HomeMy WebLinkAbout1818 ASTON AVE; ; CB023194; PermitCity of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
1 1-22-2002 CommercialAndustrial Permit Permit No: CB023194
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No: Valuation: Occupancy Group: Project Title:
Applicant:
DBML INC
1818ASTONAVCBAD
TI Sub Type: INDUST
2121200500 Lot#: 0 Status: ISSUED $34,650.00 Construction Type: NEW Applied: 10/23/2002
ACUSHNET COMPANY Plan Approved: 11/15/2002 1,155 SF OFFICE TO OFFICE Issued: 11/22/2002
Reference #: Entered By: MDP
Inspect Area: Owner:
BLACKMORE PARKVIEW ASSOCIATES
814 DODSWORTH COVINA CA 91724 P 0 BOX 424
RANCHO SANTA FE CA 920671938 u/22/02 mo2 ol
$513.08 Total Payments To Date: $176.01 Balance Due: $337.07
o2
616 966-8666 CGF 337.07
Total Fees:
Building Permit
Addl Building Permit Fee Plan Check
Addl Plan Check Fee
Plan Check Discount
Strong Motion Fee Park Fee LFM Fee
Bridge Fee
BTD #2 Fee
BTD #3 Fee Renewal Fee
Addl Renewal Fee
Other Building Fee
Pot. Water Con. Fee Meter Size
Addl Pot. Water Con. Fee
Recl. Water Con. Fee
$270.79
$0.00 $176.01
$0.00
$0.00
$7.28
$0.00 $0.00 $0.00
$0.00
$0.00 $0.00 $0.00
$0.00
$0.00
$0.00
$0.00
Meter Size
Addl Recl. Water Con. Fee Meter Fee
SDCWA Fee
CFD Payoff Fee
PFF PFF (CFD Fund) License Tax
License Tax (CFD Fund)
Traffic Impact Fee Traffic Impact (CFD Fund)
PLUMBING TOTAL
ELECTRICAL TOTAL
MECHANICAL TOTAL Master Drainage Fee Sewer Fee Redev Parkino Fee
Additional Fees
TOTAL PERMIT FEES
$0.00
$0.00 $0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00 $0.00
$35.00
$24.00
$0.00
$0.00
$0.00 $0.00 $513.08
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
,, ,..., , ,lis ,,;T':::,k.:,:, '1; ' :IrdO&CT INFORMATION
Address (include BldglSuite (I) A ~ Business Name Iat this address)
I
FOR OFFICE USE ONLY
PLAN CHECK NO- - 3i9.y
Date lo lad - a?L
7 Y, EST. VAL. 6sz) \I 01 Plan Ck. Deposit
Validated By 4s
/9/ B /fc.bshMr.+ L ,4sroM WE
MLS A 6.d
Subdivision NameINumber Legal Description
Address City StatelZip Telephone 11 Fax X
, ,. co~wDloR':r.C.oM~hNy 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
~SSU~CB. 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 end Professions Codel or that he is exempt therefrom, and the basis for the alleged
exemption. Any violatiopf Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of not more than five hundred dollars 1550011.
Name Address City StatelZip Telephone 11
State License 11 7z-r 7 5/ 7 City Businass License X /! 09 .? 9 f
Designer Name Address City StatelZip Telephone
state License I
nA#L. A AL. P.0. 6oxS096 CdU/d+ CA 9/7 C 7 6 16 946-f666
License Class d -1
. .. ,, . ., .. .. ,,
of the work for which this permit is issued.
I have and will maintain B Certificate of consent to self-insure for worked compensation as provided by Section 3700 of the Labor Cod@. for the performance
I have and will maintain workers' compensation. as rsquired by Section 3100 of the Labor Code. for the performance of the work for which this permit is
ewd. My worker's ier and policy number are:
Insurance Company Policy NO. fl4L -U/OSTr -o& Expiration Date f-1-03
[THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS l51001 OR LESS)
0 CERTIFICATE OF EXEMPTION: I Certify that in the performance of tha 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 workan' compensation cwerage is unlawful, and shall subject an employer to Criminal penalties and civil tines up to one hundred
thousand dollars 15100.000~. in addition to the coot of compensation. damages as provided for in Section 3706 of the Labor code, interest and attorney's fees.
SIGNATURE DATE
I hereby affirm that I am exempt from the Contractor's License Law for the following reason:
0 I, 8s owner of th8 property or my employees with wages 85 their sole compensation, will do the work and the structure is not intendsd or Offered for sale ISec. 7044. Business and Professions Code: The Contractor's License Law doer not apply to an owner of property Who build3 or improves thereon, and who doer
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
soid within one year of completion. the owner-builder will hsvs the burden Of proving that he did not build or improvs for the purpose of sale).
