Loading...
HomeMy WebLinkAbout17143 (26) ��� R� � CI�o�°�It����Bf� f----�'��' —� I3EF'ART1d1ENT O�COMMITNfTY&DEVELOPMENT SERVICES 1 I � f , � _ 2 P 825 E.Copley iDrive �' (409)860-3195 Fax(909)861-31.17 � , PRESS "�''%v�y'��` B�JILI)Yi�TG PEItMIT APPLICATION �'� FIRMLY o� JOBSITE �y C.' APPLICATIO PERMIT P/C�e�py �2 ADDRESS��o�� �YI E�j��v DATE ��'�� �� { NUMBER�� # �'"L� � ✓ � ISSUE TYPE OCC APN--�— LOT' TRACT DATE CONST. GROUP p OWNER RU�FU,',� /'VI�A�LL.n CK o ADDRESS_Z��',��t ��G�9tJGLCrti ZONING SE7BACKS z CITY ZIP TE . FRONT RW � o APPLfCANT T��� SIDE/SIQE STREET RW � z ¢ CONTRACTOR I � ' ' _ SIDE � p� ADDRESS ,.. � CITY ' ` C. � ZIR '�-�'7�E PROPOSED USE f w ARCH/ENG/ � � z DESIGNER �9I���� �_�O�-�'� w NO.DWEL NO. NO. � AQDRESS �s`"` J u� UNITS STORIES �BEDROOMS � CITY �}'��6?�t� ZIP TEL. .i"- o� cr� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OYVNER-BUILDER DECLARATION SFR/ADD/REM � O p I HEREBY AFFIRM UNDEFI P NALTV OF PERJURY THAT I AM EXEMPT FROM iHE CONTRACTOPS LI� ' � GaragelGarpod W CENSELAWFORTHEFOLLOWING�REASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:HNYC!TYOq (n CJ � CAUNTYWHICHREDUIRESAPERAIITT�CONSTPUCT,ALTER,IMAROVE,�EMOLISH,ORREPAIRANYSTRUP � W TURE,PRIOR TO ITS ISSUANCE. LSO REQUIRES THE APPLICANi FOR SUCH PERMIT TO FILE A SIGNE� W Pdfio/DOCk . STATEMENT THAT HE OR SHE I5 ICENSE�PURSUANT TO THE PFOVISIONS OF THE CONTRACTORS L6 '� CENSE LAW(CHAPTER 9(COMME CING WITH SECTiON 7aDo)OF OIVISION 30F THE BUSINESS AND PRO- V' POOUSP2 OFESSIONS�CODE)OHTHATHEOR^pHEiSEXEMPTTHEREFROMANDTHEBA515FOPTHEALLCGE�EXEMP- � �TION.ANYVIOLATIONOf5EGTl0 7D31.SBYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO �V �ACIVILPENALTYOFNOTMORETHANFIVEHUNOREDDOLLAR5�E5o0).�: Z Re-Roof � � � ❑I,ASOWNEflOFTHEPPOP RTY,ORPAYEMPLOVEESWITH9N/1GESASTHEIq50LECOMPENSATION, 0 COfI1R10fCi2I - Z WIIL DO THE WORK,AND THE ST�UCTURE IS NOT INTENDED OR OFFERE�FOR SALE(SEC.i044,6US4 _{ � NE55 AND PROFESSIONS CODE: HE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF j PROPERN WH�8111L�5 OR IMpRi]VES THEREON,AND WHO�OES SUCH WORK HIMSELF OR HERSELF OR '� THROUGHHISORHEROWNEMPL�OYEES,PFOVIDEDTHATSUCHIMPROVEMENTSARENOTWTENOEDOR m ;� OFFEREDFORSALE.IF,HOWEVER�THEBUILDINGORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE� .,Z TION.THE OWNER-BUILDER WILL HAV�THE BURDEN OF PROVING THAT F1E OR SHE�ID NOT BUILD OR IMPROYE FOR THE PUflPbSE OF SALE). w ❑I,ASOWNEAOFTHEPROf�ERTY,AMEXCLU5IVELYCONTRACTINGWITHLICENS'cDCONTRACTORS ',� 'TO CANSTRUCT THE PRdJECT(S�C.7a44,BUSiNSSS AND PROFESSlONS CODE:THE CONTRAC?ORS L4 V8luetiOn O ADJ.AREA . ',W' CENSELAWOOcSNOTAPPLVTO NOWNEROFAPROPERTYWHOBUIL�SORIMPRDVESTHEREON,AN� :� WHOCONTRACiSFDRSUCHPRO ECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TOq5 LICENSE LAW). �� ❑I AM EXEMpT UNOER S�C.��I� B.