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HomeMy WebLinkAboutPermit PG19-0077 - TUKWILA FIRE STATION #51 - PLUMBING SYSTEMTUKWILA FIRE STATION 51 17951 SOUTHCENTER PKWY PGI 9-0077 Parcel No: Address: Project Name: City of Tukwila Department of Community Development 300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431-3670 Inspection Request Line: 206-438-9350 Web site: http://www.TukwilaWA.Rov PLUMBING/GAS PIPING PERMIT 3523049008 17951 SOUTHCENTER PKWY TUKWILA FIRE STATION #51 Permit Number: PG19-0077 Issue Date: 7/8/2019 Permit Expires On: 1/4/2020 Owner: Name: Address: Contact Person: Name: Address: Contractor: Name: Address: License No: Lender: Name: Address: CITY OF TUKWILA 6200 SOUTHCENTER BLVD , TUKWILA, WA, 98188 JIM TESTON 11624 SE 208TH ST , KENT, WA, 98031 ADEPT PO BOX 5056 , KENT, WA, 98064 ADEPT**945CS Phone: (253) 850-8518 Phone: (253) 850-8518 Expiration Date: 12/23/2019 DESCRIPTION OF WORK: INSTALL PLUMBING SYSTEM. Valuation of Work: $633,556,00 Water District: HIGHLINE Sewer District: NONE,TUKWILA Fees Collected: $1,164,80 Current Codes adopted by the City of Tukwila: International Building Code Edition: International Residential Code Edition: International Mechanical Code Edition: Uniform Plumbing Code Edition: International Fuel Gas Code: Permit Center Authorized Signature: 2015 2015 2015 2015 2015 National Electrical Code: WA Cities Electrical Code: WAC 296-46B: WA State Energy Code: 2017 2017 2017 2015 Date: |hearbycertify that I have read and examined this permit and know the same to be true and correct. All provisions of law and ordinances governing this work will be complied with, whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancelthe provisions nfany other state orlocal laws regulating construction cxthe performance ofwork. |amauthorized tosign and obtain this development permit and agree tothe conditions attached tothis permit. Signature Print Name: -"6~rd-4 -,-imV-.m600 This permit shall become null and void if the work is not commenced within 180 days for the datepfissuance, orif the work is suspended orabandoned for aperiod nfl88days from the last inspection. PERMIT CONDITIONS: z: *^~PLU^o8|NG/GASPIPING PERMIT CONDITIONS' 2: No changes shall be made to applicable plans and specifications unless prior approval is obtained from the Tukwila Building Division. 3: All permits, inspection records and applicable plans shall be maintained at the job and available to the plumbing inspector. 4: All plumbing and gas piping systems shall beinstalled incompliance with the Uniform Plumbing Code and the Fuel Gas Code. S: No portion of any plumbing system or gas piping shall be concealed until inspected and approved. 6: All plumbing and gas piping systems shall be tested and approved as required by the Plumbing Code and Fuel Gas Code. Tests shall be conducted in the presence of the Plumbing Inspector. it shall bethe duty nf the holder ufthe permit tomake sure that the work will stand the test prescribed before giving notification that the work isready for inspection. 7: No water, soil, or waste pipe shall be installed or permitted outside of a building or in an exterior wall unless, adequate provision ismade tuprotect such pipe from freezing. All hot and cold water pipes installed outside the conditioned space shall beinsulated to minimum R-3. 8: Plastic and copper piping running through framing members to within one (1) inch of the exposed framing shall beprotected bysteel nail plates not less than 18gauge. 9: Piping through concrete ormasonry walls shall not besubject hnany load from building construction, No plumbing piping shall be directly embedded in concrete ormasonry. 10: All pipes penetrating floor/ceiling assemblies and fire -resistance rated walls or partitions shall be protected inaccordance with the requirements nfthe building code. 11: Piping inthe ground shall belaid onafirm bed for its entire length. Trenches shall bebackfiUedinthin layers to twelve inches above the top of the piping with clean earth, which shall not contain stones, boulders, dnderOU,frozen earth, nrconstruction debris. 