HomeMy WebLinkAbout2500 CHAMOMILE LN; ; CBRA2024-0170; PermitBuilding Permit Finaled
(cityof
Carlsbad
Residential Associated Permit
Print Date: 06/25/2025
Job Address: 2500 CHAMOMILE LN, CARLSBAD, CA 92008
Permit Type: BLOG-Associated Permit Residential Work Class: Condo
Parcel#: 2071020600 Track#:
Valuation: $349,121.01 Lot#:
Occupancy Group: R3/U Project#: DEV16038
#of Dwelling Units: 1 Plan #:
Bedrooms:
Bathrooms:
Construction Type:V-B
Orig. Plan Check#:
Occupant Load: 0 Plan Check#: PC2022-000S
Code Edition:
Sprinkled: Yes
Project Title: MARJA ACRES
Permit No:
Status:
CBRA2024-0170
Closed -Finaled
Applied: 09/26/2024
Issued: 10/24/2024
Fi naled Close Out: 06/25/2025
Final Inspection: 06/23/2025
INSPECTOR: Alvarado, Tony
Consultant, Landscape
Renfro, Chris
Description: MARJA ACRES: (CORAL RIDGE) PHASE FlO // BLDG F18 // UNIT 29S / / 1732 SF LIV// 487 SF GARAGE
Applicant:
KB HOME COASTAL INC
ELIZABETH SHOEMAKER
9915 MIRA MESA BLVD, # 100
SAN DIEGO, CA 92131-7001
(951) 691-5300
FEE
ATTACHED ACCESSORY & UTILITY USES
DUP FLRPLN SFD & DUPLEXES
PARK IN-LIEU ATTACHED(> 4 UNITS) NW
PUBLIC FACILITIES FEES -outside CFO
SB1473 -GREEN BUILDING STATE STANDARDS FEE
STRONG MOTION -RESIDENTIAL (SMIP)
Total Fees : $20,797.42 Total Payments To Date:
Building Division
$20,797.42
Contractor:
KB HOME COASTAL INC
9915 MIRA MESA BLVD, # STE 100
SAN DIEGO, CA 92131-7001
(760) 550-1957
Balance Due:
AMOUNT
$969.51
$1,359.28
$6,190.00
$12,219.24
$14.00
$45.39
$0.00
Page 1 of 1
1635 Faraday Avenue, Carlsbad CA 92008-7314 I 442-339-2719 I 760-602-8560 f I www.carlsbadca.gov
PERMIT INSPECTION HISTORY for (CBRA2024-0170)
Permit Type: BLDG-Associated Permit Residenti; Application Date: 09/26/2024 Owner:
Work Class: Condo Issue Date: 10/24/2024 Subdivision: CARLSBAD TCT NO 16-07 MARJA
ACRES
Status: Closed -Finaled Expiration Date: 10/20/2025 Address: 2500 CHAMOMILE LN
IVR Number: 59180 CARLSBAD, CA 92008
Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspection Inspection
Date Start Date Status
04/21/2025 04/21/2025 BLDG-17 Interior 282289-2025 Passed Chris Renfro Complete
Lath/Drywall
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-18 Exterior 282290-2025 Passed Chris Renfro Complete
Lath/Drywall
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-SW-Inspection 282438-2025 Partial Pass Chris Renfro Re inspection Incomplete
Checklist Item COMMENTS Passed
Are erosion control BMPs Yes
functioning properly?
Are perimeter control BMPs Yes
maintained?
Is the entrance stabilized to Yes
prevent tracking?
Have sediments been tracked Yes
on to the street?
Has trash/debris accumulated Yes
throughout the site?
Are portable restrooms Yes
properly positioned?
Do portable restrooms have Yes
secondary containment?
