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HomeMy WebLinkAbout16747 (26) �,.,, � ,- � — - _— �IT'�()F I��:�1mT��P� �e.._.,.i' I �j 4 ���'����T���� �DEVELQ�'MENT SEItVICES 2��2�E.Copley Drive (904)�60-3I95 Fax(909)�61-3117 PRE$J�' :�:;;„���:. �ul�.������ ���r.�c��°go�r FIRMLY n � JOBSITE �� APPR ICATION�. � � � PERMIT P/C o ADDRESS DATE NUMBE� �� � # � 18SUE � � � TYPE OCC APN LOT T�iAG'�___,_ _ DA�E CONST. GROUP � OWNER � t�i � o ADDRE S f� � ZONING` SETBACKS Z CITY i l� ZIP���-i EL.� Z FRONT RW ❑ , p APPLI ANT P ' 7EL. AEAR ❑ � SIDE/S6�E STREET RW ❑ ¢ COfVTFiACTOR 'y "' SIDE ❑ � AUDRESS ° ` v PRpPOSED USE s9 �>- o ciry _ z'P�� T��.�w�15`�����' . I aw ARCWENG/ W DESIGNER NO.DWEL, NO. NO. a AD�RESS UNITS STORIES BEDROOMS � CITY ZIF TEL. y pESCRlPTION SQ.FI: FACTOR PSF ADJ,AREANALUATION ' � . Q;WNER-6UiLDEF�DECLARATlON SFR/A�D/REM O L�� r p I HEflEBY AFFIRM�UND'cR P�P1Al7Y OF PERJUflY THAT i AM EXEMPT FROM�He coNTwperorts u- GaragelCarport LCJ CENSELAWFORTHEFOLLOWINC�REASON(SEC.7a3�.SBUSINESSANDPFOFcS510N5CCDEANYC1iYOfl (n . � U CWNTYWNICHREQUIRESAPE�a�411TTQCONSTRllCT,ALTER,IMPROVE,6EMOLISH,ORREPAIRANYSTFUC- (,f,J patio/Deck � TUflE,PRIOR iq ITS ISSIJANCE,Ai50 pEIXJIRES THE APPlICANT FOR SUCH°ERMIT TO fILE A SIGNE� W STATEMENT THAT HE OR,SHE ISILICENSED PURSUANT Ta THE PAOVISIOIJS OF THE CONTRACTOflB LI- �� � CENSE LAW(CHAPTER 9(COMMENCINCa WIiH SECTbN 7000)OI'61V!SION 3 Of THE BUSINESS AN�PRO- �" POOVSpfl FESSIONS CbD�oR'THAi H�OAISHE IS EX'c�iFPT74EREFPOM AN�THE BASIS FOP TNE ALLEGE�EXEMP- � v TION.ANYVIOLq710NOFSECTfOry 7U91�58YANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO 'Z R2-RDOf .� � ACIYIL PENALTYOF NOT MOREi�iAN F�lE HVNDRED�OLLARS($500).�: GI,ASOWNEROFTHEPflOi��RTV;ORM�EMGLOYcESWITH:WAGESASTHEIR50LECOMPENSATION, Q p� � Commercial � - W!LL Oo iHc WORK,AN�THE S;RUCT�IRE IS NOT IMEN�ED DP.OFFEAE�FOR SALE(SEG lo4a,BU51- .J � NE55 AND PFiOF6510N5 CO�E:�HE CONTPACTORS LICENSE LAW DO"eS NOTAPPLY i0 AN OWNER OF � . , PROPERTY4JHtl6U1LDSORIMPR�PVE57HEREON,ANDNM1lODOESSUCHWOaKHIMSELFOFNERSELFOP CC THROUGH�ii{5 OR HER OWN EMP40YEE5,GROVIDE�THATSl1CH IMFROVEMENTS ARE NOT INTEN�E�DR � ' 0OFFEREDFORSAIE.IF,HOWEVER�THEdUIL01NGOFIMPROVEMEN'IS�OUWITHINONEYEAROFCOMPLE- � T�ON,THE OWNER-Bl11LbER�Y�ILL HAVE THE 2UR�EN OF PRO'dING THAT HE O�SHE DID NOT BUILD OR IMPROVG FOFt THE PURPOSE OF$ALE)+� �_ ❑I,ASOWNEROFTHEPIiORERTY,�AMEXCWSIVEL"CONTPACTINGWITHLICENSEDCONTRACTOflS TO CONSTRUCT THE PROJECT(3EC.]q44,BUSINESS ANO PROFESSIONS CODE 7HE CONTAACTORS LI- VZIUeti011 � ADJ.AREA W CENSELAW�OO�SIJOThAPL,YTO�ANO'NNEROFAPROPERTYWHOBUILpSORIA9PROVESTHEREON,AND = WHOCONTRpCYSFORSUCHPROilECT5WITNACONTRACT,OR(5)L�CEIVSEOPURStJANiTOTHECOhTRAC- ' QUANTITY � DESCRIPTION FEE �'� Y TORSLICE'NSELAWJ. '' ' � � ❑1l�AA EXEMPT UNDER SEC.'