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HomeMy WebLinkAbout2903 CARLSBAD BLVD; ; CB000829; Permit04/04/2000 City of Carlsbad Commercial/Industrial Permit Permit No: CB000829 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: Project Title: 2903 CARLSBAD BL CBAD Tl Sub Type: Lot#: $33,600.00 Construction Type: 28 Reference #: MILLENIUM ARTS Tl 1200 SF NEW TENNANT SPACE COMM 0 NEW Applicant: GEORGE YERMONES 108 4010MORENABL SAN DIEGO CA 92117 858-270-4792 Owner: Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: ISSUED 03/09/2000 JM 04/04/2000 04704/2000 0001 01 C-PRHT 02 408-59 Building Permit Add'l Building Permit Fee Plan Check Add'l Plan Check Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'l Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'l Pot Water Con. Fee Reel. Water Con. Fee $0." $0.00 $0.00 $0.00 $0.00 nd) on Fee TAL RICAL TOTAL MECHANICAL TOTAL Master Drainage Fee: Sewer Fee: Redev Parking Fee: TOTAL PERMIT FEES $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $41.00 $35.00 $24.00 $0.00 $0.00 $0.00 $604.58 Inspect FINAL APPROVAL Date:Clearance: NOTICE: Please take NOTICE that approval of your project includes the 'Imposition" of fees, dedications, reservations, or other exactions hereafter colleclively 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 capactiy 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 2075 Las Palmas Dn, Carlsbad, CA 92009 (760) 438-1161 PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 1635 Faraday Ave., Carlsbad, CA 92008 FOR OFFICE USE PLAN CHECK NO. EST. VAL. Plan Ck. Deposit^ Validated By I J\y Date Address (include Bjdg/Suite Business Name (at this address) Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units Assessor's Parcel #Existing Use Proposed Use Description of Work # of Bathrooms0001 01 02 <.:--, -*O«* OO; ; ' :> 4-5n#" ' ' Name Address City State/Zip Telephone #Fax* Name Address City State/Zip Telephone # WIFi^lll^Gf0|i?l:i^l*MlSNA«ffi (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 SsetTBn 7Q31.5 by a(jy applicant for a permit subjects the applicant ^x,a-f ivilpenalty of njjj morejp.an five hundred^dollars I$500]).^ City State/Zip City Business License # Designer Name State License # Address State/Zip Telephone Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: Q I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. \Jf I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Insurance Company Policy No. Expiration Date {THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS) fj CERTIFICATE OF EXEMPTION: I certifyohat 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 WorJwrS*"C4mpenwtion Lawsyif California. WARNING: Failure to u&re workers' oompensatiopr coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars {$10&000), In additionrto the coBfof compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. SIGNATURE ^-^. C ^/ ^—- DATE 7. OWNER-BUILt 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 contractors) licensed pursuant to the Contractor's License Law). 0 I em exempt under Section _ Business and Professions Code for this reason: 1 . I personally plan to provide the major labor and materials for construction of the proposed property improvement. Q YES QNO 2. I (have / have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction (include name / address / phone number / contractors license number): 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone number / contractors license number): _ , _ 5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone number / type of work): _ _ PROPERTY OWNER SIGNATURE DATE Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 26505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? Q YESc»S--NO Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? Q YES Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? Q Y IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code). LENDER'S NAME rU Q _ 