HomeMy WebLinkAbout2906 CARLSBAD BLVD; ; CB951694; PermitBUILDING PERMI03/14/96 16:14
Page 1 of l
Uob Address: 2906 CARLSBAD BL Suite
Permit Type: COMMERCIAL TENANT IMPROVEMENT
Parcel No: 203-174-01-00 Lot#:
Valuation: 7,550
Occupancy Group: Reference*:
Description: EXTERIOR REMODEL ONLY
: SHELL BUILDING / NO OCCUPANCY
Appl/Ownr : ALVAREZ, RON
355 PINE AVE #E
CARLSBAD, CA. 92008
619
Permit No: CB951694
Project No: A9502472
Development No:
Construction type: VN
Status: ISSUED
Applied: 11/17/95
Apr/Issue: 03/14/96
Entered By: MDP
720-1839
***
Fees :
Adjustments:
Total Fees:
Fees Required ***
165.
1
Fee description
Building Permit
Plan Check
Strong Motion Fee
* BUILDING TOTAL
ected & Credits ** *
16 03/14/96 QQQ&QM
95,00
Ext fee Data
99, 00
64 . 00
2.00
165.00
95-00
FINAL/APPROVAL/
.DATE7/W
CLEARAI
CITY OF CARLSBAD
2075 Las Palmas Dr., Carfsbad, CA 92009 (619) 438-1161
APPLICATION
City of Carlsbad Building Department
2075 Las Pal-as Dr., Carlsbad, CA 92009 (619) 438-1161
1. PERMIT TYPE
From List 1 (see back) give code of Permit-Type:
For Residential Projects Only: From list 2 (see back) give
Code of Structure-Type:
Net Loss/Gain of Dwelling Units_
PLAN CHECK N!
2. PROJECT INFORMATION
4731 11/17/95 0001 01 02
C-PRMT '70-00
FOR OFFICE USE ONLY
Address
Nearest Cross Street yLEGAL DESCRIPTION Lot No.ubdivision Name/Number unit No.hase
t,HECK BELOW IF SUBMITTED:
D 2 Energy Calcs D 2 Structural Calcs D 2 Soils Report D1 Addressed Envelope
ASSESSOR'S PARCEL EXISTING USE _P_ROPOSED_USE
DESCRIPTION OF WORK
SQ.FT.# OF STORIES /# OF BEDROOMS # OF BATHROOMS
3. UUH lAur rEKSUN (a duierent rrom applicant)
NAME (last name
CITY STATE
ADDRESS
ZIP CODE
-* js—/*VX4£-
DAY TELEPHONE
U CON 1 HAU1UR LJ AliENT lJONTlUH
NAME (last name first) MAlQZZ- &W ADDRESS
CITY STATE ZIP CODE
liENT FUK OWNER
DAY TELEPHONE
5. PROPERTY OWNER
NAME (last name first)
CITY
ADDRESS
STATE ZIP CODE DAY TELEPHONE / &%>
CTIY
STATE UC.
DtilUINEK NAME (.last name Rrsu
CITY CiA&£££A& STATE
ADDRESS
ZIP CODE tyl&DQ DAY TELEPHONE
LICENSE CLASS ^" ( CITY BUSINESS LIC. # W^x>
>£5<H/
ZIP CODE UC. # ,
tion Declaration: I hereby affirm that I nave a certificate of consent to self-insure issued by the Director or Inaustnal
Relations, or a certificate of Workers' Compensation Insurance by an admitted insurer, or an exact copy or duplicate thereof certified
by the Director of the insurer thereof filed with the Building Inspection Department (Section 3800, Lab. C).
/ — O\ ~
icate of Exemption: I certify that in the performance oi
so as to become subject to the Workers' Compensation Laws of California.
or which this permit not employ any person in any manner
SIGNATURE DATE
8. OWNER-BUILDER DECLARATION
owner-Huimer ueciarauonn hereby affirm that I am exempt rrom the contractors License law lor the following reason:
D 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.).
D 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^) licensed pursuant to the Contractor's License Law).
G I am exempt under Section Business and Professions Code for this reason:
(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, commencing 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]).
SIGNATURE DATE
COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY:
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
Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district?
D YES D NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site?
D YES D NO
IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSlffiD AFTER JULY 1,1989 UNUSS THE APPLICANT
HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT,
g. TJbHSTKUC"llUN LKHU1HU AUKNUY ~"' "~~"
1 hereby affirm that there is a construction lending agency for the performance ot tne worK tor wnicn this permit is issued (Sec 3097UJ Civil Code).
