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Home My WebLink About2525 EL CAMINO REAL; 235; STE 235 PRE 2016; PermitCITY OF CARLSB * DER INFORMATION OVER). - BUILDING. DEPART A0p1icafi4*'r.-,BU1LD1N Peit -Building Permit Fee For Applicant t9 Fill-in .- Owners NamIL! /h1ç f'('j ' NO ç69.!cc ° 203*******Loo Mail Address g . lL Building Dept. Use Only ntracto Jldng Address ' 23 5 It To o A d 0 To Alter 0 Convert 0 To Move From 4 -{ - Type of Const. rameMasonryfc. '' - V. To Be Used For Kind of Foundation____________ Contractor City Bun. Lic. No. _______________________________________ Floor Space (Sq. Ft.) . . Water '.S D' sal System Attached Garage Floor Space (Sq. Ft.) Dee nspection Reco/ Legal Description Lot Block . . . ,. Subdivision _..... . Or Section Township Range - No. of Existing Build9. Will this cons e'tioii include any plumbing installation or alter- aflon? Ye,i No 0 S4aeture of Akcant (__•\ - I- - I ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION I AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY AND 'STATE LAWS REGULATING BUILDING. - Utility Company Notified Date- By I CERTIFY THAT I AM PROPERLY REGISTERED AND/OR Final LICENSED AS REQUIRED BY CITY OF CARLSBAD AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER If a check x tendered for payment for the above fee and th OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY, check is not honcred when prosdnted for payment, your . - SIGNATURE building permit will be immediately revoked. OF PERMITTEE City of Carlsbad Building Dept. Permit void if work is not commenced within 60 days of issuance. - : - 4 . - Set Bock dg. Valuation '. .i'(S Front P.L. - -'' * Main Bldg. Side P.L. Garage ________________ Other Group Z Ap PERMIT NO. '70_1 0 49. TOTAL FEE $ /'. Oc Application for MECHANICAL Permit çITYOFC AD BUILDING DEP MENT 729-1181 -Ext. 36 For Applicant to Fill In — 1111 13-10_EE_1OUb ww No. ITEM INSTALLATION AND/OR RELOCATION EACH AMT. For the installation or relocation of each forced-air or gravi- ty type furnace or burner, including ducts and vents attached to such appliance, up to and including 100,000 B.t.u.'s $4.00 -74 For the installation or relocation of each forced-air or gravi - t , type furnace or burner, including ducts and vents attached - to such appliance over 100,000 B.t.u.'s $ 5.00 For the installation or relocation of each floor furnace, in- cluding vent. $ 4.00 For the installation or relocation of each suspended heater, recessed wall heater or floor mounted unit heater.. $ 4.00 Building Dept. Use Only For the installation, relocation or replacement of each ap- pliance vent installed and not included in an application. $ 2.00 For the repair of, alteration of, or addition to each heating . appliance, refrigeration unit, comfort cooling unit, absorption unit, 0 evaporative cooling system, including installation of controls regulated by this Code. $ 4.00 BUILDING ADDRESS For the installation or relocation of each boiler or compres- sor to and including three horsepower, or each absorption system to and including 100,000 Bun's. $ 4.00 STREET NAME - For the installation or relocation of each holler or compres- sor over three horsepower to and including 15 horsepower, or _••••,/ each absorption system, over 100,000 B.t.u.'s to and inclu- . CONTRACTOR OWNER fi12'/d Al4#t/..'9 01^1e..Os i.—, #' ding 500,000 B.t.u.'s $ 7.50 For the installation or relocation of each boiler or compres- sor over 15 horsepower to and including 30 horsepower, or each absorption system over 500,000 B.t.u.'s and including 1,000,000 B.t.u.'s. $10.00 ADDRESS For the installation or relocation of each boiler or compres- nor over 30 horsepower to and including 50 horsepower, or for each absorption system over 1,000,000 B.t.u.'s to and ir1 cluding 1,750,000 B.t.u.'s. r $15.00 CITY For the installation or relocation of each boiler or refrigera- tion compressor over 50 horsepower, or each absorption system over 1,750,000 8.5.0's. $25.00 CITY BUSINESS LICENSE NO. For each air handling unit to and including 10,000 cubic feet per minute, including ducts attached thereto. $ 3.00 3, cv CITY BUSINESS LICENSE NO. For each air handling unit over 10,000 cubic feet per minute. For each evaporative cooler ntl,nr than portable type. -. $ 3.00 GROUP - For each vent fan connected to a single duct. $ 2.00 For each ventilation system which is not a portion of any heating or air conditioning system authorized by a permit. $ 3.00 INSPECTION RECORD For the installation of each hood which is served by me- chanical exhaust, including the ducts for each hood. $ 3.00 For the installation or relocation of each domestic type incinerator. $ 5.00 For the installation or relocation of each commercial or industrial type incinerator. $20.00 For each appliance or piece of equipment regulated by this