Loading...
HomeMy WebLinkAbout16580 (35) �I"I'�I�9F I)�'�+I+IOI�3�� ——�`�--- I�EP�1"�,N°I'�F C� 'I�I?E'€�LOPYaIENT SERVICES I I � 21�25 E.CopPeg�Dria�e " (904)E60-3195F�(409)�61-3fl17 PRESS ;,.,,y�...,. ���.�a���� ����acA�to� FIRMLY Q ADDR'ESS ��y S� � �°�`e-�. �+PP�ICATION '� `� l PERMIT � ��\` /C r�-� � DATE �� c a � 1 NUMBER � °�--J �� o ISSUE TYPE OCC � APN LOT' TPACT �ATE CONST. GROUP � OWNER �e� ��+�"' O A�DRESS ���`r-�-�fd���-c�'-�Ja�r'�� ZONING SETBACKS oCITY s �s e.e0 5 ZIP TEL. .���$,�`�-Zb2..�" REOART RW Ci o APPLICANT � TEL. S�� '+1��-�B�f �IDE/SIDE STREET RW ❑ � CONTRACTOR.����b�s l�'��s�• :�2N����S seDe � � a��REs�i6�. ���� � ci7v C'qt�;a�,� �i z6P f� rE�. �S�t��6�2�� PaoPosE�usE �w ARCH/ENG/ � z DESIGNER N0.DWEL. NO. NQ. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � pESCRiPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION. cn O OWNEb-6UILDER DECLRRATVON SFR/A�D/REM � I HEREBY AFFIRM UNDER PF�NALiY OF PERJURV THAi I AM E%EMPT FROM19 iHE CON7RACTORS L6 � Garage/Carport W CENSELAWFOflTHEFOLLOWING�REASbN(SEC.7a3t,5BUSINESSANDPflOFE5510N5CODE:ANYCINOR CJ COUNTYWHICHRE�l11RE5APEA�IiTO�ONSTRUCT.ALTER,IMPROVE,flEMOLISH,ORREPAIflANV5TPUG W Patic/Deck W TURE,PFIOR TO ITS ISSUANCE, LS�;cQUIR`cS TNE APPLlCANT FOR SUCN PERMI'TO FILe A SIGNED�- W � STAiEMENT iHAT HE OR SHE IS,ICEN�SED PURSUANT TO THE PROVISIONS OF THE COI�IfRACTORS LI- � � CENSELAW�CHAPTFA9(COMAdENCWGWITHSEC71DN7000)OF�IVI510N30FTHEBUSINESSANDPFiO� POOUSpe FESSIONS CODE)O,R THAT HE OR SHE IS IXEMPTTHEflE�ROM AND THE BA515 FOR THE ALLEGED E%EMP- QTION.ANVVIOLATIONOFSECTIOf�7o31.k0YANYAPPLICAtdTFORpPERMITSUBJEC'STHEAPPLICANTTO � Re-Roof �� � A CNIL PENALTY OF NOT AIOR'c TMAN FI�/E HUNORED OOLLARS(;500)J� . O ❑I,ASOWNEPOFTHEPROPEFTY,iORPAYEMPLOVEESWITHYdAGESASTY,EIR50LECOMPENSATION, � Commercial � Z WILL DO THE WORK,AN�iHE STpUCTlJRE IS NOT INTENDED oR OFFEPED FOR SALE;SEC.7a44,HU51- J � NESS ANO PFOFESSIONS CODE:THE C6NTRACTORS LICEN56 LAW DOES NOT APPLY TO AN OWNER OF = PROPERTY WHO BUILDS OR IMPR�IVES tHEREOn,AN�WHO DOES SUCH WOflK HIMSELF Oft 4EflSELF OR [� THF�UGHHISORHEROWNEMPl�OYE_�PROVIDE�THA?SUCHIMPROVEMENTSARENOTIN7E4DE�OR m � QOFFEREDFORSALE.IF,HOWEVER,IiHEB�11L01NGOftIMPROVEMENTlSSOLDW7THINONEYEAFOFCOMPLE- ' � TION,THE OWNER-BUILDER WILLi�HAVE:�,THE eUflCEN OF PROVING THAT HE OR St1E DID NOT BUILD OR , � IMPflOVEFORTHEPURPOSEOF�yALE�.�'i ❑I,AS OWNER OF THE PROPEFlN,iAM EXGLUSNElV CONTRACTPIG WITH LICENSED CONTRACTORS � TO GONSTRUCT THE PROJECT(5�,7044.BUSINE55 AN�PROFESSIDNS CO�E:THE CON7RACTORS LI- VdI'J8tI0f1 _ADJ.AREA ______ __ W CENSELAWDOESNOTAPPLYTD NOV�NEROFAPROPER'VbNHOeIJILDSORIMPROVESTHEREON,AND F NMOCONTRACTSfORSUCHPRO�IECTSWITHACONiRACTOR(S)UCE�YSEDPURSUANiTOTHECONiRAP Q[$ANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). ��. �y � ❑I AM EXEMPTUNDER SEC.