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HomeMy WebLinkAboutNo Permit Number CITY OF DIAMOND BAIt ----- '�' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ..� �� . 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ���'�� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE ''y 1 /� �_ DATEICATION�� ��'3 NUMBER 1���� #/C'`����� ADDRESS_/.....I��j� �JC�7j✓t'/J�-� .� o �, issue �, ,TYPE • OCC °T APN LOT ° TRACT s � � � DATE__ � CONST. GROUP . p OWNER , ' . � LL' ADDR SS , �o ZONING SETBACKS Z CITY ` � FRONT RW ❑ __ o ZIP TEL. � �-"' '7 g APPLICAN'� TEL. REAR ❑__ Z SIDE/SIDE STREET RW ❑ _ � CONTRACTOR SIDE ❑____,_ � CITY S - ZIP'�' r TEL. ��,{</3?�d PROPOSED USE "�y ,1.�1' � .:�' / w ARCHlENG/ � � �zDESIGNER ;�d►.lY1n r,s — � ADDRESS �'-'-"� NO.DWEL. NO. —NO. UNITS STORIES _ BEDROOMS = CITY _ ZIP TEL._ � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDEA DECLARATION SFR/ADD/REM � O ,0 I HEREBY AFFlflM UNDER PENALTV OF PERNRY THAT I AM EXEMPT FfIOM THE CONTRqCTOFS LI- - � Garage/Carport W CENSEUWFORiNEFOLLOWINGREASQY(SEC.7a31.5BL151NE55AYDPROFE5510N5CODE:ANYCITYOR �U CIXINTYWHICNPEWIRESAPEFMITTOCONSTRl1C7,ALTFR,IMPROVE,f]FMIOLISH,ORfiEPAIRANYSiflUC- W patio/Deck Z TURE,PflIOR TO ITS ISSUANCE,ALSO RFWIRES THE APPUCANi FOF SUCH PERMIT TO FILE A SIGNED �y W STATEMENT THAT ME OR SHE IS IlLENSED PURSUANT TO THE PROVISIONS OF THE CONTRACYORS LI� w � .,�, CENSEUW(CHAPTER9(COMMENCINGWITHSECTIOM7a00)OF�IVISION30FTHEBUSINESSANDPRO- � � Poo�Spa : FESSqNSCODE)ORhIATHEORSHEISEXEMPTTHEflEFROMANDTHEBASISFOFTHEALLEGEDEXEMP- (f � .V TION.ANYVIOUTIONOFSECTION70�1.5BYANYAPPUCAN7FDflAPERMITSU&1[CTSh1EAPPLICANTTO Z Re-Roaf � ACIVIII����NALiYOFNOTMORETHANfIVEHUNDRE�OOLLAR5lS500).): � Z' ,(JI,'AS9NRJEROFhIEPROPERT/,ORMVEAIPLOYEESWITHWAGESASTNEIR50LECOMPENSATION, � COmmerCial ' . YAUS�7ME WORK�1'7D THE STRUCLURE IS NOT INTENDED OR OFFF.FEO FaR SALE(SEC.7o4q,�USI- J � NE5S AAD PROFESSION6 CODE�.lHE COMFACTOR3 LICENSE lAW OOES NOT APPLY TO AN OWNER OF .�� ,.,C� Pf�PERTV VAiOBUItAS OR 11.1PROVES 7HEREON,AND WHOOOES SUCH WOPK HIMSELF OR HERSELF OR CC�. 7HROUQH HIS OR HER ONR1 EMPLAYEES.PROVIO W T:AT SUCH IMPROVEMENTS AHE NOT INTf.N�E00H m '.W'' OFFEREDiORSALEIF,HOWEVERTMEBUIL�INGORIMPROVEMEfYfI550lDWITHINONEYEAROFCAMPLE• '��� iION,THE OWNER-BUILOER WILL HAVE THE BURD[N OF PpOVING THAT HE OR SHE�IO NOT Bl11LD OR �'z� IMPAOVEFORTHEPURP0.SEOFSAIE). .,W� C]I,ASOWNEROFTHEPROPEfl7Y,AME%CLUSIYELYCONTRACTINaWfTHLICENSEDCONTRACTOflS ��I TO CONSTpUCT THE DROJEC7(SEC.7oa,Bl1SINESS AND PROFESSIDNS CODE:THE CONTRACTORS LI� V81Uation ` .� ADJ.AREA_.__ =.W. CFNSELAWDOE6NOTAPPLYTOM10NrtJEROFAPROPEHTYWHOOUIlD50HIMPHOVFSTHEREON,AND � ';��� YIlIOCONiMCT5FOH5UCHPROJEGTSWITHACONTHACTOR(S)LICENSEDPURSUANTTOTHECONTflAG QUANTITY DESCRIPTION FEE � TORS UCENSE UW.f. —_ �� 17 I AM E%EMPT UNDER SEG____ B.&P.C.FORTHIS REASON: � Q O U �' \ -- /ye � — �� DATE a' . OWNER '�.✓bILG ��c.