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HomeMy WebLinkAbout079-310-024. d /7AI �]C MISCELLANEOUS- Patio Cover/Cvd Pch UTTE CONSTRUC.TIUN. G0_.___T 1366-71� PATIO COVER (160) 13/- 71j, 75 OAKVALE CT CJ� .. - 11,7 LAMBERT, LINDA K. ETAL _ 5 Oakvale Ct., Oroville ^ B -08=T-22- 079=3T0 02- (riew single family) /2 4 — MISCELLANEOUS Re -Roof RE -ROOF SF (15 SQ) 75 OAKVALE CT _ LAMBERT, LINDA K ETAL ' i i � I k i" i i I dl 'I a � I i IIi I i i - I r BUTTE COUNTY, DEPARTMENT OF DEVELOPMENT SERVICES . BUILDING PERMIT 24 HOUR INSPECTION (IVR):' (530) 538-4365 OFFICE: (530) 538-7541 FAX#: (530) 538-2140 ONLINE PERMIT/RENEWAL PAYMENTS: www.buttecounty.net\dds PROJECT_ INFORMATION _ Site Address: 75 OAKVALE CT Owner: Permit No: $0$-1224 APN: 079-310-024 LAMBERT, LINDA K. ETAL Issued Date: 7/14/2008 By GLB Permit type: MISCELLANEOUS 75 OAKVALE CT Subtype: Patio Cover/Cvd Pch OROVILLE, CA 95966 Expiration Date: 7/14/2009 Description: PATIO COVER (160) (530) 534-3615 r Occupancy: Zoning: AR 0 - Contractor Applicant: Square Footage: • LAMBERT; -DOUGLAS E. Building Gara g e Remdl/Addn g 75 OAKVALE CT OROVILLE, CA 95966 'Other 'Porch/Patio Total (530) 534-3615 160 160 -FEE INFORMATION DBMSC Patio Cover/Covered Porc $164.00 DBSMIP Residential $0.50 Total Charged: $164.50 Fees Paid: $164.50 Balance Due: $0.00 Receipt No: B7811 LICENSED CONTRACTOR'S-DECLARATIONOWNER . /BUILDER DECLARATION- Contractor (Name) State Contractors License No. / Class / Expires I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) is in full force and effect.` of Division 3 of the Business and Professions Code] or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects X 7/14/2008 the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: Contractor's Signature Date I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE 1 COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of the property, who builds or improves thereon, and who does WORKERS` COMPENSATION. DECLARATION:. , I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: the work himself or herself or through his or her own employees, provided that such improvements 1:1I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR are not intended or offered for sale. If, however, the building or improvement is sold within one WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the year of completion, the owner -builder will have the burden of proof that he or she did not build or performance of the work for which this permit is issued. improve for the purpose of sale.). ' ❑ I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED EJ CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Professions Code: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. The Contractor's License Law dows not apply to an owner of the property who builds or improves My Workers' Compensation insurance carrier and policy number are; thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractor's License law.). Carrier: Policy Number:. Exp. Date: (This section need not be completed if the permit is for one hundred dollars ($100) or less.) 11 1 AM EXEMPT under Section 4 B. & P.C. for this reason: CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 shall not employ any person inmanner so as to become subject to the Workers' ----_�� Compensation Laws of California, and r that if I should become subject to the workers' 7/14/2008 compensation provisions of ion 3 of the Labor Code, I shall forthwith comply with those netsi ature Date provisions. n, X 7/14/2008 I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinances, rules, regulations, and State laws relating to building nature Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, injury, including death, and property damage caused by, arising out of, or in any way connected with - DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND the issuance of this permit. I hereby acknowledge that issuance of this permit does not authorize