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HomeMy WebLinkAbout2641 GATEWAY RD; 101; CB100469; Permit04-02-2010 City of Carlsbad 1635 Faraday Av Carlsbad, CA 92008 Commercial/Industrial Permit Permit No: CB100469 Building Inspection Request Line (760) 602-2725 Job Address: Permit Type: Parcel No: Valuation: Occupancy Group: Project Title: Applicant: NATHAN BEALL 3009 INDIA ST SAN DIEGO CA 92103 858-336-6594 2641 GATEWAY RD CBAD St: 101 Tl Sub Type: 2131911900 Lot#: $49,385.00 Construction Type: Reference #: KYSS BOUTIQUE: 1411 SF SHELL TO RETAIL COMM 0 5B Status: Applied: Entered By: Plan Approved: Issued: Inspect Area: Plan Check*: ISSUED 03/17/2010 JMA 04/02/2010 04/02/2010 Owner: Building Permit Add'l Building Permit Fee Plan Check Add'l Plan Check Fee Plan Check Discount Strong Motion Fee Park Fee LFM Fee Bridge Fee BTD #2 Fee BTD #3 Fee Renewal Fee Add'l Renewal Fee Other Building Fee Pot. Water Con. Fee Meter Size Add'l Pot. Water Con. Fee Reel. Water Con. Fee Green Bldg Stands (SB1473) Fee Fire Expedited Plan Review $418.56 Meter Size $0.00 Add'l Reel. Water Con. Fee $272.06 Meter Fee $0.00 SDCWA Fee $0.00 CFD Payoff Fee $10.37 PFF (3105540) $0.00 PFF (4305540) $0.00 License Tax (3104193) $0.00 License Tax (4304193) $0.00 Traffic Impact Fee (3105541) $0.00 Traffic Impact Fee (4305541) $0.00 PLUMBING TOTAL $0.00 ELECTRICAL TOTAL $0.00 MECHANICAL TOTAL $0.00 Master Drainage Fee Sewer Fee $0.00 Redev Parking Fee $0.00 Additional Fees $1.00 HMPFee $205.00 TOTAL PERMIT FEES $0.00 $0.00 $0.00 $0.00 $898.81 $0.00 $0.00 $0.00 $0.00 $0.00 $34.00 $20.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1,859.80 Total Fees:$1,859.80 Total Payments To Date:$1,859.80 Balance Due:$0.00 PPF tOVAL Inspector^Clearance: NOTICE: Please take NOTKlE trlit approval of your project includes the "Imposition" oflees, dedications, reservations, or other exactions hereafter collectively referred to as "fees/exactionsr" You have 90 days from the date this permit was issued to protest imposition of these fees/exactions. If you protest them, you must follow the protest procedures set forth in Government Code Section 66020(a), and file the protest and any other required information with the City Manager for processing in accordance with Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent legal action to attack, review, set aside, void, or annul their imposition. You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY to water and sewer connection fees and capacity changes, nor planning, zoning, grading or other similar application processing or service fees in connection with this project. NOR DOES IT APPLY to any fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of limitations has previously otherwise expired. CITY OF CARLSBAD Permit Application 1635 Faraday Ave., Carlsbad, CA 92008 760-602-2717 / 2718 / 2719 Fax: 760-602-8558 www.carlsbadca.gov Plan Check No. Est. Value Plan Ck. Deposit^ 2?T3-*^ DESCRIPTION OF WORK: Include Square Feet of Affected Area(i) (Sec. 7031.5 Business and ProfessiStwCode: Any City or County which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires theapplicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9, commending with Section 7000 of Division 3 of theBusiness and Professions Code) or that he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)). WORKERS' COMPENSATION Workers' Compensation Declaration: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-insure for workers' compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued._ i LJ I have and will maintain workers' compensation, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatioiTinsurance carrier and policy number are: Insurance Co. Policy No. Expiration Date This section need not be completed if the permit is for one hundred dollars ($100) or less. O Certificate of Exemption: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars (&100.000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. Jl$ CONTRACTOR SIGNATURE |~~| AGENT DATE OWNER-BUILDER DECLARATION / hereby affirm that I am exempt from Contractor's License Law for the following reason: O 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 (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale). D I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and contracts for such projects with contractors) licensed pursuant to the Contractor's License Law). D I am exempt under Section Business and Professions Code for this reason: 1.1 personally plan to provide the major labor and materials for construction of the proposed property improvement. 3 Yes O No 2.1 (have / have not) signed an application for a building permit for the proposed work. 3.1 have contracted with the following person (firm) to provide the proposed construction (include name address / phone / contractors' license number): 4.1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work {include name / address / phone / contractors' license number): 5.1 will provide some of the work, but I have contracted (hired) the following persons to provide the work indicated (include name / address / phone / type of work): ^"PROPERTY OWNER SIGNATURE DAGENT DATE COMPLETE THIS SECTION FOR NON-RESIDENTIAL BUILDING PERMITS ONLY Is the applicant or future building occupant required to submit a business plan, acutely hazardous materials registration form or risk management and prevention program under Sections 25505,25533 or 25534 of the Prestey-T.«aner Hazardous Substance Account Act? DYes CD No Is the applicant or future building occupant required to obtain a permit from the air pollution control district or air quality management district? D Yes O No Is the facility to be constructed within 1,000 feet of the outer boundary of a school site? O Yes a No IF ANY OF THE ANSWERS ARE YES, A FINAL CERTIFICATE OF OCCUPANCY MAY NOT BE ISSUED UNLESS THE APPLICANT HAS MET OR IS MEETING THE REQUIREMENTS OF THE OFFICE OF EMERGENCY SERVICES AND THE AIR POLLUTION CONTROL DISTRICT. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work this permit is issued <Sec. 3097 (i) Civil Code). Lender's Name Lender's Address APPLICANT CERTIFICATION I hereby aulhorize representative of the City of Carlsbad to enter upon the above mentioned property for inspection purposes. I ALSO AGREE TO SAVE, INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTS, COSTS AND EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. OSHA: An OSHA permit is required for excavaSonscver SO' deep and demolition or construction of structures over 3 stories in height. EXPIRATION: Every pemit issued by th^OTdingtte 180 days from the date of such perrrAflfif the buidpng or work authored by^g™6sus|)erxied or abandor^ at any time after tte APPLICANT'S SIGNA'3-ll-fe xi^% Building Permit A ^S^^,-^' • . 1635 Faraday Ave., Carlsba .N^? CITY OF 760-602-2717/2718 /"* Am c D A r\ Fax: 760'602'85 V*/"\rV L. JLW^Lx JOB ADDRESS CT/PROJECT* LOT* PHASE* # OF UNITS * BEDROOMS ., . , Plan Check No.ppiication d, CA 92008 Est. Value / 2/iy58 Plan Ck. Deposit gfiV n 4^^ Date SUITE#/SPACE#/UNIT# APN * BATHROOMS TENANT BUSINESS NAME CONSTR. TYPE OCC. GROUP DESCRIPTION OF WORK: Inc/ude Square Feet of Affected Area's; EXISTING USE PROPOSED USE GARAGE (SF) CONTACT NAME (If Wfrerent Fom Applicant; ADDRESS CITY STATE ZIP PHONE FAX EMAIL PROPERTY OWNER NAME _ ADDRESS CITY STATE ZIP PHONE FAX EMAIL ARCH/DESIGNER NAME & ADDRESS STATE LIC. * PATIOS (SF) DECKS (SF) FIREPLACE AIR CONDITIONING FIRE SPRINKLERS YES D # NO D YES D NO D YES D NO D APPLICANT NAME ADDRESS CITY STATE ZIP PHONE FAX EMAIL )ANTRACTOR BUS. NAME . » /frtw C0svS>-fr,jLAS'T^—^ ADDRESS / CITY ' ' ^^ STATE ZIP PHONE '' FAX EMAIL si ^« STATE uc.