&P.C.FOR THIS REASOh Q - ?j U LL - � DATE oWNER F- O II W ,¢ �LICEN ED CONTRACTORS pECLARATION W _ � �� IHEflEBVAFFIFMUNDERPENALT�'OFPERJURYTHATIAMLJCENSEDUNDERPROVISIONSOFCHAPTER � ',� 9(COMMENCINGWITHSECTION700)OF�NISION30FTHE6USINESSAN'JPHOFESSIDNSCODE,ANa Z �`X MY LICENSE IS IN FULL FORCE AN EFFECT. m ��,� LICENSE pGLyASS - ry LIC.NO. �O ��iJ173 j V DATE L�'^�d'�'��r CONTRACTOR -_ a LLJ .� WORK�RS'COMPENSATIOtJ DECLARATION ¢ � IHEREBYAFFIRMUNDERpENALT�/OGPERJURYONEOfTHEFOLLOWiNGOECLARATIONS: Z � ,,;�IHAVEAN�WILLMAINTAIMACERTIFICATEOFCONSENTTOSELF-INSUFEFORWOflKERS' _ . ¢ COMPENSAiION,ASPRO�IDEDBYSECTION37000FTliELABORCO�E,FORTHEPERFORMANCF W Q OFTHEWORKFORVJFiICHTHISPERMITISISSUED. � W IHAVEANOWILLMAINTAINWORKEfiS'COMPENSATIONINSURANCE,ASRE[]UIREDBYSEC710N 'Q 37o00fTHELABORCOD�,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPEflM171S (!'�r1, L�� ,J ISSUED.MV WORKERS'C�IMPENSAT ON INSURA�NaCE CARRIERAND POLICV NUMBERARE CONSTRUCTION �.„_ �C�,7"R `j onRaiEa � ��i'l PLAN REVIEW � ��.Z PDLICVNUMBER I g- ELECTRIC . '� (tHISSEG'�'10�'NEmNOT6�NMPLEf=�OFhiEPERM�ISFORONEHl1NDRED00LLARS(S1C0)ORLE55). PLUMBING '� ICERTIFYTHATINTHEP�flFORMANCEOFTHEWORKFORWHiCHTHISPEfiMITi51SSUE0,l MECHANICAL (3' SHALLNOTEMPLOYANY ERSONINANYMANNERSOASTOBEGOMESt1BJECTTOTFiE � WORKERS'COMPENSATI�NLAWSOFCALIFORNIA,hNDAGREETHATIFISHOULD6ECOME INSPECTIONFEE � SUBJECTTOTHEWORKE�15'COMPENSATIONPROVISIONS T THELABOF � CO�E.ISHALLFORTHWIT�HCOMPLYWITHTHOSEPPOVISI S. ISSUANCE �� '- � �p OATE: ���d PLICANL SMIP �b� '� WARNING FAILURE TO SECURE ORKERS'COMPENSATION CDVERAGE IS UNL4WFUL,AND SHALL BE ENERGY P/C 'LL SUBJECTANEMPLOYERTOCRIM�LNALPENALTIESAN�CIVILFINESUPi00NEHUNDREDTHOUSAND ENERGYPERMIT OOLLARS(510D,o00),IN ADDITION�I O THE COSTOF COMPENSATION,DAMAGES AS PROVIDEO FOR IN 'J SECTION3]oeOFTHELABORCObE,INTEREST,AN�ATTORNEV'SFEES. - �� LLL''' RETENTION FEE: � r.� O CO�STRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMUNDERPENAL OFPERJURVTH.4TTHEREISACONSTRUCTIONLENDINGAGENCV �n-' FORTHEPERFORMANCEOFiHE ORKFORWHICHTHISPERMITISISSUEO(SEC.3097,CIV.C.). � I W __'— �,� IENDER'S NAME � F+ LENOER'SAD�RE55 �� ICERTIFYTHATIHAVEREADTHI�APPLICATIONAN�STATETHATTHEABOV[WFORMATIONISCORRECT. ���Rss�//��, �`��D �� IAGREETOCOMPLYWITHALLCITYANOCOUNTYDR�INANCESANDSTAiEL4W5RELATINGTOBU1L01NG TOTAL FEES�g� � �' CONSTRUCTION,ANDHEREBYAI.�THORIZEREPREScNTATIVE50FTHI5COUNTVTOENTERUPONTME �' ABOVE�MENTIONEDPROPERTYFrJaiNSPecTioraPur�aosEs. COMMENTS � � ��Le.�-i"` m PERMITTEE NAME(PRINT� � � _ O2i�� EOFPERMITTEE , � DATE _� - � RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PWK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �', .-, .. ,..-.:, :. ,,, ,.,...,,. _ .,,. ..,.., :;^;:� �R:,t ,.t:mc K+r;;,�, .. ry:, �k ,- . , ., . .,. _. _, . , ... . ... . ... .., . . . .. "'.p �` i' .#.