Loading...
HomeMy WebLinkAbout1050 GRAND AVE; MULTI-PERMIT FILE; CB151916; PermitCity of Carlsbad S 1635 Faraday Av Carlsbad, CA 92008 Plum bIng/MechanIcal/ElectrIcal (PME) Permit 07-01-2015 Permit No: CB1 51916 Building Inspection Request Line (760)'602-2725 Job Address: 1O5O GRAND AVCBAD Permit Type: PME Status: ISSUED Parcel No 2031302000 Lot #: 0 Applied 06/22/2015 Entered By: RMA Reference #: Plan Approved: 07/01/2015 PC #: . ., Issued: 07/01/2015 Inspect Area: Project Title: EXTENDED STAY AMERICA- ADD BATTERIES FOR PEAK DEMAND SHAVING-ENERGY MANAGEMENT SYSTEM W/ 60 AMP BREAKER & DISCONNECT / * 0 Applicant: . . ., owner: STEM INC ES H/E S A PROPERTIES L L C 100 ROLLINS RD POB 49550 PROP TAX MILLBRAE CA 94030 . - CHARLOTTE, NC 28277 415 937-7863 Plumbing Fees .$0.00 Electrical Fees $160.00 Mechanical Fees . $0.00 Other PME Fees $107.50 TOTAL PERMIT FEES $267.50 Total Fees: , $267.50 Total Payments To Date: $267.50 Balance Due: , .$0.00 Inspector ______ FINAL Clearance NOTICE: Please take NOTICE th 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 permit 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 capacity changes, nor planning, zoning, grading or othersirniIar application processing or service fees in connection With this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this or as to which the statute of limitations has previously otherwise expired S S•S S. •S •..S .ITHE FOLCOWING APPROVALS REQUIRED PRIOR TO PERMIT ISSUANCE: DPLANNING DENGINEERING., E]BUILDING FIRE ELTH DHAZMAT!APCD Building Permit Application Plan Check No City of 1635 Faraday Ave., Carlsbad, CA 92008 Est. Value l. Ph:.760-602-2719 Fax: 760-602=8558 C Ck.arlsbad -: - eil:bUildingcasbadca.gov Plan ePos Date'IswPPPS JOB ADDRESS : - SUiTE#/sPACE,/UNra - APri qj cO -o.A ,T/PROJECT #. LOT # .. PHASE # # OF UNITS # BEDROOMS P BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE 0CC. GROUP DESCRIPTION OF WORK: Include Square Feet of Affected Area(s) - .. PML iA c -4w. lot- oti 84tM% 7tb &Hiz /iUui EXISTING USE PROPOSED USE,GARAGE (SF) PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES#. NO[:]YES DNO YESE NOE APPLICANT NAME PROPERTY OWNER Primary C ADDRESS F?c1wfr ADDRESS Letu STATE ' CITY .. . --' ST E - ZIP .. CITY -- r . -. . ZIP '-k 4(:-..: c-•- ' •. PHON , FAX - PHONE g-)or EMAIL . . . . . - EMAIL . . .,. . kpji'L. sie co", DESIGN PROFESSIONAL - - - CONTRACTOR BUS. NAME : ADDRESS ADDRESS Yo Lu k I' CITY , . STATE . ZIP r CITY ST E . IP - llt6ltAf- 1, 11 . ' PHONE. FAX --. PHONE FAX . EMAIL - . ' . - -' EMAIL .- _____________ - . . STATE LIC. P - .- '. STATE LiC.# - C CITY BUS. IJC. ., : •-. .,: -:- - .-- 1N ___I/o . (Sec. 7031.5 Business and Professions Code: Any City or County which requires a pérmitto construct, alter, improve, demolish or repair any structure, prior to its iss1lsO ru,reVhe -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 Secti OO of D eq ivision 3 of the Business and Professions Code) or.that he is exempt therefrom, and the basis for the alleged exemption -Any violation ofSection 7031.5 by any applicant for a permit sijects the applicant to a civil penalty of not more than five hundred dollars ($500)). . .. . . L Workers' Compensation Declaration: I hereby affirm under penally, of perjury one of the following declarations: Ell have and will maintain a certificate of consent to sure for workers compensation as provided by Section 3700 of the Labor Code for the performance of the work for which this permit is issued 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 i issued My workers compensation sum ce rand policy number are Insurance Co t Policy No Expiration Date &1/A/171, - This section need 001 be completed if the permit is for one hndmd dollars ($100) or