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Home My WebLink About1173 CHESTNUT AVE; ; CB960837; PermitB U I L D I N G P E R05/06/96 13s 29 Page 1 of 1 Job fid cress* 1175 CHESTNUT flU Permit Tups" ELECTRICfU. Parcel No- 205-210-39-00 Ua'i nations 0 0 c c u p a n c y G r o u p •• . R e f e r e n c e # s Descriptions UPGRRDE ELECTRIC SERUICE TO • 125 ftMPS. I T Suite P e rmi t N o s CB960 83 7 Project Nos 09601.155 D e u e 1 o p me n t N o » fl p p 1 / 0 w n r LIGHT ON 4044 CfiLflfJO DR1UE LA MESft, Cfl/ 91941 C o n s t r u c t i o n T y p e s U M Status-" ISSUED Qpplleds 05/06/96 Ft p r /1 s s u e « 0 5 / 0 6 / 9 6 E n t e r « r| B y " iv! D F' 619 593-6666 *••<••* Fees Required . * *> *Fees Collected S Credits Fees s -fid j ustments •• Total Fees5. Fee des Enter "Y" Remodel /P * ELECTRI cr i f 0 Hecm... 41 ,00. ' - ','-"'•' -'•00 - '•- . •- Total • Credits? .. £«--00 • ; T0ta) Paywents^. • . •"•. Ba 1 arise Due"'' ption - • / ....un'^ts ' fae'/.l)nit\ r Electric Is-sue Fee '-• >• ...-'-'--• , ' , ', r Per flfi'F' - ' ">"•"•• " ' ~\ p'cj • • ?tj TOTflL ' . ••-.-•-.'' ,00 .00 4 1 , 0 0 Ext fee 10 -j; | 1 ,00 7 '^ . 00 Data Y .7590 05/06/96 0001 01 02 C-PRHT 41=00 APPROVAL - f (. CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERADT APPLICATION City of Carlsbad Building Department 2075 Las PaImas Dr.. Carlsbad, CA 92009 (619) 438-1161 1. PERMIT TYPE From list I (see back) give code of Permit-Type:. For Residential Projects Only: From List 2 (see back) give Code of Structure-Type: Net Loss/Gain of Dwelling Units . 2. PROJECT INFORMATION PLAN CHECK NO. EST.VAL PLAN CK DEPOSIT, VAUD. BY ~ DATE FOR OFFICE USE ONLY Building or Suite No. Nearest Cross Street LEGAL DESCRIPTION Lot No.Subdivision Name/Number Phase No. CHECK BELOW IF SUBMITTED: D 2 Energy Calcs D 2 Structural Calcs D 2 Soils Report D1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORK SQ. FT. 7% # OF STORIES # OF BEDROOMS # OF BATHROOMS 3. DUNlAt.1 FtKSUN i» aitlerent irom applicant) NAME (last name first) CITY STATE ADDRESS ZIP CODE DAY TELEPHONE 4. APPLICANT -ETCONIRACIOR NAME (last name first) CITY LJ AGtN I FOR CON 1 KACTOR ADDRESS STATE Cfi DOWNER DAGtNl tOK OWNtK ZIP CODE DAY TELEPHONE 5. PROPEK'IY OWNER NAME (last name first) CITY tf££5>ADDRESS //?3 CS/££>77ULT /9l£~ . STATE ZIP CODE DAY TELEPHONE 6. CONTRACTOR NAME (last name first) STATE<^?, ZIP CODE STATE L1C. # &/S>S37- LICENSE CLASS DESTONhR NAME (last name tirstj CITY STATE DAY TELEPHONE CITY BUSINESS LIC. # ZIP CODE ADDRESS DAY TELEPHONE STATE LIC. # 7. WORKERS^ COMPENSAIMJN Workers' Compensation Declaration: I hereby aftirm that I have a certificate of consent to self-insure issued by the Director of Industnal Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). INSURANCE COMPANY SffiJT? F&H& POLICY NO./ZS^S^"?^ EXPIRATION DATE £)£> -Q/-tf& Certiticate ot 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. SIGNATURE DATE 8. OWNER-BUILDER DECLARATION Uwner-Builder Declaration: 1 hereby attirm that I am exempt trom the Contractors License Law lor the following reason: D 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.). D 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). D I am exempt under Section Business and Professions Code for this reason: (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, commencing 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 [$500]). SIGNATURE DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY: 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?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 EF ANY OF Tlffi ANSWERS ARE YES, A FINAL (^TOTC^TE OF CIOCIJPANCT MAY NOT BE ISSUED 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 9. CONSTRUCTION LENDING AGENCY 1 hereDy allirm that there is a construction lending agency tor the performance ot the worK tor which 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 intormalion is correct. 