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2557 EL CAMINO REAL; MULTI-PERMIT FILE; CB021451; Permit
6 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 05-15-2002 Electrical Permit Permit No: CB021451 Building Inspection Request Line (760) 602-2725 Job Address: 2557 EL CAMINO REAL CBAD .permit Type: ELEC Status: ISSUED Parcel No: 1563021500 Lot #: 0 Applied: 05/15/2002 Entered By: RMA 1Reference #: Plan Approved: 05/15/2002 Issued: 05/15/2002 Project Title: MACYS NENS-ELECT ONLY FOR INST Inspect Area: OF ROLL UP DOOR -PERMIT #CB021272 Applicant: Owner: WIRED RITE ELECTRIC MACYS PRIMARY REAL EST INC C/O FED DEPT STORES INC-TAX DEPT 7 W 7TH ST 1300 GARDENA AV 91204 CINCINNATI OH 45202 M6 05/15/02 0002 01 02 818 242-9891 COP 20-00 Total Fees: $20.00 Total Payments To Date: $0.00 Balance Due: $20.00 Electric Issue Fee $10.00 Single Phase per AMP 0 $0.00 Three Phase per AMP 0 $0.00 Three Phase 480 Per AMP 0 $0.00 Remodel/Alteration per AMP 0 $0.00 Remodel Fee $10.00 1 Temporary Service Fee $0.00 Test Meter Fee $0.00 Other Electrical Fees $0.00 Additional Fees $0.00 TOTAL PERMIT FEES $20.00 FINAL APPROVAL Inspector: Date: 3U v Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referreflo as 1eestexactions " 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 feeslexactions of which you have -previously been aiven a NOTICE similar to this,r as to which the statute of limitations has-i)reviously otherwise expired. PERVAIT APPLICATION CITY OF CARLSBAD -BUILDING DEPARTMENT 1635' Faraday Ave., Carlsbad, CA K008 1. `,PkOJECT,INFORMAT Address (include Bldg/Suite #) FOR OFFICE USE ONLY PLAN CHECK NO.. ,�'��♦" .� EST. VAL. Plan Ck. Deposit _ e• Validated By -Date Al J4 �^ Business Name (at this address) Legal Description ' Lot, No. Subdivision Name/Number Unit No. Phase No. Total # of units Assess ' �'eG 1Y't r J l t,r erLv r j�xiVP.ing Us Proposed Use Description of Work SQ. FT. #of Stones, # of Bedrooms # of Bathrooms --. CONTACT_PERSON-(]f`different.from applic Name Address City State/Zip Telephone # Fax # 3`:i-/'�„'AP•P.CICANT ']J Ciantiactors `❑'Agent fociCbhtractor )]: caner ``❑-°Ayeni-for W I r�� lQ ► �-c 1'evl 7 4' . 0 Cs�'�-�-�- iF✓c Name Address City State/Zip Telephone # PROPERTY -OWNER : _ ;• `' .. :. .... . - :n'_; :... „ , . Name Address City . State/Zip Telephone # •5: -CONTRACTOR GOMPANY,NAME ;"s;:= :' = • • • --- (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 exe Lion. Any vi at n of Section 7g31.5 by any applicant for a permit subjects the applican to a civil penalty of not more than five hundred dollars [$5001). W I rt'� i ire Q-er✓9r 4 J300 �a',g.,.Q/.4.�,J A,,� �I.., t � /�/2Q�/ f�'ig 2 412 y'�ri'/ Name -Address City State/Zip T lephon r# State License #3License Class City Business License # Designer Name Address City State/Zip Telephone State License # :'VNORKERS'-COMPENSATION-: _ 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 workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Z 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 c ner and policy number are: .J � Insurance Company %� 04 WWA r` Policy No. GIoG �W Expiration Date 1 0Z. (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT -IS FOR ONE HUNDRED DOLLARS [S100]-OR LESS) ❑ CERTIFICATE OF EXEMPTION: I certify thatinthe performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become s 'ect to the Workers' Compensation Laws of California. WARNING: Fai a to secure wo era' com n stion coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (8 0,000), in a 'lion tote cost of compensation, damages as -provided for in Section 3706 of the L or code interest and attorney's fees. SIGNATURE- DATE `JT I Z- :7.` .OWNER=BUILD ER:DECLARATION=^_. 