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HomeMy WebLinkAbout17493 (23) ���] 7�g�T�7�/� �77'�D,�n i 1 1 �T Ldt"LLVLo1VL D[1L0 � �--- DE�ARTMENT OP COMMUNITY&DEVELOPMENT SERVICES �I I I � 21$25 E.CopleyDrive � (409)860-3195 F�(909)861-3117 PRESS '`'%�r��� BilIL�iiPdG PERMIT APPLICATION FI R M LY o AD RIESS��� �v� �°'�-4 ��� h7�'9 s OATECATION �: � NUMBER � "'�� �1C � ISSUE TYPE OCC APN LOT TRAC DATE CONST. GROUP p OWNER �V►Yt�t?'�'Lv d�- ��ri�Y^� �,t'�3'1`Q��a o ADD E$S �f ZONING SETBACKS z CITY�ydt-�� ZIP ' � TEL.�i` � � FRONT {�W ❑ o APPLICANT���y� f�Y°TY�'TEL� S DERSIDE STREET RW ❑ z QCONTRACTOR SIDE ❑ � ADDRESS PROPOSED USE ��`� �� �C7r�g ��� ! � jeS t ��vnr-Sx�:a+�� � CITY ZIP TEL. —� �°� w ARCH/ENG/ �`�p����'� `' �e z , DESIGNER W NO.DWEL. NO. NO. � o. ADDRESS "Z. � CITY ZIP TEL. UNITS � STORIES BEDROOMS cn v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION �p� OWNER-BUIL�ER DECLARATION SFRlAOD/REM � O I FiEREBY AfFIRM UN�ER PENALTY OF PERJURY THAT IltM E%EMPT FROM TH'c CONTRACiORS LI- G8ffl98/CBf�JOfI W CENSELAWFORTHEFOLLOWINGREASON(SEC,7o31.50USINESSANDPROFESSIONSCODE:ANYCITYOR (n U COUNTYWHICHREQUIRESAPEfiMiTTOCONSTRUCT,ALTER,iMPFOVE,DEMOLISH,ORFEPAIRANYSTRUC- w � TURE,PRIOA TQ ITS ISSUANCE.AL50 REDUIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNE� W Patio/Deck SiAiEMENT THAT HE Oq SHE IS UCENSED PURSUpNT TO THE PFOVISIONS OF THE CONTRACTOftS LI- � . CENSE LAW(CHAPTER B(COMMENqNG WITH SECTION 7a0o)OF DIVISION 3 0F THE BUSINESSAND PR0- � POOUSP8 � '�; FESSIONSCODE)ORTHATHEORSHEISIXEMPTTHEFEFROMAN�THEBASISFORSHEALLEOEDEXEMP- (� ' V TION.ANVVIOLATIONOFSECTION7031.58YANYAPPLIC0.fdTFORAPERMITSUBJECTSTHEAPPLICANiTO Z Re-Roof '�..��� � ACNIL PENAITY OF NOT MORE THAN FIVE HUNDflED OOLLAflS 15500).): , � ❑I,ASOWNEROFTHEPROPERN,ORMYEMPLOYEESWITHYJAGESASTHEIRSOIFCOMPENSATION, � CommefCial - Z WILL�O TME WOAK,AND SHE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.7a44,BU51- _j T NESSAN�PflOFES510NS CODE:THE CONTRAC70RS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF � PPOPERTY WHO BUILDS OR IMPROVES THEREON,AN�WHO DOES SUCH WOFK HIMSELF OR HERSELf OR � THflOUGHHI50RHEF70WNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m � �,� OFFERE�FORSALE.IF,HOVJEVER,THEBUILDINGORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE- Z � TpN,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING TI�Ai HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). W �,J,ASONMEROFTHEPROPEfiTY,AME%CLUSNELYCONTRACiINGWITHLICENSEOCONTRACTORS � TO CONSTRUCT THE PRQIECT�SEC.7044,Bl1SINESS AN�PR�FESSIONS CODE THE CONTRACTORS LI� �� Valuation ADJ.AREA LLI CENSELAWDOESNOTAPPLYTOANOWNcROFAlROPERTYWHOBUILDSORIMPROVESTHEREON,AN� F WHOCONTRACTSFORSUCHPROJECTSWITHACONfRACTOR�SjLICENSEDPUaSUANTTOTHECONTRAG QUANTITY �ESCRIPTION FEE - � TORSLICENSELAWJ. Q�, CJ I AM EXEMPT UNDER SEC. B.8 P.C,FOR THIS REASON Q � U � � DATE��'� � OWNER U Z W � LICENSED CONTRACTORS DECLARATION W - Q � -I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEfl � � 9(COMMENCINGWITHSEC710N7000)OFDIVISION30FTHE0USWESSANDPROFESSIONSCODE,AND Z ��� MY UCENSE IS M FULL FORCE AND EFFECT. m � , � UCENSE CLASS LIG NO. � V DATE CONTRACTOR d W - � WORKERS'COMPENSATION�ECLARATION - ¢ � I HEREBV AFFlRM UN�ER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: Z . z _IHAVEANDWILLMAINTAINACERiIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' 2 Q COMPENSATION;ASPROVIDEDBYSECTION37ooOFiHELABORCODE,FORTHEPERFORMANCE U O OFTHEWORKFORWHICHTHISPERMITISISSUE�. � QW _I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�IIIRED BY SECTION 370�OF THE LABOR CO�E,FOF THE PERFORMANCE OFTHE WORK FOR WMCH THIS PERMIT IS ' f �f"° J ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIEFAND PC�ICV NUMBERARE: CONSTRUCTION � � CARRIFA PLAN REVIEW Z POUCYNUMBER ELECTRIC _ Q 0 (IFiI55ECT10NNE�NDT9ECOMPLEfE�OFTI-EPERlAITISFORqJEHUNDREDDOLL4RS($100)ORlESS). PLUMBING Z ICERTIFYTHATINTHEPEflFOflMANCEOFTHEWOP,KFORWHICHTHISPERMITI5155UED,l MECHANICAL �,3' SHALL NOT EMPLOYANY PEFSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE .—.--,� (/� WORKERS'COMPENSATIONLAWSOFCALJFORNIA,ANDAGREETHATIFISHOUL�9ECOME INSPECTION FEE 'k`�—""'�':-,_ -„'.'+� T�--- �---"."�."" = SUBJEC7T0 THE WORKERS'COMPENSATION PROVISIONS OF SECTpN 37Jo OF iHE LABOR ' �'-�-` . ,. . CODE,ISHALLFORTHWIiHCOMPLYWITHTHOSEPROVISIONS. ISSUANCE - �-�,J_ � SMIP � � ��5 �^s�a ,. �� � DATE: APPLICANT: WWAFiNINGFAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C —�� � - � SUBJECTANEMPLOYER70CPoMINALPENALTIESANOCIVILFINESUPi00NEHUNDfiED7HOUSAND ENERGYPERMIT ' DOLL4R5(E1o0,000),IN ADOITION TO THE COST OF COMPENSATIDN,DAMAGES AS PflOVIDED FOR IN � SECTION 3IOB OFTHE LABOR CO�E,INTEflEST,AN0 ATiORNEY'S FEES. iTM-r"_ , � - RETENTION FEE: � �:..�.�'.. --:.._ .,.___...._.__.___�, O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBVAFFIflMUNDERPENALTVOFPEa.:URVTHATTHERE;SACONSTRUCTIONLENDINGAGENCY . FOR THE PERFORMANCE OF THE WORK FbR WHICH THIS PERMIT IS ISSVED(SEC.309"l,qV.C.�, , Z W __" � LENDEFi'S NAME H LENDEfl'SADDRESS W ICERTIFYTHATIHAVEREA�THISAPPLICA710NAN�STATETHA7THEABOVEINFORMATIDNISCAqRECT. TOTALFEES �/m �� �' IAGREETOCOMPLYWITHALLGTYAN�COUNTYOflDINANGE5AND5TATEL4W5RELATINGTOBUiL�ING e �. CONSTriUCTION,AND HEFEBY AUTHORIZE REPRESENTATNES OFTHIS CDUNTY TO EMER UPON THE � ABWE-MENTIONEOPROPERTYFORINSPECTIONPURPOSES. COMMENTS � ��-- —_"_ m �e ��,�.-�`� L P 1+�1.t�rr��� ¢ PERMITTS�NAME(PRINT) � SIGNA/��OFPEP�EE ��D��� �! = RECPT.NO. � PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplicanYs Copy . � . x,., . . ,,.. ,� ... ... .. .- . ...,. .. _. _ , r ; ' , :��"!a � � ' , .' ., . �: €' `, .. � . ,,x � b '� 3��';:� x ,� d'� aF" .,.s� . x �a^n� � :'�: � r A i:+c� c i'^ t �� � #�,'� d k' u ��x �, �� 'z �,�x .a �,.,.� x� h`:�� -. � � : s �-I ,�, % ,6 �a ��k £{ ���' �.? �.i" , � d 'S k�'. 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