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HomeMy WebLinkAbout2175 CAMINO VIDA ROBLE; ; CB081644; Permit03-25-2009 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No Building Inspection Request Line (760) 602-2725 CB081644 Job Address Permit Type Parcel No Valuation Occupancy Group Project Title Applicant MALDONADO EDUARDO STE 125 9191 TOWNE CENTRE DR SAN DEIGO CA 92122 2175 CAMINO VIDA ROBLE CBAD Tl Sub Type COMM 0000000000 Lot# 0 Status ISSUED $25,00000 Construction Type NEW Applied 08/28/2008 Reference # Entered By KG AT&T-REPLACEMENT OF EXTERIOR Plan Approved 03/25/2009 CHILLERS,ELEC, AND NEW CONCRETE PADS APPROX 1,200 SF Issued 03/25/2009 Inspect Area Plan Check# Owner Building Permit Add'l Building Permit Fee Plan Check Add'l Plan Check Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bndge 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 Green Bldg Stands (SB1473) Fee $234 75 Meter Size $0 00 Add'l Reel Water Con Fee $15259 Meter Fee $0 00 SDCWA Fee $0 00 CFD Payoff Fee $525 PFF (3105540) $0 00 PFF (4305540) $0 00 License Tax (3104193) $0 00 License Tax (4304193) $000 Traffic Impact Fee (3105541) $000 Traffic Impact Fee (4305541) $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 •" HMP Fee TOTAL PERMIT FEES $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $000 $3500 $2400 $000 $000 $000 $000 7? $451 59 Total Fees $451 59 Total Payments To Date $451 59 Balance Due $000 BUILDING PLANS .IN STORAGE .ATTACHED 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 you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired City of Carlsbad 1635 Faraday Ave , Carlsbad, CA 92008 760-602-27 17 / 27 18 / 27 19 Fax 760-602-8558 Building Permit Application EstValuePS^O (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 issu/nce also requires'heapplicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 commending with Section 7000 of Division 3 of theBusiness and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031 5 by any applicant for a permit subjects the applicant to acivil penalty of not more than five hundred dollars ($500)) Workers' Compensation Declaration / hereby affirm under penalty of perjury one of the following declarations L_J 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 11 have and will maintain wo/kers' compensation as required by Section 3700 of the Labor Code for the performance otthe,work for. which this peamit is issued My workers compensation insurance earner and policy\ i/jfy t c^Cj i r\ ri fji -* i ft.' - r ' number are Insurance Co \£ S/VX k)V £)/£/' '~Lf\SVff-H C\_ Policy No., f &t*J I VJo 'I' r " Expiration Datey This section need not be completed if the permit is for one hundred dollars (S100) or less I | Certificate of Exemption I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California WARNING Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (8,100,000), in addition to the cost of compensation, damaaes as provided for in Section 3706 of the Labor code, interest and attorney's fees MS CONTRACTOR SIGNATURED j)__ , __ . — ^ / DATEA / hereby affirm that I am exempt from Contractors License Law for the following reason [ | 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) I | 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 contractors) licensed pursuant to the Contractor s License Law) | | 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 ^^Yes I [No 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 / 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 / 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 / type of work) y£S"pROPERTY OWNER SIGNATURE DATE S'. '.''