HomeMy WebLinkAbout2176 CORTE ARBOLES; ; CB994708; Permit02/27/2001
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Pool Permit Permit No CB994708
Building Inspection Request Line (760) 602-2725
Job Address
Permit Type
Parcel No
Valuation
Reference #
Project Title
2176 CORTE ARBOLES CBAD
POOL
2552520600 Lot # 0
$18,45000 Construction Type NEW
CILURZO RES-600 SF POOL/SPA
Status
Applied
Entered By
Plan Approved
Issued
ISSUED
12/21/1999
RMA
01/04/2000
01/04/2000
Inspect Area TL
Applicant
SAN DIEGO POOLS
2430 CAMINO DEL VECINO
ALPINE CA 91901
619-445-1877
Owner
CILURZO STEPHEN M
2176 CORTE ARBOLES
CARLSBAD CA 92009 2736 02/27/01 0002 01 02
CGP 9o-l6
Total Fees $462 35 Total Payments To Date $366 19 Balance Due $96 16
Building Permit
Add'l Building Permit Fee
Plan Check
Add'l Plan Check Fee
Electrical Fee
Plumbing Fee
Strong Motion Fee
Renewal Fee
Add'l Renewal Fee
Other Building Fee
TOTAL PERMIT FEES
$19233
$000
$12501
$000
$2000
$2700
$1 85
$000
$000
$96 16
$462 35
Inspector
FINAL APPROVAL
3///0/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 capactiy
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
01/04/2000
City of Carlsbad
Pool Permit Permit No CB994708
Building Inspection Request Line (760) 438-3101
Job Address
Permit Type
Parcel No
Valuation
Reference #
2176 CORTE ARBOLES CBAD
POOL
2552520600 Lot # 0
$18,45000 Construction Type NEW
Project Title CILURZO RES-600 SF POOL/SPA
Applicant
SAN DIEGO POOLS
2430 CAMINO DEL VECINO
ALPINE CA 91901
619-445-1877
Status ISSUED
Applied 12/21/1999
Entered By RMA
Plan Approved 01/04/2000
Issued 01/04/2000
Inspect Area
7681 01/04/00 0001 OL 02
C-PRHT
Owner
CILURZO STEPHEN M
2176 CORTE ARBOLES
CARLSBAD CA 92009
241-18
Total Fees $36619 Total Payments To Date- $12501 Balance Due $241 18
Building Permit
Add'l Building Permit Fee
Plan Check
Add'l Plan Check Fee
Electrical Fee
Plumbing Fee
Strong Motion Fee
Renewal Fee
Add'l Renewal Fee
Other Building Fee
TOTAL PERMIT FEES
$19233
$000
$12501
$000
$2000
$2700
$1 85
$000
$000
$000
EXPIRiH9PERlff!T
K!T,!lK^!l!!ffiDINflCCORDANCE\ffi7HU.B.C.
DATE v-^-ni SIGNATURE
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 capactiy
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
2075 Las Palmas Dr., Carlsbad, CA 92009 (760) 438-1161
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave , Carlsbad, CA 92008
1 : PROJECT INFORMATION ^rSt.fr
FOR OFFICE USE ONLY
PLAN CHECK NO
EST VAL
Plan Ck Deposit
Validated By;
Date /
Ul~
C-PRHT
Address (include Bldg/Suite #)Business Name (at this address)
Legal Description Lot No Subdivision Name/Numbei Unit No Phase No Total # of units
Assessor s Parcel Existing Proposed, Use
Description of Work
2 CONTAC/PEffSON (if different frornlBppliant)
#of Stories • of Bedrooms # of Bathrooms
Address City
| Owner ED: Agent fbF'cSifner
State/Zip Telephone #
Owner : xo .
