HomeMy WebLinkAbout1664 BRADY CIR; ; CB060359; Permit02-27-2006
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Pool Permit Permit No CB060359
Building Inspection Request Line (760) 602-2725
Job Address
Permit Type
Parcel No
Valuation
Reference #
Project Title
1664 BRADY CRCBAD
POOL
2054400700 Lot #
$29 750 00 Construction Type
0
NEW
YOUNG RES 850 SF POOL/SPA
W/ GAS/ELEC TO BBQ AND GAS TO 5 TALL FIREPLACE
Status
Applied
Entered By
Plan Approved
Issued
Inspect Area
Applicant
SUNDANCER POOLS
728 INPIRATION
ESCONDIDO CA 92025
760-489-5850
Owner
YOUNG RONALD L&SUSAN L
1664 BRADY CIR ,
CARLSBAD CA 92008 ,
ISSUED
02/13/2006
SB
02/27/2006
02/27/2006
Building Permit
Add I Building Permit Fee
Plan Check
Add I Plan Check Fee
Electrical Fee <
Plumbing Fee
Strong Motion Fee <
Renewal Fee
Add I Renewal Fee
Other Building Fee
Additional Fees
$242 99
$000
$15794
i $000
$2000
$2700
$298
$000
$000
$000
$000
TOTAL PERMIT FEES $450 91
Total Fees $450 91 Total Payments To Date $45091 Balance Due $000
PERMIT HAS EXPIRED IN ^OCCVDANCE WITH G B C
SECTION 106 4 4 Au A VErtDfcD BY CIIC 18 04 030
DATE />J2S!GNATURE
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
fesstexantinns of which you have previously been given a NOTICE similar to this, or as to which the statute of lim itations has previously otherwise expired
02-27-2006
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Right of Way Permit Permit No RW060079
Job Address
Permit Type
Parcel No
Start Date
Insurance Expire 10/26/2006
Liability Insurance Y
Reference*
Location
1664 BRADY CRCBAD
ROW
2054400700
Subtype MINOR
Lot* 0
Est Complete Date
Traffic Control Plan Y
GOP
Project Title YOUNG RESIDENCE
Description POOL/SPA/BBQ/FIREPLACE
Applicant
SUNDANCER POOLS
728 INSPIRATION LN
ESCONDIDO CA 92025
760-489-5850 ' «
Status ISSUED
Applied 02/27/2006
Issued 02/27/2006
Expired 08/27/2006
Entered By JJ
Total Fees $290 00 Total Payments To Date $290 00 Balance Due l $000
Permit Fee
Additional Permit Fee'
Other
Additional Fees
TOTAL PERMIT FEES
$290 00
$000
$0*00
$000
$290 00
This permit may be revoked by the City Engineer if it is deemed that inadequate progress is being made towards the completion
of the work or if the work does not meet City Standards The applicant may be billed for the cost of any corrective work that the
City must perform
Permit Release Date Released Cash Deposit?
YOU MUST CALL UNDERGROUND SERVICE ALERT (1-800 422-4133) TWO WORKING DAYS PRIOR TO WORK
UNDERGROUND SERVICE ALERT NO
IF ANY EXCAVATION OR BORING IS DONE
THIS PERMIT IS INVALID WITHOUT THIS NUMBER
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave , Carlsbad, CA 92008
PROJECT INFORMATION
327 OI/13/200& 001 11
PLAN CHECK%%
EST VAL
Plan Ck Deposit
Validated By.
Date <v*~
Address (include Bldg/Business Name (at this address)
Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units
Assessor/s Parcel #Proposed Use
Description of Work -pcot
2 CONTACT PERSON (if different from Applicant)
SQ FT t #of Stories
^
# of Bedrooms # of Bathrooms
Name s- Address City
I Contractor CfAgent for Contractor!^ Q Owner d AgenFfor Owner
fOO "
State/Zip > Telephone #Fax*
Name Address City State/Zip Telephone #
Name
5 'CONTRACTOR "COMPANY NAME
(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 basrs for the alleged
exemption Any violation of Section 7§31 5_by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500])
Name
L,cense #
Address
License Class
fJ-Ot /J Avt.
