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HomeMy WebLinkAbout2500 EL CAMINO REAL; ; CB072019; Permit07-31-2007 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Demolition Permit Permit No CB072019 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Occupancy Group 07/31/2007 # Dwelling Units Bedrooms Project Title 2500 EL CAMINO REAL CBAD DEMO 1670303200 Full Demo Y Lot* 0 Reference # CB062631 0 Structure Type 0 Bathrooms CHEVRON- DEMO EXISTING BLDG (2,072 SF) AND CANOPY Status ISSUED Applied 07/31/2007 Entered By LSM Plan Approved Issued 07/31/2007 Inspect Area Applicant SPENCER & JONES 398 NORTH 10THST COLTON CA 92324 909 825 4624 Owner KELLY RICHARD C TR&KELLY ROBERT P TR C/O CHEVRON TEXACO PROPERTY TAX D PO BOX 1392 BAKERSFIELD CA 93302 Building Permit Plumbing Fee Other Fee Additional Fees TOTAL PERMIT FEES $2000 $000 $4000 $000 $6000 Total Fees $60 00 Total Payments To Date $60 00 Balance Due $000 Inspector FINAL APPROVAL Date Clearance NOTICE Please take NOTICE that approval of your project includes the "Imposition1 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 760-602-2717 / 2718 / 2719 Fax 760602-8558 Building Permit Application Plan Check No (2£Q7 PQ l9 Est Value Plan Ck. Deposit Date 7/&t\Q'-7 ' JOB ADDRESS 25IC'f/PROJECf i 'SUirE»,-'SP4CE*'UNITd DESCRIPTION OF WORK T6T *V OF UMTS "BEDROOMS C BATHROOMS TENANT BUSINESS NAME COMSTR TYPE OCC GROUP EXISTING USECh&ircn PROPOSED USE GARAGE (SF> PATIOS (SF-) DECKS (SF)FIREPLACE YES O #NOD AIR CONDITIONING YES D NO D FIRE SPRINKLERS YES D NO D i CONTACT NAME (If Different Fom Applicant) ADDRESS CITY STATE ADDRESS2V01 ZIP • PHONE ' FAX EMAIL s*»t>0cejjbr & r PROPERTY OWNER NAME 'ADDRESS ' C'TY PHONE EMAIL STATE ""FAX ZIP AHC'l.'DESIGNERNtMFA ADDRESS STATE L1C # EMAIL STATE LIC #CLASS qpocjg/fag int lor such perminoie VswW1(Sec 7031 S 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 lor such permirtcrffle VsTfRntttatement that he islicensed 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 ofSection (0315 by any applicant for a permit subjects tne applicant to a cml penalty of not more than five hundred dollars {$500}) Workers Compensation Declaration / 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 ^SCI have and will maintain workers' frompjnsatiojr as required by Section 3700 of the Labor Code for the performancejf thei work for which this permi^ issued My workers compensation insurance carrier and policy number are Insurance Co _*Sjf&f£ "T^/j^L^" Policy No ML//55> /P* *>ODO Expiration Date __t*_£s/_*_&_J^ This section need not be completed if the permit is for one hundred dollars ($100) or less O Certificate of Exemption I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws of California WARNING Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100 000), in addition to the cost of compensate damages as provided fjr in Section 3706j>f the Labor code, interest and attorney's fees DATE hwhy affirm that I am exempt from Contractor s License Law for the following reason 1 as owner of the property or my employees with wages as their sole compensation w\\\ rlo the work and tne structure is not intended or offered for sale (Sec 70M Business and Professions Code The Contractors License Law does not apply to an owner of property who builds or improves thereon and who does such work "vmself or through his own employees provided that such imorovements are not intended or offered for sate If however the building or improvement is sold within one year of completion the owner huilde' wli have the burden of proving that he did not build or improve for the purpose of sale) I as owner of the properly am exclusively contracting with licensed contractors to const'ucl the proiecl (Sec 7044 Business and Professions Code The Contractor pi. icnnsc