# CLASSa cnYBus.ua* i a & &tfO & \~~l £-* rr&&lS£&\ civil penalty of not more than five hundred dollars ($500)). WORKERS COMPENSATION structure, prior to its issuarfce/atso requires thei, commending with Sectlorl 7000 of Division 3 of the.5 by any applicant for a permit subjects the applicant to a Worion' Compensation DtcbraUon: / hereby aflhn under penalty of perjury one rf the fotaims dectaraSons: n I hiv* and will maintain i certificate of canMnt to setf-insu^ 3700 of the Labor Code, for the performance of the work for which this permit is issued. O I have and w« maintain wort«rt'comp«n»atton, as required by Sec^ number are: Insurance Co. Policy No. Expiration Date TMsedion need not be completed if toe permit is for one hundred dollars ($100) or less. J^(^rtffic«tocrfExemp1km:lcertfyftanntrBperfomarx^ CaHomia. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dolara (4100,000), In addition to the cost of compensation, damages as provided for in Section 3706 of the Labor code, interest and attorney's fees. ^J& CONTRACTOR SIGNATURE /%f sfa^/?**3 DAGENT DATE "3 ~ Ji.3.- / 0 OWNER-BUILDER DECLARATION / hereby affirm f/Jaf / am exempt from Contractor's License. Law lor the following reason: O I, as owner of the property w my employees with wages as t^ License Law does not apply to an owner of property who builds or improves thereon, and wro does such vi^ himself or though rw own employees, provided that su^ sale. If, however, the building or improvement is sold within one year of COTptetronJte ownw^ldw wi« rave me burden of proving ^ a I, as owner of Die properly, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and contracts for such projects with contractors) licensed pursuant to the Contractor's License Law). G I am exempt under Section..Business and Professions Code for this reason: \. I personally plan to provide the major labor andmaterials for construction of the proposed property improvement. OYes ONo 2.1 (have / have not) signed an application for a building permit for the proposed work. 3.1 have contracted with the following person (firm) to provide the proposed consfrucdon (include name address / phone / contractors' license number): 4.1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work (include name / address / phone / contractors' license number): 5.1 wiK provide some of the work, but I have contracted (hired) the following persore to rjrowte tfe work irritated (indu^ ^PROPERTY OWNER SIGNATURE OAGENT DATE City of Carlsbad Final Building inspection Dept: Bulk Plan CheckS: ' Permits: Project Name: Address: Contact Person: Sewer Dist: Inspected Bv: (V\ Inspected Bv: Inspected Bv: Comments: ling Engineering Ni CB1 00469 KYSS BOUTIQUE: 1 TO RETAIL 2641 GATEWAY RD CARLA CA AlTN/sC /k^X \^\/ \f Planning CMWD 411 SF SHELL #101 Phone: 6199972739 Water Dist: CA Date Inspected: VvY<Mj\ Date Inspected: Date Inspected: StLite Fire Date: Permit Type: Sub Type: Lot: 0 n^j^MD / .D^-Abproved: " \ Approved: Approved: 05/17/2010 Tl COMM / Disapproved: Disapproved: Disapproved: Inspection List Permit*: CB100469 Type: Tl COMM Date Inspection Item 05/17/201089 Final Combo 05/17/2010 89 04/15/2010 17 04/12/2010 14 04/12/2010 34 Final Combo Interior Lath/Drywall Frame/Steel/Bolting/Weldin Rough Electric Inspector PY PY PY PY Act Rl AP AP AP AP KYSS BOUTIQUE: 1411 SF SHELL TO RETAIL Comments NEED FIRE DEPARTMENT Tuesday, May 25, 2010 Page 1 of 1 City of Carlsbad Bldg Inspection Request For: 05/17/2010 Permit* CB100469 Title: KYSS BOUTIQUE: 1411 SF SHELL Description: TO RETAIL Inspector Assignment: PY 2641 GATEWAY RD 101 Lot: Type:Tl Job Address: Suite: Location: APPLICANT NATHAN BEALL Owner: Remarks: Sub Type: COMM Phone: 6199972739 Inspector: Total Time: CD Description 19 Final Structural 29 Final Plumbing 39 Final Electrical 49 Final Mechanical Requested By: CARLA Entered By: CHRISTINE Act Comments Comments/Notices/Holds Associated PCRs/CVs Original PC# Inspection History