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HomeMy WebLinkAbout1337 CASSINS ST; ; CB971721; PermitBUILDING PERMIT 06/30/97 11:52 Page 1 of 1 Job Address: 1337 CASSINS ST Permit Type: GUNITE POOLS AND SPAS Parcel No: 215-690-23-00 Valuation: 7,995 Permit No: CB971721 Project No:, A9702190 Development No: Suite; Lot#: SP POOL Reference*: SPA& 180/PATIO ISSU5®).00 Applied: 06/23/97 Apr/Issue: 06/30/97 Entered By: RMA Appl/Ownr : SAN DIEGO CA *** Fees Required ** Fees: Adjustments: Total Fees: Fee description Building Permit Plan Check Strong Motion Fee Enter "Y" for Ele Enter "Y" for Plu * BUILDING TOTAL 619 485-1600 ollected & Credits *** , 00 64 . 00 100.00 Ext fee Data 99. 00 64.00 1.00 20.00 27. 00 164.00 CITY OF CARLSBAD 2075 Las Patoas Dr, CWstad, CA 92009 (619) 438-1161 "• • •' -*%KIS3t •**•""—™~ •---'-—"-•—-•-• "- -—-.-•!—.—..—. —- — - - .-— —.«,». 'P€RMIT APPLICATION.._ • v, ,_, ,;,,,„ ... .,, ,.,,,,_.:, ,..ia . ,,„ CITY OF CARLSBAD BlilU3lSK3 DEPAFfT^ 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 u-,sin FOR OFFICE USE OWLY PLAN CHECK NO EST;VAL.' Ptan Cfe Deposit Business Mama (at ttt* ad*»5F Name State/Zip Telephone* (Sec. 7031.6 Business^BTKLftpfessions Code: Any City or County which requires a permit to construcvajter, improve, demotEsh Or repair'any structure prtar to ttt issuance, also requires the applicant for such permit to fHe a signed statement that he islicjne»0^pufjiuant to the provisions of. the Contractor's License Law [Chapters, commending with Serttoiv^OOO of Division 3 of trw Busirm* endRroJ»»e^^ basis for the aBeoek- exemption. Any violation of Section 703t$42£anyapplicant for a pemiitsubjettr^e appUcem to a c|vU penalty, pf not more than five hundred dollars {$60011. *"if Designer Name State Lteene** Addnw /&> Workers'Compensation Declaration: I hereby affirm jfgjjiK. fW?!*V °*O^PV ¥1?$' !h*t°Jl)0win8(<»<5laff*ions: Q I have- end wlH maintain a certificate of consent'to <ae)f-in*ure for workersioempeneation as provided-toy Section 3700 of the Labor Code, for the performance of the work for which this permit la issued. nOrC4!";;< A,,' t:'hoO (2L*' I havwand-wlll maintain worttew* romp^rB«tion-/ « reo^JlrwlbT Section 3TOO tif trie-Labor Code, fui tin ueifminancB of-the word for 'which Mils ueiiiilL Is issued. My worker's compensation Insurancecarrier and poBgy number are: ^ j ^'srtiy'.'ijuioo 'M$i~ ,' L .JMnls ' ~> nf>r..:nj" Insurance Company _t^fJtfjff^_JEJfSK^. ___ (THIS SECTION NEED NOT M COMMUTED 1FTI« PtrWtrTtS FOR ONE HUNDRED DOLLARS [*10O] OR tESS) D CERTIFICATE OF EXEMPTION: I certify; that in the performance of the work for wt^h'tr* permtt Is is*ued,; I s%*H hot i^mploy'ipffierSon in any manner7»o«^ to become subject to the Wdrkers'Compensation Laws of California. ;•-.,• • ' i • •< • ••> • WARNING: FaBure t6 atJcta* worker*' compensalXv coverage Is unAwful. WM sh«rs««M» an wnptoyw w eitnM fines up to one Iwndraof- thousand dolters (*100fQ005.kiaddftkxMhrllMCfl^bf compensation, damages eAuovided for in Section 3704 of the LaW/odje, kjltraat and attorney's few. SIGNATURE A VjKift/Af^ JN^e^rf yV/S ^O^-V<X L DATE I hereby affirm that I am exempt from the Contra4tor7TLicense Law forlne following reason: D I, as owner of the property or my employees with wanes as their spje compensation, will do the-work arid the,, structure is not intended or offered few sale (Sec. 7044, Buemeee and Profesetone Codw The