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Home My WebLink AboutMarigold Center Shell Permitsffijl|ru ctty o[ san luls oBtspo ffiBuilding&SafetyDivision.-g"J0PalmStreet.SanLuisobispo,cA934o1.3249.1d05)781.7180 Constru ction Permit Project Address 3810 BROAD AssessolsParcelNumber 053-081-051 Legal Description Project Description RETAIL SHELL BUILDING B Permit Type X Building -X Mechanical X Electrical X Plumbing sign _Demolition -Grading Property Owner MARIGOLD CENTER LLC OccupanUBusiness Name ArchitecVEngineer License # Mailing Address 111 E. KATELLA AVENUE, SUITE 2 City/StateZiP ORANGE CA, 92BOT- Contractor Mailing Address City/StateZip Project Manager c Ft o PAclFlc ll lNc Contractor's Phone No. 782-8800 1111 E KATELLA SUITE 235 Contractor's State Lic. No. 503557 ORANGE CA 92667 TOM PHILLIPS FAX 782-8809 Project Manage/s Phone No. 782-BBOO Lender Name FIRST BANK& TRUST Lender Address Fire Sprinklers Dwelling Units 2zm0 MICHELSON IRVINE,CA 92714 U.B.C. Group M U.B.C. Type V-N Census number 327 Valuation c-5545 Store/Customer Service Building Permit Plumbing Permit Mechanical Permit Electrical Permit Grading Permit s.M.t.P. Energy Surcharge Accessibility Surcharge Demolition Permit Sign Permit Administrative Permit Miscellaneous ChargeiCredit lnvestigation Fees Microfilm Subtotal Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Fire Safety Surcharge Construction Unit Tax Water lmpact Water Meter lnstallation Wastewater lmpact Traffic lmpact Total Fees Balance Due Store/RestauranVTavern Fees 2,061.'t3 1,920.90 Payments 0 Stories 1 Motel Rooms Codes: UBC 94 0 NEC93 $149,920.00 $149,920.00 '!,167.80 155.67 155.67 155.67 0.00 31.48 1m.44 106.26 0.00 0.00 0.00 0.00 0.00 125.10 4,000 Sq Ft @ $37.48 with A/C Fire Sprinklers 1 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. [l 1 as owner of the property, am exclusively contracting with licensed c'ontractors to consiruct the proiect. fi 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 ceftified copy hereof 1,634.81 286.09 286.09 0.00 760.00 130.00 5,131 .00 0.00 10,289.12 0,00 E Ceftified copy is hereby furnished- Ceftified copy is filed with the City. Not applicable Payment #1 Payment #2 Total Paid Amount 1,920.90 8,368.22 10,289.12 Date og1al97 06/03/97 Receiot 6326 7399 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE n t ceftify that in the peiormance otthe work forwhich this permit is issued, I shall not employ any person in any m2nns7 5o as to become subiect to the Workels Compensation Laws of Califomia E Not aqPlicable NOTICETO 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 cerlify that I have read this application and state that the above information is correct, I agree to comply with all ciU ordinances and state laws relating to building construction, and hereby aluthoize representatives ofthis 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 authoized is not started within 180 days, or if construction orwork is suspended or abandoned for a peiod of 180 days any time after work is commenced. Special Conditions: Comments: Application Number 70'175 ApplicationDate 03118197 Permit Number 11654 lssuance Date 06/03/97 Address File Signature Agent or Date ,W Project Address 3820 BROAD Assessor's Parcel Number Project Description Permit Type Property Owner Mailing Address City/State/Zip Contractor Mailing Address City/Statezip Project Manager Lender Name U.B.C. Group Census number Building Permit Plumbing Permit Mechanical Permit Electrical Permit Grading Permit s.M.t.P. Energy Surcharge Accessibility Surcharge Demolition Permit Sign Permit Administrative Permit Miscellaneous Charge/Credit lnvestigation Fees Microfilm Subtotal Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Fire Safety Surcharge Construction Unit Tax Water lmpact Water Meter lnstallation Wastewater lmpact Traffic lmpact Total Fees Balance Due ctty Building & Safety Payments Division . 950 Palm Street . Con 971 .00 129.43 129.43 129.43 0.00 22.11 135.93 88.35 0.00 0.00 0.00 0.00 0.00 86.40 o[ qan luls oBlsp^ San Luis Obispo, CA 93401-3249 .1diis; zet-ztao struction Permit RETAIL SHELL BUILDING A X Building X Mechanical MARIGOLD CENTER LLC 1111 E KATELLAAVE C H Q PACIFIC II INC 1111 E KATELLA SUITE 235 ORANGE CA 92667 TOM PHILLIPS FAX 782-8809 FIRST BANK & TRUST U.B.C. Type V-N 327 Store/Restaurant/Tavern Legal Description CY SLO TR 2133 LT 3 Electrical X Plumbing Sign . Demolition -Grading OccupanVBusiness Name Architect/Engineer DONALD PICKEN License #c-554s Contracto/s Phone No. 782-8800 Contractor's State Lic. No.675977 Project Manager's Phone No. 782-8800 Lender Address Fire Sprinklers Dwelling Units 24OO MICHELSON IRVINE,CA 92714 Stories 1 94 NEC93 X M Codes: UBC Motel Rooms 0 Valuation Store/customer service 105'3oo Fees 2,770 Sq Ft @ with A/C Fire Sprinklers 1 reason: ! 1 u" owner of the propefty, 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 propetty, am exclusively contracting with licensed lontractors to construct the proiect. S Not appticable. 