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 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-ttieTJuiktyg Ofroial under thj/provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not cpfrfrnenced within 1 w days from Jjlre date of such permit or if the building or work authorized by such permit is suspended or abandoned at any lime after the work is commenced for a periodpf 180 days^Section 106.4.4 Uniform Building Code). APPLICANT'S SIGNATURE DATE TTE: File YELLOW: Applicant PINK: Finance City if Carlsbad Final Building Inspection Dept: Building Engineering Planning CMWD St Lite Plan Check #: Permit #: Project Name: Address: Contact Person: Sewer Dist: Inspected Bv: U Inspected Bv: Inspected By: Comments: CB000829 MILLENIUM ARTS T! 1200 SF NEW TENNANT SPACE 2903 CARLSBAD BL Phone: Water Dist: Date ' & Inspected: V, Date Inspected: Date Inspected: Date: Permit Type: Sub Type: Lot: 0 fa^f 1 Ot) Approved: X Approved: Approved: 4/17/2000 Tl COMM Disapproved: Disapproved: Disapproved: City of Carlsbad Bldg Inspection Request For: 5/3/2000 Permits CB000829 Title: MILLENIUM ARTS Description: Tl 1200 SF NEWTENNANT SPACE Inspector Assignment: DM 2903 CARLSBAD BL Lot 0 Type: Tl Job Address: Suite: Location: APPLICANT GEORGE YERMONES Owner: Remarks: Sub Type: COMM Phone: 8582704792 Inspector: Total Time: CD Description 19 Final Structural 39 Final Electrical 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Requested By: NA Entered By: CHRISTINE Act Comments Date 4/19/2000 4/10/2000 4/10/2000 4/6/2000 4/6/2000 Associated PCRs Inspection History Description Act Insp Comments 19 Final Structural 14 Frame/Steel/Bolting/Welding 34 Rough Electric 14 Frame/Steel/Bolting/Welding 34 Rough Electric PA DM FIRE APPROVAL, HANDICAP COUNTER TEMP OCC AP DM AP DM CO DM CO DM EsGil Corporation In ^Partners/tip with government for WuiCding Safety DATE: 3/3O/00 JURISDICTION: Carlsbad Q PLAN REVIEWER Q FILE PLAN CHECK NO.: 00-829 SET: II PROJECT ADDRESS: 29O3 Carlsbad Blvd. PROJECT NAME: Millenium Arts TI The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified in Remarks below are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. The applicant's copy of the check list has been sent to: Esgil Corporation staff did not advise the applicant that the plan check has been completed. Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: Telephone #: Date contacted: (by: ) Fax #: Mail Telephone Fax In Person REMARKS: The existing restroom disabled accessibility-will be deferred to the City of Carlsbad Building Department for approval as per the^applicant's conversation with Mike Peterson. Please verify. Please make the notes asin red on sheets T-1 and A-1 of the Owner Set II to the City Set I and change to City Se4 II. By: Mike Puckett Enclosures: Esgil Corporation D GA D MB n EJ D PC log tmsmldot 9320 Chesapeake Drive, Suite 208 * San Diego, California 92123 * (858)560-1468 4 Fax (858) 560-1576 EsGil Corporation In "Partners/tip with government for DATE: 3/21/00 t3 JURji JURISDICTION: Carlsbad a PLAN REVIEWER Q FILE PLAN CHECK NO.: 00-829 SET: I PROJECT ADDRESS: 2903 Carlsbad Blvd. PROJECT NAME: Millenium Arts TI The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficiencies identified below are resolved and checked by building department staff. The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. The check list transmitted herewith is for your information. The plans are being held at Esgil Corporation until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person. The applicant's copy of the check list has been sent to: George Yermanes 4010 Morena Blvd. Ste. 108 San Diego, Ca. 92117 Esgil Corporation staff did not advise the applicant that the plan check has been completed. Esgil Corporation staff did advise the applicant that the plan check has been completed. Person contacted: George Yermanes UM Telephone #: 858-292-557G Date contacted: (by: Fax #: Mail-'-' Telephone*— Fax — In