HomeMy WebLinkAbout1935 CAMINO VIDA ROBLE; 200; CB051363; Permit05-26-2005
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Commercial/Industrial Permit Permit No: CB051363
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No:
Valuation:
Occupancy Group:
Project Title:
Applicant:
RICK LIEN
619339-7425
1935 CAMINO VIDA ROBLE CBAD St: 200
Tl Sub Type:
2120921800 Lot#:
$311,550.00 Construction Type:
Reference #:
SPEC SUITE-10050 SF OFFICE TO
OFFICE
INDUST
0
INN
PC050037
Status: PENDING
Applied: 04/15/2005
Entered By:
Plan Approved:
Issued:
Inspect Area:
Plan Check*:
Owner:
1935 CAMINO VIDA ASSOCIATES L L C
C/O DOUG MCCORMICK
165 S UNION BLVD #510
LAKEWOODCO 80228
RMA
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
Reel. Water Con. Fee
$1,199.52 MeterSize
$0.00 Add'l Reel. Water Con. Fee
$779.69 Meter Fee
$0.00 SDCWA Fee
$0.00 CFD Payoff Fee
$65.43 PFF
$0.00 PFF (CFD Fund)
$0.00 License Tax
$0.00 License Tax (CFD Fund)
$0.00 Traffic Impact Fee
$0.00 Traffic Impact (CFD Fund)
$0.00 PLUMBING TOTAL
$0.00 ELECTRICAL TOTAL
$0.00 MECHANICAL TOTAL
$0.00 Master Drainage Fee
Sewer Fee
$0.00 Redev Parking Fee
$0.00 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
$34.00
$1,210.00
$24.00
$0.00
$0.00
$0.00
$0.00
$3,312.64
Total Fees:$3,312.64 Total Payments To Date:$0.00 Balance Due:$3,312.64
BUILDING PLANS
fljfftN STO&Jgfefc
JL ATTACHED
?205 05/26/05 0002 01 02
3312-64
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 lees/exactions" You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for
processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack,
review, set aside, void, or annul their imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity
changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any
fees/exactions of which you have previously been oh/en a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired.
08-29-2005
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Plan Check Permit No: PC050037
Building Inspection Request Line (760) 602-2725
3
Job Address:
Permit Type:
Parcel No:
Valuation:
Reference #:
Project Title:
Applicant:
RICK LIEN
619339-7425
1935 CAMINO VtDA ROBLE CBAD
PLANCK
2120921800 Lot#:
$0.00 Construction Type:
3 SPEC SUITES.STE 100=7359 SF,
STE 110=8749 SF & STE 200=12771 SF TOTAL(IMPROVE
Status:
Applied:
Entered By:
Plan Approved:
Issued:
Inspect Area:
PENDING
03/23/2005
RMA
Owner:
1935 CAMINO VIDA ASSOCIATES L L C
C/0 DOUG MCCORMICK
165 S UNION BLVD #510
LAKEWOOD CO 80228
Pian Check Fee
Additional Fees
$0.00
$0.00
Total Fees:$0.00 Total Payments To Date:$0.00 Balance Due:$0.00
BUI .ING PLANS
ORAGE
TACHED
Inspector:
FINAL APPROVAL
Date:Clearance:
NOTICE: Please take NOTICE that approval of your project includes the 'Imposition' of fees, dedications, reservations, or other exactions hereafter collectively
referred to as "fees/exactions.' You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must
follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for
processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack,
review, set aside, void, or annul their imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity
changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any
fees/exactions of which vou have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise exoired.
PERMIT APPLICATION
C|TY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
**!'
L/A/>A
FOR OFFICE USE ONLY
PLAN CHECK NO.
EST. VAL.
Plan Ck. Deposit
Validated By.
Date
Business Name (at this address)
Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units
Assessor's Parcel #Existing Use
£L
Proposed Use
£Description of Work
Offset '
2. CONTACT PERSON (if different from applicant)
SO.#of Stories Bedrooms
Name State/Zip Telephone # Fax #
ent for Contractor Q Owner D Agent for Owner
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 basis for the alleged
ny violation of Section 7031 .5 by any applicant for a permit subjects the applicant to a civil penalty of not mow than five hundred dollars [$500]}.
