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HomeMy WebLinkAbout16897 (1109) CITY�F'II��ON73 BA� " - �`�--� DEP�1R�l�1T��'CO &DEVELOPMENT SERVICES �. �� 21825E.Ccapleyl}rive (904}8fQ-3195�'ax(909)86I3117 PRESS ��7IL19I1WG t�ERMIIT APPLICATIC�N FIRMLY y JOBSITE �3 y,7_-r' � /� )/O�GG!' .dr DATE`CATION� r `Z,�„�"1� NU B R #fC � ADDRESS_ �i1/ � d� �/ � ISSUE TYPE OCC i -- APN LOT' TRACT pqTE CONST. GROUP p OWNER �FR��y/�90/"4/�DS � ADDRESS I��f� S- �����,�� �r 20NING SETBACKS oCITY���r ZIP��TEL.�,SJB d 3S'Z FRONT RW ❑ APPLICANT TEL. REAR _ ❑_ � SIDE/SIQE STREET RW L Q CONTRACTOR C i� ' f G SIDE C � ADDRESS 2 � CITY o ZIP�TEL. PROPOSED USE o, ARCWENG/ �z DESIGNER NO.DWEL. NO. NO. � AD�RESS UNITS STORIES BEDROOMS � CITY I ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATIaN � O�VNER-BUlLDEF DECLARATION I SFR/ADD/REM O p 1 HEREBY AFFIRM UNDER P NALTY OF PERIUHV iHAT I AM EXEMPT FROM iHE CONTPpCTORS LI- GflfHJO/C31'POII LLI CENSEL4WFOFiTHEFOLLOWMGREA50N(SEC.7031.56USMESSANDPftOFE5510N5CADE:ANYCITYOR (f� U COt1NTVVhiICHRE�l11RE5APER IiTOCONSTRl1CT,ALTER.IMPROVE,DEMOLISH,ORREPAIRANYSTRUG W Patio/Deck Z TURE,PfiIOF TO ITS ISSUANCE, LSO RE�UIRES iHE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED ' w�. 'STATEMENT THhT HE OR SHE IS ICENSED PUR5l1ANT TO iHE PROVISIDNS OF THE CONTRACiORS LI- w �, �'�'.CENSE LAW(CHAPTER 9(COMME ING WI7H SEGTION 7000)OF�IVISION 30F THE 6USINE55 AND PRO- � POOVSPfl . '�FESSIONSCODE)ORTHATHEDR�NEISEXEMPTTHEREFROMANOTHEBASISFOP�HEALLEGEDEXEMR � � �710N.ANYVIOLATIONOFSECTION�7037.5BYANYAPPLICANTFORAPERMITSUfiJEC'STHEAPPLICqNTTO z Re-Roof �A CNIL PENALiY OF NOT MORE THAN FIVE HUN�R'cD DOLIARS(S5o0).): � o� ❑I,ASOWNEROFTHEPHOPEFTV,ORMYEhSPLOYEESWITHYJAGE5A5THEIF50LECOMPENSATION. � - Z ..WILL�O THE WORK,AN�THE ST�UC7URE IS NOT IMENDED OR OFFERED FOR SALE(S�C.7044,BUSI- J Commerciai � '�NESS AND PROFESSIONS CO�E: HE CO�TRACiORS LICENSE LAW�OES NOT APPLY TO AN OWNEA OF j ' �PROPEFTYWHOBUILDSORIMPH VESTHEREON,ANDWHO�OESSUCHWORKHIMSELFOPHERSELFOfl �"'.tHROUGHHI50RHEROWNEMPL YEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENOEDOR m � ��OFFEREDFOFSALE.IF,HOWEVEA�TNE6UIL�MGOftIMPROYEMENTI5501DWITHINONEYEAROFCOMPLE- Z .TION,THE OWNER-BUILDER WILL HAVE THE BUR�EN OF PAOVING THAT HE OR SHE DID NOT BUILO OR _, IMPflDVEFORTHEPURPOSEOF ALE). (.L� CI,ASONMEflO�THEPRO ERTV,AMEXCLUSNELYCONTRACTINGWITHLICENSEDCONTRACTORS [_�' '.TO CANSTRUCT THE PROJECT(S�C.70d6,81JSME55 AN�PHOFESSIONS GOOE:7HE COMRACTORS LI- V81U0lIOf7 ADJ.AREA W ",��CENSELAWDOE$NOTAPPLYTOInNOWNEROfAPROPERTVWHOBUILDSORIMPROVESTHEREON,AN� Z..WFiOCONTRACTSFORSUCHPRO�ECTSWITHACONTPACTOP(S)LICENSEDPt7RSUANTTOTNECONTRAG QUANTITY DESCFIPTION FEE � ,� '��POfiS LICENSE LAW.). � J LJ I AM EXEMPT UNOER S�C.��, B.