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Home My WebLink About1155 CHESTNUT AVE; ; CB022249; Permitu 08-02-2002 X City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No: CB022249 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: 1155 CHESTNUT AV CBAD St: TP ELEC Lot#: TEMP POWER POLE Status: ISSUED Applied: 08/02/2002 Entered By: MDP Plan Approved: 08/02/2002 Issued: 08/02/2002 Inspect Area: Applicant: POWER PLUS 436 N QUINCE ST ESCONDIDO CA 92025 760 839-9430 Owner:2934 08/02/02 0002 01 02 CGP 20 = 00 Total Fees:$20.00 Total Payments To Date:$0.00 Balance Due:$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 Additional Fees TOTAL PERMIT FEES 0 0 '$10.00 $0.00 $0.00 i$0.00 $0.00:$o.oo, $10.00: $0.00 $0.00 $0.00 $20.00 Inspect FINAL APPROVAL Date: 0-Clearance: NOTICE: Please tfke NtfTliE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively referred to as "fere/exactiwfs." 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 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 1. PROJECT INFORMATION FOR OFFICE USE ONL PLAN CHECK EST. VAL. Plan Ck. Deposit. Validated By Date 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 Description of Work«^ 2. CONTACT PERSON (if different from applicant) SQ. FT.#of Stories # of Bedrooms # of Bathrooms Name Address City 3. APPLICANT Q Contractor "^JAgent for. Contractor D Owner Q Agent for Owner State/Zip Telephone #Fax* Address City State/Zip Telephone #Name S. 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 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 [$5001). ~ ^V. il« <y^i^e--r - - - Address '~ License Class (— Name State License # City • State/Zip City Business License tt Telephone # 2- Designer Name Address City State/Zip Telephone State License # 6. WORKERS' COMPENSATION Workers' Compensation Declaration: I 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. 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: Policy No. /5\S Tf<O ^~Z- Expiration Date J .^7 ^ Q >Insurance Company (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 OR LESS) l~l 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 ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE f~^~J^\^ DATE Sr— / f-€5*~ 7. OWNER-BUIlDER~bE^LARATIQN ~~~, ;~ ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason: l~| 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). l~l 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). ...... l~l 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. l~l YES l~lNO 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 nameTaddress / 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 / address / phone number / 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 number / type of work): PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL 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? d YES Q NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES Q 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 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 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 commenced within 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for aperiod of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE .r-A'H ^--/ DATE WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 08/08/2002 Permit# CB022249 Title: TEMP POWER POLE Description: Inspector Assignment: Type: ELEC Sub Type: Job Address: 1155 CHESTNUT AV Suite: TP Lot 0 Location: APPLICANT POWER PLUS Owner: Remarks: Phone: 7608399430 Inspector: Total Time: CD Description Act; ^Comments 32 Const. Service/Agricultural Requested By: MICHELE Entered By: CHRISTINE Associated PCRs/CVs Inspection History Date Description Act Insp Comments 07/29/02 Confirmation of meter and service request Customer HERMOSA CONSTRUCTION 7697297064 Want date: Service Address .1133 CHESTNUT AV TP CB PPSS142142 <m Cofltact:Phone:760 $39 9430 We have investigated your request for temporary service and (Jeteimfcied that th* facilities jrajj have ideutifidj tu KE3606 are tncohanaoally available fosr your us« in providing