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aligglikl� IP -%PO aiiN c1ty (7, san tuis oB , Building & Safety Division • 919 PG(D r{r-s ct�enbi6Peyinito1-3218 • (805) 781-7180 Project Address 692 MARSH Assessor's Parcel Number 002-422-024 Legal Description CY SLO MRY & CH ADD BL 7 OTN LTS 15 & 16 Project Description INSTALL 5 ELECTRICAL OUTLETS (7 ELEVEN STORE) Permit Type X Building Mechanical X Electrical Plumbing T Sign Demolition Grading Property Owner GORDON SYLVIA THE Occupant/Business Name REDBOX AUTOMATED RETAIL;7-ELEVEN FOOD Mailing Address 12 GEARY ST #303 Architect/Engineer City/State/Zip SAN FRANCISCO CA, 94108- License # Contractor POWERHOUSE RETAIL SERVICES INC Contractor's Phone No. Mailing Address 812-A SOUTH CROWLEY RD Contractor's State Lic. No. 974217 City/State/Zip CROWLEY TX 76036 Project Manager JOSH HARGRAVE Project Manager's Phone No. 817/297-8575 Lender Name Lender Address C.B.C. Group B C.B.C. TypeV-B Stories 0 Codes: CBC10 CEC10 Census 437 Commercial Alteration or Addition Dwelling nUTtsU Motel Rooms 0 Valuation Fees Total Building Value $0.00 Building Permit 0.00 Legal Declarations Plumbing+Electrical+Mechanical Permit 216.00 Grading Permit 0.00 2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION S.M.I.P. 0.50 Green Building Fee 0.00 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 Demolition Permit 0.00 commencing with Section 7000 of Division 3 of the Business and Professions Code, and Sign Permit 0.00 my license is in full force and effect Misc Charge/Credit 0.00 Administrative Permit 115.00 Contractor: POWERHOUSE RETAIL Class: B. C10 License #: 974217 Archival Fee 0.00 Subtotal 331.50 Investigation Fees 0.00 Building Plan Review Fee 0.00 Fire Safety Plan Review 0.00 Plan Review Subtotal 0.00 Development Review Fee 0.00 Fire Safety Surcharge 0.00 3a(2) - WORKERS' COMPENSATION DECLARATION - I have and will maintain Fire Systems 0.00 workers' compensation insurance Fire Sur/Sys Subtotal 0.00 Construction Unit Tax 0.00 Water Impact 0.00 Area - 0.00 as required by Section 3700 of the Labor Code, for the performance of the work for which Water Meter Installation 0.00 this permit is issued. My workers' compensation insurance carrier and policy number are: Wastewater Impact 0.00 Area - 0.00 Carrier: VALLEY FORGE INSURANCE Policy #:4025670115 Expires 02/01/14 Traffic Impact 0.00 Area - 0.00 Affordable Housing 0.00 Public Art 0.00 Code Enforcement 0.00 Park Improvement Area - 0.00 Engineering Development Review Fee 0.00 Open Space In -lieu Fee 0.00 Total Fees 331.50 Balance Due 0.00 Payments Fee Exemptions: Amount Date Receipt Payment #1 331.50 06/27/13 61221 Comments: Total Paid 331.50 Application Number130626 Permit Number 27337 Application Date 06/27/13 Issuance Date 07/02/13 Address File Signature or -71z bpi Date ■ city C sari WIS OBrL ,10 Project A ;iress 692 MARSH j&01-3218 • 805 781-7180 Assessor _s Parcel Number 002-422-024 Legal Description CY SLO MIRY & CH ADD BL 7 OTN LTS 15 & 16 Project D ascription REPLACE FIXTURES WITHIN SUSPENDED CEILING Permit T� pe X Building X Mechanical Property Owner p Y GORDON SYLVIA THE X Electrical X Plumbing Sign Demolition Grading Mailing kidress 12 GEARY ST #303 Occupant/Business Name REDBOX AUTOMATED RETAIL;7-ELEVEN FOOD City/State/Zip Architect/Engineer SAN FRANCISCO CA, 94108- License # Contractor SYLVANIA LIGHTING SERVICES Contractor's Phone No. Mailing Ar iress 2455 MERCANTILE DRIVE STE 150 City/Stat( Lip 916/638-8403 Contractor's State Lic. No. 317264 RANCHO CORDOVA CA 95742 Project N :nager Project Manager's Phone No. Lender N me Lender Address C.B.C. G )up B C.B.C. TypeV-B Census 437 Commercial Alteration or Addition Stories 0 Codes: CBC10 CEC 10 Dwelling rnts Motel Rooms 0 Valuation -nit Fees Total Building Value $0.00 Building ' 0.00 Legal Declarations Plumbinc ; Flectrical+Mechanical Permit 0.00 Grading I ermit 0.00 2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION S. M.I. P. Green BuAling Fee 0.50 0.00 1 hereby affirm under penalty of perjury that I am licensed Demolition Permit 0.00 under provisions of Chapter 9 commencing with Section 7000 of Division 3 of the Business Sign Permit 0.00 and Professions Code, and my license is in full force and effect Misc Cha ;e/Credit 0.00 Administrative Permit 132.50 Archival I :� 0.00 Contractor: SYLVANIA LIGHTING Class: C10 License #: 317264 Sur; .:I 133.00 Investiga' „i Fees 0.00 Building I -an Review Fee 0.00 Fire Sale, Plan Review 0.00 Plan review Subtotal 0.00 Developm,:nt Review Fee 0.00 Fire Safety Surcharge Fire Syste �s 0.00 3a(2) - WORKERS' COMPENSATION DECLARATION - I have and will maintain 0.00 workers' compensation insurance Fire r/Sys Subtotal 0.00 Construr, Unit Tax 0.00 Water I ;t 0.00 Area - Water,'!( Installation 0.00 as required by Section 3700 of the Labor Code, for the performance of the work for which Wast-_1 :r Impact 0.00 Area 0.00 this permit is issued. My workers' compensation insurance carrier and policy number are: - Traffic lin; :t 0.00 Area - 0.00 0.00 Y INCarrier: L[BE RTSURANCE Policy #:WA761D26077 Expires 10/01/12 Affordablee :'-3using 0.00 Public; Art 0.00 Code Enf _ement Park In,;, ; Went Area - 0.00 0.00 Engino,;r jevelopment Review Fee 0.00 Oven S; In -lieu Fee 0.00 Tolal F 133.00 Balance: 0.00 ITotaPayments Amount Date Receipt Fee Exem lions: - 133.00 10/27/11 53581 l ! 133.00 Comments: 0 Appli:1,.. Number110960 Permit Number25886 Applicati `)ate 10/27/11 Issuance Date 10/27/11 A.