Name
State License #
Address
License Class
City State/Zip Telephone #
City Business License # / gt- f £- / SO
Designer Name Address City State/Zip Telephone
State License ff _
(&;•=; WORKERS' COMPENSATION
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 ^J~f^^^ /^A-2/3 _ Policy No. l_2J^ "%&> ^ _ Expiration Date */'£>/ - &£>
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS)
Q 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 towjure workers' cpfWensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fffies up to one hundred
thousand dollars (SlB^MKttH, ffadditiotthe cost of compensation, damages as provided for in Section 3706 of the Labor code, interesfand attorney's fees.
SIGNATURE yZ--_. ~-*J*~~ _ DATE -S> / •£,& / & S
/7, OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following reason;
Q 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).
D I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The
Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractor(s) licensed
pursuant to the Contractor's License Law).
D I am exempt under Section Business and Professions Code for this reason:
1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. Q YES [JNO
2. I (have / have not) signed an application for a building permit for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number):
4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone
number / contractors license number):
5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type
of work): . „
PROPERTY OWNER SIGNATURE DATE
SECTION FOR WMflfS/DEVTMiBUiLDINQ 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? 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.
4- CONSTRUCTION LENDING AGEHCY
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 CitV 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 foi 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 Ihis Code shall expire by limitation arid 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 commenced for a period of 180 days (Section 106.4.4 Uniform Building Code).
V/XftPPLICANT'S SIGNATURE DATE
WHITE; File YELLOW: Applicant PINK: Finance
City of Carlsbad
Final Building Inspection
Dept: Building Engineering Planning CWIWD St Lite Rre
Plan Check #:
Permit #: CB051363
Project Name: SPEC SUITE-10050 SF OFFICE TO
OFFICE
Date: 07/25/2005
Permit Type: Tl
Sub Type: INDUST
Address:
Contact Person:
Sewer Dist:
Inspected/^
Bv: f^f-
Inspected
Bv:
Inspected
By:
Comments:
1935CAMINOVIDAROBLE #200
KEITH Phone: 8585255264
CA Water Dist: CA
^7 Date / /
^— Inspected: 7f2&f&^-7 * I
Date
Inspected:
Date
Inspected:
Lot: 0
Approved: iX
Approved:
Approved:
Disapproved:
Disapproved:
Disapproved:
City of Carlsbad Bldg Inspection Request
For: 08/25/2005
Permit* CB051363
Title: SPEC SUITE-10050 SF OFFICE TO
Description: OFFICE
Inspector Assignment: TP
Sub Type: INDUST
1935 CAMINO VIDA ROBLE
200 Lot 0
Type: Tl
Job Address:
Suite:
Location:
APPLICANT RICK LIEN
Owner: 1935 CAMINO VIDA ASSOCIATES L L C
Remarks:
Phone: 8585255264
Inspector:
Total Time:
CD Description
19 Final Structural
29 Final Plumbing
39 Final Electrical
49 Final Mechanical
Requested By: KEITH
Entered By: CHRISTINE
Act Comment
*P
Associated PCRs/CVs
Inspection History
Date
07/25/2005
07/19/2005
07/19/2005
07/19/2005
07/12/2005
07/12/2005
07/12/2005
07/12/2005
07/11/2005
07/08/2005
06/03/2005
06/01/2005
06/01/2005
05/31/2005
05/31/2005
05/31/2005
Description
89
14
34
44
14
24
34
44
84
84
17
24
44
14
24
34
Final Combo
Frame/Steel/Bolting/Welding
Rough Electric
Rough/Ducts/Dampers
Frame/Steel/Bolting/Welding
Rough/Topout
Rough Electric
Rough/Ducts/Dampers
Rough Combo
Rough Combo
Interior Lath/Drywall
Rough/Topout
Rough/Ducts/Dampers
Frame/Steel/Bolting/Welding
Rough/Topout
Rough Electric
Act
CO
PA
CO
AP
PA
we
AP
AP
NR
CA
AP
PA
PA
AP
NR
AP
Insp
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
Comments
NOTICE ATTCH.
T-CEIL, NEED TO FIX D.STOPS
SUPPORT MC CABLE
RE-LOC DUCTS
T-CEIL 2ND FLR
CEIL LITES 2ND FLR
DUCTS 2ND FLR
BLDG LOCKED
ROLL TO MONDAY
NEED PI SHEET SUBMITTED FOR ADDED MOP SINK & BRK RM SINK
City of Carlsbad Bldg Inspection Request
For: 07/25/2005
Permit* CB051363
Title: SPEC SUITE-10050 SF OFFICE TO
Description: OFFICE
Inspector Assignment: TP
Sub Type: INDUS!