0 I. as owner of the property. am excIusiveIy contracting with licensed Contractors to construct the project ISec. 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 contrsctorisl licensed
pursuant to the Contractor's License Law).
0
1.
2.
3.
. ... . ,,
I am exempt under Section
I personally plan to provide the major labor and materials far construction Of the proposed property improvement. YES ON0
I (have I have not) signed an application for B building permit for the proposed work.
I haw contracted with the following person (firm) to provide the proposed Construction (include name I address I phone number I contractors license number):
Business and PrOfeSSionS Code for this reason:
4.
number I contractors license number):
5.
of work):
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 i address I phons
I will provide some of the work. but I have contracted (hired) the foilowing persons to provide th8 work indicated iincluda name I address I phone number I type
Is the applicant or future building occupant required to Submit a business plan. acutely hazardour materials registration form or risk management and prevention
program under Sections 25505. 25533 or 25534 of the Piesley-Tanner Hazardous Substance Account Act? 0 YES 0 NO
1s the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? YES 0 NO
1s the facility to be constructed within 1,000 feet of the outer boundary Of a school site? 0 YES 0 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
REOUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT.
CONSTRUCTION LMDINQ AGENCY
by affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097lil Civil Code).
LENDERS NAME LENDER'S ADDRESS
,, APPL)CANTCEATIRCN . '
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 tho City of Carlsbsd 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 CONSEDUENCE OF THE GRANTING OF THIS PERMIT.
OSHA An OSHA permit is required for BXCavatiOnS over 5.0- deep end demolition or COnStiUCtiOn of structures over 3 stories in height.
EXPIRATION: Every permit
authorized by such permit is
at any time after the work is
of this Code shall expire by limitation and become null and void if the building or work
h permit or if the building or work authorized by Such permit is suspended or abandoned
4 Uniform Building Code).
APPLICANT'S SIGNATURE DATE /d-L3 -0 2
W ITE: File YELLOW: Applicant PINK: Finance
Cm of Carlsbad
Final Building Inspection
Dept: Building Engineering Planning CMWD St Lite
Plan Check #:
Permit #:
Project Name:
Address:
Contact Person:
Sewer Disk
CB023194
ACUSHNET COMPANY
1,155 SF OFFICE TO OFFiCE
1818ASTONAV
SCOTT Phone: 8186127046
CA Water Disk CA
Lot:
I YE
Date:
Permit Type:
Sub Type:
0
01/21/2003
Ti
INDUST
..........................................................................................................................................................
Inspected Date
By: Inspected: Approved: __ Disapproved: __
Inspected Date
Disapproved: __ By: Inspected: Approved: __ ...........................................................................................................................................................
City of Carlsbad Bldg Inspection Request
For: 01y2003
Inspector Assignment: TP 5w Permit# CEO23194
Title: ACUSHNET COMPANY
Description: 1,155 SF OFFICE TO OFFICE
Type: TI Sub Type: INDUST
Job Address: 1818 ASTON AV
Suite: Lot 0
Location:
APPLICANT DBML INC
Owner: BLACKMORE PARKVIEW ASSOCIATES
Remarks:
Phone: 8186127046
Inspector:
Total Time: Requested By: SCOTT
CD Description
Entered By: CHRISTINE GCL L 19 Final Structural
29 Final Plumbing
39 Final Electrical t 49 Final Mechanical
Associated PCRs/CVs
Date
01/15/2003
01/15/2003
01/15/2003
01/14/2003
12/30/2002
12/12/2002
12/11/2002
12/11/2002
InsDection History
Description Act lnsp Comments
14 Frama/SteeVEoltingelding
34 Rough Electric
44 RougNDuctdDampers
14 Frame/Steel/Eoltingelding
84 Rough Combo
17 Interior LathlDlywall
14 FramelSteel/Eoltingelding
34 Rough Electric
AP TP T-CEIL
AP TP CElLLlTES
AP TP DUCTS
CO TP T-CEIL
CO TP
AP TP
AP TP SEECARD
AP TP
/- Em - Corporation
In Partnership with Government for Building Safety
DATE: 11/14/02
JURISDICTION: City of Carlsbad
PLAN CHECK NO.: 02-3194
PROJECT ADDRESS: 1818 Aston Ave
PROJECT NAME: Acushnet - TI
SET: I1
a PLAN REVIEWER
0 FILE
[XI The plans transmitted herewith have been corrected where necessary and substantially comply
c] The plans transmitted herewith will substantially comply with the jurisdiction’s building codes
when minor deficiencies identified below are resolved and checked by building department staff.