City State/Zip
City Business License #
Telephone #
Desiqner Name 5—' _ ,, Address City State/Zip Telephone
cf>f''7 CK '
State License # £?* & / 3 \
6 WORKERS COMPENSATION >' T~ 3J 3K •> if*-* ^ " J*
Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations
d 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
N7j 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 earner and policy number are
Insurance Company c^T^L-f^^ iLLM-fiL-* Policy No Q? / J^Sa / ' ~J Expiration Date__T_
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) '
d 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 dollarsJ$1OO 000) in addition to the cost of comnensation damages as provided for in Section 3706 of the Labor code interest and attorney s fees
SIGNATURE \J(O±/UJ. Pfe^V/?^>. /Ki^^ . ._ DATE
7 OWNER BUILDER
I hereby affirm that I am exempt from the Contractor s License Law for the following reason
—n—iT-as-Djc/nerpf 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 Busine35-af«LProfessions 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 througFTrns-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 tfte~Qwner builder will have the burden of proving that he did not build or improve for the purpose of sale)
fj] 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 oWijer of property who builds or improves thereon and contracts for such projects with contractor(s) licensed
pursuant to the Contractor s License Law)
l~l I am exempt under Section Business amiProfessions Code for this reason
YES d|NO1 I personally plan to provide the major labor and materials for construction of the proposed property improvement
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 propose<construction (include name / address / phone number / contractors license number)
I plan to provide portions of the work but I have hired the following person to cooYdjnate supervise and provide the major work (include name / address / phone
ber / contractors license number) _ ^X^ _\ number / contractors license number)
\ 5 I will provide some of the work but I have contracted (hired) the following persons to provKte<he wi
\ of work) ^^-v
ork indicated (include name / address / phone number / type
\AROPERTY OWNER SIGNATURE
(\QMPLETE THIS SECTION FOR NON RESIDENTIAL 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? d YES d NO
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district' d YES d NO
Is the facility to be constructed within 1 000 feet of the outer boundary of a school site? d 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 30970) Civil Code)
LENDER S NAME LENDER S ADDRESS
9 iff APPLICANT CERTIFICATION
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 commerced foe a period of>80 days (Section 106 4,4 Uniform Building Code)
APPLICANT S SIGNATURE
Applicant PINK Finance
Permit* CB060359 Type POOL
Date Inspection Item
01/30/2008 92
01/29/2008 92
06/04/2007 23
06/04/2007 23
06/04/2007 52
06/06/2006 23
06/06/2006 51
06/06/2006 53
06/02/2006 23
06/02/2006 51
06/02/2006 52
06/02/2006 53
03/22/2006 51
03/21/2006 23
03/21/2006 51
03/21/2006 52
03/21/2006 53
03/20/2006 23
03/20/2006 51
03/20/2006 52
03/20/2006 53
03/17/2006 51
Compliance Investigation
Compliance Investigation
Gas/Test/Repairs
Gas/Test/Repairs
Underground Plumbing
Gas/Test/Repairs
Excav/Steel/Bonding/Fence
Electric/Conduit/Wiring
Gas/Test/Repairs
Excav/Steel/Bondmg/Fence
Underground Plumbing
Electric/Conduit/Wiring
Excav/Steel/Bondmg/Fence
Gas/Test/Repairs
Excav/Steel/Bondmg/Fence
Underground Plumbing
Elect ric/Conduit/Wirmg
Gas/Test/Repairs
Excav/Steel/Bondmg/Fence
Underground Plumbing
Electric/Conduit/Wiring
Excav/Steel/Bondmg/Fence
YOUNG RES 850 SF POOL/SPA
W/ GAS/ELEC TO BBQ AND GAS TO 5 TA
Inspector Act Comments
-
JM
JM
JM
JM
BN
BN
BN
JM
JM
JM
JM
JM
JM
JM
JM
JM
JM
JM
JM
JM
JM
Rl ok to expire permit Still no progress
CO EXPIRE THIS PERMIT A NEW PERMIT
FOR POOL HAS BEEN ISSUED
AP
AP POOL EQUIP /BBQ
we
AP
AP
AP
CO
CO SLIDE NOT PER ENGINEERING DETAIL
CO
CO
CA JAY
CA jay
CA
CA
CA
CO WATFR IN POOL
CO
CO
CO
NR
Wednesday January 30 2008 Page 1 of 1
City of Carlsbad
December 27, 2007
Bui I d i ng;r Depart men t
Permit Number CB060359
Issue Date 02/27/2006
RON & SUSAN YOUNG
1664 BRADY CR
CARLSBAD CA 92008
RE BUILDING PERMIT EXPIRATION
PERMIT TYPE POOL
ADDRESS 1664 BRADY CR
PLEASE CALL FOR AN INSPECTION IF WORK IS
COMPLETE
Our records indicate that your building permit will expire by limitation of time on 01/01/2008
The provisions of UBC, Section 106 4 4 as amended by the Carlsbad Municipal Code state "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 (unless issued prior to 7/1/99 which is one year from date of permit), or if the building or
work authorized by such permit is stopped at any time after the work is commenced for a period of 180 days or if
the building or work authorized by such permit exceeds three calendar years from the issuance date of permit
Work shall be presumed to have commenced if the permittee has obtained a required inspection approval of work
authorized by the permit by the Building Official within 180 days of the date of permit issuance Work shall be
presumed to be stopped if the permittee has not obtained a required inspection approval of work by the Building
Official within each 180 day period upon the initial commencement of work authorized by such permit