�i r ..'1 .... a .. . . � .. . ,. � a� , � ._ ., . ... � � � ..' �-,�a�a �, ".m �.yP v I e� 7, � R"' : '` � b o F x . ` k �,. � } � § " a � ;."„� � �� � ' �s.���'y r � ��� � '� � ' x C 's��. t i��' � . v ' � � � r 4 +a a�. ',. � a.i � �� a �" @ q��, �� ��*�4���i � �, � � �����'�.��, r�,�`. ,6� �.��..�a S. ,��,,." � s..��._.5 . � `. ,'"..�._��y. � `€+�� . k° �..� , � ��!�. � x `:.� . .�. _"e � �2..§ '_ ��� �';� ._.�'�#: �":..5',. � • � � a _� �� - � � .�,a_; � i ,. ; � � ... — _..,.._ ___..__._. , . ...__ __ __ � ._._. . _ ._.._._._ .. ._.____.._ _......... ._.__.._.. ._.,_.__... � __ _ � � � ,��� ��y�, r� ,'._`__"�._ �_____......_ �,a � � , _ _ . _____. ....._......._._._.._..._ _.:. __ __ _... ._ _ .._... _......__.. __._._. _........__.�_._._ .._..m. ---� _ �- � , f � ,,, � � a . __. ..._:. __...... . _ __� __.. �........._:.___..�._..._...__.__�=--. _.�_____....._.j _._ ._ ___.r._._.. ____. ._._,._ . � .3i-a.:,�4Stv� S€,f `.�% n �@!...i ` j a;':.i I ', � I 2 �� � ' 1 . ' ......_.._._ _,.__.........__.. ._..._......._.t,.._..._..._....................,... ..... .___._. ._ . .._ _ ____ .... . . ._.. . _... _....... . ........ ." . . . y .�...#"'4�..fr a...N E y" 1 '-:. .. i M13 ; �S .' � S ���.�.�..._........w .......`.'..•-.?.�........__..._,_... ..............�:.__, ._._..__.. .�..__....___ ..........................,.......,..........,�.._. . ..........,�.... �_...._...,�..M.._ __.�.-. ,i��. � u:.�:� .,._ 1 ; ' '. € :: ,. € . ._ .... . ._ . . . . ...�. .,i :S ,' 3.. ,. . '___..::._,_�,....... ..._�....__.._.... . ........... �...........,_...�.._. �.....� �'r�t��µ € t. . . ,. , .._. �...._ .. .. � ... . .. ...�.... �. ..,,� €�.. � t �.:'� +q /�.� i �....... J p . . � �, ... __.�.. .- . .._... __......_ ,._.._..._. .__..m.....___$ _C __ ���aS.f_...._.. �..._._.4��'��0._.____._...._ � .. " — — _. _ _.__ �. ___ .___ _ �(rY':;`�; � �:� rr� t��;� siM I� e.� L. � i..@�._�" .. .�. _.._.,_.._......_. . ....-.- __._...._�. ...._.....-,._........._.._.......__._�..._.................._._... € € �,py, � I � �-,(.$- a .��r^ �_ �' d3� �r /��s�dCN4 { - � q . ..... � ...._. _ .e..._ __._. ....�....�_`.._.__.._�_,___,,......._..__.._.. ........ � _.. _.....__...._..�..._......__ ..,..._._..._.._..._.... ' � �._ ._.._.. . ......_.._,....._.._._..__.._.�_...._..._..__.__..,..,.� x 4 a..���.a � � ,.€ � a � s�`..8,�F t �' '1 j° . .. . � . .. . . .... ... . . .. . .. .. ._ . - . ..._ . ._...._ .. .�._._.. . .....,..-.. _.......__...... � € „ 1 � 8.��'>,...� � � :��, i^�.._�.. ._.,,..._._�.,-..,. ...........,..., -.....,.,.._, _ ,.._..,._._......W_ _ ....._._ ._...� ._. .. __�_._.._......._. ........ . .___...,..,_.,__..� _. ........_.._..._..���. ......--,-..�._..,� f .� �$ '.:� .i P �, 3 ': :� ',a � "! u..,..,_."I.:..-v -'^F 1 ..,.: .............. ........_ .......... .............. . _...._._._ s...._.......,... ..__._._........