LENDER'S NAME LENDER'S ADDRESS
TO. APPUCAN1 CJ£HTIFICA11ON
I certify that I have read the application and state that the above information is correct. 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 LLABILITffiS, JUDGMENTS, COSTS
AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID OTY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA: An OSHA permit is required for excavations over 5'CT 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 hrniirh prrrnir is not commenced within 365 days from the date of such permit or if the building or work authorized by
such permit is suspended or abandqjreoTl-any time after tke workjdcommenced fora period of 180 days (Section 303(d) Uniform Builc"
APPLICANTS SIGNATURE / S * A / \ /I / DATE:
WHIT AppHcant PINK: Finance
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT* CB951694 FOR 04/29/96
DESCRIPTION: EXTERIOR REMODEL ONLY
SHELL BUILDING / NO OCCUPANCY
TYPE: CTI
JOB ADDRESS: 2906 CARLSBAD BL
APPLICANT: ALVAREZ, RON PHONE:
PHONE:
PHONE:
INSPECTOR AREA PY
PLANCK* CB951694
OCC GRP
CONSTR. TYPE VN
STE: LOT:
619 720-1839
CONTRACTOR:
OWNER:
REMARKS: MW/KATHY/729-3965
SPECIAL INSTRUCT:
TOTAL TIME:
INSPECTOR
CD LVL DESCRIPTION ACT COMMENTS
19
29
39
49
ST Final Structural
PL Final Plumbing
EL Final Electrical
ME Final Mechanical
***** INSPECTION HISTORY *****
DATE DESCRIPTION ACT INSP
042596 Final Combo CO PY
041096 Frame/Steel/Bolting/Welding AP PY
041096 Rough/Topout AP PY
041096 Rough Electric AP PY
040296 Underground/Under Floor AP PY
032296 Frame/Steel/Bolting/Welding PA PK
COMMENTS
SEE LIST 4/25
DOOR FRAMING
DEPT: BUILDING
FINAL BUILDING INSPECTION
ENGINEERING *IRE PLANNING U/M
PLAN CHECK*: CB951694
PERMIT*: CB951694
PROJECT NAME: EXTERIOR REMODEL ONLY
SHELL BUILDING / NO OCCUPANCY
ADDRESS: 2906 CARLSBAD BL
CONTACT PERSON/PHONE*: MW/GAIL/729-3965
WATER
DATE: 04/25/96
PERMIT TYPE: CTI
SEWER DIST: CA WATER DIST: CA
INSPECTED
BY: \TV
INSPECTED
BY:
INSPECTED
BY:
DATE
INSPECTED:
DATE
INSPECTED:
DATE
INSPECTED:
APPROVED
APPROVED
APPROVED
DISAPPROVED
DISAPPROVED
DISAPPROVED
COMMENTS:
CITY OF CARLSBAD
BUILDING DEPARTMENT
DATE
NOTICE 438-3550
2075 LAS PALMAS DRIVE
FOR INSPECTION CALL 438-3101. RE-INSPECTION FEE DUE?
FOR FURTHER^INFORlJlATION, CfflNT*
YES
BUILDING INSPECTOR
PHONE
CODE ENFORCEMENT OFFICER
EsGil Corporation
'ProfessionaC $Can Review 'Engineers
DATE: December 1, 1995
a FIRE
JURISDICTION: Carlsbad a PLAN REVIEWER
a FILE
PLAN CHECK NO.: 95-1694 SET: II
PROJECT ADDRESS: 2906 Carlsbad Blvd.
PROJECT NAME: Exterior Remodel for Shaul Mezrahi
• 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 ********** 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:
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:
Date contacted: (by: ) Telephone #:
REMARKS:
By: Abe Doliente Enclosures:
Esgil Corporationn CM n GP n pc 12/1/95
9320 Chesapeake Drive, Suite 208 * San Diego, California 92123 + (619) 560-1468 * Fax (619) 560-1576
EsGll Corporation
froftssionaC 3>fan Review 'Engineers
DATE: November 21, 1995 a
Q FIRE
JURISDICTION: Carlsbad "trpDtfgiREVIEWER
Q FILE
PLAN CHECK NO.: 95-1694 SET: I
PROJECT ADDRESS: 2906 Carlsbad Blvd.
PROJECT NAME: Exterior Remodel for Shaul Mezrahi
The plans transmitted herewith have been corrected where necessary and substantially comply
with the jurisdiction's *********** codes.