Law does not apply to an owner o' properly who builds 0' improver- thereon and contracts for such projects wilh contractors) licensed pursuant to thn Contractor s L'cense Law) i am exempt under Section . Business and Professions Code for this reason 1 I personally plan to provide the major labor and materials for construction of the proposed propn-ty 'mprovRrent G Yp$ n No 2 I (have / have not) signed an apphcalion for a bui'dmg permit for the proposed work 3 I have contfar.ted win the following person (firm) to provide the prooosed construction (include name addiess / 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 / con'-'actors hcense number) 5 I will p.^vin1" some cf the work hut 1 h.qve ••"Ontractod (hired) th? fo'lowmn pnr^r-n" '^ provide the wivi/ ndir-qter) (include name / addrpss •' phono / typn of wori<) PROPERTY OWNER SIGNATURE DATE ,s«is- .ari'ti* r Is the applicant or future building occupant required to sutw! a business plan acutely hazardous materials registration form or usk management and prevention program under Sections 25505 25533 or 25534 of the Presley Tanner Hazardous Substance Account Act' O Yes D No Is the aoolicanl or future building occupant rerju'red to obtain a permit from the air pollul'on control district or air quality management district' C1 Yes n No Is the facility lo he constructed wilhm 1 000 feet of (no outer boundary of a school site? D Yes D Wo EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT 1 hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec 3097 (i) Civil Code) Lenders Name Lenders Address mazmxmf^. 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 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 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 authonzed by such permit is not commenced within 1 80 days from the date of such permit or if the bAlding or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 1 80 days (Section 106 4 4 Uniform Building Code) ^APPLICANT'S SIGNATURE DATE City of Carlsbad Bldg Inspection Request For 12/26/2007 Permit* CB072019 Title CHEVRON- DEMO EXISTING BLDG Description (2,072 SF) AND CANOPY 2500 EL CAMINO REAL Lot 0 Type DEMO Sub Type Job Address Suite Location APPLICANT SPENCER & JONES Owner Remarks CAN YOU FINAL DEMO PERMIT' Inspector Assignment Phone Inspector Total Time CD Description 19 Final Structural Act Comments Requested By CHRISTINE Entered By CHRISTINE Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments Carlsbad Fire Department 01'in Review Requirements Category FL , Date of Report 07-19-2007 Name Address RHL DESIGN GROUP 2401 E KATELLA AV ANAHEIM, CA 92806 Permit # US070052 Job Name CHEVRON SS#09-1312 JobAddiess 2500 EL CAMINO REAL CBAD 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 resubnut the necessary plans and/or specifications, with changes "clouded", to this office for review and approval Conditions- .id CON0002197 [MET] ** APPROVED THIS PROJECT HAS BEEN REVIEWED AND APPROVED FOR THE PURPOSES OF ISSUANCE OF BUILDING PERMIT THIS APPROVAL IS SUBJECT TO FIELD INSPECTION AND REQUIRED TEST, NOTATIONS HEREON, CONDITIONS IN CORRESPONDENCE AND CONFORMANCE WITH ALL APPLICABLE REGULATIONS THIS APPROVAL SHALL NOT BE HELD TO PERMIT OR APPROVE THE VIOLATION OF ANY LAW Entry 07/19/2007 By GR Action AP COUNTY OF SAN DIEGO DEPARTMENT OF ENVIRONMENTAL HEALTH 1255 Imperial Ave San Diego, CA 92101 1-800-253-9933/619-338-2222 INVOICE PERMIT TYPE & NUMBER HUNT 2479 PERMIT OWNER CHEVRON 2500 ELCAMINOREAL PID 688257 CONTACT. RHL DESIGN GROUP, INC 2401 E KATELLA AVE , STE 400 INVOICE DATE 29 MAY 2007 CHEVRON PRODUCTS CARLSBAD CA 92008 ANAHEIM CA 92806 APPLICANT KELLY RICHARD C TR&KELLY ROBERTAPN- 167-030-32-00 SITE ADDRESS 2500 EL CAMINO REAL LOCATION DESCRIPTION 2500 EL CAMINO REAL, CARLSBAD, 92008-1201 PROJECT