05/23/2025 05/23/2025 BLDG-Electric Meter 285814-2025 Passed Chris Renfro Complete
Release
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
06/23/2025 06/23/2025 BLDG-Final Inspection 288465-2025 Passed Chris Renfro Complete
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-Plumbing Final Yes
BLDG-Mechanical Final Yes
BLDG-Structural Final Yes
BLDG-Electrical Final Yes
Wednesday, June 25, 2025 Page 5 of 5
PERMIT INSPECTION HISTORY for (CBRA2024-0170)
Permit Type: BLDG-Associated Permit Residenti, Application Date: 09/26/2024 Owner:
Work Class: Condo Issue Date: 10/24/2024 Subdivision: CARLSBAD TCT NO 16-07 MARJA
ACRES
Status: Closed -Finaled Expiration Date: 10/20/2025 Address: 2500 CHAMOMILE LN
IVR Number: 59180 CARLSBAD, CA 92008
Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspection Inspection
Date Start Date Status
BLDG-SW-Inspection 279639-2025 Partial Pass Chris Renfro Reinspection Incomplete
Checklist Item COMMENTS Passed
Are erosion control BMPs Yes
functioning properly?
Are perimeter control BMPs Yes
ma intained?
Is the entrance stabilized to Yes
prevent tracking?
Have sediments been tracked Yes
on to the street?
Has trash/debris accumulated Yes
throughout the site?
Are portable restrooms Yes
properly positioned?
Do portable restrooms have Yes
secondary containment?
04/03/2025 04/03/2025 BLDG-84 Rough 280562-2025 Passed Chris Renfro Complete
Combo(14,24,34,44)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-14 Yes
Frame-Steel-Bolting-Welding
(Decks)
BLDG-24 Rough-Topout Yes
BLDG-34 Rough Electrical Yes
BLDG-44 Yes
Rough-Ducts-Dampers
BLDG-SW-Inspection 280721-2025 Partial Pass Chris Renfro Reinspection Incomplete
Checklist Item COMMENTS Passed
Are erosion control BMPs Yes
functioning properly?
Are perimeter control BMPs Yes
maintained?
Is the entrance stabilized to Yes
prevent tracking?
Have sediments been tracked Yes
on to the street?
Has trash/debris accumulated Yes
throughout the site?
Are portable restrooms Yes
properly positioned?
Do portable restrooms have Yes
secondary containment?
Wednesday, June 25, 2025 Page 4 of 5
PERMIT INSPECTION HISTORY for (CBRA2O24-0170)
Permit Type: BLDG-Associated Permit Residenti, Application Date: 09/26/2024 Owner:
Work Class: Condo Issue Date: 10/24/2024 Subdivision: CARLSBAD TCT NO 16-07 MARJA
ACRES
Status: Closed -Finaled Expiration Date: 10/20/2025 Address: 2500 CHAMOMILE LN
IVR Number: 59180 CARLSBAD, CA 92008
Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspection Inspection
Date Start Date Status
Checklist Item COMMENTS Passed
BLDG-Building Deficiency 2nd story deck nail Yes
BLDG-SW-Inspection 274749-2025 Partial Pass Chris Renfro Reinspection Incomplete
Checklist Item COMMENTS Passed
Are erosion control BMPs Yes
functioning properly?
Are perimeter control BMPs Yes
maintained?
Is the entrance stabilized to Yes
prevent tracking?
Have sediments been tracked Yes
on to the street?
Has trash/debris accumulated Yes
throughout the site?
Are portable restrooms Yes
properly positioned?
Do portable restrooms have Yes
secondary containment?
02/26/2025 02/26/2025 BLDG-15 Roof/ReRoof 277188-2025 Passed Chris Renfro Complete
(Patio)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-SW-Inspection 277324-2025 Partial Pass Chris Renfro Re inspection Incomplete
Checklist Item COMMENTS Passed
Are erosion control BMPs Yes
functioning properly?
Are perimeter control BMPs Yes
maintained?
Is the entrance stabilized to Yes
prevent tracking?
Have sediments been tracked Yes
on to the street?
Has trash/debris accumulated Yes
throughout the site?
Are portable restrooms Yes
properly positioned?
Do portable restrooms have Yes
secondary containment?