1935 CAMINO VIDA ROBLE
200 Lot 0
Type: Tl
Job Address:
Suite:
Location:
APPLICANT RICK LIEN
Owner: 1935 CAMINO VIDA ASSOCIATES L L C
Remarks: CALLED IN WEDNES FOR MONDAY INSP
Phone: 8585255264
Inspector:
Total Time:
CD Description
19 Final Structural
29 Final Plumbing
39 Final Electrical
49 Final Mechanical
Requested By: KEITH
Entered By: CHRISTINE
Act Comment
Associated PCRs/CVs
Inspection Historv
Date
07/19/2005
07/19/2005
07/19/2005
07/12/2005
07/12/2005
07/12/2005
07/12/2005
07/11/2005
07/08/2005
06/03/2005
06/01/2005
06/01/2005
05/31/2005
05/31/2005
05/31/2005
05/31/2005
Description
14
34
44
14
24
34
44
84
84
17
24
44
14
24
34
44
Frame/Steel/Bolting/Welding
Rough Electric
Rou gh/Ducts/Dampe rs
Fram e/Stee!/Bolti ng/W eld ing
Rough/Topout
Rough Electric
Rough/Ducts/Dampers
Rough Combo
Rough Combo
Interior Lath/Dry wall
Rough/Topout
Rough/Ducts/Dampers
Frame/Steel/Bolting/Welding
Rough/Topout
Rough Electric
Rough/Ducts/Dampers
Act
PA
CO
AP
PA
we
AP
AP
NR
CA
AP
PA
PA
AP
NR
AP
we
Insp
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
TP
Comments
T-CEIL, NEED TO FIX D.STOPS
SUPPORT MC CABLE
RE-LOC DUCTS
T-CEIL 2ND FUR
CEIL LITES 2ND FLR
DUCTS 2ND FLR
BLDG LOCKED
ROLL TO MONDAY
NEED PI SHEET SUBMITTED FOR ADDED MOP SINK & BRK RM SINK
NOTICECITY OF CARLSBAD (760) 602-2700
BUILDING DEPARTMENT 1635 FARADAY AVENUE
DATE 7/7 r/V f TIME
LOCATION
PERMIT NO.
s -ri
JL
£ /g/g^r
A
it^r
4 A,
f
Ptr-*\
FOR (NSP^cfi^fiALL (760) 602-2725. RE-INSPECTION FEE DUE? LJ YES
FOR FURTHER INFORMATION, CONTACT
PHONE
BUILDING INSPECTOR CODE ENFORCEMENT OFFICER
City of Carlsbad Bldg Inspection Request
For: 07/07/2005
Permit* CB051363
Title: SPEC SUITE-10050 SF OFFICE TO
Description: OFFICE
Inspector Assignment: TP
Sub Type: INDUS!
1935 CAMINOVIDAROBLE
200 Lot 0
Type: Tl
Job Address:
Suite:
Location:
APPLICANT RICK LIEN
Owner: 1935 CAMINO VIDA ASSOCIATES L L C
Remarks:
Phone: 8585255264
Inspector:
Total Time:Requested By: KEITH
Entered By: JANEAN
CD Description Act Comment
14 Frame/Steel/Bolting/Welding
Associated PCRs/CVs
Inspection History
Date Description Act Insp Comments
06/03/2005 17 Interior Lath/Drywall
06/01/2005 24 Rough/TopOUt
06/01/2005 44 Rough/Ducts/Dampers
05/31/2005 14 Frame/Steel/Bolting/Welding
05/31/2005 24 Rough/Topout
05/31/2005 34 Rough Electric
05/31/2005 44 Rough/Ducts/Dampers
AP TP
PA TP NEED PI SHEET SUBMITTED FOR ADDED MOP SINK & BRK RM SINK
PA TP
AP TP
NR TP
AP TP
WC TP
CITY QFTARiSEAD
BUILDING DEPARTMENT
DATE.
LOCATION
PERMIT NO.
E (760) 602-2700
1635 FARADAY AVENUE
TIME
^/y
7
FOR INSPECTION CALL (760) 602-2725. RE-INSPECTION FEE DUE? LJ YES
FOR FURTHERJNEQRMATION, CONTACT
PHONE
BUILDING INSPECTOR CODE ENFORCEMENT OFFICER
EsGil Corporation
In VartntnRip wild government for (Buibfing Safety
DATE: 5/24/05 Q
'URIS.
