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HomeMy WebLinkAbout16840 (40) CiTY OF DIAMOTTD BAR --�'�``�-- I)EPAR'TMENT OF COMMUNITY&DEVELOPMENT SERVICES r I � �e 21825 E.Copley Drive ' (409)860-3195 Fax(909)861-3117 PRE$S %y»�'�' BI3ILDINGPER1yiI'TAPPLICATION FIRMLY o DDRIESS�,�..�I' ���I� � APPLICATION �, � �� PERMIT �� P/C � DATE NUMBER # oro ISSUE �'y TYPE OCC APN L, T TRACT DATE ' � Cd CONST. GROUP °C OWNER OO ADDRESS`�`� ZONING SETBACKS Z CITY � Z!P TE . FRONT RW ❑ o APPLICANT ' TE REAR ❑ � e � SIDFJSIDE STREET RW ❑ a 1' SIDE ❑ m CONTRACTOR ¢ ADDR S °C � PROPOSED USE � CITY ' I ZI TE . " � o ARCHlENG! , W DESIGNER NO.DWEL. NO. NO. � ADDRESS ' UNITS_ STORIES BEDROOMS � CITY � ZIP TEL. cn , � DESCRIPTION SQ.FT. FACTOR PSF A�J.AREANALUATION p� Ol�lNER•BUILDER D'cCLARATION SFR/ADD/REM O I Q I HEREBY AFFIRM UNDER PENALiY OF PERJURY THAT I AM EXEMP7 FROM THE CONTRACTORS LI- G8f2 JB/CBfP�l1 W CENSELAWFORTHEFOLLOWMGf�EA50N(SEC.7031.5BUSINESSANOPHOFESSIONSCDOE:ANVCITYOR (n _ C.) COUNTYWHICHRE�UIRESAPERMTTOCANSTRUCT,ALTER,IMPROVE,�EMOLISH,ORREPAIRANYSTRl1C- W Patio/Deck w � 7URE.PRIOR 70 ITS ISSl1ANCE,A�SO REQUIRES THE APPLICAM FOR SUCH PERMIi TO FILE A SIGNED W STATEMEM THAT HE OR SHE IS CENSED?URSUANT TO 7HE PROVISIDNS OF THE CONTRACTOR�LI- � CENSELAW(CHAPTER9(CAMMEhCING'.WITHSECTION7000�OFDIVISION30FTHEBUSINESSANDPRO- LL' POOUSpe FE9SIONSCObE)OflTHATHEOR HEISEXE7vSPTTHEREFROMANDTHEBASISFOfliHEALLEGEDEXEMP- � TION.ANVVIOLATIONOFSECTION�a31.5BYANYAPPLICANTFOFiAPERMITSUBJECiSTHEAPPLICANTTO z Re-Roof � , ACNIL PENALTY OF NOT MORE TH N FNE HUNORE��OLL4R5($500�.): . � ❑I,ASOWNEROFTHEPROPF,RTY,ORMYEMPLOYEESWI7HYJAGESAShIEIRSOLECOMPENSATION, � CommefCial �- Z WILL�O THE WOAK,AND THE SiF�UCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044.BUSI- J NESS AN�PROFESSION5 CODE:Tr1E CONTRACTORS IICENSE LAW�OES NOTA7PLV TO AN OWNER OF � PPOPERTYWHOBUILDSORIMPR VESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � ''� THflOU0HH190RHEROWNEMPL YEES,PPOVI�E�THATSUCHIMPftOVEMENTSARENOTINiENDE�OR m � OFFEFiEDFORSALEIF,HOWEVER, EBUILDINGORIMPROVEMENTIS50LDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUIIDER WILL AVE THE BUFCEN OF PROYING THPT HE OR SHE�IO NOT BUILD OFi = IMPROVEFORTHEPURPOSEOFS LE). W ❑I,AS DWNEROF THE PFOP RTY.AM EXCL'JSIVELY CONTRACTING W3TH LICENSE�CONTRACTORS � 70 CANSTRUCT�THE PROJECT(S'C.7064,0LISINESS AND PROFESSIONS CODE_THE CONTRACTORS LI- V8IU2tlOfl ADJ.AREA W CENSELAWDOESNOTAPPLYTO NOWfVEROFA'�.PROPERNWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFOflSUCHPROECTSWITHACONTRACTOR(S)LICENSEDPURSUAMTOTHECONiRAC- QUANTITY DESCRIPTION FEE � TOR3 LICENSE UW.). ' � ❑I AM EXFMPT 11N�ER SEC.