HomeMy WebLinkAbout1265 BELLEFLOWER RD; ; CB080995; Permit06-04-2008
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Pool Permit Permit No CB080995
Building Inspection Request Line (760) 602-2725
Job Address
Permit Type
Parcel No
Valuation
Reference #
PC#
Project Title
1265 BELLEFLOWER RD CBAD
POOL
2145412100 Lot#
$19,646 00 Construction Type
STERN RES- 517 POOL/SPA
0
NEW
Status
Replied
Entered By
Plan Approved
Issued
Inspect Area
ISSUED
05/28/2008
LSM
06/04/2008
06/04/2008
Applicant
MISSION POOLS OF ESCONDIDO INC
755 W GRAND AVENUE
ESCONDIDO, CA 92025
619-743-2605
Owner
STERN STEVEN&KELLY
1265 BELLEFLOWER RD
CARLSBAD CA 92011
Building Permit
Add'l Building Permit Fee
Plan Check
Add'l Plan Check Fee
Electrical Fee
Plumbing Fee
Strong Motion Fee
Renewal Fee
Add'l Renewal Fee
Other Building Fee
Additional Fees
$19275
$000
$12529
$000
$2000
$2700
$1 96
$000
$000
$000
$000
TOTAL PERMIT FEES $367 00
Total Fees $367 00 Total Payments To Date $12529 Balance Due $241 71
BUILDING PLANS
_/_ IN STORAGE
ATTACHED
Inspector
VAL
Date Clearance
NOTICE Please take NOTICE that approval of your project includes the 'Imposition of fees, dedications, reservations •-: 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 fee./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 requires information with the City Manager for
processing in accordance with Carlsbad Municipal Code Section 3 32 030 Failure to timely follow that procedure will ber .iny 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 wate rind sewer connection fees and capacity
changes, nor planning zoning grading or other similar application processing or service fees in connection with this proje t 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 ".as previously otherwise expired
City of Carlsbad
1635 Faraday Ave .Carlsbad, CA 92008
760-602-2717 / 2718 / 2719
Fax 760-602-8558
Gliding Permit Application
Plan Check No.
Est. Value
Plan Ck. Deposit f ^LS: 3 S
Date
JOB ADDR/*U
CT/PROJECT#LOT*PHASE # T~S OF UNITS
DESCRIPTION OF WO
I
SUITE#/SPACE#/UNIT#
# BEDROOMS # BATHROOMS TENANT BUSINESS NAME TYPE OF CO'NST OCC'GROUP
ase describe present use and proposed use)
(Sec 70315 Business and Professions Code Any City or County which requires a permit to construct, alter improve, demolish or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is
licensed pursuant to the provisions of the Contractors 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 70315 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500})
iC .0JW P JEN S, A T I O N
Workers' Compensation Declaration I hereby affirm under penalty ofperiury one of the following declarationsa! 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
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 workers' compensation insurance carrier and policy
ncco^D <# M^#L ^(
section need not be completed if the permit i
Expiration Date
This section need not be completed if the permit is for one hundred dollars ($100) or less
O Certificate of Exemption I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of
California WARNING Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (£100,000), in
addition to the cost of compensation, damages asprovided for in SectionJ?06 of the Labor code, interest and attorney's fees
^CONTRACTOR SIGNATURE
/ hereby affirm that I am exempt from Contractor s License Law for the following reason
D 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 Contractors
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)
3 I as owner cf 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 ; am exerr.pt under Section Business and Professions Code for this reason
1 • personally plan to provide the major labor and materials for construction of the proposed property improvement n Yes Q No
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 / 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 / contractors license number)
5 I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated (include name / ciddress / phone / type of work)
^PROPERTY OWNER SIGNATURE DATE
