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HomeMy WebLinkAbout13761 (16) • CITY OF DIAMOND BAI� ---�� DEPARTMENT OF COMMUNITX&.DEVE P T I �'Y�J��� 27660 E.Copley Drive Suite 140 PRESS (909)�60.3195 Faz(909)861-3117 Q l„'� �a�aY ,�9�f BiJILDING PERMIT APFLYCATION t� o DDRESS�-���� rC�L.�A�.S :�•N��___ DATEICATIOPJ��� G, � NUMBER '�� li/C / $ '--- — � ISSUE TYPE OCC APN LOT TRACT_�._ DATE__ CONST._ GROUP °C OWNER � ��!� - O —� ADDRESS /" "N. 0 ZONING SETBACKS w • � ' FRONT RW_. �i � CIIY ZIP, T•.. � APPLICANT /�R�, ���� REAR -- _ --- Ll-- � SIDFJSIDE STREET RW_.__ il____ � CONTRACTUR �J � �.`� SIDE � � ADDCiEuS C'7� t r i (_l� v � CITILA)F�e'"��,575'+ �(I�I ZIP��_p�_�; F�-� PROPOSED USE _ � AqCWENG/ — �z DESIGNER — NO.DWEL. NO. NO. a ADDRESS _ -- UNITS STORlES BEDROOMS � CITY ZIP_ TEL. - --- � � DESCRIPTION SQ.F7 FACTOR PSF ADJ.AREANALUATION � OWNER-BUIL�ER DECLARO,TION SFR/ADD/REM O � 1 HEREBY AFFlRM UNDER PENALN OF PERNRY TI1AT 1 AM E%EMPT FROM THE CANTRACTORS LI� G2f2J@/CdfpOf[ lJJ ^-ENSELAWFOflTHEFOILOWINGqEA504(SEC.'l031.SBUSI�IESSANDPNOFE£SIONSCODE:�NYCITVOR (n.. __ —_ C.1 COUNTYWHIQIREOUIRESAPERMR7000NSTRUCT,PLTER,IMPflOVE,DEMOUSH,ORREPAIRANYSTflUC- W 'pyll0/DBCI( W TURE,PRIOR TO ITS ISSUANCE,A1S0 REQUIRES THE APPLICANT FOR SUCH PERMI7 70 FILE A SIGNEU W STATEMENT THAf HE OR SHE IS LICENSE�PURSUANT TO THE PH041SION5 OF THE COYTRACTORS LI� � CENSE LAW(CHAPTER e(OJMMENCINO WITH 3ECTION 7oo0)OF OIYISION 50F THE BUSMESS AN�PRO- V' PooUSpa _ FESSpN50D�E�ORTHATNEONSHEISE%EMDTTMEflEFAOMANDTHEBASI5FOH141EALLFGEUEXEAIP- (� V TqN.ANYYIOLATIONOFSECTIUN7DJ1.56YANYAPPLICANYFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Roof � A CIVIL PENALTY OF NOT MORE THPN FIVE HUNDRED DOLLAPS(5500�.): � ❑I.ASOW4EROF7HEPROPEflTY,ORMYEMP40YEESWITHWAGESASTNEIRSOLECOMPENSATION, � COfIlffleYCi81 " NflLL DO TYE WOfiK,AND THE STRUCTURF.IS NOT INTEN�ED OR OFFEFED FOR SALE(SEC.7oda,BUSI- � NESSANO PROFESSIONS CDOE THE fANTRACTORS UC[NSF lAW DOES NOT APPLY TO AN OWNFR OF � PHOPERTYYMOBUILDSORIMPRDYESTIEREON,ANDWHODOESbUCHWORKHiMSEIfOFHERSELFOfi �� � TNqOUGHH150RHEROWNEAIPLOYEES,PROVI�E�THATSUCHIMPROVEMENTSAR[NUTINTEN�EOOfl �. QOFFEREOFOflBALEIF,HOWEVER7/1EBUIlDINGOHINPROVEA�ENTI550L'1WITHINCNEYEAROFC(MIPIE� _ _^__ TION,THE OWNER�BUILD£R WILL HAYE THE BUR�EN OF PROYIUG iH/t H�OR SfiE OIU NO7¢UILD OR � N9PROYE FOA 7r7E PURPOSE 9F SALE} _ . ❑1,AS OWNER OF TNE PROPF.FTV,AM E%ClU51VELY CqMRACTING WiTk LICENSEU CANTRACTCFS � TO CONSTRUC7 iME VROJEf%T�SEC,.7044,OUSINE55 AND PROFfSSIONS CA�I::THE CONTRACTORS LI- VAl1J8�lOt1 _______......