Code but not classed in other appliance categories, or for which no other lee is listed in this Code. $ 3.00 For the issuance of this permit. $ 3.00 k. 00 I ACKNOWLEDGE THAT I HAVE READ THE APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL STATE AND CITY LAWS REGULATING THE MECHANICAL CODEOF THE UNIFORM BUILDING CODE. I CERTIFY THAT I AM PROPERLY REGISTERED AND OR LICENSED AS RE- QUIRED BY THE CITY OF CARLSBAD AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF Y. - DATE JOB FINALED SIGNED BY _____________________________________________________________ L -0 10.00 tiEr RAIl PAINT PN 111111111 L PREE I4LRfl APPLICANT TO FILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS. hereby affirm that lam licensed under U[~, provialona of Chapter 9 (commencing with • S.ction 7000) of DivIsion 3 of the Business I- aced Proteeaions Code, and my license is in. !u11 force and effect. F0 1 - ..', I I hereby affirm that I am exempt from the Contrac br's License Law for the following reason (Sec. 7031.5 Business and Pretensions Code: Any city or county which re' I - quires a permit to construct. atter improve, demolish, or repair any structure, prior toils issuance also requires he or pticant for such permit to tile a signed statement that he is I licensed pUrsuant to" the• provisions of the Contractors License Law (Chapter 9 commencing with Section 7000 01 —Division 301 the Business and Professions Code) or that is ex-_ 1 ernpt therefrom and the basis for the alleged exemption. Apy., violation 01 Section 7031.5 by an applicant tsr a permit sub' - ects the applicant to Civil penally 01 not more than live hun' • I dred dollars ($500). - • .-' .-.,.' . ', CC 1.1 . I, as owner 01 the property. or my employees with wages, litif I as their sole compensation, will do the work. and the struc' o lure is not intended or offered for sale (Sec. 7044. Business ".i and Professions Code: The Contractor's-License Law does 1 not apply loan owner' 01 properly who builds or improves t -- thereon and who does such work himself or through his own j'employeos. provided that such improvements are not intend lee ed or offered or sale. It. however, the building or improve , -1 Z ' 'meet is sold within one year 01 cOmpletion., the owner-builder Will have the burden 01 proving that he did not build or im 0 .. 'prove brIbe purpose.ot sale(,.. I I, as owner 01 he property, am exclusively contracting . with licensed contractors to construct the project (Sec. 7044, I 1, c Business and Prolessions,Code: oThe 'Contractor's License 'Law does not apply loan owner 01 properly who builds or im r . proves thereon, and who contracts for each projects with a. -I contractUr(s( license pursuant to the Contractor's License Z Law(,- ' i'- - i- 1 As a homeowner I am Improving my home, and the 10110w' 4 ' - ing conditions exist:.-. , , .. . ,' . . . 14K - , J '1 The work' is being pertormed prior to sate, - - - ' 2.' 'I 'Pave-lived - in, my home, for:twelvemonths prior to completion 01 this wOrk, I lxi . .3,, I have not claimed this exemption, during ,the last three years. 0 tam exempt under Sec. ' ' - '' . BE, P,C: . 7 tor this reason •1 ." 0-" '•.a - -'- - — ' Q - thereby affirm 10011 have a certiticale 01 consent to sell.irrsure, or acertilicaleol Workers' Compensation In. surunce. era certified copy thereof 15CC. 3800. Labor Code) ::i POLICY No' '. ' ;ift , COMPANY' .: 2 vi 1 , _.L,..Copy is tiled with the city -- -- 0 Certified co''yT'nereb; furnished UJI 1 'u CERTIFICATE OF, EXEMPTION FROM - " WORKERS' COMPENSATIONINSURANCE In - • !This section need not be 'completed it the permit ' - 11 Ir.1 A ,is"Ior one hundred dollars 101001 or cost —Ui - '- 1,39 : •LJ .1 certily.thar in the performance- of' the work for which Lx this permit is issUed. I shall net employ any person in any 0 manner seas to become subject to the Workers' Compen' I' "1saliOn Laws 01 California, jNOTtCE TO APPLICANT: If, alter making this Certificate I at Exemption. you should become subject to the Workers' -. 'CompensatiOn provisions of the Labor Code' you must -. C . forthwith comply with such provisions or this permit shall f 0 - he deemed revoked, c;: ['I .0 'l hereby affirm thOt there is a construction tending I agency br the peClermance 01 lhU Work 'for which this per. I mil' is issued lSec. 3097, Civil Code)-. I c. ZI "------'-'--'-'--"-.-' lxii Lender's N am e1 "r' Lender's kddrciis1f CARLSBAD BUILDING DEPARTMENT -' '"- - - — 'APPLICATION-'& PERMIT' - 2075 Las Palmas Dr., CarIsbaepA 92009-1915 (619) 438-1161 JOB ADDRESS AV, ST,RO. HOMAS BROS NO. DATE OF APPLICATION BUSINESS LI # SE I 4L. -. V LUA 10 -'- - - - PERMIT NUMBER - - 7-5 5 C ' 7-27 -éP ZONE LOT BLOCK SUBDIVISION ASSESSOR PARCEL NO. CONTRACTOR , CONTRACTORS PHONE a OWNER'S NAME , . OWNE A'S PHONE CONTRACTOR'S ADDRESS / STATE LICENSE NO, BUILDING SO. FOOTAGE - 4"7/o fc OWNER'S MAILING ADDRESS $-I-5 7e._,a.IAZ eg. / DESIGNER DESIGNER'S PHONE DESCRI 10 OF WORK - , - -- - 1s o..i58 07/27/89 0001 01 02 DESIGNER'S ADDRESS STATE LICENSE NO. 042a F LA ELEV. - - :-NO-". - EiIdPmt' -- 899.0 F/P - I - ED - , STORIES .vD ND - •- -• - '.. . -• - '-- - - , . .