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1039 Murray Suite 200 - Permit copiesIlCy f san Building & Safety Division • 919 G®R$trM0inOMiJ3401-3218 tuis ow * ap • (805) 781-7180_ Project Address 1039 MURRAY 200 Assessor's Parcel Number 001-034-004 Legal Description CY SLO PM 73/78-81 2ND FLR PTN PAR 1 Project DescriptionTl FOR DR.EIBSCHUTZ Permit Type X Building X Mechanical X Electrical X Plumbing Sign Demolition Grading Property Owner 1039 MURRAY STREET LLC Occupant/Business Name ERNIE KIM ARCHITECT Mailing Address 1039 MURRAY AVE STE 200 Architect/Engineer City/State/Zip SLO CA, 93405-1805 License # Contractor BENSON DEVELOPMENT INC Contractor's Phone No. 805-440-6729 Mailing Address 1365 CAZADERO Contractor's State Lic. No. 802117 City/State/Zip SAN LUIS OBISPO CA 93401 Project Manager ERNIE KIM Project Manager's Phone No. 441-3128 Lender Name Lender Address C.B.C. Group C.B.C. TypeV-B Fire Sprinklers Stories 0 Codes: CBC10 CEC10 _B Census 437 Commercial Alteration or Addition Dwelling nlj-ttsb Motel Rooms 0 Valuation Non -Residential Alteration 20,000 478 Sq Ft @ with A/C Fire Sprinklers $20,000.00 Fees Building Permit Plumbing+Electrical+Mechanical Permit Grading Permit S.M.I.P. Green Building Fee Demolition Permit Sign Permit Misc Charge/Credit 0.00 Administrative Permit Archival Fee Subtotal Investigation Fees Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal Development Review Fee Fire Safety Surcharge Fire Systems Fire Sur/Sys Subtotal Construction Unit Tax Water Impact 0.00 Area - Water Meter Installation Wastewater Impact 0.00 Area - Traffic Impact 0.00 Area - Affordable Housing Public Art Code Enforcement Park Improvement Area - Engineering Development Review Fee Open Space In -lieu Fee Total Fees Balance Due 658.20 1,035.18 140.40 653.00 0.00 0.00 4.20 1.00 0.00 0.00 0.00 0.00 0.00 852.00 183.18 662.20 140.40 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,495.98 0.00 Payments Amount Date Receiot Payment #1 852.00 07/16/13 61470 Payment#2 1,643.98 09/18/13 62306 Total Paid 2,495.98 Application Number130684 Permit Number 27572 Application Date 07/16/13 Issuance Date 09/19/13 Total Building Value $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: BENSON DEVELOPMENT Class: B License #: 802117 3a(3) - WORKERS' COMPENSATION DECLARATION - 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 , 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: Address File f, SiPoRure of Contractor, Authorga Ag4Qt or Owner D city e" Sala to1S owco Building & Safety Division • 919 PGomtruetisnbR@mrk401-3218 • (805) 781-7180 Project Address 1039 MURRAY Assessor's Parcel Number 001-034-002 Project Description SEWER BACKFLOW PREVENTER Legal Description CY SLO PM 73/78-81 PAR 1 COMMON AREA Permit Type Building Mechanical Electrical X Plumbing Sign Demolition Grading Property Owner COMMON AREA OWNERS Occupant/Business Name Mailing Address UNKNOWN Architect/Engineer City/State/Zip SLO CA, 99999- License # Contractor ED CRYE & SON EXCAVATING Contractor's Phone No. 772-7457 Mailing Address 1170 QUINTANA RD Contractor's State Lic. No. 409263 City/State/Zip MORRO BAY CA 93442 Project Manager Project Manager's Phone No. Lender Name Lender Address C.B.C. Group C.B.C. Type Stories 1 Codes: CBC10 CEC10 Census Dwelling Umts Motel Rooms 0 Valuation Fees Total Building Value $0.00 Building Permit 0.00 Legal Declarations Plumbing+Electrical+Mechanical Permit 0.00 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 215.00 Archival Fee 0.00 Contractor: ED CRYE &SON Class: A License #:409263 Subtotal 215.00 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(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: STATE FUND Policy #:044-0007173 Expires 10/01/13 