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Home My WebLink About1100 LAS FLORES DR; ; CB051399; Permit04 192005 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No CB051399 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Valuation Reference # Project Title__ 1100 LAS FLORES DR CBAD MISC 1551803100 $000 PC050005 BUENA VISTA VILLAGE "FOUNDATION ONLY Applicant RANLIN CONSTRUCTION STE 203 10JJNDA VISTA Dl (760)74*6-7 ~"" 069 Subtype OTHER Status Lot # 0 Applied Entered By Plan Approved Issued Inspect Area Owner PACIFIC LIBERTY INC 991 C LOMAS SANTA FE DR #441 SOLANA BEACH CA 92075 ISSUED 04/19/2005 LSM 04/19/2005 04/19/2005 Miscelaneous Fee #1 Miscelaneous Fee #2 Additional Fees TOTAL PERMIT FEES PERMIT $500 00 $000 $000 $500 00 Total Fees $500 00 Total Payments To Date $0 00 Balance Due $500 00 6378 04/19/05 0002 01 02 CGF 500 00 Inspector FINAL APPROVAL Date Clearance 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 right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes nor planning zoning grading or other similar application processing or service fees in connection with this project NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave Carlsbad CA 92008 < \~\ FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Depos Validated By Date *•/•) 1^ / [\ Address (include Bldg/Suite #) Business Name (at this address) Q Legal Description Lot No Subdivision Name/Number Assessor s Parcel # Existing Use 'f'o fjt t} a A *T /eryk £) ft /( / Description of Work / SO FT #of Stories Unit No Phase No Total 0 of units Proposed Use # of Bedrooms # of Bathrooms , (CONTACT PERSQNiUf different from applicant) A Name 5% /ApWJCAMt i D fca Address City Agent fordontractor QQwiwr O AgenfiforOwrMjr so Address City State/Zip State/Zip Telephone # Telephone # Fax 9 > Address City State/Zip Telephone *Name MriHAQMWtfMto*^^ ' - i ^ ' i l* '.^Wf 1 % J V*W (Sec 7031 S 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 epplicant 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 703> 5 by any applicant for a permit subjects the. applicant to a civil penalty of not more than five hundred dollars I $5001) ^ - / // - -/ J— . - » - . */ / / tt ^0 "2.— / *S1 „ — __ .-»*- —•* t i * t Name State License # Address License Class /»>City State/Zip City Business License #2^ Tjlephone t /frr*-/ V-tPY~ Designer Name State License » Address City State/Zip Telephone tk SI 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 D 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 1*1001 OR LESS) GJ 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 Tobecome subject to the Workers Compensation Laws of California WARNING Failure to -secure workers compensation coverage la unlawful and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (MA&flOO) hTaddklon to thecost of compensation damages as provided for In Section 3706 of the Labor code Intereat and attorney a feea SIGNATURE, XX^2g-S~-^frL^) W^ /^X^^t - --^ _ DATE T ;• , > , * „ i " - n fi " ™ ' J f I hereby affirm that I am exempt from the Contractor s License Law 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 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) D 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) _, ____^_ ________ 6 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 , 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 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 Q NO Is the facility to be constructed within 1 000 feet of the outer boundary of a school site? Q YES Q 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 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 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 CitV 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 commenpeeyp'r a period gfc^flfrrlays (Section 106 4 4 Uniform Building Code) DATE </~f?-0r' WHITE File YELLOW Applicant PINK Finance APPLICANT S SIGNATURE City of Carlsbad Bldg Inspection Request For 01/25/2006 Permit* CB051399 Title BUENA VISTA VILLAGE Description FOUNDATION ONLY Inspector Assignment PS Sub Type OTHER 1100 LAS FLORES DR Lot 0 Type MISC Job Address Suite Location APPLICANT RANLIN CONSTRUCTION Owner PACIFIC LIBERTY INC Remarks Is'Can this permit be fmaled? Phone Inspector Total Time Requested By CHRISTINE Entered By CHRISTINE CD Description 19 Final Structural Act Comment Comments/Notices/Hold Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp 09/19/2005 11 Ftg/Foundation/Piers AP BN 09/19/2005 81 Underground Combo AP BN 09/14/2005 11 Ftg/Foundation/Piers CA PS 08/10/2005 66 Grout AP PS 08/09/2005 66 Grout NS PS 08/08/2005 66 Grout CO PS 08/03/2005 66 Grout PA PC 08/02/2005 66 Grout AP PS 08/01/2005 66 Grout CA PC 07/27/2005 65 Retaining Walls WC PS 07/26/2005 11 Ftg/Foundation/Piers AP PS 07/01/2005 65 Retaining Walls CO PS 06/24/2005 11 Ftg/Foundation/Piers AP PY 06/23/2005 11 Ftg/Foundation/Piers CO PS 06/14/2005 11 Ftg/Foundation/Piers AP PS 06/13/2005 11 Ftg/Foundation/Piers CO PS 06/07/2005 11 Ftg/Foundation/Piers AP PS Comments DECK / CABLES BY ASST SUPER UTILITY RM TOP OUT DOWELL FROM CMU TO DECK NOT INSTALLED SHORT WALL OPPOSITE UTILITY RM WALL 1ST LIFT @ ELEC RM WAITED FOR CONCRETE SUB TO INSTALL SLAB DOWELS PER PLAN WAITED ABOUT 30MINS PER KATHY @ elec rm PLAN CALLS FOR 2 / FALL & ROCK AROUND PIPE NOT PER PLAN SLAB ON GRADE & FTG @ DRIVEWAY NOT PER PLAN 17 COLUMNS NEED TO REMOVE TUBES FOR INSP COLUMNS NOT PART OF FOUNDATION SYSTEM TO FINISH GRADING 1 COLUMN City of Carlsbad Bldg Inspection Request For 08/08/2005 Permit* CB051399 Title BUENA VISTA VILLAGE Description FOUNDATION ONLY Inspector Assignment PS 1100 LASFLORESDR Lot 0 Type MISC Job Address Suite Location APPLICANT RANLIN CONSTRUCTION Owner PACIFIC LIBERTY INC Remarks PM PLEASE Sub Type OTHER Phone 6192077397 Inspector Total Time Requested By CATHERN Entered By JANEAN CD Description 66 Grout Act Comment @& 1)<s*c^L Associated PCRs/CVs Inspection History Date 08/03/2005 08/02/2005 08/01/2005 07/27/2005 07/26/2005 07/01/2005 06/24/2005 06/23/2005 06/14/2005 06/13/2005 06/07/2005 06/07/2005 06/06/2005 06/03/2005 06/01/2005 05/31/2005 05/27/2005 05/18/2005 05/16/2005 05/12/2005 Description 66 Grout 66 Grout 66 Grout 65 Retaining Walls 1 1 Ftg/Foundation/Piers 65 Retaining Walls 1 1 Ftg/Foundation/Piers 1 1 Ftg/Foundation/Piers 1 1 Ftg/Foundation/Piers 1 1 Ftg/Foundation/Piers 1 1 Ftg/Foundation/Piers 66 Grout 1 1 Ftg/Foundation/Piers 1 1 Ftg/Foundation/Piers 66 Grout 66 Grout 66 Grout 66 Grout 66 Grout 66 Grout Act Insp Comments PA PC SHORT WALL OPPOSITE UTILITY RM WALL AP PS 1ST LIFT @ ELEC RM WAITED FOR CONCRETE SUB TO INSTALL SLAB DOWELS PER PLAN WAITED ABOUT 30MINS CA PC PER KATHY WC PS AP PS @ elec rm CO PS PLAN CALLS FOR 2 / FALL & ROCK AROUND PIPE NOT PER PLAN AP PY SLAB ON GRADE & FTG @ DRIVEWAY CO PS NOT PER PLAN AP PS 17 COLUMNS CO PS NEED TO REMOVE TUBES FOR INSP COLUMNS NOT PART OF FOUNDATION SYSTEM TO FINISH GRADING AP PS 1 COLUMN AP PS WEST STAIRS AP PS PAD FTG & STEEL CO PS NEED SOILS REPORT PA PS 2ND LIFT EAST STAIRS PINK NR RB NEED SPECIAL INSP WRITTEN REPORT 1ST PA RB 2ND LIFT SEE JOB PLANS AP PS NOTED ON CARD & PLANS IN BLUE 2ND LIFT AP PS noted on card & plans in pink PA JM LIFT NORTH WALL City of Carlsbad Bldg Inspection Request For 06/07/2005 Permit* CB051399 Title BUENA VISTA VILLAGE Description FOUNDATION ONLY Inspector Assignment PS 1100 LASFLORESDR Lot 0 Type MISC Sub Type OTHER Job Address Suite Location APPLICANT RANLIN CONSTRUCTION Owner PACIFIC LIBERTY INC Remarks AM PLEASE Phone 6192077397 Inspector Total Time Requested By CATHERINE Entered By CHRISTINE CD Description 11 Ftg/Foundation/Piers Act Comment Associated PCRs/CVs Inspection History Date Description Act Insp 06/03/2005 11 Ftg/Foundation/Piers CO PS 06/01/2005 66 Grout PA PS 05/31/2005 66 Grout NR RB 05/27/2005 66 Grout PA RB 05/18/2005 66 Grout AP PS 05/16/2005 66 Grout AP PS 05/12/2005 66 Grout PA JM 