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_ .l� CITY OF DIAMOND BAI� ,,�✓�' � DEPARTMEI�iT OF COMMUNTTY&DEVELQPMENT SERVICES ,'' w 21660 E.Copley Drive Suite 190 �~'"� � (909)860-3195 Fu(909)861-3117 Tf % PRESS ������^���`� BUII:DiING PERMIT APPLICATION �,,,,.•�''° FIRMLY y JOBSITE APPLICATION PERMIT p/ L� � ADDRESS �� ���d'�a'� ��R+��� �1� DATE_Tf=�,j'��P� NUMBER � �� # � I � APN LOT� TRACT pATE ��'.�-�e ��� NPE OCC O OWNER �:IC �-t�1a "i"6fnt�+SCR►a� CONST, GROUP q ADDFiESS_$'3� Cr^cKs�es� ���' �R= ZONING SETBACKS 6 CITY_��a,.�m�+£� LSAr- ZIP�'Z TEL. fidB 1ido�S' FRONT RW ❑ a APPL CANT — TEL. .i"L� 6d Y 5" REAR ❑ � ^ ' ro � SIDE/SIDE STREET RW ❑ � CONTRACTOR��DCSya �'�.�;+°�rve-^I"iO�V SIDE ❑ Q ADDRESS .13"Y es'�.�Y-e� Par�°�rw �a+�. PROPOSEDUSE a�dr.�9ho S�{�Ee!^7 /+'�AS�s' i:��pfvae��� ,�- ��, � CITY je�.�p,mef.rfi "°>��' ZIP �It7bS"TEL. d�'6�i7�' �pi�"F`, -� � DESIGNER/�Eb�'SSJ C`o..rS��^u¢'�-a�"�^-��L,�'�%���I NO.DWEL. 3 NO. J NO. a ADDRESS s-�,➢' C/�'Kt'.� f�rr.ws ��. UNITS I STORIES N BEDROOMS� � CITY t>lpenmy•s+ �I�^ ZIP f �y TEL. ��� �+��� v� DESCRIPTION SQ.F7 FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDERDECLARATION SFR/ADD/REM Z�/L„� O I HEflEBY AFFIRM UNDER PENAITV OF PERJl1RY THAT I AM IXEMPT FHOM THE CONTRACTORS LI- Gdfd98/Cfl�Of( W CENSEIAWWRhiEFOLLOWiNG1iEASON�SEC.7031.58U5MESSPNDPROFESSIONSCODE:ANYCITYOH (n _ CJ COUNTYWFIICHREIXIIRESAPEflMITTOCONSTRUCT,A�TERYdPROVE,OEIAOLISH,OFREPAIRANVSIAUG W 711RE,PRqR TO ITS ISSUANCE,ALSO REWIkES THE APPLpANT FOR SUCH PER6AIT TO KILE q SIQNED W Patio/Deck � STATEMENT THAT HE Ofl SHE IS LICENSEO PUFSUANT TO THE PR9VISIONS OF THE CONTRACTORS LI- - CENSE UW(CHAPTER 9(COMMENCINO WITH SECTION 7000)OF DNISION 3 OF THE BUSINESS ANO PRO- � PooUSpa FESSIONS��ORTHATHEOflSHEISEXEMPTTHEREFROMAND7HEBASiSFORTHEALLEGEDE%EMP- (� � V 710N.MNVIOUTIONOFSECTION70.91.5BYANVAPPLICqNTFORAPERMIT6U&IEC7STHEAPPLICANTTO Z Re•Fioof � � ACMLPENILL7V OF NOT MOHE hIAN FNE Hl1NDRE0 Ud,LARS(S5a0�.): � ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAOESASTHEIR30lECOMPENSATION,� � COfI1R18fCIAI -� WILL 00 THE WOAI(,AN�7HE STqUCTl1RE IS NaT IN7ENDED OF OFFERE�FOR SALE(SEC.7oaa,Bl1Sl- J � NE33 AN�PRpFE3910N5 COOE:THE CONTRACTORS LICENSE LAW DOES kOT APPLY TO AN OWNEfl OF j . PfWPEHTYNhIOBU1lDSORIMVROVESTHEREON,ANDWHO�OESSl1CHWORKHIMSELFORHERSELFOH m (t THqOUGHH190RH6iOWNEMPLOVEES.PPOVIDEDTHATSUCHiMPROVEMENT3ARENOTINTENDEDOR Q ,OFFEREDFOHSALEIF,FIOWEVER,iHEBUILDMGORIMPROVBAENTISSOL�WIhIINONEYEAA�FCOMPLE- Z TION,THE OWNEfl�BUILDER N7LL HAVE THE 9URDEN OF PROVING THAT HE OR SHE DID NOT BUIL�OH � 7 MPF�VE FOR THE PURP�SE OF 3ALE�. ❑I,A9 OWNEfl OF THE PROPEHfY,AM E%CLUSIVELY COMRACTING WITH LIGENSED GONTRACTORS � TO CONSTHUCT THE PFiOJECT(SEC.70U.BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VHIU3tlOf1 ��g��Q � ADJ.AREA W CENSE UW DOES NOT APPLY TO AN OWNER OFA PflOpERTY WMO BUILDS OR IMPROYES THEREON,AND � WHOCDNRiACTSFOR5UCHPROJECiSWITHACONTR4CTOR(S)LICENSE�PURSUANTTOTHECONTRAG