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Home My WebLink About1365 CORVIDAE ST; ; CB951547; Permitic BUILDING PERMIT 10/27/95 10-19 Page 1 of 1 Job Address. 1365 CORVIDAE ST Permit No CB951547 Project No- A9502267 Development No. Permit Type RETAINING WALL Parcel No 215-691-10-00 Valuation. 648 Occupancy Group Referenced: Description 48 SF RETAINING WALL-CITY SPEC • # 222 Appl/Ownr RTISTRY LANDSCAPE 3790 VIA DE LA VALLE, STE 204 DEL MAR, CA 92014 Suite Lot# 4358 10/27/95 0001 0.1 02 C-FW 20-00 Construction Type- NEW Status ISSUED Applied 10/24/95 Apr/Issue 10/27/95 Entered By. RMA 619-792-5030 *** Fees Required **** **Fees Collected & Credits *** Fees 32.0-0 Adjustments .00 Total Fees. 32.00 Fee description Total Credits Total Payments: Balance Due: Units Fee/Unit 00 12 00 20.00 Ext fee Data Building Permit Plan Check Strong Motion Fee * BUILDING TOTAL 19 00 12 00 1 00 32 00 CITY OF CARLSBAD 2075 Las Palmas Dr , Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION H^^H City of Carlsbad Building Department ^^. ^J92075 Las Palmas Dr.. Carlsbad. CA 92009 (619) 438-1161 ^%Bftfi&r 1 PEKMJT TYPE From List 1 (see back) give code of Permit-Type For Residential Proiccts Only From List 2 (see back) Code of Structure-Type iJM^VQPm —> Net lass/Gain of Dwelling Units ^ r2_w give FD PLAN CHECK NO. EST VAL (o ^f- C? PLAN CK DEKOSIT VALID BY K, A' DATE ^ / j'Xi, py. t „ 2 PROJECT INFORMATION 429i 10/24/95 0001 01 02 C-PRHT 12,00 FOR OFFICE USE ONLY (0 f V t Cross Street S~(~Building or Suite No LEGAL DESCRIPTION Lot N 1 Subdivision Name/Number • Hour FiorE Unit No Phase No f>H / / CHECK BELOW IF SUBM11 It D 2 Energy Calcs ^2 Structural Calcs D 2 Soils Report D 1 Addressed Envelope -£"5i SSESSOR'S PARCEL O/S to*// IOOO EXISTING USE PROPOSED USE ISCRIPTION OF'WORK # OF STORIES # OF BEDROOMS # OF BATHROOMS 3 UJNTAL.T FEKiiUN in ditlerenl trom applicant; NAME (last name first) CITY STATE ADDRESS ZIP CODE DAY TELEPHONE 4 APPIJCANT D CON 1 KALTUK NAME (last name fi CITY AGENT FOK J STATE (LA iNTRACTOR ^ADDRESS ZIP CODE LTOWNER LIAGENTFOK OWNER DAY TELEPHONE & X 1 ) TJ£ " SO3G 5 PROPERTY OWNER NAME (last name first) CITY , r\ . n, f- XI r-,^L. John •*> Hl_±tU ADDRESS J~3b^> COrV\ciOi£> Sf STATE £A ZIP CODE ^-Z^Q" DAY TELEPHONE &{ 1 ) _ 6 CONTRACTOR NAME (last name first) CITY i /TI 5 f*Lj /X^DRESS STATE J\ ZIP CODE STATE LIC #^>^y/S6g LICENSE CLASS i I/L(L CLtL DAY TELEPHONE ^3*7 CITY BUSINESS LIC DESIGN LR NAME (.last name tirstj CITY /^ £_ Ay/f^L STATE AUUKthi5 J//4. ZIP CODE */ DAY TELEPHONE fc/? 79jS?^)STATE LIC # ^i ^ WORKrjg>" COMPENSATION Workers' Compensation Declaration thereby affirm that I have a cerlilicale ot consent to self-insure issuedoy the Director oflndustrial 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) INSURANCE COMPANY ^fflrrUp that in the per POLICY NO ^ B V f £/3)ApiRATioN DATE 'j J i / Certificate ot Exemption 1 certily 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 S1GNATUF DATE /£>/'?