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). ❑ 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). ❑ 1 am exempt under Section Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed "property improvement. ❑ YES ONO 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 number / 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 number / 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 number / type of work): PROPERTY OWNER SIGNATURE DATE COMP.LETETHIS'SECTION'FOR-NON-RES/DENT/Ab_BUILDIN(3PERMITS•.ONLY-,;;•z_=___ 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? ❑ YES ❑ NO Is the applicant or future -building occupant required to obtain a permit from the eir pollution control district or air quality management district? ❑ YES ❑ NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? ❑ YES ❑ 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. Sr.'..•:`GQNS.T.RUCTION',LENDING�AGENCY• .'' ..:: . .. . . .. .:.. .� . =.... ... w . _ . ... . .- _ - .. - 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 9.•,^.APPLICANT`:CERTIFICATION;:;:;=::;. ... �-;,._._::'._: _,., .. -. <.:�:.:,.:..-•.:::..'=:- '.. - • 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 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 issue by the building Official under the provisions of this Cade shall expire by limitation and become null and void if the building or work authorized by such permit is not com enced within 0 days fr the date of such permit.or•!f the building or work authorized by such permit is suspended or abandoned at any time after the work is commen ed for a per! d of 180 ys (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE AA DATE ✓`✓ 1 S 0Z- WHITE: File YELLOW: Applicant PINK: Finance UNSCHEDULED BUILDING INSPECTION INSPECTOR PERMIT # PLAN CHECK # JOB ADDRESS DESCRIPTION CODE DESCRIPTION ACT COMMENTS ,R�s 10-19-2001 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Mechanical Permit Permit No: CB013312 Building Inspection Request Line (760) 602-2725 Job Address: 2557 EL CAMINO REAL CBAD Permit Type: MECH Parcel No: 1563021500 Lot #: Valuation: $8,000.00 Reference #: Project Title: MACY'S REPLACE EXISTING CHILLER Applicant: PRC MECHANICAL 1300 GARDENIA AVE 91204 323 245-1111 Status: ISSUED 0 Applied: 10/19/2001 Entered By: MDP Plan Approved: 10/19/2001 Issued: 10/19/2001 Inspect Area: Owner: 493 1.0/19/01 0002 01. 02 MACYS PRIMARY REAL EST INC 1��B1'= " 71, 50 C/O FED DEPT STORES INC-TAX DEPT 7 W 7TH ST CINCINNATI OH 45202 Total Fees: $71.50 Total Payments To.Date: $0.00 Balance Due: $71.50 Mechanical Issue Fee $15.00 Install/Furn/Ducts/Heat Pumps Fee 0 $0.00 Fireplace Installation Fee 0 $0.00 Exhaust Fan Fee 0 $0.00 Installation/Relocation Vent Fee 0 $0.00 Hood Fee 0 $0.00 Boiler/Compressor to 15HP Feb 1 $16.50 Other $40.00 Additional Fees $0.00 TOTAL PERMIT FEES $71.50 FINAL APPROVAL InspectS:a Date: 4G✓0'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 leeslexactions " 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 probedures 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 capactiy 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 - - MpPfiOi)EC� INFOF ME1TION ., a .. ........ .... .. .... �...," ...: FOR OFFICE USE ONLY PLAN CHECK NO.� (Z-r EST. VAL. Plan Ck. Deposit Validated By Date Address (include Bldg/Suite #) ,usmess Name tat tins aaaressl 14A n r s � /r � . � 0—f �n � � : ram'% l / • /''� "_.A 19..ih.: /' -1 /J ; n.R .9 ,� le _ �ii^) �t"�� Legal Description Lot No. Subdivision Name/Number Unit No. - Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use Description of Wo/rrk�_[X`` �� / / j jj��(/J4 /p SQ. FT. #ofrSttories # of Bedrooms # of Bathrooms h^�,'..; wi;5„fw' ,�V''�,.f '�Q „'°•+' .L,�.^2t � ;aqc>-�•+ e. `3"t'r._ ,z.; r•'s.! :•rV 8,:r x--• i;„Y: •s:>xw�,. ..w�-�>s-;°�.:.a`;=': =,1-^ > Ice'it•' ,"`h.as :':: -n ��,. _€. ?w" ., p:�:;7;,.::xuM"l:;;w�...::',.c = ��•>av%'� , '2�� CQNAGT.PEHSL?1,°(if diHerBntrfroni .pPj. ,. Name Address CityState/Zip Telephone # Fax # - _ c^"•-; ,'""=�---u;"-:x">.-.�,-�,.�^".>"az«•...�. �,.;;`-.-.ter .- .,...µ�',�'*,: r �`�-:s.-•�;�,.,-"�--.:,,, ^.�`t�:�o;•'�"'_„a`.:°--.<-�-';�s�a=..;„;-y�`.'i°-`°:w;;..•'s;;cs.��`'�'�"�'?':'S°: s��."'�'>;%.'�-'' antraator'. �;.i IPAd cfir:.ContLa�to_r,:k�`. Name Address City State/Zip Telephone # ^!1: P'ROP_2."'