Centractor's Lfceoee Law does riot apply to-an owrier of preperty wh»buiJd» or improves thereon,' end 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 js sold within one yew of completion, the owner^builder witt have the burden of proving lhat he did not build'OT'improve for the purpose of~safe). ~ Q I, as owner of the property, am exclusively contracting with licensed contractors to construct tfM prefect (Sec. 7O44, Business arid 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:»Ucenaa Law). _ _ „. . . .._ ... ' '•...'' 'f"".: '....r.'• •.::.' .:.'. D I am exempt under Section Business and Professions Code for this reasdn; 1. I personally plan to provide the major labor and mata/iaja fe<|paf»e^njction e^ the'propoe^ property (mpfevernent. Q VES 2. I (have / have riot) signed an application for'• buTlding permit for the proposed work. ,^ 3.- 1 neve contracted with the foHowiog pereon (firm) to provide the propased constrectien ^ineiude neme ^ eddfeee V-phene number 7 eontr **-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 / Bhone number / contractors license number): _ _. .._ : ..._ .. ._ . . _.. .•:-'••••'' ';r'fe .-.''•"'•• :>: • -Jv ..oc--. 5. I wiN provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (Include name / addnees / phone number /type _j». „_— „«* , . . . . ... .^., _. a ^^ ..„, „, „, , ^, „ . „,. f, „ ^ . , „ ,„ „ i " ' ' ' 'Oi work/; " " ; ; _"'" ; ; - • ; ' .. . " • - • • - •-. - -•• - ^__;;;__; ^ •--"•— • • - - .."'""""'""' — ' •:""": PRGP€RTV-OWN6fl SIGNATURE- Is the applicant or future building occupant required to submit e business plan, acutely hazardous materials registration, f of m or risk management and prevention under sections 285O5, 21W33 w 28534 oTThe Prwley-Twrw Haardoos Substance AcroomAct7 Q YBS ;fJ"Np- - . ^ot^-l Q YES . D NO Y8S D NO -,,, n>it •••.;..-••. .;; -, ri .,,,- ., ^ IF ANY OF THE ANStvWW AR£ Yt8. A RNAt '^lIHlfitlKtft^^^ THE WHlC ANT'HAS MET OR IS MEE1*W TH% ' * 13 tr^awfcant or future IwJdiMo REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. I hereby affirm that then) Is a construction taming agency tor the performance of'the wort for whtoh this permit is issued Wire. 30970) Civil Code). LEND'ER'SKIAME ' ' ' ;' ' '"' !' ''.'' ''ilk'fiV' ' LENPER'SAtoBESJ > n: ' •• ': °'; :':: '•^"-"•'•; • I certify that I have read tfce application arid s^M that tM^xWelnfomraMori hcorn^ egreeto comply 4tth all City ordinances and Bflrt*'taw* rtfatlhg to fcUfolnfl tertsfriictlon. I heVeby authertee repnisermrtives of the CTf* of Carfcfced property for inspection purposes. JUDGMENTS. COSTS AND . . to-"enter upon the above mentioned ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY Of^MRUMD AXftMST ALL LIABILITIES, OSHA: An OSHA permit is required for, excavations over 5'0" deep.pjid derrmlWon or «>nstnjction of structures, oyer 3 storiee in height. EXPIRATION: Every permit Issued by the Buttdlng Official under the provtstons of this Coder shafl expire by Hmrtatlon and become null and void if it» tsumBnff"or work authorized by soon permit1 la «ot commenced within 345 days from the date of such permit or if the building; or work authorized by such permit is suspended1 or abandoned at ariy time after the wodv4*yommenced fori^erlod OM«D day* (Section 106.4.4 uniform Building Code). ^PPLiCANT'SsidNATURE" "^-^ * ^^ «aXfrl^i'M^. .'•• •'. '• - f ^^. Jr.