HomeMy WebLinkAbout4. Permit# EPM-0380-2014C. I T Y O F
SAn WIS OBISPO
L C A L I F O R N I A
Building & Safety Division • 919 Palm Street • San Luis Obispo, CA 93401-3218
BUILDING PERMIT
Temporary Pole
EPM-0380-2014
Issuance Date: 10/1/2014
Project Address: 40 Prado Road Assessor's Parcel Number: 053-041-034
Unit or Suite(s):
Project Description: TEMP POWER POLE Legal Description: SLO SUB TR PTN LTS 4 & 5 & 20
Contractor: Electricraft, Inc
Wes Treder
Business: (805) 544-8224 Mobile: (805) 431-2536
License Type: Business License License Number: BL003553
License Type: California State Contractor License License Number: 468443 Classification: C10 - Electrical Contractor
License Type: California State Contractor License License Number: 468443 Classification: C11 - Elevator Contractor
Owner: CAPSLO of San Luis Obispo County
Business: (805)-54-4-43
Fire Sprinklers: Stories 0.00 Code Year: 2013 Dwelling Units: Motel Rooms:
Census: Construction Type:
Occupancy:
Dimensions
Valuation
Category:
SQFT: Group Type Sq. Ft Factor
Valuation
Fees
Payments
Fee Name
Fee Amount
Date Receipt #
Amount
Temporary Service
$51.00
10/1/14 413-10-01-2014
$219.00
Permit Issuance
$168.00
Total Paid:
$219.00
Total Fees $219.00
Plan Check Account Payment by Contact
Contact Name Account Name Status Total Credits Total Debits
Account Balance
Total Account Balance:
Balance Due:
$0.00
Legal Declarations
#2 IDENTIFY WHO WILL PERFORM THE WORK
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.
#3 IDENTIFY WORKERS' COMPENSTATION COVERAGE AND LENDING AGENCY
WARNING: Failure to secure workers' compensation coverage is unlawfuland shal I su * ect an eploye to cri rri ral Prat t ies and ci vil f i re; upt o
$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.
3a -WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations:
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.
#4 DECLARATION BY CONSTRUCTION PERMIT APPLICANT
By my signature below, I certify each of the following:
I am a CA Licensed Contractor.
+ �L1=C=TK(Cf-AFT )Alr—
Signature of Contractor, Authorized Agent or Owner
October 01. 2014
Date