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HomeMy WebLinkAbout17155 (26) CITY OF DIAMOND BAl� � — �"� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES w . 21660 E.Copley Drive Suite'190 (909)860-3195 Fax(9U9)861-3t17 P�ES$ �" BUILDING PE APPLI ATION FIRMLY _ _ _ I L NUMBER t � JOBSITE APPLICATION h"`,� �l PERMIT ��i+��!�1 o ADDRESS �� � � DATE U� �"6J �.3,J �L� � � APN �LOT_ TR CT �SSUE �°� � TYpE OCC DATE 1, � � CONST. GROUP ' p OWNER �`� � p ADDRESS � ZONING SETBACKS � �, CITY � � y^� ip . � , FRONT RW ❑ � TEL: APPLICANT TEL. REAR ❑ z y,.` SIDEISIQE STREET RW ❑ � CONTRACTOR S-P�'Y�a� ��3 �.iJd�`� SIDE p ADDRESS ' � CITY ZIP TEL. PROPOSED USE �"'��� o ,ARCWElVG/ z DESlGNER w N0.DWEL. INO. NO. o., ,ADDRESS w UNITS STORIES BEDROOMS � CIYY ZIP TEL. �n DESCRIPTION SQ.FT. , FACTOR PSF ADJ.AREANALUATIAN Q OWNER-BUSL�ER DECLARATION SFR/ADD/REM 0 I�'HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT�AAR EXEMPT FROM THE CONTRACTORS LI- G8�8J8/C2fpOR W'�� ''CENSELAWFORTHEFOLLOWlNG'REASON(SEQ7o31.5BUSPIESSANDPROFESSIONSCODE:ANYqTYOR (n � C.��', CQUN7YWHICHREQUIRESAPERMITTOCON3TRUCT,PiTER,IMPROVE,DEMOUSH,ORREPAIRANYSTRUG � � � �.TLflE,PRIOFi i0 ITS ISSUANCE,AL50 REQUIqES TME APPLICANT FOfl SUG-I PERMIT 70 FILE A SIGNE� � Patio/Deck , � � �, 'STAiEMENT THAT HE OR SHE IS UCENSE�PURSUAN7 TO THE PROVISIONS OF THE CONTRACTORS LI- � . � .. '� �QENSE LAW'(CHAPTER�e(GOMMENCING 1NITH SECTION 7000)OP�IVISION 30F'HE BUSINES5AND Pfm� � POOUSp2 � • '�.� .FESSIONSCODEJDRTHATHEORSHEISEXEN?TTHEREFHOMAND7HEBASISFOP7HEALLEGEDEXEMP- � , �V' ��710N,ANYViOLATIONOFSECT10t�703t.5BYANYAPPLfCANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z R8-POO{ �� � . �I� A6MLPENlLLTYpFNOTMORETHANFIVEHUNDREDDOLLARS�iSoo).�. � �.❑f,A50VdNEROFTHEPRQP�RTY,ORMYEMPIOYEESPoITHWAGE5A5THEIRSOLECOMPENSATION, � CommePCiai , , - � p � . �WILL DO T E WOAK AND THE STkUCTURE IS NOT INT N . . E D'ED OR OFFEFE�7 FOFi SALE SEC.7044 8US1 Z' , J ( ��,� ��NE55 hND P'AOFESSIONS CODE:THE CONTRACTORS LlCENSE LAW DOES NOT APPLY TO AN OWNER OP _ i. . - . � ::PROPER7YWHOBUILDSOFiIMPROVEST}1EREON.ANDWHOOCESSUCHWORKHIMSELFORHERSELFOR �� -' � OC�'�, ,�.THRO�GHHISORHEFiOWNEMPIAYEES,PROVIDED7HAT5UCHIMPROVEMENTSARENOTINTENOEDOR � W' ''' c ,,,OFFEREO WRSJLLE,IF,HOWEVEi�';THE BUiLC11NGOR IMPHOVEMENT IS SOLD WITHIiJ OWE V�P,Of CAMPIE- Z�'�, ��'�TpW,THE OWt�R-BUIIDER YdILL'HAYE THE BURDEN OF PROVING TF{py HE bfl SHE DID NOT BUILD OR , _, ,;IMPROVEFORSHE�PURPOSEOFSALE). � , �I,ASOWNEP.OFTHEPROPERTY,AMEXCLUSIYELYCONTRAGiINGWITHIICENSeDCANTR G O 6d.i AT fl5 �',, '.N WNSTRUCT THE PRQiECT(SEC:7064,dUSINE55 ANO PflDFE551ON5 CDpE:THE CO�TRACTORS LI- 0(�IU841�P7 �� ADJ.AREA �W'�, �.;�CENSELAWDOES'NOTAPPLYTOAN'ONRJEROFAPNOPERTYWiiOBUI LpSORIMPROVE57HEflEON.AND �'.' �',.WFIOCONTflACTSFORSUCHPROJECTSWITHACONfRAC7QA�S)LICENSEDPIIRSlJM1TT0'iHECONTRpG QUANTITY QESCRIPTION �E� . �.