&P.C.FOR THIS REASON Q � i U � � onrE owr�Ea U z w �4�� LICEN EDCONTRACTORSDECLARATION W CC� �I HEREBYPFFIRM U�DER PENALTV OF PEPJURY THAT IAM LICENSED UNOER PROVISIONS OF CHAPTER � �''� �9(COMMENCINGWITHSECTION7000)O'rDIVI510N30FTHE6USINE55ANDPROFF5510NSCODE,AND Z X' MV LICBJSE IS IN FULL FORCE ANd EFFECT. �'. LICENSECL4SS L^.[� ���.No. 6D9�38 � _ � U;� DATE � � D CONTRACTOR�_'���� a W � � �� �ERS'COMPENSATION DECLARATION U � � � �'. �I HEflEBYAFFIRM UN�ER PENqLTY OF PEflJUqV ONEOFTHE FOLLOWING�ECLARATIONS: z � Z� �IHAVEAN�WILLMAINTAI.^}1ACERTIFICA7EOFCONSENTTOSELF-INSUriEFORWOflKERS' 2 COMPENSATION,ASPROV��EOBYSECTION37ooOF7HELABOqLOaE,FORTHEPEflFORMANCE U 4 OFTHE WORK FOR WHICHITHIS PEflMIiI515SUED. � ' ��� ,IHAVEANDWILLMAINTAINI�WORKERS'COMPENSATIONINSUflANCE,ASFEQIJIREDBYSECTION p,� 370o OF THE LABOR CODE�FOR THE PEHFORMANCE OFTHE WORK FOR WHICH THIS PEFMIT IS ISSUED.MYWORKFRS'C MPENSATIONINSURANCECARRIERAUDPOLICYNUMBERARE: CONSTRUCTION J j' CARRIER � � C�+' PLAN FiEV1EW ��� aoucvrvUmeEa _ ��. _ ELECTRIC ¢ I (THISSECTKNJN€mNOTBE�41PLEfEDOFhiEPERMRISWRIXJEHUNDRED�OLWqS�$1W)ORLESS). PLUMBING r� �.' I CERTIFYTHAT MTHE PE�FORMANCEOF THE WORK fOR WHICH iH15 PERMIT IS ISSUED.I MECHANICAI -�. w�-+�� C„3' , SHALL NOT EMPLOY'ANV P RSON IN ANY MANN[fl SO AS TO BECOME SUBJECT TO THE � WORNEPS'COMPENSATIO LAWSOFCALIFOFNIA,ANDAGREETHATIFISHOULDBFCOME INSPECTIONFEE = S�BJECTTOTHEWORKER'COMPENSATIONPROVISIONSO�SECTION370oOFTHELABOR CODE,ISHALLFOFTHV✓IT COMPLYWITHTHOSEPROVISIONS. J ISSl1ANCE O �. /�, / ����,✓ ��+. .s-r� .,5-�f-,.�,..,: ' ��. DATE: A PLICANT,C� �/f/� SMIP I �ry � fe=-=.-�"�. �' 3 f �S�. j�,. ���/�����,� ENERGY P/Cy�.. _ _ . ... _.,. -. � .._-_,...._..,- I WARNINGFAILURE SE RE RKERS'COMPENSA710NCOVERAGEIS'�NLAWFUL,AN�SHALLBE y �j � n f � SUBJECTANEMPLOYEPTOCPoMI ALPENALilESAN�CIVILFINESUPTOONEHl1NDREDTHOUSAND ENERGYPE AMIT y j����3 �II'�� f � �. �OLLAqS(5100,000),IN ADDITION' THE COST OF COMPENSAiION,�0.MAGES AS PROVIDED FOR IN� � . $ �.{� J.,I SECTION3�OBOPTHELA60RCOD.INTEREST,ANDATTORNEY'SFEES. RETENTIONEEE: I� � � � Q 'I ^ � – _ d COrySTRUCT!ONLENDINGAGENCY PRE-ALTFEE:�—�,.-g�, e,r ���.,�,�, IHEREBYAFFIRMUNDERPENALTYIOFPEflJUFYTHATiHEREISACONSTRUCTIONLENDINGAGENCY ��-�'��-"""'—..-„p.--�.—,.,.��i� '�, FORTHEPERFORMANCEOFTHEV�ORKFOflN/HICHiHISPERMITI5155UE�(SEC.3091.CIV.C.). Z � LLJ, I �� LEN�ER'SNAME � � F– ', LENDER'SA�D41E55 � , WICEFiTIFYTHATIHAVEREADiH15��}IPPLICAiIDNAN�SiATEiHATTHEA90VEINFORMATIOnISCARR=CT. TOIAL FEES �� a, I A6REE TO COMPLY WIiH ALI.CITYIAND COUNTY OPDINANGcS AND STATE LAWS RELATING�O BUILOING I � , CONSTRUCTION,AN�HEREBYAUTHORIZERePRESENTATiVESDF-HISCOUNNTOENTERUPONTHE z ABOVE�MENTIONEDPROPERTYFOpiNsaecTioNauaPoses. COMMENTS � �� �i/o.�/� ----- --- NPEFiMI�TF�AME(PRINi) �a ' �/�/O ¢ S�J� � SIGNA�UR-E�F PERMITTE�� D E '� = RECPT.NO. 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