2. WORKER'S COMPENSATION DECLARATION: t hereby affirm that I have a ceftificate of consent to self-insure, or a 'ceftificate of Workers' Compensation insurance, or a certified copy hereof V Ceftifred copy is hereby furnished. @ C",tm"a copy is filed with the City. Ll Not applicabte 3, CERTIFICATE OF EXEMPTION FROM WORKERS COMP.INSURANCE I I ceftify that in the pertormance 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 Worker's Compensation Laws of California fi Not applicable 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 orthis 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 ofthis city to enter upon the above-mentioned property for inspection parposes. Unless noted under "Special Conditions", this permit becomes null and void if work or construction authoized is not started within 1 80 days, or if construction or work is suspended or abandoned for a peiod of 1 80 days any time after work is commenced. Special Conditions: 2/> $105,300.00 $105,300.00 1,692.08 1,597.17 Date 12t2297 o2t17t98 1,359.29 237.88 237.88 0.00 760.00 134.00 5,302.00 0.00 9,723.13 0.00 Payment #1 Payment #2 Amount 1,597.17 8,125.96 - Receipt 9917 0563 Total Paid 9,723.13 Application Number 70956 ApplicationDate 12122197 Permit Number 12271 Address File lssuance Dale 02127198 Comments: or Date W ctty o[ qan luls oBtsp^ Building & Safety Division o'990 Palm Street . San Luis Obispo, CA 93401-3249 . (ios) 781-7180 Co nstruction Permit Project Address 3830 BROAD Assessor's Parcel Number Project Description Permit Type Property Owner Mailing Address City/State/Zip Contractor Mailing Address City/StateZip Project Manager Lender Name U.B.C. Group Census number RETAIL SHELL BUILDING P x Building X Mechanical MARIGOLD CENTER LLC 1111 E KATELLAAVE ORANGE CA, 92667- cHoPAC|FrClllNC ,I ,I 11 E KATELLA SUITE 235 ORANGE CA 92667 TOM PHILLIPS FAX 782-8809 FIRST BANK & TRUST M U.B.C. Type V-N Store/Restaurant/Tavern 053-081 -053 Legal Description CY SLO TR 2133 LT 2 X Electrical x Plumbing sign -Demolition OccupanVBusiness Name Architect/Engineer DONALD PICKEN License #c-5545 Contractor's Phone No. 782-8800 Contractor's State Lic. No. 675977 Project Manager's Phone No. 782-8800 Lender Address Fire Sprinklers Dwelling Units 2400 MtcHELSON IRVINE,CA 92714 Stories 1 Grading Codes: UBC Motel Rooms 94 NEC93 with A/C Fire Sprinklers $279,660.00 327 0 5,888 Sq Ft @ 0 Valuation Store/customer service 279,660 Fees Building Permit Plumbing Permit Mechanical Permit Electrical Permit Grading Permit s.M.l.P. Energy Surcharge Accessibility Surcharge Demolition Permit Sign Permit Administrative Permit Miscellaneous Charge/Credit lnvestigation Fees Microfilm Subtotal Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Fire Safety Surcharge Construction Unit Tax Water lmpact Water Meter lnstallation Wastewater lmpact Traffic lmpact 3,232.7',\3.C 2,650.28 463.80 3,1 14.08 463.80 0.00 760.00 134.00 5,302.00 0.00 Total Fees Balance Due 13,006.59 o.00 $279,660.00 1. OWNER BUILDING DECLARATIONI I am exempt from the contractols Ucense Law for the following reason: [ /, as owner of the property, or my employees with wages as their sole ddmpensation will do the work and the structure is not intended or offered for sale. Fl /, as owner of the propefty, am exclusively contracting with licensed lontactors to construct the proiect. fi Not applicable. i. woRxeR's coMpENsATtoN DECLARATIoN: I hereby affirm that I have a ceftificate of consent to self-insure, or a 'ceftificate of Wor4ers' Compensation insurance, or a cettified copy hereof Certified copy is hereby furnished. Ceftified copy is filed with the CitY Not applicable ERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE I t ceftify that in the pertormance of the work lor which this permit is issued, I shall not emptoy any person in any manner so as to become subiect to the Vlorker's Compensation Laws of California p Not appticable NOTICE TO APPLICANT: If, 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. t certify that I have read this apptication 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 representaflves of this city to enter ipon the above-mentioned propefty for inspection purposes' Unless noted under "special Conditions", this permit becomes null and void if work or construction authoized is not stafted within 180 days, or if construction or work is suspended or abandoned for a peiod of 180 days any time after work is commenced. Special Conditions: Comments: Total Building Value Legal Declarations 1,893.20 252.36 252.36 252.36 0.00 58.73 265.03 172.27 0.00 0.00 0.00 0.00 0.00 86.40 Payment #1 Payment #2 Payme Amount 3,114.08 9,892.51 Date 122297 02t17t98 Receipt 9917 0562 nts Total Paid 13,006.59 Application Number 70957 Permit Number 12272 Application Date 12122t97 lssuance Dale 0z27l9e Address File re or 2/ Date ffitj||l$ ctty o[ san luls oBtspf ffiBuilding&SafetyDivision...9tioPalmStreet.SanLuisobispo,cA934o1-3249.l-eos1zat-neo Project Address 3840 BROAD Assessor's Parcel Number Project Description Permit Type Property Owner Mailing Address City/State/Zip Contractor Mailing Address City/Statezip Project Manager Lender Name U.B.C. Group Census number Store/Customer Service Building Permit 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 lnvestigation Fees Microfilm Subtotal Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Fire Safety Surcharge Construciion Unit Tax Water lmpact Water Meter lnstallation Wastewater lmpact Traffic