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HomeMy WebLinkAbout16706 (40) �1'f�'�F��a�IOI�Ti)�3�Z �� ---1�°`--- g9EPr�t'I'16�I�IT pF C� &DE�LOPMEN'T SERVICES � I I � 21�25 E.Cap&ey Drive ' �" (y4gg079g}�76�0,g-p37195�gFa�(9U9)861-31fl7 PRESS �,',�YN"•,••. D4iE1L1011i�i� 'r���.iC�°g'�oM FIRMLY Q A�DDRIESS_ �✓°�0 �� � C1�u� AFPLICA?IO PERMIT ���� �P/C DATE sZ-� �° NUMBER � ISSUE TYPE OCC APN LOT T3�.4 T DATE � � � � CONST. GROUP p OWNER � ' LL ADDRESS � 2.0 � ZONING SETBACKS z CITY ZIP� 'fEL.^ c�- FRONT RW ❑ o APFL9CAN7 TEL. .r✓ REAR ❑ � � SIDE/SIDE STREET RW ❑ a CONTRACTOR � i>� q �"�''a ' '.r= j SiDE ❑ � ADDRESS � CITY ZIP TEL. �G2 ,�"iZ PROPOSEQ USE �"Y.��41f' ��'" ���.��I i� w ARCH/ENGI iz DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BE�ROOMS a CITY Z1P TEL. v> � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATfON � OWPJER-BUILDEA DECLAFiAiION SFR/ADD/REM O Q I HEREHY AFFIflM UDIDEfi PENALTY OF PERJUfiY THAT I AM EXEMPT FROM THE CONTRACTORS LI- � Garage/Carport W CEN5ELAWFORTHEFOLLDWINGREASON(SEC.7031.5BUSINESSANOPROFESSIONSCODE:ANYCITYOR U COUNTVWHICHFE�UIRESAPERMITTOCONSTRl1CT,AL7ER,IMOROVE,�EMOLISH,ORREPAIRANYSTR'JC- W Patio/Deck w TURE,PRIOR TO ITS ISSUANCE,ALSO qEQUIRES THE APPLICAM FOR SUCH PERMIi TO FILE A SIGNE� � STATEMENT THAT HE OR SHE IS LICENSE�PURSUANT TO 7HE PROVISIONS OF THE CONTRACTOR&LI- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION Ioao;OFDIVISION 30F THE BUSINESS AND PRO- � POOVSp& FESSIONS CODE)OR THAT HE OR$HE IS EXEMP7 T4EREFROM AND THE BA515 FOfl iHEALLEG ED EXEMP- oTION.ANVVIOLATIONOFSECTION7031.SBYANYAPPLiCANTFOFAPERMITSU&lECTSTHEAPPLICANTTO Z R2-Roof A qVIL PENALT'Of NOT MORE THAN FIVE HUN�RE��OLLARS(SSooIJ: � ❑I,ASOWNEROPTHEPROPERiY,OFMYEMPLOYEESWITH9NAGE5ASTHEIRSOLECOMPENSATION, ❑ CDmme�Ci21 �- ' Z WILL�O THE WORK,AND THE SiRUCTURE IS NOT INTENDED DR OFFERED FOR SALE(SEC.7o4a,BUSI- J NE55 AND PROFESSIONS CO�E:THE CONiRACTORS LICENSE LAVJ�OES NOTAPPLY TO AN ON/NER OF � PqOPERTYWH09UIL�50RIMPROVEShIEREON,ANDWHO�0E5SUCHWOflKHIMSELFORHERSELFOR � � THROUGHHISORHEROWNEMPLOVEES,PflOVIOEDTHATSUCHIMPAOVEMENTSARENOTINTENDE�OR � QOFFEREOFORSALE.IF,HOWEVER,THE9UIL�INGOR7MPRDVEMENTISSOLDNd11'HINONEYEAROFCOMPI_E- Z TION,THE OWNEft-BUILDER WILL HAVc THE BUR�EN OF PROVING THA7 HE OR SHE 01�NOT BUILD Oft = IMP OVEFORTHEPUflPOSEOFSALE). �,AS DWNEF OF THE PROPERTV,AA9 EXCWSNELV CONiRACTING WITN LICENSEO CONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.704b,6lJSINE55 AND PROFESSIONS CtlDE:THE CONTRACTO,RS Lf- V2I112t10f1 AOJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPfiOPERTYWHOBLIILDSORiPAPPOVESTHEREON,AN� � WHOGONTRACTSFOflSUCNPROJECTSWITHACONTqACTOft(5)LICENSE�PURSIJANTTOTHECONiRAC- QUANTITY DESCRIPTION FEE Y TORS�ICENSE LAW.). � ❑IAM EXB.A?T UN�ERSF_C. B.