DESCRIPTION/SCOPE Install three UST tanks and close four UST tanks/check#603626 /DEPOSIT DETAILS FEE CODE 6HUAT-EHO 6HUNT--EHO FEESF FEEFC DESCRIPTION rOR REMOVAL OF UNDERGROUND TANK DR NEW TANK INSTALLATION PAID ,1 MAY ° ') ?CO? ' | WN CASHIER l ("5H CHECK* \ i. TIM'E Acct 428T23 428T21 ACCT CODE 1 002430-995-1 C 1 002429-995-1 C TOTAL AMOUNT DUE AMOUNT 99000 1,38000 $2,370 00 )N MLS IOTES £LEVr,ilONS County of San Diego i^cf Environmental HeaSh Hazardous Materials DMston _ PLANAPPROVAl^ . U( Z^^q 105124 Aecfovad Bv- M Comments. Date- U ^ /O f os"R "Any change In these plans may void this approval This stampdes not constitute or imply approval by A STRUCTURAL OBSERVATIONS BY ARCHITECT OR STRUCTURAL ENGINEER OF RECORD ARE REQUIRED PER CBC 1701 REQUIRED INSPECTIONS - STRUCTURAL MASONRY - FIELD WELJDfNQ DEFERRED SUBMITTALS • ROOF TRUSS CALCULATIONS AND SHOP DRAWINGS SUBMIT TO CITY PRIOR TO FABRICATION * U G TANKS JUL-13-2007 0B 42 CHEURON 7146713439 P 02/02 July 13, 2007 In regards to Chevron 2500 El CammoRsal Cry of Carlsbad Budding Department 1635 Faraday Ave Carlsbad, CA. 92008-7314 To Whom Ii May Concern SUBJECT PROJECT DEMOLITION WL the undersigned property owner(-i) of the subject site located at 2500 El Camino Real, located in ihe Qty of (iirlsbad, grant permission to Chevron, and it's agents to fully demolish the existing structures, including bin not limited to the building, canopy, fueling system, eu. Sincerely TRTfil P Bartman Bros. 11777 San Vicente Blvd., Ste. 600 RECEIVED Los Angeles, California 90049 (310)826-8737 ^ * 4 2007 July 23, 2007 RHL DESIQN GROUP By Federal Express Mr. Larry Tidball RHL Design Group 2401 East Katella Ave., Ste. 400 Anaheim, California 92806 Re: Azalea Ground Lease at Carlsbad Chevron 2500 El Camino Real, Carlsbad, CA Dear Mr. Tidball, Per verbal instruction of Mr. Tim Calawell of Chevron, I'm enclosing herewith the Notice of Restriction on Real Property signed and notarized by the Kellys as well as the letter of authorization allowing the demolition of the Chevron Station. If you have any question, please give me a call. Sincerely, Tita Martinez Assistant to John W. Bartman JUN-12-2007 TUE 05=15 PM CITY OF CARSLBAD _ FAX NO. 760 602 8558 ' ~ DEMOLITION ASBESTOS CERTIFICATION 2-5 OO El Cgrnino fcecJjADDRESS: USE OF BUILDING TO BE DEMOLISHED: Chevron SQUARE FEET 2.O 7Z _ X NUMBER OF STORIES I PROPERTY OWNER: Robert &fng/C. -/CfeJ/ ^.npi ftcfard, Cc* ADDRESS, llTr? ggn VJccnife APPLICANT: Syaajnc-er- fr 3ones Qn^v/aA. Lon-frdfJ/brs ADDRESS: 3^3 Morfc Section 19827.5 of California Health and Safety Code states in part: "A demolition permit shall not be issued by any city ...as to any building or other structure except upon receipt from the permit applicant of a copy of each written asbestos notification regarding the building that has been required to be submitted to the United States Environmental Protection Agency or to a designated state agency, or both, pursuant to Part 61 of Title 40 of the Code of Federal Regulations, or the successor to that part. The permit may be issued without the applicant submitting a copy of the written notification if the applicant declares that the notification is not applicable to the scheduled demolition project." As applicant for a demolition permit in the City of Carlsbad, I certify that; I have read the excerpt from Section 19827.5 of the Health and Safety Code provided above; the information I have provided on this form is true and correct; and I further certify the following: (X) On the attached _ pages are copies of all written asbestos notifications regarding the above referenced building that are required to be submitted to the United States Environmental Protection Agency or to Part 61 of Title 40 of the Code of Federal Regulations, or successor to