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HomeMy WebLinkAbout16814 CI'd'1'�F IDIAMOND BAR �� DEPARTMENT OF COMA�IUNITY&DEVELOPMENT SERVICES `�� ----� —1 21825 E.Copley Drive '�`" (907)�60-3195 Fax(909}861-31 t7 PRESS '`'�Y���" BL3ILDINGPERMITAPPLICATION FIRMLY o� JOBSITE �j ��ny � l7�.P�,�����Q �e,;�,t DATE'CATION 'eJ �'�$y�� NUMBER I�d�� t #/C ADDRESS � tl f't 7�1 / g � ISSUE TYPE OCC APN LOT T ACT DATE CONST. GROUP p OWNER t�.. R3, � C' ADDRE S I � C�i" ZONING SETBACKS z CITY a G1�ZIP TEL. ' FRONT RW ❑ � APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ �� CONTRACTOR � SIDE ❑ ADDRESS a � CITY t ZIP l� TEL.',l�-'J.,rJ' �"�r�'o PROPOSEDUSE �Q� � �. / Q ARCHIENG/ z DESIGNER_ - -- — - N0.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION .,p OWNEA-BUILDER DECLAAATION SFRlADD/REM , Q . I HEREBY AFFIRM UNDER PENFLTV OF PEAJUHV THAT I AM EX6UPT FR�AA iHE CONTRACTORS LI� � GaragelCarpor[ � �LLI' �CENSELAWFORTHEF-0LLOWING'REASON(SEC.7o31.58U51NE55ANDPflOFES510N5CODE:ANYCINOR Z COUNiYWHICHRE�UIRESAPERh'tITTOCANSTRUCT,ALTER,IMPROVE,�EMOIJSH,ORREPAiRANYSTAUC- W Patio/Deck I w iURE,PPIOR TO ITS ISSUANCE,AL,SO REOUIRES THE APPLICANT FOR SUCH PERMIT TD FILE A SIGNE� � �. STATEMEM THA7 HE OR SHE IS LICENSED PURSUANi i0 THE PROVISIONS OF THE CONiRACTORS LI� CENSE LAW(CHAPTER 9(COMMENGING WITH SECTiON ioo0)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOUSPd FESSIONS CO�E)Ofl THAT HE OR SHE IS EXEMPTTHEREFROM AND THE 6ASIS FOFi iHE ALIEGED EXEMP- V. TION.ANYVIOLATIONOFSECTION7031.5BYANYAPPLICANTFORAPEFMITSUaJEC75THEAPPLICANTTO z RB-ROOf � ��� � � �ACIVIL PENALN OF NOT MOflE TNAN FIVE HUNORED�OLLARS(5500).): ❑I,ASOWNEROFiHEPROPER�'Y.ORMYEMPLOYEESWITHiNAGESASTHEIR50LECOMPENSATION, Q C0171mBfCIaI Z', 'WILL DO THE WORK,ANO THE STRUCTURE IS NOT INTEN�ED OR OFFEREO FOR SAIE(SEC.7o4a,BUSL J . '�.NESS ANO PROFESSIDNS CDOE:THE CONTflACTOflS LIGENSE LAW�OES NOT APPLY i0 AN OJJfJER OF � �.PROPERTYWFIOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWOqKHIAASELFORHEPSELFOR m �'� �:THftOUGHHI50RHEPOWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENiSARENOTINTENDEDOR WQ� 'OFFEREOFORSALE.IF,HOWEVERiTHEBUIL�INGORIMPRaVEMENiI550LDWITMINONEVEAROFCOMPt.E ,�,; TION,hIE OWNER�BUILDER WILL'�,HAVE THE BURDEN OF PRDVING iMAT HE OR SHE DIO NOT BUiLD Ofl �,�.',IMPROVEFORTNEPURPOSEOF$ALE)., ❑1,AS OWNER OG THE PRORHiTY,�AM EXCLUSIVELY CONT�4ACTING WITH LICENSED C�lTRACTOpS ��, ,TO CANSTRLiCTTHE PHDJECT(S�C.704a,BUSINE55 AND PROFESSIONS CO�E THE COMRACiORS�I- VflIU8tI0f1 � ��' ADJ.AREA W', ;CENSELAWDOE9NOTAPPLYTOANOWNEROFAPROPERTYWHOBUIL�SORIMPROVESTHEREON,AND �� '�,�WHOCONTPACTSFOPSUCHPRQVECTSWITHACdNTRACTOP�S�LICENSEDPURSUANTTOTHECONiRAG QUANTITY DESCRIPTION FEE Y� TORS LICENSE LAW.). � ❑IAM E%EMP7 UN�ER SEC. B.8 P.0.FOP THIS REASON U ' 2✓ � r,�- �ATE OWNER � V ' Z ' W �', �� LICENSEO CONTRACTORS DECLARATION W . a , CC I HEfiEBYAFFIRM UN�ER PENALTY OF PERJUFY THAT I AM LICENSEO UN�EF PFOVi510N5 OF CHqPiER � d � 9(COMMENCINGWITHSECTION7boo)OFCIVISION30FTHEBU5INESSANDPPOFESSIONSCO�E,AND z X' MY LICENSE IS IN FIRL FORCE ANb EFFECT. ' �� LIGENSE CLASS_ 1+ ����� • LIC.NO. !