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HomeMy WebLinkAbout1692 AMANTE CT; ; CB081612; Permit09-04-2008 City of Carlsbad -1635-FaradayAv Carlsbad, CA 92008 Pool Permit Permit No CB081612 Building Inspection Request Line (760) 602-2725 Job Address Permit Type Parcel No Valuation Reference # PC# Project Title 1692AMANTECTCBAD POOL 2159005000 Lot* $2 850 00 Construction Type LIUAG 75SF GUNITE SPA/GAS & ELECT TO BBQ 0 NEW Applicant MISSION POOLS OF ESCONDIDO INC 755 W GRAND AVENUE ESCONDIDO CA 92025 619-743-2605 Status Applied Entered By Plan Approved Issued Inspect Area ISSUED 08/21/2008 JMA 09/04/2008 09/04/2008 Owner LIUAG RONALD K&KATHRYN S FAMILY TRUST 11-22-05 1692AMANTECT CARLSBAD CA 92011 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 Additional Fees $4995 $000 $3247 $000 $2000 $2700 $1 00 $000 $000 $000 $000 TOTAL PERMIT FEES $13042 Total Fees $130 42 Total Payments To Date $13042 Balance Due $000 BUILDING PLANS _vl IN STORAGE ATTACHED Inspector FINAL APPROVAL Date Clearance NOTICE Please take NOTICE that approval of your project includes the Imposition of fees dedications reservations or other exactions hereafter collectively referred to as fees/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 m Government Code Section 66020(a) and file the protest and any other required 'nformation 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 theinmposition You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water ind sewer connection fees and capacity changes nor planning zoning grading or other similar application processing or service fees in connection with this proiect 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 of Carlsbad 1635 Faraday Ave Carlsbad CA 9200S - 760 602 2717 / 2718 / 2719 Fax 760 602 8558 Permit Application Pla n Check No QftQ <P* / fc 12- Est Value 2- Plan Ck Deposit JOB ADDRESS CT/PROJECT# LOT#I P # OF UNITS 1 # BEDROOMS DESCRIPTION OF WORK (Please describe present use and proposed use) )OMS # BATHROOMS TENANT BUSINESS NAME _ TYPE OF CONST OCC GROUP (Sec 70315 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 fie a signed statement that he is licensed pursuant to the provisions of the Contractors 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 703 i 5 hy any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars {$500}) Workers Compensation Declaration I hereby affirm under penalty of perjury one of (fie following declarations I have and will maintain a certificate of consent to self insure for workers compensation as provided by Section 3700 of the Labor Codi for the performance of the work for which this permit is issued ' ^je 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 workers compensation insurance carrier and policy i number are _ : Insurance Co (/O&U <5<?(- <A. Policy ^ i This section need not be completed if the permit is for one hundred dollars ($100) or less | -3 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 an/ manner so as to become subject to the Workers Compensation Laws of i 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 00 000) in | addition to the cost of compensation damages as provided for in Sectioor3706 of the Labor code interest and attorneys fees y worers compens I ^, / V/O/6? ' ^CONTRACTOR SIGNATURE l / hereby affirm that I am exempt from Contractor s License Law 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 no: 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 oid not build or improve for the purpose of sale) C11 as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec 7044 Business and Profes >ions Code The Contractor s License Law does not apply to an owner of property who bunds or improves thereon and contracts for such projects with contractor(s) licensed