JURISDICTION: City of Carlsbad cTPOTTREVIEWER
Q FILE
PLAN CHECK NO.: PCO5-OO37 SET: IV
PROJECT ADDRESS: 1935 Camino Vida Roble
PROJECT NAME: Spec Suites 100, 110 and 200 • TI
The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's building codes.
XI 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:
XI Esgil Corporation staff did not advise the applicant that the plan check has been completed.
_J Esgil Corporation staff did advise the applicant that the plan check has been completed.
Person contacted: Telephone #:
Date contacted: (by: ) Fax #:
Mail Telephone Fax In Person
X] REMARKS: Applicant to slip sheet revised sheet to City held sets.
By: Doug Moody Enclosures:
Esgil Corporation
D GA D MB D EJ D PC 5/17/05 trnsmtl.dot
9320 Chesapeake Drive, Suite 208 4 San Diego, California 92123 + (858)560-1468 + Fax (858) 560-1576
EsGil Corporation
In (Partners Rip vntfr government for QuiCffing Safety
DATE: 5/11/05 a APBJCANT
JURISDICTION: City of Carlsbad Q PLAN REVIEWER
Q FILE
PLAN CHECK NO.: PC05-0037 SET: III
PROJECT ADDRESS: 1935 Camino Vida Roble
PROJECT NAME: Spec Suites 1OO, 110 and 200 - TI
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.
X] 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.
XI The applicant's copy of the check list has been sent to:
Rick Lien
P.O. Box 930, Poway, CA 92074
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: Rick Lien Telephone #: 619-339-7425
Date contacted: stu 'oS(by: IP- ) Fax #:
Mail Telephone^" Fax In Person-^
REMARKS:
By: Doug Moody Enclosures:
Esgil Corporation
D GA D MB D EJ D PC 5/4/05 tmsmtl.dot
9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 4 (858)560-1468 + Fax (858) 560-1576
City of Carlsbad PC05-0037
5/11/05
RECHECK PLAN CORRECTION LIST
JURISDICTION: City of Carlsbad PLAN CHECK NO.: PC05-0037
PROJECT ADDRESS: 1935 Camino Vida Roble SET: III
DATE PLAN RECEIVED BY DATE RECHECK COMPLETED:
ESGIL CORPORATION: 5/4/05 5/11/05
REVIEWED BY: Doug Moody
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 disabled access. 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
or other departments.
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.
A. Please make all corrections on the original tracings and submit three new complete sets of
prints to: ESGIL CORPORATION.
B. To facilitate rechecking, please identify, next to each item, the sheet of the plans upon
which each correction on this sheet has been made and return this sheet with the
revised plans.
C. The following items have not been resolved from the previous plan reviews. The original
correction number has been given for your reference. In case you did not keep a copy of
the prior correction list, we have enclosed those pages containing the outstanding
corrections. Please contact me if you have any questions regarding these items.
D. 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 on the plans. Have changes been made not resulting from this list?
QYes QNo
City of Carlsbad PC05-OO37
5/11/05
Please make all corrections on the original tracings, as requested in the correction
list. Submit three sets of plans for commercial/industrial 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 calculations/reports 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.
These corrections are in response to items not fully addressed or as the
result of information provided, the text in bold underlined print indicates
the unresolved issue.
8. Please revise the plans to show the panel locations for the individual suites
demonstrating compliance with section 240-24 of the1999 NEC. Please indicate
on the plans the individual tenant suites. Indicate how the tenants in
space1Q9 will have access to the over-current devices in space 129?
10. Show on the site plan the complying disabled accessible path of travel from the
disabled accessible parking spaces to the primary entrance of the tenant space.
Please provide detailed plans of the path of travel, indicate slope and width, any
pedestrian ramps, curb ramps, walks, handrails, provide dimensioned parking
stall details etc. Please provide fully dimensioned plans for the new
exterior path of travel.
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.
EsGil Corporation
In Partners Rip witfi government for (Buiftfing Safety
DATE: 4/26/05
JURISDICTION: City of Carlsbad
PLAN CHECK NO.: PC05-0037 SET: II
PROJECT ADDRESS: 1935 Camino Vida Roble
PROJECT NAME: Spec Suites 10O, 110 and 20O - TI
APPLICANT
REVIEWER
a FILE
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.
