HomeMy WebLinkAboutFIRE-1235-2021 permitBUILDING PERMIT
Underground/Hydrant
FIRE-1235-2021
Issuance Date: 6/24/2021Building & 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:UNDERGROUND FIRE LINE RE-ROUTING PER CITY
STANDARDS
Project Description:
Architect: Omni Design Group
INACTIVE Thomas Reay
Business: (805) 544-9700
License Type: Architect License License Number: 19442
Contractor: D.C. Lacy Excavating Inc.
Danny Lacy
Business: (805) 431-3271 Mobile: (805) 431-3271 Other: (805) 400-9990
License Type: California State Contractor License License Number: 796998 Classification: A - General Engineering Contractor
License Type: Worker's Compensation License Number: 9154337
Owner: INACTIVE LFOA LLC
2019Code Year:Stories
:
Fire Sprinklers:Motel Rooms:Dwelling Units: 0.00
Census:437 - Commercial Alteration or Addition Construction Type:
Occupancy:
Valuation
Group Type Sq. Ft Factor Valuation
Fees
Fee AmountFee Name
Fire Sprinkler Systems - Tenant Consolidated $536.59
IT Surcharge $16.37
Total Fees:$552.96
Payments
Date Receipt #Amount
6/24/21 $552.96 31,852-06-24-2021
Total Paid:$552.96
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 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.
Signature of Contractor, Authorized Agent or Owner Date
November 12, 2024