05/06/2005 66 Grout AP PY 05/03/2005 11 Ftg/Foundation/Piers PA RB 05/02/2005 11 Ftg/Foundation/Piers CO PS 04/28/2005 11 Ftg/Foundation/Piers CA PS 04/22/2005 11 Ftg/Foundation/Piers AP PS 04/21/2005 11 Ftg/Foundation/Piers CO PS Comments NEED SOILS REPORT 2ND LIFT EAST STAIRS PINK NEED SPECIAL INSP WRITTEN REPORT 1ST 2ND LIFT SEE JOB PLANS NOTED ON CARD & PLANS IN BLUE 2ND LIFT noted on card & plans in pink LIFT NORTH WALL 1ST LI FT PERIMETER FTGS AS MARKED ON PLANS DETAIL STILL SHOWS KEY @ STAIRS BY LINDA NOTED ON PLAN IN YELLOW City of Carlsbad Bldg Inspection Request For 06/06/2005 Permit* CB051399 Title BUENA VISTA VILLAGE Description FOUNDATION ONLY Inspector Assignment PS 1100 LASFLORESDR Lot 0 Type MISC Job Address Suite Location APPLICANT RANLIN CONSTRUCTION Owner PACIFIC LIBERTY INC Remarks am please Sub Type OTHER Phone 6192077397 Inspector Total Time CD Description 11 Ftg/Foundation/Piers Requested By KATHERINE FILLERUP Entered By CHRISTINE Act Comment %r/> Associated PCRs/CVs Inspection History Date Description Act Insp 06/03/2005 11 Ftg/Foundation/Piers CO PS 06/01/2005 66 Grout PA PS 05/31/2005 66 Grout NR RB 05/27/2005 66 Grout PA RB 05/18/2005 66 Grout AP PS 05/16/2005 66 Grout AP PS 05/12/2005 66 Grout PA JM 05/06/2005 66 Grout AP PY 05/03/2005 11 Ftg/Foundation/Piers PA RB 05/02/2005 11 Ftg/Foundation/Piers CO PS 04/28/2005 11 Ftg/Foundation/Piers CA PS 04/22/2005 11 Ftg/Foundation/Piers AP PS 04/21/2005 11 Ftg/Foundation/Piers CO PS Comments NEED SOILS REPORT 2ND LIFT EAST STAIRS PINK NEED SPECIAL INSP WRITTEN REPORT 1ST 2ND LIFT SEE JOB PLANS NOTED ON CARD & PLANS IN BLUE 2ND LIFT noted on card & plans in pink LIFT NORTH WALL 1ST LI FT PERIMETER FTGS AS MARKED ON PLANS DETAIL STILL SHOWS KEY @ STAIRS BY LINDA NOTED ON PLAN IN YELLOW City of Carlsbad Bldg Inspection Request For 05/31/2005 Permit* CB051399 Title BUENA VISTA VILLAGE Description FOUNDATION ONLY Inspector Assignment PS 1100 LASFLORESDR Lot 0 Type MISC Job Address Suite Location OWNER PACIFIC LIBERTY INC Owner PACIFIC LIBERTY INC Remarks 2ND LIFT Sub Type OTHER Phone 7604201158 Inspector Total Time CD Description 66 Grout Requested By LINDA Entered By KAREN Associated PCRs/CVs Inspection History Date Description Act 05/18/2005 66 Grout AP 05/16/2005 66 Grout AP 05/12/2005 66 Grout PA 05/06/2005 66 Grout AP 05/03/2005 11 Ftg/Foundation/Piers PA 05/02/2005 11 Ftg/Foundation/Piers CO 04/28/2005 11 Ftg/Foundation/Piers CA 04/22/2005 11 Ftg/Foundation/Piers AP 04/21/2005 11 Ftg/Foundation/Piers CO Insp Comments PS NOTED ON CARD & PLANS IN BLUE 2ND LIFT PS noted on card & plans in pink JM LIFT NORTH WALL 1ST LIFT PERIMETER FTGS AS MARKED ON PLANS DETAIL STILL SHOWS KEY @ STAIRS BY LINDA NOTED ON PLAN IN YELLOW PY RB PS PS PS PS NOTICE CITY OF CARLSBAD (760) 602 2700 BUILDING DEPARTMENT 1635 FARADAY AVENUE DATE V J/-G'<r TIME. LOCATION, PERMIT NO t /7/ / '"' ~^»" FOR INSPECTION CALL (760) 602 2725 RE INSPECTION FEE DUE? FOR FURTHER INFORMATION CONTACT YES A PHONE BUILDING INSPECTOR"^ CODE ENFORCEMENT OFFICER City of Carlsbad Bldg Inspection Request For 04/22/2005 Permit# CB051399 Title BUENA VISTA VILLAGE Description FOUNDATION ONLY Inspector Assignment PS Type MISC Sub Type OTHER Job Address 1100 LAS FLORES DR Suite Lot 0 Location APPLICANT RANLIN CONSTRUCTION Owner PACIFIC LIBERTY INC Remarks Phone 7604201158 Inspecto Total Time CD Description 11 Ftg/Foundat.on/P.ers Acb CommentAda (/# Requested By LINDA Entered By CHRISTINE . ,A Associated PCRs/CVs Inspection History Date Description Act Insp Comments \ ENGINEERING I DESIGN GROUPmGEOTECHNICAL CIVIL & STRUCTURAL CONSULTANTS FOR RESIDENTIAL 1 COMMERCIAL CONSTRUCTION 2121 Montiel Road San Marcos California 92069 (760)8397302 Fax (760) 480 7477 E mail ENGDG@aol com FOOTING OBSERVATION SUMMARY Date Project Name Address Footing Location Reference Code 2001 CBC Farber Development 1100 Las Flores Drive Carlsbad California ' Geotechnical Investigation and Foundation Recommendations for Proposed Multi Family Development, to be Located at 1100 Las Flores Drive, City of Carlsbad, California", Dated December 22, 2000, Project No 0024861, Prepared by Engineering Design Group Observation of Summary lals itials A representative of E D G observed on-site soil conditions Soil conditions for the proposed footings are substantially in conformance with the referenced soils report A representative of E D G observed and measured footing excavation depth/width for the proposed footings Footing excavations extend to proper depth and competent bearing strata, and are in acceptable for new footing A representative of E D G measured footing setback from slope face The setback was in generally found to be acceptable in consideration of site soil conditions Notes to Superintendent/Foreman 1 Footing/caisson excavations should be cleaned of loose debris and thoroughly moistened just prior to placing concrete 2 In the event of a site change subsequent to our footing/caisson observation and prior to concrete placement (i e , heavy ram, etc ), we should be contacted to perform additional site observations Notes to Building Inspector 1 Soil compaction test results, including depth of fill, relative compaction, bearing values, and^soil expansion index test results are contained m the As-Graded 5eote£WTical/KeR0rt provided at the completion of grading (IF APPLICABLE) RING DESIGN GROUP Date E \FORMS\4 FRM\2000\002486 1 FARBER DEV 1100 LAS FLORES DR CARLSBAD FTGOBSwpd ALTA CONSULTANTS PLANNING » ENGINEERING » SURVEYING 490IMorena Boulevard Suite #409 San Diego California 92117 Telephone (858)5816101 Fax (858) 581 6138 April 22,2005 City of Carlsbad Public Works-Engineering 1635 Faraday Avenue Carlsbad, CA 92008 RE Farber Condominium Project / 1100 Las Flores Drive, Carlsbad, California, To whom it may concern On April 22 2005 our survey crew checked the top of foundation forms on the above referenced site The grades are in substantial conformance of the design elevation as shown on the Architectural and Structural Plans prepared for this project Should you require any additional information, please do not hesitate to call me at any time Sincerely ALTA CONSULTANTS Victor Rodriguez-Fernandez LS 5335 FLORESLUND C O N S U LTANTS April 6 2005 Ranlm Construction 1010 Linda Vista Avenue San Marcos CA 92078 Attention Mr Randy Hickman Project Project Name, Buena Vista Condos FLC# 04138/4 11 Site Observation Date Present at Site Apnl6 2005 Ms Linda Fillerup Ranlin Construction (Part Time) Hank Concrete Subcontractor Mr Kevin Pagan FLC Mr Raymond H Flores FLC Dear Randy In accordance with our service agreement to perform periodic site observations we have performed a site review of the foundation reinforcement The following findings and observations were noted Status of Construction 1 The contractor has completed the basic site excavation 2 The contractor ha< completed the perimeter footing excavation and placed the footing reinforcement and wall dowels except for the site access ramp Site Observations 1 We performed a general review of the foundation reinforcement While we did not compare the drawings with each and every field condition we found the foundation reinforcement to be in general conformance with the contract documents and good practice except for the balance of this report 7220 Trade Street Suite 120 • San Diego California 92121 Civil and Structural Engineering (858) 566 0626 FAX (858) 566 0627 www f loreslund com Panlin Construction Buena Vista Condos April 6 2005 Page 2 2 Based on this site review we have chosen to add to the perimeter foundation one more #5 continuous close to the inside toe of the footing to be tied with perpendicular bars #4 s at 24 o/c 3 We discussed the placement of the first course of block That first course is to be placed in the freshly placed perimeter footing i e wet set Note added to 10/S2 0 to this effect 4 We reviewed