_.._-.._______AD.I.AREA_____.____ W CENSEUWOOESNOTkPPLYTOANOlVNEROFAPRUPERTVWHOBUIL�SORIMPROVESTHEFlEON,AND ----- - -- ----- F NR1000NTHACTSFORSUCHPRDJ[C75WITHACONTqACTOR�51��CcNSL�PURSUANT707HF.COM"qqC- QUAN�fITY DESCRIPTION FEE Y TOftSUC[NSEI.AW.�. __ QO i NA EXEMPT UNDEfi SEC.,_____ _._.,'�7.S P.C.:OR TNIS REASON Q 3 U ' _— --'._...""_'—'_'...'_' � LL �ATE _---_OWNER_".""_�— ~ �'• � LICENSED CONTRACTORS UECLARATION � i j _ � I HEREBY AFFIRM 11N0ER PENALTY OF P[RJURY THAT I pM LIGFNSED U\'DER PFlOVISIONS Di CiiAP?FR �^ �` 4 p� Y(COMMENCINGWITHSEC7'iON7D00�OFDIVISION30FTHE8USINESSANDPROFL55lO.NSCOpE,RN1] ��__ ��✓.J�A�� S�lrt'1>n�Y"/�L+ Y1•��� AIV UCENSE IS IN NLL FORCE ANO EFFFCT. p�� (�►� �/y'G���J `i 1�ae��,? �l'�'`( dJ r � LICENSE C 55 � �� _ LIC.NO. 7 3cJ V -�.f� _.__.____�J 1 N l�,r ��3�� �- �'`7 _' j �C� ' �y�j ���/L/� � � � - W DATE'____��I� CONTRAV'TOi�l�l=.....`.f.....�[I"�1L"� a � V•��WOiiKENS'CUMPENSATION OECLAr�AT10N Q� � -- � IHEHE6YAFfIRMUNDEFPENALTYOFPFRJUflY(?NEOFTHEFQ4f.ON'INGD[CLARATIUNS: U � Z Q _ -'_�_ � IMAVEANDWI:LMAINTAINNCFRTIFICATEOFCOfISLNTTUSELf��INSUREfCRWOHi(EHS' T __- — - _ AENSFT!U1,A5PROVIDE6B1'SECTICNl37GaOFTF1ELA30:iCODF.,FCHTIIE?EHFORMINCE U = F TNE WORK FGR WH!CH THIS PENMIT la`ISSI:E�. �� fa � ' __�_—_. _'�_` w _ I HAVE M1D WILLMAIMfAIN WORKERS'WMPr.NSATION IN5URAN,^,F,A5 RF4UIHEU dY GECTION � 6 37000FTHEIAROACOOE,FOR1'HEPLftLOR1.IANC�:OFTH�.WpRKFORK'417CHTHISPEH41Y15 0 ISSUED.MY WORKERS'CAMPENSATIjH!INSU�ANC CAH�iIFH pA0 PGl ICY NUM6EP�RE: CONSTRUCTION ____,...__-_..__ � `� ._....__... _..._...—_' y CARRIkR.....i�.II�.�,.. '�.�t!� 4t� PLAN REVIEW _.......--...— ----_ -- ___ - � POLICY NUMBEH_��� � 'S- � ' ELEfTRIC -• ..._. � � -- _ �-, y /*/S -_'__ 0 (f1iSSECTIQ`INEF�M'71'REOC�I.WLEf[DOFiF�iPEWJlfISFCRONEHUM]NED 510JI0 Y�a PLUMB�NG _�_�...--L_.--`.�..- - _.'___ W MF_CHANICAL � � �GEflTIFYTNAT IM TME FERFORMANC[OF THE SYOFiK FOF WHICH THIS PERMIY IS ISSUED,I -.-- -...-..-..--...-.-- (.'j SMALt.NOlEMPLOVA4Y9EN5(NJINMiYMANYi'NSOAS70EECOMF_SUBJECTTOTHf � (n WORKERS'CAMPE�15AilON�AW50FCALIF'OIINL�,qNDqCiRE1:iMAiIfI5110ULUBLCOME ( INSP[CTIONFEE _ -'-----...--- --.._.......