Loading...
HomeMy WebLinkAbout16980 (39) CITY OF I7IAM�NL�BAR ,/ ---�"-- I3EPARTMENT�F C�MMUNdTY&DEVELOPMENT SERVICES I � 21825 E.Copley DrYve �i-' '�- (409)$60-3195 F�(909}86i-3117 r PRESS :'::.�r��` s�a.nnv�r��Tar�LicaTioN FIRMLY � JOBSITE ,/ t �Q APPLICATIOIy PERMIT � �/C o ADDRESS_ � �`b � ` 1 �w ���1, � � � DATE ✓� �� NUMBER� � � ISSUE� nPE OCC .- APN LOT TRACT DATE CONST. GROUP °C OWNER O Q ADDRESS ZONING SETBACKS z CITY ZIP TEL. FRONT RW ❑ � APPLICANT TEL. REAR ❑ Z SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR � P� � SIDE � ADDRE .p � CITY �'�'' ' IP ( TEL. L � f PROPOSED USE A� �O : rI..GNiI OVC 1�+�1 I��WB�� o ,ARCH/EN / I � z DESIGNER w NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOFi PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFIRM UNDER PENAITY OF PERJURY THAT I AM EXEMPT FROM THE CONTfiACTORS LI� G8�892JC8fPOf� W CENSELAWFORTHEFOLIOWINGIREA50N(SEC.7031.5BUSINESSAN�PROFESSIONSCO�E:qNYCITYOR (n U CDUNTYWHICHFEQUIRESAPEF�ITTOCONSTRUC7,ALTER,IMPROVE,�EMaUSH,ORREPAIRANYSTRUP W. TURE,PPoOR TO ITS ISSUANCE, LSO REQUIfiES THE APPLICAN7 F9R SUC}i PERMIT TO FILE A SIGNEO W P2Pio/DeCk � STATEMENT THAT HE OR SHE IS ICENSE�PURSUANT TO THE PROVISIONS OF THE CONTPACTORS LI� � � CENSELAW(CHAPTEF9(COMMENCINGWITHSECTION7aoo)OFDIVISION30FTHEBUSWESSAN�PRO- POOVSp2 � FESSIONSCODE)OHTHATHEOR6HEISEXEMPiTHEREFROMAND7HEBA515FORTHEALLEGEDEXEMP- (� V .TION.ANVVIOLATIONOFSECTIOry7o31.5BYANYAPPUCANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z pe-Roof � AqVIL PENALTY OF NOi MORE THI_AN FIVE HUNDRED DOLLARS($5ao).�: � ❑I,ASOWNEROFiHEPROPtFTv,ORMYEMPLOYEESWIiHN'AGESASTHEIRSOLECOMP'cNSAiION, � Commeroia� - Z WILL DO THE WORK,AN�THE ST�UCTURE IS NOT INiENDED OR OFFERED FOR SALE iSEC.7044.6USI- J � � NE55 AND PflOFESSIONS CODE: HE CONTRACTORS LICENSE LA'N�OES NDT APPLV TO AN OWNEp OF � PROPERT'WHOBLIILDSOPIMPR VESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � THROUGHHISORHEROWNEMPL'OYEES,PROVIDEDTHA75UCHIMPROVEMENTSARENOTINTENDEDOR m Q�'�OFFEREDFORSALE.IF,HOWEVER,THEBUILDIfVGORIMPROVEMENTIS50LDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILLIHAVE iHE BVP,DEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROYE FOF7HE PURPOSE OF$ALE). . w ❑I,ASOWNEROFTHEPROqERTY,AMEXCLUSiVELVWNTRAC7INGWITHLICEN5E0CINJ?RACTOFS � TO CONSTRUCT THE PRQIECT(SEC.7044,BUSINcSSAN�PROFESSIONS CO�E:THE WNTRACTORS Lb VelUdtiOn ADJ.AREA LCI CENSELAWOOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUIL�SOFIMPROVESTHEpEON,AN� � WHOCONTRACTSFORSUCHPROUECTSWITHACOMRACTOR(S)LICENSEOPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y 70R5 LICENSE LAW J. '. � ❑i AM EXEMPT UNDER SEC.'