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Home My WebLink About2561 EL CAMINO REAL; MULTI-PERMIT FILE; CB151844; PermitE City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 06-25-201-5 ' Permit No: CB151844 Building Inspection Request Line (760) 602-2725 Job Address: 2561 EL CAMINO REAL CBAD Permit Type: PME Status: ISSUED Parcel No: 1563010900 Lot #: 0 Applied: 06/16/2015 Entered By: JMA Reference #: Plan Approved: 06/25/2015 PC #: Issued: 06/25/2015 Inspect Area: Project Title: SEARS: REPLACE 4 ROOFTOP HVAC Applicant: Owner: MESA ENERGY SYSTEMS SEARS ROEBUCK&CO <LF> PLAZA CAMINO REAL C/O SEARS ROEBUCK & CO 3333 BEVERLY RD 5 VANDERBILT 92618 HOFFMAN,ESTATES IL 60179 949 460-0460 Plumbing Fees $0.00 Electrical Fees $0.00 Mechanical Fees $160.00 Other PME. Fees $0.00 TOTAL PERMIT FEES $160.00 Total Fees: $160.00 Total Payments To Date: $160.00 Balance Due: $0.00 FINAL APPROVAL Insoector: Date: g'Zd IS Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations,, or other exactions hereafter collectively referred to as "feeslexactions." You have 90 days from the date this -permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section-66020(a), and file the protest and any other required information with the City Manager for ,processing in accordance with Carlsbad Municipal Code Section 3.32:030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified feeslexactioris DOE$ NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or servicefees in connection with this -project. NOR DOES IT APPLY to any THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: [3PLANNING [ENGINEERING [:]BUILDING ®FIRE OHEALTH E]HAZMAT/APCD Building Permit Application Plan Check No. �(Lt C1 Of 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value Ph:760-602-2719 Fax:760-602-8558 Plan Ck. Deposit mI,ad email:,building@carlsbadca.gov Date (, . . ( 0� SWPPP www.carisbadca.gov 10B ADDRESS 2561 EL CAMINO REAL: SUITE#/SPACE#/UNIT# APN - - - CT/PROJECT # LOT # PHASE # #BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP C153309 - � J#OFUNITS 4 J#BEDROOMS SEARS DESCRIPTION OF WORN: Include Square Feet of Affected Area(s) INSTALLATION OF FOUR ROOFTOP UNIT. TONAGE TOREMAIN THE SAME. Weight is less than current._ Square footage of -roof : 38,000 sq.:ft. EXISTING USE HVAC PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING HVAC YES❑# N0M YES [ENO ❑ IFIRESPRINKLERS YES N0E] APPLICANT CATHY,FILLMORE PROPERTY OWNER NAME SEARS HOLFING CORP. Primary Contact ADDRESS ADDRESS 900 VERNON, WAY SUITE 100 333 BEVERLY ROAD CITY STATE ZIP CITY STATE ZIP EL-CAJON CA 92020 HOFFMAN ESTATES IL 60179 PHONE FAX PHONE FAX '619.265=5880 61-9.265.59501 916-459.9966 EMAIL CATHY_FILLMOREAMCORIGROUP,GQM EMAIL -JORGE,BEL:DAASEARSHC.,COM DESIGN PROFESSIONAL Pa ;n CONTRACTOR BUS. NAME EMCOR SERVICES, MESA ENERGY SYSTEM ADDRESS ADDRESS -900 VERNON WAY SUITE 100 CITY STATE ZIP CITY STATE ZIP EL CAJON CA 92020 PHONE FAX PHONE - FAX 619465=5880 619-265.5950 - EMAIL _ EMAIL CA -THY FIL-LMOREAEMCORGROUP.COM STATE LIC. # STATE LIC.# CLASS CITY BUS. LIC.# 611215 , B,C4;C10 1214526 (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, commendingwith 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 f$5001). Workers' Compensation Declaration: l herebya>rrm underpenaltyofpejuryone ofthe following declarations: 0✓ 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. 0 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 workers' compensation insurance carrier and policy CONTINENTAL CASUALTY COMPANY WC 4025755598 1oro1r2o1s number are: Insurance Co. - Policy No. Expiration Date T is section need not be completed N the permit is for one hundred dollars ($100) or less. 'U✓ Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. .5 CONTRACTOR SIGNATURE Cathy Fillmore AGENT DATE 6/16/2015 lherebyaFlrm that lam exempt from 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). I am exempt under Section - Business and Professions Code for this reason: 1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement. QYes QNo 2.1(have / have not) signed an application for a building permit for the proposed work. 3.1 have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors' license number): 4.1 plan to provide portions of the work, but I have hired the following person -to coordinate, supervise and provide the major work (include name / address / phone / contractors' license number): 5.1 will provide some of the work; but I have contracted (hired).the following persons to provide the work indicated (include name / address / phone / type of work): .ESPROPERTY OWNER SIGNATURE []AGENT DATE Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or25534 of the Presley -Tanner Hazardous Substance Account Act? Yes x 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 x No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Yes x No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOTBE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097`(i) Civil Code). Lender's Name Lender's Address I certifythatl have read the application and statethatthe above information is comectandthatthe information on the plans is accurate.I agree to complywith all Cityordinances and State laws relatingto buildingconst ucdon. I hereby authorize representative 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 AGAINSTALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANYWAY ACCRUEAGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. •OSHA: An OSHA permit is required for excavations over-69 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 commenced for a period of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE _,Cathy Fillmore DATE 6/16/2015 '00 STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. Only)CERTJFICATE OF OCCUPANCY (Commercial Projects Fax (760) 602-8560, Email building@carlsbadca.gQV or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP .CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. LIC. No. DELIVERY OPTIONS PICKUP: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg. 1) ASSOCIATED CB# MAIL TO: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg.1) NO CHANGE IN USE / NO CONSTRUCTION MAIL / FAX TO OTHER: CHANGE OF USE / NO CONSTRUCTION ,eAPPLICANT'S SIGNATURE DATE A i *- Inspection List Permit#: C8151844 Type: PME SEARS: REPLACE 4 ROOFTOP HVAC Date_ Inspection Item Inspector. Act Comments -08/25/2015 43 AirCond/Furnace Set - RI 08/25/2015 43 AirCond/Furnace Set PB AP 08/25/2015 49 Final Mechanical - RI 08/25/2015 49 Final Mechanical PB AP 07/14/2015 43 AirCond/Furnace Set PY NS 07/14/2015 43 AirCond/Furnace Set PY NR Wednesday, August 26, 2015 Page 1 of '1 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 07-01-2014 Permit No: CB141534 Building Inspection Request Line (760) 602-2725 Job Address: 2561 EL CAMINO REAL CBAD Permit Type: PME Status: ISSUED Parcel No: 1563010900 Lot #: 0 Applied: 06/27/2014 Entered By: LSM Reference #: Plan Approved: . 07/01/2014 PC #: Issued: 07/01/2014 Inspect Area: Project Title: SEARS -MODIFY LIGHTING FIXTURES THROUGH OUT STORE FROM FLUORESCENT TO LED Applicant: Owner: ALAN XAMISUGI SEARS ROEBUCK&CO <LF> PLAZA CAMINO REAL C/O SEARS ROEBUCK & CO 656 FELICITA AV 3333 BEVERLY RD SPRING VALLEY CA 919+77 HOFFMAN ESTATES IL 60179 61-249-3502 Plumbing Fees $0.00 Electrical Fees $158.00 Mechanical Fees $0.00 Other PME Fees $12.00 TOTAL PERMIT FEES $170.00 Total Fees: $170.00 Total Payments To Date: $170.00 Balance Due: $0.00 FINAL APPROVAL Inspector: Date: Z N �� Clearance: NOTICE: Please take NVIC f that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "feeslexactions.' 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 Managerfor processing in accordance withCarlsbadMunicipal 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. THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: ❑PLANNING ❑ENGINEERING ❑BUILDING ❑FIRE ❑HEALTH ❑HAZMATIAPCD ' Building Permit Application Plan Check No. lz 14 L Est. Value 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 plan Ck. Deposit email: building@carlsbadca.gov Date 1 ISWPPP www.carli§badca.gov 'JOB ADDRESS ' 2561 El Camino Real, Carlsbad, CA 92008 SUITEN/SPACE//UNIT/ APN - - - Cr/PROJECT # I LOT # - PHASE # I#OFUNITS J#BEDROOM& # BATHROOMS =NESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: •Include Square Feet of Affected Area(s) Perform a luminaire modification -in -place for all 2x4 and 2x2 fixtures in sales floor and office areas within the designated store. SHC will be removing, the fluorescent workings of the -said fixtures to than be replaced with the attached LED retro fit kit without alterations to the ceiling or lighting circuitry. EXISTING USE PROPOSED -USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES❑# NO❑ YES ❑NO YES❑ N0F_J APPLICANT NAME Alan Kamisugi PROPERTY OWNER NAME Sears Holdings Corporation Primary Contact ADDRESS ADDRESS 656 Felicita Ave. 3333 Beverly Rd. CITY STATE ZIP Spring Vallev CA 91977 CITY STATE ZIP Hoffman Estates IL 60179 -PHONE FAX PHONE FAX 619.249.3502 847.286.2500 EMAIL alan.kamisugi@searshc.com EMAIL lame s.terrell(a@searshc.com DESIGN PROFESSIONAL NIA CONTRACTOR BUS. NA E �� o ,r C i G l•� ADDRESS ADDRESS' _ / p 1� t �Gf,1Q �j_I( CITY STATE ZIP CITY STATE ZIP C4_ J ( 7 /0 /o PHONE FAX PHONE -73 5 -�yoao�-- F EMAIL EMAI% "IQ co STATE LIC. # STATE LICM 111912 qaWE CLASS CITY BUS. LIC.