HomeMy WebLinkAbout1366 CASSINS ST; ; CB971432; PermitBUILDING
06/09/97 14:52
Page 1 of 1
Job Address: 1366 CASSINS ST
Permit Type: GUNITE POOLS AND SPAS
Parcel No: 215-691-51-00
Valuation: 14,125
Occupancy Group: Reference*:
Description: POOL AND SPA 500 SF, GUNITE
Appl/Ownr : A MONTI POOLS
753 GRANITE HILLS
EL CAJON, CA 92019
*** Fees Required ***
PERMIT
Suite:
Lot#:
Permit No: CB971432
Project No: A9701842
Development No:
5766 06/09/97 0001 01 02
C-PRMT " 210.00
Construction Type: NEW
Status: ISSUED
Applied: 06/02/97
Apr/Issue: 06/09/97
Entered By: JM
619 588-1052
ollected & Credits
Fees:
Adjustments:
Total Fees:
Fee description
Building Permit
Plan Check
Strong Motion Fee
Enter "Y" for Ele
Enter "Y" for Plum!
* BUILDING TOTAL
31
** *
. 00
105.00
210.00
Ext fee Data
162.00
105.00
1.00
20.00 Y
27.00 Y
315.00
CITY OF CARLSBAD
2075 Las Pahnas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(760)438-1161
1, PROJECT INFORMATION C'. -*fc '»•».' *<---'
FOR OFFICE USE i
PLAN CHECK NO.
EST. VAL.
Plan Ck. Deposit
Validat
Date
CM .
Address (include Bldg/Suite #)tu.Business Name (at this address)
Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units
Assessor's Parcel #Existing Use x Proposed Use
Description of Work
2. CONTACT PERSON OfifiHewnt from applicant)
. FT.#of St if Bathrooms
Name
W APPifCANT
Address
Q Agent for Contractor
City
mr O Agam for Owner
State/Zip Telephone if Fax #
AddrBSS City State/Zip^* Telephone^*
Name *~Address City State/Zip Telephone #
is.- ^»mssti^^m^mn>mti^'' "----•• •••• — -- • - --• •
(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
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500)).
A*H C**
Name
State License #
Address
License Class
City State/Zip
City Business License #
Designer Name
State License #
Address City State/Zip Telephone
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.
Q 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 ^f\zf^-^_ rXI S^^ Policy No. \ ^ "^ ~2-'i^>'2^-^_ C Expiration Date O *" ( "~ i "7
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1*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 thecgal*4compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees.
SIGNATURE fj? ^^J^^^^^^T^S DATE (2»
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
D I, as owner of the property or my employees with wages as theip-sole compensation, will do the work and the Structure isnoljintBfidad or offered for sale
(Sec. 7044, Business and Professions Code: The Contractor's License/Taw 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 sucXimprovements 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 tb« burden of proving that he did not build or improve for the purpose of sale).
Q I, as owner of the property, am exclusively contractino/with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The
Contractor's License Law does not apply to an owner jf^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 laboi^and materials for construction of the proposed property improvement. CD YES QNO
2. I (have / have not) signed an application for a building permit for the proposed work.
3. I have contracted with the followjrlg person (firm) to provide the proposed construction (include name / address / phone number / contractors license number):
4. I plan to provide portions ofytfie work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone
number / contractors license nurfiber):
5. I will provide some of ,*fie work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type
of work): /
PROPERTY OWNER SIGNATURESlfoN/DATE
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 D 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(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 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 365 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 commenced for a perjoAof 180 days (Section 106.4.4 Uniform Building Code).
APPLICANT'S SIGNATURE ( JZ^>—<^*^—^^ S*-* DATE £# "~ 2- ~~°[ 1
WHITE: File YELLOW: Applicant PINK: Finance
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT* CB971432 FOR 10/28/97
DESCRIPTION: POOL AND SPA 500 SF, GUNITE
TYPE: POOL
JOB ADDRESS: 1366 CASSINS ST
APPLICANT: A MONTI POOLS
CONTRACTOR:
OWNER:
INSPECTOR AREA PD
PLANCK* CB971432
OCC GRP
CONSTR. TYPE NEW
STE: LOT:
PHONE: 619 588-1052
PHONE:
PHONE:
REMARKS: C/GREG/607-7706 INSPECT
SPECIAL INSTRUCT: HOMEOWNER GIVES INSPECTOR PERMISS TO ENTER BACK YARD.
