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HomeMy WebLinkAbout16729 (30) � � � �� CTTY OF DIA1ViOND BAR � ----�``--� DEPARTIvAENT OF COMMUNITY&DEVELOPMENT SERVICES I I � 21825 E.Copley Dri�e (909)860-3195 Fax(909)861-3117 P R ESS '"'�'�r�`�' BUILDIN�&PERMIT APPLICATdON F M LY JOBSITE �j �j�/��g APPLICATION � � PERMIT PIC o ADDRESS_ �� �f��'!��i-�'��': r���/ i� !!' � f DATE NUMBER #` � ISSUE TYPE OCC APN LOT TR,,'�CT � � � p OWNER �,�,t��,� "�'AdG//a�'�/� �,� a DATE � CONST, GROUP 0 ADDRES Q:.�'e'+�r"��-^,�� �`� ZONING SETBACKS Z CITY r� �2iP TEL. .� � c� FRONT RW ❑ o APPLICANT ye.. ;d � , e r =i REAR ❑ Z SIDE/SIQE STREET RW � Q CONTRACTOR �! � �v</ _ SIDE ❑ ADDRESS vl2� � �'✓"� ` �'� o CITY � ZIP TEL. PROPOSED USE ^�'�S�'�.-- i���CrG /�O� � �"` o ARCH/ENG/ - �z DESIGNER NO.DWEL. NO. NO. a ADDRESS = CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTdR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENALTY OF PEPJURY I7-IAT I AM E%EMPT FROM THE CONTfiACTORS LI- G3f8CJB/CBfPOtY W CENSELAWFORTHEFOLLOWINGREA50N(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n � C.) COUNTYWHICHREQUIRESAPERMITTOCONSTRl1CT,ALTER,IMPfiOVE,DEMOLISH,ORREPAIRANYSTRUG W PdSlO/DBCIC W TURE,PPIOR i0 ITS ISSUANCE,PLSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W STATEMENT THAT HE Ofl SHE IS LICENSED PUFSUANT TO THE PflOVISIONS OF hIE CONTRACTOFS LI- � CENSE LAW(CHAPTER 9(COMMENCMG WITH SECTION 7000)OF OIVISION 3 OF 7HE BUSINESSAND PRO- � PoollSpa � O FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEflEFROMAN�iHEBASISFORTHEALIEGE�EXEMP- (� V TION.ANV OLATIDNOFSECTION7o31,5BYANYAPPLICANTFORAPERMITSUBJECT3THEAPPUCANTTO Z Re-Root A CIVIL P ALTY OF N07 MORE THAN FIVE HUNDRED�OLLARS(SSoo).): ZASOWNEflOFTHEPROPERTY,ORMYEMPLOYEESWITH�M1'AGESASTHEIRSOLECOMPENSATION, �� COfrIffl2fCldl - � WILL DO.THE WORK,AND THE STRUCTURE IS NOT INTENOED OR OFFEREO fOR SALE(SEC,7044,BU51- �f � NE55 ANO PROFESSIONS CODE:THE COMRACTORS LICENSE LAW DDES NO7 APPLY TO AN OWNER OF � PROPERTY WHO BUILDS OR IMPROVES THEfiEDN,AN�WHO OOES Sl1CH WORK HIMSELF OR HERSELF OR CC THROUGHHISORHEROWNEMPLOVfES,PROVIDEOTHATSUCHIMPROVEMEMSARENOTINTENDEDOR m Q OFFEREOFORSALE.IF,HOWEVER,THEBUILOINGORIMPROVEMENTISSOLDWITHINOkEYEAROFCOMPLE � Z TION,THE OWNER-BUILDER WILL HAVE THE BUflOEN OF PROVINO THAT HE OR SHE DID NOT BUI�O OR � IMPROVE FOflTHE PURPOSE OF SALE). LJ J,AS OWNER OF iHE PfiOPERiY,AM E%ClU51VELY CON7flACTING WITH LICENSE�CONTRACTORS � TO COFISTRUCT TNE PROJEC7(SEC.7044.BUSINESS AN�FROFESSIONS CODE:THE CONTRACTOPS LI- ValUetiOt7 �, ADJ.AREA W CENSE LAW DOES NOTAPPLYTOAN OWNER OFA PPOPERTY WHO BUILOS OR IMPROVES THEREON,AND F� WHOCONTRACTSFORSUCHPRDJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONiRAC- QUANTITY DESCRIPTION FEE � �. � TORS LICENSE LAW.