03/25/2025 03/25/2025 BLDG-13 Shear 279542-2025 Passed Chris Renfro Complete
Panels/HO (ok to wrap)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
Wednesday, June 25, 2025 Page 3 of 5
PERMIT INSPECTION HISTORY for (CBRA2024-0170)
Permit Type: BLDG-Associated Permit Residenti; Application Date: 09/26/2024 Owner:
Work Class: Condo Issue Date: 10/24/2024 Subdivision: CARLSBAD TCT NO 16-07 MARJA
ACRES
Status: Closed -Finaled Expiration Date: 10/20/2025 Address: 2500 CHAMOMILE LN
IVR Number: 59180 CARLSBAD, CA 92008
Scheduled Actual Inspection Type Inspection No. Inspection Primary Inspector Re inspection Inspection
Date Start Date Status
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLOG-SW-Inspection 268619-2024 Partial Pass Tony Alvarado Reinspection Incomplete
Checklist Item COMMENTS Passed
Are erosion control BMPs Yes
functioning properly?
Are perimeter control BMPs Yes
maintained?
Is the entrance stabilized to Yes
prevent tracking?
Have sediments been tracked Yes
on to the street?
Has trash/debris accumulated Yes
throughout the site?
Are portable restrooms Yes
properly positioned?
Do portable restrooms have Yes
secondary containment?
12/10/2024 12/10/2024 BLDG-11 270588-2024 Passed Chris Renfro Complete
Foundatlon/Ftg/Piers
(Rebar)
Checklist Item COMMENTS Passed
BLDG-Building Deficiency Yes
BLDG-SW-Inspection 270768-2024 Partial Pass Chris Renfro Reinspection Incomplete
Checklist Item COMMENTS Passed
Are erosion control BMPs Yes
functioning properly?
Are perimeter control BMPs Yes
maintained?
Is the entrance stabilized to Yes
prevent tracking?
Have sediments been tracked Yes
on to the street?
Has trash/debris accumulated Yes
throughout the site?
Are portable restrooms Yes
properly positioned?
Do portable restrooms have Yes
secondary containment?
01/28/2025 01/28/2025 BLDG-14 274575-2025 Partial Pass Chris Renfro Reinspection Incomplete
Frame/Steel/Bolting/We
lding {Decks)
Wednesday, June 25, 2025 Page 2 of 5
Building Permit Inspection History Finaled
{cityof
Carlsbad
Permit Type:
Work Class:
Status:
Scheduled
Date
11/19/2024
PERMIT INSPECTION HISTORY for (CBRA2024-0170)
BLDG-Associated Permit Residenti, Application Date: 09/26/2024 Owner:
Condo Issue Date: 10/24/2024 Subdivision: CARLSBAD TCT NO 16-07 MARJA
ACRES
Closed -Finaled Expiration Date:
IVR Number:
10/20/2025
59180
Address: 2500 CHAMOMILE LN
CARLSBAD, CA 92008
Actual Inspection Type Inspection No. Inspection Primary Inspector Reinspection Inspection
Start Date
06/10/2025 BLDG-Planning Final
Status
287736-2025 Passed Landscape
Consultant
Checklist Item COMMENTS Passed
BLDG-Building Deficiency
NOTES Created By
Paula Cross
11/19/2024 BLDG-21
Underground/Underflo
or Plumbing
268444-2024
No
TEXT Created Date
REFERENCE: CORAL RIDGE PHASE F10 -06/12/2025
1st Landscape Review
This Phase (Coral Ridge Phase F10, Bldg F1a:
of the project includes the following Building
and Unit numbers. This Building and all its
Units are associated with the On-Site
Residential plans, LPC2021-0008, DWG
529-9M
The following Units for Bldg. F18 have
satisfactorily completed the associated
landscape installation and may be released
for Permanent Occupancy. The Permit Card
for each Unit was signed on 10 June 2025
Coral Ridge -Bldg. F18 -Unit 29S -
2500 Chamomile Lane -CBRA2024-0170
Coral Ridge -Bldg. F18 -Unit 30S-
2508 Chamomile Lane -CBRA2024-01 69
Coral Ridge -Bldg. F18 -Unit 31S -
2516 Chamomile Lane -CBRA2024-0168
Coral Ridge -Bldg. F18 -Unit 32S -
2524 Chamomile Lane -CBRA2024-0167
Coral Ridge -Bldg. F18 -Unit 33S -
2532 Chamomile Lane -CBRA2024-0166
Coral Ridge -Bldg. F18 -Unit 34S -
2540 Chamomile Lane -CBRA2024-0165
Coral Ridge Building M2, Phase 24 has been
designated as the final Building and Units for
the Coral Ridge half of the project. No Units
from this Building (M2) will be released until all
landscape punch list items and close out
documents have been completed and
approved for all phases of Coral Ridge.
