HomeMy WebLinkAbout1361 CORVIDAE ST; ; CB011898; Permit05/30/2001
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Miscellaneous Permit Permit No CB011898
Building Inspection Request Line (760) 602-2725
Job Address
Permit Type
Parcel No
Valuation
Reference #
Project Title
1361 CORVIDAE ST CBAD
MISC Subtype
2156910900 Lot#
$2,500 00
NOVAK- ADD CAN LIGHTS TO BATH
INSTALL STEAM ROOM & PLUMBING
OTHER Status ISSUED
0 Applied 05/30/2001
Entered By JM
Plan Approved 05/30/2001
Issued 05/30/2001
Inspect Area
Applicant
HILL CONSTRUCTION, ROBERT
229 OCEANVIEW DR
VISTA, CA 92084
619-758-2357
Owner
NOVAK PAUL D&PATRICIA L
1361 CORVIDAE ST
CARLSBAD CA 92009
0690 05/30/01 0002 01 02
CGF" 124=00
Total Fees $12400 Total Payments To Date $000 Balance Due $12400
Miscelaneous Fee #1
Miscelaneous Fee #2
Additional Fees
TOTAL PERMIT FEES
PERMIT
PLMB&ELEC
$7700
$4700
$000
$12400
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
1 PROJECT INFORMATION
FOR OFFICE USE ONLY
PLAN CHECK NO
EST VAL
Plan Ck Deposit.
Validated By y|
Date
Address (include Bldg/Suite #)Business Name (at this address)
Legal Description2-15 00
Lot No ubdivision Name/Number Unit No Phase No Total # of units
Assessor's Parcel #is*thg Use Proposed Use
Description of Work
CONTACT PERSON (if different from applicant
tfof Stories # of Bedrooms tt of Bathrooms
ftfc.
E3*Corioritractor
Address
CD Agent for Contractor : CD Owner
City
O Agent for Owner
State/Zip Telephone ff Fax ff
Name
4 PROPERTY OWNERN;
Address City State/Zip Telephone #
Name Address City State/Zip telephone
'S" CONTRACTOR :-:TCOMPANY;NAMEsV " • .""" ' • £ """ -*1:--' . --f*' .... lt::.'. T
(Sec 7031 5 Business and Professions Code Any City or County which requires a permit to construct, alter, improve demolish or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor s License Law
[Chapter 9, commending with Section 7000 of Division 3 of the Business and Professions Code] or that he is exempt therefrom and the basis for the alleged
emption Any violation of Section 7031 5 by any applicant for a permit subjects the applicant to a civilpenalty^of not more than five hundred dollars [$500]
Name
State License #
COO 0 o
Address
License Class
5lil
i-UQ City State/Zip
City Business License #'tutC f
Designer Name Address City State/Zip Telephone
State License #
6 »'WORKERS' COMPENSATION • >* s:...::... S' ' Vii-" ::5" K. '""
Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations
CD 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
FT 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 oToTl-' C&T^T tf"^VjfrA*-^Ci-* t'-^fJJj Policy No *"* t \ " ^*-* OyJ 51-^ Expiration Date_
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS)
l~l 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 dollanffe WO 000), intedditiorv-tn the cost of compensation damages as provided for in Section 3706 of the Labor code interest and attorney s fees
SIGNATURE t\^-/\^f [A-^xX^ DATE " ~~"
7:; OWNER-BUILDER DECLARATION _r
I hereby affirm that I am exempt from the Contractor s License Law for the following reason
|~| 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)
CD 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)
CD 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 CD YES CDNO
2 I (have / have not) signed an application for a building permit for the proposed work
3 I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number)
4 I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone
number / contractors license number)
5 I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type
of work)
PROPERTY OWNER SIGNATURE DATE
COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY ; '" si* ' I; "P>.