-t^H^WL/^^f :.HO : AppJlcin PERMIT APPLICATION CITY OF CARLSBAD BUILDING DEPARTMENT 2075 Las Palmas Dr., Carlsbad CA 92009 (760)438-1161 if." Address FOR OFFICE USE ONLY PLAN CHECK NO. L. E8T. VAL Plan Ck. Deposit, Validated Bv Date. . llhdudi; Bug/SuiteI \ Legal Description Lot No.SubdfvWon Name/Number Unit No.•haee No.Total» of unto Assessor's Parcel *Existing UM Proposed Use Description of Work vr SQ.FT.Itof Otorim ar Of BOQfOOfflS A jkj «i—_>|. _,..,-.-ir QT UBUHUiHIW Nanw Ctty Stata/ZIp Telephone f Fax * Nama dty Statayzip Atfdraaa dty State/Zip Telephone f (Sac. 7031.6 Bualnaaa and I Mtona Coda: Any CKy or County which require* a permit to conatruct altar, improve. demoBeh or repair any atruetura, prior to Ma issuance, alao requires tha applicant for auch parmtt to fHa a aignad atatamant that ha ia fconeod purauant to tha provisions of tha Contractor's Ueanaa Law IChaptar 9, commanding with Saction 7000 of Division 3 of tha Bualnaaa and Profaaalona Coda] or that ha ia axampt tharafrom, and tha beats for tha alleged exemption. Any violation of Saction 7031.5 by any applicant for a parmtt aubjaeta tha applicant to a civil panatty of not mora than five hundrad dollars 11500)). City Stste/Zip Ctty Buabwaa Ueenaa * _j. Telephone* Designer Name State Ucenoa 9 V !! /VlfftRitBtlP CtMir^lBATIOtl ^ Wo/tars' Compi Addraaa City Stata/ZIp '* „*!>*"'<•>= "•*=>%• "'gylq^y* satton Dederation: I hereby effirm under penalty of perjury one of the fo SB HH •fTgvypg;. CT I have and wHI maintain a certificate of consent to self-insure for workers' compensation aa providad by Section 3700 of the Labor Code, for the performance _1 tt,m u*jui> f ju i iihlrih *)U« a»aisis»lt lei «—.—-—JwT IIM WQiK TOT WIHUH HIM JIM II HI H mUVQ. Q I have and wW maintain workers' compensation, aa required by Section 3700 of the Labor Coda, for the performance of the work for which thia parmtt la issued. My worker's compensation Inauranca carrier and policy number are: Insurance Company • Potey No. Expiration Date . . . (THIS SECTION NEED NOT BE COMPLETED a* THE PERMIT IS FOR ONE HUNORtD DOLLARS (SlOO) OR LESS) D CERTIFICATE OF EXEMPTION: I certify that In the performance of the work for which this pennft ie ieeued, I etrt mtt empkry ony f>ers(m In any numner so as to become subject to i WARNING: Faiure tfaadure worfcera'/LUpenaatlon covAge la unlawful, and aha! i thousand doaara («1j6offl6q>. In a*Mo»Vji» coaAf ealbaneatlen. ilimiaii aa orevldsd far In Section 370S of the Labor code/attaraat and attomev's leee. SIGNATURE *T L&^-^ ^^tJ^^^O DATE_ "" ~ *?. I hereby effirm that I am exempt frd/n the O I. as owner of the property or my employes (Sec. 7044, Business and Profaailone Code: The Contractor's License Law doaa not apply to an owner of property who buMe or Improvaa thereon, and who dose such work himself or through his own employees, provided that such improvements are not Intended or offered for aato. If, however, the buHdmg or Improvement la sold within one year of completion, the owner-builder wM have the burden of proving that ha dM not buM or Improve for the purpose of sate). O I. ae owner of the property, am exclusively contracting wtth Deemed contractors to conatruct the project (Sec. 7044, Business and Profeeslens Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, end contracts for such projects wtth contractor^ Kceneed pursuant to the Contractor's License Lew). D I am exempt under Section Suslnsss and Prof aesions Coda for thia reason: . 