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HomeMy WebLinkAbout2618 EL CAMINO REAL; ; CB090725; Permit05-01-2009 City of Carlsbad 163,5 Faraday Av Carlsbad, CA 92008 Miscellaneous Permit Permit No CB090725 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Valuation Reference # PC# Project Title 2618 EL CAMINO REAL CBAD MISC 1670307700 $000 Subtype Lot# OTHER 0 SMART & FINAL-UNDERGROUND WORK INSIDE BLDG ONLY-FOR COLUMN PAD FOOTINGS, Status Applied Entered By Plan Approved Issued Inspect Area ISSUED 05/01/2009 RMA 05/01/2009 05/01/2009 Applicant CENTRE BUILDERS INC STE 113 2901 W MAC ARTHUR BLVD 92704 714424-0078 Owner VANDERBURG LIVING TRUST 08-22-90 C/O HUGHES INVESTMENTS - MANAGER P O BOX 8700 NEWPORT BEACH CA 92658 Miscelaneous Fee #1 PERMIT FEE Miscelaneous Fee #2 Additional Fees $360 00 $000 $000 TOTAL PERMIT FEES $360 00 Total Fees $360 00 Total Payments To Date $360 00 Balance Due $000 WILDING PLANS _J/L IN STORAGE ATTACHED Inspector FINAUAPPRQV, Date W^^f Clearance NOTICE Please take NOTICE that approval of your project includes the "Imposition" of fees, dedications reservations, or other exactions hereafter collectively referred to as 'fees/exactions' You have 90 days from the date this permit was issued to protest imposition of these fees/exactions If you protest them you must follow the protest procedures set forth in Government Code Section 66020(a) and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3 32 030 Failure to timely follow that procedure will bar any subsequent legal action to attack review set aside void, or annul their imposition You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes nor planning, zoning grading or other similar application processing or service fees in connection with this project NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired Ciiy of Carlsbad 1635 Faraday Ave , Carlsbad. CA 92008 760-602-2717 / 2718 / 2719 Fax 760-602-8558 www carlsbadca gov Building Permit Application Plan Check No Est Value Plan Ck Deposit Date JOB ADDRESS /\ ! 2 I? ) <K fr.t^ &>*^ «f\ £ AVC> J #^&^ SUITES/SPACtH/UNITII APN COMSTR TYPE I OCX GROUP DESCRIPTION OF WORK Include Square Feet of Affected Area(s) •'"!)/ ^f (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 for such permit to Tile a signed statement that he ftlicensed 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 there from and the basis for the alleged exemption Any violation of Section /Oil S by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500}) Workers Compensation Declaration / hereby affirm under penalty of perjury one of the following declarations n 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 C] I have and will maintain wortefs compensation as required by Section 3700 of the Labor Qpde for the performance of thework for which this permit is issued My workers compensation insurance carrier and policy number are Insurance Co l> -ftfiT C&rO j£?V? fi ^\ Policy No ^7 ( f -()£? rt (ft V^.Q^ Expiration Date DATE This section need not be completed if the permit is for one hundred dollars (S100) or less d 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 i addition to the coajjen compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees ^^^l^^]/^^^ ^^^ I hereby affirm that I am exempt from Contractors License Law lor the following reason Q I as owner of the property ot 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 proiect (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) Cl 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 Cl Yes Cl No 2 I (have / have not) signed an application for a building permit for the proposed