HomeMy WebLinkAbout15650 EXPiRED
�.;�-��� D PARTMENT�OF COMMUNITY&DEVELOPMENT SERVICES
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� (909)86Q3195 Faz(909)861-3117 PRESS
��'�^' BUII.DING PERMTT APPLICATION ' . FI�LY
' oN JOBSITE ` � APPLICATION j'�/� PERMIT �F;f n P/C
ADDRESS I S� � 7 � ✓� DATE �,��+ "" NUMBER� � �C 1t
� APN LOT T AC D TEE � �� TYPE OCC
CONST. GROUP
I p OWNER
p ADDRESS e(�,YIATU ZONING SETBACKS
Z CITY ZIP TEL. REART RW ❑
4 APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTOR I�1 A — T��� SIDE ❑
Q ADDRESS —��1}'i� p OPOSED US i °Y^ � �r
� CITY ZIP TEL.
o ARCH/ENG/ •r � r
�z DESIGNER NO.DWEL. N NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
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v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBY AFFlRM UHDER PENALTY OF PEFWRY THAT I AM EXEMPT FROM THE CONTMCTORS LI- Gef2JB/CefPOf1
W CENSE UW FORTHE FOLLOWINO REASON(SEC.7031.5 BUSINESSAND PROFESSIONS COOE:ANYCI7YOR (n
U COUNTVNMICHREOUIHESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck
� TURE,PRIOR TO ITS ISSUANCE,AL50 REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
STATEIAENT THAT HE OR SHE IS IICENSED PURSUANT TO 7HE PROVISIONS OF THE CANTMCTORS LI-
� CENSE UW(CHAPTER i(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � PooUSpa
FESSqNS CODE)OR T1UT HE OR SHE IS E%EMPT THEREFROM AND T1E BASIS FOR THEALLEOED E%EMP- (�
TION.MlYV10LATIONOFSECTION70.91.50YANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z e-Roof
� ACML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(i500).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, �ORIrtIBfClel '
WILL DO THE WORK.AND THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.70��,BU51- J
� NESS M1D PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO7 APPLV TO AN OWNER OF �
PROPERiV WliO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
CC TF1FqUOF1 HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
QOFFEREDfORSALEIF,HOWEVERTMEBUILDINOORIMPROVEMENTISSOLDWRHINONEYEAROFCOMPLE-
Z •TqN,THE OWNER�BUIIDER VALL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR .
� IMPROVE FOR THE PURPOSE OF SALE). I
w ❑I,ASOWNEROFTHEPROPERTY.AME%ClUSIVELYCANTMCTINaWRHUCENSEDCONTRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC.70H,BUSINESS AND PROFESSIONS CODE:THE COMRACTORS LI- V L8f10l1 � ADJ.AREA
W CENSE UW DOES NOTAPPLY TOAN OWNER OF A PROPERTY NM1iO BUILDS OR IMPROVES THEREON,AND • �
F WFpCOMMCTSGORSUCHPROJECTSWITHACONTRACTOR�S)LICENSEDPURSUANfTOTHECOM{UP ANTITY ESCRIPTION FEE �
� TORS LJCENSE UW.). `
❑1 AM EXEMPT UNDER SEC. B.d P.C.FOR THIS REASON Q
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OATE ONMER U
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�Q LICENSED CONTRACTORS DECLARATION w
fL I MEREBV AFFIFUI UNDER PENALiY OF PEILIURV THAT I MI LICENSED UNDER PROVISIONS OF CHAPTER �r
� 0(COMMENCINO WITM SECTION 7000)OF DIVISION�OF THE BUSINESS AND PROFESSIONS CODE,AND Z
�� NY LICENSE IS IN FULL FORCE AND EFFEC7. �
' C �� ��V �
0 LICENSE CLASS LIC.NO. ' �'� /' �
V DATE CONTRACTOR�tf/�.��iG a
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� WORKERS'COMPENSATION DECLARATION �
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� � I HEREBV AFFIRAI UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECUM7qN5: U
C/� Q
� _IHAVEANDWILLMAINTNNACEFiTIFICATEOFCONSENTTOSELF-INSUREFORWOHKEPS' _
COMPENSATION,AS PROVIDED BY SECTION 37000F 7HE LABOR CODE,FOR THE PERFORMANCE U
Q OF hIE WORK FOR NM1iICH THIS PERMIT IS ISSUED. �
0
W _I HAVE AND WILL AWMAIN WORKERS'COMPENSATION INSURANCE,AS REDUIRED BY SECTION �
Q 37000F THE LABOR COO[,FOR THE VERFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS �I^ . i // �
ISSUED.MY MORKERS'COM7ENSATION INSURANCE CARRIER AND POIICY NUMBER ARE: CONSTRUCTION L v l.�i
jc�,ppiEp PLAN REVIEW � ��
� POLICYNUMBER ELECTRIC
0 (RCSSEC,'IqNNE�NOTBEODA6LE7IDOF7FfPERAfTISi77RONEMIi%imD0UAR5(5100)ORLESS} PLUMBING
Z I CERTIFY THAT IN hIE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
('3 SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECAME SU&IECT TO THE
� YKIRKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE TNAT IF I SH LD BECAME INSPECTION FEE
SU&IECT TO THE WORKERS'COM7ENSATION PROVISIONS OF SECTION 37 OF THE UBOR
s CODE,ISH FORTHWI7HCOMPLYWITHTHOSEPROVISIONS. ISSUANCE �T �
1
p DATE:� APPUCANT: �SMIP i']T
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J WARNINO:FAIL E TO SECURE WORKERS'CA NSATION CAVERA�E IS UNUWFUL,AND SHALL BE ENERGY P/C
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� , LL SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDHEDTHOUSAND ENERGYPERMIT
DOLLARS(i100.000),IN ADDI710N TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR IN
J SECTION 37oe OF THE UBOR CODE,IN7EREST,AND ATfORNEV'S FEES. � RETENTION FEE:
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a CONSTRUCTION LENDING AGENCY PpE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTY OF PERIUfiV 7HAT 7HEHE IS ACONS7RUC710N LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PERAl1T IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME �
I— LENDER'SADDRESS /� \
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES �V I •�V ,
w I AGREE TO CAMPLV WITH ALl CITY AND CAUNTV ORDINANCES ANO STATE UWS REUTING TO BUILDING '
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF 7HI5 COUN7V TO ENTER UPON 7HE � � -
ZABOVE-MENTIONED PROPER7Y FOR INSPECTION PURPOSES. COMMENTS ' '
o ���Y� ����
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m ERMITTEE NMIE(PFINn
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� S NATUNE OF P E DATE
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TEMP POWER FIREPLAG�BOND BEAM _
WATER SERVICE MID HT. BOND BEAM '
ROOF SHEATHING �4j.. 8 FT. BJND BEAM
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC RQUGH GRADING
ROUGH PLUNIBING y FINISH uRADING
SHOWER�fUB TEST POOL ELECTRIC � '
EXT. LATH/SIDWG POOL FENCING
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