less. - [J 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 éránnér so as to become subject' to the Workers' Compensation Laws of California. - WARNING: Failure to secure workers' compens ti o coverage! unlawful, an - subject an employer to criminal penalties and civil fines upto one hundred thousand dollars (&100,000), In addition to the cost of compensation,*magyip,provid ectton 3706 of or code, interest and attorney's fees. . CONTRACTOR SIGNATURE S - • - - . -, - AGENT - - - DATE - '- - - - - thereby affirm that lam exempt from Contractor's License Law for the following mason: - - - - . ..: , • -- - S - S • - - [] I, as owner of the properly or my emloyees with wages as their sole 'compensation: v,ilido the work and the structure is not intended or offered for sale (Sect 7044, Business and Professions Code: The Cénlractor'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. It, 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.irnprove for the purpose of sale).- - - - [] I, as owner of the properly, 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 j. properly who builds or improves thereon and contracts for such projects with conlractor(s) licensed pursuant to the Contractor's License Law) i:i I am exempt under Section Business and Professions Code for this reason 1. I personally, plan to provide the maj0r labor and materials for consfruction of the proposed property improvement. ,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 address / phone I contractors' license number): ------------ * S -- 4 I plan to provide portions of the work bull have hired the following person to coordinate supervise and provide the major work (include name I address / phone /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 I type of work) ..'PROPERTY OWNER SIGNATURE []AGENT DATE - •' ,-- - --•- • ;. -.1- S--S.-- :- - - - • ----5- • - - Is the applicant or future building occupant required to submit a business pIagcety hazardous materials registration form or risk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? : YesI No - Is the applicant or future building occupant required to obtain a permit fromOTC& pollution control district or air qu,pttyrianagement district? i-,.. Yes N Is the facility to be constructed within 11,000 feet of the outer boundary of a school site? Yes INV IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNL!SS 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 there is a construction lending agency for the performance of the work this permit is issued (Sec. 3097 (i) Civii Code). Lender's Name - - Lenders Address I certify that l haviread the application and state that the above information is correct and that the information on the plans is accurate. I agree to complywith 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 INCONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA An OSHA permits required for excavations over 59 deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the Building OffCial under the provisions of this Code shall expire by trnitaion and become null and void if the building or work authorized by such permit is not commenced within 180 days from the date of such permit or if thl rig or work th by such permit in suspended or abandoned at any time after the work is commenced for a period of 181) days (Section 1.4.4 Uniform Building Code). APPLICANT S SIGNATURE / DATE - 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 buiIdinp)CarIsbadca.gov or Mail the completed torn, to City of Carlsbad, Building Division 1635 Faraday Avenue, Carlsbad, California 92008. F #: (Office Use Only) CONTACT NAME .