pursuant to the Contractor s License Law) 3 I am exempt under Section Business and Professions Code for this reason 1 ! personally plan to provide the major labor and materials for construction of the proposed property improvement n Yes 3 No 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 / contractors license number) 4 ! plan to provide portions of the work but I have hired the following person to coordinate supervise and provide the major work (m< lude name / address / phone / contractors license number) 5 I wJI provide some of the work but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work) ^PROPERTY OWNER SIGNATURE DATE Is tne 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 O 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' O Yes D No Is the facility to be constructed within 1 000 feet of the outer boundary of a school site' D Yes n No IF ANY OF THE ANSWERS ARE YES EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT i hereby affirm that there is a construction lending agency for the performance of the work this permit is issued (Sec 3097 (i) Civil Code) Lender's Name 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 agiee to comply with all City ordinances and State laws relating to building construction I hereby authorize representative of the City of Carisbad 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 OSHA An OSHA permit is required for excavations over 5 0 deep and demoht.on 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 limitj '80 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 106 4 4 Uniform Building Cede) ^APPLICANT S SIGNATURE DATE City of Carlsbad Bldg Inspection Request For 11/21/2008 Permit* CB081612 Title LIUAG 75SF GUNITE SPA/GAS & Description ELECT Inspector Assignment PY Type POOL Sub Type Phone 7607438605 EX 215 Job Address 1692 AMANTE CT Suite Lot 0 Location Inspector _ OWNER LIUAG RONALD K&KATHRYN S FAMILY TRUST 11-22-05 Owner LIUAG RONALD K&KATHRYN S FAMILY TRUST 11-22-05 Remarks Total Time CD Description 59 Final Pool Act Comments Requested By MICHELE Entered By CHRISTINE Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 11/13/2008 55 Fence/Pre-Plaster 09/24/2008 23 Gas/Test/Repairs 09/24/2008 53 Electric/Conduit/Wiring 09/17/2008 21 Underground/Under Floor 09/17/2008 51 Excav/Steel/Bondmg/Fence AP PY ok to plaster alarms ok AP PY PA PY CONDUIT ONLY AP PY AP PY OK TO GUNITE City of Carlsbad Public Works BUILDING PLANCHECK CHECKLIST POOLS Engineering BUILDING PLANCHECK NUMBER CB BUILDING ADDRESS 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 sypsion of permit to build Date ' DENIAL Please see tbc^^tta^hed report of deficiencies marked with (glfldake 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 [] Grading Permit Application [] Grading Permit Checklist [] Right-of-Way Permit Application [] Right-of-Way Permit Submittal Checklist and Information Sheet [] Storm Water Applicability Checklist ENGINEERING DEPT CONTACT PERSON NAME Linda Ontiveros City of Carlsbad ADDRESS 1635 Faraday Avenue Carlsbad, CA 92008 PHONE (760) 602-2773 1635 Faraday Avenue • Carlsbad, CA 92008-7314 • (760) 602-272O • FAX (76O) 3 Ut ,ST», D D D D D D D D D D BUILDING PLANCHECK CHECKLIST - POOLS SITE PLAN 1 Provide a fully dimensioned site plan drawn to scale Show A North Arrow B Existing & Proposed Structures Show on site plan Lines isements - ramage Patterns xistmg & Proposed Slopes C Existing Topography D Indicate what will happen with soil excavated from pool area E 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 ite Address 'Assessor's Parcel Number egal Description — Grading Quantities Cut Fill Import/Export a) If grading is not required, write "No Grading" on plot plan 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 