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Home My WebLink AboutBLDG-0929-2020 SIGNED PERMIT AND PERMIT APPLICATIONf' ^�.f Building & Safety Division Community Development 919 Palm Street, San Luis Obispo, CA 93401-3218 #1 IDENTIFY YOUR BUILDING PROJECT Property Address: 1370 Broad Street Property Owner. Edwina Olt Construction Permit Application T 805.781 7180 F 805 781.7182 sessor's Parcel # Phone: Owner's Mailing Address: 1370 Broad Street, San Luis Obispo, CA 93401 ❑Licensed Design Professional In Responsible Charge or ❑Non -Licensed Designer (when allowed by statutes): Name: James A. Quaglino, Inc. dba Quaglino Roofing _ License No. 254025 Address 815 Fiero Lane, San Luis Obispo Phone. 805-543-0560 Description of work: Tear -off, re -sheet. and re -roof Dwelling Units: Occupancy Group Conrt Type Fire Sprinklers Project Value $ 23,830.00 _ Floor Area (Sq. Ft): Living 2,800 Garage Deck Other Permit Types Required: ❑✓ Building []Mechanical ❑Electrical ❑Plumbing []Grading-C.Y ❑Demolition Select Plan Check Consultant: ❑CCC ❑WILLDAN []BUREAU VERITAS IDENTIFY WHO WILL PERFORM THE WORK (Select and Complete either2a or2b) 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 Contractor Name: James A. Quaglino, Inc. dba Quaglino Roofing C39 B ASB 254025 License Class License No. ❑ _ 2b — OWNER -BUILDER'S DECLARATION i hereby affirm under penally of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s) (Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct. alter, improve, demolish, or repair any structure, prior to its issuance. also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption An violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than rive nundred dollars ($500).): MI, as owner of the property, or my employees with wages as their sole compensation, will do []all of or❑portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code. The Contractors' Stale License Law does not apply to an owner of property who, through employees' or personal effort. builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that Elwas nun not built or proved for the purpose of sale) 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044. Business and Professions Code The Contractors' State License Law does not apply to an owner of property who builds or improves (hereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑l am exempt from Ilcensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to &0mplehon of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors I understand that a copy of the applicable law is available upon request or at hltp:irwww.lauinfU ra Uov/cdldw nlml. #3 IDENTIFY WORKERS' COMPENSTATION COVERAGE AND LENDING AGENCY (Complete 3a and 3b) WARNING. _i,t r k .rs' compensation Coverage is unlawfw and shall sub,o-!. ; , r , ,,;,,, t , metal penalties and civil fines vp iri 3100,000, in addition to the Cost of compensation, darnages as provided for in section 3706 of the iabor rode. interest acid ,ittcvneys fees 3a -WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a certificate of consent to self -Insure for workers' compensation, Issued by the Director of Industrial Relations wcich vided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued Policy No C39 B ASB 1 have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for this permit is issued. My workers' compensation insurance carrier and policy number are: Carner Redwood Fire & Casualty Insurance Company Policy NoJAWC014061 Expiration Date10/01/2020 Phone 402-393.7255 Ell certify that, In the performance of the work for which this permit Is Issued, 1 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. 3b - CONSTRUCTION LENDING AGENCY DECLARATION I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which !his permit is issued (Section 3097, Civil Code) as follows: Lender's Name and Address #4 DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below. I certify each of the following I am ✓❑a California licensed contractor or❑the property owner' or❑authorized to act on the property owners behalf". I have read this permit application and the information I have provided is correct. I agree to comply with applicable city and county ordinances and state laws relating to building construction I authorize representatives of this city or u_nty to enter the above -identified property for inspection purposes. This permit is to be issued in the name of theLLicensed Contraccc,,,��or7FC 7AT 1�r as the permit holder of record who will be responsible and liable for the construction. Print Name Maljssa Corbett _ _Signature Date 05/13/2020 requires separate verification form ""requires separate authorization formN # �LV f j - 09 z V Revised 2014 IT Y c11: BUILDING PERMIT son Luis OB I s PO Re -Roof C A L 1 1: U R N I A BLDG-0929-2020 Building & Safety Division - 919 Palm Street - San Luis Obispo, CA 93401-3218 Issuance Date: 5/19/2020 Project Address: 1370 Broad St Assessor's Parcel Number 003_-24-004 Unit or Suite(s): Project Description. TEAR -OFF, RE -SHEET, AND RE -ROOF Legal Description: Contractor: QUAGLINO ROOFING Ryan Sutcliffe Business: (805) 471-7270 Other: (805) 543-0560 License Type: California State Contractor License License Number: 254025 Classification: B - General Building Contractor License Type: California State Contractor License License Number: 254025 Classification: C39 - Roofing Contractor Owner: IRENE HYLAND Fire Sprinklers: Stories 0.00 Code Year: 2019 Dwelling Units: Motel Rooms: Census: Construction Type: Occupancy: Dimensions Valuation Category: SQFT: Group Noe Sq. Ft Factor Valuation Manual $23,830.00 Fees Payments Fee Name Fee Amount Date Receipt # Amount Re -Roof Residential - BLDG $235,02 5119/20 27,279-05-19-2020 $235.02 Total Fees: $235.02 Total Paid: $235.02 Plan Check Account Payment by Contact Contact Name Account Name Status Total Credits Total Debits Account Balance 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 Coni�actor Autho4ized Agent or ner May 19. 2020 Date