-.----.' - . -- . - - - - PARKINGSPACE RESUNITS GRADINGPERMIT ISSUED REDEVELOPMENT , TYPE OCC LOAD FIAESPR 7CENSUSTRACT, AREA . CONST , - . nO s 0 yD ND ' - - - 0 D ' Not Va/id Un/ecu Machine Certified OTY. ' PLUMBING PERMIT'- IS1iE - CITY . MECHANICALPERMIT- ISSUE . — --SUMMARY/ACCOUNT-NUMBER - -. ' Tr EACH FIXTURE TRAP - ' , 'ti INSTALL FURN. DUCTS UP TO 1O,00O BTU - ' -. • '.- .-BUILDING PERMIT '_ .00l'81O'OO'OO-8220 / EACH BUILDING SEWER ' ' . . OVER 100,000 BTU , , SIGN PERMIT , 001-810'00'00'8221 EACH WATER HEATER ANDiOR VENT. ' BOILER/COMPRESSOR UP TO 3 HP PLAN CHECK 001-810-00-00-8891 - -EACH GAS SYSTEM-) TO 4 OUTLETS ' ' -' — - . BOILER/COMPRESSOR 3.15 HP - - -- - - - TOTAL PLUMBING ..001'810'00'008222 EACH GAS SYSTEMS OR MORE, ,. . . METAL FIREPLACE - I - ELECTRICAL 001-810-00-00-8223 - EACH INSTAL.. ALTER, REPAIR WATER PIPE , VENT FAN SINGLE DUCT • , - - MECHANICAL - 001810-00-00-8224 - - - - EACH VACUUM BREAKER . ' - - MECH EXHAUST HOOD/DUCTS '' - _. MOBILEHOME 00181000'008225 WATER SOFTNER . . ' ' - . . e RELOCATION OF EA FURNACE/HEATER - - SOLAR 001-810-00-00-8226 EACH ROOF DRAIN (INSIDE) , - DRYER VENT '' . - - '. STRONG MOTION 880'519-92-33 - TOTAL MECHANICAL , I • ' - , - - 1I1/"." , FIRE SPRINKLERS 001-810'00'00-8227 - - —i TOIAL PLUMBING' [)' ' PUBLIC FACILITIES FEE 320-810-00-00-8740 - BRIDGE'FEE ' ' - 360-810-00-00-8740-' OTY. ELECTRICAL PERMIT - ISSUE. ' QTY. ', MOBILE HOME SETUP PARK-IN-LIEU (AREA I NEW CONST EA AMP'SWl OKA c .' CAR PORT . . TIF 312-810-00-00-8835 - 1 PH 3 PH' .' J -- - ' ' ' AWNING' - - ' . - u'_ - - LA COSTA TIF''" 311-810-00-00-8835' -- -- -- - 'EXIST BLDG EA AMP/SWT.BKR , , - ,. ' e. GARAGE ,. , -, , - -' FMF '1 PH - ' - 3 PH''" LICENSE TA 1 001-810'00'00-8162 -' REMODEL'A1TER PER CIRCUIT - - ' . ' /, . -i'' . -' - ' ' . -MFF- ' - - - - 880-519-92-57 TEMP POLE 200 AMPS 4 ' ' ,'' . • , ' , - -. OVER 200AMPS - TEMP OCCUPANCY (30 DAYS) ' '" - ' ' . , - • - -'... -' . .'" , -. . . . CREDIT DEPOSIT TOTL ELECTRICAL -' j,', '•r. t' ' '- ':. TOTAL -_.. TOTAL FEES PAYABLE I HAVE CAREFULLY EXAMINED THE COMPLETED "APPLICATION AND PERMIT" AND DO HEREBY Expiration. Every permit issued byfha Building Official under the provisions 0flhis * AN 0611* PE:T Is REQUIRED FOR EXCAVATIONS OVER C de shall CERTIFY UNDER PENjALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THE eopire by limitation and become null and void lithe building or work 0" DEEP AND DEMOLITION OR CONSTRUCTION OF auothorized by such permit is not commenced within 180 days from the date of such DECLARATIONS ARE TRUE AND CORRECT AND I FURTHER CERTIFY AND AGREE IF A PERMIT IS permit, or it the building or work authorized by such permit is suspended or STRUCTURES OVER 3 STORIES IN HEIGHT ISSUED: TO COMPLY WITH ALL CITY. COUNTY AND STATE LAWS GOVERNING BUILDING CON abandoned any lime after the work uq commenced for a period of tOO days. STRUCTION, WHETHER SPECIFIED HEREIN OR NOT. I ALSO AGREE TO SAVE INDEMNIFY AND PROV BY - .KEEP HARMLESS THE CITY OF,CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND BY PHON.0 t EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE APPLICA SfGNAJRE OWNER CONTRACTOR DA /71 - 1 - GRANTING OFTJ-IiSPERMiT - -. __VV. - •\ \ -- FIELD INSPECTION RECORD REQUIRED SPECIAL INSPECTIONS V INSPECTORS NOTES INSPECTION REQ. IF INSPECTORS D ATE VV . CHECKED APPROVAL V \! V V -SOILS COMPLIANCE V - - -- V - ••_V PRIOR TO V FOUNDATION'INSP STRUCTURAL CONCRETE OVER 2000 PSI PRESTRESSED---\V4 . - . - -. - - V V - -. V.- •V V V CONCRETE.V VV. POST TENSIONED CONCRETE . V FIELD WELDING BOLTS HIGHSTRENGTH4 SPECIAL MASONRY-.. PILE S CAISSONS . ;.-. - i-, ----_-- V__V__• T V.1 p - V , • 4. t - - I V V_VV - - - -- - - -. ___•_,'__* V - I -. - - _*V __V -- -- ---V __. •_\ -. - ___l - ->N --j-- •__V V_VV i: VV •• VV __V - .' -. * - • I I •, - -- \.V. - \ V -V-- V.. • V /V. V ____ ______ . V :-' •'-. V__________ ____ T: • ________ c TYPE i DATE INSPECTOR BUILDING FOUNDATION REINFORCED STEEL I MASONRY GJNITE OR GROUT SUB FRAME Li FLOOR Li CEILING SHEATHING Li ROOF- -Li SHEA V FRAME EXTERIOR LATH INSULATION INTERIOR LATH & DRYWALL V V V PLUMBING i Li SEWER AND BL/CO Li PLICO.. V V UNDERGROUND Li WASTE Li WATER - V TOP OUT •VV Li WASTE V TUB AND SHOWER PAN V - GAS TEST .V -- Li WATER'HEATER LiSOLAR'WATR V V ELECTRICAL - V Li ELECTRIC UNDERGROUND Li UFE9 ROUGH ELECTRIC Li ELECTRIC, SERVICE Li TEMPORARY\ Li BONDING LiPOOL MECHANICAL Li DUCT & PLEM., Li REF. PIPING: - HEAT - AIR COND. SYSTEMS V VENTILATING SYSTEMS VC C \ I V CALL FOR