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HomeMy WebLinkAboutConstruction Permit ApplicationBuilding & Safety Division Construction Permit Application L Community Development T 805.781.7180 ` 919 Palm Street, San Luis Obispo, CA 93401-3218 F 805.781.7182 #1 IDENTIFY YOUR BUILDING PROJECT Property Address: _ e U f 1 k pg-d, sixt eA q'3 yg1 Assessor's Parcel Property Owner: • A tt; 1[8.)LLe _ _ _ Phone: - b ---� Owner's Mailing Address: ®Licensed Design Professional In Responsible Charge or ❑Non -Licensed Designer (when allowed by statutes): Name: 14 E Iy \ G t(3S D Q, Ai h License No. G 2-78 36 Address:11�qO_AALZsO S`t Sdt-vE Z30 Sg,^ Ld'is Ol,; spo, CA 93WOhone. 91,05 qc Li 0 717 Description of work: 7c��Ined [�av���rlcsln� Dwelling Units: p Occupancy Group: U Floor Area (Sq. Ft): Living Const Type V i3 Fire Sprinklers Noo_Project Value $ `300, 000 - 00 Garage _ ` W 3,00 Deck 293 sf Other Permit Types Required: ©Building ❑Mechanical ❑Electrical []Plumbing ❑Grading-C.Y ❑Demolition Select Plan Check Consultant: ❑CCC ❑WILLDAN ❑BUREAU VERITAS fume r it Y vvnu nrrr.L PM-UMM THE WORK t5eleGt and CormpMe either 2a or2b) 2a —CALIFORNIA LICENSED ONTRACT R' DECLARATION i hereby affirm under penalty of perjury that I am licensed under provisions of ha ter 9 commencing with Section 7000 of Division_ 3 of the Business and Professions Code, and my license is in full force and effect. Contractor Name: E lZic-hCL &Qs s vP- SCh[i ��t i�en�e Class_0116 !gotLLicense No. ❑ 2b — OWNER -BUILDER' 6ECLARATQN t hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) Indicated below by the checkmark(s) I have placed next to the applicable item(s) (Section 7031.5. Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or I h a t he or she Is exempt from licensure and the basis for the alleged exemption. An violation of Section 7031.5 by anfi y applicant for a permit subjects the applicant to a civil penalty of not more than v hundred dollars ($500).): �t, as owner of the property, or my employees with wages as their sole compensation, will do ❑all of orLJportiona of the work, and the structure is not intended or offered for sale, (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the 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 it was nol built or improved for the purpose of sale) ❑ 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 (hereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' Slate License Law). ❑ I am exempt from 11cons ure under the Contractors' State License Law for the following reason: 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 Ihis permit, I cannot legally salt a structure that I have built as an owner -builder if it has nat been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law is available upon request or at 111y1h ww,lecrinfa.ca.aovlralaw.lilml. #3 IDENTIFY WORKERS' COMPENSTATION COVERAGE AND LENDING AGENCY (Complete 3a and 3b) WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to $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. -WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, Issued by the Director of Industrial Relations 0rovided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy No. _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for w ich this permit is issued. My workers' compensation insurance carrier and policy number are: artier Policy Na Expiration Oate Phone 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 el:ome 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 Cade, I shall forthwith comply with those provisions. b - CON TR CTION LENDING AGENCY DECLARATION I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code) as follows: Lender's Name and Address #4 DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify each of the folio i ring: 1 am❑a California licensed contractor or the property owner* or❑authorized to act on the property owner's behalf". I have read this permit application and the inftion I have provided is correct. I agree to comply with applicable city and county ordinances and state laws relating to building construction. I authorize re esentatives of Ihis city or c unty to enter the above -identified property for inspection purposes. This permit Is to be issued in the name of the re Contractor orLthe Property Owner as the permit holder of record who will be responsible and liable for the construction. r Print Name _aat 1 f�� _ Signature 6 - - f _Dale 9-IS Jd11 'requires separate verification form ""requires separate authorization lone FAPPLIC'A7TION#9M6 I Revised 2014 -7,61 I (-, I T Y OF sanIUIS OBI s O CALIFORNIA Building & Safety Division • 919 Palm Street • San Luis Obispo, CA 93401-3218 School Fee Payment Certification The City cannot issue a building permit until the fee required by the San Luis Coastal Unified School District has been paid. TY applicant is responsible for taking this form to the school district offices at 1500 Lizzie Bldg C. The school district will determine if a fee is required, compute and collect the fee from the applicant, and certify payment in part "C" of this form. The applicant must return this form to the Building Division and pay permit fees before the building permit can be issued. The phone numbet for the school district is (805) 549-1207. A. APPLICANT AND PERMIT