.,._...>: �:`•"�'�m`u;::,-:.»; ._...i.,,.. •.-: ;;':'.=', .._ :^ . _.> .::^. '';> `.�;=;;� � ;:' •_ 2 slvit% !�-tiSStrIYtJ ftY c-2c� C�1 ! c�31 i32 3 Z2�-- 24 Name Address City. State/Zip Telephone # r5..,..-^->-,---"`or«...-",.• _ w"'"""'"�"'°;°ze°. --""vey�° �`',:3:•` ��.,;>�>^:cw-.``y,>�'6"�„'i. ��;.".�.`��"". .>"i.?'.4:"^>> �'.p�•4,�,>=,..�.^n�.7r?: ��>-: ��:�;�,. ."'°.GON'FRA_CTOR=-iCOM A Y�11jA E.. _ _ .......i,;.:,..�.�.�:a;:�.�;�i��'�-°�"s:v:�.:�.,;��'.°„a�,-:�:,;,�.:`�:::�-..`...:,..;.�.�;i,�:;..._.,._,�;.:;�,::»-;,.:�«.�.-;:���.x�A,A.-..,,.�K�:..•�.:`�<,�.� (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 axe,Inption. Any violation of Section 7031.5 by any applicant for a permit su Iects the applicant to a civil penalty of not more than five hunaked dollars [$5001). Name / C� Address City State/Zip ��phone # State License # 3 l (� I / � License Class�j �'.Zd 3 P/'6 City Business License # /ZO,9Y31 Designer Name Address City State/Zip Telephone State License # S�•w� �VlI,ORKERS��COMFENSA, . ,m.��:-......�,:�i �;.:'�, w.:;:,m�.,; wA,:..:a'.�i,.o><,+.,e .. «m... .. a„„.M. �.'=r"<.?.i' o�..�' �:hHi: . +..,_...... -- . Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: A G3`1 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. 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 /r/f1� /L//>J Policy No. A 0,923 5 Expiration Date D� © _ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100) 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 0100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE DATE gz'z,N;.,, - . �.. - _ - ;�+<:: t ; -r.;` -n a �;c•,» i t:a ">?.,4 K•: ,3 >•%•: �•z a�•a4•,'=�•<: •L' . = Of14INER�BUILDER OECLARATI, . ' .. . , ;a : ,,..�„ • - •; .�'. " .. > , � .. .,.._..4<.'.m,.:,`.:az;.'..:, m•u?S...ix; ,.....;..:_.� ..:'Y.„:.;...5..�...s..........:...•.a..>v,„ ,.�?., ......_^ ..». „^>: ..,...t:..., I hereby affirm that I am exempt from the Contractor's License Law for the following reason: ❑ 1, 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: 1. I personally plan to provide the major labor and materials for construction of the proposed,property improvement. ❑ YES ONO 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 number / 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 number / 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 number / type of work): PROPERTY OWNER SIGNATURE DATE rw+,}nw • w;g.+,..w u.a.mi.+...+.y..we w.e p..,.. >ynw„� .w ...... ...v,s. money 3+cur (u.^yb^^ �?.Cw.=.w.. �,rw.,y, _.nu.w.�.u....w :iam.• + Y•!. s;. Y 5 t _ s �.:••:: -� ` `�$' ems:• ;w; :...�,. ;,,,:` c <; .,� ....<. i„' _ , �� GOIjAPIET�;�T,�,i�IS.SEGTI " 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? ❑ YES ❑ NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? ❑ YES ❑ NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? ❑ YES ❑ 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. r�,P}c'^,^.d^;^:`+.M.".;y.......+.r"•y.,+ ri �"'t; ..c< "<`y."�H�.-`%'.;'�i,".i.�.'; i .,.-�.y.-.- ....��,.� ..... 3 ,.�:'• . ,9..'.."" .si.":F z.Hr m�`=`>i:a:�'t� .. =,p .>." ?' �+•:•:e x'�.,::"a..•::r;" ;i-:', .,:�', r°.4isri,yc; iO�Eilliiir�Sa�nr I hereby affirm that there is a construction lending agency for the performance -of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME LENDER'S ADDRESS r. - �iE!td s�.., �1., a .....3'..>U,a"S.`w,.....,..x....,..» ,..x.� ..... a,�¢:>.`«a��.':.a....w«»,.:.>'�a....,.,......,.,..,...,;.%b?..ota,x...'N•i�c«i.:n�n,:':.r.. 1 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 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 wi in da rom 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 peri o days (S lion 106.4.4 Uniform Building Code). ,. APPLICANT'S SIGNATURE DATE C/ C_Applicant PINK: Finance Inspection List Permit#: CB013312 Type: MECH MACY'S REPLACE EXISTING CHILLER Date Inspection Item Inspector Act Comments 03/25/2002 49 Final Mechanical PS AP 03/25/2002 49 Final Mechanical PY NR NO ONE THERE 03/21/2002 49 Final Mechanical - RI 03/2112002 49 Final Mechanical PY NR COULD NOT FIND EMPLOYEE ENTRANCE Tuesday, March 26, 2002 Page 1 of 1 Dimensions and Weights 2 V ftlna dw m indude standard IW pdg vMerlwxa. S. Operatirq wefyMs incWde refipererR, dl; and water dunges. 