TOTAL TIME:
—RELATED PERMITS—
CD LVL DESCRIPTION
59 SW Final Pool
PERMITS TYPE
RW970129 ROW
STATUS
ISSUED
ACT COMMENTS
***** INSPECTION HISTORY *****
DATE DESCRIPTION
101697 Fence/Pre-Plaster
101597 Fence/Pre-Plaster
101097 Final Pool
070797 Excav/Steel/Bonding/Fence
070797 Underground Plumbing
070797 Electric/Conduit/Wiring
070197 Excav/Steel/Bonding/Fence
ACT
AP
NS
CO
AP
AP
AP
CO
INSP
PD
PD
PD
PD
PD
PD
PD
COMMENTS
ON CARD
NOTICE
"^fc-
CITY OF CARLSBAD ™ ^ ^^ ™ ™ ^^ ^^™ 438-^150
BUILDING DEPARTMENT 2075 LAS PALMAS DRIVE
- ADATE / ' / ' / TIME.
LOCATION
PERMIT NO..
FOR INSPECTON CALL 438-3101. RE-INSPECTION FEE DUE? I I YES
FOR FURT>tER INFORMATION, CONTACT _PHONE
BUILDING INSPECTOR CODE ENFORCEMENT OFFICER
City of Carlsbad
Engineering Department
BUILDING PLANCHECK CHECKLIST
POOLS
BUILDING PLANCHECK NUMBER: CB 4 7 f <J 3
BUILDING ADDRESS: J 3 (p U d$SS/fi>S
PROJECT DESCRIPTION: Pool f> ft
ASSESSOR'S PARCEL NUMBER:- ^ 9 I ~
ENGINEERING DEPARTMENT
APPROVAL
The item you have, submitted for review has been
approved. The approval is based on plans, information
and/or specifications provided in your submittal;
therefore, any changes to these items after this date,
including field modifications, must be reviewed by this
office to insure continued conformance with applicable
codes. Please review carefully all comments attached,
as failure to comply with instructions in this report can
result in suspension of permit to build.
Date:
DENIAL
Please see the.attached report of deficiencies
marked withf .-JWake 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:
By:
Date:
Date:
Date:
ATTACHMENTS
D Grading Permit Application
D Grading Permit Checklist
H Right-of-Way Permit Application
D Right-of-Way Permit Submittal
Checklist and Information Sheet
ENGINEERING DEPT. CONTACT PERSON
NAME: BRUCE EUBANK
City of Carlsbad
ADDRESS: 2075 Las Palmas Drive
Carlsbad, CA 92009
PHONE:(619) 438-1161, ext. 4374
\\Lupllmu\sys\UBRARY\ENG\WORO\OOCSCHKLST\Pool BuHIng Plandwck CkHst CHK24 form MM.Hoc
Rev. S/22/S6
2O75 Las Palmas Dr. - Carlsbad, CA 92OO9-1576 - (619) 438-1161 - FAX (619) 438-O894
1STJ/2*
a Q
Q Q
Q Q
Q Q
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Q
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BUILDING PLANCHECK CHECKLIST - POOLS
SITE PLAN
1 . Provide a fully dimensioned site plan drawn to scale. Show:
Property Lines
Easements
North Arrow
"'D. Existing & Proposed Structures
on site plan:
Drainage Patterns
Existing & Proposed Slopes
Existing Topography
ndicate what will happen with
soil excavated from pool area
Retaining Walls
(location and height)
Note: If excavated so// /s not to be removed from property but regraded on
site, s/ioiv 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:
Address
Assessor's Parcel Number
Legal Description L«-r
/ID. Grading Quantities Cut Fill
, U^{ + 2
Import/Export
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 11.06.030
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
\\Laspalmas\sys\UBRARY£NQ\WORD\DOCSVCHKLSTV>ool BuMing PlanOieck Cklist CHK24 Form BE.doc
Page 2 of 2
]W -2ND' 3RCV
D Q Q 5c. A Grading Permit has been applied for:
PE2 DWG
Grading Inspector sign off by: Date:
Q 5d. No Grading Permit required.
MISCELLANEOUS PERMITS
Q 6. A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Way and/or
private work adjacent tot he 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.