Is the applicant or future building occupant required to submit a business plan acutely hazardous materials registration form or risk manaqement'and prevention program under Sections 25505 25533 or 25534 of the
Presley Tanner Hazardous Substance Account Act7 O Yes O No
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management distn:P D Yes O No
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site9 CJ Yes D No
IF ANY OF THE ANSWERS ARE YES, /
EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT
e. <°> CD s tfp 00'® ff l
I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec 3097 (i) 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 representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD
AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT
OSHA An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height
EXPIRATION Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within
1 80 days from the date of such permit of if the building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 1 80 days (Section 1 06 4 4 Uniform Building
Code)
^APPLICANT'S SIGNATURE DATE
City of Carlsbad Bldg Inspection Request
For 09/09/2008
Permit* CB080995
Title STERN RES- 517 POOL/SPA
Description
Inspector Assignment JM
1265 BELLEFLOWER RD
Lot 0
Type POOL Sub Type
Job Address
Suite
Location
OWNER STERN STEVEN&KELLY
Owner STERN STEVEN&KELLY
Remarks
Phone 7607432605X234
Inspector
Total Time
CD Description
59 Final Pool
Requested By MICHELLE
Entered By JANEAN
Act Comments
Comments/Notices/Holds
Associated PCRs/CVs Original PC#
Inspection History
Date
08/12/2008
08/11/2008
08/08/2008
07/31/2008
07/03/2008
07/03/2008
07/03/2008
06/25/2008
06/25/2008
06/11/2008
Description
55 Fence/Pre-Plaster
55 Fence/Pre-Plaster
55 Fence/Pre-Plaster
51 Excav/Steel/Bondmg/Fence
23 Gas/Test/Repairs
52 Underground Plumbing
53 Electric/Conduit/Wiring
51 Excav/Steel/Bondmg/Fence
52 Underground Plumbing
23 Gas/Test/Repairs
Act
AP
CA
CO
AP
AP
AP
AP
AP
AP
CO
Insp
JM
JM
JM
PD
JM
JM
JM
JM
JM
JM
Comments
OK TO PLASTER - VERIFY ALARMS @ FINAL
HO
60IN FENCING REQUIRED ON WEST PROPERTY LINE
DECK BONDING
TO POOL EQUIP
OKTOGUNITE LIGHTS/EQUIP/DECK
90DEGREE SWEEP REQUIRED
Public Wo>r;ks — Engineering
BUILDING PLANCHECK CHECKLIST
POOLS
BUILDING PLANCHECK NUMBER CBD#-ff9$~
BUILDING ADDRESS
PROJECT DESCRIPTION Pool
ASSESSOR'S PARCEL NUMBER
ENGINEERING DEPARTMENT
APPROVAL
The item you have submitted for review has been
approved The approval is based on plans, information
and/or specifications grjavided in your submittal,
therefore, any chai
including field mertfifications, must be reviewed by this
office to msupe continued conformance with applicable
codes Elapse review cape'fully all comments attached,
as faihrife/fo/comply wjtn instructions in this report can
resirf1tNn/susBe"n$iQ»-6T permit to build
DENIAL
Please see ymeNgittached report of deficiencies
marked witBK Dy Make necessary corrections to
plans or ^specifications for compliance with
applicable codes and standards Submit corrected
plans and/or specifications to this office for review
>
By
By
Date
Date
Date
ATTACHMENTS
[] Grading Permit Application
[] Grading Permit Checklist
[] Right-of-Way Permit Application
[] Right-of-Way Permit Submittal
Checklist and Information Sheet
[] Storm Water Applicability Checklist
ENGINEERING DEPT CONTACT PERSON
NAME Linda Ontiveros
City of Carlsbad
ADDRESS 1635 Faraday Avenue
Carlsbad, CA 92008
PHONE (760) 602-2773
1635 Faraday Avenue • Carlsbad, CA 92008-7314 * (76O) 6O2-272O • FAX (760) 6O2-8562
^ ' * ' Rev 10/24/07
D
n
D
n
n
D
22-02. UNIT 1
33
327 -
BUILDING PLANCHECK CHECKLIST - POOLS
SITE PLAN
1 Provide a fully dimensioned site plan drawn to scale Show
LinesArrow
B Existing & Proposed Structures
Show on site plan
AXDj^mage Patterns
(P^^Existmg & Proposed Slopes
C Existing Topography
^rofie
O^^aseasements
Indicate what will happen with
soil excavated from pool area
E Retaining Walls
(location and height)
Note: If excavated soil is not to be removed from property but regraded on
site, show proposed elevations and slopes.