. B.&P.C.FOq THIS REASON Q ?�„ U � � DATE OWNER F— o W � LICENSED CONTRACTORS DECLARATION W ¢ J" � I HEREBYAFFIRM UNDER PENALI r OF PEAJURYTHATIAM LICENSED UNOEft PROVISIONS OFCHAPTER � � 9(COMMENCMGWITHSECTION7b00)OFDIVISION30FTNEBUSINESSANDPAOFESSIDNSCODE,AND Z `X MYUCENSE IS N FULL FORCEAN�D EFFECT. m � � � LICENSE CLASS�LIC.NO. � V �ATE����_ CONTRAGTOR� I a W � WORKERS'COMPENSATION DECLARATION ¢ � I HEREBVAFFIRM UN�ER PENALTY OF FERJURY ONE OFTHE FOLLOWING DECLARATIONS: z � iHAVEANDWI�LMAINTAI�,NACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' $ � ¢ CAMPENSATION.ASPRO�IDE�'BYSECTION37000FTHELAHORCOOE,FORTHEPERFORMANCE U Q OF THE WORK FOFl WHICN THIS PERMIT IS ISSUED. � QW _I HAVE AND WILL MAINTAIN WOHKEPS'COMPENSATION INSURANCE,AS REOl11RED BY SECTlON 370o OF iHE LABOR CODE.FORTHE PE(iFORMANCE OPTHE WORK FOR WHICH THIS PERMIT IS � � ISSUEO.MY WORKERS'COMPENSATION INSURANCE CAqR1ERAND POLICV NUMBERARE: CONSTRUCTION � ��� J j cqRRiw � PLAN flEVIEW ZPOUCYNUMBER ELECTRIC Q � (1HISSECTIONNEmNOTB�OJMPLETEDOFiFEPEAMRISWROhEHUf�PE�DJLtARS(E10o)ORLESS). PWMBING Z ICLRiIFYTHATINTHEP�'FFORMANCEOFTHEWORKFORYlHICHTHISPERMITISISSUED,I MECHANICAL � .--: ��'�`�q, C.S SHALL NOT EMPLOY ANY PEftSON IN ANV MANNER SOAS TO BECOME SUBJECT TO THE � E� . `,{.��.:,`,� � '._.�����% �g++ m` (/) WORKEFS'COMPENSATION LAWSOF CALIFORNIA AN�AGREETHAT IF I SHOULO BECOME INSPECTION FEE �� - ` " ,� �.�._�.. � SUBJECTTOTHEWORKE�iS'COMPENSATIONPR ISIONSOFS 370 THELABOR B � .I SHALL FORT WIT}i CORIPLV WITHT OS OVISIONS � ISSUANCE 'tl,i N����•� F, l� � �(.r p DATE: �!O AbPLICANT: � SMIP � � '� � � � ENERGY P/C � �J � J SECTION3]0 OFTHE�,p,gpR��ORKERS'COMPENSA710NCOVERAGEISUNLAWFUL,ANDSHALLBE � WARNING FAILURETO SECURE SUBJECTAN EMP!OYER TO CRIM NAL PENPLTIES AN�CML FINES UP TO ONE HIINDREO THOLISAND �—�� ��„ ( ) �fOTHECOSTOFCOMPENSATpN,DAMAGESASPROVIDEDFORIN ENERGYPERMIT ���s�y�` I �..���,......._._..m . �----M�. � m DE,INTEREST,qNDATTORNEV'S FEES. ��--�-.--����-^"-'•• � � � RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �, IHEREBVAFFIRMUNDEpPENALTMOFPERJURYTHATTHEREISACONSTRUCTIONLENDWGAGENCY FOR TNE PERF-0RMANCE OF 7HE MlORI<FOR WHICH iHIS PERMIT IE ISSUED(SEC.3o9],CIV.C.�. � Z W — j LENDER'S NAME 9 !