13 36" [914mm] WIDTH 36" Dimensions BlBlBl, BlClDlv and B2W.B2ar MUM Weijhts 36' [914mm] �----------------------- I I i EW COMPRESSOR I oy�t EAt�151kt€ - I - I do , , STARTER CONTROLS iHEgi I I I I — — — — — — — — — — — — — — — — — — — ------ .-------J EL ----_! RECOMMENDED - CLEARANCE 36" [9I 4mm] WIDTH EVAP TR 1. Dhn.W.. wo based on 3 PMEV.PR PaaiCond and LK" Wata mwwctiom Ratertd atdxnM* forexact Obs! emfoVadw. 2 Reforto the Nominsi CaWky Data whie in the Go" Dahl section fore P*V rsnpes of eadt CmWesw- 14 SENT BY: THE TRANE COMPANY; 626 013 7283; SEP-i2-01 9:35AM; PAGE 3/3 RTH C Water --Cooled S•efies R® Chiller Job Information Job01�• Los Angeles Cominents TT-14- lr .fv.myfNnn Tag' CV-1 Qtttintity 1 Unit •model RTHC Compressor type D2 J vaporatur, tYpc C2 Condenser type D2 Capacity 2011.10 tons Efficiency 0583 kW/ton NPLY 0.529 kW/ton Refrigerant charge(HFC-134a) 490.0 lb Full •triad sound pressure 83.00 dBA Note: Sound,preWire measured in accordance with ARI . Standard 575-87 at ARI operating conditions - Evaporator Infolrmation Leaving temp 44.00 F Entering temp 57.90 F Flow rate 343.00 apm Pressure drop 7.20 ft 1120 Fouling factor 0.00010 hr-sq ft-dea F/Btu Passes 3 Pass Fluid type Water Fluid,concentration Fluid freeze pt 32.00 F Electrical Information Unit voltas;e 460/60/3 Design kW 116.6 kW Min circuit ampacity 201.60 A Max OverculTent Protection RLA 161.30 A LRA 1280.00 ' A Condenser Information Entering temp Leaving temp Flow rate Pressure drop Fouling factor Passes Fluid type fluid concentration Tube tYpe 80.00 F 89.30 F 600.00 lapin 18.00 t1t H2O 0.00025 hr-sq ft-deg V/Btu 2 Pass Water Enhanced Fin - Copper Note. Certified in accordance with. the ARl Water -Chilling Packages Using the Vapor CCmpression Cycle Certmeation Progyatn, which is based on ARI Standard 550/590. 9/12/2001 PXc•idact Versiort 1.8 C:,\Aly Douarridtits\D411's Jt,bs\M-t4ys Carlsbm4.psd 05102/.2000 - Job Address: Permit -Type: Parcel No: Valuation: Reference #: Project Title Applicant: PRC MECHANICAL City of Carlsbad I 1P Mechanical Permit Permit No: CB001683 Building Inspection Request Line (760) 602-2725 2557 EL CAMINO REAL CBAD MECH 1563021500 Lot #: 0 $0.00 MACY'S-REPLACE COOLING TOWER 1300 GARDENA GLENDALE CA 91204 323 245-1111 Status: ISSUED Applied: 05/02/2000 Entered By: RMA Plan Approved: 05/02/2000 Issued: 05/02/2000 Inspect Area: MACYS PRIMARY REAL EST INC C/O:FED-DEPT STORES INC-TAX DEPT CI�V1f 7THST WINNATI 45202 6093 0510 /00 0001 01 02 , I c -PRMT 24.0i0 Total Fees: $24.00 A7notat-Payments To C2ate: $0.00\ \`� "Balance Due: $24.00 Mechanical Issue Fee r U $1,5.00 Install/Furn/Ducts/Heat Pumps`Fee $9.00 Fireplace Installation Fee $0.00 Exhaust Fan Fee 0 $0.00 Installation/Relocation- Vent Fee 0 $0.00 Hood Fee r°0 $0.00 Boiler/Compressor to 15HP Fee 0co9a�ATo $0.00 Other $0.00 TOTAL PERMIT FEES � "�°� $24.00 ____-EXPIRED PERMIT PERMff HAS fXP1RED IN ACCORDANIXIMU.B.C. SECTION 106.4.4 DA71! o . a vSIt;NATURE 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 capacty 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 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 4 Business Name (at FOR OFFICE USE ONLY PLAN CHECK No. (J� EST. VAL. Plan Ck. Deposit Validated By Legal Description Lot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use Description ai Work SQ. FT. #of Stories # of Bedrooms # of Bathrooms W Z U � @Pi qqo T, a r,, r 714 t -5- Addres's City State/Zip Telephone (Sec. 703-1.5 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 [$5001). Name YPC M/ Address (&�tqUCI City Gd5Mtn(_rState/Zipy/ " We]e h # 3 Z,3 Z State License # .