Q 7. Remarks
W.aspalmas\sys\UBRARY'ENG\WORD\DOCS\CHKLST\Pool Building Plancheck CUfcl CHK24 Forni BE.doc
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER CB
ADDRESS
DATE
RESIDENTIAL ADDITION MINOR
« $10,000.00)
TENANT IMPROVEMENT
PLAZA CAMINO REAL
VILLAGE FAIRE
COMPLETE OFFICE BUILDING
OTHER
PLANNER DATE
ENGINEER DATE
C:\WP51\FILES\BLDG.FRM Rev 11/15/90
SENT BY:THE WALTERS MGMT.CO. ; 5-23-97^ i:4an ;THE WALTERS MGMT.CO.
Po«t-lt" brand fax transmittal memo 7671
6196600440;* I/ 4
/IARA
MASTBH ASSOCIATION
May 23, 1997
Steve Butcher and Dawn Seattle
1366 Cassins Street
Carlsbad, CA92009
RE: MAR FIORE LOT 79 ARCHITECTURAL IMPROVEMENTS
Dear Mr. Butcher and Ms. Beattie:
This letter is written on behalf of the Aviara Master Association Architectural Review Committee.
Your landscape/construction plans for installation of front, back and side yard landscaping have
reviewed by the Architectural Review Committee and partially approved with conditions. Pie
review the report submitted by Landscape Architect, Denis LaClairc for the conditions of approval.!
additional information is requested and you resubmit your plan$, you must include a resubmittal fedof
$35.00 for tine second review.
The acceptance of mis application was based on aesthetics and community continuity and does iot
consider structural integrity or approval of the methods of construction. It is the •«•"««•»
responsibility to obtain all required City permits,
This approval is valid for a period of six (6) months. Construction is to commence within 120 days J id
be completed within six months of the date of approval. If you are unable to complete w
improvements within six (6) months, please notify our office.
Upon completion of the improvements, pleasw notify The Walters Management Company, via tjie
enclosed postcard, that the improvements arc complete and ready for final inspection. A review
conformant*! report will be completed within thirty (30) days.
If you should have any questions, please contact me at your convenience at 497-6556. Thank you 1
your cooperation.
Sincerely,
)&M$r
/Janet Wagner
•Afcchilecturol Control Administrator
AVIARA MASTER ASSOCIATION
cc: Architectural Review Committee
AOENT:THI<: WALTERS MAN AOEMENKXMttNY
2M1 SAN DIEGO AVENUE, SIjrrE A-2.50, SAN DlfcGO^r.llORNJA 92110-WO
SENT BY:THE WALTERS MGMT.CO. ; 5-23-97 ; 1=43PM ;THE WALTERS MGMT.CO 6196600440;# 2/ 4
May 20,1997
Aviaro Master Architectural
Review Committeec/o The Walters Management Co.2251 Son Diego Ave.
Suite A-250
Son Diego, CA 92110
Attention: Janet Wagner
Re; BUTCHEB/BEATTIE Residence
1366 Cassins Street
Lot 79/Mar Flore Community
REVIEW OF HOME IMPROVEMENT FORMS
Per your request. I have reviewed the landscape submlttal for the Aviara/Mar Flore
project-1366 Caulns Street Act 79 and have the following comments;
As Indicated by my previous review reports, the CC&R's are not explicit in
Implementation of the landscape or Individual lots and leaves the approval discretion
to the Architectural Committee. As requested by the Architectural Committee, I have
also agreed to review the plans. I am not approving the means nor methods of
construction, the Installation and guarantee to the Homeowner and Homeowners
Association. This is Ihe sole responsibility of the landscape contractor. Al existing walls
and fences should be protected and not filled against or offered In any way. The
applicant shall maintain a 5' fence/wall height, without altering the height of the
existing fence/wall, for a minimum distance of 5' from the fence/wall Into the
applicant's lot at all property line fences/walls that are shared with an adjacent
property. Al vines / espaliers which are attached to Master Association fencing shall
be detached by the applicant when fencing maintenance Is required. All existing
drainage patterns should be maintained per the CC&R's, The CC&R's should take
precedence In al situations.
