HomeMy WebLinkAbout4111 Broad Street Permits 2003-2023|lililil
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Comrnunity Development Department, 919 Palrn Street, $an Luis Obispo, CA 93401-3218
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Other Addreqs(es) on this parcel:
Reason for Application
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Applicant's Address:
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Phone: 5t/t- 56a UDefE
Property Owner:
Owner's Address
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4111 BROAD STREET. FIRST FLOOR PLAN
4111 BROAD STREET. SECOND FLOOR PLAN
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CITY OF
Building & Safety Dlvision . 919 Palm Street 'San Luis Obispo' CA 93401-3218
BUILDING PERMIT
AlVAddition - Commercial
BLDG-0594-2023
I ssuance D ate: 3 I 30 I 2023
san Lur.q,gpl$po
ProjectAddress: 4111 Broad St. 220
Unit or Suite(s): 22O
Project Description: Ij€EEIQSEUQEI
Architect:
Contractor:
Owner:
Assessor's Parcel Number: 9534.L5-002
Square Footage: 0.00
Legal Description:
Pults & Associates, LLP
Frances Gibbs
Business: (80) 5) -541- Mobile: (805) 801-5734
JW Design & Construction
Mike Gibson
Business: (805) 234-1343 Other: (805) 544-3130
License Type: Business License License Number: 044750
License Type: Califomia State Contractor License License Number: 554910
4205 ASSOCIATES, JOINT VENTURE
Business: (805) 544-31 30
Classification: B - General Building Contractor
Fire Sprinklers: Not Provided Stories 1.00
Census:
Occupancy: Business, professional offices (B)
Motel Rooms:
Construction Type:
Dwelling Units:
V-B
CodeYear: 2022
So. Ft
Valuation
$32,500.00
ValuationFactorTvoeGrouo
Manual
Fees Payments
Receipt #Fee Name Fee Amount Date Amount
Consolidated Plan $1,617.61
$869.26
$10.00
$76.73
$126.94
$2.00
$319.93
$1,278.33
3t30t23 38,673-03-30-2023
Total Paid:
$4,300.80
Commercial Tenant lmprov - Non Structural - FIRE
SMIP (Commercial)
C&D Recycling - UTIL
lT Surcharge
Green Building Fee
Building Plan Rev - Commercial - Minor
Consolidated lnspection Fees
$4,300.80
Total Fees:$4,300.80
Plan Gheck Account Payment by Contact
Gontact Name Account Name Status Total Credits Total Debits Account Balance
Balance Due:
Total Account Balance:
$0.00
) Legal Declarations I
#2 IDENTIFY WHO wlLL PERFORM THE WORK
2a - CALIFoRNIA LICENSED coNTRAcToR's DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9commencing with Section 7000 of Division 3 of the Business and Professions Code, and my lic€nse is in full force and effect.
#:I IDENTIFYWORKERS' COMPENSTATIoN covERAGE AIIID LENDING AGENGY
WARNING: Failure to secure workers' compensation @verage is unlawful, and shall subject an employer to criminal penalties and civil fines up to
$100,000, in addition to the cost of compensation, damages as provided for in section 3706 of the labor code, interest, and attomey,s fees.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
#4 DECLARATION BYCONSTRUCTION PERMITAPPLICANT
By my signature below, I certiff each of the following:
I am a CA Licensed Gontractor.
March 30,2023
of Contractor, Authorized Agent or Owner Date
Building & Safety Division . 919 Palm Street ' San Luis Obispo, cA 93401-3218
,)
BUILDING PERMIT
Modifications to Fire SPrinklers
FIRE-2487-2023
lssuance Dale: 1 21 4 12Q23
Sifi'Lurs.gplflpo
ProjectAddress: 4111 Broad St.230
Unit or Suite(s)'. 230
Project Description: SPRINKLER MODIFICATION
Contractor:
Assessor's Parcel Number: 0534!5-0Q2
Square Footage' 0'00
Legal Description:
Advanced Fire Protection
Mike Christianson
Business: (805)462-0713 Mobile: (805) 952-5358 FAX: (805)462-2739
J.W. Design & Construction, lnc.
