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. . _. _ . _. �___L... ___._-�.; _... ._. �.._. :.._ . . _ _ . . . . ___�� CITY OF DIAMOND BAI� � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES „ 21660 E.Copley Drive Suite 19(i �. -� ` PRESS (909)860-3195 Fax(909)861-3117 �.., BUILDING PERMIT APP'LICATION �� ~ . R FIRMLY �. _ � JOBSITE �q� APPLICATION PERMIT � P/C �� o ADDFiESS 1.6' �s;,��"� �C� �� DATE ����� NUMBER ��I� # �� ' �� 15SUE � � ONST. GROUP � APN LO ' TRACT ��`�� DATE p OWNER � r,v�9� .. " ADDRESS � �'� �ry'r ��'�`� ZONING =SETBACK5 9 Z CITY yi+`�.+� ZI�'� r�,.-TEL. `�,, FROPI'f , RW ❑ g APPLI ANT TEL.� REAR � SIDE/SIQE STREET RW ❑ � CONTRACTOR ` SIDE � � ADDRESS " ' "�' �� � CITY�3.�di/�°.- I ZI��TEL.���LdG PROPdSED USE w ARCH/ENG/ � WDESIGNER �� �� �`� �� cu ADDRE 5 � N0.DWEL. NO. NO. � C6TX i Zg ' � NITS STORIES BEDROQMS � �I DESCRIPTION SQ.FT. CTOR PSF ADJ.AREAN LUATION � QWNER-�UILDERDECLPWATI6N SFR/ADp/REM '� � ���, Q i HFAEBY AFF!HM UNDER P�NALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- � Cjgf890ICdfPOfl � Q. ��� W CENSELAWFORTHEFQLLOVe'INGIREASON(SEC.703I.5BUSINESSANDPROFESSIONSCODE:ANYCINOP C,��� CDUNTYWHICHREWIRE'sAPER1�i1TTOCOMSTRUCT,RLiER,fMAFOVE,DEMOLISH,OHFiEPAIRANYSTRUG l.L.I patio/Deck � . � Z NRE,PRIOR YO ITS ISSUANCE,A L50 RE�l11RES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED � W� .STATEb1ENT THAT HE�R SHE IS�ICENSED PUHSUANT TO THE PROVISIONS OF'HE CONTRAC70RS Lb � ;�", CENSELAW�CHAPTE9B(C6MM CINGWITHSECTfON7W0)DFDIVISION3OFTHEBUSINESSAN�PRO- u' POOVS(J8 ' '� �' � FESSIONSCODE)ORTHATHEOP HEISEXEMPTTHEREFROMANO7HEBASISFORTHEALIEGEDEXEMP- �J - TIOM.ANYVIOLATIONOFSfCTIOt�7o37.5BYANYAPPLICAN7FDRAPEHMiTSU&IECTSTHEAPPLICANi70 � Re-Roof : ACIVIL PENALlY OF NOT MOflETT��iiAN FNE HUNflRED�OLIARS�55oD).): � �,�. CI,ASOWNEROFTHEPRO�ERN,ORfAYEMPLOYEESWITHWAGESASTHEIR50LECOMPENSATION, O COfRf11BfC12I . � � � '. � WILI�O PHE WORK,AND THE S RUCTURE IS NOT INTEN�E�OR OFFERED FOR SALE(SEC.7044,BUSI� � � NE55 AND PROFESSIONS CODE:�THE CANTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF ��� ��PiiOPERNYhIOBUILASORIMPRpVESTHEREON.AND61hiO�0E55UCHWORKHIMSELFORHERSELFOR = � , � � � �[,ie THROUGHHISORHEROWNEMP�OYEES,PROVI�ED7HATSUCHI�APROVEMENTSAREIJOTIN7EN�EDOR m `� � ,(;-a W�; OFFEREOWRSALEIFHOWEVE "fHEBUiLDiNGORIMPHOVEM5NTI5SOLDWITHINONEVEAROFCOMPLE 7 SJ e � z����� �'710N,THE OWNER-BUILDER WI' HAVE THE BtIRDEfi QF PROYIN3 THAT FfE Ofl SHE DID tdOT BUIfD OR � �. . W�� IMPRQVEWRTf�PURFOSEO�ALE). � . . ❑I,ASOYVNEpOFTHEPRO EHiI',AMEXCLU514ELYC6NTRACTINGWIYHl10EN5EaCANTRRCTORS � TO CONSTRUCT?HE PRQIECT(�uEC.7W8.0USINESSAND PROEESSfONS CODE:THE CONTRACSORS Li- V91UetiOfl � , � � a c ADJAFEA iLl... �CENSELAWOOESNOTflFPLYTO ONMEROfAP90PERTYNh10BU1LD50RlAIPHOVESTHEREOPi,RND . _ � 1 W�ipOpNTRACr5FOR5U4H?R IEGiSW1THACOhTRACTOR(5)UCENSEDRUR9UANTTQiHECONTRNC QUANTITY DEBGRIPTiON- FEE � YTORS tJCENSE LAW.). . . � � ❑I AM EXEAIPT UNDER SEC; H.6 P.C.FOR 7HI5 RcA50N Q � ' � � W � �RTE OWNEfl Z � y � , � LICEN�ED Ct7PlTRACTORS DEC9.ARATION � � �� � 1 HEREBYAFFIRM UPdDEfl PENAL�T'OF Pff1.DUF1Y7HAT I AM LICENSED UNDER PROVISIONS OF CNAPTER � �Ff'1!� "' � ' ' � 9�COMMENCIN(3WITHSECTIONy000)OFDiVI510N9OFTHE6U5lNBSSAN�PFOFESSIONSCOOE,AND Z � , �L.s MYLICe'NSEISINFIiLLFORCEAI�DEFF6CT. m ,ei � �� � uo�r�,�Eoass ' A L��.N�. 517593 � . � oAr� 9�3 o T cor�rRncToa Pu Ite Homes a � b W � ' WORK�RS'CQMPENSATION GECLARATION J �: �, l ¢ U _ � � 1 HER AFFIAM UNDER PENIaLTYOF PERIUflY ONE OFTHE FOLE.OWING DECLARATIONS: z "�� �� G�1 !� '�iHAVEABJDWILLMAiR"AINACEAFIPICATEOFCONSENTTOSELF-INSUAEFORWOqKFAS' _ � � CqMPEri1SRTION,ASPAlZ1/IDE�BVSECTION37000FTHELABOFiCnDE,FORhIEPERFORMANf.E U FTHE WORK FOF Wii1CH THIS PERPAIT IS 158UED. � a 4 V ' � V'1 0 � I HAVEAND WPLLMAINTkN WQRKERS'(XJMPENSATION INSURANCE,AS REtlIJIRED BY SECTION ..-ry � 37o00FTHEL.AHORW6E,FORTiiE?ERFORMRNCEOF7HEWORKFORVrHICHTHISPERMITIS 1� �q ��� ISSUED.dAV WdPKERS'�MPENSATfON INSURANCE CARRIeR ANO POL!CY NUMOEAARE: CaNS7RUCTIOH� � 1 AL��h�� �� � �Aaw,E� Pacific Em lo e/e� I ns. Co PLAN ftEV1EV✓ � � POLICYNUMBER WLRC 43 11 7!'1 ELECTRlC � ,� � ''� (rti�ssEcrcwNEeorareEc�9=�.E're�oFn+e��xsTs�aw�FNuwREooaw�.lEim�oa�Ess). ?LUMBWG y:,� WJ LVSJ j� I CEAYIFY THNT IN TF'�E PERFORMANCE OF THE�NORK F0�9 WHIGH 1H15 PERMIT IS ISSUEO,I MECFIANICAL + t_1J ��� Z No (�' SHALENOTEMAl6YAtAY'.PERSONWANYMANNEASCASTOBECpMkSUBJECTTOTHE � WOPKERS'COb1PEN5ATIaN LAWS OF CALIF00NiA,AND AGREE THAi IF I SHOULD BECOME �NSPECTION FEE , � SU&IECT TOTHE V10RKER5'CAAiPENSATION