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HomeMy WebLinkAbout2105 RUTHERFORD RD; MULTI-PERMIT FILE; CB983840; PermitB U I L D I N G '11/09/'.1.,8 10: 49 P E R M ·r· T Permit No: CB983840 Proje~t No: A9805004 Devel9pment No: P9,ge· "1 .·of 1 Job Addres._s: 2106 Rt,JTHERFORD RD Permit Type: ELECTRICAL Suite, Parcel No: Lot#: Valuation: 0 Occupancy Group: Reference#: Description: 100 : PAC AMP METER PED BELL Appl/Ownr : ROBINSON ELECTRICAL 8871 TROY STREET. SPRING VALLEY CA 91977 *** Fees Required *** Fees: Adjustments: Total Fees: Fee description Enter "Y" for Ele Single Phase Per 619 . . _ 3187 i1I0?/9B oo01 OJ. Cons_truct ion 0?-:.f·Rrfr: Status: Applied: ~pr/Issue: Entere¢.1 By: 697-6040 & Credi.ts n,~ NEW 7i;-OO ISSUED" . 11/09/9-S 11/09/98 JM *** .---~-----·-------'------· - .00 .00 35,00 Ext fee Data 10.00 Y. 25.00 CLEARANCE ---,__-,..._ a, e,tmt. ~-· CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161 \ PERMIT APPLICATION FOR OFFICE USE ON,LX z l'JLA( . PLAN cHEcK No. il/J,2u _D CITY OF CARLSBAD BUILDING DEPARTMENT 2075 'Las Palmas Dr., Carlsbad CA 92009 "(619) 4'38-1161. EST. VAL. -----~-~,.;:z;:;- Plan Ck. Deposit~~--.....,.&...;-'-'<-;&-"- Validated Bv~-...Jf-.z;._¥--,;-.,..~~""""?'~ Date ________ ...._.:..+ ...... f:-'"'-t,.;- Address Onclude Bldj~uite I) . e R 'G ~ 1'. ~ I of;:) . R-u.r fte,,,, "--.U '11-.J> B1,15iness Name (at this address) EU.. }k7 ._.-(egal ~ ~ption · Lot No. Sul:idivisiol! N11111/Nuniber Unit No. Phase No. Total# of units Assessor's Parc!'I I Name ~~tm.'t. Existing Use Proposed Use ~·.;·· ,~· (Sec. 7031.5 Business and Professions Code: Any City or County which requires I 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 iicensed 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 thit he js 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 fiVJ hundred dollars ($5001). /..O . · /JI) 11l --ucn,e: · 1 o .ST~ ~1?1e.111)t,,. V LL<i-Ct-r 111 IJ· t/f·<91'l- Name Address City State p Telephone # 0 '/{) State License # '1-tl 9 'i 'i5 License Class C. f O City Business License # / ~ 0 (u Cf$ 7 ~ ....... , Designer"Name Address City State/Zip Telephone State-License # ________ ....,.... a..1¥i~~;.:co1,1~.Mit<>rG.~.,a,,~~~-:~u1:;"il~~:.a:;'.;:~;;£;'.r~1::;;~~'JG~~'.£f~t~11,:i;"fl~§.~~~~'™~~:;I~;!';.~':d;::--,;.:~~.:,;:,::.:, .. Workers' Compensation Declaration: I hereby affirm under penalty of perjury_ one of the following declarations: tJ I have and will maintain I 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. E ·I have and will maintain workers' compensation, 11 required by Section 3700 of the Labor Code, for the performance of the work for :which this permit is issued. My ~orker's compensation insurance carrier and policy number are: I Insurance Co~pany u , ; Q,o CB:Su. 19 (..,,~ . . Policy No. C;,f & o{C) 5 <oa-ao Expiretion Date 1 0 , l 1 9 (THIS SECTION NEED NQT BE COMPLETED ·1~ THE PE,RMrril FOR ONE HUNDRED DOLLARS 1$1001 OR LESS!. 0 Ci:RTIACATI: OF·EXl:MP:TION: · 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: Fail!Jre ecure•workers' compensa · coverage.is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars I · the co of compensa~ion; damages ea provided for in Section 3706 of the ~ cod~:t~~:""omey's fns. SIGNATURE • . . . . . DATE I t --k.t:j l7.~~;i:Owti1~~~UI_LD$1,DECLMATIO~\i~~f:t:I,~?J,O;\··~~~::ii~?-;;t,:f~~=~ .. ;:c\~-::[£~{,.S~.;~',i:·t'.;:,~::fiii:J!'.~2I*a~fii~~~~~'S;1~.i;l!_~~I£.~J!~[,;~~~jR?;.; :··-: I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 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 Wcense Law does not app_ly 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 l!Ot b1,1ild or improve for the purpose of aale). 