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Home My WebLink About2310 CAMINO VIDA ROBLE; ; CB071036; Permit05-02-2007 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No: CB071036 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: Project Title: 2310 CAMINO VIDA ROBLE CBAD Tl Sub Type: INDUST 2130500800 Lot#: 0 $350,000.00 Construction Type: NEW Reference #: ROCKWELL COLLINS 10,000 SF OFFICE REMODEL Applicant: LUND RICHARD STEM 3970 SORRENTO VALLEY RD 92121 619-920-2134 Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: Plan Check#: Owner: R J VIDA ROBLE INVESTORS L L C 2333 STATE ST #200 CARLSBAD CA 92008 ISSUED 04/17/2007 KG 05/02/2007 05/02/2007 Building Permit Aden 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 $1,316.56 Meter Size $0.00 Add'l Reel. Water Con. Fee $855.76 Meter Fee $0.00 SDCWA Fee $0.00 CFD Payoff Fee $73.50 PFF (3105540) SO.OO PFF (4305540) $0.00 License Tax (3104193) $0.00 License Tax (4304193) $0.00 Traffic Impact Fee (3105541) $0.00 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 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $34.00 $60.00 $60.00 $0.00 $0.00 $0.00 $0.00 ?? $2,399.82 Total Fees:$2,399.82 Total Payments To Date:$2,399.82 Balance Due:$0.00 UJILDINGPLA! N 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 She 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 Jees/exactions of which vou have previously been qiven a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired. PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE ONLY PLAN CHECK EST. VAL. Plan Ck. Deposit Validated J3y Date -/*7-£ft4 ' Address (include Bldg/Suite #)Business Name (at this address) Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units Assessor's Parcel #Existing Use Proposed Use Description "ikp -;;^«j»ii:**i:: ;"-Gvt #of Stories of Bedrooms of Bathrooms G3 ;CbntrtQr.::'7:-Qerlt fo^Conttaefto State/Zip Telephone (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 exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1S500J). Name ^ State License # Address License Class City State/Zip City Business License K Telephone # Designer Name State License # Address City State/Zip Telephone , > ///O/O iOMW8N»«noi|^:;: •.:!•';:-=,=:.- .•••..; •• :,•:•'-'.'..-.:. . .-.;... :...':. •'.".- : ' '-, V: V-•'•• ',"•.-••.,':.- 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. 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 Jed. My worker's compensation insurance carrier and policy number are: Insurance Company —^l^Q^l 6^. p~O*'j_) Policy No. /(pV /fl (aT^xiriin^flp Expiration Date (THIS SECTION NEED 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 lo secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollap (>4pO,Q(_liy, in addirVm to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. "N/ SIGNATURE //V\fy*-J' "j£^&* DATE 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason: O 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, n YES QNO 2. 1 (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 NO 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 Is the facility to be constructed within 1 ,000 feet of the outer boundary of a school site? Q] YES Q 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. $jj£;P8!fi^^ ..'..'. -'!' :••'•;:'; -'':' •' ' . ..'".- • • :- . / •-•;"'• y ' -• . ••'• 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 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. \ ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued by the building Official under the provisions of this Code shall expire by limitation and become null and void if the building 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 corrjniencedJor a perJo^of 180 days (Saetlon 106.4.4 Uniform Building Code). l*^ ezZ-—--~ -^^ (. DATEAPPLICANT'S SIGNATURE WHITE: File YELLOW: Applicant PINK: Finance City of Carlsbad Final Building Inspection Dept: Building Engineering Planning CMWD St Lite Plan Check #: Permit #: Project Name: Address: Contact Person: Sewer Dist; Inspected ji Bv: /6 Inspected Bv: Inspected Bv: Comments: CB071036 ROCKWELL COLLINS 10,000 SF OFFICE REMODEL 2310CAMINOVIDAROBLE DON Phone: 7608013408 CA Water Dist: CA <T / L Date / I -\3&ie**5*t*<z Inspected: CP//^ [^ 1 Date Inspected: Date Inspected: Date: Permit Type: Sub Type: Lot: 