_..�._�......... '....._._.._.. ._...__.,..........�«...,..............................�._µ��._............. ..._ ..._" �.�. ,.....�.w w....-....W._ . ..j`�S ,%( W �,.�A��� "�. : . �... E ... f t.. i «.t. : .� _.. _. ___.__.._ �_._ ..........._ �_..,.w.._.. .__...._..�. _..____ _ _._ _.._..�,_.__. --- _..______......... _�__w._..__. ._.._._.._._. _._...�.___ �m.. .� � .,. .... ,A . < s w c...^. �� � . ....,. ..... �...........,........__ .,... ' ...................... _..,,.._........_.._. ... r._,._..... ...............,.._.. ._._._.._........._...._. :...._..................._,._..........__. ...._.......,,...... _ {� . € .. �^' ...._....._....., � 5�-.. € �.�' y��'� � �., .. E . € ������� e .. �i,�y ._...... .. ��.:__ ._ ......._._......_ �...,__.......__,....._...�._�_ . ...._..._... � M............».._.....,.,.. ........ �..�.....................................�... ..........�...,.., � � §'„",. � i` q9 ( 6 l .d.B F..`a k �a� i..'`� ` I I . • " ' .t � .. ... . ... � _ ._ . .._ . .. , __ .... . ... _ . .. . , _. 1 . ...... ... . .._... . .._._._.�_,.__�,_�... � L. 0' '�A! Na, `�� .A.:i. #�� i .x.. .._ ._ �_..,_.._ _....___.._.......-._ �...,. ...._ _.._....____...__. .... ..... .0 ......... ............._........_........__ I_ .,..._a__.. _....... ......._"'._...__._.�....�.....v.._..,___,_.�.__ , � � k ���,�£��, " ; , .� � -: _,m. _ �_____ _ ._. ._____._�___ .. _.______,..._.._. ._ ,_..... __.._,_. .�__._____._ � _. _._._____._._.____�__-.--- ..E.. .._ ........... i .�,.p.. . .. .. e� -'.�b;. � . "� J .., ry ( � ' � .............. �m,_...,......_. .,,... . _.�.. ..,......_...__._._....... ..._......e.....�.__.. . ___.........__....,.............__'__.._._..._.__._._....__..� _ .„ ,,.,.. ... ...___. ._ �_. ' , g.'- . . . .. . .. : . �'�,. € .;"i R� +:, , � , � � i _ __.._.._ _ . . w_ � . _ __ �....__ .._ ._... __._� ___"'._ ""_ ..».___.."... -� . _ � ..._.._..�.�.._,.._ _. .. _ . .. E W f` gS;; �,.y q�.:'� � , ': �,.. � .._ _ _........._....._. __._._..__...................... _� ..__._.,,.._.�.._._...e._,...,.,_._.w.�..._..,... _ ... ... �._._. .�,.__.._ � ........_._........._......_. __.........._.._._..��----'__....... __ ,.._ .�...... _ ._ t, _ ,,.�. . '. a . > .�_ ....� _ �� _. �,>",�d'� i ..' " � � � `�. . ._... ._ m....._....._ _......,....'�...,.,_ .�...........�._. ._......,..�.._._...____.._.._._.._.e..�......_._ -- -- - ._._.__ __..__._.._.__._..._.. _ �............._.._..._,_.._-----__._._:i � i f ., � � i � a��:`.� § ; '� .:.�r. .e i .-.zi,.�.:.w � �� . c , 3��S! �: .�,� . . . .,. . _ __._, ._..t_..._. .........._.....__. .�...............__.............._..........._......_._._......_._ _ ..—s- _.�_"___.......,...... .._..__... _: .._...............__._�... - ..._._.....,...�_.._._.._. q € � t�...� . ,� ...:. I�:�...