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HomeMy WebLinkAbout1370_BROAD3-524-04 Broad 1370 t I„ Y r •'J F% +5? .dY •x i Ppn'0'.`. oq L p i r a Y S• 4� �� , . e S v st 4r z • z ��n � '(1 III city of san Luis oBmspo Building & Safety Division • 919Cr MtMofioa (P*ffjJjt33401-3218 • (805) 781-7180 Project Address 1370 BROAD Assessor's Parcel Number 003-524-004 Legal Description CY SLO MIRY CH ADD BL 88 PTN LT 4 Project Description ELECTRICAL SERVICE UPGRADE - RESIDENTIAL Permit Type Building Mechanical X Electrical Plumbing Sign Demolition Grading Property Owner EDWINA DICKINSON OLT Occupant/Business Name Mailing Address 1370 BROAD Architect/Engineer City/State/Zip SAN LUIS OBISPO, CA 93401 License # Contractor OWNER Contractor's Phone No. Mailing Address Contractor's State Lic. No. OWNER City/State/Zip Project Manager Project Manager's Phone No. Lender Name Lender Address C.B.C. Group C.B.C. Type Stories 0 Codes: CBC10 CEC10 Census Dwelling Units 0 Motel Rooms 0 Valuation Total Building Value $0.00 Fees Le al Declarations g Building Permit 0.00 Plumbing+Electrical+Mechanical Permit 110.00 2b(2) - OWNER -BUILDER'S DECLARATION - I, as owner of the property, am Grading Permit 0.00 exclusively contracting with licensed Contractors to construct the project S.M.I.P. 0.00 Green Building Fee 0.00 (Section 7044, Business and Professions Code: The Contractors' State License Law does Demolition Permit 0.00 not apply to an owner of property who builds or improves thereon, and who contracts for Sign Permit 0.00 the projects with a licensed Contractor pursuant to the Contractors' State License Law). Misc Charge/Credit 0,00Administrative Permit 0.00 By my signature below I acknowledge that, except for my personal residence in which I Archival Fee 0.00 must have resided for at least one year prior to completion of the improvements covered Subtotal 110.00 by this permit, I cannot legally sell a structure that I have built as an owner -builder if it has Investigation Fees 0.00 not been constructed in its entirety by licensed contractors. Building Plan Review Fee 0.00 Fire Safety Plan Review 0.00 Plan Review Subtotal 0.00 Development Review Fee 0.00 Fire Safety Surcharge 0.00 3a(3) - WORKERS' COMPENSATION DECLARATION - I certify that, in the Fire Systems 0.00 performance of the work for which this permit is issued, I shall not employ any Fire Sur/Sys Subtotal 0.00 person in any manner so as to become subject to the workers' compensation laws Construction Unit Tax 0.00 of California Water Impact 0.00 Area - 0.00 , and agree that, if I should become subject to the workers' compensation provisions of Water Meter Installation 0.00 Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Wastewater Impact 0.00 Area 0.00 Traffic Impact 0.00 Area - 0.00 Affordable Housing 0.00 Public Art 0.00 Code Enforcement 0.00 Park Improvement Area - 0.00 Engineering Development Review Fee 0.00 Open Space In -lieu Fee 0.00 Total Fees 110.00 Balance Due 0.00 Payments Fee Exemptions: Amount Date Receipt Payment#1 110.00 10/11/13 62609 Comments: Total Paid 110,00 Application Number130979 Permit Number 27616 Application Date 10/11/13 Issuance Date 10/11/13 Address File Z , Signature of Contractor, Authorized Agent or Owner Date I city of san his oBispo � Building & Safety Division • 919 Palm Street • San Luis Obispo, CA 93401 • (805) 781-7180 • (805) 781-7182 Fax OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION Dear Property Owner: Building Permit Application No. I JQgiq h been submitted in your name listing yourself as the builder of the property improvements specified at We are providing you with this Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated above. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. t� 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to P P P Y P 9 P Y� Y 1 serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. /­-V Z I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. V. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 'I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my to abide by these laws may subject me to serious financial risk. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four,within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sus fined by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. C . I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed J BYO. