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HomeMy WebLinkAbout12657 , � -�" ,. • --1� CITY OF DIAIVIOND BAB " �� � � DEPAR�'MENT OF C0111MUNITY&DEVELbPMENT SERVICES : � 21660 E.Copley Drive Suite 19(l� '' " �. (909)860-3195 Fax(909)861 3117 PRESS ., . B�C7Q.DING t'ER1�YT�P�ICA„I'�bN . _ : s� -- __ �: . . .�. �„ . . _.._. , FIRMLY , _ _ .>,� . ,,:,... rv: .. , . g... .,r.. �� JOBSITE .—:'°').,. • APPLICATION `"t ' �`""" ` "°`��a�"' P/C ADDRESS /o- � � � DATE � '�' NUMBER� ����#�� � APN L�T T ACT ���� D TE �2�I G��ONST. OCC p OWNER �,/,1d + , GROUP p ADDRES, ' r ZQNING SETBACKS W CITY , ZI � y TEL - � -�. .� FRONT RW ❑ �""'°< � APPLICANT - TEL,'�I,�V��21 �� REAR ❑ ✓ SIDEJSIDE STREET RW p � CONTRACTOR ��= �'° SIDE � � ApDRESS 2 e�� , �. i J, .. _ C�� .�p . r,. �d - PROPOSED USE ^ .Z L P �G'� ZIP� TE . �E� � r: � o ARC NG/ �^ � DESIGNER NO.DWEL. NO. _ NO. ADDRESS CI7Y ZIP TEL UNITS STORIES BEDROOMS � � D�SCRIPTION SQ.FL FACTOR PSF ADJ.AREANALt1ATION 4 OWNER-BUILDERDECLARATION SFR/ADD/NEM � ��7Z'D I HEfiEBV AFFIRM UN�ER PENALTY OF PERJURV TNAT I AM EXEMPT FROM 7HE CONTFlACTOqS LI� Gal'89 af�OK % W CENSEWWFORTHEPoILON'INGREASON(SEC:7ai7.68U51NESSANDPRtlKESSIONSCA�EiANYC17YOF (n � GOUNTYWHICHREWIRESAPERMITTOCPNSTfiUCT,ALTER.IMPPpVE,DEA�LISH,ORP�PAIRANYSTRUG W TURE,PRIOHTOR81S5UANCE:Al50�RE0UIRE5THEAPPLICANTFORSUCMPERAdIT7pFlLEASiQNEO W Patio/DOck .� STATEMENi TiAT HE OR SHE�IS UCENSE�PURSUANT TO THE PiiOVIS10NS OF�'fF1E CONtRACYOFiS'LI� W � � � CENQE UIW(CHA➢TER 9(COMMENCINO WITH SECTION 7otio)OF DIV510N 3 OF THE BU5INESSAND PI�O- POOVSpa : ��� FES3pN5COb�ORTHATHEORSNEISEXEMPTTHEREFROMANpTHEBASISFORTHEAILEGEDEXEMP- �(f TION.ANYVIOLATICNOFSECTION7o91.6BVANYAPPL�CANTFORAPERMITSU&IECT§THEAPPUCAPYTTO Z R8-ROOf v� �„� ACMLPENALTYOFNOTMORETHANFlVEHUNDREDDOLLARS(55oo�.): � � � ❑I,ASONMEROPTMEPROPERTV,ORMVEMPLOYEESWITHWAOESASTHEIRSOLECOMPENSA�ION, G COfnrIlBfClal � . � -- IMU.DO THE WOAIC,J�ND 7HE 5TRUCTURE IS NOT INTENOfi�OR OFFEflED FOR SALE ISEC.7044,BUSI� J � NESSAND PROFESStONS COOE:THE CONTRACTORS LICENSE LA6N DOES NOT APPLY TO AN OWNER'OF n PROPEpTVWFiOBURDSpR11APHOVESTHEREON,ANDWH000ESSUCHNbRKMNSELFORHERSELFOR �= V 2 THliOl10HHISORHEHOVJIJEYIPCOYEES,PROVIDEDTFIATSUCHiMPROVEMENTSARENOTWTENpE00R m - r.. . 0 OFFEREDFOHSPLEIF,HOWEVER,h1E9UILDMGORIMPROVEMENTISSOLDWITHINONEVEAROfCOfNPIE- � TION,THE ER-BUILDEp WILL HAVE THE BURDEN bF PROVING iHA7 HE Oq SHE DID NOT BUItD Op . . IMPRO 'fHE PURPOSE OF 9ALE} ��ONMER OF THE PROPERTV,AM IXCLUSIVELYCONTRACTINO WITH LICENSE�CONTPACTOqS Q TO NSTRUCT THE VROJECT(SECJOM,BU51NE55 AN SCONS'� E:THE CONTpACTOf15 LI- V81UHtiOt1 �ADJ.AREA LLI CENSELAWOOESNOTAPPLYTOANOWNEROFAPROPER HO UILOS RMPROVESTHEREON,AND WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOH IC SE P S ANT70THECON'iRAC- � ravsuc�sEuw.