Mike Gibson
Mobile: ((80) 5) -234-
License Type: Business License License Number: 04/.750
License Type: California State Contractor License License Number: 554910 Classification: B - General Building Contractor
Fire Sprinklers:
Census:
Occupancy:
Motel Rooms:
Construction Type:
Dwelling Units:CodeYear'. 2022Stories 0.00
So. Ft ValuationFactor
Valuation
TvoeGrouo
Plan Gheck Account Payment by Gontact
Status Total Credits Total Debits
$641.61
$641.61
Account Balance
Total Account Balance:
12t4t23
Fee Amount
Total Fees
Account Name
Fees
Balance Due:
Contact Name
Fee Name
$0.00
AmountDate
$641.61
Consolidated 41,474-12-04-2023
Total Paid:
Payments
Receipt #
$622.62
$18.99
Fire Sprinkler
lT Surcharge
i
))
Legal Declarations
f2 IDENTIFY WHO wlLL PERFORM THE WORK
2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter g
commencing with Section 7000 of Division 3 of the Business and Professions Code, and my license is in full force and effect.
#3 IDENTIFYWORKERS' COI'PENSTATION COVERAGE AND LENDING AGENCY
WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to
$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.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for whichthis permit is issued.
#4 DECLARATION BY CONSTRUCTION PERMIT APPLICANT
By my signature below, I certi[/ each of the following:
I am authorized to act on the owner,s behalf.
December 04,2023
Signature of Contractor, Authorized Agent or Owner Date
,,l
Sifi'Lurs oBrs po BUILDING PERMIT
lnterior/Utility Building
DEMO-2018-2022
lssuance Dale: 7 I 1312022
CALiFORNIA
Building & Safety Division . 919 Palm Street'San Luis Obispo, CA 9340'l-3218
4111 Broad St Assessot's Parcel Number: 053415-001Project Address:
Unit or Suite(s):
ProjectDescription:@
Architect: Pulis & Associates, LLP
Frances Gibbs
Business: (805) 541-5604 Mobile: (805) 801-5734
Contractor: JW DESIGN & CONSTRUCTION
MARY BUSTAMANTE
Business: (805) 234-2984
Owner: 4205 ASSOCIATES, JOINT VENTURE
Business: (805) 544-31 30
Square Footage:
Legal Description:
0.00
Fire Sprinklers: Stories 0'00
:
Census: 437 - Commercial Alteration orAddition
Occupancy:
Motel Rooms:
Construction Type:
Dwelling Units:Code Year: 2019
$5,000.00
Sq. Ft
Valuation
ValuationFactorTvoeGrouo
Manual
$532.21
$0.00
Receipt #
Plan Gheck rAccount Payment by Gontact
Total Account Balance:
7113122
Fee Amount
Total Fees:
Account Name
Balance Due
Gontact Name
Fee Name
1532.21
Amount
Payments
Date
$532.21
Fees
Status Total Gredits Total Debits Account Balance
Build - BLDG 36,130-07-13-2022
Total Paid:
$516.46
$1s.75
Demolit - lnterior or
lT Surcharge
Legal Declarations
#2 IDENTIFY WHO WILL PERFORM THE WORK
2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter g
commencing with Section 7000 of Division 3 of the Business and Professions Code, and my license is in full force and effect.
f,' IDENTIFY WORKERS' COMPENSTATION COVERAGE AND LENDING AGENCY
WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to
$100,000, in addition to the cost of compensation, damages as provided for in section 3706 of the labor code, interest, and attomey's fees.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
#4 DECLARATION BYCONSTRUCTION PERMITAPPLICANT
By my signature below, I certiry each of the following:
I am a CA Licensed Contractor.
Julv 13.2O22
Signature of Contractor, Authorized Agent or Owner Date
..\
$iri'Lur.{,gpl$po
Building & Safety Division. 919 Palm Street'San Luis Obispo, CA 93401-3218
BUILDING PERMIT
Alt/Addition - Commercial
BLDG-2103-2018
lssuance Date: 1 0/3/201 8
Project Address
Unit or Suite(s):
41'll Flrnad St Assessor's Parcel Number: 053.zt!-5l00,l
Legal DescriptionProject Description:
Contractor: JW DESIGN & CONSIRUCTION
MARY BUSTAMANTE
Business: (805) 234-2984
Owner: DORSI STEPHEN NTRE ETAL
Business: (805) 544-3130
Fire Sprinklers: Not Provided Stories 1.00
Census: 437 - Commercial Alteration orAddition
Occupancy: Business, professional offices (B)
Dwelling Units:
V-B
Code Year: 2016 Motel Rooms:
Construction Type:
SMIP (Commercial)
Supplemental lnspection (Building) - BLDG
Green Building Fee
lT Surcharge
Supplemental Plan Check (Building) - BLDG
Total Fees
$0.00
Plan Gheck Account Payment by Gontact
10t3118
Total Account Balance
Fee Amount
Account Name
Balance Due:
Contact Name
Fee Name
$343.80
$343.80
AmountDate
$343.80
Fees
Status Total Credits Total Debits Account Balance
18,247-10-03-2018
Total Paid
Payments
Receipt #
$7.00
$218.08
$1.00
$8.68
$109.04
Sq. Ft
ValuationDimensions
ValuationFactorTypeGroup
Manual
SQFT:category:
\ Legal Declarations
#2 IDENTIFYWHO WILL PERFORM THE WORK
2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
commencing with Section 7000 of Division 3 of the Business and Professions Code, and my license is in full force and effect.