12: The issuance ofapermit urapproval nfplans and specifications shall not bpconstrued tobeapermit for, or anapproval of, any violation nfany of the provisions ofthe Plumbing Code orFuel Gas Code orany other ordinance ofthe jurisdiction. 13: The applicant agrees that he or she will hire a licensed plumber to perform the work outlined in this permit. 14: All new plumbing fixtures installed in new construction and all remodeling involving replacement of plumbing fixtures in all residential, hotel, motel, school, industrial, commercial use or other occupancies that use significant quantities of water shall comply with Washington States Water Efficiency ad Conservation Standards in accordance with RCW 19.27.170 and the 2006 Uniform Plumbing Code Section 4OZofWashington State Amendments PERMIT INSPECTIONS REQUIRED Permit Inspection Line: (206) 438-9350 2000 GAS PIPING FINAL 8004 GROUNDWORK 1900 PLUMBING FINAL 9002 ROUGH -IN GAS PIPING 8005 ROUGH -IN PLUMBING 9001 UNDERGROUND CITY OF TUKWILA Community Development Department Permit Center 6300 Southcenter Blvd, Suite 100 Tukwila, WA 98188 http://www.TukwilaWA.gov Plumbing/Gas Permit No. P6 / —007"7 Project No. Date Application Accepted: - 5/3/ fig Date Application Expires: / (For office use only PLUMBING / GAS PIPING PERMIT APPLICATION Applications and plans must be complete in order to be accepted for plan review. Applications will not be accepted through the mail or by fax. **Please Print** SITE LOCATION Site Address: Tenant Name: 09511 Sot,,,14( 14e,- 444 Andover Park E Tukwila Fire Station #51 King Co Assessor's Tax No.: Suite Number: Floor: New Tenant: D Yes Lij ..No PROPERTY OWNER Name: City ofTukwila Address: 6200 Southcenter Blvd City: Tukwila State: WA Zip: 98188 CONTACT PERSON — person receiving all project communication _ Name: Jim Teston (Adept Project Manager) Address: 11624 SE 208th St City: Kent State: WA Zip' 98031 Phone: (253) 850-8518 Fax: Email: jimtadeptmechanica1com PLUMBING CONTRACTOR INFORMATION Company Name: Adept Mechanical, Inc. Address: 11624 SE 208th St City: Kent State: WA Zip: 98031 Phone: (253) 850-8518 Fax: Contr Reg No.: ADEPT**945CS ExpDate:12/23/2019 Tukwila Business License No.: BUSS-0997946 Valuation of Project (contractor's bid price): $ 633,556 Scope of Work (please provide detailed information): Install Plumbing System Building Use (per Intl Building Code): Fire Station Occupancy (per Int'l Building Code): Utility Purveyor: Water: City ofTukwila Sewer: City of Tukwila H:\Applications\ Fonns-Applications On Line.201L Applicationalumbing Permit Application Revised 8-9-11.docx Revised: August 2011 bh Page 1 of 2 Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below: Fixture Type Qty Bathtub or combination bath/shower 3 Dishwasher, domestic with independent drain 1 Shower, single head trap 3 Sinks 1 0 Rain water system — per draM (inside building) Grease interceptor for commercial kitchen (>750 gallon capacity) Each additional medical gas inlets/outlets greater than 5 Atmospheric -type vacuum breakers not included in lawn sprinkler backflow protections (1-5) Fixture Type Qty Bidet Drinking fountain or water cooler (per head 1 Lavatory 5 Urinal Water heater and/or vent 2 Repair or alteration of water piping and/or water treatment equipment Backflow protective device other than atmospheric - type vacuum breakers 2 inch (51 mm) diameter or smaller Atmospheric -type vacuum breakers not included in lawn sprinkler backflow _protections over 5 Fixture Type Qty Clothes washer, domestic Food -waste grinder, commercial Wash fountain Water closet 5 Industrial waste treatment interceptor, including trap and vent, except for kitchen type grease interceptors Repair or alteration of drainage or vent piping Backflow protective device other than atmospheric -type vacuum breakers over 2 inch (51 mm) diameter Gas piping outlets 6 Fixture Type Qty Dental unit, cuspidor Floor drain 14 Receptor, indirect waste Building sewer and each trailer park sewer Each grease trap (connected to not more than 4 fixtures - <750 gallon capacity Medical gas piping system serving 1-5 inlets/outlets for a specific gas Each lawn sprinkler system on any one meter including backflow protection devices PERMIT APPLICATION NOTES - Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Permit Center to comply with current fee schedules. Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation. The Building Official may grant one extension of time for an additional period not to exceed 180 days. The extension shall be requested in writing and justifiable cause demonstrated. Section 103.4.3 International Plumbing Code (current edition). I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNER OR AUTHORIZED AGENT: _J Signature: Print Name: Jim Teston Date: 05/29/2019 Day Telephone: (253) 850-8518 Mailing Address: 11624 SE 208th St Kent WA 98031 City State Zip HAApp ions \ Fonns-Applicat ions On Line\ 2011 Applications \Plumbing Permit Application Revised 8-9-11.docx Revised: August 2011 bh Page 2 of 2 Cash Register Receipt City of Tukwila DESCRIPTIONS ACCOUNT QUANTITY PAID PermitTRAK $360.50 PG19-0077 Address: 17951 SOUTHCENTER PKWY Apn: 3523049008 PLUMBING PERMIT FEE TOTAL FEES PAID BY RECEIPT: R17803 R000.322,100.00.00 0.00 $360.50 $360.50 $360,50 $360.50 Date Paid: Tuesday, June 04, 2019 Paid By: ADEPT MECHANICAL SERVICES Pay Method: CHECK 5900 Printed: Tuesday, June 04, 2019 1:49 PM 1 of 1 SYSTEMS Cash Register Receipt City of Tukwila • DESCRIPTIONS ACCOUNT QUANTITY PAID PermitTRAK $804.30 PG19-0077 Address: 17951 SOUTHCENTER PKWY Apn: 3523049008 $804.30 GAS $147.50 PERMIT ISSUANCE BASE FEE R000.322.100.00.00 0.00 $35.00 PERMIT FEE R000.322,100,00.00 0.00 $83.00 PLAN CHECK FEE R000.322.103.00.00 0.00 $29.50 PLUMBING $612.00 PERMIT FEE R000.322.100.00.00 0.00 $382,50 PERMIT ISSUANCE BASE FEE R000,322.100.00.00 0.00 $35.00 PLAN CHECK FEE R000.322.103.00.00 0.00 $194.50 TECHNOLOGY FEE $44.80 TECHNOLOGY FEE TOTAL FEES PAID BY RECEIPT: R17776 R000,322,900.04.00 0.00 $44.80 $804.30 Date Paid: Friday, May 31, 2019 Paid By: ADEPT MECHANICAL SERVICES INC Pay Method: CHECK 5893 Printed: Friday, May 31, 2019 2:28 PM 1 of 1 TEMS INSPECTION RECORD Retain a copy with permit PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Pro,' : c5— Type of lnspe 'on: Addres : /7 Date C d: Specia ns u on : Date anted: a.rn. p.m. Requester: Phone No: Approved per applicable codes. _COMMENT Corrections required prior to approval. REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 P6-19-oo77 Project: Type of Inspection: /l91%��rirf ✓�` / .r....�►" Address: Date Called: .".�N7 SP ecial Instructions: L ate Wanted: a.m. Requester: 7Z) n'l PP./71 "N Phone No: jX[APProved per applicable codes. ElCorrections required prior to approval. COMMENTS: REINSPECTION FEE REQUIRED, Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 70 Permit Inspection Request Line (206) 438-9350 P619 00—r-7 Project: Type of Inspection: Address: Date Called: Special Instructions: RoLk9'i4' FL Date Wanted: a.m. Ree er: Phone N IDApproved per applicable codes. Corrections required prior to approval. COMMENTS: e:31c— trZc>ii K irzect-e-f-t—tRI REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call, to schedule reinspection. INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO, CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Project: Type of Inspection: Address: i 7 '.6.7 ....17,1-edititir Date Called: Special Inst uctions: Date Wanted: a.m. P-m• Requester: 72--0-71 Phone No: 0-06, 23- Approved per applicable codes. 