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 215.00 Balance Due 0.00 Payments Fee Exemptions: Amount Date Receipt Payment #1 215.00 03/15/13 59885 Comments: Total Paid 215.00 Application Number130276 Permit Number 27035 Application Date 03/15/13 Issuance Date 03/15/13 Address File OQ 3 --l' b_ ) 3 or 41HAL �� y �_ f san tuis ow) - aiiBuilding & Safety Division • 911m�1yis�5 93401-3218 • (805) 781-7180 Project Address 1039 MURRAY Assessor's Parcel Number 001-034-002 Legal Description CY SLO PM 73/78-81 PAR 1 COMMON AREA Project DescriptionTl DR. GHOLIAN (DENTAL OFFICE) Permit Type X Building X Mechanical X Electrical X Plumbing Sign Demolition Grading Property Owner COMMON AREA OWNERS Occupant/Business Name Mailing Address UNKNOWN Architect/Engineer City/State/Zip SLO CA, 99999- License # Contractor MIDLAND CONTRACTORS Contractor's Phone No. 818/783-3874 Mailing Address P.O. BOX 16778 Contractor's State Lic. No. 719159 City/State/Zip ENCINO CA 91416 Project Manager SHAWN RIDENHOUR Project Manager's Phone No. 543-1794 Lender Name Lender Address C.B C. Group B C.B.C. Type V-B Fire Sprinklers Stories 0 Codes: CBC10 CEC10 Census 437 Commercial Alteration or Addition Dwelling Units 0 Motel Rooms 0 Valuation Non -Residential Alteration 100,000 2,069 Sq Ft @ with A/C Fire Sprinklers $100,000 00 Total Building Value $100,000 00 Fees Legal Declarations Building Permit 1,363.74 g Plumbing+Electrical+Mechanical Permit 0.00 2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION Grading Permit 0.00 S.M.I. P. 21.00 Green Building Fee 4.00 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 261.00Administrative Permit 0.00 Archival Fee 0.00 Subtotal Contractor: MIDLAND Class: A. B, C10, C36, License #: 719159 1,649.74 Investigation Fees 0.00 Building Plan Review Fee 1,685.26 Fire Safety Plan Review 362.33 Plan Review Subtotal 2,047.59 Development Review Fee 1,341.56 Fire Safety Surcharge 293.20 3a(2) - WORKERS' COMPENSATION DECLARATION - I have and will maintain Fire Systems 0.00 workers' compensation insurance Fire Sur/Sys Subtotal 293.20 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 000 this permit is issued. My workers' compensation insurance carrier and policy number are: Wastewater Impact 0.00 Area 0.00 Carrier: STATE COMP FUND Policy#:1957505 Expires 01/01/13 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 457.35 Open Space In -lieu Fee 0.00 Total Fees 5,789.44 Balance Due 0.00 Payments Fee Exemptions: Amount Date Receipt Payment #1 50000 10/05/12 57958 Payment #2 5,289.44 12/04/12 58637 Comments: Total Paid 5,789.44 stormwater Application Number120824 Permit Number 26807 Application Date 10/05/12 Issuance Date 12/06/12 Address File nt or Owner / 211 /z city of sari tuis oBi s;)o B Wilding & Saf .tv Division • 919 QKDfkretrLWAiIIDQ rMi43401-3218 • (805) 781-7180 Project Address 1039 MURRAY 100 Assessor's Parcel Number 001-034-003 Legal Description CY SLO PM 73/78-81 1ST FLR PTN PAR 1 Project DescriptionT.l FOR PACIF€C DIAGNOSTICS LAB Permit Type X Building X Mechanical X Electrical X Plumbing Sign Demolition Grading Property Owner 1039 MURRAY STREET LLC Occupant/Business Name Mailing Address 1039 MURRAY AVE STE 200 Architect/Engineer City/State/Zip SLO CA, 93405-1805 License # Contractor DC DESIGN & CONSTRUCTION Contractor's Phone No. 801-4400 Mailing Address 4251 S. HIGUERA SUITE 900 Contractor's State Lic. No. 887341 City/State/Zip SAN LUIS OBISPO CA 93401 Project Manager PAT BLOTE Project Manager's Phone No. 543-1794 Lender Name Lender Address C B.C. Group B C.B.C. TypeV-B Fire Sprinklers Stories 0 Codes: CBC10 CEC 10 Census 437 Commercial Alteration or Addition Dwelling n1�0 Motel Rooms 0 Non -Residential Alteration Building Permit Fees Plum