Passed Tony Alvarado
Complete
Complete
Wednesday, June 25, 2025 Page 1 of 5
December 9, 202-4-
Ms. Elizabeth Shoemaker
KB HOME
9975 Mira Mesa Blvd, Suite 700
San Diego, CA 92737
Re: Marja Acres
City of Carlsbad Grading Plan No. 529-9A
Project No. SOP 2078-0007
4907 El Camino Real
Carlsbad, CA 92070
FORM CERTIFICATION FOR:
CORALSPRINGS UNITS29~34
Dear Elizabeth,
IRVINE
SAN DIEGO
ONTARIO
LOS ANGELES
Based on our field survey today, this letter is to certify the foundation forms for Cora l Springs
Units 29-34 are in substantial conformance with the approved Precise Grading Pla n S29-98.
Sincerely,
FUSCOE ENGINEERING, INC.
Ja ~in G. Blackwelder, R.C.E. 92959 Exp. 72/37/2025
Associate Project Manager
Cc: Cra ig Stinger, KB HOME
6390 Greenwich Drive, Suite 170, San Diego, California 92122 I 858.554.1500 fuscoe.oom
Page 1 of 6
Structural
KB Home -Coral Ridge at Marja Acres Townhomes
Structural Observation Report# 12
Job#: 10-11634
Date of Observation: 3/21/2025
Date: 3/21/2025
Page: 1 of 6
Structural Observation Requested by: Structural Observation performed by: Area Observed:
Darnen Demuth
D Foundation
D Footing & Slab
D Holdown, Anchor
bolts & associated
Rebar
181 Roof & Floor Trusses
181 Roof Sheathi.ng
□ Roof Loaded
181 Second Floor wall
181 Third Floor Wall
□ Fourth Floor Wall
□
□
□
□
Shawn Afshar, PE Building F 18 (phase 10) Lots 29-34
Fram in
Observed Structural Elements and their connections
Floor Sheathing D Roof Sheathing 181 Exterior 181 Framing D Others
2nd Floor 181 1st Level 181 !st Level
3rd Floor 181 2nd Level 181 2nd Level
4th Floor 181 )Cd Level 181 3rd Level
□ 4th Level □ 4th Level
Status of Construction
181 Stair Installed 181 Bathtub Installed
□ Window Installed 181 Preliminary Drywall Installed
□ Flashing Installed 181 Drywall Stacked in Units
□ Building Wrapped □ Drywall on Wall
D Building Stuccoed □ Drywall on Ceiling
181 MEP installation on go ing 181 Sheathing one side Party Wall
Pursuant to your request, a visit to the project site was made on the above date to perform a structural observation in
conformance with CBC 2016 section 1702 and 1704.6.
Please note, not all symmetric or repetitive areas were observed, therefore please have your field personnel verify the
correction items in all similar areas. Where repair recommendations are given, verify if additional coordination may be
necessary with other trades or design professionals.
The structural observations do not constitute an approval of the work nor do they relieve the contractor or inspection agencies
from complying with project and code requirements. All observations were conducted from the ground or floor level and no
testing or inspection was performed. Our observations do not include a review of the contractors means or methods of
construction, shoring, erection, bracing, nor any associated safety precautions.
T: (714) 978-9780 I F: (714) 9 78-9788 I www.vcastruct ural.com I 1845 W. Orangewood Ave., Ste. 200 I Ora nge, CA 92868
Page 2 of 6
GENERAL ITEMS
G 1. At Exterior and Shear wall, sill plates should have minimum of (2) anchor bolts. One bolt withi n 12
inches but no less than 7 bolt diameters at the end of a siJI plate.
G2. Install MSTA36 strap at the top plates at all shear walls or exterior walls wherever the plumbing
penetrates the top plates.
G3. Install additional nailing where shiners are observed in the sheath ing.
G4. Notches and bored holes in structural members larger than allowed by the plans must be identified and
submitted to our office for review. Please submit RFJ on all these structural members to show locations
and size of al I holes and notches and we wi II provide our recommendations.