that part. ( ) I declare that the written asbestos notification is not applicable to the scheduled demolition project. Applicant's Signature Da n \word\front counter iandouts\damolitiori permit requirements doc REV April 19 2C04 JUN-12-2007 TUE_05:12 PH CITY OF CARSLBAD FAX NO. 760 602 8558 p, 02 City of Carlsbad Building Department DEMOLITION PERMIT REQUIREMENTS A demolition permit may only be issued to the owner of the property or the State Licensed Contractor that is doing the work. The contractor must provide use with a letter, signed and dated by the property owner, giving permission for the building to be demolished The fee for a demolition permit is $60 00. The attached Demolition Asbestos Certification application must be completed, signed and have the correct square footage of the structure being demolished, as well as it's use Applicant must provide a letter from San Diego Gas and Electric stating that the utilities have been disconnected Arrange for appropriate Water Authority to remove water meter unless construction of replacement structure is to begin shortly Contact the Planning Department at (760) 602-4625 or 602-4629 to determine if the structure is in the Redevelopment area, if it is in the Coastal Zone Contact the Engineering Department at (760) 602-2775 or 602-2741 to determine if a Haul Route or Right-of-Way Permit is required Notify the Fire Department at (760) 602-4666 to see if they need the use of the building for training purposes h 'word\front counter nanaouts^emolition permit requiremants doc REV April 19 2QC4 1635 Faraday Avenue • Carlsbad CA 92008-7314 • (760) 602 27DO Buildina Countor JUL-16-2007 10:44 P 02/04 SAN DISSO AIR POLLUTION CONTROL DISTRICT 10124 OLD GROVE ROAD, SAH DZEOO CA 92131 Phone (858) 586-2650 fax-. 858-586-2651 ci CD ust OWLf Postmark 1 Notification a Deceived | ree/ Receipt Sneered I Sector irisoector A^signeo/TJace NOTIFICATION OF ASBESTOS RENOVATION OR DEMOLITION OPERATIONS "tff3f9l Completed sy . '"//*,Company Cancellation D Other [specify) — _ , D Change in asnesras amount J3>£nan9s in start/end date tqitmtcroon 20**) Demolition Q Oraerefl Demolition Removal Q Emergency Demolition (removal) C Planned Henowation (annual) Address Cross Stree Address <"r>//i t/ SratB'Z,pCode Csnrac.T,Be fnone Building Size (sq, R):Building Age (years):Numfter or Flaors:i Number of Units Sulldlng pnor/presant use: "Commercial D Hosoital D Industrial D Office D K-12 Senool Puajle Bldg D House/Condo Q Shie G umv/Colleoe _fl Otngr .,.. PROJECT IMPORMATIOPL ASMStos Survey rmed?1* Pi NO U Asoescos Present DNO Will the asbestos oe Yes D No Is me building eo oe demolished? Asbestos Amount to be removed (sq/ln ft): 'Pipes Pipes. Category. iPloes Surface Area Surface Area o ^^5urf3CC Area Cornoonent1.Faolity Component:.Facility Csmponene. Total devised Amounts r\f a revision) Asbestos Hemaval SQrr n"f Asoescos Removal End Date DamolitiDn Operation Start Demolition OperaDon End Date Par revisions only Scan Dace . s Eno Date For revisions onty Revised Start Dace Revised End Dace __ Removal Contraetar Pnone C \ Demolition Contractor Name Phone Ma CSLS Ucense? ,' CJy/State/Zlp.[ Site Supervisor are reQUired pnor to -teno»j|on »no Demglxion nswovar iho actual survey is noi nrouKec- 'ope ;uortinleo «iih ior.j OniK ifi" iiS ftl 2 JLJL-16-2007 10-45 P 04/04 Faxed and nailed to Cal OSHft/S >iego 619-767-2299 ( ~"~NOTIFICATION FOR ASBESTOS-RELATED WORK DOSM, ****fa>t-srwsn^iftjsracnsetftaM) 2340 East Artesia Blvd./ L=ig Beach CA 90805 hSACQUAar==.£ ADDPgSS: ^^ — CSLi i.ir9vsp MUM5ER _ tS022B4 422-7370 F3£C1SS LOCATION (fctanccai, b«5^ Boer. icrm. apt re. eti]' TYPEOFsrr-.^'^^ S£a_&tr~^ srre OWNER srrs OV/NSS CONTACT PESSQN:.PHONE rS=,5CN FOR CONDUCTING AJR WONITORLNe, R5SPIPATOR RTTHSTING. s/ALUATiCN CFJ«SUL.