bing+Electrical+Mechanical Permit Grading Permit S.M.I.P. Green Building Fee Demolition Permit Sign Permit Misc Charge/Credit 0.00 Administrative Permit Archival Fee Subtotal 856.12 Investigation Fees Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal 1,298.77 Development Review Fee Fire Safety Surcharge Fire Systems Fire Sur/Sys Subtotal 213.04 Construction Unit Tax Water Impact 0.00 Area - Water Meter Installation Wastewater Impact 0.00 Area - Traffic Impact 0.00 Area - Affordable Housing Public Art Code Enforcement Park Improvement Area - Engineering Development Review Fee Open Space In -lieu Fee Total Fees Balance Due 850.92 0.00 0.00 4.20 1.00 0.00 0.00 0.00 0.00 0.00 1,093.72 205.05 855.64 213.04 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,223.57 0.00 Valuation 20,000 1,018 Sq Ft @ with A/C Fire Sprinklers $20,000.00 Total Building Value $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: DC DESIGN & Class: B License #: 887341 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 COMP FUND Policy #:1196191 Expires 05/01/12 Payments Amount Fee Exemptions' Date Receipt Payment #1 500.00 03/06/12 55191 Payment #2 2,723.57 04/06/12 55616 Comments: Total Paid 3,223.57 Application Number120186 Permit Number 26238 Application Date 03/06/12 Issuance Date 04/06/12 Address File Agent or Owner -&'aol, city of san Building &Safety Division • 919 PaSidiMi31501-3218 tuis oB i s �.. o • (805) 781 7180 Project Address 1039 MURRAY 200 Assessor's Parcel Number 001-031-022 Legal Description CY SLO ISABEL TR LTS 4 & 5 PTN LT 3 Project DescriptionTl @ SECOND FLOOR, CENTER WEST - Permit Type X Building X Mechanical X Electrical X Plumbing Sign Demolition Grading Property Owner CENTER WEST MANAGEMENT Occupant/Business Name Mailing Address 1039 MURRAY SUITE 200 Architect/Engineer City/State/Zip SLO CA, 93405 License # Contractor DC DESIGN & CONSTRUCTION Contractor's Phone No. 801-4400 Mailing Address 4251 S. HIGUERA SUITE 900 Contractor's State Lic. No. 887341 City/State/Zip SAN LUIS OBISPO CA 93401 Project Manager BRAD/ PAT BLOTE Project Manager's Phone No. B 801-4400 Lender Name Lender Address C.B.0 Group B C.B.C. Type V-B Fire Sprinklers Stories 0 Codes: CBC07 CEC07 Census 437 Commercial Alteration or Addition Dwelling nl nits 0 Motel Rooms 0 Valuation Non -Residential Alteration 60,000 2,771 Sq Ft @ with A/C Fire Sprinklers $60,000.00 Building Permit Fees Plumbing+Electrical+Mechanical Permit Grading Permit S.M.I.P. Green Building Fee Demolition Permit Sign Permit Misc Charge/Credit 0.00 Administrative Permit Archival Fee Subtotal 2,631.18 Investigation Fees Building Plan Review Fee Fire Safety Plan Review Plan Review Subtotal 3,622.11 Development Review Fee Fire Safety Surcharge Fire Systems Fire Sur/Sys Subtotal Construction Unit Tax Water Impact 0.00 Area - Water Meter Installation Wastewater Impact 0.00 Area - Traffic Impact 0.00 Area - Affordable Housing Public Art Code Enforcement Park Improvement Area - Engineering Development Review Fee Open Space In -lieu Fee Total Fees Balance Due 562.35 2,615.58 0.00 0.00 12.60 3.00 0.00 0.00 0.00 0.00 0.00 2,981.16 640.95 2,462.57 562.35 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9,278.21 0.00 Total Building Value $60,000.00 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: DC DESIGN & Class: B License #: 887341 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 COMP FUND Policy #:1196191 Expires 05/01/11 Payments Amount Fee Exemptions: Date Receipt Payment #1 3,857.00 08/09/10 48115 Payment #2 5,421.21 10/01/10 48803 Comments: Total Paid 9,278.21 Application Number100663 Permit Number 24981 Application Date 08/09/10 Issuance Date 10/08/10 Address File aw of ;are I.