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FACTOR PSF ADJ.AREANALUATION � OWNER•BUILDER DECIARATION SFFiJADD/REM O p I HEREBY AFFliW 6NOER PEN.LLTY OF PERIUHV THAT 1 MI E%EMDT FROA1 THE CON7MCTORS L4 GaregelCarport W CENSELAWFO�ITMEFOLIOWWOREASON(SEG7o]I.eeU5P1E55�NDVFtOFE3510NSCODEANYCI7YOH (n � COUNTYWFIIGIREOUYtESAPERMRTOCONSTRUCCAITE0.�P�IDYE.DCb�0U5H.ONREVAINANVSTAUO W PatiolDeck � � illfiE,iRqR TO ITS ISSUANCE,AL50 REWIRES iHEAPPLICANT FOR SUCFI7ERNITTO FILE�SIGNED � � 8TATEYENT TNAT HE OR SME IS LICENSEO OU0.5UANf TO TNE OROVISIONS OF THF CONTMCTOHS L4 � GEN3EUW�tliAPTERY(Ct1MMENCM0W17HSECTION7000)OFDIVL'.ION70FiNEBUSIN[55M7DDRO- � POOVSPB ff55qN6 COOE)OR THA7 HE OP SHE�S E)fEA1PTTHEREFHOM AND TME BA515 FOH iHE ALLEGED E%EMP• TqN.ANYVqU1TIOHOFSECilON70.t1.6BYANVAPPIICANTFORAPERMITSUOJECTSTNEAPPlIG1JTT0 Z RaRaot � A CML VENALTY OF NOT A10NE iliAN FNE HUNDREO 001UR5(1500).1: � 04M"�EROFTHEP1i0PER7KORMVEMPLOVEESwiTHWAGE5w5THEIqSOLEfAuvENSA770N, ❑ C,p�pmpfGie� MALL DO THE WORK IlW THE STfiVCTUqE IS MOT INTENOED OR OfFEREO FOH SALE(SEC.7oN,BU51� J NESSAHD GROFESSWNS COOE:TME CONiMCTORS LIC[NSE UW DOES NOTAPPLV TO/W OWNER OF N PfqPERTYVIHOBUlD50f11AAPROYESTMEREON,ANDYMODOE55Up7WOF1NHIY5klFORNERSELFOR � (t iHAOUGHH180RNEROWNEMPLOYEES,DNOVIDEDTHATSLICl/�APPOYEAACNTSARENOThREtaEDOR m L}1 .OFF6iED iOR SKE IF,FIOWEVEf17ME BUlDWO OR IMPROVEMENT IS SOLD WRHIN ONE YEAROF COMPLE• Z 'TqN,THE OWNER�BUILDER YALL IUVE TME BUi1DEN OF 7ROVIN�THAT HE Oq SHE O�D NOT BUILD Oq = MPROVEFORT1EPUnPOSEOFSALE�. W OL�l40WMENOF7HEFRO�EHfY,AME%[LUSNCLYCOMMC'INONiTNLILEN5E000NTMCi0135 � TO CONS7AUCi TME VRQIEGT�SEG 7MA BUSiNESS IwD PROFESSiONS CODE:THE CONTMC70R5 LI- 'a!t13�1M_ �u A0.1.AF1EA CENSE UW DOES NOTACPLY TO AY ONMER OF A PROPEpiY WF10 BUrtDS OR MPROY[S TN[REON.MA � YAIOCOMMCTSFOi15VCNPROJECfSN".iHACOHiRACTOH(S�LICENSEDPURSUAHT10iMECONTMG Q�Jp,NTIN DESCRIPTIO� FEE � TO(LSLILENSEUWJ. OIM1E%E►IPTUN�ERSEG. B.iP.C.fORTHISREA50N U 3 � �= DATE OWNEH V � W LICENSED CONTRACTORS D[CLARATION -' � w IHEREBYAFFIRAIUNDERPENA:7YOFPE0.NRY7HATIA/AUCENSEDUNDGRDROV1510NSOFCI.APTER � � 0(Cd.MENCNONAT}/SECilON7000)OFDM5�ON70FTMEBUSINESSANOPROFESS:ONSCA:E.Af:O Z X W UGENSE IS N Ft1LL FOFiCE MG EFFECT. m tL O ` r LICENSE CLASS LIC.NO. J ..._ V DATE CONTMCTOR a . . . W � WORKERS'COti1PENSATION DECLAFlATION Q � IHEREOYAFF!PAIUNOERGENAL7YOFPERM1JFYONEOFT�EFOLLOW;NCDECUM7qN5: U N Z Q O �IXAVE�NDWRIEWMAINACERTIFIGTEO�CONSENT70SELF�MSUREFORYARKERS' _ � COMCENSATION.ASPf10V�D[DBYSECTION�70aOFTHELA00RWDE.FORTMEPERFOMI.WCE W OF THL VlOP1C FOfi VVHICII TMiS VENAiT IS ISSUED. � 0 _I HAK M7D NnLL WMtiN WONCERS'COMDENSATION INSUMNC[,AS REOInRED BY SECTiON ^ {� 4Q ]7000Fh1EUBORCOOE.FORTHE7ENFONMM7CEOFTHEWORKiORVMICHTNISPERMITIS I��9/� 7 � i55UED.A/YWORKEf15COwPENSATpNWSURANCEUARiEA�N�P�I�CYNUMnERME: CONSTRUCTION ' ^ �� _[�-�' � WiFtIER PLANR[YIEW �. v 0 vaicrnuue[n ELECTRIC ` o (nssccrnHrarnwre[oxs�roocnfxrr.