� =�� � � �@ � ' V' 'OATE GONTPACTOR �' f3 9�1" a W � WORKE'RS'COMPENSATION�ECLARATION ¢ � U � IHEREBYAFFIfiMUNDERPENALTNOFPERJUR'/ONEOftHEFOLLOWINGDECLARATIONS: Z Q � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFDRWORKERS' S COMPENSATION.ASPROVIOEDBYSECTION37oDOFTHELABOFiCODE.FORTHEPERFORMANCE U � OFTHEWOHKFORWHICM'THISPEFMITISISSUED. � � W �I HAVE AND WILLMAINTAIN,WORKERS'COMPENSATION MSURANCE,AS RE�UIRED BV SECTION Q 37ooOFTHELABORCODE�FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS °�/q, ISSUED.MVWORKERS'CqMPE SATIO INSURANCECARRIER NOPOLICYNIJMBERARE� CONSTRUCTION e✓S..Y Q ?, CARRIER � � e �� � PLAN REVIEV✓ ` Z aoucv NurneEa � �¢"f� " ��� ELECTRIC _ ¢ � (IHISSECTIONNEr'DNOTBECOMPLEfEDOFTIIEPERMfTISFORONEHUf�REDCOLIARS($100)ORLESS). PLUMBING �' I CEHTIFVTHAT MTHE PEqFOFMANCE OF iHE WORK FOR WHICHTHIS�ERM�TiS I55UE�,l MECHANICAL C",� SHHLL NOT EMPLOY ANY PERSON IN ANY MPNNER 50 AS TO BECOME SUBJECT TO THE ,�,�,,,,,..� � WORKERSCOMPENSATIONLAWSOFCALIFORNIA,ANDAGPEE7HATIFISHOUL�BECOME INSPECTIONFEE .�. � SUBJECT TO THE WOPKER$'COAAPENSATION PROVISIONS OF SECTION 3l0o DF iHE LABOR =____°�'""" ~ �1,�� s� yp � CODE,I ALL DRTHWITH CDMPLY WITH THOSE �lOVISIONS. �SSUANCE ����^r �'�� 1 L�����V" � `7 ���L ' � �---- p DATE: APPLICANT: � 'Y SMIP ��� L� �� ' ENERGY P!C �' � j' WARNINGFAILURETOSEWREWORKERS'COMPENSATIONCOVERAGEISUNIAWFUL,ANOSHALLBE �� -� ^y � �� �—y. SUOJECTANEMPLOYERTOCRIMINpLPENALTIESAIJ�CIVILFINE5t1PTOONEHUN�REo1HW5AN� ENEFGYPERMI'';f �i � �OLLARS(51aa,00D),INA�PITIONTp7HE'�.COSTOFGOMPENSATION,DAMAGESASPROVIDEDFOftIN I e.dy� � SEGTION 37oe oF THE IABOR CODE,INiEREST,AND ATTOflNEY9 FEES. RETENTION FEE� �J ��' �� � � l...-� ..�. . "_` a.. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: . � " � Q ,.._:...�_�_�-- _ � I HEREBY AFFIRM UNDEft PE�ALTYi,OF PEFiJURV THATTHERE IS ACONSTRUCTION LEN�ING AGENCV �••�-ar ��-� � FOFTHE PERFOPMANCE OFTHE WORK FOR WHICH7HIS PEHMITIS ISSUE�(SEC.3097,CIV.C.�. - � �. Z Lq �2 LENDER'S NAAAE I_`� LEN�ER'SA��HESS � � _,_ � ICEFTIFYTHATIHAVEREADTHISAPPLICqTiONqNOSTATEiHATTHEABOYEiNFORMATIONISGORRECT. TOTA�FEES � 'fr "a � � IAGREETOCOMPLYWITFIALLCITY'ANDCOUNTVOF�INANCESAN�SiATELAWSRELATING708UILDING ' �� CONSiRUCTION,AND HEREBV AUTHORIZE REPRESENTA7IVES OF THIS COUNTYTO ENiER UPON THE ZABOVE-MENTIONED PftOPER1YFOfi MSPECTION PURPOSES. COMMENTS 0 �'/{;��D��j �p] v��J��. py��g = I l4iJC��� �,° 'cL��C LC� ¢ PERM� E(PRINT� }�v ��G��� � `%� 7 � SIGNATUREOFPERMITTEE � �ATE ' $ RECPT.NO. . PAID BY VALIDATION � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanPs Copy ' _.. 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