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Home My WebLink About1351 CASSINS ST; ; CB972097; PermitBUILDING PERMIT Permit No: CB972097 07/30/97 08:05 Project No: A9702654 Page 1 of 1 Development No: Job Address: 1351 CASSINS ST Suite: Permit Type: ELECTRICAL Parcel No: 215-691-37-00 Lot#: 755307/30/97000101 02 Valuation: 0 Construction ^Tffff: VN 20..(X) Occupancy Group: Reference*: Status: ISSUED Description: NEW ELECTRIC CIRCUIT Appl/Ownr : GALLEGOS, ED. 306 W. EL NORTE PKWY. ESCONDIDO, CA. *** Fees Required *** Fees: Adjustments: Total Fees: Fee description 760 985-8126 Collected & Credits Applied: 07/30/97 Apr/Issue: 07/30/97 Entered By: MDP *** it .00 .00 20.00 Ext fee Data Enter "Y" for Ele Enter "Y" for Rem< * ELECTRICAL TOTA 10.00 Y 10.00 Y 20.00 CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 JERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 FOR OFFICE USE ONLY PLAN CHECK NO. f"") - 2-^ T7 EST. VAL. Plan Ck. Deposit Validated By Date Address (include Bldg/Surte *)Business Name (at this address) Legal Description Lot No. Subdivision Name/Number UnKNo.Plus* No.Total # of units Assessor's Parcel *Existing Use Description of Work SQ.FT.*of Stories * of Bathrooms City State/Zip Telephone * Fax f SPS(P-:m:'n:rr~ —•*-»W-MZ& Name S.'CONTBACTOR: COMPANY NAME City / State/Zip Telephone f - (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, slso 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 Codel 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 dvH penalty of, not more than fivehuodrad defers 11500)).>£/? ' State License **> Address License Class City / State/Zip City Business License * Telephone* TelephoneDesigner Name Address City State/Zip State License * 6. WORKERS'COMPENSATION ' ~ * .'"" ""'- - fTT'" '^^V^^e^^^r^>\ Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: D I hsve end 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 thepdric for which this permit is issued. IB***! have and will maintain workers' compensation, as required by Section 3700 of the Labor Coda, for the performance of the work for which this permit is issued. My' worker's compt|nsation insurancecarrier end policy number are: Insurance Company (_£lJ?~\jQ&li^ Polcy No. fAf'p(oi[QU /Mart.) Expiration Date_ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*1001 OR LESS! ^ ' / 0 CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit to issued, I shad not employ any person in any manner so as to become subject to the Workers' Compensation Law* of California. WARNING: Failure to secure workers compenaalfloiv cHferage to unlawful, and snaR subject an employer to cnminsl penaltiea and tivR fines up to one hundred thousand dollars <»10>«O$TJIn wMtion to tte^nt Aftompsnsatlon. damaeei es provided for In Section 3706 of the Labarjedeylntenst and attorney's fees. SIGNATURE ^"^ ^OW^t // foflfa DATE "7/£d/7 ) »j ::.':;.owNE^-BUlUERDECLARATlOni^4I'' *''f %-*&&**fsaPCi* ~*i'~,afsts",^:. ^ijssep-'iisics:i^^*;^^^^|L^^^i^^rp.a~.;g!^l5»"f" 53G~T>=' 1 hereby ammn that I am exen^Urom/fW^omryMor's'Ucense Law for the following reason: D I, as owner of the property or/my erraldyees with wages aa their sole compensation, wM do the work and the structure to not intended or offered for sale (Sec. 7044, Business and Profesttorkiade: 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 buikHng or Improvement to sold within one year of completion, the owner-builder wiH have the burden of proving that he did not buHd or improve for the purpose of sale). O 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 Lsw does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractors) Heensed pursuant to the Contractor's License Law). D 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 hsve contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / i Nitractera 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 ftJR AfOAwfeSM*^ 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 26805,25533 or 25534 of the Prestov-Tanner Hazardous Substance Account Act? O YES D NO Is the applicant or future building occupant required to obtain a permit from tr* sir polhiticm oxrtrrt Olstrict or air o^jaHty rnanagement district? D YES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school sits? 