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HomeMy WebLinkAbout15558 �7-� �-� � � - � CITY OF DIAMOND BAlt --1�J DEPARTMBNT OF COMMUNTTY&DEVELOPMENT SERVICES `� ,�(� /� / w 21660 E.Copley Drive Suite 190 � � V( (909)860-3195 Fax(909)861-3117 PRE$S ''��� BUILDING PERMIT APPLICATTON FIRMLY . ... . ,, _:._. � JOBSITE a,�t ,,,p APPUCAT I PERMIT P/C � ADDRESS ���� /✓/�.�� ��/'� ��C L�- DATE NUMBER i�5� M c� ISSUE � TYPE OCC APN L T RA T DATE CONST. GROUP p OWNER �C / �`' ADDRESS ' ZONING SETBACKS � CITY � ^ ZIP TEL. REORT RW O� APPUCANT TEL. SIDEJSIOE STREET RW ❑ � CONTRACTOR Cc ,J`' SIDE ❑ Q ADDRESS • ' PAOPOSED US� � CITY �G�f'Jn ZIP TEL.!� Z w ARCW NG/ �z DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OOWNER-BUILDER DECLARATION SFR/ADDlREM [] I HEREBV AFFlRM UNDER PENALTV OF PERJURY THAT I M1 IXEMiT FROM 7HE CANTRACTORS LI� � Garage/Carport W CENSEUWFORTHEFd.LOWINGREASON(SEC.)o31.5BUSINESSANDPROFES510NSCADE:ANVCITVOR G�� COUNfYNT11CHREWIHESAPEHMRTOCONSTRUCT,ALTEfl.iMPROYE,DEMOLISH,ORREPNRANYSTRUG W PatiD/D6d( WTUpE,PRIOR TO ITS ISSUANCE,ALSO REqU1RES THE APPLICANT FOR SI1CH PERMIT 70 FILE A SI�NED W .� STATEMENT TfNT HE OR SFIE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTflACTOR3 LI� � CENSE LAW(CHAPTER G(COMMENCINO W�TH SECTION 70W)OF DIVISION 3 OF THE OVSINE55 AND PHO- LL' POOVSPd FE3310NS�EJORTHA7HEORSHEISEXEMPTTHEAEFFiOMAND7HEBASISFORTHEALLEDEDEXEMP� (� TION.ANYViOLATIONOFSECTION7091.5BVANYMPLICAN7FOpAPERMITSU&1EC757HEAPPLICANTTO Z RB-ROOf F IICIVILPENALTV OF NOT MORE THAN FNE HUNDRED DDLURS(f600).�: � ❑4�SOVYNEROFTHEPROVERTY,ORMVEMPLOYEESWITMWAGESASTHEIRSOLECOMPENSATON, � Commercial � YALL D�7HE WORK,AND THE STRUCTURE IS NOT IMENDED OR OFFERED FOR SAI.E(SEC.7da�,BUSI- J NESS AND PROFESSIONS COOE:THE CON7RACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PpOPERTYWFiOBUA.DSOPIAAPROVESTHERE�N.ANONAiODOESSUCHWOFKHIMSELFORHERSFIFOR m (r 'THROUOM HIS OR HER OWN EMPLOYEES,PROVI�ED 7HA75UCH IMPROVEMENTSARE NOT INTEN�ED OA LSJ _OFFEREDfORSILEIF,HOWEVER,TiEBUIL�MGORIMPROVEMENTISSOLDWITHINONEYFAROFCAMPLE- Z TqN,THE OWNER�BUILDER WILL HAVE 7HE BURDEN OF pROVINO THAT HE OR SHE�ID NOT BUtID OR = IMPROVE FOR THE PUFiPOSE OF SALE� p I,A&OVMEfl OF THE PROPEHTX AM EXCLUSIVELV CONTMCTINp WITN LICENSED CONTRACTORS ¢ TO CONSTRUCT 7NE PROJEGT(SEC.7014,BUSINE55 AND PROFESSIONS COOE'.THE CONTqACTOFiS LI- V8Il18S1011 ADJ.AREA W CENSELAW�OESNOTAVPLYTOANONMEROFAPROPERT7WN�Bl11LDSORIMPROVESTHEREDN.AND � WT1pCONTMGT5GOR5UCHPROJECT3WITHACONTRACTOR�S�LICENSEDPURSUANTTOTHEWNTRAF QUANTITY DESCRIPTION FEE Y 70RS�CENSE UW.�. � J � p IAM E%EMPT UNDER SEC. B.8 P.G.FOR 7HI5 REASON U 3 � � OATE 01NNER V � LICENSED CONTRACTORS DECLARATION W � 1 HEREBYAFFIRM UNDER PENQN Of PERJUHI'7HAT IAM LlCENSED UN�ER PROVISIONS OF CHAVTER Z o. 1 ��. � (= Y(COMMENCIN(i WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROfESS�ONS CODE,AND r��� X MY IICENSE IS IN FULL FORCE ANO EFFECT. m UJ ) /n� � Q LICENSE CtA S � LIC.NO. ✓ �v � �j �ATE A CONTRACTOR_ �• .