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Home My WebLink About1838 MARRON RD; ; CB062392; Permit08-22-2006 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No: CB062392 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: 1838MARRONRDCBAD ELEC 0000000000 Lot#: Applicant: PRIDE ELECTRIC 9160 MISSION BLVD 92059 951-681-3004 DOLLAR TREE: NEW 100AMP 3 PH. SUBPANEL FOR COOLER, FRIG & FREEZER Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 08/22/2006 JMA 08/22/2006 08/22/2006 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 0 100 0 0 $10.00 $0.00 $50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $60.00 Total Fees:$60.00 Total Payments To Date:$60.00 Balance Due:$0.00 Inspector: FINAL APPROVAL Clearance: NOTICE: Please take NOTICE tnat 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 i . CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 1.INFORMATION FOR OFFICE USE ONLY PLAN CHECK EST. VAL. Plan Ck. Deposit Validated By Date Address (include Bldg/Suite tt)Business Name (at this address) Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units Assessor's Parcel # y Description of Work -A> Existing Use SQ.FT. -5x? f Stotits C-c~> #ofSto 2. CONTACT PERSON Of different from applicant) r Proposed Use # of Bedrooms # of Bathrooms Name grfr Address City 3, APPLICANT ^Contractor D Agent for Contractor D Owner Q Agent for Owner /»///' $ tf/fr i*? Si/Pit Qfy/i £ State/Zip Telephone # £57 Fax* Name po//fr -/-re ^ 4. PROPERTY OWNER Address State/Zip Telephone # Name Address City State/Zip Telephone # 5. CONTRACTOR-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 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]). Name State License # A 1 b 5 tf "-£" Address License Class C^ ' & City State/Zip City Business License tt Telephone # Prfjf e efe&-f-rf'c- £<\-t . tyfco K\r'S£;*h Rl"** Qv&rsi'Je £& <?S7 &<?/ 3oof Designer Name State License # %l & ^ ^ - 6. WORKERS' COMPENSATION Address City State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: Sf 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. 0 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 Policy No. Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) l~l 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 ($1QO,OpO), in addition tjjhacpst of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURED ^.^ " ^^ DATE f/'Z ^ /V £ 7, OWNER^BdlLDfRDECLARATiON 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: O 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~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). l~l 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. CD YES ONO 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/VOW^JfS/Df/VTMi 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 l~l 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. 9, CONSTRUCTION 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(i) Civil Code). LENDER'S NAME LENDER'S ADDRESS 9. 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 commenpe^?ora period of tSO-dayg^Section 1^6,4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE WHITE: File YELLOW: Applicant PINK: Finance DATE INSPECTOR PLAN CHECK,:' DESCRIPTION CODE DESCRIPTION ACT COMMENTS 07/28/2006 14:47 NO.609 D003 POLICYHOLDER COPY P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE COMPENSATION IN SU RANGE ISSUE DATE: 07-27-2Q06 GROUP: POLICY NUMBER: 1828197-2006 CSTTIFICATE ID: 12 CERTIFICATE EXPIRES; 04-01-2007 04-01-2006/04-01-2007 5K DOLLAR TREE 1838 MARRON RD CARLSBAD CA 92008-1172 SK This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Instance Commissioner to the employer named below for the policy period indicated This policy is not subject to cancellation by the Fund except upon 30 days advaice written notice to tne employer. We will also give you 30 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 AFFORDINGCALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS'COMPENSATION LAM. 'EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2088 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 05-26-2006 ISATTACHED TO AND FORMS A PART OF THIS POLICY. 9e**~%8^-*&Affairs 816595 PRIDE ELECTRIC EMPLOYER FOLLIS, STEPHEN SEAN DBA: PRIDE ELECTRIC 9160 MISSION BLVD STE C RIVERSIDE CA 92509 01/31/2007 £», INDIV IREV.2-05) [KAF.CN] PRINTED : 07-27-2006