# 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 siggned 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 031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). s 1", Workers' Compensation Declaration: thereby affirm underpenally of perjuryone 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. I have and will maintain workers' compensation, as requiredJjp�y Section 3300 of the Labor Code, for the performance of the work for which� /this permit is issued. My workers' compensation ins an care and policy number are: Insurance Co. ��Gtfvrl i/�ct1`(�0N,4 1 �NSu✓6t� Policy No. `i�l)G by �� Expiration Date This section need not be completed if the permit is for one hundred dollars ($100) oriess. 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 Califomia. WARNING: Failure to secure workers' comp ation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100,000), in addition to the cost of compensatlrrffiffies ro d for in Section a Labor code, interest and attorney's fees. )K CONTRACTOR SIGNATURE AGENT DATE • • I hereby affirm that I am exempt from Contractor's License Law for the following reason: I, as owner of the -property or my employees with wages as their.sole compensation, 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). El 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 Contractors License Law). I am exempt under Section Business and Professions Code for this reason: 1.1 personally plan to provide the major labor and materials -for construction ofthe proposed property improvement. ❑Yes ❑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 / 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 I address / phone I contractors' license number): 5.1 will provide some of the work, but 1 have contracted (hired) the following persons to provide the work indicated •(include name / address / phone / type of work): )KPROPERTY OWNER SIGNATURE AGENT DATE Is the applicant orfuture 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. I hereby affirm that there is a construction lending agency for the performance of the work this permit -is issued (Sec. 3097 (1) Civil Code). Lender's Name Lender's -Address I certlfythatl have mad the application and state thatthe above information isoorrectandthatthe information on the plans is accurate.I agreeto complywith all Cityordinances and State laws relatingto building construction. I hereby authorize representative ofthe City of Carlsbad to enter upon.the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFYAND 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 requi vations over60' deep and demolition or construction of structures over stories in height. EXPIRATION: Every permit issu by the Bui ing Official under e p visions of this Code shall expire by limitation and become null and void if the building orwork authorized by such permit is notoommenced within 180 days from the date ofsuch rmit orif ildigZorvx a ed by such permit is suspended or abandoned at any timeafter the work is commenced for a period of 180 days (Section 106.4A Uniform Building Code). .ESAPPLICANT'SSIGNATUIkE DATE I / STOP:- THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE. Complete the following ONLY if a Certificate of Occupancy will be requested at final inspection. i• Fax (760) 602-8560, Email building(a Caflsbadca.goV or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S BUS. LIC. No. DELIVERY OPTIONS PICK UP: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg.1) ASSOCIATED CB# MAIL TO: CONTACT (Listed above) OCCUPANT (Listed above) CONTRACTOR (On Pg.1) NO CHANGE IN USE / NO CONSTRUCTION MAIL/ FAX TO OTHER: CHANGE OF USE / NO CONSTRUCTION ,9APPLICANT'S SIGNATURE DATE Inspection List Permit#: CB141534 Type: PME SEARS -MODIFY LIGHTING FIXTURES THROUGH OUT STORE FROM FLUORES Date Inspection Item Inspector Act Comments 09/16/2014 39 Final Electrical PY AP 09/15/2014 39 Final Electrical PY GA Wednesday, February 11, 2015 Page 1 of 1 STATE OF CALIFORNIA CERTIFICATE OF CEGLTG-1C (Revised 06/09) COMPLIANCE AND FIELD INSPECTION CHECKLIST CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE (Page 1 of 4) LTG-1C Project Name: California LED Retrofit - Carlsbad, CA #1678 Date: 5/30/2014 Project Address: 2561 El Camino Real Climate Zone: Building CFA : 90,049 Carlsbad, CA. 92008 7 Unconditioned Floor Area: 0 General Information sears Retail store, 153,194 S.F. Sales Floor w/ conditioned stockroom spaces -totaling 291,917 -Building Type: ❑ Nonresidential ❑' High -Rise Residential ❑ Hotel/Motel ❑ Schools ❑ Relocatable Public ❑ Conditioned Spaces ❑ Unconditioned Spaces Schools Phase of Construction: ❑ New Construction ❑ Addition ❑ Alteration Method of Compliance: ❑ Complete Building ❑ Area Category ❑ Tailored Documentation Author's Declaration Statement • 1 certify that this Certificate of Compliance documentation is accurate and complete. Name: John R. Higgins Signature: company: Sears Holdings Corporation Date : 5/30/2014 Address: If applicable: 3333 Beverly Road, A2-344A CEA # CEPE # City/State/Zip Hoffman Estates, IL. 60179 Phone: 847-286-6587 Principal Lighting Designer's Declaration Statement • 1 am eligible under Division 3 of the California Business -and Professions Code to accept responsibility for the lighting design. • This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with Title 24, Pages 1 and 6 of the California Code of Regulations. • The design features represented on this -Certificate of Compliance are consistent with the information provided to document this design on the other applicable compliance forms, worksheets, calculations, plans and, specifications submitted to the enforcement agency for approval with this building permit application. Name: John R. Higgins Signature: company: Sears Holdings Corporation Phone: 847-286-6587 Address: 3333 Beverly Road, A2-242B-A License # City/State/Zip: Hoffman Estates, IL. 60179 Date: 5/30/2014 Lighting Mandatory Measures - Indicate location on building plans of MandatoryMeasures Note Block: LIGHTING_COMPLIANCE FORMS & WORKSHEETS (check box if worksheet is included) For detailed instructions on the use of this and alf Energy Efficiency Standards compliance forms, please refer to the Nonresidential Manual published by the California Energy Commission. ❑ LTG-1C Pages 1 through 4 Certificate of Compliance. All Pages required on plans for all submittals. ❑ LTG-2C Lighting Controls Credit Worksheet ❑ LTG-3C Indoor Lighting Power Allowance ❑ LTG-4C Pages 1 through 4 Tailored Method Worksheet ❑ LTG-5C Pages 1 and 2 Line Voltage Track Lighting Worksheet 2008 Nonresidential Compliance Form August 2009 , 05 t (t 1 15 U STATE OF CALIFORNIA CERTIFICATE OF CEC-LTG-1 C (Revised 08/09) COMPLIANCE AND FIELD INSPECTION CHECKLIST CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE (Page 2 of 4) LTG-1 C INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST Project Name: California LED Retrofit - Carlsbad, CA #1678 Date: 5/30/2014 Installation Certificate, LTG-1-INST (Retain a copy and verify form is completed and signed'.) ' ❑ Field Inspector Certificates of Acceptance, LTG-2A and LTG-3A (Retain a copy and verify form is com leted,and signed.) ❑ Field Inspector A- separate Lighting Schedule Must Be Filled Out -for Conditioned and Unconditioned Spaces.Installed Lighting Power listed on this Lighting Schedule is only for. ❑ CONDITIONED SPACE ❑ UNCONDITIONED SPACE ❑ T. he actual indoor lighting power listed below includes all installed permanent and portable lighting systems in accordance with §146 a ❑ Only for offices: Up to the first 0.2 watts per square foot of portable lighting shall not be required to be included in the calculation of actual indoor lighting power density in accordance with the Exception to §146(a). All portable lighting in excess of 0.2 watts per square foot is totaled below. Luminaire Schedule (Type, Lamps-, Ballasts Installed Watts A B C D E F G H o ca E~ Z Complete Luminaire Description i.e, 3 lam fluorescent troffer, ( p F32T8, one dimmable electronic ballast)- `) m ' How wattage was determined 4 U) � Co z LL X -o 0 °' �, N 5 Field Inspector CEC Default from NA8 Accordin g to §130 d ore ,n Ii saloawaaxns Orion MKLDRTLx42551COM-30 45 ❑ ❑ ❑ 0— Sales Mans Orion MKLDRTLx42551COM-30 45 ❑ ❑ ' ❑ ❑ Sales children Orion MKLDRTLx42551COM-30 45 ❑ _ ❑❑ 'Sales AM]— Orion MKLDRTLx42551COM-30 45 ❑ ❑ :❑: ❑ ' Sales soNme Orion MKLDRTLx42551COM-30 45 ❑ ❑ '❑ ❑ ❑ ❑ ❑ ❑ ' ❑ ❑ ❑ ❑ , _ ❑ ❑ ❑ .: .