FINAL INSPECT!ONWHENALL APPROPRIATE ITFM APflVP UAVF RFFN APPRQVEDV V FINAL - PLUMBING ELECTRICAL MECHANICAL 41 NJ GAS SPECIAL CONDITIONS - rn ESGIL CORPORATION 9320 CHESAPEAKE DR., SUITE 208 SAN DIEGO CA 92123 (619) 560-1468 DATE: _______________________ ISDIcTI JURISDICTION: Ct4JA N OFILE COPY PLAN -CHECK NO: e9 SET: DUPE ffg DESIGNER PROJECT ADDRESS: / f PROJECT NAME: T The plans transmitted herewith have been corrected where LJ necessary and substantially comply with the jurisdiction's building codes. The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficien- cies identified . are resolved 'and checked by building department staff. The plans transmitted herewith have significant deficiencies D identified on the enclosed check list arid should be corrected and resubmitted for a complete recheck. ED The check list transmitted herewith is for your information. The plans are being held at Esgil Corp. until corrected•• plans are submitted for recheck. fl The applicant's copy of the check list is enclosed for the jurisdiction to return to. the applicant contact person. .fl The applicant's copy of the check list has been sent to: Esgil staff did not advise the applicant contact person that plan check has been completed. 9 Esgil staff did, advise applicant that the plan check. has .been completed.' Person contacted:_____________________ Date contacted:' . '• Telephone #. .... 9 REMARKS: I By: Enclosures: SGIL EGA 0 A 1-1 VW (3 DM 5.. H BftJIL D I N G P ER M I T Permit No: CB950997 08/31/95 12:36 Project No: A9501441 Pae 1 of 1 Development No: Job Address: 2525 EL CAMINO REAL Suite: 235 Permit Type: COMMERCIAL TENANT IMPROVEMENT 3453 08/31,'95 0001 Qi O Paxcel No: 156-302-09-00 Lot#: 58200 Valuation: 65,000 Construction Type: NEW Occupancy Group: Reference#: S Status: ISSUED Description: DRYWALL,ELECT,CEILING,SPRINK, Applied: 07/26/95' DEMO WALLS -- SELECT COMFORT Apr/Issue: 08/31/95 Entered By: RMA Appl/Ownr : GSI CONSTRUCTION 714-257-0162 923 GRAND CANYON RD BREA, CA 92621 *** Fees Required *** A Fes CoIlected & Credits Ole S . Fees: 85.O'bO . . T MS((\ Adjustments: / p.00 .. Ta.lCredi.ts:. .00 Total Fees: / 8.95.00 S T€al'Pyiii?s:\ 313.00 h /. ''. Yç"Bala ?icetDli'e:'\. 582.00 Fee description f Uns\Fee/'Unit Ext fee Data : Strong Motion F&eV :14.00 Building Permit 482.00 Plan'!Check 313.00 Enter 'Y'. for Plumbing Iss,ie Fee / . 20.00 Y Each Intall/Repair Water Line :>. - 1 7.00 7.00 * PLUMBING TOTAL . . / 27.00 Enter "Y" for Electric I'e Fee .>lJD 1952 5 / 10.00 Remodel/Alter Per AMP\\S '-....> 25 25.00 ELECTRICAL TOTAL 15 .00 Y 00 Install Furn/Ducts/Heat Pumps C)> 1 9.00 9.00 * MECHANICAL TOTAL 24.00 4 APPROVAL I N S P. DATE.________ CLEARANCE CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 I, PLAN CHECK NO. q5 ) Gj 9 7 eIL PERMIT APPUCATION City of Carlsbad Building Department 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 From List I (see back) give code of Permit-Type: --------------------------------------- For Residential Proiects Only: From List 2 (see back) give Code of Structure-Type: Net Loss/Gain of Dwelling Units 2. PROJECT INFORMATION 2888 07/26/95 0001 01 02 C-PRMT 313.00 FOR OFFICE USE ONLY Ui[ NO. aaress . ( ouor Nearest Lross Stree CL t LEGAL DESCRIPTION Lot No. Subdivision Name/Number Unit No. Phase No. CHECK BELOW IF SUBMITFED: 02 Energy Calcs 02 Structural Calcs 02 Soils Report 0 1 Addressed Envelope DESCFLIPTIQN WORK F: tL4 .. o - SO. Fr. 2A 4FISTOR1ES iLA # OP-BEDROOMS '03F OF BATHR6OMS .ii,i. NAME (last,name first) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE NAME (last name first) 3c.fszr/4 j9u- ADDRESS q 2.3 tL W'( STATE (..- ZIP CODE 't2-Cz 2.-I DAY TELEPHONE 1 ILl 5. PROPERTY OWNER NAME (last name first) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE r T 6.&a)wrRAmoR- _.-qtçi- NAME (last name firs ADDRESS '1 Z66) STATE ZIP CODE AY TELEPHONE CIT ~wc~, (a C? 0 9_7 C/ STATE 11C. #.ICENSE CLASS 413 CITY BUSINESS UC. # name CITY - STATE ZIP CODE DAY TELEPHONE STATE UC. # 7. WORKERS WMPENSA11ON Workers' Compensation Declaration: I hereby affirm that I have a certificate of consent to sell-insure issued by the Director 01 Industrial 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 reo fil_with Building Inspection Department (Section 3800, Lab. C). POLICY DATE -.ea.-./A~ any pe/son in any manner of California. Uwner-±iuiiar Declaration: I nerey amrm Enac i am exempi rrom we LonLracEors ucense Law jor we ioiiowing redson; 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.). 