PERMIT NO:  B19-0990
ON-LINE PERMIT
   CITY OF SOUTH SAN FRANCISCO
   400 Grand Avenue, CA 94080

INSPECTION REQUEST LINE
Building Division (650) 829-6670
Engineering Division (650) 829-6652
Fire Department (650) 829-6645
Planning Division (650) 877-8535

PERMIT TYPE
  COMMERCIAL
APPLIED DATE
6/21/2019
PERMIT SUB-TYPE
    TI
APPROVED DATE
JOB VALUE     22390
ISSUED DATE
7/29/2019
APN     015021030  
DESCRIPTION
    Installation of mechanical cooling unit and power receptacle
Seal    
    PERMIT INFORMATION
FEE SUMMARY
    SITE 890 DUBUQUE AVE
SOUTH SAN FRANCISCO, CA 94080

    APPLICANT INNOVATIVE PROJECT SOLUTIONS INC
50 CALIFORNIA ST STE 1500
SAN FRANCISCO CA 94111

    OWNER SFF REALTY FUND III LP
155 MONTGOMERY STREET STE 1600
SAN FRANCISCO CA 94104

    CONTRACTOR INNOVATIVE PROJECT SOLUTIONS INC
50 CALIFORNIA ST STE 1500
SAN FRANCISCO CA 94111
FIRE/LIFE SAFETY PC COM BLDG$236.81
PC COMMERCIAL IN$339.53
CBSC$1.00
COM - BUILDING FEE$601.50
GENERAL PLAN MAINTENANCE FEE - COMMERICAL$35.82
PERMIT PROCESSING - COMM & RES$216.00
PERMIT PROCESSING - MECH, PLUMB, ELEC$36.00
PERMIT PROGRAM MAINTENANCE FEE - COMMERICAL$26.00
SMIP COMMERCIAL$6.27
STATE MANDATED TRAINING - COMMERICAL$8.00
WASTE MANAGEMENT 1% FEE - COMMERICAL$3.91
VALUATION BASED ELECTRICAL$183.67
VALUATION BASED MECHANICAL$183.67
VALUATION BASED PLUMBING$37.81
Total Fees Charged:$1,915.99
NOTE: This job copy of this permit shall be kept on the job site to make the required entries thereon. The permit will expire if work is not started in 180 days, is abandoned, or does not receive an inspection for more than 180 days. Additional fees will be collected to renew expired permits. This is a Building Permit when properly filled out, signed and validated, and is not transferable. Construction Hour: Construction is limited to the hours of 7:00am to 7:00pm each day. No work shall be performed on certain holidays (MMC V-213-3(b)).
LICENSED CONTRACTORS 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.
License No: Expiration Date: Contractor:
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the contractors license Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pofessions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by an applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):

_____ 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 (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner or property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided
that such 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 burdon of proving that he or she did not build or improve for the purpose of sale.)

_____ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner or Property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law.)
I am exempt under Sec. _____________________ B.P.C. for this reason _____________
DATE ____________ OWNER ______________________
WORKERS COMPENSATION DECLARATION
I 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, as provided for by Section 3700 of the Labor Code, for the performance of the permit is ussued.

_____ 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:    ________________________________________________
(This section need not be completed if the permit is for one hundred dollars ($100) or less).
____ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any number so as to become subject to the workers' compensation laws or 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.
DATE    _________________ APPLICANT:    ______________________________
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
NOTICE
Please refer to the Conditions related to this permit issuance. If you believe that these Conditions impose any fees, dedications, reservation or other exactions under the California Government Code Section 66000, you are hereby notified that this document constitutes written notice of a statement of the amount of such fees, and/or a description of the dedications, reservations, and other exactions. You are hereby further notified that the 90-day period in which you may protest such fees, dedications, reservations, and other exactions, pursuant to Government Code Section 66020(a), has begun on the date of issuance of this Building Permit, or on the date that you were provided a Notice of Action for this project, whichever is earlier. If you fail to file a protest within this 90-day period complying with all of the requirements of Section 66020, you will be legally barred from later challenging such exactions. THIS PERMIT WILL EXPIRE IF WORK IS NOT STARTED IN 180 DAYS OR IF WORK IS SUSPENDED FOR MORE THAN 180 DAYS OR IF NO INSPECTION IS SCHEDULED FOR MORE THAN 180 DAYS. DO NOT CONCEAL OR COVER ANY CONSTRUCTION UNTIL THE WORK IS INSPECTED AND THE INSPECTION RECORDED ON THE JOB COPY OF YOUR PERMIT. ALL INSPECTION REQUESTS ARE REQUIRED 24 HOURS IN ADVANCE OF THE INSPECTION. ALL WORK PERFORMED UNDER THIS PERMIT MUST CONFORM TO THE APPROVED PLANS AND SPECIFICATIONS FILED BY THE OWNER OR HIS AUTHORIZED AGENT WITH THE BUILDING DIVISION. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE INFORMATION GIVEN IS TRUE AND CORRECT. I (WE) AGREE TO SAVE, INDEMNIFY, HOLD HARMLESS, AND DEFEND THE CITY OF SOUTH SAN FRANCISCO AGAINST LIABILITIES, JUDGMENTS, COSTS, AND EXPENSES WHICH MAY ACCRUE AGAINST SAID CITY IN CONSEQUENCE OF THE GRANTING OF THIS PERMIT. I AGREE TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION AND MAKE THIS STATEMENT UNDER PENALTY OF LAW.
DATE    _________________ APPLICANT:    ______________________________
* 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.
SIGNATURE OF APPLICANT OR AGENT  ;_________________________________ DATE    ____________
INSPECTION SUMMARY

______  FINAL**
______  FINAL**
Permit Finaled Date:  __________    Inspector Name:  __________________    Signature:  __________________