❑ ❑ ❑ ❑ ❑.: ❑ ❑ ❑ ❑' ❑ ❑ ❑ ❑ ❑ El ❑ ❑' ❑ ❑ ❑ �. ❑ ❑ ❑ ❑ INSTALLED WATTS PAGE TOTAL: Building total number of pages Installed Watts Building Total (Sum of all pages) Enter into LTG-1 C Page 4 of 4 1. Wattage shall be determined according to Section 130(d and e). Wattage shall be rating oflight fixture, not rating of bulb. 2. If Fail then describe on Page 2 of the Inspection Checklist Form and take appropriate action to correct. Verify building plans if necessary, 2008 Nonresidential Compliance Form August 2009 STATE OF CALIFORNIA CERTIFICATE OF COMPLIANCE AND FIELD INSPECTION CHECKLIST CEC=LTGAC (Revised 08/09) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE (Page 3 of 4) LTG-1 C Project Name: Date: INDOOR LIGHTING SCHEDULE and FIELD INSPECTION ENERGY CHECKLIST Fill in controls for all spaces: a) area controls, b)" multi -level controls, c) manual daylighting controls for daylit areas > 250 ft2, automatic daylighting controls for daylit areas > 2,500 ft2, d) shut-off controls, e) display lighting controls, t) tailored lighting controls - general lighting controlled separately from display, ornamental and display case lighting and demand responsive automatic controls for retail stores > 50, 000 ft2, in accordance with Section 131. MANDATORY LIGHTING CONTROLS - FIELD INSPECTION ENERGY CHECKLIST Field. " ' inspector Type / Description Number of Units Location in Building o. ❑ o 3 o ❑ ❑ . =o .. o , ❑ ` ❑ Field Inspector's Notes or Discrepancies: 2008 Nonresidential Compliance Form August 2009 STATE OF CALIFORNIA CERTIFICATE OF CM-LTG-lC (Revised 08/09) COMPLIANCE AND FIELD INSPECTION CHECKLIST CALIFORNIA ENERGY COMMISSION El CERTIFICATE OF COMPLIANCE (Page 4 of 4) LTG -IC Project Name: Date: Conditioned and Unconditioned space. Lighting must not be combined for compliance. Indoor Li htin 'Power'for'Conditioned Spaces Indoor Lighting Power for Unconditioned Spaces Watts Watts Installed Lighting Installed Lighting from Conditioned LTG-1 C Page 2 from Unconditioned LTG-1 C Page 2 Lighting Control Credit Lighting Control Credit _ Conditioned Spaces from LTG-2C _ Unconditioned Spaces from LTG-2C Adjusted. Installed _ Adjusted Installed _ Lighting Power Lighting Power Complies if Installed <_ Allowed = Complies if Installed s Allowed Allowed Lighting Power Allowed Lighting Power Conditioned S aces, from LTG-3C Unconditioned S aces from LTG-3C Required Acceptance Tests Designer: This form is to be used by the designer and attached to the -plans. Listed below is the acceptance test for the Lighting system, LTG-2A and LTG-3A._The designer is required to check the acceptance tests and list all control devices serving the building or space shall be certified as meeting the Acceptance Requirements.for Code Compliance. If all the lighting system or control of a certain type requires a test, list the different lighting and the number of systems. The NA Section in the Appendix of the Nonresidential Reference Appendices Manual describes the test. Since this form will be,part of the plans, completion of this section will allow the responsible party to budget for the scope of work appropriately. Forms can be grouped by type of Luminaire controlled. Enforcement Agency: Systems Acceptance. Before Occupancy Permit is granted for a newly constructed building or space or when ever new lighting system with controls is installed in the building or space shall be certified as meeting the Acceptance Requirements. The LTG-2A and LTG-3A forms are not considered a complete form and are not to be accepted by the enforcement agency unless the boxes are checked and/or filled and signed. In addition; a Certificate of Acceptance forms shall be submitted to the enforcement agency that certifies plans, specifications, installation certificates, and operating and maintenance information meet the requirements of §10-103(b) of Title 24 Part 6. The field inspector must receive the properly filled out and signed forms before the building can receive final occupancy. A copy of the LTG-2A-and LTG-3A for each different lighting luminaire control(s) must be provided to the owner of the building for their records. Luminaires Controlled LTG-2A and 3A Controls and C Sensors and L y Automatic Daylighting Equipment Requiring E o Controls TestingDescription . Y Z _ Location Acceptance 13 13 ❑ 2008 Nonresidential Compliance Form August 2009 LED Door Retrofit Features and Specifications Applications Retrofits existing 2' x 4' and 2' x 2' fluorescent troffers to LED in as little as 1 minute. Industry's first LED troffer retrofit contained within the door frame.. Construction Aluminum frame. LDR fits most existing fluorescent troffer fixtures with either prismatic lens or parabolic louvers. Optional mounting brackets adapt the LDR to flt nearly all existing troffers, Vented brackets available for plenum rated ceiling -grids. 'Electrical 120-277v Hardwired fixture. Performance information LED chip life in the 3POM and 1 FMP models is rated 375,000 hours. LED chip life in the 1COM models is rated 187,000 hours, Lumen maintenance life. (L70) is based on theTM21 calculations, lifetime of driver is not included in these calculations - optics Three -panel opaque matte, contour opaque matte, or flat matte prismatic lens choices provide glare diffusion. Finish powder coated -white. Warranty Orion LED fixtures are covered by a five-year iimited'warranty. Accessories and individual . components are covered by separate OEM supplier warranties. C uL us 'See second_page for DLC QPL listed product offerings and information r - "- LDS Fixture 4x2 shown Ordering Information Select ' MKLOR, Series MKtDIi Manufactured Kit L® Door Frame 4 Setecl �., 3 Dgtpat 37 ' so is ixiard output) 55 r HOtHighOutput) 'See second page forwattage by model 7COM Se)ect ' raturo Type TL Tratfertens TLB TroffertensvOthBrackets Lars 3POM 3 Panel Opagoe Matte lens 1FMP flat Matte Panel ICBM tbmouropartueMatte U Size 22 Za 42 W detect ColwTeaiperatum -50 5000°K 40 4000*K I 30 3000% Options {sold separately) -0-10v timer switch Select' Bracket I {blank) $tandardSteelBracke-ts — LDR*ADPr--2Fr wP Vented 2ft Bracket -- -- r LDR*ADPT-4Fr wP; Vented 4 R Bracket I Page I oft 8'00-660-9340 www.oesx.com NYSE MKT: OESX ®2014 orion Energy Systems, I -All f*ls reserved. light YearsAhead and Oran are trademarksfservice marks of Orion Energy Systems Inc. Design modification rights reserved. 20140527 LrRH7' YE/+as AHEAD, Orion nr9 v i. 1 MKLDRTLB37iiEsTestRepont327573A1 4 4 1 Zone 0-30 Lumens % Luminaire 1008 30,91 0-40 1663 49.15 0-60 2716 83.27 0-90 3261 100.00 , 1 l� ° Vertical Plane Through: i g0 1: 0-180 Horizontal 2p° 2:45-225Horizontal p° 10° 3:90-270 Horizontal Physical and Performance Information' Series - j Input Current I CC7 i CHI: 'leillt" 1Atid>ti p `Weiglitz. j . AprLaved-" Volta?p MKLDRRB4255 3POM 12D-277v 47W 0.3947-0.1753 A AM 41941m 4D00°K Al 46.44" 20.56" 293" 11 lbs. Yes MKLDRRM237 3POM 120-271v 35W 0.2874-0.1351 A AM 3251 Im 4000°K Al 46.44" 20.56" 2.93" 11 Ibs. Yes MKLDRTLB2255 3POM 120-277v 47W 0.3943-0.1771 A z0.99 4522 Im 4000°K ^02 22.44" 20.66" 2.93" 6 lbs. Yes MKLDRTLB2237 3POM 120-277v 35W 0.2867-0.1364 A z0.99 35881m 4000°K >82 22.44" 20.56" 2.93" 6 lbs. Yes MKLDRTLB4255 1FMP 120277v 47W 0.3950-0.1743A A.99 46101m 4000°K 01 46.44" 20.56" 2.93" 11 lbs. Yes MKLORTLB4237 1FMP 120277v 35W 02887-0,1304 A AM 38601m 4000°K >81 46.44" 20.56" 2,93" 11 lbs. Yes MKLDRRB2255 1FMP 120 277v 47W 0.3943-0.1753 A �0.99 4676 Im 40D0°K >82 22.44" 20.56" 2.93" 6 lbs. Yes MKLORTLB2237 1FMP 120277v 35W 0.2877-0.1364A A99 M 37121m 4000°K >82 22.44" 20.56" 2,93" $Ibs, Yes MM MKLORTLB4255' MOM 120-277v 40W 0.3275-0.1527 A AM 3679 Im 4000°K �86 46.44" 20.50" 3.55" 11 lbs. Yes MKLORTLB4237 1COM 120-277v 32W 02672-0.1275A �>_0.99 30921m 4000°K��86 46.44" 20,50" 3.55" 11 lbs, Yes MKLORTLB2255 1COM 120 277v 40W 0.3281-0.1521 A AM 3427 Im 4000 K ->86 22.44 20.50 3.55 6 lbs. Yes MKLORTLB2237 1COM 120277v - --.1271 32W D2672 Ot A '�z0.99 29161m 4000°K >86 22.44" 20,50" 3.55" 61bs, Yes The information in this table provides physical and performance information for our 4000°K models only. To see a complete DLC approval listing of our products visthttp://www.design i hg ts.org/ORL MKLDRTLB 55 11E5Test Report=577.o? Zone 0-30 Lumens % Luminaire 1300 31.01 0-40 2069 49.33 0-60 3498 83.42 0-90 4194 100.00 437...,-� �� t 874 Vertical Plane Through: y 110 1: 0-180 Horizontal 17470° 10" 02:45-225 Horizontal 3: 90-270 Horizontal Additional Specification Information: 'Actual performance may vary by up to t10% of values listed. 'Weight does not include mounting brackets. j Page 2d2 j}- 800-660-9340 www.oesx.com NYSE MKT: 0ESX ORI �` 02014 Orion Energy Systems, Inc, All rights reserved. [son, InteLite, Light Years Ahead and Orion are tredemarWservice marks of Orion Energy Systems Inc. Design odification,rights reserved. 20140527 I.aOHT Y :A AHE , �< .aS'h. mMade in USA J Orion Energy Systems LED Door Retrofit Features and Specifications Applications Retrofits existing 2' x 4' and 2' x 2' fluorescent troffers to LED in as little as 1 minute. Industry's first LED troffer retrofit contained within the door frame. Construction Aluminum frame. LDR fits most existing fluorescenttroffer fixtures with either prismatic lens or parabolic louvers. Optional mounting brackets adapt the LDR to fit nearly all existing troffers, Vented brackets available for plenum rated ceiling grids. Electrical 120-277v Hardwired fixture. Performance Information LED chip life in the 3POM and 1 FMP models is rated-375,000 hours. LED chip life in the 1COM models is rated 187,000 hours Lumen maintenance life (1-70) is based on theTM21 calculations, lifetime of driver is not included in these calculations. Optics Three -panel opaque matte, contour opaque matte, or flat matte prismatic lens choices provide glare diffusion. Finish Powder coated white. Warranty Orion LED fixtures are covered by a five-year limited warranty. Accessories and individual components are covered by separate OEM supplier warranties. G@us '.See second page for DLC OPL listed product offerings<and informatidn 0o LIGHT YEARS AHEAD, 1FMP r , LpflTixture 4X2 shown Ordering Information select MK DR _ sale$ MKWR Manufactured Kit LED Omr Frame 4 $elect --- . I 37 so lsta�rd (4") 55 HO{gh0utputl *So* secand page for wattage by Model Options (sold separately) -0=10v Dimmer switch r- 'FY 7CgM�•� 2• T 3 Select - ' Select PhrtureType Sze n Trofferlens i —, 22 W i 7L6 Troffer lens vvit Brackets l s 42 1 4 5 6 Select . . � Select - Lens Color Tomperature i 3POM 3 Panel Opaque Matte i 5D 5000°K I Lans i40 GOOD°Ky 1FlIIPanel j 3D30a1°K j 1COM j Contour Opaque Matte _ i " 7 Select " I Bracket 1 i lblank Standard Steel Brackets i i LDR V=Ar DPT 2l r W , vented & Bracket ; LBR-Y-ABPT-#TYVFyented4ftBracket Page 1 of2 800-66-0-"9340 www.oesx.com NYSE MKT: OESK 02014 Orion Energy Systems, Inc. All rights reserved. Light YearsAhead and Orion are trademarkstservice marks of Orion Energy Systems Inc. Design modification rights -reserved. 