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HomeMy WebLinkAbout2645 GATEWAY RD; MP; CB063000; Permit11-02-2006 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Electrical Permit Permit No CB063000 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Reference # Project Title 2645 GATEWAY RD CBAD St MP ELEC 0000000000 Lot # AT&T 200 AMP PEDISTAL WITH UNDERGR VAULT/MECHANICAL EQUIPMENT Status Applied Entered By Plan Approved Issued Inspect Area Applicant ROBINSON ELECTRIC 8871 TROY ST SPRING VALLEY, CA 91977 6196976040 Owner ISSUED 10/17/2006 LSM 10/17/2006 10/17/2006 RB Electric Issue Fee Single Phase per AMP Three Phase per AMP Three Phase 480 Per AMP Remodel/Alteration per AMP Remodel Fee Temporary Service Fee Test Meter Fee Other Electrical Fees Additional Fees 200 0 0 0 $1000 $5000 $000 $000 $000 $000 $000 $000 $000 $000 TOTAL PERMIT FEES $6000 Total Fees $60 00 Total Payments To Date $60 00 Balance Due $000 BUILDING PLANS IN STORAGE ATTACHED Inspector FINAL A Date 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 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave , Carlsbad, CA 92008 TION1 PROJECT INFl£k FOR OFFICE USE ONLY PLAN CHECK NO EST VAL Plan Ck Deposit Validated By Date Address (include Bldg/Suite #)Business Name (cit this address) Legal Description Lot No Subdivision Name/Number Unit No Phase No Total # of units # of Bathrooms TJameAddress 3 APPLICANT;i L/KCon'tractor D Agent for Contractor ' - City | Owner j";i'Q Agent for Owner State/Zip Telephone #Fax # Name 4 .PROPERTY OWNER Address City State/Zip Telephone Name Address City State/Zip Telephone # S CONTRACTOR COMPANY NAME . ' .•• •"' ' C-.l" • ^?|fc~:h:,;, --:' :"" . ;,. (Sec 7031 5 Business and Professions Code Any City or County which requires a permit to construct liter 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 [$500]) ?37/ Y&^-ST . SflZlNSfr \1KJW rA-Wll "' Name State License # Address License Class City State/Zip City Business License # I Telephone # Designer Name Address City State/Zip Telephone State License tt _ 6 WORKERS COMPENSATION „ ; i '" ' i - Workers Compensation Declaration I hereby affirm under penalty of perjury one of the following declarat ons L~] I have and will maintain a certificate of consent to self insure for workers compensation as provided by Section 3700 of the Labor Code for the performance of the work for which this permit is issued *fj^ I have and will maintain workers compensation as required by Section 3700 of the Labor Code for the performance of the work for which this permit is issued My worker s comoensation insurance carrier and policy number are A A Insurance Company VjUWfytSft ^\5 CD _ Policy No \A) 6"APftl 3$ Expiration Date lO (THIS SECTION NEED NOT B^'cOMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS l$100] OR LESS) t ; PI 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 compensation damages as provided for in Section 3706 of the Labor code interest and attorney s fees SIGNATURE _ DATE _ 7 OWNER BUILDER DECLARATION r , ' I hereby affirm that I am exempt from the Contractor s License Law for the following reason l~l 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 oflered 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) [~| 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 fj YES CJNO 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 COMPLETE THIS SECTION FOR NON RESIDENTIAL BUILDING PERMITS ONLY i i 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 O NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? (~l YES O NO Is the facility to be constructed within 1 000 feet of the outer boundary of a school site? !