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. A thorized Aaent or Owner ❑ate
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t1CT• 18—Iz 3 1 4 7 0 4 n FICK PCs
I APPLICATION' FOR STRUCTURE PERMIT
T 7Permit
s IS HEREBY MADE TO THE BUILDING INSPECTOR OF THE CITY OF SAN LUIS OBISPO
PLANS RECEIVED dY:
Dal' Z
No. Plans Rec'd.
l , } 2 x
No. +���
`�
Issued — Xs.
I; >
OWNER t [� �CiV
�/•]�1r7
L
ADDRESS
�.^ ? t� Ft
LICENSE
NUMBER
TYPE OF FRAME
❑ METAL ❑ TIMBER WOOD STUD
__ _J(r�
ARCHITECT
ENGINEER
FOUNDATION
❑ Cont. Conc. {4j SLAB ❑ PIERS
DESIGNER
BUILDER r.��
DESCRIPTION
EXTERIOR WALL
❑ BRICK ❑ METAL
❑ ❑ ❑ CONCRETE BLOCK STUCCO
CONCRETE TILT -UP WOOD SIDING
❑ BRICK VEN. ❑ STONE VEN. ❑ WOOD TRIM
No.
Street
Lot
Block
Subdivision/Tract No.
Lot Size
Assr's. No.
(
qT-I!��
YL
/
�E��-�
�-031-0)
IONES
Set Back
Side Lines
Rear Line
Nearest Bldg.
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'. S •`
—+. �
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