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 fj N0
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district' l~l YES l~) NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site' d YES CD NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT
8,, CONSTRUCTION LEND'JNG-AGENCY.- • :,;.;"F! ,;J;*r J:l" i; ;ff: " ;; "
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(i) Civil Code)
LENDER'S NAME LENDER S ADDRESS
9 APPLICANT CERTIFICATION .,; .••f* ,.f'" ,,&?• ^" ... of" :•" ; .,::-. ^.|::||:.,..^ ::s,. .,,::: ....... ;
I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate I agree to comply with all
City ordinances and State laws relating to building construction I hereby authorize representatives of the City of Carlsbad to enter upon the 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 conjfm^nded for apenatj oN80 days (Section 106 4 4 Uniform Building Code)
APPLICANT S SIGNATURE f~^^ iA-*L J DATE
WHITE File YELLOW Applicant PINK Finance
UNSCHEDULED BUILDING INSPECTION
DATE vuxr>-0i INSPECTOR
PERMIT #. dU^0^ PLAN CHECK #
JOB ADDRESS.
DESCRIPTION _
CODE DESCRIPTION ACT COMMENTS
City of Carlsbad Bldg Inspection Request
For 08/27/2001
Permit# CB011898
Title NOVAK- ADD CAN LIGHTS TO BATH
Description INSTALL STEAM ROOM & PLUMBING
Inspector Assignment JC
1361 CORVIDAEST
Lot
Type MISC Sub Type OTHER
Job Address
Suite
Location
APPLICANT HILL CONSTRUCTION, ROBERT
Owner NOVAK PAUL D&PATRICIA L
Remarks
Phone 7608155880
Inspector . C _
Total Time Requested By ROBERT
Entered By CHRISTINE
CD Description
19 Final Structural
Act Comments
Po
Associated PCRs
Inspection History
Date Description Act Insp Comments
06/22/2001 17 Interior Lath/Drywall AP JC
06/20/2001 14Frame/Steel/Bolting/Welding AP JC
NOTICECITY OF CARLSBAD (760) 602-2700
BUILDING DEPARTMENT 1635 FARADAY AVENUE-
DATE £/JL7/0/ _ TIME
LOCATION
PERMIT NO
FOR INSPECTION CALL (760) 602-2725 RE-INSPECTION FEE DUE? I I YES
FOR FURTHER INFORMATION, CONTACT
PHONE
BUILDING INSPECTOR CODE ENFORCEMENT OFFICER
PM P.NOVPIK 438 3332
6,20AM
P -
IHERMASOL
Heat Up \bur Life.. ,For Health
Installation Instructions
Steam Shower
Series
For machine of manufacture poet JUNE 1998
If you an • plumber inttflllng thif unit, ptoo* M*v» tftl* ewnerw mmnwi
<§ wtmnfy evrtt with th* mtmtr wlwn you ftoteft J»* tmitaltatiott.
Thank You 7
Not* Bafore contacting Cunlonw 8«Vi«« for Ttohnlaal Support plwuM
) numb*r «ntf a«rt*
H««dqutrtwr« ft T«ehnl«fti Support
2255 Union Pl»ca, Simi VaHsy, CA 93065 - (800) )7« 071 1
, N.J. 07022 - (800) «3t. 1 60t
O&//W
ftPR-20-2001 01:52 PM
To Extsosittt ISSS
P.HOVftK
Ftas
760 438 3332 P . <02
64W8S IS Hi® pi tf f
.21 AM PROM
Generator Installation Instructions
Part* Encto*»d
• QnoTouch digital control
• SO foot food cord
Steam g*n«rat<5f
Hom«own«rp«eK«t
Ritoterlatc
• Brest ball vatve
• Fip« compound
• Copper or brua nippies
(ttlzM and quanflttes p«r
Instruction*)
• h-llna fllt«r (wcommendecQ
9 3^8" brass or eepp«r union
• 1/8" bi»*s or copper union
• Wire (stow end quantities p«r
instructions)
• Copp«r tubing or pipe
• Wire cap nuts
• Ftax conduit
• Bnwt or copper u»e
connection 1 plug
• Silcona
• Pip* wr*noh
• Ttiblng eutur
• Daring toot (it flirad flttings
are used)
• Plp« (hrMd cap
• Wlrt euttart or wlr* «tripjs««
• AdjusTstXe wronoh
• @er*wdriv*ri (ph%ip« &
regular)
• Solder ft Flux
• 3/18" & 7/8" maaonary drill
• Drill motor
• Propane Tfafoh
r
wlm plug-In
Foputety
* Other toots a* rsquirod
st*»m g»n0ratof« are d»»j0n«d to
build MQ PRgS^UPS during operation.This
(e for your safety.