-----�----..._ ��. � SU&IECTTOTHF:WORI;[qS'COMPLNSAfIOYFiXri'ISIn4S0'r5EC1'I 37 FT ELA30R ' � COUE.i SHALL f-OflTFIN'ITI1 COMPLY WITH T' 'OV"' Y5. '� ISSUANCE .........__ ...._..----... __�� CJ�� ' � / QC1 � � ' SMIP ..:,,�i4:•`,-"i,,,.� .. OATE:��____'�"._ APPUCANT: - _ __ _ • '� ,. . � .-_-. _.. .._...._ _'__—_ ..... , ' �. w � �..�� ....:..,� : __... . __—' ' y' ENERGY P/C :"id. a':�� ,...;. J WARNINGfAILUIiLTO5EGl1RFWOHKERS'COMPENSATIUNL"O1�E AG[ISUNUWFUL,ANUSIiALLBE -""'--"-"'- -"'-'-'- - . LL Sl1BJECTANEMPLOYERTOCqIMiNtLPF.NAlTIE5ANI7CNILFINESUPTOONEHUNOREDTH0U5AN� ENEfiGYPERMIT OOLLARS(4700.UO�j.INMDITION TOTHE COST OF GOMPENSATION,DAMAGES AS PROVI�[=D FOR IN -----� -- � J SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATfORNEV'S FEES. RETENTION FEE: .. � :;': '' _" '__ '..._..._ —__ .. . ... ..:....: ..'" � CONSTRUCTION LENDMG AGENCY PREAU FEEk.�-,. � ��� _._.._. ___.__-_..-_—___ .3 . — ..__..'------ �. ......: '. �� � ., •. � I HEREBYAFFIRM UNDEA PFNALT'OF PERJUkV 7HAT THERE IS A CONSIAUCTION I.FNUING AG[NCV "�.. . � � � . �',�?� FORTHE PERFORMh4CE OF THE WORN FOR WHILH THIS PERMI7151SSUED(SEC.3091,CIV.C.j. "'-" �""" ' ' �" �� LL� � '� Z° �'_"__"_._' � .. --__--'_'_'_""" . �W a LENDER'SNAME_"""..--.._.._ __"'___'....' "_�' . F- LENDER'SADORESS '____".._...._....."'-__'_...__ '�. � ICERTIfVTHATINAVEH[ADTlIISAPPI.ICN'IONANDSTATETIIATTHEABOVEINFOPMATIONISCORPECT. TOTAL FE�S , W IAGREETOWMPLYW17HALLCITYANDCOUNTYOflD:NANCE3ANDFTATLI.AWSRELATIN(;TOBUIL�ING � CON6TRUCTION,AND HERE�Y A11THUf117.E fiEPRESENTATIVF.S OF THIS C011NTV t0 ENTER UPON THE ZAHOVE�MENTIONE�PflOPERI Y FOR INSPEGTION PUfiPO5E5.. � COMMENTS.------- ----------- ----- �: d {�"'/ //7"I�'1�� -- - ---- ' _ ..�1�-_✓__ _.: --- -- - ----- ------- :. m PEPMI�N EP NT) '' �I" .......'_ --_--_'- - a ��� � ��% � -,.'____-___'__ C/] "_' "_-_'"_ "_ � RE .P DATF. ..'_— i'..,5_T-'___. . /_ = RECPT.NO.�v /'�'____PAID BV VALI�ATION _ ~ WHITE-DepaRment Copy,YELLOW�inance Copy,PINK-AssessorCopy,GOL�ENROD--File Copy,GREEN-Appiicant's Copy . ........ ... _.....�.. � .m .. .. - - _. � ., �: ' ' _ � .. I K:. 2 � �.6 - #� 7„ � I � i i - Y'�""v` _ J � ' �d F . ; � , - i �za.� � , � I . a ¢ .;-, � ,'I , � . ' i : � I i - t " f�- £ _ , _t ,I , . � � .i _ ' � �e� � _ ', _ ( f ! t 7; y 4S .. q � � q { I , � . 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