lmpact Total Fees Balance Due RETAIL SHELL BUILDING O x Building X Mechanical MARIGOLD CENTER LLC 111,I E KATELLA AVE ORANGE CA, 92667- C H Q PACIFIC II INC 1111 E KATELLA SUITE 235 ORANGE CA 92667 TOM PHILLIPS FAX 782-8809 FIRST BANK & TRUST M U.B.C. Type V-N 327 Store/Restau ranVTavern Fees nstruction Permit Legal Description CY SLO TR 2133 LT 2 Electrical X Plumbing Sign -Demolition OccupanUBusiness Name Architect/Engineer DONALD PICKEN License #c-5545 Contractor's Phone No. 782-8800 Contractor's State Lic. No. Project Manager's Phone No. 782-BBOO Lender Address Fire! Sprinklers Dwelling Units 24OO MICHELSON IRVINE,CA 92714 053-08't-053 3,374.41 3,253.59 Co 1,978.00 263.67 263.67 263.67 0.00 62.11 276.90 't79.99 0.00 0.00 0.00 0.00 0.00 86.40 Stories 1 X Grading NEC 93 0 Codes: UBC 94 Motel Rooms 0 2,769.O1 484.58 484.58 0.00 760.00 134.00 5,302.00 0.00 13,308.58 0.00 Valuation 6,240 Sq Ft @ $47.40 with A/C Fire Sprinklers $295,776 00 $295,776.00 1 reason: ff /, as owner of the property, or my employees with wages as their sole -ompensation witt do the work and the structure is not intended or offered for sale- Fl 1 as owner of the property, am exclusively contracting with licensed lontractors to construct the proiect. @ 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 ceftified copy hereof fa Certified copy is hereby fumisheci. @ C",tn"a copy is fited with the CitY. L) Not appticable 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE I t ceftify that in the pertormance of the work for which this permit is issued, khall not emptoy any person in any manner so as to become subiect to the Worker's Compensation Laws of California fl Not applicable NOTICE TO APPLICANT: tf, 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- t certify that t have read this application and state that the above information is conect, I agree to compty with alt city ordinances and state laws relating to building construction, and hereby authoize representatives of this city to enter ipon the above-mentioned propefty for inspection purposes- Unless noted under "special Conditions", this permit becomes null and void if work or construction authoized is not started within 180 days, or if construction or work is suspended or abandoned for a peiod of 180 days any time after work is commenced. Special Conditions: Comments: z/z Payment #1 Payment #2 Payment #3 Total Paid 2,695.O2 484 58 10,128.98 13,308.58 12t2297 12122197 oz17t98 Receipt 9917 991 7 0565 Application Number 70958 ApplicationDate 12122197 Permit Number 12273 lssuance Dale 0i,27198 Address File of or Owner Date 7 ,ffi crty o[ san luls oBtspc Buirdins & safetv siu;';e6r*re0 *''3;1;t?#ii?;il"p?;;li'324e-i1aos) 781'7180 Project Address 3860 BROAD Assessor'sParcelNumber 053-081-058 Project Description RETAIL SHELL BUILDING N Permit Type X Building X Mechanical Propedy Owner MARIGOLD CENTER LLC Mailing Address 1111 E KATELLA AVE City/StateZip ORANGE CA, 92667- Legal Description CY SLO TR 2,133 PTN LT 1 X Electrical X Plumbing Sign _Demolition Occupant/Business Name ArchitecVEngineer License # Contractor's Phone No. 782-8800 Coniractor's State Lic. No. 675977 Project Manager's Phone No. 782-gg06 Lender Address 2400 MIgHELSON ;RV;NE,CA 92714 c-5545 Grading DONALD PICKEN Stories 1 Codes: UBC 94 NEC 93 Motel Rooms 0 Contractor Mailing Address City/StateZip Project Manager Lender Name U.B.C. Group Census number Payment #1 Payment #2 C H Q PACIFIC II INC 1111 E KATELLA SUITE 235 ORANGE CA 92667 TOM PHILLIPS FAX 782-8809 FIRST BANK & TRUST M 327 U.B.C. Type V-N Store/Restaurant/Tavern Payments Fire Sprinklers Dwelling Units 0 Valuation Store/Customer Service Fees Building Permit Plumbing Permit Mechanical Permit Electrical Permit Grading Permit s.M.t.P. Energy Surcharge Accessibility Surcharge Demolition Permit Sign Permit Administrative Permit Miscellaneous Charge/Credit lnvestigation Fees Microfilm Subtotal Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Fire Safety Surcharge Construction Unit Tax Water lmpact Water Meter lnstallation Wastewater lmpact Traffic lmpact 5,222.68 5,016.97 Total Fees Balance Due 17,300.86 0.00 12,000 Sq Ft @ $40.64 with A/C Fire Sprinklers reason: ! /, 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. l-l /, as owner of the property, am exclusively contracting with licensed c-ontractors 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 'ceftificate of Workers' Compensation insurance, or a certif,ed copy hereof Ceftified copy is hereby furnished. Certified copy is filed with the City. Not applicable 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE I I cerfily that in the pefformance 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 Worker's Compensation Laws of California fi Not applicable NOTICE TO APPLICANT: lf, after making any of the foregoing declarations, you become subject to any Labor Code or License Law provision, you must comply with such provisions orthis 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 sfafe laws relating to building construction, and hereby authoize 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 authoized is not stafted within 1 80 days, or if construction or work is suspended or abandoned for a peiod of 1 80 days any time after work is commenced. Special Conditions: Comments: $487,680.00 $487,680.00 3,050.05 406.57 406.57 406.57 0.00 102.41 426.98 277.53 0.00 0.00 0.00 0.00 0.00 146.00 4,269.76 747.21 747.21 0.00 785.00 1s7.00 5,392.00 0.00 Amount 5,016.97 12,283.89 Date 11tD4t98 oz17l99 Receipt 4292 5662 Total Paid 17,300.86 Application Number 81030 Permit Number 13246 Application Date 11104198 lssuance Dale 02h7l9g l7- SAddress File Agent or Owner Z ?77 ,W oty o[ san lurs oBrspo Buirdins & safety Division .