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HomeMy WebLinkAbout2325 CAMINO VIDA ROBLE; ; CB961992; PermitBUILDING PERMI 10/15/96 18:12 Page 1 of 1 Job Address: 2325 CAMINO VIDA ROBLE Suite: Permit Type: ELECTRICAL Parcel No: 213-050-27-00 Lot#: Valuation: 0 Occupancy Group: Reference#: Description: UNDERGROUND PLUM & ELECT ONLY : OK-PER PAT K-ONTOGEN Appl/Ownr : SLETTER, RUDOLPH 4350 EXECUTIVE DR SAN DIEGO CA 92121 619 T Permit No; Project No; Development No: Construction Type; Status; Applied; Apr/Issue; Entered By; 455-1161 CB961992 A9602845 NEW ISSUED 10/11/96 10/11/96 RMA *** Fees Required ******Fees Collected & Credits *** Fees: Adjustments: Total Fees: Fee description 47. * 47. 00 00 00 Total Credits: Total Payments: Balance Due: Units Fee/Unit .00 47.00 .00 Ext fee Data Enter "Y" for Electric Issue Fee > Enter "Y" for Remodel > Other > * ELECTRICAL TOTAL 27.00 10.00 Y 10.00 Y 27.00 UNDGR P 47.00 _/-A / BUILDING PERMI 10/11/96 08:45 Page 1 of 1 Job Address: 2325 CAMINO VIDA ROBLE Suite Permit Type: ELECTRICAL Parcel No: 213-050-27-00 Lot# : Valuation: 0 Occupancy Group: Reference*: Description: UNDERGROUND ONLY-PLUM & ELEC : ONTOGEN-OK PER PAT K Appl/Ownr : RUDOLPH & SLETTEN 4350 EXECUTIVE DR STE 301 SAN DIEGO CA 92121 *** Fees Required 619 T Permit No: CB961946 Project No: A9602061 Development No: 0314 10/11/96 0001 01 02 C-PRHT 47-00 Construction Type: NEW Status: ISSUED Applied: 10/11/96 Apr/Issue: 10/11/96 Entered By: RMA 455-1161 lected & Credits Fees : Adjustments: Total Fees: Fee description Enter "Y" for Elect Enter "Y" for Remo Other * ELECTRICAL TOTAL A * * .00 . 00 47.00 Ext fee Data 10.00 Y 10.00 Y 27.00 UNDGR PLUM 47.00 CITY OF CARLSBAD 2075 Las Patens Dr., Cartebad, CA 92009 (619) 438-1161 PERMIT APPLICATION City of Carlsbad Building Department 2075 Las Palaas Dr., Carlsbad, CA 92009 (619) 438-1161 1. PERMIT From List 1 (see back) give code of Permit-Type: For Residential Projects Only: From list 2 (see back) give Code of Structure-Type: Net Loss/Gain of Dwelling Units PLAN CHECK NO 2, PROJECT INFORMATION FOR OFFICE USE ONLY Address: Nearest Cross Street or Suite NoT LEGAL DESCRIPTION LOl No.Subdivision Name/Number Unit No.Phase No. CHECK BELOW IF SUBMITTED: D 2 Energy Calcs D 2 Structural Gales D 2 Soils Report D 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE •DESCRIPTION OF WORK OJ SQ.FT.# OF STORIES /# OF BEDROOMS # OF BATHROOMS 37 UJNTALT PEHSUN (.u ainerem rrom applicant; NAME (last name first) CITY STATE ADDRESS ZIP CODE DAY TELEPHONE 4. APPLICANT D CONTRACTOR LlAGhNTtOR CONIRACIUR LJ OWNER UAGENT FOR OWNER NAME (last name first) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE 5. PROPERTY OWNER NAME (last name first) CITY ADDRESS STATE ZIP CODE DAY TELEPHONE 6. CONTRALlOR NAME (last name firs CITY STATE STATE UC. # ZIP CODE LICENSE CLASS OAV TMPHONE CITY BUSINESS LIC. # UESlUNEk NAMH (last name hist) CITY STATE ADDRESS ZIP CODE DAY TELEPHONE STATE LIC. # 7. WORKERS COMPENSATION Workers' Compensation Declaration: T nereby affirm that I nave a certificate of consent to self-Insure issued by the Director oflndustrial 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 POLICY NO.EXPIRATION DATE Certificate of Exemption: I certify that in the performance or the worlc tor 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. SIGNATURE DATE 8. OWNER-BUILDER DECLARATION Uwner-ouilder Declaration: I hereby amrm that l am exempt irom the (Contractors License Law tor the tollowmg 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 contractor(s) 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 [S500]). SIGNATURE DATE COMPLETE THIS SECTION FUR NON-RESIDENTIAL BUILDING PERMITS ONLY: r 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 D 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 D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? D YES D NO D? ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1,1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE ADI POLLUTION CONTROL DISTRICT. 9. UJNSTKUUriUH LENDING AGENCY I hereby atlirm that there is a construction lending agency tor the performance ot the work tor which this permit is issued (Sec 3097U) tivll Code). LENDER'S NAME LENDER'S ADDRESS 10. AWLILAN1 l certify that 1 nave read the application and state that the above information is correctTT 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 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 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).APPLICANTS SIGNATURE ^~, . /? ^j . ^) <- DATE: /Q~// WHITE: File YELLOW: Applicant PINK: Finance 03/26/97 INSPECTION HISTORY LISTING FOR PERMIT! CB961992 DATE INSPECTION TYPE INSP ACT COMMENTS 10/16/96 Underground/Under Floor RI RI MW/MIKE/603-9813 10/16/96 Underground/Under Floor TP CO NO PSI TEST 10/16/96 Footing RI RI MW/MIKE/603-9813 10/16/96 Footing TP AP 10/15/96 Underground/Under Floor TP AP WASTE LINES SECT A 10/15/96 Underground/Under Floor TP AP ACID WASTE SYSTEM SECT B 10/15/96 Underground/Conduit-Wir TP AP SECT A U/G CONDUIT/BOXES > O HIT <RETURN> TO CONTINUE... WRITE IT - DON'T SAY IT! 19 eply Wanted DNo Reply Necessary City of Carlsbad Building Department WORKERS' COMPENSATION DECLARATION 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. have and will maintain workers' compensation, as required by section 3700 EL/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 Date 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 07/02/96 16:03 ©415 345 4689 RUDOLPH&SLETTEN »-» SAN DIEGO OFFICE ACOKD piwoucet CERTIFICATE OF LIABILITY INSURANCE ISSUE DATE (07/Ot/9G) , SMITH & PEEK, INC. . . JO First Interstate Ce Tier 999 3rd Avenue Seattle, Washington 91:104 NC.RUDOLPH AND SLETTEN P.O. Box 4637 Foster City, California 94! 04 THS CERTIFICATE IS ISSUED AS A MATTER OF INFQRMMION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. IMS C«HT1RCATEa3eSI«T AMEND, EXTBTO OR ALTCH THE COVeiAQeAFFOROeO nv TUC pni ICIFS BFI nw AFFQBPIMK COVERAGE COMPANY A J COMPANY & COMPANY" cCOMPANY" INDUSTRIAL INDEMNITY COMPANY IS TO CEHTii INDICATED. NOTWITHSTANDING AN' REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTlFtCATE MAY BE ISSUED OR M" r PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POUCIE! . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. Co Ltr A Type of Insurance! General Liability Commercial General U aifity ^Claims Made Occur. — Owners & Contractors f rat AutomobQa Liability __Any Aula All Owned Autos _Schoduled Autos Hired Autos Non-Owned Autos Garage Liability __Any Auto Excns Uabliity __Umbre)la Form _OlherThan Umbrete F- on Workers' Compensation and Employers' Liability The ProprietoiyPartners/ _ IncL Executive Officers are: _ Exd. Other Policy Number CH 962-6432 Policy Effective Date (MMVDD/YY) 06/30/96 Policy Expiration Date (MIUIDD/YY) 06/30/97 Limits General Aggregate $ Products/Comp Ops Agg. $ Pent. & Adv. Injuiy S Each Occurrence S Fire Damage (any on* fit*) $ Mod. Expanse (any on* pmn) S Combined Single Limit S Bodily Injury (pw peraon) S Bocfly Injury (pw accktom) S Property Damage $ Auto Only - Each Accident S Other Than Auto Only: Each Accident S Aggregate S Each Occurrence $ Aggregate S X WC STATUTORY LIMITS OTHER EL Each Accident $ 1,000,000 EL Disease-Policy Limit $ 1,000,000 EL Disease-Each Employee £ 1,000,000 Description of operations/locations/- chides/special items SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING COMPANY VWLL ENDEAVOR TO MAIL *>^ OAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AMV KIMn I IPfW THF COMPANY ITS AfJFfffi^OR BFPQFSFhnTATlVES AUTHORIZED REPftESENTATIVE- RUDOLPH\SAMPLE4