0 I, as.owner of the property, am exclusjvely contracting with licensed contractors to construct the project (Sec. 7044, Busineaa and Profes1ions 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 contractorls) licensed pursuant to the Contractor's.License Law). 0 I am exempt under Section ..,,.. _____ Busines,s lind 'Professions ·Code for this reason: 1 . I personally plan .to pr~lride th• major lilbor and materials for construction of the proposed property improvement. 0 YES ONO 2. I lhave/ 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 numbe_r):. ____________ ..a,_ ________ .....:_...:.c. ____ ..;.... __ ,--_________________ ....,. __ 5. I will' provide some of the work, but I have contract~d (hired) the following person~ to provide the ,.;..ark indicated (include name / address / phone numbe~ / type of work):_"---,---------------.....;.--------------------------------------------- PROPE.RTY OWNER SIGNATURE ___________________ ,--___ DATE _________ _ ;@.~i$.EC'J:lQ8JfQR,-l@,~~-U!.tQ.ING~.ir~QN,~~&1W~~~~~~~l~~r~~ti;:~c Is th!! a;iplic::nt or future builclinii cccupant ;equir.d to 1ubmit I busine" plan, acutely hazardous {'laterials registration form or risk management and prevention program under Sections 25505; 25533 or 25534 of the Presley-Tinner Hazardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required tci obtein a.permit from the air pollution control district or air quality management district? O YES O NO Is the facility to be co~ructed within 1,000 fHt of the outer. boundary of I school site? 0 YI;~ 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. ffjj~O:-rt~c'.fiQij,LeijpJNG~~Eii¢t~f~~~~J:;;t~i;;tt~l::~~~;:i.fqJ,(!;'f{J~~~~~f1~:;J;:;:r:::::i~f.~' . I hereby affirm that there is a construction lending agency for the performance of the ytork for which this permit is issued (Sec. 3097(i) Civil Code).· I certify that I have read the application and state that the abol(e 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 ttie, above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP ~ft'.llESS THE CITY OF CARLSBAD AGAl~ST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY· WAY ACCRllE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required·for excavations over s•o• deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by he Building· Official under t~e prov.'sions of this Code shall expire by limitation and become nuil and void if the building or work authorized by such permit is no c;,mmenced within 365 dilys fro the datt of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the · or: i \ 'i r· period of O days (Section 106 .• 4.4 Uniform Building Code). L /-/ -q B APPLICANT'S SIGNATURE -.,...l,'----\l.;::.,11=.L...-~---~:;:_..i.,.t: __ ;=:.;=-::...;..::::::o:!...----DATE ___ ......, ____ f' ______ _ WHITE: File. YELLOW: Appli7ant PINK: Finance PERMIT# CB983840 CITY OF CARLSBAD INSPECTION REQUEST FOR 12/23/98 INSPECTOR AREA PS PLANCK# CB983840 OCC GRP DESCRIPTION: 100 AMP METER PED PAC BELL TYPE: ELEC JOB ADDR$SS: 2106 RUTHERFORD RD APPLICANT: ROBINSON. ELECTRICAL .CONTRACTOR: OWNER: REMARKS: C/ROB'BIE /TEMP METER RELEASE SPEC.IAL INSTRUCT: TOTAL TIME: CD LVL DESCRIPTION 34 EL Rough Elect+iC 34 EL Rough Electric CONSTR. TYPE NEW STE: fHONE: 619 697-6040 PHONE: LOT: PHONE: ·>_j INSPECTOR ____ _.{) __ · _-_{V ____ _ ACT COMMENTS Jlf _____ _ ------.......... ---------------------------------· -,..._ ---------------------· --. --------------------------.,....---...,.....