-:" `�� Buildina & Safetv Division tors oBisvo - • Project Address 1041 MURRAY A Assessor's Parcel Number Legal Description Project Description DEMOLISH OFFICE BLDG Permit Type Building Mechanical Electrical __ Plumbing Sign X Demolition Grading Property Owner MURRAY MEDICAL CENTER LLC A CA LLC Occupant/Business Name CENTRAL COAST SLEEP LAP Mailing Address 1715 ALTA ST Architect/Engineer City/State/Zip SLO CA, 93401-3004 License # Contractor OWNER Contractor's Phone No. Mailing Address Contractor's State Lic. No. OWNER City/State/Zip Project Manager KELLI Project Manager's Phone No. 544-6870x207 Lender Name Lender Address C.B.C. Group B U.B.C. Type V-N Stories 0 Codes: CBC CEC_ Census 649 Demolish Non -Residential Building Units DemolisFedb _ Motel Rooms 0 Fees Building Permit 0.00 Plumbing+Electrical+Mechanical Permit 0.00 Grading Permit 0.00 S.M.I.P. 0.00 Energy Surcharge 0.00 Accessibility Surcharge 0.00 Demolition Permit 72.55 Sign Permit 0.00 Misc Charge/Credit 0.00 Administrative Permit 0.00 Archival Fee 0.00 Subtotal 72.55 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 Construction Unit Tax 0.00 Water Impact 0.00 Area - 0.00 Water Meter Installation 0.00 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 Plan Preparation Fee 0.00 Open Space In -lieu Fee 0.00 Total Fees 72.55 Balance Due Payments 0.00 Amount Date Receipt Payment #1 72.55 12/12/06 30022 Total Paid 72.55 Application Number061127 Permit Number 22929 Application Date 12/12/06 Issuance Date 04/15/08 Valuation $0.00 Total Building Value $0.00 Legal Declarations 1. OWNER BUILDING DECLARATION: (Ts -exempt tram the contractor's License Law for the fallowing reason: 1, as owner of the property, or my employees with wages as their sole co ensation 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. of 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 Worker's Compensation Laws of California Not applicable OT10E 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. Fee Exemptions: Comments: Address File U U& q _ 15.0 6 Signature of Contractor. Authon ent or Owner Date city of ir"- an WIS 0131 Spy, Building & Safety Division • 990 Palm Street • San Luis Obispo, CA 93401-3249 • (805) 781-7180 CONSTRUCTION PERMIT Project Address 1041 MURRAY A Assessor's Parcel Number 001-031-022 Project Description ONE WALL MOUNTED NON -ELECTRIC SIGN Permit Type _Building _Mechanical _ELectrical Property Owner CARLSSON JUDITH S THE ETAL Mailing Address %1345 BROAD City/State/Zip SLO CA. 93401- _ Contractor THE SIGN PLACE Mailing Address 3121 SOUTH HIGUERA SUITE E City/State/Zip SAN LUIS OBISPO CA 93401 Project Manager SARA TRAMMELL Lender Name U.B.C. Group U.B.C. Type _ Census number VALUATION Legal Description CY SLO ISABEL TR LTS 4 & 5 PTN LT 3 _Plumbing X Sign _Demolition Grading Occupant/Business Name HALON, DR. Pli.D. Architect/Engineer License # Contractor's Phone No. 545-9609 Contractor's State Lic. No. 636419 Project Manager's Phone No. 543-2913 Lender Address Stories 0 Codes: UBC 94 NEC 93 Dwelling Units 0 FEES Building Permit 0.00 Plumbing Permit 0.00 Mechanical Permit 0.00 Electrical Permit 0.00 Grading Permit 0.00 S.M.I.P. 0.00 Energy Surcharge 0.00 Accessibility Surcharge 0.00 Demolition Permit 0.00 Sign Permit 55.45 Administrative 0.00 Miscellaneous Chg/Cred 0.00 Investigation Fees 0.00 Microfilm 0.00 Comments: Subtotal 55.45 Building Plan Review Fee 0.00 Fire Safety Plan Review 0.00 Plan Review 0.00 Fire Safety Surcharge DAD PAYMENTS Construction Unit Tax 0.00 Application Number 60633 Amount Date Receipt Water Impact 0.00 Application Date 09/16/96 Payment #1 55.45 09/16/96 4006 Water Meter Installation 0.00 Wastewater Impact 0.00 Traffic Impact 0.00 Permit Number 11100 Total Fee Calculated 55.45 Issuance Date 09/16/96 Total Paid 55.45 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. