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HomeMy WebLinkAbout483 Mitchell Scanned address filer ���n nh ►►nlil�u9111 II ci ty t san luis =BEN Building & Safety Division • 990 Palm Street • San Luis Ot OBIS __ ___-) po, CA 93401-3249 • (805) 781-7180 Project Address 483 MITCHELL Assessor's Parcel Number 004-932-009 Project Description REPAIR FIRE DAMAGE @ BEDROOMS/LAUNDRY Permit Type X Building Mechanical X Property Owner ACKERSON KELLY M & JULIA A Mailing Address 483 MITCHELL DR City/State/Zip SLO CA, 93401-5637 Contractor SMITH & SONS DISASTER KLEENUP Mailing Address PO BOX 1447 City/State/Zip ARROYO GRANDE CA 93421 Project Manager BUD TRASK Lender Name U.B.C. Group R-3 U.B.C. TypeV-N Legal Description CY SLO CAUD TR BL 4 LT 12 Electrical X Plumbing Sign Demolition Grading Occupant/Business Name Architect/Engineer License # Contractor's Phone No. 481-2955 Contractor's State Lic. No. 388461 Project Manager's Phone No. 481-2955 Lender Address Stories 2 Codes: UBC 11 NEC 1 Census number 434 Residential Alteration or Addition Dwelling Units 0 Motel Rooms 0 Enforcement Valuation Residential Alteration/Addition/Conversion 15,000 Fees :wilding Permit 287.25 Plumbing Permit 38.29 Mechanical Permit 0.00 Electrical Permit 38.29 Grading Permit 0.00 S.M.I.P. 1.50 Energy Surcharge 36.38 Accessibility Surcharge 0.00 Demolition Permit 0.00 Sign Permit 0.00 Misc Charge/Credit 0.00 Administrative Permit 0.00 Investigation Fees 0.00 Microfilm 0.00 Subtotal 401.71 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 Construction Unit Tax/Plan Preparation 0.00 Water Impact 0.00 Area 0.00 Water Meter Installation 0.00 Wastewater Impact 0.00 Area - 0.00 Traffic Impact 0.00 Affordable Housing 0.00 Public Art 0.00 Code Enforcement 0.00 Park Improvement Area - 0.00 Total Fees 401.71 Balance Due Payments 0.00 Amount Date Receipt Payment #1 401.71 07/19/05 21542 Total Paid 401.71 Application Number050692 Permit Number 20311 Application Date 07/19/05 Issuance Date 07/19/05 $15,000.00 Total Building Value $15,000.00 Legal Declarations 1. OWNER BUILDING DECLARATION: I am exempt from the contractor's License Law for the following reason: ❑ 1, as owner of the property, or my employees with wages as their sole compensation will do the work and the structure is not intended or offered for sale. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. M Not applicable. 2. WORKER'S COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a 'certificate of Workers' Compensation insurance, or a certified copy hereof Certified copy is hereby furnished. Certified copy is filed with the City. Not applicable 3. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE ❑ 1 certify 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 Worker's Compensation Laws of California Not applicable NOTICE TO APPLICANT., If, after making any of the foregoing declarations, you become subject to any Labor Code or License Law provision, you must comply with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above information is correct, I agree to comply with all city ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. Unless noted under "Special Conditions", this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days any time after work is commenced. Special Conditions: Comments: 00000.E Address File CONSTRUVION PERMIT City of San Luis Obispo • Building Division • 990 Palm Street/Box 8100 • San Luis Obispo, CA 93403-8100 • (805) 549-7180 Project Address Assessor's Parcel Number Building Suite/Unit Legal Description Project Description Permit Class Permit Type Building Property Owner Mechanical Electrical Plumbing Sign Demolition Grading Other Mailing Address City/State Phone Number Zip Code Occupant/Business Name Phone Number Business Owner's Name Contractor's Name Mailing Address City/State/Zip Contractor's Phone No. Contractor's State Lic. No. Project Manager/Architect Project Manager's Phone No. Lender Name Lender Address U.B.C. Group U.B.C. Type Subject to Flood Zone Requirements Census Census Census Number Description A=Area A/D/Y Bldg. Value Units No. of Number Sub -Code D = Dollars per Bldg. Code per Bldg. Bldgs. Y = Yards Total Bldg. Value Total Bldg. Area or Yards of Grading Height (ft.) Stories Plan No. IfPL r l E't8 N6 PRELL (pj i F:; FEE rk !! 