-1; - File re gn;ontractor,,0rstfl-orized Agent or Owner { RECEIVED JUN 072010 city Of y� ------ For Office Use Only -- San W I S O B I S P O DATE/AMOUNT: CLASS/GROUP/CAT: BUSINESS NO: ! Q 7 1 ! BUSINESS LICENSE & TAX CERTIFICATE APPLICATION 990 Palm Street / P.O. Box 8112 - San Luis Obispo, CA 93403-8112 - (805) 781-7134 Application for: ® New Business ❑ Change of Business Name ❑ Change of Location ❑ Change of Ownership Business Name Redbox Automated Retail, LLC Legal Status of Business: ❑ Corporation lI Partnership ❑ Sole Proprietor Phone (630) 756-8098 Business Location Suite No. _CltY_San_Lujs_Qjap_Q_State_fA zip 9340, PO Box addresses cannot be accepted as business locations — If your business is located in San Luis Obispo, please complete the last page of this application. Mailing Address 1 Tower Lane Suite No. 12 0 0 City Oakbrook Terrace State IL Zip 6 0181 Owner/Contact Name See Attached Federal Employer/Social Security No. State Sales Tax No. ORA 10 0- 7 2 0 9 9 6 State Franchise No. _ _ _ Business Open Date 6 18 2 0I Tyne of Business: ® Retail ❑ Professional ❑ Service ❑ Contractor (State Licensed) Lic. No. ❑ Manufacturing/Processing/Wholesale ❑ Recreation/Education/Public Assembly ❑ Agriculture ❑ Transportation/Communication ❑ Property Rental (Residential) ❑ Property Rental (Non -Residential) ❑ Other Describe your business. Include the types of goods or services offered. Unmanned automated kiosk for DVD rentals sales usinct debit/credit cards. Are you selling or offering the following services or products?: ❑ Tobacco ❑ Massage Therapy ❑ Filming ❑ Sales on Streets & Sidewalks ❑ Soliciting Are you doing business from your home? ❑ Yes ® No Applicant / Representative: I reviewed this application and the information is accurate to the best of my knowledge. I understand the issuance of a business lie n & tax certificate does not constitute proof of compliance with other city, county, state,' -and federal regul ns. Sig ed Title Registration Coordinator Date 5 2 8 2 01 a city oC. san Building & Safety Division • 919PGoin leis of s,-io stfustionbiReanitol-3218 • (805) 781-7180 Project Address 692 MARSH Assessor's Parcel Number 002-422-024 Legal Description CY SLO MRY & CH ADD BL 7 OTN LT_S 15 & 16 Project Description ELECTRICAL OUTLET @ EXTERIOR FOR DVD RENTAL MACHINE Permit Type Building Mechanical X Electrical Plumbing Sign Demolition Grading Property Owner GORDON SYLVIA THE Occupant/Business Name 7-ELEVEN FOOD STORE #27835 Mailing Address PO BOX 13755 Architect/Engineer City/State/Zip SLO CA, 93406-3755 License # Contractor ALL CITY ELECTRIC Contractor's Phone No. 530-626-5802 Mailing Address 6201 ENTERPRISE DR. Contractor's State Lic. No. 466410 City/State/Zip DIAMOND SPRINGS CA 95619 Project Manager ALLEN Project Manager's Phone No. 530-626-5802 Lender Name Lender Address C.B.C. Group C.B.C. Type Stories 0 Codes: CBC07 CEC07 Census Dwelling nUits 0 Motel Rooms 0 Valuation Total Building Value $0.00 Fees Building Permit 0.00 Legal Declarations Plumbing+Electrical+Mechanical Permit 30.00 Grading Permit 0.00 2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION S.M.I.P. 0.00 Green Building Fee 0.00 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 Demolition Permit 0.00 commencing with Section 7000 of Division 3 of the Business and Professions Code, and Sign Permit 0.00 my license is in full force and effect Misc Charge/Credit 0.00 Administrative Permit 98.00 Contractor: ALL CITY ELECTRIC Class: C 10 License #: 328054 Archival Fee 0.00 Subtotal 128.00 Investigation Fees 0.00 Building Plan Review Fee 0.00 Fire Safety Plan Review 0.00 Plan Review Subtotal 0.00 Development Review Fee 0.00 Fire Safety Surcharge 0.00 3a(3) - WORKERS' COMPENSATION DECLARATION - I certify that, in the Fire Systems 0.00 performance of the work for which this permit is issued, I shall not employ any Fire Sur/Sys Subtotal 0.00 person in any manner so as to become subject to the workers' compensation laws Construction Unit Tax 0.00 of California Water Impact 0.00 Area - 0.00 , and agree that, if I should become subject to the workers' compensation provisions of Water Meter Installation 0.00 Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Wastewater Impact 0.00 Area - 0.00 Traffic Impact 0.00 Area 0.00 Affordable Housing 0.00 Public Art 0.00 Code Enforcement 0.00 Park Improvement Area - 0.00 Engineering Development Review Fee 0.00 Open Space In -lieu Fee 0.00 Total Fees 128.00 Balance Due 0.00 Payments Fee Exemptions: Amount Date Receipt Payment#1 128.00 06/21/10 47426 Comments: Total Paid 128.00 Application Number100392 Permit Number 24734 Application Date 05/13/10 Issuance Date 06/21/10 Address File Signature of Contractor, Authorized Agent or Owner Date . �� ha'�� �� w or son Building & Safety Division • 919 p mt'ructienbiRermit01-3218 tuffs oBisno • (805) 781-7180 Project Address 692 MARSH Assessor's Parcel Number 002-422-024 Legal Description CY SLO MRY & CH ADD BL 7 OTN LTS 15 & 16 Project Description UPGRADE @ COFFEE MACHINES & ADD SINK Permit Type X Building Mechanical X Electrical X Plumbing Sign Demolition Grading Property Owner GORDON SYLVIA THE Occupant/Business Name 7-ELEVEN FOOD STORE #27835 Mailing Address PO BOX 13755 Architect/Engineer City/State/Zip SLO CA, 93406-3755 License # Contractor P R CONST Contractor's Phone No. 898-7032 Mailing Address p0 BOX 3431 Contractor's State Lic. No. 783834 City/State/Zip SANTA BARBARA CA 93130 Project Manager GLENN MATTOX Project Manager's Phone No. 714-637-7848 Lender Name Lender Address C.B.C. Group M C.B.C. TypeV-B Stories 0 Codes: CBC07 CEC07 Census 437 Commercial Alteration or Addition Dwelling n1�0 Motel Rooms 0 Valuation Non -Residential Alteration 3,000 $3,000.00 Fees Total Building Value $3,000.00 Building Permit 105.50 Legal Declarations Plumbing+Electrical+Mechanical Permit 28.12 2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION Grading Permit 0.00 S.M.I.P. 0.63 Green Building Fee 1.00 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 Energy Surcharge 13.36 commencing with Section 7000 of Division 3 of the Business and Professions Code, and Accessibility Surcharge 8.69 my license is in full force and effect Demolition Permit Sign Permit 0.00 0.00 Contractor: P R CONST Class: B License #: 783834 Misc Charge/Credit 0. 