HomeMy WebLinkAbout2663 CAZADERO DR; ; CB021828; Permit06-24-2003
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Patio/Deck Permit Permit No CB021828
Building Inspection Request Line (760) 602-2725
Job Address
Permit Type
Parcel No
Valuation
Reference #
Project Title
2663 CAZADERO DR CBAD
PATIO
2154600100 Lot#
$3,672 00 Construction Type
FISCHER-DECK SF
Applicant
MICHAEL CRAIG PATIOS
910 NARDO
ENCINITAS, CA 92024
619-753-1566
Status ISSUED
0 Applied 06/18/2002
NEW Entered By JM
Plan Approved 06/18/2002
Issued 06/18/2002
Inspect Area SR
Plan Cneck#
Owner
FISCHER ANTHONY JR&MARIA
2663 CAZADERO DR
CARLSBAD CA 92009 '8096 06/24/03 0002 01 02
CGP 26.75
Building Permit
Add'l Building Permit Fee'
Plan Check
Add'! Plan Check Fee /
Strong Motion Fee >
Renewal Fee (
Add'l Renewal Fee f
Other Building Fee
Additional Fees
TOTAL PERMIT FEES
$5340
- $000
^$3477
r$QOO
^ $1 001 $26 75
; $000
< $20 oor $000
$136 Ol'
Total Fees $13601 Total Payments To Date *'/^ r $10926 ', Balance Due,$2675
Inspector
FINAL AP
Date
OVAL
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
Jees/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
FOR OFFICE USE ONLY
PLAN CHECK
EST VAL
Plan Ck Deposit-
Validated By—^l/ld
Date
Address (include Bldg/Suite #)Business Name (at this address)
Legal Description Lot No Subdivision Name/Number Unit No Phase No Total it of units
2.L LCONTACT^PERSON^if different from applicant!
JVD Agent for Owner
Name ,
'4" V PROPERTY OWNER!
ISPf-J^t 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
exemption Any violation of Section 7031 5 by any applicant for a permit subjects the applicant to ajiivil penalty of not more than five hundred dollars |$5001)02Mb " ' ' " -
Name ' " Address *>
State License # r^ZD^ •— *-^-Cs» License Class J^
iiA
Designer Name Address
State License #
City State/Zip Telephone #
City Business License # S* ^ i-^t?
City State/Zip Telephone
Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations
C] 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
CU 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 ^*fl^PS p^>m^ Policy No feT? foH? ^ ^O I Expiration Date Qfa - Q\ -
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [61001 OR LESS)
[H 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 additiortftto the cost of compensation damages as provided for in Section 3706 of trie Labor code interest and attorney s fees
SIGNATURE -^fllr*1" — '_ DATE '£>— ( ^ r~& ?,
^MWNER-BUlLDERDECURAtlOrfeJfs^^h^ '-'A^'.T,'^'^^W^j;^ ?t>n ^ ( ^ * V , (I vl !r; !l « J! "i.:-«, a "fi.'U.,' '.'ly Mr ' " *
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 contractorlsj 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 O 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
^FORVv^^ <« 8 1~" '^"-V «.',m," A!t '," ,V-'1 1,? " ! "','.? ''""U >.*>>. «^-^ i "V