XI 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.
X] The applicant's copy of the check list has been sent to:
Rick Lien
P.O. Box 930, Poway, CA 92074
Esgil Corporation staff did not advise the applicant that the plan check has been completed.
><] Esgi! Corporation staff did advise the applicant that the plan check has been completed.
Person contacted Rick Lien U/'V Telephone #: 619-339-7425
Date
Mail """"felephone
REMARKS:
Fax #:
In Person
By: Doug Moody
Esgil Corporation
D GA D MB D EJ D PC
Enclosures:
4/18/05 trnsmtl.dot
9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 * (858)560-1468 * Fax (858) 560-1576
City of Carlsbad PC05-0037
4/26/05
RECHECK PLAN CORRECTION LIST
JURISDICTION: City of Carlsbad PLAN CHECK NO.: PC05-OO37
PROJECT ADDRESS: 1935 Camino Vida Roble SET: II
DATE PLAN RECEIVED BY DATE RECHECK COMPLETED:
ESG1L CORPORATION: 4/18/05 4/26/05
REVIEWED BY: Doug Moody
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 disabled access. 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
or other departments.
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.
A. Please make all corrections on the original tracings and submit three new complete sets of
prints to: ESGIL CORPORATION.
B. To facilitate rechecking, please identify, next to each item, the sheet of the plans upon
which each correction on this sheet has been made and return this sheet with the
revised plans.
C. The following items have not been resolved from the previous plan reviews. The original
correction number has been given for your reference. In case you did not keep a copy of
the prior correction list, we have enclosed those pages containing the outstanding
corrections. Please contact me if you have any questions regarding these items.
D. 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 on the plans. Have changes been made not resulting from this list?
QYes QNo
City of Carlsbad PC05-O037
4/26/05
Please make all corrections on the original tracings, as requested in the correction
list. Submit three sets of plans for commercial/industrial 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 calculations/reports 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 trie City Planning, Engineering and Fire Departments until review by
EsGil Corporation is complete.
These corrections are in response to items not fully addressed or as the
result of information provided, the text in bold print indicates the
unresolved issue.
4. In buildings having floors and roofs of wood frame construction, other than
dwelling or hotel occupancies, draft stop the area between the ceiling and floor
above so that no concealed space exceeds 1,000 s.f. and no horizontal
dimension exceeds 60 L.F. (if space has sprinklers, then 3,000 s.f. and 100
L.F.). Section 708. Please revise the detail for the draft stop to show the
attachment to the structure and lateral bracing ( most of the draft stops' are
not supported by partition walls below).
5. Please revise the plans to show the location of the stairs from the second floor?
Where does the second floor stair exit the building on the first floor for
stair 238?
8. Please revise the plans to show the panel locations for the individual suites
demonstrating compliance with section 240-24 of the1999 NEC. Please indicate
on the plans the individual tenant suites. Indicate how the tenants in
space109 will have access to the over-current devices in space 129?
10. Show on the site plan the complying disabled accessible path of travel from the
disabled accessible parking spaces to the primary entrance of the tenant space.
Please provide detailed plans of the path of travel, indicate slope and width, any
pedestrian ramps, curb ramps, walks, handrails, provide dimensioned parking
stall details etc. Please provide fully dimensioned plans for the new
exterior path of travel.
The jurisdiction has contracted with Esgil Corporation located at 9320
Chesapeake Drive, Suite 208, San Diego, California 92123; telephone number of
City of Carlsbad PCO5-OO37
4/26/05
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.
EsGil Corporation
In Partnership -with government for Quitting Safety
DATE: 4/6/05 a APPLICANT"
JURISDICTION: City of Carlsbad Q PLAN REVIEWER
Q FILE
PLAN CHECK NO.: PC05-0037 SET: I
PROJECT ADDRESS: 1935 Camino Vida Roble
PROJECT NAME: Spec Suites 100, HO and 200 - TI
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.
XI 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.
X] The applicant's copy of the check list has been sent to:
Rick Lien
P.O. Box 930, Poway, CA 92074
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.
