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Home My WebLink About100 Cross Street - Suite 102 Building ApplicationBuilding & Safety Division Construction Permit Application Community Development T 805.781-7180 919 Palm Street San Luis Obispo, CA 93401-3218 F 805.781.7182 Page | 1 #1 IDENTIFY YOUR BUILDING PROJECT (highlighted fields required) Property Address: Assessor’s Parcel: Property Owner Name: Property Owner Email: Phone Number: Owner’s Mailing Address: (If different from property address) Licensed Design Professional or Non-licensed Designer (when allowed by statues) Name: License No. Address: Phone: Description of work: Occupancy Group: Construction Type: Fire Sprinklers: Yes or No Project Valuation $: Floor Area (Sq Ft.): Living: Garage: Deck: Fire Severity Zone: Moderate High Very High Permit Type: Building Mechanical Electrical Plumbing Grading-C-Y Demolition #2 IDENTIFY WHO WILL PERFORM THE WORK (Select and Complete either 2a or 2b if 2a skip to 3) 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: _________________________________License Class: ___________________License No._____________________ 2b – OWNER BUILDER DECLARATION* (Please select option 1,2 or 3)I hereby affirm under penalty of perjury that I am exempt from the Contractors’ State License Law for the reason(s) indicated below by the checkmarks(s) I have placed next to the applicable item(s) (Section 70315, Business and Professions Code: Any city or county that requires a permit to construct, alter, improv, 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 Professional Code) or that he or she is exempt for licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500) Continue page 2 100 Cross Street, Suite 102 053-257-005 Bartlein & Company, Inc (Property Management) 805-569-1121mail@bartlein.com 3944 State St, Suite 200, Santa Barbara, CA 93105 x Pults & Assoc. LLP C26942 3592 Sacramento Drive, Suite 140 SLO, CA 93401 805-541-5604 Demolish 50 lin ft wall, 2,700 sf ceiling ﬁnishes, and 2,000 sf ﬂooring. Remove elect equip. Add 22 lin ft of ﬂr-to-clg wall to enclose (E) elect equipment. B VB Yes $29,500 2,952 N/A - within city limits xxx x Greg Moore Construction B C13 643022 Building & Safey Division Construction Permit Application Community Development T 805.781-7180 919 Palm Street San Luis Obispo, CA 93401-3218 F 805.781.7182 Page | 2 1. I, as owner of the property, or my employees with wages as their sole compensation, will do all or portion of the work, and the structure is not intended or offered for sale. (Section 7044, Business and Professions Code: The Contractors; State License Law does not apply to an owner of the 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 it was not built or improved for the purpose of sale) 2. I, as owner of the property, am exclusively contacting with licensed Contractors to construct the project (Section 7044, Business and Profession Code: The Contractors’ State License Law does not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a licensed contractor pursuant to the Contractors’ State License Law). 3. I am exempt from licensure 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 reside for at least one year prior to completion 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 requests or at California Legislative Information #3 IDENTIFY WORKERS' COMPENSTATION COVERAGE AND LENDING AGENCY (select 3a or 3b) Warning: Failure to secure workers’ compensation cover is unlawful and shall subject criminal penalties and civil fines up to $100,000 in addition to the cost to compensation damages as provided in section 3706 of the labor code interest and attorney’s fee. 3a WORKERS' COMPENSATION DECLARATION (select option 1,2 or 3) I hereby affirm under penalty of perjury one of the following declarations: 1. I have and will maintain a certificate of consent to self insure for workers’ compensation, issued by the Director of Industrial Relations provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy Number: ________________________ 2. 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. My workers’ Compensation insurance carrier and policy number are: Carrier___________________________ Policy No ____________________ Expiration Date: ____________ Phone: _________________ 3. I Certify that, in the performance of the work for which this permit is issued, shall not employ any person in any manner 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 this 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 ** Authorized to agent to act on the property owner’s behalf *I am the property owner I have read this permit application and the information I have provided is correct. I agree with applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this city or county to enter the above-identified property for inspection purposes. This permit is to be issued in the name of the Licensed Contractor or the Property Owner as the permit holder of record who will be responsible and liable for the construction. Print Name of property owner or authorized agent: Signature of property owner or authorized agent: Date: *Requires owner builder form ** Requires separate authorization form Application # (revised Jan 2026) x Berkshire Hathaway GRWC631429 9/23/2026 (888)495-8949 X x