If any portion of retaining walls are over 4' in height, a separate permit is required
Retaining Wall Permit CB Applied for Approved
3 Include on title sheet
Site-Address
/j&<^ssessor's Parcel Number
/H^Xegal Description
/ \j Grading Quantities Cut Fill Import/Export
a) If grading is not required, write "No Grading" on plot plan
4 Project does not comply with the following Engineering Conditions of approval
for Project No
Conditions were complied with by
GRADING PERMIT REQUIREMENTS
Date
The conditions that invoke the need for grading permit are found in Section 15X16 010
of the Municipal code
5a Inadequate information available on Site Plan to make a determination on
grading requirements Include accurate grading quantities (cut, fill, import,
export)
5b Grading Permit required A separate grading plan prepared by a registered Civil
Engineer must be submitted together with the completed application form
attached
Note: The Grading Permit must be issued and rough grading approval
obtained prior to issuance of a Building Permit
Page 2 of 3
Rev 10/24/07
BUILDING PLANCHECK CHECKLIST - POOLS
,.ST°S
D D D 5c A Grading Permit has been applied for
GR DWG No
Grading Inspector sign off by Date -
D D D 5d No Grading Permit required
MISCELLANEOUS PERMITS
D D 6 A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Way and/or
private work adjacent to the public Right-of-Way
A separate Right-of-Way issued by the Engineering Department is required
for the following
Please complete attached Right-of-Way application form and return to the
Engineering Department together with the requirements on the attached Right-
of-Way checklist, at the time of resubmittal
Right-of-Way Permit and Pool Building Permit will be issued simultaneously
D D STORM WATER APPLICABILITY CHECKLIST
I Requires PSWP (project storm water permit) #
Q Not required
D D D 8 Remarks
Page 3 of 3
Rev 10/24/07
AJ_
6
o
T3
a
3 •<
Oa
o
g
s-zx-
|
zo
a:LLJ
<
S
S
£
£
a
Di<cc2:sVD CERTIFICATEANORM WATERancothfe5fcluj p fc S coa co o Q gmnmuioF^^sSEr^_a?:
S§l|o
O CQ Z> S "-_ < to co O LEDGE THAT I MUSNT PRACTICES (BMPSO THE MAXIMUM EXTE MOBILIZATION OF PINIMIZE THE EXPOSUTION RELATED POLLIMES COMPLY WITH TTION SWPPP THROUTION ACTIVITIES UNTPLETE AND APPROVWLEDGNAGEMENT PIVITIES TO THIMIZE THE MND TO MINIMINSTRUCTIOAT ALL TIMESNSTRUCTIONONSTRUCTIOISRUCO\
^ V.
jo
<u
(D Q.
