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Home My WebLink About2562 STATE ST; D; CB163021; PermitCity of Carlsbad , 1635 Faraday Av Carlsbad, CA 92008 Plumbing/Mechanical/Electrical (PME) Permit 09-08-2016 Permit No: CB163021 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: PC#: 2562 STATE ST CBAD St: D PME 2031012900 Project Title: OPTUM: INSTALL 4 ELECTRICAL Status: Lot#: 0 Applied: Entered By: Plan Approved: Issued: Inspect Area: OUTLETS FOR WALL MOUNTED COMPUTER SYSTEMS IN EXAM ROOMS Applicant: Owner: JACOB WEBSTER IT 1236 PORTOLA AVE TORRANCE CA 90501-2611 210-702-7852 Plumbing Fees Electrical Fees Mechanical Fees Other PME Fees TOTAL PERMIT FEES 185 ASYLOM ST HARTFORD CT 06013 860-702-5918 ISSUED 08/08/2016 SLE 09/08/2016 09/08/2016 $0.00 $163.00 $0.00 $0.00 $163.00 Total Fees: $163.00 Total Payments To Date: $163.00 Balance Due: Inspector: FINAL A~ Date: -1 Clearance: $0.00 NOTICE Aease ta<e CE ,qro,,a dyrur prtjed irdLXles tt-e "'lrrp;sti ,. d fee,s declcaicrs, resa-vatia-o, or ether <><a::ticrs -roledively rasredto as 'fees'<><a::ti :· ou t-aveOOdaysfroTitt-edate ttis penrit W3S iss..edtoprctest ifll'.)OSitior, dtt-esefees'exediOl"ls-If yru prctest thn\ yru m..ot fcllo.vthe ,:retest J>O(ll(ires set forth in G:Mnmrt Code Sedioo 68J2J(a), !I"<! filett-e ,:,ctest !I"<!~ ctherreq.ired irif<:m"moowthtt-eatyM.-,agerfcr ~rg ;, , amcit oa ,.;tt, 031sboo M.rlicipa Code SediOl"l 3.32.030. Falu-etotirreyfcllo.vtrat prooocl.rewll ba' ~subseQ.Jert lap ectioo to attack, revi~ Sil 35i00, vcid, cr anJ treir illfX)3it\on. You ere here!>,' Fl.RTl-ER N'.JTIRED trat )<U rig-I to prctest tt-es,a:ified fees'<><a::ticrs DCES NCIT APPLY to "'3ter !I"<!"""" ooonedioo fees !I"<!~ dH"9'5, nor ?arirg zcrirg g,drg or ether sinrilar ap?ic:aioo ~rg cr ,..,,;ce leas in cm,ectior, wth tns prtject. t-rn DCES IT l>ff'l Y to~ vJi ·m1 tov.h' Ii THE FOLLOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: □PLANNING □ENGINEERING □BUILDING □FIRE □HEALTH OHAZMATIAPCD Building Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 email: building@carlsbadca.gov www.carlsbadca.gov Plan Check No. Est. Value Plan Ck. Deposit JOBADDR~t.. CT/PROJECT# EXISTING USE APPLICANT NAME EMA\L PROP0SED USE GARAGE {SF) I~ FAX STATE LIC. # PATIOS (SF) DECKS (SF) PROPERTY OWNER FIREPLACE YESQ_N<Q SWPPP CONSTR. TYPE OCC. GROUP AIR CONDITIONING FIRE SPRINKLERS YES □No □ YES□No□ ZIP ,1,t./. {Sec: 7031.5 Business ~nd Profes~ions Code: Any City or Coun_ty which requires a permit to.c_onstruct, alter, improve, demolish or repair any structure, prior t~ its isst,ia ce, also re~ui[es 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 fuat he is exempt therefrom, and the basis for the alleged exemption. Any v1olat1on 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)). WORKERS' COMPENSATION Workers' Compensation Declaration:/ hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-Insure for worl<ers' compensation as provided by Section 3700 of the labor Code, for the performance of ttie worl< for which this permit is issued. ~andwlll maintain wo 'comp saUo req · by ection 3700ofthe Labor Code, for the pertormance of e work for which this permit i · sued, Myworkers'compensation in r number are: lnsurance Co. ' Poi:cy No. _ _c,c,.,,c....,,;~.u-<.L....L_,_C.