The plans transmitted herewith will substantially comply with the jurisdiction's ********** 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:
Ron Alvarez
355 Pine avenue, Suite "E", Carlsbad, CA 92008
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:
Date contacted: (by: ) Telephone #:
REMARKS:
By: Abe Doliente Enclosures:
Esgil Corporationn GA G CM n GP n PC 11/20/95
9320 Chesapeake Drive, Suite 208 * San Diego, California 92123 + (619)560-1468 4 Fax (619) 560-1576
Carlsbad 95-1694
November 21, 1995
GENERAL PLAN CORRECTION LIST
JURISDICTION: Carlsbad
PROJECT ADDRESS: 2906 Carlsbad Blvd.
DATE PLAN RECEIVED BY
ESGIL CORPORATION: 11/20/95
REVIEWED BY: Abe Doliente
PLAN CHECK NO.: 95-1694
DATE REVIEW COMPLETED:
November 21, 1995
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 disabled access. 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
or other departments.
The following items need clarification, modification or change. All items must be satisfied
before the plans will be in cohformance with the cited codes and regulations. Per Sec. 303 (c),
1991 Uniform Building Code, the approval of the plans does not permit the violation of any
state, county or city law.
1. Please make all corrections on the original tracings and submit two new sets of prints to:
ESGIL CORPORATION.
2. To facilitate rechecking, please identify, next to each item, the sheet of the plans
upon which each correction on this sheet has been made and return this sheet
with the revised plans.
3. 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 on the plans. Have changes been made not resulting from this
list?
Yes
4. Specify use of the building.
a NO
5. Provide a properly dimensioned floor plan.
6. If this is a commercial building, new and/or existing facilities serving this area must
accessible to and functional for the physically disabled. See the attached correction
sheet. Title 24, Part 2.
Carlsbad 95-1694
November 21, 1995
7. Submit electrical, plumbing and mechanical.
8. For remodels in an existing conditioned space, show that the remodeled space will not
use more energy that the existing space or show the remodeled space will conform to
the latest energy design standards.
9. The jurisdiction has contracted with Esgil Corporation located at 9320 Chesapeake
Drive, Suite 208, San Diego, California 92123; telephone number of 619/560-1468, to
perform the plan review for your project. If you have any questions regarding these plan
review items, please contact Abe Doliente at Esgil Corporation. Thank you.
DISABLED ACCESS REQUIREMENTS FOR REMODELS1
(alterations, structural repairs, additions, tenant improvements and occupancy changes)
A. GENERAL
Full access compliance is required for remodels, including:
1. The specific area being remodeled, (i.e., the "new" work).
2. Existing elements in the path of travel to the remodeled area.
(a)Parking, (b)Walks, {cJHazards, (d)Curb Ramps, (e) Ramps, (f)Elevators, (g) Stairs.
3. Entrance to the remodeled area.
(a)Entrance doors, (b)Exit doors.
4. Existing sanitary facilities serving the remodeled area.
5. Existing drinking fountains and telephones serving the remodeled area.
B. REMODELS VALUED LESS THAN $80.7102
When remodels are valued at less than $80,710, the total access compliance may be limited to the specific
area being remodeled (i.e., "new" work), provided the following conditions are satisfied:
1. The cost to upgrade the existing elements (described in A.2, A.3, A.4 and A.5 above) exceeds 20% of
the cost of the proposed project, and
2. The enforcing agency determines that "an unreasonable hardship" exists {see the attached Form HA-
1, to be completed by the applicant), and
3. The plans must still show upgrades to the existing elements, but only to the point where the cost to do
so will equal 20% of the cost of the proposed project. In choosing which elements to upgrade, the following priority list
should be used: (a) Entrance to the building (b) Route of travel (c) Restrooms (d) Public telephones (e)
Drinking fountains (f) Other elements, such as parking, alarms, signage, etc.
3Note: In determining the value of a remodel, the total costs of all improvements over the last 3 years along the same path of
travel must be included (even if the previous remodels were done by other tenants). The 20-percent provisions for determining if
upgrade costs are disproportionate and for determining the amount to spend on upgrades shall be based on this total value.
Please complete the attached declaration form (Form HA-1).
DAT111/21/95
Carlsbad 95-1694
November 21, 1995
VALUATION AND PLAN CHECK FEE
JURISDICTION: Carlsbad
PREPARED BY: Abe Doliente
BUILDING ADDRESS: 2906 Carlsbad Blvd.