- '- . . . OCCUPANT NAME -. ....... . .. ADDRESS BUILDING ADDRESS CITY STATE ZIP CITY STATE ZIP ............... . . - . . : Carlsbad CA - PHONE - .. . ' MAX EMAIL OCCUPANTS BUS LIC No DELIVERY OPTIONS PICK UP: . CONTACT (Listed above) OCCUPANT (Listed above) ' :CONTRACTOR (On Pg. 1.) # MAIL TO: CONTACT (Listed above) f' OCCUPANT (Listed above) t ASSOCIATED CB 3 CONTRACTOR (On Pg. 1) . . .. .. NO CHANGE IN USE / NO CONSTRUCTION MAIL/ FAX TOOTHER: CHANGE OF USE / NO CONSTRUCTION ..APPLICANT'S SIGNATURE . . . -. DATE 4 :,. EsGil Corporation In ai ejfiiP with covernment for tBui(iing Safety DATE: July 1, 2015 •.:. J APPLICANT JRIS. JURISDICTION: Carlsbad D PLAN REVIEWER 0 FILE PLAN CHECK NO.: 15-1916 SET: 1 PROJECT ADDRESS: 1050 Grand Avenue PROJECT NAME: 18 kW STEM Power Peaker El The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's codes. The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. The applicant's copy of the check list has been sent to: EsGil Corporation staff did not advise the applicant that the. plan check has been completed. El EsGil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone #: Date contacted: • (by: ) Email: Mail Telephone • Fax In Person REMARKS: The applicantto add the clouded Note to the remaining plan sets. By Eric Jensen • .. Enclosures: . EsGil Corporation . LI GA LI EJ LI MB LI PC 06/22 9320 Chesapeake Drive, Suite 268 • San Diego, California 92123 • (858) 560-1468 • Fax (858) 560-1576 Carlsbad 15-1916 July 1, 2015 [DO NOT PAY- THIS IS NOTAN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION Carlsbad PLAN CHECK NO 15-1916 PREPARED BY Eric Jensen DATE July 1, 2015 BUILDING ADDRESS 1050 Grand Avenue BUILDING OCCUPANCY BUILDING PORTION AREA (Sq. Ft.) Valuation Multiplier Reg. Mod. VALUE ($) Air Conditioning Fire Sprinklers TOTAL VALUE ; 7TT'7. . W • • • . , . . . * ••• • 0 • • 4 , w • • . S • • _ w4 . . __ - w • ••s. a a ç • • • •L L w . • • a • , * , r• • • • • . . a w • • . . * . ••. S 'ci•L. • • • a - - • • PowerStore.; 08, Installation Guide -- PowerStore Model 400 . p W PowerStore Model 410 ---- - - 4 r. .4 ', • ••. . . .. . , •1 , • L• • •• • • I • I 0 1.7 c . . r. . . .. . • • • • • . , . j• 40 0 j. 6qq Ile 1. • • • • * 4 9 a • ' • • 9 . • . •• •• • . . . . 9. t. , I fr• . , . 9. 9 f I 9 9 • • . . C • • C 4ft a stein Document Number: 800-1740017 100 Rollins Road 415 894 9797 © 2013 Stem, Inc. All rights reserved. Millbrae, California 94030 stem.com CbS't9tA City of Carlsbad I 1635 FaradayAv Carlsbad, CA 92008 06/19/2001 '. Electrical Permit Permit No CB012094 'Building Inspection Request Line (760) 602-2725 1,0 . S ',Job Ad tO2&QRANDAVCBAD ) Permit Type ELEC . Status ISSUED Parcel No Lot # 0 Applied 06/19/2001 Entered By JM Reference # s Plan Approved 06/19/2001 Issued 06/19/2001 Project Title: : EXTENDED STAY. AMERICA: . . .' . . Inspect Area: Applicant: Owner:.' MAGNUM ENTERPRISES 2 ANAHIEM CA 92801 515 W. WOODLAND DT 000201 02 20-00 Total Fees: $20.00 Total Payments To Date: Z$0.00 \ Balance Due: $20.00 Electric Issue Fee' ' cz- Single Phase per AMP Z .. 0 . .. . .;., . ' (—$0.00 t .. ' Three Phase per AMP ,fl Three Phase 480 Per 0/ 0 ' \$000 per AMP 0 $0.00Remodel Fee $0.00 ) r Temporary Service Fee . , . ' . $10.00 .Test Meter' Fee , . ' ' $0.00 / Other Electrical Fees Additional Fees $0.00 / INCORPORATED / TOTAL PERMIT FEES I. FINAL APPROVAL Inspector -'IC- Date 7/c/al Clearance NOTiCE: Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively rreferred to as fees/exactions." You have 90 days from the date this permit 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 . - T~er~-~ changes, nor planning, zoning, grading or other similar application procesing or service fees in connection with this project NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired. ", ...,.. ". . - . I •, t r ' 4 FOR OFFICE USE ONLY PRMlT1APPLiCATION. - •Y PLAN CHECK CITY OF CARLSBAD BUILDING DEPARTMENT EST VAL. 1635 Faraday Aye, Carlsbad, CA 92008 Validated By / 3 Date 9öçtRMATPR_ Ji Address (md e Bldg/Suite #1 -' Business Name (aihis addre s) - /9 4;lL #1t'i DO SM1I Legal D cription .i . 