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. SBipSitlHicliolII^^ !T ^-ir,"^*-' ' I hereby affirm that there is s construction tendrng agency for the performance of the work for which this permit Is Issued (Sec. 3097(1) Civil Code). LENDER'S NAME LENDER'S ADDRESS. I certify that I have read the application and atate that the above Information la comet and that the information on the plans la accurate. I agree to comply with an City ordinances and State laws relating to buHdng construction. I hereby authorize representatives of the Qt> 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 Aa LIABILITIES, JUDGMENTS, I OSHA: An OSHA permit is required for excavations over EXPIRATION: Every permit issued by the Building Official work authorized by such permit IsjurtSmSi or abandoned at any time APPLICANT'S SIGNATU! and demolition or construction of structures over 3 stories In height. the provisions of this Code shsM expire by limitation and become null and void If the building or days from the date of such permit or If the building or work authorized by such permit is suspended of 180 days (Section 106.4.4 Uniform Building Code). DATE VC" ' HW- «r.n!t..ant CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB972097 FOR 08/05/97 DESCRIPTION: NEW ELECTRIC CIRCUIT TYPE: ELEC JOB ADDRESS: 1351 CASSINS ST APPLICANT: GALLEGOS, ED. CONTRACTOR: OWNER: REMARKS: C/ED/985-8126 SPECIAL INSTRUCT: INSPECTOR AREA PLANCK* CB972097 OCC GRP CONSTR. TYPE VN STE: LOT: PHONE: 760 985-8126 PHONE: PHONE: INSPECTO: TOTAL TIME: CD LVL DESCRIPTION 31 EL Underground/Conduit-Wiring ACT COMMENTS DATE DESCRIPTION ***** INSPECTION HISTORY ***** ACT INSP COMMENTS Staib Insurance Service110 E.Wilshire Avenue Suite 212 Fullerton, CA 92832 IIS 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 POLICIES BELOW COMPANIES AFFORDING COVERAGE COMPANY •A California Compensation Ins Edward Gallegos 306 W. El Norte Parkway Escondido, CA 92026 THIS IS TO CERTIFY THAT THE POLICIES OF MBURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TOE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OP 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COLTR A TYPE OF INSURANCE GENERAL UABECT & AU1 QAI COMMERCIAL GENERAL LIABILITY CIAJMA MADE ! OWNER'S (CONTRACT J OCCUR OR'SPNOT OJMMRLE UANUTY /WYAUTO ALL OWNED AUTOS SDHEDULED AUTOS WREQ AUTOS NONOWNCO AUTOS uoi:UABtLrTY ANY AUTO ENCfiMUAMJTYnUMBRELLA FORM OTHER THAN UMIHtUA FORM EMPLOYER*' UAWJTV THE PROPRIETOR/ PAKTNEftsyeXECUTrVE OFFICERS ARE: DESCRIPTION QF OPERATIONS/LOCAT* LICENSE #536566 MCL EXCL POUCY NUMBER * W9640078S5 - •SSTpSSS? 04/01/97 POUCV EXPIRATION r 04/01/98 UMTS aENEAALAQQNBQATE PROOUCTS . COMP «P AOQ PBRSONALiADVINJUDy EACH OCCUR ACNCC FlREDAMAOEiAiwgmM MlOIXPtAIWMWftMM) COMftNED SINGLE LIMIT (Pwpvtoni 35?2ffir PnOPfiRTYQAMAOl AUTO ONLY • EA ACCIDENT OTHER THAN AUTO ONLY: EACHACCDENT AGGREGATE EACHOCCUflRfWE AOOREGATE x wwJftJrril I'Sn* EL EACH ACCIDENT EL OBEAK . POLICY UMIT CL DISEASE • EA EMPUIYEE * *t *i 1 * • i *s 1 1 s i • v- 1- -.:.'* ':•"• t 1JXWJM) • 1JOOPjDO t IJNMjOn i CONTRACTORS STATE LICENSE ; SOARD VS35 GOETHE ROAD O BOX 26000 »,CA 95826 WOULD ANY OF THE ABOVE DOCMBEO MUdEB K CANCEUCD KKME TH EXPHMTKNI 0*T£ THEREOF, THE IMWM OOMMNV WU. UOEAVO* TO UAi 30 DAY* WMTTEN NOTJCE TO THE COmfWATE NOUMR NAMED TO THE UF BUT FAILURE TO HAH. 9UCN HOTIfiS WALL MPOJC NO OMJOATIOM OR LUHUT AflgMTt OB