#3 IDENTIFY WORKERS' COMPENSTATION COVERAGE AND LENDING AGENCY
WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to
$100,000, in addition to the cost of compensation, damages as provided for in section 3706 oi the tabor cbd6, interest, and attorney's fees.
3a - WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which thispermit is issued.
#4 DECLARATION BY CONSTRUCTION PERMITAPPLICANT
By my signature below, I certify each of the following:
I am a CALicensed Contractor.
October 03, 2018
of Contractor, Authorized Agent or Owner Date
-)
$ifi*Lurs oBrspocALrroRNtnl
Building & Safety Division . 919 Palm Street. San Luis Obispo, CA 93401-3218
BUILDING PERMIT
AlVAddition - Commercial
BLDG-2255-2018
lssuance Date:'11 1212018
')
Project Address:
Unit or Suite(s):
Owner:
4'111 Flrnad St
Project Description: Legal Description
PARTITIONS IN OFFICE - PG&E
Architect: RIM ARCHITECTS
Business: (41 5) 247 -0400
Contractor:ROEBBLEN CONTRACTING
TARA RUNION
Business: (91 6) 934-821 6
License Type: California State Contractor License
License Type: California State Contractor License
License Type: California State Contractor License
License Type: California State Contractor License
DORSI STEPHEN N TRE ETAL
Business: (805) 544-31 30
Assessor's Parcel Number: 053-415-001
License Number: 734124
License Number: 734124
License Number: 734124
License Number: 734124
Classification: A - General Engineering Contractor
Classification: B - General Building Contractor
Classification: C13 - Fencing Contractor
Classification: C-8 - Concrete Contractor
Fire Sprinklers: Mt-@L!d Stories 1.00
Gensus: 437 - Commercial Alteration orAddition
Occupancy: Business, professional offlces (B)
ilt-B
Dwelling Units:Code Year: 2016 Motel Rooms:
Construction Type:
$1,000.00
Sq. Ft
Valuation
ValuationFactorTvpeGroup
Manual
SQFT:
Dimensions
Category:
Fees Payments
Fee Name Fee Amount Date Receipt #Amount
lT Surcharge
SMIP (Commercial)
Supplemental lnspection (Building) - BLDG
C&D Recycling - UTIL
Green Building Fee
Supplemental Plan Check (Building) - BLDG
$16.17
$0.s0
$327.12
$64.23
$1.00
$218.08
10t15118 18,441-10-15-2018
Total Paid
$627.10
$627.10
Total Fees:$627.10
Plan Check Account Payment by Gontact
Contact Name Account Name Status
-
rn use
Total Credits Total Debits Account Balance
RIMARCHITECTS BLDG-2255-2018 $920.55 $920.55 $0.00
Total Account Balance $920.55 $920.55 $0.00
Balance Due:$0.00
r Legal Declarations
#2 IDENTIFYWHO WILL PERFORM THE WORK
2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
commencing with Section 7000 of Division 3 of the Business and Professions Code, and my license is in full force and effect.
#3 IDENTIFY WORKERS' COMPENSTATION COVERAGE AND LENDING AGENCY
WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to
$100,000, in addition to the cost of.compensation, damages as provided for in section 3706 of the labor code, interest, and aitorney's fees.
3a 'WORKERS' COMPENSATION DECLARATION I hereby afiirm under penalty of perjury one of the following declarations:
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
#4 DECLARATION BYCONSTRUCTION PERMITAPPLICANT
By my signature below, I certi! each of the following:
I am a CA Licensed Contractor.
