HomeMy WebLinkAbout1685 CHESTNUT AVE; ; CB981415; Permit, B U 1 'L D I N G P E R M I T Permit No
06/08/98 08:03 . Project No;
Page 1 of 1 Development No;
Job Address: 1685 CHESTNUT AV Suite:
Permit Type: ELECTRICAL •
Parcel No: 205-230-06-00 . Lot#:
Valuation: 0 Construction Type;
Occupancy Group: Reference*: Status:
Description: ADD 200AMP-3PHS&200 AMP 1PHS Applied:
. ' : SERVICE,LEAVE EXIST 100 AMP AS SUB PANEL Apr/Issue;
Entered By:
Appl/Ownr : NEWBERRY ELECTRIC 760 489-0079
528 E 6TH AV
ESCONDIDO CA 92025
Fees Required
CB981415
A9801887'
* *****& 'Credits
NEW
ISSUED
05/12/98
05/12/98
RMA
***
Fees :
Adjustments:
Total Fees:
Fee description
. 00
160.00
. 00
Ext fee Data
~~.Enter "Y" for Electric-'-J^
Single Phase Per
Three Phase Per AMP
10.00 Y
50.00
100.00 .
FINAL APPROVAL
CITY OF CARLSBAD
2075 Las Palmas Dr., Carlsbad, CA 92009 (619) 438-1161
PERMIT APPLICATION
CITY OF CARLSBAD BUILDING DEPARTMENT
2075 Las Palmas Dr., Carlsbad CA 92009
(760)438-1161 "~
1. PROJECT INFORMATION
Address (include Bldg/Suite #)
FOR OFFICE USE ONLY
PLAN CHECK NO. tff /Ml S
EST. VAL. •
Plan Ck. Deposit
Validated By.
Date
BusiriBSTName (at this address)
Legal Description Lot No.Subdivision Name/Number Unit No.Phase No.Total # of units
Assessor's Parcel Existing Use Proposed Use
Description of Work
2. CONTACT PERSON (if different from applicant)
SQ. FT.
Name
3. APPLICANT ^t5ontractor
Address
Agent for Contractor
Name Address City State/Zip Telephone #
4. PR^ERTY^oMEa.
Name- *'v ^ •*•«• ^ ' "" Addre<
5. CONTRACTOR ICOMPANY 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 Secjion 7031.5 by any applicant for a permjj subjects the applicant to a cjyjLpenalty of not more than five hundred dollars [$500]).6£r AVF fcF&As&ZAo LA
City State/Zip Telephone #
Name
State License #
Address
License Class
City State/Zip
City Business License # /^
Designer Name Address City . State/Zir/Telephone'
State License #
6, WORKERS' COMPENSATION ;..'".
Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations:
O 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.
S^ 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 J Policy No.//•/^r?Expiration Date_
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100] OR LESS)
[J 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: Faijtrfe'to sdcure workersV^ompenjatjoa/eoverage is/Unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred
thousand dollars (Sn00 JJOO), in additip'n to tbXcq^Kof compensajjgn,damages as provided for in Section 3706 of the Labor Cfxje, interest^and attorney's fees.
!7. OWNEr^BWLDERDECki^TiON ..^^ • ~
I hereby affirm that I am exempt from the Contractor's License/£aw for 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).
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).
D 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 l"~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): '_
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 / typeof work): .
PROPERTY OWNER SIGNATURE DATE
COMPLETEJTHIS SECTIONifORiNQNJItESIDENTIAL 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? Q 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? Q YES Q NO
Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? O 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.
8. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097(i) Civil Code).
LENDER'S NAME LENDER'S ADDRESS
9. APPLICANT; CERTiFICATiON
I certify that I have read the application and state that the above information is correct and that the information on the plans is accurate. I agree to comply with all
City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of Carlsbad to enter upon the above mentioned
property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES
JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT.
OSHA: An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height.
EXPIRATION: Every permit issued by 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 isperopmmenced viithin 36J days^lrpm the/late of such permit or if the building or work authorized b> such permit is suspended
or abandoned at any time after .tne wortf is commenced f/r atoerj«fo/OT.180 / - - -
APPLICANT'S SIGNATURE
(tion 106.4.4 Uniform Building Code).
