HomeMy WebLinkAboutFIRE-2568-2023-SIGNED PERMIT$iri'Lur.q.gpl$po BUILDING PERMIT
Fire Sprinklers
FtRE-2568-2023
lssuance Dale: 1 12212025Building & Safety Division . 919 Palm Street. San Luis Obispo, CA 93401-3218
ProjectAddress: 619 Grove St
Unit or Suite(s):
Project Description: INSTALL FIRE SPRINKLER SYSTEM
Contractor: CENTML COAST FIRE SUPPRESSION LLC
RANDY SHRIVER
Business: (805) 440-701 3
License Type: California State Contractor License
Assessor,s Parcel Number: 001-056-029
Square Footage: 0.00
Legal Description:
License Number: 1105979 Classification: C16 - Fire Protection Contractor
Owner:John Rourke
Mobile: (
Valuation
Group Tvpe sq. Ft Factor Valuation
Fire Sprinklers:Stories 0.00 CodeYear'. 2022 Dwelling Units Motel Rooms:
Construction Type:Census:
Occupancy:
Fees Payments
Receipt #Fee Name Fee Amount Date Amount
Fire sprinkler consolidated - new
lT Surcharge
$1,156.29
$35.27
10t17t24 M,998-10-17-2024
Total Paid
$1,191.56
$1Jsrs6
Total Fees:$1,191.56
Plan Gheck Account Payment by Gontact
Contact Name Account Name Status Total Gredits Total Debits Account Balance
Total Account Balance:
Balance Due:s0.00
Legal Declarations
#2 IDENT]FY 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 I
commencing with Section 7000 of Division 3 of the Business and Professions Code, and my license is in full force and effect.
#3 IDENTIFYWORKERS' 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 certiff 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 DEGLARATION BY CONSTRUCTION PERMIT APPLICANT
By my signature below, I certifo each of the following:
I am a CA Licensed Contractor.
Januaw 22
sig , Authorized Agent or Owner Date
,2025