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Home My WebLink About1375 SHOREBIRD LN; TP; CB993078; Permit08/17/1999 Job Address: Permit Type: Parcel No: Reference #: Project Title: Applicant: City of Carlsbad Electrical Permit Permit No:CB993078 Building Inspection Request Line (760) 438-3101 1375 SHOREBIRD LN CBAD St: TP ELEC Lot#: 0 TEMP POWER-BELLA LAGO Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 08/17/1999 JM 08/17/1999 08/17/1999 3014 08/17/99 0001 01 02 fs TEMP POWER SERVICE C-ffiHT 20-00 750 N CITRACADO PRKWY ESCONDIDO CA 92025 760-439-1995 Total Fees: $20.00 Electric Issue Fee Single Phase per AMP Three Phase per AMP Three Phase 480 Per AMP Remodel/Alteration per AMP Remodel Fee Temporary Service Fee Test Meter Fee Other Electrical Fees TOTAL PERMIT FEES Total Payments To Date: FINAL APPROVAL Date:~(-~ Balance Due: Clearance: $10.00 $0.00 $0.00 $0.00 $0.00 $10.00 $0.00 $0.00 $0.00 $20.00 $20.00 NOTICE: Please take NOTICE that approval of your project includes the 'Imposition' of fees, dedications, reservations, or other exactions hereafter collectively referred to as 'fees/exactions.' You have 90 days from the date this perm~ 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 fees/exactions of which ou have reviousl been iven a NOTICE similar to this or as to which the statute of limitations has reviousl otherwise ex ired. CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161 PERMIT APPLICATION FOR OFFICE USE O~ ~ PLAN CHECK NO. Tf 078 CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760) 438-1161 EST. VAL. _________ _ Plan Ck. Oeposi,t~=--,...-----.,-- Validated BY_.!...J.:..(,A.L>,c,---,,~',-,"'7~,-:: Date, _________ _.<H-l---o/--1.,-, 1. P~ECT INFORMATION 1 /I I 15 SiloRe-.e,1r12~ LN- 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 f£/..-1rfJ Description of Work Pow£/<. SQ. FT. #of Stories # of Bedrooms # of Bathrooms 2. CONTACT PERSON Of different from applicant) Name 3. Name Address lfoN£'1 I. 5. CONTRACTOR -COMPANY NAME City D Owner O Agent for Owner -;e A-c IM:J P. or City State/Zip Telephone# Fax# C <WOl.tJJ C/1 State/Zip (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]). --T'£MP PAA0Z S'.Y.Sn;;-Mf 75,:, AJ, c mfAc(tt)o PKY S:'!£ 'I £!'CtJ,1101pp <fJlffi'> ~71P4) '139-l?'i'i Name Address City State/Zip elephone # State License# 4:B.393 3, License Class c__ /(j City Business License# 120/~ Designer Name Address City State/Zip Telephone State License # _________ _ 6. WORKERS' COMPENSATION Workers' Compensation Declaration: l hereby affirm under penalty of perjury one of the following declarations: O 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. O 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 _____ _,C.=·~AJ..,_~/t_,_ ___________ _ PoHcy No. /07 '78iJJ.JiS '/ {THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) Expiration Date / 0 · / · f 5' D 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. or era' compensation coverage la unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred ttion to the cost of compensation, damages u provided for In Section 3706 of Labor code, interest and attorney's fen. DATE \1• l'J'i°'j' 7. D I, as owner of th r perty or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sate {Sec. 7044, Business and Professions Code: The Contractor's license Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's license law). 0 I am exempt under Section ______ Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO 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 I address I phone number I 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 I phone number/ contractors license number); ________________________________________________ _ 5. I will provide some of the work, but 1 have contracted (hired) the following persons to provide the work indicated (include name / address / phone number I type of work):. ___________________________________________________________ _ PROPERTY OWNER SIGNATURE ________________________ _ DATE __________ _ COMPLETE THIS SECTION FOR NON./IESIDEN71AL BUILDING PERMITS ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 0 YES 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? D YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 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 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 ______________________ _ 9. APPLICANT CERTIFICATION I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the Citt of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST All LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is reQuired for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such per · · ot comma ed 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 aft ork is c enced for a penod of 180 days {Section 106.4 4 Uniform Burldmg Code)(\ APPLICANT'S SIGNATURE -',=/:R'""'i~ll'.a==--======----------DATE L11J~ )1 l'l55 WHITE: File YELLOW: Applicant PINK Fmance