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HomeMy WebLinkAbout13858 CI'TY OF DIAMOND BAA � - - ��` DEPA�YTMENT OF COMMUNITY&DEVELOPMENT SERVICES � _� . 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ���'y�' BUILDING PERMIT APPI.ICATION FIRMLY ,�, T JOBSITE _—�.7�f'/_ '"� qppLICATION�'��/� PERMIT 1( � P/C Q ADDRESS_ Y '�0�� �� DATE �% NUMBER � J��# � APN LOT + � TRAC7 ,S� - �SSUE TYPE OCC ¢ — DATE _ CONST._ GROUP OWNER t_—� - p ADDRE ���;� � %,f�y � ,�:'fL,���� ZONING SETBACKS "'� CI7Y ^ %ZIP����TEI.f�'_'��r•3�� FRONT Ryy n g � _ _ REAR (,--- APPLICAMT _ TE�• SIDE/SICE STREET_,.__ RW ❑ � CONTRAC70R ..S�F- ''� ! �IC�f1 ------ SIDE _,_ ❑ _ p� ADDRE,�S �'�'L L �i 7� � CITY���.�iAa G:7 ZIP' esGf TEI.J/-�'� � ��j' PROPOSED USE__ _,_ 0 ARCH/ENG/ — �ESIGNER �ii — -- NO.DWEL. NO. NO. a ADDRESS �n -- UNITS ____ STORIES BEDROOMS � CITY_ 21P� TEL._ — ---- v� —� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-SUILDER DECLARATION SFRlADD/REM O _ _ Q I HEREBY�FFlRA1 11NUEA PENPLTY OF PERIURV THAT 1 AM EXEMPT FROA!THE CONTRACTORS L6 G&fBQE/CflfDOfl W CENSEUWFOR'fHEFOl1.OWINGREA50N(SEC.7IXi1.SBUSMES3ANDPROFESSIONSCOD[:ANYCITYOR (n U COUMfYWHICHREWIRESAPERMITTOCONSTRUC'(NLTER,IMPftOVF,DEMOLISH,ORHEPA1flANY5TRUC- W Patio/Deck - � NRE.PRIOR TO ITS ISSUANCE.ALSO RE�UIRES THE APPLICANT FOR Sl1CH PEPMIT TO FlL E A SIGNtU W �_ ' STATFMENT THAT HE OR SNE IS UCENSED PURSUANT TO THF PHOYI£IONu OF THE CONTRACTORS LI� �� CENSL LAW(CHAPTER s(COMIAENCING WI7M SEC7'iON 7000)OF OMS!ON 3 OF THE BUSINESS ANIJ PRO- ��` PO4I/Spd FESSIONSCODE)ORTHATHF.ORSHEISEXEMPTTHEREFROMAN�7HFBA3ISFORTHEALLFG[DEXEMP- (j V TIDN.ANYVIOLATIONOFSECTIIXJ7031.SBYANVAPPLICANTFORAPERMITSUBJECTSTHEAPP_ICANTTO � Re-Roof � ACIVIL PENALTY OF NOT MORE THAN FIVE h1l/NDRED DOLtAHS(SSDa).): -��-- � ❑I,ASOWNEFOFTHEPROPERTCORMYEMPLOYEESWITHYJAGESAS7HE�pgp�f:L'U!AAEMSATICN. COmmBfG31 � � YVILL DO THE WORK,PND THE STRUClURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704�,BUSI- p ,_ � NESSAND PROFESSIONS CODE:TNE CONTfiqCTOFS LICENSE L4W DOES NOT APPLY TO AN OWNEH OF ; PFpPER�Y NR10 6UILD5 OF IMPROYES THEREON,ANO Wr10 DOES SUCH S40NN HIAISEL��OR HERSELF Ofl � iHRIXIGHHISORHEROWNEMPI.OVEES,PROVIDEDTHATSUGilA1PqOVEMEMSAREN071NTEN0EDOH � Q OFFEflE�FORSAlE.IF,HOWEVERTFIEBUILUINOOr�IMPROVEMEtdTISSOIDWI7HMONEYEAflOF'COMME- � -TIDN,7HE OWNER�BUILDER WILL HAVE TFIE BUR�eN OF PFOYING THiT HF.UR SHE OID NOT