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HomeMy WebLinkAbout13557 (16) • � � , `''�� CITY OF DIAMOI+iD BAI� DEPARTMENT OF COMMUNITY&DEVEL M T E � �'j� 21660 E.Copley Drive Suite l90 � (909)860-3195 Fax(909)861-3117 C'�� S ���''9N"�� BUILDING PERMrl'.APPLICATION ?,? MLY o� JOBSITE 2/��� O1_pI� Sa N� �V CT APPLICATION Q PERMIT J���� p/C��_J� � ADDRESS t « DATE _NUMBE # � . ISSUE TYPE OCC APN LOT TRACT_ DATE CONST. GROUP p OWNER M r� p ADDRESS �� T����,cel�,/�r��'� G/�-,vc— ZO ING SETBACKS � ��'" FRONT RW U-----— Z CITY Dt� p.,�,rl RLl-IP ZIP TEL.�Jfl��� REAR (_�_____ g APPLICANT TEL. — SIDE/SIDE STREET RW ❑ � CONTRACTOR ��Lr�t� SC H� _ SIDE _ ❑__. Q ADDRESS V —�-- � cirv�+q�X���ZIP�/�f��'EL. ,2 D Z ROP�OSED US o�_S�-F �c,..�,ti.�l �.�,�-�h � ARC Fh9.NG! S���-- '2.�,�t A#'`���!aq-� �7 Qk�C F� �z DESIGNER NO.DWEL. NO. NO. � AD�RESS -- UNITS_ STORIES BEDROOMS � CITY 7_IP TEL. --- � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O Q 1 NEFEBYAFFlWN UNDER PENALTY OF PERJUflY 7HAT I AM EXEMPT FRDM THE CONTRACTORS LI� GefB 0/C8�Off W CENSEUWFOHTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANOPROFESSIONSCODEANYCITVOR (n 9 p U �qJp7TyWHU)HREWIRESAPERMITTOCONSTqUCT.ALTER,IMPROYE,OEMOLISH,ORREPAIRANV3TRUC- W Patio/Deck � NflE,PNIOR TO IT$ISSUANCE,ALSO REOUIRES THE APPUCANT FOH SUCH PERMIT TO FILE A SIONED � � STATEMENT THAT HE OR SHE IS LICENS[0 PURSl1ANT TO TNE PROVISIONS OF THE CANTFiACTORS LL CENSELAW(CHAPTER B(COFAMENGMNO WITH SECTION 7aoo)OF DIVISION 30F THE BUSINESS AN�PflO� �'�' POOVSP& FES310NSCOOE)ORTHATMEORSNEISE%EMPiTNEflEFROMAN�THEBA515FORTHEALIEGEDEXEMP- (,�} TION.ANYVIOI.ATIONOFSECTION7037.b6YANYAPPLICANTFORAPERMITSl1BJECTSTHEAOPLICANTTO z Re-Roof � ACMLPENALiYOFNOTMOREh1ANfIVEHUNDFE�DOLI,FRS(55o0),): � ❑I,ASOWNEROF7HEPROPERTV,ORMYEMPLOYEESWITHWA6ESASTHEIREOLECOMPENSATIO�, � COt11rtIBfCl21 _ ' WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDEO OR OFFERE�FOF SAL[(SEC.7o<a,BU51- _I � NES3 ANO PROFESSIONS CODE:TNE CANTRACTORS LICENSE UW DOES NOT RPPLY TO AN OWNEfl OF � PROPERTY WF108UILOS OR IMPROVES 7HEREON,IW D WMO DOES SUCH WORK HIMSELF OR HERSELf Ofl Q iHROUCM HIS OR MEROWN EMPLOYEES.PHOVIDED iHAT SUCH IMPROVEMEN75AFE NOT INTEN�ED OR m O ,OFFEREDFORSA�E.IF,HOWEVERTMEBUILD!NGORIMPROVElAEN715SOIDWIiHINONEYEAROFCOMPLE- Z TION,7HE OWNER�BURDER WILL HAVE TNE BURDEfd OF PROVING THAT HE OR SF1E DID NOT RUILD Oft = IMPf�VEFORTHEPl1FlPO5EOF5ALE�. U I,AS ONRJEROF THE PROPERTY,AA9 EXCLUSIVELY CONTRACTING WITH LiCENSED CONTRACTORS � TO CONSTflUCT THE PH0.IECT(SEQ 7014,BUSINE55 AND PROFESSIONS COUE:THE CONTRACTORS LI- V81Ua110� � __..___ADJ.AREA_.,.._ W CENSEIAWDOESNOTAPPLVTOPNOWNEROFAPROPERTVWHOBU1L�50RIlAPROVESTNEREON,PN� — F WFIOCONTRACTSFORSUCMPqOJECTSWITIiACONTflACTOR�S�LICENSEDPUR5UMITTOTNECONTRAC- QUANTITY DESCRIPTION FEE Y TORSLICENSEUWJ. ¢ ❑1 AM E%EMPT UNDER SEC._ B.&P.G FOR?HIS REASON � � � � —'—_"" � DA7E____ __._. OWNER_—.—_—__—___._"_'._'...".._..._._.___ U n ' � � � LICENSED COtVTRACTORS DECLARAi'ION w � IHEREBYAFFIRMUNDERPFNAL7YOFPEi1JURVTHATIAMUCFNSEDUNU[R?FlOVI510NSOFCHnPTEF � (� B(COMMENCINO WITH SEGTION 7000)OF OIVISION 30F TMt W51ME55 ANO PFOFE5510N5 COOE,AND z �X MYIICENSE IS W FULL FOIiCEAND EF�ECT. � m � UCENSE CLASS C�T��_LIC.NO.