HomeMy WebLinkAbout2906 CARRILLO WAY; ; CB002548; Permit07/17/2000
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Pool Permit Permit No:CB002548
Building Inspection Request Line (760) 602-2725
Job Address:
Permit Type:
Parcel No:
Valuation:
Reference #:
Project Title:
2906 CARRILLO WY CBAD
POOL
2226501900 Lot#:
$11,193.00 Construction Type:
BLACK - POOL & SPA 364 SF
0
NEW
Status: ISSUED
Applied: 07/10/2000
Entered By: JM
Plan Approved: 07/17/2000
Issued: 07/17/2000
Inspect Area:
Applicant:
AZURE POOL CONSTRUCTION CO
7423 EL CAJON BLVD
LA MESA CA 91941
Owner:
NORTON D R SAN DIEGO HOLDING CO INC
1010 S COAST HIGHWAY 18B93 07/17/00 0001 01
ENCINITAS CA 92024 C-PRHT
02
179-20
Total Fees: $264.40 Total Payments To Date: $85.20 Balance Due: $179.20
Building Permit
Add'l Building Permit Fee
Plan Check
Add'l Plan Check Fee
Electrical Fee
Plumbing Fee
Strong Motion Fee
Renewal Fee
Add'l Renewal Fee
Other Building Fee
TOTAL PERMIT FEES
$131.08
$0.00
$85.20
$0.00
$20.00
$27.00
$1.12
$0.00
$0.00
$264.40
Inspector: _^
FINAL APPROVAL
Date:Clearance:
NOTICE: Please lake NOTICE that approval of your project includes the "Imposition" of fees, dedications, reservations, or other exactions hereafter collectively
referred to as tees/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.
07/17/2000
City of Carlsbad
1635 Faraday Av Carlsbad, CA 92008
Right of Way Permit Permit No: RW000323
Job Address:
Permit Type:
Parcel No:
Start Date:
Insurance Expire:
Liability Insurance:
Referenced
Location:
2906 CARRILLO WY CBAD
ROW
2226501900
09/01/2000
Y
Subtype:
Lot#:
Est Complete Date:
Traffic Control Plan:
GOP:
MINOR
0
Status: ISSUED
Applied: 07/12/2000
Issued: 07/17/2000
Expired: 09/01/2000
Entered By: TNKW
Project Title:
Description:
POOL & SPA
Applicant:
AZURE POOL CONSTRUCTION CO
7423 EL CAJON BLVD
LA MESA CA 91941 3193 07/17/00 0001 01 02
C--PRHT 210=00
Total Fees: $210.00 Total Payments To Date:$0.00 Balance Due: $210.00
Permit Fee
Additional Permit Fee
Other
TOTAL PERMIT FEES
$210.00
$0.00
$0.00
$210.00
This permit may be revoked by the City Engineer if it is deemed that inadequate progress is being made towards the completion
of the work or if the work does not meet City Standards. The applicant may be billed for the cost of any corrective work that the
City must perform.
Permit Release Date Released
YOU MUST CALL UNDERGROUND SERVICE ALERT (1-800-422-4133) TWO WORKING DAYS PRIOR TO WORK.
UNDERGROUND SERVICE ALERT NO.
IF ANY EXCAVATION OR BORING IS DONE.
. THIS PERMIT IS INVALID WITHOUT THIS NUMBER
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
Faraday Ave., Carlsbad, CA92008
FOR OFFICE USE ONLY
PLAN CHECK NO.
EST. VAL.
Plan Ck. Deposit
Validated By
Date
ttbo
/\
Address (include Bldg/Suite #)Business Name (at this address)
Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units
Assessors Parcel #Existing Use Proposed Use
Description of Work SQ. FT.#of Stories # of Bedrooms athrdrfms 85.20
Name City
Q Owner Q Agem for Owner
CK\ WMft' i d
State/Zip Telephone #Fax*
a
Name Address City State/Zip
tA'ijgSirs W:
Name Address City State/Zip Telephone
COMPANY NAME
(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 a civil penalty of not more than five hundred dollars l$500
UKWSft
Name
State License # *C?O2-\^£
Address
*) \ License Class ^^ 1 C-F35 City State/Zip
City Business License #
Telephone #
S3f
Designer Name
State License #
Address City State/Zip Telephone
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
f~) I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
"^Q ' have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My worker's compensation insurance carrier and policy number are:
Insurance Company l^Ji$C Ofi"P Policy No.\^.)f 7.0M Ufl^J^ ?> Expiration Date \CVCX "0^
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100) OR LESS)
Q 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 dollais ($100,OOQJNin addition to thajcost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees.