�, B.8 P,C.FOR THIS REASON � � V � tL, �AiE '�' OWNER .__________..._ �' Z � W Q . LICEN�ED CONTRACTORS DECLARATION W . � IHEREBYAFFIRAIUN�ERPENALiYOFP,�ERJURYTHAT1AMLiCENSEDUNDERPROVI510N50FCHAPTER �I p_, 9(COMMENCMGW�THSECTION7o00�OF01VISION30FTHEBUSMESSANOPROrESSIONSCODE,AN� Z X MV LICENSE'.IS IAI FULL FORCE ANQ EFF�CT. .�i � LICENSE CLliS$' a � LIC.NO. Z�� � � . F J �, U DATE �"�' CONTRACTOR a . W i � WORK�fiS�:OMPENSATION DECLARASION a = U � IHEREBYAFFIRMUN�ERPENALTYOFP,ER.IURVONEOFTHEFOLLOWWG'JECLARATIONS: � 0 _I HAVE AND 1MLLMAINTAI-'yIAGEFiiIFICATE OF CONSENT70 SELFINSUftE FOR WORKERS' _ z CDMPENSATION,AS PROY'IIDE�DYSECTION 3�Do OFTHE L.4BOR CODE,FOR THE PERFORFSANC'c U a OF THE 6NOFSK FOR WHICry iHIS pERM1T IS ISSUED. � � � _INAVEANDWILLMAINTAI�WOP.�ERS'COMPENSA710NINSURANCE,ASREOUIFEf1BY5ECTION QQ 37000FTHELA60RC006�iFDRTHFPERFORMANGEOFTHEWORKFORWHICHTHISAERMIiIS - ,y ISSUE�.ldYWORKERS'COMPE�SATIONINSURANCECARRIEflANDPOLICYNUMBERARE; CONSTRUCYION r '�� _ J q'`� > CARRIER � � � �cd��• PLANREVIEW � ao�_icvNUMaEq ,������ ELECTRIC � Q [iNISSECT(OPJNEmNOTBE�,COMPI�:ETEDOFhIEPERMfTISFORONEHUNDfiED�P'1AR5�$1WjORLE55). PLUMBING LLI Z ICERTIFViHATINTHEPEwFORMANGEOFTHESVORKFDftWHICN7Fii5PERMITI5155UE�.l MECHANICAL (�$ SHALLNOTEMPLOYANYP,ERSO�NINANYMANNERSOASTODECOMESUS.;ECTTOTFIC � � WORKER6'COMPENSATION LAW$OF CALIFORNIA,AN�AGREETMAT IF I SHCUL�BECOME INS?ECTION FEE i = . 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Z 8.L1 � LENDEF'SNAME .__.�:__ ..__... � P— LENDER'SADDRESS W I CERTIFY THAT I HAVE READ THIS APPLICATiON AND STATETHATTHEABOVE MFORMATION IS COf1RECT. l"OTAL FE ✓ g � � !AGREE TO C0IAPLY WITH ALL CITV ANO GOUNTY ORDINANCESAND 5 iAiE UWS REL4TING TO BUILDING � CONSiRUCT10N.AN�HEflEBYAUTHORIZE REPRESENTA-NES OF THIS COUNTYTO ENTER UPON THE � � ABOVE-MENTIONEDPRQPERTYFORINSPECTIONPURPOEES. COMMENTS_. ..__ —_ . Q j F � / �", ��' , m PE ITT ME RINi) Q cr� m ���. Aj+ � SIGNAT - MI7TEE , ''. DAT'c � _ - ' RECPT.NO. PAID BY i...9 VALIDATION 7� � � WHITE—De riment Co YELLOW—Finance Co PINK—Assessor Co GOLDENRO�File Co GAEEN—A IicanYs Co � Pa PY� PY. PY. PY� PA PY _ .. _,. . n . . ,. ,,,,,;, . , . . , � � , ��`;:� , �'A � � ,,; r'., ,� r, a, . � E .. � ,,�` �_,, r "��M��� �,'�-�.a �aa:: a � ;„ a =� „� x e , E e'�: ,• �� a' , 4, � �: 3^. �. ' � g "r � ' " a �> ��;.� q a t a i+,l y� '� d� � �� ? a" �, a J ��', �°�', � � y`;a � a � �,,., . € �" � k; ��'`� �' � ���.�. 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