--r0 Parm stftil#i1Jfi"ff.#1i24e.*€05) 781-71a0 Project Address 3870 BROAD Assessor'sParcelNumber 053-081-058 Legal Description CY SLO TR 2133 PTN LT 1 X Electrical X Plumbing sign _Demolition OccupanUBusiness Name Architect/Engineer DONALD PICKEN License #c-5545 Contractor's Phone No. 792-BBOO Contractor's State Lic. No. 675977 Project Manager's Phone No. 782-8800 Lender Address Fire Sprinklers 24OO MICHELSON IRVINE,CA 92714 Dwelling Units 0 Building Value larations Project Description Permit Type Propedy Owner Mailing Address City/StateZip Contractor Mailing Address City/StateZip Project Manager Lender Name U.B.C. Group Census number Store/Customer Service Building Fermit Plumbing Permit Mechanical Permit Electrical Permit Grading Permii s.M.l.P. Energy Surcharge Accessibility Surcharge Demolition Permit Sign Permit Administrative Permit Miscellaneous Charge/Credit lnvestigation Fees Microfilm Subtotal Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Fire Safety Surcharge Construction Unit Tax Water lmpact Water Meter lnstallation Wastewater lmpact Traffic lmpact Total Fees Balance Due RETAIL SHELL BUILDING M X Building X Mechanical MARIGOLD CENTER LLC 1111 E KATELLAAVE ORANGE C4,92667- C H Q PACIFIC II INC 1111 E KATELLA SUITE 235 ORANGE C492667 TOM PHILLIPS FAX 782.8809 FIRST BANK & TRUST M U.B.C. Type V-N 327 Store/Restaurant/Tavern Fees Grading 94 NEC93Stories 1 Certified copy is hereby furnished. Ceftified copy is filed with the City Not applicable Codes: UBC Motel Rooms 0 2,391 .25 318.7s 318.75 318.75 0.00 76.81 334.75 217.59 0.00 0.00 0.00 0.00 0.00 146.00 Valuation 9,000 Sq Ft @ $40.64 with A/C Fire Sprinklers $365,760.00 Total $36s,760.00 Dec 1. OWNER BUILDING I am exempt from the contractot's License Law for the following reason: ! /, 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 oflered for sale. l-l /, as owner of the propefty, am exclusively contracting with licensed c-o nt ra cto rs t o c o n st ru ct th e p roj e ct. $,Not aPPlicable. 2. WORKER'S COMPENSATION DECLARATION: I hereby affrrm that I have a ceftificate of consent to self-insure, or a 'ceftificate of Workers'Compensation insurance, or a ceftified copy hereof E Total Paid 14,955.77 Application Number 81031 Permit Number 13247 Application Date 11104198 lssuance Date 02117199 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP, INSURANCE I 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 lNorker's Compensation Laws of California @ Not applicable 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 ceftify 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 ofthis 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 authoized is not stafted within 1 80 days, or if construction orwork is suspended or abandoned for a peiod of 180 days any time after work is commenced. Special Conditions: Comments: 4,122.65 3,933.31 3,347.50 585 81 585.8'l 0.00 785.00 137.00 5,392.00 0.00 14,955.77 0.00 Payment #1 Payment #2 Payme Amount 3,933.31 11,022.46 Date 11t04t98 o2117199 Receiot 4292 5662 nts Address File Signature of or 7/t f ru'ry|U clty o[ qan luls oBlsp^ WBuilding&SafetyDivision.990PalmU"3;si[,sti3.fi"ffil?liT*e(805)781-7180 Project Address 3880 BROAD Assessor's Parcel Number Project Description Permit Type Property Owner Mailing Address City/StateiZip Contractor' Mailing Address City/StaieZip Project Manager Lender Name U.B.C. Group Census number Total Fees Balance Due RETAIL SHELL BUILDING L x Building X Mechanical MARIGOLD CENTER LLC 1111 E KATELLAAVE : ORANGE CA,92667- 1111 E KATELLA SUITE 235 ORANGE CA92667 TOM PHILLIPS FAX 782-8809 FIRST BANK& TRUST M U.B.c. Type V-N 327 Store/Restaurant/Tavern Legal Description CY SLO TR 2133 LT 1 Electrical X Plumbing sign _Demolition OccupanVBusiness Name MICHAELS ARTS AND CRAFTS Architect/Engineer DONALD PICKEN License #c-5545 Contractor's Phone No. 782-8800 Contractor's State Lic. No. 675977 Project Manager's Phone No. 782-8800 Lender Address 2400 MTCHELSON IRVINE,CA 92714 X Grading $995,684.00 $995,684.00 Fire Sprinklers Dwelling Units 0 Stories 1 Codes: UBC 94 NEC93 Motel Rooms 0 Valuation Store/Customer Service Fees Building Permit Plumbing Permit Mechanical Permit Electrical Permit Grading Permit s.M.t.P. Energy Surcharge Accessibility Surcharge Demolition Permit Sign Permit Administrative Permit Miscellaneous Charge/Credit lnvestigation Fees Microfilm Subtotal Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Fire Safety Surcharge Construction Unit Tax Water lmpact Water Meter lnstallation Wastewater lmpact Traffic lmpact 21 ,006 Sq Ft @ $47.40 with A,/C Fire Sprinklers Total Bui al Decla lding Value rations 5,291 .20 705.32 705.32 705.32 0.00 209.09 7Q.72 481 .47 0.00 0.00 0.00 0.00 0.00 309.60 OWNER BUILDING TION1. I am exempt from the contractor's License Law for the following reason: ! /, as owner of the propefty, or my employees with wages as their sole compensation will do the work and the structure is not intended or offered for sale. l--'l /, as owner of the property, am exclusively contracting with licensed lontractors to construct the proiect. @ Not applicable. 