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HomeMy WebLinkAbout17382 --�,',�•---- CI"I"Y OF IAIAMONI?BE1R I I i DEPr'1RTME1°TT OF C!)MMUNII'Y&DEVELOPMENT SERVICES 21�25 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ��"%v��� BUILitI1oTG PER11�dIT APPLICATION FIRMLY � JOBSITE APPLICATIO PERMIT P/C o ADDRESS 23630 Monument Canyon DATE j 'e d NUMBER�# � ISSUE TYPE OCC r APN LOT TRACT DATE CONST. �ROUP p OWNER Cimarron Oaks I HOA o ADDRESS 675 W Footh;ll Rl v�l_ #1�4 ZONING 5ETBACKS z CITY ('],gremlln� ZIP g1�11 TEL.� �_��� FRONT RW ❑ � APPLICANT � TEL. REAR ❑ Z SIDE/SIDE STREE7 RW ❑ m CONTRACTQ,F3 _Ro 1 R�nf C'n_ SIDE � � ADDRESS_ yyb�� r1CG' S . � �in`Pomnna ziP A17h7 TEL.��OO� G.00— PROPOSED 11SE REIIlOV2 existing WOO(j shakes. � ARCH/ENG1 z DESIGNER 76g nsta COR1pOSltlOri 5 1IIg eS w NO.DWEL. NO. NO. a ADDAESS � CITY ZIP TEL. UNITS STORIES fiW0 BEDROOMS � cn DESCRIPTI�N SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDEP DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I pM EXEMPT FROM iHE CONTRACTORS LI� GHf2g0/C3tPOrI W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCDDE:ANYCITVOq (n � U COUNTVWHICHRE�UIRE&APERA�1TTOCONSTRUCT,ALiER,IMPftOVE,DEMOLISH,ORREPAIRANYS7RUP W Patb/Dedc W 7URE,PRIOR TD ITS ISSUANCE,AL50 FE�UIRES THE APPLICANT FOR SUCH PERMIT i0 FILE A SIGNED W STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TD 7HE PFOVISIONS OF THE CONfRACTORS LI- � CENSE LAW(CHAPiEF19(COMMENCING WIiH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- �' POOVSPB Q FESSIONSCA�E)OFTHATHEORSHEISEXEMPTTHEREFFOMAN�TNE9ASISFORTHEALLEGEOE%EMP� (�J V TION.ANVVIOLATIONOFSECilON7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPL�CANTTO � Re-Root 3OO � � ACIYILPENALTYOFNOTMOflETHANFIVEHUNOREDDOLLARS($500).): ZpI,A50WNEROFTHEPROPERTY,ORMVEMPLOYEESWITHN'AGESASTHEIRSOLECOMPENSATION, ❑ COmBlefCial -- WILL�O THE WORK,AND THE STRUCTURE IS NOi IMENDED OR OFFERED FOR SALE(SEC.7044,BUSI- �J � NE55 AND PROFES510N5 CODE:THE CONTRACiOFS LICENSE LAW DOES NOT APPLY TO AN OWNEF OF ? PROPERTY WHD BUILDS OR IMPROVES THEREON„AND WHO DOES SUCH WORK HIMSEIF OP HERSELF OR � THROUGHHISOFHEROWNEMPLOYEES,PflOVIDEOTHAiSUCHIMPROVEMENTSAflENOTINTEN�EDOR m W DFFERE�FORS/V.E.IF,HOWEVEF,THEBUIL�JINGfJRIMPROVEMENi1S501DWITHINONEYEAROFCOMPLE� � TION,THE OWNER-eUllDER WILL HAVE THE BURDEN OF PROVWG THAT H£OR SHE DID NbT BUIL�OR Z IMPqOVEFOfl7HEPURPOSEOFSALEJ. ' - . �� ❑I,AS OWNEROFTHE PflOPERTY,AM EXCLG5IVELY COMRACTiNG WITH LICENSE�CONTRACTORS /�/�n TO CONSTRUCT THE PROJECT(SEC.7040.BUSINE55 AND PROFESSION>CODE:THE COhTRACTOpS LI� V&II18fI0f7 Sl/l Jl 1 ADJ.AREA ' W CENSELAWDOESNOTAPPLYTOANOWNFAOFAPROPER7VWHOBUILOSOftIMPROVESTHEflEON,AN� � WHOCOMRACTSFORSUCHPROJECTSWITHACONTFACTOR(S;LICENSEOPURSUAN7TOTHECONTRAG QUANTITY DESCRIPTION FEE � TOR5410ENSELAW.