work 3 I have contracted with the following person (firm) to provide the proposed construction (include name address' phone / contractors license number) 4 I plan to provide portions of the work but I have hired the following person to coordinate supervise and provide the major work (include name / address / phone / contractors license number) 5 I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work) ! ^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' D Yes D No i Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district' Cl Yes D No ! Is the facility to be constructed within 1 000 feet of the outer boundary of a school site' ~~ IF ANY OF THE ANSWERS ARE YES, / EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT 3 Yes n No I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec 3097 (i) Civil Code) Lender's Name Lender's Address I 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 constmction 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 stones 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 ifjhtfjhlding or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 180 days (Section 106 4 4 Uniform Building Code) ^APPLICANT S SIGNATURE DATE City of Carlsbad Bldg Inspection Request For 08/25/2009 Permit# CB090725 Title SMART & FINAL-UNDERGROUND WORK Inspector Assignment PC Description INSIDE BLDG ONLY-FOR COLUMN PAD FOOTINGS, CONCRETE UNDER FREEZERS, PLUMBING & ELECT IN 2618 ELCAMINOREAL Lot 0 Type MISC Sub Type OTHER Job Address Suite Location OWNER VANDERBURG LIVING TRUST 08-22-90 Owner VANDERBURG LIVING TRUST 08-22-90 Remarks CAN YOU FINAL Phone Inspector Total Time CD Description 19 Final Structural 29 Final Plumbing omments Requested By CHRISTINE Entered By CHRISTINE Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp 07/23/2009 29 Final Plumbing PA PC 06/01/2009 21 Underground/Under Floor AP PC 06/01/2009 22 Sewer/Water Service AP PC 06/01/2009 23 Gas/Test/Repairs PA PC 05/14/2009 31 Underground/Conduit-Wiring PA PC 05/11/2009 21 Underground/Under Floor PA PC 05/07/2009 31 Underground/Conduit-Winng PA PC 05/06/2009 21 Underground/Under Floor AP TP 05/04/2009 11 Ftg/Foundation/Piers PA PC 05/04/2009 21 Underground/Under Floor PA PC Comments GREASE INTERCEPTOR START 24 HOUR CLOCK TEST SEE MARKED PLAN ON SITE GREASE WASTE SECT SEE MARKED PLAN ON SITE BH fi'f i*» •i»--»WJ:t.-« Project Name Project Location Contractor U Testing Engineers • San Diego, Inc. 7895 CONVOY Ct, SUITE 18 SAN DIEGO, CA 92111 Phone:(858)715-5800 Fax: (858)715-5810 U Testing Engineers - Inland Empire 41120 ELM STREET MURRIETA.CA 92562 Phone: (909) 677-0366 Fax: (909)677-5761 PERMIT# PLAN FILE# Page Day of the Week PROJECT* INSPECTION REPORT Henry's T&l 2618 ElCamino Real Centre Builders CB090399 1of1 Wednesday 148857 Date Time Arrived Time Departed 04/29/09 On site as requested by Super Intendant Bryan Metzgerto observe the installation of (36) #5 rebar dowels for spread footings @ 3/A-J, 2/B and (68) #4 rebar dowels into the emu walls @ 1/A-J and 8/A-J. I visually inspected the drilled holes for correct depth/ diameter and ensured all holes were thoroughly cleaned out with a nylon brush and oil free compressed air prior to the injection of epoxy. Verified type-size-grade of rebar. Verified epoxy was mixed and injected in accordance with the manufacturers recommendations. Verified epoxy used was in compliance with detail 13/14 on page SD1 of the approved structrual drawings. Epoxy: Hilti hit RE-500 SD Epoxy: Hilti Hit Hy150 Lot#:1842:L3 Lot#: 115519-.L4 Exp: 5/2009 Exp: 6/2009 CERTIFICATION OF COMPLIANCE: All of the work reported herein was inspected to and meets the requirements of the Approved Construction Documents and the applicable provisions of the California Building Code unless otherwise stated. vjtwO M «>..