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HomeMy WebLinkAbout15497 (23) i �_�, CITY OF DIAMOND BAB � ' - DEPARTMENT OF COMMUNITY dt DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 140 (909)860-3195 Fax(909)861-3117 PRESS '�" B[JII.DING PERMiT APPLICATION FIRMLY � JOBSITE APPLICATION Z� [� PERMIT 1 C,�t� P/C � a ADDRESS DATE NUMBER 1iJ # i � ISSUE TYPE OCC j APN LOT TRACT DATE CONST. GROUP � p OWNER " ADDRESS � ZONING SETBACKS j Z CITYC�nA.wtA,O� �,A� ZI ��TEL. - REART RW O � g APPLICANT TEL. SIOE/SIDE STREET RW ❑ ! � CONTRACTOR 510E ❑ g ADDRES _ � PROPOS US o CITY ZIP TE p.S�g�yD � � ANCWENG/ / � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � I MEREBY AFFlfM1 UNDEP PEWLLTY OF PERA1fiY THAT I AM EXENPT FROM THE CONiMCTORS L4 GaraOe�Carport CENSELAWPoRTHEPDLLdNIN(3REA30N(SEG7o31.5�51NE53ANDPROFE551ONSCODE:MlYGTYOfl (n COINTYWHN:11RE01ARFSAPERNRTOCONSTRUCT.ALTERMPpOVE.DEI/DLISH.ORREPAIRM1Y51AUG W Pef�O/Dedc 7URE,VRqR TO R4 138UM10E,ALSO PEdJlqES 7HE APPLICANT FOR 3UCH PERI.IR TO FlLE A SIGNED W BTAlEIAENT THAT HE OR SHE IS Ut�NSED PUi13UANT TO THE PROVISIONS OF THE CONTRACTOHS LI• � CENSE UW(GTMP7ER Y(COMNENCWO WITH SECTlON 7000)OF DMSION 9 OF THE BUSINESS AND PI�� � POoUSpa FES8qN8 COD�Ofi iHAT HE OR SHE IS E7(EIIPTiHEREFi#OM M'D THE BA313 FOR THE ALLEGED EXEYP- TION.AN'/VIOLATIONOFSECTION7031.6BYANYAPPLICANTfORAPEWIT3UBJECTSTNE�PPLIGANTft7 Z F{g-Rpp( � At�L PENALiY OF NOT MORE iHAN FIVE NUNORED DOl1AR3(t5o0I.): � ❑I,ASONRIEROfTHEPNOPERTv,ORMYEMvIOYEESWITNNMGES�STHEIRSOLECOMVENSATqN, � CofnmBrGi81 - YALL DO TME WOi1K,MA TME STRUCTUNE IS NOT IMEND6D Oq OFFERED FOR SALE(SEC.70M,BUSI- J � IE88 MD PROFESSIONB COOE iT¢CONTRACi00.4 LICENSE LAW DOES NOT�PPLY TO AN OWNER OF = VRODEATV MIlIO&11L05 OR YDRDVES 7NENEqJ,MA NRiO DOES S11G1 WORK MYSELF OR HERSEIF Oq ([ Tf/H0U0HHISORHERONHEMPLOYEES,PROVI0E0TMATSUdiWPROVEMENTSARENOTMTENDEDOR m LJJ ,oFFEHEoronsuElf.nowEVERir+E&JILDWl3on�uanovEUErrt�ssotnwrrHMa�IErEAnoFcaerLE � TION,T/E ONMER�l1RDER WILL lUVE?HE BUROEN OF PROYp1G THAi HE OR SNE DI�NOT BllILO Oq MP110VE fnAT}iE PURPDSE OF SALE)• W ❑4��MEROFTIEPHOCERT;ANE%CLUSNELYCONTR�CTINCiWfTHLICEN3E�CONTR�CTORS � TO CONSTRUCT TME PROJECT(SEC.Tasr,BUSINE55 AND PIqFE5510N5 COOE:THE CONTMCTORS Ll� ValuatiDn ADJ.AiiEA W f�IBELAW�0E8f1�TAPPLYTOANOWNEHOFAPROPER7`/WHOBUMDSORMPROVESTiEflEON,AND Z wHocoHTnecTsr�sucnaHo.iEerswmi�oa+rrucron(s}��ce�seoeunswwrron�coarn�a ourwrirr OESCRIP7ION FEE � TORS LICH�SE LAW.