2 of 3 BUILDING PLANCHECK CHECKLIST - POOLS j ST», 2ND°' 3RD°! Q Q Q 5c A Grading Permit has been applied for GR DWG No Grading Inspector sign off by Date 0 Q Q 5d No Grading Permit required MISCELLANEOUS PERMITS VNQ D D 6 A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Way and/or private work adjacent to the 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 D STORM WATER APPLICABILITY CHECKLIST 7 JS Requires PSWP (project storm water permit) # D Not required D Cl D 8 Remarks Page 3 of 3 Rev 10/24/07 5V-s Xs^. "1 -^ ^ 5fc S|^ P £ 1 ^fV. OOO>-ioC/>c/)T) .^ fcrd ¥ ^ f i» o o > o ? ~ ^2z DERSTAND AND ACKNOWLEDGE THAT 1 MUST (1).EMENT BEST MANAGEMENT PRACTICES (BMPS) DURINSTRUCTION ACTIVITIES TO THE MAXIMUM EXTENTCTICABLE TO MINIMIZE THE MOBILIZATION OF POLLUTAH AS SEDIMENT AND TO MINIMIZE THE EXPOSURE OFRM WATER TO CONSTRUCTION RELATED POLLUTANTSDHERETO AND AT ALL TIMES COMPLY WITH THIS CITYROVED TIER 1 CONSTRUCTION SWPPP THROUGHTOUTATION OF THE CONSTRUCTION ACTIVITIES UNTIL THESTRUCTION WORK IS COMPLETE AND APPROVED BY TtOF CARLSBAD . .. f.W^fC^^fn c £7LRiSi/OiVNHK ^AU'^rprtS?!!. ('PRINT) -^ t /* i 1 Hm g en o O C/) 01 > ~-n < c co Of, ^ CD o m RTIFY TO THE BEST OF MY KNOWLEDGE THAT ALL OF TVE CHECKED STATEMENTS ARE TRUE AND CORRECT 1MITTING FOR CITY APPROVAL A TIER 1 CONSTRUCTION>PP PREPARED IN ACCORDANCE WITH THE REQUIREME;iTY STANDARDSz > iH § men s <v «. S *•My project is not in a category of permit types exempt from theConstructjon SWPPP requirementsMy project is not located inside or within 200 feet of an environmensensitive area with a significant potential for contnbuting pollutantsnearby receiving waters by way of storm water njnoff or non stormdischarge(s)My project does not requires a grading plan pursuant to the CarisbGrading Ordinance (Chapter 15 16 of the Carisbad Municipal CodeMy project will not result in 2 500 square feet or more of soils disturincluding any a'^or-.iatpri r^nsinjrttnn paging ^Inrkpiling pavprnpremoval equipment storage refueling and maintenance areas thatone or more of the additional following critenalocated within 200 feet of an environmentally sensitive area or th*Pacific Ocean and/ordisturbed area is located on a slope with a grade at or exceedinghonzontat to 1 vertical and/ordisturbed area is located along or within 30 feet of a storm draman open drainage channel or watercourse and/orconstruction will be initiated dunng the rainy season or will extencthe rainy season (Oct 1 through Apnl 30)STORM WATER COMPLIANCE CERTll ICA IKI S "• 1*1 * !°! w n> in "3 r5 > Z H c/i IJ>•a 1 "s?l i" °&0? Z H 0 1 j^ ICT3 .^ -^ H -2rV- — ^ „ ^^ V (/! SjJ C C"^ ^av\ v ~r vj) -s O\ L/1 ^ ~ > r?> CD^^" N'SlFSS? a|€ lgi^2S^>; z> o^c ££s ip ^^^S -3 tn gr On_ Cg2 2CO >z<!^oo •* > ^H-*H H Jrt >o 2^5 coGo ^^ ^ft-"H^ ^=2 "I*lp s> >^| S^S 5h 3q =p^lpll>5 DgS C ?D-<> > n 2 > O 3z Z 3 C r H g S^n -^S^^sib j ?=2 £2Z 3 o SnZ rn H ^ m H >H§ S * S£ ^ r- S S XZ 2 -T H w nm^> 3 J/.P an| « ?g H * f-. c/l n r-tn ^ &=; ^ r* fvIS a. S- -o2.3 § n « « 3 S !!§" 1 US ^ d ill f S ?s 8. § So J ^ us S-l ^>| q 6 /^l Z 2 r- $. |M| .;• " O B | g if- •?a.= 4^ T! > O IRCUMSTANCES WHICH MAY AILL REMOVABLE PROTECTIVE DLACE AT THE END OF EACH WOI^1 [Ti ^ 7= < w zn ~sssf^<: i-S r- -L.rn cc 2 m HZ rn i j 3- H2 ^ O* Sr « 1 ^ <~ H ~ z E 2n tr o o n S2^3i^ _^" ^.R §3 £S3Sss £S; Sz?z a g 00 £ i£*SJcE > r- >-: a c« OZ £z o ><"-:•< O •£ K*%%, ing33-2 2 * =Ssficr C o§3?w mg Z =1 1 1v? ^?^ s ^S 5S S? V &r U> -HOt/:rtTiSFACTiOiv Or TiiE CiTr Ei\GIFF PRODUCING RAINFALL1 IH OWNER/CONTRACTOR SHALL ~; z n; ^ ? P 3 > Si g rr — i rio z Z X> c. !"~ 2' m = Bao y 1 a I ° § 5 t/i i s s?s <; ; S- !in U O -HE UWNtK/CUN 1 KAL I UR SHALONTROL DEVICES TO WORKING~, r 11 "** C 3*C IT -i > SF r | V? no sI 9 2* 3 ~s. 754^ <P OO ^ CO = >.VAILABLE ON SITE TO FACILIT/MSTAI..LATION OF EROSION ANDMPS WHEN RAIN IS EMINENTis: H-3 iiT ~'i°i~ig^. 