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HomeMy WebLinkAbout16707 (44) �1°I'I'OF D��Iv1��dB3�t� , — -�'�``�--� d�EPAR"TPv�EN�'�F CO &DEVEL�FIvI�NT SERVICES ,r,A'� I h �.,, �,ti - 21825E.Cap9eyl3a'rre ��09)860-3I9�E�(409)�61_3�1°y �.L��� PRESS �°<cw�"' �[r����G�� T���,€C�TION r FI R M LY � JOBSITE r.- , j APPLICATiON ��p� PERMIT P/C o ADDRESS��� F� �Y ���� � DATE """� �� NUMBER # ' o� ISSUE � TYPE OCC APN LOT' TrZACT DATE � CONST. GROUP p OWNER /J'/JZ.���k-'S ,�✓.,a.ac. �c4a��1 o ADDRESS ''3 � �j`�/ 2iflP�� �-{� ZONING SETBACKS Z CITY �}'�Jl:a�±-,J���ZIP` TEL.�'t?5' �'d.�/�7''S�,$ ��ONT RW ❑ � APPLICANT I TEL. REA� C � SIDEJSIDE STREET RW ❑ ¢ CONTRACTQR�"'��/I�t� �-e�'�`La�€,�� SIDE ❑ � ADDRESS �'22 a �`i'_,�.� l,Aca � C�TY � z!F�tSr'�F TEL. ,.�.G-r��A3�� FROPoSEDuse u�i ARCH/IENG/ W DESIGNER NO.DWEL. NO. NO. a ADDRESS — UNITS STORIES BEDROOMS � CITY ZQP TEL. cn � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � O�/JNER-BUILDER DECLARATION SFR/AOD/REM O p I HEREBY AFPIRM l/NDER P�I NPLTV OF PERJURY THAT I AM EXEMPT FROM THE CONTRACT055 LI- Cya�y9e/CBfPOfI I,RJ CENSELAWFORTHEFOLLOWINGR'eASON(SEC.7a31SBU51NE55AN�PaOFESSIONSCODE:ANYCI7YOR (n , U COUNTYVNiICHREQUTAESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLiSH,ORREPAIRANYSTRUC- W patio/Qeck w TURE,PflIOR TO ITS ISSUANCE.AL50 I�EQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � STATEMENT hIAT HE OR SHE IS ICEN$E�PURSUANT TO THE PROVISIONS OF THE CONT.RACTORS LI- � CENSE LPW(GHAPTER 9(CAMME�JCING WITH SECTION 7000)OF DIVISION 9 OF THE BUSINESS AN�Pq0- LL POOUSPB O FESSIONSCO�E)ORTHATHEORSHEISEXEMP7THEREFAOMANDTHE8ASISFOFTHEALLEGEDEXEMP- (� , U TION.ANYVIOLATIONOFSEC710�7o39.5BVANVAPPLICAMFORAPERMIT5U6JECTSTHEAPPLICANTTO z RB-ROOf � ACNILPENALTY OF NOT MORE T�HIA�IV FI�,VE YUN�RED�OLLARS($500).): � ❑I,ASOWNEROFTHEPROPER7Y,bRPAYEMPLOVEESWITHYVAGESASTHE1R50LECOMPENSATION, ❑ CORIfiIE�Ci01 - Z WILL DO THE WOHK,AN�THE STRUCTURE IS NOT INTEN�E�OR OFFERED FOft SALE(SEC.7044,6US':� J NESS AND PROFESSIONS COOE:7NE CpNTRAC70R5 LICENSE LAW DOES NOT APPLY TO AN�WNER OF � PROPERTY WHO BUILDS OR IMPRpVE57HEREON,AND WHO�OES SUCii WORK HIMSELF OR H'cRSELF OR � Q THROUGHHISORHEHOWNEMP4IOYEES,PROVIDEDTIIATSUCHIMPROVEMENTSAflENOTINTENDEDOq m 4 OFFEREDFORSPLE.IF,HOWEVER,hIEB,UILDINGORIMPROVEMENiI550LDWITHINCNEYEAROFCOMPLE- � T�ON,THE OWNER�BUILDER WILL HAVE'�THE BURDEN OF PROVIh'G THAT HE OR SHE OID NOT BUILD OR = IMPqOVE FOR 7HE PURPOSE OF SALE).'. p I,ASOYJNEflOFTHE PROPERTY,'AM EXCLUSIVELYCONTRACTIMG WITH LICENSEP COMRACTORS � TO CONSTRUCT THE PROJECT�S�C,7044,BUSINESS AND AROFESSIONS CODE:THE CONTR0.CTORS LI- V9IU811011 A�J.AREA W CENSEL4WDOESNOTAPPLYTO NON,MEROFAPflOPERTY'NFIOBUIL�SDRIMPFIOVESTHEREON.AN� � WHOCONTRACTSFORSUCHPRO�IECTSWtTHACANfqACTOR(S)LICENSE�PURSUANi701HECONTRAP QUANTITY DESCRIPTION FEE - � TORS LICENSE LAW.). �, � � J.: r+ r o ❑IAM EXEMP7 UNOER SF_C.