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HomeMy WebLinkAbout10706 (5) .. ._ .... ......{ ... _......_. ... . ....... . _._... ...... .._......,....._,..........._....,.,..,,.,.,....-....�.__.... , iV.....,..._., :............ ._,..... .-. .. _.....:.-..�.. ,I 1F� � -" CTl'Y OF DIAMONLI BAIt f j COMMUNITY DEVELOPMENT LSEPARTIvtE�IT' ' ;,,,� 21660 E.Copley Drive Suite 190 , PR ESS �'a�' BUILDING PERMIT)APPLICATION FlRMLY � JOBSITE � 53UEGATION 2 j PERMIT � P/C /�7 < ADDRESS `'�'��` ����� ��' � �� NUMBER � � # �/ / �'��� � APN LO7� TRACT ���_�'� DATE .-. ONST. GROUP p OWNER SD� C�"'co� �-�--.�� o ADDRESS '�-0 �- p''�' ' � '�-'' ZaNING SETBACKS w ZIP ��� TEL. '9""' 6�I FRONT RW ❑ � APPLICANT �� TEL. REAR � � SIDE/SIOE STREET RW ❑ a� CON7RACTOR J"�l'Q-� �.„ r SIDE ❑ p� ADDRESS � " �'�`� PROPOSED USE ��,,,�y'Z3������ �- � CITY ZIP TEL. �^ w ARCH/ENGI •. z DESIGNER ���'+`��` ��°�Z���'�-�`�`�` NO.DWEL. NO. NO. d A�DRESS UNITS STORIES BEDROOMS a CITY ZIP TEL� "�y -"` � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATfON � a OWNER-BL'IL�ER DECLARATION SFWADD/REM O p I HEREBV AFFIRM t1N�ER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE C�NTOACTORS Lb � �ragelCarport W CENSELAWFORTHEFOLLOWMfiREAS�N(SEC.�037.5BUSINESSANDVROFESSWNSCOOE:ANYCITYOR U COl1NNWHICHHE0UIFESAPERMITTOCONSTAUC7,FLTER,IMPROVE,DEMOL13H;ORREPAIRANYSTRUP W PatiolDeck wiURE.PqlOp TO I7S ISSUANCE,AL50 qEDUIR6S THE APPLICANi FOR SUCH PFRMIT TO_FlLE A SIGNED W .` STATEMENi THAT HE OH SHE IS LICENSED PURSUANT TO TH&PROV�SIONS OF THE CONYNA6T6RS U� .� GENSE U W(CHAPTER 9(COhiMENC�NO WITH SECTION 70001 OF DIVISWN 30F THE'BUSIN@SS�AND PRO� � PDDUSp9 � FESSIONSCOOE)OR7HATHEORSHEISE%EMPTTHEREFH�MANOTHEBASISFORTNEALLEOEDEXENP� U TION.ANYViOLRTIONOFSECTION1o91.58VANVAPPLICANTFORAPERMITSU&IECT&7HEAPPUCAN7T0 z Re-Roof � AqVILPENALTVOFNOT�MORE'�HANFlVENUNOiiEDDOLLAR5�15o0)): � - � 0 ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITHWApESA37HEIRSOLECOMPENSATION, O COr11TBfCi31 z WILL DO THE WORK,AND THE STPUCTURE 16 N071NTENOED QR OFFERED FOR SALE{SEb.7odd,BU51� J NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY 70 AN OWNER OF � PROPERiYWHOBUiLO50RIMPROVESTHEREON,AN�WHODOESSUCHWORKHIMSELfOR'HEASELFOF = � THROVGHHISOqHEROWNEMOIOVEES,PROVIOEOTHAT$UCH,IAIPYIOYEMENTSAft�ENOTIMTENDEDOR � � OFFEHEOwRSALE�FHOWEVER'�'��BUILDINGQRIMPROVEMEWTISSOCDWITHINONEVEAKSOfCOMPLE� Z T�ON,THE OWNER-BUILDER WILL HAVE THE BUR�EN OF PqOVING THA7 HE�OR SNE DIO NbT�BUIID pF = IMPROVE FOR 7HE PURPOSE OF 5ALE). � . W ❑I,/SOWNEROF7HEPqOPERTV,AAAEXCLUSIVE4YCOMfiACTNO,WI7HLICENSE�C�NTRAC70P5 �j (t To CaNSTRUCT THE