1. I personally plan to provide tha rnajor labor and matariila tar e^ DNO 3. I hav» contracted wtth the foNowmg person (firm) to provide the propoaad construction (Include name / sddiaas / phone number / eoimactora fcenee number) 4. I plan to provide portions of tha work, but I have hired the following parson to coordinate, auparvfaa and provide Aa major work (Include name / number / contractors Ncenee number): 5. I win provide some of the work, but I hava cmiUauted (hired) tha fo of work): _ ' _ ,___ »to provida tha work Indicated (include name / addraaa / phone number / type PROPERTY OWNER SIGNATURE.DAT!. la tha appHcam or future buHoIng occupant required to aubmtt a business plan, acutely hazardous matarlala regiatratlon form or riak management and prevention program under Sections 25608, 28833 or 28834 of the Presley Termer Hatardoua Substance Account Act? Q YES Q NO la the eppHc^w future bt4dk«oceupamreojilred to obtan^ D YES D NO Is trwfadlrty to be TOnstnjctedvrtthin 1,000 feet irf the outv boundary of a achori D YES Q NO IF ANY OF THE ANSWERS ARE Y», A FMAL CERTHCATE OF OCCUPMICY MAY IK>T K I THE APPLICANT HAS MET OR IS MEETINO THE »TW AM POLLUTION CONTROL DISTRICT. I hereby affirm that there la a i LENDER'S NAME matruction lending agency for the performence of the work for which thia parmtt la leaued (Sec. 3O970) CMI Code). LENDErS ADDRESS • ' that thaiI certHv that I have read tha application and Ctty ordinances and State towa relating to buNbtg oonetnjctlon. property for Inspection purpoaaa. I ALSO AGREE TO SAVE, JUDGMENTS, COSTS AND M ooifoct ww that! tlw aWownooOfi on tno INMIB • ooounto. I hereby authorize repreeematives of tha Ctty of Cerlebed to enter upon the i to oomply wwi OR OSHA: An OSHA permit Is EXPIRATION: Every permit work authorized by such or sbandoned at any time APPLICANT'S SIQNATUI HANMUM THt CITY OP CARLSBAD AGAMST ALL UABUTKS, WHICH MAY M ANY WAY ACCRUE AGAWST SAD CITY M CONSEQUENCE OP THE ORANTING OF THIS PERMIT. excavations over S'O* deep and demolition or cenatructlon of atructuras over 3 atories In height. the BuMra OMcial under the previsions of this Cede ahell expire by fcnrtation and become null end veld if the butking or from tho dttv off such pormit of If tfw buHdlnQ or work Mithorizod by such portnit Is suspondsd work is cenjpieisedJot^iMBiRtel 180 days (Section 108.4.4 Uniform BuMtag Coda). • DATE *J? PINK- ..I UNLIMITED LANDSCAPE, WC. /POOLS OF ELEGANCE DESiqii AND CONSTRUCTION July 25,1997 City of Carlsbad 2075 Las Palmas Dr. Carlsbad, CA 92009 Attn: John / BuBding Department Dear John: I am writing to inform the City of Carlsbad that Unlimited Landscape is revoking responsibility for the following permit: #CB971721, residence of Stuart & Janet Newman at 1337 Cassins St. Carlsbad, CA 92009. The reason for revoking responsibility is due the the homeowners cancellation of the contract with Unlimited Landscape, Inc. The work performed by Unlimited Landscape, Inc. For the above referenced pool was the dig and excavation of the pool only. Unlimited Landscape, Inc. Is voiding permit #CB971746 for the patio cover in the rear yard. This permit was in the process, and at this time City of Carlsbad is to void this permit. Thank you for your assistance in this matter. Re Vk Unlimited Landscape & Design, Inc. 11374 Caminrto Corriente, San Diego, CA 92128 • (619) 485-1600 California Contractors