20140527 nrade busa Orion Energy ystz _.___....._......... -__.__._ Physical and Performance Information' lgM CCi DLC ilbn#Nidth: Vaseries inpuCurren ype,ofpr_e d MKLDRTLB4255 3POM 120-277v 47W 0.3947-0,1753 A 0.99 41941m 4000°K >_81 46.44" 20.56" 2.93" 11 lbs. Yes �- MKLORTLB4237 3POM 120-277v 35W 0.2874-0.1351 A 0.99 3261 Im 4000°K _>81 46:44" 20.56" 2.93" 11 lbs. Yes MKLORTLB2255 ROM 120 277v _ 47W 0.3943-0.1771 A z0.99 4522Im 4000°K 02 22,44" 20.56" 2.93" 6 Ibs, Yes MKLDRTLB2237 3POM 120-277v 35W 0.2867-0.1364A A.99 3588Im 4000°K >_B2 22.44" 20.56" 2.93" 6lbs. Yes MKLORTLB4255 iFMP 120 277v 47W 0.3950-0.1743 A z0.99 46101m 4000°K 01 46.44" 20.56" 2,93" 11 Ibs. Yes MKLORTLB4237 1FMP 120-277v 35W 0.2887-0.1384A z0.99 3860Im 4000°K -_>81 46.44" 20.56" 2.93" 11lbs. Yes MKLORTLB2255 1FMP 120-277v 47W 0.3943-0.1753A Z0.99 46761m 4000°K 02 22.44" 20.56" 2:93" 6lbs. Yes MKLORTLB2237 1FMP 120277v 35W 0.2877-0.1364 A AM 3712 Im 4000% 92 22.44" 20 56" 2 93" 6 Ibs. Yes MKLDRTLB4255 iCOM 120 277v 40W 0.3275-0.1527 A AM 3679 Im 4000°K >86 46.44" 20.50" 3.55" 11 Ibs. Yes MKLDRTLB4237 1COM 120277v 32W _ 0.21572-0.1275A �A.99� 3092Im 40000K ;->86 46.44" 20,50"^ 3,55" 11 Ibs, Yes MKLDRTLB2255 MKtDRTL82237 1COM 1COM 120 277v 120277v 40W - 32W 0.3281-0.1521 A 0.2672-0.1271 A z0.99 z0.99 3427 Im 2916Im 4000°K 4000°K >_86 �86� 22.44" 22.44" 20.50" 20.50" 3.5V 3.55"11 6 Ibs. 61bs. mm Yes - Yes 1 The information in this tableprovides physical and performance information for our4000°K models only. To seea complete DLC approval listing of our products-vist http:!lvvww.designligbts.orgfOPL MKLDRTLB 37 (IESTastRaports27578.o) Zone 0-30 Lumens % Luminaire 1008 30,91 0-40 1603 49.15 0-60 2716 83.27 0-90 3261 100.00 1 sA Vertical Plane Through: 0° 1:0-180 Horizontal 10° 2:45-225 Horizontal 3:90-270 Horizontal MKLDRTLB 55 us Test Raport3P7s77.o) Zone 0-30 Lumens 1300 % Lurninaire 31.01 0-40 2069 49.33 0-60 3498 83.42 0-90 4194 100.00 437, }g 874�. �. \4 1311-_•- ' Vertical Plane Through: y1 • ` 1: 0-180 Horizontal 1747'10° �° 2:45-225 Horizontal Q° 3: 90-270 Horizontal Additional Specification Information: 'Actual performance may vary by pp to t10% of values listed. 'Weight does not include mounting brackets, Page 2 of 2 800-660-9340 www.oesx.com NYSE MKT: OESX <:OLI i� C2014 Orion Energy Systems, Inc. All rights reserved. Ison, InteLite, Light Years Ahead and Orion are trademarkstser ice 1� marks of Orion Energy Systems inc. Design modification rights reserved. 20140527 aInUT YEARS AHEAAa Merle to US4 Orion,Energy LED Door Retrofit LDR Features and Specifications : §: Applications Retrofits existing 2' x 4' and 2' x 2' fluorescent \. troffers to LED in as little as 1 minute. Industry's first LED troffer retrofit contained within the door 3 frame.„µ:.,. spoor Construction Aluminum frame. LDR fits most -existing fluorescent troffer fixtures with either prismatic lens or parabolic louvers. Optional mounting brackets adapt the LDR to fit nearly all existing troffers. Vented brackets available for plenum rated ceiling grids. Electrical 120-277v Hardwired fixture. Performance Information LED chip life in the 3POM and 1 FMP models is rated 375,000 hours. LED -Chip life in the 1COM models is rated 187,000 hours. Lumen maintenance life VO is based on theTM21 calculations, lifetime of driver is not included in these calculations. Optics Three -panel opaque matte, contour opaque matte, or flat matte prismatic lens choices provide glare diffusion. Finish Powder coated white. Warranty Orion LED fixtures are covered by a five-year limited warranty. Accessories and individual components are covered by separate OEM supplier warranties, C S) us a 2 See second page for DLC QPL listed product offerings and information. LIQHT YEARS AHEAD: LDR Fixture 4x2 shown Ordering Information ' MKI�f1R,> Serecr Series WWR ManufacturedK'rt tEO OoorFm cne 4 Select. .,.�....�.....�.=-�.—....�,-. 37 SOIStarl 0Output'_ l 55 HO jHigh Output) 'See socond pogo for wattage IN mode+ Options (sold separately) 1 corm sefecf . . FiixtumType TL. Trofferiens TW TrefferiensvAhBrackets Lens mom 3 panel Opaque Matte tens 1FMP Flat Matte Panel 1101111 Cantaur Opaque matte -0.10v Dimmer switch 7 Select Bracket — (blank)— Standard Steel Brackets j LDR-yl -AAP72FTW Vented 2ftBracket LDR-V AfiPr-W-Wl j Vented 4 ft. Bracket "Select,..._ Size . 22 W 42 4x2 8< CotaTimperndln 50 5000°K —� 40 4000°K 30 3000°K Page t o12 800-660.9340 www.oesx.com NYSE MKT: OESX 02014 Orim Energy Systems, Inc_ A0 rights reserved_ LightYearsAhead and Orion are frademarkstserviae marks of Orion �: r Energy Systems Inc_ Design modification rights reserved. 20140527 Naaa"s USA Physical and Performance Information' �ry`�p7R`p�`'^�^,-�n/►�M- �]� je _ -1 Pow y� Series � i ypo i( I�.�.•ua��u "IFIputeowt 1 }N I �4u7WQ! (00.999 ��t��t . ! ^T^+ /��Y{ �J41' {�D fy _ I. {� 1 ,`,fir ay'yf�jy F.' iri �iGp �.; A��[.�y_��yy_. •1�•el �, •I'�l.C'.MV d*: MKLORTLB4255 3POM 12200-2^i7�7'v 0.3947-0.1753A 41941m 40DOIK aB1 46.44" 20.56" 2.,W 11 lbs. Yes MKLORTLB4237 3POM 120-277v 35W 0.2874-0,1351 A 0.99 3261 Im 4000°K �!81 46.44" 20.56" 2.93" 11 lbs. Yes MKWRTLB2255 3POM 120 277v 47W� 0.3943-0.1771 A z0.99 4522Im 4000°K �.82 22.44" 20.56" 2.93" 6 lbs. Yes MKLORTLB2237 3POM 120-277v 35W 0.2867-0.1364A Z0.99 3588Im 4000°K ;,-,82 22.44" 20.56" 2.93" 6lbs. Yes MKWRTLB4255 1FMP 120 277v 47W 0.3950-0.1743,A 0.99 45101m 4000°K 01 46,44" 20,56" UT 11 lbs. Yes MKLORTLB4237 1FMP 120277v 35W 0.2887-0.1384A Z0.99 38601m 4000°K 01 46,44" 20.56" 2,93" 11 lbs. _ Yes MKWRTLB2255 1FMP 120 277v 47W 0.3943-0.1753 A a0.99 4676Im 4000°K 02 22.44" 20-W 2.93" 6 lbs. Yes MKLDRTLB2237 1FMP 120277v 35W 0.2877-03364A 0.99 3712Im 4000°K Z82 22.44" 2056" 293" 6lbs, Yes MKLDRTLB4255 1COM 120-277v 49W 0.3275-0.1527A z0.99 36791m 4000°K A 46.44" 20.50" 3.55" 11 lbs, Yes MKLORTL84237 1COM 120 277v 32W 0.2672-0.1275 A z0.99 3092Im 4000°K ;->86 46.44" 20.50" 3.55" 11 lbs. Yes MKLDRTLB2255 1COM 120-277v 40W 0.33281-0.1521 A z0.99 3427Im 4000°K >_86 22.44" 20.50" 3.55" 6lbs. Yes MKWRTLB223711COM 120277v 32W 0.2672-0.1271 A �0.99 2916Im 4000°K �86 22.44" 20.50" T 3.55" 61bs, _ _. Yes *The information in this table provides physical and performance information, for our 4000°K models only. To see a complete DLC approval listing of our products vist httn:I&ww.desianllights.org/OPL MKLDRTLB 37 IIES70stReport327b73.01 Zone 0-30 Lumens % Lurninaire 1008 30.91 0-40 1603 49:15 0 60 2716 83.27 0.90 3261 100.00 t to VartiCal Plane Through: D 1:0--180Horizontal 2: 45-225 Horizontal 0° 10° 3:90-270 Horizontal MKLDRTLB 55 (IESTog Report327577.0) 1 0-30 1300 31.01 0-40 2069 49.33 0-60 349B 03.42 0-90 4194 100.00 437,. / 1311 ' >k� Vertical Plane Through: 1 1° 1:0-180Horizontal 1747' ., 0 2: 45-22ra Horizontal 00 10 3:90.270Horizontal Additional Specification Information: 'Actual performance may vary by up to±10% of -values listed. 'Weight does not include mounting brackets. Paget of 2 $00-660-9340 WWW.oesx.com NYSE MKT.- OESX OON 02014 Orion Energy Systems, Inc. All rights reserved, Ison, Iniel-ite, L'ght Years Ahead and Orion are lrademaricslservice marks of Orlon Energy Systems Inc. Design modification fights reserved. 