Detail 10/S2 0 based on our review perimeter wall footing is eccentric with a 6 heel as shown and dimensioned on S3 0 5 A discussion was held relative to the podium deck and the slope to be built into the forming system This discussion was centered around the architects cross section After some discussion of this method it was agreed additional detailing was required Corrections and comments made in this job site observation report and in the field visitation do not relieve the contractor from compliance with the requirements of the construction drawings Therefore it is the inspectors and contractors responsibility to comply with the construction drawings Should you have any questions please call This opportunity to be of professional service is sincerely appreciated Very Truly Yours FLORES LUND CONSULTANTS aymond H FkSres S E CEO RHF/lw R \Admm Projects\Structural Folder\2004 Projects\04138\Site Observ Report New Construction doc Rev 1/04 SPECIAL INSPECTOR'S REPORT Inspection Office (626) 795-0770AMERICAN INTERNATIONAL INSPECTIONS AND TESTING Inspection Fax (626) 432-1717 kbataom626@charter net 0 REIMPORT ED CONCRETE WPOST TENSION < OMf flETE D REINFORCED fMSONPY D OTHER Q HI TEN BOLTING D STRUCTURAL STEEL ASSEMBLY D WELDING DSHOP D RELD , . PERMIT * UiLf. C606- CONTRACTOR SUB CONTRACTORCITY INSPECTOR MIX DESIGN* READY MIX CO PLACEMENT CHECK BY CU YDS PLACED SPEC STRENGTH » 28 DAYS# OF CYLINDERS SLUMP SUPERINTENDENT WELDING OPERATORS »-^y^y |>V in-s **-***. usffl^ G/0 -. \ i L Ptftfn g Deputy Injector tracto/s Representative p°NlM TWES WED THURS v-'^FBI SAT SUN | ALL INSPECTiON BASED ON A 4 HOUR MINIMUM OVER 4 HOURS=a HOURS ALSO ANY INSPECTION THAT EXTENDS PAST NOON I SPECIAL INSPECTOR'S REPORT Inspection Office (626)795-0770AMERICAN INTERNATIONAL INSPECTION AND TESTING Inspection Fax (626)432-1717 Email kbalcom626(g)chaftef net 0 ftEINTORCED CONCRETE Q POST TENSIOM COMPETE a REINFORCED MASONPY 0 OTH6R OHITEM BOLTIMG D STRUCTURAL STEEL ASSEMBLY a WELDING D SHOP a C1ELD JOB ADDRESS MAP BOOK JOB PHONE DIRECTIONS "ROJECT PILLING PERMIT < DATES OWNER DEPUTY INSPECTOR ENGINEER CONTRACTOR CITY INSPECTOR PHONE SUB-CONTRACTOR MIX DESIGN *READY MIX CO PLACEMENT CHECK BY SUPERINTENDENT CU YDS PLACED SPEC STRENGTH « 28 DAYS # OF CYLINDERS SLUMP LAB TESTING DATE CALLED WELDING OPERATORS CERT f EXPIRATION ELECTRODES /VT\ <M Vtai^a-rx t <vg. j?gg CT— ~JT Y *""~ V ^4-<^ JajSHavu. <£4 ^^_ * lifrrr^- tn Contractors Representative | ALL INSPECTION BASED ON A 4 HOUR MINIMUM OVER 4 HOURS=8 HOURS ALSO ANY INSPECTION THAT EXTENDS PAST NOON j Office DEPUTY INSPECTION REPORT RfaMSSfeWNSPECTION SERVICE JjplEINFORCED CONCRETE Q POST TENSION CONCRETE a REINFORCED MASONRY D OTHER O HI TEN BOLTING D STRUCTURAL STEEL ASSEMBLY D WELDING D SHOP D FIELD r JOB ADDRESS OWNER JOB PHONE ARCHITECT PROJECT J/^PERMIT *ENGINEER BILLING CONTRACTOR PHONE SUB-CONTRACTOR CITY INSPECTOR PHONE B94 MIX DESIGN #READY MIX CO SPEC STRENGTH ® 28 DAYS CU YRDS PLACED # OF CYLINDERS SLUMP WELDING OPERATORS CERTIFICATE #EXP DATE ELECTRODES DATE WORK INSPECTED S EPUTY INSPECTOR CERTIFICATE NUMBER JN TUES WED THURS FRI ^.SAT /SUN ALL INSPECTIONS BASED ON A 4 HOUR MINIMUM OVER 4 HOURS ALSO ANY INSPECTION THAT EXTENDS PAST NOON WILL BE AN B HOUR MINIMUM SPECIAL INSPECTOR'S REPORT AMERICAN INTERNATIONAL INSPECTIONS AND TESTING Inspection Office (626) 795-0770 Inspection Fax (626) 432 1717 IEINFORCED CONCRETE D POST TENSION CONCRETE ^REINFORCED MASONRY Q OTHER II TEN BOLTING a STRUCTURAL STEEL ASSEMBLY D WELDING Q SHOP O FIELD J ADDRESS JOB PHONE f ffa f / I O/ S C f / f . -r" p BOOK DIRECTIONS OJECT PERMIT » LING X" PHONE JDRESS TV INSPECTOR PHONE ^ /> . jr*j**»4 IX DESIGN* y* READY MIX CO PLACEMENT CHECK BY / Li" YDS PLACED SPEC STRENGTH ® 28 DAYS * OF CYLINDERS SLUMP /ELDING OPERATORS CERT * ATE WORK INSPECTED fd s ' "S ^.'~>' ""* £. / fi* f\ /r */%f ICHIBAN PERCENTAGE OF COMPLETIONy / , 'Z / // '^ / sf .S / <^J.-s, > s ^y , ~^\s -' Oeputyjnspector ,' ' CONTRACTOR MOM s^ I T^ES WED THURS FHI f 1 iJ^ C 1 DATES ft <t / /Vi^f DEPUTY INSPECTOR ENGINEER f ^ ^ i i// CONTRACTOR / <> / SUB-CONTRACTOR <" ^/ ^ r^y, SUPERINTENDENT CELL PHONE FOREMAN LAB TESTING DATE CALLED EXPIRATION ELECTRODES .^., s,S S,^ J> ^ J$r f^A^Vf J -^ * X JF > f\ JRr jf y^ t / f f/a Ojf LffP* •S REPRESENTATIVE" / " ~^ " SAT SUN ALL INSPECTIONS BASED ON A 4 HOUR MINIMUM OVER 4 HOURS=8 HOURS ALSO ANY INSPECTION THAT EXTENDS PAST NOON WILL BE AN 8 HOUR MINIMUM SPECIAL INSPECTOR'S REPORT AMERICAN INTERNATIONAL INSPECTIONS AND TESTING Inspection Office (626) 795 0770 Inspection Fax (626)432-1717 * OF CYLINDERS SLUMP REINFORCED CONCRETE d POST TENSION CONCRETE J&REINFORCED MASONRY d OTHER -II TEN BOLTING D STRUCTURAL STEEL ASSEMBLY Q WELDING O SHOP d FIELD ICHIBAN PERCENTAGE OF COMPLETION ALL INSPECTIONS BASED ON A 4 HOUR MINIMUM OVER 4 MOURS=8 HOURS ALSO ANY INSPECTION THAT EXTENDS PAST NOON WILL BE AN 6 HOUR MINIMUM SPECIAL INSPECTOR'S REPORT AMERICAN INTERNATIONAL INSPECTIONS AND TESTING Inspection Office (626) 795 0770 Inspection Fax (626)432 1717 D REINFORCED CONCRETE D POST TENSION CONCRETE D REINFORCED MASONRY D OTHER Q HI TEN BOLTING O STRUCTURAL STEEL ASSEMBLY D WELDING D SHOP D FIELD JOB ADDRESS JOB PHONE OWNER' MAP BOOK DIRECTIONS DEPUTY INSPECTOR PROJECT PERMIT »ENGINEER BILLINC™"" ADDRESS PHONE CONTRACTOR CITY INSPECTOR PHONE SUB-CONTRACTOR MIX DESIGN*READY MIX CO PLACEMENT CHECK BY SUPERINTENDENT FOREMAN '/XA CELLPHONE CU YDS PLACED SPEC STRENGTH ® 28 DAYS * OF CYLINDERS SLUMP LAB TESTING DATE CALLED WELDING OPERATORS CERT #EXPIRATION ELECTRODES DATE WORK INSPECTED •/4 f ICHIBAN PERCENTAGE OF COMPLETION r 1, CONTRACTOR S REPRESENTATIVE \ v. MON ^x1"TUES WED THURS ^FHI d"',/SAT SUN ^ ALL INSPECTIONS BASED ON A 4 HOUR MINIMUM OVER 4 HOURS=8 HOURS ALSO ANY INSPECTION THAT EXTENDS PAST NOON WILL BE AN 8 HOUR MINIMUM Rev 6/99 SPECIAL INSPECTOR'S REPORT AMERICAN INTERNATIONAL INSPECTIONS AND TESTING Inspection Office (626) 795 0770 Inspection Fax (626) 432 1717 ^REINFORCED CONCRETE D POST TENSION CONCRETE D REINFORCED MASONRY O OTHER a HI TEN BOLTING O STRUCTURAL STEEL ASSEMBLY D WELDING O SHOP D FIELD JOB ADDRESS JOB PHONE OWNER MAP BOOK DIRECTIONS DEPUTY INSPECTOR PROJECT PERMIT «ENGINEER BILLINC ADDRESS PHONE CONTRACTOR CITY INSPECTOR PHONE SUB-CONTRACTOR MIX DESIGN*READY MIX CO PLACEMENT CHECK BY SUPERINTENDENT FOREMAN CELLPHONE CU YDS PLACED SPEC STRENGTH ® 28 DAYS * OF CYLINDERS SLUMP LAB TESTING DATE CALLED WELDING OPERATORS CERT #EXPIRATION ELECTRODES DATE WORK INSPECTED sr &AJS7 frtf T&i SJJ ICHIBAN PERCENTAGE OF COMPLETION (S-«___X ^^™*n"J~~~~—r Depuly'lnspector 3^f^ f /• *• ^ MON / j^ CONTRACTOR S REPRESENTATIVE \ TUES WED THURS /5 J?1 f FRI <_>^ </SAT SUN ALL INSPECTIONS BASED ON A 4 HOUR MINIMUM OVER 4 HOURS=8 HOURS ALSO ANY INSPECTION THAT EXTENDS PAST NOON WILL BE AN 8 HOUR MINIMUM Rev 6/99 ENGINEERING DESIGN GROUP 2121 Montiel Road San Marcos CA 92069 Office (760) 839 7302 FAX (760) 480 7477 E mail ENGDG@aol com DAILY FIELD REPORT PROJECT. ADDRESS DATE ' Z 3 ~ L A*> fLoft, £6 EQUIPMENT PROJECT NO NAME/COMPANY CONTACTS DESCRIPTION OF FIELD OPERATIONS f ** r/V/f ft- _ £>/H T~IF riL I 4 > ,/. if FIELD DENSITY TESTS TAKEN FAILURES -RETESTS Arrive Depart A D A D A D D TOTAL DAILY HRS SPECIAL INSPECTOR'S REPORT AMERICAN INTERNATIONAL INSPECTIONS AND TESTING Inspection Office (626) 795 0770 Inspection Fax (323) 254 8887 D REINFORCED CONCRETE D POST TENSION CONCRETE D REINFORCED MASONRY d OTHER D HI TEN BOLTING a STRUCTURAL STEEL ASSEMBLY D WELDING D SHOP D FIELD JOB ADDRESS"?'JOB PHONE OWNER MAP BOOK DIRECTIONS DEPUTY INSPECTOR / PROJECT PERMIT * BfLLINT ADDRESS PHONE X;0NT-HACTOR CITY INSPECTOR PHONE SUBiCONTRACTOR- MIX DESIGN #READY MIX CO PLACEMENT CHECK BY SUPERINTENDENT FOREMAN CELLPHONE CU YDS PLACED SPEC STRENGTH ® 28 DAYS # OF CYLINDERS SLUMP LAB TESTING DATE CALLED WELDING OPERATORS CERT #EXPIRATION ELECTRODES DATE WORK INSPECTED s °7 te rfa&m ICHIBAN PERCENTAGE OF COMPLETION y CONTRACTOR'S REPRESENTATIVE *£#/*TUES ,WED THURS FRI SAT SUN ALL INSPECTIONS BASED ON A 4 HOUR MINIMUM OVER 4 HOURS=8 HOURS ALSO ANY INSPECTION THAT EXTENDS PAST NOON WILL BE AN 8 HOUR MINIMUM Rev 6/99 SPECIAL INSPECTOR'S REPORT ING Inspection Office (626) 795-0770 Inspection Fax (626) 432-1717 }*CINFORCEDCONCI«Tf O POST TENSION CONCRETE O REINFORCED MASONRY Q OTHER ' - O STRUCTURAL STEEL ASSEMBLY Q WELDING QSHOP D FIELD -? I HGQ MAP BOOK omEcnoNS DEPUTY I PROJECT 9H.LING ADDRESS V CITY INSPECTOR PHONE SUB-CONTRACTOR MIX DESIGN *READY MIX CO PLACEMENT CHECK BY CU YDS PLACED SPEC STRENGTH • 28 DAYS FOREMAN * OF CYLINDERS SLUMP LAB TESTING DATE CALLED W6LDINQ OPERATORS EXPIRATION ELECTRODES T ICHIBAN PERCEhrrAGICf Deputy ImpKtor "•*^^* mVf^pL 4~~~J^ COMTMCTOm MMntNTATNf !