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Home My WebLink About1911 CALLE BARCELONA; BLDG 4; CB033086; Permit. '- 12-30-2003 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: Project Title: Aoolicant: City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Building Inspection Request Line (760) 602-2725 Commercial/lndustriaI Permit Permit No: CB033086 191 1 CALLE BARCELONA CBAD TI Sub Type: COMM Lot #: 0 Status: ISSUED $71,490.00 Construction Type: NEW Applied: 11/12/2003 FOURM BLDG 4 CREATE 1 NEW Plan Approved: 12/30/2003 SUITE-# 156-W/FIRE CORRIDOR- 2383 SF Issued: 12/30/2003 Reference #: Entered By: SB Inspect Area: Plan Check#: Owner: VRATSINAS CONSTRUCTION COMPANY P 0 BOX 2558 LllTLE ROCK, AR 72203-2558 501 -376-001 7 Building Permit Add'l Building Permit Fee Plan Check Add'l Plan Check Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'l Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'l Pot. Water Con. Fee Recl. Water Con. Fee $438.76 $0.00 $285.1 9 $0.00 $0.00 $1 5.01 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Meter Size Add'l 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 Parking 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 $1 10.00 $0.00 $0.00 $0.00 $0.00 $0.00 $848.96 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 (See. 7031.5 Business and Professions Code: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law exemption. Any violation of Section 7031.5 Name ' [Chapter 9, cornmending with Section 7000 of city Statelzip elephone # - Address V.C.C. State License X 7 265 7 License Class City Business License # Designer Name Address City State/Zip Telephone FOR OFFICE US€ ONLY PLANCHECK N (-= . EST. VAL. 7L q 70 Validated By Date State License X Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: 0 of the work for which this permit is issued. Insurance Company 0 I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit IS Policy No. L254///9/d?wf2 Expiration Date /c /- /3,F/ CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit IS issued, I shall not employ any person in any manner so as up to one hundred I (THIS SECTION NEED NOT BE CO~LETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$io01 OR LESS) d shall subject an employer as provided for in Section 37 0 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). 0 1, 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) 0 1. 2. 3. I am exempt under Section I personally plan to provide the major labor and materials for construction of the proposed property improvement. (7 YES ON0 I (have I have not) signed an application for a building permit for the proposed work. I have 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 t address I phone I will provide some of the work, but I have contracted Ihired) the following persons to provide the work indicated [include name I address I phone number I type PROPERTY OWNER SIGNATURE 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? [7 YES NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Is 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 REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 0 YES 0 NO LENDER'S NAME City ordinances and State laws relating to building construction. I hereby authorize representatives of the Citt. 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 of work authorized by such permit kauthonzedbysuchpermitissuspendedorabandoned at any time aft[, Ihe work is co APPLICANT'S ;NATUR DATE li/iz,/o? n 106.4.4 Uniform Building Code). 85/1812884 12: 22 13585528429 NBDEL 5D PAGE 81 - City of Carlsbad 1835 Faraday Avenue Cadsbad. CA S2OQ8-7344 (769) 69 @ April 28,2004 Permit Number: CB033086 Issue Date: 12/30/03 FOURTH QUARTER PROPERTIES 300 VILLAGE GREEN CIRCLE #200 SMYRNA GA 30080 RE: BUILDING PERMIT EXPIRATION ADDRESS: 1911 CALLE BARCELONA PLEASE CALL FOR AN INSPECTION IF WORK IS COMPLETE PERMIT TYPE: TI Our records indicate that your building permit will expire by limitation of time on 6/27/04. 