~l YES O NO IF ANY OF THE ANSWERS ARE YES A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLE SS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT :8. CONSTRUCTION LENDING AGENCY .,...,. ' i J *•• I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(0 Civil Code) LENDER S NAME LENDER S ADDRESS 9 APPLICANT CERTIFICATION I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate I agree to comply with all City ordinances and State laws relating to building construction I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned property for inspection purposes I ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST 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 commenced for a period of 189} days (Section 106 4 4 Uniform Building Code) APPLICANT S SIGNATURE not com :ommpn Kl ^ DATE WHITE File YELLOW Applicant PINK Finance Inspection List Permit* CB063000 Type ELEC AT&T-200 AMP PEDISTAL WITH UNDERGR VAULT/MECHANICAL EQUIPM Date Inspection Item Inspector Act Comments 05/08/2007 39 Final Electrical JM Fl OK TO FINAL 11/03/2006 39 Final Electrical JM AP METER PED ONLY - DO NOT FINAL PERMIT 10/19/200632 Const Service/Agricultural RB CA NO PERMIT FOR VAULT 10/19/200639 Final Electrical RB CA NO PERMIT FOR VAULT Wednesday May 09 2007 Page 1 of 1 City of Carlsbad Bldg Inspection Request For 11/03/2006 Permit* CB063000 Title AT&T- 200 AMP PEDISTAL WITH Description UNDERGR VAULT/MECHANICAL EQUIPMENT Inspector Assignment RB 2645 GATEWAY RD MP Lot Type ELEC Sub Type Job Address Suite Location APPLICANT ROBINSON ELECTRIC Owner Remarks Phone 6196976040 Inspector Total Time CD Description 39 Final Electrical Requested By KIM Entered By CHRISTINE Act Comment A^ Comments/Notices/Hold Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 10/19/2006 32 Const Service/Agricultural CA RB NO PERMIT FOR VAULT 10/19/2006 39 Final Electrical CA RB 09/18/06 MON 08 19 FAS 760 744 3188 IRISH CONSTRUCTION 5TA. 4S-r5l.B2\3S RIGhT AT MIDDLE EDGE OF VAULT PL FWR. FED . .r OFF CURB AT&T EASEMENT I—" I L=#— 1-CEVPLAN EX. r=2Dp PLACE 624- SIDEWALK CEV ( IN AT&T EASEMENT SEE DETAIL 1 TRENCHING CATA ASPHALT CONCRK DIRT TCTAu Taco 000 000 000 000 JOINT 000 OQO 000 030 TOTAL 000 ODD 025 025 ~* •CL'ac EC LL CR8L G 31 - CENTgrOKE = StGN CURVE = WO CURVE = LOT UNE = RIGHT OF VBVf = CUSS LINE= as - i^t-"- STOPM r>r»Ai 1 -=?.*- UK V Pl- CAB = MANHOLE = FWCE - PEDESTAL n CftcliNET - J ,-^n,u.- • _G^ '--,T^^= i HI. suasisuwjss SHOW * TWOUOES (!) jR 5L t 3 =Ui ALuuIKlHS UJ5T 3c «RE AN «", WPACTDR £ "^ A — _£ •" c _ :-ic A. s> =* ;.N OU/18/Ob MOW 08 s'V 18 FAX 760 744 3188 WANTED DATE IRISH CONSTRUCTION Aj^SempraEnergy uaay- EtecTRlC METER & SERVICE LOCATION 2X 2 D OVERHEAD Ta //2 7/^2- )ERGROUND.SPECS ATTACHED DJT MEET BEffO BgOMML pQESlDEttTlAL PROJECT NO JOB NO ADDRESS &MOHATDRIUM SPtECT AGSMCV PHONE? .YEAR. DCUST SERVICE ATTACHMENT poirn AND/OR METES LOCATION C.