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Home My WebLink About2041 GAYLE WAY; ; CB043545; PermitJ ::>~ce_ S"l;<'oa~,,,,';!!~.,~~ ~~~~~~!~"" 09-13-2004 Electrical Permit Permit No: CB043545 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: 2041 GAYLE WY CBAD ELEC Status: Parcel No: 20515201 00 Lot #: 0 Applied: Entered By: Reference #: Plan Approved: Issued: Project Title: PHILLIPS RES-REPLACE100 AMP Inspect Area: ELECT PANEL W/NEW 200 AMP PANNEL Applicant: PHILLIPS FAMILY TRUST 06-13-95 2238 OCEANVIEW RD OCEANSIDE CA 92056 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 TOTAL PERMIT FEES 100 0 0 0 Owner: PHILLIPS FAMILY TRUST 06-13-95 2238 OCEANVIEW RD OCEANSIDE CA 92056 ISSUED 09/13/2004 RMA 09/13/2004 09/13/2004 $10.00 $25.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $35.00 Total Fees: $35.00 Total Payments To Date: $0.00 Balance Due: Inspector: Date: Clearance: $35.00 NOTICE: Please take NOTICE tha approval of your project includes the "lmpos1 ion" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." Yo 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 f s/ xa in fwhi h ouh ve r vi I n iv naN Tl imil r hi orastowhi h oflimi in h r viou I PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE ONLY PLAN CHECK No. C/JaLf 1sys EST. VAL. __________ _ Plan Ck. Deposit d Validated By , __ 4 Date Q] fJ/o t I 17"', Business Name (at this address) Legal Description Lot No. Subdivision Name/Number Name Address 3 . APPLICANT O Contractor 0 Agent for Contractor O Owner City 0 Agent for Owner • Na19e Address City Unit No. Phase No. Total # of units # of Bathrooms LS/311/) State/Zip Telephone# .. ~ROPERTY OVXNER /·fe@ Pt./., fl,/> 5 tz 2 s-.:::C1:....::C:!::€:cfl.c:t-?:..:t1:.L1-=-l:!=w::,__ ....... rY~ca:.c;;e...c.-Au:t?::...:s:21..:LQ=:it___..C""'A,,._,_. ---1-i .... zo=..)'-. <-L._f __ Z.,_,&,"""o.c.,___,Lt/-"3...L'1_-..... g"-o---'t"-7..._ Name ~ Ad.!ress City S.tate/Zip Telephone # • 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 struct ure, 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 [$5001). Name Address City State/Zip Telephone# State License # _________ _ License Class _________ _ City Business License # _______ _ Designer Name Address City State/Zip Telephone State License # _________ _ 6. WORKERS' COMPEtiiSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 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. O 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) 0 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 abor code, interest and attorney's fees. mlGNATURE ~ ~ DATE 3 . OWNER-BUILDER DECLARATION · • 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). ,8. 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 ). 0 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. 0 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 I phone number I 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 I phone number / contractors license number):, _________________________________________________ _ 5. I will provide some of the work, but I have c:,ntracted (hired) the following persons to provide the work indicated (include name I address I phone number / type of work): ~ -::-&-- PROPERTY OWNER SIGNATURE J,e JL ~ DATE _________ _ (COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING .P~RMITS 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 Act7 0 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 ? 0 YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES O 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. .CONSTRUCTION L_ENDlfllG ~GENC:Y I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 30970) Civil Code). LENDER'S NAME ______________ _ LENDER'S ADDRESS __________________________ _ 19. 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 Cit\! 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 limilation and become null and void if lhe 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 \ /.t any time after the work is commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). )APPLICANT'S SIGNATURE ~ a~ DATE J1..,-z. /fr et-Cf01 WHITE: File YELLOW: Applicant PINK: Finance UNSCHEDULED BUILDING INSPECTION PERMIT# ~-~5<-(S .PLANCHECK, ___ _ JOB ADDRESS 2 ° 4 ( 6 ~1 k i:y, DESCRIPTION ________________ _ CODE DESCRIPTION ACT COMMENTS 33 ~ mJvv