00 Ad m i n istrative Permit 0.00 Archival Fee 0.00 Subtotal 157.30 Investigation Fees 0.00 Building Plan Review Fee 118.92 Fire Safety Plan Review 25.57 Plan Review Subtotal 144.49 3a(3) - WORKERS' COMPENSATION DECLARATION - I certify that, in the Development Review Fee 120.82 performance of the work for which this permit is issued, I shall not employ any Fire Safety Surcharge 28.73 person in any manner so as to become subject to the workers' compensation laws Construction Unit Tax 0.00 of California Water Impact 0.00 Area - 0.00 , and agree that, if I should become subject to the workers' compensation provisions of Water Meter Installation 0.00 Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Wastewater Impact 0.00 Area - 0.00 Traffic Impact 0.00 Area - 0.00 Affordable Housing 0.00 Public Art 0.00 Code Enforcement 0.00 Park Improvement Area - 0.00 Waterway Management Fee 0.00 Open Space In -lieu Fee 0.00 Engineering Development Review Fee 0.00 Total Fees 451.34 Balance Due Payments 0.00 Amount Date Receipt Fee Exemptions: Payment #1 451.34 03/30/10 46372 Comments: Total Paid 451.34 Application Number100239 Permit Number 24533 Application Date 03/30/10 Issuance Date 03/30/10 Address File or --, / 5>011 0 Please Return with ApplicatiF-mI..ee ". Downtown Surcharge $25 BUSINESS NO. _ lill1`if 1 �I III1111111111111Ic4 of San WIS OBISPOA � CLA SA/GROUP/ CAT IM124 BUSINESS TAX CERTIFICATE APPLICATION Finance Department • (805) 781-7134 • 990 Palm Street / P.O. Box 8112 • San Luis Obispo, Ca 93403-8112 Application for: Alew Business J Change Business Name J Change of Location J Change of Ownership J Change of Mailing Address Confirm with Community Development that the business is consistent with city regulations prior to establishing your business location. Community Development Department - (805) 781-7170 - 990 Palm Street San Luis Obispo, CA 93401 • Lower Level City Hall Business tVrsme � eQ:i jC I� & 19 +I� �'�e- j 5�--j 1 NC Business Phan&73 :2 ry P (Doing Business As (DBA) OR In Care of C-EY—MI L-. C49A-Tf 7 — 15 osll -F s' S-Fj<vt CAS Legal Status (Corporation, Partnership, Sole Proprietor) C��! I ��� 1 Business Locafian rl6 ■��T] 5t -I !d it ids r i 77V4r1� slate Zip Mailing Location L �f� _ Suite No. City__ State Zip Q�nrn Name Social Security No. Sla�fe Fran hise Now f 3 1 Federal ID No. to Sales Tax No. h �i. . State License No. (if applicable) _._ Business Open Dafe Gross Receipt.__ ._I Lit names, home. addresses and 50CIAL SECURITY NUMBERS of all principles in the business (use additional pages if necessary) W18IC/, - -- — - - ^ Type of Business: XRetail J Wholesale J Professional XService J Contractor (State Licensed) J Manufacluring f J Property Rental (Residential) J Property Rental (Non -Residential) /10 '� ��t, �✓� Does your business have non-profit status? J Yes )<No If yes, will you be doing solicitations? J Yes J No N yes, the solicitations will be performed by: J Owner iJ Employee J Volunteer J Hawker ❑ Permit # (Issued by Police Dept.) Fully describe your business (Include type of goods or services offered, hours, etc.): *ASFRViCF s 4� W- cywL - StTt-3ws ReN, 4-ecn�i�,Qfsrl��n4�x-Tim Please check one: XGround Floor J Upper Floor ❑ Number of Employees: full-time part-time Approximate floor area occupied by the business: s 0 5square feet. Area devoted to outdoor sales or storage: ' r square feet. Are you sharing with another business D If yes, with whom: Name and address of Landlord as stated on Lease L- YYLV/, N this application is for change of location, name; ma ing a reds or o ne� ip, womp ete tt{e grow : Previous Name or Owner Previous Location/Mailing 01 06/29/,-QOS 14:44 021162 PLU Applicant/Representafive: 1 have reviewed this application and the attached material. The information is accurate to the best of my knowledge. 1 understand the Issuance of a business tax certificate does not constitute proof of compliance with other city, county, state and federal reguiaifont. ihcfuding Urn to zonin , uildi ode or oth r land use regulations (SLOMC 3.01.102). Date SI Title AOP�I�] �` d� Ilfll���lllfllll +IIIII��I r f 11 I G �.MISPO ........... A • I � _� Community Development Department, 990 Palm Street, San Luis Obispo, CA 93401-3249 (805) 781-7171 ADDRESS CHANGE NOTIFICATION Grid: 1 -kO ❑ Change Address From: To: XCreate New Address: ❑ Delete/Retire Address: ❑ Establish Suite Numbering: ❑ Correction/Clarification: } Assessor's Parcel Number(s): O o Q - Other Address(es) on this Parcel: -e Reason for Application: Ufi f'no]-\- Applicant: E r�)EA �- \ Phone: _ —IS_3 "-: Q I - Applicant's Address: �qq Mays '\ �5 LY Ce t L� Q q3 tic 1! Property Owner: JG\ V- S IJ W 1Q QOT CX\ 4[ Phone: Owner's Address: c) Pox C; I—o (C' qi.9 0 M Owner/Agent and Authorization Sketch Addressing Flan Blow or Attach Copy L d- tiy� :1. ddY�i�4]l, i......5... all= IMIM Comments/Special Notification: n, Y2 -e� l zm+f Y" me- Ccs 2 V0411,1LOP city o f ,san tuis oBi sno 1111lize Building & Safety Divisiol, - 990 Palm Street • San Luis Obispo, CA 93401-324. - (805) 781-7180 Construction Permit Project Address 692 MARSH Assessor's Parcel Number _ 002-422-024 Legal Description CY SLO MIRY & CH ADD BL 7 OTN LTS 15 & 16 Project Description REPLACE FLOOR DRAINS - 7-ELEVEN Permit Type Building Mechanical Electrical X Plumbing Sign Demolition Grading Property Owner GORDON SYLVIA THE Occupant/Business Name 7-ELEVEN FOOD STORE #27835 Mailing Address PO BOX 13755 Architect/Engineer City/State/Zip SLO CA, 93406-3755 License # Contractor MID STATE PLUMBING & DRAIN Contractor's Phone No. 473-8270 Mailing Address 460 S. ELM Contractor's State Lic. No. 779258 City/State/Zip ARROYO GRANDE CA 93420 Project Manager REX Project Manager's Phone No. 473-8270 Lender Name Lender Address U.B.C. Group R-3 U.B.C. Type V-N Stories 1 Codes: UBC 1 NEC 1 Census number Dwelling Units 0 Motel Rooms 0 Building Permit Fees Plumbing Permit Mechanical Permit Electrical Permit Grading Permit S.M.I.P. Energy Surcharge Accessibility Surcharge Demolition Permit Sign Permit Misc Charge/Credit 0.00 Administrative Permit Investigation Fees Microfilm Subtotal Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Development Review Fee Fire Safety Surcharge Construction Unit Tax/Plan Preparation Water Impact 0.00 Area - Water Meter Installation Wastewater Impact 0.00 Area - Traffic Impact Affordable Housing Public Art Code Enforcement Park Improvement Area - 40.00 0.00 0.00 5.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 34.75 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total Fees 40.00 Balance Due Payments 0.00 Amount Date Receipt Payment #1 40.00 02/02/05 18730 Total Paid 40.00 Application Number050082 Application Date 02/02/05 Permit Number 19848 Issuance Date 02/02/05 Valuation Total Building Value $0.00 Legal Declarations 1. OWNER BUILDING DECLARATION: I am exempt from the contractor's License Law for the following reason: ❑ 1, 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. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ' Not applicable. 2. WORKER'S COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a 'certificate of Workers' Compensation insurance, or a certified copy hereof Certified copy is hereby furnished. Certified copy is filed with the City. Not applicable 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE ❑ 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 Wo er's Compensation Laws of California �Not applicable NnTICE TO APPLICANT.• If, after making any of the foregoing declarations, you become subject to any Labor Code or License Law provision, you must comply with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above information is correct, I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. Unless noted under "Special Conditions" this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days any time after work is commenced. Special Conditions: Comments: Address File or Owner Illl�ll����� i� �I Ilill�u lllll c i ty of sari WIS OB I spr) Building & Safety Division • u90 Palm (reel • an LUi ,Obisp CA 9340j-3249 - (605) 761.7180 Mdons rucion hermit Project Address 692 MARSH Assessor's Parcel Number 002-422-024 Legal Description CY SLO MRY & CH ADD BL 7 OTN LTS 15 & 16 Project Description FIRE SPRINKLER SYSTEM FOR EXIST BUILDING Permit Type X Building Mechanical Property Owner GORDON SYLVIA THE Mailing Address PO BOX 13755 City/State/Zip SLO CA, 93406-3755 Contractor A+ FIRE PROTECTION Mailing Address 1644 CANYON CREST LN City/State/Zip PASO ROBLES CA 93446 Project Manager JIM O'LOUGHLIN Lender Name U.B.C. Group M U.B.C. Type III-N Electrical Plumbing Sign Demolition Grading Occupant/Business Name 7-ELEVEN FOOD STORE #27835 Architect/Engineer License # Contractor's Phone No. Contractor's State Lic. No. 226-0790 781615 Project Manager's Phone No. 226-0790 Lender Address Stories 1 Codes: UBC 98 NEC98 Census number 437 Commercial Alteration or Addition Dwelling Units 0 Motel Rooms 0 Vnh infirm Building Permit Fees Plumbing Permit Mechanical Permit Electrical Permit Grading Permit S.M.I.P. Energy Surcharge Accessibility Surcharge Demolition Permit Sign Permit Administrative Permit Miscellaneous Charge/Credit Investigation Fees Microfilm Subtotal Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Fire Safety Surcharge Construction Unit Tax Water Impact Water Meter Installation Wastewater Impact Traffic Impact Affordable Housing Public Art NMI 35.00 35.00 0.00 0.00 0.00 0.00 0.50 0.00 0.00 0.00 0.00 0.00 -35.50 0.00 0.00 35.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Total Fees 35.00 Balance Due payments 0.00 Amount Date Receipt Payment #1 35.00 01 /17/02 2176 Total Paid 35.00 $1.00 Total Building Value $1.00 Legal Declarations 1. OWNER BUILDING DECLARATION: I am exempt from the contractor's License Law for the following reason: 1, 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. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. Not applicable. 2. WORKER'S COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a 'certificate of Workers' Compensation insurance, or a certified copy hereof Certified copy is hereby furnished. Certified copy is filed with the City. Not applicable 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE 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 Not applicable NOTICE TO APPLICANT: If, after making any of the foregoing declarations, you become subject to any Labor Code or License Law provision, you must comply with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above information is correct, I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property forinspection purposes. Unless noted under "Special Conditions", this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days any time after work is commenced. Special Conditions: Comments: Application Number 020401 Permit Number 16513 ORIGINALLY TAKEN IN AS A REVISION. CONVERTED TO PERMIT ON 4-15-02. FEES ADJUSTED TO ACCOUNT FOR MINIMUM PLAN CHECK Application Date 04/15/02 Issuance Date 04/15/02 FEE PAID. TB Address File L L-,,- 4- Signature of Contractor, AuthorizedAgorit or Owner Date 0 BUSINESSNO.. & city of san leis os�spo �;�;�;�, IIdV�'���I�h BUSINESS TAX CERTIFICATE APPLICATION Finance Department • (805) 781-7134 a 990 Palm Street / P.O. Box 8112 + San Luis Obispo, Ca 93406-8112 Application for: ❑ New Business ❑ Change Business Name ❑ Change of Location _�).,Change of Ownership ❑ Change of Mailing Address * Confirm with Community Development that the business is consistent with city regulations prior to establishing your business location. Community Development Department • (805) 781-7170 • 990 Palm Street San Luis Obispo, CA 93401 • Lower Level City Hall Business Name `� -E LE yeo � I�;s � �'3 5 �+- Business Phone Doing Business As (DBA) OR In Care of _ � r'l Legal Status (Corporation, Partnership, Sole Proprietor). r' S' t - ' eilt; Business Location ' ) fl IN f suite No. CityAn► LAr Cis'. State L zap 1 01- "q3 rfi Mailing Location Suite No. City14is VL6-C,S#ate, � zip 1 r< 0A0-1 c, CAI Ut-y s lrli?f?ti� 1,. t;? - Ili Owner Name_ _��- -2 Social Security No. r � r• i State Franchise No. Federal ID No._ State Sales Tax No._ State License No. (if applicable) Business Open Date Gross Receipts List names, home addresses and SOCIAL SECURITY NUMBERS of all principles in the business (use additional pages if necessary) Type of Business: Retail ❑.Wholesale ❑ Professional ❑ Service ❑ Contractor (State Licensed) ❑ Manufacturing ❑ Property Rental (Residential) Does your business have non-profit status? ❑ Yes -A No ❑ Property Rental (Non-Residentidl) If yes, will you be doing solicitations? ❑ Yes ❑ No If yes, the solicitations will be performed by: ❑ Owner ❑ Employee ❑ Volunteer ❑ Hawker ❑ Perrrlit # (Issued by Police Dept.) Fully describe your business (Include type of goods or services offered, hours, etc.): [� + : fJ rr Svc-r ani. LcJ 