^ a W � WORKERS'COMPENSATION DECLAHATION � 4 � �HEREBYAFFIRM UNDER PENALTY OF PERJURY ONEOFTHE FOLIOWING DECLARATIONS: U � Z Q 0 _IHHVEANDWILLMAINTAINACERiIFICATEOFCANSENTTOSEIF-�NSUAEFORWORKERS' 2 � COMPENSATqN,AS PROV�DED BV SECTION 37oa OF 7HE LABOR CODE,FOR THE PERFORMANCE �U OFTHE WORK FOR WHICHTHIS PERMIT IS ISSUED. � 0 W _IHAYEANUWILLMAIMAINWORKERS'COMPENSAT�ONINSURANCE,ASRE�UIRE�BYSECTION O 37000FTiE LA80JJJ���R OODE,FOR THE PERFORMANCE OF iHE WORK FOR WHICH iNIS PERMIT IS 1SSUED.MY WO�'COMP NSgTjON INSIIRAyCE CA p AN�PqLICY NUMBER ARE'. CONSTRUCTION � CnaR�R� � �� `'r�A ��0 ��^r PLAN REVIEW Z POLICYNUMBER .� ELECTRIC 4 Q (1T14SSECiqNNE�NDTBEOJfMIEfEDOFTHEPEPoMISFiN7�NE��M11W�lEDO�LLAi�.(51a010FilES`� PLUMBING Z I CERTIFY THAT IN THE PERFORMANCE OF iHE WORH FOR WMICH THIS PERMIT IS ISSUED,I MECHANICAL �"°���� ---- (� SHAIL NOT EMCLOY ANV VERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE i��."'��'�'+,,���� � WORNERS'COMPENSATION LAWS OF ClLLIFORNIA,AND AGPEE 7NAT IF I SHOULO BECOME INSPECTION FEE SI�JECTTOTHENbiiKERS'COMPENSATI NSOFSECTION37oaOFTHELABOR CODE,I/SHyALLFORTHWITH COMPLV WI HOSE PR ioNs. ISSUANCE / � �,.,.�"� 5MIP .� "°g�`$ ..s O DATE:�J� APPLICANT: w ENERGY P/C � � '"'P"��,��8�-'f��' J WAHNINO:FAILUHE TO SECURE W�RKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE �;y,.^� r�+�,j �y SU&IECTANEMPLOVERTOCRIMINALPENALT�ESANDCIVILFWESUPTOONENUNOPEDTHWSAN� ENERGYPERMIT y' 'L t✓��j `1���a`�`�°�,1 DOLURS�S�00.000),INADOITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIOEDFOHIN ?ra�V�— ' ✓�'� J SECTION37oeOFTHEI.A80RCODE,INTEREST.ANDATTORNE7'SFEES. � �+�p:� �-`�'� � RETENTIONFEE: ��'�j��3'� > � CONSTRUCTION LENDINGAGENCY PRE-ALT FEE: � I HEREBV AFFlRM UNOER PENALTY OF PERJURV THAT TNERE IS ACONSTRUCTION LENOING AGENCV FOR THE PERFORM � THE WORK FOR W T�PERM IS ISSUED(SEC.3087,CIV.C.). , W � � LENDER'S NAME � ' F– LENDER5AODRE55 WICERTiFYTHATIHAVEREA�7HISAPPLICATIONANDSTATET1iFTTHEA80YEINFOFiMATIONISCARRECT. TOTAL FEES � , � I A6REE TO COMPIV WITH ALLCIiV AN�COUNTY ORDINANCES AND STATE L4W5 REUTING TO BUILOING . , CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTRTIYES OF THIS CWNN TO ENTER UPON THE S� ABOVE-MENTIONEP PAOPERN FOR INSPECTION OURPDSES. �MMENTS � C / l ya� � m PERMI NAME P Q � � SIGNATUHEOFPE E DATE = RECPT.NO. PAID BY VALIDAIION ~ WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROO—File Copy.GREEN—AppiicanYs Copy 7:";'�r�:�^5_''s,+w,.r..� �.��:,�,v -iis e�;��yik"�dR�.e_r:.�..,.i y�.N�t�.:g 3�. i'to � ,.::o�,.t���? al;rt-.i?r, ..,.� +"�,''w �. �''` . ,. E.:i��.,�r �;Y o.. . u�,,�w+ :X.N;�, v . .�?5;7:'�"� ,X,,: 'F. �i'N"�:'#` �1,�"... . . �. '� ���� � �a��� ��k� � �. . . a �t��� ��& ,�� �� � � � ���`� x: � . :�� � ��a � � �_. � _, �� � � "� � ���.����� . . � �..�.��� � .�� : ,.. _ .� � � Fa� � _ �� � .. �� .. . , . fi � � S�`"�'s � � � j � . 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