----------------------· ----------------- DATE DESCRIPTION 121698 Rough Electric ***** INSPECTION HISTORY***** ACT INSP AP P$ r12,rJ 6ri ;fJ COMMENTS SEO ONLY ' ' l Mllllt'Heitf\l·,.;•ga111lft.•. •:a• tnu.l'ftlffliWll!W-IIIGIIIWllneOf'-..e6Y. -~--tllql,lirelt"' .nNICIIIJ __ .,... MIIClull .-11111'• W JaelnG.lll&~ SU I of M1J paa.cnLlltf b ... Oll&""~CIIIII-~ ~~ft. lit ~~ffll c1ew.01 • .,._...,..a,caJnJIQlltal',.._. N*ft)Gffl la fl~ :con~N PllMati! ltaa 11C1n1t SIXal! "'la~ INISIIIIJecaaa&«lfflllllallii- ~ldenllflao9tffl ~ and uM t,11111&,er It a. w...ut1ea•atsor·lft'll-1111bu.,__.~lftCWli"I 91111lprt,ent. ad ~ .af clr,1-,nt,lstaht" :,Jl'IDCCI~ cl_aar.llllQL l .rTTAalCM OT.I.QQ Qa,-, ss:~ ' l · CA.1LE-IIOI.Ec=C1 .. CIWl1"BT O~a CJ~ • ll . ~i,. ~-:-:~ :· ~-~~;;;,~~ i~ ~~ ::~ !;;. :~ =~~~;;.:;..-~ {.;;;O~XW1~~:•.1~ .. -~:"!'!. ~-~-!i~.._~.,,.;· ~-;ao.;;=•;;. :;;;-SIZll;~~:f~ I i I . I ,. I ' j ,. I . ' i t i i . I CiDDH C no. .... ., --- 100~ .J T .-,-,r,i •..1 CJSTA1'E ·-......:--I..\OCM /4/4At6 ~'00 EXISTING Cl 01•· CJ7\l\l• RIOW POLE RI_Sl!.11 CUA0 - - ~l-17 ~t'c1:o -·ssz" s19s· ....... in=i,o' --s61so-1n B U I L D I N G PERMIT Permit No: CB983204 Project No: A9804185 Development No: 1)9/23/98 11:27 Page 1 of 1 '"' Job Address: 2105 RUTHERFORD RD Suite: Permit Type: ELECTRICAL Parcel No: 212-120-20-00 Valuation.: o Lot#: Const~uction·Type: NEW Occupancy Group:. Reference#: . Status: ISSUED Applied: 09/23/98 .Apr/Issue: 09/23/98 Description: __ INSTALL 31 8FT1 FLORESCENT LITE ' 7.t,NCE · · ,, Entered By: BT 626-285--'.473"3 PERMIT HAS EXPIRED IN ACCORDANCE WITH U.B.C .. SECTION 106.4.4 . . DATE q / af 4 SIGNATURE fJ1. Vll>_ ~-. I L APPRoVAL-"'j t CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438.;H61 . 1 -~- PERMIT APPLICATION FOR OFFICE USE ON~<? ·J PLAN CHECK NO. -, /) 33!!.-, CITY OF CARLSBAD BUILDING DEPARTMENT _ 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 EST. VAL.------,-----~~~ Plan Ck. Deposit ___ __, ____ _ ~:~=-at-ed_B_y_·~~~-~---~:·¼-,';,-~:.#ii:~f-ri->'H...,.ir--- Legal Description · Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Name· Address City Siate1Zip Telephone.# f.'_,. _____ ..... ,,,--..,,,, ..... '•'"' -~ .• A,:-'; .P,ROPE~O,W_~.!'B'.' . ..:.. -~---'-~-~~;"' Name Address City S.tate/Zip Telephone# ~::;, ·.C.Q~WW9.8.:.9.Q.~P..~ri't'.:',fl~!YIIL ,;;_ . " . · --~·-· · .. · :, . ;J .:· ... · , . -···' ,(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 issua·nce, 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 ~. commending with Section 7000 of Division 3 of the Business and Professions Code) or that he is exempt therefrom, and the basis for the allege·d exemption. Any violation of Sectio~031,5 by :!.W ap~ant for a permit subjects the app9t to a civil penalty of not more than five hundred dollars [$500Jl. Sitfe{lJo A (Uc{RI<, ~2.~ CLo~l2Ly A~ /ernfreclJy, C,4 7'f7<to [CU] ?./,J~;'-t7-33 Name Address T City f State/Zip • Telepho e #. State-License # ~' / l 7 7 License Class (? -/t> City Business License #~~~,µ~-rq:.~ Designer Name Address City Telephone State License # . ;sy -:-vloRKEJW::;r -=-o-::OM;;:;;;;:Pf;;;;N:::;S:;::;:A;;;:T:;::10:;:::N;::" ;;: _=·, ,=,.= .. ,. . -~ ·-:-;--·"' ... ,. ; -. . ··-·· .. -. -:;·:--:-:· ---.:~:"".·.~"'7:;s·· -:;_·7~-=:::.: :";:_;'f"V-:;;'~;"'?·'?· :::-::~,.z:; Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: D ) 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: ~ _ /.,. e..l-O Insurance Company c· Al.. C cwt e PolicyNo.L 'f<gC. /7180~ Expiration Date 6 r 71 (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 ahy 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 code, interest and attorney's fees. SIGNATURE. ________________________ ..,... __ -'----DATE _________ _ t~r:}:?PWNE~?