0 f Approved: *^ Approved: Approved: 06/15/2007 Tl INDUST Disapproved: Disapproved: Disapproved: UNSCHEDULED BUILDING INSPECTION DATE Tx/un INSPECTOR PERMIT # i \O-\L- PLAN CHECK # JOB ADDRESS DESCRIPTION CODE DESCRIPTION ACT COMMENTS Inspection List Permit*: CB071036 Type: Tl Date Inspection Item 07/03/2007 89 07/02/2007 89 06/29/2007 89 06/29/2007 89 06/21/2007 89 06/21/2007 89 06/15/200789 06/15/200792 06/14/2007 34 06/14/2007 97 06/08/2007 14 06/08/2007 84 06/06/2007 14 06/06/2007 34 06/06/2007 44 05/17/2007 17 05/14/2007 14 05/14/2007 24 05/14/2007 34 05/04/2007 44 Final Combo Final Combo Final Combo Final Combo Final Combo Final Combo Final Combo Compliance Investigation Rough Electric T-24 H-Cap Consultation Frame/Steel/Bolting/Weldin Rough Combo Frame/Steel/Bolting/Weldin Rough Electric Rough/Ducts/Dampers Interior Lath/Drywall Frame/Steel/Bolting/Weldin Rough/Topout Rough Electric Rough/Ducts/Dampers INDUST Inspector Act - TP - TP - TP TP TP TP TP RB RB TP TP TP TP RB RB RB TP Rl AP Rl CA Rl CO NR PI CO PI AP AP PA AP AP AP AP AP AP AP ROCKWELL COLLINS 10,000 SF OFFICE REMODEL Comments N/COMP OK TO OCCUPY SITE ACC. ? NEED REV. S/LN CONF. DRAFT STOP T-BAR SYSTEM T-CEIL CEIL LITES DUCTS WALLS ONLY WALLS ONLY DUCT PRE-WRAP Tuesday, July 03, 2007 Page 1 of 1 -*. EsGil Corporation In Partnership witfi government for Quitting Safety DATE: 4/27/07 JURISDICTION: City of Carlsbad PLAN CHECK NO.: 07-1036 SET: I PROJECT ADDRESS: 2310 Camino Vida Roble PROJECT NAME: Rockwell Collins - TI OPJ-ICANT Q PLAN REVIEWER Q FILE The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. X] The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified in the remarks below are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil 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 contacted: Date contacted: Mail Telephone Telephone #: (by: ) Fax In Person X] REMARKS: Applicant shall attach the add notes in red on sheets TS-1 an By: Doug Moody Esgil Corporationn GA n MB t rlsbacTRoof Mounted Policies to the plans and EJ n PC Enclosures: 4/19/07 9320 Chesapeake Drive, Suite 203 + San Diego, California 92123 + (858)560-1468 * Fax (858)560-1576 City of Carlsbad O7-1036 .4/27/07. VALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PLAN CHECK NO.: 07-1O36 PREPARED BY: Doug Moody DATE: 4/27/07 BUILDING ADDRESS: 2310 Camino Vida Roble BUILDING OCCUPANCY: B TYPE OF CONSTRUCTION: UN BUILDING PORTION Tl Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code AREA ( Sq. Ft.) 10000 cb Valuation Multiplier 34.37 By Ordinance Reg. Mod. VALUE (S) 343,700 343,700 $1,298.08 Plan Check Fee by Ordinance Type of Review: G Repetitive Fee Repeats Complete Review D Other i—i Hourly Structural Only Hour Esgil Plan Review Fee $843.75 $726.92 Comments: Sheet 1 of 1 macvalue.doc PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB ADDRESS DATE Y I RESIDENTIAL RESIDENTIAL ADDITION MINOR (<$10,000.00) TENANT IMPROVEMENT PLAZA CAMINO REAL CARLSBAD COMPANY STORES VILLAGE FAIRE COMPLETE OFFICE BUILDING OTHER PLANNER ENGINEER DATE DATE . . -O O O PLANNING DEPARTMENT BUILDING PLAN CHECK REVIEW CHECKLIST Plan Check No. CB 071036 Address: Planner: Jo Marauez APN: 213-050-08-00 2310CaminoVidaRoble Phone:(760) 602-4619 Tt .Net Project Density:Type of Project & Usei Zoning: P-M _General Plan: PI Facilities Management Zone: CFD (in/out) # Date of participation: Circle One DU/AC Remaining net dev acres: (For non-residential development: Type of land used created by this permit:, DD D Legend: ^ Item Complete Environmental Review Required: DATE OF COMPLETION: )ltem Incomplete - Needs your action YES NO X TYPE Compliance with conditions of approval? If not, state conditions which require action. Conditions of Approval: Discretionary Action Required: APPROVAL/RESO. NO. PROJECT NO. YES NO X TYPE DATE OTHER RELATED CASES: Compliance with conditions or approval? If not, state conditions which require action. Conditions of Approval:^ D D D Coastal Zone Assessment/Compliance Project site located in Coastal Zone? YES. CA Coastal Commission Authority? YES_ NO NO X 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): NO X Habitat Management Plan Data Entry Completed? YES _ If property has Habitat Type identified in Table 11 of HMP, complete HMP Permit application and assess fees