-.. v-i Inspector Certifications: Inspector's Name: Approval Signature: Date Reviewed: City of San Diego #998 ICC #5258600 Jerod J. Harris \ D Testing Engineers - SaV-iego A BVNA, Inc Company 7895 Convoy Court, Suite 18 San Diego, California 92111 Phone (858) 715 5800 Fax (858)7155810 D Testing Engineers - Inland Empire A BVNA, Inc Company 41146 Elm Street, Suite A Murrleta, California 92562 Phone (951)677-0366 Fax (951) 6775761 CONSTRUCTION INSPECTION REPORT 'DSAFile# DSA APPLICATION # Client PO # NTP# PROJECT #111*57 Project Name /•*€*•» £y Project Location CJf&f 6 Contractor Building Permit # x/ Ij Field Documents Referenced 1 1 Type of Equipment Used Density Count Q] Sample Type '•f f^.'^VI^ /^Aftlf^fT Date H llf\ ]OS 5A£> Plan File # Report | | Notice to Comply n Concrete Q D Anchors D D Welding D Q] nthnr Soils Report 1 1 Plans Date Moisture Count i Time Arrived Nr# Reinforcing Steel Masonry Bolting Wonthar PI Specs Date QaaeTVoa Time Departed OSHPD # 1 I Pre Post Tensioned Tendon [3 Soils 1 1 Fireproofing Man Pnwor PI RFI # Calibration Dates Amount Made/Taken 1 I Batch Plant 1 1 Foundations 1 1 Metal Decking PI Codes Gage# TD AT This Work DWas D Was Not Inspected, Tested, and Sampled in Accordance With Requirements of the DSA Approved Documents The Work Inspected D Met D Did Not Meet the Requirements of the DSA Documents The Work Tested D Met D Did Not meet the Requirements of the DSA Documents The Work Sampled D Met D Did Not meet the Requirements of the DSA Documents CERTIFICATION OF COMPLIANCE To the best of my knowledge, all of the observed work, unless otherwise stated, is in Conformance with the approved plans and specifications and the workmanship provisions of the Applicable code :et D Did Not Meet Cc Project Architect _ Structural Engineer _ Inspector of Record _ Inspector's Signature _ Approval signature / Name / Company Reviewed by _ DSA Regional Office School District Certification # / Exp Date Inspector's Name Revlewed Copy to Architect Structural Engineer Project Inspector DSA i,ii •<^^^?\ L3™ Project Name < Contractor t Bunding Permil S t D Testing Engineers - San L-iego a A BVNA, Inc Company '• 7895 Convoy Court, Suite 18 San Diego, California 921 1 1 Phone (858) 715-5800 Fax (858)715 5810 CONSTRUCTION -&J j-JV 'J f=AiCv\ l_g2-_, /AAi/Z-^e-f /*Ai>fcAp ^-•Ote F?*H.-.o<2r>ieu_r &t<*-~< Testing Engineers - Inland Empire A BVNA, Inc Company 41146 Elm Street, Suite A Murneta, California 92562 Phone (951)677 0366 Fax (951) 677 5761 INSPECTION REPORT DSA File ft DSA APPLICATION » Client PO ft NTP ft PROJECTS H&*>5~\ Date ^/tS/01 Time Arrived D £ ° - Sufe-yO^T-e-^Cie:^ Time Dmarted Plan File ft OSHPD ft •"T" Field Reoort f~l Notice to Comolv NC ft Date Cleared I I Concrete Q Anchors I I Welding D Other n , Reinforcing Steel I I Masonry [I] Bolting , Weathe r _! Pre Post Tensioned Tendon Lj Batch Plant ; Soils 0 Foundations I I Fireproofing H] Metal DecKing Man Power Documents Referenced l~~l Soils Report [~| Plans Date _ Type ol Equipment Used ^(^"? } W-M-'Ai^X- ' Density Count Moisture Count [j Sample Type D Specs Date.D RFI # .l~l Cooes Calibration Dates Gage Type Gage ft Amourjt Made/Taken -TO t S UOQ..V., ^f^K'?