November 02,2018
)
of Contractor, Authorized Agent or Owner Date
Sifi'Lur.q,gpl$po BUILDING PERMIT
AlVAddition - Commercial
BLDG-0243-2017
lssuance Dale: 21 28 I 20 17
Project Address
Unit or Suite(s):
Project Description: REPLACE EXTERIOR ENTRY OVERHANGS
Contractor: JW Design
JERRY WILLIAMS
Busi ness : (805) 7 04-7 281
License Type: California State Contractor License
Owner: BALL ROLAND S REVOCABLE TRUST (TR 1)
Building & Safety Division . 919 Palm Street'San Luis Obispo, CA 93401-3218
4111 Ftrnarl St Assessor's Parcel Number: 053-415-001
Legal Description
License Number: 554910 Classification: B - General Building Contractor
Fire Sprinklers: Not Provided Stories 1.00
Census:
Occupancy: Business, professional offices (B)
Dwelling Units
V.B
CodeYear: 2016 Motel Rooms:
Construction Type:
$84,000.00
Sq. Ft
ValuationDimensions
ValuationFactorTvpeGroup
Manual
SQFTCateqory:
$0.00
$1 ,132.00
$1,132.00
Amount
Plan Check Account Payment by Gontact
2128117
Total Account Balance
$1,132.00
Fee Amount
Total Fees
Account NameContact Name
Balance Due:
Fee Name Date
Fees
Status Total Credits Total Debits Account Balance
10,642-02-28-2017
Total Paid
Payments
Receipt #
$24.00
$606.00
$4.00
$303.00
$195.00
SMIP (Commercial)
Supplemental Plan Gheck (Building)
Green Building Fee
Supplemental lnspection (Building)
Fire Safety Surcharge
t .a..1 .!.r-$*fulio l,.t-*...
Legal Declarations
#2 IDENTIFY WHO WILL PERFORM THE WORK
2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9commencing with Section 7000 of Division 3 of the Business and Professions Code, and my license is in full force and effect.
#3 IDENTIFY WORKERS' COMPENSTATION COVERAGE AND LENDING AGENCY
WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to
$100'000, in addition to the cost of compensation, damages as provided for in section 37OO oi the tabor cbd6, interest, and aitorney;s fees.
3a ' WORKERS' GOMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which thispermit is issued.
#4 DECLARATION BY CONSTRUCTION PERMITAPPLICANT
By my signature below, I certify each of the following:
I am a CALicensed Contractor.
Februarv 28.2017
of Contractor, Authorized Agent or Owner Date
ctty cf san luls oBrlpo
Buitdino & safetv Division. srg p6ofr?efnardriomiFegnnif01-3218. (805) 781-7180
ProjectAddress 4111 BROAD 110
Assessor'sParcelNumber 053-415-002 Legal Description
DescriptionCELL SITE MODIFICATIONS
x Building X Mechanical X Electrical X Plumbing Sign
-Demolition -Grading
DORSI STEPHEN N TRE ETAL OccupanUBusiness Name
2710 BRANCH MILL RD ArchitecUEngineer
License #ARROYO GRANDE CA, 93420-6103
Contractor's Phone No.601/898-4450
112 E STATE STREET Contractois State Lic. No.
RIDGELAND 391 57
WESTTOWER Project Manager's Phone No. (56Z)SOO-g66S
Lender Address
C.B.C. Group B
census 437 - cofrfrErciat
C.B.C. TypeV-B Stories 0 Codes: CBC13 CEC13
Dwellins tfiifi0
Valuation
Non-Residential Alteration 20,000
Project
Permit Type
Property Owner
Mailing Address
City/State/Zip
Contractor
Mailing Address
City/State/Zip
Project Manager
Lender Name
Payment #1
Payment #2
Total Paid
Alteration or Addition
Fees
Building Permit
Plumbing+Electrical+Mechanical Permit
Grading Permit
s.M.l.P.
