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HomeMy WebLinkAbout13733 (17) ��� � CITY OF DIAMOND BAA � DEPARTMENT OF COMMLJNITY&DEVELOPMENT SERVICES 21660 8.Copley Drive Suite 190 (909)86d3195 F�c(909)861-3117 PRESS �'�'�� BiJII.pIIVG PERMIT APPLICATION FIRMLY � JOBSITE � � APPUCATION �J6 PERMIT �1C , o AD�RESS DATE NUMBER # ' � ISSUE TYPE OCC i � APN LOT 7RACT � DATE CONST. GROUP � p OWNER M1� YL.[,ilte�_r�.�t. �` ADDRESS �P ZONING SETBACKS � CITY � ZIP 'TEL. - � � FRONT pyy ❑ � APPLICANT ��, REAR ❑ � SIDE/51DE STREET RW O k � CONTRACTOR C Sla� O ADDRE S —' � CRY t-- ZIP I CI TEL. PROPOSED USE f ,� o ARCWENG/ � � �� �i DESIGNER NO.DWEL. NO. NO. y CDDRESS Z'P �L UNITS STORIES BEDROOMS � cn DESCRIPTION Sa.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDEfl DECLARATION SFWADD/REM Q 1 HEREBV AFFlF4 lA1DER PEWLTV OF VEiWRY T/AT I MI E%E1./PT FAOA1 TH�corrtnacTORs u- GaragaiCarport Il� CENSEIAWFpiTHEFOLLOWINGREA30N(SEG]N1.58USINESSPNOVROFE55!(M�ISCODE:ANYCITYOA (n �..� OOUNfYVMNCHHE0UWE5APFU1ITTOCONSTfiUCT,KTERMPROYE,DENOt13N,ORflEPA1RANY5TRUG- W Z TURE,PFiqp TO ITS ISSUANCE,�L50 REq11RES THE MP�IGWT FOR SUqf PERMIT TO FlLE A SIGNED W Patio/Deck � BTAlEMEM 1H11T HE OR SHE IS LICENSEO PURSUANT 70 7NE PROVISiONS OF THE CON7RACTORS U- � � CENSE LAW(dUVTER Y(COMMENGINO WITN 3ECTION]mo)OF OIVISlON 3 Of THE PUSMESS AIV�PRO- PooVSpa Ff93qNSCOpE�ORTHATMEOF5NE15ENEYPTTMEREPRONAN�1TfEBA5i5FOR7HEHLlEGEDEXEMv- (� ✓ I TION.ANVVqIATqNOFSECT10N7W1.58YANYAPVLiCANTFOq�PER611TSU8JECTSTHEAPPtICANTTO � Re-AO01 F ACIVILPENAITYOFNOTMOFETHANLNEHUNOPEDDOlURS({600).): j O ❑4��7EROFTHEPROPERTY,ORMYEAI7LOYEE5WITHWAGESASIHEIRSOLEC04PENSATION, O COITIfiiBfCIBI - Z WM.L 00 THE WONI(M1D THE STRUCTURE IS NOT INTFNDED OR OFFEHEO FOH SALE(SEC.�w.t,BlASI- �J � qE83 MID PipFE$SION9 CW E THE CONTPACTOR9 LICENSE LAW OOES NOT APPLY 70 AN ONWER OF � PhDPEFRVMhIDBU1lD50iiNPROVESTHEFlEON.ANDNMODOE55UCH4NDRKHIMSELFORHEFLSELfOR m � iHp0UO11M50RHEHOWNEMPI.OYEES,PROVIDEDTHATSUGIMPHOVE7�ENiSMEhbiINTENDE00F OFFBiFP FURSYE IF,IIOY/EYEI�TME BUILDVN30R MIPROVEYENi IS SOLD WITHIN ONE YEAH OF C011P1E- � iION,THE OYMEq-BUILDER W1LL H4YE THE 6UR�EN OF PROV�Na TXAT ME OR SHE DID!qT PNtD OR NIFPOVE FOR TME PUHP�E OF SI�LE). �yJ ❑1.ASOVMER OF THE PROPEFTY.AM EIfq.USNELY CaJTR1CTING WITH LICEI�56D CONTRACTORS ¢ TD[DNSTRUCT 7TE➢ROdECT(SEC.70U,6USINF55 AND PRDFESSIONS COOE:THE CONTqACTORS LI- V8II18f10f� ApJ.qREq W CENSELAN/DpE3NOTAPPLYTOANOWNEROFAPROGERTVWIiD8UMD50RIMPqOVESTi1EflEON,M7D = NR7000MRACTSPoRSUCHPRQIECTSWITIACONTRACfOR(SILICENSEO?URSUANiTOTH£CMlTMG QUANTITY DESCRIFTION FEE � ro�.sucEr+sEuw.x . ❑I 11M E%EMPT IRYIER SEC. B.8 P.G FOR THIS RERSON J Q U � � � T D/QE OWNEfl U � W LICENSED CONTRACTORS DECLARATION � � w I HEflEBY AFFIRM UNDER PENALTY OF VERtt1RV T}1AT I I1M LICENSED UNOEq PfiOV1510N5 OFCHAPTER � � i(COINIENCRK3WITMSEGTKK17oW)OFDNi510N]oFTHEeV51NESSANDPROFES5lON5cO0E.AND Z ��� W LICEM9E i5 W Ml FORCE.wD EFFECT. m 0 UCENSE QASS � ,�_,LIC.NO.7��S�-�—/—�—r� � � wrE � "�a` . �� cor�w.cTcus�s-��'���^— a WORKERS'COMPENSATION DECLARATION a � 1 HEREBY AFFlRN UNDER P@11V.TY OF PE0.NIRY ONE OF THE FOLIOWiNC.OECLAflATKKJS; Z � _IWI4EANDW7LLMAMITNN�CEATIFICATEOFCONSEMTOSEIF-�NSUREFORWORKERS' _ � - COMPENSATION.