� j(/ U License Class —/6-20 City Business License # a& i Designer Name Address City State/Zip Telephone State License # [61— K Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 11 1 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. sl� 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 T=���-, (51-71-1 Policy No. WA4�2eOOq 0'(_ Expiration Date 9 Z, (THIS SECTION -NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS) [I CERTIFICATE OF EXEMPTION: 1-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 ($100,000LJ�iflon to the cost Of compensation, -damages -as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE DATE I heieby affirm that I am exempt from the Contractor's License• Law for the following reason: El 1, 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). ❑ 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). El 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. C] YES [I NO 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 number / 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 number / 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 number /type of work): PROPERTY OWNER SIGNATURE DATE ,ma _0 Lu 4, 1 row 61"Mi J* "s, 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 E] NO Is the applicant or future building occupant required to Obtain a permit from the air pollution control district or air quality management district? F] YES 171 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. [80,022Z*1-0 tiEtivt I W� �IJERD I hereby affirm that there is a construction- lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME LENDER'S ADDRESS p,� V, CA?FVZ(F_,,JtTJ �g 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 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 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 commenc no o (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE, DATE WHITE: File _>EtfCOW. Applicant PINK: Finance fl-Ir es, City of Carlsbad Bldg Inspection Request For: 9/7/2000 Permit# CB001683 Title: MACY'S-REPLACE COOLING TOWER Description: Type: MECH Sub Type: Job Address: 2557 EL CAMINO REAL Suite: Lot 0 Location: APPLICANT PRC MECHANICAL Owner: MACYS PRIMARY REAL EST INC Remarks: Inspector Assignment: Phone: 7605359037 Inspector: Total Time: Requested By: ROY Entered By: ROBIN CD Description Act Comments 13 Shear Panels/HD's 4414- .61-6 6) 12446a L'lrjtlT Gl,�'Jf'G�1 15 Roof/Reroof - Associated PCRs Inspection History Date Description Act Insp Comments �= Cltv of Carlsbad Building . - • - August 25, 2000 Permit Number: CB001683 Issue Date: 5/2/2000 MACY'S PRIMARY REAL EST INC 7W7THST CINCINNATIOH 45202 RE: BUILDING PERMIT EXPIRATION ADDRESS: 2557EL CAMWO REAL PERMIT TYPE: MECH PLEASE CALL FOR AN INSPECTION IF WORK IS COMPLETE Our records indicate that your building permit will expire by limitation of time on 10/29/2000. The provisions of UBC, Section 106.4.4 as amended by the Carlsbad Municipal Code state: "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 (unless issued prior to 7/l/99 which is one year from date of permit), or if the building or work authorized by such permit is stopped at any time after the work is commenced for a period of 180 days or if the building 'or work authorized by such permit exceeds three calendar years from the issuance date of permit. Work shall be presumed to have commenced if the permittee has obtained a required inspection approval of work authorized by the permit by the Building Official within 180 days of the date of permit issuance. Work shall be presumed to be stopped if the permittee has not obtained a required inspection approval of work by the Building Official within each 180 day period upon the initial commencement of work authorized by such permit. Before such work can be recommenced, a new permit shall be obtained to -do so, and the fee, therefore, shall be one-half the amount required for a new permit for such work, and provided that no changes have been made or will be made in the original plans and specifications for such work, and provided further that such suspension or abandonment has not exceeded one year. In order to renew action on a permit after expiration, the