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Home My WebLink About12179 .\ i � CITY OF DIAMOND BAx � �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES JJ 21660 E.Copley Drive Suite 190 _- (909)860-3195 Faz(909)861-3117 PRESS ��''�'�' BUII.DING PERMIT APPLICATION FIRMIY N` JOBSITE � APPLICATI PERMIT "� � P/C o ADDRESS �� 1Jt�C�3Yc'3G'1 _�. DATE ��.L�"'�']-�4_NUMBER �'"� # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER "' ADDRESS �-3� � I��t'C;��d�� ZONING SETBACKS Z CITY i�iti►vH?/Y � ZIP�,,2 TEL. >�3�� FRONT RW ❑ � APPLICANT n"' TEL.�! L� REAR ❑ SIDEISIDE STREET RW ❑ � CaNTRACTOR i �r SIDE ❑ Q ADDRESS ' = PROPOSED USE �I�-�- �/tS-��a iI� o CITYQO-��--GYY1� ZIP 1"lC} TEL. � �' wo ARCH/ENG/ �z DESIGNSR NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � � " DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION . Q OWNER-BUILDER DSCLARATION SFWADD/REM � � 1 HEREBY AFRPIA UNDER OENAITY OF PERIURY THAT I A!A EX9APT FROM iHE CONTi7ACTORS ll- GflfOge/CefpOf[ W CENSEUWFOR7NEiOlIOWIN6REA50N(SEC.7031.58USINESSANOPROFESSIONSCODE:ANYCIT'OR (n U CWNTYWHICHREWIpESAPEHMI77000NSTRUCT,NLTEFLIMPROVE,OEMOUSH,ORHEPNRANVS7RUo -�Ll pytiolDBCk - W- NRE PRiOfl TO ITS ISSUIWCE.A150 RE-0UIRES TME APPLICANT WR SI1Chl PERMIi TO FILE AS�GNED w STATEMENT THAT NE OR SHE IS LICENSED PUflSUANT TO THE PROYISIONS OF THE CONTMCTOPS LI- - � CENSE UW[GHAPTER 9(COMMENqNG WITH SECTION 700D)OF DIYISION 9 0F THE BUSINESS AN�PRQ - � POOUSQa FESSIONS CODEj OR THRT HE Ofl SHE IS EXEMPTTHEREFflOM AND THE BA515 FOR TNE ALLEOED EXEMP- TION.ANYVIOLATIONOFSECTIDN703t.5BVANVAPPLICANTFOqAPERMITSU&IECTSTHEAPP�ICANTTO - Z pe-Roof � ACMLPENALTYOFNOTMORE7HANFIVENUN�REODOLLARS(55oD).): � ❑I,ASOWNEHOFiHEPROPERTV,ORMYEMPLOYEEStNiHWAGESASTHEIRSOLECOMPENSATION, � COlflrtiOfCiel - - WILL DO THE YYOHK.AND THE STflUCtUflE IS NOT INTBiOED OR OFFEfiED FOR SALE(SEC.7o44,8U51- J � NESS ANU PROFESSIONS CODE:TNE CONTFACTORS LICEN3E LAW DDES NOT APPLV To AN OWNER OF - � - PflOPEHTYW/iOBU1LD50HIMPflOVESTHEREON,ANDYMODOESSUCHWORKNIMSELFORHERSEIFOR � THHOUGHHISORHEROWNEMPLOYEES,PflOViOEDTHATSUCHIMPROVEMENTSARENOTINTENDE60R . � - Q OFFENEDfORSALEIFHOWEVEf�THEBWLDINOORIMPfiOVEMENTISSOLDWfTMINONEYEAROFWMRE- - ..� -TION.THE OWNER$UNDER WILL HAVE THE BURDEN OF PflOV!NG THAT HE OR SNE DID NOT 8tlit9 OR - " � IMPNOVEFORTHEPURP03EOFSqLE). . W ❑1,AS ONMER Of TME PROPERiY,AM EXCLUSNELY CONTflACTI�p W�TH IICENSED CONTflACTORS - - Q TO CONSTRUCT THE PROJECT(SEC.70M,9USINESS AAID FftOFES510N5 CODE:THE CONTRACTORS LI- - VflI1J8f101f ADJ.AREA - W- CENSELAWDOESNOTAPPLYTOANOWNEflOFAPROPEflTYWMOBU1L090RIMPROVESiHEREON,AND - - � WIiOCONTMCTSWRSUCHPH0.)ECTSWITNACONiPACTOR(S)LICENSEDPI1R511AIJTTOTNECONTRAG