0 1, 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 [$5001). SIGNATURE DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS 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? DYES 0 N Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? DYES 0 N Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? DYES ONO IF ANY OF ThE ANSWERS ARE YES A FINAL CERTIFICATE OF OCEUPANCY MAY NOT BE ISSUED AFItR JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISmIcr. WNS11UCl1ON LENDING AGENCY I hereby attirm that there is a construction lending agency tor the pertormance 01 the work tor which this permit is issued (Sec 3097(i) Civil Code). LENDER'S NAME LENDER'S ADDRESS APPLICANt CE1fI1FICAflON I certily that I have read the application and state that the above intormation is correct. 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 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 deep and demolition or construction of structures over 3 stories in height. Expiration. Every permit isa e e provisions of this Code shall expire by limitation and become null and void if the (Section 303(d) Uniform BuiliiJg.Cod4 from the d1ateAf s h permit or if the building or work authorized by within 365 days building or work authorized b such permitissuspended or 0 1. CITY OF CARLSBAD INSPECTION REQUEST PERMIT# CB950997 FOR 10/02/95' DESCRIPTION: DRYWALL, ELECT6 CEILING, SPRINK, DEMO WALLS -- SELECT COMFORT TYPE: CTI JOB ADDRESS: 2525 'EL CANINO REAL APPLICANT: GSI CONSTRUCTION PHONE: CONTRACTOR: PHONE: OWNER: PHONE: INSPECTOR AREA TP PLANCK# CB950997 0CC GRP CONSTR. TYPE NEW STE: 235 A LOT: 714-257-0162 REMARKS: MW/RALPH/714-639-0939 INSPECTOR SPECIAL INSTRUCT: TOTAL TIME: --RELATED PERMITS-- PERNIT# TYPE STATUS CB951087 MISC ISSUED AS950054 ASC ISSUED 19 ST Final Structural' , 29 'PL Final Plumbing ' 39 EL Final Electrical' 49 ME Final Mechanical ***** INSPECTION HISTORY ***** DATE DESCRIPTION ACT INSP , COMMENTS 092795 Final Combo CO TP SEE INSP NOTES 092695 Final Combo. ' CO TP NOT COMPLETE,RESTRNS,FIRE SIG 092595 Ftg/Foundati6n/Piers CA PK 092195 Frame/Steel/Bolting/Welding CO. TP SEISMIC BRACE FOR ROUND DROP 092195 Rough Electric AP TP CEILING DOWN & TRACK LITES' 091895 Frame/Steel/Bolting/Welding CO TP , .S.F.& SOFFIT, 091895 Interior Lath/Drywall AP TP ' 'WALLS DUP. 091595 Frame/Steel/Bolting/Welding CO TP ' SOFFIT STORFRT FRAME(SEE CARD 091595 Rough Electric CO TP ' 091595 Interior Lath/Drywall AP TP WALLS ONLY 091495 Frame/Steel/Bolting/Welding AP TP WALLS(N.INCL,S..F. OR. SOFFIT) 091495 Rough Electric AR TP CONDUIT @ WALLS 09149.5 Rough/Ducts/Dampers NR TP . EsGil Corporation ProfesstonU Plan Review Engineers DATE: August 30, 1995 JURISDICTION: Carlsbad PLAN CHECK NO.: 95-997 SET: III PROJECT ADDRESS 2525 El Camino Real Space 235 ANT JURIS. U FIRE U PLAN REVIEWER U FILE - 'L PROJECT NAME: Remodel of Space 235 of Mall U The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. El'-The plans transmitted herewith will substantially comply with the jurisdiction's codes when minor deficiencies identified below are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith Is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheôk. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant óontact person. J The applicant's copy of the check list has been sent to: EJ Esgil Corporation staff did not advise the applicant that the plan check has been completed. U Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Ralph Cox - Date contacted: 8/30195 (by: Abe) Telephone #:appt. U REMARKS: 1. Applicant to carry approved set of plans to the city. Ok'd by Raenette. By: Abe DolLente S Enclosures: Esgil Corporation 0 GA 0 CM GP PC 8/29/95 trn5mt;,dot 9120 Chesapeake Drive, Suite 208 • San Diego, California 92123 • (619) 5601468 • Fax (619) 560-1576 Carlsbad 95-997 August 4,199S VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad• , PLAN CHECK NO.: 95-997 PREPARED BY: Abe Doliente ' DATE: August 4, 1995' - BUILDING ADDRESS: 2525 El Camino' Real Space 235 BUILDING OCCUPANCY: B-2 TYPE OF CONSTRUCTION: Ill-N BUILDING PORTION BUILDING AREA (sq. ft.) VALUATION MULTIPLIER'' VALUE ($) Space 235 of Mall TI 929 SF ' per city 65,000 4 S Air Conditioning ' Fire Sprinklers TOTAL VALUE ' ., ' ' ' 65,000 Building Permit Fee: Plan Check Fee: Comments: ESGIL FEE = 0.80 X 313.30 = $'250:64 $ 482.00 $ 313:30 ' Sheet of 1 valuefee.dot t B U I L D I N G PE R M I T Permit No: CB951087 08/09/95 15:00 Project No: A9501441 Pagei, 1 of 1 . Development No: Job Address: 2525 EL CAMINO REAL ' Suite: 235 Permit Tyke: MISCELLANEOUS Parcel No: 156-302-09-00 Lot#: Valuation: 0 ' Construction Type: NEW Occupancy Group: Reference#: Status: ISSUED Description: DEMOLITION PERMIT-NO CONSTRUCT Applied: 08/09/95 SELECT COMFORT - Apr/Issue: 08/09/95 - Entered By: RMA Appl/Ownr : GSI CONSTRUCTION 714-2570162 - ' 923 GRAND CANYON RD : BREA, CA 92621 '- *** 'Fees Required A Fe?s CoNected & Credi€sT Fees: jo.00O S1(\ Adjustments: / 00 Tota1.Credi.ts: .00 Total Fees: / 3.0'.00 Tbta lRa¼yn1t .s: .00. I Balance Due: 30.00 Fee description f Jny\'h/Unit Ext.fee Data Ile Miscellaneous Fee > ' * I ' -DEMO