fa. M* <A> 4043
Cit ' State/Zi
Fax #
3 APPLICANT A D;Conjtractor
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
exerjrjption Any/TjolatKin of Section ?03J Sty any apjjlicajit for a permit subjects-^he^appljcant to a civil penalty oHpoj, rrjore than five hundred dollars I $5001)
Address
License Class
Name
State License #
City State/Zip Telephone #
City Business License # 1,-jQi J/jQ
Designer Name Address City State/Zip Telephone
State License #
°6" ""WORKERS'COMPENSATION ,..., ^ •••lifth •:„ f:*^ ' ':°:" ' "i:"
Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations
O 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
m I have and will maintain Worlrers^coBapensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued My worker s conyeQgjftiojnrf^upKta^cawenenApolicy number are
Insurance Company '^ffit{Vff(( <^? 'Policy
(THIS SECTION NE^D°NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS)
0 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 'So one hundred
thousand dollars Jr$100 0/DO\in additiodjo the) cost of compensation damages as provided for in Section 3706 of the. Labor code interest and attorney s fees
S.GNATURE /j ^fQ^WAJ DATE JcQ'^2/~f^
h?1' OWNER-BUILDER DECLARATION : ,„. "" ".'.'" '•"*-' ' ' , ,^f :*lr :i:-f::, ' 'to
1 hereby affirm that I am exempt from the Contractor s License Law for the following reason
n 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)
Cl 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 contra Dtor(s) 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 O YES [~lNO
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
COMPLETE THfS SECTION
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? O YES [U 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 fj NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? |~| YES l~l 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
CONSTRUCTIONI LENDING: AGENCY
onatruction lending agency for the performance of the work for which this permit is issued (Sec 30970) Civil Code)
~/lLENDER'S NAME ' ' / /1 LENDER S ADDRESS
I hereby affirm that triers-is a i
/ J
APPLICANT CERTIFICATION
I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate I agree to comply with all
City ordinances and State laws relating to building construction I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned
property for inspection purposes I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST AIL 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 ouilding 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 cornfflanced/fi^a period cf 180 days (Section 106 4 4 Uniform Building Code)
APPLICANT S SIGNATURE \t J //xfJx^TZ^VL/ DATE
WHITE File YELLOW Applicant PINK Finance
City of Carlsbad Bldg Inspection Request
For 03/01/2001
Permit# CB994708
Title CILURZO RES-600 SF POOL/SPA
Description
Inspector Assignment TL
2176 CORTEARBOLES
Lot 0
Type POOL Sub Type
Job Address
Suite
Location
APPLICANT SAN DIEGO POOLS
Owner CILURZO STEVE M
Remarks
Total Time
Phone
Inspector
Requested By JOHN OR JOSH
Entered By CHRISTINE
CD Description
59 Final Pool
Act Comments
Associated PCRs
Date
02/05/2001
09/01/2000
08/02/2000
04/28/2000
04/28/2000
04/28/2000
04/28/2000
04/27/2000
Inspection History
Description
59 Final Pool
59 Final Pool
55 Fence/Pre-Plaster
23 Gas/Test/Repairs
51 Excav/Steel/Bondmg/Fence
52 Underground Plumbing
53 Electric/Conduit/Wiring
51 Excav/Steel/Bondmg/Fence