NOTE:
Failure to follow Installation Instructions specifi-
cally may cause the warranty to ba void.
Make aura Power Fiuah i* in the closed position
before turning on the water.
APR-20-2001 01:52 PM
• Ta SxteaLfa W5 ftm TKfflBSOl
"V3Q 3332 P. 03
IU/ZO/9S 10i57ao p 3 of 3
8-1 EM 999 3 2 AM FROM
Requirements for proper Installation
1. Use copper or brass Wimps only. {N6VEH U$& GALVANIZED FmWOS)
2. The water inlet, steam outlet and pressure relief valve nu*d bntM untans for *a*y r«movaJ
nuimtt b> uprjgh*, •eea^atfilp n a Ial aurt ^ with p^ f^nr>ftftttf%n«3< The
Aecma pan*i and Fow»r Flush mutt b« unobstruetvtf and Allow for «asy acc«88.
4. Unit may be Installed up to SO feet away from shower area.
5. Dftiml plumb a trap m the steam l(n« or plumb 1he prt»«ur» rehet vaN*e> into the steam lint.
6. Pitch ateam tine bacK towards generator and »M«I^ p^ff^iy i»wt pttny^^ 1^^
V. Before connecting water Hne to the generator, Kuah water line into a five gallon call to remove any
slit or other material* that may be In the Itrw. A TnemieSoi in-line water fitter is recommended.
. Mate wire water ia turned on to unit and the
operating the unit.i before
Note: Failure to follow specrfio installation instruction^ may cauee the warranty to be void
Figure 1
various options for the TrwmaSo) steam bath generator location.
r*.«.I4M SWSmt*
APR-20-2001 01:53 PM(V Miens .
3-10-19S9 S 22AM
P.NOVftK „,„„„„.„,78SSM5K.
5332 P.
Jfl if I Jf !
P 4
Water Inlet
Refer to figure 2 for the following:
1. Connect tee 10 the hot or 00(4 water line. Install copper pips or tubing to tn» toe. n an in-line Wter is to be metalled
on the water Una to the ganerfttor. (which te tug0wl«d), « would be preVanle to netftli trie tee on the co(0 water Itrta.
2. Inetall ft br«9* •hut-oft vsttv* on t»w watw lni«t line m »n #w«»»lw« «f«a prior to t» brass union »nd r6comm«n<ted
Mine water inter
3. 8»tof« making th« i«at eonn«otten to trt« 3/ff* wat«r irt« iln* coming to th« grut, fiush tn« wat«f iio« into * dv« gallon
pal! 1o mmovft any slit or other material* that may M in the Im*.
4. Mak« tha final connection and turn on wt»r AU ThtrmeSel B^narators ere »qulpp«d with an automatic watar fill
syttem. Th« water wil) stop after unit is fitted, ufafai «•« «*«| feM»f wu«h m ^> »y ^nf^ pn^tM^n
IMPORTANT: MAXIMUM WATER PRESSURE 80 P.S.I.
Steamhead Installation
1. Of ill« 7/9* dimeter note In the «tieww wartl or weB *pew the bath tub for the steam eottet tm». Refer to figure 2a
. as ft Quide tor re proper locatton ot tri* hot*,
* CAUTK>N:Theeteamhea<llehoWAndehouWnotbeio*«te«Maraee«tofbenc»ir
2. Connect 1/S"ftf>, copper ptpa o' copper ftjftng «ntf t/%* or*4» unfen onto the ete«/n out»t. Run a 1 fST copper ptp«
• ram the uflier to the 7/5* hole »n waJI. IntttB a t/JT M LR on the end of the W pfp#<«lr»tf»amh«»d.
