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HomeMy WebLinkAbout16666 (35) -_�---_-_ _ ___ - _. �- _ �.� CITY OF DIAMOND BAl� �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 PRESS Y��"' BUILDING PERMLT APPLICATYON -- FIRMLY o AD RI SS �/JB '/ � ���Vl!(.�'4�� �"' DATECATION � �� NUMBER ��'°` 4��#/C � , ISSUE g TYPE OCC APM L T TRACT DATE 9 " � CONST. GROUP ' � OWNER �i.1'�' 7�� p ADDRESS � ZONING SETBACKS z, CITY rafJF�`aL,���� ZIP TEL. � REART RW ❑ g APPLICANT I 3EL. SI�E/SIDE STREET RW ❑ � CONTRACT � �a . SIDE � ❑ � ADDRESS �� � s PROPOSED USE �' CITY ZIP �� / TEL. W' ARCWEP7G! ' z DESIGNER I Na.DV�IEL. NO. NO. nW.!' ADDRESS UNITS STORIES BEDROOMS �,, CITY ZIP TEL. ,vy, DESCRIPTION Sa.FT. FACTOR PSF ADJ.AREANALUATION � OI�1NE4i-�UILDER DECLARATION SFRlADD/REM O I 0, ' ' 1 HEflEBY pFF7RlF UNUER P�NPL7Y OF PEflJURY THAT!AR�EXEMPT FROM THE CONTHACTORS LI- � ("jgf898/CdfpOfl � 11J. .CENSELAWFOR7HEfOLLOWING EASON(SEC.7031.58USINESSANDPROFESSIONSCODE:AM1'YCITYOR C��. COUNiYWHICHRE0UIf1ESAP�R""��''ITTOCONSTRUCT,ALTEH,IMFROVE,�EMOLISH,ORREPAIRANYSTRUC- � p��io/Deck � � � W�� �,7URE,PRIOR�ip ITS ISSUANCE,n,�50 REQUIRES THE APPlICM1T FOR SUCH PERMIT TO FILE A SIGNED ��� .,STAYEMENY THAY.HE OR SHE IS Y�ICENSm PURSUANT TO iHe PROVISIONS OF THE CONTFAC?ORS L4 CENSE�LAW(CFi4PTER e(COMMEYLdCMG WITH SEOTION 7o00)OF�IVlSION 3 OF THE BUSINESS AND PRO- V' PooVSpa ��'� ��.FESilONSCODE)ORTHATHEORpNEISEXE>APT7kER6FROMANDTHEBASISFORTHEALLEGEDEXEMP• � � � . U� TiDN.ANYVIOLAYIONOFSECTION7091.5BYANYAPPLICANTFONAPERMITSU93ECTSTHEAPPLICANTTO � Re-Rooi A CIVIL P6NALTY OF NOT MORE T AN FNE HUNDRED DOLLARS(5500).): ryi �I.ASOWfdEHOFTHEPROP�RYY,t7RMYEMPLOYEESWITHWAGE5A5THEIR50lECOMPENSATION, C� COfI'1R18fC18I � ' � WILL DO TNE'WQRK,AND TfiE 57 UC7USiE IS NOY INTENDED GR OFFEHED FOR SALE(SEC.7044,BUSI- J S�.NESS ANO PAOFESSIONS GODE: HE CONTRACTORS LICENSE LAW�OES NOT APPIY 70 AN OWNER OP . �. ��N' ���PROPER7YWHO�BVILDSORIMPq�VES7H6REON,ANDWHODOESSIJCHWOFIKHIMSELFORHERSELFOR � "CL'�, "THRDUGHHI56qHEHOWNEAfa YEES,PPOVIDSDTHATSUCHIMFROVEMENTSAREN�TINTENOE�OR � ' „�'�,i ;OFfEREDFOflSALE.IFHOWEV THEBUILDINGORIMRROVERIENTISSOLDWITHINONEYEAROfCAMPIE- ' �'TKNI,THE OWdJEq�8U1L�ER WILL HAVE THE BUftDEN OF PROVIN�PHAT HE OR SHE DIQ NOT BtJILD OR Z IMPHOYE fOR THE PURPO5E OF AL£j: ���. qI,ASONR3�ROFTNEPRO-LERTY,AMEXCLUSIVELYCONTRACTWGWITHIIGENSEDCANTRACTOAS � � ��. �TO C'AN54flUCT�THE PRQIECT(a�.C.7e6d.BUSINESS AiJD PROPESSIONS COPE:7HE GOIVTftAGTOFS L7� . V01U&tI0f1 _ ADJ.AflEA LLd, �.CERtSEL9W�0ES�tdO?,APPIVTOUIOWNEAOFAPROPERTYWHOBUiLDSORIMPFOVES?HERC-0N,RfiD . '_�� 'W'k6CtlNFRAC7S�FORSUCHPFoUEcrswrnaAcorr�'aacroa�s��EcsNSEoauRsuaarrorHEcoN'rnno QVANTITY DESCRIPTION FEE � �4'"" ��sons uceAse uw.>. ! .��..YI� . .