Act
CO
CO
AP
AP
AP
AP
AP
CO
Insp
JC
TL
TL
TL
TL
TL
TL
TL
Comments
NEED SELF CLOSING HARDWARE
RECEP @ COMPOOL NO POWER
SEE NOTICE ATTACHED
inspection List
Permit* CB994708 Type POOL CILURZO RES-600 SF POOL/SPA
Date
02/05/2001 59
02/05/2001 59
09/01/2000 59
08/02/2000 55
04/28/2000 23
04/28/2000 51
04/28/2000 52
04/28/2000 53
04/27/2000 51
Inspection Item
Final Pool
Final Pool
Final Pool
Fence/Pre-Plaster
Gas/Test/Repairs
Inspector Act Comments
Excav/Steel/Bonding/Fence
Underground Plumbing
Electric/Conduit/Wiring
Excav/Steel/Bonding/Fence
JC
TL
TL
TL
TL
TL
TL
TL
Rl
CO
CO
AP
AP
AP
AP
AP
CO
NEED SELF CLOSING HARDWARE
RECEP @ COMPOOL NO POWER
SEE NOTICE ATTACHED
l
Tuesday, February 13 2001 Page 1 of 1
City of Carlsbad Bldg Inspection Request
For 02/05/2001
Permit* CB994708
Title CILURZO RES-600 SF POOL/SPA
Description
Inspector Assignment TL
Type POOL Sub Type
Job Address 2176 CORTE ARBOLES
Suite Lot 0
Location
APPLICANT SAN DIEGO POOLS
Owner CILURZO STEVE M
Remarks
Phone 6197780228
Inspector
Total Time
CD Description
59 Final Pool
Requested By JOSH
Entered By CHRISTINE
Act Comments
Associated PCRs
Inspection History
Date Description
09/01/2000 59 Final Pool
08/02/2000 55 Fence/Pre-Plaster
04/28/2000 23 Gas/Test/Repairs
04/28/2000 51 Excav/Steel/Bonding/Fence
04/28/2000 52 Underground Plumbing
04/28/2000 53 Electric/Conduit/Wiring
04/27/2000 51 Excav/Steel/Bonding/Fence
Act Insp Comments
CO TL RECEP @ COMPOOL NO POWER
AP TL
AP TL
AP TL
AP TL
AP TL
CO TL SEE NOTICE ATTACHED
NOTICE
CITY OF CARLSBAD (760) 602-2700
BUILDING DEPARTMENT 1635 FARADAY AVENUE
DATE ^( <T/r> / TIME
LOCATION
PERMIT NO C /? 5 9 </7
I ____ IFOR INSPECTION CALL (760) 602-2725 RE-INSPECTION FEE DUE? ____ YES
FOR FURTHER INFORMATION, CONTACT ____ ____
PHONE
TC _ __
BUILDING INSPECTOR CODE ENFORCEMENT OFFICER ®
City of Carlsbad Bldg Inspection Request
For 4/27/2000
Permit# CB994708
Title CILURZO RES-600 SF POOL/SPA
Description
Inspector Assignment
2176 CORTEARBOLES
Lot 0
Type POOL Sub Type
Job Address
Suite
Location
APPLICANT SAN DIEGO POOLS
Owner CILURZO STEPHEN M
Remarks
Phone 6197780228
Inspector
Total Time
CD Description Act Comments
51 Excav/Steel/Bondmg/Fence
Requested By JOSH
Entered By ROBIN
Associated PCRs
Inspection History
Date Description Act Insp Comments
CITY OF CARLSBAD
BUILDING DEPARTMENT
NOTICE
DATE :? 7 OO
LOCATION 2/7 £,
PERMIT NO Cfi
(760) 602-2700
1635 FARADAY AVENUE
TIME
CT'£..<?*}<J
/
FOR INSPECTION CALL (760) 602-2725 RE-INSPECTION FEE DUE? i I
FOFLFURTHER INFORMATION, CONTACT
YES
/ {/"BlillLDINtklKlSPECTOR u*'CODE ENFORCEMENT OFFICER
City of Carlsbad Bldg Inspection Request
For 9/1/2000
Permit* CB994708
Title CILURZO RES-600 SF POOL/SPA
Description
Inspector Assignment TL
Type POOL Sub Type
Job Address 2176 CORTE ARBOLES
Suite Lot 0
Location
APPLICANT SAN DIEGO POOLS
Owner CILURZO STEVE M
Remarks
Phone 6197780228X4
Inspector
Total Time
CD Description
59 Final Pool
Requested By JOSH
Entered By ROBIN
Act Comments
Associated PCRs
Inspection History
Date Description
8/2/2000 55 Fence/Pre-Plaster
4/28/2000 23 Gas/Test/Repairs
4/28/2000 51 Excav/Steel/Bondmg/Fence
4/28/2000 52 Underground Plumbing
4/28/2000 53 Electric/Conduit/Wiring
4/27/2000 51 Excav/Steel/Bondmg/Fence
Act Insp Comments
AP TL
AP TL
AP TL
AP TL
AP TL
CO TL SEE NOTICE ATTACHED
CITY OF CARLSBAD
BUILDING DEPARTMENT
DATE
NOTICE
LOCATION r)
PERMIT NO
(760) 602-2700
1635 FARADAY AVENUE
f. ,
*
TIME //- /*>"