Green Building Fee
Demolition Permit
Sign Permit
MiscCharge/Credit 0.00AdministrativePermit
Archival FeeSubtotal 607 '70
lnvestigation Fees
Building Plan Review Fee
Fire Safety Plan Review
Plan Review Subtotal 400.50
Development Review Fee
Fire Safety Surcharge
Fire Systems
Fire Sur/Sys Subtotal 0.00
Construction Unit Tax
Water lmpact 0.00 Area -
Water Meter lnstallation
Wastewater lmpact 0.00 Area -
Traffic lmpact 0.00 Area -
Affordable Housing
Public Art
Code Enforcement
Park lmprovement Area -
Engineering Development Review Fee
Open Space ln-lieu Fee
Total Fees
Balance Due
Motel Rooms 0
Total Building Value
$20,000.00
$20,000.00
-Legal
Declarations
2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
commencing with Section 7000 of Division 3 of the Business and Professions Code, and
my license is in full force and effect
Contractor: WESTOWER Class: A, B. C10 License #:744137
400.50
202.00
0.00
4.20
1.00
0.00
0.00
0.00
0.00
0.00
400.50
0.00
441.32
0.00 3a NOT SPECIFIED
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,449.52
0.00
Payme
Amount
nts
Application Numberl4041 2
ApplicationDate 05121114
Permit Numbet 28261
lssuance Dateffi-
500.00
949.52
't,449.52
Date
05t21t14
07t08t14
Receiot
65337
65992
Fee Exemptions:
Comments:
Address File
re or
z -E- r\
Project Address 4111 BROAD 130
Assessor's Parcel
Project DescriPtion
Permit Type
Property Owner
TI FOR MANAGED CARE SYSTEMS
X Building Mechanical
DORSI STEPHEN N TRE ETAL
Legal Description CY SLO TR 1993 LT 2 (COMMON AREA)
x Electrical Plumbing Sign
-Demolition -Grading
OccupanVBusiness Name
Mailing Address 2710 BRANCH MILL RD ArchitectiEngineer STE
City/State/Zip ARROYO GRANDE CA, 93420-6103 License #c-8611
ContractorContractor.sPhoneNo.661/835-927o
Mailing Address P.O. BOX 41765 Contractor's State Lic. No.701
urty/stale/zrp BAKERSFIELDCAg33S4
Project Manager FRANCES GIBBS Project Manager's Phone No. 541-5604
Lender Name Lender Address
C.B.C. Group _B C.B.C.TypeJ-B_
Census 437 Commercial Alteration or Addition
Non-Residential Alteration
Fees
338.50
153.00
0.00
1.26
1.00
0.00
0.00
0.00
0.00
Building Permit
Plumbing+Electrical+Mechanical Permit
Grading Permit
s.M.l.P.
Green Building Fee
Demolition Permit
Sign Permit
MiscCharge/Credit 0.00AdministrativePermit
Archival Fee
Subtotal 493'76
lnvestigation Fees
Building Plan Review Fee
Fire Safety Plan Review
Plan Review Subtotal 338 50
Development Review Fee
Fire Safety Surcharge
Fire Systems
Fire SuriSys Subtotal '105'68
Construction Unit Tax
Water lmpact 0.00 Area -
Water Meter lnstallation
Wastewater lmpact 0.00 Area -
Traffic lmpact 0.00 Area -
Affordable Housing
Public Art
Code Enforcement
Park lmprovement Area -
Engineering Development Review Fee
Open Space ln-lieu Fee
Total Fees
Balance Due
Paym ents
Amount Date
06/30/1 4
07130114
L egal Declarations
2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9
commencing with Section 7000 of Division 3 of the Business and Professions Code, and
my license is in full force and effect
Contractor: JTS CONSTRUCTION Class: B. C10. A. C-8 License #:701750
3a(2) - WORKERS'COMPENSATION DECLARATION - I have and will maintain
workers' compensation insurance
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:
Carrier: CALIF CONTRACTORS Policy #:45Q3@ Expires 12131114
Fee Exemptions:
Fire Sprinklers
Valuation
6,000
Stories 2
Dwelling UiliF0
Codes: CBC13 CECl3
Motel Rooms 0
with A/C Fire Sprinklers
Total Building Value
L_7
$6,000.00
$6,000.00
0.00
338.50
0.00
Payment #1
Payment #2
541.00
762.'14
365.20
105.68
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1,303,14
0.00
Receipt
65895
66338
Total Paid 1 ,303. 14
Application Numberl40583 Permit Numbet 28323
Application Date OGt3OlM lssuance OateTfiifii+-
Address File
Comments:
or Owner
()-
ctty cI san luls oBtlpo
Division . 919
Project Address 41 11 BROAD
Assessor's Parcel 053-41 5-001
Project DescriptionSlGN - FREE STANDING (2)
Permit Type Bui6ing Mechanical
Property Owner DORSI STEPHEN N TRE ETAL
Mailing Address 2710 BMNCH MILL
City/State/Zip
Contractor
Mailing Address
City/State/Zip
Project Manager
Lender Name
C.B.C. Group
Census
ARROYO GMNDE CA, 93420-6103
SAN LUIS OBISPO CA 93401
C.B.C. Type
Fees
Building Permit
Plumbing+Electrical+Mechanical Permit
Grading Permit
s.M.r.P.