DATE
WHITE: File YELLOWrApplicant PINK: Finance
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT* CB981415 FOR 06/09/98 INSPECTOR AREA PY
DESCRIPTION: ADD 200AMP-3PHS&200 AMP 1PHS PLANCK# CB981415
SERVICE,LEAVE EXIST 100 AMP AS SUB PANEL OCC GRP
TYPE: ELEC CONSTR. TYPE NEW
JOB ADDRESS: 1685 CHESTNUT AV STE: LOT:
APPLICANT: NEWBERRY ELECTRIC PHONE: 760 489-0079
CONTRACTOR: PHONE:
OWNER: PHONE:
REMARKS: C/DOUG/ INSPECTOI
SPECIAL INSTRUCT: PAUL YOU PROBABLE DID THIS INSPECTION $>N MONDAY;
TOTAL TIME:
CD LVL DESCRIPTION ACT COMMENTS
33 EL Service Change/Upgrade
INSPECTION HISTORY *****
DATE DESCRIPTION ACT INSP COMMENTS
CITY OF CARLSBAD
INSPECTION REQUEST
PERMIT* CB981415 FOR 06/08/98 INSPECTOR AREA PY
DESCRIPTION: ADD 200AMP-3PHS&200 AMP 1PHS PLANCK# CB981415
SERVICE,LEAVE EXIST 100 AMP AS SUB PANEL OCC GRP
TYPE: ELEC /£rS£~ CONSTR. TYPE NEW
JOB ADDRESS: ~-t?#5 CHESTNUT AV STE: LOT:
APPLICANT: NEWBERRY ELECTRIC PHONE: 760 489-0079
CONTRACTOR: PHONE:
OWNER: PHONE:
REMARKS: C/DOUG/489-0079 INSPECTOR
SPECIAL INSTRUCT:
TOTAL TIME:
—RELATED PERMITS— PERMIT# TYPE STATUS
CB973808 ELEC ISSUED
CD LVL DESCRIPTION ACT COMMENTS
34 EL Rough Electric
***** INSPECTION HISTORY *****
DATE DESCRIPTION ACT INSP COMMENTS
05/11/1998 .09:41 7607417686 TPTSP PAGE 02
NEWBERRY ELECTRICAL
RESIDENTIAL
COMMERCIAL
UPGRADES
)EL
Vour sW
.A
our
832 CAMINO DHL MAR SUITE #1 DEL MAR, CA (619) 259-0622
05/11/1998 09:41 7607417686
•i '•' '"
PAGE 03
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Submitted to Applicant
by: DonAltevers
AGREEMENT FOR EXTENSION
AND CONSTRUCTION OF OVERHEAD ELECTRIC
PARTIES
This Agreement, dated ^^'_X/%<is made and entered into, by and between SAN DIEGO GAS &
' f r . •.
ELECTRIC COMPANY, a corporation, hereinafter called "Utility", and , /
/MtidtU^sC' ^-fO§€S~ ~^2ffl4£<&t£&. . hereinafter called "Applicant".
RECITALS "_XV -.•'•.' ;
- - - . ' ' - - ,• " ' i ^ . "_, ' " . ' • " " - • , "'',•..-_•.'
Whereas, Applicant requests Utility to furnish overhead electric service to the premises known as {Setter
Naa*»»y, located at 1685 Chestnut Avenue, Carlsbad, CA. v^ ^ &fe
AGREEMENT "'".,-• -. " :: ' ./. • .';•' '••-,"" -''''. V.'v';.• -••-..''.'. ...'..-.' ''' - V;';.
Therefore, in consideration of the mutual promises herein, the parties agree as follows: ;
1. GENERAL. In accordance withi California Public Utilities Commission Rules 15 and/or 16, the
allocation of work on Work Order(s) and the cost information summarized in Appendix A and
contained in the Appendices) B, which Appendices) B is attached hereto and by this reference
incorporated herein, Utility and/or Applicant shall construct a(n) overhead electric extension.
2. CONTRACT EXPIRATION. Once Applicant has started to perform the work required by the
Contract Documents, Applicant agrees to exercise reasonable diligence in pursuing such work to
completion within one year after the date of the Contract Documents. If such work has not been
completed within one year after the date of the Contract Documents, Utility shall have the right,
upon giving written notice to Applicant, to cancel and terminate the Contract Documents. .If Utility
elects to cancel and terminate the Contract Documents, Utility shall return to Applicant an amount
equal to the above cash advance, minus Utility's costs. "Utility's costs" are defined as the actual
costs (including but not limited to labor, materials and overhead) incurred by Utility prior to such
cancellation and termination in connection with work done in furtherance of Applicant's project, plus
the actual costs of removing any of the installed facilities which Utility desires to salvage, minus the
salvage value of such facilities. In the event Utility's costs exceed the above cash advance,
Applicant agrees to pay Utility a sum equal to the amount by which the Utility's costs exceed the
advance. Upon exercise of its right to cancel and terminate and upon payment to Applicant, all of
Utility's obligations under the Contract Documents shall cease.