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 If you have any questions, please contact the Building Inspection Department at (760) 602-2700. (760) 602-2725. Christine Wauschek Office Specialist 1635 Faraday Avenue Carlsbad, CA 92008-731 4 (760) 602-2700 FAX (760) 602-8560 @ City of Carlsbad Bldg Inspection Request For: 04/2 1 /2004 Permit# CB033086 Inspector Assignment: PS Title: FOURM BLDG 4 CREATE 1 NEW Description: SUITE-# 156-WFIRE CORRIDOR- 2383 SF Type: TI Sub Type: COMM Job Address: 191 1 CALLE BARCELONA Suite: Lot 0 Location: APPLICANT VRATSINAS CONSTRUCTION COMPANY Owner: Remarks: FINAL? OR SEND LETTER3 Phone: Inspector: Total Time: Requested By: CHRISTINE CD Description Entered By: CHRISTINE Act Comment 19 Final Structural Associated PCRs/CVs PCR03049 ISSUED FORUM-BLDG 4-REV FENESTRATION,; COLUMNS,FOOTINGS,SHEAR&MOMENT FR PCR03054 ISSUED FOURM Q CARLSBAD REV TJPS; FLOORING BLDG # 4 PCRO3106 ISSUED FORUM-MOVE DEMISE WALLS-BLDG 4; PCR03166 ISSUED THE FOURM BLDG 4 REV ELEC; PCR03167 ISSUED FORUM BLDG4- REPLACE STONE VEN; TO MARBLE SHEET A1-2 & A5.3 STONE CUI Inspection History Date Description Act lnsp Comments 02/1 2/2004 14 Frame/Steel/Boltin~elding NR PS EsGil Corporation . In Partnership with Government for Building Safe? DATE: 12/19/03 JURISDICTION: City of Carlsbad PLAN CHECK NO.: 03-3086 SET: I1 PROJECT ADDRESS: 1911 Calle Barcelona Suite 156 PROJECT NAME: The Forum - Exit Corridor 0 The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction’s building codes. The plans transmitted herewith will substantially comply with the jurisdiction’s building codes when minor deficiencies identified in the remarks below are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. 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 Corporation until corrected plans are submitted for recheck. contact person. 0 The applicant’s copy of the check list has been sent to: [XI Esgil Corporation staff did not advise the applicant that the plan check has been completed. (7 Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone #: Date contacted: (by: ) Mail Telephone Fax In Person Fax #: REMARKS: Applicant to slip sheet SA1 and A2 to the revised sheets, and add note in red on sheet AI to city held sets. By: Doug Moody Enclosures: Esgil Corporation 0 GA 0 MB EJ 0 PC 12/6/03 trnsrntl.dot 9320 Chesapeake Drive, Suite 208 San Diego, California 92123 (858) 560-1468 Fax (858) 560-1576 EsGil Corporation In Partnership with Government for @uiCdng safety DATE: 11/24/03 JURISDICTION: City of Carlsbad PLAN CHECK NO.: 03-3086 0 PLAN REVIEWER 0 FILE SET: I , PROJECT ADDRESS: 1911 Calle Barcelona Suite 156 PROJECT NAME: The Forum - Exit Corridor 0 0 0 w 0 w 0 w 0 The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. 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 and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. The applicant's copy of the check list has been sent to: Nadel Architects / Steven Kohn 5465 Morehouse Dr Suite 165, San Diego, CA 92121 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: Steven Kohn Date contacted: t I 1 zy log (by: f++) REMARKS: By: Doug Moody Enclosures: Telephone #: 858-552-8424 Fax #: 858-552-8429 Mail Uelephone Faxd In Person Esgil Corporation I7 GA MB EJ 0 PC I 1 /I 4/03 tmsmtl.dot 9320 Chesapeake Drive, Suite 208 San Diego, California 92123 * (858) 560-1468 * Fax (858) 560-1576 City of Carlsbad 03-3086 .11/24/03 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO.: 03-3086 OCCUPANCY: M USE: Retail ITYPE OF CONSTRUCTION: VN ACTUAL AREA: 2383sf 1ALLOWABLE FLOOR AREA: STORIES: 1 I I SPRINKLERS?: YES REMARKS: DATE PLANS RECEIVED BY JURISDICTION: 11/12/03 ESGIL CORPORATION: 11/14/03 DATE INITIAL PLAN REVIEW PLAN REVIEWER: Doug Moody COMPLETED: 11/24/03 JURISDICTION: City of Carlsbad I I HEIGHT: OCCUPANT LOAD: N/A I DATE PLANS RECEIVED BY 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, i.e., plan sheet number, specification section, etc. Be sure to enclose the marked up list when vou submit the revised plans. ' TENANT IMPROVEMENTS WITHOUT SPECIFIC ENERGY DATA OR POLICY SUPPLEMENTS (1997UBC) tiforw.dot City of Carlsbad 03-3086 * 11/24/03 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 calculationsh-eports 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 calculationslreports to EsGil Corporation, 9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468. Deliver all remaining sets of plans and calculations/reports 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. Provide a statement on the Title Sheet of the plans stating that this project shall comply with the 2001 edition of the California Building Code (Title 24), which adopts the 1997 UBC, 2000 UMC, 2000 UPC and the 1999 NEC. -- - ~ - - I. 2. Please clarify the wall details for the new corridor and demising wall. 0 Revise detail 2 if it is intended to be part of the rated corridor it must extend to the I hour rated roof assembly per section 1004.3.4.3.1 3. Please note on the plans “AC Cable is not allowed in A, B, E, H, and I occupancies. 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’. 