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Home My WebLink About167 HEMLOCK AVE; ; CB001761; Permit{l\-10?) . City of Carlsbad 05/05/2000 Electrical Permit Permit No:CB001761 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: 167 HEMLOCK AV CBAD ELEC 2042522000 MELIDEO RESIDENCE Lot#: 0 UP GRADE SERVICE FROM 60 TO 200 AMPS Applicant: JONES MARK 137 BEAUMONT DR VISTA CA 92084 760 758-2287 Total Fees: $40.00 TOTAL PERMIT FEES 0 , ... :, " "' : • •"' '0 • t , ' "' 4t lnspectodL FINAL APPROVAL Date: & /·~ O Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: Clearance: ISSUED 05/05/2000 MDP 05/05/2000 05/05/2000 05/05/00 0001 01 C-PRMT $40.00 $40.00 NOTICE: Please take NOTICE that 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 r~ht to protest the speoffied fees/exactions DOES NOT APPLY to water and sewer connection fees and capacliy changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project NOR DOES 1T APPLY to any fees/exactions of which vou have nreviouslv been niven a NOTICE similar to this or as to which the statute of limitations has nreviouslv otherwise expired. CITY OF CARLSBAD 2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161 02 40-00 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 1, PRMCT IN~IPN /6 7 ~ /o cK. lb/ t.. FOR OFFICE USE ONLY PLAN CHECK NO. (»-\] ~ ( EST. VAL. __________ _ Plan Ck. Deposit ________ _ Validated By __________ _ Date ______________ _ Addresi rn~de 6)1.~ o/o ck.. (I.J ~. ( c,,,y' If j r.l J.. Business Name (at this address) Legal Description Cot No. Subdivision Name/Number Unit No. Phase No. Total # of units Assessor's Parcel # Existing Use Proposed Use Descr~6./ ,~~ ~ ~ 11-,-p .f6'1)t'a!-t,J)~D ¼·;~)(( #of Stories # of Bedrooms # of Bathrooms 2. COr,ITACT PERSOt,I Uf different from applicant) . Name Address City State/Zip Telephone# Fax# :3. APPLICAN:r IX( Contractor O Agent for Contractor 0 Owner O Agent for Owner . Address / State/Zip, C ~ I Telephone # :;l''Cl ..:::;,:s r-.:) ;) ~ -y~t, .... Name )J (C./( /1-1 EJ..i})J::C) .6. CQNTI\ACT0~ • CQMe~NY NAIYI.E Address /6, 5 f/.~--, .. ./o ck_ City c~v1,~J State/Zip Tel~~hone # ~ 6 -7-2. '9-Yo 76 (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 [$50011. Name /\4Jt'R,C .;;f'o<JE.( e.z::cc:.7:l(t'c::Address 13 I ~o.:f])r, ,_ .. ~ City tt 1 ... q ~,, 7 State/Zip ~ 11 1 Telephone # 7(,() -7 Si"~~~ 1 State License# J.../ 3 9? ?~ License Class C -I (J City Business License # _______ _ 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. O 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 ____________________ _ Policy No. ____________ _ 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 ($100,0001. in addition to t"e_ cost of ompensation, damages as provided for in Section 3706 of the Labor co e, interest and attorney's fees. SIGNATURE -<.., DATE S' ~Ofl<'.J 7. OWNER-BUILDER DECLARATION -~~ .. :£,,;; ~ I hereby affirm that I am exempt from the 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 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. 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 (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 / phone number / type of work): ________________________________________________________ _ PROPERTY OWNER SIGNATURE ______________________ _ DATE -----------COMPLETE THIS SECTION FORNON-flESIDENnAL BUILDINQ PERMIJ~orn:y 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 Act7 0 YES O 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 O NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? 0 YES O 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. B. CONSTRUCTION LENDING .~GENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 30970) Civil Code). LENDER'S NAME Ai IA LENDER'S ADDRESS I ---------------------------- 9, APPLICANT CERJIFICATION 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 commenced within 180 days from Iha date of such permil or if the building or work authorized by such permil is suspended or abandoned at any time after the work is co~c~d for a peri~d of 180 days (Section 106.4.4 Uniform Building Code). /£"/.J.. () 8 APPLICANT'S SIGNATURE ~ ~ -~ DATE 5 _ _ c) v WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Bldg Inspection Request For: 6/1/2000 Permit# CB001761 Inspector Assignment: Tille: MELIDEO RESIDENCE Description: UP GRADE SERVICE FROM 60 TO 200 AMPS Type:ELEC Sub Type: Phone: 7607582287 Job Address: Suite: Location: 167 HEMLOCK AV Lot 0 lnspecto~ APPLICANT JONES MARK Owner: MELIDEO NICHOLAS&MARY REVOCABLE TRUST Remarks: Total Time: CD 33 Description Service Change/Upgrade ----------- Associated PCRs Inspection History Date Description 5/25/2000 33 Service Change/Upgrade Act Requested By: MARK Entered By: CHRISTINE Comments ,,,. ,w r,tv,n.... 7;~-~--- Act lnsp Comments CO PS ON CARD