•0 CD
CQ Q
isE o
(U c
si
w
>
S E
e S)Js
s
«
o "o2 *=
I
a
i
0)
&
zz
c S
O CQ
s
ju9LJjo6euB|/\|
9JSBAA S1SJOUOQ
9}S6/v\ snopJEZe|-j
lusujsBEuew
3JSBM P'lQS
IOJIUDO
pUB UOI}U9A9Jd ||ldg
1U9LU96BUB|AJ 9|ldlpO]g
gsn leuejeyg
pus«S
Buiueeio
jueiudinbg PUB SJOIMSA
i,
SUOl}BJ9dQ
6uipUIJQ PUB eUlABc)
UOIJEAJOSUOO J9JEM
uoonjjsuoQ pazi|iqeig
SS9J(53/SS9j6uj
_J
"
)9|U| UIBJQ UJJOig
JOiJjeg Beqpues
PUE Guid09Ar\S 199JIS
ujjgg 6eg ISABJO
snosjsqy
U16Q >|09L|Q
deji tusujipes
eouaj 1113
SUISJQ adois
PUB Sa^lQ U^IE?^
Buiipinin POOAA
SCTSSOffe.oso
Best Management Practice(BMP) Description ->8-TOA
9-1AIM
9-WM
fr-WM
E-IAIM
3-WM
l-WM
8-SN
i-SN
B-SN
l-SN
z-ai
t-Hl
(H-3S
8-3 S
.-3S
9-3 S
S-3S
fr-3S
E-3S
1-3S
H-03
6-03
8-03
L 03
CASQA Designation ->Construction Activity>
X
X
X
X
1
a
g1
•ero
C
^
X
*
>c
^Trenching/ExcavationStockpilingDrill ing/Bon ngConcrete/Asphalt SawcuttingConcrete flatworkI1Conduit/Pipe Installation^£
1O
S
(fl
ro
1a
0)
s
f Equipment Maintenance and FuelingHazardous Substance Use/StorageO)
1D Site Access Across DirtOther (list)•~
1
co
S.
|
£
G
o
o
5
P
"5
c
o
3-a
3
^
—
1
1
•S
1
2
3
~
ro
>
™
^
y
"c
&
%
5
U
1
_c
s
~
1 1, „ 8
11 1 il i
|||:l |
||ill ?It 1 1? i i
E > ^|| 5
j 3*1 1 || |
|l|l|| |
| 5 | § | 1 =
U 'J> ^ - rR S-
' I § $ C S °
IPIH 1
sS||p| f
ililli 1
Ill^i i
H^slf I
|Hl|a !
IS^HI I
~u 3 3 -5 •= y v1 -t b S,jj r: F
0 a; « § £. " £I'lliil i
1-512-il |
I s^ll<£ f
|^ fo^l g
- H S E S S ;
£ rt ~ ~3 — § —
•£ 0.7 2|o -5
S g ' r- r c >
-g J= -^ 53 ff 2 '
S - = S — S 1
H £ ,0^5-3 ^n boxes provided for that puipose afrom (he list located alon the top ofecled BMPs selected from Ihe listis Stabilized Conslrucion Ingrcss/LDO\ \vhcrelhel\voineet Asanolheiic in the blank column mulct Ihe In.out what each BMP description me;i« c ^ ^ ,~, -5 \
i- o -| s i c i
a
c
1
u
o1
o
a
H
|
5
1
g:
0
c
^rs
O
I
1
a
u-
1
5
1
o-o explains the California Sionmvater•=Therefcience
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER CB080995
ADDRESS
DATE 5/30/08
RESIDENTIAL ADDITION-
MINOR (<17,000.00)
RETAINING WALL
VILLAGE FAIRE
POOL/SPA
TENANT I IMPROVEMENT
COMPLETE OFFICE BUILDING
OTHER
PLANNER Deborah Milam
ENGINEER
DATE 5/30/08
DATE
ii \Aii\iii\\((ii'\ri ii/m\M\ii/iA(;i\i MUM; AHNIIIVALS
Chent# 9923 3MISSPOO1
ACORD^ CERTIFICATE OF LIABI
PRODUCER
HRH of San Diego
Insurance Services
9339 Genesee Avenue, Suite 300
San Diego, CA 92121
INSURED
Mission Pools of Escondido, Inc
755 West Grand Avenue
Escondido, CA 92025-9990
LITY INSURANCE SESST™"
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
INSURERS AFFORDING COVERAGE
INSURER A Praetorian Insurance Company
INSURER B Wausau Underwriters Insurance Compan
INSURER c Nationwide Mutual Insurance Co
INSURER D
INSURER E
NAIC#
22292
26042
23787
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR
LTR
A
C
B
^DD'L
NSRC TYPE OF INSURANCE
GEr
x_
X
JERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
| CLAIMS MADE \ x| OCCUR
$2,500 Ded
GEN L AGGREGATE LIMIT APPLIES PER
| POLICY [~X1 j^T | | LOC
AUTOMOBILE LIABILITY
X
X
x_
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS/UMBRELLA LIABILITY
| OCCUR | | CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED'
If yes describe under
SPECIAL PROVISIONS below
OTHER
POLICY NUMBER
H01 0000504
ACPBA781 2584050
WCJZ91441063018
POLICY EFFECTIVE
DATE IMM/DD/YY)
04/01/08
04/01/08
04/05/08
POLICY EXPIRATION
DATE (MM/DD/YY1
04/01/09
04/01/09
04/05/09
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence!