� a,.,... E �.... .6 .... �"� � � } _�; ..... �.,,,__.............�,......_ �—_ `_.__..__ _ _,_. .....,,.__...._ .. . {yJ�4�.,. <.�t., . ,. .m...,,.......{� . �. , L'. "�. ' � �,._............,,,....:_...,.,..._.. :_.,._._.............................................._ ___...._._ _........._...._......_..__._..._._,,._..._�._.............._.._....._....,.... ........_W... . ......,..._..______' . .....r ..,..,,�._......._.._...._.............._..._._.� __ _ �.,..�_"____.�_-r�__..._�._""' '1 ..., . _...�...,. ...... .,...... . . . .. ... ._ . ....._�. �..._�. � _._..._.�.�._ .__.. _ . . . -_-� s� �a.�, x ��� . ,�.� u��!�;�� �e�.�a��s� �a���. � �_..-...�,.._...._....__......,.......,._...._..._.. ...�_.,.............:..,._.._._... . ..._ ......_.._:....,._._..,,.._............... ,._.... ... _.. ._s.: .�._:�"a._ ,.:.a >....._.._.._._ ............._...�....._._._..._..._.__..___._. : y - � __.^.__�_..�.__ . _ . � .j � . . �_.. __�..� . Y a a"._'� �.s� €�; .w , :.a�--:�,.F°� ,,,_..�:! .:i,_..._....._.......m....._....,...,. ,_.._................__..:.,.. ._............_._...........,.....M.,,._.�,.... .�...._.__._ _._....._.... ..,,_....,.�.. ..,......,........,...._,_.........._,_...,...,.,............,,,..-.........,........_..._._.W.__...._,...�._.__.�...�.�w._....._._,..�',� € i 4 .....�_._.,......._....................,,.,..,,............. _.....__...,,.._.....,.,...._.......__......._._.........._.......�......._..,..._ ....__._._._.__._....__..,....Y._.......__._.,,__...�.,�.._..�..r..,.�'_ _"__"._..._.. ..._._......W ,. _:_............_................«..,....,...w...„..............._........._.......,..........,,,... �_.....�....._.�..._....................,. g �_._....._......,..,,,.......__..._.....�...._....,,........._....... . ,.._..W......_ ._.�........_._..._,......_.............. ...._......,_...__....................__..... ..,.............__ ............_�_..,_....._�__ � ..._................. . .. ._ ...... ... N . ..._ ._._,__ ... � �_...._......,._,..__.__,._...............�..................__.�....e-..._._._,_...�.._.._..__.._._..........,._�_..._._,_.._....,..........�........,......_.....,,__... ....._. . .............___..._____'_'__._...___"'_'_—'_—__�_...._._......,�_...... � ,_"_._..__.._..� � 0 B i,«..,.......«.._........v..�._w...�..,...,�..............�....._.._..__.._._.__.....,..,_...._ ... ......._............._......,..................._.....�'_'_�„_m._..�...._........_..._.......,._.... . ...___.......�_......_.........,.._.,.....,..._.....,._...._..............._..._._.................._..._._....___�__... ....._.�...._.._..................-: } � �.__._....................... ...__..__......_.............,..-_...._.__�,._r.__�_............................_...,........................_.._..,.,......,......................_....__..___...u..—....