HomeMy WebLinkAbout11885 _�� _ CITY OF DIAMOND BAIi �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
�� . 21660 E.Copley Drive Suite 190
(909)560-3195 Fax(909)861-3117 PRESS
` �`'�'��� BUILDING PERMIT APPLICATION FIRMLY
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.n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
p 1 HEREBV AFFIR\I UNDER PENAl7V OF PERJURY THAT I AM EXEMPT FFOM THE CONiRACTORS�I� G8f2QB/C8lPO17
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� TURE,PRIOR TO ITS ISSUANCE,ALSO REWIRES THE APPLICANT�OR SUCH PERMIT TO FILE A SIGNE� W
,� ST�TEMEM THPT HE OR SHE IS LICEN5ED PUR3UANT TO THE PROVISIONS OF THE CONTRACTORS LI�
CENSE LAW(CHAPTER e(COMMENCING WITH SECTION 70W)OF�IVISION 9 OF THE BUSINESS AND PRD� � POOUSpa
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A CIVIL PENIILTY OF NOT MORE THAN FNE MUNOHED DOLlAflS(550U�.):
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WILL DO THE WOflK,M1D THE STRUCfURE IS NOT INTENDED OR OFFEfiEU FOR SAIE(SEC.7oaa,BUSI� J
� NESE ANO PROFESSIONS COOE:TME CANTRACTORS LICENSE LAW UOES NOT APPL7 TO AN OWNER OF
PROPERTYWIiOBUILD50PIMPqOVESiMEREON,ANOWHO�0ES5UCNWORKHIAISELFONHERSELFOR �
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, Z 'TIOPI,THE ONMER$ULLDER WILL HAVE THE 811R0EN OF PiiOVMG TiAT HE OF SHE DID NOT Bl11LD OR
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Q' I I HEREBY AFFIRM UNOER PENALTY OF PER1UflY THAT I AM LICENSFD UNDER PROVISIONS OF CHAPT[R I� I
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Z I CERTIFYTHAT IN THE PERFORMANCE UF THE WORN FOR WHICN Tt115 PERMIT IS ISSUED,1 MECHAN�CAL __„_,___ __,____ ___
,(�J SHALLNOTEMDLOYANYPEFSONINANYMpNNER50A5TOBECOME5l19JECT70THE
' ;�'� WORKERS'COMPENSATIONIAWSOFCAUFORNIA.ANDAGREETHATIFISHOULDBECOML INSPECTIONFEE _.._.______._._
SUBJECT TO THE WOfiKERS'COMPENSpTION PHOVISIONS OF SECf10N]]OOOF TH[LAdOR
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J SECTION77oeOFT1iELABORCADE,INTEFiEST.ANDATTORNEY'SFEES. RETENTIONFEE:
�d�� CDNSTRUCTION LENDING AGENCY PRE-ALT FEE:
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FOR 7HE PERFORMANCE OF THE WORH FOfl WHICH THIS PERMIT IS ISSUED ISEC.9097,CIV.C.).
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��� I CERTIFY THAT 1 HAVE FiEAD THIS APPLICATION AND STRTE7HATTHE AEIOVE INFORMATqN IS CCRRECT. TOTP L FEES
��� IAGREETOCOMPLYWITHALLCITYANDCOUNTYOHUINANCESANDSTATELAWSRELATINGTOBUILDING //�� ��jjq
,�; CONSTNUCTION,AND HEREBV AUTI�IOflIZE REPRESENTATIVES OF THIS COIJNTV TO ENTEfi UPDN TH£ _ -- I / ]� � / }
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