/9S 8 OWNER-BUI Jl DECLARATION Owner-Builder Declaration I hereby arrirm that 1 am exempt trom the Contractors License Law lor the tollowing 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 suth projects with contractor(s) licensed pursuant to the Contractor's License Law) D 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 [S500]) 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 Act7 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 EF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNIJiSS THE APPLICANT HAS MET OR IS MFJ-TING HIE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT 9 CONSTRUCTION LENDING AGENCY I hereby atlirm that there is a construction lending agency tor the pertormance ol the work tor which this permit is issued (Sec 3097(0 Civil Code.) LENDER'S NAME LENDER'S ADDRESS TO APPLJCANI 1 certily that 1 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 LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SATO CITY IN CONSEQUENCE OF TI IE GRANTING OF THIS PERMIT OSHA. An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height Expiration Every permit issued by the Building Official under the provisions of this Code shall expire by limitation and become null and void if the building or work authorized by such permit is not commenced within 365 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 for a period of 180 days (Section 303(d) Uniform Building-Code" APPLICANT'S SIGNATURED \t u „ A,, /Lf „ M „-,, ) DATE ' '" ' rE:/File YELLOW: Applicant PINK: Finance 04/02/96 INSPECTION HISTORY LISTING FOR PERMIT* CB951547 DATE 11/08/95 11/08/95 11/02/95 11/02/95 11/01/95 11/01/95 10/31/95 10/31/95 INSPECTION TYPE Final Masonry Final Masonry Grout Grout Footing Footing Footing Footing INSP ACT COMMENTS RI PY RI PY RI PY RI PY RI AP RI AP RI AP RI NR BJN/792-5030 MW/SCOTT/AM PREFERRED MW/JENNIFER/729-5030 MW/792-5030 HIT <RETURN> TO CONTINUE... PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB DATE ADDRESS RESIDENTIAL ADDITION MINOR «$ 10,000.00) TENANT IMPROVEMENT PLAZA CAMINO REAL VILLAGE FAIRE COMPLETE OFFICE BUILDING OTHER fakJ/ t/U4£3&*('~ /^i^^^fy^/rwr/^ /^—x- PLANNER DATE ENGINEER DATE 10-27 C.\WP51\FILES\BLDG.FRM Rev 11/15/90 D D D s craa D D D D D D ODD D D D Inclusionary Hoiking Fee required. YES _ NO ^^ (Effective date of [nclusionary 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, nght-of-way width, dimensioned setbacks and existing topographical lines. 2. Provide legal description of property, and assessor's parcel number Setbacks: Front: [nt. Side- Street Side: Rear: 2. Lot coverage: 3. Height: 4. Parking: Additional Comments J-1 " ^ f ^ Required Required Required Required Required Required Spaces Required Guest Spaces Required p-^vj **n u- «. Shown Shown Shown Shown Shown Shown Shown Shown J exJj*^ *s«Jj( 1 ^ C, C\ \f Ji /V^r ~l^— ^. U/ 0k 1 1 i\ ' $ O A-W eh 4~O O k "f> i A O\ i9 j) ToV ^ 1 "/^ c3'**\ *T^xP ^>^ ^^d A ix\ P<^0 ( Oft ^-^N 1 U^l )^^ C J t0 OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER DATE ° PLNOCFRM STATE OF CALIFORNIA—THE RESOURCES AGENCY PETE WILSON, Governor CALIFORNIA COASTAL COMMISSION SAN DIEGO COAST AREA 3111 CAMINO DEL RIO NORTH, SUITE 200 SAND,EGO, CA 921081725 EXEMPTION LETTER /. / S^l *~ DATE: NAME: LOCATION: PROJECT: \r> ftsaAvL &VKJIS4 4f / Lu^tft(htou*u /jraLw. . ( 12- ' ) *~^~ X This is to certify that this location and/or proposed project has been reviewed by the staff of the Coastal Commission. A coastal development permit is not necessary for the reasons checked below. The site is not located within the coastal zone as established by the California Coastal Act of 1976, as amended. The proposed development is included in Categorical Exclusion No. adopted by the California Coastal Commission. The proposed development is