__���_ � .W DATE�I��'__ COi`flNACTOR__,_��'���j—� n. �V« � WORKEFlS'CO�APENSATION DFCLRRATION "'1 ' — y' IHEREBYAFf�HMUNDERPENAI.TVOFPERIURVONEOFTiEFOLIOWINGDECLARATIUNS: �� � — � [�,� _ _ Q � _INAVEAN�WILLMAIN'fAiNACEp?IFICATEOFCONSFNI'TOSELF-INSl1R[FORWOflKERS' x .� COMPENSATION,AS PROVID[D OY 9ECilON 370o OF THE LABOH CO�E,FOR THE PERFORMAkCE W I_ OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � � W _IMAVEANDWILLMAIMIIINWORKEflS'CAMPENSATIONINSUfiANCE,ASRFOl1iRLOBYSF.CTiqN � � Q 37000F THE IA90R CO�E,FOR TNE PEqi'ORMANCE OF TI IE VlORK fOR WI1:Cl1 Tl{�S P[FiMIT IS _ �� ISSUED.MY WORKERS'COMPENSATKKJ INSl1RPNC[CARFtIEH FND POLIGY NUMBGR ARE CONSTRUCTION __..� _.,...., y ____ , �,..-.. . � ,.. �j CARRIER �����,6��V�—.----'-'—.--- .�_� PLAN REVIEW . � i�)�.../ _ � PaLICY NUMBER__�p a�s=(���f r��L_� _� _— _.-`. ._._...--..—_...' Q 7� � � , ��,t� ELECI"RIC � (fFi1SSECTIJfJNE�N0T8E0.�L[TEAOFTNEPE ISFO�iON[ WR[�[XM1N�S�s�aoloit�[ssa PLUMBING ___ ___,______ Z ICEflTIFYTHATINTiEPERFORMANCEOFTiEWORKFORWH:CHThI15PEqMITI5155UEtl,l MECHANICAL .__.______ _._______ _ �'..(,�j. .SMALL h0T EMPLOY ANY PERSON IN A7JY MANNER 50 AS TO BECAME SU&IECT TO THE y� WORKER5'COMPENSATIONLAWSOFCALIFORh7A,ANDAGREFTHATIFISHOl1:OHECOME INSPECTIONFFE __,.._.__ /� � � • -'-- - SU&IECTTOTHEWOflKERS'COMPENSATIONPROVISIONSOFSECTION370oOFT1iELA80fl Y -<;, „ ' / (.. � COOE I SHALL FORTHWITH COMPLY WITH TMOSE PROVISIONS. ISSUANCE _..,._,,;_ �: ' �� ,__ `' f�� p DATE: APPLIGANT: _ SMIP ..�. ,- ...... . . _ __. _"__ _'_ _ ._.__ _'..'..' — J WARNINO:FAIL=�E WORKEFiS'COMPLN TION COVERAGE IS lAW!-�.A�LL BE ENEHGY PIC . _'"'_�—_ _ _ _"__ LL SUQIECTANEMPLOYERTOCFIMI4ALPENALTIESpNOCIVILFINESUPTOONEHUNDREDT110U5NJD ENERGYPERMIT , DOLLARS(f700.00o),IN AODITION TO THE COST Of COMPENSATION,OAMAGES AS PROVIOED FOR IN —��-�--����-��-----������ � SECTION3/oeOFTNELAWRCODE,INTER[ST,ANDATTORNEV'SFEES. RETENTIONFEE: __,____ 4 � CONSTRUCTION LENDING AGENCY PFE•ALT FEE: p /' ------------_. '�� i HEREBY AFFIR\I UNOER PEN�LTV OF PERJURV TFIATTHEAE IS ACONSTRUCiION I.ENDING AGENCY �C��'. _ ____ _ FORTHE PERFORMANCE OF'IHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEQ 3097,CIV.C.). �'� W. ��i LEN�ER'SNAME � � _— ___'— � — _ ' "�— '""_" � LENDER'SAD�FESS__ — � � � ICERTIEVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVC-INfORM�TIONISCORflECT. TOTAL FEES ��,C�� � L W I AGftEE TO COMPLV WITH ALL CITY AND COUNTY ORDINAhCES AND STATE LAWS RELATING T0 9UILDING � � CONSTRUCTION,ANDHEREBYAUIHOHIZEREPA[SENTATIVFSOFTIIISCOUNTYTOENTERUPONTfIE Z ABOVE-MENTIONED PROPEHYY FOR INSPECTION PURPOSES. COMMENTS o N ------- � � -�_------�-�-- ---- ---------- ---�--�--�------�— m PERMITTEENAME(PRINT) ' � Q ��' _—_ q � 1 /"� �1 � / _ "____ '—__—'_ � SIGNATUREOFPERMITTEE UATE = RECPT.NO.�,___ PAID BY _l,___ VALIDATION ~ WHITE—Depenmen[Copy,YELLOW—Finence Copy,PINK--Assessor Copy,GOL�ENROD—File Copy,GREEN—Applicanl's Copy _ . . , . � , . � � ; , ; : : ���,. 4 '���.. . � � ,. � ! ' I � - -�t'• - i � � �, �� � - '. '.�� � � ( i ! I ' I . � , i � � r ., � . , � i , . � � . . , � � . . , t I . „ . i , t ... ;. .. •si . . ;? 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