�. � ❑I AM EXEMP7 UN�ER SEC. B.R P.C.FOR THIS REASON Q ' � U � � DATE OWNER U � J � LICENSED CONTRACTORS�ECCARATION W d Q I HERE6YAFFIftM UN�ER PENALTY OF PEAJURYTHAT IAM LICENSE�UYDER PROVISiONS OF CHAPTER � . I � 9(COMMENCING WITH SECiION 7000)OF DNISION 3 0F THE BUSINESSAND PROFESSIONS CODE,AND z �X MY UCENSE IS IN FULL FORCEAND EFFECT. m . � � LICENSECLASS C-39 FTTC uc.Na.��],3067 � ' � on� 5-31-03 CONTRACTOR Roval Roof Co. nJ, w � WORKERS'COMPENSATION DECLARATION � Q � I HERE6V AFFIflM UNOER PENALTY OF PERJURV ONE Of iHE FOLLOWING DECLARATIONS Z Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEN7TO SELF-INSURE FOfl WORKERS' _ ¢ COMPENSATION,ASPROVI�EDBYSECTION37ooOF7HELABORCODE,FORiHEPEFFORMANCE `U OFTHE WORK FOR WHICH THIS PERM!71S ISSUED. � � . � W XX�HAVEAN�WILLMAINTAINWORKERS'COMPENSA�IONINSl1RpNCE,ASREOUIflEDBVSECTION Q 37ooOFTHELABORCO�E,FOR'iHEPEFiFORMANCEOFTHEWORKFORWHICNTHISPERMITIS �J 'R� ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBEPAqE: CONSTRUCTION � , j� cnRRiea �A.M.S�. �� � PLAN REVIEW Z PoucvrvuraeER ___wC2 4�.R Ah �7 ELECTRIC ¢ (IHISSEC110NNEmNOTBECOMPLETEDOFT}IEPERMITISFOHQVEHIJNDRm�OLLARS(E700)ORLESS). PLUMBING ' � Z I CEfl71FYTNAT IN THE PERFORMANCE OF THE WOPoC FOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL ��'� ' (!3 SIiALLNOTEMPLOYANVPERSON',NANVMANNERSOASTOBECOMESUBJEC7TOTHE h� � �"'�-�������� � - � WORKERS'COMPENSATION LAW$OF CALIFOFNIA,ANDAGREETHAT IF I SHOUL�BECOME INSPECTION FEE '�. '� ' � SUBJECTTOTHEVlORKERS'CO�APENSATIONPFOVISIONSOFSECTION31aoOFTHELA30R �q , CODE,I SHALL FORTHWITH COMpLY WITH:THOSE PROVISIONS. ISSUANCE r �&1 EA � ,r� � S'T'b � Q " . ��' £..��' a i p DATE APPLICANT: SMIP � W ' J WAflNING FARURE TO SECURE WORKEAS'COMPENSATION COV[RAGE IS UNLAWFUI,AND SHALL BE ENERC]Y P�C __,_., SU9JECT AN EMPLOYER TO CRIMINAL P�NHLTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND � � DOLLARS(51oo,oa0),INADOITIONTOTHG�COSTDFCOMPFNSATION,DAMAGESASPROVIDEDFORIN ENERGYPERMIT P.:".' �"'---r..-- ' � 3ECTION37080FTHELABORCODE,INT�RESiANOATTORNEY'SFEE& RETENTIONFEE: �� � ow_'. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � Q � IHEflEBVAFFIRMUNDERPENALTYOFPERJURYTHAiTHEREISACONSTRUCTIONILNDINGAGENCY � =OR THE 7EftFORMpNCE OF7HE WORK'FOR WHICH THIS PERMIT IS ISSUED(SEC.309].CIV.C.). - . Z W � LENDER'S NAME 1_- LENDER'SAO�RESS � �' ICEPTIFYTHATIHAVEREADTHISAPPLi�`ATIONAND5TATETHATiHEABOVEINFORMATIONISCORRECT. TOT/'1LFEES ' �e 3y� � I AGREE TO COMPLY WITH AILqTV AND�COUNTY OFi01NANCESAND STATE L4W5 RELATING TO BUILOING - � CONSTRUCTION,ANOHEREBVAUTHORIZEREPRESENTATIVESOFTHISCOUNiV70ENiERUPONTHE �, � ABOVEMENTIONEDPROPEFTVFORINSPECTIONPURPOSES. 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