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HomeMy WebLinkAbout17158 � �_.��_.._ �__�._,.--, �ITY OF D�AAMOND BAR ,�'"�'"""`�'�'""�,I ---��``'--- DEPARTMENT OF COMMUNTI'Y&c DEVELOPMENT SERVICES � I � 21&25 E.Copley Drive (909)R60-3195 Fax(909)861-3117 � PRESS BUILDING PERMIT APPLICATION FIRMLY o DDRIESS��� ���� DATE�ATION� �f.� l!� NUMB R #/C lY' o ISSUE /� " ry'�� TYPE OCC `r APN LOT TEiACT DATE "r V CONST. GROUP p OWNER ���'.T�A�'�, � ADDRESS ��r3 �L,���';✓"`� ZONING SETBACKS Z CIN��YY1^�i1>�i1 C�ZIP TEL. FRONT RW ❑ � APPLICANT TEL. REAR ❑ � SIDElSiDE STREET RW ❑ z m CONTRACTOR��✓..`� �j�. CNC�/'ieJ (� � SIDE ❑ � 'ADDRESS���"��,f}�l�^ f-�-A1� � CITY �.ol��,�✓� ZIP� TEL.�-y� �'�-�� PROPOSED USE oARCHLENG/ w 'DESIGNER NO.DWEL. NO. NO. a AD�RESS � '','CITY ZIP TEL. UNI7S STORIES BEDROOMS c� cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p�� OWNER-BUILDER DECLARATION SFR/ADD/REM O 1 HEREBY AFFIFM UNDER PENAITY OF PERJURY THAT 1 AM EXEMPT FROM hIE CONTFlACTOflS LI- G8f2JB/Cdfp01'I W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANOPROFESSIONSCODE:ANYCITYOR (n . U COUNTYWHICHREQUIRESAPEflM,ITTOCONSTRUCT,ALTER,IMPflOVE,DEMOLISH,ORREPAIRANYSTRUC- W � TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES PHE APPLICANi POR Sl1CH PERMIT TO FILE A SIGNED w Pa1i0/DeCk STATEMENT THAL HE OH SHE IS LICENSED PURSUANi TO THE PROVISIONS OF THE CONTRACTORS LI- � �' CENSE LAW(CHAPTEfl 9(COMMENCWG WITH SECTIDN�000)OF OIVISION 3 OF THE Bl1SINE55 AN�PRO- LL' POOUS�JB ' FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMAND7HEBASISFORTHEALLEGE�E%EMP- � � � TION.pNYVIOLATIONOFSECTION7031.5EVANYAPPLICANTPoRAPcflMITSUBJECTSTHEAPPLICANTTO Z Re-Root � � A CIVIL PBJALTY OF NOT MORE TI1AN FIVE HUNDRED DOLLARS(55�e).): . 0 ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITH.WAGESASTHEIRSOLECOMPENSATIO��, � COrt1rt12fCIflI - Z � WILL DO THE WORK AND THE STRIICTURE IS NOT IN7EN�ED Oq OFFEREO FOfl SALE(SEC,7044,6U51- J � ' NESS AND PROFESSIONS CODE:1`HE COMRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OP � � . PflOPERTYWH09UILDSORIMPRQVESTHEREON,AN�WHODOESSUCHWORKHIMSELFORHEFSELFOR � 'THROUGHHISORHEROWNEMPLbVEES,PflOVIDE�THATSUCHIMPROVEMEMSARENOTINTENDEOOR m , � �,�OFFER�FOR$ALE.IF,HOWEVER,;THEBUIL�INGORIMPPOVEMENTISSOLDWITHINONEVEAROFCOMPLE- z; ' TION,THE OWNER-BUIL�ER WILL HAVE THE BURDEN OF PROVING TI1AT HE Ofl SHE�ID NOT BUILO OR , �,�� IMPROVE FORTHE PUflPOSE OF$ALE). � , ❑I,ASOWNEROFTHEPflDP�Efl1Y,AMEXCLU5IVELYCONTRACiiNGWITFiLiCENSEDCDNTRACTORS g[ �,TO CONSTRUC7 iHE PROJECT(SEC.Io44,BUSINESS AN�PROFESSIONS CODE:THE CONTRACTOAS LI- Valuation ADJ.AREA W, '. CENSELAWDOESNO7APPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPHOVESTHEREON,AND �� WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSE�PIJRSl1ANTTOTHECONTRAG QUANTITY DESCflIPTION FEE � , TORS LICENSE LAW.J. � Q Q ❑I AM EXEMP7 UNDER SEC, B.