•»iii*»i^.y v.,i^\»s,i'-A•""^>-i-'~:"-s-iti^': Is the applicant or future building occupant required to submit a business plan acutely hazardous materials registration form or nsk management and prevention program under Sections 25505 25533 or 25534 of the Presley Tanner Hazardous Substance Account Act' | | Yes I iNo Is the applicant or future building occupant required to obtain a permit from the air pollution control distnct or ainjuality management district7 I lYes PlNoIs the facility to be constructed within 1 000 feet of tbe outer boundary of a school site' IF ANY OF THE ANSWERS ARE YES, EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT l~lYes I I No I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec 3097 (i) Civil Code) Lender s Name Lender s Address I hereby authonze representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES JUDGMENTS COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT OSHA An OSHA permit is required for excavations over 5 0 deep and demolition or construction of structures over 3 stones in height EXPIRATION Every permit issued by the Building OrrMI under the provisions of this Code shall expire by limitation and become null and void if the building or work authonzed by such permit is not commenced within 180 days from the date of such permit or if the building orj^prk authorize^ by such permit is suspended or abandoned at any time after the work is commenced for a penod of 180 days (Section 106 4 4 Uniform Building Code) .^APPLICANT'S SIGNATURE City of Carlsbad Final Building Inspection Dept Building Engineering Planning CMWD St Lite Plan Check # Permit# CB081644 Project Name AT&T-REPLACEMENT OF EXTERIOR CHILLERS,ELEC, AND NEW CONCRETE PADS APPRO Address 2175 CAMINO VIDA ROBLE Lot Contact Person STEVE Phone 8587225737 Sewer Dist Water Dist •*"=<- Date Permit Type Sub Type \ 05/26/2009 Tl COMM Inspected Bv Inspected Bv Inspected Bv Comments Date Inspected Date Inspected Date Inspected Approved Approved Approved Disapproved Disapproved Disapproved City of Carlsbad Bldg Inspection Request For 06/01/2009 Perrnit# CB081644 Title AT&T-REPLACEMENT OF EXTERIOR Inspector Assignment MC Description CHILLERS.ELEC, AND NEW CONCRETE PADS APPROX 1,200 SF Type Tl Sub Type COMM o Job Address 2175 CAMINO VIDA ROBLE Suite Lot 0 Location APPLICANT MALDONADO EDUARDO Owner Remarks Phone 8587225737 Inspector Total Time CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Act Comment £L Requested By STEVE Entered By CHRISTINE Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 05/26/2009 19 Final Structural 05/26/2009 29 Final Plumbing 05/26/2009 39 Final Electrical 05/26/2009 49 Final Mechanical 03/27/2009 11 Ftg/Foundation/Piers 03/27/2009 31 Underground/Conduit-Wiring PA MC PA MC CO MC NOTICE ATTACHED PA MC AP MC FOOTINGS STEEL FOR CHILLER PAD AP MC CONDUIT ONLY TO P1 & P2 DISCONNECTS City of Carlsbad Bldg Inspection Request