�'� B.&P.G FOR THIS REASON Q; � , k$a'��''^�`�' - B� "'S V� LL DATE � � OWNE�9 � , Z w o LICEN$ED GONTRACTORS DECLARATIJN �� . Et 1 HEREBY AFFIFM UN�FR PENALTj'OF PEH.IURY THAT I AM LICENSED UN�ER PROVISIONS OF CHAPTER � d 9(COMMENCING W17H SECTION 7b�)Ok DIVISION 3 OF THE BUSM'c55 AND PROFESSIONS COOE,AND Z ?C MY LICENSE IS IN FULL FORCEANb EFFEG7, � LICENSE CLASS F LIC.NO. � ������ j V DATE CONTRACTOF n- ' LLI � WORKERS'COMPENSATION DECLARATION -� U � IHEREBYAFFIftMUNDERPENALTVOFP,ERJURYONEOfTHEFOLLOWINGDECLARATIONS: C!J a � _IHAVEANDWILLMAINTAIN,ACE�iTIFICATEOFCONSENTTOSELFINSUREFORWDRKERS' 2 CAMPENSATION,ASPR0I�IDE09VSECTION37�OOFTHEIABORCODE.FORTHEPERFORMANCE U � OFTHEWORK'rORWHICyTHiS'�IPERMITISISSUED. � W I _1 HAVE AND WILL MP.INTAI�WORKERS'COMPENSATION INSURANCE,TS REQUIRED 6Y SECTION � 370aOFTHELA60RCD�2,F-0R,THEPERFORMANCEQF7HEWORKFORWHICHTHISPERMITIS ISSUE�.MYWORKERS'C�MPEPISATIONfN9URANCECARRIERANDPOLICYNUMBERARE�. CONSTRUCTION � CARRIER p�I }� �.�7 PLAN REVIEW a POLICYNUM6ER IJ„�y ��Tv� ' ELECTRIC � .r� V "�'� v,m.,,,,.7 Q ((HISSECT.ONNEmNOT6yOJM EfEDOFTHEPERM(i'ISFOflOI�EHUIJ�REDDCllARS($1W�ORLESS). PLUMBING ��_t���4_ __ W L g Z I CERTIFYTHAT M iHE PEryFOR ANCE OF THE WORK FOP WHICHTHIS PERMIT IS ISSUED,I MECHANICAL p Y C;J SHALLNOiEMPLOVANYPERS NINANYMANNERSOASTOBECOMESUBJECiiOTHE g � W�PKERS'GOMPENSATIO,NLA SOFCALIFORNiA,ANOAGRE�THATIFISHOUL�BECOME I INSPECTIONFCE 9 �����1 ' _i' oA _ � SUBJECiTOTHEWORKE S'CO PENSATIO�'PROVISIONSOFSECTION37a00FTHEL4BOR �f GODE,I SHALLFORiHWIT�II CO PLY WITHThbSE PftOVISIONS. ISSUANCE L �l � p DATE: APPLICYINT: SMIP + � W , I .G,�,�,�. J WARNINCl:fAiLURETOSECUREWpRKERS'COMPENSATIONCOVERAGEISUNLAWFUL,AhDSHALLOE ENERGYP/C ___ __ �y SUBJECiANEMPLOVERTOCRIMI�JALP�NALTIESANOC:VILFiNESUPTOONEHUNDAE�THIX15AN0 ENERGYPERMIT �OLLARS(S7�o,00�),INAD�ITION O7HI'COSTOFCOMPENSATION,DAMAGESRSPROVIDEDPoRIN J SECiION 3708 OFTHE LABOR CO E,INT REST,AND ATTOflNEY'S FEES. RETENTION FEE: 2 � CO STF{UCTION LEND9NG AGENCY pRE-ALT FEE: . � � 1 H'cREBVAFFIPM UNDEP RENALT�OF P�ER.IURV THAT THERE IS A CONSTR�JCTION LENDING AGENCY FOFiTHCPERFORMANCEOFTHE ORKIFORWHIC THU^PERMI7ISISSUEQ(SEC.30B],dV.C.]. Z W ' i . — ._ _.. ___ .. —... 2 LENDER'S NAME i —___—_ � I r. _ WLENOER'SAODRE55 I T� ,_ .__. _...__ _____. __.— x�� � ' TOTALFEES � I CERiIFY THAT I HAVE READ THIS�PPII�A71 AN'S7ATE iH. 'fHE A VE INFORMAiION IS COFRECT. � IAGREETOCOMPLYWITHALLCIT ANDCfSU NO�DINANCEu t�STA`�EL4WSRELATING7DBUILDIN3 CONSiRUCT10N,ANDHERE6YAU7HORi�R RES NiATIVES THISc UNiYTOEM1TEflUPONiHE zABOVE-MENTIONED PROPERTV FQR INS EC N P POSES.� � COMMENTS � � ° C� u � m PE6iMITTEE NAME(PRINT) � � t¢i5 - q — � SIGNATU EOFPEflMITTEE '',, ' E , TE � � ' ' � � RECPT.NO. 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