20140527 MM LIOMT YEARS AHEAD. Madele USA 10-08-2013 City of Carlsbad 1636 Faraday Av Carlsbad, CA 92008 Cogeneration Permit Permit No:CB122003 Building Inspection Request Line (760) 602-2725 Job Address: 2561 EL CAMINO REAL CBAD Permit Type: COGEN Sub Type: EVG Status: ABANDOND Parcel No: 1563010900 Lot #: 0 Applied: 10/04/2012 Valuation: $30,000.00 Constuction Type: NEW Entered By: RMA Occupancy Group: Reference #: Plan Approved: Issued: Inspect Area: Plan Check #: Project Title: SEARS- INSTALL 3 NEW ELECTRIC VEHICLE CHARGERS Applicant: Owner: BAKER ELECTRIC INC SEARS ROEBUCK&CO <LF> PLAZA CAMINO REAL C/O SEARS ROEBUCK & CO 1298 PACIFIC OAKS PL 3333 BEVERLY RD ESCONDIDO CA 92029 HOFFMAN ESTATES IL 60179 619-745-2001 Building Permit $309.22 PLUMBING TOTAL $0.00 Add'I Building Permit Fee $0.00 ELECTRICAL TOTAL $0.00 Plan Check $216.45 MECHANICAL TOTAL $0.00 Add'I Plan Check Fee $0.00 Additional Fees $0.00 Plan Check Discount $0.00 Strong Motion Fee $3.00 Green Bldg Stands (SB1473) Fee $1.00 TOTAL PERMIT FEES $529.67 Total Fees: $529.67 Total Payments To Date: $216.45 Balance Due: $313.22 FINAL APPROVAL Date: Clearance: NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactions." You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any TH9'FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: ( PLANNING OENGINEERING CI BUILDING 0 FIRE ® HEALTH Cl HAZMAT/APCD Plan check No. Building Permit Application :°"►fir 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value 30 CITY 0 F Ph: 760-602-2719 Fax: 760-602-8558 10 �email: buidling@carlsbadca.gov Plan Ck. Deposit Date SWPP I ��j�V www.carlsbadca.gov JOB'ADDRESS \ SUITE#/SPACE#/UNIT# AP /�� - F _ g c _ CT/PROJECT #- LOT # PHASE # # Of UNITS #BEDROOMS #'BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC: GROUP r510-aO1- tt-Uc7 u DESCRIPTION OF WORK: „(nclude-S are Feet ofAflectedArea(s) F4- r�-� (,fit VC7cD" ' EXISTING USE PROPOSED USE GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES ❑ #_ NO ❑ YES ❑ NO ❑ YES ❑ NO ❑ APPLICANT NAME (Primary Contact):z:� cc'' . APPLICANT NAME (Secondary Contact) ADDRESS ADDRESS CITY STATE ZIP i5cd Jr ZoL;g CITY STATE ZIP PHONE FAX PHONE FAX %(oo 7 c( i EMAIL 1 d.,j-s - G EMAIL PROPERTY OWNER.NAMES CONTRACTOR BUS. NAME ADDRESS AD ESS STATE` ZIP b CI �S CITY STATE ZIP b O -PHONE FAX PHONE FAX -EMAIL EMAIL ARCH/DESIGNER NAME& ADDRESS STATE DC. # STATE LIC.# r� ( �E��P CLASS C-to CITY BUS. LIC.# C Z1,18R 1 (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 statementthat-heis licensed-pursuanttothe provisions Oft Contractor's License Law tChapter 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 i0315 by any applicant for a permit subjects the applicant to a civil -penalty of not more than five hundred dollars ($500)). Workers' Compensation Declaration: / hereby affirm under penalty of perjury one of the following declarations: ❑ 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. J211 have and will maintain workers' compensation, as required by Section 3700 of the Labor Code; for the performance of the work for which this permit is, issued. My workers' compensation insurance carrier and policy number are: Insurance Co."vc t L. , fk"",e v . _ k%-S or• e `� Policy No. W C (DSs3 q 9 �-0 3 Expiration Date 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 (&100,000), in addition to the cost of compensation damages as pro ' ed for in"Section 3706 of the Labor code, interest and attorney's fees. AC,] CONTRACTOR SIGNATLIZ �r� ❑AGENT DATE i)` u- (i Z_ I hereby affirm that t am exempt from Contractor's License Law for the following reason: O I, as owner of the property or my employees with wages as their sole compensation; will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improvesthereon, 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 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). O 1 am exempt under Section Business and Professions Code for this reason: 1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement, O Yes O 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 / contractors' license number): 4. I plan to provide portions of.the work, but I have hired the following person to.coordinate, supervise and provide the major work (include name / address / phone / contractors' license number): 5. i will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work): E PROPERTY OWNER SIGNATURE OAGENT DATE i awe m Sx bra �. ,.5 Is the applicant or future building occupant required to submit a business pla acutely hazardous materials registration form or risk management and prevention program underSections 25505, 25533 or 25534 of the ?resley-Tanner Hazardous Substance Account Act? O Yes -No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or airqua ity management district? O Yes M-No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? O Yes r&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. I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (1) Civil Code). Lender's Name Lender's Address; I certifythatI have read the application and statethattheabove information iscorrectand thatthe information on the plans Is accurate.I agree to complyWth all City ordinances and State laws relatingto building construction. I hereby authorize representative 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 50' deep and demolition or construction ofstructures over 3 stories in height. - EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shag 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 ofsuch permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 106A.4 Uniform Building Code). A!SAPPLICANT'SSIGNATURE DATE Z..._ a STOP: THIS SECTION NOT REQUIRED FOR BUILDING PERMIT ISSUANCE: Complete the following ONLY if a Certificate of Occupancy will be requested at final .inspection. FaX (760) 602-8560, Email www.building0cadsbadda.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. CO#: (Office Use Only) CONTACT NAME OCCUPANT NAME ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP Carlsbad CA PHONE FAX EMAIL OCCUPANT'S, BUS. LIC: No. DELIVERY OPTIONS O PICK UP: ❑ CONTACT'(Listed above) ❑ OCCUPANT (Listed above) ❑ CONTRACTOR (On Pg. i) ❑ ASSOCIATED CS# M-MAIL TO: ❑ CONTACT (Listed above) ❑ OCCUPANT (Listed above) ❑ CONTRACTOR (On Pg. i) o NO CHANGE IN USE / NO CONSTRUCTION O MAIL / FAX TO OTHER: _^ _ - - - ❑ CHANGE -OF USE./ NO CONSTRUCTION ,!SAPPLICANT'S SIGNATURE DATE ALLN 4►+� CITY OF V CARLSBAD Community & Economic Development AUGUST 1, 2013 BAKER ELECTRIC 1298 PACIFIC OAKS PL ESCONDIDO CA 92029 RE: APPLICATION DATE: PLAN CHECK #: w ADDRESS: EXPIRATION DATE: PERMIT TYPE: DESCRIPTION: 10/04/2012 CB122003 2561 EL CAMINO REAL 10/03/2018 COGEN INSTALL 3 NEW VEHICLE CHARGERS www.carlsbadca.gov You applied to have your plans checked on the date noted above. To date, the related building permit has not been obtained and the original plan review application will expire on the date noted above. This courtesy notice is sent to advise you of the following provisions of the City's codes regarding expiration: 18.04.035 - Section 107.4 amended —Expiration of plan review. Section 107.4 of the California Building Code is amended to read. Applications for which no permit is issued within one year following the date of application shall expire by limitation, and plans and other data submitted for review may thereafter be returned to the applicant or destroyed by the Building Official. 90 day extensions of the plan review period may be granted by the Building Official after review of a letter of explanation provided to him by the property owner. An extension of time aranted by the Building Official does not by right, apply to any related Discretionary Permit under review. Plans submitted and not retrieved from the building department prior to the plan check expiration date noted above will be destroyed. In order to provide better service, please indicate your handling choice for the plans originally submitted and r turn this letter to the Building Department. Project Abandoned — I will pick up the plans within.10 days and Abandoned — Plans may be destroyed If you have any questions, please contact the Building Division at (760) 602-2719. Building Division CC: SEARS Building Division 1635 Faraday Avenue, Carlsbad, CA 92008-7314 T 760-602-2700 F 760-602-8560 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 03-25-2003 Plumbing Permit Permit No: CB030855 Building Inspection Request Line (760) 602-2725 Job Address: 2561 EL CAMINO REAL CBAD Permit Type: PLUM Status: ISSUED Parcel No: 1563010900 Lot #: 0 Applied: 03/25/2003 Construction Type: NEW Entered By: MDP Reference #: Plan Approved: 03/25/2003 Issued: 03/25/2003 Project Title: SEARS Inspect Area: UNDERGROUND PLUMBING ONLY Applicant: Owner: 2089 03/25f 03 0002 01 02 ICE BUILDERS PLAZA CAMINO REAL, COS, C/O SEARS,ROEBUCK & CO 421 CERRITOS 3333 BEVERLY RD ANAHIEM 92805 HOFFMAN ESTATES IL 60179 714 491-1317 Plumbing Issue Fee $20.00 Fixture or Trap 1 $7.00 Building Sewer 0 $0.00 Roof Drain 0 $0.00 Install/Repair Water Line 0 $0.00 Water Heater and/or Vent 0 $0.00 Gas Piping System 0 $0.00 Vacuum Breaker 0 $0.00 Other Plumbing Fees $0.00 Master Drainage Fee $0.00 Sewer Fee $0.00 Additional Fees $0.00 TOTAL PERMIT FEES ti $27.00 Total Fees: $27.00 Total Payments To Date: •. $0.00 Balance Due: $27.00 I r U I I I age %r WAnd w 01 M C16arance: NOTICE: Please take NOTICE that approval of your project includes the "Imp sition" of as, dedications, reservations, or other exactions hereafter collectively referred -to as "fees/exactions." You have 90 days from the date this permit wa issued t protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3:32.030. Failure -to timely follow that procedure -will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any 27.00 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1685 Faraday Ave., Carlsbad, CA 92008 0 CAiI D c'q</FOR��P FOR OFFICE USE" ONLY PLAN CHECK NO • ` US EST. VAL. Plan Ck. Deposit Validated By_ Date Assessor's Parcel # Existing Use Proposed Use Name Address City State/Zip Telephone .# Fax # +�'� ' �?`I,:.A .�<s-' S",,C,,,Q��:..�ieCLtlC�-'t�i�ll��.$n,w.�.,��,fCrl" t0��,;:xt.ai�� 1�z A 871tafQ��. el`�•.�` �`�f'c';,A _�•.�-��.�'�� ..�"��'"' Name Address City State/Zip Telephone # •w, •W' •k:"t=",,;, k:< ,•SF`�„"o"c`"»""_yvtL4;Y:.".;�.;'�—,,.n.:;,,Y,`ro•r, "'W ,<+, a�•,""';r,„"v„, ;Y^; i�tYpi^f':.i�•`r`''}''�Nr"L;,�;"?