in Permits Plus (A/P/Ds, Activity Maintenance, enter CB#, toolbar, Screens, HMP Fees, Enter Acres of Habitat Type impacted/taken, UPDATE!) i 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!) H:\ADMIN\COUNTER\BldgP1nchkRevCnklst Rev 3/06 Site Plan: 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). Provide legal description of property and assessor's parcel number. Policy 44 - Neighborhood Architectural Design Guidelines D D 1- Applicability: YES NO ___ D D 2. Project complies YES NO D D D Zoning: 1. Setbacks: Front: Interior Side: Street Side: Rear: Top of slope: Required Required Required Required Required 2. Accessory structure setbacks: Front: Required Interior Side: Required Street Side: Required Rear: Required Structure separation: Required Shown Shown Shown _Shown Shown Shown Shown Shown Shown Shown D D 3. Lot Coverage:Required Shown D D 4. Height:Required Shown 5. Parking:Spaces Required Shown (breakdown by uses for commercial and industrial projects required) Residential Guest Spaces Required Shown Additional Comments: Correction #1- Please show on Title Sheet or Mechanical Plan that all AC units and ducts will be covered by the parapet and will not be seen from a distance of 500 ft. I have attached an example of equipment screening for your perusal, thank you. OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTE H:\ADM1N\COUNTER\BldgPlnchkRevChklst Rev 3/06 Carlsbad Fire Department BLDG. DEPT COPY Plan Review Requirements Category: TI, INDUST Date of Report: 04-19-2007 Reviewe Name: Address: Permit #: CB071036 Job Name: ROCKWELL COLLINS 10,000 SF Job Address: 2310 CAMINO VIDA ROBLE CBAD have submitted for review is ii adequately conduct a review to )t _ _ _ and/or standards. Please review a11 ^SflHiPHi'to'RH'ini1 11 I'll i i resubmit the necessary plans ana/or specitical :ice for review and approval. Conditions: Cond:CON0002012 [MET] APPROVED: THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUEANCE OF A BUILDING PERMIT. THIS APPROVAL IS SUBJECT TO FIELD INSPECTIONS, ANY REQUIRED TESTS, FIRE DEPARTMENT NOTATIONS, CONDITIONS IN CORRESPONDENCE AND COMPLIANCE WITH ALL APPLICABLE CODES AND REGULATIONS. THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE ANY VIOLATION OF THE LAW. Entry: 04/19/2007 By: MS Action: AP SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY UPFP* HV# BP DATE Business Name _ / zfe^-^^/f Lj£>//f*t5 Project Address "2-5 /0 &$#%//& £/#&fe? t Mailing Address x\ Project Contact Business Contact , / City / L / City Telephone # State Zip Code State Zip Code APN# Plan File* Telephone # The following questions represent the facility's activities, NOT the specific project description^ PART I: FIRE DEPARTMENT - HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: Indicate by circling the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are circled, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. 9.1. Explosive or Blasting Agents 2. Compressed Gases 3. Flammable/Combustible Liquids 4. Flammable Solids 5. Organic Peroxides 6. Oxidizers 7. Pyrophorics 8. Unstable Reactives Water Reactives 10. Cryogenics 11. Highly Toxic or Toxic Materials 12. Radioactives 13. Corrosives 14. Other Health Hazards 15. None of These. PART II: SAN DIECO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISIONS fHMPi: If the answer to any of the questions is yes, applicant must contact theCounty of San Diego Hazardous MaterialsDivision, 1255 Imperial Avenue, 3™ floor, San Diego, CA 92101. Call (619) 338-2222 prior to the issuance of a building permit. FEES ARE R YES 1. D 2. D 3. D 4. 'n 5. D 6. D EQUIRED. . Expected Date of Occupancy: / / NO 3 Is your business listed on the reverse side of this form? (check all that apply). 3 Will your business dispose of Hazardous Substances or Medical Waste in any amount? 