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HomeMy WebLinkAbout17545 (665) CITY OF I)gAR�IOND�AR � �-----��' -� DEPARTMENT OF COMMUNITY�DEVELOPMENT SERVICES � � 21825 E.Co}sley Drive ` k a ' "```' PRESS (909)860-3195 Fax(904)&61-31 ll "%•��>'�� BiIILDiNG PERMI�'AP�'LICATION FIRMLY � JOBSITE �g�^7�� � ) APPLICATION PERMIT P/C o ApDRESS r� 7'�� ���1si,���1(�' (..�fi/i DATE �� NUMBER�� # o� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER ��e LL ADDRESS L�1 ZONING SETBACKS � CITY ZIP���TEL. f3 �� �� FRONT RW ❑ p' APPLICANT TE�fL+t 233-3'��i9 REAR ❑ z �` SIDEJSfDE STREET RW ❑ �, CONTRACTOR �K�'3 _ SIDE ❑ ADDRESS � �^ � CITY � ZIP �. 2., TE` !? - �-. PROPOSED USE � 9�`' d`-�✓rt✓e�?�`�-d�,' � � o ARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. � ,AfJDRESS UNITS STORIES BEDROOMS �` C1TY ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFIRM L1N�ER PENALTY OF PERJl1RY 7HAT I AM E7(EMPT FROM THE CONTRACTORS ll� GdfaJe/Ca�P01'� W CENSELAWf-0RTHEFOLLOWINGflEA50N(SEG7o31.5BU56JE55ANDPROFE5510N5CO0E:qNYqTYOF (n . CU COUNTYWHICH�REOUIRESAPERlAITTOCONSTRUC7ALTER,IMPROVE,DEMOLISN,ORFtE:AiPANYS7RUG �� �TURE,PRIOR TO ITS 156UANCE,ALSO REQUIRES iH�AAPLICAN7 FOR SUCH PERMIT i0 FlLEA SIGNED w Patio/Deck . ..STAiEbtENT THpT HE OR SHE IS LICENSED PURSUANT TO THE PFOVISIONS OF THE CONiRACTORS LI� ��.�'CENSE LAW(CHAFTER 9�COMMENCING WITH SECTION 7000�OF�IVISION 30F iHE 6USINE55 AN�PRO- u' Pool/Spa �FESSIONS CObE)OflTHATHE ORSHE IS E%EMPTTHEREFROM AND THE Bh515 FORTHEALLEGED EXEMP- V �TION.ANYVIOLATIONOfSECTION7o31.5BYANYAPPLICANTFORAPEPMIiSUBJECTSTHEAPPLICpNiTO z Re•Root ' .ACNILPENALTYOFNOiMORETHANFIVEHUNDRe�DOLLAFS�$5oo).): �. ❑I,ASOWNEROFiHEPROPERTY,ORMYEMPLQYEESWITH]NAGESASTHEIRSOLECOMPENSATION, C� COfnfflE�Cidl -- Z,;.WILL DO THE WO}iK,AN�THE STRUCTURE IS NOT INTENDED 6R OFFERED FOR SALE(SEC.7D4M1,BUSI� �J ..�,NE55 AND PROF�SSIONS CO�E:THE CONiRAGiORS�ICENSE LAW COES NOT APPLV TO AN OWNEfi OF � '.�PflOPERTYYJHOBUILO50RIMPROVESTHEREO+I.ANDWHODOESSIICHWORKHIMSELFORHERSELFOR � � "'�THqOUGHHISORHEROWNEMPLOYEES,PROV!�EDTHATSUCHIMPROVEMENTSARENOTINTENOEDOR m Q� '�OFFEREDFOftSALE.IF,HOWEVER.THEBUILDINGORIMPROVEMENiISSOLDWIiHINONEVEAROfCOMPIE �, �,.TION,iHE ONMER-9UILDER WILL HAVE THE BUR�EN OF PROVING TMAi HE OR SHE DtD NOT BUILD OR � "��IMPFiOVEFORTHEPURPOSEDFSALEJ. W ❑I,MS ONRJER OFTHE PROPE�9TY.AM E%CLUSIVEIY CONiRA;CTING WITH LICENSED GONTRACTORS �' '70 CONSTflUCT THE PROJECT(SEC.704a,BUSMESS AND PROFE3310N3 GODE:THE CON7RACTORS U� V81UeCi0� ADJ.AREA LLI ,�CENSELAWUOESNOTAPPLYTOANOWNEflOFAPROPERTYWH09UILDSOflIMPROVESTHEflEON,AND �� '��WHOCONTRACiSFORSUCHPROJEC7SWITHACON7RACTOR(S)LICENSEDPURSUANT70THECONTRAC- Q�JANTITY DESCRIPTION FEE Y '70R5 LICENSE LAW). ' . � ❑i AM EXEMPT 11NDER SEC. B.