judged to be repair or maintenance activity not resulting in an addition to or enlargement or expansion of the object ofsuch activities (Section 30610(d) of Coastal Act). The proposed development is an improvement to an existing single family residence (Section 30610(c) of the Coastal Act) and not located in the area between the sea and the first public road or within 300 feet of the inland extent of any beach (whichever is greater) (Section 13250(b)(4) of 14 Cal. Admin. Code. The proposed development is an improvement to an existing single family residence and is located in the area between the sea and the first public road or within 300 feet of the inland extent of any beach (whichever is greater) but is not a) an increase of 10% or more of internal floor areaf, b) an increase in height over 10%, or c) a significant non-attached structure (Sections 30610(a) of Coastal Act and Section 13250(b)(4) of Administrative Regulations). (OVER) MINIMUM REQUIREMENTS FOR Retaining Wall/Sloping Backfill San Diego Area Chapter International Conference of Building Officials C**tue CM* /••* Commas 3* u« Onaiwd* »CTM» EI C«nm Crcnut Itconaa *r»n* teia Li w«* l«non t>w»SanOmaConniy SjrMtnat Stmo SaUnt 6«Oi. T»r»«un. vim CHAPTER POLICY 222 Novtmbtr 1992 Construction of retaining walls, except thos« less than thre« fe«t high and not supporting surcharge, -equires a permit and is regulated by local building codes This chapter policy outlines requirements for re- taining walls with sloping backfill. Chapter Pohcy 221 covers retaining walls with level backfill Contact your local building department for 'nfor- rration on how to obtain a permit for a retaining wall I INSPECTIONS Inspections must be performed dunng several phase* of construction Please call for inspections at the following ernes- A When the footing has been dug with the steel tied securely in its rina: position, and the site is ready for the concrete to be placed, a footing inspection is needed B Amasonrypregroutinspectionisrequiredwhen the block has been laid and the steel is in place, but before the grout has been placed. 1. If cleanout holes are used, block may be laid to the full height at the grout pour before calling for the pregroutinspecaon. Grout shall be placed in a continuous pour in grout 1 ids not exceeding 6 feet 2 If cleanout holes are not used, a masonry pregrout inspection is required pnor to each grout pour. Block cannot be lai dhi gher than the grout pour Note that cleanouts are required for all grout pours over 5 feet in height C After grouting is completed and rock or rubble wall drains are in place, but before earth backfill is placed, call for a backfill/drainage inspection D When all work has been completed call for a final inspection. II. WALL HEIGHT Wall height iameuured from the topaf the footing to the top of the wall. Walls not shown in Tables A and B on page 2 must be designed specifically for the enstingcondiUon The walls shown here are designed to retain earth banks from level to a slope of 1 horizontal to 1 vertical (sloping surcharge). No building foundation, driveway, or other loading on the upper level is allowed within a distance equal to the height of th* wall rn. BLOCK All block must be type "N" grouted solid with f m - 1,500 pel IV MIX REQUIREMENTS Note that use of plastic cement ts not permuted in retaining walls located in Seismic Zone