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HomeMy WebLinkAbout16152 (34) __._ _i - - - -- , , � CITY OF DIAMOND BAIi �A/ -----`��—' DEPARTMENT OF GOIVIMUNITY&DEVELOPMENT SERVICES _ W 21660 E.Copiey Drive Suite 190 '; - (909)860-3195 Fau(909)861-3117 PRESS 9M,. BUILDING PERMIT APPLICATION ���'�-`"�� , ,� FIRMLY o DDRtE5S_ tL��� ���� ���� 6.-��0 �ATEICATION ` <..�-�� l NUMBER ���� �/C ������ � APN� L T TRACT �1'��� ISSUE TYPE OCC DATE CONST. GROUP. °C OWNER �r��,.y� '� p ADDRE _sa_�`��`�.�.— � i 4^ ,k'�. ZONING SETBACKS Z CITY � ZI TEL. !4l. FRdNT RW C g APPLICANT TEL. REAR �ti C Z SIDE/SIQE STREET r RW G ¢ CONTRACTO �! ,� SIDE iT, C. , QADDRES � , � PROPOSED USE r� �"`: T . „ , , z DESIGN�R _ �C^� w ARCHAENG/ ,'� y �w� '�'i�'" Gl�� irr +� zi _ c I �" � ADDRE '-� NO.DWEL. NO. NO. ,, m ��ITS STORIES BEDF300MS ,.�� ClTY . r ZIP TE � ` , ,� „ DE3CRIP.TION SQ'.FT. F CTOR PSpF� ADJ.AREANALUATION ' � � �IVINER�BUILDE9 DECLARATION SFR/ADD/REM y e 6,! r O ''� ' I HEAEBY AFFIRb9 UNDER PENALTY pf�ERJUiiY THAT I FlM EREMPS FROM THE CONTRACiORS LI� Gflf8Q8ICflfPOfl p�, �� �LLa .CENSELAYdfOflTFPEFOLLOWINGiiEASON�SEC:7097.5BU51NE55AtJOPROFES510N5CODE:ANYQTYOR (n _ I .� ��;.COUNTYWHICHflEOUIR€SAPE9F�IITTOCANSIBUCT.ALTER,IMPROVE,DEMOLISH,ORflEPAIRANYSTHUC- I1j p9tioODeCk � - � � �� �� � 7URE.PRIOR TO ITS ISSUeSNCE,AlLSO REGIIJIRES THE APPLICANT FOFi SUCH PERMIT TO FILE A SIGNED � ,� STATEMENT THAT HE OR S1IE IS hICENSEO PUR^sUANT TO THL'-PROVISIONS OF THE CONTRACTORS LI• . , , �:CENSE LAW(CFiMTER B iCdMMEJCINd WITH SEGTfON 7000)OF OIVI510N 3 OFTHE BUSINE55 AN�PR0- LL' POOVSpB ��FESSIONSCODE)OP.THATHEOR HEI9EXEMPTri1EREFROMANOTHEBA5ISFORTHEALLEGE�EXEMP- V �i710N,pNYYIOLATIONO�SECTlOt�7(i31.5BYANYAPPIICANTFORAPERMITSUBJECTSTHEAFPIlCANTTO Z RB-ROOt � - � � - � ' F '�ACIYILPENALTY OF NOT MORET pN fIVE HUN�R��OLLARS(S5uo).): � , . � ,� , ❑I.ASOWNEROPTHEPHO,EpTf.OF�MVEFAPL0YEE5WITHWAGESASTHEIR50LECOMPENSAitON, � Commercial � � - � � WILC DO THE WORK,ANO THE S�L'11CT11R�IS N6T INTENDEp OR OFFERE�FOR SALE(SEC.7044,BUSf- J NESS AtdD PHOFESSIONS CO�E_:I�HE CANTRACTOi1S LICENSE LAW DOES NO7 APPI.Y TD AN OWNER OF ' .� � � � '��PFlOpEATYUNiOBUIIDSORIMP�}�'VE67HEREON,ATdDWFIOGOES�SUCNWORKHIMSE�FoqHENSELFOR m � ''�,THROUGHHISORHEROWNEMPI�YEE$,PflOVIQEOTHATSUCHIMPR04EMENTSARENOTiN7ENDEDOH ' W '�OFFEREDF'OR5QEIFHOWEVE THEBUI40iNGOFiIMPROVEMENTIS5C�19WI7HINONEYEAfiOPCAPAPLE� ;,Z. '%710N,7HE OWNER-BUILOER WI l�l,HAVE iHE BURD£N OP PROVING TRAl NE OR SHE OID NO7 BUILU OR �,_ �i IMPROVEFDBTHEPURPOSEOF$ALEj. � ', o, �W.;. ❑I•ASOWNEROF7NEPROPERT`l,M{¢XCtUSIVELYCONTMCTENGM'ITH6ICENSEDIXDNTRACTOR5 � ��� ��,.TO CON57RUCT 7HIE PRQIECT(IEC.7o41,8i151NES5 AhD PHOFESSIONS CODE:THE COMTRACTORS LI- V0I118�IQ(1 ADJ.AREA .