1'c -1 -; i t N nrrf,FF PERM". j_tc�:.,;i ' HE t-._�_�.--I r. L. I�� _La .,. 5._ ,_LL! .,. i�; j�.,-. ,lr•_ �,r ._ � INr:.F BUILDLNG PERMIT IS3.60 87H FLAN CHECK rgF.CHAI "AiL FEE" E ' I FLE?TFtli'.AI i=�Et>Iltf P'11.06$ j 11E, PEEN T DEMOLITION F'ERM11 T 5,:1,F'. HAjiltLi_ii+F`l:Ti H A.'+ CH U' f . F1 fi Special Conditions: E W. E S 141. :,ki EP 1.06 clPIicf ILIN it,.t'I4 .tilt. E;j}LtjE; PERMIT V IN6 I.'i ittik!i �L!..ROFI€.li HE TIME AND MATERIAL DMINISTRATIVE 1 •.t,!iL i .LJ Ja.. WdNT F'AH11 (J cii_: Nf^ Permit Number G Issuance Date Authorized Department Representative Date Application Number Application Date Activity Code Activity Date This permit is only valid when endorsed by an authorized representative of the Community Development Department. LEGAL DECLARATIONS OWNER BUILDER DECLARATION: NOTICE TO APPLICANT: I am exempt from the contractor's License Law for the following reason: If, after making any of the foregoing declarations, you become subject to any Labor Code or ❑ I, as owner of the property, or my employees with wages as their sole compensation will do License Law provision, you must comply with such provisions or this permit shall be deemed the work and the structure is not intended or offered for sale. revoked. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. I certify that I have read this application and state that the above information is correct, I agree ❑ Not applicable to comply with all city ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection WORKERS COMPENSATION DECLARATION: purposes. I hereby affirm that I have a certificate of consent to self -insure, or 'a certificate of Workers' Compensation insurance, or a certified copy hereof (Sec. 3800, Lab. C) Unless noted under ''Special Conditions," this permit becomes null and void if work or ❑ Certified copy is hereby furnished. construction authorized is not started within 180 days, or if construction or work is suspended ❑ Certified copy is filed with the City. ❑ Not applicable or abondoned for a period of 180 days any time after work is commenced. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE ❑ I certify 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 Worker's Compensation Laws of California. Signature of Contractor, Authorized Agent or Owner Date El Not applicable 0 0 0002 U �tJ ungniarAPPucem rrune-nie nun Aa-w 1 w,u-wu:no: — �►I�n���������n ,III �ii��������� I�►IIIIII IIII �a �of San WIS oB>spo _ YA M A - CONSTRUCTION PERMIT A 3608 Department of Community Development, 990 Palm Street/Post Office Box 321;San Luis Obispo, CA 93406 (805) 541=1000 ext 79 TYPE OF ❑ Combination ❑ Building ❑ Remodel ❑ Electrical ❑ Plumbing ❑ Mechanical ❑ Solar ❑ Grading PERMIT ❑ Retaining Wall ❑ Parking Lot ❑ Demolition ❑ Moving ❑ Other Project Address 483 Mitchell Drive Use Zone R-1 Lot Number 12 Block 4 Tract Caudill Tract Assessor's Number 004-932-0009 Owner Kelly & Julia Ackerson Address 433 Mitchell Dr. , SLO, Contractor Can. of -Builder Northland. Pure Water EvaironmAddress 1115 Chestnut, Burbank, Phone Architect Ca Day Phone 818-841-8080 or Designer Address Phone Lic. No. Te OCCUPANCY & GROUP ? -3 TYPE OF CONSTRUCTION: FOUNDATION: ❑ Wood ❑ Concrete ❑ Slab ❑ Piers/Caissons FRAME: ❑ Wood Stud ❑ Metal ❑ Timber ❑ Masonry EXTERIOR WALL: ❑ Wood Siding ❑ Stucco ❑ Masonry Veneer ❑ Masonry ❑ Brick ❑ Concrete Block ❑ Metal ROOF: ❑ Built-up ❑ Metal ❑ Composition Shingle ❑ Tile ❑ Wood Shingle/Shake HEATING: ❑ Electric ❑ Gas Furnace ❑ Gas Wall ❑ Solar STATE REQUIREMENTS: ❑ Energy ❑ Sound ❑ Handicapped fires LEGAL DECLARATIONS LICENSED CONTRACTORS DECLARATION: I am licensed under the 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. License Class C-36 License Number 450493 Contractor Northland Envirommntloate 7-6-87 OWNER BUILDER DECLARATION: I am exempt from the contractor's License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation will do the work and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ I am exempt under Sec. B. & P.C. for this reason WORKERS COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or 'a certificate of Workers' Compensation Insurance, or a certified copy hereof (Sec. 3800. Lab. C). ❑ Certified copy is hereby furnished. ❑,Certified copy is filed with the•eowgy4lanning Department. City CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE I certify 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 Worker's Compensation Laws of California. Date Applicant NOTICE OF APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ, C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above -mentioned property for inspection purposes. NOTICE Unless noted under "Special Conditions," this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days any time after work is commenced. Signature of Contractor or Authorized Agent Signature of Owner (If Owner Builder) WHITE — Applicant YELLOW — File PINK — Assessor GOLD — Counter Day Phone PROJECT INFORMATION Tvne of Proiect: install -4 ter SOftne °: Pronoseduse Residential Setbacks: Front Sides Rear Floor Area Garage Barn CarportCovered Porch Deck Storage No. Bedrooms No. Bathrooms No. Stories Buildina Heiaht Retaining Wall Information: Length He Material Mobile/ Modular Home Information: Manufacturer Year Serial No. D.O.H. No. D.M.V. Lic. No. State No. Bedrooms Moving Building Information: Present Location Locality Present Use Proposed Use Tot. Lin. Ft. of Fdtn. Grading Information: Tot. Cut Cu. Yds.; Tot. Fill Cu. Yds.; Area of Disturbance TOTAL VALUATION $ - Plan Check No. i_�W$ Combination Permit ....... $ Building Permit ........... $ Electrical Permit .........$ Plumbing Permit .........$ 20.00 Mechanical Permit ........$ Other: $ Other: $ TOTAL PERMIT FEES $ ❑ Construction Unit Tax $ TOTAL FEES $ REQUIREMENTS❑ Water Fees to be Paid p Other ❑ Fire Hydrants for Const. ❑ Sewer Fees to be Paid W.C. Insurance Ed City Business License ❑ C/G/S Permit Reg'd. El State Contractor's Lic. ❑ Encroachment Permit SPECIAL CONDITIONS VALIDATION John L. Kellerman/ill Authorized Department Representative Date 16-83 SEQ DATE TOTAL AMOU i I��I►►�IIIIIIIIIII I. ,!lilll II1111I��IIII Illlllli city of San tul S OBI Sp0 _� CONSTRUCTION PERMIT 2846 Department of Community Development, 990 Palm Street/Post Office Box 321, San Luis Obispo, CA 93406 (805) 541-1000 ext °79 TYPE OF 0 Combination ❑ Building ❑ Remodel ❑ Electrical ❑ Plumbing ❑ Mechanical ❑ Solar ❑ Grading PERMIT ❑ Retaining Wall ❑ Parking Lot ❑ Demolition ❑ Moving ❑ Other Project Address Lot Number 12 Owner_ Contractor or Builder_ Architect or Designer 483 Mitchell Drive Block 4 Tract Caudill. Kelly & Julie Ackerson Owner J. D. Brannon Address Use Zone R--1 Assessor's Number 4-932-09 483 Mitchell Dr., SLO, CA Phone Day Phone Address 3534 Eingleo St. , SLO,CA Phone 543-797S Lic. No. C--10863 Tenant_ Address Day Phone OCCUPANCY & GROUP TYPE OF CONSTRUCTION: V FOUNDATION: ❑ Wood ❑ Concrete ❑ Slab ❑ Piers/Caissons FRAME: ❑ Wood Stud ❑ Metal ❑ Timber ❑ Masonry EXTERIOR WALL: ❑ Wood Siding ❑ Stucco ❑ Masonry Veneer ❑ Masonry ❑ Brick ❑ Concrete Block ❑ Metal ROOF: ❑ Built-up ❑ Metal ❑ Composition Shingle ❑ Tile ❑ Wood Shingle/Shake HEATING: ❑ Electric ❑ Gas Furnace ❑ Gas Wall ❑ Solar STATE REQUIREMENTS: n Energy ❑ Sound ❑ Handicapped LEGAL DECLARATIONS LICENSED CONTRACTORS DECLARATION: I am licensed under the 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. License C Contractor License Number Date OWNER BUILDER DECLARATION: I am exempt from the contractor's License Law for the following reason: ❑ I, as owner of the property, or my employees with wages as their sole compensation will do the work and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ I am exempt under Sec. B. & P.C. for this reason Date Appli WORKERS COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or 'a certificate of Workers Compensation Insurance, or a certified copy hereof (Sec. 3800, Lab. C). ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the county Planning Department. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE I certify 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 Worker's Compensation Laws of California. Date Applicant NOTICE OF APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above -mentioned property for inspection purposes. NOTICE Unless noted under''Special Conditions,'' this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days any time after work is commenced. Signature of Contractor or Authorized Agent PROJECT INFORMATION Type of Project: "`i : !- s' ; ., LDD i'1 i JN & REMODEL Proposed Use: residential Setbacks: Front 20Sides 51 Rear Floor AreaT2 7 s f Garage Barn CarportCovered Porch Deck 310 s:f Storage No. Bedrooms 3 No. Bathrooms 1 No. Stories Building Height 23 r Retaining Wall Information: Length Height Material Mobile/ Modular Home Information: Manufacturer Year Serial No. D.O.H. No. D.M.V. Lic. No. State No. Bedrooms Moving Building Information: Present Location Locality Present Use Proposed Use Tot. Lin. Ft. of Fdtn. Grading Information: Tot. Cut Cu. Yds.; Tot. Fill Cu. Yds.; Area of Disturbance TOTAL VALUATION ...... $ 37,000. Plan Check No. $ Combination Permit ....... $ 327.60 Building Permit ........... $ Electrical Permit .........$ Plumbing Permit .........$ Mechanical Permit ........ $ Other: $ Other: $ TOTAL PERMIT FEES $ ❑ Construction Unit Tax $ TOTAL FEES $ ° REQUIREMENTS❑ Water Fees to be Paid ❑ other ❑ Fire Hydrants for Const. ❑ Sewer Fees to be Paid ❑ City Business License ❑ C/G/S Permit Reg'd. ❑ State Contractor's Lic. ❑ Encroachment Permit SPECIAL CONDITIONS i VALIDATION �&el lerman/ve 9 / 12 / 86 Signature of Owner (If Owner Builder) WHITE — Applicant YELLOW — File PINK — Assessor GOLD — Counter Authorized Department Re SEQ DATE TOTAL AMOUNT Date 16-83 ►i�►iiiiiii�i�� �ii'I IIh°11'''i' IIIIIIII city of son tui s OBI spo j CONSTRUCTION PERMIT' Department of Community Development, 990 Palm Street/Post Office Box 321, San Luis Obispo, CA 93406 (805) 541-1000 ext. 79 TYPE OF ❑ Combination ❑ Building ❑ Remodel '❑ Electrical ❑ Plumbing ❑ Mechanical ❑ Solar ❑ Grading PERMIT ❑ Retaining Wall ❑ Parking Lot ❑ Demolition ❑ Moving ❑ Other Project Address _ Lot Number 483 Mitchell Drive: Use Zone Block 4 Tract Caudill Assessor's Number 93401 Owner ,�kPrsnn Address Mote a J-�i°..SL0.CA Day Phone Contractor or Builder Address Phone Architect or Designer Address Phone Lic Tenant- Address Day Phone OCCUPANCY & GROUP TYPE OF CONSTRUCTION: FOUNDATION: ❑ Wood ❑ Concrete ❑ Slab ❑ Piers/Caissons FRAME: ❑ Wood Stud ❑ Metal ❑ Timber ❑ Masonry EXTERIOR WALL: ❑ Wood Siding ❑ Stucco ❑ Masonry Veneer ❑ Masonry ❑ Brick ❑ Concrete Block ❑ Metal ROOF: ❑ Built-up ❑ Metal ❑ Composition Shingle ❑ Tile ❑ Wood Shingle/Shake HEATING: ❑ Electric ❑ Gas Furnace ❑ Gas Wall ❑ Solar STATE REQUIREMENTS: ❑ Energy ❑ Sound ❑ Handicapped LEGAL DECLARATIONS LICENSED CONTRACTORS DECLARATION: I am licensed under the 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. License Class License Number Contractor Date OWNER BUILDER DECLARATION: I am exempt from the contractor's License Law for the following reason: ❑ 1, as owner of the property, or my employees with wages as their sole compensation will do the work and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ I am exempt under Sec. B. & P.C. for this reason Applicant WORKERS COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or 'a certificate of Workers' Compensation Insurance, or a certified copy hereof (Sec. 3800, Lab. C). ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the county Planning Department. Applicant CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE I certify 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 Worker's Compensation Laws of California. Date Applicant NOTICE OF APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above -mentioned property for inspection purposes. NOTICE Unless noted under''Special Conditions,'' this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days any time after work is commenced. Signature of Contractor or Authorized Agent No PROJECT INFORMATION Type of Project: J, (.;i ICA.L SERVICE Proposed Use: residential Setbacks: Front Sides Rear Floor Area Garage Barn CarportCovered Porch Deck Storage No. Bedrooms No. Bathrooms No. Stories Building Height Retaining Wall Information: Length Height Material Mobile/Modular Home Information: Manufacturer Year Serial No. D.O.H. No. D.M.V. Lic. No. State No. Bedrooms Moving Building Information: Present Location Locality Present Use Proposed Use Tot. Lin. Ft. of Fdtn. Grading Information: Tot. Cut Cu. Yds.; Tot. Fill Cu. Yds.; Area of Disturbance TOTAL VALUATION ...... $ Plan Check No. $ Combination Permit ....... $ Building Permit ........... $ Electrical Permit .........$ Plumbing Permit .........$ Mechanical Permit ........ $ Other: $ Other: $ TOTAL PERMIT FEES $ ❑ Construction Unit Tax $ TOTAL FEES $ REQUIREMENTS❑ water Fees to be Paid ❑ Other ❑ Fire Hydrants for Const. ❑ Sewer Fees to be Paid ❑ City Business License ❑ C/G/S Permit Reg'd. ❑ State Contractor's Lic. ❑ Encroachment Permit SPECIAL CONDITIONS VALIDATION Authorized Department Representative Date Signature of Owner (If Owner Builder) WHITE —Applicant YELLOW — File PINK —Assessor GOLD —Counter SEQ DATE TOTAL AMOUNT 16- ►►��►�I►ii � IIIIIiIlillllllll(II' � I IIIIIii►��i illl � aW of San IUIS OBISPO. COMMUNITY DEVELOPMENT DEPARTMENT Construction Regulations Division `._' " _"... ....... 990 Palm Street • Post Office Box 321, San Luis Obispo, CA 93406-0321 • 805/54T--= 549-7180 Date: April 2, 1984 E. M. Ackerson 483 Mitchell Drive San Luis Obispo, Ca. 93401. The Electrical Permit(s), No. 0105 , issued on 8-4-83 for Electrical service at 483 Mitchell Drive expired by limitation. You are advised no inspection or approval was made/granted for the work permitted. If you wish an inspection to be made, the permit(s) shall be renewed as set forth in Section 302(d) of the Uniform Building Code. Sincerely, John L. Kellerman Chief Building Official JLK:ve cc: :s CC"'�'t) ���iiillllilllll ;;;'� I11111I���II� ���� Ilf Clt! of - son WI S OBl spo CONSTRUCTION PERMIT Department of Community Development, 990 Palm Street/Post Office Box 321, San Luis Obispo, CA 93406 (805) 541-1000 ext. 79 TYPE OF ❑ Combination ❑ Building ❑ Remodel ❑ Electrical ❑ Plumbing ❑ Mechanical ❑ Solar ❑ Grading PERMIT ❑ Retaining Wall ❑ Parking Lot ❑ Demolition ❑ Moving ❑ Other Project Address 483 Mitchell Drive Use Zone Lot Number 12 Block 4 Tract Caudill Traolt Assessor's Number 932-T09 E. M. Ackerson ` Owner Address Day Phone Contractor Owner or Builder Address Phone Architect or Designer Address Phone Lic. No. Tenant- Address Day Phone OCCUPANCY & GROUP TYPE OF CONSTRUCTION: FOUNDATION: ❑ Wood ❑ Concrete ❑ Slab ❑ Piers/Caissons FRAME: ❑ Wood Stud ❑ Metal ❑ Timber ❑ Masonry EXTERIOR WALL: ❑ Wood Siding ❑ Stucco ❑ Masonry Veneer ❑ Masonry ❑ Brick ❑ Concrete Block ❑ Metal ROOF: ❑ Built-up ❑ Metal ❑ Composition Shingle ❑ Tile ❑ Wood Shingle/Shake HEATING: ❑ Electric ❑ Gas Furnace ❑ Gas Wall ❑ Solar STATE REQUIREMENTS: ❑ Energy ❑ Sound ❑ Handicapped LEGAL DECLARATIONS LICENSED CONTRACTORS DECLARATION: I am licensed under the 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. License Class License Number Contractor Date OWNER BUILDER DECLARATION: I am exempt from the contractor's License Law for the following reason: I, as owner of the property, or my employees with wages as their sole compensation will do the work and the structure is not intended or offered for sale. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. ❑ I am exempt under Sec. B. & P.C. for this reason r bate_ Applicant WORKERS COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or 'a certificate of Workers' Compensation Insurance, or a certified copy hereof (Sec. 3800, Lab. C). ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the county Planning Department. CERTIFICATE OF EXEMPTION FROM WORKERS COMP. INSURANCE I certify 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 Worker's Compensation Laws of California. NOTICE OF APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above -mentioned property for inspection purposes. NOTICE Unless noted under''Special Conditions,'' this permit becomes null and void if work or construction authorized is not started within 180 days, or if construction or work is suspended or abandoned for a period of 180 days any time after work is commenced. . Signature of Contractor or Authorized Agent Signature of Owner (It Owner Builder) PROJECT INFORMATION Type of Project: install 19y AiiP Electrical Service Proposed Use: res. Setbacks: Front Sides Rear Floor Area Garage Barn CarportCovered Porch Deck Storage No. Bedrooms No. Bathrooms No. Stories Building Height Retaining Wall Information: Length Height Material Mobile/Modular Home Information: Manufacturer Year Serial No. D.O.H. No. D.M.V. Lic. No. State No. Bedrooms Moving Building Information: Present Location Locality Present Use Proposed Use Tot. Lin. Ft. of Fdtn. Grading Information: Tot. Cut Cu. Yds.; Tot. Fill Cu. Yds.; Area of Disturbance TOTAL VALUATION ...... $ -- Plan Check No. $ Combination Permit ....... $ Building Permit ........... $ Electrical Permit .........$ 20 00 Plumbing Permit .........$ Mechanical Permit ........ $ Other: $ Other: $ TOTAL PERMIT FEES $ ❑ Construction Unit Tax $ TOTAL FEES $ REQUIREMENTS❑ Water Fees to be Paid ❑ Other ❑ Fire Hydrants for Const. ❑ Sewer Fees to be Paid ❑ City Business License ❑ C/G/S Permit Reg'd. ❑ State Contractor's Lic. ❑ Encroachment Permit SPECIAL CONDITIONS itjf' stl t VALIDATION 8/4/83 WHITE — Applicant YELLOW — File PINK — Assessor GOLD — Counter Authorized Department Representative Date -83 SEQ DATE TOTAL AMOUNT City of San Luis Obispo, Calif. ORIGINAL Department of Public Works APPLICATION and PERMIT for SIDEWALKS and CURBS Na 702 Fee or Deposit __..___-______ -T Permission is requested to have the following work performed at the location -ified below: San Luis Obispo, Calif., S , W, side of -...___-__-.__ . _ Street, between�G°'��-r!____ and _- __.-uM--tiA�treets, at house No. � __._in front of Lot ------- in Own _-- --- - -- ---- -� Block __._ ----------- in the _...__ _._... _____ Subdivision of the City of Address San Luis Obispo, California. Construct standard cement sidewalk. Length --------------------- .------ Wid h -__-_ _. _....._ Surveyed on ................:. 19 ...... Construct standard concrete curb and l" gutter. Length -------- -------------------------------------- ❑ Construct standard c ncrete ram Length -----.__-_-__ -_ I �: _ -- f - Ca Wid Grades A --- - ----- ------ o repair Approved on . 19 --- --- Length ----- - - Width --- -- - Square Fee By Ins a -- ---- 9------ REMARKS:Q _ _ p Cted on j 1 Contractor: A /- ------------------- Address: �c 13 l t� t J1 r r C y = r `tention is called to the provisions listed on reverse side of this permit which shill become part of; agreement. Work to commence on/or .Lit -------- - ----. .--- _-_._-.._., 19 ....... and continue without delay until completed. Dated 19 Signature of Owner ------,1 1 � Permission is hereby granted to//perform the work described above, in accordance with conditions stated. � —// C p Date granted _..__-__ ................................... 191-X Department of Public Works ---------------------------- City Engineer or Authorized Agent000008 GENERAL PROVISIONS 1. it is understood and agreed by the Permittee that the doing of finy work un- der this permit shall constitute an acceptance of the provisions. 2. Before starting work the Permittee shall notify the City Engineer, or his au- thorized agents. Such notice shall be given at least one day in advance of the date work is to begin. 3. This permit shall be kept at the site of the work and must be shown to any representative of the City ,Engineering Department or any law enforcement of- ficer on demand.. 