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HomeMy WebLinkAbout14345 ___.�._....,� _ _�� CITY OF DIAMOND BAB ' � DEPARTMENT OF COMMUrTITY&DEVELOPMENT SERVICES > _ . ,; 21660 E.Copley Drive Suite 190 _.�..._ . '� w ' PRESS ,,.,. (909)860-3195 Fax(909)861-3117 �� Bi3ILDING PERNIIT APPLICATION _ FIRMLY QJOBSITE i— _ APPLICATION I � C� . PERMIT ����-��- P!C a ADDRESS DATE � � NUMBER # � ISSUE NPE OCC APN LOT RACT DATE CONST. GROUP p OWNER .//�'� ,i LL ADDRESS ZONING SETBACKS � CITY ��(��ry ZIP�l�TEL !�" FRONT RW ❑ APPLICANT TEL. REAR ❑ � SIDE/SIQE STREET RW � a� CONTRACTO ;.� f-�'� SIDE � � ADDRESS PROPOSED USE � ��r � �� � CITY C� ZIP EL. � ARCH/ENGI WDESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS = CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � p� OWNER�UILDER DIECLARATION SFR/ADD/REM O 0 1 HEREBY AFFlHM UNDER PENAL7Y OF PEfiJURY THA7 I AM IXEMP7 FHOM THE CONTRACTORS LI- � GaragelCarport W CENSEUWFOflTHEFOLLOWINGflEASON(SEC.7031.58USINESSANDPflOFE5510N5CADE:ANYCffYOR U CWNiYNMICHRE�UIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,�EMOLISH.ORREPAIRANYSTRUC- W PaIlO/DeCIC WTURE.PRIOH TO ITS ISSUANCE.ALSO RC-0UIflES THE APPLICANT f-0R SUCH PERMIT TO PILE A SIGNEO W � STATEMENT THAT HE OR SHE IS IJCENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTOFiS LI� � CENSE UW(CNAPTER B(COMMENCIN[i WI7H SEC710N 7000)OF OIVISION 3 OF THE BUSINESS AND PRO- �' POOI/Spa FESSIONS CODk7 OR THAT HE OR SHE IS ExEMPTTWEREFROM AND THE BASIS FOR hIE ALIEGED EXEMP� TION.ANYVIOLATIDNOFSECTION70a1.68VANVAPPLiCAN7FORAPERMITSUBJECTSTHEAPPLICANTTO Z RaRoof � AqVIL PENALTY OF NOT MOflE THAN FIVE HUNDRED DOLLARS(5500).): � ❑I,ASOWNEROFTHEPflOPERTY,ORMYEMPLOYEESWITHWAGE9A3THEIR50LECOMPENSATION, � Commercial WILI.W THE WORK ANQ THE SiRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BU51- J NESS AND PROFESSIONS WOE:THE CONfHACTORS LICENSE LAW�OES NOT APPLY TO pN OWNER OF � PNOPERTYNAi08UILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFOHHERSELFOR m � THROIHiHHISORHERONMEMPLOYEES,PROVIDEOTHATSUCHIMPROVEMEMSARENOTINTENDEDOR ,� 0 OFFERmWRSA�EIF,HOWEVER1HEeUILOiN[3DRIMPHOVEMENTISSOLDWITHINONEYEAHOFCOM7LE- Z ��TION,hIE OWNER-BUILDEH WILL HAVE 7HE BURDEN OF PROVING THAT HE OR SHE DID NOT BIJRL OR = IMPROVE FOR7HE PUfiPOSE OF SILL�. ❑I,AS ONMEROF THE PROPERN,AM E%CLUSNELY CONTMCTING WITH LICENSED CONiRACTORS Q- TO CONSTRUCT 7HE PROJECT(SEC.7oM/,BUSMESSAND PROFESSIONS CODE THE CONTRACTORS U- V8IUHilOf1 ADJ.AREA W CENSEU�WOOESNOTAPPLYTOANOWNEROFAPHOPERTYWHOBUILDSOHIMPROVE9THEflC-0N,AND � WFqCQNTMCTSFORSUCHPROJECTSWITIiFCONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE - Y roAs uc�use uw.�. � O ❑I AM EXEMPT UMER SEC. B.&P.Q FOFl iHIS REASON U � 3 � LL' �ATE OriNER U � LICENSED CONTflACTORS DECLARAT�ON � W _ � I HEREBY 11FFIRM UNDER PENALTY OF PERJUHY THAT I AM LICENSED UNDER PROYISIONS OF CHAPTER �� . - p� a(COMMENqN(iWITH5EC710N7000�OF01VISION30FTHE8U51NESSANDPROFE5S10NSCODE, � .