�. QUANTIT' DESCRIPTION FEE � ❑�AM IXEMPT UND SEC. �-"��. THIS R'cASON J � U r �F6°�. i'°�,�,: ,,��# ,°�a' u' DA7E +� � OWN6R �'w... F– __ . . ..:. .. � .. . . . . ,. . _... C� UCENSED CONTRACTORS DECUIRATION .W � I HEREBYAFFIRM UND6i PENALTY Of PERJURY THAT IAM LICENSF.D UNOER PROVISIONS OF CHAPTER� � �y 8(CXMiMENqNO WITH SECTION 7o0oJ Of D�VISION 3OF iHE BUSINESS AND PROFESSIONS CODE.ANO Z 6X yy�JCENSE IS N NLL FORCE AND EFFECt m .rY � . o LICENSE C>I,.'AS/§. •'�-> LIC.NO,�'_�..�' - p � U DA7E�a r `� � - CONTRACTOR:: .�a[".^i9Rd ,� c �e�,F� -d LIl / � WORKERS'COMPENSATION DECLARATION a � I HEREBYAFFlRM UNOEH PENAL7Y OF PEPJUF1'!ONE OF THE FOLLOYJING DECLARATIONS: � -' " Z - � _IHAYEANDWILLMAINTAINACERTIFICATEOFCONSENTT03ELF-INSUREFORWORKERS' s - ' : � . k _, Q COIAPENSATION,AS PROVIDEO8V5ECTION 37o00F TME LABOR CO�E,FOF THE PERFORMANCE U� Q OFTHE WORK FOR WHICH THIS PEpMIT IS ISSUED. �� . QW A1 HAVE AND WIIL AfAINTAIN WORKERS'COMPENSA710N IN5URANCE,AS REOl11RED BY SECTION � ����-• -� ���_� � ��� 370oOF7HELABOftCODE,FORTHEPERFORMANCEOFTrIEWORKFORWHICHTHISPERMITIS ��—�'_'��� J ISSUEOMYWORKERS'COMPENSATIONINSURANCECARRIERANDPOLICYNUMBERARE: CONSTRUCTION _ ,: _..... ._ ..... Q . . .. ..... .,_ . ... ..:..,. .,. .,. ,.. . .. �. .. .. .... ..... ..... _..._ . . _. � caaaiEa PLAN REVIEW Z aoLICVNUMeER__ ELECTRIC ¢ � � (IHl55ECf10NNE�NOTBE00MPIFTF.DOFTHEPERFNTISFORONEHUIVOFlEDDOIIARS(5100�ORLE55). PLUMBING �. . �J Z 1 CERTIFV THAT IN THE PERFORMANCE OF WOR�Oq WHICH T is aFaMit ts issuEo,i� MECHANICAL __���� C,�J SHALL NOT EMPLOY ANV PERSON IN ANY MA ER SO�S TO ECO SUB.'�ECT TO THE (/� WORKEfiS'COMPENSATION LAWS OF CALIF AGR TH T F I SHOULD BECOME INSPECTION FEE � SU&IECTTO EWORKERS'COMPENSATIONPROV NSd E�TI 37aoOF?HELABOfl . . , = CAOE ISHA FORTHWITMCOMPLYWITHTHOSEP 10 . ISSUANCE o 0 p DATE: � � APPLICANT e SMIP J WARNINO:F ILUP�TOSECUREWOflKEFS'COMPENS�IOKCOVERA ISUNLqWFUL,0.ND5F7ALLBE ENERGYP/C � � SU&IECTANEMPLOYERTOCRIMINILLPENALTIESANDCiViIFINESUPTOONEHUNDREDTHWSAND ENERGYPERMIT ¢ OOLLAflS(5100,000J.IN ADDITIONTO THE COST OF COMPENSATION,DAMAGES AS PROYIDED FOR IN -'* SECTION37oeOFTNELABORCODE,INTEREST,AN�ATTORNEVSFEES. RETENTIONFEE: •L �V OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ � I HEREBV AFFlfiM UNDER PENALTY OF PEflJUfiY THAT THERE IS A CONSTRUCTION I.ENDING AGENCY, FOR THE PEFFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUEU(SEC.3097,CIV.CJ, Z W �T LENDEfl'SNAME . � _, ,. � � . , _ � F— LENDER'SPD�FESS �.f/ �1 W iCERTIFYTHATIHAVE ADTHISAPPl1 ONANDSTATETHATTHEABOVEINFORMATIONISCARRECT. TOTAL EES �� «�`r ✓ ' I �� � ( 1{^ �t�l �i � IAGREETOCO LYWI, PLLCIT'AND UNTYORDINANCESANOSTATELAWSRELATINOT08UILDING V^ �l�F' � CONSTRUCTI AN� REBVAl1T1iOW RECRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE /�.C� �t , z A80VE-ME ED ER1V FOR IN Ecgwru vuaroses. 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