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HomeMy WebLinkAbout16269 �.. _ �.,. , ���;a�. ,- ����`��Z` _ _�n� CITY OF DIAMOND BAI+t DEPARTMENT OF COMMUNITY&DEV�LO�MENT SERVICES G��.�G'--cr/ � 21660 E.Copley Drive Suite 190 ��'' �, (909)860-3195 Fax(909)861-3117 "�� .����:�' ` Pf�E$$ """°� FIRMLY BUILDING PERMIT APPLICATTON .,_ . _ •,� . ,, ..,.� } J�BSITE /� o J_^'��� ���-j pn��� APPLICATION PERMIT P/C o ADDRESS�r Qr"C 0�� 1�T—��'1���` DATE 3/16!O1 NUMBER 162 69 � � ISSUE TYPE OCC APN LOT RACT DATE CONST. GROUP p OWNER p ADDRESS ZONING SETBACKS �W CITY - � ZIP TEL. �" �� FRONT RW ❑ APPLICANT r f[. ; REAR p zq, SIDElSIQE STREET pyy ' ❑ � CONTRACTOR SIDE � � ADDFiESS_ � � CITY ��a • ZIP TEL. PROPOSED USE o ARCH/ENG/ � z DESIGNER � ADDRESS NO.DWEL. NO. NO. v� UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFWAD�/REM p 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8f8 B/C3 W CENSEIAWFORTHEFOLLOWINGHEA50N(SEG7o31.58USINESSANDPHOFESSIONSCODE:ANYCITVOR (n 9 �rt V COUP(ryyyF11CHHEWIRE5AVEflMITTOCONS'I'RUCT,ALTER,IMPROVE,DEMOtISH,ORREPAIRANYSTf1UC- w TURE,PRIOR TO ITS ISSUMICE,AL50 REW I�ES THE APPUCANT FOR SUCH PEqMIT TO FILE A SIQNED W PatiolDeck � STATEMENT THAT HE DR SHE IS UCENSED PURSUANT TO THE VROVISIONS OF THE CONTRACTOpS L6 � CENSE lAW(CHAPTER 9(COMMENCINQ WITH SECTION 7o0oJ OF�IVISION 3 OF THE BUSINESS AND PRO- u' PooUSpa FESSIONSO�DE)ORTHATHEOASHEISE%EMPTTHEREFqOAAANDTNEBASISFORTHEALLEGEDEXEMP� (�J TION.ANYVIOLATIONOFSECTION7031.58YANVAPPUCANTFORAPERMITSUBJECTSTHEAPPUCANTTO Z Re-Raof � A CIVIL PENALTV OF NOT MORE TNMI FIVE NUNDRED DOLURS�5500).j: � ❑I,ASONMEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, COfi7f176fClel . WIIL DO THE WORK,AND THE STHUCTURE 1S tJOT IN7ENDE0 OR OfFEfiED FOR SALE(5EC.�7o4�,BUSb a � NE35 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW�DES NOT APPLY TO AN'OWNEfi OF ? PROPERTY WtlO BUILDSOR IMPROVES 7HEREON.AND WHO�OES SUCH WORK HIMSELF OR HERSELF OR � TFIRWOHHiSORHEROWNEMPLOYEES,PHOVIDEDTHATSUCHIMPROVEMEMSARENOTIMENDEDOR m � OFFEREDFORSALEIf,FiOWEVERTMEBUILDINGOFIMPROVEMENTiSSOLDWITHINONEYEAROFCOMPIE- � TpN,THE ONMER-BUILDER WILL HAVE THE BUPDEN OF PRONNG THA7 HE OR 5HE�IO NOT BUIID OR = IMPF�VEFORTNEPURPOSEOFSALE} � W ❑I,ASOWNEROFTNEPROPERTY,AMEXCLUSIVELtlCONTRACTINGWITHLICENSEDCONTRACiORS � TO CANSTRUCT THE PROJECT(SEC.�MI,BUSINESS AND oqOFES510N5 CODE:THE CONTRACTORS ll- V2fU3f10� ADJ.AREA W CENSELAWDOESNOTAPPIVTOANOMMEROFAPROPERTYWMODUIZDSOflIMPROVESi'HEREON,AND — W/IO CONTRACT6 FOfl SUCH PR0.IECTS WITH ACONTRACTOR(S)LICEkSED PURSUMff TOTHE CONTRP,C- rorasuceNseuw.�. DUANTI7Y �ESCRIPTION FEE � ❑IAM E%FMpT UNDER SEC. . B.