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HomeMy WebLinkAbout17533 —--�'�"�--- CITY OF DIAM�ND BAR �...__.. "" DEPARTMENT OF CONiMUN1TY&DEVELOPMENT SERVICES � .�. „� 21825 E.Coptey Drive � -' (909�860-3195 Fa�c(9�9}861-3117 PRESS '�`'%��`�' BUILDINGPERMIT APPLICATION FIRMLY � JOBSITE �"'' APPLICATIO PERMIT P/C n ADDRESS�� � �� DATE P ��--- NUMBER 7� # � ISSUE TYPE OCC APN--�LOT TRACT DATE CONST. GROUP p OWNER "-�-v,�`o»(1„OO_�' " ADDRESS .� �yC B ' 1 �/� �'� ZONING SETBACKS z CITY�+.�� � ZIP 7FL, FRONT qW ❑ � APPUCANT TEL, REAR ❑ Z ,p SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR C�e—�-���'�a �% � ` SIDE � ADDRES�5�7� .� �-,_1� � �1 > C . � CITY��"i'".a.=.-,:oaa ZIP 9�� TEL. �396�.2"zt7' PR�POSED USE « w ARCH/ENG/ � � ' z DESIGNER w NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. UIVITS STORIES BEDROQMS � �n DESCRIPTlON SQ.FT, FACTOR PSF A�J.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM � O p I HEREBY AFFlRM UNDER PENALTY OF PERJUpY THAT I AM EXEMPT FROM THE CONTRACTORS LI- GeIe�E/Gd�pOfl LLI CENSELAWFOFTHEFOLLOWINGREASON(SEC.7031.58USINESSRNDPROFESSIONSCOOE:ANYCITYOR (n CJ COUNNNhiICHRE�UIRESAPERMITTOCONSTFUCT,qLTER,IMPFWE,�EMOLISH,ORREPAIRANYSTHUC- W TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck � STATEMENT THAT HF OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRAC70R5 LI- � � CENSELAW(CHAPTER9�COMMENqNGWITHSECTION700o�OFDIVISION30FTHEBU51NES5ANOPRO- POOI/Spd � FESSIONSCADE)ORTHATHEORSHEISE%EMPTTHEflEFROMANDTHEBA51SFOqTHEALLEGEDE%EMP- � TION.ANYVIOLATIONOFSECTION7037.5BVANYAPPLICAN7FORAPEflMITSU&IECTSTHEAPPLICAViiO Z Re-Roof A CNIL PENALT'OF NOT MOFETHAN FNE HUN�RED DOLL4flS(ESoo).): Z ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITH�WAGESASTHEIRSOLECOMPENSAT70N, � Commercial - WILL�O THE WOAK,AND iHE STRUCTURE IS NOT INTEN�ED OR OFFERED FOR SAIE(SEC.7o44,BUSI- J � NESSAN�PROFESSIONS CODE:THE COMRACTORS LICENSE lAW DOES NOT APPLY TO AN OWNER OF � PflOPFATY WHO BUILDS OR IMPROVESTHEREON,AND YMO DOES SUCH WOflKHIMSELFOR HERSELF OR � 7HROUGH HIS OR HER OWN EMPLOVEES,?ROVIDED THAT SUCH IMPROVEMENTS ARE NO7 MTEN�E�OR m Q OFFEREDFORSAIE.IF,HOWEVER,THEBUIL0INGORIMPflOVEM6YTI�SOL�WITNiNONEYEAAOFCOAAPLE- z TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVINO THAT HE OA SHE DID NOT BUILO OR � IMPROVE FOR TME PUFPOSE OF SALE). W �I,ASOWNEROFTHEPROPERiY,AMEXCLU3IVELYCONTFACTINGWITHLICENSEDCONTRACTORS � TO CANSTRLICT THE PflOJECT(SEC.7044,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- V2IUdYlOfl �� ApJ.AREA W CEN8ELAWDOESNOTAPPLYTOANOWNEROFAPPOPERTYWHOBUILOSORIMPqOVESTHEREON,AN� � WHOCONTRACTSFORSUCHPROJECTSIMTHACONTRACTOR(S)LICENcEDPURSUANTiOTHECONiPAP QUANTITY DESCRIPTION FEE Y TORSLIGENSELAWJ. � CJ 1 AM EXEMPT LINOER SEC. 8.$P.G fOft THIS REASON Q ?� U '� LL DATE OWNER F— Z U � LICENSED COYfRACTORS DECLARA710N W ¢ � I HEqEBY AFFIRM UNDER PENALIY OF PEAJURV THAT I AM LICENSED UNDEF PROVISIONS OF CHAPTER � . d 9(CDMMENCINGWRHSECTION7o0o)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z W MY LICENSE IS IN FULL FORCE AN�EFFECT, m � LICENSE CLASS�UC.NO. O s,�L�j�� � . U DATE�� CONTRACTOR__C�G��!