The plans transmitted herewith have significant deficiencies identified on the enclosed check list
0 The check list transmitted herewith is for your information. The plans are being held at Esgil
0 The applicant‘s copy of the check list is enclosed for the jurisdiction to forward to the applicant
0 The applicant‘s copy of the check list has been sent to:
with the jurisdiction’s building codes.
and should be corrected and resubmitted for a complete recheck.
Corporation until corrected plans are submitted for recheck.
contact person.
[XI Esgil Corporation staff did not advise the applicant that the plan check has been completed.
0 Esgil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: Telephone #:
Date contacted: (by: 1 Fax #:
Mail Telephone Fax In Person 0 REMARKS:
By: Doug Moody Enclosures:
Esgil Corporation 0 GA 0 MB 0 EJ 0 PC 1 117IO2 tmsmtl.dot
9320 Chesapeake Drive, Suite 208 San Diego, California 92123 + (858) 560-1468 + Fax (858) 560-1576
EmCorporation -
In Partnership with Government for Building Safety
DATE: 11/1/02
JURISDICTION: City of Carlsbad
PLAN CHECK NO.: 02-3194
PROJECT ADDRESS: 1818 Aston Ave
PROJECT NAME: Acushnet -TI
SET: I
0 FILE
0 The plans transmitted herewith have been corrected where necessary and substantially comply
0 The plans transmitted herewith will substantially comply with the jurisdiction's building codes
when minor deficiencies identified below are resolved and checked by building department staff.
0 The plans transmitted herewith have significant deficiencies identified on the enclosed check list
The check list transmitted herewith is for your information. The plans are being held at Esgil
0 The applicant's copy of the check list is enclosed for the jurisdiction to foward to the applicant
The applicant's copy of the check list has been sent to:
with the jurisdiction's building codes.
and should be corrected and resubmitted for a complete recheck.
Corporation until corrected plans are submitted for recheck.
contact person.
David Minto
P.O. Box 5096,Covina, CA 91723
0 Esgil Corporation staff did not advise the applicant that the plan check has been completed.
Esgil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: David Minto (4.U)
Date contacted: I I I I 102 (by: IC, )
Mail delephone/ Fax In Person
Telephone #: 626-966-8666
Fax #:
0 REMARKS:
By: Doug Moody Enclosures:
Esgil Corporation 0 GA 0 MB 0 EJ 0 PC 10/24/02 tmsmU.dot
9320 Chesapeake Drive, Suite 208 San Diego, California 92123 (858) 560-1468 Fax (858) 560-1576
City of Carlsbad 02-3194
11/1/02
PLAN REVIEW CORRECTION LIST
TEN ANT IMP ROVE M ENTS
PLAN CHECK NO.: 02-3194
OCCUPANCY: B USE: Office
TYPE OF CONSTRUCTION: IIN ACTUAL AREA: 1162 sf
ALLOWABLE FLOOR AREA: STORIES: 1
JURISDICTION: City of Carlsbad
HEIGHT:
SPRINKLERS?: YES OCCUPANT LOAD: 11
REMARKS:
DATE PLANS RECEIVED BY
JURISDICTION: 10123102 ESGIL CORPORATION: 10/24/02
DATE INITIAL PLAN REVIEW PLAN REVIEWER: Doug Moody
COMPLETED: 11/1/02
FOREWORD (PLEASE READ):
This plan review is limited to the technical requirements contained in the Uniform Building Code,
Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws
regulating energy conservation, noise attenuation and access for the disabled. This plan review
is based on regulations enforced by the Building Department. You may have other corrections
based on laws and ordinances enforced by the Planning Department, Engineering Department,
Fire Department or other departments. Clearance from those departments may be required
prior to the issuance of a building permit.
Code sections cited are based on the 1997 UBC.
The following items listed need clarification, modification or change. All items must be satisfied
before the plans will be in conformance with the cited codes and regulations. Per Sec. 106.4.3,
1997 Uniform Building Code, the approval of the plans does not permit the violation of any
state, county or city law.
To speed up the recheck process, please note on this list (or a copy) where each
correction item has been addressed, Le., plan sheet number, specification section. etc.
Be sure to enclose the marked up list when you submit the revised plans.