— LENDER'SAODRE55 � ICERTIFYTHATIHAVEREADTHISAPPLICATIONANOSTATETHAT7HEABOVEINFORMAiIONISCOqRECT. TOTAL FEES - /��a �� W i AGR[E TO COMPLY WliH ALL qTY AN�COJNTV ORDINANCES AND S?ATE LAWS REL4TING TO BUILOING � +��� a �' CONSTRUCiION,ANDHEREBYAUTHORIZEREPRESENTATIVE50FTHI5COUNTYTOEN�ERUPONiHE z ABOVE-MENTIONEO PROPERTY FOfl INSPECTION PUFPOSES. COMMENTS cr T � �� � ��� — � Y - �' m PERMITTEE N E( I T) �� ��� � � i�v"��,,. ' �� . � SIGNAlUREOFPERMITTEE '�, DATE �/ ,ry . � RECPT.NO. �ii7�� PAID BY �►� /��J f VALIDATION WHITE—Deparlment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Flle Copy,GREEN—ApplicanPs Copy�� . . ..; •• :�,_. . _.... ' "�,.�.:' : '.:', ' ^ :::�;,:: .:':�:'... . 'fi!-;K:nx ' . . �A:�ir .,l?U�..;w.-.. �-.. . -.. . ...� ... . .. . . . . . , .. . . .. ' :..� r � : F ti .. i...il.. ....�� x . 4� ,'•'.I v� �� � .,5�:. �„� .. �. � .. � . � .. 3�w M �:;o- ,, �' s ��. .s s a���. � � � a tt'� � �.�,-� � � � ' � 4' t x�� � a� r �, r � .. � �,�x a i.."�" '"P � .� � n s �, � � �€� �'�a � �Md �r � � � '� s �':• .' € .'� 4� �.. a 'S ,., ' .� � � � �. �: z § * � z- � �'�, � �' :,� ��° �" �� � r a,,�'4 � ,%Y � 4� a ; , a e 4 :,d �,.. n,:�.�±� .;,:�^�. �'a, €�'�,.,�;:*'" ^� ra:"� . ., ,.,. k ..; '�.�r"� ., a.... .».au ��'�x µ �xi��r�.. . s.^h. �° ..� L ¥ � ��.k.. ,.�..�a. �. t � x. � _:, � � n,.. . . .� � � ' _ a � __ ....... ' . _.._. ._ ._ ._ . _ . ...... _ � a'"�.:''� y� S"ts:. .'._ .. .. .... _. ��r '� � __.......... ......._........._,..—"_"... ._._...�.� R . . __ ;__.__....._.,...�._ . .,... ..._ __._._ _._....._.. __ . _ .. . .._..,. _.._� . r�� t �.:` i . i � �.:E r �"�� ' ���...' , :._: € ; . �., �...:. �. ,_,_.._.�._.._.._.�..._...�._.._ __..._.....t...,._.._._.... __.._.._._..,._..........._ _ ..._..........____._._ ,. . __..._.__...__�__. _ ._._.._._.,.__.._.`.. .. ......... .... _.__�.__ ._......_.._.,._...__....,.........,_...._........ ._ _i.._ _.� �,- �,, � ��Rr�-: � s,�,C .r , .,,. � � � �i -'' ^ ,.x., i � . ._ � ,_, . > �. .. _.....�. ._.._..?.._.. .. _.. .:.. .___._.'._..._ .__ __, .___�__....___ _... ...... ......--__._ �; , ...�...._.._ .._ . ...__ -r. �. _.._.,_._......._._..__.._, __.� .. ; ,, _ �'..'', r , I � i .��a ,��', _ . � _ ' .',, . ! W.. , 3 . .. ... ._. .._ _.. .. ._.. _.... .. . .. ._ �. _ ..._ .. . .,_......_._�..� ... .__.__—� a � �tn.'"� �r r.:�i F�;: _�...._._ .��`..�._ _�.' ..�. ��_.�.�.�..4�'_�. . r �....::.__�.....:..._... � r r � .. _. _., ... ... ,. ..._ ..,...._ ..._..._ : 3, _• €� y . � { yi`t, . ^€ } i'} e, �, � � p _ � �' a�?t1 "',-� H��� ' € €�/ � % � 1 8 � � 1't � Q),�1 l , ___. _ __� _ __- -� , _ - w.. _ __._._ . ._.. .,_.___.___ :. _ __._____ ---..... --_____ . , r�W , `',;��,�d� ��: � ��r n �� ; ' ' i F �; �� r ��':� ..._. _ .. ..�. . . ......_ � ___ _ . _ .. .. . ..._... .. � .._.. . ....._ , . .. . . ..._ . .._ ,"t r.,s �;.,.:,;�.., '�f l�+b� :.:s �,.