&P.C.FOR 7HI5 REASON Q ' ' � U � � OATE OWNER � �. o . LICENSED CONTRACTORS DECLARATION W ¢ � 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � . , � ¢ � 9(COMMENCINGWITHSECTION70o0)OFDNISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z X � MY LICENSE IS IN FULI FORCEAND EFFECT. ' . � ��UCENSECLA^yG V" �� _LIC.NO. � ��J►�.. • ��• � U �� DATE ��° CONTRAC70fi'!!Y � �. . W �. WORKERS'COMPENSATION DECLARATION a �� IHEREBYAFFIRMUNDERPENALNOFPERJURYONEOFTFiEFOLLOWINGDECLARATIONS: z ����,�_ ,��A e P'"� z. _IHAVEANDWILLMAINTAINACERTIFICAiEOFCONSE7J7TO5ELFINSUREFORWORKERS' _ ¢ COMPENSATION,ASPROVIDEDBYSECTION37aoOFTH:LABORCWE,FORTHEPERFOflMANCE w O OF iHE WORK FOR WHICH THIS PERMIT IS ISSUED. � ' W �IHAVEANDWILLMAINTAINWORKERS'COMPENSA710NINSURANCE,ASREI]UIRE�BYSECTION �� 37aD OFTHE I:ABOR CDDE,FOR THE PERPoRMANCE OF THE WOflK FOR WHICH THIS PEFiMIT 15 ISSUEOJMYWORKEflS'COMPE,N�S�A/TJO�NINSUflAN E RRIERAN��sy`OLICYNUMBERARE: CONSTRUCTION � CARFIEE ��_'T"f`'+� �-I��{�,__ PLANREVIEW , 0 �POLICYNIIlA9ER�� y� �i ..-_. y � ¢ ��, ���.m--- -P�`--f ELECTRIC � (�}iISSECTIONNEmNOTBEOJMPLEfEDOFhIEPERMfTISFORONEHLTDRED�OILARS($10G)ORLESSy PLLIMBING � �Z, I CERTIFVTHAT M THE PcRFORMANGE OF THE WORK FOR WHICH THIS?EFIMIT�:S ISSUE0,1 MECHANICAL � �J� SHALLNOTEMPLOYANYPERSONMANYMANNERSOASTOBECOMESU9JECTTOTHE �"� � � �� � ' [,/7 WORKEFS'COMPENSA:IONL4YVSOFCqLIWqN1A,ANDAGREEiHATIFISHOUL BECOME INSPECTIONFEE - �' ' ""/-::� � :~ _ � SUB C7 T0,HE WORNERS'COMPENSATION PROVISIONS OF SECTION 3700 HE LABO � � " �' �-- - �" O co .i SH���r FortrHwirH coMP�r wirH��Paovi Ns. �, ISSUANCE p�yy�@ c � � .DATE: ld � APPLICANT:_ wl�S1_ SMIP a .k ktiY � /�1 Ii OWARNI �y:r'AIL RETOSECUREWORKEflS'COMPENSATIONCOVERAOEISUNIAWFl1L,pNOSHALLBE ENERGYPIC __3 � �SUBJE TANEMPLOYEHTOCRIMINALPENALTIESANDqVILFMGSUPTOONEHUNDRE�THOUSAND ENERGYPERMIT 6-"`��r t� DOLLARS(51oo,oW�,IN PDDIiION TOTHE CO'oT OF COMPENSATION,DAlAAGES AS PROVIDED FOR IN qI���'' J �SECTION3]o80FThIElABORCODE,INiER55i,ANDATTORNEY'SFEES. ��,'�' � G3� p� . RETENTION FEE: _ _ _ � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: p —-- � IHEREBYAFFIqMUNDERCENALTVOFPEAJURVTHATTNEREISACONSTRUCTIONLENDINGAGENCY FOR THE PERFORMANCE OFTHE WOflK FOR WHIGH THIS P<_RMii IS ISSIIE�(SEC.3o9],CIV.C.). Z W = LENOER'SNAME � F— LENDErl'SA�DRESS W, ICEflTIFYTHATIHAVEREADTHISAPPLICATIONANOSTATETHAi7HEABOVEINFORMATIONISCOqRECT. TOTAL FECS � /,�yc�� � I AGflEE70 COMPLY WITH ALL CITYAND COUNTY ORDINANCESANO STATE LRWS RELATMG 70 BUILDING / �{ ��. CONSTRUCTION,AND HEREBV AUTHOPIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ���ff/ Z."ABO �MENiIONE� RDPEPTY FOR INSP CTION Pl1RPO5ES COMMEN75 �', ' ��If✓�� — — ��'��' P IttEE NAME PflINi) d. �'i �''. � ATU E � � , RECPT A0. �� PAID BY ���� VALIDATION ~ � WHITE—DepartmeM Copy,YEILOW—Finance Copy,PINK—Assessor Gopy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy x , r� , � � ' %�` . , . . . : '�I:�s ... _ � �,.; � _ �{'w , .. ..E � d#x��� �:�� �' � �� � "� a a' � '�� � .� w €� �` ; r.� ��s �..wS� a F �:, c J "� r r d'� �� �e`Y } �, � 4 � € �. c� �a 'r � � � ;�, ; ? �; a r s + � i :. x t � � .�- �s �'�.���+ : � ,t U f #,�a; r ��F „� � a �a� � ,a J a � y r f� a # �; '.-+�p �yy�:�'k s ' � .. n..�:�.�....�.....�* h .__t`"n_..�'... t���P. . .. . �:, a�- r ,r � .# a .� �.a .r _ ;�g..s e_a�'#..�..� _*.,.#�..�'._ ,.a e..#�'. .a�. .. .�. .. a-,a.n..._' . �,. .. , > ._ .a r..k.. .�z5��.'sd��.,.��.,s�„x��. r. k � "' �, • . � :..,.'n� ,,. .� .,n; ..+E. .s._i -p..� , S � �: '...1',. . '. 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