DATE PLANS RECEIVED BY
TENANT IMPROVEMENTS WITHOUT SPECIFIC ENERGY DATA OR POLICY SUPPLEMENTS (1997UBC) tiforw.dot
City of Carlsbad 02-3194
11/1/02
Please make all corrections on the original tracings, as requested in the correction
list. Submit three sets of plans for commerciallindustrial projects (two sets of plans
for residential projects). For expeditious processing, corrected sets can be
submitted in one of two ways:
1. Deliver all corrected sets of plans and calculations/reports directly to the City of
Carlsbad Building Department, 1635 Faraday Ave., Carlsbad, CA 92008, (760)
602-2700. The City will route the plans to EsGil Corporation and the Carlsbad
Planning, Engineering and Fire Departments.
2. Bring one corrected set of plans and calculationsheports to EsGil Corporation,
9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468.
Deliver all remaining sets of plans and calculationslreports directly to the City of
Carlsbad Building Department for routing to their Planning, Engineering and Fire
Departments.
NOTE: Plans that are submitted directly to EsGil Corporation only will not be
reviewed by the City Planning, Engineering and Fire Departments until review by
EsGil Corporation is complete.
I.
2.
3.
4.
5.
6.
7.
Each sheet of the plans must be signed by the person responsible for their
preparation, even though there are no structural changes. Business and
Professions Code.
Please provide electrical plans.
Provide multiple switch lighting controls.
Please note on the plans “AC Cable is not allowed. NM cable is restricted
(without City approval) to one and two family dwellings. Note on plans that an
equipment ground conductor is to be installed in all flexible conduits”. Per City of
Carlsbad.
Please note or show mechanical ventilation will be provided in all rooms, capable
of supplying outside air, at a minimum rate of 15 cubic feet per minute per
occupant. UBC, Section 1202.2.1.
Revise plans, or door schedules, to show that every required passage door has
232” clear width, per Section 11338.2.
Where a pair of doors is utilized, at least one of the doors shall provide a clear,
unobstructed opening width of 32 inches, per Section 11336.2.3.1.
To speed up the review process, note on this list (or a copy) where each
correction item has been addressed, i.e., plan sheet, note or detail number,
calculation page, etc.
City of Carlsbad 02-3194
11/1/02
Please indicate here if any changes have been made to the plans that are not a
result of corrections from this list. If there are other changes, please briefly
describe them and where they are located in the plans.
Have changes been made to the plans not resulting from this correction list?
Please indicate:
Yes 0 No 0
The jurisdiction has contracted with Esgil Corporation located at 9320
Chesapeake Drive, Suite 208, San Diego, California 92123; telephone number of
858/560-1468, to perform the plan review for your project. If you have any
questions regarding these plan review items, please contact Doug Moody at
Esgil Corporation. Thank you.
Valuation Reg.
PORTION ( Sq. Ft.) Multiplier Mod.
TI 11 62 City Valuation
I
VALUE ($)
34,650 I
Air Conditioning
Fire Sprinklers
TOTALVALUE I 34,650
I $270.79)
. ._ ($176.011 1994 UBC Plan Check Fee 3 _____
Type of Review:
0 Repebtive Fee -;1 Repeats __
Complete Review 0 Structural Only
CI Other
Hourly I I Hour'
Esgll Plan Review Fee 0 1 $151.64)
Comments:
Sheet1 of 1
macvalue.doc
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER CB (3) - V,?V DATE /O-'Lrd\L
RESIDENTIAL TENANT IMPROVEMENT
CARLSBAD COWANY STORES
VILLAGE FAIRE
ENGINEER DATE
Carlsbad Fire Department 0231 94
Fire Prevention 1635 Faraday Ave.
Carlsbad, CA 92008 (760) 6024660
Plan Review Requirements Category: Building Plan
Date of Report: 10’28’2002 Reviewed by:
Name: David Minto
Address: P.O. Box 5096
City, State: Covina CA 91723
Plan Checker: Job#: 023194
Job Name: Acushnet Co. Bldg #: CB023194
Job Address: 1818 Aston Ave. Ste. or Bldg. No.
Approved The item you have submitted for review has been approved. The approval is
based on plans, information and I 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 and standards. Please review carefully all comments
attached as failure to comply with instructions in this report can result in
suspension of permit to construct or install improvements.
0 Approved
Subject to
The item you have submitted for review has been approved subject to the
attached conditions. The approval is based on plans, information and/or
specifications provided in your submittal. Please review carefully all comments
attached, as failure to comply with instructions in this report can result in
suspension of permit to construct or install improvements. Please resubmit to
this office the necessary plans and I or specifications required to indicate
compliance with applicable codes and standards.
0 Incomplete The item you have submitted for review is incomplete. At this time, this office
cannot adequately conduct a review to determine compliance with the
applicable codes and I or standards. Please review carefully all comments
attached. Please resubmit the necessary plans and I or specifications to this
office for review and approval.