the use or occupancy of any sidewalk, eet, or subsidewalk. I hereby authorize representatives of Butte ATTORNEY'S FEES. County to enter the above menat propertrt__for inspection purposes. I hereby certify that I am the pr perty owner gr m ath ue con the he property owners behalf. _ CONSTRUCTION LENDING AGENCY b; - _ -. _ - 7/14/2008 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for Name Of P2 a [SIG ] Print Date the performance of the work for which this permit is issued. (3097 civ. code) Owner ❑ Contractor OR; ' ❑Agent for Owner Agent for Contractor FILE COPY Lender's Address City State Zip I BUTTE COUNTY O��T��0 DEPARTMENT OF DEVELOPMENT SERVICES 0 0 BUILDING PERMIT APPLICATION* 00 0 OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 c P'_ c A FEE WILL BE REQUIRED AT TIME OF APPLICATION Website: www.buttecounty.net/dds OV N� PLEASE PRINT CLEARLY F ILE "When filed, this application and all supporting material becomes subject to the Calif i lic Record AQ. All Pa, related to this application is subject to public inspection and will be posted on the County's website for electronic access. CONTRACTOR OWNER INFORMATION Last Name L p-, AddressPo /3 Fit Name bo C, o S Mailing Address I S oc 1���►/e C City v fov1, t Fax State Zip Pho:710 say 36is Fax E-mail State License Number CONTRACTOR Name _30e reA(4(Rt_F06r Poor. AddressPo /3 City Par4a 5c Stale cA Zip J Phone Fax E-mail Lic. # 9 Y $ I Class J APPLICANT INFORMATION ARCHITECT/ENGINEER Name Address Address State City PhonS3 3615' State Zip Phone Fax E-mail State License Number APPLICANT INFORMATION Name Address City O� " C o State Zips T T PhonS3 3615' Fax E-mail W M -IM WA 'v/ PROJECT LOCATION AP# f v Property Address �S ec k�a li C f City Ot vi'l Q 9S'y�� WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than licensed contractors, a certificate of worker's compensation must be shown at the time of permit issuance. I LENDING AGENCY I Name Lddress DESCRIPTION OR SCOPE OF WORK. av X i co Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA I Yes I No Occ. Type Const. Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-2140 Fax www.buttecounty.net/dds OWNER -BUILDER INFORMATION An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "owner -builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: ° If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $500 or more for the entire project and such persons are not licensed as contractors or subcontractors, then you may be an employer. ° If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal ° income tax withholding, federal social security taxes, workers/ compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks to you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. ° For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perforin their work personally or through thier own employees, without a license contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractor is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board's automated telephone information system at 1-800-321 -CLSB (2752) or by accessing thier website at www.CSLB.ca.gov. PLEASE COMPLETE AND RETURN THE ENCLOSED OWNER -BUILDER VERIFICATION FORM SO THAT WE CAN CONFIRM THAT YOU ARE AWARE OF THESE MATTERS. THE BUILDING PERMIT WILL NOT BE ISSUED UNTILL THE VERIFICATION IS RETURNED. OWNER BUILDER VERIFICATION PLEASE COMPLETE THIS FORM AS REQUIRED BY THE STATE OF CALIFORNIA (SENATE BILL NO. 831 EFFECTIVE JULY 1, 1980). NO BUILDING PERMIT WILL BE ISSUED UNTIL THIS VERIFICATION IS RECEIVED. I PERSONALLY PLPROVIDE THE MAJOR LABOR AND MATERIALS FOR CONSTRUCTION OF THE PROPOSED PROPERTY IMPROVEMENT. S NO) 106 VE NOT) SIGNED AN APPLICATION FOR A BUILDING PERMIT FOR THE PROPOSED WORK. 3. I HAVE CONTRACTED WITH THE FOLLOWING PERSON (FIRM) TO PROVIDE THE PROPOSED CONSTRUCTION: NAME ADDRESS CITY PHONE CONTRACTORS LICENSE NO 4. I PLAN TO PROVIDE PORTIONS OF THE WORK, BUT I HAVE HIRED THE FOLLOWING PERSON TO COORDINATE, SUPERVISE, AND PROVIDE THE MAJOR WORK: NAME ADDRESS CITY PHONE CONTRACTORS LICENSE NO 5. I WILL PROVIDE SOME OF THE WORK BUT I HAVE CONTRACTED (HIRED) THE FOLLOWING PERSONS TO PROVIDE THE WORK INDICATED: NAME ADDRESS PHONE TYPE OF WORK Description: PATIO COVER (160) Reference Number: B08-1224 Applicant Name: LAMBE Owner's Name: LAMBE] Signature of Property Owner: AP # : 079-310-024 Date: 6 --2.