Loading...
HomeMy WebLinkAbout2855 CARLSBAD BLVD; ; CB973802; PermitBUILDING PERMIT 12/12/97 14:38 Page 1 of 1 Job Address: 2855 CARLSBAD BL Suite: Permit Type: ELECTRICAL Parcel No: 203-231-01-00 Lot#: Valuation: 0 Occupancy Group : Permit No: CB973802 Project No: A9704903 Development No: Reference* : Description: ELECTRIC LINE OT 18" DEEP : FOUNTAIN Appl/Ownr : MISSION POOLS 755 W GRAND AVENUE ESCONDIDO CA 92025 *** Fees Required *** Construction Type: NEW : ISSUEDa Apr/Issue: Entered By: JM 760 560-2935 Collected & Credits Fees: Adjustments: Total Fees: Fee description Enter "Y" for Ele Enter "Y" for Rem * ELECTRICAL TOTA 20 ts .00 .00 20.00 Ext fee Data 10.00 Y 10.00 Y 20.00 ** * FINAL APPROVAL INSP, CLEARANCE CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 FOR OFFICE USE ONLY PLAN CHECK NO.' EST. VAL. Plan Ck. Deposit Validated By. Date •* PL/SO Address (include Bldg/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 # of Bedrooms # of Bathrooms Name Telephone #Pax # Name Address City State/Zip Telephone # f^T fir- 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 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, end 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]).uJ. Name State License # Address License Class City State/Zip City Business License t Telephone # Designer Name State License # Address City State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: n 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. 53- 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 ' ( / Xissued. My worker's compensation insurance carrier and policy number are: Insurance Company Policy No Expiration Date (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*100] OR LESS) O 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 ts unlawful, and shaH subject an employer to criminal penalties and civil fines up to one hundred thousand dollars WIOO.OOT^in addition'to the dpst of compensation, damages as provided for In Section 3706 of the Labor1 coda^lMerest and attorney's fees. SIGNATURE \ Kt^T^Y^ DATE ~ I hereby affirm that I am exempt from the Contractor's License Law for the following reason: n 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 sate. 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). Q 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 I »m 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 and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Q YES D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? O YES Q NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES O 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 OFRCE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I hereby affirm that there-is a c LENDER'S NAME sjfuction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). _... LENDER'S ADDRESS I certify that 1 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 CrtV 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'Q" deap 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 —, .___.. -. s "srlfte work Ss^ommeneed for a period of 180 days (Section 106.4.4 Uniform Building Code). I1) /&^7»VC OATE WHITE: File YELLOW: Applicant PINK: Finance or abandoned at anytime after APPLICANT'S SIGNATURE A«VoKl>. CERTIFICATE OF INSURANCE ISSUE DATE (MIMXWY) 03/18/97 PRODUCER TIMOTHY S. MILLS INSURANCE SERVICES, INC. P.O. BOX 86259 SAN DIEGO CA 92138-6259 INSURED Mission Pools of EscoodHo Inc Dunn Brothers Leasing, Et al 755 West Grand AvenueEscondklo CA 92025-9990 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS HO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY LETTER COMPANY D LETTER D COMPANY f\ LETTER ° COMPANY n LETTER U COMPANY C LETTER c Zenitti insurance Company UUVcHAutb -' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THiS CERTIFICATE 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. UMlTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POUCY NUMBER POUCY EFFECTIVE POLICY EXPIRATION DATE (MMTO/YY) DATE (MM/DD/YY) GENERAL LIABILITY COMMERCIAL GENERAL L1ABIUTY '•:'•>. '" CLAIMS MADE "" OCCUR. OWNER'S & CONTRACTOR'S PROT. ; AUTOMOBILE LIABILITY " ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS " "^ NON-OWNED AUTOS ', OARAGE LIABILITY EXCESS LUBIUTY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND EMPLOYERS'LUBIUTY "OTHER "" UMITS GENERAL" AGGREGATE PRODUCTS-COMP/OP AGG. PERSONAL & ADV. INJURY EACH OCCURRENCE FIRE DAMAGE (Any one fire) MED. EXPENSE (Any one person) COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE EACH OCCURRENCE AGGREGATE Z042038802'04/05/97 04/05/98 X STATUTORY LIMITS EACH ACCIDENT " S DISEASE • POLICY LIMIT S DISEASE - EACH EMPLOYEE $ DESCRIPTION OF OftERAT1C^SAiK^TK)NSAfEHCLES«PEClAL fTEWS Re; All operations of the named insured. "10 Days Notice of Cancellation for Non-Payment of Premium. 1,000,000 1,000,000 1, ooo7ooo CERTIFICATE HOLDER CHy of San Diego Bug Inspection Dept MS 301 1222 First Avenue San Diego CA ACORD 25-S (7/90) 92101 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENQBWO&WiSXXXXXXXX MAIL 30 *DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BMX>6WXJee(J»>«l(K KW»RXRW8fX^:KmX^'EXCEPT 10 DAYS FOR NON PAYMENT OF PREMIUM AUTHORIZED REPRESENTATIVE ~~ S-©ACORD CORPORATION 1990