License #429010 CITY OF CARLSBAD INSPECTION REQUEST PERMIT! CB971721 FOR 10/15/97 DESCRIPTION: 240 SF POOL & 8PA& ISO/PATIO TYPE: POOL JOB ADDRESS: 1337 CASSINS ST APPLICANT: LBATHEM AND COMPANY CONTRACTOR: OWNER: REMARKS: C/TOM/? SPECIAL INSTRUCT: PHONE: PHONE: PHONE: INSPECTOR AREA PD PLANCK* CB971721 OCC 6RP CONSTR. TYPE NEW STB: LOT: 760 944-2905 TOTAL TIME: —RELATED PERMITS— CD LVL DESCRIPTION 59 SW Filial Pool PERMIT! TYPE RW970157 ROW CB972308 PLOW STATUS ISSUED ISSUED ACT COMMENTS ***** INSPECTION HISTORY ***** DATE DESCRIPTION ACT INSP 091897 Fence/Pre-Plaat«r AP PD 091797 Fence/Pr«-Pla«ter AP PD 080197 Excav/Steel/Bonding/Fence AP PD COMMENTS AP ON 9/17 J, I Citv of Carlsbad ;ring Department BUILDING PLANCHECK CHECKLIST POOLS BUILDING PLANOHECK NUMBER: BUILDING ADDRESS: /33? 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 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. Please review carefully all comments attached, as failure to comply with instructions in this report can result in suspension-of pjrmit to build. Date: Please marked plans or applicable DENIAL attached report of deficiencies Make necessary corrections to cations for compliance with and standards. Submit corrected plans and/or specifications to this office for review. By: By: By: Date: Date: Date: ATTACHMENTS D Grading Permit Application D ending Permit Checklist LVRfght-of-Way Permit Application D Right-of-Way Permit Submtttal Checklist and Information Sheet ENGINEERING DEPT. CONTACT PERSON NAME: BRUCE EUBANK City of Carlsbad ADDRESS: 2075 Las Palmas Drive Carlsbad. CA 92009 PHONE:(619) 438-1161, ext. 4374 CUM CHK24 Fomt BE.docRn.lOM* 2O75 Las Palmas Dr. • Carlsbad, CA 92OO9-1576 • (619) 438-1161 • FAX (619) 438-O894 BUILDING PLANCHECK CHECKLIST - POOLS PLAN 3RD/ Q 1. Provide a fully dimensioned site plan drawnjto scale. Show: ^A., North Arrow ^y. Property Lines IXB\ Existing & Proposed Structures •T). Easements Q Q 2. Show on site plan: . / / S P&wV Drainage Patterns *T). Indicate what will happen with vtf. Existing & Proposed Slopes soil excavated from pool area -/C. Existing Topography J E. Retaining Walls <l # (location and height) Note: tt 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 _______ >GK Q Q 3. Include on title sheet: Address (/a/Assessor's Parcel Number . Legal Description - Grading Quantities Cut Fill Import/Export Project does not comply with the following Engineering Conditions of approval for Project No. Conditions were complied with by: Date: GRADING PERMIT REQUIREMENTS The conditions that invoke the need for grading permit are found in Section 11.06.030 of the Municipal code. Q Q Q 5a. Inadequate information available on Site Ran to make a determination on grading requirements. Include accurate grading quantities (cut, fill, import, export). Q Q Q 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 Permtt must be Issued and rough grading approval obtained prior to issuance of a Building Permit «LJS|Mlmntoy>1UWMRY\B«9WVOm>OaC8\CHKL8T«>ool BdUtag Phndltck CUM CHK24 F«m BE4K Page 2 of 2 3RD/ Q Q Q 5c. A Grading Permit has been applied for: PE2 DWG Grading Inspector sign off by: ' Date: Q 5d. No Grading Permit required. MISCELLANEOUS PERMITS Q 6. A RIGHT-OF-WAY PERMIT is required to do work in Citv Riaht-of-Wav and/or private work adjacent tot he public Right-of-Way. A separate Right-of-Way issued by the Engineering Department is required