BUTCHER/BEATTIE Residence The landscape submlttal included a
hardscape/landscape plan for the front, back and side yards. Also included In the
submlttal was a plan view detail of a patio/trellis cover and photographs of portions
of the property. The proposed improvements for the front yard Include a walkway
from the public sidewalk leading to the front entry. 32" high stucco entry columns &
wa!s, an entry courtyard/patio area with a fountain, a pebble stone/river rock dry
stream bed between the driveway and the left side property line (as viewed from the
street), a gate added to the existing wall at the left side yard, a stepping stone
pathway from the driveway leading to the left side yard, landscape, mounding,
boulders, lawn, shrub beds and trees. The proposed improvements for the back yard
Include a flagstone patio with the following elements; a barbecue/wet bar, a
fireplace, a gas torch, and an 18" high soot wall. Other proposed Improvements for
the back yard Include a pool & spa with an adjacent 30* high patio, a 48* high seat
wad adjacent to the 30* high patio, a waterfall feature, a 32* high seat wall adjacent
to a sculpture element, boulders, landscape mounding, lawn and shrub beds which
scape
tects
9885
Suite 1
SwDii
C4lHonla92121
Elm Road
|9-452 5884
4S2 5886
SENT BY:THE WALTERS MGMT.CO. ; 5-23-97 ; 1=44PM ;THE WALTERS MGMT.CO.6196600440;# 3/
. Avtora/Mar Rore
BUTCHER/BEATT1E/Lot 79
May 20,1997
Include trees. The proposed Improvements for the ten side yard Include a trellis
covered patio off the dinning room, a sculpture/water fountain feature, a Jtone paver
pathway, a utllty area, various shrubs and trees. The proposed Improvements for the
right side yard Include a stone paver pathway and various shrubs. Pedestals with
potted plants are shown In the back and side yards. The color of the trellis cover is to
match the trim of the house. The stucco columns/walls are to match the house, and
the front entry walkway Is to be either all flagstone or flagstone bands with exposed
aggregate concrete. An elevation drawing of the water fountain feature is shown on
the plan. The landscape and hardscape materials appear to be ft character with
the Avtarc Master Community and I feel the landscape submittal should be partially
APPROVED wffh the rWowty condition*
^. A portion of the applicant's back yard Is in zone one of the overall firesuppression zone. No plant material over 3' In height at maturity or
combustible structures ore allowed within zone one. Therefore the tree
ad/acent to the waterfat feature, the three trees adjacent to the 32" high seat
waH/scvfptvrd area, the large shrub closest to the back fence along the left
side property Une and the forge shrub & vine closest to the back fence atony
the right side property Sne are DENIED.
2. Tto appfcant has Indicated plant material beyond the back fence. The area
beyond the back fence Is a Homeowner's Association maintained area.
Improvements of any kind are not allowed within the Homeowner's
Association maintained area, therefore the proposed plant material
Improvements beyond the fence are DENIED.
3. No elevatton sketch or overall height b provided for the fireplace, however a
notation Js provided that states 'see fireplace detail 9 model'. We do not
have the resources to review the fireplace at the model, therefore more
Information witt be required from the applicant prior to approval of the
element. The fireplace is currently DENIED. The applicant shaOprovide an
elevation sketch of the fireplace, or a photograph of the referenced fireplace,
and the overall height and finish/color short be Indicated for review prior to
approval.
4. Though a plan view sketch of the trettts cover was Included In the submittai, no
elevation sketch was submitted, nor was an overall height Indicated. Jhe
ovefaff height shot not exceed 9'.
5. No material or finish/color 1$ indicated for the new gate added to the existing
waff at the left side yard. The gate shaff match the existing gates of thecommunity.
6. Several types of plants ate given on the plant material legend, shown on the
plan, for each symbol. Though most of the plants appear to be acceptable,
Magnolia grandrflora "Southern Magnolia "is not acceptable due to its size at
maturity. If Magnolia trees ate desired, the applicant shatt install a smaOer
variety of the tree. As weff, the applicant shall use appropriate types of plants
In given locations. For example, in the narrow side yards a tree type which if
columnar shaff be selected instead of a type which is a broad dome canopy
tree. AH frees shai be kept thinned and pruned to keep potential views from
neighboring tots as open as possible. All trees shall be ^staffed a minimum
distance of 3' from any adjacent property Une. The applicant shall be
responsible tor controlling the growth of the trees from encroaching Into theneighbors tots.