� � � . �� �,,s _ _.._ ____�S-�__..._, _ ' [ _.._ € __ _ , _a i�C.."I_._.�. .t��.....� � �:�...,ry � € '..: , � �. ...._ . . .. .. , . ... ... ___ .... �� . ... ..-.... . _ . .._._. .... . .. ..... .......;. c :^.� r` � i..a, 1 i% � ' [ ' �'€ ' € "� � '� ��. � � i @ � _,._ '_`.. ._ ..__..._......___..._m.._..__............._.. ._........___. ..._.._,_ 1. ... �.._ ___._._. ..._. ., .__._.....,_._._.__ ......_..._._�._. .._........_........M......_,._._..._.._ ��� �' �w:::: � � I ���r � ...� ��s.�: i_ __� i � � _ , ' ��',.t ..,,. , ..+..hL.&.�f . , .. , e.. ' � ,"�` .rt �,.. �.-.._ . .. . ,....._ ...._ .._ �. . . .. ...... ._ ,. ......m...........,�._............._.........�.. ' I 'Yt .s 'H � x.�Q r d : i ' 1 _ . . . y.,..._._..,....._._...._..... .....�.............� :.a. _........ ._,. ..._.. . _._........,...._........ ....... ..,,............. ,.._.,.......,................,..._.....«..,..........�........... — — - < _' '�ra .� � . ._ .,,....�.....,... .�. !r. ';t.". � ��' 4.: - . �.' � " . i i __.�w.._.__.__._ _,._.___,____._..____..__.._ ._ _._,._. ___._---____.r�.__._. _._�.._ ___..__ _ .__._._...__.__.__.._ �F�w �.�?, .� � i d. r, � a �.. °� g d�:7 � $ ,,s�.7 e _...�- v,. ,_....__._. .�.._..�...............__...__. _.._.__.._.. •. .� � ...._.,......__..........._..,,...__. _._...._ .._.._..._ . . _. .. ... ... . , _..... ..� ' ..__ . � k_T.,._._. ..............�_........,................_ . � �.,.�ri,,°g I�..;a j.�,'•� ,�d.,..� j € j .:.._:.� :`.�.+.6, .�+ : € r g .�.. ,,.._,._,.. . ...____� �a._. _...,.,__._....... ._F_._.._........._..,........................,,,,......_...._,._.._ �t ..... ..,........,..,..,......-...................,....... ........._. ...,,,._.-._..... �-.._......_.__.......�..._..,...._...,,...._........._._...__.�_� ��a�:s . � �. � �.� � � ; ` ; .��� � .��;,, � E � . _ . _ . __�________._. ___,�__.._.. ; @`�-� ;W� . __ ; ° � ' i � _ __ _.._ ____;____ ._,..__ --..... .� �.._.., __.?.__- � _ --_._ _..._._______„�..__�._..��_._w_�.._ ___..__,._. � ; �. E , � ,_ ��'�.,,,,_. ` �... .�.? �. ��. � 3 d,._... � �i r ' � tl _ _ . ... _ ..,__r __ � ____.__� �,. t �L..i �' 1 �,' �i�.i _ ..� ..,,,___ .. ..... d. ... ._ � .. � .__�"'�. .. .. r � . ... .... . .. ... € ,........�....�._....,__.............�...�,._.r...__ � �'I I;��„` � ;{� �` f�,.l� --�_" -'�^,• €__ 4. .... � ..._._._..,-,..,»...__._...._._._�._._..,.-,....�._..._._...__..._..._............_..,............. ._ __......__ ._.. _.._ _._.........._'. _ _._ ._........................_....,. __ . t i E ;".,s�,�t C..x4 i.';°'n.+:"� 4 . i .�.: :. � . 4. � „�i s , ,- � � �m . . ..