for the following: 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 Q 7. Remarks llLu)»tni<Uy>tUBRARY\ENGWVOROIOOC8KHKLSTV>l»l BuHng Pttnchec* CHW CHKM FofmBEJJoc PLANNING DEPARTMENT , BUILDING PLAN CHECK REVIEW CHECKLIST i Plan Check No. GB Planner APN: Van Lvnch Address Phone (619) 438-1161, extension 4325 Type of Project and Use: l^^falfc tvJs£L Project Density:_ Zoning; PC- General Plan; 'f&4>*\ Facilities Management Zone: / f ' Remaining net dev acres:Date of participation: **r <^i I DD (For non-residential development: Type of land used created b/ this permit; ) \ Legend: P\| Item Complete |TJ Item Incomplete - Needs your action <'! Environmehtal Review Required: Yls___NO ^ TYPE '::^'' DATE OF COMPLETION: Compliance with conditions of ap0rbvar? If hot, state^conditions which require action. Conditions of Approval: , -••.••-*^:y ••.... ..^ ^ D D Discretionary Action Required: APPRO VAL/RESO. NO. PROJECT NO. YES DATE OTHER RELATED CASES: '-.•.-• .-• i- _ _ __ _ Compliance with conditions or approval? If hot, state Conditions which require action. Conditions of Approval: _ ........ I I I I Coastal Zone Assessment/Compliance " Project site located in Coastal Zone? YES X. NO CA Coastal Commission Authority? YES NOX v If California Coastal Commission Authbrrty: Contact them at - ^111 Camino Del Rio North, Suite 200, San Diego CA 92108-1725; (619) 521-8036 Determine status (Coastal Permit Required or Exempt): NOCoastal Permit Determination Form already completed? YES_ If NO, complete Coastal Permit Determination Form now. Coastal Permit Determination Log #: Follow-Up Actions: 1) Stamp Building Plans as "Exempt" or "Coastal Permit Required" (at minimum Floor Plans).s 2) Complete Codetal r4arfn}t Determination Log as needed. D Inclusionary Housing Fee required: WG&•**'*< NCF JX- (Effective date of Inclustonarv Housing Ordinance - May 21,1993.) Data Entry Completed? YES NO II,.. v ; UACT; NE'XTlS; Construct housing Y/N; Ent^rFw Amount {See fee schedule for amount); Return) Site Plan: . " • v c ••^-y-' •..-., .;•.-.. , ' .••'' f I ii 1. Provide a fully dimensional stteij|lan tffawn to scale. Show: North arrow, property lines, easements, existing and proposed structures, streets, existing street improvements, right-of-way width, dimensional setbacks and existing topographical lines. --• j~~] {_j 2. Provide legal description of property and assessor's parcel number. Zoning: Q CD I. Setoacks: ES-D..D ODD r-ront: Required Interior Side: Required Street Side: Required Rear: , Required 2. Accessory structure setbacks: Front: Required Interior Side: Required Street Side: Required Rear: Required Structure separation: Required 3. Lot Coverage: Required 4. Height: Required H, . V r •;'.'.' 5. Parking: Spaces Required Guest Spaces Required Additional Comments •-;V-. -T'V ' : -..-.••. -4 • • . , .'. 'I... •;•.!.' '; "•• ' t-.". '.": -i-r-f**- ' - onpwn -&M«— ., ? £•2- Shown 6-2 "•— — " Shown —*— if^-V ' Shown "3.O.' . • ,-i-'i :•>;• .•;'". • • '"." ':. v ..•;'-. '»."'• 'i' ; • '. ' ' : ; \Shown •••••• \ Shown . Shown Shown Shown jJ/L Shown -f-...~, ... , ii^-.^C '•'{•-••• •••.v!- -Shdwrv' - '.: •--'^' -"• • j . ; i 'r'\l •.•^:;-v, •••^?;^;-: ,,,',-,.•,- / • - •. •' Shown ;.-. •.:.-- ;.-: >: ••• : -, ••^•..•.•X^VA- - -, ' v • : '• " - , . --••'. ... , ,:: . : ... .„;...- ' ,.: >',;. . -,+.;.,.-. j ' •....);; ;-• •;'*'._, vt« s'.-, .• !"' f ','"' '» I-' '" ;'!' . •. ''•',{ '' i j..'