* SAT HOj!>Ra ENGINEERINGmDESIGN GROUP 2121 Montiel Road San Marcos CA 92069 Office (760) 839 7302 FAX (760) 480 7477 E mail ENGDG@aol com PROJECT_ ADDRESS EQUIPMENT NAME / COMPANY CONTACTS DAILY FIELD REPORT _DATE PROJECT NO DESCRIPTION OF FIELD OPERATIONS (5 #t£./£i/ &TI <?A/ _ f-o #- _ <°/4- E> L£,TT£ ft- 222 FIELD DENSITY TESTS TAKEN FAILURES -RETESTS Arrive Depart A D A D A D A D TOTAL DAILY MRS ENGINEERINGIDESIGN GROUP 2121 Montiel Road San Marcos CA 92069 Office (760) 839 7302 FAX (760) 480 7477 —„. E mail ENGDG@aol com A PROJECT. ADDRESS EQUIPMENT NAME/COMPANY CONTACTS DAILY FIELD REPORT .DATE .PROJECT NO DESCRIPTION OF FIELD OPERATIONS ,r- FIELD DENSITY TESTS TAKEN FAILURES -RETESTS Arrive Depart A D A D A D A D TOTAL DAILT MRS J..INSPECTIONS REGISTERED INSPECTOR 9s DAILY REPORT Office (760)451 9021 Office Fax (760) 451 Field Manager Cell (760)468-41 (24 hours) Office Cell (760)468-4^ Email wmkoinspections@yahoo com DATE I /J? Job Name Job Phone # * Owner JobAddress Cay Zip Architect Map Book Pg | Directions Engineer Permit No Issued By City Inspector Q Shotcrete D Gudte aStracfattlSted D PortTenAMedConcrete Requested D Epoiy D Flreprooflnj a Other DHl-TenBoWnf Beady Mix Phot MixDengntf PSI (g 2! D»ys Phone #tt*pr ft ' Type A Drypack Info Contractor r/ -V / . fiS^i f Batch*Exp Date Sub-Contractor WELDING INFO Superintendent / Porman WekttagUpenton "ertifiQ««Km#/Ejq> Dtte Electrodw Inspectorls Name / Phone # WORK INSPECTED J%^ TEST PERFORMED TTPE OF SAMPLE Quantity at Set Slump fin) Concrete Temp CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED I HAVE FOUND THIS WORK TO COMPLY WITJtTHE APPROVED PLANS, SPECIFICATIONS, AND APPLICABLE SECTIONS SPECIALTT WHITE OFFICE COPY , CANARY ACCOUNTING Q Air Temp THE TBSTSMIF*ESRB>HESaiTAHVE LOCATION a me CONTINUED ON NEXT PAGE D PAGE £OF_ REG HOURS OT HOURS DT HOURS TRAVEL SAMPLES All inspections based on a minimum of 4 hours and over 4 hours Shourmmtmum. Also any inspection mat extends past noon will be an 8 hour minimum. PINK INSPECTORS COPY GOLDENROD JOB SITE COPY *„ j.1**^.^*** Southern California Soil and Testing, Inc 6280 Riverdale Street P O Box 600627 San Diego CA 92160 (619) 280-4321 Concrete Compressive Strength Test Report File Number Project Title Project Location Architect Engineer Contractor 0412468 American International Inspection Los Flores 11 00 Las Flores— i-*--. Permit No Plan File No City of Carlsbad Location In Structure Material Supplier Mix Designation Admixture(s) Time in Mixer Air Content Air Temp Truck Number Samples Made By Column Pads Mins Slump Inches % Unit Weight pcf 0 Concrete Temp Ticket Number Samples Tested By 0 CN Laboratory Number Mark Date Made Date Received Date Tested Diameter Inches Area Square Inches Maximum Load Pounds Compressive Strength psi Age Tested Days Required 28 Day Strength psi Fracture Type 7249 06/07/05 07/05/05 07/05/05 600 2827 122 250 4320 28 3000 7250 07/05/05 129750 4590 28 7251 07/05/05 130500 4620 28 Specimen sampling identification and compressive strength testing were performed by this agency in accordance with the applicable ASTM C39 standards This agency makes no other warranties express or implied Legend Fracture Type - Cone =C Cone and Split =CS Cone and Shear =CSH Shear = S Columnar = CL 1 Distribution (1) American Inspections •NBBBB* Reviewed By ^~ —-^ <^/ > -c/L Edward C Trasoras RCE # 44235 7/11/2005 Southern California Soil and Testing, Inc 6280 Riverdale Street P O Box 600627 San Diego CA 92 160 (619) 280-4321 Concrete Compressive Strength Test Report File Number Project Title Project Location Architect Engineer Contractor 0412468 American International Inspection 11 06 Las Flores Ranlin Buena Vista Village Permit No Plan File No CB051399 City of Carlsbad Location In Structure Matenal Supplier Mix Designation Admixture(s) Time in Mixer Air Content Air Temp Truck Number Samples Made By West Wall Utility Room Footing Superior 867P Mms % 78° 407 JW Slump Inches Unit Weight pcf Concrete Temp Ticket Number Samples Tested By 450 73° 834 CN Laboratory Number Mark Date Made Date Received Date Tested Diameter Inches Area Square Inches Maximum Load Pounds Compressive Strength psi Age Tested Days Required 28 Day Strength psi Fracture Type 0632 07/30/05 08/09/05 08/27/05 0633 08/27/05 600 2827 138250 4890 28 3000 C 136500 4830 28 0634 Discard C Specimen sampling identification and compressive strength testing were performed by this agency in accordance with the applicable ASTM C39 standards This agency makes no other warranties express or implied Legend Fracture Type - Cone =C Cone and Split =CS Cone and Shear =CSH Shear = S Columnar = CL 1 Distribution (1)_Amencan Inspections •••••I Reviewed By Edward C Trasoras RCE#44233 9/14/2005 Jun 06 05 0939a Hank Blatmk & Associates 714 590-8622 p1 HANK BLATNIK & ASSOCIATES 12891 Nelson Street • Garden Grove CA 92840 • (714) 590-8625 • FAX (714) 590-8622 REQUEST FOR INFORMATION Request For Iitformation Number To Phone Fax Project Description Project Location \ tD\p Date Items In Question, Submitted By Signature Date Reply D Please See Attached Answered By Signature Please reply to this Request For Information on or before <>in order to ensure mat a complete proposal will be submitted to your company If you have any questions, or need further clarification please do not hesitate to contact me at (714) 590-8625 Thank you CC INiIVJO—133_ 000 rnOl (/>55 ~"m01 m0) -1o £ro mo > w X 2 — O 01 S 00 O s ° 0) r^ o3 §1 <o 3 uD0v^71m\Jjw0 z ^>r m z 0 zmm TJ 0) "n^^^^0•n^O3)m0)rcz D O 0 Z 09 C§ Z H 09 Tl O O CO Tl Tl Xm m o S'sSi° 03 __ co o o O > Tl > Hi- mm '-N U» O Ct/-/ SEE MORE INSPECTIONS IN PC050005 JEFFREY s WINTER CERTIFIED SPEC'AL INSPECTOR STRUCTURAL STEEL/WELDING 2000 INTERNATIONAL BUILDING CODE i>e individual named irreoi s CERTIFIED in the Category shown having beer o <~° fed pursuan tc SJG e<=sfui completion of the prescribed \i i^enreainrements Expirat on date June 15 ZOM , t s /__ NO 1026192-85 ___(£*/. ^ j<f -^ <*Not v3fctl j/rtmss signed by cirti tea e holder CC <crt/tat/on at e t onrrp&x' aW? expe lenc rouid br vpr/f ( k nwhd^, of ace if c, h\ fora/ uxdrr ion nnchrcf'; JEFFREY SWNTER CERTIFIED SPECIAL INSPECTOR JBC STRUCTURAL STEE ./WELDING 1997 UNIFORM BUILDING CODE Th° individual named hereon is CERTIFIED in Lh shown having been so certified pur jant <x> success completion of the prescribed wrftte i examination Exoiration date June is yWb1' f s / NO 1026192-85 _ dfdtf* «* ttiT f Notyral^inless <: gned bv cet Cr c emficavon attests to competent km dedge of cod a Applicable experience should br verified by oca/ ;un di(T/on ' sta r international Conference of Butfcfing officials JEFFREY 5 WINTER CERTIFIED SPECIAL INSPECTOR UBC STRUCTURAL MASONRY 1997 UNIFORM BJiLJING CODE Trie mdiv dual named Hereon is <~ERTIRED in the category shown having oeen so certified pursuarv.to successful comoiet'on of the p °scr bed written requ remen _ CXD anon date May 19 2005 * MO 102619284 .