~tiJliDElfDEOI..ABAt1QN>:~ -~~::.:~:~. -n ,n~ .. ',:::,: >.~ :N:::::--~~A- 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: D I, as owner of the property or my employees with wages as their sole compensation, will dci the work aricl 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 1s 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). · tJ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Bl!siness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and c·ontracts 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 r,eason: · 1. · I perso.nally plan to provide the major labor and material~ for construction of the propqsed property improvement. 0 YES ONO 2. I (have / have not) signed an application for a building permit for the proposed work. 3._ I have contraqted, with the following peri;on (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 !icense 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 ____ ,---________________ _ !co. PL , ··"HIS'SEC, 10 ':Fo :.No. ... ES/0. ,,, . .,,.1:.801 'D ' '"ER rrs·o"'i;.y; < .,:· · -" .M,.fil:E'.a_ .. " ... lin\.!N..EQE . .'JNIJL . 'f!J,JJ!':,',_. ."'~JN.!U! ... IYI. , "'--.. -- Is the applicant or future building occupant required to sul:>mit a business plan, acutely hazardous materlals registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the PresleyaTanner Hazardous Substance Account Act? 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? D YES D NO Is the facility to be constrl/cted within 1,000 feet of the outer boundary of a,.sc;hool site? -D YES O NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT, BE ISSUEP UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. i{i;:,;.&@~'r,i\0¢Itiffi:J~P1N~M~~~v:z .: . -;; :~-:..:_::..: .. -~ ·.: ;:, ": ::.:-:. ::; :L~ >,:::,',.:..:c:.::: ,_:·:'J2EZc;Y"J./f;:::r:_; __ ,:_: ~-~-')-,:~~' :>:::,:::'.~'.:c.22:::r:--~~t;~,~7y:;:,-··:,'. · ;"'V{Tl · 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 . ....=;,::..:.;,.:.:..:.~=:::::=;:::::;:::;=:::;::;:;:;:;:::::;:::::::::;:::::;::;;;:::::;::-:-:-=:;;:::::-::;;;::;;::;;:::;:::;:;;:;;::;;:;;:;;;;,;;:;;;;;:;:;;;:;;::::;;;;:;;;:; ~~:~RW .. C.Att1lQeJtTirtlqAif-l,Qr1t,·:~:" "" ~ -NA ·,~~:--:._~". _,_ &J, .. :..,.:~ .. ~~:,.;~ ,$;<' ~· .:-..:.-<&-~~'~i~A~-:~~:~\ ·,:/,T~~~a0=rz'fz~~~:::-I:::~.~<~~~~-~~~ ' I certify th·at I have read the application and state that the abo.ve information. is corrept and that the information on the plans is accurate. I agree to comply with all City ordinances a,nd State !aws 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. EXPIRATION: Every· permit issued b work authorized by S\JCh permit is n t c or abandoned at any time after APPLICANT'S·SIGNATURE over 5'0" deep and demolitiqn or construction of structures over 3 stories in height. s from the date of such permit or if the building or work authorized by ·such permit is suspended ~ o· f 1-80 days (Section 106.4.4 Uniform Building Code). "'1 ., _ q A _ _ · DATE -1+--c.--=µJ'---~-...._ I· -=~=------ WHITE: File YEtLOW: Applicant PINK: Finance --'"~-~--) 03/21~97 13:30 Page 1 of 1 B-U I L D I N G Job Address: 2105 RUTHERFORD RD Permit Type: ELECTRICl~L Parcel No: 212-120-20-00 P E R·M I T · suite: _Lot#: Permit Project Development No: No: N,o: Valuation: o Construction Type: Occupan,cy Group: Ref.e:cence# ~ Status: Description: INSTALL TRANSFORMER, SUBPANEL . . : LIGHGTING & METER PANEL FOR STRG.SPACE Applied: Apr/ If:? s u-e : Entered By: INSP .. -pp·ROVAL _.......