PLAN CHECK NO.: 95-1694
DATE: November 21, 1995
BUILDING OCCUPANCY: ?
TYPE OF CONSTRUCTION: ?
BUILDING PORTION
Exterior Remodel
Air Conditioning
Fire Sprinklers
TOTAL VALUE
BUILDING AREA
(sq. ft.)
Existing
VALUATION
MULTIPLIER
per city
VALUE
($)
8,900
8,900
UBC Building Permit Fee:
UBC Plan Check Fee:
Comments: ESGIL FEE = 0.80 X 70.16 = $ 56.16
$ 108.00
$ 70.16
Sheet 1 of 1
vatuefee.dot
Johnston Construction
Uo
I.
**3. •^rvxs.-rercL. 2-3-^
General Contractor Lie # 593770
3949 Highland Drive • Carlsbad, CA 92008 • [619] 434-8950
'1 9/1 flfi: 34 fi1 q~7?9-1 31 HI VTI I RFAI PAfiP
WITCH CREEK WINERY
PROPOSAL AND CONTRACT
DATE: 2/79/96
TO: SHAULMEZRAHI
2906 CARLSBAD BOULEVARD
CARLSBAD, CA 92008
Thank you for the opportunity to raikp thai proposal for thu project
agreement If you approve of the proposal, p!
B,A.WORTHINO,INC.(
coo^lcte Ibe foUowing construction work:
SCOPE
TQ-rAl . AMOUNT
Me attached apecifica
ease sign and return oac copy in the enclosed envelope,
famish all material* and perform all labor necessary to
ions
(S7v5SaOO)
5 FIFTEEN (15) wo bag days
VAVMKMTH TO nr MAUK AS imi. 1,011 ^a»
30H-AT DEMOLITION OF ENTRY
30W-AT INSTALLATION OF STORE FRONT
30% -AT STUCCO BRQWNCOAT/DRYW AIL HUNG
-AT HNAL INSPECTOR SZGNEDO TBYOTY
AGREEMENT ACOTED BY
AGREEMENT ACCEPTEP BY
DATE
I)ATE
DATE
"2 J T W ~1 " i 1. i jor.-'i . TI-I
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER DATE
ADDRESS C
RESIDENTIAL TENANT IMPROVEMENT
RESIDENTIAL ADDITION MINOR
« $10,000.00)
OTHER.
PLAZA CAMINO REAL
VILLAGE FAIRE
COMPLETE OFFtCE BUILDING
PLANNER DATE
DATE
C:\WP51\F1LES\BLDG.FRM R«v 11/15/90
PLANNING CHECKUST
Plan Check No.
er
Address Z
Phone 138 1161 oxt.ecW+fcpa
APN:
(Name)-293,5
U V V
fiil
Type of Project and Use COM M 5Gc I ftC
Zone Vfc Facilities Management Zone I
CFD (in/out) #
circle (If property in, complete SPECIAL TAX CALCULATION
WORKSHEET provided by Building Department.)
Legend
5 5 S
a. a. a.
Item Complete
Item Incomplete - Needs your action
1, 2, 3 Number in circle indicates plancheck number where deficiency was
identified
D D D Environmental Review Required: YES
DATE OF COMPLETION:
NO TYPE
D
Compliance with conditions of approval? If not, state conditions which require action.
Conditions of Approval
Discretionary Action Required: YES NO A TYPE
APPROVAL/RESO. NO. DATE:
PROJECT NO.
OTHER RELATED CASES:
Compliance with conditions of approval? If not, state conditions which require action.
Conditions of Approval
D D D California Coastal Commission Permit Required: YES NO X
DATE OF APPROVAL: __
£>JU
San Diego Coast District, 3111 Camino Del Rio North, Suite 200, San Diego, CA. 92108-1725
(619) 521-8036
Compliance with conditions of approval? If not, state conditions which require action.
Conditions of Approval :
City of Carlsbad
Fire Department * Bureau of Prevention
Plan Review: Requirements Category: Building Plan Check
Date of Report: Thursday. November 30.1995 Reviewed by:.
Contact Name Ron Alvarez ^_^_^__^___
Address 355 Pine Ave #E
City, State Carlsbad CA 92008
Bldg. Dept. No. 95-1694 Planning No.
Job Name Unknown project
Job Address 2906 Carlsbad Ste. or Bldg. No.