« » i»i S. Ca-~?E3 ASeE; F^OJSC7s3.'0£ S.MSSGHNCY G. REASON:, CJV.C. DOSrl * Sit ON SATJ3 EJN. D SST. 5ND OATS.T "WCRX PRACTC25" G 2 stage iscsntsmmsticn G Class II tfecsA, sra« ^C-:6c3l fearrte-T ,S^Vel melees C Or/ rencvsl Ocser Neaamn prtssura tndbsure ^ZS^fl tfspossbie bedy protecion DFulI Q Mlni-endos^re Rscfine wastg dFs=egl Q HE?A FA^RS n Glove bags E Du''-^11'chLla /S-fa^A H rrssX res?:-as:/s 'vsnuat remcvaf rr.eSJjeds D C.-ne D Ainne-Type C Mecfianfesd removal mettsds ^Wanually Icwerins D O iher *rcteAve Messure_ (dEssfceariw'atiere^flrjiiS.T cv/AL'-'ATlCN C* SXrQSURS FOTENTUL; (circle cne): S«-r IMS =-pleieS tolice io SIB neareat DOSH Clstric; EafcKsnenl Office (53 lo www df ca -cWtap/Dt3hSpSesrar.,n»nO W hsun pr.cr |o ^^rr.e.ncsfr.ent erubestas-reiatBd work (Ind separsts phas« afwe*. when ***««* pnrtcea-art ,-««!,_ind! if e-^ueat! il r^<=nt,Sucu3 te«uin,]. Any c.^nSe .r L-B rnfe™aii=r, ?rt:vfced shall be wcrted to u-« DQSH C,»l-=! O^se t( cr fce'-re Uta lirp» cf',',« cSinS8 If era/ly, c=nflrm In wnL'^g Irr.r-etfta'ely. ta no ta(*r Ihan 24 hcare ef lh> c'-. TOTflL P.04 JUL-16-2007 10.45 OF ASBESTOS RENO 'ION OR DEMOLITION OPERATIONS P 03/04 Waste Transporter*!. Nane waste Transporter*? Hams Address.Address Cltv/Scate/Zip Contact Person Wast B Disposal Site (Landfill): Pnone .7^7(9 Contact Person Phone. Con-ct *«*«fc Q 7/ » Asbestos Detection Procedures: Check me appropriate procedures and analytical mecnoos used CDdetecrcne presence of asbestos containing materials Survey Bulk Sampling Inspection D TEM Q Other D PCM Describe ««rlc practices and ef.Bi"««"-)ng controls to be used. Chuck applicable mechodE below. O Water Amended Water Roofing Cutting Saws Hign Pressure water Blase infrared Machines Cranes (wrecking ball, clamshell, bucket) Zambahi Bead Blast Floor Buffer .. _ Demolition w/rooflng materials in place using sfeoge hammers r_ Axes D Shovels D Demolition w/Cat I Floor dies \r place D ice Cruppers C Prv Bars fj Bulldozer D intandonii Burning D Sackhoes Q Other D Skid Loaaers/Doocats/Top Loaders n Terminator"1 D Implosion D Explosion D Negative Air Machines G Full ConcDrnmene D 3 Stage Decon P Glove Bag Critical Barters For Ordered DomolWon provide a copy at the ordur and complete the information Wow; Agency Name AU Bronzing Person Title Date of Qraer Dae Ordered to Begin.Phone- Contingency Plan Descnoe acOons to be followed if unexpected aSOestos is found during demolition _r removal or astestos material becomes distuned, crun-.Dled, pulvenzed nr reduced to powder, Isolate area, mist air, dampen material. Clean spill, properly package for disposal. Training CartrflcaUori I certify mat an mdiviouai tram«0 In tne provisions of this ntgulaoon {CFR Part 61, Subpart M) will be on site dunng tne removal ana evidence that the required training has been accomplished by Qiic person will be available for inspection dunng normal business houn, /7 / I certify cnat the acove informan»n\t$ correct.Information Certification: Qnginal notifieaibns are to be sufimnad lo ffm aolnctaf least 10 working days prtor 5 lemovnl or dsrnomion. flevH&i noucat ar» to be suomifled if soon 35 possible but no later man Ihe ongna/ ssur dia Ongmal noirficacions cannot be accapttd wiinoui the roquffsd fee(si iftuJe *0(l)(2)) hcwavar /eviead rctrficailonj w|fl ae acrapsa wmout me raqi/itad IM provides the u»e a paid orior to TIB sun dau o' WB ongmai noullcailon. SDAPCO SUBPAHTM-aule361 woe A \jg£ Sempra Energy winny" Notice of Service Discontinuance PERMIT DEPARTMENT, CITY OR COUNTY OF" Carlsbad. Calif SERVICE WILL BE DISCONTINUED TO' ADDRESS 2500 El Camlno Real BY (Date) July 31. 