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Home My WebLink About12948 ,, �� _ _1,�� CITY OF DIAMOND BAIt /J^C, DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �T � 21660 E.Copley Drive Suite 190 �,,,, (909)860-3195 Fax(909}861-3117 PRESS �' BLIILDING PERMIT AP�.�CA'�'I`Il�`lv ` . ,' _,. _ _ ... _. � -- -- - . - , , ,.., FIRMLY 2 _ ., , , ¢ D RfESS �17 /�� ' APPLICATION - .J PERMIT Z P/C p DATE NUMBER # � ISSUE TYPE OCC APN—�— l,�T-�-� TRACT DATE CONST. GROUP p OWNER �/r' [�1"��C' dC�. o ADDRES,S�yZS' �-c9 �I�it�� ZONING SETBACKS W CITY(tOf�L_�r2N� ZIPS'r�3"S'TEI� _ �� REART RW ❑ � APPLICANT TEL. � � SIDE/SIDE STREET RW ❑ � CONTRACTOR �L�-sr�+C� SIDE p ADDRESS � CITY ZIP TEL. PROPOSEDUSE �M�t�-�prr �G � , CKjjldL�' o ARCH/ENG/ z DESIGNER � ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � <n DESCRIPTION SQ.FT: FqCTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFRlAOD/REM O I HEHEBY AFFIRM UNDER PENALiY OF PERJURV THAT I AM EXEMPT F(70M THE CONTRACTORS ll� G$I'8J0/CBI�1plt W CENSEUWFORTHEFOLLOWINOREASON(SEG7o31.68USINESSANDPFiOFESSIONSCODE:ANYC11YOq (n U COUHTYYNiICFIREIXIIRESAVERMrt7000N5TRUCT,AI.TER,IMPROVE,�EMOLISH,ORFEP/UHANYSTRUC� w W TURE,PRqR TO RS ISSUANCE,QSO REQUIqES TME APPLICANT FOA SUCM PERMIT TO FILE 0.SIGNEO W PatiolDeck � STIITEMENT THAT HE ON SME IS LICENSED PURSUM7T TO THE PROVISIONS OF THE CONTHACTORS U� � CENSE LAW(CHAPTER G(WMMENCINCi WITH SECTION 7000)OF pIVISION 3 OFTHE BUSINESS AND PR0- POOUSpB FESSqNSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP• (� TION.ANYVIOLATIONOFSECTIdV703t.68VANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Root � A CMl CENALTY OFNOTl.bRE THAN FIVE HUNDRED DOLURS�5500).): � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOI.ECOMPENSATIDN, � COrt101BfCi01 -- WILL DO THE WORK AND THE STRUCTURE IS NOT IMENOED OR OFFERED FOR SALE(SEC.7o4I,BUSI- J � NE33 AND PROPESSIONS CODE:1HE CONTRACTOR3 LICENSE LAW OOES NOT APPLY TO PN OWNER OF ? PROPEHTY NM110 BUILDS OR IMPROYES THEREON.AND WHO�OES SUCH WORK HIMSELF OR MERSELF OR Q THROUCiHNI50RHEROWNEMPIOYEES,PROVIOEOTHATSUCHIMPROYEMENTSARENOTINTENOEDIXi m 0 OFFERFAFORSJLLEIF,FIOWEVER,THEBULDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOSIPLE- Z TION,THE OWNEF�BUILDER WILL HAYE THE BUROEN OF PROVING THAT HE OR SHE DID NOT BUIID OR = MIPHOVE FORTHE PURPOSE OF SAIE�. W ❑I,ASONMEROFTHEPpOPERTV,AMEXCLUSIVELVCONTRACTINGWRHLICENSEDCONTRACTORS � TO CONSTHUCTTHE PROJECT(SEC.70u,BUSINESS PND PqOFESSIONS CODE:THE CONTRACTOqS ll- VeWBtiOn ADJ.AREA � CENSEUWDOESNOTAPPLVTOANOWNEPOFAPROPERNWHOBUILDSORIMPPOVESTHEREON,ANO WFIOCOMMCTSFOR&UCHPROJECTSWITHACONTRACTOR(S)UCENSEDPURSUANTTOTHECONTRAF QUANTITY DESCRIPTION FEE � NRE LICENSE LAW.