Before such work can be recommenced, a new permit shall be obtained to do so, and the fee, therefore, shall be
one-half the amount required for a new permit for such work, and provided that no changes have been made or
will be made in the original plans and specifications for such work, and provided further that such suspension or
abandonment has not exceeded one year In order to renew action on a permit after expiration, the permittee shall
pay a new permit fee
Any person holding an unexpired permit may apply for an extension of the time within which work may
commence under that permit when the permittee is unable to commence work within the time period required by
this section for good and satisfactory reasons The Building Official may extend the time for action by the
permittee for a period not exceeding 180 days on written request by the permittee showing that circumstances
beyond the control of the permittee have prevented action from being taken No permit shall be extended more
than once
Please check below indicating your intentions and return this letter to us
Project abandoned A new permit will be obtained prior to commencing work
No fee extension requested for 180 days (attach a letter of explanation)
Renewal permit requested
If the project has been completed and only a final inspection is needed, please call the inspection request line at
(760) 602-2725
If you have any questions, please contact the Building Inspection Department at (760) 602-2700
Christine Wauschek
Office Specialist
1635 Faraday Avenue • Carlsbad, CA 92008-7314 • (760) 602 2700 • FAX (760) 602 8560
City of Carlsbad
November 2, 2006
RONALD & SUSAN YOUNG
1664 BRADY CR
CARLSBAD CA 92008
RE BUILDING PERMIT EXPIRATION
PERMIT TYPE POOL
Bui Id ing Department
Permit Number CB060359
Issue Date 02/27/2006
ADDRESS 1664 BRADY CR
PLEASE CALL FOR AN INSPECTION IF WORK IS
COMPLETE
Our records indicate that your building permit will expire by limitation of time on 12/03/2006
The provisions of UBC, Section 106 4 4 as amended by the Carlsbad Municipal Code state "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 (unless issued prior to 7/1/99 which is one year from date of permit), or if the building or
work authorized by such permit is stopped at any time after the work is commenced for a period of 180 days or if
the building or work authorized by such permit exceeds three calendar years from the issuance date of permit
Work shall be presumed to have commenced if the permittee has obtained a required inspection approval of work
authorized by the permit by the Building Official within 180 days of the date of permit issuance Work shall be
presumed to be stopped if the permittee has not obtained a required inspection approval of work by the Building
Official within each 180 day period upon the initial commencement of work authorized by such permit
Before such work can be recommenced, a new permit shall be obtained to do so, and the fee, therefore, shall be
one-half the amount required for a new permit for such work, and provided that no changes have been made or
will be made in the original plans and specifications for such work, and provided further that such suspension or
abandonment has not exceeded one year In order to renew action on a permit after expiration, the permittee shall
pay a new permit fee
Any person holding an unexpired permit may apply for an extension of the time within which work may
commence under that permit when the permittee is unable to commence work within the time period required by
this section for good and satisfactory reasons The Building Official may extend the time for action by the
permittee for a period not exceeding 180 days on written request by the permittee showing that circumstances
beyond the control of the permittee have prevented action from being taken No permit shall be extended more
than once
Please check below indicating your intentions and return this letter to us
Project abandoned A new permit will be obtained prior to commencing work
No fee extension requested for 180 days (attach a letter of explanation)
Renewal permit requested
If the project has been completed and only a final inspection is needed, please call the inspection request line at
(760) 602-2725
If you have any questions, please contact the Building Inspection Department at (760) 602-2700
Christine Wauschek
Office Specialist
1635 Faraday Avenue • Carlsbad CA 92008-7314 • (760) 602-270O • FAX (76O) 602-8560
City of Carlsbad
November 2, 2006
Permit Number CB060359
Issue Date 02/27/2006
SUNDANCER POOLS
728 INSPIRATION
ESCONDIDOCA 92025
RE BUILDING PERMIT EXPIRATION
PERMIT TYPE POOL
ADDRESS 1664 BRADY CR
PLEASE CALL FOR AN INSPECTION IF WORK IS
COMPLETE
Our records indicate that your building permit will expire by limitation of time on 12/03/2006
The provisions of UBC, Section 106 4 4 as amended by the Carlsbad Municipal Code state "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 (unless issued prior to 7/1/99 which is one year from date of permit), or if the building or
work authorized by such permit is stopped at any time after the work is commenced for a period of 180 days or if
the building or work authorized by such permit exceeds three calendar years from the issuance date of permit
