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HomeMy WebLinkAbout15948 �. _�� CITY OF DIAMOND BA� �' � IDEPARTMENT OF COMMiJNITY&DEVELQPMENT SERVICES 21660 E.Copley Drive 5uite 190 {909)860-3i95 Fax(909)861-3117 PRE� l�" 9�... BUII,DYNG PERMIT APPLICATIOlv Plan 1 C FIRMLY a JOBSITE $S1 Canyon View Ct. AATLICATION � � ���� PERMlT ��Q � P/C PP Q ADDRE55 ' ` D E NUMBER ' # � 1SSUE 7YPE , OCC APN LOT TRACT DATE CONST, GROUP p pWNE_ R �UEt@ Oi11@ OY�3 o nno��ss 18407 Von aY►178t1 . V t �- 20NING SETBACKS � cirY lrvine ziP 9261��,. 9497 0 FaorvT Rw ❑ APPLICANT TEL. REAR � p z SIDE/SIaE STREE7 RW ❑ � CONTRACTQR SIDE ❑ n�oREss PROPoseousE NSFR - SEWER LATERAL _ o, CITY Z!P TEL: ow ARCHlENG/ z ,DESIGNER NO.DWEL NO. ND. � ADC�RE55 UNITS STORIES BEDROOMS � C1TY ZIP 7EL. � , u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ; � � OWWER-BUILDER DECLARATION SFf?lADD/REM � � � O � I HEFi�Y AfFhiM UNDEH PEkALTY OF PERIURY THAT'�1 AM E%EMPT FROM THE CONiRACTORS LF Gaf8Je/C3fpOrt �� � CENSELAWFOR7HEFQLLOWINGREASON(SEC.7031.6BUSIK'ESSANDPROFESSpNSCODE:ANVCITYOR (n � � COIINTYWHICHPEWIRESA.PEqMITTOCONSiqUCT,ALTEF,IMCROVE,DEMOLISH,ORREPAIRANV5iRl1C- L7,I pytio/DeCK NflE,PAIOR TU IT5 ISSUANCE,AISO FFAU{RES iNE APPLICANT FOq SUCH PEflMIT TO FIIEA SIGNED u"� .STATEMENi THAT ME OR SHE 15 LICENSEO Pl1R5lJANi TO THE PpOVIS1�NS OF THE CONTHAC70R5 LI- 'W �,' '�CENSEUW(CW�PTER9(COMMENCiNGWffHSECTIONJPOo)OFDIVISION30FTHEBUSINESSANOPRO- V' POOV�d " ' �FE93pN5CO0E}OflFHATHE�RSHEI3EXEMPTTHE}7EFftOMAN�THEBA313FOflTHEALLEGEDE%EMR �'(� �� ��TION.ANYYIOLATbNOFSECTION7a97.58YANYAPPLICANTFOflAPERMITSU&IECiSTHEAPPLICAMTTO Z (�e•RODI - �� � � ACIVILPENALTYOFNOTMOAETHANFIYEHUNDREDDOLLARS($500).): " ' ' �, ❑I,ASOWFdEROFTHEPROPER7Y,QRMVEMPLOV6ESW17HWAGESASTHFIRSOIECOMPENSATION, � Cotttm9�Cid1 � . . ' �,WI4 DO THE WORK,IND iHE STqUCTURE IS NOT IN7ENOED Ofi OFFERED FOR SALE(SEC.Y�46.BU56 � � '�NESS ANO PRbFES510fd5 C09E:THE CONTRACTORS LI�15E LAW DOES NOTAPPLY T�AN OWNEfd DF � ' . �pI�pERTY VYli9 EUItAS OR IMPROVcSTHEREON,AND WHO�OES SUCH WORK HIM5ElFOR HERSELF OR � ',THfiOUGHHISORHEROKNEMF'LCYEES,PROYIOEDTHAT9UCHIMPflOVEMENTSARENOTINTENDEDOR � � ' - � � �� ','�.OFFEREDFORSALElF,HOWEVER,THEBUILDIMGOflIMP80VEMENTISSOIAWITHI�YONEYEAROfCOMP4E - ' z. '�iION,TFtE OWNER-BIIILDER WILL HAYE THE 