&P.C.fORTH15 REASON U � y S LL �ATE +�' 04YNER �' � Z w o LICENSED CON7AACTORS DECLARATION W ¢ � I HEREBYAFFIRM UNOER PENA�TY OF PERJURY THAT I APA LICENSEO UNDER P.ROVISIONS OF CHAPTER �, [,L 9�COMMENCINGWITHSECTION�Ooo)OF�IVISION30FTHEBUSINESSAN�PROFESSIONSCO�E.ANO Z lX MY LICENSE IS IN FULL FORCE ANp EFFECT. m o LICENSECLASS L1C.N0. � � J V DATE CONTRACTOR d . W � WORKERS'COMPENSATION DECLARATION Q �r �� �-'� ����( � U � I HEREBV AFFIpM 11IJ0EH PENALTY OF PERJURY ONE OFTHE FOLLOWING DECJPATIONS: Z "� IHAVEANDWILLMAINTAINACERTIFlCATEOFCONSENT705ELF-INSl1REFORWORKERS' _ COMPENSATION,ASPROVIDEDBYSECTION3]aaO�THELABOftCODE,FORTHEPERFORMANCE U 4 OFTHEWORKF9RWHICHTHISPEflMITI5155UED. � � W _I HAVE AND WILL MAIMAIN WORKEPS'COMPENSATION INSURANCE,AS REOl11ftED BY SECTION Q 370oOFTHELA60RCODE,FORTHEPERFORMMICEOFTHEWORKFORWHICHTHISPEPMiTIS ISSUED.MYWORKERS'COMPENSATIONINSURANCECARRIERANOPOLICYNUM6ERARE: CONSTRUCTION j cnaaiea PLAN REVIEW ZPOLICYNUMBER ELECTRIC Q 0 (iHI55EC710NNEmNOTBEO�MFtEfEDOFhiEPERMRISWRIXJEHLNDPEDCOLLARS�$100)ORLESS). PLUMBING W Z I CERTIFYTHAT INTHE PERFORIdANCE OFTHE WORK POR WHICH THIS PERMIT IS ISSUED,I MECHANICAL ��� (.� SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECaME SUBJECT TO THE � WORKERS'COMPENSATIONLAWSOFCAL'.FORNIA,AN�AGReETHATIFISHOULOBECOME INS?ECTIONFEE = SUBJECTTOTHEWORKERS'COMPENSATIOVPROVISIONSOFSECTION37ooOFTHELABOR l(,/�� WDE,ISHALIFORTHWITHCOMPLYWI7HTHO5EPROVI51oN5. ISSUANCE � Vw � SMIP p DATE: APPLICANT: J WAfiNItdG:FAILURE TO SECU0.E WORKERS'COMPENSATION COVERAGE IS UNL4WFl1L,AND SHALL BE ENERGY P/C � SUBJECTANEMPLOYERTOCRIMTlALPENALTIESANOqVILFiNESUFTOONEHUNDRE�THOUSAND ENERGYPERMIT DOLLAFS(b100.000),IN!ODITION TO THE COST OF GOMPENSATION,�AMAGES AS?ROVIDED FOR IN J SECTION31080FTHELP.BORCODE.INTEREST,ANDATTORNEv'SFEES. - p9ETENTIONFEE: � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE O � IHEREeYAFFIRMUNDERPENALTYOFPERJUFYTHATTHEPEISACONSTRUCTIONLENDINGAGENGY n- FDRTHEPERFORMANCEOFTHEWORKFDRWHICH-f}fISPEflMII'ISISSUE6(SEC.309],CIV.C.). Z W S LENDER'S NAME � I— LENDEA'SA�DfiESS � T C [+ /6 �'\ w ICEflTIFYTHATIHAVEREA�THISAPPLiCATIONAN�STATETHATTHEA00VEINFOHR7AiIDNISGOHRECT. IQTAL FGEi7 l.�e� �f d I AGREE TO COMPLY WITH ALL CITYAND COUNTY ORDINANCES ANO 57AiE LAWS RELPTING-0 BUILDING V�" � CONSTriUCTION.ANDHEREBYAUTHORIZEREPRES'cNTATIVE50FTHI5COUNTYTOENTERUPONTHE Z ABOVEMENTIONE�PROPERTYFORINSPECTIONPUPPOSES. COMMENTS � �r�'o F� �r m � '�`� ¢ PEflMI7TEE�AVAE(PRINT� � �...� ��.. /��/ � � SIGNAT P flMITTEE� �ATE y ,�"�"� "`"�"— RECPT.NO. '9 ..�_PAID 8Y VALIDATION ~ WHITE—Department Copy,YELLOW—Flnance Copy.PINK—Assessor Copy,GOLDENROD--Filz Copy,GREEN—ApplicanYs Copy : . _. _ �,.. _ � �. .., . , ,. . . 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