Review 1 st 2nd 3rd Other Agency ID
FD Job # 023194 FD File #
JAN 0 B 2003
City of CAPUSBAD
BUILDING DEPI.
. ..
9
0 9 4
J ..ti,
i !! 1
..
7
I
I.
WALL FRAMING DETAIL
5. (1)WYER @/a" TYPE "X' GYP. BD.
6. 3-5/8'. X Z5.a. AT. 23- O.C. 9% 7. FINISH PER NOTES ON PUHS.
E. 114" DIA, SHOT PINS AT 32- O.C. AND 12". FRon ENDS C OPENINGS.
9. BOTTOM TRACK 1O.RUBBCR TOP-JET BASE 11.EXIST. CONC. SLAR
~~.DIAG. BRACE STUDS AT 1wo.c. -
C.H.C.- CHICAGO HETULIC CORP.
ALTERNATE DIF~ECTION - TYP.
I' b'
Q
.
DBMC, Inc.
GENERAL BUILDING CONTRACTOR
November 4,2002
Tenent Improvement
Acushnet Company
18 18 Aston Ave.
Carlsbad, CA
1.
2.
All work in this project shall comply with the 1998 edition of the California Building
code (title 24), which adopts the 1997 UBC, UMC and the 1996 NEC.
The floor area of the remodeled area is and will remain at 1162 sq. ft.
The existing construction of building is concrete tilt-up. With Sprinklers.
The present area is and will remain office area.
Currently the occupant load is 4 persons and no new occupants.
The previous use of the tenant space has been office
All suspended ceilings will comply with UBC tables 25-A, 16-0 & 16-B
All passage door hardware shall he lever type
All doors to be minimum 3’ x 7’ including pairs, with 32” clear width.
The primary access has been inspected by DBMC, Inc. and found to be compliant
with all ADA requirements.
Mechanical ventilation will be provided in all rooms, capable of providing outside
air, at a minimum rate of 15 cubic ft. per minute per occupant.
3.
4.
5.
6.
7.
8.
A
3
David B. Mint0
Page 1 of 1
PO Box 5096 Covina, CA 91723
626 966-8666 Office 626 915 3746 FAX
DBMC, Inc.
GENERAL BUILDING CONTRACTOR
Novcmbcr 4,2002
Tenent Improvement
Acushet Company
1818 Aston Ave.
Carlsbad, CA
ELECTRIC
Lighting From panel HA 277/480 Breaker # 18 Existing
sei swiiching on p~ans
Receptacles from panel H3. 2 k3
Fed hom Existing panel HPB
NEW: Add 2 new circuits fiom panel LB 20 amp each
NOTE: AC Cable is not allowed. NM cable is restricted to one and two family dwellings.
Equipment ground conductor will be installed in all flexible conduits. Per City Of Carlsbad
Page 1 of 1 PO Box 5096 Covina, CA 91723
626 966-8666 Office 626 915 3746 FAX
I
lit
ii/i5/2002 09:ii State COMP Ins Fund 3 916269153746 N0.074 tM03
POLICYHOLDER COPY
I STATE P.0. BOX 420807, SAN FRANCISCO, CA 941424807
FUN D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
COMPENSATION INSURANCE
NOVEMBER 15, 2002
CITY OF CSLLSBAD BUILDING DEPT
1635 FARADAY AVENUE CARLSBAE CA 92008
GROUP: OOOQlb POLICY NUMBER: 10535-2002 CERTIFICATE ID: 35 CERTIFICATE EXPIRES: 01 - 01-2 003 oi-oi-~ooa~o~-oi-~oo~
This is to certily that we have issued a valid Workers Compensation insurance policy in a lorm approved by the California insurance Commissioner to the ernplayer named below for Ihe policy penod naicated.
This policy IS ngt sub.& to cancellabon by me Fdna excepl upon 10 day3 advanes written notica to the employer.
We will alSo give you 10 days advance nobce should this policy be eancdled prior to its normal expidon
Tnis cenificae of insuraMe is nd an insurance poli and does not amend. wend or aHer (he coverage afforded by Ihe policies lisle0 herein. Notwithstanding any requircrnenf term or condition of any contract or other document Witn respecl to which Miis ceMcate of insurance may be issued or may prrtain. th. insurance aflomed by lhe policies descriBed herein is SubjMt to ail the le- exdufionr, and mndldons. of wcn policies
EMPLOYER'S LIABILITX LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRBNCE
...,.
'.. . ,' , , ,
.. ..
DBMC , IK PO BOX 5096
COVINA CA 91723
SClf 10265 WPF-Ut NE 1
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