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HomeMy WebLinkAbout1057 CANNON RD; ; CB970344; PermitBUILDING PERMIT 02/24/97 14:04 Page 1 of 1 Job Address: 1057 CANNON RD Suite: Permit Type: ELECTRICAL Parcel No: Lot#: Valuation: 0 Occupancy Group: Referenced: Description: ELECTRIC SERVICE PANEL : PACIFIC BELL Permit No Project No Development No CB970344 A9700479 Construction Type: NEW Status: ISSUED Applied: 02/24/97 Apr/Issue: 02/24/97 Entered By: JM Appl/Ownr *** ROBINSON ELECTRIC 8871 TROY STREET SPRING VALLEY, CA 91977 Fees Required *** Fees : Adjustments: Total Fees; Fee description Enter "Y" for Electr Single Phase Per * ELECTRICAL TOTAL 35.0 619 697-6040 Collected & Credits A *** —02- C-PRHT . 00 . 00 35. 00 Ext fee Data 10.00 Y 25. 00 35.00 CLEARANC CITY OF CARLSBAD 2075 Las Primus Dr., Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (619)438-1161 FOR OFFICE USE ONLY PLAN CHECK NO. EST. VAL. Plan Ck. Deposit Validated B; Date Address {include Bldg/Suite #) /Oh 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 Work ^. CONTACT^ERSON & different from applicant] to SQ. FT.# of Bathrooms Name Address City State/Zip Telephone *Fax City State/Zip Telephone * Name Address City State/Zip Telephone # (Sec. 7031.5 Business and Professions Coda: Any City or County which requires a permit to construct, after, 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 70OD of Division 3 of the Business and Professions Coda] or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars 1*500]).' Name Address . ^ . City State/Zip Telephone # State License # Y ^ ' 7 ( 3 License Class ' / / ^ Citv Business License * / ^ G *"** / ^ ^ <?/?~C_ P,-<=.^c_ Designer Name " Address State License # City State/Zip Telephone fcMWQBKEI^COMPeNSAT^^ Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: yQi 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. Q 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 <- /} t~] P ,Policy No.LU 0 7cf ^ // l.'-fO- OS Expiration Date /6 -/- (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*100) OR LESS) Q CERTIRCATE 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 t& secure- workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($TOO,000), in addition to th*£o»t of compensation, damages as provided for HI Section 3706 of the Labor coda. Interest and attorney's fees. SIGNATURE ' ^f - ^O - ( /-- £u\>-S^-er^-~ _ DATE ~2- ~ ^ V" ^ 7 OWNER-BUILDER DECLARATION , -. .- _ ^v -.-_ : ... . •• . -^ir; I hereby affirm that I am exempt from the Contractor's License Law for the following reason: Q 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 aale). Q I, •* owner of the property, am exclusively contracting with licensed contractors to construct the protect (Sec. 7044, Business end Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for auch projects with contractor!*) licensed pursuant to the Contractor's License Law). Q I am exempt under Section Business and Professions Code for this reason: 1. I personally plan to provide the major tabor and materials for construction of the proposed property improvement. Q YES QUO 2. I (have / have not) signed an application for a building permit for the proposed work. 3. I have contracted with the totlowing 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 I address / phone number / contractors license number): _ • ____ _____ _ ______ __ 5. I will provide some of the work, but t have contracted (hired) the following persons to provide the work indicated {include name / address / phone number I type of work): __ _ _ PROPERTY OWNER SIGNATURE ___ DATE &3M£U^JHIS,SE<nKMM^ Is tha applicant or future building occupant required to submit a businotw plan, acutely Hazardous materials registration torn program under Sections 2S505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Q YES Is the applicant or future building occupant required to obtain a permit from the air pollution control district orajr^uality management district? Is the facility to be constructed within 1 ,000 feat of the outer boundary of a school site? Q YES J2«0 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. risk management and prevention , Q YES -0NO 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 _j\J'Q_ M__^"^_. LENDER'S ADDRESS 59;,... 