INFORMATION Permit Number: BLDG-5219-2019 Assessor's Parcel Number:004-705-006 Applicant Name: , MUICK TAYLOR FAMILY TRUST Project Address: 3731 Orcutt Rd B. BUILDING TYPE & SIZE INDICATED BY PERMIT APPLICATION Building Type: Building - New Accessory Building Floor Area: # New SQFT # Demo SQFT Total SQFT Residential: 581.00 0.00 581.00 Commercial: 0.00 0.00 0.00 Total: 581.00 0.00 581.00 Pgrmit application reviewed by: nessa Nichols, Peknit Serades Coordinator Date June 04, 2020 C. SCHOOL DISTRICT VERIFICATION OF FEE PAYMENT I hereby certify that the required development fee has been paid to the San Luis Coastal Unified School District for the building described above. AB 2926 fee: Sq. Ft. x fee TOTAL FEE CALCULATED $ Signature Date RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO: City of San Luis Obispo Community Development Department 919 Palm Street San Luis Obispo, CA 93401 This document is recorded for the benefit of the City of San Luis Obispo, a Municipal Corporation, and recordation without fee is requested, per Government Code § 27383. AGREEMENT CONDITIONS OF USE FOR ACCESSORY STRUCTURE An Agreement regarding Conditions of Use for an Accessory Structure for property located within in the City of San Luis Obispo at: 3731 Orcutt Rd (APN: 004-705-006) This agreement is made and entered into this day of 20_, by and between (hereinafter called "Owner") and the City of San Luis Obispo, a Municipal Corporation, (hereinafter called "City"). WITNESSETH WHEREAS, Owner is the owner of that certain real property located in the City of San Luis Obispo, County of San Luis Obispo, State of California, as described in attachment "A" (the "Property"); and WHEREAS, Owner has made application with City to build a new structure, described and delineated on plans submitted with Building Permit application BLDG-5219-2019 for construction of an Accessory Structure, as defined in § 17.158.006 and as further described and regulated by §17.70.010 of the Municipal Code; and NOW, THEREFORE, in consideration of the above recitals and mutual covenants, terms, conditions and restrictions contained herein, Owner hereby declares that the Property shall be held, transferred, encumbered, used, sold, conveyed, leased, and occupied subject to this Agreement (and incorporating the above recitals herein by this reference) which shall run with the land and shall be binding upon Owner's heirs, successors in interest, legal representatives, administrators, grantees, assigns, lessees, or any other occupiers and users of the Property, or any portion of it, as follows: 1) The parties hereto agree that execution of this agreement by Owner and City entitles Owner to proceed to modify or construct the accessory structure depicted in plans submitted with the above -referenced building permit application; and 2) Owner agrees: a) That the use of the accessory structure shall be limited to: a Workshop, Garage, Hobby Room, and Cabana, as depicted and described in the plans submitted with the above -referenced building permit, and cannot contain living space, including bathing facilities or a kitchen; and b) To to allow the City, upon reasonable time and notice, to inspect the premises for compliance with this agreement and to verify continued compliance with requirements of Zoning Regulations § 17.70.010 (Accessory Structures) and Health and Safety Codes IN WITNESS WHEREOF, the parties hereto have executed this agreement on the day and year first written above. Owner ALL SIGNATURES MUST BE NOTARIZED Date Date City of San Luis Obispo Date [Owner Name], Owner [Owner Name], Owner Michael Codron Community Development Director EXHIBIT "A" Legal Description APN: 004-705-006 A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached and not the truthfulness, accuracy, or validity of that document. State of California } County of San Luis Obispo } On before me, Date Name and Title of the Officer personally appeared Name of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he (she or they) executed the same in his (her or their) authorized capacity (ies), and that by his (her or their) signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature Signature of Notary Public Place Notary Seal Above A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached and not the truthfulness, accuracy, or validity of that document. State of California } County of San Luis Obispo } On before me, Date Name and Title of the Officer personally appeared Name of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he (she or they) executed the same in his (her or their) authorized capacity (ies), and that by his (her or their) signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature Signature of Notaa Public Place AfotM Seal Above A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached and not the truthfulness, accuracy, or validity of that document. State of California County of San Luis Obispo On before me, Date Name and Title of the Officer personally appeared Name of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he (she or they) executed the same in his (her or their) authorized capacity (ies), and that by his (her or their) signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature Signature of Notary Public Place Notary Seal Above