1 Corrections required prior to approval. COMMENTS: Inspector: Date; REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection, INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT AO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 P : nspec on: Date Ca Spec*al Lnstructions: a e Wanted. ii a.m. p.m. 2-01, 'Requester: Phone No: AlApproved per applicable codes. kCOMMENTS: Corrections required prior to approval. REINSPECTION FEE REQUIRED. Prior to next inspettior fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Pc, 107 7 Project: 1 N.k w f LA- Fk&) T e of Inspection: TA) pL i , , Address. J795j 44-Ar_ari,--- Pk Date C ed: Special Instructions: Date Wanted: —10 --20 / S a.m. P-m- Requester: Phone No: proved per applicable codes. COMMENTS Corrections required prior to approval. REINSPECTION FEE REQLIIRED. Prior to next inspection. ee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. INSPECTION NO. INSPECTION RECORD Retain a copy with permit PG-t 9 -6077 PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Project: Type of inspection: / Address: ©ate Called: Special Instructions: )0/' � ♦� �wl PL11J/ �C+ ' Date Wanted: a.m. Requester: Phone No: proved per applicable codes. © Corrections required pri to approval. COM [ENTS: �Pr�zav i) , ., AMMM.wMM.Y.IW.WM... nspector: Date: -..6---717 REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd.. Suite 100. Calf to schedule reinspection. INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 P4/9 e2;777 Project: 1/F,iZU Si Type of Inspection: GRatAa vete- Addre : Date Called: Specialnstruc ons: DatKanted: 7-azi . . p.m. Requester: --ffAri Phone No: Approved per applicable codes. Corrections required prior to approval. COMMENTS: j„,„,.., e--- --°' ••• �pp Fro 61,7 ) G9 1 3 • 0 i REINSPECTION FEE REQUIRIED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. (206) 431 w3670 INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 Permit Inspection Request Line (206) 438-9350 pecial instructions. Approved per applicable coders. © Corrections required prior to approval. COMMENTS: REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. INSPECTION RECORD Retain a copy with permit N CT ON NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION Pk. vi 42c:rn 6300 Southcenter Blvd., #100, Tukwila. WA 98188 Permit Inspection Request Line (206) 438-9350 (206) 431-3670 Project: Type of n pe on: Address: 1 .4 Date Called: Special n u tions: Da e anted: a.m. p.m. Requester: Phone No: Approved per applicable codes. Inspector: Corrections required prior to approval. Date,..)- 1,2 REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Project: F5 07 Type of Inspection: (;;;R6UKJO gi Address: I 7475/ .5o0M-eillY K Date Called: Special Instructions: Date Wanted: a.m. pm. Requester: Phone No: proved per applicable codes. LI Corrections required prior to approval. COMMENTS: Inspector: 4Date: 742-1? REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Cali to schedule reinspection. Inspector: 4Date: 742-1? REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Cali to schedule reinspection. INSPECTION RECORD Retain a copy with permit PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431w3670 Permit Inspection Request Line (206) 438-9350 Project: :w-Type of Inspection: Address: Date Called: Specie Instructions: Date a ted: Requester: Phone No: Approved per applicable codes. COMMENTS: Corrections required prior to approval. REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. City of Tukwila Department of Community Development 12/3/2019 JIM TESTON 11624 SE 208TH ST KENT, WA 98031 RE: Permit No. PG19-0077 TUKWILA FIRE STATION #51 17951 SOUTHCENTER PKWY Dear Permit Holder: Allan Ekberg, Mayor Jack Pace, Director In reviewing our current records, the above noted permit has not received a final inspection by the City of Tukwila Building Division. Per the International Building Code, International Mechanical Code, Uniform Plumbing Code and/or the National Electric Code, every permit issued by the Building Division under the provisions of these codes shall expire by limitation and become null and void if the building or work authorized by such permit has not begun within 180 days from the issuance date of such permit, or if the building or work authorized by such permit is suspended or abandoned at any time after the work has begun for a period of 180 days. Your permit will expire on 1/20/2020. Based on the above, you are hereby advised to: 1) Call the City of