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Home My WebLink About1747 CATALPA RD; ; CB962250; PermitBUILDING P S R M I 12/3i/9t._ 14": 50 Page 1 of 1 Job Address 17*7 CATALPA RD Sunte Permit Type- RE^IDENTA^ ADD/ALT Parcel No: 21!5-515~05-00 Lot*: Valuation. 28,952 Occupancy Group- Reference*• Description: 30$ SF ADDITION-SINGLE STORY T Permit No: CB962250 Project No- A9603194 Development No: 1741 12/31/9& 0001 01 02 C-TPMT 328- Appl/Ownr . KOLB, CHRIS 7720 EL CAMINO REAL CARLSBAD CA 92009 A*A Fees acquired *A* - ' #166 Fees: 509^, Adjustments. Total Fees. 50 , Fee description Building Permit Plan Check Strong Motion Fee * BUILDING TOTAL Enter 'Y" for Plumbif^ Each Plumbing Fixture * PLUMBING TOTAL Enter "Y" for Electric Enter "Y" for Remodel A ELECTRICAL TOTAL "ee Construction Type:VN Status- ISSUED Applied- It/20/96 Apr/Isbue- 12/31/96 Entered By: PMA 619 943-1911 & Credits -». A A. i ta ' *-«it ! I,j- X?-- 4. A it 00 181,00 328,00 Ext fee Data 278.00 181 00 3 00 462 00 20 00 Y 7 00 27 , 00 10 ,00 Y 10,00 Y 20,00 FINAL APPROVAL DATE±2ilZ CLEARANCE, CITY OF CARLSBAD 2075 Las Palmas Dr , Carlsbad, CA 92009 (619) 438-1161 PERMIT APPLICATION City of Carlsbad Building Department 2075 Las PaImas Dr., Carlsbad, CA 92009 (619) 438-1161 From List 1 (see back) give code of Permit-Type For Residential Projects!_Only From List 2 (see back) give Code of Structure-Type ^ Net Loss/Gain of Dwelling Units PLAN CHECK NO PLAN CK DEPOI VALID BY DATE 2 PROJECT INFORMATION 1117 11/20/96 0001 01 02 C-PRrfT 183-00 FOR OFFICE USE ONLY Address Nearest Cross Street uildTng or Suite No' LEGAL DESCRIPTION Lot No M- Subdivision Name/Number Unit No Phase No BELOW If bUBMll I ED D 2 Energy Calcs D 2 Structural Calcs D 2 Soils Report D 1 Addressed Envelope ASSESSOR'S PARCEL EXISTING USE PROPOSED USE DESCRIPTION OF WORK SQ FT # OF STORIES # OF BEDROOMS^-*OF BATHROOMS £?*" 3 UUM TAtrr WiHSUlM (.it airtereirrom applican NAME (last name first) CITY ADDRESS^//- , STATE 4 AWLLCAfJl JB NAME (last nairie CITY 5 I'ROP NAME (last name CITY ZIP COPE DAY TELEPHONE D AGENT FOR CONTRACTOR ADDRESS \t})\ ZIP CODESTATE DAY TELEPHONE ADDRESS / STATE ZIP COPE DAY TELEPHONE NAME (last name first) CITY ^AN^^^ /-A-STATE STATE UC # NAME (last narri(fTirsir ADDRESS ZIP CODE tf'fflfl'l DAY TELEPHONE LICENSE CLASS CITY BUSINESS UC # AULIRE^ Zlp CODE DAY TELEPHONE STATE UC /orkenT Compensation Declaration rhercby alrirrrf that I have a certificate of consent to sell insure issued by the Director ot Industrial 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) v Certified te of Exemption i certiry that in the performance oRrJeworirfor Which this permit is so as to become subject to the Workers' Compensation Laws of California >f employ any person m any manner SIGNATURE DATE JimUR bKOARATION owner-Builder Declaration 1 hereby attirm tnat l am exempt trom the Contractor's License Law lor tne lollowing reason 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 ihdt 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 ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Se'C 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 projectswith contractor(s) licensed pursuant to the Contractor's License Law) 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 [$500]) SIGNATURE DATE COMPLETE THIS SECTION Fok NON-RESIDENTIAL BUlLDlNcJ ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or nsk management and prevention program under Sections 25505, 25533 or 25534 of the Presley-Tanner Hazardous Substance Account Act? 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 distnct? D YES D NO Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? O YES D NO IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED AFTER JULY 1, 1989 UNLESS THE APPLICANT HAS MET OR IS MINTING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. 