4. All work shall be. executed in every respect in a thorough and' workmanlike manner. The contractor shall preserve all stakes set for the lines, levels or meas- urements of the work in their proper places until authorized to remove them by the Engineer, and any expense incurred in replacing said stakes which the con- tractor or his subordinates may have failed to preserve shall be borne by the contractor. 5. The contractor shall give forty-eight (48) hours notice ,in writing, when he will require the services of the Engineer for laying out any portion of the work. He shall dig all stak6 holes necessary to give lines and levels. 6. The contractor shall not disturb any monuments or stakes found on the lines of the improvement until ordered by the Engineer, and he shall bear the expense of re -setting any monuments or stakes which may be disturbed without orders. 7. The contractor shall remove at his own expense all obstructions such as trees, stones, debris, roots, etc., that may be in the way of making the proposed im- provements. 2. No material shall be stored to cover more than one-third the width of the street. Zhe contractor shall observe all the regulations of the City of San Luis Obispo, in relation to the obstruction of the streets, keeping open passageways, and protecting the same when they are exposed and would be dangerous to pub- lic travel. He shall also erect and keep erected, by day and night, a fence or prop- er barrier along the line of work and across the ends of the same, in order to guard the public effectively from danger of falling into trenches,. or from up- setting their vehicles against the earth thrown up during the progress of the work, and he shall post all proper notices and signals to the public of the state of the street while the work is in progress. No more than one cross street shall be closed at one time. 9. The Permittee is responsible for all liability for personal injury or property damage which may arise out of work herein permitted, or which may arise out of failure on the Permittee's part to perform his obligations under this permit in respect to maintenance. In ithe event any claim of such liability is made against the City of San Luis Obispo, or any department, officer, or employee thereof, permittee shall defend, indemnify and hold them and each of them harmless from such claim. 10. Any sewer connection or water pipes that may be broken by the contraetor or his agents shall be replaced by said contractor at his own expen§e. 11. A red light must be maintained at each end of barriers from sunset until sunrise, and a watchman employed as additional security whenever the same may be needed. 12. In case it should be necessary to move the property o;' any owner of a pub- lic utility or franchise, such owner will, upon proper application by the contract- or, be notified by the City Engineer to move such property within a specified reasonable time, and the contractor 'shall not interfere with said property until after the expiration of the time specified. 13. The right is reserved to the owners of public utilities and franchises to enter upon the street for the purpose of making repairs or changes of their property that may become necessary by the work, The City shall also have the privilege of entering upon the street for the purpose of repairing sewers, or making house drain connections therewith, or repairing culverts or storm drains. 14. The contractor shall remove all surplus material and rubbish from the work after its completion, and before he makes application for the acceptance of the work. 15. The contractor shall notify the City Engineer when he desires a final inspec- tion of the work, when the latter will, as soon as possible make the necessary examination, and if the work is found in compliance with the above specifications, the City Engineer will furnish the contractor with a certificate to that effect. 16. For further provisions attention is. called to the Standard Specifications for Portland Cement Concrete Sidewalk and Combination Curb and Gutter.