Person REMARKS: By: Mike Puckett Enclosures: Esgil Corporation D GA n MB n EJ D PC 3/13/00 tmsmtl.dot 9320 Chesapeake Drive, Suite 208 4 San Diego, California 92123 4 (858)560-1468 4 Fax (858) 560-1576 Carlsbad 00-829 3/21/00 PLAN REVIEW CORRECTION LIST TENANT IMPROVEMENTS PLAN CHECK NO.: 00-829 OCCUPANCY: M TYPE OF CONSTRUCTION: VN ALLOWABLE FLOOR AREA: SPRINKLERS?: Yes REMARKS: DATE PLANS RECEIVED BY JURISDICTION: 3/9/00 DATE INITIAL PLAN REVIEW COMPLETED: 3/21/00 JURISDICTION: Carlsbad USE: Retail Sales ACTUAL AREA: l,200sfTI STORIES: HEIGHT: OCCUPANT LOAD: 40 TI DATE PLANS RECEIVED BY ESGIL CORPORATION: 3/13/00 PLAN REVIEWER: Mike Puckett FOREWORD (PLEASE READ): This plan review is limited to the technical requirements contained in the Uniform Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws regulating energy conservation, noise attenuation and access for the disabled. This plan review is based on regulations enforced by the Building Department. You may have other corrections based on laws and ordinances enforced by the Planning Department, Engineering Department, Fire Department or other departments. Clearance from those departments may be required prior to the issuance of a building permit. Code sections cited are based on the 1997 UBC. The following items listed need clarification, modification or change. All items must be satisfied before the plans will be in conformance with the cited codes and regulations. Per Sec. 106.4.3, 1997 Uniform Building Code, the approval of the plans does not permit the violation of any state, county or city law. To speed up the recheck process, please note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet number, specification section, etc. Be sure to enclose the marked up list when you submit the revised plans. TENANT IMPROVEMENTS WITHOUT SPECIFIC ENERGY DATA OR POLICY SUPPLEMENTS (1997UBC)tiforw.dot Carlsbad 00-829 3/21/00 1. Please make all corrections on the original tracings, as requested in the correction list. Submit three sets of plans for commercial/industrial projects (two sets of plans for residential projects). For expeditious processing, corrected sets can be submitted in one of two ways: 1. Deliver all corrected sets of plans and calculations/reports directly to the City of Carlsbad Building Department, 2075 Las Palmas Drive, Carlsbad, CA 92009, (760) 438-1161. The City will route the plans to EsGil Corporation and the Carlsbad Planning, Engineering and Fire Departments. 2. Bring one corrected set of plans and calculations/reports to EsGil Corporation, 9320 Chesapeake Drive, Suite 208, San Diego, CA 92123, (858) 560-1468. Deliver all remaining sets of plans and calculations/reports directly to the City of Carlsbad Building Department for routing to their Planning, Engineering and Fire Departments. NOTE: Plans that are submitted directly to EsGil Corporation only will not be reviewed by the City Planning, Engineering and Fire Departments until review by EsGil Corporation is complete. 2. It appears that the ramp along the disabled accessible path of travel from the parking spaces to the tenant entrance does not have the required 60" level landing at the top of the ramp. The plan shows an obstruction like a planter within the required landing. Please revise the plans to show a complying path of travel. 3. The existing restroom does not appear to be disabled accessible complying. Please revise the plans to show that there is the required 28" clearance between the edge of the water closet and edge of lavatory for the single accommodation restroom. 4. If it is desired to appeal the requirement for upgrades regarding disabled access provisions, please fill out the enclosed "Application for Unreasonable Hardship" and submit it to the Building Department for approval. 5. Please show or note that the cash wrap transaction counter is disabled accessible with a counter height of between 28" and 34" AFF for a minimum length of 36". 