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Home My WebLink About103 EARTHWOOD_FIRE-1378-2022CITY OF san tu,C~L9l?!~P0 BUILDING PERMIT Fire Sprinklers FIRE-1378-2022 Issuance Date: 5/17/2022 Building & Safety Division• 919 Palm Street• San Luis Obispo, CA 93401-3218 Project Address: 103 Earthwood Ln Assessor's Parcel Number: 053-291-001 Unit or Sulte(s): Square Footage: 0.00 Project Description: INSTALLATION OF NEW EIRE SPRINKLER SYSTEM Legal Description: Contractor: Owner: Fire Sprinklers: Census: Occupancy: Group LOT 1: PLOT PLAN 1: TRACT 3089 LSE Fire Protection, Inc. Laura Salazar Wathen Castanos Business: (559) 432-8181 Stories 0,00 Valuation Type Fees Code Year: 2019 Dwelling Units: SQ. Ft Factor Valuation Motel Rooms: Construction Type: Fee Name Fee Amount Date Payments Receipt# Amount Supplemental Inspection (Building) -BLDG IT Surcharge Total Fees: $358.12 $10.92 $369.04 5/17/22 35,421-05-17-2022 Total Paid: $369.04 $369.04 Plan Check Account Payment by Contact _c_o_nta ___ ct_N_a_m_e __ ....,.. __ A_cc_o_u_n_t_N_am_e _______________ 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 afflnn 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 $100,000, In addition to the cost of compensation, damages as provided for In section 3706 of the labor code, interest, and attorney's fees. I have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor Code, for the perfonnance of the work for which this pennit is issued. #4 DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify each of the following: I am a CA Ucensed Contractor. Signature of Contractor, Authorized Agent or Owner May 17, 2022 Date Building & Safety Division Construction Permit Application Community Development 919 Palm Street, San Luis Obispo, CA 93401-3218 #1 IDENTIFY YOUR BUILDING PROJECT T 805.781 .7180 F 805.781 .7182 Property Address: Lot 1 -103 Earthwood Lane, San Luis Obispo CA 93401 Assessor's Parcel# ____ -__ Property Owner: _w_at_h_e_n_c_a_st_a_no_s ___________________ Phone: 559-432-8181 ext. 136 Owner's Mailing Address: 1446 Tollhouse Rd, Ste 103, Clovis CA 93611 [Zlucensed Design Professional In Responsible Charge or □Non-Licensed Designer (when allowed by statutes): Name: LSE Fire Protection, Inc. License No. 950739 -------- Address: 28568 Lantern Park Lane, Menifee CA 92584 Phone: 951-274-0734 Description of work: INSTALLATION OF NEW FIRE SPRINKLER SYSTEM; LOT 1; PLOT PLAN 1; TRACT 3089 Dwelling Units: __ Occupancy Group: R3 / U Const Type 13D Fire Sprinklers ~Project Value$ _2_,4_0_0 ___ _ Floor Area (Sq. Ft): Living 1,811 Garage 424 Deck _____ Other_3_6_5 _____ _ Permit Types Required : □Building □Mechanical □Electrical □Plumbing []Grading-C.Y __ □Demolition Select Plan Check Consultant: □CCC QvvlLLDAN □BUREAU VERITAS IDENTIFY WHO WILL PERFORM THE WORK (Select and Complete either 2a or 2b) D NTRA T R' DEC TI 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: LSE Fire Protection, Inc. License Class C-16 License No. 950739 0 2b -OWNER.f3UILDER'S DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors·-s~tat_e_L-ic_e_n-se-La-w-for- the reason(s) indicated below by the checkmar1<(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 Di vi sion 3 of the Business and Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. An~iolation of Section 70 31.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fi~hundred dollars ($500).): LJI, as owner of the property, or my employees with wages as their sole compensation, will do Dan of orLJportions 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 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 bu ilding or improvement Is sold within one year of completion, the Owner-Builder will have the burden of proving that ,!ulas not built or improved for the purpose of sale) LJ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044 , Business and Profess ions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). 0 I am exempt from llcensure 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 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 request or at http://www.leginfo.ca.gov/calaw.html. #3 IDENTIFY WORKERS' COMPENSTATION COVERAGE AND LENDING AGENCY (Complete 3a and 3b) 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 . ATI I hereby affirm under penalty of perjury one of the following declarations: I have and wlll maintain a certificate of consent to self-Insure for workers' compensation, Issued by the Director of Industrial Relatlons ~ vided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy No. I have and wlll maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for ich this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Falls Lake Insurance Company Policy No FLA012070 Expiration Date 7-21-22 Phone 0 I certify that, In the performance of the work for which this permit Is Issued, I shall not employ any person in any man_n_e_r _s_o_a_s_t_o become subject to the workers' compensation laws of Callfornla, 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 pe~ury that there is a construction lending agency for the performance of the work for which this perm it is issued (Section 3097, Civil Code) as fo llows : Lender's Name and Address ______________________________________ _ #4 DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify each of the following: I am[Zla California licensed contractor orOthe property owner* orOauthorlzed to act on the property owner's behalf"*. I have read this permit application and the information I have provided is C01Tect. I agree to comply with applicable city and county ordinances and state laws relating to building construction . I authorize ~resentatives of this city o~unty to enter the above-identified property for inspection purposes. This permit Is to be Issued in the name of thel.{Jllcensed Contractor orLJthe Property Owner as the permit holder of record who will be responsible and liable for the construction. Print Name Eduardo Moreno Signature _ __:;;::.::::~~!~=::::===========--Date 5-13-22 * requires separate verification form **requires separate authorization form• APPUCAT,'ON # Revised 2014