1 -? £ •% % 6 Io?SS* <o § ~l *§t £9i ~>.LL NECESSARY HQUIPMHNT ANd 2 > rrX >. Vi Vl n:ft I- win Cf ^f X.^ §>iifr ^\ Pv 3 5 p 5 FORM/H 2 !C/! w~ ^•^ ,__. 2 r/5 _CITY OF CARLSBADTORM WATER POLLWATER POLLUTION PRHVHNTIOz r* E 3s o2 TJ»w ^§ H O ^0r>y. i! 7? i o N r 3 3 £L 5 O •? cr. n> o r 1 c t; I! '-£ ?£ K £ s 8 i. CO v; C d: •§ S 1 |1 | i 1 1 S 1 kl-ii1 u ^ ^- s." y ^ fcr •/> r- - r. » r ,G in by reviewing the list of construct!)n boxes provided 1'or that purpose afrom the list located alon the top ofected BMPs selected from the lislis Stabilized Conslrueion Ingress/F.jox wheic the two meet As anotheiic in Ihe blank column under the IK.out what each BMP descnption mea^ |-S|s^a.= - K'2. = d g fi < j £i "^ ^T ~- n ^ £T < -'S'Jl^g'Jr- £ "" =" i. = - 1 S" | f»|lg-|| g f 1 ! | sl-f I =1ls-i.l| » 3 5 1> % * =•!1 l!flfli 1 i-li =S Is- 1 :,|||||i i |25-B-*"fi 1 lilf|li I || 1 3. 1=1 = 9 a s a i- PR p w IS e. 2, S S 1 Iliffjs £. s S r S 3 o. 2 | |S|?o|S 1 |1f|||| a II f"1! go i ° s-s =^TS s S n"-J32^pS S. — 31 -i ? 3 8 'a §r?<^?g£ S 3 3 N ? g-1 1 li"I?s " " S. S 3 'S1 §s?Nl I illEs! S •> = a 3,- z 3, = 5.3 e | « 5. |. o Site Access Across DirtX IHazardous Substance Use/Storagem I i 1 ,3 I tu 1 Waste DisposalStucco/Mortar WorkConduit/Pipe InstallationT) 1 o CD ^"Concrete/Asphalt Sawcuttmgi? 1 1 ,_StockpilingTrenching/Excavation>^ h 5?Grading/Soil Dsturbanceh X CASQA Designation ->Construction ActivityEC 7 ECS EC 9 EC 11 SE 1 SE 3 SE-4 SE 5 SE 6 SE7 SE8 SE 10 TR 1 TR2 NS 1 NS 3 NS 7 NS8 WM 1 WM 2 WM 3 WM4 WM 5 WM6 WM8 Best Management 1'rjictice(BMP) Description ->Gee-textiles S Mats Wood Mulching Earth Dikes and Drainage Swales Slope Drains Silt Fence - Sediment Trap Check Dam Fiber Rolls Gravel Bag Berm Street Sweeping and Vacuuming Sandbag Barrier Storrn Drain Inlet Protection Stabilized Construction Ingress/Egress Stabilized Construcion Roadway Water Conservation Practices Paving and Grinding Operations Potable Water/Irrigation Vehicle and Equipment Cleaning Material Delivery and Storage Material Use Stockpile Management Spill Prevention and Control Solid Waste Management Hazardous Waste Management Concrete Waste Management § JUS Jp ! 3 . 3 c/>s m Oo i mi 5</> I o o. o I? s5; zi ° CD =» inif II•a "• cutn -0 JS" O ^ E| Is: o?II CD O- II IVI PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB081612 DATE 08/21/03 ADDRESS 1692 AM ANTE CT RESIDENTIAL ADDITION- MINOR (< 17,000.00) RETAINING WALL VILLAGE FAIRE POOL/SPA TENANT IMPROVEMENT COMPLETE OFFICE BUILDING OTHER SPA PLANNER GINA RUIZ ENGINEER DATE 8/25/08 DATE II \AIDIIN\IIIIATI ll/l'l \\\IM,/I M l\l I HIM AI'I'IIIIVAIS V Chent# 9923 3MISSPOO1 ACORD,. CERTIFICATE OF LIABI PRODUCER HRH of San Diego Insurance Services 9339 Genesee Avenue, Suite 300 San Diego, CA 92121 INSURED Mission Pools of Escondido, Inc 755 West Grand Avenue Escondido, CA 92025-9990 LITY INSURANCE DATE (MM/DD/YYYY) 03/28/08 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 INSURERS AFFORDING COVERAGE . INSURER A Praetonan Insurance Company /T"/ INSURER B Wausau Underwriters Insurance Compan INSURER c Nationwide Mutual Insurance Co INSURER D INSURER E NAIC# (22292 26042 23787 COVERAGES 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR A C B \DDL NSRC TYPE OF INSURANCE GENERAL LIABILITY X x~ COMMERCIAL GENERAL LIABILITY | CLAIMS MADE | X| OCCUR $2,500 Ded GEN L AGGREGATE LIMIT APPLIES PER | POLICY r~xl JECT I I LOC AUTOMOBILE LIABILITY X X X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS GARAGE LIABILITY ANY AUTO EXCESS/UMBRELLA LIABILITY | OCCUR | I CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED'' If yes