9 OJN^ I HUCTtON LEN I hereby affirm that there is a~construction lending agency tor the pertormance of the work tor which this peimit is issued (Sec 3097(i) Civil Code) LENDER'S NAME LENDER'S ADDRESS TO AFFLKJVN1 1 certify tnat I 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. LlABliJTIES, JUDGMIJ4TS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SATO 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 structuies over 3 stones in height Expiration Every permit issued by the Building Official under the provisions of this Code shall expire by limn ation 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 afjor the work is commenced for a period of 180 days (Section 303(d) Uniform Buildme Code) APPLICANTS SIGNATURE /Vy _S~2?5fA DATE TE: File YELLOW: Applicant PINK: Finance CITY OF CARLSBAD INSPECTION REQUEST PERMIT^ CB962250 FOR 03/31/97 DESCRIPTION: 308 SF ADDITION-SINGLE STORY TYPE: RAD JOB ADDRESS APPLICANT: CONTRACTOR: OWNER: 1747 CATALPA RD B.A. WORTHING, INC PHONE: PHONE: PHONE: INSPECTOR AREA DC PLANCK# CB962250 OCC GRP CONSTR. TYPE VN STE: LOT: 619 729-3965 REMARKS: RS/TERESA/729-3965 SPECIAL INSTRUCT: INSPECTOR TOTAL TIME: CD LVL DESCRIPTION 19 29 39 49 ACT COMMENTS ST Final Structural PL Final Plumbing EL Final Electrical ME Final Mechanical ***** INSPECTION HISTORY ***** DATE DESCRIPTION 022897 Interior Lath/Drywall 022897 Exterior Lath/Drywall 022597 Insulation 022497 Rough Combo 021397 Shear Panels/HD's 021397 Roof/Reroof 021197 Roof/Reroof 013097 Ftg/Foundation/Piers 013097 Ftg/Foundation/Piers ACT AP AP AP CO AP AP CA CO AP INSP DC DC DC DC DC DC DC DC DC COMMENTS NEED WINDOWS PER CONTRACTOR 8:30 MUCH 720 IN FTGS 1:00 EsGll Corporation Professwna.C'PCan Review 'Engineers DATE 12/6/96 Q^APPIJCANT dTjURJS> U FIRE JURISDICTION Carlsbad Q PLAN REVIEWER a FILE PLAN CHECK NO 96-225O SET II PROJECT ADDRESS 1747 Catalpa Rd PROJECT NAME Pahl/Tejeda Residential Addition I The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes The plans transmitted herewith will substantially comply with the jurisdiction's ********** codes when minor deficiencies identified below are resolved and checked by building department staff The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck The check list transmitted herewith is for your information The plans are being held at Esgil Corporation until corrected plans are submitted for recheck The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person The applicant's copy of the check list has been sent to Esgil Corporation staff did not advise the applicant that the plan check has been completed Esgil Corporation staff did advise the applicant that the plan check has been completed Person contacted Chris Kolb Date contacted 12/6/96 (by CM) Telephone # in person REMARKS The attached revised sheets must be inserted into the city set of plans in order to make a second set of approved plans. By CHUCK MENDENHALL Enclosures Esgil Corporation Q GA O CM p EJ D PC Walk in trnsmtl dot 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 4 (619)560-1468 + Fax (619) 560-1576 * *EsGil Corporation n %ev icif 'Engineers DATE 12/3/96 D APPLICANT JURISDICTION Carlsbad a PLAN REVIEWER Q FILE PLAN CHECK NO 96-2250 SET I PROJECT ADDRESS 1747 Catalpa Rd PROJECT NAME Pafal/tejeda Residential Addition The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's *********** codes The plans transmitted herewith will substantially comply with the jurisdiction's ********** codes when minor deficiencies identified below are resolved and checked by building department staff The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck The check list transmitted herewith is for your information The plans are being held at Esgil Corporation