SENT BY:THE WALTERS MGMT.CO. ; 5-23-97 ; 1:45PM ;THE WALTERS MGMT.CO.-
page 3
Avlara/Mar Flore
BUTCHER/BEATTIE /lot 79
May 20,1997
6196600440;# 4/ 4
7. The 49" high seat wati. and the waterfall feature in the back yard shot bo
finished on the side facing the common/open space area,
8. No pool & spa equipment 1$ shown on the plan. According to the guidetoes,
pool, spa and fountain equipment must be placed so as not to disturbadjacent properties, and the equipment shall be enclosed by fencing at least
5'in height and screened from view. As wet, the installation of the equipment
shaf conform to off requirements as outttned in the guidelines. Since the
neighbors may not have had an opportunity to review the location of the
equipment, the applicant-should communicate the proposed location of the
equipment to the adjacent neighbors.
9. The applicant did not Include drainage plan as part of the submrrtal. Theexisting drainage pattern at the time when overall grading was completed by
me Builder is designed without consideration of proposed landscape
improvements. Patios, walks, mow strips, planter wails, etc, will entrap surface
water. At surface water must have positive drainage away from the building
and be collected in a landscape drainage system. The ARC is not responsible
for installation of proper drainage. This is the sole responsibility of the owner
and/or his landscape contractor.
As Indicated above, the installation is the sole responsibility of the landscape
contractor The irrigation system should be designed with the ability to controldifferent water zones (sun, shade, shrubs and lawn areas). The Irrigation system should
be reviewed routinely to avoid over spray. There should be a minimum
slope/drainage of 2% away from the building and water should be collected In an
atrium type catch basin In all planting areas. Planting areas shall be a minimum of 4"
below the existing stucco screed on the building. Al walks and walls that are
adjacent to the existing building should have appropriate joint materials. AllImprovements must meet the minimum requirements of the Avlara's residential
Architectural and Landscape Improvement Manual.
If construction work requires the use of common area, or access from property not
owned by the applicant for purposes of transporting labor and materials, or tor the
temporary storage of materials for the work, the applicant shall obtain written
permission from the Aviara Master Association and the owner for the right to enter
during construction, A copy of the letter granting permission shall be submitted to the
ARC prior to commencement of construction. A security deposit or bond, as deemed
necessary by the ARC. my be requited from the owner. Unused deposits will be
refunded after completion of work and final acceptance by ARC. Payment will be
refunded by U.S. Mai within 30 days after ARC'S final acceptance.
My recommended approval and the approval of the Board does not take
precedence over the requirements and regulations of the City of Carlsbad. Please
cali with any questions or comments to the above-mentioned Items.
DentslaClatre, ASIA, RIA 3861
Marquez«Kuhlken
Landscape Architects
Imis UM> M. :,<me> res ASSESSMENTPWPOSB 0*1. no UABIUTYis tssum FOB nc ACMUCTu-ic D*TA SHOW. «stssafsrums m^ CCMPIY WIH uxai suaiivigni OR a"
^saTPM——SCIF SW DIEGO.NO. 415 P.Z/2
COMPELNHATI-,,
INSURANCE
P.O. BOX 420807, SAN FRANOieOO, CA 84142-0807
PLJ INI|Dr> ,pERTIFICAT^OF WORKERS
DECEMBER'"'"
>V'S'.* r ,-»>»'i-
Th|S ie to certify ttyft we have Issued a valid Workers' Compensation insurance policy in n torrn approvdd by the California
ln»mno«r>3mmt*s(on«r to th« employe named bwo^v for trie policy period indioatea. ' i
TTtis policy \t not subject to cancellation by the Fund except upon ten days' advance written noqc* to me employer. .
• . ; •- ; . ._ . _ • .;.:';- ._• , . • _ . • . ' \'\." \ ".'••;•". :'<-'• '.'•"' • . i . ".* ."
We will also give you TEN days' advance notice should thte policy bo e^nooticd prior to ita normal expiration. .
.'•.,• ••-,'•.•.• ..' ' . , ' •..,', t '•'... • •(.'.!•'-...'..--. • - * • • •:..-. . . • • •. '.•_•.,,...••• x -. : ... !
This certificate of Insurance Is not en insurance policy and dom not amend, extend ar alter the coverage afforfl^j by tfw
policies (Mod twreir> Ndtwitnstandlrig any requireme or oth«r document
.— '
ANTONIO MONTI ff^^s;^
7S3 CRANITE HILLS CHICLE
EUCAJON CA 92019 NR
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND
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