�'�. B.8 F.C.FOR THIS REA30N U � +1���/ � _. � �ATE �' oWNER U Z yy� o L6CEN$ED CONT�fACdORS DECLARATION —� ¢ � w � I HEREBYAFFIRM UNDEA PENAIT}'OF P'�,ERJURV THAT I AM LICENEED UNDGR PROVi510N5 GF CHAPTER � d 9(COMMENCINCa lMhi SECTION 7G00)O�DIVISIQN 3 0F THE 6�SIfdE55AN17 PROFES510N5 GODE,AN� Z �X MY LICENSE IS IN FULL FORCEANp EFF�CT. , m o LIGENSE CLA �"��I �' LIC.ND. f.7 +/�� � /r i�� U DATE_� � �_ CONTRACTOR ��e��3 L,68°�9�:+.� s d � I � �� `� ORK�RS'�'AMPENSA"fBON DECLARAYION � Q � IHEREBYAFFIRMUNDERPENALT�'OFPIEAJURYONEOFTHEFOLLOWIIVGDECLARATIONS: U - Z 0 IHAVEANDWILLMAINTFU�ACE�ii1FICATEOFCONSENTTOSELF-INSUREFDflWORKERS' � COMPENSATION,ASPRO�IOED9YSECTION37ooOFhIELA60PCODE.FOR7HEPERFORMANCE U ¢ FTHEWORKFORWHIC THISIPERMITISISSUm. � � � �IHAVEAN�WILLMAINTPA WOF�KERS'GOMPENSATIONWSUPANCE,ASREQUIRE�BYSECTtON Q 37o00FTHELA80RC06�FORITHEPEflFORMANCEOFTHEWORKFORWHICHTHISPERM1T15 ISSUE�.MYYVORKEAS'C�MPEh�SAT!ONINSURANCeCARRiERANDPOLICYNUMBERARE�, CONSTRUCTION _ � CARRIER_���'�d-���I�y ��y �m'f� PLA�N REVIEW �$g� Z POLICY NUMBER�,�x'� �!��I ELECTRIC —��,�, � Q (iHISSECTIIXVNE�NOTB�WMA�LEfE�OFTHEP"tRMITISF�RONEHUf�DREDQJLLARS($t00�ORLESS�. PLUMBING W � 755UED,i MECHANICAL Z I CERTIFY THAT IN THE P@RFOF ANCE�F TME WORK FOR WHICH THIS PERMI715 � SHALLNOTEMPLOYANY�ERS(�NINANYMANNEREOASTOHECOMESUBJECiiOTHF WORKERS'COMPENSATION LA S OF CALIFORNIA,ANO AGREE THqT IF 1 SHOUL�BECOME INS?ECTION FEE _ � SUBJECT TO THE WORKE�iS'C�MPENSATION PFOVISIONS OF SECTION 370o GFTHE LABOR � ,� � � "'�x;."'- '�� O E SHAIzLFO HWI7IiCO�a�vwirHTHosEaaovisioNs. ISSUANCE o �.`` �A, , —___ .._�_ . __ _ _,i;— ( � t� I � DA7E: �`� YJ�PLIdINNT: SMIP f]pp ... � . —� WARNING FAILURE TO SECURE RK6 5'COMPSNSATIIXJ COVERAGElS UNLAWFUL,AND SHAI L eE ENERGY P/C @ ' ���.r t I J py SU&IECTANEMPLOYERTOCFIM ALP'.NAlT1E5ANDqVILFINE5UPi00NEHl1NDREDTHWSANO ENERGYPCRMIT �OILARS(5100,ao0J.IN ADDITION O TH COSiOF COMPENSAiION,OAMAGES AS PROVIOEJ FOR IN : J SECTION 37oe OF THE LABOR CO E,M EREST,AND ATTORNE�'S r'EES. RETENTION FEE: ��_;_, " � CO STF�iUCTION LENDING AGENCY pRE-ALT FEE: �""��"�"�"'""�-.-�-^—� O � IHEREBYAFFlRMUNDERPENALTVDF ERJURYTHATTHER.EI5RCONSTRUCTIONLENDINGAGENCV � FOFi7HEPERFOqMANCEOF7HEWORKFORWHICHiHISPERMI7151SSUE�(SEC.3091,qV.4j. � I _ � LENDEfl'S NAME � 5= LBJ�F_R'SA�[IRESS � � j \ � ICERTIGYTHATIHAVEPEA�THISIAPPU ATIONANDSTATETHATTliEA60VEINFOHNATIONISCORRECT TOTA�FE��7 ' l �1 \, � `// � � �A�>� IAGREETOGOMPLI'\YITHALLCI YANOCDUNTYORDINANCESANDSTATE'.AWSPELATINGTO&11LDING CONSTRUCTION,ANDFEREBYAU HORIIZEREPRESENiATIVESOFTHISCOUNttTOENTERUFONINE zABOVE-MENTIONEO PRDPERTV FOR IN PECTION PURPOSES. COMMENTS � l . (j _ �G H.