Date Description Act Insp Comments 04/15/2010 17 Interior Lath/Drywall AP PY 04/12/2010 14 Frame/Steel/Bolting/Welding AP PY 04/12/2010 34 Rough Electric AP PY To: City of Carlsbad BUtLOmQ DIPAKTMINT 1638 Faraday Avanira, Carlsbad, CA 92008 Phorw: 760402-7841/ Fax: 7604024661 Plan Chech Comments / 2OO7 Codes Steve > I i loo "OH STF\E BOROSSAY TUESDAY THROUGH FRIDAY H'M Pta plane atapartortM«P1anChaclirMponMpl«aMratijror«dmarlMds«twHhtharwwpr^^ • Thte to «fiy||J2IWLBEMEmZCU^.Coinm«it« or approve do ix^ dapartmantravtaw. For failbrmaUon on tha statua of approval from othar dapartmanla contaot •taffQ760402-2717 / 2718 / 2719. A 0 vXx, >-x ocMrv Feeder Diagrams (Electrical Plans) 2007 California Electrical Code Article 215.5 Published: ApriM 985 Revised: June 2007 The intent of this newsletter is to clarify the general requirements for electrical plans for installations in the San Diego area. For new single-family residential services, an approved plot plan showing the size and location of the service equipment is required. When the service is rated over 200 amperes, additional information may be required by the authority having jurisdiction (AHJ). All commercial services regardless of size and residential services over 200 amperes* require complete electrical plans. These plans shall include a description of all loads to be served, the size of service, feeder and branch circuit overcurrent devices, the size and type of conductors, the AIC rating of equipment, grounding and bonding details and the wiring methods to be utilized. Calculations to justify the proposed installation must be provided. Generally, single-line diagrams will be required as well as plans showing the location of all proposed electrical equipment to be installed. In addition, plans and calculations must be provided for lighting loads regulated by the current^ °~ Building Energy Efficiency Standards of State of California Title 24, Part 6 All electrical plans shall be signed as required by the California State Business and Professions Code and, where applicable, shall contain the Statement of Compliance required by Title 24. The San Diego Chapter of ICC also recommends that each authority having jurisdiction (AHJ) require meter locations be shown on all building plans prior to permit issuance, and that each AHJ verify these locations in the field prior to its final approval of the gas and electric systems. Plan review should include review of code provisions, such as exit court requirements and requirements for fire protection of exterior walls based on distance to property line. Note: These general plan requirements are based on typical installations. An AHJ may find it necessary to require additional plans or calculations at any stage of design or construction. "Consult with AHJ for specific requirements based on size of service. PLANNING/ENGINEERING APPROVALS PERMIT NUMBER CB 10-0469 DATE 3/18/10 ADDRESS 2641 Gateway Rd RESIDENTIAL ADDITION- POOL/SPA MINOR (< 17,000.00) TENANT IMPROVEMENT RETAINING WALL VILLAGE FAIRE COMPLETE OFFICE BUILDING OTHER PLANNER Chris Sexton DATE 3/18/10 £T H:\ADMlN\COl]NTER/PUNNING/ENClNEERINCAPPROVAlS aenette Abbey To: Cc: Subject: kitfire@sbcglobal.net Mike Peterson RE: Recommended for Approval Hi Daryl- Thank you for e-mailing these to us. I have a question for you. The second document attachment is titled as "CB100469 - Kyss Boutique—but—when I open the document—at the top—the project information says CB100336—Best Buy Mobil—2525 El Camino Real-0-space 240. Could you help clear this up for us. Thanks again for your willingness to help us. From: Daryl [mailto:kitfire@sbcglobal.net] Sent: Wednesday, March 31, 2010 8:47 AM To: Brenda Wardwell Cc: Janet Altar; Raenette Abbey Subject: Recommended for Approval The following have plans have been recommended for approval. CB100336 Best Buy Mobile 1/2 hr CB100469 PC Kyss Boutique 1/2 hr Vary IK vtjcwne* Daryl K. James & Associates, Inc. 205 Colina Terrace Vista, CA 92084 760-724-7001 kitfire@sbcalobal.net RECOMMENDED FOR APPROVAL Page: lofi * Da/y/ K. James & Associates, Inc. Checked by: Daryl Kit James 205 Colina Terrace Date: March 30. 