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Home My WebLink About2375 CAMINO VIDA ROBLE; B; CB051693; Permit06-03-2005 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No: CB051693 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: Project Title: Applicant: NE CHAPO 2375 CAMINO VIDA ROBLE CBAD St: B Tl Sub Type: 2130502700 Lot #: $234,856.00 Construction Type: Reference #: PHOTOMEDEX-7576 SF OFFICE TO OFFICE INDUST 0 VN Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: Plan Check#: ISSUED 05/13/2005 RMA 06/03/2005 06/03/2005 ,760 634-3636 4 Owner: WELLS FARGO BANK TR P O BOX 63700 SAN FRANCISCO CA 94163 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 $962.36 Meter Size $0.00 Add'l Reel. Water Con. Fee $625.53 Meter Fee $0.00 SDCWA Fee $0.00 CFD Payoff Fee $49.32 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 $76.00 $110.00 $77.00 $0.00 $0.00 $0.00 $0.00 $1,900.21 Total Fees:$1,900.21 Total Payments To Date:$625.54 Balance Due:$1,274.67 BUILDING PLAN, IN STORAGE ATTACHED 978? 06/03/05 0002 01 02 COP 12?4"6i Inspector: FINAL APPROVA.APPROVAU/*//s/.r 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 1o 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 BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE ONLY PLAN CHECKNO. EST. VAL. ot Plan Ck. Deposit Validated By Date 5llJ/0' Address (include ite t 1 1 /N *vviQfr Business Name (at this addre Legal Description ot SubdivisJaruNameiNumberivisjon-Namert"*Unit No.Phase No. Total # fTGRAssessor's Pare Existing Use Proposed Use Description of Work SO. FT.#of Stories QMS" # of Bedrooms # of Bathrooms Name Address City 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 emption. 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 [S500]}. Name State License tf &O S ^ ^\ Address License Class (3 City State/Zip City Business License # \ /— Telephone #i x U t?%\ A^.O 0 Designer Name State License # Address City State/Zip Telephone 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. [J 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 _ Policy No. _ 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 to secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars tIQD.OOOl. in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. " DATE £ - 3 ~ & 5 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). Q 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). Q 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 QNO 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 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 CD 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. 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 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 for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every permit issued authorized by such permit is not co at any time after the work is comm APPLICANT'S SIGNATURE the building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work ,ed*vithin 180 days from the date of such permit or if the building or work authorized by such permit is suspended or abandoned "' period of 180 days {Section 106.4.4 Uniform Building Code). oATE WHITE: File YELLOW: Applicant PINK: Finance GItyifCirlsbad Final Building Insnection Dept: Building Engineering Planning CMWD St Lite Utee Plan Check #: Permit*: CB051693 Project Name: PHOTO ME DEX-7576 SF OFFICE TO OFFICE Address: 2375 CAMINO Contact Person: KEITH Sewer Dist: CA Inspected , A Bv: ^(_ /*« «4 I&*V\ Inspected Bv: Inspected Bv: VIDAROBLE #B Phone: 8585255264 Water Dist: CA Date 1 \ Inspected: 7//$-/tf5 Date Inspected: Date Inspected: Date: Permit Type; Sub Type: Lot: 0 Approved: ^^ Approved: Approved: 07/18/2005 Tl INDUST Disapproved: Disapproved: Disapproved: Comments: City of Carlsbad Bldg Inspection Request For: 10/12/2005 Permit* CB051693 Title: PHOTOMEDEX-7576 SF OFFICE TO Description: OFFICE Inspector Assignment: TP Type: Tl Job Address: Suite: Location: APPLICANT GENECHAPO Owner: Remarks: Total Time: Sub Type: INDUST 2375 CAMINO VIDA ROBLE B Lot 0 CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Phone: 8585255264 Inspector: Requested By: KEITH Entered By: CHRISTINE Act Comment Associated PCRs/CVs Inspection History Date 07/18/2005 07/14/2005 07/14/2005 07/14/2005 07/14/2005 07/13/2005 07/12/2005 07/12/2005 06/15/2005 06/15/2005 06/13/2005 06/08/2005 06/08/2005 06/07/2005 06/07/2005 06/07/2005 Description 89 14 24 34 44 84 14 34 24 34 17 14 34 14 24 34 Final Combo Frame/Steel/Bolting/Welding Rough/Topout Rough Electric Rough/Ducts/Dampers Rough Combo Fram e/Steel/Bolting/Welding Rough Electric Rough/Topout Rough Electric Interior Lath/Drywall Frame/Steel/Bolting/Welding Rough Electric Frame/Steel/Bolting/Welding Rough/Topout Rough Electric Act CO AP we AP AP CO NR NR AP AP NR AP AP CO AP CO Insp TP TP TP TP TP RB TP TP TP TP TP TP TP TP TP TP Comments NOTICE ATTCH T-CEILRM116, CEILLITES116, DUCTS RM 11 6, 123 123 123 SEE NOTICE ATTACHED T-CEIL CEIL LITES NOT COMP. DMZ WALL LOW WALLS C/O SECT/ City of Carlsbad Bldg Inspection Request For: 07/18/2005 Permit* CB051693 Title: PHOTOMEDEX-7576 SF OFFICE TO Description: OFFICE Inspector Assignment: TP Type: Tl Job Address: Suite: Location: APPLICANT GENECHAPO Owner: Remarks: Sub Type: INDUS! 2375 CAMINOVIDAROBLE B Lot 0 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 History Date Description Act Insp 07/14/2005 14 Frame/Steel/Bolting/Welding AP TP 07/14/2005 24 Rough/Topout WC TP 07/14/2005 34 Rough Electric AP TP 07/14/2005 44 Rough/Ducts/Dampers AP TP 07/13/2005 84 Rough Combo CO RB 07/12/2005 14 Frame/Steel/Bolting/Welding NR TP 07/12/2005 34 Rough Electric NR TP 06/15/2005 24 Rough/Topout AP TP 06/15/2005 34 Rough Electric AP TP 06/13/2005 17 Interior Lath/Drywall NR TP 06/08/2005 14 Frame/Steel/Bolting/Welding AP TP 06/08/2005 34 Rough Electric AP TP 06/07/2005 14 Frame/Steel/Bolting/Welding CO TP 06/07/2005 24 Rough/TopOUt AP TP 06/07/2005 34 Rough Electric CO TP 06/07/2005 44 Rough/Ducts/Dampers WC TP Comments T-CEILRM116, 123 CEILLITES116, 123 DUCTS RM 116, 123 SEE NOTICE ATTACHED T-CEIL CEIL LITES NOT COMP. DMZ WALL LOW WALLS C/O SECT/ CITY OF CARLSBAD BUILDING DEPARTMENT DATE. LOGATIO& PERMIT NO. (760) 602-2700 1635 FARADAY AVENUE TIME C/C Jl ttdfl FOR INSPECTION CAU (760) 602-2725. RE-INSPECTION FEE DUE?YES FOR FURTHER INFORMATION, CONTACT ;. ----PHONE BtHLKNG INSPECTOR CODE ENFORCEMENT OFFICER City of Carlsbad Bldg Inspection Request For: 07/13/2005 Permit# CB051693 Title: PHOTOMEDEX-7576 SF OFFICE TO Description: OFFICE Inspector Assignment: TP 2375 CAMINO VIDA ROBLE B Lot 0 Type: Tl Job Address: Suite: Location: APPLICANT GENECHAPO Owner: Remarks: CEILING INSPECTION Total Time: Sub Type: INDUST Phone: 8585255264 Inspector: Requested By: KEITH Entered By: CHRISTINE CD Description Act Comment 14 Frame/Steel/Bolting/Welding 24 Rough/Topout 34 Rough Electric 44 Rough/Ducts/Dampers Associated PCRs/CVs Date 07/12/2005 07/12/2005 06/15/2005 06/15/2005 06/13/2005 06/08/2005 06/08/2005 06/07/2005 06/07/2005 06/07/2005 06/07/2005 06/06/2005 06/06/2005 06/06/2005 Inspection History Description 14 34 24 34 17 14 34 14 24 34 44 14 21 24 Frame/Steel/Bolting/Welding Rough Electric Rough/Topout Rough Electric Interior Lath/Drywall Frame/Steel/Bolting/Welding Rough Electric Frame/Steel/Bolting/Welding Rough/Topout Rough Electric Rough/Ducts/Dampers Frame/Steel/Bolting/Welding Underground/Under Floor Rough/Topout Act NR NR AP AP NR AP AP CO AP CO we NR AP we Insp TP TP TP TP TP TP TP TP TP TP TP TP TP TP Comments T-CEIL CEIL LITES DMZ WALL NOT COMP, LOW WALLS C/0 SECT/ N/INCL 4IN C/O SECT. NOTICECITY OF CARLSBAD (760) 602-2700 BUILDING DEPARTMENT 1635 FARADAY AVENUE DATE "7 _ *~ f $ ~& S" TIME _ LOCATION PERMIT NO. /\A1 yf.