until corrected plans are submitted for recheck The applicant's copy of the check list is enclosed for the jurisdiction to forward to the applicant contact person The applicant's copy of the check list has been sent to Chris Kolb 1911 Saxony Rd, Encmitas, CA 92024 Esgil Corporation staff did not advise the applicant (except by mail) that the plan check has been completed Esgil Corporation staff did advise the applicant that the plan check has been completed Person contacted Date contacted (by ) Telephone # REMARKS By CHUCK MENDENHALL Enclosures Esgil Corporation D GA Q CM n EJ D PC 11/25/96 tmsmtidot 9320 Chesapeake Drive, Suite 208 + San Diego, California 92123 + (619)560-1468 + Fax (619) 560-1576 CITY OF CARLSBAD PLAN REVIEW No. 96-2250, SET I DATE: 12/3/96 NOTE The items listed below must be corrected prior to apprval of the plans Submit two sets of revised plans and a copy of this list indicating where or how the correction was made 1. The general code notes on sheet T-1 are incorrect The current codes are the 1994 UBC, UMC, UPC and the 1993 NEC Revise the notes to be consistent with the current city and state requirements 2. Note on the plans that smoke detectors will be provided inside all existing bed rms and the condor providing access to the bed rms UBC310 912 3. Electrical receptacles within the workshop/studio must be GFI protected 4 . The type "X" drywall on the studio wall adjacent to the house must be 5/8" thick mm 5. The 4X12 ridge beam must be DF/L # 1 grade to span as shown on the plans 6. Note on the foundation plan that the hold down bolts must be tied i place prior to foundation inspection 7. Specify on the plans the type of roof covering you intend to use If you have any questions regarding the items above, please contact Chuck Mendenhall at 560-1468 VALUATION AND PLAN CHECK FEE JURISDICTION Carlsbad PREPARED BY CM BUILDING ADDRESS 1747 Catalpa Rd BUILDING OCCUPANCY R# PLAN CHECK NO 96-2250 DATE 12/3/96 TYPE OF CONSTRUCTION VN BUILDING PORTION addition Air Conditioning Fire Sprinklers TOTAL VALUE BUILDING AREA (ft2) 300 VALUATION MULTIPLIER 94 VALUE ($) 28200 28,200 • 1991 UBC Building Permit Fee Q B!dg Permit Fee by ordinance $ 27800 • 1991 UBC Plan Check Fee D Plan Check Fee by ordinance- $ 18070 Type of Review • Complete Review Q Structural Only G Hourly Q Repetitive Fee Applicable Q Other Esgil Plan Review Fee $ 144 56 Comments Fire Services Review Fire Alarm Complete Review Other rj Suppression System Esgil Fire Services Review Fee Comments $ Sheet 1 of 1 macvalue doc 5196 1-30-97 To whom it may concern, I am writing you to let you know that the contractor for 1747 Catalpa Dr Carlsbad, CA 92009, residence of James Pahl and Cnstina Tejeda is no longer Chris Kolb-General Contractor but Brooks Worthing of B A. Worthing, Inc . PO Box 1041 Carlsbad, CA92018or690 Carlsbad VillageDr Suite 201 Carlsbad, CA 92008 His license #B-1 #398764 Theresa Gundlach Office Manager City of Carlsbad Engineering Department BUILDING PLANCHECK CHECKLIST DATE BUILDING ADDRESS PROJECT DESCRIPTION ASSESSOR'S PARCEL NUMBER EST VALUE 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 conform a nee with applicable codes Please review carefully all comments attached, as failure to comply with instructions in this report can result in suspension of permit to build D A Right-of-Way permit is required prior to construction of the following improvements Please marked wi specifi Lot DENIAL attached of deficienciesreport Make necessary corrections to plans or specifications for compliance with applicable codes and standards Submit corrected plans and/or specifications to this office for review By By By Date Date Date By FOR OFFICIAL USE ONLY -~-~~ - N"-"^ xT ENGINEERING AUTHORIZATION TO ISSUE BUILDING PERMIT; Date ATTACHMENTS