Persorrcontacted: Rick Lien C^^J Telephone*: 619-339-7425
Date contacredr" imy#? (by:/S^ ) Fax #:
Mail ^-xTelephone^'/ Fax In Person
REMARKS:
By: Doug Moody Enclosures:
Esgil Corporation
D GA D MB D EJ D PC 3/24/05 tmsmtl.dot
9320 Chesapeake Drive, Suite 208 * San Diego, California 92123 + (858)560-1468 + Fax (858) 560-1576
City of Carlsbad
4/6/05
PC05-O037
PLAN REVIEW CORRECTION LIST
TENANT IMPROVEMENTS
PLAN CHECK NO.: PC05-0037
OCCUPANCY: B
TYPE OF CONSTRUCTION: IIIN
ALLOWABLE FLOOR AREA:
SPRINKLERS?: YES
REMARKS:
DATE PLANS RECEIVED BY
JURISDICTION: 3/23/05
DATE INITIAL PLAN REVIEW
COMPLETED: 4/6/05
JURISDICTION: City of Carlsbad
USE: Office
ACTUAL AREA: 26158sf
STORIES: 2
HEIGHT:
OCCUPANT LOAD: 298
DATE PLANS RECEIVED BY
ESGIL CORPORATION: 3/24/05
PLAN REVIEWER: Doug Moody
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 you submit the revised plans.
TENANT IMPROVEMENTS WITHOUT SPECIFIC ENERGY DATA OR POLICY SUPPLEMENTS (1997UBC)tiforw.dot
City of Carlsbad PC05-0037
4/6/05
Please make all corrections on the original tracings, as requested in the correction
list. Submit three sets of plans for commercial/industrial 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 calculations/reports 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.
1. Plans and calculations shall be signed by the California state licensed engineer
or architect where there are structural changes to existing buildings or structural
additions. Please include the California license number, seal, date of license
expiration and date plans are signed. Business and Professions Code.
2. Provide a fully dimensioned floor plan showing the size and use of all rooms or
areas within the space being improved or altered. Draw the plans to scale and
indicate the scale on the plan. Section 106.3.3.
3. Show any existing fire rated corridors. Identify and provide construction details
for proposed new fire rated walls and methods of integrating existing walls .
4. In buildings having floors and roofs of wood frame construction, other than
dwelling or hotel occupancies, draft stop the area between the ceiling and floor
above so that no concealed space exceeds 1,000 s,f. and no horizontal
dimension exceeds 60 L.F. (if space has sprinklers, then 3,000 s.f. and 100
L.F.). Section 708.
5. Please revise the plans to show the location of the stairs from the second floor?
6. Pease revise the plans to show the doors to room 236 to comply with the
following: Corridors shall have interior door openings protected by tight-fitting
smoke and draft control assemblies rated 20 minutes. Doors shall be
maintained self-closing or be automatic closing by action of a smoke detector per
Section 713.2. Doors shall be gasketed to provide a smoke and draft seal where
the door meets the stop on sides and top. Section 1004.3.4.3.2.1.
7. 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
City of Carlsbad PC05-0037
4/6/05
family dwellings. Note on plans that an equipment ground conductor is to be
installed in all flexible conduits".
8. Please revise the plans to show the panel locations for the individual suites
demonstrating compliance with section 240-24 of the1999 NEC.
9. When alterations, structural repairs or modifications or additions are made to an
existing building, that building, or portion of the building affected, is required to
comply with all of the requirements for new buildings, per Section 1134B.2. These
requirements apply as follows:
a) A primary entrance to the building and the primary path of travel to the
altered area, must be shown to comply with all accessibility features.
10. Show on the site plan the complying disabled accessible path of travel from the
disabled accessible parking spaces to the primary entrance of the tenant space.
Please provide detailed plans of the path of travel, indicate slope and width, any
pedestrian ramps, curb ramps, walks, handrails, provide dimensioned parking
stall details etc.
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.
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 Q No Q
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 PC05-0037
4/6/05
VALUATION AND PLAN CHECK FEE
JURISDICTION: City of Carlsbad
PREPARED BY: Doug Moody
BUILDING ADDRESS: 1935 Camino Vida Roble
PLAN CHECK NO.: PC05-0037
DATE: 4/6/05
BUILDING OCCUPANCY: B TYPE OF CONSTRUCTION: IIIN
BUILDING
PORTION
Tl
Air Conditioning
Fire Sprinklers
TOTAL VALUE
Jurisdiction Code
AREA
(Sq.Ft.)
26158
cb
Valuation
Multiplier
30.00
By Ordinance
Reg.
Mod.
