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Home My WebLink About150 CHINQUAPIN AVE; ; CB041293; Permit04-16-2004 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No CB041293 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Reference # Project Title 150 CHINQUAPIN AV CBAD St TP ELEC Lot# CHINQUAPIN LOTS TEMP POWER POLE Status Applied Entered By Plan Approved Issued Inspect Area Applicant JOEJEFFERIES 750 N CITRACADO PKWY ESCONDIDO CA 92025 760439 1999 Owner ISSUED 04/16/2004 SB 04/16/2004 04/16/2004 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 0 0 $1000 $000 $000 $000 $000 $000 $1000 $000 $000 $000 $2000 Total Fees $2000 Total Payments To Date $000 Balance Due $2000 3002 03 CGF-'0 00 SIGNATURE PERMIT APPLICATION 'CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 1 PROJECT INFORMATION FOR OFFICE USE ON PLAN CHECK NO EST VAL Plan Ck Deposit Validated By/ Date (Jl *1 SO Chinquapin Ave TP (include Bids/Suite Tt)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 # *Temp Power Pole ription or WonF Existing Use Proposed Use Desc SQ FT #of Stories # of Bedrooms # of Bathrooms CONTACT PERSON (if different from applicant) Name 3 APPLICANT [ *Garv£ Address City D Contractor Q Agent for Contractor P Owner Q Agent for Owner Jevmour ?4S8 S Santa Fe Ave Vista CA. 92084 State/Zip Telephone # Fax # 760-439-1999 /rent r uvvncn *Kevstone Communities 5333 Mission Ctr. Rd Ste 360 SD 92108 619-299-4855 J Aridrns!; ' Citv State/Zm Teleohone #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 ' '—' J-"~-~ '"=<v>" *Temp Power Systems 2458 S Santa Fe Ave, Vista, CA 92084 Name State License # * /1O1 /I*4oJ4 Designer Name State License # Address TO License Class f~* JJ ^ Address City State/Zip 1 (\ City Business License #1U City State/Zip Telephone # P01650 Tefephone 6 WORKERS COMPENSATION Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations n 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 Insurance Company *gtnte FUIld P°''CV N° 1589783-2003 Expiration Date 10/01/04 (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) Q 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 . _____ , DATE 7 OWNER BUILDER DECLARATION f I hereby affirm that I am exempt from the Contractor s License Law for the following reason |~l I &s owner of the property or my employees with wages as thair 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) Q 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) f~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 YES flNO 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 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 I phone number / type of work) _; PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR NONRESIDENTIAL 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? Q YES L~D NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? CD Y£S f~| NO Is the facility to be constructed within 1 000 feet of the outer boundary of a school site? Q YES CD 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(0 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 a period of 180 days (Section 106 4 4 Uniform Building Code) APPLICANT S SIGNATURE DATE WHITE File YELLOW Applicant PINK Finance City of Carlsbad Bldg Inspection Request For 05/11/2004 Permit# CB041293 Inspector Assignment Title CHINQUAPIN LOTS TEMP POWER Description POLE Type ELEC Sub Type Phone 7605972904 Job Address 150 CHINQUAPIN AV Suite TP Lot 0 Location Inspector APPLICANT JOEJEFFERIES Owner Remarks / Total Time Requested By GARY Entered By CHRISTINE CD Description Act Comment A/ rT^/7 #32 Const Service/Agricultural n\ i/- -/ /£ ^ 39 Final Electrical f/^J C^ Associated PCRs/CVs Inspection History Date Description Act Insp Comments 64/08/2004 15 46 7B07378523 09 «»9 &i9-299-4845 KEYSTONE ROCK SPRING AQfi&UENT FOR PRIVATE STOftM DRAIH WITHW PLOT" 4P/V 206*013-16 (LOT 1 G 2004 DEPT SP COMPENSATION INSURANCE CERTHOUDER COPY PO BOX 807 SAN FRANCISCO CA 94142-0807 FUND CERTIFICATE OF WORKERS COMPENSATION INSURANCE ISSUE DATE 10-01-20O3 GROUP POLICY NUMBER 1589783-2003 CERTIFICATE ID 583 CERTIFICATE~EXPIRES 10-01^2004 10-01-2003/10-01-2004 CONTRACTORS STATE LICENSE BOARD WORKERS COMPENSATION UNIT P 0 BOX 26000 _ SACRAMENTO CA 95826 SP LICENSE NUMBER #433433 INCEPTIOM DATE 1O-G1-2O03 D 0 - - - SP This is to certify that we have issued a valid" Workers Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration , This certificate of insurance is not an insurance policy and does not amend extend or alter the coverage afforded by the policies listed herein Notwithstanding any requirement term or condition of any contract or other document with respect to which this certificate of insurance 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 AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS $1 OOO 000 00 P1R OCCURRENCE ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY EMPLOYER LEGAL NAME TEMP POWER SYSTEMS 625 FEE ANA ST PLACENTIA CA 92$?0 POWER FABRICATING INC AND/OR JEMP POWER SYSTEMS INC (REV 3 03)PffiNTED.