D Dedication Application U Dedication Checklist D Improvement Application Q Improvement Checklist D Future Improvement Agreement D Grading Permit Application n Grading Submittal Checklist D Right-of-Way Permit Application rj Right-of-Way Permit Submittal Checklist and Information Sheet D Sewer Fee Information Sheet \\LASPALMAS\SYS\LIBRARY\ENG\WORD\DOCSW»«LSn8iiking PtanchK* ChM BP0001 Pom DR doc ENGINEERING DEPT CONTACT PERSON Name David Rick Address Phone City of Carlsbad 2075 Las Palmas Dr, Carlsbad. CA 92009 (619)438-1161, ext 4324 A-4 Rn 0/21/M 2O75 Las Palmas Dr • Carlsbad, CA 92OO9-1576 • (619) 438-1161 - FAX (619) 438-O894 BUILDING PLANCHECK CHECKLIST SITE PLAN £r Q 1 Provide a fully dimensioned site plan drawn to scale Show North Arrow ^D^ Property Lines Easements • ^^ Existing & Proposed Structures ^C. Easements /C) Existing Street Improvements (r) Right-of-Way Width & Adjacent Streets 2 Show on site plan Drainage Patterns oHo^ pr^'^ #} \*r '^M r/f*^ v<*cfc of- Existing & Proposed Slopes Existing Topography Q 3 Include note "Surface water to be directed away from the building foundation at a 2% gradient for no less than 5' or 2/3 the distance to the property line (whichever is less)" [Per 1985 UBC 2907(d)5] On graded sites, the top of any extenor foundation shall extend above the elevation of the street gutter at point of discharge or the inlet of an approved drainage device a minimum of 12 inches plus two percent" [Per 1990 UBC 2907(d)5] Q 4 Include on title sheet Site address Assessor's Parcel Number C^Legal Descnption For commercial/industnal buildings and tenant improvement projects, include total building square footage with the square footage for each different use, existing sewer permits showing square footage of different uses (manufacturing, warehouse, office, etc) previously approved EXISTING PERMIT NUMBER DESCRIPTION Page 1 of 4 HlWORDVDOCS\CHKLST\Bl»ktno Ranchaek CWs< BP0001 Forni OR doc BUILDING PLANCHECK CHECKLIST DISCRETIONARY APPROVAL COMPLIANCE oRD^ Q Q 5 Project does not comply with the following Engmeenng Conditions of approval for Project No Conditions were complied with by Date DEDICATION REQUIREMENTS Q Q 6 Dedication for all street Rights-of-Way adjacent to the building site and any storm drain or utility easements on the building site is required for all new buildings and for remodels with a value at or exceeding $ , pursuant to Code Section 18 40 030 Dedication required as follows Dedication required Please have a registered Civil Engineer or Land Surveyor prepare the appropnate legal descnption together with an 8 %" x 11" plat map and submit with a title report All easement documents must be approved and signed by owner(s) pnor to issuance of Building Permit Attached please find an application form and submittal checklist for the dedicalion process Provide the completed application form and the requirements on the checklist at the time of resubmittal Dedication completed by Date IMPROVEMENT REQUIREMENTS Q Q 7a All needed public improvements upon and adjacent to the building site must be constructed at time of building construction whenever the value of the construction exceeds $ , pursuant to Code Section 18 40 040 Public improvements required as follows Please have a registered Civil Engineer prepare appropnate improvement plans and submit them together with the requirements on the attached checklist for a separate plancheck process through the Engineering Department Improvement plans must be approved, appropriate securities posted and fees paid pnor to issuance of permit Attached please find an application form and submittal checklist for the public improvement requirements Provide the completed application form and the requirements on the checklist at the time of resubmittal