No. 3 or 4 A. The concrete mix for footings must ne«t a compressive strength of f c • 2,000 psi minimum, or the following proportions by volume 1 part Portland cement 2V, parts sand 3", parts J/4 inch maximum-size gravel 7 gallons of water maximum per sack of cement B The mortar mix must have a compressive strength equal to 1,800 psi minimum. One possible mix contains the following proportions by volume 1 part Portland cement 3V, parts sand V, part hydrated lime or lime putty C Grout must have a compressive strength equal to 2,000 psi minimum One possible mix contains 'he following proportions by volume* 1 part Portland cement 3 parts sand 2 parts pea gravel ('/,-inch aggregate) Add water until pouring consistency is achieved without segregation of the grout constituents Rod or vibrate immediately Rerod or revibrate grout about 10 minutes after pounng to ensure solid consolida- tion. Stop grout 2 inches from top of masonry units when grouting of second lift is to be continued at another time Note All cells must be filled solid with grout V. MORTAR KEY To insure proper bonding between the footing and the first course of block, a mortar key must be formed by embedding a flat 2x4 flush with and at the top of the freshly poured footing Itshould be removed after the concrete has started to harden (about 1 hour) A mortar key may be omitted if the first course of block is set into the fresh concrete when the footing is poured and a good bond is obtained. VI. WALL DRAINS Wall drains(four-mch-diameter) must be placed at 6-foot intervals along the length of the wall and located just above the level of th* soil or paving on the front face of the wall The drains may be formed by placing a block on its side at 6-foot intervale, by leaving out the mortar in the vertical spaces between all the blocks (head joint) in the first course abcvn the soil or paving on the front face of the wall or by any Pag* 2 of 4 San Diego Area Chapter • IC8O • Chapter Policy 222 November 1992 other acceptable equivalent method Backfill behind wall drains or open head joints must be loose rubble or gravel 12 inches wide and extending from the top of the wall to the top of the footing VII. SOIL Wall design, footing sizes and reinforcing steel are all based on an active earth pressure with an eqxva- lent fluid weight of 30 pounds per cubic foot All footings must extend at least 12 inches into undis- turbed natural soil or compacted fill which has been compacted to at least 90 percent density Soil should be dampened prior to placing concrete in footings A soilsreport, compiled by a licensed civil engineer, may be required. Amimmum of 7 feet must be provided homor.tally from the toe of the footing to daylight where the ground slopes away from the base of the wall Footing sizes given in Table Aare based or. a 1,000 psf maximum soil bearing value, use of a larger bearing value will require des:gn by a licensed archi tect cr civil engineer specifically for the existing conditions A soils report, compiled by a licensed civil engineer, may be required VIH. REINFORCING STEEL Reinforcing stee] must be dercrred and comply with ASTM specification A615-85, Grade 40 or 60 When one continuous bar cannot be used, a lap or splice of 40-bar diameters is required Two #3 bars must be placed longitudinally 'n the footing as shown in Figures I and 2 For 6-mch or 8-inch blocks one #3 reinforcing bar must be piacad longitudinally in the center of the wall in a mortar joint every 16 inches as the blocks are laid up For 12 inch blocks one #4 reinforcing bar must oe placed longitudinally in the center of :he wall in a mortarjomtevery 16 inches as tre blocks are laid up IX. USE OF TABLES Determine height of wall to be constructed as described above and the si ope of retained earth Using Table A with the appropriate wall height and slope of retained earth, read T, R, K and W designations Then proceed to Table B TaDle A / Requirements for Various Slopes of Retained Earth (Horizontal Run to Vertical Rise) Wstl Level Hi TRK W 1 S" A 1 N V 4* 2'-0' 2'S' 3 0' 3'S- 4'-0* 4 6- 5--0' S'-S' 6 0- 7--0' 8 0' A 1 N 14" A 1 N V 7- A 1 N 2'-0' A 1 N 2-1* B 1 N ?4* 8 1 N 2'-6" 840 2' 9" 850 3'-0* C S E 3'-3- C 5 E 3-V C 5 G 4--S' $ to1 4 fel TRK W A N V-4' A N V-4- T R K W A 1 N V-4- A 1 N 1'-4' A N i r A i N r-r A N Z 0- i A 1 N 2-0- A N y.\' B N ?-4" 880 2--S' 840 Z-V 36 D JO" C 5 E 3'3' Q S F y-W A 1 N 2'-r 8 1 N 24" 820 2'-6' BSE ?-S" BSE 3-0- C 5 £ 3'-4- C 8 F 3--10' 3 tot TRK W A 1 N 1-4- A 1 N V4° A 1 N V-r At N 20- A 3 0 21 1- 81 D 24* 320 2'-6" BSE 2'-B* 2101 TRK W A 1 A 1 A 1 A 1 A 3 B 1 B 4 B 6 BSE 3'-0- C 5 C 5 £ 3' 4' C 5 C 6 G 3'1T C 7 N 1 4- N T4- N 1-7" 0 2**0* I'/, 101 KOI TRK W TRK W A 1 N VS' A 1 D 1'8' A I D V-tO- AtE 22" 0 2-r 8 I E 2'4' 0 2'4" E 2' 6' P 2*-fl* F 3'-2* F 3 6" G 4'-T B 4 F 25- 8 S F 3r C 5 G 3'5' C S G 39' C S G 42" A 1 D 1-7' A 1 0 1-10" A 1 E 22' 81 F 2'5' 84 F 24 8 6 Q 34' C 5 G 3'3- Table B «*« / Values for T, R and K : Well Type snd TMeknMs, T A — 7yp» 1, e* ' B — Typ« 1, 8" block Mock C*— Type II, 8" and 12" block Footnotes Reinforcing Steel, R 1 — f3 oars <g> 24" o c 2 — *4 bars <g> 32' o e 3— «3bars<g> iS'oc 4 — *4Dars@24'oc 5 — »4 bars @ 1 S* o c 6— #5 bars® 16* oc 7 — »6 bars® 16'0 C Key alze, K (Width by depth) 0 — 6- * 6- E — 8' * 8° F— irxir G - 12' x 18' N — Nan* 1 Footing sizes arc based on 1 ,000 psf maximum soil bearing vafue The resultant is within IPO middle third of (he footing 2 Walls not shown in *e tables above must be designed specifically for the actual condition 1 All construction must comply with Sha specifications shown in this information bulletin 4 All blocks must be grade *N* grouted solid with an Cm - 1 500 osi 5 For Wall Type II the first 32 inches of block, regardless of wail heigtt. must be 12-ineh-wide masonry units Nov«mb«r 1M2 San Oi«go Araa Chapt«r • ICBO • Chapter Policy 222 Paga 3 of 4 Figure I/Type I retaining wall with sloping backfill Concrete block 2" minimum to' > 6" maximum H f Lap splice(See Section Vt'l) Waif ^ dram ^ 2 • #3 barstypical 3* dear typical ftWCS&aA4'53* ?«<^s TJiS!?3f£! tStxr ^** A §&tftSi ! -Keysize, K W Slope ol retained earth(given as horizontal runto vertical rise) Horizontal steel(See Section VII! lor applications) Wall thickness6" when T-A8" when T-B 2" clear Reinforcing steel, R Gravel backfil! 