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HomeMy WebLinkAbout16655 (32) . _i.__. _-__._ � �'L�'��"��f�,���, �.� ---�'��___ l7EPP��1<!'I'�F C`pi�1/Ii7A�4TY c'�7aE`aTELO��NT SERdICES I B `� z�s�s E.c����y�4�e � PRESS �� (909}360-3195Faac�909)851-3fl37 '�-;vx�'`� t���.����� ����.�CA�'�or� ' FIRMLY � JOBSiTE C' �JJ O� APPLICATION � � �� PERMIT P/C Q ADDRESS ' ��t a pqTE � NUMBER � # o �SSUE ��ONST. GROUP � APN L T�Y'��+�. DATE p OWNER � �+ " ADDRESS ZONING SETBACKS Z CITY ��� ZfP _ TEL.�T � � � FRONT RW � 2 APPLICANT TE{„ REAR � � SIDE/SIQE STAEET RW � __ ¢ CONTAACT R SIDE C � ADDRESS i PRQPOSED USE � CIN Z7P�7'P� TEL.1�� - � ARCH/ENG/ �� Z DESIGNER NO.DWEL. NO. NO. � ADDRESS UNiTS STORIES _�_BEDROOMS � CITY ' ZI�__ 'fEL. _ � DESCRlPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDcR^vECLARATIpN $FR/ADD/REM O I HERE9Y AFFIRM 11NDER P�NALTV OF PEFUUAY TH.4T i AM EXEMPT FROM THE CONfRACTOiiS LI- GflfflJB/C8fP01� � � CENSELAWFOR7HEFCLLOWINGj?EASON(SEC.7o31SBU51:4C5SANDfROF�S5iON3CODE:ANYCITYOR � U COUNTYWHICHFEQUIPESAPERMITTOCONuTRUCT,ALiER,iMPHOV9,DEMOUSH,OFIREPAIRANYSiRUG- IJ.J patio/Deck 'WTURE,PRIOR 70 ITS ISSUANCE.dLSO REQUIRES THE APPLICAt�T FOR SUGH PERMiT TO FILE A SI�ryEO w � STATEMENT THAT HE OR SHE IS GCENSm PURSUANT TO THE PftOVI510N5 OF THE CONTRACTORS U- CENSE LAW(CHAP7ER 9(COMMENCING WITH SEC710N 70D0)OF�IVISION 3 OF 7HE BUSINESS AND PRO- V" PooVSpa o FESSIONSCOJE)ORTHATHEOfl�'NEISEY.ElAP?THEREF0.Cfr:AN�TH'r.8A515FOA7H£AUEGECIE%EMP- V TION.ANVVIOLA7IDNOFSECTION�7o31.58YANYA�PL!CANTFORAPEFMITSUBJ'eC73'HSAPPLICANTTO Z Re-Root r A CIVIL PENALTY OF NOT tAORE i kN FIVE HUNDREO DOILARS(SSOe).): o 174A50WNEFYOriFIEPROP FiV,OtiMVEMPLDYEESN/iTMYJA3ESA5TMeIR30LECOMPENSFTION, ❑ �,`OITITIBfG18I z WILL DO THC YJORK,ANO THE ST�UCiURE IS NOT INTENDED OFl OFFEFED FOR SALE(SEC,�094,6U51- J � NESS AND PflOFE5510N5 CODE:�HE COMRACTOH3 LICENSE lAW 70E5 NOT APPLY i0 AN OWNCR OF � PROPERTYWM02UILDSORIMPRQVESTHEflEON,ANDWHO�0E5SUCHWORKHIMSELFORHERSELFOFi Q THROUGHHISORHEROWNEMPL,bYEES,PROVIDEI7THAT5l1CHihiPROVEME(JTSARENOTIN7eNDEDOFI m QOFFERmFORSALE.IF,I�.OWNE9.T41EHU1L�INGORIIJPFOVFpAENTIS50LOWITHINONEYEAROFCOMPLE- � TION,THE OWNER�BWLDER WII L AVE.THE BURDEN OF PFOVI�G?HAT HE GR SHE DI�NOT BUILD OR = IMPROVE FORTHE PURPOSE OF�ALE).. C4A50'NNEFOFTHEPRO RTY,AhtC%CLUSNELYCONTRACTIIVGWITHLiCENSEOGONTPAC'fORS �' TO CONSTRUCT TiE PFOJECT(S�C.'o4<,BUSINE55 AND PflOFE5510N5 CODE:THE C6NTRAClORS LI- V0IU9iIOfv ADJ.AREA 4J CENSELAW�OESNOTAPPLYTO NOWPIEROFA�ROPERTYfNHOBUILDSORIMPROVESTHEREON,AN� . � WHOCANTRACi5FOR5UCHPRO.�ECiSWITHACONTRACTOR(5)LICEI3SEOPUHSUANTTOTHECONiRAC- QUANTlTY DESCRIPTION FEE ,� � TORS LICENSE LAW.1. �� I O ❑I AM E%EMPT UNDER SGC.