�',.LLI I.CENSELAWDOESNQTAPPLYTOANOWNERO�,dPROPERTWWHOBUILDSOAIMPqOYESTHEREON,AND - . . _ ',WFIOCOIdTRACTSFORSUCHPRO.IECTSWITIIACONTRACTOfl(S)LICENSE�7PUR&UANT70THECONTRAG (�UANTITY.-.�� DESCRiPTION „� ' FEE����� � ��,�TORSUCENSELAW.). � � � /� �' �.'� ❑IAM EXEMPSUN�ER S�C. B.&P.C.F�R 7HI5 REASON U {.,�� , ,�:.�. . , � � ' �" DATE ONTlER U f. . � W � Q LICFNSED CONl'RAC70R5 DECLARATION ,�I , .��: I HEREBYAPFIRM UNDER PENPLTY OF PERJURY THAT I AM LICENSEO UN�ER PROV!SIONS OF CHAPTER � . /�� �. . �,' � � e .�.p� ( .�aoo�OF.ONISiON30FTHEBUSINESSANOPROPESSIONSCODE.AN� � ��r. , 9 COFIMENCIMG WITH SECTION 7 '., X;', MY UCENSE IS IN F'LIiL FORCE D EFFECT. — . ���� '� ���' a �, "� . � ' r...� LL1 C � . :�'� UCENSE CLASS__� _LIC.,NO._ S��7 J 9 3. � � � v,'' oare 9�3�09 coNraacToa PUIf� Fiomes � � � I �' �APORK�R3'COMPEN5RT90NDECLARATfON a � ., �,. � . , U ' . „ N„ IHER HFFIRMUNL'ERPENALTYOFPERJURYONEOFTHEFOLLOWINGDECLARATIDNS: � � ��,,. i��� ��,�., IHAVEANDWILLAAAINTAINACERTIFlCATEDFCONSENTTOSELFdNSUR'eFORWOFKEFS' � - , ��^�+.i� ��.�`�9� CAAITENSATIoN,ASPROVIDEDBVSECTe�Pla7ooOFTHEIABOACODE,FORTHEPER=ORMANCE `U �� �J d� WOFK FOF MiHlGH THIS PERMiT R ISS�ED. U OF7H@ � .C2"� � , � . � 4�° �I NAVEAN�WILLRAAIN"AIN WORkERS'CbMPENSATiON INSURANCE.AS REQUTAED BYSECTION tg ,{�,,,,// C! 97o0OFTHELFEURCadE,FDH'tHEPERFORkANCEOFTHEWORICFORWHICHT,415PERMlTI& � � 1 ,e�'p'E1� � x�'y,A � 0� ISSL'ED.MYWORKERS'6IXNPEkSATIONINSURANS:ECARR:ERANbPOLICYNUMBERRNE: CONSTRUCTION �C "�J ��i '� t�� e �" �A�R,ER Paci9ficl Em�toyee Ins. Co. PLANREVIEW �� POLICYNJMSER_'�, . �O ELECTRIC � r .�� �' (PNISSF.CfIqJNE�NOT�EWlUREfIDqFhIEPEPAMi'ISFORONEM1fd�iED00l1MS(5100)ORLEoSj. PLUMBING- • � '� ',�� W i (� a � ICERTIFY7tiATWiHEA flFORMAVCEQFTHEWORKFORWHICHTWSPERMITI5155UED,1 MECHANICAL _����^-°' Y ��.�� r--�" CS SMALLNOiEMPLOYAN�P'eRSOP1INANYMAN4JERS�ASTOBECOME5U9JECT707HE �. WOFKFFiS'COMPENSATION LAWS OF CALIFORNIA,AND AGFlEETHAT If i SHOULD BECOME INSPECTION FEE . , � ` SU&IECT TO 7HE SVOqKERS'COdAPENSAT�ON PROVISIONS OF 5ECTION 37C0 Of THE LABOR a� �I �-= ISSUANCE �°J r� ,� CA6E,ISHALLFOR7HW�'fHCOMPLYWITHTHOSEPROVI610N5. � '' o pp7E 517/01 APPLICANT � PLIItE Homes SMIP C_A � J � ENERGY P/C � :J�. WARNING:FAILURE?O SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE . —�� .�� , �—y SU&IECTANEMPLOYERTOCP3f�11NALPEdSAl71ESANDCIVlLFMESUPTOONEMUNDflEDTHOU5AND �NERGYPERN1iT �OLLARS(57o0,000),IftlAD�ITIOI�ITOTHECOSTOFCOMPENSATiON,DAMAGE9ASPROVIDEDFOR7N ------------�---------- — ,�� SECTIDN37080FTHELABORCO�E,INTcREST,AvWATTORNEYBFEES. FlETENTIONFEE: 'o C�NSTP,,UCTION LENO!NG AGENCY PRE-ALT FEE: � �•� IHERE9VAFFIflMUNOEflPENpL�IYOFPEH.lUFVTHA7THEREISAfANSTAUCTIONLENDINGAGENCY _ FOR THC PERFOflMANCE OF THE WOftKiiFOR WHICH THIS PEFiMiT IS ISSUEO(SEC.309],CIY.C.i, . 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