£tsfartcAJ7& 77? SOG4E APPLICATION REG-OS''' CAU. /NOTE. SNSPEC REQ-0 PRIOR TO SET' CS^ITY/COUMTY D STATE GENERAL CUSTOMER INFORMATION Meier Helghl "JO min. -53'" .Tiax frorn finisfi gfaiie (o cqnter !ms of meter basa Meters ays required to be readily accessi&te 24 hours per day Meters must be located m a safe area fras gf any potentially Mazardous of dangerous comfilian Provide 3 ft XSft minimum clear and lesvet working space in tronl of meler Where meter room is proposed, contact ths Planner at the nearest SOG&E office- Meter bases and rosier sgrviqft disconnects must bs localotl al or immediately adjacent lo each other and be Ictenft'fiod wtfi address and urul number if setvss POLS s__ _ LADDER ARMS asa o D EXISTING Q STOP TRENCH Q1 D7W FROM POLE RLS£H QUAD OVH1HEAD SERVICES PROVIDE MINIMUM GROUND CLEARANCE OF . R. at point of attachment of service wines ___^__ FL airer driveway or parking area . PI at outer limit of vehituiar traffic" .. Ft - -_ - ._ .._.-, UNDERGROUND SERVICE PROCEDURE FOR INSTALLATION 1 Pay ali monies due Q APPLICABLE BrJbT APPLICABLE *¥-"vi'CfZJS2- Phone SOG&E al ^?^?ff-jaM-' 9 working daya poor to trenching to arrar.ga with Inspector and imfiate irenchir,g process, 3. PHONED!GALERT1-SQ0227-2SOI}ATL=ASTTWODAYSPR10RTOTHSNCH- 1«G FOR LOCATION OF UNDERGROUND UTILITIES 4 Excavate trench, install conduil and SEivicc enlrgnce equipment at meter location CALL ABOVE PHONE # FOR INSPECTION Do not cover coriduH v/Itiiaul inspector's wailen approval [o bacffli 5 CaJf inapador when trench is backfilled <and ct>mpacted lor mspecbon If ssrvtee entrance equipment is installed after QacMUl. CALL ASOVE PHONE * FOR INSPECTION OF THE EQUIPMENT 5 Meter will be set aftar inspector haa approved inslalfation Including service equipment, and receipt of city/county/steic irwpcdion clearance ADD L INFORMATION (DeWch before completing this seciion )_ JT TRENCH DGAS OTE(.CO DcATV SEC HEIGHT CABLE POLE BEND BY Dcusr pannis STJM an sp-= HANPHOLEBY QCIJETOMER DSOG8.S OsTDPASEI. CONDUIT er QcusrTO^ER OSBGIS see TBSNCH INSPECTED i APPROVED Br DATE PAYMENT 3Y CUST CEL ft S EXCS533 -^MISCS PHASE -METEH CUPS AAWN svurrcri 0CTS BfisT BY ?A5S FAClcmES RgQ D urnLmes UAXIMUU coNTRiBimoN TO FAL-UT .AMPS If SDQ&E 8n«uft!flis hazarefaus pr to»c matersai v;ha& pariofreing ca/izinwlloi'i <sf you/ prosed, SOG45 will holt wcrft fanedatsly ii-d i< v/iil bn ycur rciponsifciBiy to rfrncvs And/or clean Q) ail tiazaAlqus or i"^a= raaiensl prtcr to SDG5^ ainlinylng eoruirucibn SOGfi.5 3ti»B have no tafcilily of oWigaU'oft v»h-Jao«»Br ta clain up remove cl rcmscfteilc ^-^ hazardous or loxlc materials dscowias during fta course ol cansiTucllan urtasa « la through (issllgence of SV>a&E. Cusiampr-owncij iaaSiics lo receive fr'ecwc:! selves are s'Jiicc! jo a!l appileahlc tocsl ami jtara at CaltfcmtE inspgcKon 5«'.norEy require nonUL aifflcing aadfc^s aid/or .-ruler ca== must tie poslsd pner lo raatei 501. Inlomradon a!i lhi3 shsot Is void aftar e rwvuhs rram dala feep Lhia no:ise wllh hu!iSng permit WHtTEOFUGlMAl.-Customer WKTE COPY - Dfeliitt Op»<aoH5 YELLOW - Planner 60LD-CT QWer '07 03212 Owl 09/18/06 MON 08 19 FAX 760 744 3188 IRISH CONSTRUCTION OOOoooooo ooooooooo LOOK SW too TLUGS 11300-12x5x7-504 Ol(T ± TO RlGrlT Of WAY iO± TO CENIERUIC SW. 51+7500 MKj?130Q-SE£ DETAIL ± TO NEW CEV IS TO PP [E 4: EXPOSE 5-A' DU & 1-3" DU A. 49+S7SS/096S1 RT (APPROX.) JD 4" DUCTS TO COUPLING ASSEMBLIES -IE C£V EXTEND THE 3* DUCT TO THE »PQWER PEDESTAL PLACE OJCT(S)US^D MATE LCM13N ONLY 8 VERFT LOMKN Sr ^- _fi^1- ^7 -*],:„ 3 (J) 3 R. i'L SffiE=S i(Jb ^ 7 THE PROJECT RECURS DCTATCN. CGhlsTHyCTOW 'UK. W1LEE: WD !MF\£UHNT ALL SSTT MAW6EMENT PRACHCES (ff-JP 5) ffi RiOUIFS 70 ENSURE COMP'JWK W,TH S8C POL!