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HomeMy WebLinkAbout2175 CAMINO VIDA ROBLE; ; CB962421; PermitBUILDING PERMI 12/23/96 11:38 Page 1 of 1 Job Address: '2175 CAMINO VIDA ROBLE Suite Permit Type: ELECTRICAL Parcel No: Lot#: Valuation: 0 ' Occupancy Group: Reference*: Description: TEMP POWER POLE-PAC BELL EXPAN T Permit No: CB962421 Project No: A9603460 Development No: 1631 12/23/96 0001 01 02 C-PRMT 20-00 Construction Type: NEW Status: ISSUED Applied: 12/23/96 Apr/Issue: 12/23/96 Appl/Ownr PERFORMANCE POWER 10638 PROSPECT AV SANTEE CA 92071 619 596-4622 Entered By: RMA *** Fees Required ***ected & Credits Fees : Adjustments : Total Fees: Fee description 20 Enter "Y" for Electr Enter "Y" for Tempo * ELECTRICAL TOTAL A * * .00 .00 20 . 00 Ext fee Data 10.00 Y 10.00 Y 20. 00 'APPROVAL INSP CLEA CITY OP CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION City of Carlsbad Building Department 2075 Las Palms Dr., Carlsbad, U 92009 (619) 438-1161 1. PERMIT TYPE A -^Commercial U New Building TJ Tenant Improvement B - D Industrial D New Building D Tenant Improvement C - D Residential D Apartment D Condo D Single Family Dwelling D Addition/Alteration D Duplex D Demolition D Relocation D Mobile Home D Electrical D Plumbing D Mechanical DPool D Spa D Retaining Wall D Solar D Other 2. PROJECT INFORMATION PLAN CHECK NO FOR OFFICE USE ONLY JlITS Ql/nino Nearest Cross Street P/)l/)/YVir No. or auite NO. LEGAL DESCRIPTION Lot Unit No.Phase NO. CHECK BELOW IF SUBMITTED: D 2 Energy Calcs D 2 Structural Calcs D 2 Soils Report D 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE .PROPOSED USE DESCRIPTION OF WORK SQ.FT. "Tirop. Rw/r Poles - I -if nU CTY1DICC# OF STORIES 3. UUN Hsur PEH3UN tii ouierent irom applicantNAME ADDRESS ZIP CODE 3175 ftoirino Vicfa DAY TELEPHONE T FOR CON IKACIURADDRESS ZIP CODE a OWNER U AtifcNT HJK OWNER DAY TELEPHONE CITY STATE ADDRESS ZIP CODE DAY TELEPHONE 6. GONT NAME a Workers' Compensation Declaration: I hereby attirm that I have a certificate or consent to self-insure issued by the Director or Industnal Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C). INSURANCE COMPANY ft/4-7Certificate or Exemption: I certify that in /he pertormance ot the work so as to become subject to the Workers' Compensation Laws of California. ich this permit is issued, I shall not employ any^person in any manner SIGNATURE DATE L 8. OWNER-BUILD]ION Owner-Builder Declaration: I hereby attirm that 1 am exempt from the Contractors License Law tor the following reason: 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.). 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 contractors) licensed pursuant to the Contractor's License Law). I am exempt under Section Business and Professions Code for this reason: (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, commencing 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]). SIGNATURE DATE COMPLETE THIS SECTION FOR NON-REblDfcNllAL BUILDING PERMI1& 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 JSf 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 «.NO Is the facility to be constructed within LOOO feet of the outer boundary of a school site? D YES )rf NO IF ANY OF THE ANSWERS ARE YES; A JTNAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1. 