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Home My WebLink About2180 RUTHERFORD RD; ; CBC2021-0418; Permit                                                                  (Cityof Carlsbad City of Carlsbad_ COMMERCIAL BUILDIN G PERMIT APPLICATION 8-2 Plan CheckCBC2021-0418 Est. Value PC Deposit Date 11/2/21 Job Address 2180 Rutherford Rd , Carlsbad, CA 92008; San Diego County Suite: APN: 212-070-2500 ----- Tenant Name: Verizon Wireless Lot#: Year Built: _____ Occupancy: ____ _ □0 □0 Construction Type_· _____ Fire Sprinklers: yes no A/C: yes no BRIEF DESCRIPTION OF WORK: Verizon to modify its existing cell site on rooftop of building D Addition/New:_n_a ___________ New SF and Use,_n_a ___________ New SF and Use, ____ Deck SF, Patio Cover SF (not including flatwork) D Tenant lmprovement :_N_A _____ SF, Existing Use_c_el_l s_it_e ____ Proposed Use _n_a _____ _ ______ SF, Existing Use Proposed Use ______ _ D Pool/Spa:_n_a ____ SF Additional Gas or Electrical Features? _n_a ___________ _ DD DD □□ D Solar: ___ KW, Modules, ___ Mounted, Tilt: Yes/ No, RMA: Yes/ No, Panel Upgrade: Yes/ No D Plumbing/Mechanical/Electrical Only: ---------------------------- □ Other: This permit is to be issued in the name of the Property Owner as Owner-Builder, licensed contractor or Authorized Agent of the owner or contractor. The person listed as the Applicant below will be the main point of contact throughout the permit process. PROPERTY OWNER APPLICANT [!) PROPERTY OWNERS AUTHORIZED AGENT APPLI CANT 0 Na me: Callaway Golf Company Address:2265 Rutherford Road City: Carllbad State:_C_A __ Zip:92008 Phone: (949) 556-7060 Email: ehiggins@tectonicengineering.com DESIGN PROFESSIONAL Name: Tectonic Engineering Consultants, Address: 2415 Campus Dr.Suite 265 APPLICANT 0 City: Irvine State:_C_A __ Zip: 92612 Phone: 949-502-8555 Emai I: ehiggins@tectonicengineering .com Architect State License: CA44343 ------------ Name: Verizon Wireless/ Tectonic Engineering Address: 2415 Campus Dr.Suite 265 City: Irvine State:~Zip:_9_26_1_2 __ _ Phone: 949-502-8555 Email: ehiggins@tectonicengineering.com CONTRACTOR BUSINESS Name: CIK Power Distributors Address: 240W. Grove Ave. APPLICANT 0 City: Orange State: CA Zip:_9_28_6_5 ___ _ Phone: 877-245-7697 Email: S.carter@CIKpower.com / 8.Jott,JS#,J (6.. Ctl< f~'411f.A , CP/t-1 State License:_96_9_72_9 ____ Bus. License: ______ _ 1635 Faraday Ave Carlsbad, CA 92008 B-2 Ph: 760-602-2719 Fax: 760-602-8558 Email: Building@carlsbadca.gov Page 1 of 2 Rev. 08/20 IDENTIFY WHO WILL PERFORM THE WORI{ BY COMPLETING (OPTION A) OR (OPTION B) BELOW: (OPTION A): LICENSED CONTRACTOR DECLARATION: I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 7000} of Division 3 of the Business and Professions Code, and my license is in full force and effect. I also affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a certificate of consent to self-insure for workers' compensation provided by Section 3700 of the Labor Code, for the performance of the work which this permit is issued. Policy No. ________________________ _ ~ 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 workers' compensation insurance carrier and policy number are: Insurance Company Name: ..,,.,.,,..,,T-;,,-,h-,,e.,....H-a-r_t-fo_r_d ___________ _ Policy No. 72UEAQI0517 Expiration Date: __ 1_0_11_2_12_0_2_2 ______________ _ 0 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 worke rs' 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 $100,000.00, in addition the to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. CONSTRUCTION LENDING AGENCY, IF ANY: 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: ____________________ _ CONTRACTOR PRINT: Brian L. Johnson SIGN: 3,uc;..n.-L ~LX-<Wn-DATE: _4_,,_s,_20_22 _____ _ (OPTION B): OWNER-BUILDER DECLARATION: I hereby affirm that I am exempt fram Contractor's License law for the following reason: 0 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). 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 Business and Professions Code Division 3, Chapter 9, Article 3 for this reason: 0 "Owner Builder aclmowledgement and verification form" has been filled out, signed and attached to this application. Proof of identification attached. 0 Owners "Authorized Agent Form" has been filled out, signed and attached to this application giving the agent authority to obtain the permit an the owner' behalf. Proof of identification attached. By my signature below I acknowledge that, except tor my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner-builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site: http://www.leginfo.ca.gov/calaw.html. OWNER PRINT: SIGN: _________ DATE: ______ _ APPLICANT CERTIFICATION: SIGNATURE REQUIRED AT THE TIME OF SUBMITTAL By my signature below, I certify that: I am the property owner or State of California Licensed Contractor or authorized to act on the property owner or contractor's behalf. 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 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 ANYWAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations aver 5'0' deep and demolition or construction of structures over 3 stories in height. APPLICANT PRINT: Emanuel Higgins SIGN:C~d~DATE: 10/19/21 1635 Faraday Ave Carlsbad, CA 92008 Ph: 760-602-2719 Fax: 760-602-8558 Email : Building@carlsbadca.gov B-2 Page 2 of 2 Rev. 08/20                                          {city of Carlsbad