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HomeMy WebLinkAbout2176 SALK AVE; ; CB081977; Permit10-24-2008 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No CB081977 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Reference # PC# Project Title Applicant 2176SALKAVCBAD ELEC 2120210100 Lot* Status ISSUED Applied 10/24/2008 LSM 10/24/2008 10/24/2008 SCRIPPS HEALTH-ADD (6) 120V ELECTRICAL RECEPTACLES ON 2 20 A CIRCIUTS IN Entered By Plan Approved issued Inspect Area Owner H G FENTON PROPERTY CO 7577 MISSION VALLEY RD #200 SAN DIEGO CA 92108 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 0 0 0 0 $1000 $000 $000 $000 $000 $1000 $000 $000 $000 $000 $2000 Total Fees $20 00 Total Payments To Date $20 00 Balance Due:$000 Inspector FINAL APPROVAL Date I* J Clearance NOTICE Please take NOTICE thai 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 nght 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 Carlsbad 1635 Faraday Ave Carlsbad CA 92008 ' 760-602-2717/2718/2719 Fax 760-602-8558 Building Permit Application Plan Check No. Est. Value Plan Ck. Deposit Pate JOB ADDRESS 2176 SaIk Ave SUITE#/SPACE#/UNIT# CT/PROJECT # 1 N/A * BEDROOMS # BATHROOMS N/A N/A TENANT BUSINESS NAME Scnpps Health CONSTR TYPE NFS OOCGROUP B DESCRIPTION OF WORK Include Square Feet of Add (6) 120V electrical receptacles on (2) 20A circuits in Room 1025 EXISTING USE P Med Office CONTACT NAME (If Dlttmnt Fom Applicant) ROPOSED USE Med Office GARAGE (SF) N/A ADDRESS CITY PHONE EMAIL PROPERTY OWNER NAME STATE ZIP FAX H G Fenton Co ADDRESS 7577 Mission Valley Road CITY San Dieqo PHONE 619-400-0120 EMAIL STATE ZIP CA 92108 FAX 619-400-0111 ARCH/DESIGNER NAME & ADDRESS Perkins & Will. 617 W 7th Ave. LA C6 STATE LIC # PATIOS (SF) N/A DECKS (SF) N/A FIREPLACE APPLICANT NAME ADDRESS NOG] AIR CONDITIONING FIRE SPRINKLERS Richard Greenwell 650 Opper Street CITY STATE Escondido PHONE EMAIL 760-746-1004 FAX CA ZIP 92029 760-741-7935 rgreenwell@bergelectnc com CONTRACTOR BUS NAME ADDRESS CITY PHONE EMAIL STATE LIC * Berqelectnc 650 Opper Street STATE Escondido 760-746-1004 FAX CA ZIP 92029 760-741-7935 rgreenwell®bergelectnc com 85046 CLASS C-10 CITY BUS LIC# 189600 (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}) WORKERS' COMPENSATION Workers' Compensation Declaration / hereby affirm under penalty of perjuty one ofthe following declarations LJ 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 l/JI 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 earner and policy number are Insurance Co Traveler. Property Casualty Co of Am Policy No VTC2JUB9494A68308 Expiration Date """« This section need not be completed if the permit is for one hundred dollars ($100) or less I I Certificate of Exemption I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California WARNING Failure to secure workers' compensation coverage is unlawful, and • lull subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, damages m f £$ CONTRACTOR SIGNATURE / hereby affirm that I am exempt from Contractor's License Law for the following reason | | I as owner of the property or my employees with wages as their sole compensation wil 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 ownei-buildet will have the burden of proving that he did not build or improve for the purpose of sale) I I 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 lo the Contractor's License Law) [I I am exempt under Section Business and Professions Code for this reason 1 I personally plan to provide the major labor and matenals for construction of the proposed property improvement. I |Yes | ho 2 I (have / have not) signed an application lor 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 / 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 / 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 / type of work) ^"PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR N O N -1? E S I D E N T I A L BUILDING PERMITS ONLY Is the applicant or,future building occupant required to submit a business plan acutely hazardous materials registration form or