2010 Vista, CA 92084 T. (7601 724-7001 Email: kitfire@sbcglobal.net APPLICANT: Nathan Beall JURISDICTION: Carlsbad Fire Department PROJECT NAME: Kyss Boutique PROJECT ADDRESS: 2641 Gateway Road 101 PROJECT DESCRIPTION: CB100469 1411st Tl THE FOLLOWING SHEETS HAVE BEEN REVISED FOR CORRECTION IN THE FINAL PLAN SET STAMPED FOR RECOMMENDED APPROVAL A1.0 SITE PLAN V Revise sheet title to Title Sheet/Site Plan V Type of Construction in accordance with CBC Table 601 V Type of Occupancy V Sprinklered or non-sprinklered V Provide Scope of Work for this project V Provide List of applicable codes (see attached) V Provide North directional arrow A1.1 FLOOR & REFLECTED CLG PLANS V Provide notes denoting all proposed work V Provide door and door hardware specifications. V Denote location of exit signs V Denote type 2A10BC Fire extinguisher L.1 LIGHTING PLAN •V Denote emergency lighting V Emergency lighting and exit signs supplied with minimum 90 minute battery back up? S^O^WW**.,^,!,.,^; SAN DIEGO REGIONAL HAZARDOUS MATERIALS QUESTIONNAIRE OFFICE USE ONLY UPFP# HV# BP DATE / I The following questions represent the facility's activities, NOT the specific project description. PART I: FIRE DEPARTMENT - HAZARDOUS MATERIALS DIVISION: OCCUPANCY CLASSIFICATION: Indicate by circling the item, whether your business will use, process, or store any of the following hazardous materials. If any of the items are circled, applicant must contact the Fire Protection Agency with jurisdiction prior to plan submittal. 5. Organic Peroxides 9. 6. Oxidizers 10. 7. Pyrophorics 11. 1. Explosive or Blasting Agents 2. Compressed Gases 3. Flammable/Combustible Liquids 4. Flammable Solids 8. Unstable Reactives 12. Water Reactives Cryogenics Highly Toxic or Toxic Materials Radioactives 13. Corrosives 14. Other Health Hazards 15. None of These. PART II: SAN DIEGO COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH - HAZARDOUS MATERIALS DIVISIONS (HMD): If the answer to any of the questions is yes, applicant must contact the County of San Diego Hazardous Materials Division, 1255 Imperial Avenue, 3'" floor, San Diego, CA92101. Call (619) 338-2222 prior to the issuance of a building permit. FEES ARE REQUIRED. Expected Date of Occupancy: /3 / /O /, YES NO Is your business listed on the reverse side of this form? (check all that apply).D n D D D D ^ . rjg Will your business dispose of Hazardous Substances or Medical Waste in any amount? Ea Will your business store or handle Hazardous Substances in quantities equal to or greater than ^+ 55 gallons, 500 pounds, 200 cubic feet, or carcinogens/reproductive toxins in any quantity? Gf Will your business use an existing or install an underground storage tank? 0^ Will your business store or handle Regulated Substances (CalARP)? El Will your business use or install a Hazardous Waste Tank System (Title 22, Article 10)? D CalARP Exempt / InitialsDate D CalARP Required Date Initials D CalARP Complete Date Initials PART III: SAN DIEGO COUNTY AIR POLLUTION CONTROL DISTRICT: If the answer to any of the questions below is yes, applicant must contact the Air Pollution Control District (APCD), 10124 Old Grove Road, San Diego, CA 92131-1649, telephone (858) 586-2600 prior to the issuance of a building or demolition permit. Note: if the answer to questions 3 or 4 is yes, applicant must also submit an asbestos notification form to the APCD at least 10 working days prior to commencing demolition or renovation, except demolition or renovation of residential structures of four units or less. Contact the APCD for more information. 1 • YES HI 2. D 3. 