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. L,4 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) _ Certified copy is hereby furnished. _ Certified copy is filed with the City. 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. 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: CERTIFICATE OF EXEMPTION FROM WORKERS COMP. [NSURANCE _!fi'a;ertify that in the performance of the work for which this permit is issued, 1 sh �—� employ any person in any manner so as to become subject to the Worker's Compensation C) Laws of California, Not applicable Signatur Cnntraetor, Authorized Agent or Owner Date Address File city of ;are tuis ot5isr o BuildinQ & Safet Division • 919 P L9 r{ i~ i 01-3218 • 805 781-7180 Project Address 1039 MURRAY Assessor's Parcel Number 001-031-022 Legal Description CY SLO ISABEL TR LTS 4 & 5 PTN LT 3 Project Description LANDSCAPE WATER METER AND WORK ORDER Permit Type Building Mechanical Property Owner MITCHELL JOHN R THE ETAL Mailing Address 3211 BROAD ST STE 205 City/State/Zip SLO CA, 93401-6770 Contractor OWNER Mailing Address City/State/Zip Project Manager JOHN Lender Name C.B.C. Group C.B.C. Type Census Fees Building Permit 0.00 Plumbing+Electrical+Mechanical Permit 6.00 Grading Permit 0.00 S.M.I.P. 0.00 Green Building Fee 0.00 Energy Surcharge 0.00 Accessibility Surcharge 0.00 Demolition Permit 0.00 Sign Permit 0.00 Misc Charge/Credit 0.00 Administrative Permit 34.00 Archival Fee 0.00 Subtotal 40.00 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 Construction Unit Tax 0.00 Water Impact 0.00 Area - 0.00 Water Meter Installation 216.00 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 Total Fees 256.00 Balance Due payments 0.00 Amount Date Receipt Payment #1 256.00 06/17/09 42993 Total Paid 256.00 Application Number090471 Permit Number 23916 Application Date 06/17/09 Address File Issuance Date 06/17/09 Electrical _x_ Plumbing Occupant/Business Name Architect/Engineer License # Contractor's Phone No. Contractor's State Lie. No. OWNER Sign Demolition Grading Project Manager's Phone No. 459-4250 Lender Address Valuation Stories 1 Codes: CBC07 CEC07 Dwelling nljRETO Motel Rooms Total Building Value $0.00 Legal Declarations 2b(2) - OWNER -BUILDER'S DECLARATION - I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. 3a NOT SPECIFIED Fee Exemptions: Comments: city of ;an Luis osisK D Project Address 1039 MURRAY Assessor's Parcel Number 001-031-022 Legal Description CY SLO ISABEL TR LTS 4 & 5 PTN LT 3 Project Description NEW MEDICAL OFFICE 1UILDING Permit Type X Building X Mechanical X Electrical X Plumbing Sign Demolition Grading Property Owner MURRAY MEDICAL CENTER LLC A CA LLC Occupant/Business Name DR. ADAM JANETTE CELL 550-0465 Mailing Address 1715 ALTA ST Architect/Engineer STEVEN D. STEWART City/State/Zip SLO CA, 93401-3004 License # C-14746 Contractor DAVID SCARRY CONST INC Contractor's Phone No. 544-6870 Mailing Address 1130 GROVE Contractor's State Lic. No. 757351 City/State/Zip SAN LUIS OBISPO CA 93401 Project Manager STEVEN STEWART Project Manager's Phone No. 545-9042 Lender Name Lender Address C.B.C. Group B U.B.C. TypeV-N Fire Sprinklers Stories 2 Codes: CBC01 CEC04 Census 324 Office Suitding Dwelling nl] its-b Motel Rooms 0 Valuation Offices 8,415 Sq Ft @ $102.30 with A/C Fire Sprinklers $860,855.00 Offices -2,480 Sq Ft @ $0.00 Residence -658 Sq Ft @ $0.00 Fees Total Building Value $860,855.00 Building Permit Legal Declarations 5,826.45 1. OWNER BUILDING DECLARATION: Plumbing+Electrical+Mechanical Permit 2,330.79 1 am exempt from the contractor's License Law for the following reason: Grading Permit 0.00 ❑ 1, as owner of the property, or my employees with