: a. Attach the tteamhead and weuteheon to the copper tripe, CAUTION: Da not obatrutt the eteem line wKrj arty
ehui-of( vaJvee, pluge or oap* AU. ThenMftel eteem aenertloni are <i*eigneo' to butW NO PBESflune.
4> The ream flne cart run up, down, t* horizontal; bt^mann«f nu\ tjgwn unit m*r\ ^p. if ft does, a steam trap win be
produces at the (ow point tocfcfog trte Mow of (team, fnaulata Die steam outtet p<ptng if trie piping run exce«d« 10 feet
or it expoMd to eoW areet. NOTE; Ue* eteem rated ineuWon.
Otartbtfef• eantoi
94* wtf 2*
Wvwmm
weJt
T!J
01 :53 PM P.NOVftK
from
T60 436 35352 P . 05
15 S?JQ p 5 of S
9-ISM 929 S 22AM FROM P 5
Electrical Installation
NOTE; AH aUKrtrical wiring must t» done per local etectrteai codas
Wre 8/200 wwiwwKfcK* Ay National Sfootrfea! Code Minimum wo* tompw&ure rating 90C
\Swiwiittvir fflwiiw
80
84
140
- 240
395
€25
GOO
900
Win tiWboe
10
10
8
8aet
\ 2
Breaker Siz«
25
30
40
50
60
'70
70
too
1, Turn off »H «l*ctriwy to the woriilng area at th» main breakw panel.
3. Connect th* 208/240 VOit A.C, electrtwl line to wiras labaled 1 & 2 in junction box on g«n«rator
(see figure 3)
InatruttitMto eonitfiu* on ptgv &
K>UCH PAD
Figure S Wiring Ofagrwn
Choose the appropnate steam generator after calculating the adjusted
steam room cubic footage Refer to the ThermaSol Brochure for the
proper steam generator model When a calculated cubic foot capacity falls
between two models, always choose the higher-rated generator
Model Installation
Custom Design
Vapor Proof
Doors & Enclosures
Alternate Attic Location
(insulated to prevent freezing)Slope Ceiling T Per Foot
Stea/nroom also
used as Shower
Tile or Water
Proof Finish
Steamhead 12" above
Floor Opposite Bench
or Seat
Slope Steam Pipe
To Prevent
Condensation from
Collecting
Silicons comers
or Joints
Non Organic
Adhesive or
Thin Set
Backer Board
1/2" Minimum
Exterior Grade
Plywood Seat
Reinforcement
Vapor Retarding
V Membrane
Insulation for
Interior and Exterior
Walls
vapor Proof Lights
Rated For Wet
Environment
Steam Generatorin Vanity
Sub Floor
Vapor Retarding
Membrane
_, _ Bench Slightly Sloped
r510^00' to' CondensationAlternate Basement "°wanj Drain Run ot)
Location Insulated and Dry
Technical Support Numbers
-0711 or (805) 520-2468 West Coast(800) 776
(800) 631-1601 or (201) 941-8222 East Coast (* ) EST.
®?^l^^^r?^T?^^^?;?&=''.' 4'-j'-'£:~.''•'••':;:' - r?.-:$-f;.:•-.-."* .V-'^iM^aii-i-J-:;-^ •••?":!• *r\vir-i:- J^•?.a^'-'---''-'-'''----:i'''•'•'' ' '."-•.'-".-* f.: "'-~ .-'...-•--iM .'-'••• •• '.:.--'.-•;'.'"•;:."-"r.