Work shall be presumed to have commenced if the permittee has obtained a required inspection approval of work
authorized by the permit by the Building Official within 180 days of the date of permit issuance Work shall be
presumed to be stopped if the permittee has not obtained a required inspection approval of work by the Building
Official within each 180 day period upon the initial commencement of work authorized by such permit
Before such work can be recommenced, a new permit shall be obtained to do so, and the fee, therefore, shall be
one-half the amount required for a new permit for such work, and provided that no changes have been made or
will be made in the original plans and specifications for such work, and provided further that such suspension or
abandonment has not exceeded one year In order to renew action on a permit after expiration, the permittee shall
pay a new permit fee
Any person holding an unexpired permit may apply for an extension of the time within which work may
commence under that permit when the permittee is unable to commence work within the time period required by
this section for good and satisfactory reasons The Building Official may extend the time for action by the
permittee for a period not exceeding 180 days on written request by the permittee showing that circumstances
beyond the control of the permittee have prevented action from being taken No permit shall be extended more
than once
Please check below indicating your intentions and return this letter to us
Project abandoned A new permit will be obtained prior to commencing work
No fee extension requested for 180 days (attach a letter of explanation)
Renewal permit requested
If the project has been completed and only a final inspection is needed, please call the inspection request line at
(760) 602-2725
If you have any questions, please contact the Building Inspection Department at (760) 602-2700
Christine Wauschek
Office Specialist
1635 Faraday Avenue • Carlsbad CA 92008-7314 • (760) 602-2700 • FAX (76O) 6O2-856O
City of Carlsbad
Public Works — Engineering
BUILDING PLANCHECK CHECKLIST
POOLS
BUILDING PLANCHECK NUMBER CB D(}()
BUILDING ADDRESS /^^ &r«JJV
PROJECT DESCRIPTION Pool
ASSESSOR'S PARCEL NUMBER fftO$~ W0 ' 07
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
By Date
DENIAL
Please see me attached report of deficiencies
marked withjST*^ 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
ATTACHMENTS
Grading Permit Application
Grading Permit Checklist
Right-of-Way Permit Application
Right-of-Way Permit Submittal
Checklist and Information Sheet
ENGINEERING DEPT CONTACT PERSON
NAME JOANNE JUCHNIEWICZ
City of Carlsbad
ADDRESS 1635 Faraday Avenue
Carlsbad, CA 92008
PHONE (760) 602-2775
H \WORD\DOCS\CHKLSTPMl Building Planctiect Cklist CHKM Foim BE doc
1635 Faraday Avenue - Carlsbad CA 92OO8-7314 • (760) 602-2720 • FAX (760) 602-8562
Q
Q
U
BUILDING PLANCHECK CHECKLIST - POOLS
SITE PLAN
1 Provide a fully dimensioned site plan drawn to scale Show
A North Arrow
B Existing & Proposed Structures
/
2 Show on site plan
Drainage Patterns
Existing & Proposed Slopes
Existing Topography
C Property Lines <Q
D Easements
D Indicate what will happen with
soil excavated from pool area
/IT) 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
A Site Address
B Assessor's Parcel Number
C Legal Description
D 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 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
Page 2 of 2
H \WORD\DOCS\CHKLST\Pool Building Plancheck Cklist CHK24 Foim BE doc
HS
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2ND/ ^
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5c A Grading Permit has been applied for
PE2 DWG
Grading Inspector sign off by Date
5d No Grading Permit required
MISCELLANEOUS PERMITS
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
7 Remarks
H \WORD\DOCS\CHKLST\Pool Building Plancheck Cklist CHK24 Form BE doc
SD
FOLICYHOLDER COPY
COMPENSATION
INSURANCE
PO BOX 807 SAN FRANCISCO CA 94142-0807
F"UND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE 04-11-2005
STATE CONTRACTOR'S LICENSE BOARD
P 0 BOX 26000
SACRAMENTO CA 95826
SD
GROUP
POLICY NUMBER 0735975-2005
CERTIFICATE ID 11
CERTIFICATE EXPIRES 04-11-2006
04-11-2005/04-11-2006
LICENSE NUMBER LICENSE # 482435
INCEPTION DATE 04-11-2005
Do so
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 30 days advance written notice to the employer
We will also give you 30 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 document
with 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 exclusrons and conditions of such policies
AUTHORIZED REPRESENTATIVE
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS
PRESIDENT
$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
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-11-2005 IS ATTACHED TO AND
FORMS A PART OF THIS POLICY
EMPLOYER LEGAL NAME
SUNDANCER POOLS
728 INSPIRATION LN
ESCONDIDO CA 92025
WILLIAMS DAVID A AND
WILLIAMS SUSAN C
(REV 3 03)PRINTED <»/"/aOOB
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER CB
ADDRESS
RESIDENTIAL ADDITION MINOR
« $10,000.00)
OTHER
DATE
TENANT IMPROVEMENT
PLAZA CAMINO REAL
CARLSBAD COMPANY STORES
VILLAGE FAIRE
COMPLETE OFFICE BUILDING
PLANNER DATE
ENGINEER DATE
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