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
PRODUCTS COMP/OPAGG
COMBINED SINGLE LIMIT
{Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accident)
AUTO ONLY EA ACCIDENT
OTHER THAN ^ ACC
AUTO ONLY AGQ
EACH OCCURRENCE
AGGREGATE
X WC STATU OTH
TORY LIMITS ER
EL EACH ACCIDENT
EL DISEASE EA EMPLOYEE
E L DISEASE POLICY LIMIT
$1.000.000
$100.000
$
$1,000,000
$2,000,000
$2,000,000
$1,000,000
$
$
$
$
$
$
$
$
s
$
$
$1,000,000
$1,000,000
$1,000,000
The Certificate Holder is named as additional insured per attached form CG2010 07/04 but
only for ongoing swimming pool, spa and/or water feature operations for The City of
Carlsbad performed by or on behalf of the Named Insured
**10 DAY NOTICE APPLIES IN THE EVENT OF CANCELLATION FOR NON-PAYMENT OF PREMIUM
CERTIFICATE HOLDER CANCELLATION
City of Carlsbad
Ann Joanne
1635 Faraday Ave
Carlsbad, CA 92008-0000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES
AUTHORIZED REPRESENTATIVE
l^bt^^-MU^r
ACORD 25 (2001/08) 1 of 2 #5591064/M591056 3KMCC ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the pohcy(ies) must be endorsed A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing msurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon
ACORD 25-S (2001/08) 2 of 2 #8591064/M591056
POLICY NUMBER H010000504 00 00 CA COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)Location(s) Of Covered Operations
Blanket as required by written contract and effective
during the policy period as stated on the policy
declarations
Blanket as required by written contract
Primary Insurance applies It is agreed that such
insurance as is afforded by this policy for the benefit of
the additional insured shown shall be primary
insurance, and any other insurance maintained by the
additional msured(s) shall be excess and
noncontnbutory as respects any claim, loss or liability
allegedly arising out of the operations of the named
insured, provided however that this insurance will not
apply to any claim loss or liability which is determined
to be solely the result of the additional msured's
negligence or solely the additional msured's
responsibility
Information required to complete this Schedule, if not shown above, will be shown in the Declarations
Section II - Who Is An Insured is amended to in-
clude as an additional insured the person(s) or organi-
zation^) shown in the Schedule, but only with respect
to liability for "bodily injury", "property damage" or
"personal and advertising injury" caused, in whole or in
part, by
1 Your acts or omissions, or
2 The acts or omissions of those acting on your
behalf,
in the performance of your ongoing operations for the
additional msured(s) at the location(s) designated
above
B With respect to the insurance afforded to these addi-
tional msureds, the following additional exclusions ap-
ply
This insurance does not apply to "bodily injury" or
"property damage" occurring after
1 All work, including materials, parts or equipment
furnished in connection with such work, on the pro-
ject (other than service, maintenance or repairs) to
be performed by or on behalf of the additional in-
sured^) at the location of the covered operations
has been completed, or
2 That portion of "your work" out of which the injury
or damage arises has been put to its intended use
by any person or organization other than another
contractor or subcontractor engaged in performing
operations for a principal as a part of the same pro-
ject
CG 20 10 07 04 (Blkt)' ISO Properties, Inc , 2004 Page 1 of 1