�. ❑I AM E%EMPT UNDEP SEC. 8.8 P.C.FOR THIS RE0.50N J � o a ?r„ V . ,. .. .. � DATE �"I '�Y OWNEH �� ' /�' � . � LICENSED CONTRACTOHS ECLARA ION J � W I HEREBY AFFIRM UN�ER PENALTV OF PEFLIURY THAT I AM LICENSm UNDE9 PROVISIONS OF CHAPTER � � B(COMMENdNO WITM SECTION 1000)OF�IVISION 3 OF'fHE BUSINESS AN�PROFESSIONS CADE,AND Z �� MY IICENSE IS IN NlL FORCE AND EFFECT. m r i � LICENSE CLASS L�C.NO. � � J V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV 0.FFIRM UNDER PENALTY OF PERJURY ONEOF THE FOILOWiNG DECIARATIONS: Z � _IHAVEANDWILLMAINTAINACERTIFlCATEOFCONSENTTOSELF-INSUREFORWORNERS' � �� COMPENSATION,ASPROVIOEDBYSEC710N37ooOFTHEI.ABORCODE,FORTNEPERFORMANCE w OF 7HE WORN FOR WHICH THIS PEPMIT IS ISSUED. � � W _I HAVE AND WILL MAIMAIN WOBKERS'COMPENSATION INSURANCE,AS RE�l11RED BY SECTION /.� Q 370o OFTHE LABOR CODE.FOR THE PERFOiiMANCE OF THE WORK FOR WHICH THIS PERMIT IS C 9 // ISSUED.IdV WORKERS'COAIPENSATION INSURANCE CARRIER M�GOLICV NUMBEfl ARE: CONSTRUCTION �l' � �/ � CARRIEH PLAN REVIEW ZPOUCVNUMBER ELECTRIC 6 0 (TFiISSECTICNNE�NOTBEOJMRETFDOFTHEPEPIMISFaFiONEHUNOHE�00U1AS(51ao)IXiLE55R PLUMBING Z I CERTIFV THAT IN THE PERFORMANCE OF THE VJORK FOR WHICH THIS PERMIT IS ISSUEO,I MECNANICAL (,'j SHALL NOT EMPLOV ANY P£RSON IN ANY MANNER SO AS TO 9ECAME SU&IECT TO THE � WORKERS'COMPENSATIONUWSOFCALIFORNIA,ANDAGREETHATIFISHOULOBECOME INSPECTIONFEE � SU&IECTTO THE VYORKERS'COMPENSATION PROVISIONS OL'SECTION 3�0o Of THE LABOR - � CO�E,I SMALL FORiHWITH COMPIV WITH TF105E PROVISIONS. ISSUANCE � SMIP f p OATE: APPLICANT. ___..—.__ _ J WARNINQ:FAILURETOSECUREWORKERS'COMPENSA710NCAVERAGEISUNLAWFlJL,ANDSHALLBE ENERGYP/C � SU&IECTANEMPLOYERTOCRIMINALPENALT�ESANDCMLFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f100,OWJ,IN ADDIIIONTO THE COSTOF COMPEN9ATKKJ.DAMADES AS PROVIDED FOR IN ¢ SECTION37080FTMEUIBORCOOE,MTEREST,ANDATfORNE1"SFEES. RETENTIONFEE: �fTVPI T7AAK!'11sY7lU d CONSTRUCTION LENDING AGENCV �'�T�,�=��T'��-D� O PRE-ALT FEE: t rrr nrwrr-� ■r,��-f^•rV � I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION IENDING AOENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS�SSUED(SEC.3oe7,CIV.C.). . . . Z W � LENDER'S NAME � F- LENDER'SA�UHE55 r W I CERTIFV TiAT I HAVE READ TMIS APPUCATION AND STATETHATTHEABOVE INFORMATKKJ IS CARHECT. TOTAL FEES �� d �y r�� IAGREETOCAMFLVWITHALLCITYANOCAUNTYOR�INANCESANOSTATELAWSRELATINGTOBUILDING � CONSTRUCiION,ANO HEREBV AUTHORIZE REPqESENTATNES OF TNIS COUNTY TO ENTER UPON THE , - , _ Z ABOVE�MENTIONED PflOPERTV FON INSPECTION PURPOSES. COMMENTS o �� ,L ; m ¢ PERMITTE�NAME(PRIN'n -' S-ry „ •1 _� .. aJ L�J . dC i V�}C./ � .� . . � ONANREOPPE EE DATE � � = FiECPT.NO. PAID BY ✓ �'��VAU�ATION ~ WHITE—Department Capy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROP—File Copy,GREEN—ApplicanPs Copy .,.... ., � .,...... ....:,,:�: ,::a,�. ,: ,. ...�,,�:, . ...�. ,,,,,_;° hw� �<n-a i,� y�.-.. :.-.�. ..n::_�, . . „ , . . . � �� 5� � �O� ,.. .. .,..f�K-t ... . ... . ... . . . . ....�, . . �. .. ,,.. . . . _. . � :,.. 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