PPOVISfOP7S OF SECTION 37oa OP THE LABOR � ��+`� = CODE,B SHALL FOPTHWIrH COfAPLY WITH TNOSE PROVISIONS. ISSUANCE I dJ�� � /� " Pulte Homes sM�P �"�� / p DATE:_ 5 � O�FPPLIGANT:. b � WdRNWG FAIWRETO SECIJRE VYORKERS'COMPENSATION COVERAGE IS i1NLAWFUL AND SHALL 6E EPIERGY P/C � S;{ \ �j �y SU&IECTANEMPLOVEFiTOCFlFSINA�PENALTIESAN�CIVILFINESUPTOPNEHUN6REDTHOUSANO ENEqGYPERMIT __���'_y_l_ ', �70LUR5(S1oa,00o),IN PDDITIOFI TD THE COS7 OF COMPENSATION,DAMAGES AS PStOVIDED FOR IN � SECY7QN 3Tae OF TiE�BOR CqDE,INTEREST,ANDATfORNEY'S FEES. ' RETENTIOV�I FEE: oCQNS7RUCTION LENDING AGE�CY PRE-ALT FEE: � I HEREBYAFFIRM UNDcR PENAL OF PERIURY THATTHERE IS A CONSTRUCiION LENDiNO AOENCY ' � FORTHEPEflFORMANCEOFTH�WGRKFOftWHICHTH19PEqMITI5135UED(SEC.309],CIV.C.). ` ,(` . , '�" None (Pulte Homes Corp) � � � ; � LENOER'SNAME ' F— LENDEFi'SADDRESS � ICER7IFYTHATIHAl�EREADTHiSAPPLICATIONANDSTA?ETHATTHEAHOV'cINFORMATICNISCAfiREC7. TOTAL�CES � � � �. ,a��� '� � I AGREETO CAMPLY WITH qLL CI�TI'AN7 COLINTY ORDINANCES ANO STATE LAWS REL4TING TO BUILDING J P �'� � CONSTRUCTION,AN�HEPEeYAI1THORf qEPRESENTATiVES�FTHISCOUNiYTOENTEHUPONTHE � . , '�. � � � ABOVE-A9EMTIONED PROPERTY¢`OfiiN ECTION PURpOSES. COMMENTS - �� p �! d�li ¢ PERMfTTEE NAME(PRI ' . , � •-j��-�r � SIGN CP PERMITTE ' DAYE i ',"� = RECPT.NO. PPJD BY —� 1 �VALIDATION'�':'��, � � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy �� � �� � °����:P �a..w.. ..v� -r..��.,.��4 ' �' �.����:��"`"-.', ' � . . t`�b�' �k� � �"�,�, ^,���� �..,,� `r.. . � . � w��� �..'"a°t . „ , ... �*s. ,^�..,� . ��+ ��z�,' :�p:�..,y?�n�c d�€�;•.,:r ����„�.'�a,�t'�. .:: � �,��,-���'��."�'$�s�'�"�"'�sC"# �� .�°� � :`:�`� � °� �`� �,n�r'e a��'��� ���^�"� '� �.`:���g:,'" "� -�,� � � %r��..$ x �� ��" �"�a �b +�� �xib^9�i:. �.� �,��„q Cg�a ra .z� �;y,&�'�- ��; �R i � �� ,�� �� � � �;�� ..��u�-;�z a ' "as�.�°� �� .��.oaz*��-�a...a',.!�i� �§�4'.��.re���.?`�':�`a m�-�'��'.,,�'.�� �d�aA� '�n 4 "`�4�� a � i*��^1�sS^� � £ ���,..a ����.���t�� ���""r d� ',�'..�i� �u'�.s "� .'��a��:� '�:;��'a � �' �.'i�.,..,��.,� _:$���'��;..� t� d�; b � ..,'�"�.���""��:�..r:������r_r..e��n. ��,�.nW'�,•a^�..,. �F.�i.._ >��.' �.�� � . ., ,,,..a.,.+:'?J'+. C fi, '�:' ' k�,`.� . 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