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Clay Oft�An WIS OBI spy -
Building &Safety Division • 990 Palm Street/Box 8100 • San Luis Obispo, CA 93403-8100 • (805) 781-7180
CONSTRUCTION PERMIT
Project Address 1759 ROYAL
Assessor's Parcel Number 053-122-011
Project Description 5' MASONRY FENCE AT FRONT YARD
Permit Type
X Building _Mechanical _Electrical
Property Owner
MCDONALD EL & BJ
Mailing Address
1759 ROYAL WAY
City/State/Zip
SLO CA, 93405-6335
Contractor
OWNER
Mailing Address
City/State/Zip
Project Manager
ED MCDONALD
Lender Name
U.B.C. Group
R-3 U.B.C. Type V-N
Census number
434 Residential Alteration or Addition
VALUATION
Residential Alteration/Addition/Conversio $ 4,000
rim —tom
Legal Description CY SLO TR 322 LT 11
_Plumbing _Sign _Demolition
Occupant/Business Name
Architect/Engineer
License #
Contractor's Phone No.
Contractor's State Lic. No.
Project Manager's Phone No
Lender Address
Stories 1
Dwelling Units 0
Total Building Value
4,000
4,000
PAYMENTS
Application Number 50552 Amount Date Receipt
Application Date 07/13/95 Payment #1 144.46 07/13/95 8689
Permit Number 10165
Issuance Date 07/13/95 Total Paid
LEGAL DECLARATIONS
OWNER BUILDER DECLARATION:
I am exempt from the contractor's License Law for the following reason:
1, as owner of the property, or my employees with wages as their sole compensation
will do the work and the structure is not intended or offered for sale.
_ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project.
_ Not applicable
WORKERS COMPENSATION DECLARATION:
I hereby affirm that I have a certificate of consent to self -insure, or 'a certificate of
Workers' Compensation insurance, or a certified copy hereof (Sec. 3800, Lab. C)
_ Certified copy is hereby furnished.
_ Certified copy is filed with the City.
X Not applicable
CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE
144.46
542-0239
_Grading
Codes: UBC 91 NEC 90
FEES
Building Permit
87.25
Plumbing Permit
0.00
Mechanical Permit
0.00
Electrical Permit
0.00
Grading Permit
0.00
S.M.I.P.
0.50
Energy Surcharge
0.00
Accessibility Surcharge
0.00
Demolition Permit
0.00
Sign Permit
0.00
Administrative
0.00
Miscellaneous Chg/Cred
0.00
Investigation Fees
0.00
Microfilm
0.00
Subtotal 87.75
Building Plan Review Fee
56.71
Fire Safety Plan Review
0.00
Plan Review 56.71
Fire Safety Surcharge
0.00
Construction Unit Tax
0.00
Water Impact
0.00
Water Meter Installation
0.00
Wastewater Impact
0.00
Traffic Impact
0.00
Total Fee Calculated
144.46
Balance Due
0.00
NOTICE TO APPLICANT:
If, after making any of the foregoing declarations, you become subject to any Labor
Code or License Law provision, you must comply with such provisions or this permit shall
be deemed revoked.
I certify that I have read this application and state that the above information is correct,
I agree to comply with all city ordinances and state laws relating to building construction, and
hereby authorize representatives of this city to enter upon the above -mentioned property for
inspection purposes.
Unless noted under "Special Conditions", this permit becomes null and void if work or
construction authorized is not started within 180 days, or if construction or work is
suspended or abandoned for a period of 180 days any time after work is commenced.
Special Conditions:
_ 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 Worker's Compensation y
Laws of California. A�2, �/ /LC�_,,a
Not applicable Signature o ontractor, Authorized Agent or Owner Date
Address File