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HomeMy WebLinkAbout14-4371 ;,:�:;:.. rx'"':'�`� CIT4'(�3F DIANI(�NI}I3�-'�R _.:: J�: _..:. . _ ����I i�i� DEPt�RTI�r�E�`�3T C3F CC):�r1NIUNIT�&DEVELO►Pl�'IENT SER�ICES ! '��� E�}�■. �1e °'�� ���'`� 21�31�Cople��Dri�Te,Diamond�3ar,C��91765 PRESS �, � g � :.4 1^F� '���F���i}��: , x d� � � .a,;�'���t �� �».n. ♦ s • �� ;,.���� ��0�)839-7{}�(} Fax:��()9}�b1-311? BUlIC�121�T II1S�}E'C�IC3Il H()��lI1C{�������9-7Q27 ' '' � F�RMLY ;+�,, �.i�:,s• �"'',�`!�'� Bt�ILDINC�PER�'1r1IT�PPLI�t�TIC}i� ��� � } �, '' ���' � APPLl�ATIC3N DATE: ; ��°� ��� P/C# � JOB S1TE ADDRE �-� .�� �.�� ��'�,r� ���.. ...� _ SS , ,� _ ..-_ 1 z AP�1 L4T TRACT ISSUE DA�E: .��'� PERMIT# - " J A� � ,� OWNER T1fPE�ONST (?CC GROUP: w � AD�RESS ,a CITY _._�__Z1P„�__� TEL.___. _._. _ ZONING FRONT�KS RW � � �PPLICANT TEL. REAR []�_ � �'��"" ` � � SIDE/SlQE STREET RW ❑ � �(�NTRACTC�R �'+�-.�...�_��4� �.��,��►�,�t . �.r�. SIDE� ❑ o� A D D R E SS ��S'� �� ��'. •` ..__.���� ---._.._. _._._. • PROP�JJSED USE � ciTv �►�� Z!P �-��- TEL.�y� ��� �'�/z-- _ 0 o ARCHIENG/QESiGNER �'--�"' w o ADDRESS — #Q1NEL.UN1TS #ST4RlES #BEDROOMS z CITY Z1P TEL. `� DE�CRIPTION SQ.�T. FAGT4R PSF ADJ.AREANALUATIQN m OUVNER-BUILQER DE�LARATl4N � SFR/ADO/REM '� 1 hereby a#firm under pena�ty of perjury that I am exempt from the Con#ractor's 5tate License Law for the reason{s) 0 o indicat�d bei�aw by the checkmark(s),I have placed next to the appiicab{e item{s)[S�etian 7031.5,8usiness and Garage/Carpnrt W Professions Code:Any city or caunty that requires a p�rmit to construct,atter,improve,demolish,or repair,any zstructure,prior#o its issaance,also requires tt�e applicant for the permit ta fi{e a signed statement that he or she � PatiolDeck � is licensed pursuanE to the provisions t�f the Contractor`s State License law(Ghapter 9j Commencing wit�Section W � 700U of aivisian 3 of the Business and Pr€�fessions Code]ar that he or she is exempt from licensure and the basis for � PoallSpa � the aAeged exemption.Any vit�lati4n of Section 7Q31.5 by any applicant for a permit subjects ttte�pplicant to a civil penatty z Re-Roof � of nat mare than five hundred dollars($500). � o (�t,as ov#rner of the property,or my employees with wages as their sale compensation,will do{�all af or(�portions -� Commercial � of the work,ar�d the structure is not intended or offered i+or sale(Section 7044.Business antl Professions Code:The m � Contractars'State License Law does nat apply to an owner of prop�erty who,thraugh employees'or persona!e�fort,builds � or improves the property,provided that the improvements are not intentled or offeretl far sale.!#however,the builtling or � improvement is sold within one year of campietion,the Ovtrner-Builder will have the burden of proving that it w�s r�at buiit p or improved for the purpase of safe.j. �"� I,as owner of tl�e ro e am exclusivel c�ntractin witt�licensetl Contractors to ca��struct the ro ect Section 0 �-� � ��' y � � j � Vaivation: Adj.Area: 7044,Business and Professions Code:The Contractors'St�te License Laav does not apply to an owner of property who z bui(ds or impraves#hereoi3,a��tl who contracts far the prajects with a licensed Contractor pursuan#to ifte Contractars'State QUAI�ITITY DESC Rf PTIQN FEE cr� � Li�ense Law.). o (�)1 am exempt from licensure under ihe Contractor's State License!aw for the foll�wing reason(s}: � � � � By my signature beiow 1 acknowledge that,exce�t#or my perso�al resitlence in which f musi have resided fior at least one � o year prior to completion o#the improvements covered by this permit,l cannot le�alfy sell a struciure that I have buii#as an � Q owner-builder if it has not been cons#rtEcted in its entirety by licensed contractors.I understand that a copy of the applicabie ,� � 1ati•o,Section 7044 af ihe Business and Professions Cade is available upan request�r�hen this application is submitted or at f' �� �" ,/' ,�� .• �....-*��.,,r y��. ���.(.'