permittee shall pay a new permit fee. Any, person holding an unexpired permit may apply for an extension of the time within which work may commence under that permit when the permittee is unable to commence work within the time period required by this section for good and satisfactory reasons. The Building Official may extend the time for action by the permittee for a period not exceeding 180 days on written request by the permittee showing that circumstances beyond the control of the permittee have prevented action from being taken. No permit shall be extended more than once. Please check below indicating your intentions and return this letter to us. Project abandoned. A new permit will be obtained prior to commencing work. No fee extension requested for 180 days. (attach a letter of explanation) Renewal permit requested. if the project has been completed and only a final inspection is needed, please call the inspection request line at (760) 602-2725. If you have any questions, please contact the Building Inspection Department at (760) 602-2700. PAT KELLEY Principal Building Inspector 1 635 Faraday Avenue • Carlsbad, CA 92008-731 4 • (760) 602-2700 • FAX (760) .602-8560 FBI'LE No. 994.01./26 '00 17:00 ID:WG 0ocker-•,dorf, Inc. •3104581036 PAGE 6 A Y Cooling Tower Data Shoat Trevor Day Monarch Mechanical 323-255-0111 Fax: 818-S49-0270 Project: Macys Carlsbad Location: ` Product Type: AT Cooling Tower Selection Criteria Q >>va car Steve Lewis WG Dockendorf, Inc, 501 Santa Monica Blvd Suite 700 Santa Monica, CA 90401 310-451-0630 Fax: 310-458-1036 Date: 01/26/00 Page: 1 Capacity (Tons): 290.00 Capacity (MBH): 4,350,000 Fluid` Water Flow (GPM): 870.0 Fntering Fluid Temp (F): 95.0 Leaving Fluid Temp (F): 85.0 Wet Bulb (F): 72.0 Selection AT Capacity Percent Qty Model (M8H) Capacity 1 19-211 4,367 100.4 # Fans: 1 Overall Length: 10, 5,501, # Fan Motors (HP): (1) 10.00 Overall Width: 8' 5.501, Overall Height: 10' 9.25" Air Flow (CFM): 50,210 Operating Weight (lbs): 7,690 Shipping Weight (lbs): 4,390 Pump Head (ft of water): 13.5 Heaviest Section (lbs): 2,230 Evaporated Water Rate (gpm): 8.7 Recommended Bleed Rate (gpm): 8.7 Pricing Base Model: Options Selected Aluminum ladder fl F., Fan Motor: Inverter duty ; ) UJ Stainless steel water touch basin' -J 0 Toshiba NEMA 1 VFD w/ bypass �� r CD Total Price per Unit, Esc Factory; $14,795 4_ Number of Units: x 1� Total Price for Location, Ex Factory: $14,795 Estimated Inland Freight: 660 Freight Allowed Price: 15,355 PhC MECHANICAL pROTECl 1300 GARDENA AVE. Q•ti MESH �Oy GLENDALE, CA 91204 O CMIFlCAnON a C-16 LICENSE NO. -q 311690 FILE N6. 994-01/26 '00 17:00 ID:WG Dockeridorf, Inc. • 3104581036 PAGE 5 Steve Lewis WG Dockendorf, Inc. 501 Santa Monica Blvd Suite 700 Santa Monica, CA 90401 310-451-0630 Fax: 310-458-1036 Date: 01 /26/00 Trevor Day Monarch Mechanical Phone: ..323-255-0111 Fax: ' 816-649-0270 Project, Macys Carlsbad Location Gentlemen: Thank you for requesting a quotation for EVAPCO equipment- We are pleased to submit our offer as follows. (1) EVAPCO Model AT 19= -11 induced draft counterfiow cooling tower certified to cool 870 gpm of water from 95OF to 85OF at.720F entering wet bulb temperature: Technical Data for each unit: # Fan Motors (HP): (1) 10.00 Air Flow (CFM); 50,210 Pump Head (ft of water): 13.6 Evaporated Water Rate (gpm): 8.7 Recommended Bleed Rate (gpm): 8.7 Operating Weight (lbs): 7,690 Shipping Weight (lbs): 4,390 Accessories Included with offer: _Aluminum ladder Stainless steel water touch basin Fan Motor: inverter duty Toshiba NEMA 1 VFD w/ bypass Total. Not price Including accessories; $15,355 excluding tax, including freight FOB factory with full freight allowed to Los Angeles Area,CA, Shipment: 4 weeks after receipt of purchase order and release for fabrication. Quote is valid for purchase within 60 days and shipment within nine months from date of this quotation. Terms of payment are: Net 30 Days All purchase orders must be addressed to EVAPCO, Inc. c/o of the undersigned. Sincerely, WG Dockendorf, Inc. �QROTE Steve Lewis Manufacturers' Representative Q" CLASSIFICATION C-16 PRC MECHANICAL "�� LICENSE NO, 1300 GARDENA AVE. 311690 GLENDALE, CA 91204 ��.o% �1FNDAi Page: 1 FILE 994- 01/26 '00 17:00 ID:!