-r*.- .-« - *»* ^t "a~r-:-/-v. ?.<•
o
1 FOR INSPECTION CALL (760) 602-2725 RE-INSPECTION FEE DUE?
" FOR FURTHER INFORMATION, CONTACT
n YES
PHONE
T ^BUILDING INSPECTOR CODE ENFORCEMENT OFFICER
C i t v sbad
Public Works — Engineering
BUILDING PLANCHECK CHECKLIST
POOLS
BUILDING PLANCHECK NUMBER CB
BUILDING ADDRESS -76-
PROJECT DESCRIPTION Pool *-
ASSESSOR'S PARCEL NUMBER
ENGINEERING DEPARTMENT
APPROVAL
The item you have submitted for review has been
approved The approval is based on plans, information
and/or specifications provided in your submittal,
therefore, any changes to these items after this date,
including field modifications, must be reviewed by this
office to insure continued conformance with applicable
codes Please review carefully all comments attached,
as failure to comply with instructions in this report can
result jn suspension of permit to build
Date
DENIAL
Please see the—attached report of deficienc IBS
marked with/LD/Make necessary corrections, to
plans or specifications for compliance with
applicable codes and standards Submit corrected
plans and/or specifications to this office for review
By
By
By
Date
Date
Date
ATTACHMENTS
Grading Permit Application
Grading Permit Checklist
Right-of-Way Permit Application
Right-of-Way Permit Submittal
Checklist and Information Sheet
ENGINEERING DEPT CONTACT PERSON
NAME
City of Carlsbad
ADDRESS 2075 Las Palmas Drive
Carlsbad, CA 92009
PHONE (619)438-1161
2075 Las Palmas Dr • Carlsbad, CA 92009-1576 • (760) 438-1161 • FAX (760) 431-5769
BUILDING PLANCHECK CHECKLIST - POOLS
SITE PLAN
RD/
1 Provide a fully dimensioned site plan drawn to scaje Show
Arrow .^Property Lines
Existing & Proposed Structures /0>Easements
2 Show on site plan
--^Drainage Patterns ^^b^3<-J JS Indicate what will happeri with
Existing & ProposedTSIopes,.^ _^so^ excavated from pool area
Existmg Topography"~T2^— - x^Retainin9 Walls
- - (locatlon and ne'9nt)
-——A/ote /f excavated soil ;s nof roBe removed from property but regraded on
site, show proposed elevations and slopes.
If any portion of retaining walls are over 4' in height, a separate permit is required
Retaining Wall Permit CB _ Applied for _ Approved
>eT Q Q 3 Include on title sheet
Site Address
Assessor's Parcel Number
Description
D Grading Quantities Cut Fill Import/Export
a) If grading is not required, write "No Grading" on plot plan
4 Project does not comply with the following Engineering Conditions of approval
for Project No
Conditions were complied with by Date
GRADING PERMIT REQUIREMENTS
The conditions that invoke the need for grading permit are found in Section 11 06 030
of the Municipal code
5a Inadequate information available on Site Plan to make a determination on
grading requirements Include accurate grading quantities (cut, fill, import,
export)
5b Grading Permit required A separate grading plan prepared by a registered Civil
Engineer must be submitted together with the completed application foim
attached
Note The Grading Permit must be issued and rough grading approval
obtained prior to issuance of a Building Permit
- y.VORD-,DOCS',CHKLST'Pool Building PiancflcCK Ck!ist CHK24 Form BE doc
H ST/ 2ND/ 3RD/