1f✓A100 9,eejs" ) f R Please check one: �i Ground Floor ❑ Upper Floor ❑ Number of Employees: full-time part-time Approximate floor area occupied by the business: square feet. Area devoted to outdoor sales or storage: square feet. Are you sharing with another business ••• , If yes, with whom: Name and address of Landlord as stated on If this application is for change of location, name, mailing address or ownership, complete the following: Previous Name or Owner �av � )rum+� ��� J �• • [� - A_ uC J Previous Location/Mailing ' L �1 � f r L 6 S 1)&! �ME- Applicant/Representative: Title ,,r , , - - Date Printed on recycled paper. ORIGINAL - Finance WHITE - Planning CANARY - Utilities PINK - Customer 2020-6313 city o f SN- `IUI S OBI Sp0 SIGN PERMIT APPLICATION DEPARTMENT OF COMMUNITY DEVELOPMENT* 990 PALM STREET/P.O. BOX 321, SAN LUIS OBISPO, CA 93406 • (605) 549.7160 Please fill In the unshaded areas where appropriate, as fully as you can. Use Ink and print clearly. Attach a site plan and a scale drawing or photograph of your sign. We have a pamphlet that tells what needs to be Included Inthe site plan and scaledrawing. The pamphlet also tells under what circumstances a sign must be reviewed by the city's Architectural Review Commission (ARC). Copies of the complete Sign Regulations also are available. What is the name of the business which the sign identifies., �, - Value of sign: At what address is /_� f �f� Is this an off- this sign located? �i `' premises sign? / +F If this is an off -premises sign, what is the address of the business the sign identifies? Who should we contact if we have questions about this application? �lyle, 4 J, u 1- Address of person to contact Where should we send the approved permits? Name / AHrl'eee / .J �o / r_. !C (-F X \ / -- -, V1 Wrk - o phone •� - �, J'/ If there's anything else we should know about your sign - something that's NOT shown on the site plan and scale drawing - use this space to explain. If you are asking for an exception to the Sign Regulations, give your reasons here. or NOTE: Be sure i line designated 4 the city might not approve what I'm applying for, PROPE T OWNER OR ORIZED GENT: The applicant has my of approval: Per mla n o put up a s n s' lliar to one proposed. /K -0(0 Dat Sig at re ate the signatures of both the applicant and the property owner. If you a the applicant and own the property, sign twice, once on each blank t—. � otnce use only Signpt-I— ALLOWED PROPOSED Zone - - - - - Copy: t Setback c k- h1r)(J. endfjt,� C _ REVIEW AND FEES REQUIRED: Sign Type �% Materials: XS Ign Permit Requir Height - _ Colors Sign App. Fee $ Area of Sign 'nALe❑Approved ❑Denied Date Other Features: i Sign ALLOWED PROPO D Setback Sign Type IT Height Area of Sign r. Signfl ALLOWED PROPOSED Setback Sign Type Height Area of Sign ❑ Bldg. Approval Req'd Copy: Building Fee $ ❑ Approved ❑ Denied Date Materials: XARC APgrejY,fiequired. y�� 1. Colors: " ARC fee $ +�- ❑ Declared minor & Incidental Other Features: _ ❑ Approved ❑ Denied Date Copy: Materials: Colors - Other Features: ❑ Use Permit Required, Use P$r��t Fee $ ❑ Approved ❑ Denied Date Total Area Total Area of All Signs of All Signs Allowed Proposed Community Development Dept. 0 o' II v ( LLn c) z m D x Iu ? ' Hug! Im N� z v m fi 0� m Q r 00 O C m 0 1 > 0 m � ni D m z m � D o rf G C rT m in 1 D N T m 0 z 0 T -4 0 n L - - 8 --J{ a a� o g ARCHITECTURAL REVIEW COMMISSION 6y Date I I 7 M R1 "1 6 tT: r~l fi O D Od m m L o �N 2 � Z $ Spa 2m wd�o w 5'�c 7TyF,�wn�� n B x 'A o m m fa�1?��a C7 a „-'� ep•f� a Tall D r O m � G 0 � J Z N R1 1 r is. aKo \ D r- 0 I n u m 3 o�y Ei N yq ^ o 4c d'n�o ��� y m om'}�sv F�mnon a v 0 o f nm N o C- r > m p °o m Z m D m Z D O -- Z Om li rn O N T r m r m D 7 m � m m O z IjLW, 0 _T N D r m Z 0 cn El ' - v r � _ rn ^ s O � r 41, 80 a� SH- 6 (OiL -ELFuEn a eu GN4 SING SINGLE ELEMENTS AllB AVAILABLE IN TWO SIZES: Note; These Singls Elements can be used for Non-Standsrdf arrangamenta. For example, it space 1s limited on building for mounting a Standard Ir x 4' or p' x 3' Canopy Sign, or if any ordinance requlres a monument sign In a epeclel mood, brick or any other specified frame used Instead of the Stan- dard Pole Sign. 1. 7.1=1e'�eit Logo Face Panel, 4' x 4' with matching frame cabinet. 2. Red Face Panel, 4' x 4' with matching frame cabinet. 3. 7.Eleven Logo Fsce Panel, 3' x.3' with matching frame cabinet. 4. Red Face Panel, 3' x 3' with matching frame cabinet, ant Book For_fnore details and ordering instructions check with the 7•Eleven Stores Equipment 8OATA•Nf3ARA COLDRS: RED Wyandotte hint • O75 Sick Swoon Paint F2SMSpray ►rlow6ity Paint SpnYIU point Silk swoon hint Spray Viscosity Paint A5.4417 Plexlples 2793 PMS Pont— Ink • 11e5 OFIANOE Wyandotte PsIM _ Silk swoon Pelnt Vtac»eity PON aF-2-IM S Spey gprayld Paint4e silk swoon Point Spray viscosity Point Plaxlplas 211e PMS Psnione Ink - 1e5 ©� pREEM Wyandotte Point Silk spoon Point spray Viscosity Paint aF-2.715e S Spraylal Prllnl 23 A44148 Silk Salon Paint Spray Viscosity hint AS444e Plexlplas - 2108 PMS Portions Ink - 356 Qil Q W HRE Wyandotte Paint lk Screen Point SpVlsooslty Paint FP,2.105 Cool White pray Spnyld Paint Silk Screen -point Spray Viscosity Paint �W801-W Plexlolas W - 7138 Sherwin Wllllante Paint lll�llllllllui���INI�I �I �IIIII� C I tY Of 0,An WIS o B 15 p O Building & Safety Division • 9au Palm Street • San Luis Obispo, CA 93401-3249 • (806) 781-7180 Construction Permit Project Address 692 MARSH Assessor's Parcel Number o02-422-024 Legal Description CY SLO MIRY & CH ADD BL 7 OTN LTS 15 & 16 Project Description 1 20 AMP DEDICATED CIRCUIT Permit Type Building Mechanical X Electrical Plumbing Sign Demolition Grading Property Owner GORDON SYLVIA THE Occupant/Business Name 7-ELEVEN FOOD STORE #27835 Mailing Address PO BOX 13755 Architect/Engineer City/State/Zip SAN LUIS OBISPO CA, 93406-3755 License # Contractor ALLIED INTERSTATE Contractor's Phone No. 818-504-3370 Mailing Address 9864 GLENOAKS BLVD Contractor's State Lic. No, 458547 City/State/Zip SUN VALLEY CA 91352 Project Manager NORM BERTUCH Project Manager's Phone No. 818-504-3370 Lender Name Lender Address U.B,C. Group