3URDEN OF PROVING THAT HE OR SHE DiU NOT BUILD OR � ��IMVROVEFOR'tHEpURPO5EOFSALE). � , ❑I,ASOWNEROFiHEPROPER7Y,AMiEMCLUSIVECVCANTR4CTINGWITHtICENSEDCOMRRCYORS � .'TO CONSTFIUC7 7HE PH0.1ECi(5EC.104{.BUSWESS AN�PflOFESSIONS CQDc�THE CONTqACTORS LI- j/y��gt;On A��.AREA _. �,CENSFLA6YOO�S.ND7APPLY70AN01YkEFdFAPROPERTYWFf06U1LD50RIMPflOVEST'nEREON,AN� ' W. ;�W}1000NTRACTSFQASUCHPRQI@C?fiW�ThiAC�d1'RACTOR(S)UCEN5EDPURSUAN7TOTHECONTRAF QUAN7ITY �ESCRIPTION FEE� - � � TOABLICENSELAW.J. 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Y90RK�RS'GOMPENSA710N DECLARRTiOFI �I � 1 HEREBtl AFFIRRI UND6R PENRL7V�JF PEEiJUAY ONE DFTHE fOLLON1ING DECLAHATIORS; z � �IHAVEANDWILLKRAINTdI1dACc'A7!FICA7EOFCCN56N7TOSELFINSUREFORK'ORKERS' ,y i COMPEMSATION,ASPROYIDEOBY°ECTI6Id37aoOFTHELABORCODEFORTHEPERFGRMANC6 � � 0F TIiE WORK FOR WHICH THiS PERMITlSISSUED. � � h �I HAVEA✓JD W!LL.MAIPITAIN WORKcRS'COldPEldSAYION INSURANCE,AS REOUIF.E�BY 5EC71ON � �Q, 370JOiTHELf�90N�6E,FOATHEPEPoF`^.RMANCEOFTHEWORKWRWHICNTHISPERMIi15 ISSUED.!AY WOFlKEFIS'COMrEPISATiOP11NSUAANCE CARRIEP RN�POGCV NUMBEfl ARE: COM1PSTRUCTISJN J ��:, caHRieq � � I PLAN AEVIEW �" voucreuu�naEa I ELECTROC _ _� a.� mf�sscr��ue�nroie=�rtroc�n��arwru�aa�s�r�w�nocunn.s(s+ooloa�Ess� I PL'JMBIN3 ' ����� 4 PJIECHAf41CAL . Z��� I CER7IFYTFiNT ItJTiiE PEflFORhWNCE OF?HE Ye'OftK FOR WN�CH THIS PEflb11T IS IS3UED,1 C;S'� SHAl4 P10T EPAPLOV d,PfY PERSON M kNY MANkER 60AS TO BECOME SUBJECT 70 THE �.�� WOfiKEqS'COFAPEMlSAiIONIAWSOFCALIFORNIA,A�UDAGPoEETHA?IFISHOUL�86COME iNSPECTIONFEE - � �' SU&1EC7 TOTHE WORKERS'COFAPENSATION PRCVISIONS OF SECTION 37a00FTHE�ABOR � (�� � � CQDE,1 SHALI.EORTHkVII'H CCMPLV WITH THQSE PflOVISIONS. �SSUANCE � ' SMiP ' (,,.,��DATE: � APPLICANT. J,'. '.WARNING:FAILURfiTO SECURE WORKERS'COMPENSATIDN COVERAGE IS UNIAWFUL,ANO SNALLBE ENERGY P/C , `y,,',SUOJECTAN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES I/PTOONE HI/NOREO THOUSAN� cNEFiGY PERMIT �DOLLARS(51ao.a�,tNADD!710NTOTHECOSiOFCOMFENSATIIXd,OAMAGE5A5PRddIDEDFORM �, �!.�!�'�,��,SECilON37oBOFTHELA60RCODE,INTEflEST.AtJDhiiORNEY'SFEES. RETENTIONFEE: �� o� CONSTRUCTIOhi CENpIFJG AGENCY PRE-AlT FEE: , 0."��,,IHEflERYAFFlRMUNOERPEMALTVOFPERJURYTHATTNEREISFCONSTRUCTSONIElDINGAGENCY ' �. 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