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HomeMy WebLinkAbout1781 CANNON RD; ; CB041559; Permit05-10-2004 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No: CB041559 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Reference #: Project Title: 1781 CANNON RDCBAD ELEC Lot#: SHEA HOMES 100 AMP ELEC METER IRRIGATION Status: ISSUED Applied: 05/10/2004 Entered By: SB Plan Approved: 05/10/2004 Issued: 05/10/2004 Inspect Area: Applicant: SHEA HOMES 10721 TREENA STREET STE 200 SAN DIEGO CA 92131 Owner: 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 100 0 0 0 $10.00 $25.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $35.00 Total Fees:$35.00 Total Payments To Date:$0.00 Balance Due:$35.00 DATE 9-. SIGNATURE PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 J2&. FOR OFFICE USE ONLY PLAN CHECK NO. ^^\$Si EST. VAL. Plan Ck. Deposit Validated By. Date £. Address {include Bldg/Suite # )AA, Subdivision Name/Number Business Name ja^this address) <??-/( Legal Description Lot No.Unit No.Phase No.Total # of units Assessor's Parcel #isting Use Proposed Use Name Address City State/Zip Telephone # (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 Codel 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 1*5001). Name State License tt Address License Class City State/Zip City Business License # Telephone # Designer Name State License # Address City State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: Q 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. 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 insurajjctcarrier and policy numbe^ve: Insurance Compan^X//V ^ fl/0 rM ^Jfi£t"/£j£L -J-JV£. Policy No. V/^» "O^"** Expiration Date_ __ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) / G 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: Failura^tp secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (4>00,000), in addjtion-t9 the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. DATE £~~/C* * ff irm that I am exempt from th^CSntractor's License Law for the following reason: '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 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 contractors) licensed pursuant to the Contractor's License Law). fj 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. Q YES QNO 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 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 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 ANV 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. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(1) Civil Code). LENDER'S NAME LENDER'S ADDRESS 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 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 the building or work authorized by such permit is not commenced within 1 80 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 commencedjor ajorfiod of 180 days (Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE WHITE: File YELLOW: Applicant PINK: Finance Inspection List Permit*: CB041559 Type: ELEC SHEA HOMES 100 AMP ELEC METER IRRIGATION Date Inspection Item Inspector Act Comments ___ 05/13/200432 Const. Service/Agricultural RB AP 05/12/2004 32 Const. Service/Agricultural RB CO SEE NOTICE ON JOB CARD Monday, September 20, 2004 Page 1 of 1 UNSCHEDULED BUILDING INSPECTION DATE PERMIT # O JOB ADDRESS -^ INSPECTOR PLAN CHECK# DESCRIPTION CODE DESCRIPTION ACT COMMENTS ACQRD,. CERTIFICATE OF LIABILITY INSURANCE Fag. t of 3 ovmTaooa PRODUCE* INSURED 877-55S-676S Willis ttozrth America, Inc. - RAgia»l Cert Cent*r 11201 M. T»tMft Blvd. Suit* 300Phoenix, A.Z 05028 She ft Bo»*fl 10721 Tr«oi3» sr.r««t Suit* 200 BAT, Diego, CA 92822 I 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. INSURERS AFFORDING COVERAGE WSURERA: A»«rictn Za tarnation A l Specialty Li»Bo ?» 25663-000 INSURERS: W*tion»l Union Pinre IztBuranc* Co. ot Pitt 19*45-001 INSURERC: Aaerioaa Bone ABBumne* Company 15380-005 INSURER D: INSURER E; COVERAGES THE POLICIES OP INSURANCE LISTED BELOW HAVfc BEEN 1SSUSD TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE IS9UEO OR MAY PERTAIN, THE INSURANCE AFFDRDEP BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCHPOLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUC6O BY PAID CLAIMS. INSfiLTR A B B C B ! B TYPE OF IMSURANCE . GENERAL LJABILTFY X COMMERCIALGENERALLIA8U-ITY ICLAJMSUADE |jc 1 OCCUR GEN'L AQSREOATE HMfT APPUES PER xl POUCT rn 5B& 1 1 LOC AUTOMOBILE tUBUJTV _X_] ANY AUTO J AUOWN6DAUTOS i SCHEDULED AUtOS HIRED AUTOS NON-OWNED AUTOS OABASE LIABlljry J ANVAUTQ H EXCESS UAaiLfTY __J OCCUP [ J CLAIMS MADE DEDUCTIBLE i RETENTION 9 WORKERS COMPENSATION AMD ENtPLOTKRS'UA&IUTY officers Included OTHER POLICY NUMBER GL2S73S44 AOE 8261462 VA 82S1461 TZ 8251459 HA 6261460 7165833 tMTf tmuabmrr 8/1/2003 fl/1/2003 8/1/2003 B/l/2003 B/l/2003 8/1/2003 POLICY EXPIRATIONDATEtMH/OD/rfl 8/1/2004 6/1/2004 8/1/2004 8/1/3004 8/1/2004 S/l/2004 LIUITB EACH OCCURRENCE FIR6 QAMAOe<Any oo«ft«l MED EXP (ftnyonafwraofi) PERSONAL i AOV IH/URY GENERAL AGGREGATE PROEJUCTS - COMP/OP AOS COMBINED SINGLE LIMIT(Ed aoddanl) BOCXLYIMJURV (PVp«rM>n) 6OOILY INJURY {PeraBODan)} PROPERTY DAMAGE (Pwwcld«M) AUTO ONLY -EA. ACCIDENT AUTOONLY: AOO EACH OCCURRENCE S 4,000,000 5 50 r Onp * 5,000 j__JU.OOO^ 000 * 5,000,000 S * 1,000,000 I * S S S S S AGGREGATE , S xiT^ms m E.L EACH ACCIDENT E.L DISEASE • CA EMPLOYEE EX. WSEASE - POLICY LIMIT S I 1 $ 1,000,000 S 1.000.000 I 1.000.000 DESCRIPTION OP OPEBATlONS'tOCATIONlWEHICLM/EXCUISIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The certificate holder is named ae additional insured under the General Liability coverage per the attached endorsement and under the Automobile Liability par Che policy fozna. This insurance is primary per the policy form. See Attached Endorsement. Grose-Liability and Swvarability of Interest apply per the policy foxia. CERTIFICATE HOLDER Aacmo«M.msy«c-. INSURER Limn: CANCELLATION City of C*rlel>«d Oftie* oi th« E&gine»r 5950 El Cwnino R«*l Carlsbad^ CA 92D06 1 SHOULP ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLCD BEFORE THE EXPIRATION DATS THEREOF, THC WKUIMCl INBUHER WILL KXflUUDXXK MAJL 3 ° DAYS WRITTEN NOTICE TO THE CERTT1CATE HOLDER NAMED TO THE LengBlKXMUlfiKXXKHKttQIlQj. mBaBKJ^xaaucaaay^yoassK^^ AUTOQAKtypeMieSBMTATIVE . / ' > /- > -T ^*xTA-^v Xvt^-. v?y? ACORD 25-3(7/97)Coll:782?40 Tpl:lS3852 Cert:33016%7 ©ACORO CORPORATION 1988