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HomeMy WebLinkAbout16911 (40) -.__.>-.--:._- ,. .. __.i_. - ---- . .. . _ _ � ... _.. . - ^w r CITY OF I)TAMOND BAR � -�'`q�---- DEPARTMENT OF COIvA�1tINiTY&DEVELOPMENT SERVICES � � 21825 E.Copl�y Drive � ' ��" � (909)�60-3195 Fax(909)8613117 �,,. PRESS �"%.v»�"��' BUILDING PE�tMIT APPLICATION FI R M LY a DDRES� O ,�S%� APPLICATION �I r �,�l PERMIT I�� I � P/C DATE '�-� ���•J NUMBER # � ISSUE TYPE OCC APN LOT �- TRACT DATE CONST. GROUP °C OWNER ��6-C`�N� OO ADDRES ZONING SETBACKS oCI ZIP TEL�O FRONT RW ❑ APPLICANT TEL. REAR ❑ � SIDE/SIQE STREET RW ❑ Z ¢ CONTRACTO I $ SIDE ❑ � ADDRE S �J o CIT`�/ �.__ ZIP TEL. P��yv�D.}bE ' � o ARCH/ENG/ W DESIGNER N0.DWEL. NO. NO. ` a ADDRESS UNITS STORIES BEDROOMS � C1TY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION � OWNER-BUILDER OECLARAT!ON SFR/ADD/REM � O p 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS L- GeIdJB/CdipOfL ll:l CENSEIAWFORTHEFOLLOWINGIREASON(5[C.�o31.5BU51NESSAND?ROFESSIONSCODEANVCI7VOR ((� , U COl1N7YWHICHREQl11qE5APERMITTOCONSTRUC7,ALTER.IMPROVE.DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck Z TUqE,PRIOP TO ITS ISSUANCE,AlSO REQUIRES THE APPLICANT FOR SUCH?ERMITTO FILE A SIGNE� w STATEMENT THA7 HE OR SHE IS LICENSED PURS�ANT SO THE PFOVISIONS OF TNE CONTRACTORS LI- � � CENSE LAW(CHAPTER 9�GOMMErGING WITH SECTION 7000)OF OIVISION 3 OF iHE BUSINE55 AND PRO- �'�" PooVSpa � FESSIONSCODE)OqTHA7HEORSfiEISEXEMPT7HEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� � TION.ANYVIOLATIONOFSECTION7a31.5BYANYAPPLICANTFORAPERMITSUBJECiSTHEAPPLICANTiO z R2-ROOf A CIVIL PENALTY OF NOT MORE TNAN FNE HUNORED DOLLARS(S5o0).j: � ❑I,ASOV✓IJEftOFiHEPROP;ERTV,OP.MYEMPLOYEESWITHWAGESASTHEIR50LECOMPENSATION, 0 COfPIRiBfCiBI - Z WILL DO THE WORK,ANO THE 57FlUCTU�9E IS NOT INTENOED OR OFFEREO FOR SALE(SEC.7044,6USI- J NESS AND PROFESSIONS COOE:THE CONTRACTOfiS LICENSE LAW DOES NOT APPLY i0 AN OWVER OF � PROPERTYVIHOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHEPSELFOR � �i CC iHROUGHHISORHEROWNEMPL'OVEES,PROVIDE�THATSUCHIlAPROVEMEMSARENOiINTENDE�Ofl m �� W OFFEREDFORSALE.IF,HOWEVER,�,THEBUILDINGORIMPFOVEMENTISSOLDWiTHINONEYEAROFCOMPLE- I Z TION,THE OWNER-BUILDER WILL���HAVE THE BURDEN OF PROVlNG THAi HE OR SNE DIO NOT BUILD 0:3 � 'IMPROVE FDR THE PURPOSE OF SALE).� ❑I,AS OWNEROFTHE PFIOP`ERTV;AM EXCLUSIVELV CONTRACTING WITH LICBJSED CONTflACTORS � TO CANSTRUCT THE PROJECT(SkC.7a44,BUSINESS AND PF70FE5510!<�5 CODE:THE CONTRACTOflS LI- V81UdtI0f1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANONMEROFAPROPERTYWNOBU�DSORIMPROVEShiEREON,AN� .� WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPUflSUkNTTOiHECONTflAC- QUANTITY DESCRIPTION FEE - Y tOfiS LIGENSE LAW.j. ' � ❑I AM E%EMPT LINOER SFC.'�. 