£ crJsaux^cx «~ /* v- FOR INSPECTION CALL (760) 602-2725- RE-INSPECTION FEE DUE? LJ YES FOR FURTHER INFORMATION, CONTACT PHONE BUILDING irmrs^Tsa' _ M CODE ENFORCEMENT OFFICER City of Carlsbad Bldg Inspection Request For: 06/07/2005 Permit# CB051693 Title: PHOTOMEDEX-7576 SF OFFICE TO Description: OFFICE 2375 CAMINO VIDA ROBLE B Lot 0 Type:TI Sub Type: INDUS! Job Address: Suite: Location: OWNER WELLS FARGO BANK TR Owner: Remarks: Total Time: CD Description Act Comment 14 Frame/Steel/Bolting/Welding 24 Rough/Topout 34 Rough Electric 44 Rough/Ducts/Dampers Inspector Assignment; TP Phone: 8585255264 Inspector: Requested By: KEITH Entered By: CHRISTINE Associated PCRs/CVs Inspection History Date Description Act Insp Comments CITY OF CARLSBAD BUILDING DEPARTMENT DATE. LOCATION PERMIT NO. E (760) 602-2700 1635 FARADAY AVENUE TIME. J /g -i- FOR INSPECTION CALL (760) 602-2725, RE^NSPECTION FEE DUE? FOR FURTNERJJslFeRWffrCJN, CONTACT .-£0Z ^^ - • *^ YES PHONE BUILDING INSPECTOR CODE ENFORCEMENT OFFICER I EsGil Corporation In Partnership with government for(Building Safety DATE: May 27, 2O05 JURISDICTION: City of Carlsbad PLAN CHECK NO.: 05-1693 SET: I PROJECT ADDRESS: 2375 Camino Vida Roble, Suite B PROJECT NAME: Tenant Improvement for Photomedex a APLCANT PEAlTREViEWER Q 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. 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: 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: Telephone #: Date contacted: (by: ) Fax #: Mail Telephone Fax In Person REMARKS: By: Edward Wilczak Esgil Corporation D GA D MB D EJ D PC Enclosures: May 17, 2005 tmsmtl.dot 9320 Chesapeake Drive, Suite 208 * San Diego, California 92123 * (858)560-1468 + Fax (858) 560-1576 City of Carlsbad 05-1693 May 27, 2005 VALUATION AND PLAN CHECK FEE JURISDICTION: City of Carlsbad PLAN CHECK NO.: O5-1693 PREPARED BY: Edward Wilczak DATE: May 27, 2005 BUILDING ADDRESS: 2375 Camino Vida Roble, Suite B BUILDING OCCUPANCY: TYPE OF CONSTRUCTION: BUILDING PORTION Ten. Improvmnt. Air Conditioning Fire Sprinklers TOTAL VALUE Jurisdiction Code AREA ( Sq. Ft.) 7576 CB Valuation Multiplier 31.00 By Ordinance Reg. Mod. VALUE ($) 234,856 234,856 $962.36 1994 UBC Plan Check Fee Type of Review: C] Repetitive Fee ^1 Repeats Comments: Complete Review D Other . Hourly Structural Only Hour Esgil Plan Review Fee $625.53 $538.92 Sheet of macvalue.doc PLANNING/ENGINEERING APPROVALS PERMIT NUMBER ADDRESS ga f&6J3 DATE / * RESIDENTIAL ;. -RESIDENTIAL ADDITION MINOR << $1O,OOO.OO) TENANT IMPROVEMENT PLAZA CAMINOREAC CARtSBAD COMPANY STORES VILLAGE FAIRE COMPLETE OFFICE,BUILDING OTHER PLANNER DATC ENGINEER DATE 5^7/05 ODD D D D D D D PLANNING DEPARTMENT BUILDING PLAN CHECK REVIEW CHECKLIST Plan Check No. CB Planner APN: Address Greg Fisher Phone (7601 602-4629 Type of Project & Use: (J -ftJT**-^-- Net Project Density: Zoning: ft//"/ General Plan: ujs Facilities Management Zone: DU/AC CFD (in/out) #_Date of participation:Remaining net dev acres: Circle One {For non-residential development: Type of land used created by this permit: Legend: ^ Item Complete Environmental Review Required: DATE OF COMPLETION: Item Incom YES fe - Needs your action TYPE Compliance with conditions of aj Conditions of Approval: oval? tf not, state conditions which require action. YES NO TYPE DATE -ATED CASES: Discretionary Action APPROVAL/RESCVNO. PROJECT Nl OTHER Cora51iance with conditions or approval? If not, state conditions which require action. Jonditions of Approval: — —_ Coastal Zone Assessment/Compliance Project site located in Coastal Zone? YJ CA Coastal Commission AuthorityT^YES NO If California Coastal Commtssitfn Authority: Contact them at - 7575 Metropolitan Drive, Suite 103, San Diego CA 921P#4402; (619) 767-2370 Determine status (Coaital Permit Required or Exempt): Coastal Permit Determination Form already completed? YES_ If NO, complete Coastal Permit Determination Form now. Coastal Permit Determination Log #: NO >w-Up Actions: 1) Stamp Building Plans as "Exermjt?