SIGNATURE ^\^TW> ^JJUX^. DATE *"T • \ (> Q O
7. OWNER-BlilLDERDECLARATION '• •'^£Jp'/:- ^ v f""'1-:;*.-•;.'"" - '•'.
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 contractor(s) licensed
pursuant to the Contractor's License Law).
n 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. Q YES [~lNO
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): i ^^
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 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 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 district? C] YES Q 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 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 co
LENDER'S NAME
for whiclilhisjjerlending agency for the performance of the work for whiclilhjsjjermit is issued (Sec. 3097(i) Civil Code).
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.
EXPIRATION1. Every permit issued by the building Official under the provisions ol this Code shall expire by limitation and become null and void II 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 f^r a period qM€O,rJays (S^tion 106.4.4 Ljnjfcjrm Building Code).
APPLICANT'S SIGNATURE ^C/A/^W \UV ^-KUl 1 U>/ U^ DATE \ ' V(VO Q
PINK: Finance
PERMIT APPLfCATION
CITY OF CARLSBAD BUILDING DEPARTMENT
1635 Faraday Ave., Carlsbad, CA 92008
FOR OFFICE USE ONLY
PLAN CHECK NO.
//
EST. VAL.
Plan Ck. Deposit
Validated By{
Date
Address (include Bldg/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
(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. Anyviolation of Section 7031.5 by any applicant for a permit subjects the applicantio a civil penalty of not more than five hundred; dollars, [$500D.
BWd. QVtof&ft OV
Name
State License* OOZ- ' '
Address
C-> | License Class
U
B-\c-es City State/Zip
1 City Business License #
Telephone #
f^srf • ~~ "
DesigneYTIame *r-^~
State License # *-<!^lx
Address City 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.
*Q 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 \V\£CO£Jp Policy No.\MC7.CA(^ i *SM JS Expiration Date \Q ' Q\'Q ^
{THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] OR LESS)
Q CERTIFICATE OF EXEMPTION: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as
to become subject to the Workers' Compensation Laws of California.
WARNING: Failure to secure workers' compensation coverage Is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred
thousand dollars 1$ 100,000), to-addltion to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees.
SIGNATURE ^CAX/VpC^ ^<QO(IQ\p DATE "1
7. OWNER-BUILDER DECORATION'V? ~O
I hereby affirm that I em 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 contractor(s) 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. 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
NO
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 fj 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 Q
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.
j*i!lilNST*l^ : •' •-;,:: =. " ! • • ;- ;
I hereby affirm that there is a consltuction lending agency for the performance of the work for which this permit is issued (Sec. 3097{i) Civil Code).
LENDER'S NAME 2. 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 E>'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 comnlenced for aperiod of 180 davs (Section 106.4.4 Uniform Building Code).