-....... DATE Afi&i/,..1- . CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92()09 (619) 438-1161- CB970592 A9700768 NEW ISSUED 03/17i97 03/21/97 JM PERMIT APPLICATION FOR OFFICE USE O~ V PLAN CHECK NO. Z::705 fz_, CITY OF CARLSBAD 8UILDING DEPARTMENT ·2075 bas Palmas Dr., Carlsbad CA 92009 (619) 438-1161 Subdivision N1m1/Number Assessor's Parcel I Existing Use Unit No. · Phase No. Total I of units Proposed Uae Name · AddrNI · -City · State/Zip Telephone I (Sec. 7031.5 Business and Professions Code: Any City or County which requirn I permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, ilso requires the applicant for such permit to file I signed· statement that he is licensed pursuant to the provisions of the Contractor's Ucense 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 [$600)). Name Address City State/Zip Telephone I State Ucense I ________ _ .Ucense Class ________ _ City Bulinna; Ucense I _______ _ Designer Name Address City State/Zip Telephone· State Ucense I -. ~QMP,Qi.U.~~~~ia~~~~~~~~;,~~~;J;~'iQ:~~~;.:. Workers' Compensation Declaration: I hereby affirm under· penalty of parjurv. ona of the following declarations: 0 I hive and will maintain a certificate of consent to-Hlf~nsure for workers' compensation II provldad by Section 3700 of the Labor Code, for the performance of the work for which ~ permit is issued. 0 I hive and will maintain workers' compensation, u required by Section 3700 qt the Labor Code, for thl performance of the work for :which this permit is issued. My worker's compensation insurance carrier and policy number·1r1: Insurance Colr!pany ______ --'-----..... ---------Policy No • ...,..___________ Expiration Date _______ _ (THI~ SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1$100) OR LESS) 0 CERTIFICATE OF EXEMPTION: I certify that in the performanca of the work for which this permit is issued, I shall not employ any person in any manner 10 as .to become subject to the Workers' Compensation Laws of California. WARNING: Flilure to ucure•workers' compensation coverage is unlawful, Ind shall subject an employer to crimlnll l)llllltlu Ind clvU fines up to one hundred thousand dollars ($100,000), In lddltlon to the cost of compensation, dlmsgea u provided for In Section 3706 of the Llbqr c:ocle, Interest Ind 1ttomey'1 fet11. SIGNATURE. ___ '----------------------"---------DATE ________ _ -~J..ffifoji·_: .. 'iilV!LQ~:pE~D.9-N~1::;;~;>:J~~;~;::':.\~f".jF•:;¥ill~i:'~,i"lfi'-~~t't.~+.ir~itl~mi&~'.§':5: I here affirm that I am exempt from the Contractor's Ucenaa Law for the following r!IHOn: I, as owner' of the property or my employeu with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Profeuions Codi: The Contractor's Ucensa Law does not apply to 1n owner of property who builds or Improves thereon, and who does such work himself or through his own employ-, provided that such improvements are not intended or offered for sale. If, however, the building or improvement la sold within one yur of completion, the owner~ldlr will hive the burden of proving that lie did not build or Improve for the purpose of 11111. 0 I, 11.owner of the property, 1in excluaively contracting with licensed contractors to construct the project (Sac. 7044, Business and Professions Code: The Contractor's Ucense Law does not apply to 1n owner of property who builds or improves thereon, and contracts for euch projects with contractor(1I licensed pursuant to the Contractor's Ucenae Law). 0 I 1m· exempt under Section ______ Business and Professions Code for this ru1on: 1. I personally plan to provide the majof'l1bor and materials for construction of the proposed property improvement. 0 YES ·ONO 2. I .