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HomeMy WebLinkAbout16326 _ _ ... .,_.,._._._. _ �: �,��%�e� �-----�`'-- D PARTM NT OF COMMUNITY&DEVELOPMENT SERVICES f��v�61G� � � 21660 E.Copley Drive Suite 190 ��/�.,� (909)860-3195 Fa�c(909)861-3117 � PRESS �����J BUII.DING PERMIT APPLICATION FIRMLY '� JOBSITE ,f �+ i x� '� ,� APPLICA710N PERMIT PJC o ADDRESS�..�/ /V- �E�. J�L Liy y ���•(1/t� DATE 3/28/01 NUMBER 16326 � $ ISSUE TYPE OCC APN LOT TRACT DATE C�NST. GROUP p OWNER J/r'I/��/II� p AODRESS�IWI� ZONING SET6ACKS Z CITY ZIP TEL. REART �W ❑ g APPLICANT TEL. SIDEISIDE STREET RW C7 � CONTRACTOR � • -=NS.J- S SIDE O p� ADDRESS ` ' PROPOSEDUSE Dishwasher Chanqe OUt � CITY�,Q,�2�.Q.,�g— ZIP�.�,�ZTEL � o ARCH/ENG/ ��/� � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP 7EL. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAWATION OOWNER-BUIL�ER DECLARATION SFR/ADD/REM Q I HEREBY AFFIRM UNPER PENAITY OF PEiL'URY THAT I AM EXEMPT FR061 THE CONTRACNqS LI- GBfBJB/C&�p01i W CEN6ELAWFORTHEFOLIOWINGREASON(SEC.7031.6BUSINESSANDPROFE5SbNSCODE:ANYCITVOR (n C.,7 COUNryWHIGHNEOUtRESAPERMIiTOCONSTRIICT,ALTER,IMPROVE,DEA�USH,ORHEPAIRANVSTRUG W pyliolD9Ck Z TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE ApPIICANT FOR SUCH PERMIT TO FlLE A SIONED � STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE UW(CNAPTER G(COMMENCINO WITFI SECTION 7000)OF�IVISION 30FTHE BUSINESS AND PRO- � POOUSp2 FESSqN50�DE)ORTHATMEORSMEISEXEMPTTHEREFROMANDTNEBASISFORTHEALLEGEDEXEMP- � TION.ANYVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSU&lECTSTHEAPPUCANTTO Z RB-ROOf � A CML PENAL7Y OF NOT MORE THAN FNE HUNDRED�OLI.AflS(5500).�: � ❑I,ASOWNEROFTHE7ROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial - WILL DO THE WORK,AND THE STRUCTURE IS NO7INTENOED OR OFFERED FpR SPLE�SEC.'D44,BUSI- J NESS ANO GROFESSIONS CWE:THE CANTRACTORS LICENSE U1W�OES NOT APPLY N AN OWNER OF � PROPERTYWHO6UILDSOfliMPROVES7HEREON.ANDWHODOESSUCHWORKHI{ASELFORHERSELFOR m � THiqUQHFI150RHEROWNENPLOVEES,PROVIDEDTHATSUCHIMPROYEMENTSARENOTINTENOEDOR QOGFEREDFORSALEIF,HOWEVER,TF�BUILDNOORIMPROVEMEMISSOLDWRHINONEVEAROFCOMPLE- Z TION.TME OWNER$UILDER WILL HAVE 7HE eURDEN OF PROVING THAT HE OR SHE DI�NOT DUIIA Oq = IMPROVEFOPTHEPURPOSEOFSAL�. W ❑I,ASOWNEROFTHEPROPERn;AMEXCLUSIVELYCONTRACTINRWITHLICENSEDCONTMCTORS � TO CONSTRUCT THE PRQIECT(SEC.7014,�I5WES5 AND PROFESSIONS COD'e:YHE CONTRACTORS LI- V21U8ti0n _ ADJ.AREA W CENSELAWOOESNOTAPPLVTOANONT'EROFAPROPERTYWFIODUl4DSORIMPfiOVESTHEREON,AND � WFpCONTMCTSFORSUCHPROJECTSWITHACONTRAC70R�5�UCENSEDPURSUNJTTOTHE00NTRAC- QUANTITV DESCRIPTION FEE � 70R3 LICENSE UW.). � J ❑I AM IXEMPT UNDEfl SEC. B.