�S PtiOVIDEO 6Y SECTION 3Too OF THE U00N CO�E.FOR h1E PEHFORMANCE W OF tHE M/OFK FOR WMK]i TM�B PERMIT IS ISSVED. � � _IHAVEANDWILLMAIHTAIHWOA(ERS'CONPENSATIONINSUiiANCE,ASREWIREDBYSECTION I� �J� O3�a00FTNE R E,F RTHEPERFOFMMlCEOFT EWORKWPWHI@i7NI5PERMITIS � .,./ ISSUED.MY"='��Q���NSATI06lJM ANCECA fRAN�POLICYNUAIBERME: CONSTRUCTION t Q � y CARRIER . PLAN AEVIEW � pa�cY M�us�RY,�y 2 ELECTR�C _ 0 (MSSEC�qNNF�HOTBECL�.REi�oFT+EVEaAi6R7aa7Etll.�ix�oDouaRs(Stm7atLE5sF PLUMBWG Z lCERTIFY7HA7 W THE PERFORMANCE OF1NE WORK FOR WNICHT115 PEftMiT IS ISSUED,1 MECHANICAI (� SHN.LNOT FMPLOYM'�FERSIXV IN ANV MANNER SOAS TO 9ECOME SUBJEGTTO THE � WORKERS'COMPENSATqN1,�W50FCALIFORNl/�,/WOAOREETHATIFISLIOUI�R[COME INSPECTIONFEE S SUBJFCTTOTHEWORKEAS'COMPENSATIONPROVISIONSOFSECTION o00fTNElABOR � cooe,i sw�u Foanrvnn�coraa�v w��r�ovisania� f/�� ISSUANCE d DAIE:/��_a.�- S�0.PPLtCAM: � SMIP � � ENEHGV P/C � WARNINfI'FAlURETO SELURE KORKERS'COMPENSAipN COVER�GE IS UNIAWFUL AND SHALL BE � � SUBJECTANEMPLOYENTOCRIMINILLPENALTIEBANDCIViLRNESUPTOONEHUNDREDTHOUSANO ENERGYPERMIT �OIIARS(it00,000�,IN WDITON TO THE COST OF COMPENSATION,ON.�P.GE&AS PROVIDED FOH IN � J SECTqN770lOFTIELABORCODE,INTEREST,ANDA7TORNEV5fEES. RETENTIONFEE: Q I d CONSTRUCTION LENDING AGENCV PREALT FEE: � � INEREBYAFFIRMUNOERDENPLTYOFPERRIRYTHATTHEREIS�CONSTflt1CT10NLEN0INGAGENCY FOR 7NE PERFONMANCE OF THE WORK FOR WHICM TMIS PERMIT IS ISSUED(SEC.30W,CIV.C.�. � � IENDER'SNAME �S IENDERBADDRESS '-`- ICERTIFYTHATIHAVEREAOTMISAPPLICNTnNANOSTATETHATTHEABOVEINFORAlAT10NI5CORRECT. TOTAL FEES � � IAGREETOCOMPLYWITH/�LLCRYMIOWUNTYORDINANCESANDSTATEUWSqEUT�N6TOBUILAING � � WNSTqUCTION,AND HEREBYAUT4NIRIZE REPNESENTATIVES Of THIS CIX1NT'TO ENTER UPON THE Z A60VEMEMqNED PROVERTY FOFi INSPE(:T10N WHPn5E5. COMMENTS � � � � J � m P EE N E(PRIN� - ¢ � �o �q � I � - - � SIGNATUREOFPERMITTEE � DATt � RECPT.N PAID BY VALIDATION f WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Cc�y,GOLDENROD—File Copy.GREEN--Applicenfs Copy I �13''� CJF �1���1� �,�t� i��'����'��C�� �����"�#i.x i � „ - '..,Y . . : y '_ p r .'�7��_ �yl�.. .Y��:a �;'. �.s . � &; .' l �.,. . �t'a f SET�AC�; ! ` j FLf�i��JOf5� ; i ' , _.I v—._. _._.__� __ ._ .____.___�;___—__._ __—--.—.._ _.�__! _ __�__ _-- � �TuSiFt?F�Rf��,STEEL ( i FI-9A r�E���t�S I � � E _ � ___ _ —_ � .��___ —_._ _— ____ ELEC�RIC G(-i.^�l1ND i i i ( U11�JEFi f=�UO�C7aJCT , --_--__._ _...--�------ ---___. _ —�_ � � __..._ _..� _�_�... �!�t7Ut�C3 P' Utn�1�fG 4_� � ��_UPlLER FLOC}R Ciii`,3�iJIT o ______ — - _� _._� .__.__._.�. ..___ _ ._ S�Af3 GFittD� ; 't _____. ��FiREi='�_t�C:�FC:U�vL`s�s[CJ'��' ; ' � }t-�-,-���__(-.yrS ,_ __._._ ._ f r (- �ry ,q ._�..___________� �__..________ . . + 4 GC��'13',rlll�r�� E ' ' � �}`t��l_�iti���4dL}[a��a3Vt � � i .�.._.�P..� i .---- ..._. � =LatN!�R���VlG�_�.__— ; � � yi3�.�i-'�'. 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