�C, ��i!I� J —... ,,. aPEh]f�EE Nq�E(PF11NT) �i . .,, t�](llA �q � 71J3� �V � � �I V l '�. � 5 OF PEPMITTEE ATE `� �' � . RECPL NO.�j_�_ __ PAID BY V,4LIDATIDN ~ WHITE—DepaRment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GCiDENROD—File Copy,GREEN—ApplicanYs Copy� . _ , .,.., . ::.;..,. ,.,„ .,., ..,.. . .a�,a,, � ,..;-,;. �--', r�_ � , � , . � . . . . - ,. .. ,. _ . ., �� _ .. ... '�..:� s'::a � , 4��.:,, .a ,.."'.t. i��. . <�� �.., ��.. � . ., ... .,n? ._..�. ��„a- �!� a r f ��a-a n � 5 � e:- i" � p €a k,� - a . r s , a � : � � r m : s � „� .,> d � ', a �:! � �: a� �� iT ; �'§ � ._ n �P �: � I" � ffi i 1 ; a ��; y ; ^� a :: r � P . � �� � x Y i�� ��.��c�.;��ts.�..,'.z'.'�"�� ��W.�:t�:.� .,.�.�...�_...'.,�,�..�.:; „ -__"_? ;'� ,�_,.a � �* � r ,�v .� .. ...�.�... . _.:�,x .: � �� �v � � �a" � . ,.�z. .o-,e,:.., ,a _ � �: _ r , � � r »:....�._.�_,, m a�....,,� * . i� .-._.. �.«... � € " , ' . 4 '� 'w."�.i ae li� ( €._ �" . , i . �._.. .__._ .__.._.__ ..._... _..._...�..__. . ............_...... �. �.._� .,...._.._ _ ..................... .........._................,,,... �. ....._......,...�. . ..........._........._......_....._..._...�__�.. ._ ......... . d,.�l.i�,f R € , � p a�= _ _rc t . �..i,r t., � �"' . - !' .�"- : . . . ..�....1 ....... ..._.......... ._..__..._ , :......._.._'�-_...._............ ......._.�.__ .._........._.-"_ ;..._.__.._..__._.._....._..._..�_.._..._._......__.._._�.�.�_..._._._._.�_�.i � _.._ „�,........_.__...,__ ..................._._ :� 1...� v.�*, . ,. ! i,.,�a .... F . � �..: g", '',. : l._...,_...,,....,..........,....__._..�_..�.�.�_..�..,. .___�,..,....._,._._.__.... �......,._._.....__._�._.�..._.........___._....u :-..,._._......�...,,....,..,,_.._ ._.._........._........_............._., ��Y...._..____.._........._..,...... ..............._._�..____.�... ...,..._......_.___�..._'�: ' i '" � st 'i � � .,.€.." ¢ � ` ; _ e`4 4'I � �>.. ' _ __ ____ - — -- --- r _.... __, ._...,......._._ __..._._.�_._. _._......... .�._..._..,....___....._....._......._..._...:_.�.. .._, - �^ t i�� ��r�! I i.3�..£�� 1 �` .�... E �. f 3 ,7 F,_........-....___ .. ......,,._..,._....__.. .._...._.....:.__«..,.._.._......._.,�.�........_.._....................._.. ............,.:... .._..........................._.._...._.....,_..,.....,....� � A'.��`''�F �: C � �.....�. ��.,` � __ . .. ,_.. . .... _._ �} . � . I _........ .... ... ..... ..,. ..........,._...... . ...... � ...: . ._ _....... _ . _... ..._.__._.,..._._.._,.._..__..._.� : f I 9 �,+f`'� r-Y'� 1 ` �'€,.'. "�.� `� �._�--- � �.