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 Act7 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 district7 D YES CD NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q YES Q NO -
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE
REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT
1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097(i) Civil Code)
LENDER'S NAME *™^"'LENDER'S ADDRESS
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 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 commeiwed within 1 80 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 commencesy^- a period of 180 days (Section 106 4 4 Uniform Building Code)
APPLICANT'S SIGNATURE DATE
WHITE File YELLOW Applicant PINK Finance
City of Carlsbad Bldg Inspection Request
For 07/01/2004
Permittf CB021828 Inspector Assignment SR
Title FISCHER-DECK 230 SF
Description
Type PATIO Sub Type
Phone 7604318136
Job Address 2663 CAZADERO DR
Suite Lot 0 \IA/\
Location Inspector — W V
APPLICANT MICHAEL CRAIG PATIOS
Owner FISCHER ANTHONY JR&MARIA
Remarks PM'PLEASE „
Total Time Requested By TONY
Entered By CHRISTINE
CD Description Act Comment
19 Final Structural
Associated PCRs/CVs
Inspection History
Date Description Act Insp Comments
07/08/2002 11 Ftg/Foundation/Piers AP SR OK TO POUR FTG
06/20/2002 11 Ftg/Foundation/Piers CO SR NOT WIDE ENOUGH/STEEL NOT AS PER PLAN
— ZED Structural Engineers
7920 MiramarRd #127
San Diego Ca 92126-4206
TEL (858) 549-6996 FAX (858) 549-2121
SCALE
SHEET NO OF
CALCULATED BY
JOB
O DATE +— S -
FISCHER DECK
By APPROVED
CONTENTS :
DESIGN LOADS JlM/fc-5- £86> Dl ~~> °2
DECK FLR FRAMING FF1 --> FF5
COLUMN DESIGN Ctfy of CA^L'SEArf1 ~-> Cl
FOOTINGS BUILDING-DEFT. X -> Fl
GOVERNING CODES :
UNIFORM BUILDING CODE 1997
AMERICAN CONCRETE INSTITUTE (318-95) 1995
AMERICAN INSTITUTE OF STEEL CONSTRUCTORS MANUAL ... 9TH EDITION
DESIGN CRITEREA :
1- SEISMIC ZONE
2- WIND EXPOSURE
3- MAXIMUM ALLOWABLE SOIL PRESSURE
4- MATERIALS & DESIGN STRESSES (U.O.N)
: 4
: N/A
: 1,000 PSF
- FRAMING LUMBER
- G.L.B. COMBINATION
- BOLTED CONNECTIONS
- CONCRETE
5- BASIC LIVE LOADS :
- ROOF
- FLOORS
- SPECIAL
DECKS
CORRIDORS
LIVING
DOUGLAS-FIR LARCH (NORTH)
24F-V8
A307
F'C = 2,500 PSI
N/A
40 PSF
N/A
N/A
N/A
— ZED Structural Engineers
7920 MiramarRd #127
San Diego Ca 92126-4206
TEL (858) 549-6996 FAX (858) 549-2121
SCALE
SHEET NO £>/OF
CALCULATED BY DATE
JOB
SYNOPSIS OF THESE CALCS :
THE DECK IS RESTRAINED IN TWO ORTHOGONAL DIRECTION BY THE
FRAME OF THE 2 STORY HOUSE FRAME AND THUS WOULD NOT
NECESARILY NEED A LATERAL SUPPORT OF ITS OWN.
NEVERTHELESS THE 6x6 POSTS WITH THEIR POST/BEAM HEAVY "CC"
CAP CONNECTOR AND THE POST/FOOTING HEAVY POST BASE "CB"
CONNECTOR WILL PROVIDE CONSIDERABLE ADDITIONAL REDUUNDANT
STIFFNESS.
PLEASE NOTE : THAT ANY DECK LATERAL LOAD IMPOSED ON THE HOUSE
WOULD BE NEGLIGIBLE COMPARED WITH THE EXISTING LATERAL LOADS
THAT THE 2 STORY HOUSE IS DESIGNED FOR AND THUS THE EXISTING
SHEAR WALLS OF THE HOUSE WOULD NOT NEED TO BE RE-CHECKED.