APPLICANT'S SIGNATURE <T<k>d^b "*C3\&&A DATE *\ \Q ' QO
WHITE: File /YELLOW: Applicant PINK: Finance
City of Carlsbad Bldg Inspection Request
For: 9/15/2000
Permit# CBO02548
Title: BLACK - POOL & SPA 364 SF
Description:
Inspector Assignment: SR
2906 CARRILLO WY
Lot 0
Type: POOL Sub Type:
Job Address:
Suite:
Location:
APPLICANT AZURE POOL CONSTRUCTION CO
Owner: MORTON D R SAN DIEGO HOLDING CO INC
Remarks:
Phone: 6196973363
Inspector:
Total Time:
CD Description
52 Underground Plumbing
Requested By: APRIL
Entered By: CHRISTINE
Act Comments
Associated PCRs
Insoection Historv
Date
9/8/2000
9/6/2000
9/5/2000
9/1/2000
8/16/2000
8/16/2000
8/9/2000
8/9/2000
8/9/2000
8/9/2000
8/7/2000
Description
55 Fence/Pre-Plaster
55 Fence/Pre-Plaster
55 Fence/Pre-Plaster
55 Fence/Pre-Plaster
52 Underground Plumbing
53 Electric/Conduit/Wiring
23 Gas/Test/Repairs
51 Excav/Steel/Bonding/Fence
52 Underground Plumbing
53 Electric/Conduit/Wiring
51 Excav/Steel/Bonding/Fence
Act
AP
CO
CA
CO
AP
AP
AP
AP
AP
NR
CO
Insp
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
SR
Comments
NEED TO BOND POOL TO IRON FENCE BY FINAL
ALL IS OK EXCEPT FOR E/ SIDE FENCE
NO GATES, NO ALARMS, NO EQUIPMENT
APPROVED ON 8/9
SEE ATTACHED NOTICE AND RESULT
City of Carlsbad Bldg Inspection Request
For: 8/7/2000
Permit# CB002548
Title: BLACK - POOL & SPA 364 SF
Description:
Inspector Assignment:
2906 CARRILLO WY
Lot 0
Type: POOL Sub Type:
Job Address:
Suite:
Location:
APPLICANT AZURE POOL CONSTRUCTION CO
Owner: MORTON D R SAN DIEGO HOLDING CO INC
Remarks:
Phone:
Inspector:
Total Time:Requested By: CONNIE
Entered By: CHRISTINE
CD Description Act Comments
51 Excav/Steel/Bonding/Fence ^JL3 "
Associated PCRs
Inspection History
Date Description Act Insp Comments
CITY OF CARLSBAD
BUILDING DEPARTMENT
DATE Of l/OQ
NOTICE
LOCATION
PERMIT NO.
(760) 602-2700
1635 FARADAY AVENUE
TIME
CXJU
£&%$_
C^Q £&.
FOR INSPECTION CALL (760) 602-2725. RE-INSPECTION FEE DUE?
FOR FURTHER INFORMATION, CONTACT
YES
PHONE
BUILDING INSPECTOR CODE ENFORCEMENT OFFICER
City of Carlsbad
Public Works Engineering
BUILDING PLANCHECK CHECKLIST
POOLS
BUILDING PLANCHECK NUMBER:
BUILDING ADDRESS: Aff/Va £acV/UO u)
PROJECT DESCRIPTION: Pool
ASSESSOR'S PARCEL NUMBER:
ENGINEERING DEPARTMENT
APPROVAL
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 modifications, 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 build.
fa.\JD0rfo Date:
DENIAL
Please see the attached report of deficiencies
marked wi{K_Q^jMake necessary corrections to
plans or specifications for compliance with
applicable codes and standards. Submit corrected
plans and/or specifications to this office for review.
ATTACHMENTS
D Grading Permit Application
D Grading Permit Checklist
D Right-of-Way Permit Application
D Right-of-Way Permit Submittal
Checklist and Information Sheet
ENGINEERING DEPT. CONTACT PERSON
NAME: TANIYAWADE
City of Carlsbad
ADDRESS: 1635 Faraday Avenue
Carlsbad, CA 92008
PHONE:(760) 602-2773
H:\WQBD\DOCS\CHKLST\Pnnl CMtet CHK?< Fa
1635 Faraday Avenue • Carlsbad, CA 92008-7314 * (76O) 602-2720 • FAX (76O) 602-8562
ISTV lND/_>RD/
Q
Q
43
BUILDING PLANCHECK CHECKLIST - POOLS
SITE PLAN
1. Provide a fully dimensioned site plan drawn to scale. Show:
North Arrow
Existing & Proposed Structures
2. Show on site plan:
Drainage Patterns
Existing & Proposed Slopes
Y. Existing Topography
roperty Lines
Easements
Indicate what will happen with
soil excavated from pool area
Retaining Walls
(location and height)
Note: If excavated soil is not to be removed from property but regraded on
site, show proposed elevations and slopes.
If any portion of retaining walls are over 4' in height, a separate permit is required.
Retaining Wall Permit CB Applied for Approved
3. Include on title sheet:
Site Address
. Assessor's Parcel Number
iC^ Legal Description
Quantities Cut Fill Import/Export
4. Project does not comply with the following Engineering Conditions of approval
for Project No.
Conditions were complied with by:
GRADING PERMIT REQUIREMENTS
Date:
The conditions that invoke the need for grading permit are found in Section 11.06.030
of the Municipal code.
