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Home My WebLink About17410 (10) crrx o�D�orm B� -----�''�`---1 DEPARTMENT OF COMA�I[JNITY&DEVELOPMENT SERVICES I 21825 E.Copiey Drive ` (909)860-3195 Fa�c(905)861-3117 PRE$$ `'°%.�:��` BUILDINGPERMITAPPLICATION FIRMLY � JOBSITE ��ff �`�/�j J1 �� APPLICATION � ��° ��`.��MBER k�� "" #/C a ADDRESS � 7 DATE � ISSUE PE pCC ;4PN—�—�LOT TRACT DATE CONST. GROUP p OWNER �'rt�/l.e��$.�- `�` ADDRE � ZONING SETBACKS z CITY =�0� ZIP .�� TE � -�� REORT RW o g APPLICANT TEL. SIDE/SIDE STREET RW ❑ a CONTRAC�T,OR '� �'�' SIDE ❑ � � � ADDRES �� PROPOSED USE + "� � CITY ZIP�3 TEL. r o ARCFUENG/ y, W DESIGNER NO.DWEL. NO. NO. � ADDRE55 UNITS STORIES BEDROOMS � CITY ZIP TEL. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUIL4ER DECLARATION SFR/ADD/REM O � p I HEREBY AFFIRM UNDER PENALN OF PERJUHY THAT I AM EXEMPT FflOM THE CONTRACTORS ll- � Garage/Carport . W CENSEIAWFORTHEFOLLOWINGREA50N(SEC.7a37.5BU51NE55FNDPflOFE5510N5CODE:ANYCITYOfl U COUNTYWHICHflEQUIRESAPEflMITTOCIXJSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTPUC- W Patio/Deck Z il1flE,PfiIOR TO ITS ISSUANCE,ALSO REQUIRES.iHE APPLICANT FOR SUCH PERMIT i0 PILE A SIGNED W W. STATEMENi THAT HE OR SHE IS LICENSEO PUR5UANT TO THE PROVISIDNS OF THE CONTRACTORS ll- � CENSE lAW(CHAPTER 9(COMMENCING VJITH SECTION 7000)OF DIV',SION 3 Oi THE BUSMESS AN�PRD- � PooVSpa � � FESSIONSCODEJORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGFDEXEMP- � TION.ANYVIOLATIONOFSECTION�7031,5BYANYpPPLICANiFORAPERMITSU6JECTSTHEAPPLICANTTO Z Re-Roof � AqViLPENALNOFNOTMOFETNANFIVEHUNDREDDOLLARS(55o0).)�, � � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESW(THWAGESASTHcIR50LECOMPENSATION, 0 �mmercial � WILL DO THE WORK,AN�THE STAUCTURE IS NOT INTEN�ED OR OFFEREO FOR SALE(SEC.7o4a,BUSI- J 4ESS AND PROFESSIONS CO�E:iHE CONTRACiORS LICENSE lAW DOES NOT APPLY TO AN OVJNEfi OF � PROPEHTYWHOBUIL�SORIMPRdVESTHEREON,.�AN�WHO�OESSl1CHWORKHIMSELFORHERSELFOR � � THRDUGHHISORHEROWNEMPLOVEES,PROVI�EDTHATSUCHIMPROVEMENTSARENOTINTEN�EDOR m �', OFFEREDFORSALE.If-;HOWEVER,7HEBUILDINGORIMPflOVEMENTISSOLDWITHINONEYEAROFCOMPIE- Z TION,THE OWNEF-BUILDER WILL HAVE THE BURpEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR IMPROVE FORTHE PUflPOSE OF 9ALE�. w ❑I,ASOWNEROFTHEPROP�FTY,HMEXCU151VELYCONTRACTINGWITHLICENSEDC�NTRACTORS � TO CANSTRUCT THE PROJECT(SEC.7o44,BUSIN�SS AND PROFESSIONS COOE:THE CONTRAC70R5 LI- ValuatlOn ADJ.AREA W� CENSELAWDOESNDTAPPLYTOANOWNEFOFAPPOPERTYWHOBUILDSORIMPROV'eSTHEP,EON.AND �� '.WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSE�PURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE � Y TORSLICENSELAW.