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HomeMy WebLinkAbout13783 (14) ��' CITY OF DIAMOND BAI� � DEPARTMENT C1F COTvi1GIUNIT'Y&TSEVELOPMENT SERVICES e suite lsio PRESS � BtJn.DING PE 9ov)s�i-31i7 _.._. (�>a as 9sF��,ArirLiCA�'io�T` ..:. ,�.. - ,. ,. . ..,; :�> __.� , :;.�<.,M . ... .:: FIRMLY �9M' � JQBSITE /a APPUCATlON PERMIT � �g 4� P/C � ADDRESS Z� �[J�� ��g jln.y� �� DATE_ �"`����s NUMBER � ` V� # c� ISSUE TYPE aCC APN �OT TRACT DATE CONST. GROUP p OWNER o ADDRESS �l� l.?ZG � o "�,p ZONING SETBACKS � CITY�. �v� ZIP ' 7EL. S��4I=J��x�� REORT RW ❑� APPUCANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOFt {_ SIDE ❑ - � ADDREj�S �' PROPOSED USE ' " �,Q,,, Cl7Y 11-� ZIP�;�_ TEL. `7 � � � ARCH/ENG/ • � Z DESIGNER NO.DWEL. NO. NO. � A�DRESS UNI7S STORIES BEDROOMS � CITY ZIP TEI.. � DESCRlPTIOIV SQ,FT: FACTOR PSF ADJ.AREANALUATION � � OWNER•BUILDER DECLARATION SFR/ADDiFiEM O p I HEflEBV AFFlRM UNDER PEN�LTY OF PERJURV THAT t AA1 EXEMPT FROM THE CONTRACTORS�I- � Gd�flg9/Calpofl W CEPI5ELPIWFORTHEFOLLOWINOREASON(SE�.70.71.5BUSINESSANO�ROFESSIOtJSCOPEANVd'YOR � COUNTVWHICHREQOfliESAPERK11Tl'O-COF15'1'RUCI:PLTER.IMPROVE,OEAIOlISH,OpREPAIRANVS7qUC• W patio/Deck - W TURE,PRIOH TO ITS 1$SUMICE.AlSO�REQUIRES iHE APP�ICANi FOR SUCH PERMI?'TO FlLE A SIGNED � STATEMENT THAT HE OFi SHE�LACENSED-PURSUANf TO TfiE PpOVISIONS OF THE"CANTRACTORS L.I- � CENSE LAW(CHAPTER 9(COMMENCINQ WITH SECTION 700b)OF DIVIStON 3 OFYHE BUSINE55 AND PfiO- �'�' POOUSP2 FE9SIONSCODE)ORTHATHBORSHEISEXEMPTTNEPEfROMANOTHEBASISFORTHEALLE�EOEXEMP- (� TIOM.ANVVIOI.ATKJNOFSECTION7037.58VANVAPPLICANTFORAPERMITSU9JECTSTHEAPPLICANTTO Z RB-ROOf � A GML PENALTY Of NOT MOflE THAN rIVE HUNDRED DOLLARS(S5D0).): � ❑I,ASOWNEROFTHEPROPER7V.ORMYEMPLOYEEuWITHWAGESASTHEIRS�LECOMPEN5A710N, C.� Comf119Yc181 - WILL 00 THE WORK,NND THE STNUCTURE IS NOT INTENOED OP OFfERED FOR SALE(SEC.7044,BUSI� J NE65 AND PNOFESS�ONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNEq OF � PIiOPERTVWFIOBURASOpIMPROVESTHEliEON.M'OWH�JDOES5UCFIWYJRKHIMSEI,FORHERSEIFOR � GC TNROIIGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCNIPAPROVEMENTSAR£NOTIN7ENDEDOp � i ' O ,OFFEFEOFORSALEIF,HOWEVERTHEBUILOINGORIMPPOVEMEM1550lOWfRiINONEYEAROFCOVAPLE Z TIOM,hIE OWNER�BUILbER Wtt1 HAVE THE BURDEN��oF PRtlVING THAT HE OR SNE DID NOT BUIL�OP IMPRDVE FOR 7HE PURPDSE OF SALE). � � OI,/�gOWNEHOFTHEPROPERIV,AM[XCLUSlVElVCqNTRACiINGWITHLICENSEDCON7RA.CTOFiS � ..y � TO CbNSTRUCT THE PROJEC7'(SEC.70r4,BUSINESS AND PftOFES510N5 CODE:THE CONTPAC fOflS LI• �/81U321011 A�J.AREA W CENSEUWDOE5NOTAPPLYTOANOVMEROFAPROPEpNWMOBUKDSORIMPF�VESTHEHEON,AND � WFIDCONTMCTSFOpSUCHPROJEC7'SWITHACONTRACTOR�S�LICENSE�PURSl1ANTTOTHECONTRAG pUANTITY ESCRIPTION FEE Y 70R5 UCENSE UWJ. � J � O I AM E%EMPT UN�ER SEC. ____�__B.