VALUE ($)
784,740
784,740
$2,522.41
1994 UBC Plan Check Fee
Type of Review:
Repetitive FeeRepeats
Complete Review
D Other
,—I Hourly
Structural Only
Hour
Esgil Plan Review Fee
$1,639.57
$1,412.55
Comments:
Sheet 1 of 1
macvalue.doc
PLANNlNC/ENGINiERINC APPROVALS
PERMIT NUMBER
ADDRESS
DATE 5
RESIDENTIAL
-! RESIDENTIAL ADDITIOI* MINOR
f<$10,OOO.OOl
TENANT IMPROVEMENT
PLAZA'CAKUNO REAE
CARLSBAD COMPANY STORES
VILLAGE FAIRE
COMPLETE OFFICE.BUILDINC'
OTHER e^Jinrc.
PLANNER DATE
ENGINES DATE
DD
DD
PLANNING DEPARTMENT
BUILDING PLAN CHECK REVIEW CHECKLIST
Plan Check No. Of r&#$ ~^7
Planner fMllti. AWVW
"7 / •"•» S\'/3 ~) 1 &~APN: (-1 2- Q" t ( o
Type of Project & Use: 7~/
Zonina: f Ifi General Plan: 'f 1
CFD (in/out) # Date of participation:
Address (7J>^ L&f-fH*
Phone (760) 602- <f^2
Net Project Density: f^/A'
Facilities Manaoement Zone: f
Remaining net dev acres:
riv (/(PW^i^trK
—DU/AC
Circle One
(For non-residential development: Type of land used created by this
permit:__ \ • • )
Legend: IS Item Complete Q Item Incomplete - Needs your action
Environmental Review Required: YES NO /^ TYPE :
DATE OF COMPLETION: '
Compliance with conditions of approval? If not, state conditions which require action.
Conditions of Approval: , '
Discretionary Action Required:
APPROVALyRESO. NO.
PROJECT NO.
YES NO TYPE
DATE
OTHER RELATED CASES:
Compliance with conditions or approval? If not, state conditions which require action.
Conditions of Approval: _ ;
ED CH Coastal Zone Assessment/Compliance
Project site located in Coastal Zone? YES __ NO y
CA Coastal Commission Authority? YES NO A
If California Coastal Commission Authority: Contact them at - 7575 Metropolitan Drive, Suite 103,
San Diego CA 92108-4402; (619) 767-2370
Determine status (Coastal Permit Required or Exempt): '
Coastal Permit Determination Form already completed? YES NO
If NO, complete Coastal Permit Determination Form now.
Coastal Permit Determination Log #:
Follow-Up Actions:
1) Stamp Building Plans as "Exempt" or "Coastal Permit Required" (at minimum Floor Plans).
2) Complete Coastal Permit Determination Log as needed.
Inclusionary Housing Fee required: YES NO X
(Effective date of Inclusionary Housing Ordinance - May 21,1993.)
Data Entry Completed? YES NO
(A/P/Ds, Activity Maintenance, enter CB#, toolbar, Screens, Housing Fees, Construct Housing Y/N,
Enter Fee. UPDATE!)
Site Plan:
RevSktil
CD 1- Provide a fully dimensional site plan drawn to scale. Show:. North arrow, property lines,
easements, existing and proposed structures, streets, existing street improvements, right-of-way
width, dimensional setbacks and existing topographical lines (including all side and rear yard
slopes).
Q D 2. Provide legal description of property and assessor's parcel number.
ODD
ODD
ODD
nan
ana
Policy 44 - Neighborhood Architectural Design Guidelines
1. Applicability: YES NO
2. Project complies YES _NO j.
D D D 2. NAccessory^sfructure setbacks:
Intefior Side
reetsSide:
Rear.
Top of slo>e
Required
Required,
Required.
Required.
Required.
Shown
Shown
Shown.
Shown.
Interior Side:
redtSide:
tear:
Structure^eparation:
Required
Required
Required
Required.
Required.
Required.
Shown
Shown
Shown
Shown.
Shown.
Shown.
Required
Spaces Required
Shown
Shown
Shown
(breakdown by uses for commercial and industrial projects required)
Residential Guest Spaces Required . ; Shown
Additional Comments
. -
a I tufa -hart Marl
.cpar.-et er
tern/rose*/< "There '. fo nfracs
OfcTO ISSUE AND ENTERED APPROVAL INTO COMPUTER
H:VADMINVCOUNTCR«ldgPlnchkRevChld«t
&£ DATE.