3. CONTRACT COMPLIANCE. If. after six (6) months following the date the Utility is first ready to
serve residential loads for which allowances were granted, or one (1) year for non-residential loads
for which allowances were granted, Applicant fails to take service, or fails to use the service
contracted for, Applicant shall pay the Utility an additional Contribution, based on the allowances
for the loads actually installed.
4. EXCESS FACILITIES. If the loads provided by Applicant result in the Utility installing facilities
which are in excess of those needed to serve the actual loads, and the Utility elects to reduce such
excess facilities, Applicant shall pay the Utility its estimated total cost to remove, abandon, or
replace its excess facilities, less the estimated salvage value of any removed facilities.
5. EASEMENTS. Applicant shall, upon Utility's request, execute Utility's standard form easements for
the construction, service, presence, maintenance or inspection of Utility's facilities as may be
required hereunder. .•'
6. PAYMENT OPTIONS. Applicant has the option of advancing a non-refundable or refundable
amount as described in the Appendices). The total refundable amount shall be subject to refund,
without interest, in accordance with the following provisions: .-.••. , :
a) Refunds will be made within ninety (90) days after the date Applicant becomes eligible for
a refund, except that refunds may be accumulated to a $50 minimum orthe total : :
refundable balance, if less than $50. : > i / •
b) Residential. Refunds will be made on the basis of a new customer's permanent load
connecting to the line extension which produces additional revenues to Utility. Such
refundable amount will be that amount which is on file at the time the refund(s) become
eligible. The refund will be deducted from the total refundable amount, and the remaining
amount subject to refund represents that portion of the extension cost not supported by
•• . . -.-.. . ' . ' 'revenues. •..*;^:;>-V''' ••"•':' ••'/','.'•"• "••••' •'^^'•y^'/'''::":^.i'<.^"..'"^-f'/.^-' •V'tv^vv"'
•.' •• • ••'••' •'. -.1':.' "i'-':''f--' '"*'•"''••;'". ••"''•"'•V'.H; •-••'.."''^: ' •'•' ffi'/^;'-.^^----^'''*'.',?'••;.'-. s'?-?' ~-~::'^'$&
: c) Non-Residential. Refunds will be made on the basis of Applicant's or new customer's I;
permanent load connecting to the line extension which produces additional revenues to
Utility., Utility shall be responsible to review Applicant's actual base annual revenue for the
first three years from the date Utility is first ready to serve. Applicant shall be responsible
for notifying Utility if new, permanent load is added in the fourth through tenth year from the
.date Utility is first ready to serve. Such review shall determine if additional revenue \^:.
supports any refunds to Applicant. : W ;^*J r i- V!;|^
7. ASSIGNMENTS. This Agreement may be assigned by Applicant only upon the assignee's written
acceptance of said assignment, and the prior approval of Utility as evidenced by written
endorsement thereon; however, such approval shall not constitute a release of Applicant's
obligation hereunder unless expressly so provided in said endorsement. Utility may refuse to
accept an assignment of this Agreement unless executed on form furnished and approved by
Utility.
8. COMMISSION CHANGES. Applicant shall be governed by Utility's applicable Rates and Rules on
file with the California Public Utilities Commission, which Rates and Rules are made a part hereof
by reference, and a copy of which will be furnished to Applicant on request. This Agreement shall
at all times be subject to such changes or modifications as said Commission may, from time to
time, direct in the exercise of its jurisdiction.
ELECTRIC AGREEMENT
9. CONSTRUCTION RESPONSIBILITIES. Applicant shall perform at its expense all
trenching/excavation, backfilling and compaction, including furnishing any imported backfill material
required, and will furnish and install all distribution and feeder conduit and substructures required,
all in accordance with Utility's General Conditions and Specifications, attached hereto and made a
part hereof by this reference. Upon Utility's final acceptance of said installation in accordance with
the referenced General Conditions, Applicant hereby grants, sells and conveys to Utility all its
rights, title and interest in and to all materials installed. Once the extension receives final
acceptance, Utility agrees to own, operate and maintain such extension.