„ .�._ .�..,.. .... ............�........_. .w_.__... (_...._..................._..........,..._.,____._.__._ .. ._. � .. .._. ......_.... . ..._........_ _.__.� ' . .'_' �E z n� ( � .._ .:m.. E .M � �.�.'`�, �... '��.�:.. .. �. a..:: : € '. �''. _...�-�: i,._.....„,.�...�,... .._. _ ....._......_......_a.__..._. ..................... ........._..._......_.._....._........_.�.� ..a.._ ...... ._ ... _._...__._ .._. ...___"_' _._.._ _.._ ._... �:, .:,�? � � � i ,u,, j:,, . ; ' " ' k ._,�..._.�.. �i: .. .. . �a�"a� ..�?..l� ,e ¢_.F�e �i r � a ,.«..........................._..�...�.......__�._...... . ...._...._�... ._-__._.___ .,,,____.._.......................,,..........,,._...._....,._ E.;.....,,......_..... _.�__�_•_•_•__....__.___. .........._.........._._.__...._ ,.._�...._.__.�..,.__........._.._.... �.................... ... r, ...: i�. � �e.. .. w�. 'rv� �:.6.'I'�:'^°. { S,. .".:, € �:..� �i ". �\ x 'S'�e',.,. ..��; �; . . .�.� � _. _.�..<. ................_.v��.,._.._. .�. .. .. _.,...,... .. .. . _.... . ....... ..._.... __. . ._ . . . . ; _ __. t k ; i � � y ky,.��� �t I : :. '� il� `� �:. - ...... ... .._.:"...,,_.,.____t_._._..�...................,,..........�.,......_ � _ ... __..._.�,. . , .. . __..._._.. ___......._. � 9..,�.,.�i..'vl.,�"� '� � .L�� . .. .. ..,.,.....v... . . ... .. ... ._. .. _ � �.+}' t �il.'.. :,, .__..."_ ' _.._._.—� _____. ._..__._._ .._._ �•'.. ._,._.._..e.,.a.. _...._ . _ _...._.,....._._..____,....� �'"._, ..... . . ....._.._ n._, � ..... ... _..... ._._. F , i, x � ���;��3 'F ',� 4 �� , . . Si ''.. �� .:;i. { ( �,, �,. .... .,......,..v:......,'.._.. ..__..____ _._.._..._. ._,._._...,_,.�..._ _ ...._....- _..... . _..__..�___.____ .,�.._..,...__._...�. ......._ _. ' � �__�.._._�___..._�_.,....._._....................... .<...� „„..`&t .e- .. ., _ I� �4 ..6 s� ..4..�.;"��.w.»._.a .�..��_ 8 1_u. , i . i �. t I,__ ........ ._ __�_. . � ._ '� � ......... . .... ..�,., ...._ .. .... ,. .._...... ........._... C ;, �te�r-�;�; 3�0. '., . . �,y ',: S , ( ( I � w _ ...... ........e..s. . ._..�..__�. ._...... ....,. _ _....... € ._ ......... � _ ._.__,...... 1 s: � ?.�,�i$'�. t$g ...- f ��.s��i ; t �'`�i "-S �^ ..,_. .. __._.�....� �.�,........_.....,.._............._.......,...,_.....,.........., ��. p _......,.._.._ ........... ....._.... E S.i::'����"_., �."�a.C.Yn. 3',„.t�1 ; E .z.r" .4E�i::.9..�.d a. ._ . ... . ... ._"_ .'__. ,� . ._ ._._..�......m,.a--->...,...._.....,...._...... �....._........... .................._..._._ .._"__.'_` __" _ .........,.........,..........._..,.,,.. ..,............,,. ....__"_ "._.���.,__..._�_�,�_.�..._ yF_ �:+. ..y....... . �-- . ' � a.� e � f�" & t :...d..F.,,? � !