GS. At shear walls around openings, the sheathing shall be nailed to common studs at all panel joints
including above and below the opening. In some areas the sheathing was observed to be split onto
adjacent studs. Stitch nail adjacent studs at all panel joints with 16ds at the edge nailing spacing per the
shear wall schedule.
G6. Ensure that all point loads such as from headers, beams have sufficient support beneath that matches the
width of the beam or girder truss.
G7. Ensure that beam to beam connection hangers receive max. nailing.
G8. All exterior non-shearwalls should have min. l/2"¢anchor bolts @ 48 "o.c. shearwall schedule.
G9. AC line sets that will penetrate shear walls must be brought to the attention of the engineer before
installation.
GI 0. Ensure aJI floor diaphragm and shear wall sheathing is no less than 24" wide.
G 11. Install trimmers for beams and headers per structural plan.
G 12. Ensure that floor joists are installed per plan.
G 13. Headers must fully bear on trimmers, add hardwood shim in the gap or reinstalJ headers.
G 14. Fasteners for pressure preservative treated and fire retardant treated wood shall be of hot dipped zinc
coated galvanized or stainless steel. Exception: Provide a letter from the manufacturer of the treated wood
product stating that corrosion resistant fasteners are not required.
Carry all multiple studs, posts or trimmers from floor above down to floor below or beam below. Provide
solid blocking at floor level to transfer load from upper post/studs/trimmer to lower post/studs/trimmer.
T: (714) 978-9780 IF: (714) 978-9788 I www.vcastructural.com j 1845 W. Orangewood Ave., Ste. 200 I Orange, CA 92868
Floor Framing Page 3 of 6
The following circled items are observed omissions and deficiencies that must be corrected prior to completing the building. Refer to
attached figures for the location of observed items. Correct similar items in all locations
Sole Plate
SP Sole plate split or broken or has excessive notch.
SPt Sole plate size/thickness is not per plan.
SP2 Sole plate must be in full contact with floor
sheathing.
SP3 Sole plate nailing is not per plan.
Ho/down Hardware
HD Holdown is missing or damaged or mislocated or
~ HD2
HD3
HD4
HOS
size not per plan.
Holdown strap is not nailed.
Holdown post is not per plan. Replace post or add
post/stud per fix detail.
Holdown from above is not in line with the holdown
below, or beam below.
Provide solid wood filler under holdown post.
Stitch nail 2x stud with B.N.to the holdown post
with 16d staggered, spacing should be per shear
wall schedule.
Column/Post
CC Column/Post base is missing or not per plan.
CCI Column/Post must be continuous thru floor space.
Install squash block to bridge upper column and
lower column.
Shear Wall
SW Shear panel missing or not per plan or SW
thickness not per SW schedule or nailing not per
SWl
SW2
SW3
SW4
sws
SW6
SW schedule or length not per plan.
Structural sheathing splices should be on common
member.
Shear panel or top plate is damaged.
3x stud is required behind adjoining panel edges.
Boundary nailing must be applied along Holdown
post.
Minimum sheathing dimension is 24".
Shear wall detail at party wall is not per plan.
SW7 Only one side at double shear wall is observed at
this time.
SW8 Shear wall detail is not per plan.
SW9 For double sided shear wall, structural sheathing
splices should be offset at opposing faces of wall so
that, joint do not land on one common stud.
Shear Transfer
A35 A35, shear transfer connector, 16d nailing at shear
AJ
wall to blocking is insufficient or installation is
unacceptable.
Blocking over/under shear wall is not installed per
plan or installation is unacceptable.
~ag strap is missing or installed incorrectly. ~ ~~ag Strap is not nailed.
Stud Wall
W Stud Number/Size/spacing is not per plan. Add
studs.
Wt Stud is damaged or has excessive notch or hole at
utility penetration. Replace or add stud.
W2 Add stud under point load from beam or girder truss
per plan.
Framing
F Joist/Truss Joist, size/spacing is not per plan.
Ft Joist/Truss Joist has excessive notch or bored hole.
Repair per special instruction.
F2 Install full depth blocking at bearing wall.
F3 Joist/Truss Joist to beam hanger is missing, is not
the right size, is damaged or installation is
unacceptable.