A — ZED Structural Engineers
7920 MiramarRd #127
San Diego Ca 92126-4206
TEL (858) 549-6996 FAX (858) 549-2121
SCALE
SHEET NO OF
CALCULATED BY
JOB
DATE
LOAD COMBINATIONS : UBC SECTION 1612.3.2
WILL BE BASED ON ALLOWABLE STRESS DESIGN USING THE 33% INCREASE
DESIGN LOADS EXTERIOR 2ND STORY DECK
DECKING
FRAMING
MISCELLANEOUS
3.0
3.0
1.0
FLOOR LIVE LOAD
D.L.- 7.0 PSF
L.L.= 40.0 PSF (REDUCIBLE)
— ZED Structural Engineers
7920 MiramarRd #127
San Diego Ca 92126-4206
TEL (858) 549-6996 FAX (858)549-2121
SCALE
SHEET NO OF
CALCULATED BY DATE 01
JOB 0 y<<
MINIMUM JOIST SIZE
SPAN
61
8'
10'
12'
14'
16'
18'
201
22'
24'
SPACING
16" 0/C
24" 0/C
16" 0/C
24" 0/C
16" 0/C
24" 0/C
16" 0/C
24" 0/C
16" 0/C
24" 0/C
16" 0/C
24" 0/C
16" 0/C
24" 0/C
16" 0/C
24" 0/C
16" 0/C
24" 0/C
16" 0/C
24" 0/C
ROOF
FLAT
2x4
2x4
2 x 4 SS
2x6
2x6
2x6
2 x 6 SS
2x8
2x8
2 x 8 SS
2 x 8 SS
2 x 10
2 x 10
2 x 10 SS
2 x 10 SS
2 x 12
2 x 12
2 x 12 SS
2 x 12 SS
2 x 14 SS
SLOPED
2x4
2x4
2x6
2x6
2x6
2 x 6 SS
2x8
L 2x8
2x8
2 x 10
2 x 10
2 x 10
2 x 10
2 x 12
2 x 12
2 x 12 SS
2 x 12 SS
2 x 14 SS
2 x 14
2 x 14 SS
RESIDENTIAL FLOOR
NO CONC
2x4
2x6
2x6
2 x 6 SS
2 x 6 SS
2x8
2x8
2 x 10
2 x 10
2 x 10 SS
2 x 10 SS
2 x 12 SS
2 x 12 SS
2 x 14 SS
2 x 12 SS
2 x 14 SS
2 x 14 SS
CONC TOP'G
2 x 4 SS
2x6
2x6
2 x 6 SS
2x8
2 x 8 SS
2 x 8 SS
2 x 10 SS
2 x 10 SS
2 x 12 SS
2 x 10 SS
2 x 14 SS
2 x 12 SS
2 x 14 SS
ABOVE TABLE CAN BE USED PROVIDED THAT THE FOLLOWING ARE TRUE :
1- MOISTURE CONTENT IS LESS THAN 19%
2- DEAD LOADS ARE : FLAT ROOF 15 PSF
SLOPED ROOF 24 PSF
FLOOR (NO CONC TOPPING) 10 PSF
FLOOR {WITH CONC TOPPING) 25 PSF
3- JOISTS ARE REPETITIVE.
4- DEFLECTION CRITERIA : L/240 FOR TOTAL LOAD L/360 FOR LIVE LOAD
— ZED Structural Engineers
7920 MiramarRd #127
San Diego Ca 92126-4206
TEL (858) 549-6996 FAX (858) 549-2121
SCALE
SHEET NO OF
CALCULATED BY
JOB
DATE - 01
NOMINAL
SIZE
2x4
2x6
2x8
2 x 10
2 x 12
2 x 14
4x4
4x6
4x8
4 x 10
4 x 12
4 x 14
4 x 16
6x4
6x6
6x8
6 x 10
6 x 12
6 x 14
6 x 16
6 x 18
8x4
8x6
8x8
8 x 10
8 x 12
8 x 14
8 x 16
8 x 18
REACTION (LBS)
FLOOR
332
522
689
880
1,070
1,260
780
1,220
1,610
2.050
2.490
2,940
3,380
1,220
1,720
2.340
2.960
3,590
4,210
4.830
5,450
1,610
2,340
3.190
4,040
4,890
5,740
6,590
7,440
ROOF
420
653
861
1.100
1,340
1,580
980
1,530
2,010
2.560
3,110
3,680
4,230
1,530
2,150
2,930
3,700
4,490
5,260
6.040
6,810
2,010
2,930
3,980
5.050
6,110
7.170
8,230
9,300
MOMENT #1(FT-LB)
FLOOR
363 *
778 *
1,240 *
1,860 *
2,500 *
3,110 *
736
1,570
2,730
4,110
5,580
7,040
9,320
•1,050
2,770
5.160
8,960
13,130
17,790
23,100
29.070
1,380
3.780
7,910
12,700
18.600
25, 600
33,800
43.100
ROOF
453 *
972 *
1,560 *
2,320 *
3,130 *
3,890 *
920
1,970
3,420
5,140
6,970
8,800
11,660
1.310
3,460
6,450
11,200
16,410
22.230
28,880
36,340
1,730
4.720
9,890
15,900
23,300
32.000
42,200
53.800
MOMENT SS(FT-LB)
FLOOR
573 *
1,220 *
1,960 *
2,930 *
3, 940 *
4,910 *
1.160
2,480
4,310
6.480
8,790
11,090
14,700
1,660
3.460
6.440
11.030
16,160
21. 900
28,440
35.780
2,180
4,720
9,380
15,000
22,000
30,400
40,000
51.000
ROOF
716 *
1.530 *
2,450 *
3,660 *
4,920 *
6,140 *
1.450
3,100
5,390
8.110
10,990
13,860
18,370
2.070
4,330
8,060
13,790
20.200
27.370
35,550
44.720
2.720
5,900
11.700
18,800
27.600
38,000
50,100
63,800
I (IN4)
5.4
20.8
47.6
98.9
178
291
12.5
48.5
111
231
415
678
1.030
19.6
76.3
193
393
697
1,130
1,710
2,460
25.9
104
263
536
951
1,540
2.330
3,350
(*) VALUES OF 2x'S ARE INCREASED BY 15% FOR REPETITIVENESS.