$'-© $' Butte County Department of Public Works J. MICHAEL CRUMP, DIRECTOR LAND DEVELOPMENT DIVISION Storm Water Managment Program 7 County Center Drive Oroville, CA 95965 (530) 538-7266 .Telephone o�Y""�ivr .C.* o � Fo. O .0 O. O O o O o S (530) 538-7171 Fax trc W� www.buttecounty.net/dds National Pollutant Discharge Elimination System (NPDES) Phase II Construction Storm Water Permit and Storm Water Pollution. Prevention Plan (SWPPP) Acknowledgment [LESS THAN 1.ACRE 1 Reference Number: 1308-1224 Dater 06/25/2008 Location: 75.OAKVALE CT By: KCG Parcel Number: '079-310-024 Sub Type: Patio Cover/Cvd Pch Owner Name: LAMBERT, LINDA K. ETAL Phone: (530) 534-3615 Description: PATIO COVER,(160). ' By signing below, I the project owner/owners' agent, certify that this project WILL NOT DISTURB 1 acre or more of land and that I therefore, do not need to apply for a Construction Storm Water Permit from the State of California Regional Water Quality Control Board. Phased projects that contain multiple site buildouts of less than one acre but when combined With subsequent phases total more than*one acre of.disturbed soil will require a Construction Storm -Water Permit from the state of California Regional Water Quality Board. I am aware that submitting false and/or inaccurate information or failure to apply for a Construction Storm Water Permit from the ,State of California Regional Water Quality Control Board for, this project that disturbes one acre or more of land may result in revocation of grading and/or other permits or.other santions provided by law. Signed:. _ Date: 06/25/2008 Title: �0 /h mac,. e l FILE Butte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DIRECTOR 7 County Center Drive Oroville, CA 95965 (530) 538-7601 Telephone (530) 538-2140 Fax www.buttecounty.net/dds NOTICE TO BUILDERS" Before your building permit can be issued, your plans must be checked for compliance with the California Building Codes. In addition, your plans are routed to other regulatory entities including but not limited to Planning, Public Works, Environmental Health, and the California Department of Forestry for their clearances and approvals. There are some things you can do to expedite your permit - 0 Make sure your application is complete. 0 Be responsive to requests from County departments for any additional materials or requirements. The Building Division places its highest priority on processing building permits as quickly as possible and each day that passes without a complete application adds to processing time. Every permit issued by the Building Official shall expire and become null and void if the work authorized by such permit is not started or completed within one year from the date of issuance of such permit. A permit may be renewed (for a fee) prior to expiration an indefinite number of times, provided construction progress has been documented by the Building Division during each year during scheduled inspections. No changes may be made in the original plans and specifications for such work. In order to reinstate action on a permit after expiration, the permittee shall pay a new full permit fee and additional plan checking and documentation may be required. Upon completion of work covered by this permit, please contact this office for final inspection. As a reminder to you, it is illegal to occupy this building or any portion of the building for which this permit is issued without a final inspection. EXPIRATION OF PERMIT APPLICATION AND REFUND POLICY" Application for which a permit has not been issued