6. Note on plan that suspended ceilings shall comply with UBC Tables 25-A, 16-0 and 16-B. 7. Please revise the code edition statement on the Title Sheet of the plans to include the 1996 NEC. 8. Please provide a note that mechanical ventilation will be provided in all rooms, capable of supplying outside air at a minimum rate of 15 cubic feet per minute per occupant. UBC, Section 1202.2.1. Carlsbad 00-829 3/21/00 To speed up the review process, note on this list (or a copy) where each correction item has been addressed, i.e., plan sheet, note or detail number, calculation page, etc. Please indicate here if any changes have been made to the plans that are not a result of corrections from this list. If there are other changes, please briefly describe them and where they are located in the plans. Have changes been made to the plans not resulting from this correction list? Please indicate: Yes Q No a The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake Drive, Suite 208, San Diego, California 92123; telephone number of 858/560-1468, to perform the plan review for your project. If you have any questions regarding these plan review items, please contact Mike Puckett at Esgil Corporation. Thank you. Carlsbad 00-829 3/21/00 City of Carlsbad Building Department APPLICATION FOR UNREASONABLE HARDSHIP EXCEPTION TO STATE OF CALIFORNIA DISABLED ACCESS REQUIREMENTS (EXISTING BUILDINGS; Section 1134B of Title 24) When existing buildings are remodels and, when the valuation of the modifications is less than approximately 88,962 dollars, the California State Building Code allows relief from some accessibility requirements when the cost of compliance with those regulations is disproportionate. Disproportionate cost is defined as when the cost of all compliance requirements except mandatory measures exceeds 20% of the cost of the project. Where the cost of alterations necessary to fully comply is disproportionate, access shall be provided to the extend that is can without incurring disproportionate costs. In other words, accessible elements must be provided or upgraded to a maximum cost of 20% of the project valuation. Priority for providing access should be given in the following order: A. An accessible entrance, B. An accessible route to the altered area, C. At least one accessible restroom for each sex, D. Accessible telephones, E. Accessible drinking fountains, and F. When possible, additional accessible elements such as parking, storage and alarms. NOTE: SEE CHAPTER 11B, DIVISION IV, CALIFORNIA BUILDING CODE FOR MANDATORY REQUIREMENTS AND THE COMPLETE TEXT OF THE REGULATIONS FOR ACCESS COMPLIANCE IN EXISTING BUILDINGS. Documentation of Unreasonable Hardship: PLEASE PRINT Project Address: Plan Check #: Proposed Use: Owner: Telephone: Applicant: Telephone: Signature: Please Print Name: 2075 Las Palmas Dr. • Carlsbad, CA 92009-1576 • (760)438-1161 • FAX (760) 438-0894 Carlsbad 00-829 3/21/00 WORKSHEET FOR DISPROPORTIONATE COSTS 1. PROJECT VALUATION 2. VALUATION OF OTHER AREAS WITH SAME PATH OF TRAVEL (Total valuation dating back to 1994) 3. TOTAL OF LINE 1 &2 IF LINE 3 EXCEEDS THRESHOLD AMOUNT ($88,962), FULL COMPLIANCE IS REQUIRED. IF LINE THREE IS LESS THAN THRESHOLD AMOUNT, COMPLETE WORKSHEET BELOW. 4. ESTIMATED COST OF UPGRADING ENTIRE PATH OF TRAVEL 5. PROPORTIONATE COMPLIANCE COST (Divide line 4 by line 3) 6. ENTER TWENTY PERCENT OF PROJECT VALUATION 7. MINIMUM COMPLIANCE COST OBLIGATION (Lesser of lines 5 & 6) INDICATE BELOW HOW COST OF COMPLIANCE OBLIGATION WILL BE SPENT ITEM ESTIMATED COST SIGNATURE OF APPROVING AUTHORITY: TITLE: PLEASE ATTACH THIS DOCUMENT TO THE APPROVED PLANS FOR THE USE OF THE BUILDING INSPECTOR AND THE CONTRACTOR. THANK YOU Carlsbad 00-829 3/21/OO VALUATION AND PLAN CHECK FEE JURISDICTION: Carlsbad PREPARED BY: Mike Puckett BUILDING ADDRESS: 2903 Carlsbad Blvd. BUILDING OCCUPANCY: M PLAN CHECK NO.: 00-829 DATE: 3/21/00 TYPE OF CONSTRUCTION: VN BUILDING