Green Building Fee
Demolition Permit
Sign Permit
MiscCharge/Credit 0.00AdministrativePermit
Archival Feesubtotal 541 'oo
lnvestigation Fees
Building Plan Review Fee
Fire Safety Plan Review
Plan Review Subtotal 0.00
Development Review Fee
Fire Safety Surcharge
Fire Systems
Fire Sur/Sys Subtotal 0.00
Construction Unit Tax
Water lmpact 0.00 Area -
Water Meter lnstallation
Wastewater lmpact 0.00 Area -
Traffic lmpact 0.00 Area -
Affordable Housing
Public Art
Code Enforcement
Park lmprovement Area -
Engineering Development Review Fee
Open Space ln-lieu Fee
Total Fees
Balance Due
-3218.
Legal Description cY sLo TR 1993 LT 1 (COMMON AREA)
NAME YET)
Electrical Plumbing X Sign
-Demolition
OccupanUBusiness Name
ArchitecVEngineer
License #
Contractor'sPhoneNo. BO5-ZB1-0427
Contractor's State Lic. No.811
Project Manager's Phone No.
Lender Address
Codes: CBC10 CEC10
PAW SIGN CO
143 SUBURBAN RD.suTlE 110
Stories 0
Dwelling LlEii-O
Grading
Motel Rooms 0
Total Paid 541.00
ApplicationNumberl3{141 PermitNumber2TT09
Apptication Date 11ffi- lssuance oate@iT
Valuation
Total Building Value $0.00'-Legal Declarations
2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
commencing with Section 7000 of Division 3 of the Business and Professions Code, and
my license is in full force and effect
Contractor: SOUTHPAW SIGN CO Class: S.5 License #: 811159
3a(3) - WORKERS' COMPENSATION DECLAMTION - 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 subiect to the workers' compensation laws
of California
, and agree that, if I should become subject to the workers' compensation provisions of
Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Fee Exemptions:
Comments:
0.00
0.00
0.00
0.00
0.00
0.00
541.00
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
0.00
0.00
0.00
0.00
0.00
541.00
0.00
Paymen
Amount
ts
Payment #1 541.00
Date
11t22113
Receipt
631 30
Address File nature or
ctf,y ol san luls oBls)o
Division . 919
ProjectAddress 411'1 BROAD 130
Assessor's Parcel Nu
Project Description
Permit Type
Property Owner
Mailing Address
City/State/Zip
Contractor
Mailing Address
City/State/Zip
Project Manager
Lender Name
C.B.C. Group B C.B.C. TypeV-B
Census 437 Commercial Alteration or Addition
Non-Residential Alteration
-
FeeS
Building Permit
Plumbing+Electrical+Mechanical Permit
Grading Permit
S,M.I.P.