�'�, B,&P.C.FOFTHIS REA5aN Q - � U u. � DATE OWNER U � Z W ¢ UCENS�ED CONTRACTORS DECLARATION w Q IHEREBYAFFIRM'UN�ERPENAL7{OFPERJURYTHAiIAMLICEN5E0UNDERPROVI51IXJ50FCHAPTER � � 9(COMNENCING WITH SECTION 7d0o)OF DIVISION 30F THE BUSINESSAND PROfESSIONS COOE,AND Z `X MY LICENSE IS IN FULL FORCE ANb^EFFECT, m � LICENSEv C�LA55 � �"�si' LIC.NO.�� �!�- � WDATE ( ��~L�� I ' CONTRACTO � y � a � WORKqRS'COMPENSATIO ECLA ATI ���°' Q � � U � 1 HEREBY AFFIRM UNDER PENALT�OF PERJURY ONE OFTHE FOLLOWINO DECLARATIONS: Z Z IHAVEANDWILLMAINTAIryACER7IFlCATEOFCONSENTi05ELF-INSUREFORWORKEflS' 2 COMPENSATION,ASPRO�IDED�YSECTION37o00FTHELABORCODE,FORTHEPERFORMANCE U ¢ OFTHE WORK FOR WHICI�THIS�,PERMIT IS ISSUED. � 0 ' � I HAVE AND WILL MAINTAIf�WORKERS'COMPENSATION INSURANCE,AS REOl11RED BY SECTION � Q 3700 OFTHE LABOF COD,FOR'THE PERFORMANCE OFTHE WORK FOR WHICH THIS PEPMIT IS ISSUED.MYWORNEAS'C NPErySATIOfN�INtl1SURANCECARRIERANOPOLICYNUMBERARE: CONSTRUCTION �I `� cnqrtieA ' � �Iv.11 PLAN REVIEW > ��q� ��y��p� I � POLICYNUM6ER!/ '�`C�C � "T GZs.'���� r� ELECTRIC I 4 I I Q (iHlSSECTIGVNEmNOTBEOJMPI.ETEDOF'I}:EPERMfTiSWRONEHL4JDREDDOLLARS�510�ORLESS). PLUMBING W I� �� Z I CERTiFYTHAT W THE PE�tFORMANCE OFTHE WORK FOR WHICHTNIS PEflMIT I5155UED,l MECHANICAL I (,'3 SHALL NOT EMPLOV ANY PERSON IN ANY.MANNEP SOAS TO BECCME SUBJECT TO THE y I fn WORKERS'COMPENSATI�NLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULOBECOME INSPECTIONFE� - `�' -:"��.- '�� = SL79JECT TO THE WORKE S'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR € � "'"'�,r � �� I � R ���'1. CODE,ISHALLFOR7HWIT COMPLY WITHTHOSE PROVISIONS. ISSUANCE � �-..-�•'_.�' � .�.� � SMIP �ATE: A PLIGANT: � , W WAFNING FAILURE TO SECURE ORKERS'COMPENSATION COVEFAGE IS UNLAWFIJL,AND SHALL BE ENERGY P/C � p � ��, '. � SUBJECTANEMPLOVEflTOCFIU ALPENAL7IESANDqVILFINESUPTOONEHUNDFEDTHOUSAND ENERGYPERMI�f ' y, DOLLARS($100,OW),INAODITION OTHECOSTOFCOMPENSATION,DAMAGESASPROYIDEDFORIN ��T � I J SECTION37080FTHELABORCO E,INTEREST,ANDATTOflNEY'SFEES. RETENTIONFE �r y " � ' � CO STRUCTION LENDING AGENCY �"'�""`"-^•�—_M---�=�-_---__—. . 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