PH0.IECT�SEC.7044,BUSWESS AND PROFESSIONS CODE:TNE CONYRACTOR9 LI� VdluetiOfl ''✓ `Jr AOJ.AREA W CENSELAN�OOE6NOTAPPLYTOANOWNEROFAPROPER7VWHOBUILOSOPIMPROVESTNEttEON,ANO � WNOCONTqACTSFORSUCHPRQIECTSWITHACANTfiACTORfS)UCENSE�PUHSUAMT70TFIECONTRqP QUANTI7Y DESCRIPTION FEE � TORSLICENSELAWJ. � � ❑1 AM D(EMPT UNDER SEC. 8.g P.C.FOR THI&REASON U � � �'= oA7E OWNER V � ac� UCENSED CONTRACTORS DECLARATION �j CL I HEREBY AFFlRM UNDER PENAI.7Y oF PERJl1FivTHAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER �e d B(COMMENCINGWITHSECTION7000)OFONISION30FTHEBUSINES$ANDPqOFESSIONSCG�DE.AND Z !G MV UCENSE IS IN FULL FORCE ANO EFFECT, m � UCENSE CWSS f,,,L� I.IC.NO. ��,��,4La.��.�,,�9 p�pg+`�� � V pATE � �-� �_CON7RACTOFi_pvl"'V�''L,S"MJ� 'l.�^�. O- LLJ , '� .��. ... .. � WORKERS'COMPENSATION DECLARATION�-� -� � ���� V � I HEREBV AFFIRM UNDER PENALT'OF PERJURY ONE OF THE FOLIAW WG DECUMTIO�S. LJ� Q � _I HAVE AND WILL MAINTAM A CERTIFICATE OF CONSENT TO SELf•INSURE FOP WORNERS' S COMPENSATION.RSPROVIOEDBVSEGTION37o00FTHEUBORCO�E,FORTHEPERFORMANCE 'U OF THE W�RK FOR WHICH THIS PERMIT IS ISSUE6. .� O W �IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREOIIIREDBV3ECTpN Q310o OF 7HE LABOR CODE,FOR THE PEPFORMANCE oF THE WOfiK FOR WHICHIHIS PEFMIT IS �.. �`J ISSUED.MVWORKERS'C-OyMs�PEN.�S+AyTrIONINSURAN�CEtC��ApR�RIERAN�POLICYNIIMBERARE: CONSTRUCTION �-,,{—r�—�/��j � � � CAHFIER � Y',i.�O�: ��.K���l LAN REY� ✓Cl � `�V P�+� _ . Z POUCY NUMBER " � ELECTRIC Q � (fHtSSEc170NNE�NOTBEODId�°LEfEDOFTHEFE'f#VfISFORONEFR1MitED00lLAFSlt+ao)OR ). PLUMBING Z I CERTIFY THAT M THE PERFORMANCE OF 7HE WORK FOR WHICH TMS VERMIT IS ISSUEO,I MECHANICAL `K�+t- �} SHALLNOTEMPLOYANYPERSOMINANYMANNER60ASTOBECOMESUeJECT70THE �� � � WORKERS'COMPENSATIONLAWSOFCALIFORNI, DAGREETHATIF�ISHOULDBECOME INSPECTIONFEE � —y-rry� = SUd1ECTTOTHEWORKEiiS'COMPENSATION V IONSO ECTION37000FTHELAHOR ��� � W V CADE J SHALL FORTHWITH COMpLV WITH TH OVISIONS fSSUANGE ���, -p ✓ /\ p �ATE: �*� � 'Y APPLICANT: . """"����TM� SMIP � � � ENERGY P/C __ WARNING FAILURE TO SECURE WOHKERS'COMPENSATIO CO' 0. S UNLAWFUL,AND SHALLBE ��—y, SUBJEC7ANEMPLOYERTOCRIMINALPENALTIESANDCIVIL N TOONEHUNDREDiHOUSAND ENERGYPERMIT DOILARS(L7 W.00U�,IN ADDITION TO THE COST OF COMPENSA ON.DAMAGES AS CROVIDEO FOR IN aSECTION37080FiHEU190flCODE.INTEREST.ANOATTORNEV'SFEES FETENTIONFEE: pW„ CONSTRUC710N LENDING AGENCY PRE-AlT FEE: � 1 HEREBY AFFIRM UNOER PENALN OF PERJURYTHATTHERE�.S ACONSTflUCTION 1EN01N0 AGENCY FORTHE PERWRMANCE OF THE WOflK FOR WH�CH THIS PEPMIT IS ISSUED ISEG.�aW,CIV.CJ. 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