<....._......._..............................__._._. ..................... .._.................,,....._.................................,...._.......__.._�._.____ .._...................._....._.....,..! � d �'�......,.,..,�_�....._.._.v».__....................................._........_.._._...�......._..,...... ,.s...._..._.�._..n..<..�,...,.,_..........................«,.............,....,...._........a.. ........._._........._.......,.................,........_....m._..........._._... .. ........._...,....,._. ..........._._..««....,..................,................. ............_...._.:.�.._._.._......_� £ � ......,._.._.,.... ..�..._............_......._..�...__..,...._..__......v..._........",..«......................................... .. ..:.:.,....i................�........__. ._.._ _,.__.`_'._ ..._..._....._.. .... .........__'__...._________. ... ,........_...�_..,...._� �.......«......,........__...,.�..�..._._.._.....__..._.�................ ... �{ . ......................__.__�_..._._ ._ ._.._..__._ ...._._..._._.�...r��......,.._..........,................. ...e.__,..._.�,...,.._......._,...,..,...,.__....r..,�._..�.��_............................_...........,,....... .,.....,._...........__......___.__._�_..._................�........._..-.-� �..:.w.«. . �n. 4>"'�"au�",k�. c.a....,t�. ..__.._..v_.�.__. . € . �.,..,,..._.................................._._..... _....,..................... ....,_..._'_"___�....._....._........._._.�......,...._.._._..,._._.�_..�._�.._,.,.�._�._.._...._{ �,d k"'4 € d � � _..Y._.�._._..__._.�..w.._�.,m» —....._.___ t �L m, x � _.v.�....._ �,'�������� �� ��������r�a� �* _—____..___._�._ __ _... _. _.�__ __ . _ _ —� ,� ���_ � � �`"����'�����s����������� ��"� ___ € �"c���a ������� � � ��a� ___ _..m. .__._.�,�..____.___,_,. ._ _ . __.. _..__.__ _._. ._.. .__ .._..._._...____._.__��_...____..__.___-- _� �,��������� ����.:q�a"�����W°�.��,���,� �".��. . , �* r5� � � �,�,��� ; _ _ _, _�_.__� _ _. ____.._.___ __ �„.� �,&�,�x�'�� ^ ���'� -�'a G '�7. _..... ..._. : ' ; � � � � � � w�'&'�x��'u°�� � � �� t R�� ;x �� � .'�:' _._. _ __._..._ .Y�. . , ......._. .,� M . ��,� ��°�����.��a��,��a ���, � � _.�, ..�.. _.. ... ,.�. ...�,.. _... ., ..._.�.. ,......_ .. .�. .. .._....�.__ ��a�d"������� t a . ,� � q y +�� q�:- � � '� 'B a. �- '� '�m� .. .... . . ._............ ......_.._.... .....�.._ ..,_. ._... . , _. —..._ .._.. ....._ ... _..._._._...N�.... �t. � B � '�.- _..�... � �', � ���a����'� "�����"���-� a����:� �'�'� '� � ������1"� �wk. . . � � � �'"e a �.�� � _..__._.�.._.._� . . . .. ... .. . . � aa�� a����� �� d . . . .. . ......... . ...... . _. .._. .. . ...... . . _. .��._�''�a.�.,�..:�..��;�_�. �a.�.,.<c_�.�..�, . . a ��. ������A�� ���g�����I���� . �� ` � .� . .._.., ..._.. ._. . . .. .. _ .... . ..�n.�...m._..�.m..M,.,.,....a.,.,a._....n