(hive / have not) signed an application for a building permit for the proposed work. ~-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 Fhave hired the following person to coordinate, supervise and provide the major work (includa name / address / phone number/ contractors license number):. _ _,, __________________________________________ _ 5. I-will provide-some of the work, but·, have contracted (hired) the following persons to provide the-work indicated (include name/ address / phone number/ type of work):. _______________________ __,_.,... ____________________________ _ PROPERTY OWNER SIGNATURE __ ---"------------------DATE ~~---~-----'·-···--···--·~··· ··.:··" ,.,_,, __ ,, ...... ,,.:·· •·· ~., .. •.'" ··· , .... .....,. .. -,:--v~1:tl'!;'~~-~----~----.-... -,1'ml:'.:Jl'.ln.?>'~~~~, i'dc'.~~Q~U~Y.l!;.l)JliQ,f!MM.IJ •. &Ui.:,:rt;.l/k.. Is tlli, 11;:;:ili:::::it or future l:uildlnv o.:cupant r11quiroid t.:i iii,l;;mit a butiineu pi1n, acutely hlzarcious materials rag11tr1tion form or risk m1111gement and prevention pr~m under Sections 26605, 26633 or 26534 of the Prealey-TaMer Hazardous Substance Account Act? 0 YES O NO Is the applicant or future building occupant required to obtain I permit from the air pollution control district or air quality management diatrict? 0 YES O NO Is the f1cility to be co~cted within 1,000 fNt of the outer. boundary of I school 1it1? 0 YES O NO IF ANY OF THE ANSWERS ARE YES, A FiNAL CERTIRCATE 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. ff~~rtmw.qiQ~JENPfrf.<ij,~~~~~~.lJ;:~.W-~~Jp.J' _,,.,;,,-· ~~~~.¼i~~ifL-:: I hereby affirm that there is a construction landing agency for the performance of the work for which-this permit la iuuad (Sac. 3097(11 Civil Code). 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 r1l1ting to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon ttie above mentioned property for inspection purposes. I ALSO AGREE TO SAYE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS, cosrs AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is requi~ed for excavations over 5•0• dnp and demolition or construction of structures over 3 stories in height. EXPIRATION: !;very permit iuued by the Building Official under the.provisions of this Code shall expire by limitation and become null and void if the building er work authorized by such permit is not commenced within 366 d1va ·frQm the-d1t1 of such permit or if the0building or work authorized by such permit is SU$pended or abandoned It any time after the k is c m for I period of 180 ~aya (Section 106.4.4 Uniform Building Code). / /,, APPLICANT'S SIGNATURE _ . . DATE ,3/ f 1 (f 7 YELLOW: Applicant PINK: Finance ~-' ~, ...... f ,, CITY OF CARLSB~O INSPECTION REQUEST PERMIT# CB970592 FOR 04/02/97 DESCRIPTION: INSTALL TRANSFORMER, SUBPANEL LIGHGTING & METER PANEL FOR STRG SPACE TfPE: ELEC RUTHERFORD RD STE: 8 PHONE.: 619 INSPECTOR AREA PLANCK# CB970592 OCC GRP CONSTR. TYPE NEW LOT: JOB ADDRESS: 2105 APPLICANT: RIP CURL CONTRACTOR: OWNER: PHONE: PHONE: /} REMARKS: RS/MIKE/930-5646 SPECIAL INSTRUCT: INSPECTOR--,;/~/ _______ _ · TOTA:J:i TIME: --RELATED PERMITS-- CD LVL DESCRIPTION PERMIT# CB960212 SE960018 FS960017 FAD96023 CB961619 SE960137 AS970014 US970009 CB970452 TYPE INDUST swow FIXSYS FADD RETAIN swow ASC HI SIGN STATUS ISSUED ISSUED ISSUED ISSUED ISSUED ISSUED ISSUED ISSUED ISSUED ACT COMMENTS 34 EL Rough Electric /1// ~/J ,#le,-,t,,,i!?P~J'J X/1/l/V/ '°3C£ ------'----------------"-----/j)P ; . I ---------'-------,-------_.;...--,----,-------------------'----~ ***** INSPECTION HISTORY***** DATE bESCEIPTION AC.T INSP COMMENTS