�. � � �IAMEXEMPTUNDERSEC. ORTHISREASON Q ' ' ?„ U LL � DATE OWNER U Z W �� LICENSED CONTRACTORS DECLARATION W Q � IHEFEBYAFFIflMUNOEflPENHLTYOFPEAJURYTHATiAMUCENSEDUN�ERPROVISIONSOFCHAPTER � � 9(COMMENCINGWITHSECTION�000)OFOIVISION30FTHEBUSINE55ANOPFOFESSIONSCODE,AN� z `X MY LICENSE IS IN FULI FOFCE AND EFFECT. m � LIGENSE CLASS LIG NO. j V DATE CONTRAGTOR a. W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRAA UN�ER PENALTY OF PERJURY ONE OFTHE FOLLO'NING DECLARA710NS: Z Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTT�SELF-INSUFEFOqWORKEFS' _ ¢ CAMPENSATION.ASPROVIDE�BYSECTION31ooOF7HELA80RCODE.FORTHEPERFORMANCE W Q OFTHEWDRKFORWHICHTHISPEPMITISISSUED. - � � _I HAVE AND WILL MAINiAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED 9Y SECTION �'y Q 37000FTHELABORCD�E,FORTHEPERFORMANCEOFTHEWORKFOFWHICHTHISPERMITIS I iII�S � ISS�E�.MV WDRNEAS'COMPENSATION INSURANCE CARPoERAN�POLICV NUMBER ARE: CONSTRUCTION P ((y� J j cnqaiEq PLAN REVIEW - ZPOLICVNUMBER ELECTRIC Q � (IHISSECTIONNEmNOTBEO�MREfEDOFhiEPERMRISWRONEHUNDREDOIX.tARS�SIO�ORLESS). PLUMBING ..��J `r`+,� � �1 `T�Y^"„j``. Z I CERTIFV THAT INTHE PEaFOFMANCE OFTHE WORK FOR WHICH THIS PERMIT I5 1SSUE�,l MECHANICAL _ � (,'3 SHALL NOT EMPLOY ANY PERSON IN ANY 1AANNER SOAS TO BECOMc SUBJECT TO THE Q (/� WOAKEriS'COMPENSATIONLAWSOFCALIFOFNIA,ANDAGHEETHATIFISHOUL�OECOME INSPECTIONFEE A � SU6JEGTTOTHEWORKERS'COMPENSATpNPROVI510NSOFSECTiON37000FTHELABOR ' . � � j � COOE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE �� ��� � SMIP _ � �4'_� . p DATE: APPLICANT: ��p^—p _ J WARNINGFAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANOSHALLBE ENERGYP/C "-"—"`'°- -.�,� � � SUBJECTANEMPLOYERTOCRIMINALPENA�7IESAN�CNILFINESUPTOON'eHUNDREDTHOUSAND ENERGYPERMIT �OLLAFS(E1 ao,o0o),IN A�DITION TO THE COST OF C�MPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION37060FTHELABORCOOE,IMEREST,ANDATTORNEY'SFEES. RETENTIONFEE: � QCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIPM UNOER PENALTV OF PEfiJURV THAT THERE IS A CONSTRUCTION LENOING AGENCY FOR TH�PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUE�(SEC.309�,CIV.C.�. , Z W � LENDER'S NAME 1-^ LEN�ER'SADDRE55 r� � ICER7IFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHqTTHEABOVEINFORMATIONISCORflECi. TOTAL FEES ���r� �$�"' J� � � p,�� W 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE IAWS RELATING i0 BUILDING � ����� : , � �w�, � CONSTRVCTION,AN�HEREBY AUTHORIZE REPRESEMATIVES OF THIS COUNTY TO ENTEft UPON THE ^,,y.,p J (7}� Z ABOVE-MENTIONEDPROPERTYFORINSPECTIONPUqPO5E5. COMMENTS -'���'�'iV�'V��K"] J�U`� � a.. �y �lID ' � y �' . �l �� 9/'f.�.f � .______—_—""___ m PERMITTEps E(PRIN - - � _ . �" �i � SIGNATVRE E ATE = RECPT.NO. 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