PERM' MISCELLANEOUS INCORPORATED 1952 3099 00/09/95 0001 01 02 1 . C-PRMT 30.00 -. APPROVAL .. INSP. Z&, DATE' CLEARANCE CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 06-062005 Commercial/Industrial Permit Permit No: CB051400 Building Inspection Request Line (760) 602-2725 . Job Address: 2525 EL CAMINO REAL CBAD St: 235 Permit Type: TI Sub Type: COMM Parcel No: 1563020900 Lot #: 0 Status: ISSUED Valuation: $9,765.00 Construction Type: VN Applied: 04/19/2005 Occupancy Group: . Reference #: Entered By: AMA Project Title: FAST FIX- 315 SF RETAIL TO Plan Approved: 06/06/2005 -. RETAIL . Issued: 06/06/2005 Inspect Area: Plan Check#: Applicant: ' * Owner:- .MARY RYAN ' . -'PLAZA CAMINOREAL C/O WESTFIELD CORP INC 11601 WILSHIRE BLVD P 0 BOX 3749 92690 LOS ANGELES CK90025 (561)330 6060 Building Permit / $99.69 \ . Add'I Building Permit Fee r\7~~ $0.00, Add'l Red. Water Con. Fee ,-. $0.00 Plan Check / $64.805'j,Meter FeeL '\ 3 $0.00 AddI Plan Check Fee $0.00 1 SDCWA Fee \ $0.00 Plan Check Discount S $0.00 CFD Payoff Fee \ - - \ $0.00 Strong Motion Fee / $2.05 PFF \ t7 \ $0.00 Park Fee . J '-Tj $0.00 FF (FD Fund) $0.00 LFM Fee f $0.00 -Ycese Tax I $0.00 Bridge Fee J $0.00 License Tax (CFD Fund5) $0.00 BTD #2 Fee $0.00 Tffic Impact Fee j.. I $0.00 BTD #3 Fee . $0.00(Tra4Ic Impact (CFD Fund) $0.00 Renewal Fee $0.00 \ PLUMBING TOTAL / J $41.00 AddI Renewal Fee . $coo ELECTRICALTOTAL Other Building Fee \ \ \ $0.00 MECHANICAL TOTAL / /. $24.00 - Pot. Water Con. Fee \ \ '-.... $0.00 Master Drainage Fee / / $0.00 Meter Size \ 7 / $0.00 AddI Pot. Water Con. Fee (j$O.00 Rde Parking Fee / / -- '$0.00 - Red. Water Con. Fee 'N $0.00 CoAAdditional;Fees ,/ / - $0.00 N.. 'TOTAL PERMIT FEES $266.54- S Total Fees: $266.54 Total Payments ToDate: (,-'\\ '$64.8O BáIanceDue: $201.74 ". -'1I--(( 9908 06/0,' 02XDfNG.P1,AJ.,,,,, _%~ 201-74 f TN 3 1 k-) IN GE _ATTACHED' .d -:,*. , - - ----S FOR OFFICE USE ONLY P IT AP LIC ON . ..: PLAN CHECK NO.Q O1'/pO ..1:. EST. VAL. CIT 0 VGe ~PA~NT' 1635 Faraday Ave., Carlsbad, CA 92008 Validated By Date PR3 !ECTJNQRMAT1ON Address (include - . Be ,me(atthisd&ess Legal Description Lot No Subdivision Lme/Number it No Phase Total # of uniWt Assessor's Parcel #. . . Existing Use .' ' . Proposé Use . ' ' T. .-'/ ) / Lju . rtc.M-i L1 -• . Ic . ......... Description of Work........................SQ. FT. ' ' #of StQrles # of Bedrboms' # of Bathrooms -- _CONTACJON (if different from app anti r9''ec 12ri I2 ____( __I j J'Jf./TJ __UiTh1 ___ Name Address - City . State/Zip Telephone # Fax # / 'I'L , j . &J LAJ( rvr•'-i (J f)1J;1.f4..J (1)LA71 . Address . City State/ZiO Telephone # I Name _ Addrlss1 city S,telZip Tplpphono~ ft L L CONTACTO _ CM$NE I * (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 Codel or that he is exempt therefrom; and the basis for the alleged ,:exerrirfion. Any violation of ction 7031.5 by any applicant for a ermit subjects thea plican t a civil penalty of not morethanfive hun red dollars ($5001). , 11D'L L& (7 . Nam Address City State! ip elephone # State Licne # (_RLÔ b_'4 License Class - . ity Business License # k_ Designer Name .. . . . -. Address -- . City . . . ' State/Zip Telephone. State License #,' - -- , . ', . . '•' ': - - . - . _WORKERS ATON -- Workers' Compensation Declaration: ,l hereby affirm under penalty of perjury one ofthe following declarations: 0' I have-and will maintain a certificate of consent to self-insure-for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of t work for which this permit is issued. I have and will maintain workers' compensation, as required by Section 3700of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Insurance Company ' __.- . Policy No. \11>162S_1k _b4' - . Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1$ 1001 OR LESS) - ..- CERTIFICATE OF EXEMPTION:. I certify that in the performance of the work,for which thispermit is issued, I shill not employ any person in any manner so,as to become subject to the Workers' Compens ' lifornia. WARNING: Failure "~wvorke nsation' covera is unlawful, and shall subject an'emp!oyer to criminal penalties and civil fines up to 'one hundred' thousand dollars ($ cost of compe ation, damages as provided for in Section 3706 of theLabor code. interést'and attorney's fees.' SIGNATURE __' _...-. DATE 17 I1RDE C. ThTION - - I hereby affirm that I am exempt from the Contractor's License Law for 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): o 1,a5 owner of the property, am exclusively contracting with licensed 'contractors to construct, the pro, 7644 Business' and Professions, Code:' The 'Contractor's License Law does not applyto an owner of property who builds or improves thereon, contracts for,such projects with contractor(s) licensed pursuant to the Contractor's License Law). O lam exempt under Section Business and Professions Code for this'reaso 1. I personally plan to provide the major labor and materials for construction of the pr 'ed property improvement. 