U.B.C. Type V-N Stories 1 Codes: UBC 94 NEC93 Census number Dwelling Units 0 Motel Rooms 0 Valuation Total Building Value $0.00 Fees Legal Declarations Building Permit 0.00 1. OWNER BUILDING DECLARATION: Plumbing Permit 0.00 1 am exempt from the contractor's license Law for the following reason: Mechanical Permit 0.00 ❑ 1, as owner of the property, or my employees with wages as their sole Electrical Permit 1 10 compensation will do the work and the structure is not intended or offered Grading Permit 0.00 for sale. S.M.I.P. 0.00 ❑ I, as owner of the property, am exclusively contracting with licensed Energy Surcharge 0.00 contractors to construct the project. Accessibility Surcharge 0.00 N Nof applicable. Demolition Permit 000 2`,, WbRKER'S COMPENSATION DECLARATION: Sign Permit 0.00 1 hereby affirm that I have a certificate of consent to self -insure, or a 'certificate Administrative Permit 33.90 of Workers' Compensation insurance, or a certified copy hereof Miscellaneous Charge/Credit 0.00 Certified copy is hereby furnished. Investigation Fees 0.00 Certified copy is filed with the City, Microfilm 0.00 Not applicable Subtotal 35.00 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE Building Plan Review Fee 0.00 ❑ I certify that in the performance of the work for which this permit is issued, Fire Safety Plan Review 0.00 1 shall not employ any person in any manner so as to become subject to the Plan Review Subtotal 0.00 Worker's Compensation Laws of California Fire Safety Surcharge 0.00 1Not applicable Construction Unit Tax 0.00 Water Impact 0.00 NOTICE TO APPLICANT: Water Meter Installation 0.00 If, after making any of the foregoing declarations, you become subject to any Wastewater Impact 000 Labor Code or License Law provision, you must comply with such provisions Traffic Impact 000 or this permit shall be deemed revoked. Total Fees Balance Due 3500 000 Payments Amount Date Receipt FPayment 35.00 02/05/98 0424 35.00 Application Number 80083 Application Date 02/05/98 Permit Number 12227 Issuance Date 02/05/98 1 certify that I have read this application and state that the above information is correct, I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. Unless noted under "Special Conditions", this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days any time after work is commenced. Special Conditions: Comments: Address File or (7) �f BUSINESS NO. �I i city of san Us osispo °° .^~°m 0,1humn.. go BUSINESS TAX CERTIFICATE APPLICATION Finance Department a (805) 781-7134 a 990 Palm Street / P.O. Box 8112 a San Luis Obispo, Ca 93406-8112 Application for: ❑ New Business ❑ Change Business Name ❑ Change of Location Change of Ownership ❑ Change of Mailing Address Confirm with Community Development that the business is consistent with city regulations prior to establishing your business location. Community Development Department • (805) 781-7170 - 990 Palm Street San Luis Obispo, CA 93401 - Lower Level City Hall Business Name -��1�L [�l! k n �J Y 1Q- Business Phone ; " �' Doing Business As (DBA) OR In Care of. JZJ—N_ l r Legal Status (Corporation, Partnership, Sole Proprietor) L U Y UOYO U ►' Business Location 6Q Z 4 Y oJ' h 3 • Suite No. City J L4 O _ Stater Z€p �7 1HO } Mailing LocationL-� 1 o Suite No. City , ti�(y.. Sfale_� V Zip b l Owner Name ! �� ` Social Security No. State Franchise No. Federal ID No., State Sales Tax No. � State License No. (if applicable) Business Open Date l i Gross Receipts List names, home addresses and SOCIAL SECURITY NUMBERS of all principles in the business (use additional pages if necessary) Type of Business: *Retail ❑ Wholesale ❑ Professional ❑ Service ❑ Contractor (State Licensed) ❑ Manufacturing ❑ Property Rental (Residential) ❑ Property Rental (Non -Residential) Does your business have non-profit status? ❑ Yes -.J'No If yes, will you be doing solicitations? ❑ Yes ❑ No If yes, the solicitations will be performed by: ❑ Owner ❑ Employee ❑ Volunteer ❑ Hawker ❑ Permit # (Issued by Police Dept.) Fully describe your business (Include type of goods or services offered, hours, etc.): nA (nOX r A rrr IJ n Please check on10 )(Ground Floor ❑ Upper Floor ❑ Number of Employees: full-time _ part-time Approximate floor area occupied by the business: L i square feet. Area devoted to outdoor sales or storage: square feet. Are you sharing with another business I.'._') If yes; with whom: Name and address of Landlord as stated on Lease If this application is for change of location, name, mailing address or ownership, complete the following: Previous Name or �7Y Q Previous Location/Mailing LT QA. _ Applicant/Representative: I have reviewed this application and the attached material. The information is accurate to the best of my knowledge. I understand the issuance of a businep tax certificate does not constitute proof of compliance with other city, county, state and federal regulations, Including but not limited to Ing, building code or other land use regulations (SLOMC 3.01.102). Signed Title Cos Data ji TPrinted on recycled paper. ORIGINAL - Finance WHITE - Planning CANARY - Utilities PINK - Customer 2020-6313 il�� ii���lll!llllli�' IIIIII� city of c*an WIS OBI sp(N Building & Safety Division • 990 Palm Street • San Luis Obispo, CA 93401-3249 • (805) 781-7180 CONSTRUCTION PERMIT Project Address 692 MARSH Assessor's Parcel Number 002-422-024 Project Description PARKING LIGHT STANDARD Permit Type X Building _Mechanical X Electrical Property Owner GORDON SYLVIA THE Mailing Address 200 E DELAWARE APT 16-D City/State/Zip CHICAGO IL, 60611- Contractor YOUNG ELECTRIC SIGN COMPANY Mailing Address 1443 S. CUCAMONGA City/State/Zip ONTARIO CA 91761 Project Manager ROBERT MOUNTAIN,_RME _ Lender Name U.B.C. Group U-2 U.B.C. Type V=N Census number 329 Structure other than Building/Sign Legal Description CY SLO MRY & CH ADD BL 7 OTN LTS 15 & 16 _Plumbing _Sign _Demolition _Grading Occupant/Business Name 7-ELEVEN FOOD STORE #27835 Architect/Engineer License # Contractor's Phone No. 909-923-7668 Contractor's State Lic. No. 652155 Project Manager's Phone No. 909-923-4024 Lender Address Stories 1 Codes: UBC 94 NEC 93 Dwelling Units 0 VALUATION FEES Structure Other Than Building............ $ 2,000 2,000 Building Permit 63.50 -Plumbing Permit 0.00 Mechanical Permit 0.00 Electrical Permit 8.46 Grading Permit 0.00 S.M.I.P. 0.50 Energy Surcharge 0.00 Accessibility Surcharge 0.00 Demolition Permit 0.00 Sign Permit 0.00 Administrative 0.00 Miscellaneous Chg/Cred 0.00 Total Building Value 2,000 Investigation Fees 0.00 Microfilm 6.95 Comments: Subtotal 79.41 Building Plan Review Fee 71.96 Fire Safety Plan Review 0.00 Plan Review 71.96 Fire Safety Surcharge 0.00 PAYMENTS Construction Unit Tax 0.00 Application Number 60636 Amount Date Receipt Water Impact 0.00 Application Date 09/17/96 Payment #1 151.37 09/17/96 4030 Water Meter Installation 0.00 Wastewater Impact 0.00 Traffic Impact 0.00 Permit Number 11105 Total Fee Calculated 151.37 Issuance Date 09/17/96 Total Paid 151.37 Balance Due 0.00 LEGAL DECLARATIONS OWNER BUILDER DECLARATION: I am exempt from the contractor's License Law for the following 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. _ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ot applicable 744, WORKERS COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or 'a certificate of Workers' Compensation insurance, or a certified copy hereof (Sec. 3800, Lab. C) Certified copy is hereby furnished. _ Certified copy is filed with the City. _ Not applicable CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE _ 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 Worker's Compensation Laws of California. 244at applicable NOTICE TO APPLICANT: If, after making any of the foregoing declarations, you become subject to any Labor Code or License Law provision, you must comply with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above information is correct, I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. Unless noted under "Special Conditions", this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days any time after work is commenced. S"Fial Conditions: Signature of Contractor, Authorized Agent or Owner Date Address File flfllli' Iflf� city Of oan WIS OBI Spn ARM.Building & Safety Division • 990 Palm Street • San Luis Obispo, CA 93401-3249 • (805) 781-7180 CONSTRUCTION PERMIT Project Address 692 MARSH Assessor's Parcel Number 002-422-024 Project Description REPLACE EXISTING LIGHTING FIXTURES Permit Type _Building _Mechanical X Electrical Property Owner GORDON SYLVIA THE Mailing Address 200 E DELAWARE APT 16-D City/State/Zip CHICAGO IL, 60611- Contractor LITE HOUSE ELECTRIC Mailing Address 464 W 11TH ST City/State/Zip SAN PEDRO CA 90731 Project Manager RONNIE KEYSE Lender Name U.B.C. Group M U.B.C. Type V=N Census number Comments - Legal Description CY SLO MRY & CH ADD SL 7 OTN LTS 15 & 16 _Plumbing _Sign _Demolition _Grading Occupant/Business Name 7-ELEVEN FOOD STORE #27835 Architect/Engineer License # Contractor's Phone No. 310-832-1169 Contractor's State Lic. No. 429638 Project Manager's Phone No. 800-424-1169 Lender Address Stories 1 Codes: UBC 94 NEC 93 Dwelling Units 0 VALUATION FFFS PAYMENTS Application Number 60249 Amount Date Receipt Application Date 04/18/96 Payment #1 35.00 04/18/96 2076 Permit Number 10867 Issuance Date 06/07/96 Total Paid 35.00 LEGAL DECLARATIONS OWNER BUILDER DECLARATION: I am exempt from the contractor's License Law for the following 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. _ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. Not applicable WORKERS COMPENSATION DECLARATION: I hereby affirm that 1 have a certificate of consent to self -insure, or 'a certificate of Workers' Compensation insurance, or a certified copy hereof (Sec. 3800, Lab. C) _ Certified copy is hereby furnished. _�gCertificd copy is filed with the City. _ Not applicable CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE _ 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 Worker's Compensation Laws of California. Not applicable Building Permit 0.00 Plumbing Permit 0.00 Mechanical Permit 0.00 Electrical Permit 25.85 Grading Permit 0.00 S.M.I.P. 0.00 Energy Surcharge 0.00 Accessibility Surcharge 0.00 Demolition Permit 0.00 Sign Permit 0.00 Administrative 9.15 Miscellaneous Chg/Cred 0.00 Investigation Fees 0.00 Microfilm 0.00 Subtotal 35.00 Building Plan Review Fee 0.00 Fire Safety Plan Review 0.00 Plan Review 0.00 Fire Safety Surcharge 0.00 Construction Unit Tax 0.00 Water Impact 0.00 Water Meter Installation 0.00 Wastewater Impact 0.00 Traffic Impact 0.00 Total Fee Calculated 35.00 Balance Due 0.00 NOTICE TO APPLICANT: If, after making any of the foregoing declarations, you become subject to any Labor Code or License Law provision, you must comply with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above information is correct, 1 agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. Unless noted under "Special Conditions", this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days any time after work is commenced. Special Conditions: Signature of Contractor, Authorized Agent or Owner Date Address File city of man WIS OB I SPO Building & Safety Division • 990 Palm Street • San Luis Obispo, CA 93401-3249 • (805) 781-7180 CONSTRUCTION PERMIT Project Address 692 MARSH Assessor's Parcel Number 002-422-024 Project Description REMODEL STORE HC UPGRADES COFFEE BAR Permit Type X Building _Mechanical X Electrical Property Owner GORDON SYLVIA THE Mailing Address 200 E DELAWARE APT 16-D City/State/Zip CHICAGO IL, 60611- Contractor R D ENGINEERING & CONST INC Mailing Address 1660 N MAGNOLIA City/State/Zip EL CAJON CA 92020-1242 Project Manager Lender Name Legal Description CY SLO MRY & CH ADD BL 7 OTN LTS 15 & 16 X Plumbing _Sign _Demolition _Grading Occupant/Business Name 7-ELEVEN FOOD STORE #27835 Architect/Engineer License # Contractor's Phone No. 619-562-2265 Contractor's State Lic. No. 596438 RICH SALDINO Project Manager's Phone No. 619-562-2255 Lender Address U.B.C. Group M U.B.C. Type V=N Stories 1 Census number 437 Commercial Alteration or Addition Dwelling Units 0 VALUATION Non -Residential Alteration ............... $ 10,000 10,000 Total Building Value 10,000 Comments: PAYMENTS Application Number 60196 Amount Date Receipt Application