4. Please clearly indicate on the single line diagram and panel schedule the new and existing. 5. Show that the minimum strike edge distances are provided at the level area on the side to which a door (or a gate) swings, per Section I 133B.2.4.3: a) 224” at exterior conditions. 6. ’ Show that the space between two consecutive door openings in a vestibule, which serves spaces other than a required exit stairway: a) Provide 248 clear space from any door opening into the vestibule when door is open 90°, per Section 1 133B.2.4.4. b) Doors in series shall swing either: i) In the same direction. ii) Away from the space between the doors. City of Carlsbad 03-3086 11/24/03 To speed up the review process, note on this list (or a copy) where each correction item has been addressed, Le., plan sheet, note or detail number, calculation page, etc. 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. City of Carlsbad 03-3086 , 11/.24/03 PALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PLAN CHECK NO.: 03-3086 PREPARED BY: Doug Moody DATE: 11/24/03 BUILDING ADDRESS: 191 1 Calle Barcelona Suite 156 BUILDING OCCUPANCY: M TYPE OF CONSTRUCTION: VN 1994 UBC Building Permit Fee 1994 UBC Plan Check Fee +F! Type of Review: Complete Review 0 Structural Only 0 Repetitive Fee 'Ti Repeats I 0 Other 0 Hourly -1 Hour * Esgll Plan Revlew Fee I $429.761 I $279.341 r $240.67 I Comments: Sheet 1 of I rnacvalue.doc PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB 03 5 DMO DATE RESDD€lU"Bm RESIDENTJAL ADDmON MINOR 1 < $IO,ooo.ao-, CARLSSAD COMPANY STORES VILLAGE FAlRE COMPLETE OFFICE BUILOING OTHER ... DATE - ENGINEER. Carlsbad Fire Department 033086 1635 Faraday Ave. Carlqbad, CA 92008 Fire Prevention (760) 602-4660 Plan Review Requirements Category: Building Plan Date of Report: 1 1/25/2003 Reviewed by: Name: Nadel Architects Address: 5465 Morehouse Drive Suite 165 City, State: San Diego CA 92121 Job#: 033086 Plan Checker: Job Name: Forum Bldg 4 Blda #: CEO33086 Job Address: 1911 Calle Barcelona Ste. or Bldg. No. 156 Approved 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 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. 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 / 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 / or standards. Please review carefully all comments attached. Please resubmit the necessary plans and / or specifications to this office for review and approval. Review 1 st 2nd 3rd Other Agency ID ILittle Rock, AB 72203 INSURER 0 I TYPE OF INSURANCE A GENERAL LIABILITY x COMMERCIAL GENERAL LIABILITY 7 I CLAIMSMADE OCCUR POLICY NUMBER KK09101712 - A I GENL AGGREGATE LIMIT APPLIES PER i n go+ n LOC AUTOMOBILE LIABILITY KK09101712 x ANYAUTO - ALL OWNED AUTOS SCHEDULED AUTOS - - x HIREDAUTOS x NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO - - 01/01/04 x WCSTATU- OTb E.L. EACH ACCIDENT E.L. DISEASE. EA EMPLOYE E.L. DISEASE. POLICY LIMIl 1 ACQ!W; CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YY) I 03/25/03 1-501-664-7705 Bamsey, Krbg, Barrel1 & Lensing, Inc. P.O. Box 251510 Little Rock, AR 72225 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I I ONLY AND CONFERS NO-RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE I INSURED Vratsinas Construction Co P.O. Box 2558 1NSURERA:St. Paul Fire & Marine Ins. Co. INSURER 6: INSURER C: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE - 01/01/03 LIM 'OLICY EXPIRATION $1000000 $250000 $5000 $1000000 $1000000 $2000000 H I 01/01/04 1 COMBINEDSINGLE LIMIT (Ea accident) 01/01/03 $1000000 BODILY INJURY (Per person) s BODILY INJURY (Per accident) PROPERTY DAMAGE (Per acddent) AUTO ONLY. EA ACCIDENT OTHERTHAN e AGC AUTO ONLY: ~-~ OCCUR 0 CLAIMS MADE DEDUCTIBLE I 01/01/03 EMPLOYERS' LIABILITY $500000 $500000 $500000 OTHER ____.l_ll__ .._ .- ,~. ., . -..I IESCRIPTION OF OPERATlONSROCATIONSNEHICLESIEXCLUSlONS ADDED BY ENDORSEMENTEPECIAL PROVISIONS / Yf7 he certificate holder is listed as additionally insured only as respects to work performed by the insured. \ ----__I. _li . - - - - EERTIFICATE HOLDER I I ADDITIONAL INSURED INSURER LETTER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 5 DAYS WRllTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. hUTHORIZED REPRESENTATIVE I L>4/L'3 &9y 0 ACORD CORPORATION 1988 ity of Carlsbad indy 635 Faraday Ave. arlsbad, CA 92008 USA I ACORD 254 (7/97) vratsinas 1001369 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. %E. State of Colrfornro ~rrs CONTRACTORS STATE LICENSE BOARD L A16un ACTIVE LICENSE E~iia*io* 07 /31/2003 %_.._ . 1 Q -3 b 4 \ 2 I 2