HomeMy WebLinkAboutBLDG 20141; city of sari Luis oBisro
Building & Safety Division ■ 919 tom' r 401-3218 • (805) 781-7180
Project Address 190 SANTA ROSA
Assessor's Parcel Number 001-031-028 Legal Description 009.82 AC RECREATION (PARK) _
Project Description CELL SITE MODIFICATION - AT & T, 6 NEW PANEL ANTENAS & 3 NEW PIPE MOUNT RRU'S
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 WESTOWER COMMUNICATIONS INC Contractor's Phone No. 601/898-4450
Mailing Address 112 E STATE STREET Contractor's State Lic. No. 744137
City/State/Zip RIDGELAND MS 39157
Project Manager TRICIA KNIGHT Project Manager's Phone No. 448-4221
Lender Name Lender Address
C.B.C. Group _S-2 C.B.C. TypeV-B Stories 0 Codes: CBC10 CEC10
Census 437 Commercial Alteration or Addition Dwelling nUEtts-b Motel Rooms 0
Non -Residential Alteration
Building Permit
Fees
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 270.10
Investigation Fees
Building Plan Review Fee
Fire Safety Plan Review
Plan Review Subtotal 267.00
Development Review Fee
Fire Safety Surcharge
Fire Systems
Fire Sur/Sys Subtotal 0.00
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
267.00
0.00
0.00
2.10
1.00
0.00
0.00
0.00
0.00
0.00
267.00
0.00
234.96
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
Valuation
10,000
Total Building Value
Legal Declarations
2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION
$10,000.00
$10,000.00
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: WESTOWER Class: A, B. C10 License #: 744137
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: HARTFORD FIRE Policy #:20 WN 000523 Expires 12/31/14
Total Fees
772.06
Balance Due
0.00
Payments
Amount
Fee Exemations:
Date Receipt
Payment #1
200.00
08/07/13 61771
Payment#2
572.06
01/14/14 63734
Comments:
Total Paid
772.06
Application Number130764
Permit Number 27816
Application Date
08/07/13
Issuance Date 01/14/14
Address File � uyY( 1
Signature of Cont ac . Authorized Anent or