nsk management and prevention program under Sections 25505 25533 or 25534 of the Presley Tanner Hazardous Substance Account Act? | |Yes 1/lNo Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? FlYes f/1 No Is the facility to be constracted within 1000 feet of the outer boundary of a school site? Fives F/lNo 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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec 3097 (i) Civil Code) Lenders Name Lenders Address APPLICANT IterebyautrxxizerepresentatveoftheCrtytf 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 O'c^arKldemota EXPIRATION Every permit issued by the Building Offioal under the previsions rftjKGxIe shall expire by lirntatonarxlb 180 days from tte date o(su* pern* a if the buMing or work a^^ ^APPLICANTS SIGNATURE Storm Water Compliance Exemption Form I am applying to the City of Carlsbad for the following type(s) of construction permit: 0 Building Permit Q Right-of-Way Permit [7] My project is categorically EXEMPT from the requirement to prepare a storm water pollution prevention plan (SWPPP) because it only requires issuance of one or more of the following permit types Electrical Fire Additional Fire Alarm Fixed Systems Mechanical Mobile Home Plumbing Patio/Deck Re-Roofing Sign Spa-Factory Sprinkler Water Discharge Project Storm Water Threat Assessment Criteria* A/o Threat Assessment Criteria | | My project qualifies as NO THREAT and is exempt from the requirement to prepare a storm water pollution prevention plan (SWPPP) because it meets the "no threat" assessment cntena on the City's Project Threat Assessment Worksheet for Determination of Construction SWPPP Tier Level My project does not meet any of the High, Moderate or Low Threat criteria described below Tierl • Low Threat Assessment Criteria | | My project does not meet any of the Significant or Moderate Threat cntena, is not an exempt permit type (See list above) and the project meets one or more of the following criteria • Results in some soil disturbance, and/or • Includes outdoor construction activities (such as roofing, saw cutting, equipment washing, material stockpiling, vehicle fueling, waste stockpiling) Tier 2 • Moderate Threat Assessment Criteria | | My project does not meet any of the Significant Threat assessment Cntena described below and meets one or more of the following cntena • Project requires a grading plan pursuant to the Carlsbad Grading Ordinance (Chapter 1516 of the Carlsbad Municipal Code), or, • Project will result in 2,500 square feet or more of soils disturbance including any associated construction staging, stockpiling, pavement removal, equipment storage, refueling and maintenance areas and project meets one or more of the additional following criteria • Located within 200 feet of an environmentally sensitive area or the Pacific Ocean, and/or • Disturbed area is located on a slope with a grade at or exceeding 5 horizontal to 1 vertical, and/or • Disturbed area is located along or within 30 feet of a storm dram inlet, an open drainage channel or watercourse, and/or • Construction will be initiated during the rainy season or will extend into the rainy season (Oct 1 through Apnl 30) TierS - Significant Threat Assessment Criteria i I My project includes clearing, grading or other disturbances to the ground resulting in soil disturbance totaling one or more acres including any associated construction staging, equipment storage, stockpiling, pavement removal, refueling and maintenance areas and/or | | My project is part of a phased development plan that will cumulatively result in soil disturbance totaling one or more acres including any associated construction staging, equipment storage, refueling and maintenance areas or, | | My project is located inside or within 200 feet of an environmentally sensitive area (see City ESA Proximity map) and has a significant potential for contributing pollutants to nearby receiving waters by way of storm water runoff or non-storm water discharge(s) / certify to the best of my knowledge that the above checked statements