A- ZED Structural Engineers
7920 Miramar Road, Suite 127
San Diego, Ca 92126-4206
Te! (858)549-6996 Fax (858)549-2121
SCALE
SHEET NO
CALCULATED BY A ' /L.
CHECKED BY
JOB
.OF.
.DATE /' 1
DATE
A — ZED Structural Engineers
7920 MiramarRd #127
San Diego Ca 92126-4206
TEL (858) 549-6996 FAX (858) 549-2121
SCALE.
SHEET NO
CALCULATED BY
JOB
OF
DATE 0 X.
GLB DESIGN BASIS :
1- DESIGN IS BASED ON THE UBC 1997 SECTION 2316.
2- GLB COMBINATION : 24F - V8
3- APPEARANCE : ARCHITECTURAL
4-- SPECIES OF OUTER LAMINATION : DOUGLAS-FIR LARCH
5- SPECIES OF INNER LAMINATION : DOUGLAS-FIR LARCH
6- MOISTURE CONTENT : LESS THAN 16%
(AS IN THE CASE OF INTERIOR STRUCTURES).
FOR WET USE THE VALUES WOULD HAVE TO BE
ADJUSTED.
7- VALUES ARE VALID FOR SIMPLY SUPPORTED WITH UNIFORM DISTRIBUTED
LOADS AND FOR CANTILEVERED/CONTINUOUS BEAMS WITH ANY TYPE OF
LOADING.
8- MAXIMUM LENGTH OF BEAM : 60'
9- LENGTH OF BEAMS ARE ASSUMED TO BE EQUAL TO 20 TIMES ITS DEPTH
FOR THE PURPOSE OF CALCULATING THE VOLUME FACTOR Cv-
A — ZED Structural Engineers
7920 MiramarRd #127
San Diego Ca 92126-4206
TEL (858) 549-6996 FAX (858) 549-2121
SCALE
SHEET NO
CALCULATED BY
JOB
A"A
OF
DATE
FLOOR GLB (NO DURATION LOAD INCREASE)
D
(IN)
9
101/2
12
131/2
15
161/2
18
191/2
21
221/2
24
251/2
27
281/2
30
311/2
33
34i/2
36
371/2
39
40i/2
42
431/2
3
R(K)
3.0
3.6
4.1
4.6
5.1
5.6
6.1
6.7
7.2
7.7
8.2
8.7
9.2
9.7
10.3
1/8
M('K)
8.4
11.4
15.0
18.7
22.7
26.9
31.5
36.4
41.6
47.1
52.9
59.0
65.4
72.1
79.0
G
KIN4)
189
301
450
640
878
1,160
1,510
1,930
2,410
2,960
3, 500
4,310
5,120
6,020
7,030
LB WIDTH
Cv
1.000
1.000
1.000
0.989
0.969
0.950
0.934
0.919
0.906
0.893
0.882
0.871
0.861
0.852
0.843
SIZE
R(K)
5.0
5.9
6.7
7.6
8.4
9.3
10.1
10.9
11.8
12.6
13.5
14.3
15.2
16.0
16.9
17.7
18.6
19.4
20.2
5 1/8
M('K)
13.8
18.6
23.7
29.3
35.4
42.0
49.2
56.8
64.9
73.5
82.6
92.1
102
112
123
134
146
158
171
KIN4)
311
494
738
1,050
1,440
1,910
2,490
3,160
3,950
4,860
5,900
7,080
8,400
9,880
11,530
13,340
15,340
17,530
19,920
Cv
1.000
0.990
0.964
0.942
0.922
0.904
0.889
0.875
0.862
0.850
0.839
0.829
0.820
0.811
0.802
0.795
0.787
0.780
0.774
ZED Structural Engineers
7920 MiramarRd #127
San Diego Ca 92126-4206
SCALE
SHEET NO OF
CALCULATED BY