•:IG `Dockeridorf, , Inc. - 3104581036 PAGE 5 "V98 two Trevor pay Monarch Mechanical Phone: ...:323-255-0111 Fax: 818-549-0270 Project, Macys Carlsbad Location Gentlemen: Steve Lewis WG Dockendorf, Inc, 501 Santa Monica Blvd Suite 700 Santa Monica, CA 90401 310-451-0630 Fax.- 310-458-1036 Date: 01 /26/00 Page: 1 Thank you for requesting a quotation for EVAPCO equipment. We are pleased to submit our offer as follows. (1) rEVAPCO Model AT 19.21_1, induced draft counterfiow cooling tower certified to cool 870 gpm of water from 95OF to 85OF at 12OF entering wet bulb temperature. Technical Data for each unit: # Fan Motors (HP): (1) 10.00 Air Flow (CFM); 50,210 Pump Head (ft of water): 13.6 Evaporated Water Rate (gpm): 8.7 Recommended Bleed Rate (gpm): 8.7 Operating Weight (lbs),- 7,690 Shipping Weight (lbs): 4,390 Accessories Included with offer: _Aluminum ladder Stainless steel water touch basin Fan Motor Inverter duty Toshiba NEMA 1 VFD w/ bypass Total Not Price Including accessories; excluding tax, including freight FOB factory with full freight allowed to Los Angeles Area,CA, Shipment: 4 weeks after receipt of purchase order and release for fabrication, Quote is valid for purchase within 60 days and shipment within nine months from date of this quotation. Terms of payment are: Net 30 Days All purchase orders must be addressed to EVAPCO, Inc. c/o of the undersigned. Sincerely, WG Dockendorf, Inc, Steve Lewis Manufacturers' Representative PRC MECHANICAL 1300 GARDENA AVE. GLENDALE, CA 91204 co CLASSIFICATION CLICENSE N0. ,"'� 311690 4' 61 -A CMIRCAVON C-16 LICENSE NO. 311690 Notes: I. Make-up water pressure 20 psi MIN. 50 psi MAX. 2. Heaviest section is lower section. 3. An adequately sized' bleed line must be installed in the cooling tower System to prevent build-up of impurities in the recirculated water. 4. Do not use drawings for certified prints. Dimensions subject to change. S. Motors are shipped loose for fiield.mounting_ Qt 7: 1 f Model: AT 19-211 Connections: Description Inlet: Outlet: Make-up: Drain: Overflow: Page: 1W Qty Size Type 1 8" Beveled for Welding 1 8" Beveled for Weldinc, l 2" Male Pipe Thread 1 3" Female Pipe Thread 1 3" Female Pipe Tbread ect: Macys Carlsbad Capacity: Fan Motors: 'Weights (Ibs) Fluid: Flow (GPM): Water 870.0 1 HP 10.04 Shipping: 4390 Temp Ia (F): 95.0 Wig: 7690 Temp Out (F): 85.0 Type: TEFL Heaviest: 2230 Wethulb (F)_ 72.0 Elec: 460/3/60 No Sections: 2 Aluminum ladder, Stainiess steel water touch basin, Fan Motor: Inverter duty, Toshiba NEMA 1 VFD wi hypass PRC MECHANICAL 1300 GARDENA AVE. GLENDALE,CA 91204 Date: o1/uro4 a-- P.O. Box 1300 Westminster, MD 211s8 Phone 410-756-2600 Pax 410-756-6454 9 I- 'm z P A O r N, 0) O O -.7 d e 0 n 77 0 T 0 w O A 0, 0 w a) e F I4.E No. 994 01 /26 ' 00 17 :01 I D : WG Dock encl o r f , Inc. 3104581036 PAGE 7 Layout Criteria Recommended Clearances Around Units (Feet) From Unit Ends to Wall: 3 Between Unit Ends: 2 From Sides to Wall: 3 Between Unit Sides: 6 Refer to. the Equipment layout Manual or contact your Sales Representative for more details on layout criteria. Shipping Data Total Gross Total Description Domestic Skidded Dimensions (in) Cubic Feet Cubic Feet Wt (ibs) Gross Wt Section Length Width Haight (lbs) Basin: 1 142 102 80 671 671 2,230 2,230 Casing: 1 142 102 56 469 469 2,160 2,160 Totals: 2 1140 1140 4,390 4,390 PRG WHOM 1300 GARDENA AVE. GLENDALE,CA 91204 0 Z K CLOIRCAT/0N `y< Uj Ul C-16 ,J LICENSE lVp, 311690 ®� CP DAL� w74. tB U I L D I N G P E R M I T 01/05/96 12:20 Page 1 of I Job Address: 2557 EL CAMINO REAL Suite: Permit Type: ELECTRICAL Parcel No: 156-302-15-00 Lot#: Valuation: 0 Occupancy Group: Reference#: Description: ONE ELECTRIC CIRCUIT FOR DOOR : ALARM "BULLOCKS" Appl/Ownr : B.H. ENTERPRISES 16227 GREENHILL DRIVE VICTORVILLE, CA. 92 , 3-9-2------ - ---Fees -Required -- ----------- Fees. `2 0. 