10. BETTERMENT. Where mutually agreed upon by Utility and Applicant, Applicant shall perform
additional work to install additional facilities in accordance with Utility's specifications, timing, and
applicable tariffs. Utility shall reimburse Applicant, Utility's estimated installed cost of such facilities
and work, by applying a credit toward Applicant's advance. Any amount not so credited shall be
reimbursed to Applicant upon final acceptance of the work and facilities by Utility.
11. OWNERSHIP COSTS. When any portion of a refundable amount has not qualified for a refund at
the end of twelve (12) months from the date Utility is first ready to serve, Applicant will pay to Utility
an ownership charge on the remaining refundable balance. The difference between the total
refundable advance and any refunds made or eligible to be made to Applicant shall serve as the
basis of a monthly ownership charge which is determined as customer financed facilities, in
accordance with Rule 2. A monthly ownership charge is in addition to the refundable amount and
will normally be accumulated and deducted from refunds due to Applicant. This provision does not
apply to individual residential Applicants.-'Any unrefunded amount remaining at the end of the ten
(10) year period shall become the property of the Utility. ^
.'''•' v 4 * j'iJ'v T ?
GAS AGREEMENT , \- /A'^C^IL , „ ,"
*• t \\f-r ^T ^
." ' '^ - *- " > ' f
12. CONSTRUCTION RESPONSIBILITIES. Utility is responsible for the installation of distribution
main, valves, regulators, and other related distribution equipment required to complete the
extension, including all necessary trenching/excavation, backfilling and compaction, and any
imported backfill material required, as delineated in the Work Order(s) mentioned herein, y :
13. CONSTRUCTION OPTIONS. Where muiuailyjaglreed up^
shall have the optionof performing all excavation, toi^filjing and compaction, including
any imported backfill material, and substroctures reqw
Conditions and Specifications, attached hereto and made part hereof by this reference. Utility shall
reimburse Applicant, Utility's estimated installed cost of such facilities and work, by applying a credit
toward Applicant's advance. Any amount not so credited shall be reimbursed to Applicant upon
final acceptance of said work and facilities by Utility. ;^vl '-
• •• . . • ' '"'"";t ..•-'• >• >~"J i - . .
14. OWNERSHIP COSTS. When any portion of a refundable amount has not qualified for a refund at
the end of thirty-six (36) months from the date Utility is first ready to serve, Applicant will pay to
Utility an ownership charge on the remaining refundable balance. The difference between the total
refundable advance and any refunds made or eligible to be made to Applicant shall serve as the
basis of a monthly ownership charge which is determined as customer financed facilities, in
accordance with Rule 2. A monthly ownership charge is in addition to the refundable amount and
will normally be accumulated and deducted from refunds due to Applicant. This provision does not
apply to individual residential Applicants. Any unrefunded amount remaining at the end of the ten
(10) year period shall become the property of the Utility. ;
APPLICANT INSTALLATION ^ ) •
15. Where the Applicant Installation option is selected, the Applicant, shall use qualified contractors to
install that portion of the new extension normally installed by the Utility. Such installation shall be in
accordance with the Utility's design and General Conditions and Specifications, attached hereto
and made a part hereof by this reference.
16. PAYMENT OPTIONS. Applicant has chosen one of the following:
[ ] A refundable contribution representing the Utility's total estimated installed cost as
described in the Appendices) or; > * '
."'- ' •' -:'' '- ' ,'t j- ' '
P(] A non-refundable contribution representing a percentage of the refundable amount as
described in the Appendices) to this agreement.
17. AUTHORIZED SIGNATURE. If Applicant is a corporation, partnership, joint venture or a group of
individuals, the subscriber hereto represents that he has the authority to bind said corporation,
partners, joint venture or individuals as the case may be. :
18. EFFECTIVE DATE. The Contract Documents shall become effective only upon the date signed
by the authorized Utility representative.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed for and on behalf
of each, by their duly authorized agents, partners, or corporate officers.
Applicant:
Address:
SAN DIEGO GAS & ELECTRIC COMPANY,
a corporation
By:_
(Authorized Individual-Utility)
Date Executed:
Type of Customer
p ~~
Residential [ ] Non-Residential [X]
i
Individual [X] Subdiv/Dev. []
Phone No.