2007 S ELECTRJC METER NO 1736362 Q GAS METER NO. ALL SERVICE LINES WILL BE REMOVED THIS BUILDING CAN BE MOVED OR RAZED AFTER THE ABOVE DATE SAN DIEGO GAS & ELECTRIC BY _ /MymaMoran PHONE 7J50-480-7781 DATE' July 30,2007 PM Forms: NotteeofSfirviceDiscontlnuancedoc Revised 6/20/06 POLICYHCL0£R COPV PO BOX 420807. SAN FRANCISCO CA 94142-0807 F~LJfNID CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE 07-O1-2006 COMPENSATION INSURANCE CONTRACTORS STATE LICENSE BOARD WORKERS COMPENSATION UNIT P 0 BOX 26000 SACRAMENTO CA 95826 SJ GROUP OOOO46 POLICY NUMBER O015590-200S CERTIFlCATc U- 1 CERTIFiCAT- EXPRcS O7-01-2007 07-01-2005/07-01-2007 LICENSE NUMBER * 184669 INCEPTION DATE O7-01-200S DO SJ IMS 15 to certify thst >ive have issued A valid Workeis Cotrpsn-ia'.iofl insurance poiic/ in a form approved n» L.jiif'3'nia insurance Com:-ii£S;oner to we employe" named below for the policy per.oci indicated Tris police <s not subjuct tn caicelis'ion by thp F^rsd excepi ^por 1O days advance w->Uen notice to *ne ' '• « will .iijo give vou ^Q c;),i vfranco notice shousd ihss policv oe canceSIsd PHOT icj t« normal exoira'icj Irii cer it;cate of msirarce is rot a" insurance- policy ana does »o' amend extend «f aiter the coverage Dy th« poi'Cy listed herein Notwitr-s land ing anv requiremen. term or conciiuon of any contract or other.1/1 :h rosDOCt to which this csruficste af insurance TIS/ be issued or to wnicn )t nay pertain the insurance df:1- ;dcd b>/ iho pol.cy dpscnbed herem 15 subjec! "o all 'he terms exclusions and conditions of such policy EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS S1.0OO.OOO PER OCCURRENCE EM^LOYCP SPENCER ft JONES A CORP •598 N JOTH ST COLTON CA 92324 SJ PRINTED 06-19-2006 M0410 License Detail Page 1 of 2 California Home ! Tuesday, J License Detail Contractor License # 184669 CALIFORNIA CONTRACTORS STATE LICEN DISCLAIMER A license status check provides information taken from the CSLB license data base Before 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 tc complaint disclosure, a link for complaint disclosure will appear below Click on the hn button to obtain complaint and/or legal action information • Per B&P.Zp71_J7_, 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 ont Board's license data base * * * Extract Date 07/31/2007 Business Information * * * SPENCER & JONES P O BOX 645 COLTON, CA 92324 Business Phone Number (909) 825-4624 Entity Corporation Issue Date 07/06/1959 Expire Date 01/31/2009 * * * License Status * * * This license is current and active All information below should be reviewed. * * *Classifications * * * Class A~~ B C-8 C36 Description GENERAL ENGINEERING CONTRACTOR GENERAL BUJLDiNGCQNTRACIQR CONCRETE PLUMBING http //www2 cslb ca gov/CSLB_LIBRARY/License+Detail asp 07/31/2007 License Detail Page 2 of2 * * *Certifications * * * Cert I Description IHAZ(HAZARDOUS SUBSTANCES REMOVAL! Bonding Information * * * CONTRACTOR'S BOND: This license filed Contractor's Bond number 944376C in the anr $12,500 with the bonding company INDEMNITY COMPANY OF CALIFORNIA. Effective Date 01/01/2007 Contractor'sBondmgJllstory BOND OF QUALIFYING INDIVIDUAL^): The Responsible Managing Officer (RMO) GE GORDON SPENCER certified that he/she owns 10 percent or more of the voting stock/equ corporation A bond of qualifying individual is not required Effective Date 08/19/1987 Workers Compensation Information * * * This license has workers compensation insurance with the STATE COMPENSATION INSURANCE FUND Policy Number 046-0015590 Effective Date 07/01/2005 Expire Date 07/01/2008 Wprkers_Compensat!onHistory Personnel listed on this license (current or disassociated) are listed on other licet Personnel List Other Licenses H License Number Request |Contract_or._Name_Request Personnel Name Request Salesperson Request I Salesperson Name Request © 2006 State of California Condrt!ons_ofUse Privacy Policy htlp //www2 cslb ca gov/CSLB_LIBRARY/License+Detail asp 07/31/2007