terapOTSKy powsr for your project, if the tempomy service is to be provided ovtfh^ad, please place your facilities no closer than 10 ft or no flutter than 100 ft from the pole Usted above. Place temporary pole within 25 it of a driveable surface* or use 25-class 5 cfimbable pole with depth gauge attached. All facilities should te placed wu the premises served. A3 sooa as you provide us with a firm, date you plan to install vow facilities, we can schedule your service installation. The meter will be set pending receipt of both hilling application and municipal inspection. For any questions or further information concerning this fbim call JotocAcuna7«0 9317301 ___ base. Muten IBS JC£|iikti to b« MftdUy «cet9UDfaj« 24 HK. /day Meiers mutt be lecitfsd in » wfc «*» floe of >»y pM^aou naiarea or oaanawa i/rarft»«,. fmviite y »3' ete!B md fevtl uHnftg tifMO In »a«i 01 m«cr. Wtais a*w coatad tftc fltstfeit BlXiftE office. usher «ad te idED1«te4 wife tif and smjj nutibw S For ovobead EUUTDS install wittuB 100 ft of the pole. cmst iMintaja a impunnta «t: !?• »1 ® point of «a««ctjcin. 18 ft @ Ooutor of <tre«i ur 12 curb whichever it kss. 1$ ft ovw coausmKsia! dm'ewayi.. 1 ?, it ovm DJg Akrt US(XM22-4)33 at l 4SliB prior te tr«fi<Ssa&.* meter clips 120/240 Volt: Utilities maximum Cuaomer Mratst Steilitiu to receive «t«Ctrk- acrvka an subject (a all loot! wv) TOW f* laa{m.'<laB owWuhy nx<<uiuu«aB, If'SDOaS OIEWratEn Wsanteus or tank AnUadaJ white jwrftBUJij,B MwnruntiBii «f your r»n/«t, »•««». wt" Itsh feiaMdi«l«b' mil it wi to mmo w uul/v clem all buantciu] or touc nwterlal r*^ to SDC*K coUJmufij oaiWtwtto^ SDtuit ituU isve ua Jiobilily nr ahtifatafa to cliaa, KjnAve or mediate toy tmxnkrae or tank material dwovomi -Mig its wufu of tusaWuctioa. UiUcw U i« thiuueK nv-Kligcocc a/ SD(>«E. revised 12/29/00 t>0 S3oi/\y3s ...... 11: 55 fiPR 03> 2002 *1247-: 2/3 OF LIABILfTY (•ROWUCSR Inauranea Scurvies* RoadS61 3oufcl-| 0*k Cevin* CA 91723 Phona: 626-966-3664 F««; 6*6-966-3395 THIS MRTSPiCATi OMLV AMD CCMIffil HOUHeR. TMB tERTWCATE DOES NOT AUEHD, EXtEKD OR ALTER THE COVtRAGg AFFQROEP flY Wi POLfCIBSM16W. Hartford Fire Inuyurtno't Co. State Mferkal la*. Ca. COVERAGIS ANV REOUBHUEnr, TEWOfl COWII^OF^V'COMI'R.viToSc3'''*tM OOCUWKT «V!TM ^EsfTC' io WiHICWTwi rWWlW^fc'tMY HfclSSUCDOfi ^_rJ*f~* WAY reRTHtN. r?t» i«»-j«iLNt".b.^nSKOtliHTT«pp^liriPXDFSr.m«pllHFRFIIIISKuFllFr;rTOAl.L7IILTCRVIS, WCLLI5IO1B ANO eOlSUH (OKH! OP 8UCH _,-' POLICES *OSR(:flATFi.lMff88llOWNWA.YH»v«MttM'*'r'>UeirlltlvpAII,if.l.AIH» . . ' 'LTR! T"hi OF WSDWNCE ; rOuCVMUMUM SftW^XilK'&SW1 ISHl^JfiZBr???*' ' UWTt 1 GENERAL l.lA6>inV - r~*~)A • IX 1 £L)*flU£RCirvL jfcNeH/\L UAB'.LlTV ' f MMSMA3C . X OCCUR | ._ . ': CPA*'.'. AC^Jv^rp i NUir Ai*f Litff ^iAu r pn6- 1! POLICY . jlgf ' ' LOC i 1 A : X i AMVAUI0 *lt OWNtU AUTOJ ' f ' " i X KiON-nWNrD«ITOSH . 1 ANVAvlTO occun ; CLAIMS MADL i RETENTOh $ WORKtRS COMPENSATION AND B . eM«.Oy«WLIA8llJTY i ! Of wat ' " ...j- ». - j LidiJiJlity 72UBSOA1991 03/31/02 03/31/03 : ' . i 72xnemrR0906 03/31/02 03/31/02 ': : \ 1535110*02 03/31/02 03/31/03 ' tAlX U^L'LIRBf UCF 1 1 r 0 00 / 000 HKfc UAMAUf (Arty wTiriii: Ml 0 r HP (My W» W ICfi) I'fcflieUMAl. t 4UV IMI JHV (ifNFRAI MJORfOAK ^Orvcrs.cgWW'ACC COUStNEOSlWQlELirJITleteauMrt) BOOltYIMJUKY (P* «^r,) DOCILVtWJURy Aim) ottr - f A ACCI Jt«( AGGttei^f ~"^ x TS^S^ 1°^" ri FACHACCIMNT £.t. UlSfcAat • f A TMflOlrtt 6,l,:U(9kASt J»ftHfM*«T ; .1300, do 6 • l,Q,frO.,QQft .2,Cd<?,000_ si, 000, 000 i t i *» 1 $ J 1 ll,000,QOO » 1,000, 000 MS-813572 02/25/02 02/25/03- $1,000,000 BcacRi^rviliiii '(if .4touT»Na/t.(5<kTia«aA«HeLg»rtB«vu*ow* AOOBB «v •juswwuiwmsi'eeiAi.wttH/iSiei** Certificate holder is included as additional insured. CERTIFICATE H010ER : Y imu**a; n*u*tx i,ern«*i CANCELLATION CCBXOOO cwv GA 92008 ACORD 2S-3 (r/BT) 8W5W.O AW Of TH5 A8CVC tHKIOttB «SL«SES U CANCB.LEO UPQK THB WBi«AT»H Mi« TH»«*n» TW« I*$IHMA M$URFB v««»L B»WU»0« TO *M- 3Q BAY* wmtTEN WOTIO* TO TH» drtf PUCltt tlftl DFB PUHFn Tt> -full L*<», kUT MULUHTTO BO W $tMtL HMKBJBOATNES / /M • ^ fijteSohd CORPORATION 198£