Social Security Number or
Tax I.D. Number ~
Applicant is a corporation: Yes [ ]
S *i
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San Diego Gas & Electric
An Enova Company
1623 WEST MISSION ROAD • ESCONDIDO, CA 92029-1109
PLA 590
PROJ# 831366-010
Aprils, 1998
Doug Newberry
Newberry Electrical
832 Camino Del Mar, Suite 1
Del Mar, CA 92014
Subject: 1685 Chestnut Avenue, Carlsbad
Dear Mr. Newberry:
Your request for overhead electric service to the above project has been investigated.
It will be necessary to extend 218 feet of electric line to serve your project. This extension will
require a construction advance of $0.
Your Rule 15 allowance of $2,722.00 is based on the estimated annual revenue (commercial).
<""
These advances are covered by contract.
You are to provide an acceptable clear route, including any necessary tree trimming, prior to
the installation of the new extension. SDG&E will be unable to schedule the installation of our
facilities until an acceptable clear route has been provided. In performing this work, you are
responsible for obtaining all necessary permits and for adhering to all applicable governmental
and regulatory statutes, codes, and rules. Upon completion of your work, please contact the
SDG&E Project Coordinator to inspect the route and to schedule the installation of the new
facilities.
As soon as possible, please review and sign the enclosed contracts and return the ORIGINAL
and one copy to Project Management in the enclosed envelope.
If you cancel your request, we will retain a portion of the original payment which represents
SDG&E's expense of processing your request. The remaining amount, if any, will be refunded
to you.
This offer shall expire at the end of the business day on June 5, 1998. If you request a new
cost estimate after that date, a new engineering fee may be required.
Your costs, as cited herein, are subject to change at any time. All cost calculations are based
upon SDG&E's filed tariffs, SDG&E's internal costs, and all applicable governmental or
regulatory statutes, regulations, codes and rules. Should any change in, or addition to, those
tariffs, costs, statutes, regulations, codes or rules in any way impact these cost calculations,
you will be subject to any resulting increase or decrease.
Doug Newberry 2 April 3, 1998
The costs quoted in this letter include a cost component to cover the utility's estimated liability
for State and Federal Income Tax.
By March 31, 1998, you or your future customers can choose to buy your electricity from an
energy service provider or SDG&E. Either way, SDG&E will continue to deliver electricity to
your new project. Please let me know if you would like to receive an SDG&E information
packet explaining your new options in California's competitive electric market, including a list of
energy service providers authorized to conduct business in this area. In addition, you may
obtain several informative brochures through the Electric Education Call Center, authorized by
the California Public Utilities Commission, at 1-800-253-0500.
If I may be of further assistance or if you have any questions, please call me at the number
listed below. Our hours are from 7:00 AM - 4:00 PM, Monday through Friday.
Sincerely,
)on Altevers
Customer Project Planner
Telephone: (760) 480-7727
DLA:jc
Enclosures
cc: Contracts
SD
COMPENSATION
I N SU RANGE
FUND
P.O. BOX 807, SAN FRANCISCO,CA 94101-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 02-O1-98
POLICY NUMBER: 1176053 - 98
CERTIFICATE EXPIRES: 02-01-99
STATE CONTRACTOR'S LICENSE BOARD
P 0 BOX 26000
SACRAMENTO CA 95826
JOB: LICENSE # 534815
INCEPTION DATE: 02-O1-98
D.O.: SAN DIEGO
•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 30 days' advance written notice to the employer.
We will also give you 30 days' 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 insurance afforded by the
policies described herein is subject to all the terms, exclusions and conditions of such policies.
PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE.
STANDARD EXCLUSION: INDIVIDUAL EMPLOYERS AND HUSBAND AND WIFE EMPLOYERS ARE NOT ELIGIBLE
FOR BENEFITS AS EMPLOYEES UNDER THIS POLICY.
.ENDORSEMENT #2O65 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 02/O1/98 IS ATTACHED TO AND
FORMS A PART OF THIS POLICY.
EMPLOYER LEGAL NAME
NEWBERRY ELECTRICAL SERVICE
528 EAST 6TH
ESCONDIDO CA 92025
NEWBERRY, DOUGLAS A.
PRIIMTFD- 01-17-98
THIS DOCUMENT HAS A BLUE PATTERNED BACKGROUND SCIF 10265 (REV. 2-95)