are true and correct. I understand and acknowledge that even though this project does not require preparation of a construction SWPP, I must still adhere to, and at all times during construction activities for the permit type(s) check above comply with the storm water best management practices pursuant to Title 15 of the Carlsbad Municipal Code and to City Standards 'The City Engineer may authorize minor variances from the Storm Water Threat Assessment Cntena in special circumstances where it can be shown that a lesser or highte Construction SWPPP Tier Level is warranted Owner/Owner's Authorized Agent Name Owner/Owner's Authorized Agent Signature City of Carlsbad Bldg Inspection Request For 10/29/2008 Permit* CB081977 Title SCRIPPS HEALTH- ADD (6) 120V Inspector Assignment Description ELECTRICAL RECEPTACLES ON 2 20 A CIRCIUTS IN ROOM 1025 Type ELEC Sub Type Job Address 2176 SALKAV Suite Lot 0 Location Inspector OWNER H G FENTON PROPERTY CO Owner H G FENTON PROPERTY CO Remarks p m please Phone 6199853252 Total Time Requested By MARK Entered By CHRISTINE CD Description 34 RoughElectric Act Comments Commen olds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments Client* 74178 20BERGELE ACORD- CERTIFICATE OF LIABI PRODUCER Hub Int'l of CA - LA Culver CL Hub Int'l of CA Ins Serv, Inc 6101 W Centinela Ave, #210 Culver City, CA 90230 INSURED Bergelectnc Corporation P O Box 45029 Los Angeles, CA 90045-0029 LITY INSURANCE DATE (MM/DD7YYYY) 06/24/08 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 BELOW INSURERS AFFORDING COVERAGE INSURER A. Travelers Property Casualty Co of Am INSURER s National Union Fire Ins Co Pittsburg INSURER c General Insurance Company of America INSURER D- American Economy Insurance Company INSURER E NAIC# 25674 19445 24732 19690 COVERAGES MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR A D B A A C UJD'l NSRC TYPE OF INSURANCE GENERAL LIABILITY x_COMMERCIAL GENERAL LIABILITY | CLAIMS MADE | X| OCCUR GENT. AGGREGATE LIMIT APPLIES PER. ~\ POLICY fxte HLOC ALT X X X OMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY X| OCCUR | | CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If/as describe under SPECIAL PROVISIONS below OTHER Equip Float Lease/Rent Equip Install Floater POLICY NUMBER VTC2JCO9494A695TIL 02CE1331753 BE7658777 VTC2JUB9494A68308 VTRJUB9494A67108 COP2395054 POLICY EFFECTIVE DATE (MMfDDSYY) 07/01/2008 07/01/2008 07/01/2008 07/01/2008 07/01/2008 07/01/2008 POLICY EXPIRATION DATE IMM/DD/YYI 07/01/2009 07/01/2009 07/01/2009 07/01/2009 07/01/2009 07/01/2009 LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES fEa occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGO COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per parson) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT PTHFR THAN ^ ACC AUTO ONLY AQG EACH OCCURRENCE AGGREGATE X I WC STATU- I IOTH- I TORY LIMITS I I ER E L EACH ACCIDENT E L DISEASE - EA EMPLOYEE E L DISEASE - POLICY LIMIT H.000.000 1300.000 $5.000 $1,000.000 s2.000.000 $2,000,000 $1,000,000 $ s $ $ $ $ $5,000.000 $5,000.000 $ $ $ $1,000,000 $1,000,000 $1,000,000 $500,000 Limit $5,000 Deductible $2,000,000 Limit CERTIFICATE HOLDER CANCELLATION Information Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION D ATE THEREOF, THE ISSUING INSURER WILL JOOeeOMUW MAIL *3n DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,XXXXMX98Ba%>OOaOSattK JUUdUUUUtlOWAJUUUtK&MXKJOOCiUJOtXKKXJUW xraeetracMgaaxx AUTHORIZED REPRESENTATIVE /^a //• T&S^ ACORD 25 (2001/08) 1 Of2 #M65431 ABE © ACORD CORPORATION 1988 Jon 10 2004 - JJtlfm Lot 1 Fenton Carlsbad Research Center HG Fenton Company g » i = /Chisgg — Sw 16, 2006 - 209pm P-\l«*lg*»\771«.000 Safel C(rt6od n\UD\$NEEIS\A.1MJinjhg 01/21 ,2 oo o —I o o oo •g o o< -I &> ^* i-f Q. O 0)IIll" PROJECT SCRIPPS CLINIC CARLSBAD - Tl DONNC GILMORE & ASSOCIATES, INC Consulting Mechanical and Electrical Engineers 4051 E La Palma Ave. Ste A Anaheim, CA 92807 Ph 7146304291 Fax- 7146304805 1U POWER FIRST FLOOR PLAN BHHo.SCME NTS CHEChfe BY KK. KK. JOB Mo. 7058 LJ.L 9/17/08 E-1021B ESK-6