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HomeMy WebLinkAbout2732 LOKER AV WEST; ; CB973296; PermitBUILDING PERMI 10/30/97 13:28 Page 1 of 1 Job Address: 2732 LOKER AV WEST Suite Permit Type: PLUMBING Parcel No: Lot#: Valuation: 0 Occupancy Group: Reference*: Description: UNDERGROUND PLUMBING ONLY-NO : FRAMING Appl/Ownr : PREVOST CONSTRUCTION 619 9883 PACIFIC HEIGHTS BLV STE J SAN DIEGO CA 92121 *** Fees Required *** Permit No Project No Development No Construction Type Status Applied Apr/Issue Entered By 457-8250 CB973296 A9703486 NEW ISSUED 10/30/97 10/30/97 RMA Fees : Adjustments: Total Fees: Fee description Other * PLUMBING TOTAL .00 .00 30.00 Ext fee Data 30.00 UNDRGRND 30.00 MIT DANCE WITH U.B.C DATE SIGNATURE. FIML APPROVAL INSP.DATE CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 USE ON PLAN CHECK NO, EST. VAL. Plan Ck. Deposit Vali Date 705.00 Address (include BJdg/Suidress (includ 2,151. Business Name (at this address).mSu xir-vG£> Unit N< Phase No. Total # of units Name Address City State/Zip Telephone * (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 fts 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 e oermrt subjects the applicant to a civiloenalty of not more than five hundred dollars [*600]). r>Y1^Ll./f*yST Name State License # __{ Designer Name State License 9 " ( rf1/t<,f~* '~r>SZ4<f \ © & *-> r&LC i T i c_ FT Address ^_^ License Class 1*3 Address i-.toMT\"^ ft 1 I/id T5 * 1 ) , ( ^ . CfZ./2 [ [tp(i7tJ5 /" o££O Ctty State/Zip Teleoh^ne # City Business License * <3X>£( ftftffl 4rV City 1 ' State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: Q I have and will meintain 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. Q 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 compenpatioil insurance carrier ancLpolicy number are: f~Ut^ri _ Policy No. /^/.D^AZ^*? "7 Expiration Date // - /~Insurance Company (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*100) OR LESS) Q 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 totecurt porkers' rarflpfnsatkn coverage Is unlawful, and shall subject an employer to criminal penalties and ctvH fines up to one hundred thousand dollars (Mtio^DOOL in pdotlon/to tfmcpst nt compensatkm, damages at provided for hi Section 3706 of the Labor code. Interest and attorney's fees. SIGNATURE ( /. 3xJC ^) vV//^<r c DATE / O " I hereby affirm that I am exempt from the Contractor's License Law for the following reason: Q 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 ere 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 Lew 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). Q 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. Q YES QNO 2. I (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. 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 number / 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 number / type of work): ..._.. PROPERTY OWNER SIGNATURE DATE Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management end prevention program under Sections 26505, 2S533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Q YES jQ NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES Vj NOt f\ Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES \?f 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 the/e is a construction lending agency for the performance of the work for which this permit Is Issued (Sec. 3097(1) Civil Code). 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. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Bulldjng 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 comm or abandoned at any time after the work Is c APPLICANT'S SIGNATURE witftin 365 days from the date of such permit or if the building or work authorized by such permit is suspended icVdfor a period of 180 days (Section 106.4.4 Uniform Building Code). WHITE: Rle YELLOW: Applicant PINK: Finance 07/27/98 INSPECTION HISTORY LISTING FOR PERMIT* CB973296 DATE 12/04/97 11/06/97 11/04/97 11/03/97 10/31/97 INSPECTION TYPE INSP ACT COMMENTS Rough/Ducts/Dampers PS CO Compliance Investigatio TP PI Ftg/Foundation/Piers TP AP Underground Combo TP NS Underground/Under Floor TP AP LEFT STOP WORK NOTICE SLAB PREP @ U/G PLUMB NEED REV ON 3" HIT <RETURN> TO CONTINUE... CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB973296 FOR 12/04/97 DESCRIPTION: UNDERGROUND PLUMBING ONLY-NO FRAMING TYPE: PLUM JOB ADDRESS: 2732 LOKER AV WEST APPLICANT: PREVOST CONSTRUCTION PHONE: CONTRACTOR: PHONE: OWNER: PHONE: INSPECTOR AREA TP PLANCK* CB973296 OCC GRP CONSTR. TYPE NEW STE: LOT: 619 457-8250 REMARKS: C/ARNIE/619/969-8524 INSPECTOR SPECIAL INSTRUCT: THIS INSPECTION MIGHT HAVE BEEN DONE ON WED TOTAL TIME: —RELATED PERMITS—PERMIT* TYPE AS940041 ASTI CB972730 CTI AS970181 ASTI CD 44 LVL DESCRIPTION ME Rough/Ducts/Dampers STATUS ISSUED ISSUED ISSUED ACT COMMENTS ***** INSPECTION HISTORY ***** DATE DESCRIPTION 110697 Compliance Investigation 110497 Ftg/Foundation/Piers 110397 Underground Combo 103197 Underground/Under Floor ACT INSP PI TP AP TP NS TP AP TP COMMENTS LEFT STOP WORK NOTICE SLAB PREP @ U/G PLUMB NEED REV ON 3" CITY OF CARLSBAD BUILDING DEPARTMENT DATE, NOTICE LOCATION. PERMIT NO.. 438-3550 2075 LAS PALMAS DRIVE TIME. FOR INSPECTION CALL 438-3101. RE-INSPECTION FEE DUE? jRTWeFTinTORMATION, CONTACT YES PHONE CODE ENFORCEMENT OFFICER CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB973296 FOR 11/03/97 DESCRIPTION: UNDERGROUND PLUMBING ONLY-NO /// FRAMING TYPE: PLUM JOB ADDRESS: 2732 LOKER AV WEST APPLICANT: PREVOST CONSTRUCTION PHONE: CONTRACTOR: PHONE: OWNER: PHONE: REMARKS: C/ARNIE/619/969-8524 SPECIAL INSTRUCT: INSPECTOR AREA TP PLANCK* CB973296 OCC GRP CONSTR. TYPE NEW STE: LOT: 619 457-8250 INSPECTOR TOTAL TIME: —RELATED PERMITS— CD 11 12 21 31 PERMIT* TYPE AS940041 ASTI LVL DESCRIPTION STATUS ISSUED ACT COMMENTS ST Ftg/Foundation/Piers ST Steel/Bond Beam PL Underground/Under Floor EL Underground/Conduit-Wiring DATE DESCRIPTION INSPECTION HISTORY ***** ACT INSP COMMENTS P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATIONrINSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE OCTOBER 23.1997 POLICY NUMBER: 1215362-97 CERTIFICATE EXPIRES: r CARLSBAD CROSSROADS LTD 5666 LA JOLLA BLVD STE #133 LAJOUACA 92037 L_ JOB: HISAMITSU PHARMACEUTICAL CO REMODEL / 2732 LOKER AVE WEST CARLSBAD CA 92008 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon tfKXays' advance written notice to the employer. 30 30 We will also give you TJ&fcdays' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or after the coverage afforded by the policies listed herein. Notwithstanding any requirement term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of such policies. AUTHORIZED REPRESENTATIVE PRESIDENT ENDORSEMENT #5015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 10-23-97 IS ATTACHED TO AND FORMS A PART OF THIS POUCY. NAME OF ADDITIONAL INSURED: CARLSBAD CROSSROADS LTD HISAMITSU PHARMACEUTICAL COMPANY EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COST: $1,000,000 PER OCCURRENCE. ENDORSEMENT *2065 ENTJTLH5 CERTIFICATE HOLDER'S NOTICE EFFECTIVE 10-23^7 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER r PREVOST CONSTRUCTION INC 9883 PACIFIC HTS BLVD STE J SAN DIEGO CA 92121 NR IS DOCUMENT H 2KKIS1M1;SCIF 10262 (REV. 3