. NAME ,^^^- . -— ADDRESS y> tfr j/ jr f ^tSff'fS&^/rSQ' i\.(/ ) ^^ ^^ CITY ^o • — STjJE ZIP df£- (^-/f0t0/V (?/*~ ^010/9 PHONE, FAX EMAIL STATE LJC.# --, .. ., __, CLASS , CITY BUS. LJC.#(7f)Z~7s^. 1/7*Y0(us6 ^ Ji> 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 thepplicant 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 01usiness 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 (Sec, Business and Professions Code) or . ...civil penalty of not more than five hundred dollars {$500}). WORKERS' COMPENSATION Worker*' Compensation Declaration: / hereby affirm under penalty of perjury one of the following declarations: G I hive and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this perm it is issued. I have and will maintain workersjjcorngejuation, jjs-ssquired by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Insurance Co. 5 //?/ ^ /^"CVteO Policy No. <96//$'5~tp &£>£<} Expiration Dale /"^/-—// This section need not be completed if the permit is for one hundred dollars ($100) or less! d Certificate of Exemption: I certify that in the performance of the work for which (his permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage i* unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (4100,000), in addition to the cost of compensation, damages asuevided^gr In Sutfgn/3706 of the Labor code, interest and attorney's fees. Jg$ CONTRACTOR SIGNATURE /^-</^ S/bf^^ fefAGENT OWNER-BUILDER DECLARATION DATE I hereby affirm that f am exempt from Contractor's License Law for (he following reason: a I, as owner of the property or my employees with wages as their sole compensation, win do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's 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). fa 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 f property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law). O I am exempt under Section ..Business and Professions Code for this reason: 1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement a Yes a No 2.1 (have / have not) signed an application for a building permit for the proposed work. 3.1 have contracted with the following person (firm) to provide the proposed construction (include name address / phone /contractors' license number): 4.1 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 / contractors' license number): 5.1 will provide some of the work, but I have contracted (hjpri) thejollowing^rsyislo provide the work indicated (include name / address / phone / type of work): JtSPROPERTY OWNER SIGNATURE/^^f MAGENT DATE City of Carlsbad Bldg Inspection Request For: 06/01/2010 Permit* CB100142 Title: SHELL STATION-REPLACE ALL FUEL Description: DISPENSERS Inspector Assignment: PY 1145 CARLSBAD VILLAGE DR Lot: 0 Type: ELEC Sub Type: Job Address: Suite: Location: APPLICANT GLOBAL PETROLEUM SERVICES Owner: KNOLL ADRIENNE Remarks: Phone: 6192775111 Inspector: Total Time: CD Description 34 Rough Electric Act Comments Comments/Notices/Holds Requested By: TONY Entered By:XHRISTINE Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 03/23/2010 31 Underground/Conduit-Wiring NR PY WORK COMPLETED WITHOUT INSPECTION City of Carlsbad Bldg Inspection Request For: 03/23/2010 Permit* CB100142 Title: SHELL STATION-REPLACE ALL FUEL Description: DISPENSERS Inspector Assignment:a. 1145 CARLSBAD VILLAGE DR Lot: 0 Type: ELEC Sub Type: Job Address: Suite: Location: APPLICANT GLOBAL PETROLEUM SERVICES Owner: ZANDER ARDIS Remarks: Phone: 6198902193 Inspector: Total Time: CD Description Act Comments 31 Underground/Conduit-Wiring ~{\) (— ' Requested By: DENNIS Entered By: CHRISTINE Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments Inspection List Permit*: CB100142 Type: ELEC SHELL STATION-REPLACE ALL FUEL DISPENSERS Date Inspection Item Inspector Act Comments 06/01/201034 Rough Electric - Rl 06/01/201034 Rough Electric PY AP FINAL 03/23/201031 Underground/Conduit-Wirin PY NR WORK COMPLETED WITHOUT INSPECTION Tuesday, June 01, 2010 Page 1 of 1 Check a License or Home Improvement Salesperson (HIS) Registration - Contractors Stat... Page 1 of 1 Department of Consumer Affairs "**•••- ^ •GOV Contractors State License Board Contractor's License Detail - License # 923763 At, DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying 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 to public complaint disclosure, a link for complaint disclosure will appear below. Click on the link or 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 onto the Board's license database. License Number: Business Information: Entity: Issue Date: Expire Date: License Status: Classifications: Bonding: 923763 Extract Date: 02/02/2010 GLOBAL PETROLEUM SERVICES INC 771 JAMACHA ROAD #251 ELCAJON, CA92019 Business Phone Number: (619) 456-9790 Corporation 10/17/2008 10/31/2010 This license is current and active. All information below should be reviewed. CLASS