��u . +1,...,....k�::-._. 2@�� ' ` ; _................_...._..._..,.,,...�..._......_. ...n_...... .._....._........_........__..............___..._..._..._...,...,._._.......v..,........_...._.....� ._.T_.._._. �,.e, . ..._ .._................ .. .. ._ .. ... ......,... ., ���,. .. € .,.�:Y 6 .:�. i � , _ y .. . , . :., � ...,.. __.....__._...._......,....�.�_____.�....�.� ._.,_.,_._.......__..�_ . _.e..._ .. . � .�..__ ._...._ _....... ..._...�.._. . . ..._.__.._. ..._._ k .x . ( ' � ,'... m � .&,.� i � 'mm : � t ,='� � �..;45,�,¢�.. , � .,"� �, � :: . i - �� a .._....�. _ ._......._...._.._. .........,....i._..._._,.... .__..._ _......_._..._...__�._...._�.__ ^-i -- -:_ .. . . . . . _ .. ,. . . . k �,-?::�'1`.°n�a P�.n.,im: i � � t t-���.. t S.'��.e . 3 . _ .. . ..,_ z �__._.�................... ......,.....,..,._..__..'.'__....____..___.,,._....._ � _.._.._..__._........._......_.._...,..........i . , , � ,_ ..._ j........,.._..__....,.._........._._..�.._....�........__.._._..._...�_._.�. .. �....._._._.. �-y„, .���:: , , �'�;,;� , ; �i,sa � �� §-"� � � _ _ _....._. . .__m�,_.__ Me ._.,. m__.__._.__,..,._ ._� _.� .._.___.___..m.. _.._..___.___�...__._._ __..___.__ _..,_._ ' i.'�;i�:...+.e i ?,;,, < � . ,5-(6":C. =r _�"��>. , a i-�.., j_. 9 e � ....�.._....e,,._....._.__._....._..,e..r............ ..__._.._._..._._...,.._.._..,..._,.....,.....__,�.. -� ._..'� .... ...._..........._...... ._._..__..........._.......'_ '._�..__..._.._........._...»._...._�.____` � ��6`�q� °",�.���ez�s����.T, ' � <,.�;-,a.. "'� ",..:_ � � .Pa"�-����.. j� j� :. � ,.. � .�._..�_.. ......, —____._ .....,....__. _...._. �_ .. . ..._......... ............... . ._...__ _. . __ .. .._..___ . ... . , � ' �` r-��^e v I � '�, �.`�.d r t'. ...... .� � i ...._ ._.. _....�_.__...._.�. .._. ._ ..._... .._. E _......_"__.. .....__............... .,..............�.......,,.....,r._ �_._�,.__....�_�_ . .,., .....,,,.� . �l�v �.XE���€ ��,,h i - , � I €'I€ �.�4ae � ��i ' __.......__..__ G-.. . _�_.._.�..�......_..__.___._......_,_._...____......J...W....,_._..�.._._�,__..�....._.__.._._._�.__. �a..._.,.�_�.�.__....,.. .-t.. _._...,.....,............._._..__.�_�.._.._.i, .,�_....__...�.._..____.. . .. I _�w.......-......_.�...._.�.�..,.....,r,.._.� .,...... . . __ . . ..... .._.._ ... .. . _.. . qt "�.;;�i:"r a x•,�-'z „ d»-���... ...�� .,._._.._........--..i � �'� .a � �a a r^a��t���a�"w ��;�' � i v. ' i .<.w:m:v.��......r=�.k.,',�.. ..�.�,�`�Ws.�.ma;�.,.n �.":��,.t.u,a n", : .. ,.. f ,s/ "✓ � : C ` .��a`'.�_�i".n�'�,��° m..:�+ ._ l.�Jlon� '; d� .�. � ic.. �1 �� ' � ��<.,,.._.��_..w���_��_�n�.��___.__;�,._�___ __.__._..�_7___._._.___.__.