3 Will your business store or handle Hazardous Substances in quantities equal to or greater than 55 gallons, 500 pounds, 200 cubic feet, or carcinogens/reproductive toxins in any quantity? "3- Will your business use an existing or install an underground storage tank? S- Will your business store or handle Regulated Substances (CalARP)? ^ Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? D CalARP Exempt / Date Initials D CalARP Required / Date Initials n CalARP Complete / Date Initials PART III: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT: If the answer to any of the questions below is yes, applicant must contact the Air Pollution Control District (APCD), 10124 Old Grove Road, San Diego, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition permit. Note: if the answer to questions 3 or 4 is yes, applicant must also submit an asbestos notification form to the APCD at least 10 working days prior to commencing demolition or renovation, except demolition or renovation of residential structures of four units or less. Contact the APCD for more information. 1. YES D NO 2. a D na Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the APCD factsheet at http://www.sdapcd.orq/info/facts/permits.pdf, and the list of typical equipment requiring an APCD permit on the reverse side of this from. Contact APCD if you have any questions). (ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 1,000 feet of the outer boundary of a school {K through 12)? {Public and private schools may be found after search of the California School Directory at http://www.cde.ca.gov/re/sd/: or contact the appropriate school district). Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos? Will there be demolition involving the removal of a load supporting structural member? Briefly describe business activities: /kr/*Mi7~fr« Briefly describe proposed project: I declare under penalty of^erjury that tO'trie best of my knowledge and faelieftheyresponseymade herein are true afid correctnseyrru Name of owner or Authorized Agent rutrafTc Signature of Owner or Authorized Agent-Date FOR OFF1CAL USE ONLY:FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:. BY: „DATE: EXEMPT OR NO FURTHER INFORMATION REQUIREO COUNTY-HMD APCD RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY COUNTY-HMD APCD RELEASED FOR OCCUPANCY COUNTY-HMD APCD HM-9171 (08/06)County of San Diego - DEH - Hazardous Materials Division ROYA CONSTRtfiC7>pN, INC May 02, 2007 City of Carlsbad 1635 Faraday Ave. Carlsbad, CA 92008 RE: Luxtera: located 2320 Camino Vida Roble Rockwell Collins: 2310 Camino Vida Roble To Whom It May Concern: Please consider this letter to be authorization for Dick Lund and or Mike Day, to pull permits under California State License #686410 and City of Carlsbad License #B 1201892 on behalf of Royal Pacific Construction Inc. for the above referenced projects. Rick Day, President Royal Pacific Construction, Inc. Workers Compensation - State Fund-Policy #1647864-2006 Expires 9/10/07 California License #B686410 4011 Avenida de la Plata, Suite 301 • Oceanside • California 92056 Phone (760) 421-4000 • Fax (760) 421-1560 CALIC. B686410 POLICYHOLDER COPY SD COMPENSATION INSURANCE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: O9-10-2006 GROUP: POLICY NUMBER: 1647864-2006 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 09-10-20O7 09-10-20O6/09-10-20O7 CONTRACTORS STATE LICENSE BOARD WORKERS COMPENSATION UNIT P 0 BOX 260OO SACRAMENTO CA 95826 SD LICENSE NUMBER:#686410 INCEPTION DATE:09-10-2OO6 DO:SD 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 ^Q days advance written notice to the employer. We will also give you ^Q 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 policy 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 to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. JTHORIZED REPRES£NTATI\ EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: PRESIDENT $1,000,000 PER OCCURRENCE EMPLOYER ROYAL PACIFIC CONSTRUCTION, INC DBA:ROYAL PACIFIC CONSTRUCTION, INC 4011 AVENIDA DE LA PLATA STE 301 OCEANSIDE CA 92056 /.2-05) SD M041O PRINTED 08-17-2006 I his WX1M&t i" HAS A TRUE DEFENSA™ WATERMARK AND VISIBLE FIBERS DISCERNIBUr ?=POM BOTH SIDES CITY OF CARLbBAD BUSfNESS REGISTRATION CERTIFICATEBUS. NUMBER 1201892 DATE ISSUED 8/22/2006 SIC CODE 15 OWNER FIRM OR :OflPO^ATION NAME BUSINESS NAME MAILING ADDRESS CITY AND STATE BUSINESS LOCATION 5245 AVENIDA ENC1NAS STE F S!C DESCRIPTION Building Construction-Genera! Building Contrac EXPIRATION DATE 8/31/2007 ROYAL PACIFIC CONSTRUCTION, INC. ROYAL PACIFIC CONSTRUCTION, INC. 4011 AVENIDA DE LA PLATA # 301 OCEANSIDE, CA 92056-5802 THIS DOCUMENT IS ALTERATION PROTECTED AND REFLECTS FLUORESCENT FIBERS UNDER UV LIGHT silEtiS£§£<.? «^=i"5s *i * i. \^i)- .< COo u, LU o: —sis 68E.Socr OH -3