&P.G FOFTHIS FEASON � U � � ', ', DATE OWNER F" Z , U O � . � LICENSED CONTAACTORS DECLARATION W ¢ ' CC IHEREBYAFFIRMUNOERPENALTY'OFPERJURYTNATIAMLICENSEDUNDERPROVISION50FCHAPTER � p.. � 9(COMMENCMGWITHSECTION�oOo)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND z X "MY IIGENSE IS IN FULL FORCE AND EFFECT. � �-7 /j L � I LICENSECLASS CB '��'a°, LIC.NQ / 7 ��� � � � DATE����t /� CONTRACTOR'��.f�`"� ��sf3��3j' ��� WORKER5'COMPENSATION DECLARATION 9��sr��� U L �r � ' IHEREBVAFFIRMUNDERPENALTYOFPERJURVONEOFTHEFOLLOWINGDECLARATIONS: z �� A � !O. d � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWOflKERS' _ � ¢ . CAMPENSATION,ASPROVI�ED'BYSECTION37ooOFTHELABORCODE,FORTHEPERFORMANCE 'U Q , OFTHEWORKFORWHICHTHIS,PEpMITISISSUE�. � w I HAUEAI�ID WILL MAINTAIN WOFiKERS'GOMPENSATION INSURANCE,AS REQUIRED BY SECTION � 37000FTHELABORCODE,FOR'THEPEflFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSUED.AIYWOFKFAS'COMPENSATIONINSUPANCECARRIERANDPOLICYNUMBERAFlE�. CONSTRUCTION j cnaaiEa�.�/IP71y�"(�E,d�✓g`P�/!�d*`l ��,��b J�.� PLANREVIEW ZPOLICYNUMBER��'_YI ��c"I�cB�d �^ ELECTRIC ^'S � � QHISSECiIONNEmNOTBEOJMPLEfEDOF'IiEPERMRISPJRONEHUt�REDOd.lARS�$100)ORLESSJ. PLUMBING _ Z, ICERTIFYTHATINTHEPERFORMANCEOFiHEWOPKFORWHICHTHISPERMITISISSUEO,I MECHANICAL `� (�, SHALL NOT EMPLOY ANY PERSbN IN ANY MANNER SO AS TO BECOME SUBJECiTO THE (/� WORKERS'COMPENSATIONLAINSOFCA�IFORNIA,ANDAGftEETH IFISHOUL�BECOME INSPECTIONFEE ? SUBJECTTOTHEWDRKERS'COMPENSATIONPqOVISIONSOFSE ION370oOFTHELABOR CODE.I SHALL FORTHWITH COMPLV WIT HO PROVISIONS. ISSUANCE � SMIP p DATE:�� APPLICANT: "J'� WARNINGPAILURETOSECUREWORKERS'COMPENSATIONCOVERGEISUNLAWFUL,ANDSHALLBE ENERGVP/C �y SUBJECTANEMPLDYEHTOCRIMINALPENALTIESANDCIVILFINES PTOONEHUNDREDTHOUSAND ENERGYPERMIT OOLL4RS(51 oo.ou0),IN AODITION YO THE COST OF COMPENSATION,DAMAGES AS PROVIOED FOR IN � SECTION3]OBOFTHELABORCODE,INTERESiANOATTORNEY'SFEES. RETENTIONFEE: __ • OCONSTPUCTION LENDING AGENCY PRE-AlT PEE � IHEREHYAFFIfiMUNDERPENALTYOFPERJURVTHATTHEREISACONSiPUCTIONLENDMGAGENCV FOR THE PERW RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.309],CIV.C.�. Z W' S' LENDER'S NAME �' i— IENDEH'SADDRESS � TOTAL FEES �,�`� �� ICERTIFY7HATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORFECT. W I AGfiEE TO COMPLY WITH ALL GTYAN�COUNTY OR�INANCES AND STATE LAWS REl.ATING TO BUILOING � CONSTrIUCTION,ANDHEREBYAUTHORIZEflEPRES�NTATIVE50FTHISCOUNTYTOENTERUPONTHE � A80VEMENSIONE�PPOPERTY FOR INSPEGTION PURPOSES. 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