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HomeMy WebLinkAbout1995 COSTA DEL MAR RD; ; CB111018; PermitCity of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 05-13-2011 Electrical Permit Permit No: CB111018 Building Inspection Request Line (760) 602-2725 Job Address: 1995 COSTA DEL MAR RD CBAD Permit Type: ELEC Status: ISSUED Parcel No: 0000000000 Lot#: 0 Applied: 05/13/2011 Entered By: MDP Reference #: Plan Approved: 05/13/2011 PC#: ... Issued: 05/13/2011 Project Title: LA COSTA RESORT CART BARN Inspect Area: 200 AMP FEED FORM LA COSTA CART BARN TO TEMP Applicant: '•-.. Owner: POWER PLUS •..*: 436 N QUINCE ST 92025 760839-9430 : Electric Issue Fee $10.00 Single Phase per AMP 0 $0.00 Three Phase per AMP 0 $0.00 Three Phase 480 Per AMP 0 $0.00 Remodel/Alteration per AMP 200 $50.00 Remodel Fee $0,00 Temporary Service Fee $0.00 Test Meter Fee $0.00 Other Electrical Fees $0.00 Additional Fees $0.00 TOTAL PERMIT FEES $60.00 Total Fees: $60.00 Total Payments To Date: $60.00 Balance Due: $0.00 FINAL £PpROVAL Inspector: *-* Date: -> "^ 1 "/ < 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. CITY OF CARLSB, Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 760-602-2717 / 2718/2719 Fax: 760-602-8558 www.carlsbadca.gov Plan Check No. | /- |61 © iEst. Value Plan Ck. Deposit Date JOB ADDRESS PACE#/UNITf,' CT/pnojECT *PHASE* OOF UNITS * BEDROOMS'» BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Areafs) j jf- e\, 1 1 m/v i \ ~~ fo ff \~ v*^y> (SF) I PATIOS (SF) (CE 01 EXISTING USE PROPOSED USE GARAGE (SF)ECKS (SF)FIREPLACE YESD #NOD AIR CONDITIONING YES D NOD FIRE SPRINKLERS YES D NO D CONTACT NAME (If Different Fom Applicant APPLICANT NAME ADDRESS Si ADDR STATE CITY,STATE '/I ZIP ,O7^ PHON PHON EMAIL EMAIL PROPERTY OWNER NAME CONTRACTOR BUS. NAME ADDRESS ADDREl vt cm-STAT ZIP STATE ZIP PHONE FAX 'HONE FAX EMAIL EMAIL ARCH/DESIGNER NAME & ADDRESS CITY BUS. LIC.*7 (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 theapplicant 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 theBusiness 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 acivil penalty of not more than five hundred dollars ($5001). Workers' Compensation Declaration: / hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-insure lor workers' compensation as provided by Section 3700 of the Labor Code, tor the performance of the work for which this permit is issued. SJ have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, tor the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy * number are: Insurance Co. ff / tf fit, jff^A.b h C- fer/xw . TV ^ wi /- Policy No. ^ "i. Cw^~l^l^")\ 0 */ Expiration Dale 3— >?>-/^ This section need not be completed if the permit is for one hundred dollars ($100) or less. CD Certificate of Exemption: I certify that in the performance ot the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100.000), in addition to the cost of compensation, damages asjjrovid^d for injection 3^06 of the Labor code, interest and attorney's fees. £$ CONTRACTOR SIGNATURE A I hereby affirm that I ant exempt from Contractor's License Law lor the following reason: D I, as owner of the property or my employees with wages as their sole compensation, will do the work and Ihe 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 wilhin one year of completion, the owner-builder will have the burden of proving that he did nol build or improve for the purpose of sale). D I, as owner of Ihe properly, am exclusively contracting with licensed contractors lo 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 lor such projects with conlractor(s) licensed pursuant lo the Contractor's License Law). D I am exempt under Sector, Business and Professions Code for this reason: 1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement. D Yes D No 2.1 (have / have not) signed an application for 3 building permit for the proposed work. 3.1 have contracted with Ihe following person (firm) lo provide the proposed construclion (include name address / phone / contractors' license number): A. 