DESCRIPTION D40 SERVICE STATION EQUIPMENT AND MAINTENANCE B GENERAL BUILDI_NG_CONTRACTOR CONTRACTOR'S BOND This license filed Contractor's Bond number SC6368740 in the amount of $12,500 with the bonding company AMERICAN CONTRACTORS INDEMNITY COMPANY, Effective Date: 03/02/2009 C^trjSastoElsJBondingJHisjQry BOND OF QUALIFYING INDIVIDUAL 1. The Responsible Managing Officer (RMO) DENNIS CHARLES O'NEILL certified that he/she owns 10 percent or more of the voting stock/equity of the corporation. A bond of qualifying individual is not required. Effective Date: 10/17/2008 2. The Responsible Managing Officer (RMO) THOMAS EDWARD FYSH certified that he/she owns 10 percent or more of the voting stock/equity of the corporation. A bond of qualifying individual is not required. Effective Date: 10/17/2008 This license has workers compensation insurance with the STATE COMPENSATION INSURANCE FUND Policy Number: 467-0011359 Effective Date: 01/24/2009 Expire Date: 01/01/2011 Workers' Compensation: Personnel listed on this license (current or disassociated) are listed on other licenses. Personnel List I Other Licenses Conditions .ofJJse | Privacy Policy Copyright © 2010 State of California https://www2.cslb.ca.gov/OnlineServices/CheckLicense/LicenseDetail.asp 02/02/2010 SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY UPFP# HV# BP DATE The following questions represent the facility's activities, NOT the specific project description. PART I: FIRE DEPARTMENT- HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: Indicate by circling the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are circled, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. 5. Organic Peroxides 9. 6. Oxidizers 10. 7. Pyrophorics 11. 8. Unstable Reactives 12. 1. Explosive or Blasting Agents 2. Compressed Gases 3. Flammable/Combustible Liquids 4. Flammable Solids Water Reactives Cryogenics Highly Toxic or Toxic Materials Radioactives 13. Corrosives -etrrer+teattl PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISIONS (HMD): If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 1255 Imperial Avenue, 3'° floor, San Diego, CA 92101. Call (619) 338-2222 prior to the issuance of a building permit. FEES ARE YES 1. D 2. D 3. D 4. D 5. D 6. D REQUIRED. Expected Date of Occupancy: / / NO D D D D Dn Is your business listed on the reverse side of this form? (check all that apply). Will your business dispose of Hazardous Substances or Medical Waste in any amount? Will your business store or handle Hazardous Substances in quantities equal to or greater than 55 gallons, 500 pounds, 200 cubic feet, or carcinogens/reproductive toxins in any quantity? Will your business use an existing or install an underground storage tank? Will your business store or handle Regulated Substances (CalARP)? Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? D CalARP Exempt / Date Initials D CalARP Required / Date Initials D CalARP Complete / Date Initials PART III: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT: If the answer to any of the questions below is yes, applicant must contact the Air Pollution Control District (APCD), 10124 Old Grove Road, San Diego, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition permit. Note: if the answer to questions 3 or 4 is yes, applicant must also submit an asbestos notification form to the APCD at least 10 working days prior to commencing demolition or renovation, except demolition or renovation of residential structures of four units or less. Contact the APCD for more information. 1. YESn NOn n n nn nn Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the APCD factsheet at http://www.sdapcd.orQ/info/facts/permits.pdf, and the list of typical equipment requiring an APCD permit on the reverse side of this from. Contact APCD if you have any questions). (ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 1,000 feet of the outer boundary of a school (K through 12)? (Public and private schools may be found after search of the California School Directory at http://www.cde.ca.Qov/re/sd/: or contact the appropriate school district). Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos? Will there be demolition involving the removal of a load supporting structural member? Briefly describe business activities:Briefly describe proposed project: I declare under penalty of perjury that to the best of my knowledge and belief the responses made herein are true and correct. Name of owner or Authorized Agent Signature of Owner or Authorized Agent Date FOR OFFICIAL USE ONLY:FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:. BY:DATE: EXEMPT OR NO FURTHER INFORMATION REQUIRED COUNTY-HMD APCD RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY COUNTY-HMD APCD RELEASED FOR OCCUPANCY COUNTY-HMD APCD HM-9171 (04/07)County of San Diego - DEH - Hazardous Materials Division CB100142 1145 CARLSBAD VILLAGE DR