8.8 P,C.FORTHIS REASON U � LL � OATE OWNER U � W � LICENSED CONTRACTORS DECLARATION W d � i HEREBYAFFIRM UNDEF PENALTy OF PEflJURV THAT I AM LICENSED UNOER PROVISIONS OF CHAPTEF � d 9(COMMENCING WITH SECTION 70ooJ OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS GODE,ANO Z `X MY LICENSE IS M FULL FORCEAN�EFFECT. m ' � LICENSE C S G � LIC,NO._i��'��� J V DATE r r' � CONTFACTO �- W � WORKERS'COMPENSATION DEGLARATION a = U � I HEREBYAFFIPM UNDER PE�ALT�'OF PEflJURV ONEOFTHE FOLLOWING DECLARA110N5: Z � ^IHAVEANDWILLMAINTAIIJACERTIFICAiEOFCONSENTT�SELF-MSUREFORWORKEFS' _ CAMPB35ATION.ASPROVIDEO-BVSECTION370oOFTHELA90RCODE,FORTHEPERFORMANCE U ��� a OFTHEWORKFORWHICFITHISPERMITISISSUED. � � W 1 HAVE PND WILL MAMTAIf�WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION \ p�, Q 37000FiHELABORCODE4FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISAERMITIS ����+—��p' , II a ISSUEO.MY WORKE 'CD ENSATIO2N INSURANC ERAND PO ICYNUMBERARE: CONSTRUCTION 1 � J � CARFIER � Z PLAN REVIEW Z POLICYNl1MBER_ ', �'�r�� ELECTRIC Q � Q ((HISSECTKKJNEmNOTBE��,CON:PLE'�EDOFiHEPERMfTISEORONEHUI9RED00LLW3�$iW70RLESS). PLUMBING . � � MECHANICAL � � Z I CERTIFV THAT INTHE PEJf��ORlAANCF OF iHE WORR FOR WHICH THIS PEFiMIT IS ISSIIED,I � �' -' ('} SHALL NOT EMPLOYANY ryER50N IN ANY MANNER SOAS T�GECOME SV�JECTTO THL ,s �" `' N WORKERSCOMPENSATIO�JLAWSOFCALIFOftM1IA,ANDAGREETHATIFISHOLILDBECOME INSPECTIONFE�'$[ ��e'� d..'��.;_'�� _�i"- , _ � SU&IECTTOTHEWORKEF'S'CDMPENSATIONPROVISIONSOFSECilON3lo00FTHELABOr7 yyy � &-. �' ' �t^'y� � COOE,ISHALLFORiHWITHCOMPLVWITt+7HO5EPROVI510N5. �SSUANCE € 6� ,+�yy�yy� d%�� � SMIP � ��°�!�x �N'439! � f I� �. p DATE:_ A�PLICANT: � J WAflNING:FAILURETOSECl1REWQRKERS'COMPEN5ATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C G � � � SU&IECTANEMPLOYEflTOCRIMB�IALPENALTIESANDqViLFWESUPTOONEHUNDREDTHOUSAND a�m��c�M � M.' .. � '� DOLL4RS�StOa,oWJ,INAD0ITION7I0THECOSTOFCOMPENSATION,�AA�AGESASPROVIDE�FORIN ENERGYPERM4T� � / � � SECTION 3700OF THE LABOP CODE,INTEFEST,ANDATTORNEY'S FEES. HETENTION FEE:���;� 1 OCO�ISTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMUNDERPENALT�OFPERJURVTHAThi=REISACONSTRUCTIDNLENDINGAGENCY FORTHEPERF-0qNANCEOFTHE OflKFORWHICHTHISPEFiM17151551JE�(SEC.3097,CIV.G.). Z W � LENDER'S NAME _ ��, Iu LENDER'SADDFESS � � ICERTIFYTHATIHAVEREADTHiSAPPLICATIONANDSTATEiHATTHFABOVEMFORMATIONISCOqRECT. T�TA�FEES � �j � I AGFiEETO COMPLY WITH ALL CITY;AND COUNTV OPDINpNCEo"AN�STATE LAWS flELATING TO BUILOING � CONSTRUCiION,ANDHEREBYAUT,HORIZEFEPRESENTATNESOFTHISCOUNTVTOENTEFUPONTHE � ABOVE-MENTIONEOPROPERTYFOFINSPECiIONPLIRPOSES. COMMENTS � J � � PERMITTEE Nl1ME(PflIN ¢ p g,- _p � �Jj SIGNATUflEOFPEF EE , DATE = RECPT NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENR06—File Copy,GREEN—Applicant's Copy .. . .. . .._ � . �,. _.�,.-...._.. ,.'r.�.. ...- " r�, .,..��:k'�.�: h..�l,{.".i. �.t:ys3.a7 �F�.ew.-:. . .. . ...,.s.. _ . .. . y s�i. 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