0}60 S Adjustments: 00,:,, To Total Fees: 00Tp-t; Fee description ------------------ Enter "Y" for Ele Enter "Y" for Rem * ELECTRICAL IOTA tr,ic Is,sue de"' X INCORPORATED 19 Permit No: CB960028 Project No: A9600059 Development No: VA, 0110 96 -Vol 01. 02 rl_K�Aff 20 - C10 1 Construction Type: VN Status: ISSUED Applied: 01/05/96 Apr/Issue: 01/05/96 Entered By: MDP 619 241-8158 B a 1 unit 1,1ected & Credits ----------------------- RT fm LCARANCE �JL_ CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 .00 .00 20.00 t Ext fee Data ------------------ 10.00 y 10.00 y 20.00 PEERMIT APPLICATION City of Carlsbad Building Departwnt >i'w 2075 Las PaLwas Dr., Carlsbad, CA 92009 (619) 438-1161 1. PERMIT'I'm From List 1 (see back) give code of Permit -Type: --------------------------------------------------------- For Residential Proiects Onlv: From List 2 (see back) give Code of Structure -Type: Net Loss/Gain of Dwelling Units 2. PROJECT INFORMATION 6.00E-�- PLAN CHECK NO. EST. VAL PLAN CK DEPOSIT VALID. BY DATE FOR OFFICE USE ONLY nunain ui No. Near Cr! Stir tu,`r�n <vrCy �� CJ CHECK BELOW IF SUPM1 I FED: ❑ 2 Energy Calcs ❑ 2 Structural Calcs ❑ 2 Soils Report ❑ 1 Addressed Envelope DESCRIPTION OF WORK G jam_ C` SQ. FT. (� ( # OF STORIES # OF BEDROOMS # OF BATHROOMS name first) ADDRESS CITY STATE ZIP CODE DAY TELEPHONE NFTY last name first) ADDRESS. C STATE(;, ZIP CODE C�'j92/� 92_y' !DAY TELEPHONE 4, r q 2 1// 115 7 97 PROPERTY OWNER LCZY(las nam first ADDRESS �1 L� / > STATE( ZIP CODE 20t DAY TELEPHONES t CC I-, " ' I o. wivtntu.tvx �� �� NAME (las name first S o ADDRESS/4 Z 7 6;, _. 5� C TY rSTATE 6;1 ZIP CODE (2 �Z DAY TELEPHONE I G ' �e STATE LIC. # 6 O � I LICENSE CLASS C /0 CITY BUSINESS LIC. _# 2 �ESLGICER-Nl(lG[E ast name firstADDRESS CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. # or ers ompensation c aration: I hereby atfirm that I have a certificate of consent to se -insure issued by the Director of Industriar- 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 o Exemption: ru at in a performance o e workor which is permiris issued, shall not employ any person in any manner so.as to beco a subject to a Workers' Compensation Laws -of California. SIGNATU DATE Jam' caner -Builder ara on: hereby a irm a am exemptrom aContractors cense Law for e o owing 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 Cityor 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 7b00 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 t pplicant to a civil penalty of not more than five hundred dollars ($5001)." SIGNATURE - DATE_ Is the applicant or futurd 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? ❑ YES ❑ NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? ❑ YES p NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? ❑ YES ❑ NO IF 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.AIR POLLUTION CONTROL DISTRICT. LENDER'S NAME LENDER'S ADDRESS certity that I nave read the application and state that the above information is correct. I agree to comply with all City ordinances an rate aws 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'C1TY OF CARISBAD 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 36S days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time=fte a work is commenced for a period of 180 days (Section 303(d) Uniform Building Code) APPLICANT'S SIGNATURE TDATE: CJ CITY OF CARLSBAD INSPECTION REQUEST" PERMIT# CB960028: FOR 01/09/96 DESCRIPTION: ONE ELECTRIC CIRCUIT FOR DOOR .ALARM "BULLOCKS" - TYPE: ELEC JOB ADDRESS: 2557 EL CAMINO REAL STE: APPLICANT: B.H. ENTERPRISES PHONE: 619 241-8 CONTRACTOR: PHONE: OWNER: PHONE: REMARKS: MWW/BERNIE/241-8158 INSPECTOR SPECIAL INSTRUCT: FOR DOOR ALARM/SECURITY @ BULLOCKS FR T UR TOTAL TIME4 CD LVL DESCRIPTION ACT COMMENTS 34 EL Rough Electric�,g� ***** INSPECTION HISTORY ***-** DATE DESCRIPTION ACT INSP COMMENTS INSPECTOR AREA PLANCK# CB960028 OCC GRP CONSTR. TYPE VN LOT: