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HomeMy WebLinkAbout2618 EL CAMINO REAL; ; CB983416; Permit&V8& BUILDING PERMIT 10/06/98 J.1 03 Page 1 of 1 Job Address- 2618 EL CAMINQ REAL , Suite' - Permit Type: MISCELLANEOUS , Parcel No- ^~ Lot#-» . Permit No. CB983416 Project No: A9804438 Development Wo. Valuation- 11 ,000 Occupancy Group: Referenced Description. INSTALL 22 SKYLIGHTS ICBO#2469 : SMART AND FINAL it * Appl/Ownr • MILLER CONSTRUCTION 1241 DISTRIBUTION WAY VISTA CA 92083 ** A Fees Required ** * Construction Type. NEW Status- ISSUED ' Applied- 10/06/98 Apr/Issue: 10/06/98 Entered By: JM 760 599-0123 llected & Credits Fees Adjustments: Total Fees: 203 00 Fee description ",.A* *vr «a *w /•• .i< IT-tsta^r^-^rf^r"C^**?;••*' Miscellaneous Feev #1 ijiS%g&*'j&' \;?*-^'>-C' MISCELLANEOUS TOTALp^^r-f/ V'^-»rj^r>*~™ ' W «*.o-.^>"- ' *""x .932 iO/06/98 000^^)1 02C-PRMT 203-00 203 -00 Ext fee Data , 203.00 PERMIT FEE 203 00 .K , * * A FINAL APPROVAL . /^ DATF CLEARANCE CITY OF CARLSBAD 2075 Las Palmas Dr , Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION F , , -^i CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 1 PROJECT INFORMATION FOR OFFICE USE ONLY PLAN CHECK NO EST VAL _f_r^ Plan Ck Deposit Validated By i Date Address (include Bldg/Suite *)Business Name (at this address) Description Lot No Subdivision Mima/Number Unit No Phase No Total * ol units Assessor s Parcel *23+.I S6 FTDas c notion *of Stones * of Bedrooms of Bathrooms CONTACT PERSON (rf different from applicant) APPLICANT Address City Q Agent lor Contractor Q Owner Q Agent torOwner State/Zip Telephone It Fax * Name 4. PROPERTY OWNER Address t City State/Zip Telephone * Nume , Address City State/Zip Telephone * E CONTRACTOR - COMPANY NAME " "~ "™~—-,—^- ™—-™. — .—<- (Sec 7031 5 Business and Professions Code Any Crty 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 sioned statement thtt 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 examptipn 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 (550011 fCity / State/zp City Business License 9State License Address License Class Telephone f Designer Name Address Crty State/Zip Telephone State License # _ 6 WORKERS' COMPENSATION ~ - ----- Workers Compensation Declaration I hereby affirm under penalty of penury 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 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 BOlicy number are Insurance Company Policy No Expiration Date_ (THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*1001 OR LESS) Q CERTIFICATE OF EXEMPTION I certify thet in the performance of the work for which this permit is issued, 1 shall not employ any person m any manner so as TO become subject to the Workers' Compensation Laws of California WARNING Failure to secure workers' compensation coverage (s unlawful, end ahall subject an employer to criminal penalties and civil fines up to one hundred thousand 'dollars (8100,000) m addition to the cost of compensation, damages mm provided for In Section 3706 of the Labor code. Interest end attorney's fees SIGNATURE ; , DATE » 7 OWNER-BUILDER DECLARATION , ' ••,-:•' '* I hereby affirm that I am exempt from the Contractor's License Lew 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 aale (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 auch improvements are not Intended or offered for Mia H, 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 aato) D I as owner of the property, em exclusively contracting with licensed contractors to construct the project (Sec 7044, Business and Professions Code The Contractor s License Law does not tppty to an owner of property who builds or improves thereon, and connects tor euch projects wtth contracted*} bcerwed pursuant to the Contractor s License Law) am exempt under Section Business and Professions Coda for this reason YES1 I personally plan to provide th« major labor and materials for construction of the proposed property improvement 2 I (have / have not) signed an application for a building permit for the proposed work *i 