4 LotNo. - Subdivision Name/Number . .. ' Unit No. Phase No. -Total # of units F a r Assessors Parcel # ' , Existing Use Proposed Use 4 ,. Description of Work .'- -- . . 2 . SQ. FT........ #0f52prie5' -- " # of Bedrooms . # of Bathrooms 7?7 ' " applicant) 7/yf J-7/e -.'Name ___Address __7 City c71r,.i- State/Zip Telephone #•__' _...L L3 APor Con_rpctor fl enforontractor fl nor D i'Tor net 4 ......7/g1/ Name ( Address City State/Zip Telephone '# 4 41t1 PROPEFQWNER / 4Z _-_- ' Name Address C-' City State/Zip Telephone # ' IR (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, commendirg ith Seciion7000 of. Division 3 of the Business and Professions Code] -or.that he is exempt therefrom, and the basis for the alleged exem tion. Any violation of Se'ction 7031.5 by any applicant f0r apermit subjects the a licant to a civil penalty oil not more than five hundred dollars ($5001). /k6M1n1_ptc-_(AF 2c'5 £'/mI &_nAG __cU_9?itti_J// N e Address, City ., State/Zip ,Telephone # - 'State License # ',"3I'_$77 * 'License Class ' ____• _- '. City Business License '# Designer Name Address 7 City State/Zip Telephone State License # - WQKER AT1L a — ' T - - - - z Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations 0 I have and will maintain a certificate of consent self insure for worke's compensation as provided by Section 3700 of the Labor Code for the performance of the work for which this permit is issued , -" $ 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 compens,tion insurance carrier and policy nuber are ' Insurance ... Polic No:/37? ___'t'_-'' _, -Expiration Datec//Ic?2_ (THIS SECTION NEED NOT BE COMPLETED IF.THE PERMIT IS F0RONE HUNDRED DOLLARS ($100) OR LESS) 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 Tapper so as to become 'subject to the Workers Compensation Laws of California - - WARNING: Failure t sec e wo;ke compensation coverage is unlawful, and shall 'subject an employer to criminal penalties and 'civil fines up to one hundred - thousand dollars ( . 0) ' ' to the cost of compensation, damages as provided for in Section 3706 of.th ebor C e, interest and attorney's fees. SIGNATURE DATE OWNE•LDEROLARATION. I hereby affirm that I am exempt from the Contractors License Law for the following reason: - -- -: - - I as owner of the property or my employee's 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 su'ch'improvemen'ts are not intended or offered for sale, If, ho .,ever, 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,tarn exclusively co0rracting with licensed contractors to construct the project (Sec 7044 Business and Professions Code The Contractor's License Liw does not apply to an owner of property 'who builds orimprovss thereon, and contracts for such projects with contractor(s) licensed pursuant to the Contractor' ontractor s License Law) a 0 I am exempt under Section'-- Business and Professions Code for this reason -. 1 I personally plan to provide th 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 (firml to provide the proposed construction (include name I address /'phone number / contractors license number): - - . . - - - - <--' - 4 I plan to provide portions of the work but :l, have hired the folloving pers'on to coordinate supervise and provide the major work (include name / address / phone -. number I contractors license number(: _____________... 5. I will provide some of the work, but l.hav'e contracted (hired) the follwing per to provide the work indicated (include name / address / phone number/ type of work): - - - I PROPERTY OWNER SIGNATURE'-- __.