&P.C.FOR THIS REASON U � � � DATE OWNER � Z W _ � UCENSED CONTRACTORS DECLAflATION � � W ` I NEREBY AFFlRM UNDEfl PENILLTV OF PERJURY TF1AT 1 AM UCEIVSED UN�ER PROVISIONS OF CHAPTER � � 9(COMMENCINO WITH SECTIQN 7004)OF DIVISION a qF THE BUSINESS AND PROFESSIONS COOE.AND Z X MY LICENSE IS IN FULL FORCE AN�EFFECT. m tL /s/� � 0 LICENSE CLASS l i��� UC.NO, �����_ � J V DATE _ CONTRACTOF _ d w � WORKERS'COMPENSAfION DECLARATION —i = a � t HEREBV AFFlRM UNDER PENALN OF PEFJURY ONE OF THE FOLLOWING DECLARATiDP�S: � Cl� Z a � �_IWIVEANDWILIMAINTAINACEPTIfICA7EOFCONSENTTOSELF-INSUREFORWORKERS' 2 � COMPENSATION,ASPROVID�BYSECTION37000FTHELABONCODE,FORTNEPERWFlMANCE w Of THE WORK FOR WHICF7 TMIS PEFMIT IS ISSUEP. � O W __IHAVEANDWILLMAINTAINWORKERS'CAMPENSATIONINSURANCE,ASREQVIREDBYSECTION Q 370oOFTHELABORCODE,FORTHEPERF4HMANCEOFTHEWOP,KFORWHICHTHISPERMiT15 � ISSLIE�.MV WORKEqS'COMPENSFTION INSURANCE CARPoERAND POLIGv NUMBERAFE� CONSTRUCTION � PLAN REVIEW CAPRIEA ���� �'7� � POLICYNUMBEa_�.�L'✓°��_� ELECTRIC � 41 .50 o �rwsskclrowrve�r+oraeu».w.�oFn+eFeroxr�sioaoNeHuroa�raiaris�a+wloatessl. PLUMBING W MECHANICAL Z 1 CEflTIFYhIqT IN THE PERFORMANCE OF THE'NORK FOR WHICH THIS PEPMIT IS ISSUED,I (} SH/�LLPoOTEMPLOYANYPEPSONINANYMANNER:AASTOBECOlAESU&IECSTOTHE (n WORKERS'COMPENSATIOIdLAW50FGAUFORNIA,ANDAC.REETHATIi1SH0'JLOBECOME INSPECTIONFE� � SU&IECTTOTHEWORKFRS'�'AVJIPENSATIONPFlOVISIONSOFSECTION37000FTHELABOF ^ ZCJ_QA_ � CODF.ISHAIFORTHWITNCOMPLYWiTHTHnSEPROVI510N5. ISSUANCE ���j �'=i."1 j � 3! 0 SMIP ---_� p DATE:_.. _— APPLiCANT: _.. . � ENERGY P!C WAFlNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNIAN'fUL,AND SHALLBE LL SU&IECTANEMPLOYERTOCRIMWALPENALTIESANDCIVILFINESUPTOONEHUNpREOTHOUSAN� ENERGYPERM17 DOLURS(5100.000).IN ADOITION TO THE COST OF COMPENSATION,DqMAGESAS PROVIDED FOR IN � SECTION37o80FhiElABORCODE,INTEREST,ANOATTORNEVSFEES. flETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � __..__....___..._-..-__......._... � IHEREBYAFFIRMUNOERPENALTVOFPERJURYTHATTHEREISACONSTRUCTIONLENDINGAGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED�SEC,7oe7.CIV.C.1. Z W � ��NDER'S NAME �_.....__,_.. F— LENDER'SADDRESS --- c ' �� wI CERTIFY THAT I HAVE REPD THIS APPLICATION AND STATE iHA'f THE ABOVE MFORMATION IS CORRECT. 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