Flitt*L»f f Lw Seiies
Steam Bath Generators
Pamper yourself in the comfort of your home with the wondrous benefits of steam
Elite will recharge your body & spirit enhance circulation promote healthier skin
and a new you1 Elite the best of the best1
All the features offered by others PLUS an abundance of features found only
from ThermaSol1 Compare and realize the "Elite" value1
• Exclusive stainless steel split tank technology
• Recognized worldwide ThermaSol generator with stainless steel tank1
• Proportional Heating System1 (PHS) eliminates irritating temp fluctuations
ULTIMATE in temperature maintamce1 ThermaSol Patented
• Dual memory Settings' programs two separate time & temp settings
• Automatic PoWCrFlush1 does more ihan drain it power cleans the tank
• Pause .iHow^ a break wrhout resecting entire program
• LED Clock1 digital time display
• Diagnostics' monitors xour unit
Elite can be plumbed 25 feet away
ThermaSoPs Aroma Therapy steamhead (sample essential oil included)
Optional
OneTouch Control
gives you remote capability
activates your Elite can be
mounted anywhere1
Best Of The Best
OneTouch Control
105/» x3'/i
. CSA/NRTL Listed
38 -*r 1 7 long x 11 Vi wide x 12 tall (at piping clearance)
Standard Combinations
Item no Color & Trim List Price
Standard Combinations
Item no Color & Trim List Price
EB5C Black/Chrome
EBSB Black/Brass
EB5W Black/White
EB5G Black / Gold
EB5SF Special Finishes (see below;
5 kw 30 amps 100 cu ft 28 Ibs
EB7C Black/Chrome
EB7B Black/Brass
EB7W Black/White
EB7G Black/Gold
EB7SF Special Finishes (see below)
7 kw 40 amps 200 cu ft 29 Ibs
EB9C Black / Chrome
EB9B Black/Brass
EB9W Black/White
EB9G Black/Gold
EB9SF Special Finishes (see below)
9 kw 50 amps 300 cu ft 29 Ibs
Elite can be ordered with a white control face To order white, substitute the 2nd letter which is "B" with a "W"
Example EB5C would be changed to EW5C Available in the following designer finishes Nickel, Satin Nickel, Black Nickel, Satin Chrome, and Pewter
i"lay require additional production time
$1880.
$1985
$1985.
$2025
,) $2069
Ibs
$1985.
$2090.
$2090
$2130.
,) $2174
bs
$2090
$2195
$2195
$2235.
,) $2279
Ibs
EBIIC
EBIIB
EBIIW
EBIIG
EBIISF
EBI3C
EBI3B
EBI3W
EBI3G
EBI3SF
EBI5C
EBI5B
EBI5W
EBI5G
EBI5SF
Black / Chrome
Black / Brass
Black /White
Black /Gold
Special Finishes (see below)
11 kw 60 amps 400 cu ft 30 Ibs
Black / Chrome
Black / Brass
Black / White
Black / Gold
Special Finishes (see below)
13 kw 70 amps 525 cu ft 30 Ibs
Black / Chrome
Black / Brass
Black / White
Black / Gold
Special Finishes (see below)
15 kw 80 amps 600 cu ft 31 Ibs
$2210
$2315
$2315
$2355
$2399
$2405
$2510
$2510
$2550
$2594
$2510
$2615
$2615
$2655
$2699
SD
COMPENSATION
INSURANCE
PO BOX 807, SAN FRANCISCO.CA 94101-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE 10-01-00
POLICY NUMBER 044-00 UNIT 0020371
CERTIFICATE EXPIRES 10-01-01
CONTRACTORS STATE LICENSE BOARD
ATTN: WORKERS' COMP. UNIT
BOX 26000
SACRAMENTO CA 95826
JOB #590069
INCEPTION DATE 10-01-00
D 0 SAN 01 EGO
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated
This policy is not subject to cancellation by the Fund except upon 10 days' advance written notice to the employer
We will also give you -JQ days' advance notice should this policy be cancelled prior to its normal expiration
This certificate of insurance is not an insurance policy and does not amend extend or alter the coverage afforded
by the policies listed herein Notwithstanding any requirement term or condition of any contract or other documentwith respect to which this certificate of insurance 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
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS $1,000,000 00 PER OCCURRENCE
STANDARD EXCLUSION INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE
FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY
EMPLOYER LEGAL NAME
ROBERT HILL
229 OCEANVIEW DRIVE
VISTA CA 92084
HILL, ROBERT E AND
HILL, DIANE M
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND
PRINTED 09-20-00 P0409
SCIF 10265 (REV. 2-95)