0 YES DNO .2. ((have I have not)-signed an application for a building permit for the proposed w k. ' . I have contracted with the following person (firm) to provide the proposed nstruction (include name'I'address I phone number / contractors license number): -' - I plan to provide portions of the work, but I have hired the following per on to coordinate, supervise and provide the major work (include name I address./ phone number / contractors license number)- 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 -I ..... _-: __' _'' ' DATE Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration ~f.r~m risk,managementand prevention program under'Sectióri's' 25505, 25533'or 25534 of the'Presley-Tanner HazardoUs Substance Account Act? 0 YES' . - Is the applicant or future building occupant required to obtain a permit from the air pollution control distric or - quality management district? 0 YES Is the'facility to-be constructed within 1,000 feet of the'outer boundary of a school site?' 0 YES' IF.ANYOF 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. ONt RU 7. ' r I hereby affirm that there is a construction lending agency for the performance of the 'work for,which this permit is issued (Sec. 30970) Civil'Code). LENDER'S NAME: .'-'"- __ LENDER'SADDRESS 'l certify that 'l have read the application and stété that theabove information,is correct and that the information on the plans is accurate. l'agree to comply with all City ordinances and State laws 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 ANYWAY ACCRUE AGAINST SAID CITY INCONSEQUENCE 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 unde he provisidns 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 .180 days from he date of. suchpermit or if the building or work authorized by such permit is suspended or abandoned - at'any.tirrie átterlhO work is commenced for'a perfod 0(180 dà'e Section 106.4.4 UnifOrm Building Code). APPLICANT S SIGNATURE a DATE TE: File 'YELLOW: Applicant' PINK: Finance City of Carlsbad Bldg Inspection Request For: 08/26/2005 Permit# CB051400 Inspector Assignment: TP Title: FAST FIX- 31,5 SF RETAIL TO Description: RETAIL Type: TI Sub Type: COMM Job Address: 2525 EL CAMINO REAL Suite: 235 Lot 0 Location: APPLICANT MARY RYAN Owner: PLAZA CAMINO REAL Remarks: AFTER lOAM Total Time: Phone: 8184488717 lnsector:.__________ Requested By: NA Entered By: CW CD Description Act Comment 19 Final Structural A)0 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Associated PCRs/CVs PCR05108 PENDING FAST FIX REV TO HVAC, AND; FRONT Inspection History Date Description Act Insp Comments 08/23/2005 89 Final Combo NS TP 08/11/2005 89 Final Combo CO TP CORR N/COMP. SEE CARD 07/27/2005 89 Final Combo CO TP SEE JOB CARD 07/18/2005 24 Rough/Topout AP TP AIR TEST WASTE I NOTE NO WATER TO SUITE 07/18/2005 29 Final Plumbing WC TP 07/15/2005 14 Frame/Steel/Bolting/Welding AP TP T-CEIL 07/15/2005 19 Final Structural WC TP 07/15/2005 24 Rough/Topout CO TP NEED TEST 07/15/2005 34 Rough Electric AP TP CElL LITES 07/15/2005 44 Rough/Ducts/Dampers AP TP DUCTS, REPLACE HP UNIT PLATFORM EXIST 07/14/2005 39 Final Electrical CO TP N/C 07/14/2005 84 Rough Combo CO TP T-CEIL 07/11/2005 14 Frame/Steel/Bolting/Welding CO TP T-CElL SEE CARD 07/11/2005 24 Rough/Topout NR TP - 07/11/2005 34 Rough Electric PA TP SUB PNLS 07/11/2005 39 Final Electrical WC TP • City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 06-16-2005 Plan Check Revision Permit No:PCRO51O8 Building Inspection Request Line (760) 602-2725 Job Address: 2525 EL CAM INO REAL CBAD St: 235 Permit Type: PCR Status: PENDING Parcel No: 1563020900 Lot #: 0 Applied: 06/07/2005 Valuation: $0.00 Construction Type: NEW Entered By: SB Reference #: CB051400 Plan Approved: Issued: Project Title: FAST FIX REV TO HVAC, AND Inspect Area: FRONT Applicant: Owner: MARY RYAN PLAZA CAMINO REAL C/O WESTFIELD CORP INC 11601 WILSHIRE BLVD P0 BOX 374992690 LOS ANGELES CA 90025 Plan Check Revision Fee $120.00 Additional.Fees $0.00 Total Fees: $120.00 Total Payments To Date: $0.00 Balance Due: $120.00 CibO5i -Ul) 3 / 1O FINAL APPROVAL Inspector: 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. Project Title: SELECT COMFORT ADD 100 AMP ELECTRIC METER VD\" Applicant: PACIFIC COAST ELECTRIC INC. Job Address: Permit Type: Parcel No: 7978 LOS PINOS CR CARLSBAD, CA 92009 619-942-3500 Reference #: (( , I CC / - - 'J'ç.. ' $10.00 Single Phase per AMP o C' '- -- . $0.00 Three Phase per AMP 1 100/ C) $50.00 Three Phase 480 Per AMP 1- / 0 '' \ \ - 'T $0.00 Remodel/Alteration per AMP' —... 0 -' '- $0.00\ Remodel Fee -./ / N - -• - --- --- - __.;..7 \ '•\ . $0.00 \ Temporary Service Fee - - . 