{'##«• *' £~\- *J~ N^fe^TO ur ess s gned By certificate ho der (B'("/i<toiT( t ;i ip' ( T krnwl c/gt )( rorfc i id andard \(,,/( h ( (xpi r ; ' /' f- f rt iv Innl 11 d c(r)n international conference of Building Officials JEFFREY S WINTER CERTIFIED SPECIAL IE1SPECTOR STRUCTURAL MASONRY 2OOO IMTBmATlONAL B JILDiNC CODE The individual named hereon is CERTI ED in the Cdfegorv havingbeensocertifiedpursuanttosuccessfj co'-'pietior of he prescribed written requirements Expiration date May 19 2005,, / : *f /-^ .*<—- iiess "s« ned bv cert cate o *cNO 102619284 lf SO ( ( rli/irition attc t. to competent kr r w/ed}ic oC rode a d ? App/icib/e experience houW be vpnffed t /ora/ /on dtc1 o « JEFFREV S WiNTEH CERTFiED SPEC AL INSPECTOR UBC REINFORCED CONCRETE 1997 UNIFORM BUILDING CODE The rdividua1 ramad h° °on is CERT RED in the category showr having been so <-et f icd pu suant to successf J come!" en of the oresT bed w iren exammat on Bcpfa«- o- date Jury 19 20C6 NO 1026192 88 ' C TI c« nn a t App/ c b e cxp° rer* c OITIP f*^ "v T JIV/POCC of rodf 1 C/ nn°T CJ rt^iv /on/ ;ur diet on JEFFREY S f INTER ^ » CERTIFIED SPECIAL INSPEC'CF ''^ * REINFORCED CONCRETE 2000 INTERNATIONAL 'JUI,.DiNG CODE The individual named hereon i <"ERTIRED >r i ° 3 =>gc~\ shown having been so cetif °d oursuan o s^ccos"; completion of the prescribed writ pnreauirer":"'ts EXP ration date July 19 nap*/ NO 102619288 &^i/S ^£_ 'f f ^ erf ficanon anew t ) App/icab/e experience hoildbt . gred bv ccrt f "ai0 i iw edits f cd n t f ''ivlocilnir r'r c? THE C3TY OF SAN OIEGO DEVELOPMENT SERVICES DEPARTMENT 'N^PECTTON SERVCES DIV!S CN Tel (858) 492 5070 =ax '858) 492 5098 SPECIAL INSPECTOR DCARD CITY OF TEMEDULA REGISTERED SPECIAL INSPECTOR NAME WINTER' CERTICONC: BUS LIC # REG DATE E-INFORCED 010458 EXP APR 07 2005 12 18 8587200149 Pa96 2 APR 07,2005 12^18 ^ ^ 18EC560l570 *r < jouo 11 * K * REQUEST FOR BUILDING PERMIT FOR PARTIAL BUILDING CONSTRUCTION To BuiWing Official, jurisdiction of Pursuant to the provisions of the Uniform Building Coda, Section 303 (a) the undesigned requests that a building permit be issued for &I/&AJA for the proposed buBdmg to be located at and identified as Plan Review Number Acknowledgment is made that plans for the entire structure are not complete and/or that the plan review has not been completed We recognize that proceeding with partial construction at this time is entirely at our own risk, with no assurance that the permit for the entire building or structure will be granted We further absolve the jurisdiction of and Esgll Corporation and officers and employees thereof, of all responsibility for the issuance of a partial permit and further agree that any work performed under this permit will be removed or otherwise corrected to be in accord with the requirements of the final approved plans when a permit for the entire building or structure is granted It Is agreed that neither the jurisdiction of nor Esgil Corporation, and officers and employee* thereof, will be liable for expenses incurred as a result of removal or correction of work which may be necessary to comply with the final approved plans Signature ///*/•?£/t^C , x. Date ^hjo 5 / 7 Date ~~ Date 7/1206 APR O/.^OtlS U T> lfi585dOlj/( */ EsGil Corporation In Partnership wit A government for (Butldtng Safety DATE July 15, 2005 Q ABPJJCANT JURIS! JURISDICTION Carlsbad Q PLAN REVIEWER Q FILE PLAN CHECK NO PC05-0005 SET II (FND only REV) PROJECT ADDRESS 1100 Las Flores Dr PROJECT NAME Buena Vista Village Apartments - Foundation Only/Plan Change I I The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction s building codes I I The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff I I The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck The check list transmitted herewith is for your information The plans are being held at Esgil Corporation until corrected plans are submitted for recheck I I The applicant s copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person I I The applicant s copy of the check list has been sent to LINDA HANA 1010 LINDA VISTA DRIVE SAN MARCOS CA 92078 I I Esgil Corporation staff did not advise the applicant that the plan check has been completed lAI Esgil Corporation staff did advise the applicant that the plan check has been completed Person contacted Linda Hana (>/M) Telephone* (760)420-1158 Date contacted ^fi5/o5(by /«- ) Fax # 760-730-0265 Mail Telephone — Fax-*" In Person REMARKS By Sergio Azuela Enclosures Esgil Corporation D GA D MB D EJ D PC 7/7 tmsmUdot 9320 Chesapeake Drive Suite 208 * San Diego California 92123 * (858)5601468 * Fax (858) 560-1576 Carlsbad PCO5-0005 July 15, 20O5 GENERAL PLAN CORRECTION LIST JURISDICTION Carlsbad PLAN CHECK NO PC05-OOO5 PROJECT ADDRESS 110O Las Plores Dr DATE PLAN RECEIVED BY DATE REVIEW COMPLETED ESGIL CORPORATION 7/7 July 15, 2005 REVIEWED BY Sergio Azuela FOREWORD (PLEASE READ) This plan review is limited to the technical requirements contained in the Uniform Building Code Uniform Plumbing Code Uniform Mechanical Code National Electrical Code and state laws regulating energy conservation noise attenuation and disabled access This plan review is based on regulations enforced by the Building Department You may have other corrections based on laws and ordinances enforced by the Planning Department Engineering Department or other departments The following items listed need clarification, modification or change All items must be satisfied before the plans will be in conformance with the cited codes and regulations Per Sec 106 4 3 1997 Uniform Building Code the approval of the plans does not permit the violation of any state county or city law • Please make all corrections on the ongmal tracings as requested in the correction list Submit three sets of plans for commercial/industrial projects (two sets of plans for residential projects) For expeditious processing corrected sets can be submitted in one of two ways 1 Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department 1635 Faraday Ave Carlsbad CA 92008 (760)602-2700 The City will route the plans to EsGil Corporation and the Carlsbad Planning Engmeenng and Fire Departments 2 Bnng one corrected set of plans and calculations/reports to EsGil Corporation 9320 Chesapeake Dnve, Suite 208 San Diego CA 92123 (858)560-1468 Deliver all remaining sets of plans and calculations/reports directly to the City of Carlsbad Building Department for routing to their Planning Engmeenng and Fire Departments NOTE Plans that are submitted directly to EsGil Corporation only will not be reviewed by the City Planning Engmeenng and Fire Departments until review by EsGil Corporation is complete • To facilitate rechecking, please identify, next to each item, the sheet of the plans upon which each correction on this sheet has been made and return this sheet with the revised plans • Please indicate here if any changes have been made to the plans that are not a result of corrections from this list If there are other changes please briefly descnbe them and where they are located on the plans Have changes been made not resulting from this list? Q Yes a No Carlsbad PCO5-OO05 July 15, 2005 1 Provide a complete list of all proposed plan changes including a) A brief descnption of each proposed plan change b) The sheet or sheets which are change as a result of each proposed plan change c) The identification symbol and number used to identify each proposed plan change on the plans 3 Provide all applicable structural design calculations for all proposed plan changes 4 Please provide a construction detail for the previously exterior wall (now is an mtenor wall) Additional corrections may follow • ALL SHEETS OF THE PLANS AND THE FIRST SHEET OF THE CALCULATIONS ARE REQUIRED TO BE SIGNED BY THE CALIFORNIA LICENSED ARCHITECT OR ENGINEER RESPONSIBLE FOR THE PLAN PREPARATION PLEASE INCLUDE THE CALIFORNIA LICENSE NUMBER, SEAL, DATE OF LICENSE EXPIRATION AND THE DATE THE PLANS ARE SIGNED BUSINESS AND