For 05/26/2009 Permit* CB081644 Title AT&T-REPLACEMENT OF EXTERIOR Inspector Assignment MC Description CHILLERS.ELEC, AND NEW CONCRETE PADS APPROX 1.200SF Type Tl Sub Type COMM Job Address 2175 CAMINO VIDA ROBLE Suite Lot 0 Location APPLICANT MALDONADO EDUARDO Owner Remarks Phone 8587225737 Inspector Total Time CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Act Comments Requested By STEVE Entered By JANEAN Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 03/27£009 11 Ftg/Foundation/Piers AP MC FOOTING & STEEL FOR CHILLER PAD 03/27/2009 31 Underground/Conduit-Wiring AP MC CONDUIT ONLY TO P1 & P2 DISCONNECTS NOTICECITY OF CARLSBAD (760) 602-2700 BUILDING DEPARTMENT 1635 FARADAY AVENUE TIME LOCATION PERMIT NO |-2.o u i {(Tin -1-' ; 1 FOR INSPECTION CALL (760) 602-2725 RE-INSPECTION FEE DUE? I YES FOR FURTHER INFORMATION, CONTACT JM PHONE . BUILDING INSPECTOR •, CODE ENFORCEMENT OFFICER EsGil Corporation In (Partners/tip witfi. government for (ButCcfing Safety DATE 9/8/08 CTAEEUCANT •^tfjURIS^ JURISDICTION City of Carlsbad ^-a-PtAN a FILE PLAN CHECK NO O8-1644 SET I PROJECT ADDRESS 2175 Camino Vida Roble PROJECT NAME AT&T Chiller Replacement - TI XI 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 X] 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 contacTIfd Telephone # Date contacted (by ) Fax # Mail Telephone Fax In Person REMARKS By Doug Moody Enclosures Esgil Corporation D GA D MB D EJ D PC 9/2/08 9320 Chesapeake Drive, Suite 208 4- San Diego, California 92123 * (858)560-1468 *• Fax (858) 560-1576 City of Carlsbad O8-1644 9/8/O8 [DO NOT PAY- THIS IS NOT AN INVOICE] VALUATION AND PLAN CHECK FEE JURISDICTION City of Carlsbad PLAN CHECK NO 08-1644 PREPARED BY Doug Moody DATE 9/8/O8 BUILDING ADDRESS 2175 Camino Vida Roble BUILDING OCCUPANCY B TYPE OF CONSTRUCTION IIB BUILDING PORTION Tl Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code BlHn Pprmit FPP hv Drrlma AREA (Sq Ft) 1200 cb Valuation Multiplier City Valuation By Ordinance nrp ^ Reg Mod VALUE ($) 25,000 25,000 $234 75 Plan Check Fee by Ordinance Type of Review 0 Complete Review fj Structural Only j Repetitive Fee~^,~| Repeats D Other i—I Hourly Esgil Plan Review Fee Hour* $152 59 $131 46 Comments Sheet 1 of 1 macvalue doc PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB 08-1644 DATESeptember 4, 2008 ADDRESS 2175 Camino Vida Roble RESIDENTIAL ADDITION- MINOR (< 17,000.00) RETAINING WALL VILLAGE FAIRE POOL/SPA TENANT IMPROVEMENT COMPLETE OFFICE BUILDING OTHER PLANNER CS ENGINEER \ ^A- CT7 DATE 9/4/8 DATE II \ADMIS\IUi;CTRB/m\MXi;/hM,l\RERl\!; APPROVALS Structural Calculations AT&T Corporate Real Estate Chiller Replacement 2175 Cammo Vida Roble Carlsbad, Ca TengProj No 20727001 Date 8/28/08 O)1 3 CHILLER CONNECTIOr NTS Z\ fv -. I" o ^ V ^7-<• ^ ,. , fh^4 i- <i— — -© J^ V g£-R 2-^2 Z^ i/7 CO 'o ; oI 0)O) COQ. C O Xo CO O)c to •aa> M=roO o I .-Qo (DT3 OC (Q O e ...Q. Q. MS DOCUMENT IS 11* PSUPERTY OF CARRIER CORPORATION A«) IS DELIVERED UPON THE EXPRESS COhOITION THAT THE CONTENTSWILL NOT BE DISCLOSED OR USED WITHOUT CARRIER CORPORATIONS WRITTEN CONSENT SUBMISSION OF THESE DRAWINGS OR DOCUMENTS HOES NOT CONSTITUTE PARTPERFORMANCE OR ACCEPTANCE OF CONTRACT A United T«d-*ir,|og(<rs Cainp o> CM CO OO CD T> 5CO k. CD O -acu CD CO.