. . '- .;' :," ' OK TO ISSUE AND ENTERED APPROVAL INT© COMPUTER DATE COMPENSATION INSURANCE FUND MAY 29.1997 P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A, * .*»;.,•,„ CITY OF SAN ATTN: BUMHNG DEPARTMENT 1222 RRST AVENUE MS 301 SAN DIEGO, CA 92101-4153 JOB: ALL OPERATIONS L This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California jnsurance Commissioner, to the employer named.below for the pojtoy period indicated. • /..<... . , • ..... ---''• '••• ' ' ''•''- "' ' ' •• • -•'-_ _ ^ This policy Is not subject to cancellation by the Fund except upon tgofjays1 advance written notice to the employer. 30 30We will also give you l^^lays' 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 insurances afforded by the policies described herein issubject to all trrafiwrns, exclusions and Oond«orwof.suchpolides. . r'-,:. 4~ O; ',. "* , .,, •. , -IK^.-v"V ', .'*• - r^ - '! , - >* /. . •?/*, ••• <>• /%*.-i , . -":•'v-v*-*"^;'-**".4 vf,».\ .;*~?."V. ,•> . .>< * >% '-.^ • ',„•;<v.ki- I-;-- -",•< <• -'/• ^ ' *•**',*> fr* V 'tv ^ s * T1-?^ ' ' ^A*^ * </*^ ^% a< .' ,»,^rf*>f .x % ,' x: •" * „ rt«^f J^^, «*•-''< -'&«..'& ~- "?'•*>;{. ' \*,-4. •*&••'?••: .,^-^;%< --• ~J *., „ ~'f -«:.»*->, «•%*•;'»•- 4.-T '.V^V.WS111'^-v- t^^ ,," ::- - '- -*'•;/< AUTHORIZED I EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COST: $1,000.000 PER OCCURRENCE. ENDORSEMENT 32063 ENTITLED CERTIFICATE HOLDER'S NOTICE EFFECTIVE 05-29-97 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. „«•,-' _ -fciS",^ * ,' ' ' '- >., - LEATHEMAND 1824 AVE DE LAS ADELSAS ENCINITAS CA 92024 NR THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND POLICY HOLDER'S CO DATE (MM/DO/YY) 08/21/96 PRODUCER TANENBAUM-HARBER OF CA. INC 11610 IBERIA PL., SPITE 200 SAN DIEGO, CALIFORNIA 92128 (619) 487-8839 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 COMPANY A CAL COMP INSURANCE COMPANY UNLIMITED LANDSCAPE, INC. 11374 CAMINITO CORRIENTE SAN DIEGO, CA 92130 COMPANY B COMPANYc COMPANYo THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED 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 CLAIMS. ^ ; TYPE OF INSURANCE OB4ERAL LIABILITY COMMERCIAL GENERAL LIABILITY [ CLAIMS MADE |, [ OCCUR OWNER'S & CONTRACTOR'S PROT AUTOMOBILE LIABILITY = At. r AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS AABAAB i IABU rrv ANY AUTO EXCESS LIABILITY j UMBRELLA FORM | { OTHER THAN UMBRELLA FORM \ I WORKERS COMPENSATION AND EMPLOYERS1 LIABILITY THE PROPRIETOR/ 1 1 aiei PARTNERS/EXECUTIVE OFFICERS AHE: gXCL OTHER i POLICY NUMBER G968143954 POLICY EFFECTIVE DATE (MM/DO/YY) ' 8/01/96 POLICY EXPIRATION DATE (MM/DO/YY) 8/01/97 LIMITS GENERAL AGGREGATE PRODUCTS • COMP/OP AGO PERSONAL tADVMJURY EACH OCCURRENCE FIRE DAMAGE (Any on* Ira) MED EXP (Anyon* ptnon) BOOLY INJURY0*rpmon) BOOH-Y INJURY (PWMCMlM) PROPERTY DAMAGE AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH ACCIDENT AGGREGATE EACH OCCURRENCE AGGREGATE I VWSIAIU* 1 juin*TORY LIMITS! 1 ER EL EACH ACCIDENT EL DISEASE -POLICY LIMIT EL DISEASE - EA EMPLOYEE t t t *$ t $ $ $ t *83qi$MiBaaR%fflBS8BiMBBs$$ f $ % t $ $ 1,000,00( $ 1,000,00( % 1,000,00( CITY OF CARLSBAD 2075 LAS PALMAS DRIVE CARLSBAD, CA 92009 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTWCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAO. SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE COMPANY, ITS AGENTS OH REPRESENTATIVES.