2. WORKER'S COMPENSATION DEGLARATION: I hereby affirm that t have a ceftificate of consent to seff-insure, or a 'certificate of Workers' Compensation insurance, or a ceftifred copy hereof I Certified copy is hereby furnished- fi C",tifi"d "opy is filed with the City. LJ Not applicable 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE I I cerlify that in the peiormance of the work for which this permit is issued, I shalt not employ any person in any manner so as to become subject to the Workels Compensation Laws of California S Not applicable NOTICE TO APPLICANT: tf , after making any of the foregoing declarations, you become subiect to any Labor Code or License Law provision, you must comply with such provisions orthis permit shall be deemed revoked. I certify that I have read this application and state that the above information is coirrect, I agree to comply with all city ordinances and sfafe laws relating to building construction, and hereby authoize 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 authoized is not stafted within 180 days, or if construction or work is suspended or abandoned for a peiod of 1 80 days any time after work is commenced. Special Conditions: Payment #1 Payment #2 Payments Amount 7,407.16 24,311.54 Receipt 0564 131 I 9,14a.O4 8,703.41 Date 02t17t98 04/1 0/98 7,407.16 1,296.25 1,296.25 0.00 1,570.00 397"00 10,604.00 0.00 31 ,718.70 0.00 Total Paid 31 ,718.70 Application Number 801 07 ApplicationDate OZl17l98 Permit Number 1240'l Address File lssuance Date 04/21l98 Comments: u/zz tt* *W,illU ctty o['tn luls oBtspn WBuildingas"t"tyDivision.9b-6Palmstreet.SanLuisobiSpo,cA934o1-3249.(8b5)781.7180 CONSTRUCTION PERMIT Project Address ?onn RpnAn Assessorrs ParceI Number 053-081-051 Project Description Permit Type Property oHner Mai Iing Address c i tylstate/Zi p Cont ractor Mai I ing Address ci tylstate/Zi p Project Manager Lender Name U.B.C. Group Census number F SANTA CLARA ST STE 1OO VENTURA CA. 93002- L O PACIFIC II INC 111 F KATFI I A SIIITF 235 ??7 cf ^FAlPacf tr rFAnf /TavaFh 60304 05/ 17 /96 Legai Description Architect/Engineer License # Contractor's Phone No pAyMENTS - Amount Date Receipt 8,639.19 05 /2',1 /96 2466 42,509.07 10/31 /96 4660 Contractorts State Lic, No. ToI,I COURTNEY c-13635 782-8800 qn?cq7 -FEES Bui Iding Permit Plumbing Permit MechanicaI Permit. EtectricaI Permit Grading Permit MAPKFT _!_Bui tding _x_Mechanical. X El.ectricat X Ptumbing -sign Demotition MAPINNI N VFNTIIRFS A CA LTD PTP occupant/Busi ness Name voN-s sToRF #306 _Gradi ng cA 92667 JAY AT COURTNEY & ASSOCIANTES Project Managerrs Phone No Ee,l -?,1(n FIRST RANK 8 TRUST Lender Address 2ANO MICHFISON IRVINE CA 92715 U.B.C. Type Itt-N Fire Sprinkl.ers Stories 1 Codes: UBC 94 NEC 93 Dwetting Units 0 VALUAT I ON Store/Customer Service... $ 2,460,000 54,605 sq Ft 2,460,ooo uith Fire Sprinkters and with A/C TotaI Buitding VaIue 2,460,000 s.1{. t.P. Energy Surcharge 1, Accessibi I ity Surcharge Demotition Permit sign Permit Admi ni st rat i ve Mi scel Ianeous Chg/cred Investigation Fees Microfi tm Corments:subtotat 15,373-98 Buitding Ptan Revieu Fee 12,637.24 Fire Safety Plan Review 2,211.52 Ptan Review 14,848.76 Fire Safety Surcharge 2,211.52 Construction Unit Tax 0.00 Water Impact 2,373.00 Llater lleter Installation 422.00 l.laster'rater tmpact 16,0'19.00 Traffic Impact 0.00 TotaI Fee Catcutated 51,248.26 Balance Due 0.00 9 1 1 1 027.25 203.33 203-33 203.33 0 .00 516.60 263.72 821 -t+2 0.00 0.00 0 .00 0.00 0-00 135.00 Apptication Number Application Date Payrnent #1 Payment .#2 Issuance Date 10/3'1195 Total Paid 5'l ,248-26 -- LEGAL DECLARATIONS Permit Number 11195 OWNER BUILDER DECLARATION: I am exempt from ttre contractor's License Law for the following reason: _ I, as owner of the properry, 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. u/ Not applicable WORKERS COMPENSATION DECLARATION: I hereby affirm that I have a certificate ofconsent to self-insure, or'a certificate of Workers' Compensation insurance, or a certified copy hereof (Sec. 3800' t ab. C) _ Certified copy is hereby turnished. y(efified copy is filed with the City. _ Not applicable CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE _ I certiry 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 Laws of California. for applicable NOTICE TO APPLICANT: If, aft?r making any of the tbregoing declarations, you become subject to any Labor Code or License t:w provision, you must comply with such provisions or this permit shall be deemed revoked. I certiry 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 properry 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: 2ft//74 Date Address File Signature of Contractor, Authorized Agent or Owner 'W clty o['an luls oBlsPn Buitding & Safety Division . gVO Palm Street . San Luis Obispo, CA 93401-3249 . 