*:o COQ_ 0 Q(Oco.o 00c c<p > o OJ C£ ooTO —• o o-j <- <f <~i n> T o s -H « O -!•o> IT! m -^ g" ™ . <5 § re I- '^ S T ^ 2S j? "! ? o § 3 "g. ™ I S ;ra.mo r° 1: "g- ^ •»C Is J ", 3 a" tr- lv & vxo 1N3SMOO hQLLOW SNOU-VHOddM H3IHHVOinoHtiw (Bin MO i33<;o-iDSia 3s J.ON 111 SINHINIX) 311 l»Hi NOUIIM03 SS3MJX3 3KL NOdf! tQ>J3AIT3O ^1 IWV NOU.VHOJsiuavn jo ^i«3d;ibd 3Hl si iNjwnrjoa SHI J3IJJDQ T)QiCOCD -J O> (D "*CL > oo>3^o Q.fi) 7JOCT (D m o (Da5jo"a o to woX O)o g oo I* C O -4-> Oto Xoeot_ fi D) Q .o t0)O CD LU X]oo: Oc OJO <TJ o a £L 0. \ r\Y-t-\£±r-O <J 1 1 1 d Technologies Company IHIS DOCUMENT IS THE PROPERTY OF CARRIER CORPORATION AND IS DELT/ERED UPON THE EXPRESS CONDITION THAT THE CONTENT'S WILL NOT BE DISCLOSED OR USED WITHOUT CARRIER CORPORATION S WRITTEN CCNSENT SUBMISSION OF THESE DRAWINGS OR DOCUMENTS DOES NOT CONSTITUTE PART PERFORMANCE OR ACCEPTANCE CF CONTRACT \ ' "O D «21 O 5 Lfi4-» § I O (D (/I < = S x t! OO C/l ro > D QJ o -§o ET ^-t- 50 oo CD CD <DO)CDQ. O) CM O O (D T3 5CO O T3)D)3 GedcodeMe with a Google Map Page 1 of 1 . - M; . •' ' .Clellarv-Palorinar- • egoland ' "~ imSyPark . • - ~ f\* \\ --• ••"' -'Aviara outac M . vjata ©2£K@" Jele Atlsis3-0®ftBS of Use, ;. > *. »_'«r* r ~~~.&£" _ " - ' 2175 Camino Vida Roble,Carlsbad,CA,,33 118026,-117 279366 Conterminous 48 States 2003 NEHRP Seismic Design Provisions Latitude = 33 118026 Longitude = -117 279366 Spectral Response Accelerations Ss and S1 Ss and S1 = Mapped Spectral Acceleration Values Site Class B - Fa = 1 0 ,Fv = 1 0 Data are based on a 0 01 deg grid spacing Period Sa (sec) (g) 02 1 174 (Ss, Site Class B) 10 0 444 (S1, Site Class B) t Seismic Load ASCE 7-05 Sect 13 3 1 Fp= 0 4 ap SDS Ip Wp (1+2 z/h) Rp Fpmm = 0 3 SDS Ip Wp Fpmax = 1 6 SDS Ip Wp Address From Geocodeme - Geocode U S address Latitude 33118026° Longitude-117 279366° From USGS EQHAZMAPS Period (Sec) Sa (g) 02 1 1174 (Ss, Site class B) 10 0 444 (SI, Site class B) Use Site Class D IBC Sec 1613 5 2-No soils report Table 114-1 Fa = 1 03 (Ss mterpo ) Table 11 4-2 Fv= 1 56 (SI mterpol) Eq 114-1 SMS = Fa Ss-103x1 174= 1209 g Eq 11 4-2 SMI = Fv Si - 1 56 x 0 444 = 0 693 g Design Spectral response acceleration parameters Short Period SDS = 2/3 SMS = 2/3 ( 1 209) = 0 806 g Long Period SDI = 2/3 SMI = 2/3 ( 0 693 ) = 0 462 g Ip= 1 5 Essential Facilities, Cat III (Table 115-1) Ap= 1 0 } Chillers (table 136-1) Rp= 25 Seismic Loads Z= 0 Sec 13 3 1 ht orpt of component attachment w/respect to base h= 9 Z/h=l + Kh = 1 3 Sec 13421 (anchors embedded in cone ) Kv= 02 SDS Vert scis factor (13 3 1 note) = 02x081 = 16 Fp = 04x 1x81x15 (1 + 2xO)Wp = 020Wp ,, use 25 Fpmm = 0 3 x 81x1 5 Wp = 0 36 Wp Fpmax = 1 6 x 81x1 5 Wp = 1 94 Wp Antenna = 122 Tower = 08 Wp =13 kips Fh = Fp(asd) = 0 36 /I 4 Wp = 0 3 Wp = 4 kips ( w/o kh=l 3 for anchors in cone ) Fv = Kv Wp = 16 /I 4 Wp = 0 2 Wp = 2 6 kip (w/o kh=l 3 for anchors in cone) Alternative Basic Load Combo (IBC 1605 3 2) D + E/1 4 = D + Eh/l 4 + Ev/l 4 Eq 16-20 LCI 09D + E/1 4=09 D +Eh/1 4+Ev/1 4 Eq 16-21 LC2 Transverse Section L C 1 C=T= 4x3 151(1 11 x4) = 053 kip (Wp+Fv)/8=156/8 =1 95k T= 053-1 95 = 0 (no uplift) C= 0 53 + 1 95 = 2 48 k/bolt ( Down) LC2 C=T= =053k (0 9 Wp-Fv)/8 = 9 1/8=1 14 Tn= 53-1 14 = 0( no uplift) C= 053+1 14= 1 67k/ bolt Mounting Bolts Per Sect 1342 V= (4/8 ) 1 3 = 650 #/ bolt ( small) T=0 Use 5/8" dia Hilti Re-500 SD (304/316) per ICC ESR 2322 Footing D equipt Ftg Ev 13 \ 24 X 37k 2_6 D+ Ev =39 6-40 kips 8'-0"r IJ XMa -4x4 75+40(8/2)=40X X=353 e=8/2 -X =0 47' < 8/6 qmax=(40/(8x!9 75))/(l+0 47/8) - 0 4 ksf r _T \ . t i . 