qUAN7tTY DESCAIPTION FEE � - Y TORS IJCENSE UWJ. - � ❑I AM EXFJAPT UDAEH SEC. B.8 P.C.FOH TH15 REASON - U � � . - .. - .. - � - DATE OWNER V -� UCENSED CONTRRCTORS DECLARATION W - � I HEREBYAFFIRM UNDER PENAITY OF PERJUHY iHA71 AM IICENSED UNDER PPOVISI04S OFCHqP7ER Z _ Tv � �p_-- 9�COMMENC@KiWfTHSECTpN7000)OFOIVISIOP130FTHE8USiNESSPNDPAOFE5510N3CODE,AND �`� X MY LICENBE IS Ml FULL FORCEAND EFFECL - � UCENSE C(ASS l„��{G' LIC.NO.��`F' � - j - V DATE��C� °`��Q CONTMCTOR��'-'��- _ W . � WORKERS'COMPENSATION DECL4RATION `�j�;'� a _ . . - - . _ . O.. . . . . . tFl � V µ � V � IHEREBVAFflRMUNDERPENALTYOFVERIURYONEOFTHEFOLIOWIN4DECLARAT10N3 z - Q � _IHAVEANDWILlMA1NTA�NACEHfIFICATEDFCONSENTTOSElFINSUFEFOFWORKERS' �, 2 � COMPENSATION,ASPflOViDEOBYSECTION37000FTMELABORCODE,FORTHEPERFORMANCE U OF7HE WORK FOR WHICH THIS PEPM�T IS ISSUED. �� W _IHAVEPNDWILlMA1NrAINWORKERS'GOMPENSATIONMSUPANCE,ASHEQUIREDBYSECTION �� Q 3�OOOGTHELA90RCODE,FORTHEPERWRMANCEOFTHEWORKFORWHICH7HISPERMITIS "= 0 ISSUED.A1Y WORKEAS'COMPENSATION�NSUR/WCE CAqqIER ANO POLICY NUM9EP AflE CONSTRUCTION . J. i . ., -.____ ___—__ �' � CARRIER �.Y ' . � . .�'� �`� - � �• PLAN REVIEW � Z ra1CY NUMBER � � � 1 �'' '� ` ' ELECTRIC d ` 0 (nussEcnont��rpieeca�.t�EooF'n��a�xi�sratauErax�n�o �(S+ao�atiEss} MBING� �� w ICERTIfYTHATINTXEPERFORMANCEOFTHEriOflKFORWHICMTHISPERMITISISSUED,I MECHANICAL - Z - (s -SHALL NOT EMPIAYANV PEPSON IN ANV MANNER SOAS TO BECAME SUBJECTTOTHE ' - �' WORKERS'COMPENSATIONLAWSOFCALIFORNIA.PNDAOREETHATIFISHOULDBECOME INSPECTIONFEE � SU&IEGTTOTHEWOPKEflS'COMPENSATIDNPROVISbNSOFSECTION3IooOFTHELABOR /'`�(� � CODE,I SHALL FORTHYJI7H COMPLV WITH T �E PP ISION5. • ISSUANCE � • `�l.� � � - "p DATE: � �� APPLICANT. � SMIP ___ . � ENERGY P/C _ ,J WARNING:FAIWRETOSECUREWORKERS'CObiPENSFTI COYERAGEISUNLAWFUL,ANDSNALIBE � SUBJECTANEMPLOYEflTOCflIMINALPENALT�ESAkOCIVILFINESUPTOONEHUNOREDTHOUSAND ENERCaYPERMIT O�LLAR5(f100,000).IN ADDITiDN TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN � SECTION 37080F TME LABOR WDE.INTEREST,ANDATTOPNEY'S FEES. RETENTION FEE: - � - W CONSTRUCTION LENDING AGENCY PHE-ALT FEE: 't a' 0 �- IHEREBYAFFIflMUNOEFPENRLNOFPERJURYTHAT7HEREISACONSTPUCTIONLENDINGAGENCY WRTHE PERWRMANCE OFTHE WORK FOfl WHICH TMIS PEPMIT�S ISSUED(SEC.3091,qV.C.). Z W -�_ LENDEP'S NAAIE --____._ F_ LENDEFYSADDNE59 w ICERTIF1'THATIHAVEREA07HISAPPUCATIONANDSTATETHATTNEABOVEINFONMATIONISCAfiNECT. TOTAL FEES � �� - � IAOREETOCOMPLYWITHALLCfTYANDGWNTYORDINANCE5AND5TA7EUWSRELATINGTO8UILDING � yr.�----�— - COPISTRUCTION,AN�HEREBV AUTiORIZE REPRESENTATIVES OF THIS COUNTY TO ENTEP 11PON TNE ZA80VE-MENTIONEOPROPEflTYWRINSPEGTIONPURPO5E5. 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