1e-eOS1 Zat-ZteO Property OHner Mai I ing Address city/state/zip cont ractor Mai L ing Address Ci tylstate/Zip Project Manager Lender Name U.B.C. Group Census number Apptication Number Apptication Date MAPTGNIN CFNTFR IIC * 11 ,t F TATFI I A AVF SITITF 205 cF ca 92467 Project Addness ?o?n nDn^n Assessorts Parcet Number 053-081-051 Project Description NEt, RETAIL SToRE BUILDING G,/H/J Permit Type X Buitding -fMechanical X Etectrical CONSTRUCTION PERMIT LegaI Description U-B.C _!_P L umbi ng -S i gn occupant/Business Name Architect/Engineer License # Contractorrs Phone No- Demotition _Gradi ng Contractorts State Lic. No 503557 Project Managerrs Phone No.a1a-996-A28t+ Lender Address 2/*00 M .HFI qNN IPVINF 92715 Type \t!-Jj-t$dnk!S, stories 1 Codes: UBC 94 NEc -lf- Due[ [ ing Units 0 -FEES- Bui lding Permit 1,962-60 Ptumbing Permit 661.51 Mechanical Permit 661 -51 ELectrical Permit 661.51 Grading Permit 0 s-M. I.P. 200 Energy Surcharge 694 Accessibi Iity Surcharge 451 Demotition Permit 0 Sign Permit 0 Administrative 0 Miscet laneous Chg/Cred 0 Investigation Fees 0 Microfi [m 291 subtotat 8,586.29 BuiLding P[an Review Fee 6,947 Fire safety Ptan ReView 1,215 Pl.an Review 8,162.88 Fire Safety Surcharge Construction Unit Tax blater Impact t"later Meter Instattation tlastewater Impact Traffic Impact TotaI Fee CaIcutated Batance Due NOTICE TO APPLICANT: If, after making any of the foregoing declarations, you become subject to any Labor Code or License Law provision, you must comply with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above information is correct, I agree to comply with all city ordinmces and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned properry for inspeceion purposes. Unless noted under "special Conditions", ttlis permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspeuded or abandoned for a period of 180 days any time after work is commenced' Special Conditions: N DANIFI I INC NON PICKFN C - 55/.5 782-8R00cCI VALUAT ION Store/Customer Service.$ 957,099 25,710 sq Ft 957,099 with Fire Sprinkters and with A/C Total Buitding Vatue 957,099 Corments: DOES NOT INCLUDE SCHOOL FEES, IMPACT FEES IF APPLICABLE, PLANNING 0R PUBLIC TJORKS FEES. 1111 E KATELLA SUITE 235 cA 92657 nnN PI CTFN FI ST BANK & TRUST M ?27 Qt^ralPeetarrnant /Tavenn 60571 08/20/96 00 99 71 56 00 00 00 00 00 90 13 75 215.75 0.00 520 _ 00 384.00 26?.O0 0. 00 130-92 0 .00 Payment #1 Payrnent #2 Amount Date Receipt 9,255.69 08/?0/96 3659 20,875 -32 10/31 /96 4662 1, 1, 10, 30,Permit Number 11193 Issuance Date 10/3'l/96 Total Paid 30'130-92-------*-_ LEGAL DECLARAT IgiI5 OWNER BUILDER DECLARATION: I am exempt from the contractor's License Law for the following reason: _ l, 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. _ l, as owner of the property, am exclusively contracting with licensed contractors to con$ruct the project. y'Not applicable WORKERS COMPENSATION DECLARATION: I hereby affirm that I have a certificate ofconsent to self-insure, or 'a certificate of Workers' Compensation insurance, or a certified copy hereof (Sec. 3800' Lab. C) _ Cgrtified copy is hereby furnished. VCefiifieA 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 mirnner so as to become subject to the worker's compensation Lawsd California /Not applicable Signailre of Conftactor,Asent or Owner Date Address File ,W clty o[ qan luls oBlsp^ Building & Safety Division .9s0 Palm Street . San Luis Obispo, CA 93401-3249 .'805) 781-7180 Project Address 3940 BROAD Assessor's Parcel Number Project Description Permit Type Property Owner Mailing Address City/StateZip Contractor Mailing Address City/State/Zip Project Manager Lender Name U.B"C. Group Census number Store/Customer Service Building Permit Plumbing Permit Mechanical Permit Electrical Perrnit Grading Permit s.M.l.P. Energy Surcharge Accessibility Surcharge Demolition Permit Sign Permit Administrative Permit Miscellaneous Charge/Credit lnvestigation Fees Microfilm Subtotal Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Fire Safety Surcharge Construction Unit Tax Water lmpact Water Meter lnstallation Wastewater lmpact Traffic lmpact Total Fees Balance Due RETAIL SHELL BUILDING F x Building X Mechanical MARIGOLD CENTER, LLC 111 E. KATELLAAVENUE, SUITE 2 ORANGE CA, 92867- cHoPAC|F|ClllNC 1111 E KATELLA SUITE 235 ORANGE CA 92667 TOM PHILLIPS FAX 782.8809 FIRST BANK & TRUST M U.B.C. Type V-N 327 Store/Restaurant/Tavern Fees Construction Perm it Legal Description X Electrical X Plumbing OccupanUBusiness Name Architect/Engineer License # Contractois Phone No. Sign _Demolition _Grading DONALD PICKEN c-5545 782-8800 Contractor's State Lic. No. 503557 Project Manager's Phone No. 782-8800 Lender Address Fire Sprinklers Dwelling Units 24OO MICHELSON IRVINE,CA 92714 Stories I Codes: UBC Motel Rooms 94 NEC93 0 0 Valuation Total Paid 15,828.24 Application Number 70176 Permit Number 11768 Application Date O3/14/g7 lssuance Dale O7l21lg7 9,920 Sq Ft @ $45.50 with A./C Fire Sprinklers reason: n 1 "" owner of the property, or my employees with wages as their sole mmpensation will do the work and the structure is not intended or offered for sale. l-l /, as owner of the property, am exclusively contracting with licensed c-o ntya cto rs to c o n st ru ct th e p roj e ct. fi Not appticable. 