3 I have contracted with the following person (firm) to provide the proposed construction ^Include name / address / phone number / contractors licenaa 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 / pnone number / contractors license number) _ _ j ___ __ ____ _ _ _____ ___ 5 I will provide some of the work, but I have contracted (hired) the following persons to provide the work Indicated (include name I address / phone number / type ot work) _ \ PROPERTY OWNER SIGNATURE DATE COMPLETE THIS SECTION FOR WOW-RES/DHrTMi BUILWNQ PERMITB ONLY ~" — ' ~j"" r ------ ""' Is the applicant or future building occupant required to submrt a business plan, acutely hazardous materials registration form or nak management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Q YES Cr~-l9& Is the applicant or future building occupant required to obtain a permit from the etr pollution contrordistnct or air quality management district7 D YES Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES JO^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 * "' "" ""' ~ ' j " " ' ' 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 ADDRESSLENDER'S NAME " >_ •9 APPLICANT CERTIFICATION ---,--_ _ . . _ (1 ..,„,,_, 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 ebove mentioned property lot 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 Cade shall expire by limitation and become null end void if the building or worK authorized by such permit is not commenjrfd within 365 days from the date of such permit or tf the building or work authorized by such permit ts suspended or abandoned at any time after the work is commenced^Xor a period/of^l 80 days (Section 106 4 4 Uniform Building Code) APPLICANT S SIGNATURE DATE WHITE File YELLOW Applicant PINK Finance IACQRD^ CERTIFICATE OF tw PRODUCER (619)578-5200 FAX (619)578-5699 ]ross Insurance, Inc 9820 Willow Creek Road, Suite 350 San Diego, California '92131-1112 Attn Ext INSURED Miller and Company, Inc , Marty Miller Construction and Charles M. Miller, Reneta Miller and Greg Goss 1241 Distribution Way Vista, CA 92083 ABILITY INSURANCE °™> i MIS CEK i iniiA 1 1 is ISSUED AS A MA 1 1 bK Ol- 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 Golden Eagle Ins A COMPANY B COMPANYc 1 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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 BY PAID CLAIMS 00 TYPF nF INSURANCE POLICY NIIMRFR POLICY EFFECTIVE POLICY EXPIRATION .LTR T™^ OF INSURANCE POLICY NUMBER DATE ,MM;D[WY, OATE (MM/DD/YY) LIMITS i GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X OCCURA CCP55593400OWNER S & CONTRACTOR S PROT AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS X SCHEDULED AUTOSA C CCP55593400X HIRED AUTOS X NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM WORKERS COMPENSATION ANDEMPLOYERS LIABILITY A THE PROPRIETOR/ INCL NWC31745902 PARTNERS/EXECUTIVE OFFICERS ARE EXCL GENERAL AGGREGATE $ 2 000 000 PRODUCTS - COMP/OP AGG S 2 000 000 „..,„,, PERSONAL &ADV INJURY $ 1 nnn 00004/01/1998 04/01/1999 J-.uuu.uuu EACH OCCURRENCE $ ^ 000,000 J FIRE DAMAGE [Any one fire) S 5Q QOQ MED EXP (Any one person) $ 5 QOQ COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY - (Per person) 04/0l'/1998 04/01/1999 1 BODILY INJURY ,(Per accidenl) PROPERTY DAMAGE $ i j AUTO ONLY -EA ACCIDENT $ OTHER THAN AUTO ONLY EACH ACCIDENT S AGGREGATE I EACH OCCURRENCE $ , ' AGGREGATE $ S TORY LIMITS ER EL EACH ACCIDENT $ 1,000,000 ' ' EL DISEASE - POLICY LIMIT $ 1 f QOO , 000 | EL DISEASE - EA EMPLOYEE S 1 f QOO , 000 OTHER DESCRIPTION OF OPERATIC NS/LOCATIONSA/EHICLES/SPECIAL ITEMS L979 INTERNATIONAL DUMP TRUCK, #D2127J6B24855 j City of Carlsbad Building & Engineering Department 2075 Las Palmas Drive Carlsbad, CA 92008 ACORB 25.5(1 796} CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION OATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 13Q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AiyjJyND UPON THE COMPANY, 1TSAGENTS OR REPRESENTATIVES AUTHOW2E6 REPRESENTATIVE (^/^ / / r'^^'f^L'"^^^i^—^ ©ACORD CORPORATION 1988 ^y-