2-- , -. -'$0.00 Test Meter Fee - / \ '—" $0.00 Other Electrical Fees '7 '. ,'-- ,-- -$0.00 Additional Fees , / j $ . . / . $0.00 _-<j •-—' TOTAL PERMIT FEES .' s / $60.00 * •; 1Y lnn+rin lees ía ran / 2525 EL CAMINO REAL CBAD St: 235 ELEC 1563020900 Lot #: 0 Owner: PLAZA CAMINO REAL C/O WESTFIELD CORP INC 11 601,WILSHIRE BLVD LOS ANGELES CA190025 Status: ISSUED Applied: 04/27/2005 Entered By: KG Plan Approved: 04/27/2005 Issued: 04/27/2005 Inspect Area: City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No: CB051514 Building Inspection Request Line (760) 602-2725 04-27-2005 \ -• - / Total Fees: $60.00 Total Payments To Date: s--- - $0.00 Balance Due: I $60.00 1962 7017 04/28/05 0002 01 02 COP 60-00 FINAL APPFOVAL InsPecto(I 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 Caflsbad 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 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE ONLY PLAN CHECK NO.Có/5/Y' EST. VAL. Plan Ck. Deposit Validated By - Date . Address (include Bldg/Suite #) - . Business Name (at'this address) Legal Description Lot No. Subdivision Name/Number - Unit No. Phase No. Total # of units Use Proposed Use Description of Work SQ #01 stories # of Bedrooms # of Bathrooms 2 COP TACT PERSON if'dlffeVent from apldant) • . . ' Name Address City State/Zip - Telephone # - Fax # 3 PPPLICANT LM"Contractor Agent for Contrctor Owner E A'ent for O-wner Name . Address - City State/Zip . Telephone # 4-ttPRO.PEEY4OVNER . ' :---- - '-- 4 ZA Afl N 44'. Ø WE~7F,ED. i/6 O, / 10. 4.4 9Oc? :5w. - Name . Address - City State/Zip Telephone # 5 bPffRACTOR Co i—Wi,NAME (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 ption. Any V lotion of Secti 7031.5 by any applicant for a permit subjects the'applic nt to a civil penalty of not more than five hundred-dollars ($5001). i4 / - r th-' C. - 3 3 Name Address City -. - -State/Zip Telephone II State License # ._f6~' _7 - License Class c.L•(Q _-- .- City Business License # Designer Name - - - Address - - - -City - State/Zip Telephone State License # - - - - - - - 16. WORKECOMPE'ATIQN ' r. - - - -- :- Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 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 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: Insurance Company - . . Policy No.- -- Expiration Date__________________ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) - - CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure-to secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines .up to one hundred thousand dollars P900.00 ). - addition to th oat of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE /II/L?Y? _ _---- DATE.7O$ 7 O'NNERUILDER DETCLARATION I hereby affirm that I am exempt from the Contractor's License Law for 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). - - 0 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). 0 I am exempt under Section Business and Professions Code for this reason: I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO - I (have'/ 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 / addróss / phone number / contractors license numbed' 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 I address I phone number / contractors license number): - - I will provide, some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address I-phone number / type of work): PROPERTY OWNER SIGNATURE ,--- DATE (COMPLETE rHISSECTI0N FOR NONRESIDENTIAL BUILDING PERMITS 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? 0 YES 0 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 0 NO Is the facility to be constructed within 1,000 feet of. the outer boundary of a school site? - 0 YES 0- 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. cONSTiiJCTION LENbiG AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 30970) Civil Code). LENDER'S NAME- -,. 'LENDER'S ADDRESS _..-.- AILIA1IT CERTIFLCATiÔ 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 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 - 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 180 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 comm4ed for a pfiod of 180 days ,Section 106.4.4 Uniform Building Code). - APPLICANT'S SIGNATURE ,1I/'77t /'EftZ( - - - - - DATE 4"2 7- WHITE: File 'YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 05/05/2005 Permit# CB051514 Inspector Assignment: Title:, SELECT COMFORT ADD 100 AMP Description: ELECTRIC METER Type: ELEC Sub' Type: Phone: 7609423500 Job Address: 2525 EL CAM INO REAL - Suite: 235 Lot 0 Location: Inspector: OWNER PLAZA CAMINO REAL Owner: CHASM ENTERTAINMENT INC <LF> PLAZA CAMINO REAL Remarks: CALL WITH YOUR ETA Total Time: CD Description Ac Comment 39 Final Electrical Associated PCRs/CVs Inspection History Date Description Act Insp comments Requested By: DON Entered By: CHRISTINE