flUILD OR -'----"—' � IMPROVEFOR7HEPURPOSEOFSALE). �y ❑I,ASOWNEROFiHEPFlOPERTY,AfAEXCLUSIVELYCONTR4CTITdGWIhII.IC[NSEDCqNTNACTORS -- � TO GONSTRUCT TF1E PROJECT(SEC.7oM,BUSINE53 PND PRUFESSIO4S CqUF:ff�lE CONTRACTURS ll- V81UetlOfl ADJ.AREA W CENSELAWDOESNO'fAPPLYTOAN0IYNEROfAPROPfH'fYWfIOEUILUSOflIMPROVESTHEFEON,AUD ___ - '---- ----- � W1qCONlRACTSFORSUCHPROJECTgWITHACONTFJ�CTOfl!S)LiCEN6EDPURSUANTTOTHEWNTRAO G�UANT!7Y DESCRIPTION FEE TORS LICE45E L4W.). � ❑I PM EXEMPT UNOER SEC. _____________�.A P.C.FOR THIS HEASUN Q�_�� 't,�I -� / �✓j ~L �,•'�j U /•� �. ------------.._..----._..__.......---- fL�_ .+ ��✓f��2f-!r F S -� .�� � DATE____—_—_�oWNEF1_._.__—'_"_._'_'_-- V p.;7 � . _-- , W i, �;.,f •� '_— — �/. � � LICENSED CONTRACTORS�EGIARATICN W� :! :�" w � � . . ��`lc�.- Z • 7. IHEREBYAFFIRMUND'cHPENpL7YOF?ENUF+YTHATIAMiICEN5E0UNDERP'nOViSIONSOFCMAPTER � . / .� � � B�COMMENCINOWRNSEC7'IOh!7000)OFDIVISION90FTHE9USWF£SANDPfl�'[SSIONSCOCE,ANO �� �_�I'\//� ' , MY UCENSE IS IN FUI,L FOFCE ANU EFFECT. y. 7 - � LICENSECLASS �. 7 / LIC.NO. .. �f` �, / jr—�—._.�'� .� y . �.,,• ,L� ���� � F— �"".�'-'� �' s� '' '�. J�� V � . e�� .� � �' t�� V. �ATE��___�,.r�—_"_'_ CONTRACTCR..��.L .✓�1�.,�d.��.. . , . ,• . .,,� w � � � � � � �� WORKERS'CUMPENSATION UECI.ARRTI� Qt ���� �� z .. � y � U �'-- � G �,�� j — .c.r`��., � � I HERLBV AFFlRM UNDER PENALTY Of PERJURY ONE OF THc FOLLOWING CECLARATIGNS: ���� /��,,� �r -`J� �l�y {+�.`} K /�� ( !r/ C.] _IHAVF.RlDWILlFAA1N7AINACfHTIFICATE6:WtJSENTTCSEL�-!N3UHF.fORWDIIKF.'RS' _ � ��, y., , � / J/� � i (a7MPENSATION,ASPFOVIDF.[lBYSFCTlO!1a7ouOFTMrLRBURCODF:,FUq1'NF:PEFFCflb!Ati�l: � (_) ��> �f.���"�''� �' _ /s -�,r UF iHE WORK fOR WHICH Tk11S v�HMIT IS ISSUED. p w I S ` . e3�t 1°�If�6�'�"`t e• � .6�/��� °'��,7� - �� Q ___I HAVE AN�WILL MAINTAIN VJORKF.RS'fAM?E"NSATION fNS:1RANCF:.RS FIE�UIRED 9Y SECTION 3700OF TNE LABOR CO�E.FOR THE PERFORMANCE OF THE WORK FOp WHICH TriiS P[RMIT IS .��' � $ � ISSUEO.MYYtOHI A�CAAiPENSA710NiN5URA�G6CARRIERANO 'ICYNUMBEHARE� CONSTRUCTION ,.___ _.__,__. __ ____ - �•V iP � ,._,f-;�'�f� 1°`LY i2' _...__— --_... . ....—__' � CAHRIER � � PLANREVtEW ., ...._„ __ _ _ +, �' POLICYNUM�ER_'��--6r��.y=�G_7_�-- . ELECTRIC -- - - ---......- - ¢ "t �1 � �r�ussecr�r��rareEoa,�w�.�ooFns�pEFn,ar�srtwav.h�oxY.�ws;mx�oR�ss� FLUMBING _...____��.,�,,.r.�--- �.�..1+.�,�(-- I�� z IC R'flfYhIATIN7HEPEflFORMANCEOFTk1EWORKFORW111CFIT1115PEFlMITI5155UED,1 MECfiANICAL ____._,_.,.