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HomeMy WebLinkAbout12708 CITY OF DIAMOND BA& ������ �---�'�'— DEPARTMENT OF COMMUNITY&DEVELOPMBNT SERVICES . � . 21660 E.Copley Drive Suitc 190 (909)860-3195 Fax(909)861-3117 PRESS ���°��� BUILDING PERMIT APPLICATION FIFIMI..Y __ � JOBSITE ���-� �`�(�° \ _ � APPLICATION y% /� PERMtT P1C o AODRESS `��"�.-`�� DATE^ L NUMBE # � ISSUE NPE OCC APN L T�---y�- -,�.T CT DATE CONST. GROUP p OWNE�'("�C l.S �-- ►' � C�rS�,.�l— p ADD�2ESS� � �� ! _ ZONING SETBAGKS Z CITY� �h.u-- ZIP EL. FRONT RW LI g APPLICAN't�l�„��^ TEL. REAR ❑ �.,d, SIDE/SI!}E STREET RW ;� � COMTRACT R ��. � -�_., SIDE ❑ ADDRESS�L�.� � ClTY ZlP�� TEL. �'��C" PRQPOSED USE o ARCHlENG! - ��,, DE5IGNER NO.DWEL. NO, NO. � ADDflESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � u� DESCRiPT10N SQ.FT. FACTOR PSF A0.1.AREANALUATION p� . OWNER•BUILDER DECLARATION SFR/ADD/REM O I HEflEBY AFFIRM UNUEfl PENAL7Y�F PEflJUPY THAT 1 AM E%EMPT FROM TNE CONTpACTORS LI- GflY8J8(CdfpOfi W CEN3ELAWPoRTHEFOI,LDWINOREA90N(SEC.]037.58U3MESSANDPROFE53bN3CO0E:ANYCITVOq (h U C06MTYWNtC14PEWIRESAPEfiM1TTOCONSTRUCT,q{,TER,IMPflOVE.�EMOLISH,ORREPAIRANYSTRUC- W patlo(DBCk W TIIFiE.PRIOR TO ITS fSSt/ANCE,ALSO HEQUIRES THE APPLICANi FOR SUCH PERM17 TO FIIE A SIONED W ST0.TEMENT THAT HE OH SHE IS LICENSEO PURSUANT TO THE PROVISION6 OF THE CANTMCTORS U� � CENSE LAW(GiAP7ER B(COMMENCIN6 WfTH SECTION]000�OF OIVISION 3 OF THE BUSINESS AND PRO- LL' Po0U5Pd � fESI0N5CODElOflTHATHEORSHEBEXEMP7THEREFROMANDTHEeASISFORTHEAILEGEDEXEMP- (� � TION.ANVVIOLATIONOFSECTIONT031.68VANVAPVLICANTFORAPEPMITSUBJEGTSTHEAPPUCANi70 Z Re-Roof ACIVIL PENALiV OF NOT MORE THM!FIVE HUNDHEO OOLLARS{f600).�: � ❑I,ASOYMEROFTHEPROPEflTV�ORMYEMPLOYEESWITHWA0E5A5THEIP50LECOMPENSATION, � Cammercial - Z N7LL DO THE WORI(,ANO THE 9TRUCTIIflE 13 NOT INTEND5D OR OFFERE�FOq SALE(3EG 7044,BUSI� J � NE55 ANO PHOFESSIONS COUE:THE CONTHACTORS LICENSE LAW DOES NOT APPLY TO AN OWNEfl OF ? PF�PERTYYAIO BUILb50N IMPROVES THEFEON,AND NMO OOES SUCN WORK HIMSELFOR HEpSELF OR � THROUGH H7&OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENT&0.RE NOT INSEHDED Oq m OFFFAEOFORSALEIF,HOWEVER,ilIEBUILDINGORIMPflOVEMENTIS50L0 WITNINONEYEAROFCAMPLE Z TION.THE OWNEFFBUIIDER WIl4 HAYE THE 9URDEN OF PROVINQ TMAT IiE OR SHE DiD NOT BUIL�OR � � 1MPqOVE FOR THE PUflPOSE OF SpLE7. W ❑I,ASOWNEROFTHEPPOPEfiTY.AMEXCLUSIVELY('ANTHACTINGWIiHLICENSEDCANTRAC70R9 Q TO CONSTWCT THE PRDJECT(SEC.]014,BUSINESS ANO PROFESSIqJS CADE:THE CONiFACTORS U- V81ilflllOfl AD.I.AREA � W CEN9ElAW00E3NOTAPPiYTOANOWNEflOFAPROPERTYWHOBUiLD30RIMPROVE9THEREON,AN� � WHOWNTMCTSPDRSUCMPR0.IECTSWITHACONSRRCTOR�S)UCENSEDPI1RSl1ANTTaTHECONTRAC- QUANYITY