HomeMy WebLinkAbout210 Via San Remo 5-27-83(�
OW Ne yrport Blvd.�b !(� 60 CITY OF NEUVPORT BEACH PLAN CHEct��,r10 _
ine Permits- J40-213 L 1. Lam-' �
Ills as 640-2161 BUILDING DEPARTMENT J
APPLICATION FOR BUILDING PERMIT
BUILOIND J� J,/ �/ \
LOCALITY Icq Oss 6T.1
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ADDRESS L� I%/ N % CLg55
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STATE �j 99 a
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DESCRIPTION OF WORK
WORKERS' COMPEN N ECLA ATION
TIF ATE OF ....... TO
I ...EBY "lam THATI HAVE A c...
ELP-INSURE, E OR A R IFICgTE OF W KF�RAI COMPENSATION
INSURANCE, R ERT1... COPY TTHH'EERE� C98Lm0y/0. LAU...I.
P LICY NeOM AN'
COPY IS HEREBY FURNISHED. "
NEW❑ ADD ❑ ALTER REPAIR ❑ DEMOLISH ❑
sq. FT PlD4 HO
TO�E9 RA L
WORK T....... P p ^9 J
t
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T :RIEO
IENpCTV RE OR
fE�S1A RTIPI 9 FILED WTH THH BVI 1 G H ARTMENT.
PPLI ANT
AL
OwYe - ✓�. APP LI<p Nr
LICENSED CONTRACTORS DECLARATION
1 HEREON AFFIRM THAT 1 AM LICENSED UNDER PROVISIONS OF
-
CHAPTER 9 IS.. ME NC ING WITH SECTION 7000' OP DIVISION I OF TXE
CERTIFICATE OF EXEMPTION FROM WORKERS'
SUSI NE95 AND PROFESSI CODE: AND MY LICENSE IS IN PULL
COMPENSATION INSURANCE
FORCE AND ERF ec T.
/
IT 15 SECTION NEED NOT BE COMPLETE. IP THE PERMIT IS FDA ONE
LICENSE CL
UNDRUD DOLLARS IF100) OR LESS.I
,JL_I... /NOO./.,/�
CONTRACT. P(JII(�ATE ��J//�Yh9
1 RTIPY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH
����'-��
THIS PERMIT 19 ISSUED. 1 SHALL NOT EMPLOY ANY PERSON IN ANY
COMPEN9A-
OWNER -BUILDER DECLARATION
ANNER SO AS TO BECOME SOOIBCT TO THE WORKERS'
I HEREBY AFFIRM THAT 1 A EXEMPT FROM THE CONTRACTOR'S
TION LAWS OP CALIFORNIA.
LICENSE LAW FOR THE FOLLOWING REASON 'SEC' 70]1:5. BUSINESS
PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES
ATE gPPLICq NT
ANPEAMIT TO CONSTRUCT, ALTER, IMPROVE. OEMOLI X OR REPAIR
ANY STRUCTURE PRIOR TO ITS NC E, pLSO R O Ifl 5 TH,Ey.
N YI -YK"A i hNT yP gRTEP.NAKIN TXI9 q I I T@ OP
FSEUg
NT FORSV CH PERMIT TO FILE A SIONEO STAT MENT"THq
P V* 6HOV Lb B ME U JE T TO' THQ BID RKER9'
M. N }IRRN jj % '
NryATIb SET' INgl. H OR coo vp T FDR
.PPLICq
HE IS LIC6NSH. PURSV ANT TO TXE PROVISIONS OF TXE T A Tp
j1 (�� LL MM
IIIH GEMMS Y((''W ITH CrI' PW5VIStONS OR THIS' 6Jj, 1'1' SHALL BE
LIC 6N SE LAW 'CHAPTER 9 ICE MHNCINO WITH SECTION TOO t �,L�r'
DIVISION 3 OF THE BUSINESS SINE59 AN. PR OFE991 ON9 OR TN , HE
`v.'p �V
HEM "k
CODB)
IS8%EMP TTHEREF ROM AND THE BASIS FORTH. ALLHG ..... ..
- `.CONSTRUCTION
ANY VIOLATION OF SECTION ]OD1.8 DY AN APPLICANT PO A .(,MIT
L EN DING AGENG'Yf
...,J.. '
BIECTS THE APPLICANT TO CIVIL PENALTY OF NOT MORE M1HAN
I NEFt'EBY PM T1�ATI R -1 A C N T U 1 N LEN IIN AGENCY
FIVE XV NOED DOLLARS'SS00'A.':
1, AS ONNHR OF THE P OPEgTY OR my EMPLOYEE W I1 q
P H.,.P„Eg Q„[ HCE OP. ITM E., K O WHICH TH 6RMIT IS
AS THEIR POLE COMPENSATION, WILL EO THE WORK, AN TN dI RV
TUB NOT INTENDED OFFERED POfl SALE (SEC..TEA 9�
I.EN. ER's NAME
PIS OR gVSING
U€ii
AN0 ROFESSION9 THE CONTRACTOR'S IICEN SEO�Lk W'^.NOT
APPLY To PROPERTY
AWHOOWNER
.ENDER'S AOOgEES
DCESOHUCHW RK HIM SE LFILO B,T. R BUSH HIS
THEREON, AND WO
OWN PROVIDED THAT IM PROV EM Ery TS ARE NOT
1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT
I NTH N.E.LO OP F.RE. POH ALE. IP, HOWEVER, THE BUILDING
THE ABOVE INFORMATION 14 CORRECT. I AGREE TO COMPLY WITH
R IMPROV HM ENT IS SOLO WITHIN O E YEAR OF COMPLETION, TH.
ALL CITY p COUNTY O .INANCMS A STATE LAWS RELATIND TO
OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OIO
BUILDIND CONSTRUCTION, A . .....Y 0.V THO RIZE P6PRESENTA-
rv.NTER
NOT BUILD OR ISFOR THE PURPOSE O ALE.).
TIVES F THIS COUNTY TO UPON THE ABOVE -MENTIONS.
❑ ELY
PROPERTY FOR INSPECTION PURPOSES.
1, q9 OWNER O THE PROPERTY, AM X IV ONT TIN.
WITH LaENSEB CONTRACTORS TO H T U T THE_CT
I)� %/�.
]OJG, DUSINE SSANOP THE CON TRACTOR'S LIC.NSF.
EOF
V� `_J(l
LAW DOES NOT APPLY TOSAN OWNER PROPERTY WHO BUILOE O
SIGNATURE O PERMITTER DATE
IAMPROVES THEREON, Al. WHO C NTRACTS FOR SUCH PROJECTS WITH
oNl..CT.R'S' ucEry s.D OPBREVANT rO THE CONTRACTOR'S
ESTIMATED J
FINAL
Lice N9E LAW.'.
/�yg
VALUATION $ (.f (,% ��"'
VALUATION $
❑ I AM EXEMPT UNDER sec. B.&P.C. PRR THIS a SON
PLAN OTHER
PERMIT
- -'
CHK. FEE $ FEES $
FEE $
ADJUSTED TOTAL
OpTE WNER
P, C. FEE $ BALANCE
OUE $
WORK MUST BE STARTED WITHIN A PERIOD OF 180 DAYS FROM THE DATE OF VALIDATION OR T I PER 1 BECOMES
p NULL AND VOID.
u PLAN CHECK VALIDATION UK. M... GASH PERMIT VALIDATION UK. M.D. ....
O, 5 E-n 1� �,.-p 7.,
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