PROFESSIONS CODE If you have any questions regarding these plan review items, please contact Sergio Azuela at Esgil Corporation Thank you EsGil Corporation In Partnersfitp wttK government for Guiding Safety DATE June 21, 2005 a AEEUCANT JURISDICTION Carlsbad OPT3NREVIEWER Q FILE PLAN CHECK NO PCO5-OO05 SET I (FND only REV) PROJECT ADDRESS 1 1OO Las Flores Dr PROJECT NAME Buena Vista Village Apartments - Foundation Only/Plan Change _j The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes I | The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff I 1 The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck The check list transmitted herewith is for your information The plans are being held at Esgil Corporation until corrected plans are submitted for recheck I I The applicant s copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person The applicant's copy of the check list has been sent to LINDA HANA 1010 LINDA VISTA DRIVE SAN MARCOS CA 92078 I I Esgil Corporation staff did not advise the applicant that the plan check has been completed Esgil Corporation staff did advise the applicant that the plan check has been completed Person contacted Linda Hana Telephone # (760)420-1158 Date contacted ofei/o5(by (^ ) Fax # 760-730-0265 Maif-^ielephone ^ Fax*"^ In Person REMARKS By Sergio Azuela Enclosures Esgil Corporation D GA D MB D EJ D PC 6/13 tmsmttdot 9320 Chesapeake Dnve Suite 208 4 San Diego California 92123 + (858)560 1468 + Fax (858) 560 1576 Carlsbad PC05-0005 June 21, 2005 GENERAL PLAN CORRECTION LIST JURISDICTION Carlsbad PLAN CHECK NO PC05-0005 PROJECT ADDRESS 1100 Las Flores Dr DATE PLAN RECEIVED BY DATE REVIEW COMPLETED ESGIL CORPORATION 6/13 June 21, 2005 REVIEWED BY Sergio Azuela FOREWORD (PLEASE READ) This plan review is limited to the technical requirements contained in the Uniform Building Code Uniform Plumbing Code Uniform Mechanical Code National Electrical Code and state laws regulating energy conservation, noise attenuation and disabled access This plan review is based on regulations enforced by the Building Department You may have other corrections based on laws and ordinances enforced by the Planning Department Engineering Department or other departments The following items listed need clarification, modification or change All items must be satisfied before the plans will be in conformance with the cited codes and regulations Per Sec 106 4 3 1997 Uniform Building Code the approval of the plans does not permit the violation of any state county or city law • Please make all corrections on the ongmal tracings as requested in the correction list Submit three sets of plans for commercial/industrial projects (two sets of plans for residential projects) For expeditious processing corrected sets can be submitted in one of two ways 1 Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department 1635 Faraday Ave Carlsbad CA 92008 (760)602-2700 The City will route the plans to EsGil Corporation and the Carlsbad Planning Engineenng and Fire Departments 2 Bnng one corrected set of plans and calculations/reports to EsGil Corporation, 9320 Chesapeake Dnve Suite 208 San Diego CA 92123 (858)560-1468 Deliver all remaining sets of plans and calculations/reports directly to the City of Carlsbad Building Department for routing to their Planning Engineenng and Fire Departments NOTE Rans that are submitted directly to EsGil Corporation only will not be reviewed by the City Planning Engineenng and Fire Departments until review by EsGil Corporation is complete • To facilitate rechecking, please identify, next to each item, the sheet of the plans upon which each correction on this sheet has been made and return this sheet with the revised plans • Please indicate here if any changes have been made to the plans that are not a result of corrections from this list If there are other changes please briefly descnbe them and where they are located on the plans Have changes been made not resulting from this list? a Yes D No Carlsbad PC05-0005 June 21, 2005 1 Provide a complete list of all proposed plan changes, including a) A brief description of each proposed plan change b) The sheet or sheets which are change as a result of each proposed plan change c) The identification symbol and number used to identify each proposed plan change on the plans 2 Provide a letter from the soils engineer confirming that the proposed plan changes to the foundation plan, and specifications have been reviewed and that it has been determined that the recommendations in the soil report are properly incorporated into the plans (required by the soil report - page 11) 3 Provide all applicable structural design calculations for all proposed plan changes 4 Please provide a construction detail for the previously exterior wall (now is an interior wall) Additional corrections may follow The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake Drive, Suite 208, San Diego, California 92123, telephone number of 858/560-1468, to perform the plan review for your project If you have any questions regarding these plan review items, please contact Sergio Azuela at Esgil Corporation Thank you EsGil Corporation In (Partnership wttA government for (BmCfing Safety DATE 6/17/05 Q APPLICANT d JURIS JURISDICTION Temecula a PLAN REVIEWER Q FILE PLAN CHECK NO B05-1653 SET II PROJECT ADDRESS 26531'A1 Ynez Rd PROJECT NAME Guidant Clean Room and Mezzanine TI |~| The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff [~~1 The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck ™ The plans are being held at Esgil Corporation until corrected plans are submitted for recheck I I The applicant s copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person I I The applicant s copy of the check list has been sent to Esgil Corporation staff did not advise the applicant that the plan check has been completed I I Esgil Corporation staff did advise the applicant that the plan check has been completed Person contacted Telephone # Date contacted (by ) Fax # Mail Telephone Fax In Person D REMARKS By Chuck Mendenhall Enclosures Esgil Corporation D GA D MB D EJ D PC 6/14/05 trnsmtldot 9320 Chesapeake Dnve Suite 208 * San Diego California 92123 + (858)560 1468 + Fax (858) 560-1576 Temecula BOS-1653 6/17/05 1 Please make all corrections on the originals and submit 3 new complete sets of prints, to The jurisdiction's building department 2 Each sheet of the plans must be signed by the person responsible for their preparation, even though there are no structural changes Business and Professions Code Electrcial sheets were not signed by the electrcial engineer 4 Provide a copy of the hazardous materials (Life-Safety) report prepared by Shirmer engineering Does the new clean room storage and research facilities affect the requirements contained in the Life-Safety Report by Shirmer Engineering'? Please clarify The response was 'proved-see the attached report" There was no hazardous materials report provided with the plans for recheck 6 A complete description of the activities and processes that will occur in this tenant space should be provided A listing of all hazardous matenals should be included The matenals listing should be stated in a form that would make classification in Tables 3-D and 3-E possible The building official may require a technical report to identify and develop methods of protection from hazardous matenals Section 307 1 6 the response was "See attached report" There was no report submitted with the plans 8 What is shear wall type L as shown on sheet S-2 between gnd lines 16 & 17 The shear wall 'L' is not listed in the shear wall schedule The response was " Done" The plans still show a shear wall type 'L' but the shear wall schedule does not list a type 'L' shear wall Please clarify 9 Specify and detail on the plans the installation of the 5/8" Ab for the new shear walls in the existing continuous