will expire one year after date of application. Refunds may only be made upon written request by the person who originally paid the fees. Refunds for permit applications, if the permit has not issued, but not after 180 days from the date of fee payment. Fees paid at the time of application are for Plan Check and administration. The Plan Check portion of fees is refundable only if the permit is cancelled or withdrawn before any plan checking is done. Building Division costs will be deducted prior to authorizing a refund and a charge to process the refund application will be assessed. Refunds on permits (issued) may be requested prior to the expiration of the permit, provided no work has been done pursuant to the permit. An Inspection may be required (and deducted from any refund amount) to determine no work was done. Fee/refund information can be read on-line at http://municii)alcodes.lexisnexis.com/codes/butteco/ "When filed, this application and all supporting material becomes subject to the California Public Records Act. All public information related to this application is subject to public inspection and will be posted on the County's website for electronic access. Reference Number: B08-1224 Date: 06/25/2008 Location: 75 OAKVALE CT Parcel Number: 079-310-024 Owner Name: LAMBERT, LINDA K. ETAL Phone: (530) 534-3615 Description: PATIO COVER (160) Signature of Applicant: Date: 06/25/2008 FILE 0 r�\ - APPROVED PLANS AND PERMIT SHALL BE ON SITE L/3 FOR ALL INSPECTIONS s', +� — �31\ THE 2007 CBC, CMC, CPC, CEC, AND 2005 CALIFORNIA R ENERGY STANDARDS AS r0ther:_ NGDIVISION-BUILDING PLANAPPRQVAL AMENDED BY THE JURISDICTION �� �� APPLY TD THIS PROJECT, � Date; . Q%`" �/✓ LBndc�a ture: r -- ra };c S FILE COPY 75 ��K Vc,Ie �.t BUILDING PERMIT# ASSESSOR' ' PARCEL# O &1; " BUTTE, Y� ... APPROVE) o o • a x 6 RA��" ^S ay o L new /�q i Jeri 4-v e,X;Sf1nJ r c\ cr$ D �tNcP -top ffla{p c�Fwgl Soli 610 h ov r 6eQ� A-35 oheo cy owe 3�yX OP) X 9 x1 o a(7�6 ' PoS�'- t o lie �,.-� . X61- (r ced e 01 nd C4,5 qh /7ec.� /e P- f� d i x: . APPROVED ��GUS2 90 k< sl vJ —Z 1 � ?c n 7a 2ill - qI" i ce /C� p s c �o -9 BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT, 24 HOUR INSPECTION (IVR): (530) 538-4365 OFFICE: (530) 538-7541 FAX#: (530) 538-2140 ONLINE PERMIT/RENEWAL PAYMENTS: www.buttecounty.net\dds . _ _ _--- —.. PROJECT INFORMATION Site Address: 75 OAKVALE CT Owner: Permit NO: B0$-1225 APN: 079-310-024 LAMBERT, LINDA K ETAL WARNING: URE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, Issued Date: 06/25/2008 By KCG Permit type: MISCELLANEOUS 75 OAKVALE CT Subtype: Re -Roof OROVILLE, CA 95966' Expiration Date: 06/25/2009 Description: RE -ROOF SF (15 SQ) (530) 534-3615 Occupancy: Zoning: Contractor Applicant: Square Footage: ALL WAYS ROOFING LAMBERT, DOUGLAS E. Building Garage - Remdl/Addn PO BOX 545 75 OAKVALE CT PARADISE, CA 95967 OROVILLE, CA 95966 Other Porch/Patio Total (530) 876-0113 (530) 534-3615 FEE. INFORMATION DBMSC Re -Roofing $119.00 LICENSED CONTRACTOR'S DECLARATION Contractor (Name) State Contractors License No. / Class / Expires ALL WAYS ROOFING 904871 / C39 / 10/31/2009 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. X 06/25/2008 Contractor's Signature Date WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY one of the following declarations: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑I HAVE AND WILL MAINTAIN WORKER'S COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers' Compensation insurance carrier and policy number are; Carrier•. State Fund Policy Number:713-0020323 Exp. Date:10/01/2008 (This section need not be completed if the permit is oror on�llars ($100) or ess. I CERTIFY THAT IN THE PERFORMAN F THE WORK FOR WHICH THIS PERMIT IS ISSUED, I shall not employ any person ' y manner so as to become subject to the Workers' Compensation Laws of California, an a ee that if I should become subject to the workers' compensation mpensation provisions of lion 7 of the Labor Code, I shall otthwith comply with those provisions. 