__�__�___._..._.,_.._�___w.__„____�_._._.._ _.�..,i �..�.�,__________.�._____�__ .___.____.__.___.___.____�,__________.__.______..___._.___._�_______._..__.._.�____ _. __._�._____._�; � _ � ____.________ _. _____�___._______.__ _____ _____________ _ �..___.� ..____��..____._.�.,._______.__._________.__.____�___ € � ___._.____ ..___ ._a �__�..�_.________.__ -----_..___w________._w__�.. _��._-� ___. _.__,___ ___________ _._�____�� � � _.________�. ___._._--------_a . _...__._..___----_______ ________..__.�_.______ ____.._ .._�°. _ ___ . ;__..�._�___..,_.��_._...�__--- -- � _ __� _ _.__._�.�..�_--______�.,__._._.._ _._ ___� :; __..,_._ ; ;,________��___��_�__�.�._____..__��_____..__�.._._.____m__.___---�_____�__._,_____._T__.________..��.�__.� � � � __ _ _�___ _-----____--- -_______..______.___,�w._.__.____.--�_ ____ ____.__._�_..__.._-----_ ._____—, � � � °��':��.� `'a� . »u�:�� .._.____._.._ f � � A=-� �i� ;;E ��x € __��.__.� A. _. ___-__. .___. ._. _..� .._ _...w ._ ..___--1 � � � —.� _.__.. ---.�.__._ �. ��������������'�a���"��������,��'�"�� ��': ._ .m.M...��,.n __.�.......___.._�.._____._---________.. . t � �� ' � ����p.��s�e'��'�e����: ��s a�a��'��x��x����'d��'w � �����������>������������r�a�����a� - -... _ . -i ��. _� _. _ __�_. _._�.��� .____�_ �� a � ,� ��� • �,.,�a= � a ���a �"t�a � � ���`u j � g�„ ,�*,.����`����,� �'�'xd���� �':s�,.. x . .. ... .. , _. ...�.. ..m.__...___�..__.__.�........_.....___.��..._..................._ � .. y.qg ,�i x�k&s���4��° r�R _.... _....._.._...__...,.....�......_.....�...._.�._.d_,�._.._.._,.,,.,._ .. .. ._ ............ �� �' '� 65 '��a��^�ax�d"'��a'�� ,.��,� � s ? i�>�'a� ad�k�P �a��,�������&�� " ....._._,._...__........_._.....__—_____�.`.._..__..._.............__.---..._i � ._....._......................,.,...... ��.,,�d�'��$���d�#4�'ir 8�8���4'��'&�'s�����M a,a�;� _...,_..__.._._.....a.................._,..._....__......�.....��.-_.W.�............_....,................__.,,,,... �",�w � -. � � �.�,., • p � 4w4 � ����,�����'��*����"���������������*�a _............� ----._ __,... ._._,.,._._.w.M _., _. ��a�'�'��"��'�'��k"��"`�a a���,����k`��; � . �._.._ ..�.. . . ...._...�„ . . ..._ . .._.... % � �����a�`��+�r��a'�����W�aax��� � .__._.�_— ._ ___ ___... � � � ����a����' "������9m�a ��'"���d�e g'�; ...._... . .. . . .. .. ._..�.. . ._..,...._..,._.._� ....e_.. . ......,,............._.�._ �..X I� " �� ��•,�.r �a��,�t�&'���&� �. , �. . °' ° g����'«���������r�:�ws����.��.���.e.,:�w�.�. �M.��a..�a.._�.._............,,.,....,�_.�.__.-..�..._.a.___�..�,..__._....�.�.._.M. ..�_.......__.....,.�M......mm....._..,.._.....�._ ._._.�o-__.__........__........�.�.r_��__..............�..�.�_.._.___-_�_ --r