�. � ❑I AM EXEMPT UNDER SEC. B,8 P.G FORTHIS flEASON U � LL � DATE OWNER U Z W � � LICENSED CONTRACTOFS DECLAAATION W � ¢ '� 1 HEREBY 0.FFIRM UNDER PENALTY OF PEflJURYTHAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d: ,9(CDMMENCINGWITNSECTION7000)OFDIVISIOM30FTME0USINESSANDPROFESSIONSGODE,AND z X MY LICEMSE iS IN FULL FORCEAND EFFECT. r � .�� LIGENSE/CA/�'SS^—�� /}, LIG NO. ` �— -�� U�. �ATEy� /�'' L� `(�' � CONTRACTO a W [� WORKERS'COMPENSATION DECLARATION a = U � IHEREBVAFFIRMUNOERP�NALryOFPEPJUflYONEOFTHEFOLLOWMG�ECLAFA710N5: z � IHAVEAN�WILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ Z COMPENSAiION.AS PROVI�ED 8Y SEC710N 370o OF THE LABOR CODE,FOR TNE PERFOflMANCE U ¢ OF iHE WOFiK FOF WHICH THIS.PERMIT IS ISSUE�. � 0 W _IHAVEANDWILLMAINTAINWORKER5COMPENSATIONINSURANCE,HSREQUIREDBYSEGTION Q� 37ooOFTHE LABOR Cb�E,FORTHE PERFORMANCE OFTHE WORK FOR WHICH7HIS PERMITIS ISSUED.MV WORKFFS'COMPENSA710N INSURANCE CARfl1ER AND POLICY NUTABEA AflE�. CONSTRUCTION __ ___ J � CARRIER PLAN REVIEW ZPOLICYNUMBER ELECTRIC Q Q (IFiI55ECilONNEmNOTBEO�MPLEfEDOPTHEPERMRISWRONEHUNDREDDOLLAHS�$100)ORLESS). PLUMBING Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � 9HALLNOTEMPLOYANVPERSONINANVMANNERSOASTOBECOMESU9JECTTOTHE , (/� WORKERS'GOMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOUL�BECOME INSPECTIONFEE = SU9JECTTOTHEWDRKERS'COMPENSATIIXJAflOVI510N50F5ECTION370aOFTHELABOR � � CO�E.1 SHALL FORiHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE (� � SMIP +�i`�+ p OA7E: APPLICANT. "�� WARNMGiFAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C � SUBJECTANEMPLOYERTOCRIMINALPENAL7IESANOCIVILFINESUPi00NEHUNDREDTHOUSAND ENERGYPERMIT OOLLARS(S1oo,o00),IN AD�ITION 70 THE COST DF COMPENSATIDN,DAMAGES AS PROVIDEO FOfl IN J SECTION3]OB OFTHE LABOR CODE,IN?EREST,ANO ATTORNEY'S FEES. RETENTION FEE: � aw. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O �' IHEREBYAFFIRMUNDERPENALTYOFPERJURVTHATTHEREISACONSTRUC110NLEN�INGAGENCV FOR THE PERFORMANCE OF iHE 4VORK FOa W HICH THIS PEiiMIT IS ISSUED(SEC.309],CIV.C.). . � W 2. LEN�ER'S.NAME � F= LENOEFi'SADORESS W� TOTAL FEES ��,�p� I CEPTIFY THAT I HAVE READ THIS APPUCATION ANO S7ATE THAT7HE ABOVE INFORMATION IS COqqECT. � IAGflEETOCOMPLYWITHALIdNANDCOUNTVORDINANCE5AND5TATElAWSREI.ATINGTOBUILDING � CONSTRUGTION,ANOHEREBYAUTHOR2cREPRESENTATIVE50FTHISCOVNTYTOENTERUPONTHE z ABOVE�MENTIONcD PROPERTY FOF INSPEGTION PURPOSES. COMMENTS � � �-�'��-' �� C' ��7` � m PE E NAME(PRIN1� � `� ___ v�' r.��Krl�4��'.�-�7aai e Uj ,RE OF PERMITTE � DATE _� �� . RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicenfs Copy .. ._. . ;,, .. .. .. � _ . , , , . ,, ;Y, . .. � ._..:. , .'.. 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