2. WORKER'S COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to seff-insure, or a 'ceftificate of Workers' Compensation insurance, or a cefttfied copy hereof V certifred copy is hereby furnished. ffi"nn"a "opy isfiled with the City. L) Not applicable 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE I I certify that in the pertormance 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 Workels Compensation Laws of California @ftot applicable NOTICE TO APPLICANT: tf, 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. t certify that I have read this application and state that the above information is correct, I agree to compty 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 authoized is not stafted within 180 days, or if construction or work is suspended or abandoned for a peiod of 1 80 days any time after work is commenced. Special Conditions: $451 ,360.00 $45'l ,360.00 2,72s.1o 362.99 362.99 362.99 0.00 94.79 381 .21 247.78 0.00 0.00 0.00 0.00 0.00 125.10 4,660.95 4,479.18 3,812.O7 667.11 667.11 0.00 760.00 130.00 5,131 .00 0.00 15,828.24 0.00 Payment #1 Payment #2 Payme Amount 4,479.18 11,349.06 Date 03t18197 07t21t97 Receiot 6326 7984 nts Address File Comments: or ?/zr/?? ,M ctty oF can luls oBtspn Building & Safety Division .990 Project Address 3960 BROAD Assessorrs ParceI Number 053-081-051 Project Description NFU SAV-NN DRIIG STORE Palm Street . San Luis Obispo, CA 93401-3,2-49 CONSTRUCTION PERMIT . (bb5) 781-7180 _Gradi ng HFRBFT NADEL -feeS- Buitding Permit 4,131.75 Plumbing Penmit 550-76 Mechanical Permit 550.76 Etectrical Permit 550.76 Grading Permit 0.00 s.M. I.P. 161.02 Energy Surcharge 578.40 Accessibi Iity Surcharge 375.96 Demotition Permit 0.00 Sign Permit 0.00 Administrative 0.00 Miscel laneous Chg/Cred 0.00 Investigation Fees 0-00 Microfi [m 368.35 subtotal 7,267 -76 Buitding Ptan Review Fee 5,784.03 Fire Safety Ptan Review 1,012.21 Ptan Revielr 6,796.24 Fire Safety Surcharge 1,012.21 construction Unit Tax 0.00 Ltater Impact 1,520-00 I'later Meter lnsta[ [ation 384.00 trasteHater Impact 10,262.00 Traffic Impact 0-00 TotaI Fee Calcutated 27,242.21 Balance Due 0-00 Permit Type Property owner Mai L ing Address Ci tylstate/Zi p Cont ractor Mai Iing Address Ci ty,/State/Zi p Project Manager Lender Name U.B.C. Group Census number Appt ication Number Apptication Date IGOLD CENTER X Bui Lding X Mechanicat LLC * 1111 E- LATELLA AVE SUITE 235 cE_ cA 92a67 C I] O PACIFIC II INC 1111 F rATF| A SI|ITF 2i5 NRANGF EA 92567 IN PATEL AT NADEL PARTNERS FIRST RANK AND TRUST M U.B.C ?27 ct^F6lD6ci.r rrtht /T^\raFh 60839 't2/05/96 LegaI Description X Etectrical. -LPl.umbing -Sign Demolition occupant/Bus i ness Name SAV-ON #3152 C-567+ contractorrs Phone No 782-8800 Contractor's State Lic. No 5ni557 Project Manager's Phone No.31 0-826-21 00 Lender Address 24NN MICHFISON IRVINE- CA Type V-N Fire Sprinkl,ers Stories 1 Codes: UBC 91 NEc 93 Dwetting Units 0 Architect/Engineer License # PAYMENTS - Amount Date Receipt 6,796.24 12/05/95 5063 1,667 -18',12/05/96 5063 18,778.79 02/25/97 6016 store/Customer Servi ce. with Fire Sprinkters and with A/C Corments: VALUAT I ON . 15,852 Sq Ft a $ 45.50 766,766 Total Buitding Vatue 766,766 Issuance Date 02/25/97 Total Paid 27,242.21 LEGAL DECLARATIgN5 Payment #1 Payment #2 Payrnent #3 Permit Number 11t+12 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 md 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. Z1 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 cenified copy hereof (Sec. 3800, Lab. C) _ Certified copy is hereby furnished. 4(Certifielcopy 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 mirnner so as to become subject to the Worker's 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 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 ifconstruction or work is suspended or abandoned for a period of 180 days any time after work is corunenced. Special Conditions: 2/25/7?z:t2 Signature of Contractor Agent or Owner Date Address File Ml]]]]lllU clty o[ qan luls oBlsp^ WBuilding&SafetyDiVision.9YoPalmaffiil[fffi"fl"';il-i.fo'.(€ios1zat.zeo Project Address 3970 BROAD Assessor's Parcel Number Project Description Permit Type Property Owner Mailing Address City/StateZip Contractor Mailing Address City/Statezip Project Manager Lender Name U.B.C. Group Census number Store/Customer Service Building Permit Plumbing Permit Mechanical Permit Electrical Permit Grading Permit s.M.l.P. Energy Surcharge Accessibility Surcharge Demolition Permit Sign Permit Administrative Permit Miscellaneous Charge/Credit lnvestigation Fees Microfilm Subtotal Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Fire Safety Surcharge Construction Unit Tax Water lmpact Water Meter lnstallation Wastewater lmpact Traffic lmpact Total Fees Balance Due RETAIL SHELL BUILDING D x Building X Mechanical MARIGOLD CENTER, LLC 1 1 1 E. KATELLA AVENUE, SUITE 2 ORANGE CA,92867- CHQPACIFICIIINC 1111 E KATELLA SUITE 235 ORANGE CA 92667 TOM PHILLIPS FAX 782-8809 FIRST BANK& TRUST U.ts.C. Type V-N Store/Restaurant/Tavern Fees 053-081-05'1 3,154.46 2,996.72 Date 03t18t97 07t21t97 X Legal Description Electrical x Plumbing sign -Demolition -Grading Occupant/Business Name Architect/Engineer DONALD PICKEN License #c-5545 Contractor's Phone No. 782-8800 Contractor's State Lic. Itlo. Project Manager's Phone No. 782-8800 Lender Address Fire Sprinklers Dwelling Units 24OO MICHELSON IRVINE,CA 92714 M 327 Stories 1 Codes: UBC Motel Rooms 94 NEC93 0 0 Valuation 6,085 Sq Ft @ $45.50 witn A/C Fire Sprinklers reason: ! /, 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. l--'l /, as owner of the property, am exclusively contracting with licensed lontractors to construct the proiect. lfNot applicable. 