________. ______. _.-,-'- _- - DATE 77Agg. -EL 3 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, 2553i. or 25534 of the Presley Tanner Hazardous Substance Account Act? 0 YES 0 NO lathe applicant or future building occupant required to obtain a permit from the ai pollution control district or air quality management district? 0 YES 0 NO Is the facility to be constructed within 1 000 feet of the outer boundary of 'a school site? -[].,YES 0 NO a. a IF ANY OF THE ANSWERS ARE YESA 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." -. '--- - SIt I hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is issued (Sec 3097(m) Civil Code) v - - •LENDER'S NAME - __- ___-- __- - LENDER'S ADDRESS _•, _---- _..- _a .--' _ r9APNLRIcflPN — in I certify that I have read the application and state that the above information is correct ad that the mnformiation on the plans is accurate I agree to comply with all City ordinances: and State laws relating to building construction. I hereby, authoriierepresentative's of the'Cit, of Carlsbad to enter upon theabov'meniioned property for inspection purposes'. - I ALSO AGREE TO. SAVE, INDEMNlFY'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 buildi icial undr the provisions of this Code shallexpire by limitation and become null and void if the building or work - - authorized by such permit is not commenced w in 1 0 days am the date of sudl permitor if the buildingor work authorized by such permit is suspended or abandoned- - - at any time after the work is commenced fo r d 5 (Section 106.4.4 Uniform Building Code) -APPLICANT'S SIGNATURE __-___,- _ ,.DATE'__'.72'__ - - r- - - ,-•, - -- -. WHITE: File 'YELLOW: Applicant-PINK: Finance - - - - - City of -Carlsbad Bldg Irspection Request For: 07/03/2001 Perrnit# CB012094 0 Inspector Assignment: Title: EXTENDED STAY AMERICA Description: Type:ELEC Sub Type: Phone: 7607998703 Job Address: 1028 GRAND AV Suite:. Lot 0 tr Location Inspector APPLICANT MAGNUM ENTERPRISES Owner Remarks Total Time Requested By GARY Entered By: ROBIN CD Description Act Comments 32 Const. Service/Agricultural fl Associated PCRs Inspection History . Date Description Act insp Comments City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Sign Permit Permit No:CB020300 Building Inspection Request Line (760) 602-2725 kOSt) T026.,,GRAND AV CBAD SIGN 2031303400 Lot #: 0.. $9,500.00 Construction Type: NEW EXTENDED STAY-4 WALL SIGNS W/ ELECT & ELECT TO MONUMENT SIGN Job Address: 2Permit Type: Parcel No: Valuation: Reference #: Project Title Status: ISSUED Applied: 01/30/2002 Entered By: AMA Plan Approved: 01/30/2002 Issued: 01/30/2002 Inspect Area: . Applicant: Owner: -.-'SWAIN SIGN INC EXTENDED STAY CA INC 7 N i384E 5TH ST / 450E LAS OLAS BLVD #1100' ',"ONTARIO CA 91745 '.s ' FORT LAUDERDALE FL 33301 909 460-2530 / 9983 01/30/02 0002 01 02 II COF 184-49 . Total Fees: $184.49 . Total Payments To pate: •$o.00 \., Balance Due: , $184.49 -- . .. Building Permit ., - -.' $99.69 Add'I Building Permit Fee .7 ' $0.00 Plan Check .1 J .. f $64.80 AddI Plan Check Fee '. ....' ,.A ,:* . '•.. $0.00 Electrical Fee ... i / . :. $0.00 RenewalFee '".j ,jJ_ ., I V $0.00 AddI Renewal Fee' '—- $0.00 Other Building Fee f , $20.00 Additional Fees , . . ..' / $0.00 \ I / TOTAL PERMIT FEES, \.. •Icp .... $184.49 / ..-.n -.. . - 1/ V FINAL APPROVAL Date: Clearance: NOTICE: Please take NOTICE that approval of your project includes the "lmposition'f fees, dedications, reservations, or other exactions hereafter collectively '... referred to as "fees/exactions." You have 90 days from the date this permit 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 imposion 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 you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 'S 11, PROJECTINFORMATION . . . . • .