^ v •><^^&j&it&&iA^3^^ Po So This Work DWas DWasNol Inspected, Tested, and Sampled in Accordance Jith Requirements of the DSA Approved Docume, D Met n Did Not Meet the Requiremen»ol the DSA Documents ! D Met G Did Not meet the Requireme^^yje DSA Documents D Met D Did Not meet the Requirements of irMDSA Documents CERTIFICATION OF COMPLIANCE To the best of my knowledge, all of the observed work, unless otherwise stated, is in Conformance wit; approved plans and specifications and the workmanship provisions of the Applicable code Did Not Meet Cc Project Architect Structural Engineer Inspector of Record .Inspectors Signature DSA Regional Office School District Certification ft / Exp Date Inspector's Name ;, /oval signature / Name / Company Reviewed by <opy to Date. Date Reviewed Architect. i Structural Engineer Project Inspector DSA @ °' ^'MlVjWJ =- DSA Fl|e #Testing Engineers • San Diego D Testing Engineers - Inland Empire • | A BVNA, Inc Company A BVNA, Inc Company DSA APPLICATION # 7895 Convoy Court, Suite 18- 41 1 46 Elm Street, Suite A San Diego California 92111 Murrieta, California °?562 Client PO # "p'hone (858)7i'5~58o6 Phone '(951) 677-0366c=i» rnKn\ 7-iK r.am Fax ^q<i1^ fi77.f;7R1 iNir* PROJECT* jVSg6"7 iHillf.VI CONSTRUCTION INSPECTION REPORT ' Project Name t^tA^Y Project Location ^-Atl^ Contractor £<5vJX Building Permit # Q^Field Documents Referenced \v$ Type of Equipment Used Opnsity Count Q] Sample Type ) (^AnOA-eW Mi\iCi^-r " Date RAO Time Arrived /° 5° ^ /£viul?6£/ Time Departed ; Plan File # OSHPD # Rsport j | Notice to Comply NC # .- Dfltfl ^[egred | | Concrete d Reinforcing Steel [H Pre-Post Tensioned Tendon Q Batch Plant Q Anchors d Masonry 0^ Soils D Foundations O Welding CD Bolting Q Fireproofing I I Metal Decking | | nthnr WfiBthnr Man Pnwnr Soils Report |~~| Plans Data Fl Specs Date fl RFI # fl Cooes Calibration Dates Moisture CQiint •„.'. ' " ' ' OflfjeTypa Gage* Amount MadeATaken This Work DWas D Was Not Inspected, Tested, and Sampled In Accordance With Requirements of the DSA Approved Documents The Work Inspected The Work Tested The Work Sampled D Met D Did Not Meet the Requirements of the DSA Dments D Met D Did Not meet the Requirements of the DSA D Met D Did Not meet the Requirements of^ DSA Docurr CERTIFICATION OF COMPLIANCE To the best of my knowledge, all of the observed work, unless otherwise stated, Is In Conformanoe with the approved plans and specifications and the workmanship provisions of the Applicable code ' • '•• •<• •lol Meei Cc Project Architect Structural Engineer Inspector of Record Inspector's Signature ;Approval signature / Name / Company Reviewed by : DSA Regional Office School District Certification # / Exp Datj tor's N#Te Date. Architect , Structural Engineer Project Inspector DSA /<s&\ •DTJECEni BODCI33I Project Name Project Location Contractor U Testing Engineers • San Diego, Inc. 7895 CONVOY CI, SUITE 18 SAN DIEGO, CA 921 11 Phone: (858) 715-5800 Fax: (858)715-5810 U Testing Engineers - Inland Empire 41120 ELM STREET MURRIETA, CA 92562 Phone: (909) 677-0366 Fax: (909)677-5761 PERMIT* PLAN FILE# Page Day of the Week PROJECT # INSPECTION REPORT Henry's T&l 2618EICamino Real Centre Builders CB090399 1of1 Monday 148857 Date Time Arrived Time Departed 05/04/09 07:30:00 AM 09:30:00 AM On site as requested by Super Intendant Bryan Metzger to inspect the rebar conditions for cooler slab on grade @ B.2-B.8/1- 1.4; H.3-J/1-1.5; B-B.5/5.2-5.7 and spread footings @ 3/A-G.5 Verified type-size-grade and lap lengths of reinforcing steel. Ensured all clearances were met and maintained as indicated in the approved drawings. Verified column hardware hardware was secured in place, verified length of bolts and ensured bottom nuts were tack welded in place. Debris and falloff to be removed from the bottom of footings prior to the placement of concrete. CERTIFICATION OF COMPLIANCE: All of the work reported herein was Approved