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Home My WebLink About2417 CAMINO VIDA ROBLE; ; CB081792; Permit09-18-2008 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No: CB081792 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC#: Project Title: 2417 CAMINO VIDA ROBLE CBAD St: CS ELEC 2131101600 Lot#: 0 T-MOBILE- 200 AMP SERVICE FOR CELL SITE Applicant: HERCA TELECOM 18610 BECK PERRIS CA 92570 909-520-6311 Status: ISSUED Applied: 09/18/2008 Entered By: KG Plan Approved: 09/18/2008 Issued: 09/18/2008 Inspect Area: Owner: PALOMAR CONGREGATION OF JEHOVAHS WITNESSES VISTA ATTN: DAVID PERPICH 2012 HARMONY WAY VISTA CA 92081 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 200 0 0 0 $10.00 $50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL PERMIT FEES $60.00 Total Fees:$60.00 Total Payments To Date:$60.00 Balance Due:$0.00 PERMTT HAS EXPIRED SECTION 106.4. DATE CORDANCE WITH C 8 C 8V1C.M.C. 18.04.030 Inspector: FINAL APPROVAL Date:Clearance: NOTICE: Please take NOTICE that 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 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 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 www.carlsbadca.gov Building Permit Application Plan Check No1 Est. Value Plan Ck. Deposit JOB ADDR CT/PROJECT*3-£. \J ,£ PHASE # I # OF UNITS I # BEDROOMS DESCRIPTION OF WORK: Include Square Feet of Affected Areafs, SUITE#/SPACE#/UNIT# # BATHROOMS TENANT BUSINESS NAME CONSTR.TYPE OCC. GROUP EXISTING USE PROPOSED USE GARAGE (SF)PATIOS (SF)DECKS (SF)FIREPLACE YES D #NO D AIR CONDITIONING YES D NO D FIRE SPRINKLERS YES D NO D CONTACT NAME (H Different Font Applicant)APPLICANTNTNAME-^ ADDRESS ADDRESS CITY STATE ZIP PHONE FAX EMAIL EMAIL PROPERTY OWNER ^C CONTRACTOR BUS. NAME ADDRESS ADDRESS CITY STATE ZIP CITY EMAIL ARCH/DESIGNER NAME & ADDRESS STATE LIC. #STATE CLASS CITY BUS. LIC.# (Sec 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter. imr....licensed .pursuant to the provisions of the Contractor's License Law {Chapter 9, commending with Section 7000 of ISection 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five I , prior to its issuance, also requires the applicant for such permit to file a signed statement that he is-' J} or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of WO R K ,1 R S '' C O IW P B N .$ A T I O N Workers' Compensation Declaration: thereby affirm under penalty of perjury one of (he following declarations: O 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. I have and will maintain workers' compensation, as/equired by Section 3700 of the Labor Code, for the performance of the work fqiwtiich this permit is issued. My workers' compensat»ry1nsufance-ratrier_.and policy ~~ 'f 'iff) • *' ~ '"-'fnumber are: Insurance Co.Policy No.Expiration Date /~' 'i^yt-'Q This section need not be completed if the permit is for one hundred dollars ($100) or less, n 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 Labor code, interest and attorney's fees. J&i CONTRACTOR SIGNATURE DATE ^/ ~ /5f O W-NJEiR-B.U;! L D.ER' -O-tt.C L A'.kf AT I&N I hereby affirm thai I am exempt from 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). a 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). d I am exempt under Section _.Business and Professions Code for this reason: O No1 . 1 personally plan to provide the major labor and materials for construction of the proposed property improvement. O Yes 2. 1 (have / have not) signed an application for a building permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors' license number): 4. 1 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. 1 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 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? O Yes a No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? a Yes a No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? O Yes D No IF ANY OF THE ANSWERS ARE YES, / EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. CO W S T ft U C* ION L E N t> 1 N %- A G E N C Iff I hereby affirm that there is a cbnstmctiort lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civil Code). Lender's Name Lender's Address I certify that I have read the application and state thatthe above information is correct and that the information on the plans is ac«utate.lagreetoc«mplyv^ all Ci^ ordinances and State laws relanngtobuH I hereby authorize representative of the City of Carlsbad to enter upon Ihe above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD 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 Ihe Building Official under theppvisjons of this Code shall expire by limitation and become nun and void if the building or work authorized by such permit is not commenced within 1 80 days from Ihe date of such permit or if Ihe building or wort^rctfigrized by such pent* is suspentel^abandoned at any time after Ite*^~^ ''" .^APPLICANT'S SIGNATURE DATE