�i ;G%";"':"a.xM,,.p'.^-'�;6'�"';}':,�,",�"; �4'�'�Pu��?a��E '� •x1!�'r:''�3" k.�s��`- tl . �,, s' k � �?" t x.:"S�',_ �.£:_..�:.-,.._�.a>.�M� r..�»�3�.a..u.', aS'w�.�3k:'H.�. Name Address City State/Zip Telephone # .c�«6°.a'A.w�.,��, i��'«. ".� ",.. ., .. � .. ''"�'ad��uua�t� aua��w`:' :v<N;,a�-""�•�''''.�".f�.��1'..;.''3fiLie.::tr;:'%��k„`�."a� ci.sbz',�".;.s�'S�,�:,3aa',"'a.�.•.u,�;.i�c4aeY%��"s.4�' (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 )icensed 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 [05001). Name Address �y City State/Zip Telephone # ��G..cJ , State License•# License Clas0 G C(ty Business License # Name Address City State/Zip State -License # �r<^• Y�t:»•nrn ,"r^,;a` .��."'�." �. R,I�jrtiS�5`!�=T:i��''_�.;',•'�.mm��'�:�.:n:;.�"."�y�:;^�."�'��":�'�'S`�,M`��'t�,;:a.�'�.;".was;��3*P?�'�"��.-=.,,�,�.��,:�.�,--'.-�t1.;�m,�-.�-,„�.��`=',�:��.�'�at Workers' Compensation Declaration:' I hereby affirm under penalty of perjury one of the following declarations: ❑ 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. ❑ 1 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 cc ensation-(nsurance carrier and policy nu or are: Insurance Company ,�1'(,j/l,/ Pol(cy-No(�fwJJGGs'C xpiration Dat��'d� "(THIS SECTION NEED "NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLA�OR LESS) ❑ CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, 1 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'ahall subject an employer to criminal -penalties and civil fines up to one hundred thousand dollars ($100,000),.In addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE -DATE - .w.>..w _,..._,a,,.,,. ,--�..,w.:,.,.:. �.«v,.....,..-.,.a�.w9:�..,.r+�m�e«:h.s�z mow. nebv+,.�amxi :u�e!r-.,wa+.� <,-,>...z,.,rw•1.s: �a!msr-m.<v,aamma-u�vip.w�.s�sf 1.•s.a�- �^,•s,+,�., z�#as <:r�, u::lk� �..::^Y'xapll„•�a•, �?:,^.nhs'v_s'�:'.'a:i.'"�;6t�"`iu;,��,sh5� �+:;:sT� I hereby affirm that 1 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). ❑ 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: 1. I -personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ YES ❑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 �0 PL TES HS�SEC 0 aF0 �NUII� � l� f� APE i, 0 `-=-si�;'.a�;•"•�3.,•��'�"'�• '�`" K �•M�.�r,s_ s,.-.«� u ..,��,�,..� ..�...i�..........«.., ��.. �.�.�...R�,.�� 1��,t:.«.��-,;�,�M..�;:-.m;.a�,�a,,,�,.,.�.ai� ::��:�`�t=�:�:.�sa:::;;�.•i.� 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. ?�,s �r"�"i� aA SIG 'zG;��•w?.�>�`..`::��g',i•'r.�, ,�''„�.=,;;�.o��''Y>•r�`. °4,: b� �:�:�'t.�::,:� ;,,,e-%.��.r•-F--ky'3"�,� `�,�;;�i``,,��=�, �:,`_��,::�v'1^;=^::: �3 kR•1,.,..�sl`�?.�,.,r+��....�1.,,,,=i��i1��ta.. U,�«.,,.._.,,.�R. �w,.•...,..,.,,..d,.a,,..a;�:.,?'�x.;.aai'�.;,. �">.:x-...:.z'�,:'..,..t'tA"�:�.u'�.Ms�m,.-.µ..¢.�.,3..,.;«..,.�� z,,',x,•�,�s._. � �:.,,.., .z, a..-..,..........,., i....._..a::�r..: v_. 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 .e•�`"'"'"'•-�S';?'�-aTa.��;g.^+,� ^: 3:`�i;-zr-•'�r.;�;z•�i�'T;%�?'�;3'T,�3 ^^rs��.xa,^��.•�.�c ^F_s�'? �;£.s'?'r'•"„'�'�#+a x� �,°��ls�=„''��-°. 4�.-'u�'i��T�.�„Y..� �i��..,...!l,� u.a�auxz"4',..:�2"a:� as>,w•.......we:.w' �.:.kda> `h,�';,o:;•.h, �,,.•x:.;.:,.,?au�;.,S'.�:;,ir-,,,.�:; SmC.}.:zr.',.''' a`i�� c •"'ia �x...:sr,:.• , :�mK,..�axi&u.,,4;u'« �,..a:c 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 permi 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-suc>ralmIt is not comment ifr•#99�e1 from t of such,permit or if the building or work authorized by such permit is suspended or abandoned at any time after a work is comment r period of 180 y action 06.4 niform Building Code). APPLICA • T'S SIGNATURE DATE WHITE: File YELLOW: Applicant PINK: Finance A. C City of Carlsbad Bldg Inspection Request For: 05/13/2003 Permit# CB030855 Title: SEARS Description: UNDERGROUND PLUMBING ONLY Type: PLUM Sub Type: Job Address: 2561 EL CAMINO REAL Suite: Lot 0 Location: APPLICANT ICE BUILDERS Owner: PLAZA CAMINO REAL Remarks: PLUMBING AT WALLS Total Time: CD Description Act Comment 24 Rough/Topout Associated PCRs/CVs Inspection History Date Description Act Insp Comments 03/26/2003 21 Underground/Under Floor AP PS PARTIAL Inspector Assignment: PS Phone: 7604340941 Inspector:-�F— Requested By: DAN Entered By: CHRISTINE City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 02-� -26 3 Miscellaneous Permit Permit No: CB030491 Building Inspection Request Line (760) 602-2725 Job Address: 2561 EL CAMINO REAL CBAD Permit Type: MISC Subtype: OTHER Status: ISSUED Parcel No: 1563010900 Lot #: 0 Applied: 02/20/2003 Valuation: $0.00 Entered By: MDP Reference #: Plan Approved: 02/20/2003 Issued: 02/20/2003 Project Title: SEARS Inspect Area: DEMO EMPLOYEES RESTROOM & WOMENS LINGERIE Applicant: Owner: 9357? '0 20103 (;* 0 2 01 22 ICE BUILDERS PLAZA CAMINO REAL C�.:�-=" C/O SEARS ROEBUCK & CO 421 CERRITOS 3333 BEVERLY RD ANAHIEM 92805 HOFFMAN ESTATES IL 60179 714 491-1317 Miscelaneous Fee #1 PERMIT $60.00 Miscelaneous Fee #2 $0.00 Additional Fees $0.00 TOTAL PERMIT FEES $60.00 Total Fees: $60.00 Total Payments To Date: $0.00 Balance Due: $60.00 FINAL APPROVAL Inspector: �' Date: 9 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 "feeslexactions." You have 90 days from the date this permit was issued to protest imposition of these feestexactions. 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 6() - X PERMIT APPLICATION CITY OF�CARLSBAD BUILDING DEPARTMENT 16$5 Faraday Ave., Carlsbad, CA 92008 OF CART u �'4 v r c'9t/FOR��P FOR OFFICE USE ONLY -PLAN CHECK NO. C-, 3 EST. VAL. Plan Ck. Deposit Validated By Date Assessor's Parcel #' Existing User Proposed Use Name Address City State/Zip Telephone # Fax # �a�►.�.R � C�T�� a:.antS�" ��I��'� • "t;:#or�Contr� or��`�•�e��' or"` rae[t��„• �P �- g °''"`�'t':� .. � '��i s'. ��. ; ': �i; �,",s_t�-�' Name Address" City State/Zip Telephone # T...,a,n •s+pp ,!� j,�.'j..��"� 9", a''"`1•='i-v"x:,'..�'^�:-mw�P..��"emu'tax:zY-:�«s[ix'-ET'a'�".t�'��'��t��•�4u.�F:•>-<zF'why.,"�,X�,r•='"ra='^�..1<*�^=ark". L4�=;�+zt;.>'c�n+-+�•�-�.'a�k�' --: ��=.�' �'�-E�",,,,...� �•*``ti Q ErSiIaT�V � 14,. yS',v^� ��+,� � '` ^im.•, .f. '�i-.. i�� .:—S c."" I" U=�" ,Aa Name Address City State/Zip Telephone # a:..a.'`'*..:w'"�.a:P.rat3s-:�...w'�:°a+su,%,aS::aF;a"a„r.�w�.�,«�,�:ai'�..?-a�'�.'s.:avd'd.a-sib.+,'�''s•aiuiu�S'.}s�'"•'�'3�a'S` �xNa.a` L.. (Sec. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter; improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law ' [Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or that he is exempt therefrom, and the basis for the alleged exemption. Any violations Sect i 031.5 by any applicant for a. permit subjects thS applicant toy civil pe sity of not m9r,9 than five hundred dollars 0001) Name �/ Address City State/Zip License Cias,(i[ :^�� City Business License # State License # 2 %`�" 7 Designer Name Address City State/Zip Telephone State License-# •;,;<m-g�;?ss-`"•Q;,�;;•�;c;r•^�xugn-�lw^;�!^ "�`"• tom.,- ��?F�'sue=s�a�T�>�"."^�asv"'¢'� t '�y''a^'^ ' ?�:;• �.-., `,iyr•:?si'�'-'s t8i�e,;��ERS C �•PE�S�T�.O��aAr�';�`�i�i.�':.i�»c•�ca�i�:�,�'?��;xs�. �w��.'.�`;x�ae: �:.;:;�s�-`�:�t.•."�""a ltt`�:",�w.��:a>"�.,.µ�1��`a,�:�r,�::�:s��'�.�#�;"�.-a.�sccz"4��::��` 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. 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 poi(c number are: /� / / j nsurance Company �Ii/r!//iP. Lll'�/G'� tiG Policy No �_EJe i. �21; "expiration Date/ L' —I/— if d% THIS_ SECTION NEED=NOT BE COMPLETED -IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [S1001 OR LESS) ❑ 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 ($100,000), 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 I hei*eby affirm that I am exempt .from the Contractor's License Law for the'foliowing 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 []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 a....-. � �»ax '"""S �,��..a'�,,�'S�y�'`...,�., �-'�,�,�wra3 -.'�.7y.. �.� "i`^-,, *-�.,, ?°s.•�,x-x;,,^•:°,s � "+ Ems;,. �y,.x�::��;,.. OII�PL��HS SE��EQ� 711ONt��✓�uj��[i l?R�.:::': a : _ "" C>�t `;s :;u ,,-" 1a t'r• Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley -Tanner Hazardous Substance. Account Act? ❑ 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. t-"<.� , �}. ^�'t}ss °s%'k;, ^'«"-y'=�•,� �,!nr^:y a . t;s+:s ^-na- P• 3<r�.• =•,a �:¢,•^ ;.•-_ - •mow t `�:, 's �'!'� �(: -) ''N, �7��+T'�,f<,•'�„to�z�-�:_STr'.:.=.`�.1'.•'w��;:i'a:'f•:.a�—:?-'•i'.. ``•s%`�.: •l -?,+`�•°�i ;<�,' x�, t.ra•'e.g:z �. ,ns•2.,a,y,,.a 3!'g%"�u"t��.��;;. ,z."^'a:�;�^';x, Kµ ;��i �3r'�:��G��a.•x",_�....,.,s..;�aa•:.M.�,..�.,�,>.m.:�A�a4r...:�..,...,.._.__._,..._.....,�.."•l"...•.•...•.>x,•:�a_Aa'��W<.�.a.<��.��xa..".�,z•.`a_�,..�r*. _...�.,:�.._�za,..�r,., I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(() Civil Code). LENDER'S NAME LENDER'S ADDRESS "5`^�'y""m;,�„.�.''Fl:'Trzw �:'*,:�i.:.:sv'.�""�s: t? °"�° ^Y";€�'.t'e"t:y-""'�•v' mrs': 4a-ssa a•�:a'n T flCi 10 ',.�.n � «,�c,Aa.A,c��«psi,i;,�:')„,aa3#.s�,a.:;,.t�,•'x:��.�.-a,'firma.��:�.s��'�'`�^"�`az.�.�z,.a�:.�;aax;�"�;�5...�=�..,a..,2:;�,t'a.ii&:a,':�::iNkab;�:�. �.