Construction Documents and the applicable provisions of the Ca *'/}/,••'>• Inspector Certifications: Inspector's Name: Approval Signature: Date Reviewed: City of San Diego #998 ICC #5258600 nspected to and meets the requirements of the lifornia Building Code unless otherwise stated. Jerod J. Harris ET Testing Engineers - San Diego /4 BMM, /nc Company 7895 Convoy Court, Suite 18 • San Diego, California 92111 Phone (858)715-5800 Fax (858) 715-5810 CityD Testing Engineers - Inlan^mplre A BVNA, Inc Company 41146 Elm Street, Suite A Murrieta, California 92562 Phone (951)677-0366 Fax (951)677-5761 CONSTRUCTION INSPECTION REPORT DSA Fil DSA APPLICATION # Client PO # NTP# PROJECT # Proiect Name H (~~hJ Pro|ect Location A (fl Contractor C, El £VS /\dA£'l^(E~l T & 1 X EL CAMlf^O ££~AL \j~ne,&' Atj/LbfmS Building Permit « £& Otf O^^tf Plan File * Shield Documents Referenced I I Type of Equipment Used Density Count Q Sam pie Type Report Q Notice to Comply D Concrete ^ n Anchors Q D Welding Q Q Othor Soils Report 1 1 Plans Date Moisture Count Date 5" ~ 4 Time Arrived Tims Departed OSHPD # Mr # nato cleared Reinforcing Steel 1 I Pre-Post Tensioned Tendon Masonry l~l Soils Bolting n Fireproofmg WfiathRr Man Power D Specs Date D RFI # Calibration Dates Oage Type Amount Made/Taken /- OH ~7ZO °13>O D Batch Plant f~l Foundations Q Metal Decking FT! Codes Gage # -y / /- /3~_J//-i r— z -5" "7 xw.Z>FocrnAJaS 3 /A- 6. S~ TH-er -sere /A/ TD This Work DWas D Was Not Inspected, Tested, and Sampled in Accordance With Requirements of the DSA Approved Documents The Work Inspected D Met D Did Not Meet the Requirements of the DSA Documents The Work Tested D Met D Did Not meet the Requirements of the DSA Documents The Work Sampled D Met D Did Not meet the Requirements of the DSA Documents CERTIFICATION OF COMPLIANCE To the best of my knowledge, all of the observed work, unless otherwise stated, is in Conformance with the 0/M"et n approved plans and specifications and the workmanship provisions of the Applicable code Did Not Meet Cc Project Architect Structural Engineer Inspector of Record Inspector's Signature Approval signature / Name / ( Reviewed by DSA Regional Office School District Certification # / Exp Date CtTV OF Inspector's Name pany Date. Date Reviewed Copyjo Architect Structural Engineer Project Inspector DSA THIS DOCUMENT HAS A TRUE" DEFENSA™ WATERMARK. ANFl VISIBLE FIBERS DISCERNIBLE FHOM BOTH SIDES NOT TRANSFERABLE BUS NUMBER 1226969 DATE ISSUED 8/12/2008 6IC CODE 15 OWNER FIRM OR CORPORATION NAME BUSINESS NAME MAILING ADDRESS orr ANO STATE CITY OF CARLSBAD BUSINESS REGISTRATION CERTIFICATE POST IN CONSPICUOUS PLACE TTw PVNTV *«« or cBfportf »n wmd Wow to QT«nM >hu bumm ewtifioal* purnMiM 10 At p-vMOM ol tr« Oty ft««n(B> LJovot OnflnMttM* to Mig.tg.1 * eMry on et tuftAxt itw bwtnM^ trid*. c*f*g, piAMbn. •HnMton or oecupalion «Mcrib^ bHow IMMHC* of iht cwftfic** * nol jn MtfenNM.*. M n of dDtn^n* wdb Mm onflrunoM or uwi Th» ii»n* ta ii*wt( tvUftMff MrtftcoUan In* *• Dcwtwt !• Mbjact ift of kwrnpl Iram itctmlng By tti BUSINESS LOCATION 2901 W MACARTHUR BLVD STE 112 SIC DESCRIPTION Building Construction-General Building Contrac EXPIRATION DATE CENTRE BUILDERS, INC CENTRE BUILDERS, INC 2901 W MACARTHUR BLVD STE 113 SANTA ANA, CA 92704-6922 KEEP FOR YOUR RECORDS BUSINESS TAX RECEIPT BUS NO 1226969 DATE ISSUED 8/12/2008 08 070G $8000 BALANCE $000 TAXES PAID IN ACCORDANCE WITH CITY BUSINESS TAX ORDINANCE CITY OF CARLSBAD THIS DOCUMENT IS ALTERATION PROTECTED AND REFLECTS FLUORESCENT FIBEF1S UNDER UV LIGHT State Of California CONTRACTORS STATE LICENSE BOARD _ _ -» ACTIVE LICENSEComunierABma 