Green Building Fee
Demolition Permit
Sign Permit
MiscCharge/Credit 0.00AdministrativePermit
Archival Fee
subtotal 352 90
lnvestigation Fees
Building Plan Review Fee
Fire Safety Plan Review
Plan Review Subtotal 262.44
Development Review Fee
Fire Safety Surcharge
Fire Systems
Fire Sur/SYs Subtotal 46.44
Construction Unit Tax
Water lmpact 0.00 Area -
Water Meter lnstallation
Wastewater lmPact 0.00 Area -
Traffic lmpact 0.00 Area -
Affordable Housing
Public Art
Code Enforcement
Park lmprovement Area -
Engineering Development Review Fee
Open Space ln-lieu Fee
Legal DescriPtion
INSTALL 3 NEW , MOVE LIGHTING,ADD EXIT SIGNS
X Building X Mechanical X
DORSI STEPHEN N TRE ETAL
2710 BRANCH MILL RD
ARROYO GRANDE CA,93420-61 03 License #
JTS CON ON Contractor'sPhoneNo. 661/835-9270
P.O. BOX 41765 Contractofs State Lic. No. 701750
ELD CA 93384
Project Manageis Phone No' S+t-5OOATREVOR
Lender Address
Electrical x Plumbing sign
-Demolition -Grading
OccupanVBusiness Name
CY SLO TR 1993 LT 2 (COMMON AREA)
Stories 0 Codes: CBC10 CEC10
Dwelling Unii-O Motel Rooms 0
Valuation
10,000 $10,000.00
$10,000.00
216.00
124.00
0.00
2.10
1.00
0,00
0.00
0.00
9.80
Total Building Value
-Legal Declarations
-
2a - CALIFORNIA LICENSED CONTMCTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of chapter 9
commencing with Section 7000 of Division 3 of the Business and Professions Code, and
my license is in full force and effect
Contractor: JTSCONSTRUCTION Class:E--QI-9--A.G-8 License#'.701750
3a(3)-WoRKERS.coMPENsATIoNDEGLARATIoN-lcertifythat'inthe
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
, "nJ"gi""
inrt, if I should become subject to the workers' compensation provisions of
section 3700 of the Labor code, I shall forthwith comply with those provisions.
Fee Exemptions:
0.00
216.00
46.44
0.00
46.44
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
Balance Due
661.78
0.00
Pay ments
Payment #1
Payment #2
Amount
262.44
399.34
Date
'toto3l1'l
10t19t't1
Receiot
53250
53484
Total Paid 661.78
Application Numberl 1 0864
ApplicationDate 1O]OA11
Permit Numbet 25876
tssuance aate7fiiiffi-
Address File
Comments:
nt or
7)
W ctty o[ian luls oBlsf"c
Rr rildinn .R Qafairr F)irrieinn o
Project Address 4111 BROAD 220
Assessor's Parcel Number 053-41 5-002
TENANT I
o ollrangfrtrct i a nniRe Effi ifi o r -s2 1 8 o (805) 7 a1 -7 1 ao
Legal Description cY sLo TR 1993 LT 2 (COMMON AREA)
5,923 Sq Ft @ with A/C Fire Sprinklers
Total Building Value
Grading
$296,1 50.00
$296,1 50.00
Project Description
Permit Type
Property Owner
Mailing Address
City/State/Zip
Contractor
Mailing Address
City/State/Zip
Project Manager
Lender Name
C.B.C. Group
Census 437
Payment #1
Payment #2
x Building I Mechanical
DORSI STEPHEN N TRE ETAL
Electrical X Plumbing Sign
-Demolition
OccupanVBusiness Name SRI INTERNATIONAL
Architect/Engineer STEVE PULTZ
License #c-
Contractols Phone No 544-3130
Contractor's State Lic. No.55491 0
Project Manager's Phone No. 5+t-S60+
Lender Address
Stories 0
Dwelling UTIE-0
Codes: CBC07 CEC07
Motel Rooms 0
X
B C.B.C. TypeV-B Fire Sprinklers
Commercial Alteration or Addition
Valuation
Non-Residential Alteration 296,150
PO BOX 13210
slo cA,93406-3210
J W DESIGN AND CONST
POBOX1154
slo cA 93406
TREVOR @ PULTS
Fees
Building Permit
Plumbing+Electrical+Mechanical Permit
Grading Permit
s.M.l.P.
