HomeMy WebLinkAboutBLDG 2010� P1 i;zcity Of S",..1 tuis OBISPO
Buildings & Safety Division • 919GAMUWaCM (915CMA3401-3218 (BM
Project Address 190 SANTA ROSA
Assessor's Parcel Number 001-031-028 Legal Description 009.82 AC RECREATION (PARK)
Project DescriptionCELL SITE EQUIPMENT MODIFICATION - VERIZON
Permit Type
X Building X Mechanical X
Electrical X Plumbing Sign Demolition Grading
Property Owner
CITY OF SAN LUIS OBISPO (940)
Occupant/Business Name SANTA ROSA PARK
Mailing Address
990 PALM ST
Architect/Engineer
City/State/Zip
SLO, CA 93401-3249
License #
Contractor
TRI-SQUARE CONSTRUCTION INC
Contractor's Phone No. 916/933-3530
Mailing Address
1261 HAWKS FLIGHT CT
Contractor's State Lic. No. 816574
City/State/Zip
EL DORADO HILLS CA 95762
Project Manager
CLARENCE CHAVIS
Project Manager's Phone No. 925/498-2340
Lender Name
Lender Address
C.B.C. Group
B C.B.C. TypeV-B
Stories 0 Codes: CBC07 CEC07
Census 437
Commercial Alteration or Addition
Dwelling nllTts 0 Motel Rooms 0
Valuation
Non -Residential Alteration
$0.00
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
232.50
40.00
0.00
0.50
0.00
0.00
0.00
0.00
29.40
302.40
0.00
232.50
0.00
232.50
222.20
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
757.10
0.00
Payments
Amount Date Receipt
Payment #1 250.00 09/10/10 48536
Payment #2 507.10 03/23/11 50808
Total Paid 757.10
Application Number100752 Permit Number 25345
Application Date 09/10/10
Issuance Date 03/23/11
Total Building Value $0.00
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: TRI-SQUARE Class: B. C10 License #: 816574
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 #:1958803 Expires 03/01/12
Fee Exemptions:
Comments:
Address File
4,_- -3 --Z 3-11
or Owner Elate