1 agree to comply with all 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 SATO CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over S'O" deep and demolition or construction of structures over 3 stories in height. Expiration. Every permit issued by the Building Official undp building or work authorized by such permit is not^ommen"J such permit is suspended or abandonee at anyone after) APPLICANTS SIGNATURE; the provisions of this.Code shall expire by limitation and become null and void if the —:'.\\m 365 days from the date of such permit or if the building or work authorized by is commenced for a period of 180 days (Section 303(d) Uniform Building CodeV DATE: S> WHITEf File YELLOW: Applicant PINK: Finance CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB960837 FOR 05/07/96 INSPECTOR AREA DESCRIPTION: UPGRADE ELECTRIC SERVICE TO PLANCKf CB960837 125 AMPS. OCC GRP TYPE: ELEC CONSTR. TYPE VN JOB ADDRESS: 1173 CHESTNUT AV STE: LOT: APPLICANT: LIGHT ON PHONE: 619 533-6666 CONTRACTOR: PHONE: OWNER: PHONE: REMARKS: MW/ SPECIAL INSTRUCT: BETWEEN 11 AND 2 PLEASE INSPE TOTAL TIME: CD LVL DESCRIPTION 33 EL Service Change/Upgrade ACT COMMENTS DATE DESCRIPTION ***** INSPECTION HISTORY ***** ACT INSP COMMENTS C i t y o f C a rj sb ad Building Department WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self-insure for A. workers' compensation as provided by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. have and will maintain workers' compensation, as required by section 3700 f 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 COMPANY POLICY NO.EXPIRATION DATE: (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS) 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 • C. workers compensation^ l|aws of/California. Signature Date Warning: Failure to secure workers' compensation coverage is unlawful, and shall be 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. March 3, 1995 2O75 Las Palmas Dr. • Carlsbad, CA 92009-1576 - (619) 438-1161 - FAX (619) 438-0894 COMPENSATION INSURANCE FUND P.O. BOX 807, SAN FRAIMCISCO,CA 94101-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE -*•':.,-•?.; - r"* J," f "f - C*"" /*', ISSUE DATE 08-01-95 POLICY NUMBER; 1257990 -"95 „ CERTIFICATE EXPIRES: 08-01-96' <<* CITY OF SAN DIEGO ATTN: BUILDING DEPARTMENT 1222 FIRST AVENUE SAN DIEGO CA 92101- /* • % •_/• ,iT*V,' C ri:*/W-~;i JOB: ALL'OPERATIONS •.Vr*'"_;„;,*..*; >* " I?.- ^">n'-*"<«?•?«'; *tt'^' .•"-v^i^"-•as ^cp •t?» ">- 'i*'•>, S--r ~^T«' •-••.•••:•>-••.' "- -• T- - •,~-*f-t' '•>, ~~, * *<•«•-" v* ;i"v". >" vr.?--—>- ^ -rx^'f -2»^ jy ^ v ^.^ rsThis is to~ certify that we have issued a valid Workers' Compensation insurance-policy in a-form approved by the '"*„- £V,sS*V= • We will also give ypu 30 days' advance notice should this policy be cancelled prior to its normal expiration. policies described herein is subject to a« the terms, exclusions and conditions of such policies.'^,-^V'' '•«- '"' EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: "$1,000,000.00 PER OCCURRENCE,-~ • - -f»-W^ rX-^--^ STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE~NOT ^ELIGIBLE^ A: ^ ™ ~~^?*\-SfS FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY. :t^ ^^ , '.",. ^ I *. J ~n i, r v " •^•, - - a^~ .ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08/01/95 IS ATTACHED TO AND ~v 'r'5^" FORMS A PART, OF THIS POLICY. _ - , ^ ^ M „ .. » * x .1 : ,. i^A'M. v J,',"- <sfe'- *-> 'vi\."S, -V-^M. ^' ^^, . " ' ^V*-*''-'^^*«l **rf,^*» " EMPLOYER LEGAL NAME LIGHTZ ON 4644 CALAVO DRIVE LA MESA CA 91941 DUNNINGTON, TROY AND DUNNINGTON, SHERRI _. 07" 19~9S on AOQ SCIF 10265 (REV. 2-95