5a. Inadequate information available on Site Plan to make a determination on
grading requirements. Include accurate grading quantities (cut, fill, import,
export).
5b. Grading Permit required. A separate grading plan prepared by a registered Civil
Engineer must be submitted together with the completed application form
attached.
Note: The Grading Permit must be issued and rough grading approval
obtained prior to issuance of a Building Permit
Page 1 of 2
STV 2ND/ 3RD/
Q G 5c. A Grading Permit has been applied for:
PE2 DWG
Grading Inspector sign off by: Date:
Q rj Q 5d. No Grading Permit required.
MISCELLANEOUS PERMITS
Q 6. A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Way and/or
private work adjacent tot he public Right-of-Way.
' ^ A separate Right-of-Way issued by the Engineering Department is required
Please complete attached Right-of-Way application form and return to the
Engineering Department together with the requirements on the attached Right-
of-Way checklist, at the time of resubmittal.
Right-of-Way Permit and Pool Building Permit will be issued simultaneously.
Q Q 7. Remarks
Page 2 of 2
PLANNING/ENGINEERING APPROVALS
PERMIT NUMBER CB
ADDRESS ;lieu),
DATE -7//Y /OP
RES IENTIAL ADDITION MINOR
« $10,000.00)
TENANT IMPROVEMENT
PLAZA CAMINO REAL
CARLSBAD COMPANY STORES
VILLAGE PAIRE
COMPLETE OFFICE BUILDING
OTHER
PLANNER DATE
ENGINEER DATE
oocs/MBrornu/Piannmg Engineering ADonnnis
CERTIFICATE OF LIABILITY *PRODUCER
Water idga Insurance Services
10525 Vista Sorrento Pkwy #300
San Diego CA 92121
Michael S. Galloway
PhdMNo. 858-452-2200 F«No. 858-452-6004
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANYA INSCORP - Ins Corp of NY
INSURED COMPANYB Legion Insurance Company
Bob Kelly
DBA.: Azure Pool Construction
7423 El Cajon Blvd.
La Mesa CA 91941
COMPANY
C
COMPANY
D
COVERAGES :
THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NPMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS.
COLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DD/YY)LIMITS
GENERAL UABIlfTY
COMMERCIAL GENERAL LIABILITY
GENERAL AGGREGATE
CAIC10017209 09/01/99 09/01/00 PRODUCTS - COMP/OP AGO
CLAIMS MADE OCCUR PERSONAL & ADV INJURY
OWNER'S ft CONTRACTOR'S PROT
$1,000 PD PEP.
EACH OCCURRENCE
FIRE DAMAGE (Any one fire)
PER OCCURRENCE MEO EXP (Any ww pmwn)
12,000,000
12,000,000
$ 1,000,000
11,000,000
50,000
50,000
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
CAIC10017209 09/01/99 09/01/00 COMBINED SINGLE LIMIT S 1,000,000
BODILY INJURY
(Pw pereon)
HIRED AUTOS
NON-OWNED AUTOS
BODILY INJURY(PeraeddBFiQ
PROPERTY DAMAGE
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT
OTHER THAN AUTO ONLY;
EACH ACCIDENT
AGGREGATE
EACH OCCURRENCE
AGGREGATE
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
X I n\* o i n i u*I TORY LIMITS
OTH-
ER
EL EACH ACCIDENT
THE PROPRIETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE
INCL
EXCL
HC20916343 10/01/99 10/01/00
$1,000,000
EL DISEASE - POLICY LIMIT S 1,000,000
EL DISEASE • EA EMPLOYEE $1,000,000
OTHER
DESCRIPTION OP OPERATK>NS(LOCATIONS'V^tCLES/SPECML ITEMS
*EXCEPT 10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM.#3802. FAX TO: 697-3790.83 ' CHEVROLET TRUCK I.D.
CERTIFICATE HOLDER. ;
PROOF02
PROOF OF INSURANCE
INDIVIDUAL CERTIFICATES ISSUED
UPON REQUEST
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREQ^Q^atfB^O*fW!TlwS^mEAVOR TO MAIL
*30 DAYS WRITTEN ffYICE TO [HE CainJ lOn&flOLcfeR NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCl^lOffiETytAj^mtjCf E NO OBI|JATION OR LIABILITY
OF ANY KINO UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.