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Home My WebLink About1645 SANDALWOOD LN; ; CB070208; Permit01-25-2007 City of Carlsbad * 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No CB070208 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Reference # Project Title 1645 SANDALWOOD LN CBAD ELEC 2051305200 Lot# MASON RES REPLACE 100 AMP PANEL W/NEW 200 AMP PANEL Applicant HATFIELD ELECTRIC 8898 MADISON AV LA MESA CA 91941 858 531 8007 Status ISSUED Applied 01/25/2007 RMA 01/25/2007 01/25/2007 Entered By Plan Approved Issued Inspect Area Owner MASON EDWARD J 1645 SANDALWOOD LN CARLSBAD CA 92008 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 100 0 0 0 $1000 $2500 $000 $000 $000 $000 $000 $000 $000 $000 TOTAL PERMIT FEES $3500 Total Fees $35 00 Total Payments To Date $35 00 Balance Due $000 Inspector FINAL APPROVAL 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 FOR OFFICE USE ON, PLAN CHECK NO EST VAL Plan Ck Deposit. Validated By / Date / Address (include Bldg/Suite #)Business Name (at this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units Assessor's Parcel #Existing Use Proposed Use Descnption of Work SQ FT £Uc\eve#i ^viua i>PGrcA^ CONTACT PERSON^different from apphcartt) Name Address City State/Zip Telephone #Fax# [JT.. APPLICANT%Cqntractc Name J3_A.9§2t for Contractor.D Owner _P___AgerrtJp£Owner_ Ux Address City State/Zip Telephone # PROPERTY OWNERu^^vT^~l.G.U^ gk^aiu^Cio'We C^lsfe^t^ZBc^ ''^^u^Pn^ Name Address City State/Zip Telephone # (Sec 7031 5 Business and Professions Code Any City or County which requires a permit to construct alter improve demolish or repair any structure pnor 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 violation of Section 7031 5 by any applicant fop a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500])Mm Name State License # /Vr-Y7 ^S O t Address License Class C* t O City State/Zip City Business License # Telephone # Designer Name State License # Address City State/Zip Telephone # [6 f WORKERSCOMPENSATION Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations "^13- 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 the work for which this permit is issued D I have and will maintain worker's 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 earner and policy number are -— i r*\j-N-o I Insurance ComoanvS^Qfe VlJ(T\QgJb^lVtfyvJ»\4utr \>UfiflPolicv No GUO^S/jCQC) Expiration Date *•' (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 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 tha cost Af compensation faamajbfei are provided for in Section 3706 of the Labor Code interest and attorney s fees. SIGNATURE jxW.lUiJ^ A lAga3>J[^/ DATE {"^J^-Q-r |7 OWNER BUILDE^^KJLJiR^^ta^^^_^J''_^l^__^^']'"^*~'^' '/'" "'"' «"'" _"'~^~~^^ .'~<~, "~7"^ ------- - *~"' — •••- | 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 d 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 contractors) licensed pursuant to the Contractors 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 matenals for construction of the proposed property improvement DYES D NO 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 / /ontractors 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 WHITE File YELLOW Applicant PINK Finance PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 FaradayAve, Carlsbad CA 92008 Page 2 of 2 {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 for or nsk management and prevention program under Sections 25505 25533 or 25534 of the Presley Tanner Hazardous Substance Account Acf? 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 El CONSTRUCTION LENlNG~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(1) Civil Code) LENDER S NAME LENDERS ADDRESS APPLICANT CERTIFICATION JI 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 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 JUDGEMENTS COSTS AND OSHA An OSHA permit is required for excavations of 5 0 deep and demolition or construction of structures over 3 stones in height 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 for a penod ofpBO days (Section 106 4 4 Uniform BuildmaCode) APPLICANT S SIGNATURE DATE WHITE File YELLOW Applicant PINK Finance r «• UNSCHEDULED BUILDING INSPECTION DATE -IC.-A'-I INSPECTOR A PERMIT # oni»v>/** PLAN CHECK# JOB ADDRESS DESCRIPTION. CODE DESCRIPTION ACT COMMENTS POLICYHOLDER COPY SD COMPENSATION INSURANCE PO BOX 420807 SAN FRANCISCO CA 94142-0807 CERTIFICATE OF WORKERS COMPENSATION INSURANCE ISSUE DATE 1O-O1-2OO6 O035620-2O06 GROUP POLICY NUMBER CERTIFICATE ID- 1 CERTIFICATE EXPIRES 1O-O1-2OO7 10-O1-2OO6/1O-01-2OO7 CONTRACTORS STATE LICENSE BOARD ATTN WORKERS' COMP UNIT BOX 26000 SACRAMENTO CA 95826 SD LICENSE NUMBER LICENSE PERMIT #859352 INCEPTION DATE 1O-O1-2OO6 DO SD This is to certify that we have issued a valid Workers Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated, This policy is not subject to cancellation by the Fund except upon -JQ days advance written notice to the employer We will also give you 1O days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement term or condition of any contract or other documentwith respect to which this certificate of insurance may be issued or to which it may pertain the insurance afforded by the policy described herein is subject to all the terms exclusions and conditions of such policy PRESIDENT UNLESS INDICATED OTHERWISE BY ENDORSEMENT COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS, EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS $1 OOO.OOO PER OCCURRENCE EMPLOYER HATFIELD HERSHEL JEFFREY DBA HATFIELD ELECTRIC 8898 MADISON AVE LA MESA CA 91941 SD (REV 2-05)PRINTED 10-19-2006 M04O9