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 tha Crty 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 tha building or work authorized by such permit is pot commenced within 365 days from the date of auch permit or if the building or work authorized by such permit is suspended or abandoned at any time after tharwork is commeficWJor a peridjj of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE WHITE: File YELLOW: Applicant PtNK: Finance . ' CITY OF CARLSBAD INSPECTION REQUEST PERMIT* CB970344 FOR 02/2*797 INSPECTOR AREA DESCRIPTION: ELECTRIC SERVICE PANEL #7 PLANCK* CB970344 PACIFIC BELL OCC GRP TYPE: ELEC CONSTR. TYPE NEW JOB ADDRESS: 1057 CANNON RD STE: LOT: APPLICANT: ROBINSON ELECTRIC PHONE: 619 697-6040 CONTRACTOR: PHONE: OWNER: PHONE: REMARKS: BJN/ROBINSON ELEC/697-6040 SPECIAL INSTRUCT: INSPECTOR TOTAL TIME: CD LVL DESCRIPTION 39 EL Final Electrical ACT COMMENTS DATE DESCRIPTION INSPECTION HISTORY ***** ACT INSP COMMENTS FEB-11-1997 15=48 BOCK COMPANY •r QOv. P. 03 SXJND5RGPOUWO-SPCCS ATTACHED JJT Mfi£T REOTS tf^OMM' MOftATOfWJU EFFECT - A6ENCT DATE CfilUCU. - PENDING STREET RESUAFAClNa SERVICE ATTACHMENT POINT AMOW WiT» LOCATION "" I " CV ~NQTfc tNtPEC M»O MtfOH TP «gT HtTATE O Jr mm wrl* *fer on nisK AP»V* wcco&n. lAODCA ARMS MEOTOD EMTlNO Q «TO» TRENCH Of- Of*- PftOUPOlE M>E«QUAO. n c*»NoeiicTEHO*tMSPEcnqNTDcL.>«&.*»'* PMOV10B MINIMUM •AOWW CLbUUMCS OF: ft •| _o LBWTH UE UMOTH Q MAUAULCO«MCTlOf»EtIW«NOLfliNftV PANEL PMOflTO QOMSmUCTtON NOTBfc DTEM» Dow JJCHBBMT 8«tu»btceoHauiT;«T DCMTOWR DMMMI tat, OCPOU ACCT. OATC wtct TILBWCWC UH CONTftiftiriON TO MW.T '—"" -*— r*' ~"i •'—'"• « flWMT IM. HRMIMIIW W iMi Cftf*I <• ««W WW • OMA* •Vv""BlEfl EPjp IBABRM1 EJP ••ffHMp||tftfn c^*n «i MI>MW<B utftti n TOTflL P.82 IACOIW. CiRTFICATE OF INSURANCE 7™"' PRODUCER Calco Ins Brokers & Agents M50 F r azee Road .O. Box 85371 San Diego, CA 92186-5371 619-260-3846 INSURED Rob i nson Company Contractors , Inc. dba: Robinson Electric 8871 Troy Street Spr ing Val ley , CA 91977 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A COMPANY B American Automobile Ins. Co. COMPANY C American Insurance Company COMPANY D Calif Casualty I ndemn i t y Exch COVERAGES THISISTOCl INDICATED.NOTWITHSTANDINGANYREQUIREMENT.TERMORCONDITIONOFANYCONTRACTOROTHEROOCUMENTWITHRESPECTTOWHICHTHIS 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. LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. CO LTR 8 C TYPE OF INSURANCE GENERAL LIABLITY JL COMMERCIAL GENERAL LIABILITY | CLAIMS MADE [')<"] OCCUR OWNER'S 8. CONTRACTOR'S PROT AUTOMOBILE LIABILITY X _*. QA ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS 1AGE LIABILITY ANY AUTO 1 EXCESS LIABILITY 1 D UMBRELLA FORM OTHER THAN UMBREL WORKERS COMPENSATION EMPLOYERS' LIABILITY THE PROPRIETOR/ PARTNERS/EXECUTIVEOFFICERS ARE: OTHER -A FORM AND | INCL EXCL POLICY NUMBER 8H1MZG80641003 8H1MZA80158341 - WC79000139-02 POLICY EFFECTIVE DATE (MM/DD/YY) 4/01/96 4/01/96 10/01/96 POLICY EXPIRATION DATE (MM/DO/YY) 4/01/97 4/01/97 10/01/97 ; LIMITS GENERAL AGGREGATE PROOUCTS-COMP/OP AGG PERSONAL & ADV INJURY EACH OCCURRENCE FIRE DAMAGE (Any one fire) MED EXP (Any one person) COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE AUTO ONLY • EA ACCIDENT OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE X STATUTORY LIMITS EACH ACCIDENT DISEASE - POLICY LIMIT DISEASE • EACH EMPLOYEE S 2000000 * 2000000 S 1000000 S 1000000 S 50000 S 5000 J 1000000 I s $ $ $ s $ s $ S 1000000 I 1000000 * 1000000 DESCRIPTION OF O PER ATlONS/LOCATIONSfVEH IDLES/SPECIAL ITEMS Re: All Jobs & Operations of the Named Insured in the State of California Certificate holder is named as additional insured per CG2010 attached 30 Days Cancel lation No t ice Except 10 Days for Non Payment of Premium City of Carlsbad Attn: Building Department 2075 La Pa Imas Dr i ve Car I sbad , CA 92008 ACORD 25-S (3*93) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WIUJ^HrtKdfcX-froXMAPL 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. *M#«JU^^X<AfcSuk*>^Ki*^^ AUTHORIZED REPRESENTATIVE \^y^. 15008100C^__y / fi-^£~~&-^s. — © ACOflD CORPORATIONS 993