�'.'y� X the fallowing Web site:http/www.leginfo.ca.gov/caia���.html. z - o D�TE: SIGN: � ''�� ' �' LIGENSED CONTRACTOR'S DEClARATION � A �'�' � �. ';:��i� +�,P��. � � � I hereby affirm under penafty of perjury that I am licensetl under provisians of Chapter 9(commencing wi#h Section 7000) w m of Division 3 of the Business d Profess�ons Code,and my license is in ful!farce and effect. J cn "'� � LfCENSE S: � ' IC.NO.: Y� ! � � � z ac c� DATE: CONTRACTOR: V J--�� `► * �f t'. � d WORKER'S COMPENSA7IQN DECLARAT30N � � I NEREBY AFFIRM UNDER PEIVALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: � I have and will maintain a Cert�ficate af Cansent to Self-lnsure for Worker's Compensai'son,as prflvided�y CORlSTRUCTION:� � Sectior�3700 of the Labor Cotle,far the performance of the w�rk for whicl�#iiis permit is issuetl. PLAN REVIEIIV: � -���1 haue and wil!maintain Wor�er`s Compensation Insurance,as required by Section 3700 of the Labor Code,far � z the perfarmance of the wor��pt,�hich this permit is issued.My 1Norker`s Compensat'son Insurance Carrier and ELECTRIC: �__ _ ��_ ___._._...._..—_ _ � .__ �[ Po(icy Number are: ;�,,. PLUMBING: ��'�.,�... � GARRIER '' �r� '��' `J . � MECHANICAL:__.____________.______ __.._..__.._.._._.._�..__. � .�.— w � POLiCY NUMSER �� �'� � � INSPECTION FEE: � (THIS SECTIdN NEED N�T BE C4MPLETED IF THE PERMIT IS FOR ONE NUNDRED DOLLARS��1�)OR LESS�. lSSU�NCE;__ __ _.._.__ _.� _����._._. � 1 certiiy t1�at in the performance�f the work for whicl�this permit is issued,I sl�a[I not empla any person in any manner so as to 0 bec�me subject to`t�e Worker's C�mpe��sation Lav�rs Californi.And agree that if sh Id becom subjec�to th�Worker's SM 1 P: _�..._._ w Cc�mpertsali ro i�ns of Section 3700 ofi ihe Labor I st�11 f h itli mply it tto�"'ovi ru. ENERGY P/C: --� ��'"` i" r S t�°�'q� '�/r�`r.�' . � DATE: APPLICAPdT: �� ENERGY PERMIT. � VI►ARNiNG:F�aift�re to secure Worker's Compensation coverage is unlawful,� shall sub}ect an employer tn criminaf RETENTIQN FEE: mm �. � panalties antl c'rvi!fines up to ane hundred thnusand dolfars($100,OQ0),in atldition to ttte cast�f the campensation, � tlamages as provided for in section 37U8 0#tl�e labor code,interest,and attnrney's fees. PRE-ALT FEE:___________.. ..__.._._�. ___. _� ______.___.._.. � GO�ISTRUCTI�N LENDI�IG AGENCY BSAF: � !hereby affirm under penalty of perjury tt�at ti�ere is a Construction Le,�tling Agency#or the performance of the work for ._. __---.-----------------._.____.__.__._.._._._.�__.__..__ ___---�.____..__...__ _____. _..._ = which this permit is issued�Sec.3097,Civ.C.}. ? .._._....�.�.__ .�.. ._ � LENDER'S I�IAME: � ._.._..___�...W..__.__�....___.__._._.....�_...._.__.._________.�..._W..__._ __....�__ __..._._.�W.. _...Z._',� .__._ � LEND�R'S ADORESS: � I certify that 1 have re�d this applicaiio�and state ft�at the abave informatian is correct.l�gree to compiy with all city a�d TQTAL FEES county ordinances and state laws relating ta builtling construction,and hereby authorize representatives of this county t� � , ,� COMMENTS: --.__...---.------------.-------..._.---__.__._..�..._--------._____.__..�.__.._.�____.__...__.___.__.___.._.W....__...._..____._.._..__-------..._. � enter upan the abo�e- nta€�ned property f mspection purp�ses. -� � , _....��.._�..._..___....._.__._._._......_�.�......_...._�....__�..... �.__________ ___..._ .._ � �-,�. m ,,;,'� ��, s _.._.__�___...__.._�.._._.._..__..._....._....___..._.__._...__..........__.__.._...._._.__...__._._._.__..__..._...._.____._...__...._�..._..______.�.____..._______..__...._.........__._ '� PER 1 E NAtUIE{ T� ¢, ` � , L..�.. A C �" ........... .�...__...._.____ _ ,.-�... ��.................. � � , PAID BY: ✓ � VALIQAT!{3N: � = S1G�tATURE Of PERMfTt'EE ATE REGEIPT# � WH1TE—Department Copy,I�ELLOW—Finance Copy,PlNK—Assessor Copy,GaLDENRt�D—File Capy,GREEN—Appticant's Copy � � �.,� �.v�a. �� �a ���r�� r p r ru„ y �.�� � �'� A,���`�' �,������������� �. �� �'S<3����i.�'� �''1/'� �� �'��' ��.9f.. ��y����� ���,��R�� ���.��� �. �' � f�r. ! � � � !�i ,; � � �, �/ ' /� `�., �� . '. 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