� � ���r.....�._..m.. _mm,.�� �.ww...�......�.._..�.......m.�._.�.�,�.w�..� ':"' _� .. . ,_._.. ._.._ . . . .._.. ...��._..___ .. .. ..... �� ..... � f . . 3 .,` , _.._....,,. , € i"_§f:{,..� e.Ca....'''..f ya�.v ���, � #.,:� ._,.,�u. ` �, �. ,... .� _.�._. ....,_..�..._..�........__,..... . .. . .__ _. .. .. . ..,_ . .._ ...... .. _�._� ... ... _ _..,,...._._.__ , ..r�. , � ��`���i�n�. _.?�':�5��.�P..;s €, �..:.��C' ' ',. � . ��...................�..�..�._._...._......_.�..._.. ,_...-._ ..._..._._ .._..,.._._............_..,.....,........_.._ _.___....._. .i. _ ._,.__'�__..�__..._ _....,.......,._._�""_ ''.,;-_.._.�.._..___.:.... ....._._.,._.................�......,...__........._.�__..._ _. _. €, € � i � i � : ;_ -, : _ �' .. , � � � � -._..._y._ x___..�.___..__...._..._._... ..........e....._. .. __.�.,,..... ,.........._._ ... .. ......_ .. . r'� �'a � � �„��_ : r a a � . __�...._._. ._____ _ ��'; . E .. i ��� .�..�.�..�_�'.t�,��.�g��.w ::�_�,_�;.:?.�.� � I . ''�. �a`,.._._.a...__._.............._._,_.,..._................,.»..._......__..�..,,._..._.... .._...........,___.._...._ _........__._.. ,. _....._,........._. _._.__..I..,_._.__....._........._.,_,__,.._.. .._._ . �„�''�$s� �� '" � ':: ..__.�_..e.....__._..�.........,._...... .. x.�,a . > ,,;� �, ..._,,._,._. __.....___.._._..r _.,._.._.__.__.._�_ ._.._.__...__, . __.._ _._... .._.._,...,_ ..__ _._.. . .....__. __........, __...._..._ _ __...__ __. .._..__.,_._ r.. ._�,,.._ i t i i..:.....,..:_,..._..�,...._....._.......,,...._........_..._._.�.._.__..._...._._._._..�.__...._....._.__._..._,:____................w.......__....._.........�.__.............._...,...._... ..... ......_.._......_._.._.,...... . ._.._........._... , ......_.....�._._.---.__..__._..._..__.._._._.__-----s � s 8 ....._..._..._......._....,....._ ....,..._....._.........,..._.,..,....__ ..-_...._..__. _._._.._._. __.—__'""_.._._'____...�_._...__....................... . ..........._........_.__...__'__ .... ................,...,.....,.._.� . _.�_.....«..,.,..,._......,..._...a..� �........�,...._,.,e.._'_r..._....................._.._.._.�.�.,......,.-._,..- � B 9 � ....«............................,....._......,_....�,.T ._..__...._....__....__.`_.__.__.__........,,..,.,...__....,...__........._�_ ..<..........:...._. ..........., ......_.___...._..... _.,......_..,,........_�......_..�___._.�....._...._.........,...«...».........................._....._._...�.. __..�._........_......_.....� ...._,..a..._,,.�.......e. � : 3 �...._..._..._T .._..._._.� _____..___.�,_,._............