describe under SPECIAL PROVISIONS below OTHER POLICY NUMBER H01 0000504 ACPBA781 2584050 WCJZ91441063018 POLICY EFFECTIVE DATEfMM/DD/YY) 04/01/08 04/01/08 04/05/08 POLK Y EXPIRATION DATE IMMIDO/YY) 04/01/09 04/01/09 04/05/09 LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Fa nnrjirrence) MED EXP (Any one person) PERSONAL & AOV INJURY GENERAL AGGREGATE PRODUCTS COMP/OPAGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) AUTO ONLY EA ACCIDENT OTHER THAN AUTO ONLY EAACC AGG EACH OCCURRENCE AGGREGATE X I WCSTATU I TORY I IMITS lOTH I ER EL EACH ACCIDENT E L DISEASE EA EMPLOYEE EL DISEASE POLICY LIMIT 51,000,000 5100,000 s 51,000,000 32,000,000 $2,000,000 51,000,000 s $ s $ s $ $ s s s $ 51,000,000 s1, 000,000 $1,000,000 The Certificate Holder is named as additional insured per attached form CG2010 07/04 but only for ongoing swimming pool, spa and/or water feature operations for The City of Carlsbad performed by or on behalf of the Named Insured **10 DAY NOTICE APPLIES IN THE EVENT OF CANCELLATION FOR NON-PAYMENT OF PREMIUM CERTIFICATE HOLDER CANCELLATION City of Carlsbad Attn Joanne 1635 Faraday Ave Carlsbad, CA 92008-0000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3fl* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE &WbM% ^JUckrvr ACORD 25 (2001/08) 1 of 2 #3591064/M591056 3KMCC ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED the policy(ies) must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) If SUBROGATION IS WAIVED subject to the terms and conditions of the policy certain policies may require an endorsement A statement on this certificate does noi confer rights to the certificate holder in lieu of such endorsement(s) DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing msurer(s) authorized representative or producer and the certificate holder nor does it affirmatively or negatively amend extend or alter the coverage affoi ded by the policies listed thereon ACORD 25-S (2001/08) 2 of 2 #8591064/M591056 POLICY NUMBER H010000504 00 00 CA COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orgamzation(s)Lot ation(s) Of Covered Operations Blanket as required by written contract and effective during the policy period as stated on the policy declarations Blanket as required by written contract Primary Insurance applies It is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional msured(s) shall be excess and noncontribulory as respects any claim, loss or liability allegedly arising out of the operations of the named insured, provided however that this insurance will not apply to any claim loss or liability which is determined to be solely the result of the additional msured's negligence or solely the additional insured s responsibility Information required to complete this Schedule, if not shown above, will be shown in the Declarations Section II - Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation^) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by 1 Your acts or omissions, or 2 The acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional msured(s) at the location(s) designated above B With respect to the insurance afforded to these addi- tional msureds the following additional exclusions ap- ply This msuiance does not apply to "bodily injury" or "property damage" occurring after 1 All work, including materials, parts or equipment furnished in connection with such work, on the pro- ject (other than service, maintenance or repairs) to be performed by or on behalf of the additional m- sured(s) at the location of the covered operations has been completed, or 2 That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same pro- ject CG20100704(Blkt)© ISO Properties Inc , 2004 Page 1 of 1 < CM 0. O J LLJ v)liJ V H cQ VJ 0 1 Jo _0 -£i60