� '���,TORSLICENSELAW.). � �'�. ��I RM E%EMP7 UHDEA SEC. B.8 P,C.FpP.THIS REASON a �� U V'"" �'���DWTE CVJN6R � . � ��, '. ' C� . . �. Cy' w C' — - � LSCENSED CON7RACTORS DECLARATION -1 � . � i H' W �� .I HEREBYAFFIRM UNDER PENALTY oF P£RJURY7HAT I AM LICENSED UNOER PROVISIONS Of CFiAPTEfl � � � �:�e Ct9MM NCI T P . E MO W!N SEGTKKJ 7000 OF IYi lo , �" D 5 N30FTP1EBUSINESSAND.FOFESSIQNSCO�E AND i ) . y� ��MY GCENSE IS IN FULL FORCEAND EFFECT. Z 'W". m ,o�'� IICENSECLASS UG YO. � F-' J DATE cOPfiRACTO Q. C3 R w. ��� ' WOF9hCERS'COP�IPENSA710N DECLARATIUN -� � � , ¢ ��.���, �� U �', i FiEREBV AFFlFM UNDER PENALry OF PERJUHV ONE OFTHE FOLLOWING DECLRRATIONS: Z '�'� �� '� lHAVEAP�WILLMAINTAiWACEFidIFlCA�EOFCANSENTTOSELFdN U a 5 RE FOR WORKERS' 2 � ���-COMpENSATfQN.NSPFlflVIDEDBVSECTION37WOFTNELABORCODB.FOR7kERERFbRA1ANCE U OFTHEWORKFORINH�CHTHISPERlA1TISiSSUED. � �. � Ll2 i HANE AND WI , LL MAINYAIN tYORKEFS'(T�MPENSATION INSURANCE,p5 REQUIHED BY SECTI9N h B��� Q �37000FhIElfi90R�7E FOFIYHEPERWRMkNCEOFTHEWQRKf-0pWHICH?HISP .... . , � � . � ERMITIS �(�J �� ISSUEO.MY WORKERS'COMPEMSATION iNSUA.WCE C,�RRiEA AND POI.ICY NUMBERARE: COYVSTRUCTION - ' ��d c/ '¢. g y cARw�H � PLAN REVIEW �1 � � ���� POLICYNUM3ER ELECTRIC _____ °"�r�,.�9� a - (!HlSSEi.'11CYdNE�NOTBEGXrIP�ETE�OFiNEPERMMPISFORINJEFtt:�DAEDOq.kN3 1mORLESS. PLU�v9BING ��.L'1. ETE (� ) 1 ''� ' f CERTIFV THAT IN TriE PERFOF➢MANCE OFhIE WOqK fOR WHICH THIS PERMIT IS ISSUED,I MECHANICAi (S SHALLNO7EtvfPLCYANYPERSONIfiANYMANNER50A5TO8ECAMESUBJECTT07HE ';gTj� WORKEPoS'COMPENSATION LAWS OF CALIFORNiA,AND AGHEE THAT IF I SHOULD BECOME INSPECTION FEE _ SU2JECT TO?HE WORKERS'COMPENSATION PflCYISIONS OF SECTiON 37Go OF THE LAB�R � .= CADE.ISHALLFORTHVr'ITHCQFAPLV`NITNTHOSEPROVlSIONS. ISSUANCE �.� � DATE: � A�P�lCANT: SMIP ,� !'� J' ENEROY P!C . ,,.J i WAftNINa:FAILUflE 70 SECUFiE WORKERS COMPENSATiON COVERAGE IS UtJLAWFUL,AND SHAIL BE . ''�.,�y;'. SU&IECTANeMPl.OYERTOCRIMBdALPENALTIESAN�CIVIIFINESUPTOQNEHUNDREDTHOUSAND - , ENERGY PERMIT DOLLARS Si00.000,INA0DITIONTOTHECOSTOFCOMPENSA7iON DAMAGESASPR I - �' ( S , , W DEO FOR IN ��_I' SECTION37080FTH O - , E LAB R CODE,INTEREST,ANDATTORNEV'S FEES. ,,.., ��'CCr RETENTIONFEE: ;w �,d� CON3TRUCT!ON LENDING AGENCY . O PRE- LT FGE: �.. H.. .�p 1 EREBVAFFIRFAUNOERP N �O �. E ALTY FPERJVRYTHATTHEREISRCONSTRUCTIONIENGWOAO ENCV �p FOR THE PERFORMANCE DF 7HE WORK FOH WHICH THiS PEfiMIT IS ISSUED SEC.30W CIV.C.. — Z. f . 1 PW. l �'',T' LENOER'S NAME � ' -sS' � � .ENDEH°SADDRESS �' �' ' � f . � I CERTIFV THAT I HAVE READ THIS APPLICATIIXd AND STATE THAT THE ABOVE INFOR ATION I �,,, M s�AAE�T. TOTAL FEES `^'''� � � , IA6REETOCOMPLYWITNALLCIttqNDGOUNTYOH�INANCESAPlDSTATEL4WSRELA71NGT0 �°� "���.: BUILDING 1 "�' CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNiV TO ENTEP UPON THE ' ' � ' Z. ' A80YEd.1ENTIONED PROPEHiY FOR INSPECTION PURPOSES. . � — � COMhAENTS - . ,�I.,, � . . . � , - �J' I ✓�'1� � � � �t z-�-- m� PERMVTTEEN PAIN7 � � ( 1 v � � � � �� � °I SIGNATUAE OF P'eRMIT . - � EE DATE :_ � RECPT.NO. PAID BY _ _ VAI.IDA'f70N N' WHITE—De amnent Co YELLOW—Flnance Co PINK—Asse or ss Co GOLDENR D—Fil , O e Co GHEEN— li P P . canYs Co Y PY, PY PY. 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