DESCRIPTION FEE � TOHS UCEN9E LAW.). ❑I AM E%EMPT UNOER SEC. B.6 P.C.FOR THIS REASON Q � U � �DATE OWNER V � W gd LiCENSED CONTRACTORS DECLARATION W OC I HEREBY AFflRM UNDER PENPL7Y OF PEFU7IPY THAT IAM LICENSED UNDEN PPAVISIONS OF CHAPTER � � 9�COMMfiNCINGWITHSECT10N7o0o)OFDIVISION30FTHEBl1SMESSANOPROFESSION5WDE,AN� z �X� MV UCENSE IS IN FUL pRCE AND EFFECT. m LL{ 0 LICENSE S .-� LIC.NO. j F J V OATE � _C�NTRACTOR d W � � WORKERS'CAMPENSATION DECLARATION Q . � IHERE6YAFFfRMUI4�EqPENAL7YOFPERJURV�NEOFTHEFOLLOWIN6DECLARATIONs: U � Z C1 _iHAVEANDWILLMAINTAINACEflTiFlCATEOFCONSENTTOSELF-INSUREFOflWOi1KER5' � � COMPENSATION.ASPROVIDEDBVSECTION3]OOOFTHELABORCODE.FORTNEPERFOqMANCE �U f7P'Yl7E WORK FOR WH1CH THIS PERMIP IS ISSUED. � O ��� !-1 HAVE ANU WILL MAINTAIN WORI(ERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION Q 37oD Of THE LABOR CODE.FOR THE PERFORMANCE OF THE WOqK FOq WH{CN THIS PEAMR IS ISSUEO.MY RKEAS COMPEN��/gTqN INS Ncc��C�RR�E Ay0 OLICY NUMBEflARE: CONSTFUCTION � C0.RRIER ��1t+-��-�°+`--t��-�� � PLAN REVIEW Z POL�cYNUMaeR �y�� � � ELECTRIC Q Q (IHISSECTNXdNEmNOTBEOCM4lETEDOFiHEPEPMfTISFORONEHUN�IiEDDOLLAFIS(510070RLE66A UMBING __ r � ZICERTIfYTHATINiNEPEIiFORMANCEOfTHEWORKWRWHICHTHISPERMITISISSUED,1 MECHANICAL (J SHALLNOTEMPLOYANVPERSONWANYM0.NNERSOASTDBECOMESU6JEC7TOTHE � WOR1(ERSCOMPENSATIONLAWSOFCPLIfqRNIA,AN�AGREETHATIFISHOUIOBECAME �NSPECTIONFEE Sl� C7 TO TH WOPKEFS'COMPENSATION GqOVI510NS OF SECTIDN 3'laa OF IE LABOR � Cq0.I�CItL � WITIiCOMPLYWITH O EPRO ISIO,�jS, j I$SUANCE p OATE: . APPLICANT. .�. '�•-,-- �'""""' �SMIP J WARNMG FAILURE TO SECURE W�P!(ERS'COMPENSATION CDVERAGE I5 UNIAWWL,ANO SHRIL BE ENERGV P/C __ _ � SI)BJECTANEMPLOYERT�CRIMINALPENALTIESANOCIVILFINESUiTOONEHUNDREDTHOUSAND ENERGYPERMIT ��_.g���i/�[]]�[��AT DOLLARS(51oo,oaa).WAOOITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFOIiIN y�y� T��� � SECTION37080FTHE LABOR CO�E,INTEREST,ANDAT7ORNEY'S FEES. RETENTION FEE: ������,�`�r e�cemv Q CANSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEFEBVAFFfRMUNDEflPENAf.NOFPERJURYiHATTHEREISACONSTRUCTIONLEN�WGAGENCY ' fOq THE PEHFOqMANCE OF T}iE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.ao9�.cIV.C.�. Z I.i! � LENDEf75 NAME F- LHJDEP'SA�DRESS , . /'`) � ICEFiTIFYTHATIHAVEREADTHI3APPUCATIC/NANUSTATETHATTHEAeOVEINFORMATIONISCARqECT. TOTAL FEES (�j � IAGflEETOCOMPLYWITHALIqTYANDCOUMYOR0INANCESAN�STATELAWSRELATiN6TOBUILDING � L " � CANSTqlICT10N,ANO HEREBY AUTHOFiIZE REPRESENTATIVES 0F THiS COUNTY TO ENTEH UPON iHE Z A60VE-MENTJ NE�PROPER WRlNSPECT{oNP OSES. 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