__'�'�_��__ .C7. SN 1NOTEMPLOY.tNYPERSONINMVMMNFRSOASTOBECfJNESUEJEC?70iHE I 'y' RKERS'COMPENSATIONLAWSOFCALIFORNIP,ANDAGfiEETNATIFISHOUL[1�FCOM1: �NSPECTIONFEE ____,_____., _„__ j. � BJECTTOTHEWORKEfl3'COMPENSATIONPRCYISIONSOFSECTION97GOOF7HELABOH � ¢���n �•� r�� .sys� � CADE.I SHALL FO�, +WIhICQMPLY WI7H OSE PROVISIONS. � y ISSUANCE � � � R at�'f �j �7 e.. C i.�f O `'�,-�"Y �J'/L'� ��1f�/ /�— SMIP " _tZ---r--y. p �ATE:�� 0.PPLICANP. � ��� /�'� !� � �.._ • u, °'.� a �i"I7I1�1�/i�:l'�1i`�. B�3 �� J WAflNING:FAILUflEN SECURE WORKEflS'CAMPENSATION GOVEHRGE IS UNLAWFUL,AND SHALLOE ENERGY P/C �aT �F"Y_': t p py� .{,��_""_" ""___'_ ��y� SU6JECTANEMPLOYEHTOCRIMINALPENALTIESANDCIVILFIKESUPTOONEHUNDREDTHOUSNJD '�¢T{,1„;^a�f�.t��,.- y'4,1".��R.,y,r��"��bj;. : DOLLAHS(E100,OOO�,INADUIiIONTOTHECOSTOFCOMPENSATION,DAMAG[SASPPOVI�FOF()RIN ENERGYPERMIT ::'...., . . ... - _'___—_......_ � J SECTION37aeOFTHELABORCADE,IN7ERE5T,�NDATfORNEY'SFEES. RETENTIONFEE: � - -_'---.._._.,."__ '...-'—_'__'_--__"_ d GONSTRUC710N LEN�ING AGENCY PRE-ALT FEE: p ------..—.._.......--------- � IHEREBYAFFIRMUNDEflPEN/LTYOFPEFlJURYTHATTHER[ISACONSTHUCTIONLEN�INCAGCNCY ______ FOR THE PERF'ORMANGE OF THF WORK FOfi W HICH TMIS PEqMI7151SSVED(SF,C.3091,CIV.C.). W' __.".____"'___..—_.__""'. � � IENDEH'S NAME_"'_"""'__.... (�Ya —"_—_'_'__'._ e...'-- 'j F_. LENDER'SAODHESS �� � I AGREE TO COMPLYVWI7HAALL CIITY ANDI COT N1Y OHUINANCES AND STA�[LA'N9�ELAT NG IU�UIRDING TOTAL FE ES �� (pNSTRUCTIIXJ,ANDHEFEBYAUTHOHIZEHEPHESENTAfIVt50FTMI5COUNTVTUF.NT[RUPONTHE � � ABOVE-MENTIbNED DROPEFTY FOR INSPCCTION PURPOSES. z COMMENTS__ p �-'--------- � �,' ) c,.� �_�.,�,• 1� - -� - -1---------�- a PENMITTLE RIN7) �;�� . "_ -..'-�'-'"_ ,__"_ ,�✓/ _'_'yii/ � �� � _' '"'_'_-'_J'._- G�-d'__ ..G_'.'�:.�'-�,_.__ a.��y ��'_-_ ' , �: SIONATUflEOFPEftMI � DATF. !y ; - = RECPL NO._____,__„______..___PAlD BY • VALIDATION__________ ~ WHITE-0epaAment Copy,YELLOW-finence Copy,PINK—Assessor Copy,GOLUENROD—File Copy,GREEN—Applicant's Copy � � _. d.-,.�._.' , , . ..., _ .._ .. _ _ ; ' ; �� # �'� � ; , , . . p•9 ....... x � .e��. ' i,`. i '' t ' , � � '� — x { � 1 44 ` I _ � k ..k � I , . �,,. " _ - _ N� • � _ t( � � ^" � � 1 _ } y � g � � 1. ' '�. � �: _ I C � 7 ; � I ; I � I' � � i F 1 - - ', ; i , ,. ", 1 '. . f T" . . 1 � ', •' � � '. 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