�`�:.,�,a;.sAS:'c�ic 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 C(tq 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 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 ' o from th uch permit or if the building or work authorized by such permit is suspended or abandoned at any time after t work is commen for period of 180 ection .4.4 �4 rm, Building Code). APPLICAr"dT'S SIGNATURE WHITE: File ,YELLOW: Applicant PINK: Finance 0 1 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 b4-25-2002 Miscellaneous Permit Permit No: CB021278 Building Inspection Request Line (760) 602-2725 _Job Address: 2561 EL CAMINO REAL CBAD Permit Type: MISC Subtype: REROOF Status: ISSUED Parcel No: 1563010900 Lot #: 0 Applied: 04/25/2002 Valuation: $93,500.00 Entered By: JM Reference #: Plan Approved: 04/25/2002 Issued: 04/25/2002 Project Title: PLAZA CAMINO REAL - SEARS Inspect Area: REROOF 78,700 SF - FIRESTONE ULTRAPLY Applicant: Owner: 5925 04/25/02 0002 01 02 COATES ROOFING COMPANY PLAZA CAMINO REAL COS, C/O SEARS ROEBUCK & CO BOX 1340 3333 BEVERLY RD _PO c`3EMINOLE OK 60179 HOFFMAN ESTATES IL 60179 405-382-2113 Total Fees: $884.00 Total Payments To Date: $0.00 Balance,Due: $884.00 Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES PERMIT FINAL APPROVAL Inspector:— — �Ub Date: Clearance: $884.00 $0.00 $0:00 $884.00 NOTICE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "feestexactions." You have 90 days from the date this permit was issued to protest imposition of these feestexactions. If you protest them, you must follow the protest procedures set forth in Government Code Section_66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to -timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified feestexactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any 884.00 FOR OFFICE USE OPI L- PLAN CHECK O. EST. VAL. PERMIT APPLICATION t " Plan Ck. Depos( _ CITY OF CARLSBAD BUILDING DEPARTMENT Validated By,V!% 1635 Faraday Ave., Carlsbad CA 92008 "' Date ��rb`e`Y,r�,a�'.Y%-i{5 �<d-,<;�� w a� <. � rs a'F �:cr �� '+s;. z3, ar �'�; �':•i'2,-?., i 1''w;., �st:.�:. �„ (. �a1,;..<,°a L$ �•.a-,.eaa�-�,..:<.�'�^.va`�z�,r,.uw's.;;�i.�'"a.•::�-"�"�:�s�a",«�u"..�.n7• w''x�'''•rs`�"�'��^','.'r�r�a.:aa�i?ir.Yi;�'-;Y.�:;."''�"-;'c.�i-`«'•'`u�.'�v;"��.�"a:•;u�'�'.a�s.,�' a"%� SEARS #1678 Address (include Bldg/Suite #) Business Name (at this address) 2561 EL CAMINO REAL CARLSBAD CA 92008 Legal Description Lot No. � Subdivision Name/NumtSer Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use C�1mm0Ar-c • `fie QW-p- ?%? Description •of Work SQ. FT. # of Stories # of Bedrooms # of Bathrooms '�;�%;'0��"r"��.�c•"•*.ir�i�''�+`�``l'�C7,�i�s'Z:;i,r "•�'`%.'w^�ai�',"��"em�x` �,o�, ��v"�;�`�f��'v'a�r`'��,:a.,s• s- r S wun�' � c.:..: a,..ka;Yr«: i��L"!_�aF��,✓ l." Name Address City State2ip Telephone Fax# �• � Fv z�.ra+ �^' -,,y� m ,v rc ^fie �t�47�er c@9f�e i^• _ a �,TMa+g p��. �'�"� _"',e�,=m�, ,�� S� Y� � h �$ yip!! '�y. �" 4i +•-.; :,��C�y yF� i Y..` �a�e g, �r.:r: '.:y?,.'r �,�y,1g � _r ". �; �'..��?d COATES ROOFING COMPANY, INC. SEMINOLE OK 74818-1340 405-382-2113 _ Name Address 'City State/Zip Telephone# i4i-�'��cs..��'5�;:u.�-^;..,-°^'u��2 ��$'w�i,.' � ,, �, ..;u�f ',aJ,,;„� '^ix.�s.. �' fiery.'-^ > �. �' � �-. .�.-".,4.,•.^ �"`�`'�'�a�".�. a'. ,� SEARS, ROEBIICK 3333 BEVERLY RD HOFFMAN ESTATES IL 60179 972-864-2516 Name Address City State/Zip Telephone# (Sec. 7031.5 Businessand Professions Code: Any City or County which requires a permit to construct, after, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9, commending with Section 7000 of Division 3-of the Business and Professions Code] or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500]). COATES ROOFING COMY PANINC. P.O. BOX 1340 SEMINOLE OK 74818-1340 405-382-2113 Name Address City State/Zip Telephone # State Llcense # 580602 License Class C - 31 City Business License # I ( 3 LJ a Designer Name Address City State/Zip Telephone # State License # S:s. 6 i�•y�� -u;�-�,'�"�'��,a�-,w'�`.'�,"'�,,..;;�.��-,,,��-,,�a"q""s..``�d,."�"";�?,,. w..r.. ,:,�:"'y�y,�"<�-."�"-^.•°�,•"�"'G•s??'''"".f��,,,��,��`.'","�^.s.�x; ';�1.`�„';Y.,�;,:1.: ;�..>��•; '.„.�.� ,l�y'�' s � tea. '*��;.,.�..�^x�;.�.u.�.:�� 'za�.,�� - ' :�.; Via.: r:�.• w w� Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: ❑ 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. J[ I have. and will maintain worker's 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 ZURICH AMERICAN INS Policy No. TC250538884 Expiration Date MAY 2002 (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) ❑ CERTIFICATE OF EXEMPTION: 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to )secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars($100,000), in addition to the cost of compensation, damages are provided for in Section 3706 of the Labor Code, Interest and attorney's fees. SIGNATURE DATE ::�•�:�;.,.�;�.,,.�:�,�-�:�,.:�,��;��r-,�-,,�.w��, ..,tee,.-�.�..�� . ��,��,�••..:�.,,..,�� .�;,:_,�,,.�� I hereby affirm that 1 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 d 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). ❑ 1 am exempt under Section Business and Professions Code for this reason: 1. 1 personally plan to provide the major labor and materials for construction of the proposed propertyihiprovement. ❑ YES ❑ NO 2. 1(have/have not) signed -an application for a building permit for the proposed work. 3. I.have contracted with the following person (firm) to provide the proposed construction -(include name / address / phone 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 I address / phone number I /ontractors 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 WHITE: File YELLOW: Applicant PINK: Finance PERMIT APPLICATION ' CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad CA 92008 Page 2 of 2 Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration for 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. is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(1) Civil Code). LENDER'S NAME LENDER'S ADDRESS 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. 1 ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGEMENTS, 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 of 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 w 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at anytime after the work is commenced for a period dkl8kdays (Section 106f+AUniform Building Code). APPLICANT'S-SIGNATUREDATE ✓�C� WHITE: File YELLOW: Applicant PINK: Finance APR.25.2002 2":04PM COATES ROOFING APk-U3-ZUU? WED II'3l AM 0111 U� CAK3WAD FAX N0, 760 $02 65590.699 P.2 P. 02 11If r City Of Carlsbad SUPPLEMENTAL BUILDING PERMIT APPLICATION FOR REROOFING 1. JOB ADDRESS: 2561 EL CAMM RM 2. TYPEOF,B.UILDING: RESIDENTIAL-COMM . ERCIAL,.!_. 3. ROOF SLOPE: RISS 1/$-.rtnches In 12 inches 4. NUMBER OF EXISTING ROOF COVERINGS (circle one) (i 2 3 s. TYPE OF EYJST11 G-ROOF COVERING . Pvc SHEATHING *6. NEW. ROOF MATERIAL, Pvc CLASS s WEIGHT PER SQUARE 7. NUMBER OF SQUARES 787 s. TRADE NAME FnmT= Z .yMANUFACTURER_Fms 9. ROOF SYSTEM LISTINO UL No. &MA CBO No. 10. IS THE EXI3TING STRUCTURAL. DESIGN RICIENT TO SUSTAIN THE WEIGHT OF THE PROPOSED ROOF? YES' ' NO All roof coverings am required to'bi CLASS A. Combmstible roof coverings of any type or classification are-Orohibited. 1 understand the follo ing inspections are requlmd:. 1. Tear OfliPro4nspection prior to install new roof covering. 2. Finallpapeatlon 1 agree to provide a ladder extending of least 2 rungs above the roof for Contractor'Owner, Contractor Name CDMS RMFING COMPANY, INC. *6 - Rolled Roofing, Standard/Lite Tile, AsphalVC*mp Fiberglass, Built up, Other. aten'l City of Carlsbad .Bldg Inspection Request For: 06/21 /2002 Permit# CB021278 Inspector Assignment: RCB Title: PLAZA CAMINO REAL - SEARS Description: REROOF 78,700 SF - FIRESTONE ULTRAPLY Type: MISC Sub Type: REROOF Job Address: 2561 EL CAMINO REAL Suite: Lot 0 Location: APPLICANT COATES ROOFING COMPANY Owner.: PLAZA CAMINO REAL Remarks: AUTO MGR HAS THE INSP CARD Total Time: Ph6ne:4058184758 Inspector: R4,13 Requested By: CRAIG BLAIR Entered By: CHRISTINE CD Description Act Comments 19 Final Structural xTI x1A Associated PCRs Inspection History Date Description Act Insp Comments 05/14/2002 15 Roof/Reroof AP RC OKTO PROCEED INSTALLING ROOFING MATERIAL City of Carlsbad 0 04/20/1999 Mechanical, Permit Permit No: CB991524 Building Inspection Request Line (760) 438-3101 Job Address: 2561 EL CAMINO REAL CBAD Permit Type: MECH Parcel No: 1563010900 Lot #: 0 Valuation: $0.00 Reference #: Project Title: SEARS ROEBUCK REPLACE 8 EXISTING UNITS WITH NEW ONES Applicant: RELIABLE MECHANICAL STE G 9260 ISAAC ST SANTEE CA 92071 619-562-4968 Status: ISSUED Applied: 04/20/1999 Entered By: MDP Plan Approved: 04/20/1999 Issued: 04/20/1999 Inspect Area: PLAZA CAMINO, REAL , C/0-SEARS ROEBUCK & CO 3333 BEVERLY,-RD , HOFFMAN,�ERWiES IL 60179 B16 04/20/99 0001 01 02 Total Fees: $87.00tal Payments 'fofDate' $0.00,r "`Balance Due: $87.00 Mechanical Issue Fee Install/Furn/Ducts/Heat Pun Fireplace Installation Fee Exhaust Fan Fee Installation/Relocation Vent Hood Fee Boiler/Compressor to 15HP Other TOTAL PERMIT FEES � � I t J �� $1,5.00 is Fee 8 c $72.00 $0.00 r0 $0.00 ee �'$0.00 $0.00 e 0Ncoraa ArEo,'( $0.00 v ( a'D� $87.00 FINAL APPROVAL Inspector: Date: &L 2 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 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 CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 FOR OFFICE USE ONLY C PLAN CHECK NO. 1C� ' 1 i J� EST. VAL. Plan Ck. Deposit Validated By Date :1. 