�. ❑I AM EXEMPT IRAEH SEC. 8.i P.Q FOR h115 REASON 4 U � ¢ DATE OMMER V � W LICENSED CONTRACTORS DECIARATION -� � w 1 MEHEBY AFF9M UNDER PEN,LLTY OF PERJURY 1HAT I AM LICENSED UNDER PROVIS�ONS OF CHAPTER V. s 0(OOMMENCMKlMIITMSECTION70W)OF01415qNaOFTHEBUSINESSANDVFOFESSIONSCODE,AND Z X W UCENSE IS W FULL FORCE AND EPFECT. � LLI �.,�s-i,,�6 � LICENSE ._�_LIC.NO. j � w� cornancToa�fliit[��i� a � WORKERS'COMPENSATION DECLARATION ���1 �� Q � � I NEREBV AFFIR4 UNDER FEWITY OF PENUflY ONE OF THE FOLLOWING DECLAMTIONS: U C� Q G �IiUYEAt�pWILLMAIHTAINACERfIFlCATEOFCONSEMTOSEIF-INSUREFORWORKERi' _ � C0IWENSATION,A4PRDVID�BYSECTON37000FtHELA[�ORCODEFORTHEPERFORMANCE W oF n�woau roA wH�niis eerwrt�s issuEo. g � _I lUVE AND W�LL MAIHTAIN WOAKERS'WMPENSATpN INSURANCE,AS REOUIRED BY SECTKKJ /� I r/, Q 3700 OF TIIE IABOH O�DDE,FOR THE PERFOiAAANCE OF THE WORK FOR WHICM TNIS PEFMIT IS I U���{-/ ' ISSUED.MVMCRKERS'CQYGEN3 INSUR RRIERIIN�POLICYNUP9ERARE CONSTRUCTION �� � �pqiEp��t (���i�� f I PLANREVIEW ��'��� ?�'� Z aaicrraueEA_�h .-_�_n/�/ST7 ' ` `- ,- ELECTRIC 4 8 (IV#eSECiqNNE�lpigEmAwtEfH)oFnEpEwATSR%ioNEHIN��DOIlMSR1m)ORLE551 PLUMBING (� � I CERIIFYTHAT Ml hIE PERFORWINCE OF THE WORK FOR WHICH THIS PERMI715ISSUED,1 MECHANICAL R��J� � (`l SWLLL NOT EMPLOV ANY PER50N M ANV MANNER 50 AS TO BECdAE SU&IECT TO THE (n WORKERSCOMFENSATIOHU�W90GCALIFORNIA,AN�MiREETHATIFISHOULOBECOAAE INSPECTIONFEE S 8UBJECTTOTHEWORKENS'COM7ENSATIONPROVISIONSOFSECTKKi37000FTHEUBOR '-' 1 a � ' .s.'fi>£ 1 ✓: xi 1 coo�,i rNca.�v�vNnn�nroserr+ov��ows. ISSUANCE 1i^., a t.7_'R:�L :�i�i'''•. O \ - . � p D�iE APPLICAM: ii 1 SMIP � ENERGY P/C WAHNINO:F URE SEWREWORKER4COMPENSATqNCOVEMQEISUNUWFUI.ANOSMALLBE � $UBJECTIW PLOVENTOCNMIN+LLVENALTIESANOCMLFWESUPTOONEHUNDREDTHOUSAND ENERGYPEFMIT DOL4IRS(5100.Oaoj.M!ADDI71�NT0 THECASTOF COMPENSATpN,DAMAGESAS PROVI�E�FOR IN J SECTIDN97oeOF7HEUBORC00E.WTEHEST,ANDATTORNEY'SFEES. RETENTIONFEE: � a CANSTAUCTION LENDING AGENCY PRE•ALT FEE: O � I HEREBYAFFIHM IMUEH PENAL7V OF PERJURY THAT THERE IS ACONSTPUCTION LEN�IN13 AGENCY 2 FOR TNE PERFORMANCE OF THE W�RK �R WHICH TH�S PEflYIT IS ISSUE�(SEC.70W,CIV.C.). . LL7 � LENDEN'S NAME F- LENDER'S MDPE55 W ICER71FYT1ATIHMEREADiH19APPLICATIONANDSTATEhUT7HEFBOVEMFOPoAATIONI6CORRECT. TOTAL FEES p_ 1 AOREE TO COMVIY WITH ALi.CITY/�ND COUNTY OHDINANCES AN�STAtE Uw5 RELATMlO 70 BUILDINCt � � ' CONSTRUCTION,MID HEREBY AU7110RIZE REPRESEMATIVES OF iH15 CWNTV TO ENTER UPON iHE �. ABOVE�MEHTIONED PROPERTY FOR INSPEC710N PURPQSES. 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