736518LAW*Mjrnfev • WWW • V tn »_.... CENTRE BUILDERS INC 05/31/2009 CERTHOLDER COPY COMPENSATION I N S URANCE PO BOX 420807, SAN FRANCISCO.CA 94142-0807 FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02-19-2009 GROUP POLICY NUMBER 1735800-2008 CERTIFICATE ID 192 CERTIFICATE EXPIRES 04-04-2009 04-04-2008/04-04-2009 sc PLAZA SOUTH, LLC PO BOX 8700 NEWPORT BEACH CA 92858-8700 SC JOB HENRY'S MARKET CONVERSION JOB #2139 COMMERCE CA This is to certify ttiat 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 policy listed hereia Notwithstanding any requirement, term or condition of any contract or other documentwith respect to which this certtf;cate 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 AUTHORIZED REPRESENTATIVE^ PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS- $1,000,000 PER OCCURRENCE ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-04-2005 IS ATTACHED TO AND FORMS A PART OF THIS POLICY EMPLOYER CENTRE BUILDERS. INC 2901 W MACARTHUR BLVD STE 113 SANTA ANA CA 92704 SC (REV 2-06) [B14.SC] PRINTED 02-19-2009 Check a License or Home Improvement Salesperson (HIS) Registration - Contractors Stat Page 1 of 1 Department of Consumer Affairs ^7 ^ 'GOV Contractors State License Board Contractor's License Detail - License # 736518 /1\ DISCLAIMER A license status check provides information taken from the CSLB license database Before relying on this information, you should be aware of the following limitations > CSLB complaint disclosure is restricted by law (B&P 7124 G) If this entity is subject to public complaint disclosure, a link for complaint disclosure will appear below Click on the link or button to obtain complaint and/or legal action information v Per B&P 7071 1.7, only construction related civil judgments reported to the CSLB are disclosed %x Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration •' Due to workload, there may be relevant information that has not yet been entered onto the Board's license database License Number Business Information Entity Issue Date Expire Date License Status Classifications Bonding Workers' Compensation Extract Date 05/01/2009736518 CENTRE BUILDERS INC 2901 WMACARTHURBLVD#113 SANTA ANA, CA 92704 Business Phone Number (714)424-0078 Corporation 05/29/1997 05/31/2011 This license is current and active All information below should be reviewed CLASS DESCRIPTION B GENERAL BUILDING CONTRACTOR CONTRACTOR'S BOND This license filed Contractor's Bond number 8032813 in the amount of $12,500 with the bonding company FIDELITYANP-PEPOSIT COMPANY. OF MARYLAND Effective Date 01/01/2007 Contractor's Bonding History BOND OF QUALIFYING INDIVIDUAL 1 The Responsible Managing Officer (RMO) RONALD LUTHER MILLER certified that he/she owns 10 percent or more of the voting stock/equity of the corporation A bond of qualifying individual is not required Effective Date 08/27/2002 This license has workers compensation insurance with the STATE COMPENSATION INSURANCE FUND Policy Number 719-0000606 Effective Date 04/04/2009 Expire Date 04/04/2010 Workers Compensation History Personnel listed on this license (current or disassociated) are listed on other licenses Conditions of Use | Privacy Policy Copyright © 2009 State of California https //www2 cslb ca gov/OnlmeServices/CheckLicense/LicenseDetail asp 05/01/2009 n j2 1CQ Approved01 in PlanningEngineeringul Ou. ?^HazMat/Air Qualn^ ro I >> 1 •o u C£ <U VI \ Forms/Feesz Qu.U Z cu z I HazMat/Healthz <uI z § z u_u_Q. Z UJ Q. Z oo u Z 1(U1X1 Z Stormwaterz Workers Compz z OJ n:Q Q OJ n +js Commentsen 2 5m 1 Planning1 EngineeringSiLL Need?(iiro a r a r a (uro a co a 01 o a o cI I S 5 I 8< £ ^