&P,Q FOR THIS 41EASON Q 3 � LL DATE _ OWNEfl � — Z U Q w � IICENSED CONTRACTORS DECLARATION w � 1 HEREBYAFFIRM UNOER PENALTY OF GEflJUflY TNAT I AM UCENSED UNOER PROVISIONS Of CHAPTER � � p� B(COMMENCINOWITMSECTION7o00)OFDIVISION30FTHEBUSINESSANDPROFESSIQNSCADE,AN z ��� MY UCENSE IS IN FULL FORCE EF ECT. y��, _ (n a �� � ,�..., � - r uceNs�cuss uc.No. �L�_ � U DATE�""�Q '_C�� CONTRACTOR a W � WORKERS'COMPFNSATION DECLARATION a � IHEREBYAPFIRMUNDERPENALTYOFPERJt1R1'ON'eOFiNEFQLLOWINGDECL.ARATIONS: z � �IHAVEAN�WILLMAINTAINACERTIFICATEOFCONSENTTOSEIF-INSUREFORWORKEFS' a COI.IPENSATION,ASPROVIOEDBYSEC7lQN3)WOFTHELAB'JRCODE,FOqTFfEPEflFORMANCE U Q 1JF THE WORK FOR WHICH THI$PEP.MIT IS ISSUED. � � / ��_INAVEANUWIILMAINTNNWORICERS'CQMPENSATIONINSUFANCE,ASREOUIREDBYSFCTION Q 37000F7HELAPORCODE,FORTHEPERFOFIAANCEOFTHEWORKFORWHICHTHISPERMITIS ISSJEO.IAY WORKERS'COM�PEyN^�"fT.ION INS RANCE CARRI A� OIICY IJMtllRARE: CONSTRUCTION � CARRIER_���`��� ��--�� PLAN REVIEW � POIICV NUMBER ELECTRIC Q � (TH4SSECTK7NNE�NOTBECOMPLEfIDOFiNEPEFUMISFOR01JEF0.NLN�EDDIX.W�S1S100)ORLESS� PLUMBING — L3J Z ICERTIFYTHATINTHEPEFFORMANCEOFTHEWORI(FORWHICHTHISPERMITISISSUE�,i MECHANICAL (� SHALL NOT EAIPLOY ANV VERSON:N ANV MANNER SOAS TO BECOME SUBJECT TO THE � WORKER5 COMP�NSATIOry LAW5 OF C�1.IFORN10.ANO AGR[E THAT Ir I SI�iOVLD BECOME INSPECTION FEE � S SUBJEC TOTkE /ORKERS'COMPENSATIONPROVISIpNSOFSECTION370oOFTHELABOR q '^�s;� �,... GODE.1 rHAI..L F TMWITM COMPLY WI PROVISIONS. ISSUANCE __���1r_ �, ao v p �ATE:_y� __7� �� APPLICANT. �_ ��_ SMIP __ � ' 1-� J WARNItJG FAILURE TC SECURE WORKERS'COMPENSATION CAKRAGE IS UNUWFUL,AND SIT Y P1C _ _ LL SUBJEC7ANEMPLOYERTOCPIMINALPENALTIESAHDCIVILFINESUPTOONEHUNOREDTHOUSAN� ENERGYPERMIT DOLLARS(i!00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PNOVIDED FOR IN � SECTION37080FTHELABORCOOE,INTEREST,ANDRTTOflNEY'S�EEs. RETENTIONFEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMUN�CRPENALTVOFPERJURYTHATTHEREISACONSTRUGTIONIENDMGAGENCY �4����"�""' � FOH THE P^cRFORMANCE OF THE WOFK FOfl W HICH THIS PERMIT IS ISSUED(SEC.3o W,CIV.C.). Z W � LENDER'S NAME _ F— LENDER'SADORESS W 1 CERTIFV THAT I HAVE READ THIS APPLICAT:ON AND STATE THAT THEA60VE INFORMATION IS CORRECT. TOTAL FE ES � IAGREETOCAMPLVWITHALLCITYANDCDUNTYORDI CESANDSTATEIAWSREUTIN0T08UILDINR � CONSTRUCTION,AND HEREBY AUTHOR2E REPRESEN TIYES OFTHIS COUNTV TO TEF UPO THE Z ABOVE-MENTIONEDPROPERNF RIN GECTIONPUR OSES. N S O � '^� Ii / m PEHMITTEE AME ) Q N � SIGNA7URE DF ITTEE OATE = RECPT.NO. PAID BY - VALIDATION ~ WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicanfs Copy � ' ;,.r,v��;-; - p,u. .��, � . � ��� ,� ��„ ���'��� ���5�.� .:�,. � . . . I�d ����� � � ,� ��r;� ' � � ��. �+.� ��,.����i„.a � �'_���;::� ;a�. . . � „�"^��"�.«��� .: ��� x:: � . �m� � ��:"�"�r � x -�,'�' .. -a� �� �w ��_ ,:� ��a� � c���; � �:��� �� �"� : ����,�.: � ,��� :��� ��� _ z� �.."`_� � �.�r� ���� � '� � �u�m� - p„�F ��,.� •+. �. �� .�� �' • �� � , a,M a� � , �� ',� ��_ � � � � � .., ..�.. � � . ,. .. ,. . g m�.��.�.�. �. -�'ra �� � .�:#4 .mK��`` �.s� � ..,.,r... �J" �'. ...�.. I � � ~' � �,i� �.g� ._ .. .. r �»._ - .. . " ..._.......��..__._.......,,.._. 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