��CA-• ::� V zs ° w ,:��, LICENSED CONTRACTORS DECLARATION ;� ' W �� :� IHEREBY AFFIRAI UNOEfl PENALTV OF PER1lIHV hIAT I AM LICENSEO UYDER PROVISIONS OF CHAPTEfl ; B(COMMENCING WITi SECTION 70ao)OF DIVISION 3 OF THE BUSINESS AND PROfESS:ONS CODE,AND ,, � � ' MY 6iCENSE�S IN FULL FORCE AND EFFFCT, , � ��� C� �.0� IiCENSE CLASS____ UC.NO. __ . : j � �U�-. UATE.� CONTFACTOR._.__ __."__.'_'__".... K R W, a ��' WORKERS'CQMPENSATION DECLARATIOY � � � ' � �'�'� I HER'cBV AFFIRM IJN�ER PENFLTY OF PERJURY ONE OF THE FOLLUWING UECIARATIONS: '.;�',; � � a 0�; _IMAYEANDWILLMAINTAIItlACERTIFICATEOFCONSENTTU�[LfdN3UflEFORWORKERS' � A COMP[NSA710N,AS PROVIDED BYSECTION 37ao�F 7HE UBOR CO�[,f�OR THE P[RFORMANCE W � ��':� OF 7HE WORK FOR WHICH THIS PF.HMIT IS ISSUED. 0. � '�W' _I HAVE AND WILI MAINTAIN WORKEHS'CAMPENSATION INSUHANCF.,AS(iF.0U1RED BV SF.CTfON �¢i 37000FTHF.IABORCODE,FORTNEPERFORMANCEOFTHEWOPKFI7RWHICHiHI.SPC-RMITIS Q� � P9 0' ISSUED.MV WORKERS'COMPENSATIDN INSURANCE CARRIEN PND POLICV Nl1M8ER ARE: , CONSTRUCTION .....__._____.......__._—..—_ __—_—__._ iI '"��f � s� :.j� caaRiER _.. .-------._...._._..._ PLAN REVIEW _...._...---------� -�✓.r- .-� aa.ICY NUMBEa ELECTRIC ,..___,........__..__ ..___ ,Z! Q � (fHI55ECIlONNEH7NO7BEW6W.Efti�OFT}gPEPMRISFOFl�NEMN�17RE0D71.1M5�5100)ONlE55�. PLUMBING 'ZW I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHiCH THIS PEHMIT IS ISSUE�,I MECNANICAL . —'_—__......"__'__—'__'__ �(}' SHAIINOTEMPLOYANVPEH50NINANVMANNERSOA5T09ECOMESUBJECTTOTHE �[/]� WORXERS'CAMPENSATIONLAWbOFCAIIFOFNIA,AND�RF:ETFiA'fIFISHUl11.09F.COME INSPECTIONFEE ,,._____ ' SU&IECT TO7HE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000i=T11E LA[30R �ry —��.„/��/y � ''~, CODE,ISHALLFORTHWITFICOMPLYWITHhIOSEPROVI510N5. ISSUANCE _. .._.__.. �'r�^r�✓ �; �`��- . �SMIP ;��p�, DATE: APPUCANT: ."_"_.___--_._. __._.'_"__'--- ���� W' ENEAGY P/C "�J� W0.flNING:FAILUPETOSECUflEWORKERS'COMPENSATIONCOVEFlAGCISUNLA\YfUL,ANDSHALLBE J .....__—'___..._._._. .._........—._...___'_' " "_'.'— _'_ '.:�y� SUQIECTANEMPLOYEHTOCRIMINRLPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSANU ENEHGYPERMIT ' DOLLARS(51aa.oaaJ,INADDITIONTOTHECOSTOFCOMPEN3AT10N,DAMAOE9ASPROVIDEDFORIN --"------'--'-"'----'--'--'-'-'--'-----'---'-- _ _ ._—.__ _ ' � J; SECTION37oeOFTHELAeORCODE,INTEfiESLANDATTORNEY'SFEES. flETENTIONFEE: '�.. '—_'—__... __ �d� CONSTRUCTION LENDING AGENCY pRE-ALT FEE: ,;O': ..'.�: I HEREBYAFFlM7 UNDEH PENALTY OF PERJUFY TMAT THFRF.IS ACONSTflUCTION LENDMG AGENCY •�; FOR 7HE PERF'ORMANCE OF TH[WORK FOR N7iICH THIS PERMIT IS ISSUED lSEC.3097,CIV.C.�. �� �� � W _ � .': LEN�EWSNAME ___. ..— • ' �:�,. ..___"_"_'_—_"_'—___'_ _" _—"'_'--_'_ � .F—', LENDER'SADDRESS_._..""____' '—"--_--.. � TO7AL FEE�(�� `�'� e� ���� )]/y ,��///��� /�/�� y � _�W�' ICERi1FVTMATIHAVEREADTMISAPPLICATIONANOSTATETHATTHEABOVEINFORMATIONISCORRECT. �qil� (/,� .. �, I AGREE TO COMPLY WIfH ALI.CITV AND CAUNTV ORDINANCES ANU STPTE LAWS RF.LATING TO BUILDING Y X CANSTRUCTION,ANOHEREBVAUTHORIZEREPRESENTATIVESOFTHISCOUNTYTOFN�EPl1PON7HE �? ,�*� �yK� !f /) � Z A90VE�MENTIONEO PflOPERN FOfl INSPECTION PUNPOSES. COMMEN�S�Y OT DII'11Y1ON��•Y" �'� / �'� � t�iNG AND. 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