Green Building Fee
Energy Surcharge
Accessibility Surcharge
Demolition Permit
Sign Permit
MiscCharge/Credit 0.00AdministrativePermit
Archival Fee
Subtotal 4'638'72
lnvestigation Fees
Building Plan Review Fee
Fire Safety Plan Review
Plan Review Subtotal 3,972.25
Development Review Fee
Fire Safety Surcharge
Construction Unit Tax
Water lmpact 0.00 Area -
Water Meter lnstallation
Wastewater lmpact 0.00 Area -
Traffic lmpact 0.00 Area -
Affordable Housing
Public Art
Code Enforcement
Park lmprovement Area -
Wateruay Management Fee
Open Space ln-lieu Fee
Engineering Development Review Fee
Total Fees
Balance Due
--Legal Declarations
2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
commencing with Section 7000 of Division 3 of the Business and Professions Code, and
my license is in full force and effect
Contractor: J W DESIGN AND CONST Class: B License #: 554910
3a(2) - WORKERS'COMPENSATION DECLARATION - I have and will maintain
workers' compensation insurance
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:
Carrier: STATE FUND Policy #:7190000049 Expires 04101111
Fee Exemptions:
Comments:
2r. tO
2,624.05
1,049.37
0.00
62.19
12.00
367.34
238.77
0.00
0.00
0.00
285.00
0.00
3,269.34
702.91
3,321.50
789.79
0.00
0.00
0.00
0.00
0.00
0.00
980.75
0.00
0.00
0.00
0.00
0.00
13,703.01
0.00Payme
Amount
nts
3,972.25
9,730.76
Date
04t't3t10
05t24t10
Receipt
46560
47070
Total Paid '13,703.01
Application Number{ 00285
ApplicationDate 04113/10
Permit Numbet 24665
lssuance oateTffi-
Address File
re or Date
*HtUlltlllllU ctty oF$An luls oBtspe
WBuilding&SaletyDivision.990Palm.iiL;:{?iii."??:i'i"dffiffi1?'o(805)781-7180
Project Address 41 11 BROAD
Assessor'sParcelNumber 053-415-001 Legal Description cY slo TR 1993 LT 1 (COMMON AREA)
Project Description SIGN NON-l LLUMINATED MONUMENT CREEKSIDE
Permit Type Building Mechanical Electrical Plumbing x Sign
-Demolition -
Grading
Property owner WILLIAMS GERALD A TRE ETAL occupanvBusiness Name EcoNoMlc VITALITY coRP.
Mailing Address 178 BROAD ArchitecVEngineer
City/State/Zip SLO CA, 93405-1708 License #
Contractor's Phone No.000-0000
Contractor's State Lic. No.000000000
Project Manager's Phone No. 544-7774
Lender Address
Dwelling Units 0
Stories 0 Codes: UBC 1 NEC 1
Motel Rooms 0Census number 324
Building Permit
Plumbing Permit
Mechanical Permit
Electrical Permit
Grading Permit
s.M.t.P.
Energy Surcharge
Accessibility Surcharge
Demolition Permit
Sign Permit
Misc ChargeiCredit
lnvestigation Fees
Microfilm
Subtotal
Building Plan Review Fee
Fire Safety Plan Review
Plan Review Subtotal
Development Review Fee
Fire Safety Surcharge
Construction Unit Tax
Water lmpact
Water Meter lnstallation
Office Building
0.00 Administrative Permit
89.70
0.00
0.00 Area -
0.00 Area -
Contractor
Mailing Address
CityiState/Zip
Project Manager
Lender Name
U.B.C. Group
Wastewater lmpact
Traffic lmpact
Affordable Housing
Public Art
Total Fees
Balance Due
Payment #1
NOT REQUIRED
cA 00000
PIERRE RADEMAKER
U.B.C. TypeV-N
Valuation
Fees la
Value
ons
1. OWNER BUILDING
I am exempt from the contractor's License Law for the following reason:
! t, as owner of the propefty, or my employees with wages as their sole
compensation wiil do the work and the structure is not intended or offered
for sale.[.] /, as owner of the propefty, am exclusively contracting with licensed
bitractors to construct the project.
fif,ruor appticabte.
{. wonxeR's coMpENSATIoN DEGLARATToN:
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
fl Certitiea copy is hereby furnished.
Werilfiea copy isfiled with the City,
LJ wot applicable
3. CERTIFICATE OF EXEMPTION FROM WORKERS GOMP. INSURANCE
'l I certify that in the peiormance of the work for which this permit ls issued,
I shall not employ any person in any manner so as fo become subiect to the
Wqlker's Compensation Laws of California
p|ot appticabte
NOTICE TO APPLICANT:
lf, after making any of the foregoing declarations, you become subiect 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 authoize representatives of this city to
enter upon the above-mentioned propefty for inspection purposes. Unless
noted under "Special Conditions", this permit becomes null and void if work
or construction authorized is nof sfarted within 180 days, or if construction
or work is suspended o r abandoned for a period of 1 80 days any time after
work is commenced.
Special Conditions:
Comments:
Total Bu
$0.00
$0.00ilding
rati
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
89.70
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
89.70
0.00Payme
Amount
nts
Date
09t02103
Receipt
1100989.70
Total Paid 89.70
Application Number030996 Permit Numbet 18407
Application Date oglo2lo3 lssuance Date 09/02/03
Address File
t
Date