footings The response was "Done See structural sheet" there are no anchor bolt details for retrofitting the existing foundation with new anchor bolts Where on the plans do I find this information? Please clarify END OF REVIEW The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake Dnve, Suite 208, San Diego, California 92123, telephone number of 858/560-1468, to perform the plan review for your project If you have any questions regarding these plan review items, please contact Chuck Mendenhall at Esgil Corporation Thank you Carlsbad PC05-0005 June 21, 2005 VALUATION AND PLAN CHECK FEE JURISDICTION Carlsbad PLAN CHECK NO PC05-0005 PREPARED BY Sergio Azuela DATE June 21, 2005 BUILDING ADDRESS 11OO Las Flores Dr Buena Vista Apts/Plan Changes BUILDING OCCUPANCY R-l & S-3 TYPE OF CONSTRUCTION I-FR/V-lhr BUILDING PORTION Time Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code AREA (Sq Ft) cb Valuation Multiplier By Ordinance Reg Mod VALUE ($) Bldg Permit Fee by Ordinance Plan Check Fee by Ordinance $240 00 Type of Review D Repetitive Fee Repeats D Complete Review D Other m Hourly Structural Only 2 Hours Esgll Plan Review Fee $192 00 Based on hourly rate Comments Sheet 1 of 1 macvalue doc EsGil Corporation In VartnenRtp vntR government for Qmlaing Safety DATE April 15, 2005 a APPLICANT JURISDICTION Carlsbad a PLAM REVIEWER a FILE PLAN CHECK NO PC05-OOO5 SET III PROJECT ADDRESS 1 1OO Las Flores Dr PROJECT NAME Buena Vista Village Condominiums - Foundation Only [X] The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes I I The plans transmitted herewith will substantially comply with the jurisdiction s building codes when minor deficiencies identified below are resolved and checked by building department staff I | The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck I I The check list transmitted herewith is for your information The plans are being held at Esgil Corporation until corrected plans are submitted for recheck I I The applicant s copy of the check list is enclosed for the junsdiction to forward to the applicant contact person I I The applicant s copy of the check list has been sent to IXI Esgil Corporation staff did not advise the applicant that the plan check has been completed I I Esgil Corporation staff did advise the applicant that the plan check has been completed Person contacted Telephone # Date contacted (by ) Fax # Mail Telephone Fax In Person REMARKS By Sergio Azuela Enclosures Esgil Corporation D GA D MB D EJ D PC 4/14 tmsmUdot 9320 Chesapeake Drive Suite 208 + San Diego California 92123 + (858)560 1468 4 Fax (858) 560 1576 EsGil Corporation In Partnership -with government for Quitting Safety DATE April 6, 20O5 O.APPUCANT JURISDICTION Carlsbad a PLAN REVIEWER a FILE PLAN CHECK NO PC05-0005 SET II (FND-only) PROJECT ADDRESS 1 100 Las Flores Dr PROJECT NAME Buena Vista Village Condomuniums - Foundation Only I I The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes I I The plans transmitted herewith will substantially comply with the jurisdiction s building codes when minor deficiencies identified below are resolved and checked by building department staff I I The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck E<3 The check list transmitted herewith is for your information The plans are being held at Esgil Corporation until corrected plans are submitted for recheck I I The applicant s copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person The applicant s copy of the check list has been sent to HeberJ Hurd 40335 Winchester Road Suite E 186, Temecula CA 92591 Esgil Corporation staff did not advise the applicant that the plan check has been completed Esgil Corporation staff did advise the applicant that the plan ofieck has been completed Person contacted HeberJ Hurd^n/ Telephone # (951)926-1000 Date oe^^Y/^ (by & ) Fax # <4s/j 1a6 /W3 Mail^^TelephoneLX^ Fax-^m Person REMARKS By Sergio Azuela Enclosures Esgil Corporation D GA D MB D EJ D PC 3/31 tmsmtldot 9320 Chesapeake Dnve Suite 208 ^ San Diego California 92123 + (858)560 1468 * Fax (858) 560 1576 Carlsbad PC05-0005 April 6, 2005 RECHECK PLAN CORRECTION LIST JURISDICTION Carlsbad PLAN CHECK NO PCO5-0005 PROJECT ADDRESS 1100 Las Flores Dr SET II (FND-only) DATE PLAN RECEIVED BY DATE RECHECK COMPLETED ESGIL CORPORATION 3/31 April 6, 2005 REVIEWED BY Sergio Azuela FOREWORD (PLEASE READ) This plan review is limited to the technical requirements contained in the Uniform Building Code Uniform Plumbing Code Uniform Mechanical Code, National Electrical Code and state laws regulating energy conservation noise attenuation and disabled access This plan review is based on regulations enforced by the Building Department You may have other corrections based on laws and ordinances enforced by the Planning Department Engineering Department or other departments The following items listed need clarification modification or change All items must be satisfied before the plans will be in conformance with the cited codes and regulations Per Sec 106 4 3 1997 Uniform Building Code the approval of the plans does not permit the violation of any state, county or city law A To facilitate rechecking, please identify, next to each item, the sheet of the plans upon which each correction on this sheet has been made and return this sheet with the revised plans B The following items have not been resolved from the previous plan reviews The original correction number has been given for your reference In case you did not keep a copy of the pnor correction list, we have enclosed those pages containing the outstanding corrections Please contact me if you have any questions regarding these items C Please indicate here if any changes have been made to the plans that are not a result of corrections from this list If there are other changes, please briefly describe them and where they are located on the plans Have changes been made not resulting from this list? QYes QNo *> Carlsbad PCO5-OOO5 April 6, 2O05 All corrections included m this list are dedicated for the Foundation Only Permit The previous list of corrections remains applicable for the full building permit 1 Please make all corrections on the ongmal tracings as requested in the correction list Submit three sets of plans for commercial/industrial projects (two sets of plans for residential projects) For expeditious processing, corrected sets can be submitted in one of two ways 1 Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department, 1635 Faraday Ave Carlsbad CA 92008 (760)602-2700 The City will route the plans to EsGil Corporation and the Carlsbad Planning Engmeenng and Fire Departments 2 Bring one corrected set of plans and calculations/reports to EsGil Corporation 9320 Chesapeake Dnve, Suite 208, San Diego CA 92123 (858) 560-1468 Deliver all remaining sets of plans and calculations/reports directly to the City of Carlsbad Building Department for routing to their Planning, Engmeenng and Fire Departments NOTE Plans that are submitted directly to EsGil Corporation only will not be reviewed by the City Planning, Engmeenng and Fire Departments until review by EsGil Corporation is complete 2 All sheets of the plans and the first sheet of the calculations are required to be signed by the California licensed architect or engineer responsible for the plan preparation Please include the California license number seal date of license expiration and the date the plans are signed Business and Professions Code 3 When special inspection is required the designer shall complete the attached Special Inspection Notice 4 Provide a copy of the project soil report prepared by a California licensed architect or civil engineer The report shall include foundation design recommendations based on the engineer's findings and shall comply with UBC Section 1804 a) The soils report was expired on December 22, 2001 Please provide a letter from