•:. FOR OFFICE USE ON PLAN CHECK NOL&ÔZO3OI' EST. VAL. W jcOr .O Plan Ck. Deposit Validated By / Date Address (in?lude 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 Description of Woj4) C *'&4_.\ '-t.r( SQ. FT. #of Stories # of Bedrooms # of Bathrooms kt (1) t1'.Ni- tn1- 2. CONTACT PERSON (if different from applicant) Name Address City State/Zip Telephone # Fax #' APPLICANT - Contractor 0 Agent for Contractor ' 0 Owner 0 Agentfor Owner V?L _(0 ' _O"%O Name - - - Addrest -. City State/Zip Telephor( z) qr-f_ 's' 4 PROPERTY OWNER 7. e.kQAIf/ p ple_p, (s 97-OI Name Address CityU State/Zip Telephone # 5. CONTRACTOR - COMPANY NAME (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 ex S2 tion. 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$5001). - 'c -c..i- . t 1c1- ( c) qo-c3c) Name - Address City - State State License # 1If2,_Ot' License Class City Business License # ame Address City State/Zip Telephone State License # 6....-..W.ORKERSCO?v1PENSATlQN:-.- -:- •.: . - . ,.: .:--:..... ...; . Workers' Compensation Declaration: I 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 workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 ,,/lssued. My worker's compensation insurance cArrier and policy number are: / Insurance Company ''trt,4øsg,... Policy No. _..71Ob1 Expiration Date_________________ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1001 OR LESS) 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 is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (OO, 00), in addit n to the cost of compensation, damages as provided for in Section 3706 of the Lafior cod ej interest and attorney's fees. SIGNATURE . DATE .SO/Of ATION-. . ...... . . - : ..- - :...- .-. .•- . ;--i- .•:----- --------.- I heieby affirm that I am exempt from the Contractor's License Law for the following reason: 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 Contraëtor'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: . I personally plan to provide the major labor and materials for construction of the proposed property improvement. 0 YES ONO I (have / have not) signed an application for a building permit for the proposed work. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number): 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): 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 COMPLETEmls:SEcTIoNFoR-NoNREsIDEN.rIAL- BUILDlNGPERMITSONLY ................- -: •.--H.......:i..:.:..::: : . :- .- - .. - 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 0 NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? 0 YES 0 NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES 0 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.:E: CONSTRUCTION iLENDING iAGENCY --:---.-- ... i:.,......:., ----.• .:-- -. 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 Cit' 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 permit is not cp(llmenced ithiti 180 days from the date of such permit or if the building or work authorized by 213C permit is suspended or abandoned at any time after the work is co nced r pefod 01180 days (Section 106.4.4 Uniform BuildingCode). APPLICANT'S SIGNATUR .\,'' DATE (.1 WHlTEIFile YELLOW: Applicant - PINK: Finance Inspection List Permit# CB020300 Type SIGN EXTENDED STAY-4 WALL SIGNS W/ • ELECT & ELECT TO MONUMENT SIGN Date Inspection Item Inspector Act Comments 07/18/200211 Ftg/Foundation/Piers PS WC NOT REQUIRED UNDER 6 FT 07/18/2002 38 Signs PS AP WALL SIGNS ONLY 07/17/2002 11 Ftg/Foundation/Piers PS NR . ., - 1. - .• . k • • ....... •. : . . .1 '4) . .. .....• • Thursday November 21 2002 Page 1 of I • - -. . -) 4.