The URL can be used to link to this page

Home My WebLink About1681 DOCENA RD; ; CB044077; Permit11-03-2004 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No CB044077 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Reference # Project Title 1681 DOCENARDCBAD ELEC 2159100500 CROWLEY RESIDENCE GAS & ELEC TO BBQ Lot# Status Applied Entered By Plan Approved Issued Inspect Area ISSUED 11/03/2004 MDP 11/03/2004 11/03/2004 „ Applicant BURL JORDAN LANDSCAPE 2740 LUCIERNAGA ST 92009 760 04-0675 Owner CROWLEY MICHAEL F 1681 DOCENARD CARLSBAD CA 92009 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 $1000 $000 $000 $000 $000 $1000 $000 $000 $2700 $000 TOTAL PERMIT FEES $4700 Total Fees $47 00 Total Payments To Date $0 00 Balance Due $4700 4732 11/03/04 0002 03 Q2 COP 4?., 30 Inspector 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 FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Deposit Validated By Date Address (include Bldg/Suite *)Business Name (at ttus address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total tt of units Assessor's Parcel #+.f« Existing Use Proposed Use Description of Work 2 CONTACT PEBiSQN (If difleram from applicant) SO. FT tto\ Stories ft of Bedrooms tt of Eiathroorns CA- Name Address City [3' .,-"APPLICANT . Q Contractor @J Agent for Contractor Q Owner Q Agent for Owner State/Zip Telephone #Fax » Name Address City State/Zip Telephone * C. Yo I&*& t 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 structuie, 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 violation of Section 7031 15 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars |$5001) Tor*** InnAtco**. a'723 irff*^ A Name State License » ^l^^ft /Address is License Class City State/Zip t "City Business License # lai Telephone tt Designer Name State License tt Address City State/Zip Telephone 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 tha performance of the work for which this permit is issued pCl 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 Insurance Company 7-frt.rk^ Crt^—A .—/-yl 5 J^-j^yf/V Policy No / "?£ "7 (0 I i OH Expiration Date /" JV ~0 5 (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) Q 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 coda interest and attorney's fees SIGNATURE ~f '-j/G^> DATE //- 3 0 */ ^^jxm^»m^^fymm^A^m^A^f'-^^^-:... ri, -;-~. - v-- .. •>«'.»,. - .1- I hereby affirm that I am exempt from the Contractor's License Law for the following reason l~l 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 tor 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) 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec 7044, Business and Profession'. 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) Q 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 Q YES QNO 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 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 managament and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? O YES O 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 LH NO Is the facility to be Constructed within 1,000 feet ot the outer boundary of a school site? Q YES Q 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,_LQQNSTRUCTION LENDING 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(0 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 representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes I ALSO AGHEE 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 alter the work is commenced fpr a penptt-oSUp days (Section 106 4 4 Uniform Building Code) APPLICANT'S SIGNATURE rV ~ //(\/f^ ~~ _ DATE ) f-~*> ~l WHITE File YELLOW Applicant PINK Finance City of Carlsbad Bldg Inspection Request For 05/19/2005 Permit* CB044077 Inspector Assignment JM Title CROWLEY RESIDENCE Description GAS & ELEC TO BBQ Type ELEC Sub Type Phone 7608040675 Job Address 1681 DOCENA RD Suite Lot 0 Location Inspector APPLICANT BURL JORDAN LANDSCAPE Owner CROWLEY MICHAEL F II Remarks Total Time Requested By KAREN Entered By CHRISTINE CD Description Act Comment 29 Final Plumbing I J^ ^ 39 Final Electrical Associated PCRs/CVs Inspection History Date Description Act Insp Comments 05/12/2005 39 Final Electrical CO JM NO ONE HOME - GATE LOCKED 11/12/2004 23 GasATest/Repairs WC PY ALREADY DONE SEE HISTORY 11/09/2004 23 Gas/Test/Repairs AP JM BBQ 11/08/2004 23 Gas/Test/Repairs CO BN 11/08/2004 31 Underground/Conduit-Wiring AP BN II roen 00 O z T> I P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE COMPENSATION .INSURANCE ISSUE DATE: 02-19-2004 CONTRACTORS STATE LICENSE BOARD WORKERS COMPENSATION UNIT P O BOX 26000 SACRAMENTO CA 95826 GROUP POLICY NUMBER 17676 n-2004 CERTIFICATE ID 1 CERTIFICATE EXPIRES 01-31-2005 01-31-2004/01-31-2005 LICENSE NUMBER. 815808 INCEPTION DATE 01-31-2004 D.O.. SP This is to certify that we have issued a valid Worker's 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 ID cancellation by the Fund except upon 10 days advance written notice to the employer We will also give you 10 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 thepolicies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance 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 AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. EMPLOYER >!PR2MN LANDSCAPE SC1F10262E Aceapt thb cartiflcate only » you see a faint wateimatk thai reads -OFRCWL STATE FUND DOCUMENT ILCNSPJ PRINTED- 02-19-2004 PAGE 1 OF1