Date 03/26/96 Payment #1 241.47 03/26/96 1781 Payment #2 277.18 05/02/96 2242 Permit Number 10740 Issuance Date 05/02/96 Total Paid 518.65 LEGAL DECLARATIONS OWNER BUILDER DECLARATION: I am exempt from the contractor's License Law for the following 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. _ I, as owner of the property, am exclusively contracting with licensed contractors to Zristruct the project. Not applicable WORKERS COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or 'a certificate of Workers' Compensation insurance, or a certified copy hereof (Sec. 3800, Lab. C) 4"Ccrtified copy is hereby furnished. _ Certified copy is filed with the City. _ Not applicable CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE _ 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 Worker's Compensation Laws of f'alifornia Not applicable Codes: UBC 94 NEC 93 FEES Building Permit 162.25 Plumbing Permit 21.63 Mechanical Permit 0.00 Electrical Permit 21.63 Grading Permit 0.00 S.M.I.P. 2.10 Energy Surcharge 0.00 Accessibility Surcharge 13.36 Demolition Permit 0.00 Sign Permit 0.00 Administrative 0.00 Miscellaneous Chg/Cred 0.00 Investigation Fees 0.00 Microfilm 20.25 Subtotal 241.22 Building Plan Review Fee 205.51 Fire Safety Plan Review 35.96 Plan Review 241.47 Fire Safety Surcharge 35.96 Construction Unit Tax 0.00 Water Impact 0.00 Water Meter Installation 0.00 Wastewater Impact 0.00 Traffic Impact 0.00 Total Fee Calculated 518.65 Balance Due 0.00 NOTICE TO APPLICANT: If, after making any of the foregoing declarations, you become subject to any Labor Code or License Law provision, you must comply with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above information is correct, I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. Unless noted under "Special Conditions", this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or, work is suspended or abandoned for a period of 180 days any time after work is commenced. Special Conditions- % Signatur of Contractor, Authorized Agent or Owner to Address File „u��N�lll Ilf f it Ill ��� II I� CI tY Or `` an IU.I S O B l Sp n Building & Safety Division • 990 Palm Street • San Luis Obispo, CA 93401-3249 • (805) 781-7180 CONSTRUCTION PERMIT Project Address 692 MARSH Assessor's Parcel Number 002-422-024 Legal Description CY SLO MRY & CH ADD BL 7 OTN LTS 15 & 16 Project Description ADD 20 AMP DEDICATED CIRCUIT & OUTLET Permit Type _Building _Mechanical X Electrical _Plumbing _Sign _Demolition _Grading Property Owner GORDON SYLVIA THE Occupant/Business Name 7-ELEVEN FOOD STORE #27835 Mailing Address 200 E DELAWARE APT 16-D Architect/Engineer City/State/Zip CHICAGO IL 60611- License # Contractor ALLIED INTERSTATE Contractor's Phone No. 818-504-3370 Mailing Address 9864 GLENOAKS BLVD Contractor's State Lic. No. 458547 City/State/Zip SUN VALLEY CA 91352 Project Manager NORM BERTUCH Project Manager's Phone No. 818-504-3370 Lender Name Lender Address U.B.C. Group U.B.C. Type V-N Stories 1 Codes: UBC 91 NEC 90 Census number Dwelling Units 0 VALUATION FEES Building Permit 0.00 Plumbing Permit 0.00 Mechanical Permit 0.00 Electrical Permit 17.25 Grading Permit 0.00 S.M.I.P. 0.00 Energy Surcharge 0.00 Accessibility Surcharge 0.00 Demolition Permit 0.00 Sign Permit 0.00 Administrative 17.75 Miscellaneous Chg/Cred 0.00 Investigation Fees 0.00 Microfilm 0.00 Comments: Subtotal 35.00 Building Plan Review Fee 0.00 Fire Safety Plan Review 0.00 Plan Review 0.00 Fire Safety Surcharge 0.00 PAYMENTS 110 Construction Unit Tax 0.00 Application Number 50830 Amount Date Receipt Water Impact 0.00 Application Date 11/06/95 Payment #1 35.00 11/06/95 0117 Water Meter Installation 0.00 Wastewater Impact 0.00 Traffic Impact 0.00 Permit Number 10419 Total Fee Calculated 35.00 Issuance Date 11/06/95 Total Paid 35.00 Balance Due 0.00 LEGAL DECLARATIONS OWNER BUILDER DECLARATION: I ant exempt from the contractor's License Law for the following 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. _ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. 7-j±1ot applicable 7-- WORKERS COMPENSATION DECLARATION: 1 hereby affirm that I have a certificate of consent to self -insure, or 'a certificate of Workers' Compensation insurance, or a certified copy hereof (Sec. 3800, Lab. C) _ Certified copy is hereby furnished. _( Certified copy is filed with the City. Not applicable CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE _ 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 Worker's Compensation Laws of California. ;?�"ot applicable NOTICE TO APPLICANT: If, after making any of the foregoing declarations, you become subject to any Labor Code or License Law provision, you must comply with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above information is correct, I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. Unless noted under "Special Conditions”, this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days any time after work is commenced. S ccial Conditions: Sig tune of Contractor, Authorized Agent or Owner Date Address File MEMORANDUM TO: Tom Baasch, Building Official FROM: Michael Smith, Hazardous Materials Inspecto DATE: August 29, 1990 RE: Request an Environmental Hold Be Placed on 692 Marsh Street During a review of Fire Department records regarding this site, it is clear that an number of underground storage tanks have been abandoned in place, (approximately 12, ranging in sizes from 500 gallons to 10,000 gallons). Documentation shows that some or all of the tanks were filled with sand or slurry, however, this process is only partially effective in stabilizing these types of tanks. (Most tanks are only half filled). Because of this reason, as well as long-term liability, this procedure of tank abandonment is no longer acceptable. All underground tanks are to be removed. Therefore, before any future developments, i.e. demolition for new construction or modifications, all underground storage tanks remaining on this site shall be removed, and a thorough site investigation and cleanup shall be performed. Contact the Hazardous Materials Inspector for further information. cc: Spencer Meyer, Inspector