00 Total Charged: $119.00 Fees Paid: $119.00 Balance Due: $0.00 'Receipt No: B7812 r OWNER / BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5), Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License Law [Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars [$500]; Please check one of the following: I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property, who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proof that he or she did not build or improve for the purpose of sale.). 1, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (Sec. 7044, Business and Professions Code: The Contractor's License Law dows not apply to an owner of the property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the +Contractor's License Law.). ❑ I AM EXEMPT under Sectio B. & P.C. for this reason: S X 6/25/2008 Owner'sNISilirn.Aure 4Z Date 06/25/2008 I hereby certify that I have read this application and state that the above information is correct. I agree Signature Date to comply with all City and County ordinances, rules, regulations, and State laws relating to building WARNING: URE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, construction, and with any and all conditions of permit. I agree to defend, indemnify, and hold harmless Butte County, its officers, agents and employees from any and all claims and liability for personal AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE injury, including death, and property damage caused by, arising out of, or in any way connected with HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, the issuance of this permit: I ereby acknowledge that issuance of this permit does not authorize the DAMAGES AS PROVIDED FOR INSECTION 3706 OF THE LABOR CODE, INTEREST AND treet, or subsidewalk. I hereby authorize representatives of Butte use or occupancy ofkovention�ed ATTORNEYS FEES. County to enter th property for inspection purposes. I hereby certify that I am the _ CONSTRUCTION LENDING AGENCY prop"owneract on the property owner's behalf. - b 7 06/25/2008 I HEREBY AFFIRM UNDER PENALTY OF PERJURY that there is a construction lending agency for Nam Permitt[SIGN] Print Date the performance of the work for which this permit is issued. (3097 civ. code) Owner Contractor OR. Agent for Owner Agent for Contractor Lender's Address City State Zip 'FILE COPY ` BUTTE COUNTY DEPARTMENT OF DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION* OFFICE #: (530) 538-7541 FAX #: (530) 538-2140 A FEE WILL BE REQUIRED AT TIME OFAPPLICATION Website: www.buttecounty.net/dds PLEASE PRINT CLEARLY PERMIT NO. ,06.122 BIN # **When.filed, this. application and all supporting material becomes subject to the California Public Records Act. All public information related to this application is subject to public inspection and will be posted on the County's website for electronic access. OWNER INFORMATION Last Namem L Fi Name Mailing Address-oo City rig(/;, Ile -I State Zp Phonts 3c '3 r 3 (o r g Fax E-mail APPLICANT INFORMATION CONTRACTOR Name AddressQ le Address Address A p � 0;r -s- q CityA, e State Zip 4S Phone .) (o_ or! Fax E-mail State License Number Lic.# r1� Class APPLICANT INFORMATION ARCHITECT/ENGINEER Name AddressQ le Address j G City Citymro State Zp Phone V/1 [ Fax E-mail q State License Number APPLICANT INFORMATION Name C^ AddressQ le d j G Yes Citymro Occ. State Zip V/1 [ q Phone S '7 r Fax E-mail PROJECT LOCATION API (1 Property Ad T, L � O G tiG city� � � W �s 91o6 WORKER'S COMPENSATION Policy Number Carrier If hiring anyone other than licensed contractors, a certificate of worker's compensation must be shown at the time of permit issuance. LENDING AGENCY Name Address DESCRIPTION OR SCOPE OF WORK. S Q re Sq FT- Living Garage Open Cov ❑ Structure Built without Permits ❑ Proposed Change of Occupancy (Note previous use): For office use only: Zoning Flood Zone SRA Yes No Occ. Type Const.