« LtTIER ISSUES S"1"^ AAT,/i -SrHj'jM" AH STLRfji iVAl^j5 ^C^UT'CN C=JTO-"^- OSSj) 1ND ?A »EGU'JiTiCNS ?U3'JSHlD IN 1°9Q AS MODirJ 2" THE PKA5E II RUi £ IN ISM !N OSLS5U WHCH»« M PAVDJEhTr WILL COMrLY iVlTri CT, SiD 5S-1' FOR *!QICHa i' TO 6 *K, WDC1 TRi-NCTc3 Vffli COUi-lf MW S*N OIECO REG STO DWG, G-24 TYPE A ftESURWitW - - NP PSMITS. C!TC OF CARLSBAD— EXCAVATION RECORK. »T4T JOs 5^6^301 OCaftNES. RO-SETK 760~"3S-3iM S3C INSPECTOR BffiiNNER 750-459-3 11 5 LWc: CCUPLETED 02/03/2QOS REVISED OS/13/20D6 re^Vrt, D6(1S) E-C^ES OCNVCARLSSAD 50 34?* [7 lf.-.~~ TliilSJ £|i-^7i*50^ tWe-^-3 i,P VOSSP3 -3 ^ or «™w ^^ ^ CEy A, JOB wwa"i sal OJ74 OW 1.j_ o- 1 PSV >m . ^^ so§i -I^AM _ 7607397494 # 2/ 2 ,jfta Energy unnty- ELECTRIC METER & SERVICE LOCATION TB // 2^7 f^- D OVERHEAD BUNDERGROUNP SPECS ATTACHED D JT MEET REQ D EB<5OMM L D RESIDENTIAL NAME^T/^/7 - d£?lS(& &/2-£3iS/ ADDRESS ££s<~/'5~ tfT^-TZyZts/yy )<*& <T'<5 f .POWER SOURCE ^_ CONTACT S-J~, ' ff) ^*77''U£K__ T)lteZ-£5>/ PHONE » 8'S^-^^-2^^3> "SERVICE ATTACHMENT POINT AND/OR METER LOCATION QttS'fe/rfCj f£/-rfr PuU-'UtfZi.TTZd/yi S/&J (LtiU\)&t; & J^dfetZST&Cs OAJ ^&77i--5?jO£ O/^ &W (L/ft-L /c&2~ jfrLL- ^/&>£%3?77d ^ Hf SnfiXF APPLICATION RF« n^f CAI 1 / ~OCf6' ^nf— x'-^V-J? GENERAL CUSTOMER INFORMATION Meter Height 40 mm 63 max from finish grade to center line of meler base Meters are required to be readily accessible 24 hours per day Meters must be located in a safe area free of any potentially hazardous or dangerous condition Provide 3 ft X3ft minimum clear and level working space in front of meter Where meter room is proposed contact the Planner at the nearest SDG&E office Meter bases and meter service disconnects must be located at or immediately adjacent lo each other and be identified with address and unit number it serves OVERHEAD SERVICES PROVIDE MINIMUM GROUND CLEARANCE OF Fl at point of attachment of service wires Fl over driveway or parking area Fl at outer limit of vtehirular traffic Ft UNDERGROUND SERVICE PROCEDURE FOR INSTALLATION s> 1 Pay all monies due D APPLICABLE HllOT APPLICABLE 2 Phone SDG&E a( <71?^3at'J 3 working days prior to trenching to arrange with inspector and initiate trenching process 3 PHONE DIG ALERT 1-800 227 2600 ATLEASTTWO DAYS PRIOR TO TRENCH- ING FOR LOCATION OF UNDERGROUND UTILITIES 4 Excavate trench install conduit and service enlrance equipment at meter location CALL ABOVE PHONE # FOR INSPECTION Do not cover conduit without inspector's written approval to backfill 5 Call inspector when trench is backfilled and compacted for inspection If service entrance equipment is installed after backfill CALL ABOVE PHONE # FOR INSPECTION OF THE EQUIPMENT 6 Meter will be set after inspector has approved installation including service equipment, and receipt of city/counly/state inspection clearance JT TRENCH DGAS DTELCO DCATV SEC HEISHT r=ARI F PDLP CONDUIT BY OdlRTnUPR PISDnRP SI7P r.nm c POI P npMO av DrajBT r)snfiiPon pAninc: sr:H nn SI7P HAWDHOLRRV riCUSTDMPII DsDRRE l~l STO PARF t CONDUIT BY [^CUSTOMER D SDG&E SIZE | - 3 ' ' TRENCH INSPECTED & APPROVED BY DATE PAYMENT BY CUST CBL PL S EXCESS S . MISC S -^ WIBP I PHARP /2^/£ VA/niTAGE "^ METFR CLIPS MAIM swirr.H £OO METPFywR IT) r:rs ft^pi p rnNTA'NFn QtEST BY PASS FACILITIES REQ D IJTIt ITieS MAXIMUM CONTRIBUTION TO FAULT CURflBir4^)'QOC' AMPS IV SDG&E encounters hazaidous or toxic material while performing consimclion of your project SDG&E will halt work immediately and H will be your responsibility to remove and/or clean up all hazardous or toxic material prior (o SDG&E continuing construction SDG&E shall have no liability or obligation whatsoever lo clean up remove ol remediate any hazardous or toxic materials discovered during the course ol construction unless M is through negligence ot SDG&.E PROJECT NO <*Z.