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CITI'�F DIAMOND BATt �;;::� ""�'� �- -I�� DEPART1vIENT OF COM1vIUNITY&DEVELOPMENT SERVICES �°`T��� � ' 21825 E.Copley Deive �' "`. {909)860-3195 Faac(909)861-3117 ='� � PRE$$ '��`�»n�'�" �UIL.DING PE1tMIT APPLICATION FIRMLY Q� JOBSITE ,,J' APPLICATION ' PERMIT ��`'"'""` P/C ADDRESS V4� ~ DATE � r� � � NUMBER�� # � ISSUE TYPE OCC APN LOT -`RACT DATE CONST. GROUP p OWNER Q ADDRESS ' ZONING SETBACKS z CITY � ZIP TEL. FRONT RW ❑ � APPLICANT TEL. REAR ❑ z SIDE/SIDE STREET RW ❑ ¢ CONTRACTO SIDE ❑ � ADDRE�S p PROPOSED SE CI ZIP TEL. �� w ARCH/ENG/ ���fi��� � � z DESIGNER w NO.DNJEL. . -� � a ADDRESS ' � 'CITY ZIP TEL. UNI7S STORIES BEDROOMS � - cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECLARATION SFWA�D/AEM O '. p '„ 1 HEREBV AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FAOM THE CONTRACiORS LI- G8f8JBICflfpOfl . W 'CENSELAWFORTHEFOLLOWIMG:REASON(SEC.7037.58USINESSANOPROFESSIONSCODE:ANYCITYOR ' ((� 'U. :COUNNWHICHREQUIRESAPERMITTOCONSTflUGT,ALTER,IMPROVE,DEMOLiSH,OflREPAIRANI'STRUG W i ''TURE,'RRIOR TO ITS ISSUANCE,ALSO flE9UIRE5 THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED . W Patio/Deck �� .SiATEMENT THpT HE Oq SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- �' �'I,CENSE LAW(CHAP7ER B�(COMMENCING.WITH SECTION 7oao)OF DIVISION 30F iNE BUSMESS AND PRo. �'�' POOVSpfl � Q�, ;:�,FESSIONSCObE)ORTHATHEORSHEISE%EMPTTHEREFFOMAN�THEBASISFOFTHEALIEGEDEXEMP� (� � U i;TION.ANYVIOLA710NOFSECTION7u37.58YANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTiO Z Re-Roof � A'CIVII�PENALTV OF NOT MORE TFIAN FNE HUNDRED DOLLAflS(E500).): 0�� ' ❑I,ASONTIEROFTHEPROPERT',ORIdYEMPLOYEESWITHSYAGESASTHEIR50LECOMPENSATION, � COfi'IrtI0fC18I - Z�, �,Vi'ILL DO 7HE WORk(,AND THE§7AUCTURE IS NOT INiENDEO Ofl OFFERED FDR SALE(SEC.7044,8U51- .J ���� ';NESS AN�PflOFESSIONS'�COOE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TD AN OWNER OF ? � +'�PROPEHTYWFIOBUIL�SORIMPR�IVES?HEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR �'� '�"THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS AqE NOT INTEN�ED OR CO � �.� ;,'�,OFFEREDFORSAIEiFHOWEVEFi;THEBU�DMGORIMPROVEMENTISSOL�WITHINONEYEAROFCOMPLE- ' '�� ;'i T10N,THE OWNER-Bl/1LDEP WILL'�,HAVE THE BUPDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR i;''.,'.IMPROVEFOFl�THEPURPOSEOFSALE). ' ❑I,ASOWNEqOFI'HEPROPERN,AMEXCLUSIVEIYGONTRACTMGWITH�ICENSEDCONTRACTORS ��'�', �!'�;'�TOCANSTftUCTTHE.PROJEGT(SEC.7o44,BU51NE55AN�PROFE5510N5CODE:THECONTRACTORSLI� I V8IU821DI1 ADJ.AREA � W�� �;'�.CENSELAW��OESNOTAPPLYTOANOWNEROFAPROPERTI'WHOBUILDSORIMPROVESTHEREON.AND �.�"�,;���:WHDGONTflACTSFORSUCHPROUECTSWITHACONTflAC70R(SILICENSEDPUASUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE � Y�, {�TORS LICENSE LAW.). � ,Q �I, ❑I AM EXEMP7 UNDER SEC., B.