wages as their sole S. M.I. P. 180.78 compensation will do the work and the structure is not intended or offered Energy Surcharge 815.92 for sale. Accessibility Surcharge 530.35 ❑ 1, as owner of the property, am exclusively contracting with licensed Demolition Permit 0.00 contractors to construct the project. Sign Permit 0.00 ❑ Not applicable. Misc Charge/Credit 0.00 Administrative Permit 0.00 2. WORKER'S COMPENSATION DECLARATION: Archival Fee 489.50 1 hereby affirm that I have a certificate of consent to self -insure, or a 'certificate Subtotal 10,175.79 of Workers' Compensation insurance, or a certified copy hereof Investigation Fees 0.00 Certified copy is hereby furnished. Building Plan Review Fee 7,261.72 Certified copy is filed with the City. Fire Safety Plan Review 1,270.80 Not applicable Plan Review Subtotal 8,532.52 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE Development Review Fee 6,287.71 ❑ I certify that in the performance of the work for which this permit is issued, Fire Safety Surcharge 1,427.87 1 shall not employ any person in any manner so as to become subject to the Construction Unit Tax 0.00 Worker's Compensation Laws of California Water Impact 29,838.00 Area - 29,838.00 ❑ Not applicable Water Meter Installation 450.00 NOTICE TO APPLICANT: Wastewater Impact 3,859.00 Area - 3,859.00 Traffic Impact 33,336.36 Area - 6 3. 3,33636 If, after making any of the foregoing declarations, you become subject to any Affordable Housing 3,336042 .375 Labor Code or License Law provision, you must comply with such provisions Public Art 3,804.28 or this permit shall be deemed revoked. Code Enforcement 0.00 1 certify that I have read this application and state that the above information Park Improvement Area - 0.00 is correct, I agree to comply with all city ordinances and state laws relating to Waterway Management Fee 1,079.47 building consrruction, and hereby authorize representatives of this city to Plan Preparation Fee 0.00 enter upon the above -mentioned property for inspection purposes. Unless Open Space In -lieu Fee 0.00 noted under "Special Conditions" this permit becomes null and void if work Total Fees 141,833.75 or construction authorized is not started within 180 days, or if construction Balance Due Payments 0.00 or work is suspended or abandoned for a period of 180 days any time after work is commenced. Arn❑unt Date Receipt Fee Exemptions: Payment#1 8,532.52 11/17/06 29729 Payment #2 43,378.79 11/14/07 35272 Payment #3 89,922.44 12/28/07 35836 Total Paid 141,833.75 Comments: Application Number061067 Permit Number 22928 Application Date 11/17/06 Issuance Date 04/15/08 Address File kp L-11150� re of Conlrbctor. 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Used as Units Type Group Use Fire ROOF COVERING ❑ COMP. BUILT-UP ❑ METAL ❑ WOOD SHGLS. COMP. SHGLS. ❑ TILE ❑ WOOD SHAKE SPECIAL REQUIREMENTS HEATING ❑ ELECTRIC ❑ GAS FURN. ❑ GAS WALL VALUATION and FEES i "- '<' r VALUATION OF WORK BUILDING PERMIT FEE $�-__ - PLAN CHECK FEET r_.$ TOTAL FEE ................................$ Q r �— LIST ITEMS PERTAINING TO THIS APPLICATION AREA COST REQUIREMENTS FOR ISSUE PARKING PROVISIONS IV USE Width Length Height Stories Sq. Ft.I Sq. Ft. MAIN BUILDING ACCESSORY BLDG. CURB, GUTTER & SIDEWALK OTHER STRUCTURES PLANNING COMMISSION APPROVAL ADDITION WORKMENS COMPENSATION V BUSINESS LICENSE ALTERATION STATE LICENSE REPAIRS Li OTHER MOVING DEMOLISH 1 have carefully examined the above completed application and I know the same is true and correct ordinances and State laws governing building construction will be complied with. Sign here — By — Owner , I Authorized Agent All City APPROVED FOR ISSUE BY: ATE: / f'. 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