Rev 9/01
STUDIO WEST
IN'TERI-ORS
April 14, 2005
City of Carlsbad
Planning Department ,
1635 Faraday Avenue
Carlsbad, Ca 92008
Re: 1935 Camino Vida Roble
Responses to corrections
1. Number of parking spaces and breakdown of spaces is now shown on the site plan.
2. There are no new proposed units being added to the roof
4425 UPLAND STREET
LA MESA, CA 91941
619-465.5118
FAX.303.5118
Carlsbad Fire Department 050037
1635 Faraday Ave.
Carlsbad, CA 92008
Plan Review Requirements Category:
Date of Report: 03/24/2005
Fire Prevention
(760) 602-4660
Building Plan
Reviewed by:
Name:
Address:
Rick Lien
P O Box 930
City, State: Poway CA 92074
Plan Checker:
Job Name: Spec Suites
Job #: 050037
Job Address: 1935 Camino Vida Roble
Bldg #: PC050037
Ste. or Bldg. No,
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 The item you have submitted for review has been approved subject to the
Subject to 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.
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.
R*avip\V 1<sf Pnrt 3rd
FD Job # 050037 FD File #
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STRUCTURAL NOTES:
GENERAL:
1. The contractor shall verify all dimensions before starting work, and the owner
notified immediately of any discrepancies found.
2. In case of conflict, notes and details on the drawings take precedence over this
sheet.
3. Character of the soil is NVyQ • Design allowable soil
bearing pressure is • psf.
4. Where no construction details are shown or noted for any part of the work,
the details shall be the same as for other similar work.
5. Construction shall be in conformance with the requirements of the California
Building Code, 2001 edition.
6. Should any loose fill, expansive soil, ground water, or other adverse conditions
be encountered during excavation, the owner shall be notified and all work
stopped immediately.
7. Neither the owner or the engineer of work will enforce safety measures or regulations,
the contractor shall design, construct, and maintain all safety devices, including
shoring, and shall be solely responsible for conforming to all local, state, and
federal safety and health standards, laws,.and regulations, and shall indemnify
the owner and engineer of all responsibilities.
STRUCTURAL STEEL:
1. Structural steel rolled shapes, plates, and bars shall be per ASTM A36 or
ASTM A992. Steel pipe used for structural purposes shall have physical properties
conforming to ASTM A36.
2. Welding to be shielded metal arc method using E70xx electrodes. Field welding to be
continuously inspected by a registered deputy inspector. Welding technique, work-
manship, and inspection shall conform to: AWS Dl .0, "Code for Arc and Gas
Welding in Building Construction".
3. Square and rectangular structural tubing (HSS) shall be per ASTM A500 Grade B.
4. Unless noted otherwise, materials and workmanship shall conform to the latest
edition of: "AISC Specifications for the Design, Fabrication, and Erection of
Structural Steel for Buildings".
5. Machine bolts and anchor bolts shall conform to AISC A307, Grade A. High-
strength (HS) bolts shall conform to ASTM A325; field inspection required for
installation.
6. Unless otherwise shown, bolts to be %" diameter, 1 !4" minimum edge distance,
and 3" minimum spacing.
7. Welds identified as requiring continuous or periodic inspection need not have
special inspection when the welding is done in an approved fabricator's shop.
However, the approved fabricator must submit a Certificate of Compliance in
accordance with CBC sections 1701.5.5 and 2231 A.
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POLICYHOLDER COPY
COMPENSATIONIN SUKANCB
FUND
P.O. BOX 807, SAN FRANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 11-01-2004
CITY OF SAN DIEGO
ATTN BLDG DEPT
1222 FIRST AVE MS301
SAN DIEGO CA 92101-4153
SO
GROUP:
POLICY NUMBER: 1215362-2004
CERTIFICATE IE* 160
CERTIFICATE EXPIRES: 11-01-2OO5
11-01-2004/11-01-2005
JOB: ALL OPERATIONS
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, exclusions and conditions of such policies.
AUTHORIZED REPRESENTATIVE PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: *1,000.000.00 PER OCCURRENCE.
ENDORSEMENT 12065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 11-O1-2OO4 IS ATTACHED TO AND
FORMS A PART OF THIS POLICY.
EMPLOYER LEGAL NAME
PREVOST CONSTRUCTION,
339 N HIGHWAY 101
SOLANA BEACH CA 92075
INC PREVOST CONSTRUCTION AND/OR
SOLANA BEACH BUILDERS. INC
-„ 10/15/2004
?4