E3 Approved - The item you have submitted for review has been approved. The approval is
based on plans; information and/or specifications provided in your submittal;
therefore any changes to these items after this date, including field modifica-
tions, must be reviewed by this office to insure continued conformance with
applicable codes. 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.
D Disapproved - Please see the attached report of deficiencies. Please make corrections to
plans or specifications necessary to indicate compliance with applicable
codes and standards. Submit corrected plans and/or specifications to this
office for review.
For Fire Department Use Only
Review 1st 2nd 3rd
Other Agency ID
CFD Job# 95278 File*
2560 Orion Way • Carlsbad, California 92008 • (619) 931-2121
Uhk
our
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1 I
1994 UNIFORM BUILDING CODE 11B-1A
SINGLE OCCUPANCY
TOILET
CENTERLINE
OF
FIXTURE RUSH
ACTIVATORON WIDE
SIDE
TO EDGEF WATERLOSET
RUSH
ACTIVATOR
ON WOESIDE
MULTIPLE TOILET
STALL
AU. DISPENSERS
HIGHEST OPERABLEPART
36" GRAB BAR-
-42" GRAB BAR
12*
MAX
SIDE ELEVATION
to
THIS DIAGRAM ILLUSTRATES THE SPECIFIC REQUIREMENTSOF THESE REGULATIONS AND IS INTENDED ONLY AS ANAID FOR BUILDING DESIGN AND CONSTRUCTION
FIGURE 11B-1A
NOVEMBER 22, 1995 1-207.60
D D
ODD
DDD
D
DDD
nnn
nnn
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Inclusionary Housing Fee required: YES _ NO r\^
(Effective date of Inclusionary Housing Ordinance - May 21, 1993.)
Site Plan:
Zoning:
1. Provide a fully dimensioned site plan drawn to scale. Show: North
arrow, property lines, easements, existing and proposed structures,
streets, existing street improvements, right-of-way width, dimensioned
setbacks and existing topographical lines.
2. Provide legal description of property, and assessor's parcel number.
1.Setbacks:
Front:
Int. Side:
Street Side:
Rear:
2. Lot coverage:
3. Height:
4. Parking:
Additional Comments
Required
Required
Required
Required
Required
Required
Spaces Required
Guest Spaces Required
Shown
Shown
Shown
Shown
Shown
Shown
Shown
Shown
OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER
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to 9^=0^0 te
DATE
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City of Carlsbad
Building Department
hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self-insure for
A. workers' compensation as provided by section 3700 of the Labor Code, for
the performance of the work for which this permit is issued.
I have and will maintain workers' compensation, as required by section 3700
B. of the Labor Code, for the performance of the work for which this permit is
issued. My workers' 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)
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
H C. workers compensation laws of California.
Warning: Failure to secure workers' compensation coverage is unlawful, and shall be
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.
March 3, 1995
2O75 Las Palmas Dr. • Carlsbad, CA 92OO9-1576 • (619) 438-1161 • FAX (619) 438-0894
SD
COMPENSATION
INSURANCE
FUND
P.O. BOX 807, SAN FRANCISCO,CA 94101-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 01-01-96
"*' * POLICY NUMBER; 229-96 UNIT 0006537
. CERTIFICATE EXPIRES::,01-01-97 t- .• •<'- • "- •-• *; "c
: ALL OPERATIONSCITY OF CARLSBAD
ATTN: BLDG DEPT
2075 LAS PALMAS DR
CARLSBAD CA 92009
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 30days' advance-.written' notice to the employer.
• • ,— 't '-^ ,,— -A- • ,. »v ^ ^ /_ -^ *"* ''"'•/ .«"» " " '~~> " ' - ' *
-' • .-. - f- .*•*• ;-„•"* «'^-': >".V''^Ts:;j ':•• • ''' ' ' •'•••-'.-"•' ••"<-**• •-."•• . ••-'•''^'%.s. ;«*\--,'1 'We will also give you 30 days' advance notice should this policy be cancelled prior to its fio'rmal 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, terra or" condition: o.f; any contractVor 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. A, •":,>':' ' <•- '
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS:^ $1 ..OOO.OOO.pO PER OCOIRRENCE. -
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE: 01/01/96 tV ATTACHED TO AND
FORMS A PART OF THIS POLICY. , - "
EMPLOYER LEGAL NAME
B.A. WORTHING INC
PO BOX 10M
CARLSBAD CA 92018
B.A. WORTHING, INC.
PRIMTFn- 12-1.6--J
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 10265 (REV. 2-95)
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