�rs:rncnEwn�ocu�s�iala�iEssA PLUMD:NG _ •R.�� (10� `1 c w d".�if�Aj� '1� Z IGERTIFYTUTNTHEPERFOM7ulGEOFTMENqRKFORWMICHTMISPER1AiTI5155UED,1 M•ECHANICAL _�—\_y� (,'} SHAt1lq7EM7LOYANYPER50NN/V1YMV�NER50ASTOBEWMESU&IECTTO7FIE • r '�� � YIORKEftSCOMPENSATIONUW50Ff,`J'�IFORNI�AND�GREETMATIFISHOUI.DBECOME �IFT NFEE J � S SUBJEGT TO THE WORKERS'W�dPEN5AT10N PRO`AS�ONS OF:ECT�ON a7oo Oi 71/E UBOR � '"7' caoE.�sHut voAnrwin�owncir win�nasc vaovisaus. ISSUANCE � S —� � G Q o �L =•. � . ( � p DAh: APRICANT: —��—� " W ENERGY P/C �' �S — J WApNING:FIULURE TO SECURE MiOF7KER5'COMPENSATION CAVERACE IS UNUWFlII.�ND SHALI BE —�' `-y SUBJECTMlfiuPLOYERTOCtUNINAIFENALTIESANDCNILFWE5UP700NEMUNDREDTF10U5�ND ENEFlGYPEFlMIT �, � OOlLMS(f 700,000),N/�DDITION TO THE COST Of COYPENSATqN,D�ACf S AS PFlOViDED iIXi IN /� � SECTION]70lOFTXELABORCOOE.NTEFEST,MJOATfOfWE1"SFEfS. RETENTIONFEE: �� (�•`�� -- pw_, CONSTRUCTION LENDING AGENCY PRE•ALT FEE: � � IHEREBYIFFiNAIN+DERPENALTYOFDE0.JUpYTNATTNEREU^ACONSTM1C710NLENDIN6AGENCY — 1 1(�.��.�_ FOR 7ME PERfOliMANCE OF TME WORK FOR WNICH THIS PERMIT IS�SSVED(SEC.7091.CIV.C.). —[`J�-j-� � � LEt�DER'S WwE � � r— � lENOER'SADDAE54 � ICERTIFYTUTINAVEREADTHISAPPl1UTIONAI:DSTATETIUTTHE�l10VEMFORMATIONISCORfl[CT. TOTAL FEES w IACREE70C01APLYYATHILLLCm'�NDWl/NTVORD!wWCE5AND57ATEUMSRELATWOTOBVR�INd � � CONSTRUCTION.ANDHERCBYAUTHONIZEREPRESENTATNESOFTMISCOUNfTTOEMEflUPONTME ZABOVE�M[NiIONEDiROPERTYFORINSPECTION7URPOS[S. COMMENTS � ��.�;�.-- c�e Aa,�:s.���"'� Ln�r- .s�6 s . pCl�� /� . /�/� ���--L � S'T6�V_f' ' ¢ VERMi E NAYE(DR! '\V�'r�//{�_ ^ I "�'7l l'� \. , � fA II "uer^•i ySIG u �OF i —7 Dn7E � ' RECPT.NO. _PAID BY _VALIDATION WHITE-0epartment Copy.YELLOW—Finance Copy,PINK�Assessor Copy, OLDENROD—File Copy.GREEN—Applirant's Copy CITY OF DI�.MOND BAR ; � _ - ' • , RdSPECTiO�J RECORD • ' ' ' " ^ �-- � ��_,_.._..__�.______�. _�._._........_. .�_ _...._ _._.�._�..., ,.._..._,...._._. � . ... _ - - -- _ �.l►y�=�-a���'��r��r� 'e1.SI�= '.�►v�-�..�.���^���� �il►����=.�'.¢Ce1i�E� � s� �e.Y����. �li��,��=�:.:�c�^{ SET.BACK �_'.._i-;C.I�:..._._......,i .....,...,........`.. .�FLOOR JOIST__....�.._�`._ .., w • = i�:�i�.. _ ... ......___... �Y�;. 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