the soils engineer updating the findings and conclusions of the soils report 5 Provide a letter from the soils engineer confirming that the foundation plan, grading plan and specifications have been reviewed and that it has been determined that the recommendations m the soil report are properly incorporated into the plans (required by the soil report - page 11) 6 The applicant shall complete the attached form for REQUEST FOR BUILDING PERMIT FOR PARTIAL BUILDING CONSTRUCTION and submitted to the Building Department for review and approval If you have any questions regarding these plan review items, please contact Sergio Azuela at Esgil Corporation Thank you REQUEST FOR BUILDING PERMIT FOR PARTIAL BUILDING CONSTRUCTION To Building Official, jurisdiction of Pursuant to the provisions of the Uniform Building Code, Section 303 (a) the undersigned requests that a building permit be issued for for the proposed building to be located at and identified as Plan Review Number Acknowledgment is made that plans for the entire structure are not complete and/or that the plan review has not been completed We recognize that proceeding with partial construction at this time is entirely at our own risk with no assurance that the permit for the entire building or structure will be granted We further absolve the jurisdiction of and Esgil Corporation, and officers and employees thereof, of all responsibility for the issuance of a partial permit and further agree that any work performed under this permit will be removed or otherwise corrected to be in accord with the requirements of the final approved plans when a permit for the entire building or structure is granted It is agreed that neither the jurisdiction of nor Esgil Corporation and officers and employees thereof, will be liable for expenses incurred as a result of removal or correction of work which may be necessary to comply with the final approved plans Signature Date Owner Date Engineer/Architect Date Contractor f \pendmg\parpermt doc 7/12/95 ENGINEERING I DESIGN GROUP GEOTECHNICAL CIVIL! STRUCTURAL CONSULTANTS FOR RESIDENTIAL i COMMERCIAL CONSTRUCTION 2121 Montiel Road San Marcos California 92069 ;e July? 2005 (760) 839 7302 Fax (760) 480 7477 E mail ENGDG@aol com To Re Subject References PARSER FAMILY LIMITED PARTNERSHIP Attention CurtFarber 991C Lomas Santa Fe Drive #441 Solana Beach CA 92075 Proposed Multi Family Development to be Located California Wall Backdram Installation a\11(1100 Las Flores Drive 1 "Updated Soils Report" Dated September 10,2003, Prepared by the Engineering Design Group 2 "Geotechmcal Investigation and Foundation Recommendations, for Proposed Multi-Family Development, to be Located at 1100 Las Flores Drive, City of Carlsbad, California" Dated December 22, 2000, Project No 002486-1, Prepared by the Engineering Design Group We have prepared this letter per the request of the City of Carlsbad inspector to address the configuration of building retaining wall backdrams at the above referenced lot As referenced in our soils report for the site a wall backdram system is required specifically to reduce hydrostatic pressure behind the wall We provide a minimum retaining wall backdram detail in Appendix C of our report The intent of the backdram system is drain off subsurface water collecting behind the wall to a suitable outlet point Unlike closed pipe systems backdrams are open and influenced by the level of hydrostatic rise behind the wall Because of fact a minimum 2% slope is not necessary for a backdram pipe to function since there is a pressure gradient created by the rise of water above the pipe which drives the water through the pipe It is our opinion maintaining a nearly flat configuration (minimal rise typically no more than 8 ) to the backdram is preferable to trying to create a minimum 2% slope in the pipe particularly where the pipe runs are long Specifically if a minimum 2% slope is applied to a 200 ft long section of pipe the pipe will have to be raised 4 above stem level before water even enters the pipe If the pipe is laid flat the pressure gradient caused by the water rise above the pipe will cause the pipe to function well before it reaches a 4 height It is important to recognize the backdram recommended in our soil report is for hydrostatic buildup only and should notbe relied upon as a waterproofing component The design by the Architect should assume the wall may ba^dbwct to the short term accumulation of water behind the wall and be waterproofed as determined by tlje'projeict architect summary representatives of Engineering Design Group observed the configuration of retaining wall 'backdrauns for the above referenced and found the pipe configurations meet the intent of the project soils re If you have any questions regarding this letter or if we can be of further service please do not hesitate to ntact our office Sincerely ENGINEERING DESIGN i leal JUJ| Steve Norn>-—' V*' vaRGE#2590, RCE#47672 CEC cc Linda Hanna Ranlm Construction 2590 JXP12^1^5 C^CHl^fc Iml ^F CAV.^^ E \LETTER\LETTER 1\2000\002486 1 FARBER MULTI FAMILY DEV 1100 LAS FLORES DR CARLSBAD FRENCH DRAIN LETTER wpd CONTRACTORS STATE LICENSE BOARD STATE OF CALIFORNIA 9821 Business Park Drive Sacramento CA 95827 1703 Mailing Address PO Box 26000 Sacramento California 95826 0026 1-800-321-CSLB(2752) www cslb ca go v Exemption from Workers' Compensation Before the Contractors State License Board can issue a new license or reinstate reactivate or renew an existing license the applicant or licensee must have on file a Certificate of Workers Compensation Insurance or a Certificate of Self Insurance issued by the Director of Industrial Relations or must obtain an exemption To be exempt from Workers Compensation an applicant or licensee must submit this form to the CSLB certifying under penalty of perjury that he or she does not employ anyone in a manner that is subject to the Workers Compensation laws of California (See Business and Professions Code Section 7125) • Do not submit this form if you have an inactive license—it is not required • Do not submit this form if the license Qualifier is a Responsible Managing Employee (RME) • Do not submit this form if you have employees For exemption from Workers Compensation check only one box below D I am an out of state contractor and I do not hire employees who reside in California (Please provide a certificate of insurance from your workers compensation insurance carrier) p(l do not employ anyone in a manner subject to the Workers Compensation laws of California PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK BUSINESS NAME (Exactly as it appears on CSLB records)LICENSE OR APPLICATION FEE NUMBER BUSINESS MAILING ADDRESS (Number/Street or P 0 Box) \OVQ City State ZIP Code J^flV} CV\OAff.O^ BUSINESS PHONE NUMBER FAX NUMBER < -760) -744 E-MAIL ADDRESS D Check this box if the above address is new FALSIFICATION OF ANY DOCUMENT IS GROUNDS FOR DISCIPLINARY ACTION I certify under penalty of perjury under the laws of the State of California that the information provided on this exemption statement is true and accurate I understand that upon employing anyone in a manner that is subject to the workers compensation law of the State of California the claim of exemption executed under this form will no longer be valid I also understand that as soon as I employ anyone subject to California s workers compensation law I must obtain a Certificate of Workers Compensation Insurance submit that certificate to CSLB within 90 days of its effective date and continuously maintain the coverage provided by the certificate in accordance with the law I further understand that failure to comply with this requirement is grounds for disciplinary action /On at i/L. DATE CITY/COUNTY/STATE Signature of Owner Partner or Officer Print Name 13L 50 (6/04) ES ~n 00 O™ O C 03> CO CO oo CO o O m mw Djo o CD