--oT''Coastal Permit Required" (at minimum Floor Plans). 2) Complete Coastal Permit Dfi*emrii nation Log as needed. ODD Inclusionary Housing E«B required: YES NO (Effective date ofjrfclusionary Housing Ordinance - May 21, 1993.) Data Entry/Completed? YES NO (A/P/Dja^Activity Maintenance, enter CB#, toolbar, Screens, Housing Fees, Construct Housing Y/N/Enter Fee, UPDATE!) H:\ADMIN\COUNTER\BldgPlnchkRevChklst Rev 9/01 D DD Site Plan: 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). Provide legal description of property ancKassessor's parcel number. Required Requited Requireo\ Required \ Reauired \ Shown Shown Shown Shown Shown 2. Accessory structure setbacks: Policy 44X Neighborhood Architectural Design Guidelines 1. Applicability: YES 2. Project complieXYES /NO ODD D D D Zoning: 1. Setbacks: Front: Interior Side: Street Side: Rear: Top of srope: Front: iterior Side: Street Side: Rear: Structure separation: 3. Lot Coverage: Required Required Required Required Required Required Required 5. Parking: (brea Residential Guest Spaces Required Shown own Shown Show Shown paces Require pwnjjy-uSes for commercial and industrial projects required) Shown Additional Comments Correction #1 - Please show on Sheet 1 the total number of parking spaces provided and required on site for each use per Chapter 21.44. Correction #2 - Is there any proposed roof mounted equipment associated with this building permit? If so. will the equipment be screened bv an existing parapet wall or is new screening material required? Please see the attached handouts for examples. .^^__ OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER DATE H:\ADMIN\COUNTER\BldgPlnchkRevChklst Rev 9/01 Carlsbad Fire Department 051693 1635 Faraday Ave. Carlsbad,'CA 92008 Plan Review Requirements Category: Date of Report: 05/19/2005 Fire Prevention (760) 602-4660 Building Plan Reviewed by: Name: Address: City, State: CHAPO& HALL ARCH. P.O. Box 687 Cardiff By the Sea CA 92007 Plan Checker: Job Name: Job Address: Job#; 051693 Photomedex 2375 Camino Vida Roble Bldg #: CB051693 Ste. or Bldg. No. B 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. D Approved Subject to The item you have submitted for review has been approved subject to the attached conditions. The approval is based on plans, information and/or specifications provided in your submittal. Please review carefully all comments attached, as failure to comply with instructions in this report can result in suspension of permit to construct or install improvements. Please resubmit to this office the necessary plans and / or specifications required to indicate compliance with applicable codes and standards. D Incomplete The item you have submitted for review is incomplete. At this time, this office cannot adequately conduct a review to determine compliance with the applicable codes and / or standards. Please review carefully all comments attached. Please resubmit the necessary plans and / or specifications to this office for review and approval. Review FD Job # 1st 9nH 3rd 051693 FDFile# Othf^r Agpnry ID E I >3 W 1 O Oo o00 o-sio Sc2S COPoo 10-XV oO1 5D COMPENSATION N SURANCE POLICYHOLDER COPY P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 FUND ISSUE DATE: CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 11-O1-2O04 GROUP: POLICY NUMBER: CERTIFICATE ID; PRENTISS PROPERTIES MANAGEMENT LP 706 PALOMAR AIRPORT RD STE 320 CARLSBAD CA 92009 1215362-2004 287 CERTIFICATE EXPIRES: 11-01-200511-01-2O04/11-01-2OO5 JOB: NTN COMMUNICATIONS 5966 LA PLACE COURT #1OO CARLSBAD CA 92OO8 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 documentwith 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 ,OOO,OOO.OO PER OCCURRENCE. ENDORSEMENT #2O65 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 11-01-20O4 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 EV.3-03)PRiNTED:PQ410