&P,C.FOR THIS REASON U � LL' DATE ONMER _._ ,U Lll � LIGENSED CON7RAC70RS DECIARATIOM � � IHEHEBVAFFIPMUNOERPENPLTYOFPERJURYTNATIAMLICENSFDUNDER�OPOVIS;ONSOFCHAPTEF � !�� d. 9�COMMENCINOWITHSECTION700010FDIV1310N30FTHEBUSINESSANDPROFESSIONSCO�E,AND Z MY UCENSE IS IN FV4L FORCE.4ND EFfECT. L 4 .Cc� � LICENSE CLASS � � LIC_NO. �_ � H � � d V �ATE -- _ GONTRACTOR. � _ ��P �������'VOAKERS'COMPEN5ATi0� ION � ^� � I H HEBY AFFIRM UNDER PENALTY OF PERJURV ONE OFTHE FOLLOW NG DECUHATbNS eg�� � C!9 � �Q � I FiAYE AWD WIIL MAINTAIN AGERrIFICATE OF CONSENTTO S'cLF-INSURE FOR WORKERS' _ � GOMPFNS�TION,AS PROViDED BY SECTION 37COOf TNE UL'Ofl CODE,FOR TH&?ERFORMANCE � �„ oF THE WORK FOR WNICH 7HIS PEAMIT IS ISSUEO. � � , ��I HAVE ANO WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOJIRED BY SECTION r� /` i,Q,j Q 37000FTHEIABOPCODE,FORTHEPEf3FORMANCE6FTHEWORKFOfiWHICHTHISPERMITIS S �J, ISSUED.MiY WORNEAS'COlAPENSATIOT'INSUFlMNCE CARRIER AND POLICY NUMBER ARE CONSTRUCTION � f �d �� j cnaaiea_ � a1f.n _ PLAN HEVIEW -- � POLICYNUM9F�`(e%C_�_����—���:� �- ELECTRIC __� d � (I}fISSEI,'M.NNE4�NOTBECOASPLE'EDOF'ri7EPEiUMTISFOR�NEHIM'CN-�EDxLLAtiS(S1W�CALESS). PGUMBING " C� PL Z ICERYIFY7HATINhiEPERFORMANCEOFTHEWQAKFORWHICNTHISPERAIIT�IS�iSSUEO.I MECHANICAI. �� � �} SHALLNOTEMPIOYPNYPERSONINANVMANNF.PSOAST09ECOMESUBJECTTOTHE Vj WORKERS'COMPENSATIONLAWSOFCALIFOflNIA,ANDAGREETHATIFISHOULOBECOME INSPECTIONFEE _ SU&lECTTOTHEWOFNERS'C0IAPENSATb FROVISIONSOFSECTION3'1a00FT1-EIAAOti /'� [' = CO�E.I SHALL WHIHWITN COMPLY WITH OSE PROVISIONS �� ISSUANCE }�i� y� f ���a �y fX..3 o �s� SMIP °'n'w �- �f�. �;+� p DATE:�����=,�,— ApPUCANT: � ^'�. u, WARNING:FAILURE TO ECURE WORKERS' PEN5 N COVEPAGE IS UNLAWPUL AN�SHALL BE ENERGY P/C � �� �dy n d.'��. d �f$'� �p�!�� � SUHJECTANEMPLOYERTOCRIM:NALPE IESAN NILFINESUPTOONEHUNDREOTHOUSAN� � �� ;" �=�" ' ;.i V" �OLLARS(570a,0001.INADDITIONTOTHE 3TOFCOMPENSATION,DAMAGESASPROVIDEDFOA�N� ENERGYPERMIT �'�-.+ �D ;�1`�L ':-� J SECTION 3708 OF THE LABOA CODE,INT Esr,aho nTroauers F�Es. RETENTION FEE: oC ------- a CONS7RUCTIONLENDINGAGENC`/ PRE-ALTFEE: ___ O � 1 HEREBY AFGIRM UN�ER AENALTY Of PERJUFV THAT iHEflE IS ACONSTqUCT10N LENbING AGENCY FOR hIE PERFORMANCE OFTHE WOflK FOR WFiICH THIS P�RMIT IS ISSUED(SEC.3C9],CIV.C.). Z W � LENDER'S NAME 1— IENOERSADORE55 _ � � ICERTIFYTHATIHAVEREPA7HISAPPUCATIONANDSTATETNATTHEABOVEINFORMATIONISCORRECT. TQ�AL FEES � I AGREE TO COAIPIV W1TN ALL CITY ANO COUNTY OR�INANCES ANO 5iATE UtWS RELATING i0 BUILDING n' CON$TFRICTION,ANDHEREBYAUTHORI2GREPRESEMATIVESOFTHISCOUNTYTOENTERUPONTHE� Z0.BOVE•MENTIONEDPROPERTYFORINSPECTIONPURP0.5ES. COMMENTS d � �-�,� �.�'2 ` ¢ PE EE (P INT / f ��� � � 51 flE HMI EE DATE = RECP7.NO. 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