• MV LICENSE IS IN FULL FORCE AND EFFECT. . ,m � LICENSE9CLASS � ./ LIC.NO. ��✓ /--� V DATE / � � CONTRACTOR �- W � WORKER5'COMPENSATIQN DECLARATION i � � IFiEREBYAFFIRMUNDERPENALTYOFPERlURYONEOFTHEFOLLOWINGDECLARATIO � � Q � _IHAVEANDWILLMAINTAINACERTIFlCATEOFCONSENT7OSELF-INSUFiEFORWORKEfiS' 2 - � COMPENSATION,ASPROVI�E�BYSECTION37000FTHEUIBORCODE.FORTHEPERWRMANCE W OF THE WORK FOR WHICH THIS P6RMIT IS ISSUED. � � � W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS flEDUIflED BYSECTION � r ` (�'�/'�� Q 37000FTHElPBOHCODE,FORTHEPERFORMANCEOFTH WORKFOflWHICHTHISPERMITIS 1 �`f � ISSUEO.hIV W0 RS• SA7 E CAFi R AND POLICY NUMBER ARE: CONSTRUCTION � CAHRIER PLAN REVIEW � POLICY NUMBER ELECTRIC . 0 (I}6SECT10NNE�NOTBEWNPLEtE�OFlTEPEFiMSFORONEHUNDREDDOLfA9S(51C0)OHLE55�. PLUM8ING �. ;.x,..'F,��,-� Z ICERTIFYTHATINTHEPERFORMANCEOFTHEWOHKFORWHICHTHISPERMITISISSUED.I MECHANICAL `�� (•J 6HALL NOT EMPLOV ANV PEPSON iN ANV MANNEii SO AS TO BECAME SL/BJECT TO THE � WOflKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGPEETHATIFISHWLDBECAME INSPECTIONFEE SUBJECTTO THE WORKERS'C01�1PEMSATION PFiOV�S10NS OF SECTION 3700OF hIE LABOR = ISSUANCE ����� '� �S$ �_ - CADE,I SHALL FORTMW�TH COMPLY WITM THOSE PROVISIONS. � SMIP t p DATE: APPLICANT. � - . W ENERGY P/C �����''�-u�a�'`a`.�'��i�z� ��.�e �� WpRNING:FAIWHETOSEWREM/OPotERS'COMPENSATIONCAVEPAGEISUNLAWFUL,ANDSNALL6E g�g�,'g��y,�n p,y 'g�, ,J SU&IECTANEMPLOYEflTOCPoMINALPBJALTIESANDqVILFINESUP700NEHUNDREDTFIOUSAND ENERGYPERMIT ��11I I7€aC4"a88'�Sa`^Td'�'��S S DOLLARS(5700.000).IN ADOITION TO THE CAST OF CAMPENSATION,DAMAGES AS PflOVIDEO FOR IN � SECTION37080F'fHELABORWDE,INTEREST,ANDATTOFWEY'SFEES. � pETENTIONFEE: a CONSTRUCT�ON LENDING AGENCY � PRE-ALT FEE: � IHER�YAFFIPMUNDERPENALTYOFPEEUURYTHATTHEREISACONSTRUCTIONLENDMGAGENCY d FOR THE PERFORMANCE OFTHE WORK WF WF71CH 7MI5 PEflMIT IS ISSUED(SEC.3087,CIV.C.). � . - . Z W � LENDER'S NAME F_ LENDER'SAODRESS . �j � ICEH7IFYTHATiHAVEREAUTHISAPPLICATIONANDSTATEl11ATTHEABOVEINFOPMATKKiISCORHECT. TOTHL FEES � / ��� � IAGREETOCOMPLYWITHALLCITY/WDCOUNTYOf1DINANCES/WOSTATEUWSRELATINGTOBUIIDMG ' � CONSTRUCTON,ANUHEREBYAUTHORIZEREPRESENTATNESOFTHISCOUNTYTOENTERUPONTNE . - � � ABOYEMENTIONED PflOPERTY FOR INSPECTION PURPOSES. COMMENTS -- 0 J � m PER E NAME PINn t a . Q � � �,; � � SIO O ERMfTTEE �ATE - = RECPT.NO. PAID BY VALIDRTION ~ � WHITE-0epartment Copy,YELLOW�inancs Copy,PINK—Assassor Copy,GOLDENROD--File Copy,GREEN—Appl'�canCs Capy � , . .,.._ , ,J ... ., . ��T� C)F [�����N� �3�1R t �1`"� � � � , . � � , , � � �����c�c . ��t�fl€��c�ts�r : �r��t�r��n�s�s�r��� ; ��a��c��nn�r� ��.�c���������� ��o�� ��oa�av��r ��s�ur��?��t�t����� � e����� ��.cso�cc�n��u�� � �L��C��A��}� � FIF?��'LAC�F(�U�lDATIC}� j __ `TE���C3V���i � �[R�P�A�E BC.�NCS�EAlt� �1,��"�F3��R�tl�� �ldl�F�T.BC}NC��E�� �— . a_ F�C3t)F�1����'-�=Fl�I� :�°i , . _ ._ 8 FT.��t�t��EA�11 _ _ �� `€�i�IG°El+7TdLl,��"IC3�? ' �[I�AL�Q�lD��A� { R�C7�=�t�VE� PftE-G�[f��It�9C� ��t3C��3#-i�A�'�(�� ��N��{9�� i�Q�a(a�i���C�'6�C� F�Q�I�#-�CaF�AC}9�iC� ��l;C��i��I��BI�iC� { �i�i1S�C��6A�t1�tG S�e.'?Y���f?"C.��i���' PC`C1L�LEt:TF3(C; � , L:�7'Hl�li�!t�+:� � �t�t�L�E�CtI�G �1V�i.L Ii�S�J���'��t� F'C?C3��Ih��L ��(Ll�d�l��'�L.r'#�°I€�� t�F��6TE}�PS. 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