HomeMy WebLinkAboutFIRE-0440-2023 permitBUILDING PERMIT
Fire Sprinklers
FIRE-0440-2023
Issuance Date: 4/3/2023Building & Safety Division • 919 Palm Street • San Luis Obispo, CA 93401-3218
053-061-034Project Address:990 Industrial Wy Assessor's Parcel Number:
Unit or Suite(s): 0.00Square Footage:
Legal Description:FIRE SPRINKLER SYSTEM IN EXISTING BUILDINGProject Description:
Contractor: Bixler Fire Protection
BROCK Bixler
Business: (805) 602-2960
License Type: California State Contractor License License Number: 905045
2016Code Year:Stories
:
Fire Sprinklers:Motel Rooms:Dwelling Units: 0.00
Census:Construction Type:
Occupancy:
Valuation
Group Type Sq. Ft Factor Valuation
Fees
Fee AmountFee Name
Fire Sprinkler Systems - Tenant Consolidated $771.21
IT Surcharge $23.52
Total Fees:$794.73
Payments
Date Receipt #Amount
4/3/23 $794.73 38,700-04-03-2023
Total Paid:$794.73
Contact Name Account BalanceTotal DebitsAccount Name Status Total Credits
Plan Check Account Payment by Contact
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 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.
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 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.
#4 DECLARATION BY CONSTRUCTION PERMIT APPLICANT
By my signature below, I certify each of the following:
I am a CA Licensed Contractor.
Signature of Contractor, Authorized Agent or Owner Date
November 12, 2024