JOB
o DATE o-i - o-y
TEL (858) 549-6996 FAX (858)549-2121
ALLOWABLE POST LOADS <KIPS)
FLOORS
H
8
9
10'
11'
12'
13'
14'
i £ '
1 7 '
1 ft '
9f! '
4x4
6.99
5.68
4.69
3.92
3.32
2.85
2.47
4x6
10.9
8.89
7.34
6.15
5.21
4.47
3.88
4x8
14.3
11.6
9.65
8.09
6.87
5.89
5.11
6x4
20.7
18.2
15.8
13.7
11.9
10.3
9.10
O . -Lu
6x6
24.8
23.0
20.9
18.9
16.9
15.0
13.4
6x8
33.8
31.3
28.6
25.7
23.0
20.5
18.3
1 £ i
11 i
U p
Q 7ft
6x10
40.4
37.8
34.7
31.6
28.4
25.4
22.8
9H A
1 ft "3
1 £ £,
14 Q
19 1
8x4
30.9
29.2
27.2
25.1
22.8
20.6
18.6
i £ ft
i ^ i
11 £
19 A
8x6
37.8
36.6
35.3
33.7
31.9
29.9
27.8
8x8
51.5
50.0
48.1
45.9
43.5
40.8
37.9
zo . i
Z o . 1
8x10
65.3
63.3
60.9
58.2
55.1
51.7
48.1
o 1 . o
8x12
73.7
71.7
69.3
66.5
63.3
59.8
56.0
J / . y
ROOFS :
H
8
9
10'
II1
12'
13'
14'
1 S *
i & '
17'
1 Q '
9n i
4x4
'7.19
5.80
4.76
3.97
3.36
2.88
2.49
4x6
11.2
9.08
7.46
6.23
5.27
4.52
3.91
4x8
14.7
11.9
9.81
8.19
6.94
5.94
5.15
6x4
22.9
19.6
16.7
14.2
12.2
10.6
9.28
6.44
R 9fl
A "71
6x6
28.9
26.0
23,1
20.4
17.9
15.7
13.9
19 "3
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1- H IS EFFECTIVE HEIGHT IN FEET.2- GRADE #1.
A-ZED Structural Engineers
7920 Mtramar Road, Suite 127
San Diego, Ca 92126-4206
Tel (858)549-6996 Fax (858)549-2121
SCALE
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PO BOX 807, SAN FRANCISCO,CA 94101-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE 06-01-01 ' , , ' , * "
COMPENSATION
f N SURANCE
FUND
POLICY-NUMBER 1076665 - 01
CERTIFICATE EXPIRES 06-01-02
CITY OF OCEANSIDE, BUILDING DEPT
300 N. HILL STREET
OCEANSIDE CA, 9205**
JOB ALL OPERATIONS
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 ,document
with 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
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS. $1,000,000 00 PER OCCURRENCE
STANDARD EXCLUSION INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE
FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY • ;
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06/01/01 IS ATTACHED TO AND
FORMS A PART OF THIS POLICY
EMPLOYER LEGAL NAME
MICHAEL CRAIG PATIOS
910 NARDO RD
ENCINITAS CA 9202U
COTHRAN, DAVID E AND
COTHRAN. LESLIE A
PRINTED 05-17-01 P0409
SCIF 10265 (REV. 2-95)