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following project address: 4L A1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. � 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Print Name of Property Owner(__CJAi,� k GJ D, - C N SO ►, Signature�__ o�a� �. .,�_ . 4� ,�{S ,�� Date: city of San Wis OBI Sp0 0 Building & Safety Division • 919 Palm Street • San Luis Obispo, CA 93401 • (805) 781-7180 • (805) 781-7182 Fax AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Note: This form shall be completed by the property owner only when designating an agent of the property owner for purposes related to a construction permit for the Owner -Builder. Project Location or Address: Scope of Construction Project (or Description of Work): Excluding the Owner's Acknowledgment and Verification of Information Form, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owneo Builder Permit for my project. Name of Authorized Agent: �' ip Address of Authorized Agent: �' Phone I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Name (please print): A Property Owner's Signature: Date: Building Application No. ClLyvrShclIUISOBISrJ � AI� BUSINESS TAX CERTIFICATE SUPPLEMENT Department of Community Development - 990 Palm Street - San Luis Obispo, CA 93401 - (805) 781-7171 Print clearly in ball-point or type only in unshaded area. Attach this form to your completed business tax certificate application and return both to the Finance Department. *Be sure to confirm with the Planning Division that your business is consistent with city regulations prior to establishing your business location. APPLICATION FOR: Y New Business ❑ Contractor ❑ Change of Mailing Address ❑ Change of Location ❑ Change of Ownership Applicant E� e ` ( I"-) Business Name Business Nlaiii ng A Fully des cribe your business (Include type of goods o� services offered, hours, etc.) PLEASE CHECK ONE: Ground Floor ❑ Upper Floor Day Phone � 4 q —�_) 7� `f (r If your business occupies more than one address or site in San Luis Obispo, please include other addresses and indicate primary address: Number of Employees: =- full-time 11 cc�� part-time Approximate floor area occupied by the business: d.�`� square feet. Area devoted to outdoor sales or storage: � square feet. Prior Tenant, If Known: y c^1 ZONING INFORMATION What zone is the business in? Is the business allowed in this zone? ❑ Yes -permit not required ❑ No ❑ Yes -with a permit. Zoning Regulations Classification REQUIRED PARKING City parking requirements are based on the floor area or lot area of your business. Check the city's Zoning Regulations and the Parking and Driveway Standards to determine the number, size and type of spaces required. Total number of off-street parking spaces provided exclusively for the business: Total number of off-street parking spaces required by the city: HOME OCCUPATION PERMITS You will need to apply for a Home Occupation Permit if your home in a residential zone is the base of operations for your business -serving as a mailing address, office, shop, or related use -even if you do work in other locations. The property owner must sign the permit application, consenting to the home occupation. Is this a home occupation? ❑ No 1KYes If so, has a home occupation permit been applied for? ❑ No Yes Date Applied SIGN PERMITS You may need a sign permit (Signs for home occupations are not allowed.) Refer to the city's Sign Regulations. Is a sign permit required? ❑ No ❑ Yes If so, has a sign permit been granted? ❑ No ❑ Yes, application number Received By Date Supplement Approved By C Date :71; 1 t S Notes to file 0I��WI11N�X"�III city -%f a7AI l luis WiCertifi e No. BUSINESS TAX CERTIFICATE APPLICATION Finance Department • 990 Palm Street/ P.O. Box 8100 • San Luis Obispo, CA 93403-8100 • (805) 781-7134 Application for: Q- ew Business ❑ Change of Mailing Address ❑ Change of Location ❑ Change of Ownership Applicant F Business Name Mailing Address Business Location �_� \ tU CA J 4 6_�" ' D Former Owner/ Tenant (if known) Doing Business As (DBA) , h. U `7 3 v ( Suite No. City '7' 0 t ?)Y o 1 State ( -0--- zip Telephone No. (Business)" /'��' Telephone No. (Home) Legal Status (SoleProprietor, Corporation, etc.); List names, home addresses and social security numbers of all principals in the business(use additional pages if necessary) 11 Type of Business: ❑ Retail ❑ Wholesale A Professional ❑ Service ❑ Property Rental (Residential) ❑ Property Rental (Non -Residential) ❑ Manufacturing ❑ Contractor Does your business have non-profit status? ❑ Yes ,t No If yes, will you be doing solicitations? ❑ Yes jQ No If yes, the solicitations will be performed by: ❑ Owner ❑ Employee ❑ Volunteer ❑ Hawker Gross Receipts State Sales Tax No. Federal ID No. State License No. (if applicable) State Franchise Tax ID No: Describe the nature of your business:, ,^.c ff this application is for change of location, mailing address or ownership, compleife a following: Previous Business Name Previous Location / Mailirg Address PreviousOwner 1. Applicant / Representative: I have reviewed this application and the attached material. The information is accurate to the best of my knowledge. I understand that in addition to obtaining a business tax certificate, I must comply with all other city, county and state regulations., Signedt� �, ,��r t.� ``--' Titl@ i Date_ y Approvals squired: ❑ Community Development Department Signature ❑ Police Depatment Signature ❑ Other: Signature FOR OFFICE USE ONLY Title Date Title Title Date Date Classification Number Business Group BIA J Yes < L) No Payment Date Tax Amount Paid 2020 83 i 3 ®Printed on recycled paper. PLANNING City HOMEEOCCUPATION PERMIT Department of Community Development, 990 Palm Street • Post Office Box-84 , San Luis Obispo, CA 93403-8100 • (805)781-7171 tia Please print clearly or type only in the unshaded areas. Return this completed form with your a5&00 application fee. This form will be your permit when approved. In some cases, you may have to comply with additional conditions. Also, be sure to get a business license. NOTE: Private property regulations such as deed restrictions or Conditions, Covenants and Restrictions (CC&Rs) of homeowners associations may restrict or prohibit home occupations even if such use is allowed by City regulations. Applicants are encouraged to determine compliance with any applicable private regulations before applying for City approval. Business Applicant + C�� II Name Phone Address l t rC? R c� ��• k C, 0—&-r f � y C' l Zone �) Do you own the home? ❑ Yes 5(No. (If you do not own the home, the owner must sign this form consenting to your home c upation.) Accurately describe your home occupation* *A more detailed description of and a site plan malt' be required later. In some cases a hearing may be required. REQUIREMENTS FOR APPROVAL My home occupation will comply with the following: 1. This business will be conducted entirely inside without altering the appearance of the home, grounds or adjacent buildings. 2. There will be no sales or displays on the premises. 3. There will be no signs other than address and name of resi- dents. Those signs will meet the requirements for my zone. 4. There will be no advertising which identifies the home occupa- tion by street address or location. 5. My home occupation will not encroach on any required parking, yard or open space. (Parking space in a garage is normally re- quired parking.) 6. No vehicle larger than a 3/4-ton truck will be used in connection with my home occupation. Parking for vehicles used in connection with my home occupation will be provided in addition to parking required for the residence. 7. Activities conducted and equipment or materials used will not change the fire safety or occupancy classification of the premises. Utilities will not be used in amounts greater than normally provided for residential use. 8. My home occupation will not create noise, dust, vibration, smell, smoke, glare, electrical interference, or other hazard or nuisance. 9. No employees other than residents of my home will be allowed. 10. Clients or customers will not visit my home between 10:00 p.m. and 7:00 a.m. APPLICANT: I understand that, if a permit is issued, I must meet the requirements listed above. If the requirements are not met, the permit will be void and the home occupation must cease immedi- ately. Applicant t" Date OWNER:* As owner of the property, I give the applicant permis- sion to conduct business there subject to these conditions. Owner's V� Name (print) Owner's Signature o Date *The property manager of an apartment complex or the park manager of a mobile home park may sign in place of the owner. A0. Pe00 WHITE -FILE YELLOW -APPLICANT PINK -FINANCE