4. Q D Q Q Will the subject facility or construction activities include operations or equipment that emit or are capable of emitting an air contaminant? (See the APCD factsheet at http://www.sdaDcd.oro/info/facts/permits.pdf , and the list of typical equipment requiring an APCD permit on the reverse side of this from. Contact APCD if you have any questions). (ANSWER ONLY IF QUESTION 1 IS YES) Will the subject facility be located within 1 ,000 feet of the outer boundary of a school (K through 12)? (Public and private schools may be found after search of the California School Directory at http://www.cde.ca.gov/re/sd/: or contact the appropriate school district). Will there be renovation that involves handling of any friable asbestos materials, or disturbing any material that contains non-friable asbestos? Will there be demolition involving the removal of a load supporting structural member? Briefly describe business activities:Briefly describe proposed project: favQUJ I declare under penalty of perjury that to tk»g_^est of my knowledge and belief the responses made herein are true and correct. Name of owner or Authorized Agent Signature of Owner or Authorized Agent Date FOR OFFICIAL USE ONLY:FIRE DEPARTMENT OCCUPANCY CLASSIFICATION:. BY:DATE: EXEMPT OR NO FURTHER INFORMATION REQUIRED COUNTY-HMD APCD RELEASED FOR BUILDING PERMIT BUT NOT FOR OCCUPANCY COUNTY-HMD APCD RELEASED FOR OCCUPANCY COUNTY-HMD APCD 1 (04/07)County of San Diego - DEH - Hazardous Materials Division Check a License or Home Improvement Salesperson (HIS) Registration - Contractors Stat... Page 1 of 1 Department of Consumer Affairs Contractors State Li Contractor's License Detail - License # 640817 card DISCLAIMER: A license status check provides information taken from the CSLB license database. Before relying on this information, you should be aware of the following limitations. ••» CSLB complaint disclosure is restricted by law (B&P.Zl24j>). If this entity is subject to public complaint disclosure, a link for complaint disclosure will appear below. Click on the link or button to obtain complaint and/or legal action information. ••» Per B&P 7071,17, only construction related civil judgments reported to the CSLB are disclosed. ~» Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration. ~» Due to workload, there may be relevant information that has not yet been entered onto the Board's license database. CLASS DESCRIPTION CONTRACTOR'S BOND License Number: ?1°,817 _ _ _ __ E?*1*01 Patf: 03{22/?°1° GOSSETT INC dba A M G CONSTRUCTION Business Information: 29885 2ND STREET UNIT W & X LAKE ELSINORE, CA 92532 Business Phone Number: (951) 245-1189 Entity: Corporation Issue Date: 03/25/1992 Reissue Date: 03/25/2008 Expire Date: 03/31/2010 _ ___ ___ _ License Status: This license is current and active. All information below should be reviewed. Classifications: B GENERAL BUILDING CQNIBACIQB. sS^^^HMHHBHHiM This license filed Contractor's Bond number SC6364046 in the amount of $12,500 with the bonding company AMERICAN CONTRACTORS INDEMNITY COMPANY. Effective Date: 03/02/2009 Bonding: ContracMsJond.ing..Hjste.ry. 1. The Responsible Managing Officer (RMO) ALFRED MICHAEL GOSSETT certified that he/she owns 10 percent or more of the voting stock/equity of the corporation. A bond of qualifying individual is not required. Effective Date: 03/25/2008 This license is exempt from having workers compensation insurance; they certified that they have no employees at this time. Workers' Compensation: Effective Date: 10/14/2009 Expire Date: None WQrMcs'..ComEensation...Histgry 03/25/2008 LICENSE REISSUED TO ANOTHER ENTITY ^^^^^^^^1 Conditions .of. Use | Pnya.cy....Po!i.cy. Copyright © 2010 State of California https://www2.cslb.ca.gov/OnlineServices/CheckLicense/LicenseDetail.asp 03/22/2010 ^^^ i ^ "^^ v,^° o ^~ j. 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