��, B.1 P.C.FOR THIS REASON U � � /� � � �ATE . �. DWNER U f� I�S Z lL� � � LICEN3E�CONTRACTORS DECLARATEOIV —� ¢ W � I HEREBYAFFIRM UNDER PENALTY OF PERJUPV THAT I A�1 LICENSEO UNDER PROVISIONS OF CHAPiER Ur d 9(COMWENqNG WITH SECTION 7Eoo)OF DIVISION 30F THE BUSINESS AND PROFESSIONS C0'�E,AND z XW MV UCENSE IS IN Fl1LL FORCE ANd EFFECT. � G d LICENSE CLA/S$ �'�UC.NO. 2���^/-9_�/ � V �A7E���.f���� GONiRACTOP ��Ir .J� a . 11.7 � WORK�,"�F?S'bOMPENSATiON DECLARATIGN a � � U � IHEREBYAFFIfiMUNDERPENALNOFPERJUFYONEOFTHEFOLLOWINGDECLARATIONs: z Q � _IHAVEANOWILLMAINTAINACERTiFlCATEOFCONSENTTOSELF�INSl1REFOflWORKEFS' 2 Q CAMPENSATION,ASPROVDEOBYSECTI0�31ooOFTHELABORCODE,F"9FTHEPERFORMANCE � F iHE WOftK F4R WHICF�THIS PERMIT!S i55UE0. � � ,,,���yyy W i HAVE AND WILL MAIN7AIN WORKERS'COMPENSATION INSUfiAPJCE,AS REOUIP,ED BY SECTlON + ��� Q 97000FTHELABOFlCOD FOR,THEPERFORMANCEOFTHEWOFKFO:IYdNICHTHISPERMITIS — ISSUE�.MYWOHKERS'C�MPE ATIONINSU ECARRIER DPbLICYNUA9BERARE: CONSTRUC7ION j caaaiER___ . _-_ PLAN REVIEW _, � ?OLICY NUMBEP��l� � ! ELECTFIC ---- Q yv i r/ Q (IHISSECTptJNEmNOTBE�OMPLETEDOFiHEPERMITISR�ROVEY,IJNCIRE�IX%LARS(51WJORLE55). I PLUMBING _ � I CERTIFV THAT IN THE PERFDRMANCE OF THE WOAK FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL — (� SHA'�LNOTEMPIOYANVpERS(1N!NANYMPNNERSOASTOBECAMLSU9JECTTOTFiE INSPECTIONFEE ° �� � -� vy WORKERS'COMPEN$ATION�A�SOFCALIFOFiNIA,AN�AGRCETHATIFISHOULDBECOME SUBJECTTOTHEWORKEF�S'COh1PENSATIONPROV IONSOFSEC ON3i000FT LABOR � fSSUANCE '�� � � "��� �� ' - COD I A�LFO HWITtiCOM'rLYW�TriTMUS nOVISiONS. `�.---��,_ E Fq / o ��'1�a?l . SM�� � p �ATE:__ A�PLICANT� w � ENERGY P/C F J WARNING.FAILURE TO SECURE WbRKEI75'COMPENSATION COVERAGE IS UNLAWFlIL,AND 54ALL 9E �-- .. . � J E �y SUBJECTANEMPLGYERTOCRIAII ALPENAL7IESANJCIVf'�FME>UPIOONEHUNUFEDTH011SAND ENERC�YPERMIT --- DOILARS�§t OO,o00),IN ADOITIUN�O T HE COST OF COMPENSAT ION,DAMAGES AS PFIOVIDED FOR IN J SECTION37080FTHELABORCO�E,INT�REST,AN�ATTOFNEY'SFEES. RETENTIONFEE: _ � a CO�ISTRUGTION LENDING AGENCY PFE-ALT FEE� -'�°� _.. ___ �______..._.�� O OC IHERE9YAFFIRMUNDEflPENALT�OFPERJUR TH THERElSACONSTRUCTIONLEN�{NGAGENCY �- �OR THE PERFORMANGE OFTHE 4JOR �'�,F F IC HIS PERA7IT IS ISSIJED(SEC.3097,CIV C.). , � _'— 2 LENDER'SNAME -�--- _._. �i F- LEN�ER'SA�DLiE55 �, ^7 p//''�j1J � ICEFTIFYTHATIHAVEREADTHISAPPLICATIONAN�STATETHAT7HEABOVEIN%ORMATIONISCOfiRECT. ' TQTML FEES '4d' e % d IAGREE7000MPLYWI7NALLCITYAND',COUNTYORDINANCESANDSTATELAWSREL4TINGToeU1LDING � CONSTRUCTION,AND HER<_BY AL'THORIZF_REPRESENTATIVES DF THIS COUP(TV TO EMER l/PON THE � ABOVE-MEN710NE']PROPERTY idR INSPECTION PURPOSES. COMMENTS � � G __ � S Q�___ � - m PERMITTE' AME(PFiI' •I/��L- //1 // �/�/ � _ ...— i ¢ /� v [_��L � _ 1 � SIG A REO PEaMITTEE DATE 7 F7ECPT.PvC. 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