_._...,»_..._..._.........._.........�.._.,..._..._......,..�.�..,___.....................................__.............,,,............_........._..,............ . ........ . ..............._...................,......_.........._.._....._.�_._.�_...._.._.....�........�....,...._.,..,._._...... .._.._._..��._.........__,sj v � �.,.�._..___._. __.m._...e_._. ,_._._._�_._�__._._.__...._...._...____�_._._.______.�_._�___..___ _...m -- -_-. . __. ._._..--.--- _�.._�_.�_�� q �. _ . _ _ ___��_..---. —_..-.-._ _______.. .--,--..,_....__.__...___�_____.__.____..._.____, _,.____.____._.__ __.__...., .�_ .._.��_ ___ .---_.. ___ '� i e* ' � � :'� �.4 . ... . .. � 3 g �. �_. ._____._...._:...._..........._,_._.._...._.___�..__..._.._.._:.........._��._.._..____.__�.._._........_.. ...___._....._��....W......._,..._.._.. ,_........._ ���,� ;..r � _.._.._._._..._._._..�.._ . '"� � .. . ... .... ..__�,.__..._..__,__._.._ ���� � � .._�.�....._.......,,�._......__.,...,_.„_....._._..._...,.._._._....�.,......._... _.._....^ __ . ����� ���� ����� re��&'a�� ������� ......._�_._____. . ._'_�_..................._......,....__..............,.....-...,..,.__. _...._ _"__-, � �'��������,9�a 4���t ��# �� ��a��q ��� e� ��� �a�����„��������� � � ���� �: �� �������,` ������ ��ra��r ? � #���,?��'��:��..�.�'I���a��.����a������ .__. _.._._._....,,,. ..,_......__.._..._.,_.._...__.....�. ........._...................,.._...__..._.._..._.. .,__...,._.........._......._......._.. ...__.........._..�.__.__....___._.................,.._....._...,..,�.._...._..._..,....._...,. § �az :a,� ��.R� t s�� �f� �e � "n -.�:�.r ��°� -g ��'���k . . . ......,._.,..._...._....._........_._.__.._..___....�.._...._........_. $ � ��,°;��6'�.�" „`"NyS�������d a'���4�q�_i ...........__.�,._.....�.. . ........ . .. . . _. ... . ... .. . ........,...._._......�._.._._.� � � v�� � � � � � {��a��"�%�'� ���a� �� '�. �p��:a a'�. ........._....__..._.___ .__..... ___.__...__ ..._......._ . _...._.........._�__�_.�.., � �'��a d x a� �,'��4'."� ��� .' ..,.... . . _.__ . ...._ _.�.._. . . . . , � y�'# e�' a r ������w k����:�a�a�,�'@^:. ...._ ,-� � '���� �a� r�a'�a��a� g�„�e�',����a��� ; _.._....__.._......,,__...._.._.__ ...._.........._..._...._.�__ ..�.__._...._.__�_._...,,....___.._._...._..� � ��� �� ����� � �� ��� ��� �s .._ _ ..._ __ __. _. � �����������"��&����.`t�������*������u: � __ _ _ _.. __ _ __ _V �. �,�..-.s�,�m�:��,.:.�........ ......._..._,, ,�..,_�.�.,aFm..,.._,_..,_..._.....w._._...m.m...._._...x..__.�._.a�.m, � ....,�,a_.�._u.�....�..x....���Am,..,.v.�_.....x..�. .�_�,m�.,.,_v�.....�„�,�m<.