1 - "'• "I •i r & f^f--"*"^ \ j, 1 '" 1 */3 f rt-12' 1975^ x 1 5 ( assuming with eccentricity) 0 6 ksf small < 1 5 ksf OK Asmm- 0 002x12x12 -0 29 sq in Use #5@12'ew RJ. DAUM CONSTRUCTION COMPANY O Garden Grove Office 11581 Monarch Street Garden Grove California 9284 1 Tel (714) 894-4300* Fax (7 14) 894-4449 E-mail mperong'ft'ridaum com • San Dic^o Office 7562 Trade Street San Diego California 92121 Tel (858) 621-8750 • ha\ < 858) 621-8756 t-niail dhejiti (7-ridjuin com March 25, 2009 City of Carlsbad Carlsbad. CA RE Permit Process To Whom It May Concern This letter is to authorize Kim Roth to pull permits for the AT&T Chiller Replacement (2175 Camino Vida Robles, Carlsbad) on behalf of R J Daum Construction Co Please feel free to contact our office should you have any questions Sincerely Douglas Beatty Operations Manager L \Forms\Authonzations\Authonzation - Pull Permit doc 3430991 1 , , ACORD CERTIFICATE OF LIABILITY INSURANCE Producer Amanda Vandertlp Wood Gutmann & Bogart Insurance Brokers 15901 Red Hill Ave , Suite 100Tustm CA 92780 714 505 7000 www wgbib com License No 0679263 Insured RJ Daum Construction Co , A Nevada Corporation 11581 Monarch StreetGarden Grove CA 92841 Date (mm/dd/yy) 6/30/2008 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 INSURER Travelers Prop Cas Co of America A INSURER Seabnght Insurance Co B MINSURER N C Of ational Union Fire Ins Co Pittsburg, PA INSURER D INSURER E COVERAGES ---'.---"; ..» - :.;&;'-.'?- jv, !r,\; _~ - "^ -;--- =" ;i-": - - •'.':-.?.• ~.•_-".. THE' POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEDNOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THETERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INS LT A A A A C B t\ I 7 m A7 7 TYPE OF INSURANCE ENERAL LIABILITY COMMERCIAL GENtRAL LIAS ^CLAIMS MADE JTjfJCCU Owners/Cont Pr N'L AGG LIMIT APPLIES PER POLICY J7JpROJECTJ~) LOG UTOMOBILE LIABILITY ANY AUTO All OVVNHD AUTOS SCHEDULED AUTOS HIRED AUTOS NOW OWNED AUTOS Hired Phys Dam $50,000 limit GAKACjt LIABILITY _JANY AUTO /]OCCUR [~j CLAIMS MADE ^DEDUCTIBLE""(RETENTION $ MPLOYERS LIABILITY Rntd/Leasd hquip POLICY NUMBER DTECO7819B144TIL08 DTEC07819B144TIL08 DT8107819B144TIL08 DT8107819B144TIL08 BE 7658799 BB1081079 QT6605638H06ATIL08 POLICYEFFECTIVEDATEMM/DD/YY 7/1/2008 7/1/2008 7/1/2008 7/1/2008 7/1/2008 1/1/2008 7/1/2008 POLICYEXPIRATIONDATEMM/DD/YY 7/1/2009 7/1/2009 7/1/2009, ;, 7/1/2009 7/1/2009 1/1/pnnQ //1/2009 -. U.U...U.I.JII.UWM »j-wi-iin,i.L^LAi,LUJIUI\liAL)UtL>tl tNUOKStMtNi; PtCIAL PROVlSIO LIMITS EACH OCCURRENCE FIRE DAMAGE (Any one fire) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS COMP/OP AGG COMBINED SINGLE LIMfl BODILY INJURY Per person) BODILY INJURY Per accident) PKOftRl Y DAMAGE (Per accident) * 1.000.000 s 300.000 s 5.000 J 1.000.000 s 2,000.000t 2.000.000$ t 1,000,000 t t AUTO ONLY EA ACCIDENT i OTHER THAN EA ACC|S AUTO ONLY J^fJ ' ACH OCCURRENCE M AGGREGATE $ S.OOO.flufT 5,000000Is r /) STATUTORY UMIT T^THEIS