1989 UNLESS THE APPHCANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 9.UJNUUMU AGENUY I hereby attirm that there is a constructionlendmg agency lor the pertormance ot the work Tor which this permit is Issued tsec 30971U Civil (jodej. LENDER'S NAME LENDER'S ADDRESS 10. APPLICANT CERTIFICATION I certify thatThave read the application and state mat the above information is correct. I agree to comply with all City ordinances and Mate 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 AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST AIJ, I JABILTriES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SATO CTTY 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 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 365 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 commenced for a period of 180 days (Section 303(d) Uniform Building Code). i *~\ j-^zt If) fAPPLICANTS SIGNATURE /. I - ^ . I DATE: /S* 1/7?)M( 6 WHITE: Ffle YELLOW: Applicant PINK: Finance CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB962421 FOR 12/24/96 DESCRIPTION: TEMP POWER POLE-PAC BELL EXPAN TYPE: ELEC JOB ADDRESS: 2175 CAMINO VIDA ROBLE APPLICANT: PERFORMANCE POWER CONTRACTOR: OWNER: REMARKS: MW/VICKI/596-4622 SPECIAL INSTRUCT: INSPECTOR AREA PLANCK* CB962421 OCC GRP CONSTR. TYPE NEW STE: LOT: PHONE: 619 596-4622 PHONE: PHONE: INSPECTOR TOTAL TIME: —RELATED PERMITS— CD 32 PERMIT* CB961224 SE960088 TYPE INDUST SWOW STATUS ISSUED ISSUED LVL DESCRIPTION EL Const. Service/ Agricultural ACT COMMENTS DATE DESCRIPTION INSPECTION HISTORY ***** ACT INSP COMMENTS City of Carlsbad Building Department WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations; I have and will maintain a certificate of consent to self-insure for A. workers' compensation as provided by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 workers' 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) 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 ™ C. workers compensation laws of California. Signature L Warning: Failure to secure workers' compensation coverage is unlawful, and shall be 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. March 3, 1995 2O75 Las Palmas Dr. • Carlsbad, CA 92009-1576 • (619) 438-1161 • FAX (619) 438-O894 CERTIFICATE OF INSURANC ISSUE DATE (MM/DD/YY) 09/19/96 PRODUCER HALLMARK ASSOC INS SERVICE SANDLIN & ASSOC INS AGENCY P.O. BOX 769 DOWNEY, CA 90241-0769 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BROW. ^_^^_^__^__^_ INSURED PERFORMANCE POWER SYSTEMS, INC. 1326 E. FRANCIS ONTARIO. CA 91761 COMPANY LETTER COMPANY LETTER COMPANIES AFFORDING COVERAGE MT.HAWLEY INSURANCE CO GOLDEN EAGLE INSURANCE CO COMPANY LETTER COMPANY LETTER THIS IS TO CERTIFY THATTHE 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. TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE DATE (MM/DD/VY) POUCY EXPIRATION DATE(MM/DD/YY)UNITS GENERAL LIABILITY X 1 COMMERCIAL GENERAL LIABILITY | CLAIMS MADE j X I occun- X I OWNER'S * CONTRACTOR'S PHOT. Ylx,c,u GENERAL AGGREGATE PHODUCTS-COMP/OPAGGR. .MGL119260 09/11/96 09/11/97 PERSONAL & ADV. INJURY EACH OCCURRENCE FIRE DAMAGE (Any one lire) X BROAD FORM PD MED. EXPENSE (Any one person) 2,000,000'Hp&M' 1,000,000 liMMPO 50-000 sjjo" AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS ; SCHEDULED AUTOS X I HIRED AUTOS NON-OWNED AUTOS OARAGE UA8IUTY COMBINED SINGLELIMIT 1,000,000 BODILY INJURY(Per pirion) CCP 433582 00 09/11/96 09/11/97 BODILY INJURY{Ptrtccfdent) PROPERTY DAMAGE EXCESS L1AMUTY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURENCE WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY .X.I: STATUTORY LIMITS NWC 322705 03 09/11/96 09/11/97 DISEASE-POLICY LIMIT 1,000,000 DISEASE-EACH EMPLOYEE 1,000,000 OTHER DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED, PER THE ATTACHED. RE; ALL OPERATIONS *TEN (10) DAY NOTICE OF CANCELLATION MAILED FQRNON PAYMENT OF PREMIUM. CITY OF CARLSBAD 2075 US PALMAS DRIVE CARLSBAD, rCA 92003 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 3fl DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.