2. WORKER'S COMPENSATION DECLARATION: I hereby affirm that t have a certifrcate of consent to self insure, or a 'certificate of Workers' Compensation insurance, or a cettified copy hereof V Ceftifred copy is hereby furnished. ffC",tinra copy is fited with the CitY. l) Not appticable 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE I t ceftify that in the performance of the work forwhich this permit is issued, I shatt not emptoy any person in any manner so as to become subiect to the Workys Compensation Laws of California @flot applicable NOTICE TO APPLICANT: If, 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 ceftify that t have read this application and state that the above information is correct, I agree to compty with all city ordinances and state laws relating to buitding construction, and hereby authoize representatives of this city to enter ipon the above-mentioned property for inspection purposes. Unless noted under "special Conditions", this permit becomes null and void if work or construction authoized is not stafted within 1 80 days, or if construction' or work is suspended or abandoned for a peiod of 1 80 days any time after work is commenced. Special Conditions: Comments: $276,868.00 $276,868.00 1,821 .85 242.85 242.85 242.85 0.00 58.1 4 255.O4 '165.78 0.00 0.00 0.00 0.00 0.00 125.10 2,550.40 446.32 446.32 0.00 760.00 130.00 5,131 .00 0.00 12,618.50 0.00 Payment #1 Payment #2 Payments Amount 2,996.72 9,621 .78 Receipt 6326 7984 Total Paid 12,618.50 Application Number 70177 ApplicationDate 03118197 Permit Number 11769 lssuance Dale 07121197 Address File =?z4t- or ?/zr/7? *Ml]l]]lllru clty o[ qan luls oBlsp^ WBuilding&SafetyDivision.bgoPalmffiilffifi3.tri."TllllTa9.l805)781-718o Project Address 3980 BROAD Assessor's Parcel Number Project Description Permit Type Property Owner Mailing Address City/StateZip Contractor Mailing Address City/StateZip Project Manager Lender Name U.B.C. Group Census number Total Fees Balance Due NEW RESTAURANT x Building X Mechanical MARIGOLD CENTER, LLC - 1'I'11E. KATELLA SUITE 235 ORANGE, CA 92867 OWNER TOM PHILLIPS A-3 U.B.C. Type V-N 327 Store/RestauranUTavern 3,093.11 2,683.29 Legal Description Electrical X Plumbing _sign OccupanVBusiness Name CARt'S JR ArchitecVEngineer H. CYRUS JALLALI License #c-22382 Contractor's Phone No. Contractor's State Lic. No. Project Manager's Phone No. 782-8800 l-ender Address Fire Sprinklers Demolition _GradingX Stories 1 Codes: UBC Motel Rooms 0 94 NEC93 Dwelling Units o Valuation Restaurant 240,000 3,035 Sq Ft @ Fees Building Permit Plumbing Permit Mechanical Permit Electrical Permit Grading Permit s.M.t.P. Energy Surcharge Accessibility Surcharge Demolition Permit Sign Permit Administrative Permit Miscellaneous Charge/Credit lnvestigation Fees Microfilrn Subtotal Building Plan Review Fee Fire Safety Plan Review Flan Review Subtotal Fire Safety Surcharge Construction Unit Tax Water lmpact Water Meter lnstallation Wastewater lmpact Traffic lmpact 1 1,631 .30 217.45 217.45 217.45 0.00 50.40 22A.37 148.44 0.00 0.00 0.00 0.00 0.00 382.25 with A/C Fire Sprinklers $240,000.00 $240,000.00 reason: I 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 owner of the propefty, am exclusively contiacting with licensed to construct the project. Q Not applicable. 2, WORKER'S COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to seff-insure, or a 'ceftificate of Workers' Compensation insurance, or a certfied copy hereof I Certnea copy is hereby tumished. l) Certified copy is filed with the City. lA Not applicabte 3. CERTIFIGATE OF EXEMPTIOI! FROM WORKERS COMP.INSURANCE f I certify that in the pertormance 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 Workels Compensation Laws of California @ Not appticabte NOTICE TO APPLICANT: lf, after making any of the foregoing declarations, you become subject to any Labor Code or License Law provision, you must comply with such provisions orthis permit shall be deemed revoked. t c;ertify that I have read this application and state that the above information is conect, I agree to comply with all city ordinances and sfafe /aws relating to building construction, and hereby authoize 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 authoized is not stafted within 180 days, or if construction or work is suspended or abandoned for a peiod of 1 80 days any time after work is commenced. Special Conditions: 2,283.65 399.64 399.64 0.00 1,520.00 384.00 10,262.00 0.00 't8,342.O4 0.00 Payments Payment #1 Payment #2 Amount 2,683.29 15,658.75 Date 01to9t97 o5t23t97 Rece!pt 5447 7265 Total Paid 18,342.04 Application Number 700{ 8 ApplicationDate O1lO9l97 Permit Number 11629 Address File lssuance Date 05123197 Comments: or Owner 7