Tukwila Inspection Request Line at 206-438-9350 to schedule for the next or final inspection. Each inspection creates a new 180 day period, provided the inspection shows progress. -or- 2) Submit a written request for permit extension to the Permit Center at least seven(7) days before it is due to expire. Address your extension request to the Building Official and state your reason(s) for the need to extend your permit. The Building Code does allow the Building Official to approve one extension of up to 180 days. If it is determined that your extension request is granted, you will be notified by mail. In the event you do not call for an inspection and/or receive an extension prior to 1/20/2020, your permit will become null and void and any further work on the project will require a new permit and associated fees. Thank you for your cooperation in this matter. Sincerely, ---bt)(�P Bill Rambo Permit Technician File No: PG19-0077 6300 Southcenter Boulevard Suite #100 • Tukwila, Washington 98188 • Phone 206-431-3670 • Fax 206-431-3665 AN* City of Tukwila Department of Community Development - Jack Pace, Director June 3, 2019 William Hill, CBO, ACO BHC Consultants 1601 Fifth Ave, Ste 500 Seattle, WA 98101 RE: Supplemental Nonstructural Review Development Permit PG19-0077 Tukwila Fire Station #51 — 17951 Southcenter Pkwy Dear Mr. Hill, Allan Ekberg, Mayor Please review the enclosed set of plans and documents for compliance with the 2015 Uniform Plumbing Code. As always, once all items have been reviewed and deemed correct, please provide two approved sets of approved plans and calculations with original approval stamps back to the Permit Center, attention Building Official. If you have any questions regarding these drawings and/or the scope of work feel free to contact Jerry Hight (City of Tukwila Building Official) at 206-431-3675. If you should have any questions, please feel free contact us in the Permit Center at (206) 431-3670. Kandace Nichols Permit Technician encl File: PG19-0077 Tukwila City Hall • 6200 Southcenter Boulevard • Tukwila, WA 98188 • 206-433-1800 • Website: TukwilaWA.gov PERMIT COORD COP'( PLAN REVIEW/ROUTING SLIP PERMIT NUMBER: PG19-0077 PROJECT NAME: TUKWILA FIRE STATION #51 SITE ADDRESS: 17951 SOUTHCENTER PKWY X Original Plan Submittal Response to Correction Letter # DATE: 05/31/19 Revision # before Permit Issued Revision # after Permit Issued DEPARTMENTS: TAC It(A)C. .7-511 Building Division is tro 46) Public Works Fire Prevention Structural Planning Division Permit Coordinator II PRELIMINARY REVIEW: Not Applicable (no approval/review required) REVIEWER'S INITIALS: DATE: 06/04/19 Structural Review Required DATE: APPROVALS OR CORRECTIONS: Approved Corrections Required (corrections entered in Reviews DUE DATE: 07/02/19 Approved with Conditions Denied (ie: Zoning Issues Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg D Fire Ej Ping 0 PW Ej Staff Initials: 12/18/2013 C,orttact Safety & Health Claims & Insurance shngton State Department of Labor & Industries r-- 'Search L&I A-Z index Itelp Nty L&] Workplace Rights Trades & Licensing ADEPT Owner or tradesperson Principals BURR, SHELTON N, PRESIDENT BURR, VALERIE B, MEMBER Doing business as ADEPT WA UBI No 601 443 349 PO BOX 5056 KENT, WA 98064-5056 253-850-8518 KING County Business type Corporation Governing persons SHELTON NOLSETTE BURR VALERIE BALLOU BURR; Certifications & Endorsements License Verify the contractor's active registration / license / certification (depending on trade) and any past violations, Construction Contractor Active, Meets current requirements. License specialties GENERAL License no, ADEPT**945CS Effective — expiration 02/10/2006— 12/2312019 Bond AMERICAN CONTRACTORS INDEM CO Bond account no 100020987 Received by L&I 11/16/2007 Insurance Colony Ins Co Policy no. 103GL000467504 Received by L&I 07/13/2018 Insurance history Savings S12,000.00 Effective date 04/02/2007 Expiration date Until Canceled $1,000,000,00 Effective date 07/15/2018 Expiration date 07/15/2019 Help us improve