12" wide Mortar key(see sect ion V) 12" minimum concretedepth, 12" minimum intonatural ground or approvedcompacted fill Note: A minimum of 7 feel must be provided horizontally from the toe of the footing to daylight where the ground slopes away from the base of the wail Pag* 4 of 4 San Diego Area Chapter • IC8O • Chapter Policy 222 Novambtr 1992 Figure 2/Type II retaining wall with sloping backfill A 2" minimum to 6" maximum Slope of retained earth Concrete block Horizontal steel (See Section VII! for applications) 2" clear 5' maximum Reinforcing steel, R 2Va - clear Gravel backfill 12" wide Mortar key (See Section V; Not less than 32" See Table B, Footnote 5 3" clear typical 12" minimum concrete depth, 12" minimum into natural ground or approved compacted fill Note: A minimum of 7 feet must be provided horizontally from the toe of the footing to daylight where the ground slopes away from the base of the wall City of Carlsbad Building WORKERS' COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations I have and will maintain a certificate of consent to seif-msure for 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 C workers compensation laws of California Date 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 (9100,000), 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 Or • Carlsbad, CA 92OO9-1576 • (619) 438-1161 • FAX (619) 438-0894 ACIMSII. CERTIFICATE OF INSURANCE OATE f»»U)D,YY) PRODUCER TANENBAUM-BARBER OF CA. INC. 11610 IBERIA PL., SUITE 200 SAN DIEGO, CALIFORNIA 92128 5/24/35— 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, | COMPANY i A INSURED LANDSCAPE ARTISTRY INC. 3790 VIA DE LA VALLE SUITE 204 DEL MAR, CA. 92014 „_ JRANGER INSURANCE COMPANY COMPANY B CAL -COMP .INSURANCE COMPANY COMPANYc COMPAMV D COVERAGES THIS IS TO CERTiFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICA-EO NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHiCH THIS CERTIFICATE WAY 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 UMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS _ . 00 ! TYPE OF INSURANCE POUCY NUMBER ' POLICY EFFECTIVE '| POLICY EXPIRATION U|BTSLTR 1 TYPE OF INSURANCE POUCY NUMBER OATt (MM/DWYY) ' OATE (MM/WVYY) | LJHIIB ! - - .,-- — — } OENIAAL UABIUTY j «' ^-'COMMERC*. SEN6RAL LIABILITY , i CLAIMS MADE [T1 OCCUR GI.0671 8 | , OWNER S & CONT PRCTr"l ! 1 , AUTOMOBILE LIABILITY : |_ • ANY AUTO i AIL OWNED AUTOS j 1 ; SCHEDULED AUTOS ' HIRED AUTOS | ! WON OWNED AUTOS i ; , GARAGE LIABILITY 1 ANY AI/TO ! EXCESS UABtLITY i UMBRELLA FORM j OTHER THAN UMBRELLA FORM , WORKERS COMPENSATION AND i EMPLOYERS UABILFTY B THE PROPRIETOR' ! ! „..,.. W9 5 4 1 0 1 ! PARTNERS/EXECUTIVE 1 j OFFICERS ARE •• i EXCL OTHER ! i 1 ! GENERAL AGGREGATE i * 1 f ; ' PRODUCT S-COMP/OP ftGG 1 1 i - *-*79 05/01/95 05/01/96 PERSONAL » A?\ IKUWY __,$ j : i jFIRE DAMAGE (Any one lira) !( , ' : " "' MED EXP(Aji) one person) it i j i COMBINES SINGLE LIMIT ,1 : i BOCN.V INJURY I , r j |;p*rpmm) ;* ! , ' BOOILY INJURY i .liPeraoxJent) !* | j PROPERTY OAMA3E $ ! i AUTO ONLY EA ACCIDENT $ OTHER THAN ALTO ONLY ! EACH ACCIDENT '» AGGREGATE I EACH OCCURRENCE $ AGGREGATE * I ;'i ! j __ STATUTORY LIMITS j 701 O4/O1/95 Q4/Q1 /96 "CM ACCIDENT JS 5 1 DISEASE POLICY LIMIT $ 4- ~ -t t DISEASE EACH EMPLOYEE t -J ! 000,000 000,000 000,1200 DQQ, 000 -50^000 5,000 I - 000)000 DESCRIPTION OF OPERATVoMS/LCCATIONS/VEKICLES.'SPECiAL ITEMS CERTIFICATE HOLDER FOR PROOF OF INSURANCE ONLY ACORD 25-S (3/93) CANCELLATION SHOULC ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEU KFORf. THE EXPIRATION DATE THEREOF, THE (SSUIN5 COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICAt* HtHMf NAMED TO THE LEFT. BUT FAILURE rOJttHr+HCH HQVCe SMALL mPOStp4<MlG*noN OH UABIUTY OF ANY WHO UPON TOT COMPANY \ITS jfaflf OR REPRESEMTAITveS 9 ACORD CORPORATION 1993