Improvement Plans signed by Date Page 2 of 4 H \WORD\DOCS\CHKLST\Bukfcng PUnctwck CWit BP0001 Form DR doc BUILDING PLANCHECK CHECKLIST j sv 2ndy 3rd/ Q Q Q 7b Construction of the public improvements may be deferred pursuant to Code Section 18 40 Please submit a recent property title report or current grant deed on the property and processing fee of $ __ so we may prepare the necessary Future Improvement Agreement This agreement must be signed, notarized and approved by the City pnor to issuance of a Building permit Future public improvements required as follows __ Improvement Plans signed by Date Q Q 7c Enclosed please find your Future Improvement Agieement Please return agreement signed and notanzed to the Engineenng Department Future Improvement Agreement completed by Date Q Q 7d No Public Improvements required SPECIAL NOTE Damaged or defective improvements found adiacent to building site must be repaired to the satisfaction of the City Inspector pnor to occupancy GRADING PERMIT REQUIREMENTS The conditions that invoke the need for a grading permit are found in Section 11 06 030 of the Municipal Code Q Q Q 8a Inadequate information available on Site Plan to make a determination on grading requirements Include accurate grading quantities (cut, fill import, export) Q Q Q 8b 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 Grading Inspector sign off by Date Q 8c No Grading Permit required Page 3 of 4 H VWORD\DOCS\CHKi.ST\BmWno Pfcnchock ChM BP0001 Form DR Hoc BUILDING PLANCHECK CHECKLIST MISCELLANEOUS PERMITS si/ »^nd/ ordy 1 Q 9 A RIGHT-OF-WAY PERMIT is required to do work in City Right-of-Way and/or pnvate work adjacent to the public Right-of-Way Types of work include, but are not limited to street improvements, trees, dnveways, tiemg into public storm drain, sewer and water utilities Right-of-Way permit required for * *>irf /C t&r Q A separate Right-of-Way permit issued by the Engineering Department is required for the following Q 10 A SEWER PERMIT is required concurrent with the building permit issuance The fee is noted in the fees section on the following page Q Q 11 INDUSTRIAL WASTE PERMIT is required Applicant must complete Industnal Waste Permit Application Form and submit for City approval prior to issuance of a Permit Industnal Waste permit accepted by Date Q Q 12 NPDES PERMIT Complies with the City's requirements of the National Pollutant Discharge Elimination System (NPDES) permit The applicant shall provide best management practices to reduce surface pollutants to an acceptable level prior to discharge to sensitive areas Plans for such improvements shall be approved by the City Engineer prior to issuance of grading or building permit, whichever occurs first Page 4 of 4 H \WORttDOCSVCHKLST\Bukfng Ptanchoek CUM BP0001 Form DR doc D PLANNING DEPARTMENT BUILDING PLAN CHECK REVIEW CHECKLIST Plan Check No. CB Planner _ APN: I& <rr> O M1Address Phone (61 9} 438-1161, extension Type of Project and Use Zone: *^-" I Facilities Management Zone- CFD (in/6uty# Circle^Gfie (If property in, complete SPECIAL TAX CALCULATION WORKSHEET provided by Building Department 1 Legend Item Complete Item Incomplete - Needs your action YESEnvironmental Review Required: DATE OF COMPLETION- TYPE Compliance with conditions of approval7 If not, state conditions which require action Conditions of Approval | | Discretionary Action Required: APPROVAL/RESO. NO PROJECT NO YES NO TYPE DATE OTHER RELATED CASES Compliance with conditions or approval7 If not, state conditions which require action Conditions of Approval , l Coastal Zone Assessment/Compliance Project site located in Coastal Zone7 YES f\ NO _ If NO, proceed with checklist, if YES, proceed below Determine status (Exempt or Coastal Permit Required) H- If Exempt, proceed with