^<T £'tf*''sf \ JOB NO /^/ & MOHATOnillWirPFFCT AftFNCY TYPF DATE CHI 1 ICAL PENDING STRtE 1 HESURFACING MONTH S~ YFAR TCP REQ D L^ST EXC & PERMITS REQ D D CUST Q^DG&E 'L- 7& J>£diJiO£~ /^r7U£-/A v-/-^£ ^"£&fi}£t//7~ ^7j£/%\j£3~-<yCjn £3L>P£& (_J}J&> ~2-<^$yj J& ' /??l=7E9. Z&//J-Y ££ t ' •ij^ /^€/^j£ 7& /Zt&c/iP/y) — /fy^rfi/^y 23<Q ' //ff^^&fezisZi&t NOTE INSPEC REO D PRIOR TO SET LH^ITY/COUNTY D STATE POLE 1 AHOFR ARMS RFnn PI FXISTINRH STOP TRENCH Dl D?'/ FROM POLE RISER QUAD *N I ""'^>^ SWFiJft^Zb ^ ~^^~ f'z.' i'\ ~\ r^i^l^S3"^^ ( ) "^ V ^/ p j < ClJEPlil#e£\j£L i)K£k~lh£? j^ 3PP£^. f^T~T^JlJLS£CJf(^^' iN FtfdMr ~^ ADD L INFORMATION (Detach before completing this section ) ' f /W^Ai/L^-^^J^^^^u^^-^ T^V^/p/7 ^ -7^57 ^A?/^ f [£>J (r / £} b* f ^^ ~^^ ' * Customer owned laalities lo receive: electrical service are subject to all applicable local and slate ol California inspection aulhonly requirements Building address and/or meler base must be posted prior lo meler set Inlormation on this sheel is void after 6 months from dale Keep Ihis notice with building permit DISTRIBUTION WHITE ORIGINAL - Customer WHITE COPY - District Operations YELLOW Planner GOLD - C T Order 107 09212 (3/04) ACORD- CERTIFICATE OF LIABILITY INSURANCE ROi?£iPF PRODUCER Rancho Mesa Insurance Agency 5 010 Gillespie Way, Suite 108 Caaon CA 92020 .none: 619-937-0164 Fax:619-937-0168 INSURED ! i Robinson Electric I 8871 Troy Street Spring Valley CA 91977 DATE (MM/DD/V VYV) 09/30/05 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCATE J HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE INSURER A. Cypress Insurance Company INSURER B INSURER C INSURER 0 INSURER £ NAIC# i '* COVERAGES ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OH MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS OCCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSH ADU'L LTR INSRD TYPE OF INSURANCE & 1 GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY | CLAIMS MADE | | OCCUR GEN L AGGREGATE LIMIT APPLIES PER ' POLICY | iSlcr | |LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY | OCCUR [ | CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABILFTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' If yes describe under SPECIAL PROVISIONS below OTHER POLICY NUMBER W5A08133 POLICY EFFECTIVE DATE (MM/DD/YY) 10/01/05 '•ffiESEffiRT 10/01/06 LIMTTS EACH OCCURRENCE UAMAlab lUHbNIbU PREMISES (Ea occurence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS COMP/OPAGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY EA ACCIDENT OTHFH THAN EA ACC AUTO ONLY AQG EACH OCCURRENCE AGGREGATE _ 1 WC STATU I OTH X | TORY LIMITS 1 EH E L EACH ACCIDENT E L DISEASE EA EMPLOYEE E L DISEASE POLICY LIMIT $ $ $ $ $ $ $ $ $ ii $ $ $ $ $ $ $ $ ;' $ $1000000 $1000000 $1000000 ; 1 RE. ALL OPERATIONS *10 DAY NOTICE FOR NONPAYMENT OF PREMIUM :ERTIFICATE HOLDER CANCELLATION CITYSAN CITY OF SAN DIEGO ATTNj BUILDING INSPECTION DEPT 1222 FIRST AVENUE, M/S 301 SAN DIEGO CA 92101 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL * 3 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. 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