F4 Provide support under beam.
FS Beam is damaged. Repair per special instruction.
F6 Beam size is not per plan. Replace or reinforce per
special instruction.
F7 Beam location is incorrect or beam is missing.
F8 Provide blocking under bearing wall.
F9 Brace interior wall per plan.
Ft O Framing is not per plan.
Ft 1 Detail is not per plan.
Framing at Opening
HR Header size is not per plan or missing.
HRI King stud is missing or nailing from king stud to
end of header is not sufficient.
HR2 Provide sufficient trimmer per plan.
HR3 Header is not long enough. Replace or repair per
special instruction.
HR4 Horizontal straps and blocking at top and bottom of
opening are missing.
HRS Nail horizontal straps at top and bottom of
opening.
HR6 Install continuous rim at floor level.
HR7 Replace blocking with continuous rim at shear wall.
Diaphragm
D Diaphragm nailing is incorrect. Min. nailing is 12"
o.c. at field and 6" o.c. at edges and at boundaries.
D1 Plywood diaphragm is damaged. Replace.
D2 Block diaphragm edges and provide adequate
nailing.
D3 Horizontal sheathing is not extended to wall.
D4 Boundary nailing installation is not complete.
D5 Minimum sheathing dimension is 24".
Stair
Mc Stringer has excessive cuts.
Met Stringer hanger is missing.
Miscellaneous
MC Hanger is missing or size is not per plan.
MCI All the hangers should receive maximum nailing.
MC2 Notched & bored holes should be per detail on plan.
MC3 All the connections should be fastened per
manufacturer's specifications.
MC4 Remove furring strips prior to installing sheathing.
o-
0r--t-+-+--UJJIL--+-rrti1'IIL-+--t:-ii1lr=tt-t-+--Lillmri--'r--t-~IUJJ+r----r--rn
S2-D21
Page 4 of 6
Install post (aligned
with post above) &
solid blocks at rim
REFER TO UNITCOMPOSITt
STRUCTURAL INFO NOl
6.2-PLEX -SECOND FLOOR FRAMING PLAN
S2-D21
Page 5 of 6
REFER TO UNIT COMPOSITE
STRUCTURAL INFO NOT
6.2-PLEX -THIRD FLOOR FRAMING PLAN
Page 6 of 6
S2-D22 REFER TO UNIT COMPOSITE FR.
STRUCTURAL INFO NOT SH
6.2-PLEX -ROOF FRAMING PLAN I
«~ ~ C IT Y □F
CARLSBAD
CERTIFICATION OF
COMPLETION LANDSCAPE
INSTALLATION
P-25(D)
Project Name: Marja Acres -Phases F10 (Bldg. F18)
Permit Address: 4901 El Camino Real
Permit Number: LPC2021-0003, CT 16-07
Development Services
Planning Division
1635 Faraday Avenue
(760) 602-4610
www.carlsbadca.gov
Drawing Number:_5_2_9-_9_M ________________________ _
I certify that I have inspected the planting and irrigation system and that:
1) All landscape work has been installed and completed per the plans and
specifications approved by the City of Carlsbad;
2) All required soil amendments were incorporated;
3) The installed irrigation system is functioning as designed and approved;
4) The irrigation control system was properly programmed in accordance with the
irrigation schedule; and
5) The person operating the system has received all required maintenance and
irrigation plans.
~~&-; RobStreza 6/9/2025
Project Landscape A'r'thitect or Professional of Record Date
License Number and Expiration Date: 4536 ----------12/2026
Firm Name: GMP, Inc. ----------------------
Phone number: 858-558-8977 ----------------------------
Following receipt of this Certification of Completion by the City, a final review of the installation
will be performed by the City. Fax the certification letter to: 760-436-7327; or email the form to
bp@dugmoredesignstudio.com
Call the Landscape Inspection Request Phone Line at 760-436-7327 to schedule the inspection .
Inspection Contact Name:_J_a_m_e_s_"_Ji_m_m_,y:._"_W_ill_ia_m_s _______________ _
Phone Number: 760-801-2755 ----------------------------
Contact or Firm Name: Nissho of California --------------------------
P-25(O) Page 1 of 1 Revised 04/12