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 / contractors' license number): 5.1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work): JS^PROPERTY OWNER SIGNATURE DAGENT DATE City of Carlsbad Bldg Inspection Request For: 05/26/2011 Permit* CB111018 Title: LA COSTA RESORT CART BARN Inspector Assignment: Description: 200 AMP FEED FORM LA COSTA CART BARN TO TEMP SALES TRAILER Type: ELEC Sub Type: Job Address: 1995 COSTA DEL MAR RD Suite: Lot: 0 Location: APPLICANT POWER PLUS Owner: Remarks: fust for the set up.- notEMR Phone: 7608399430 Inspector:, Total Time: CD Description 32 Const. Service/Agricultural Act Commen Requested By: MICHELE Entered By: CHRISTINE Comments/Notices/Holds Associated PCRs/CVs/SWPPPs Original PC# Inspection History Date Description Act Insp Comments 5 or 3 5u .? 8 8398 209 mi 'ON S 1 KJ Zt'LO DHl/HOZ/ZI/IYll HO AIIO wa 01:21 nni Agoktr • CERTIFICATE OF LIABILITY INSURANCE3/31/2012 ^ToTT THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Insurance Brokers, LLC 725 S. Figueroa Street, 35th Fl. CA License #OF 15767 Los Angeles C A 900 17 (213)689-0065 l1!^™, SR Bray, LLC dba Power Plus! 1J01895 pOWer Plus Solutions Corp. dba Power Plus! Power Plus International, Inc. 1210 N. Red Gum Street 'Vnahoim C A n3Pflfi CONTACTNAME: PHONE IF AX IMC. Ha. Ext): I/A/C. No): E-MAILADDRESS: INSURER(S) AFFORDING COVERAGE INSURER A: Old Republic General Ins Corporation INSURERS : Philadelphia Indemnity Insurance Company INSURER c : Indian Harbor Insurance Comoanv INSURER D : INSURER E : INSURER F : NAIC# 24139 18058 36940 COVERAGES SRBRA01 Q3 CERTIFICATE NUMBER:11076843 REVISION NUMBER:xxxxxxx THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF 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. INSRLTR TYPE OF INSURANCE ADDL INSR SUBR VVVD POLICY NUMBER POLICY EFFfMM/DD/YYYY)POLICY EXP fMHTOO/YYYYI LIMITS GENERAL LIABILITY X A1CG37451104 3/31/2011 3/31/2012 EACH OCCURRENCE .COMMERCIAL GENERAL-LIABILITY CLAIMS-MADE I X I OCCUR $25,000 Ded/occ. DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: "XJ POLICY (I SJSr f~1 LOG PRODUCTS - COMP/OP AGG 1.000.000 100.000 5.000 1,000,000 2.000.000 2.000.000 AUTOMOBILE LIABILITY PHPK702649 3/31/2011 3/31/2012 X X COMBINED SINGLE LIMIT(Ea accident)1.000.000 ANY AUTO ALL OWNED AUTOS HIRED AUTOS Comp. - SIR/: BODILY INJURY (Per person)XXXXXXX SCHEDULED AUTOS NON-OWNED AUTOS Coll. - SlK/$d BODILY INJURY (Per accident)XXXXXXX PROPERTY DAMAGE XXXXXXX K XXXXXXX UMBRELLA LIAB EXCESS LIAB DED OCCUR CLAIMS-MADE NOT APPLICABLE EACH OCCURRENCE XXXXXXX AGGREGATE JCXXXXXXL RETENTION $XXXXXXX WORKERS COMPENSATION AND EMPLOYERS'LIABILITY y/|g ANY PROPRIETOR/PARTNER/EXECUTIVE I—Tl OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) ' ' If yes, describe under DESCRIPTION OF OPERATIONS below A1CW37451104 3/31/2011 3/31/2012 ,, I WCSTATU-I IOTH-X [TORYLIMITSJ [ ER N/A E.L. EACH ACCIDENT 1.000.000 E.L DISEASE - EA EMPLOYEE 1.000.000 E.L. DISEASE - POLICY LIMIT 1.000.000 Professional Liability (Errors & Omissions) PEC0034524 3/31/2011 3/31/2012 Aggregate: $2,000,000 Each Claim: $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD101, Additional Remarks Schedule, tf more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION 11076843 Evidence of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05)The ACORD name and logo are registered marks of ACORD /£>1988-ZB10 ACORD CORPORATION. All rights reserved