tL EACH ACCIDtNr |$ EL DISEASE £A EMPLOYEE $ $100,000 ' QOO 000 ' J)00 OOTJ S — — [Proof Of Insurance {CERTIFICATE HOLDER Proof Of Insurance Proof Of Insurance [ACORD 25-$ (7/97) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE" EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL •3U .DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE— •"-" • "•"• • w ••"- *»u'*i» i^n 11 nuiucK raMivibLJ I U I nt LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRE ISENTATIVES• 10 pays for Non-payment of Premium ,0ACORD CORPORATION 1988 State Of California '».-. CONTRACTORS STATE LICENSE BOARDJ-T« ACTIVE LICENSE Consumer ABatn 1^7760 « ^. R J DAUM CONSTRUCTION COMPANY ABO8 08/31/2010 Check a License or Home Improvement Salesperson (HIS) Registration - Contractors Stat Page 1 of 1 Department of Consumer Affairs '^;:\j^ tebv Contractors State License Board Contractor's License Detail - License # 127760 f-\ DISCLAIMER A license status check provides information taken from the CSLB license database Before relying on this information, you should be aware of the following limitations '<• CSLB complaint disclosure is restricted by law (B&P 7124 6) If this entity is subject to public complaint disclosure, a link for complaint disclosure will appear below Click on the link or button to obtain complaint and/or legal action information - Per B&P 7071 17, only construction related civil judgments reported to the CSLB are disclosed ?•> Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration >•• Due to workload, there may be relevant information that has not yet been entered onto the Board's license database License Number Business Information Entity Issue Date Expire Date License Status Classifications Bonding Workers' Compensation Extract Date 03/25/2009127760 R J DAUM CONSTRUCTION COMPANY 11581 MONARCH STREET GARDEN GROVE, CA 92841 Business Phone Number (714) 894-4300 Corporation 11/26/1951 08/31/2010 This license is current and active All information below should be reviewed DESCRIPTION A GENERAL ENGINEERING^CONTRACTOR B GENERAL BUILDING CONTRACTOR C-8 CONCRETE CONTRACTOR'S BOND This license filed Contractor's Bond number 196669 in the amount of $12,500 with the bonding company AMERICAN CONTRACTORS INDEMNITY COMPANY Effective Date 01/01/2007 Contractor's Bonding History BOND OF QUALIFYING INDIVIDUAL 1 The Responsible Managing Officer (RMO) MARK ALAN PERONG certified that he/she owns 10 percent or more of the voting stock/equity of the corporation A bond of qualifying individual is not required Effective Date 12/30/2008 This license has workers compensation insurance with the SEABRIGHT INSURANCE_CQM.PANY Policy Number BB1091079 Effective Date 01/01/2009 Expire Date 01/01/2010 Workers' Compensation History " Personnel List Conditions of Use | Privacy Policy Copyright © 2009 State of California https //www2 cslb ca gov/OnhneServices/CheckLicense/LicenseDetail asp 03/25/2009 U 0) re •o •>o aa < o ^ y =o 5 ^ vQ Cip 2-•v>o tn cc EL ^5 1 V"o—Vs ci™ ilj S 1 ^~< y >« ^C tZ s ^ ^__ ?» o 0 a. ~- o I ^L« g a p ^D i reQ M L.aj Commto 5CO tn cc. HI ti)c ooc rc o >sm Q 8c: Ini/l 8u.1 Forms/z oo oco Z QU.U Z EL Z ^ 01 a. Z a.C/i OOo. GO Z tZ z •% ! 1— Oco o ^ Q r>^*. 4 0 01a 0u M001u , j"J 01 •xi c E0u U ro h ^s fi-ll•*u sIf2 14