&P.Q FOR THIS REASON Q � � 'i U � �. ' pATE� OWNER I-' Z.. ".. W �.'. ��' � LICEN$ED CONTRACTORS DECLARATION W Q ��"� '�. I HEfiEBVAFFIRM UNDER PENALTY OF PERJURY THAT IAM LJCENSED l/N�ER PROVISIONS OF CHAPTEfi � d�; ',;9(COM6AENCWGWITHSECTION7p00)OFDIVISION30FTHEBUSINESSAN�PROFESSIONSCODE,AN� z .w'.' ''.MY LICENSE IS IN FULL FORCE pND EFFECT. m ���� 'LICENSE CLASS w� _ LIC.NO, �f�-� j � ~ '.�ATE,� '""�`"�! GONTRACTOR w I. r �� WORKERS'COMPENSATION DECLARATION Q �' ' IHEREBYAFFIRMUNOERPENALryDFPERJIJRYONEOFTHEFOLLOWINGDECLARATIONS: z '�' _IFIAVEAN�WILLMAINTAINACEFTIFICATEOFCANSENTTOSELF-MSUREFORWORKERS' ¢ �Q�'. ". COMPENSAiION,A5PR041DED��9YSECTION37ooOFTHELA90RCO0E,FORTHEPERFORMANCE U . OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W 0 � QW _IHAVEANDWILLMAINTAINWORKEflS'COMPENSATIONINSURANCE,ASRE�UIREDBYSECTION �'ry 37000FTHELA90RCO�E,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS grf ISSUED.MY WOR EFS'COMPENSATION IN URANCE CARFIERAND POLICY NUN6ERARE: CONSTRUCTION ��� �n Q > caRRi6R PLAN REVIEW ZPDLICYNUMBER ` ELECTAIC Q ' . ' , �. _.._ _'_ - . .� -.._. ..._. _,_... � (iH65ECTKlNNEbNbYBEC�MRETE�OFTI-�PERIAITISf�ORONEHUNDREDDd,LARS(SiW)ORLESS). PLUMBING '-� Wi =._._ _-, , . . . Z. ICERTIFVTHATINTHE�Pc�6iFORMAM1'CEOFTHEWOP.KFORWHICHTHISPERMITISISSUED,I MECHANICAL �- (7 SHAI_NOT EMPLOY ANY PER50N IN ANY MANNER SOAS TO BECOME SUBJ[CT TO TI1E `. y�p�y �Uj� WORKERS'CqMPEN8q71qNLAWSOFCALIFOPNIA,AN�AGftEETHATIFISHOUL�BECOME INSPECTIONFEE I �6 S � �C�rS`� F SUBJECTTp7HE'WORKERS'COMPENSATIONPftOVI510NSOFSECTYJN37000FTHELA80R ! �� m''-�`T� �' � � CO�EISHALLFORTf{WIZ}iCOMPLYWITHTHOSEPROVI 'N;.o ISSUANCE �__ ��./v � 6 "`.. � � SMIP �.--, � � OATE:/ � �� �� APPLICANT. B� �W;� e � ' � �� ENERGY P/C s-.=.� '-- -> --... , ' DOLLARS E70�,O000� SECU�EWORKERS'COMPENSATIONCOVEFAGEISUNLAWFUL,ANOSHALLBE �-' ---- . _ _,, , WARNING FAIUIRE��T ��� � ERTO pIMINALPENALTiESANDCIVILFINE5UPi00NEHUNDRED7HOl15AND ENERGYPERMIT � N pD�ITION,TO THE COST OF COMPENSATION,DAMAGES AS PROVI�ED FOF IN J�'' SECTION3]o90F7HELABOR�CO�E,INTEREST,ANOATTORNEV'SFEES. Ea' p� � RETENTION FEE: / 0.': � ��CdNSTRUCTION LENDING AGENCY PRE-ALT FEE: O` � ��'" IHEREBYAFFIRMUNDERPENALTYOFPERJURYTWATTHEREISACONSiRl1CTIONLENDMGAGENCV n-' FOR THE PERFORMANCE OF�THE WORK FbR WHICFI THIS PERMIT IS ISSUED(SEC.3o97,CIV.C.�. � Z' W: �;�. ' LENDER'S NAME '1^-�� �. LEN�ER'SADDAESS 6 W�" . ICERTIFYTHpTIHAVEREADTHISAPPLIGTIONAN�STATE7HATTHEA90VEINFORMATIONISCORRECi. TOTALFEES ��f,,.�,/ � d�, �..I AGREE TO GOMPLV WIiH ALL CITV AND COUNTY OR�INANCES AND STATE LAWS RELA7ING TO BUILOING �WA '�;�Z��.'�, CONSTRUCTION,ANDHEFEBYAUrHORRER[PIiESENTATIVE50FTHISCOUN7YTOENTEFiUPONTHE �"ABOVEMENTIQNE�P PERTY FOR INSPECTION PURPOSES. COMMENTS - Q", J.', �,'. m � PERMITfEE'�N E PRINT) � �/j�. 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