checklist, if Coastal Permit required, hold building permit iintil Coastal Permit issued Coastal Permit Determination Form already completed7 YES _ NO _ 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) 2) Complete Coastal Permit Determination Log as needed CH [H Inclusionary Housing Fee required: YES NO n a a (Effective date of Inclusionary Housing Ordinance - May 21, 1993 ) Site Plan: 1 Provide a fully dimensional site plan drawn to scaie Show North arrow, property lines, easements, existing and proposed structures, streets, existing street improvements, right-of-way width, dimensional setbacks and existing topographical lines 2 Provide legal description of property and assessor's parcel number n n n n n n n n Zoning: 1 Setbacks: Front Int Side Street Side. Rear 2. Lot Coverage 3 Height 4 Parking Spaces Guest Spaces Additional Comments 7/?'Required C~LX Required ^?.<?" Required *//A Required *• / ?' Required ^*~ 1 ®*0 Required t— *O Required <-- -~ Required " (JOU9 Shown *~Z~O Shown C • *fff Shown "/* Shown td^cf/ ou / Lin tfbhown 1^*1 u [° Shown ^2^O Shown C__ Shown " ' 1 _j — OK TO ISSUE AND ENTERED APPROVAL INTO COMPUTER City of Carlsbad ^ ^••^•MWPVq^M^^P^^^^^^H^H^^^^MBuilding Department WORKERS'-COMPENSATION-DECLARATION. I hereby affirm under penalty of perjury one of the following declarations1 I have and will maintain a certificate of consent to self-insure for A. 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 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 POL-ieY-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 Signature"Date 12. ~ ' 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 ($100,000), 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 Dr * Carlsbad, CA 92OO9-1 576 - (619) 438-1161 • FAX (619) 438-O894 RODUCER insurance Unlimited CA License No. 0173960 12526 High Bluff Dr. #250 San Diego CA 92130 Robert M. Hamzey, Jr. r.on.No 619-481-4030 Fa. NO 619-481-5687 CERTIFICATE OF LIABILITY INSURANCE KOL1013 DATE (MM/DD/YY) 12/05/96 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, COMPANIES AFFORDING COVERAGE COMPANYA Golden Eagle Insurance Company NSUR6O Chris Kolb Contractor Mr. Chris Kolb 7720 B El Cainino Real #162 Carlsbad CA 92009 COVERAGES 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 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) 'OUCY EXPIRATION DATE (MM/DD/YY)LIMfTS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY J CLAIMS MADE |_ ( OCCUR OWNER S & CONTRACTOR S PROT GENERAL AGGREGATE PRODUCTS COMP/OP AQG PERSONAL 8. ADV INJURY EACH OCCURRENCE FIRE DAMAGE (Any one firs) MED EXP (Any one person! AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIREQ AUTOS NON-OWNED AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY(Per accident! PROPERTY DAMAGE GARAGE LIABILITY ANY AUTO AUTO ONLY EA ACCIDENT OTHER THAN AUTO ONLY EACH ACCIDENT AGGREGATE EXCESS UABIUTY UMBRELLA FORM OTH£f) THAN UMBRELLA FORM I ACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS LIABILITY WC STATU-TORY LIMITS OTH_ER l£L EACH ACCIDENT * 1,000,000 THE PROPRIETOR/ PARTNERS/EXECUTIVE OFFICERS ARE INCL EXCL HWC38545800 08/30/96 08/30/97 EL DISEASE POLICY LIMIT 41,000,000 EL DISEASE EA EMPLOYEE * 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS *10 day notice of cancellation for non payment of premium.Plan check # 96-2250Project address: 1747 Catalpa Rd.Carlsbad, CA 92008Pahl/Tejeda CERTIFICATE HOLDER COFCARL City of Carlsbad Building Dept. 400 Carlsbad Village Drive Carlsbad CA 92008 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL *3_0 DAYS WRITTEN NOTICE TO 1 HE CERTIFICATE HOLDER NAMED TO THE LEFT BUT FAILURE TO MAIL SUCH NOTIC1- SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES AUTHORfZEORBPf Robert M. Hamzey, Jr. ACORD 25-S (1/951 ACORD CORPORATION 1988