PORTION Tenant Improvement Air Conditioning Fire Sprinklers TOTAL VALUE BUILDING AREA (ft.2) 1,200 VALUATION MULTIPLIER 28.00 VALUE | ($) I 33,600.00 33,600.00 G 1994 UBC Building Permit Fee • Bldg. Permit Fee by ordinance: $ 301.53 G 1994 UBC Plan Check Fee • Plan Check Fee by ordinance: $ 195.99 Type of Review: G Complete Review G Structural Only G Hourly G Repetitive Fee Applicable G Other: Esgil Plan Review Fee: $ 156.80 Comments: Sheet 1 of 1 macvalue.doc 5196 MARCH 27, 2000 TO: BUILDING DEPARTMENT FROM: Management Analyst, Redevelopment Department TENANT IMPROVEMENTS TO EXISTING RETAIL SPACE LOCATED AT 2903 CARLSBAD BLVD. - MILLENIUM ARTS - PLAN CHECK NO. CB000829 I have reviewed the building plans for the above referenced project. The project is exempt from the redevelopment permit process because the proposed work qualifies as a maintenance activity. Therefore, no land use permit is required. I do not have any objection to the issuance of the building permit for this project. This information will be entered into Permits Plus. If you have any questions, please contact me at X2813. LORI H. ROSENSTEIN Carlsbad Fire Department 000061 1635 Faraday Ave. Carlsbad, CA 92008 Plan Review Requirements Category: Date of Report: 03/14/2000 Fire Prevention (760) 602-4660 Building Plan Reviewed by: Name: Address: City, State: Studio C 5252 Balboa Ave. Suite 607 San Diego CA 92117 Plan Checker: Job Name: Millennium Arts Job Address:2903 Carlsbad Bl CB000829 Ste. or Bldg. No. Approved The item you have submitted for review has been approved. The approval is based on plans, information and / or specifications provided in your submitted; therefore any changes to these items after this date, including field modifications, must be reviewed by this office to insure continued conformance with applicable codes and standards. Please review carefully all comments attached as failure to comply with instructions in this report can result in suspension of permit to construct or install improvements. Approved The item you have submitted for review has been approved subject to the Subject to attached conditions. The approval is based on plans, information and/or specifications provided in your submittal. Please review carefully all comments attached, as failure to comply with instructions in this report can result in suspension of permit to construct or install improvements. Please resubmit to this office the necessary plans and / or specifications required to indicate compliance with applicable codes and standards. Incomplete The item you have submitted for review is incomplete. At this time, this office cannot adequately conduct a review to determine compliance with the applicable codes and / or standards. Please review carefully all comments attached. Please resubmit the necessary plans and / or specifications to this office for review and approval. Review FDJob# 1st 2nd 3rd 000061 FDFile# Other Aqency ID flrnettbConstruct ion Fax:858-270-4795 r 4 '00 7:09 P.01 P.O. BOX 480807rQAN FRANCISCO, CA,94142-0807 FUND ' •' • •" '•' W4&'^ $£*>*4:r H^'^eV11 CITV-QF SW4-*-^-••-<->^'' BUIL0I TW» *> to ortlfy thai InBUranc* OoffwnlMloririrtb th« employtr hanwWlMiowfQt trie• - • - • liwfarwe.pbllcy In.ft form approved by the Callfbrri^ ' ", wr^tfn noHc*to the emptoyer. -,Wo vrHtaleogTvo you ^ days' advance not1 ThJf <*imca4of insurant* Is not on Insurance policy arid does rtof .ahWrtfl, fl><tehd oT Utter the coviwaae affordftd ««^ t»ef*rr, N6tv(fWi^ixJH>fl. any "reqii^^" ' '" "'•inc«^^|^p'^r,ma/'perrMt''^- —•-'-^*-tJ^-' : to all.th^fife^V^Kifli^^f^9)^.of such. x^^>-?u,,,. ^'*rr~r>' 'Psir^'-rr -••.-v*i-L•;,•...'- ^••yaSft^' j'. V*'*s»*w* ''-• ' •*'.«' ' v •>'•, ..' •. "H«fi,«:i^^Vi^Wf. -w"4't »>' * '^$*% - r5^«fia^^^^^^j >UTMORIZ»D REPBfi UIflBllg|5tXHH iNaOC.,^^.^ eUTJTlfeD CEftHFlCAT^«dLD6RS? NOTICE IS ATTACHED .TO flND FaRMS ft PflRT OF-W3 POLICY, IHIi DOCUMTNT HAS A Bl It! I'A TII UN) 1) I'.ACM JluUNU