Q Q Q 5c A Grading Permit has been applied for
PE2 DWG
Grading Inspector sign off by Date
5d No Grading Permit requiredt
MISCELLANEOUS PERMITS
6 A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-W&y and/or
private work adjacent to the public Right-of-Way
A separate Right-of-Way issued by the Engineering Department is required
for the following
Please complete attached Right-of-Way application form and return to the
Engineering Department together with the requirements on the attached Right-
of-Way checklist, at the time of resubmittal
Right-of-Way Permit and Pool Building Permit will be issued simultaneously
7 Remarks
-, \v,'3R3'DOCS'iCHKLST'.Po()l Bujdnv.; Plancneck Cklist CHK24 Form BE doc
Walendgs Insurance Services
10525 Vista Sorrento Parkway, Suite 300
San Diego, CA 92121
INSURED
|Future Therapeutics, Inc
,Dba San Diego Pools
JP O Box 304
'Rancho Sante Fe, CA 92067
OF INFORMATION ONLY AND
ONFERS NO RIGHT UPON THE CERTIFICATE HOLDER THIS ( ERTIFICATE
DOES NOT AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES BELOW
~~ '"COMPANIES AFFORDING COVERAGE
COMPANYA Legion Insurance Company
COMPANY
B
COMPANY
C
COMPANY
0
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST ED BELOW HAVE 0£tN ISSUED TO THfc INSURED NAMED ABOVE FOR THE POLlCV F'ERIOD
I INDICA ri-D NOTWIThbTANDING ANY REQUIRCMENT TERM O« CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICAIh MAY BE ISSUED OK MAY PERTAIN THb INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJtCT fO ALL THt 1EKMS
I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
CO
,'lTD TYPE OF INSURANCE
iGENERAL LIABILITY
COMMERCIAL GENERAL (..'ABILITY
CLAIMS MADE I ]oCCU«|
IWNfcH 5 A CONTRACTOR1:. PRO f |
\-AUTOMCBitT LIABILITY
'ANV AUTOS
! ALL OWNED AUT03
SCHEOULCD AUTOS
HIKED AUTOS
NON-OWNED AUIOS
I
GARAGhTJABiLlTY
ANY AUTO
_ J
IABILITY
UMBRFLLA FORM
'OTHER THAM UMBRELLA FORM
WORKERS COMPENSATION AND
i EMPLOYEES LIABILITY
THE PROPRIETOR/
PARTNfcRS/EXECUTIVE
OhFICERSARE
HER"
INCL
EXCL
I
AU POLICY
NUMBER
WC2Q999735
POLICY EFFECTIVE
DATE (MM/DO/YY)
05/05/99
POLICY EXPIRATION
DATE (MM/DO/YY)
05/05/00
•
LIMITS
GENERAL AGGRfcGA F6 J
PRODUC1S-COMP/PO AGG ~|
fFRSONAL & ADV INJURY j
EACH OCCURRENCE |
FIRF DAMAGE (Any on« in)
MED EXP (Any one person)
COMBINED blNGLF LIMIT
BODILY iNJURf '
Per Dflfson)
BODILY INJURY
(Per eccdenl)
PROH6«TY OAWAGC
AUTO C5HLV fcA ACCIDEKT
OTHEfrtTWTMJTO ONLY
tACH ACCIDtNT
A75CRFGAT6"'
EACH OCCUpKbNCE j
AGGREGATE |
— — i
| STATUTORY LIMITS
EACH ACCIDENT $1000.000
DISEASE POLICY LIM.T « 1 .£'00 000
DISEASE EACH EMPLOYEE Si ,000 000
|;
DESCRIPTION OF OPERATIONS/ LOCATIONS/VEHICLBSPECIAL ITEMS
I
CONTRACTORS STATE LICENSE #512408 RE ALL CALIFORNIA OPERATIONS REVISED
CONTRACTORS STATE LICENSE BOARD
'ATTN. WORKER'S COMP UNIT
P O BOX 26000
[SACRAMENTO, CA 95826
SHOULOANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED I
'BEFORE THE EXPIRATION DATE THEREOF, THFJ ISSUING COMPANY i
WILL ENDEVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE |
CERTIFICATE HOLDER NAMED TO THP4.EFT BUT FAILURE TO MAIL '
SUCH NOTICE SHALL IMPOSE NOflfiLTCATlON OR LIABILITY OF ANY
'KINO UPON THE COMPANY ITS ^G^NTS OP- REPRESENTITIVES
AUTHORIZED
REPRESENTATIVE
TO'd 3NI>I O33IQ NVS