'PROJECT' INFORMATION - 2561 El Camino Real, Carlsbad, CA 9.200.8 Sears;• Roebuck & Co. Address (include Bldg/Suite #) Business Name (at this address) Legal Description Lot No. Subdivision, Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use ReplAace HVAC systems Description of Work SQ. FT. #of Stories # of Bedrooms # of Bathrooms 2...,CONTACT,PERSON,{if.differant=from applicant] ;•;_. „f- :. ._ -. - .. Name Address City State/Zip Telephone # Fax # 3. ,',APPLICANT'_.':Contractorr cj❑:Agent:for.Coniracior, 1;, • ,Owner..__;:rjAgerit for;Owoer: -., ' Reliable Mechanical, Inc.; P.O. Box 712349; Santee, CA 92072-2349 (619)562-4968/562-3734 Name Address City State/Zip Telephone # 4.. '`PROPERTY`OWNER . :.. _ ..... Sears, Roebuck & Co., _.. Name Address City State/Zip Telephone # _;;.... 5:". `'CON.TRACTOR = dOMPANY.•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 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 1$500]). Name State License # uesigner Name State License # License Class Address City City Business License # Telephone 6. •WORKERS'.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 carrier and policy number are: Insurance Company Golden Eagle Insurance Policy No. NCW 383626-00 Expiration -Date 8/1/9-9 (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100] OR LESS) ❑ CERTIFICATEO TION: 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 subje to the Work rs' Compensation Laws of California. 'WARNING: Fa)lu a to thousand dollar x SIGNATURE and -shall subject an employer to criminal penatt a and ci it fines up to one hundred as as provided for,in Section 3706 of the Labor c into at and attorney's fees. DATE �//_ 7. OWNER WILDER DECLARATION 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). ❑ 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: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. ❑ YES ONO 2. 1 (have / have riot) signed -am 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-havehired 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 •COMPLETE,THIS'SECTION FOR,NON-RES/DENT)AL'.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? ❑ 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 constructedwithin 1,000 feet of the outer boundary of a school site? ❑ YES ❑ NO IF ANY OF THE ANSWERS ARE YES, ATINAL 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. _..... - , :8... CONSTRUCTION LENDING'AGENCY '.: ' ::.:, ;': • := ,,;. = ._ 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 it, •.•''AP_P.LICANT'CERTIFICATlON_,::.�:.:_•-��=_�:�'�,:.::_e.A„.;:.:`_C.:<-'1.�:.._,_;_�:, - _ ___-.,y,•c - 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 vationa over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issu d by the B-'iding 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 con o m aye from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after t or o enced or pa►ied ef-1$ tion 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE - DATE 20 WHITE: File YELLOW: App i t PINK: Finance City of Carlsbad Inspection Request For: 6/1 /99 Permit# CB991524 Inspector Assignment: RB Title: SEARS ROEBUCK Description:. REPLACE 8 EXISTING UNITS WITH NEW ONES Type: MECH Sub Type: Job Address: 2561 EL CAMINO REAL Suite: Lot 0 Location: APPLICANT RELIABLE MECHANICAL Owner: PLAZA CAMINO REAL Remarks:, Phone: 6195624968 Inspector: rl -----�/ Total Time: Requested By: PAT Entered By: CHRISTINE CD Description Act Comments 49 Final Mechanical Inspection History Date Description Act Insp Comments 5/1'8/99 34 Rough Electric CO RB SEE NOTICE ATTACHED 5/18/99 39.-Final Electrical CO RB SEE NOTICE 5/18/99 43 AirCond/Furnace Set NR RB 2ND TIME - SEE NOTICE ATTACHED 5/12/99 44 Rough/Ducts/Dampers NR SP NO CONTRACTOR OR ACCESS '"I B U I L D I NG PERMIT Permit No: CB920712 07/22/92 11:40 Project No: A9201704 Page i of I Development No: Job Address: 2561 EL CAMINO REAL Suite: Permit Type; ELECTRICAL 056 07/22/V- 0001 01 02 Parcel No: 156-301-09-00 Lot#: r,-PPMT 20 - 00 Valuation: 0 Construction Type: NEW Occupancy Group: Reference#: Description: ADD LIGHTS FOR ATM BY SEARS Appl/Ownr : ALLIED INTERSTATE 11929 VOSE STREET N. HOLLYWOOD, CA ' Fees Required -----------------------C' - --- Fees: Adjustments: .00 T 6 Status: ISSUED Applied: 07/22/92 Apr/Issue: 07/22/92 Validated By: DC 818 504-3370 Collected & Credits ---------------- Total Fees: Tot -al P4 Balan, Fee description --------- --------- - iEnter."Y" for Elec r 1 0 u e Fe -r Enter "Y" for Remo el�2r iOr ELECTRICAL TOTAL( i INSP. CLEb� CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 .00 .00 20.00 Ext fee Data ---------------- 10.00 Y -T 10.00 Y 1 20.00 APPROVAL imnar 9/1"f Jq PLAN CHECK NO. �'� PERMIT APPLICATION _ City of Carlsbad Building Department ) 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161: A - kammercial U New Building U Tenant Improvement B - ❑ Industrial ❑ New Building ❑ Tenant Improvement C - ❑ Residential ❑ Apartment ❑ Condo ❑ Single Family Dwelling ❑ Addition/Alteration ❑ Duplex ❑ Demolition ❑ Relocation ❑ Mobile Home Wlectrical ❑ Plumbing ❑ Mechanical ❑ Pool ❑ Spa ❑ Retaining Wall ❑ Solar ❑ Other 2. VAL I CK DEPOSIT D. BY FOR OFFICE USE ONLY Nearest Cross Street t No. Subdivision Name/Number Unit No. Phase No. CHECK BELOW IF SUBMITIED: ❑ 2 Energy Calcs ❑ 2 Structural Calcs ❑ 2 Soils Report ❑ 1 Addressed Envelope DESCRIPTION OF WORK ='Nel ly1'{t L4...-6 Q'S ��T�e3 �-nD� ��-nr,�.�•�,.,►, SQ. FT. # OF STORIES /* sm, �j�-�f dye .qt% '�'j iLL4 y J. W14 rALT'PIILml�faii eri rent from applicant) NAME ADDRESS CITY STATE ZIP CODE DAY TELEPHONE NAME ADDRESS CITY STATE ZIP CODE DAY TELEPHONE NAME {( ADDRESS CITY J 1,5 lF� STATE 6* ZIP CODE 4T-100A DAY TELEPHONE NAME f.».l4a R� ADDRESS �vOq �fivo1 * g,4, e CITY�ji ��t/ STATE ZIP CODE DAY TELEPHONE g'$)5(04.-�P] 0 cswW ESTATE LIC. # LICENSE CLASS CITY BUSINESS LIC. # JlCjf�L�iDESIGNER N7MIR- CITY STATE ZIP CODE DAY TELEPHONE STATE LIC. # Workers' Compensation aration: I hereby affirm that I have a certificate of consent to se -insure issued y the Director of 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 thereof filed with the Building Inspection Department (Section 3800, Lab. C).. INSURANCE COMPANY 4; I,A'fr-1 �•„1 A POLICY NO. 1 1_4a-3©6— EXPIRATION DATE /1 ' 1, 93 so as to become subject to the Workers' Compensation Laws of California. SIGNATURE DATE T-ZMNER-BUIWER DECLARATION nw—ner-Builder aration: I hereby attirin 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). ❑ 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 [$500]). 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? ❑ 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? Cl YES Cl 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 DMRICr. ereby atfirm that there is a construction fending agency -tor the performance of the work for which this permit is issuea (Sec soyi(i) uivn uoae). LENDER'S NAME LENDER'S ADDRESS 1 certify that I have read me application ana state mar me aoove mrormauon is correct. i agree to comply wim an airy oromances ana Mate 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 CARISBAD AGAINST ALL-LiABHXr ES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CrrY IN CONSEQUENCE -OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. Expiration. Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 365-days from the date of such permit or if the building or work authorized -by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 303(d) Uniform Building Code). nr.,-. .9,.-. -, I 9 CITY OF CARLSBAD INSPECTION REQUEST PERMIT# CB920712 FOR 08/21/9,2 INSPECTOR AREA MC DESCRIPTION: ADD LIGHTS FOR ATM BY SEARS PLANCK# CB920712 OCC GRP TYPE: ELEC CONSTR. TYPE NEW JOB ADDRESS: 2561 EL CAMINO REAL STR: FL: STE: APPLICANT: ALLIED INTERSTATE PHONE: 818 504-3370 CONTRACTOR: PHONE: OWNER: PHONE: REMARKS: MH/NORM/818-504-3370 INSPECTOR L--� SPECIAL INSTRUCT: TOTAL TIME: --RELATED PERMITS-- PERMIT# TYPE CB920497 ELEC WDP02121 WDP CD LVL DESCRIPTION 39 EL .Final Electrical DATE DESCRIPTION S-TATUS ISSUED ISSUED ACT COMMENTS Ap ***** INSPECTION HISTORY ***** ACT INSP COMMENTS B U I L D I N G P E R M I T 05/20/92 08:32 Page i of I Job Address: 2561 EL CAMINO REAL Str- Permit Type: ELECTRICAL Parcel No: 156-301-09-00 Valuation: 20,000 Construction Type: NEW Occupancy Group: B2 Reference#: Description: ADD PARTIONS/MOVE DISPLAYS :'ADD 60 AMP CAPACITY Appl/Ownr : SWENSON, FRITZ 408 1701 FORTUNE DR. SUITE SAN JOSE CA 95131,,-- Permit No: Project No: Development No: Fl: Ste- 77211 05/24/p_ 0001 01 C-PRMT Status: Applied: Apr/Issue: Validated By: 434-1686 CONTRACTOR : MUNDY ELECTRX-6---" '46 /�omIic. --� 19222 SO P16NEER��-� 0V CERRITOS,,'6A 9 �011 f 10 -1k Fees Rewired - - - - - - - - - - - - - - - - - - - - - Fees: 0 Adjustments; to Total Fees, Zcc0, aymert b land 'All e Fee description nits ems: F ---------------------- Enter "Y" for Elec�ric Is Three Phase Per APIP ELECTRICAL TOTAL INCORPORATED 1952 CB920i197 A9200977 02 20.00 ISSUED 05/20/92 05/20/92 MDP 310 9247878 ' , I & Credits X------------------ .50 CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 .00 20.00 20.00 Ext fee Data ---------------- 10.00 Y 30.00 40.00