-__ Expiration Date _--,,'-,'-''.,'C,,~'---- ~section need not be corrpleted if the permit is for one hundred dollars ($100) or less LJ Certificate of Exemption: I certify that in the performance of the worl< 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' mpensatlon coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thous d dollars (&100,000), in addition to the cost of compensation, damages a for ion 3706 of the Labor code, interest and attorney's fees. ,.NS CONTRACTOR SIGNATURE I hereby affirm that I am exempt from Contractor's Ucense Law for the following reason: □ □ □ I, as owner of the property or my employees with wages as their sole corrpensation, 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 wtio builds or improves thereon, and who does such worl< himself or through his own employees, provided that sucli improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden Of proving that he did not build or improve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor's License Law), I am exempt under Section _____ ,Business and Professions Code for this reason: 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement Oves 0No 2. I (have I 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 I phone I oontractors' license number): 4. I plan to provide portions of the work, but I have hired the following person to ooordinate, supervise and provide the major work (include name / address I phone/ contractors' ~cense number): 5. I will provide some of the work, but I have contracted (hired) the fol~ing persons to provide the worl< indicated (include name I address I phone I type of work): ..65 PROPERTY OWNER SIGNATURE □AGENT DATE ... COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY Is the a~icant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk man&Jement ar.d prevention program under Sections 25505, 25533 or 25534 of the Presley-'tanner Hazardous Substance Account Ac(! □ Yes □ No Is the applicant or future building occupant required to obtain a permit from the air pollution control d'strict or air quality man,;ljJement 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. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read the appllcation and state that the above Information Is correct and that the infonnatlon on the plans is accura1e. I agree to complywilh all City ordnances and State 1av.s relating to building construction. I hereby aulhorlze representatiVe of the City of Garlsbad to enter up::m the aOOve mentioned property br insi=,ectkrl pul'JX)SeS, I ALSO AGREE TO SAVE, INDEMNIFY AfJD KEEP HARMLESS THE CrTY OF CARLSBAD AGIIINST ALL LIABILITIES. JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AG<\INST SAID CITY IN CONSEQUENCE OF THE GRANTING Of THIS PERMIT. OSHA: MOSHA pem,~ is required brexcavations over 5'0' i...q1i>o<,rn.,..trudion of structures over 3 stories i1 height EXPIRATION: Every permit issued by the Buildin u s of th IS Code shall expire by lknitation and berome null and void Wthe building orv-.ork authorized by sudl permit IS not oommenred within 100days from the date of sudl permit or i uildi by sudl permit is suspended or abandoned at any time after the 'MJl1< is oommenred for a period of 180 days (Section 100.4.4 Uniform Building Code) . ..@S' APPLICANT'S SIGNAT DATE ,# t -/f:. 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 building@carlsbadca.gov or Mail the completed form to City of Carlsbad, Building Division 1635 Faraday Avenue, Cartsbad, 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. DEL.NERY OPTIONS PICK UP: □ CONTACT (listed above) o OCCUPANT (Listed above) o CONTRACTOR (On Pg. 1.) MAIL TO: □ CONTACT (Listed above) o OCCUPANT (Listed above) □ ASSOCIATED CB#•------------- o CONTRACTOR (On Pg . .1) □ NO CHANGE IN USE/ NO CONSTRUCTION MAIL/ FAX TO OTHER: _______________ _ □ CHANGE OF USE/ NO CONSTRUCTION A$ APPLICANT'S SIGNATURE DATE Inspection List Permit#: CB163021 Date Inspection Item_ 09/28/2016 34 Rough Electric 09/28/2016 34 Rough Electric 09/28/2016 39 Final Electrical Thursday, September 29, 2016 Type: PME Inspector Act RI PY AP PY AP OPTUM: INSTALL 4 ELECTRICAL OUTLETS FOR WALL MOUNTED COMPU Comments AM PLEASE Page 1 of 1