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Home My WebLink AboutBLDG-2764-2015 permits�nLuis 0BI S Q BUILDING PERMIT p� Alt/Addition - Commercial L I F O R N I A BLDG-2764-2015 Building 8 Safety Division - 919 Palm Street - San Luis Obispo, CA 93401-3218 Issuance Date: 10/15/2015 Project Address: 990 Industrial Way Assessor's Parcel Number: 053-061-034 Unit or Suite(s): Project Description: RENEW PERMIT #28080 Legal Description: CY SLO SUB TR PTN LT 113 Contractor: Interiors By Norma Business: (805) 543-0676 Owner: WEAVER FAMILY LLC ETAL Representative: GRADUATE RESTAURANTS INC A CA CORP Fire Sprinklers: Not Provided Stories 1.00 Code Year: 2013 Dwelling Units: Motel Rooms: Census: Construction Type: Occupancy: Dimensions Valuation Category: SQFT Group Type Sq. Ft Factor Valuation Fees Fee Name SMIP (Commercial) Green Building Fee Permit Issuance Total Fees: Fee Amount $0.50 $1.00 $222.50 $224.00 Payments Date Receipt # 10/15/15 4,380-10-15-2015 Total Paid Amount $224.00 $224.00 Plan Check Account Payment by Contact Contact Name Account Name Status Total Credits Total Debits Account Balance Total Account Balance: Balance Due: 50.00 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 workerscompensation 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. 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. _ I Signature of Contractor, Authorized Agent or Owner October 15, 2015 Date Building & Safety Division Construction Permit Application Community Development T 805.781.7180 919 Palm Street, San Luis Obispo, CA 93401-3218 F 805.781.7182 X1 IDENTIFY YOUR BUILDING PROJECT Property Address: C--YqO 1N OufJ12iAL WA Assessor's Parcel 9) Property Owner: WC'A Ue2 FAnti Ly L-1-C LTA L Phone: 35 5 1-!1 070D 05T1 1Z Owner's Mailing Address: Z%61 W-MI(IA►) 41/0 SCO ,CA `j34401 00Licensed Design Professional In Responsible Charge or ONon-Licensed Designer (when allowed by statutes): Name: 5 M I T S-T 9Ltc T fZA I& 20 u p L L(' License No. Address: 3/1 EL to A y 5 U i T e Z y U Phone: ,?Q5 K 3 cl - 211 G Description of work: U PSTc12 PR► -'3 n F tic Lv5 cA 2'o Dwelling Units: Occupancy Group: Floor Area (Sq. Ft): Living Const Type Fire Sprinklers Project Value $ Garage Deck Other Permit Types Required: OBuilding OMechanical OElectrical OPlumbing OGrading-C.Y ODemolition Select Plan Check Consultant: OCCC ❑WILLDAN OBUREAU VERITAS #2 IDENTIFY WHO WILL PERFORM THE WORK (Select and Complete either 2a or 2b) O 2a - CALIFORNIA LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 commencing wit, SAefction 7000 of Division 3 of the Business and Professions Code, and my license is in full force and eff ct. Contractor Name:C D—MtAt.(( S -/ License Class License No. 1 O 2b - OWNER -BUILDER'S DECLARATI N I hereby �Ft� 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 that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): O I, as owner of the property, or my employees with wages as their sole compensation, will do O all of or O portions 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 not built or improved for the purpose of sale) O 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 thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). O 1 am exempt from licensure 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 this permit, I cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law is available upon request or at htto://www.leainfo.ca.aov/calaw.html. #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. 3a -WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: O 1 have and will maintain a certificate of consent to self -insure for workers' compensation, Issued by the Director of Industrial Relations provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy No. O 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 Policy No Expiration Date Phone O 1 certify that, in the performance of the work for which this permit Is issued, 1 shall not employ any person in any manner so as to become 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 Code, I shall forthwith comply with those provisions. 3b - CONSTRUCTION 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 following: I am O a California licensed contractor or O the property owner' or [� authorized to act on the property owner's behalf". I have read this permit application and the information I have provided is correct. I agree to comply with applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this bsty & ounty to enter the above-idenFirrilt d property for inspection purposes. This permit is to be issued in the name of the O Licensed Contractor or C� the Property Owns ')as the holder of record who will be responsible and liable for the construction. I I Print Name �� h A(' Y K I i L 1w vv\ Signature 1 `� / \ �" Date b I� -' 5- `requires separate verification form "requires separate authorizatiorrferr'n APPLICATION # Revised 2014