pUANTITY DESCRIPTION FEE - 0 TOIi3 UCEN9EUWJ. - � /Rp ❑IAM EXEMPTUNDER SEG. B.8 P.C.FOATHIS pEASON U 'r �� � ' tj � � � �= DATE OWNER U W � LICENSED CONTRACTORS DECLARATION W � I HEREBYAFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDEfl PROVISIONS OF CMAPTER � p� � �}' d Y(COMMENqNGWITHSECTION7000)OFDIViSION30FTHEBU51NES5AN�PROFE5510NSCODE,AND Z i � - �/ `�j MY LICENSE IS IN NLl FORGEPNU EFFEGT. m � UCENSE C SS � � LIC.NO. +� � �� � � � �_ �_ � V DATE � J � � CONiRACTOR� � 0- W � WORKERS'COMPENSATION DECLARATION Q � � �a !�"tS . �11 V .yy�.e i/ � IHEFEBYAFFIRMIAJDERPENALTYOFPERIURYONEOFTHEFOLLOWING�ECLARAT10N5: C� Q � _INAVEANDWILLMAINTAINACERTIFICATEOFO�NSENTTOSELF-INSl1REFOFiWOflKERS' _ CAMPENSATION.AS PROVIDED BY SECTION 37ooOFTHE IABOR CODE,FOfl7HE PERFORMANCE W OFTHE WORK FOR WHICHTHIS PERMIT IS IS9UED. � 0 Q !I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION IN9URANCE.AS RE�UIRED BY SEC710N �9�J�� 37000FTHELABORCODE,FOR'THEPEfiFORMANCEOPTHEWORKFORWHICHTHISPERMiTIS :[1_I. J ISSUED.MY WORKERS'GOMPENSATION INSURANCE CAHRIER PND POLICY NUMBEfl RRE: CONSTRUCTION ✓`7 � q1RqIER VIEW �! t� Z POLICV NUMBER E Q � (niss�r�N�nioreE�rEnoFn��wwr�swraorvEH�ae000unaslSioo)ora�ss�. PLUMB Z I CERTIFV THAT IN THE PERFORMANCE OF THE VJORK FOH WHICH THIS PEHMIT IS ISSUE�,I M NICAL � '(„)' SHALLNOTEMPLOYANVPERSONINANYMANNERSOASTOBECOMESUBJECTTOTHE � WORKERS'COMPENSATION UWS OF CALIFOqN�A.4ND AGREE THAT IF 1 SHOULD BECOME �FEE � SUBJECTT07HEWORKERS'COMPENSATIONPROVISIONSOFSECTIDN37000FTHELABOfl J"9� CODE,i SHALI.FORTHWITH COMPLY WITH THOSE PROVISIO . SSUAN �r � p'j"� � p''�Q] SMIP p DATE:�� APPLICANT:�"Y7C� � J WARNING FAILUflE TO SECURE WORKERS'COMPENSqTION COVERAGE I5 UNLAWFUL,AND SHALL BE ENEFlGY P �� „ ,�D � �y SU&IECTPNEMPLOYERTOCRIMINALPENALTIESANOCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERM ' �� _ _. �1 A �,� Rlil`�=� DOLLARS(i100.000),IN ADDITIIXJTOTHE COSTOFCOMPENSATION,DAMAGES AS PROVIDE�FOR IN i�y,�� J SECTION370eOF7NELABORCODE,MTEREST,ANDATfORNE1"SFEES � RETENTIONFEE: Q O � CONSTHUCTION LENDING AGENCY PRE T F • � � C�C IHEREBVAFFILiMUNDERPENALTYOFPERJUHYTHATTHEREISACONSTRUCTIONLEN�MGA6ENCV - �t- FORTNEPEqFppMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED(SEC.3097,CIV.C.). W "/� � � � IENDER'S NAME ,y/� - !— LENDER'SADDRESS !"//fY . W� TOTAL FEES L ,/'? G 10ERTIFYTHATIHAVENFAOTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. �r��' V' •v" \f " y�Iy"`� d 1 AGREE TO CAMPLV WITH ALl CITYAND COUNTYORDINANCESAND STATE UWS RELATMG TO BUILDING � CONSTRUCiION,ANDHEREBYAUTHOWZEREPRESENTATIVE50FTHISCOUNTYTOENTERUPpNTHE - Z ABOVE�IENTIONED PROPER'TY FOR INSPEGTION PURPOSES. COM ENT � �'t� /�i R-,�'-�S`/ ` �' m , ¢ PERMITT NAME(P ) - � N ��l ��1`��� !l�-13¢�r� � SI-G�IN ERMITfEE DATE � . = RECPT.NO. PAID BY VAL DATION ~ WHITE—De Ament Co YELLOW—Finance Co PINK—Assessor Co GOLDENFOD—File Co GREE licant's Co Pe PY. PY� PY� PY. 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