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Home My WebLink About121 CHINQUAPIN AVE; ; CB022182; Permit07-25-2002 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No: CB022182 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: 121 CHINQUAPIN AV CBAD St: TP ELEC 2060700400 PALISADES TEMP. POWER POLE Lot#: Applicant: POWER PLUS 436 N QUINCE ST ESCONDIDO CA 92025 760 839-9430 Status: ISSUED Applied: 07/25/2002 Entered By: MDP Plan Approved: 07/25/2002 Issued: 07/25/2002 Inspect Area: Owner: KEYSTONE CARLSBAD L L C 206? 07/25/02 0002 01 CGF" 02 20-00 Total Fees:$20.00,Total Payments To Date:$0.00 Balance Due:$20.00 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 0 0 0 0 $10.00 . $0.00 $0.00 $0.00 $0.00 $0.00 $10.00 $0.00 $0.00 $0.00 $20.00 Inspector: FINAL Date: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 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. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 1. PROJECT INFORMATION 12 \ FOR OFFICE USE ONLY PLAN CHECK NO.J EST. VAL. Plan Ck. Deposit. Validated By Date Address (include Bldg/Suite #) Legal Description Assessor's Parcel # Description of Work i I Business Lot No. Subdivision Name/Number ' •'.. Existing Use -^ . SQ. FT. #of Stories Name (at this address) Unit No. Phase No. Proposed Use # of Bedrooms Total # of units n of Bathrooms 2. CONTACT PERSON (if different from applicant) Name 3, APPLICANT ^^ 0"Agen Address Q Contractor. 0"Agent for Contractor. d Owner City CD" Agent ; for Owner State/Zip Telephone #Fax* Name 3o WWV^JJxwK C/ftf. Address fiv iS^ I ^ 3Z_t*i r-v City Telephone # PROPERTY OWNER Name 5. CONTRACTOR Address City State/Zip Telephone COMPANY 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 the Business and Professions Code] or that he is exempt therefrom, and the basis for the alleged exemption. Any violatiooAtSection 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001). •£/•?> C- Name State License # Address License Class City State/Zip Telephone # City Business License # V'Z-.C? 4> 2- ia^V Designer Name ' • . Address City State/Zip Telephone State License # ' _ _ . 6. WORKERS' COMPENSATION Workers/ Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: l~l 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 thejaKJfk for which this permit is issued. El 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: O <~J r -3 ptA^X^A. _ ____ Policy No. / ^> £^5 / / O ^ ^Expiration Date s"~ ' ^>) ^O ~yInsurance Company (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) n 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 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. SIGNATURE _ . _ _ ] _ DATE _ 7. OWNER-BUILDER DECLARATION 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 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). |~l 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). n 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. d YES dNO 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 COMPLETE THIS SECTION FOR/VO/vVfl£SroCT7MttBU!Kll!tiIliRMITS 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 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. 8. CONSTRUCTION (.ENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME • . LENDER'S ADDRESS 3. APPLICANT CERTIFICATION 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 representatives of the CitV 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 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 commenced fbr aMriod pf|180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE "^Tx ^^^\>T • DATE WHITE: File YELLOW: Applicant PINK:.Finance City of Carlsbad Bldg Inspection Request For: 08/02/2002 Permit* CB022182 Title: PALISADES Description: TEMP. POWER POLE Inspector Assignment: Type: ELEC Job Address: Suite: Location: APPLICANT POWER PLUS Owner: Remarks: Sub Type: 121 CHINQUAPIN AV TP Lot 0 Phone: 7608399430 Inspector: Total Time: CD Description 32 Const. Service/Agricultural st Comments Requested By: MICHELE Entered By: CHRISTINE Associated PCRs/CVs Inspection History Date Description Act Insp Comments 07/30/2002 32 Const. Service/Agricultural CO PY CAN NOT READ BREAKER AMPS - REPLACE BREAKER p.ai B0 ONI ...... 11 :SS APR 03> 2002 *-1247-: 2/3 861 3wfch 0*k F»*k Road Cevinii CA 91723 Phone: 626-966~36$4 Fa*;6*6-366-3395 .ppa Gopp.jS«S» . HOUJfiR. TMB CeRfneftfiBp6* NOT UIEHO, ALTER THE COVgRACg AFfQflPEfrBV THi" " ' WaUfgftS AffQft&ING COVERAGE Hartford Fire Inyuwaicn Co 8tt.t*. """"""'" "••••""-"• - JMSUHFRC Markal INSURE* D tat. Ca. \ \ ! ANY REOUSS^T, TERM W«WmiWN« ANY COFffl^TQll^ i(JW*«c:wtMtiC*ftfl*l6A*fcllllMHfclSSUE60ft ^^i— » ~~ WAYPEirWM m» "TOa^N<'-t;i^bKOtaRYT«PPOI^1FSW».HmFnHFHFI»^ S—~^ , POUCK8 A09RF«ATFliMITaSllOVWNMAYH»V«!iH:k»»(rl>Ueir(l(tV**JI,OlAI»«» . . "SJI TVPeQFItWWMICE : MJUCVHlrtlift SA^fjtfi-SSWK* ISffiPi JfiSffifrfl?14 ! LIMT» [GENERAL LWOLtiY ' f 1 MMft MAOC X OBCUn L_mlJ. „ . . 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RETENTION $ i WORKERS COMPENSATION AND ; EMPLaWBKrLIABKJTy i otken C P**d?<ji(j j) i^»3.1 Liiiyijity 72DBSOA1991 03/31/02 03/31/03 72t)KMOR0906 03/31/02 03/31/02 i • i i i i r T — j; , 1555110-02 03/31/02 03/31/03 1 kALHtMJL'UMFNCF nKto«wuF(*^«,r,,; 'Mromf(M,w»>«rw,)' aTNFRAI MMREOAtB TOCnocrS • COMW' *CC COMSWEOSWMlEyHIT(CtMKMn) eOOILYIKIUHV (n» pwren) MffOONLY - EA ACCI *NI WCHOCcuawNCf W***™.- « WC &TATU* ]^J^" Cl PACHACCDENT tuuiSbwe-fArwiottt £1, oi^fcWt; PAI «•> IIUIT ' 11,000,000 ,1300,000 ilfl.ftiOO «l,OOtQ,OQp M % f OOv'tf-d^O^I" 1 2 ,900,000^ * 1,000, 000 J * I 1 11,000,000 *l,0flfl.400 41,000.000 MB-813S73 02/25/02 02/25/03; $1,000,000 i BCSi»l)H^W^4Mm*I10N»Ua<kt1ONaW«Mlfflr«»«KLU*0«**OOeD Certificate holder id included as additional insured. . ^* ' .' ,'r I- CERTIFICATE HOL8GR ;V | A0wiism*i.iiwui«eo!t««u<<»i.en« A CANCELLATION GCBXDOO AGORD 25-9 (7/97) NOTUM TO TUB QjMl*lCm HOI Of B H4HFn TO -f»l» LWf, BUT MIUMV-TO BO 16 $HAU HIPOKNOOOLKMttOilOB tfihtftV OF^ANV^^WIB u*OK ft* MgWM tt« AdtMTS Clt / / .A- —