�,. �� �.. � . . . . '��y�,I q I AM EXEMPT UN�EH SEC� 0.8 P.C.FCR 7HIS REASON U - � ',,a!' � � ' � . . '�+`�. DATE OWNEFl U . . � ' LBCEN EDCQNTRACTARSDECIARATtON � � � /� I HEflE6YAFFIRM UNS�ER PENAL OF PERJUftY THRT I AM LICENSED UNQEfl PFOVISIONS OF Ci1APTEfi �¢ � �, l/ ' f`�����. Q'�:,,,�..S(CCMMENGING WITH.SECiIOPi CO)GF DMSION 3 OFTHE Bi/51NE55AN�PROFESSIONS CODE,AND � 4 << �� AdY LICENSE IS IN FUtL t�CRCE A D EFFEC7. � o, LICENSE IA .: �� , LIC.NO. � -��.g� � i JI �, �DA7F �_ � CONTRACTOR -� � +� a � li1 ;�' INORK�RS"COMPENSATION DECLARATION Q � �� 1 HEflEBY AFFIHM UtdJER PENh OF PERJURY ONE OFYHE FOLLOWING DECLARATIONS: .- U qn Z ��� _1HAVEAN�INILLMAINTAryP.CEFii3�tCATEOFCANSENTTOSELF-INSUREFORWORKERS' � ' ' . � COAAPENSATicN,ASPiiOr/IDE�BY6ECTION57ooOF7HELA@ORCODE.FORTHEAERFCRMANCE UW OF?HE WORK FOfl MJ410 7HIS PERMIi IS ISSUE6. � , �5: . . . . . . _ ud _,IHqVEANDWI�I.PAAIMANvVORKEfiS'COA�PER'SATiGNINSUFkNCE,ASRE�UIREDBYSECTION - � 37oCOF TNE LAROR Co ,FOR7HE 2EFIFORMANCE OF TH"c WORK FOR WHICHTHIS PERMIT IS 4 tSSUE�.MY WQSi S'C�PAPENSATIpN IN IRANCE CARfl1ER AND POLICY NIJM�Ek AAE: COIVSTP.UCTION y: cARqi�R� � PLANREVIEW �� roucrnur�aeR �� � �• s .��� — ELECTRIC H � �na�,s=c:4x.wwE�nr�?�Eoau�ooFn�aE�ur�swr�oNe��Eo�inas�ssro}on�EssA PLUMBING � w MECHANICAL � i CERTiFY THAT IN iHE P�PFbRMAYCE OFTHE WORK FOR WHICH THIS PERPAIT 951SSUED.I SHALLN�TEMPLGYAPI PEfl�NINAN7MANNERSOAS70BECOMESUBJECT70THE �ry WORKERS'CDMPENSAT4'JNLAWSOGCALIFOFlNIA,ANCAGREETHATIFISHOULDBECDME INSPECTIONFEE � SU&IECTTO7HEWORKERS'C:SMPENSATIONPROVISIONS�fSECiIQN37oo0FT'riELhBOR � CODE,ISHALI�ORTHW�FICCfiAPLYWITHTHOSEPROVISION5- ISSUANCE _ p' SM�P ry �A7E: PPhICANT: ---��---�— . �. WARNING�FAILURE?O SECIJRE'yYORKER5 COMAENSATION COVERAGE IS UNlAWFUL,AND SHALL BE E�JERGY P/C �y SUBJECTANB.IPLOYERTOCRiY41NALPENALTI'eSAN�CIV!LFIFiESUPTOONEH�N�RE�THOIJSAN� ENERGYPERMIT DOLLARS�E1o0.000).IN FODITIOf�TO TI1E C057 OF COMPENSATION,DAMAGES AS PROVIDED FOF IN � SECYION 37oB OFTHE LABOR C OE,INTEflEST,ANO ATTORtdENS FEES. - RETENTION FEE: W� CbhISTRUCTION LENDING AGENCY pRE-ALT FEE d � IHEi3E8YAFFIRMUNDEflPENALITYOFPcflJl1FYTHATTHEREISACONSTRUCTIONLENDMGAGENCV FOfl 7HE PERFORMANCE OF TH�WORK FOii WHICH THIS PERMIT IS ISSUED(SE0.309],CIY.C.). . � l.d! ''�. - . � � � � iENDER'S NAME ' !-- LEN�EA'SADDRESS , _ c . . .W ICERTIFYTMA7IMAVEREADTHISAAPLtCATIONAN�STATETIIAYTHEABOVEINFORMAT10NiSCARflECT. TOTfYL FEEJ /, pp ///nne , . .,� 1 AGREE TQ COMPLY WITHALI C�TY AND COUNTV OROINRNCES AND STATE LAWS RElAT1NG TO BVILDING / / e� � CANS?RUCTION,ANDHEAEBY UTH4FIZEFEPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE (,.�� � � A80V'c-ME TIONEDPFiOPERTY ORINSPECTIONPURPOSES. 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