� pJ„ W C � WORKERS'COMPENSATION DECLARATION ¢ � 1 HEREBV AFFIRM UNDER PENALTV OF GERJURY ONE OFTHE FOLLOWINQ DECLARATIONS: Z � _I HAVE AND WILL MAINTAIN A CERTIFIGATE OF GONSENTTO SELF�INSURE FOR WORKERS' _ Q COMPENSATION,ASPflOVIDEDBVSECTION3]ooOFTHELABORCODE,FORTHEPERFORMANCE U Q OFTHEWORKFORWHICHTHISPERMIiI515SUED. � Qw �IHAVEAN�WILIMAINTAINWORKEFS'COMPENSATIONINSURANCE,ASREWIREDBYSEGTION 3700OFTHELABORCODE,FOR?HEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS �r$ � J ISSUE�.MYWORKEAS'COMPENSATIONINSURANCECAFPoEFANOPOLICYNUMHERARE: CONSTRUCTION �I�6s''<� � a CARRIER 1--,� PLAN REVIEW � z POlICV NUMBER_ ��1.9�''..c�'�'r��S�� -��� ELECTRIC Q 0 (i}iISSECTIONNEmN0T8EWMPLETEDOFIHEPERMITISFOqOtJEHUNDREDOdJARS($70�ORLESS). PLUMBING W Z I CEfl�IFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSIIED,I MECHANICAL (� SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESUBJECT70THE y - - . (n WORKEFS'COA�PENSATIONLAWSOFCALIFORNIA,AN�AGREETHATIFISHOULOBECOME INSPECTIONFEE 7�._`. '%���. �- SUBJECiTOTHEWORKERS'COMPENSATiONPROVI510N50F5EGTION37ooOFTHELA60fl 3,�-.•- �l�""" y.�ry� ^ � CODE,I SHALI FORTHWITH COMPLY WITHTHQSE PROVI5�10iN5. . ISSUANCE � �„/, 1p DATE: "T Q�. APPLICANT.�,�/�_l e� A h__�y� SMIP ��� �f��';� ; , �� �� ENERGY P/C E J WARNING: AIL E TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AN�SHAIL 9E -- � SU6JECT AN EMPLOYER,TO CRIMINAL PENAlTIES AND CIVIL FMES UP TOONE HUN�RED THOUSANO ENERGY PERMIT � DOlL4RS(51 oo.ot9),IN ADbITION TO THE COST OF COlAPENSATION,DAMAGES AS PROVIDED FOR IN tp � SECTION 37ae OFTHE LABOR COUE,MTEREST,AN6 ATTDRNEY'S FEES. RETENTION FEE: B.'g-"b��..—. �Q' OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � � IHEqEBYAFFIRMUNDEfiPENALTYOFPERJURY7HHTTHEREISACON57RUCTIONLEN�MGAGENCV FOq THE PERf-0RMANCE OFTHE WORK�OR WHICH THIS PERMIT IS ISSUED(SEC.309�,CIV.C.�. Z W � LENDER'S NAME F— LENDERSqDDRESS ,,p � ICERTIFYTHATIHAVEREADTHISAPPLICqTIONANDSTATETHATTHEABOVEINFORMAT�ONISCORRECT, TOTAL FEES `�O �c �°'� � I AGREE TO COMPLV WITH ALL GTY AN�COUNTY ORDINANCES AND STATE L4N5 RELATING TO BUIIDING 0 a. � CONSTRUCTION,ANDHEREBYAUTHORIZEPEPRESENTATIVESOFTHISCOUNTYTO'cNTERUPONTHE z ABOVE-MEN710NED PROPERTY FOR INSPECTION PURPOSES. COMMENTS 0 . _. � �� �r �����Y �� , m PERMI7T�HM�,E(PRI�NT �j � � '��J /�/ ( .c �c �.1 /�'' O �� � SIGNA7URE ERMITTEE - D E ,.�)�, � RECPT.NO.._9 t'��_PAID BY � VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PWK—Assessor Copy,GOL�ENROD—File Copy,GREEN—Applicant's Copy �S 1 3„+ ..'� ,: _. . . � l � :°�. » .,...:.. I €� S - - x x .x� - _ �� . . ._ .9 .�„_ � �"""a�,�:,-s �. '��.. ( ;� � u i� ;�i..� � �� �' ��. u x s a` ,. . ' m � � ,y a w,s ,. A §�" . ° „ s„� b .a , ; �' , �. � � ''.`�" � "v a ,p "� � � § x � �rq s"5 � � � � � � ;"� '�"���ay a`§ �a+ m� r `-� $ � "� ;, i"��.n a �,�',.. ;.'` �'� �. 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