HomeMy WebLinkAbout17072 (44) �� CITY OF DIAMOND DAR � DEPARTMENT OF COMMUNITY�@,DEVELOPMENT SERVICES , ,; � 21825 E.Copley Drive (909)860.3195 Fax(909)861-3(17 PRESS BUILDING PERMIT APPLICATION FIRMLY d DDR'ESS��7 VC7 /l,�i .�_S�1 N� L.,,J APPUCATION ,_,I _v PERMIT I��lC o DATE �� NUMBER � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER p ADDRESS�2�SS'Of R�S'�D 20NING SETBACKS gCITY f��,�1vI�AJI7 RAR ZIP��TEU. ��, FRONT RW ❑ APPLICANT TEL. REAR p zd SIDE/SIDESTREET RW ❑ � CONTRACTOR� SIDE ❑ � ADDRE S '� /�/.PrL j7�/T,T�ST PROPOSED USE �C% f�C� � CITY{��'Df/�_�;� ZIP�!74.)TEL w ARCH/ENG/ � � ` z DESIGNER � a ADDRESS / r" NO.DWEL. rIO. .a NO. � CITY �D IP TEL UP�ITS l STORIES BEDROOMS 3 v� ,�— cn DESCRIPTION S�.Fi. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFFVAOD/HEM O 1 MEREBY AFFIRM UNOER PENKTV OF PEiWRY TNAT 1 AM E%EMPT FROM TME CON?MCTpRS ll• G8f3Qlf/C81P0f[ W CENSEUriFOFi7HEfOLLOWIN�RFA50N(SEC.70.71.68USINESSANDFROFESSiONSCADE:ANYCITYOR (n U COUNTYWHICHRCOUIRESAPERMITTOLONSTRUCT.ALTERMPqOVEDEMOLISH,ORREPNRANVSTRUC• W Pa110/DBtk W TURE.GRIOR TO RS ISSIIANCE.ALSO R£OUIRES TNE APPLICA!!f FOH SUCH CER41T TO FILE�SIGNED W � STATEIAENT THAT HE OR SME IS UCENSED GU0.5U/�NT TO TNE VRONSIONS OF THE CANTRACTORS ll� � � CENSEUW(CHMTERO�COM4CNCW0WITH5[C710N1000)OFDIVISqN7OFTHEBUSINE55ANDVRO� POO�SPB gFE5510NSCODE)ORTHATNEORSHEISE%EMP7TNEREFROMANDTMEBASi5F0/iTHEALIEGEDE%EMP• � T10N.ANYVIOLATqNOF5ECT10N10]1.SBYANYAPPLICANTfOR11PERMITSV0.)EGTSiMEAP7L�CANTTO Z Re-Rool A CIVIL VENALTY OF NOT MORE T11AN FNE NUNpqEO DOLUHS(f500�): ZOlASOWNEROF7HEVROPERTv,ORNVEMttOVEESNnTHWAGESAST�iEIRSOLECOAIPENSATpN, O COmmerCial WILL DO iHE WORN,AND TNE STRUCTURE�S NOT INTENDED OR OFFERfD iOR S1LLE(SEL.70�1.BU57� J � NESS IW'�PROLESSIONS WOE:TME COrRRACT00.5 LICENSE L/�W DOES NOT AVPLY TO AN OWNER OF j GROPEHTY NMO BU0.05 OR IMPROVES TMEREdJ,AKD Nn10 DOES SUp1 WORK NiIASEIF Oii HfRS[LF OR CZ TMqOUCNHI50RHEHOWNEAIPLOVFES,PROVIDEDTHATSUCNMPROVEMENTSARENOTNTENDEDOR m Q OFFEREDFORSALE.IF,FqWEVERn7EBUILDINGORIMPROVEMENTI550LDN1THINONEYEAROFLOMG�E• Z TqN.iHE OwNER�eUiLDER M^LL 1uVE TME BUR7EN OF VROVINO 7N�7 HE OR SHL DID NOT BUItD OR � IMPiqVE iOR TME PURPQSE OF SALE). w 04ASOW4EROFiNEGROPERiY.AA1E%CIUSNELVCANTRALTINGWITHIICENSEDCONTMCTORS [C TO CONSTRUCT THE PRO.IECT fSEC.7a11.BUSINESS IWD VROFESSIONS LO�E:THE CONTMCTORS ll� V31u0tiOn ADJ.AREA W CENSEUWDOESNOiAPPLYTOANOYMEflOFAPROPERiVNR10Bl1ILD50RMFROVESTHEREON.AKJ � NM1�OCONTRACTSFORSUCHVPQIECTSYATMACONT{UCTOR(S�LICENSEDPURSUANTTOTNECONTRAC- QUANTITY �ESCRIPTION FEE Y T00.5LJCENSEUw). � O IAA1 EXEM7i UNDER SEG 8.�P.C.FOR TNiS REASON Q � U LL DATE OWN[R � O w F LICENSED CONTRACTORS DECLARATION w ¢ � I MEREBY�FFIpM UNOER PENALN OF PENURY 7MAT IAM LICENSED UN�ER PRONSIONS OF CHAPTER � / t 5� d Y�COMMCNCINGWITMSECiKKJ7D00)OFDIVISqN70FTHEBU51NE551W�PROFE5510N5CODE,ANU Z. 7 ' .S V X MY UCENSE IS N FULL FOFCEAND EfFECT. m 11J S' � UCENSE CUSS LIC.NO. �v S � V Da7E �coaiancio .�s � a � �W KERS'COMPENSATION OE LARATION a NIHEREBY G�IRA1UNOfR�ENALTYOFDE0.NNVONEOFTNEFOLLOW�NCO[CU1RATqNS: Z � � �INAVEANDWILIMAMTUNACERTIFICATEOFCONSENTTOSELFaNSUHEFORVqR1(ERS' _ Q COMPENSATqN,ASVROVIDED8Y5EGTION]7000FTMEUBORCODE.FORiHEVERFORMANCE W Q OF THE WORK FOR WH1G1 T1115 GERAIIT LS ISSUED. � w �INAVEANDWILLNAINTAMWORKER5COMPENSATqNINSUMNCE,A5RE0UIREDBYSECTION � ]7000FTMEU80ROODE,FORTHEPERFORMANCEOFTHEWOHKFORWHICHTHISVERMITIS LSSUED.MYWORKEAS'LOMPENSATIONINSURANGECARRIERANDVOLILYNUTACERARE: CONSTRUCTIDN � CARqIER STi<Sj���eJ�• PLANpEVIEW Zva�crNuuoEa_//f_���?�� —� ELECTRIC ¢ 7'T J TJ 0 (nM1:s[cr�wNcmNOTs[oobstFfEooFn[vEaMrsFrna+eH.rai[noaulsg�oc)oRLEss). PLUMDING .�� W � Z I CERTIFV MAT N THE PERFORIA+IYCE Of TNE VlORN FOR KMICH iHIS PERMIT IS IS5Uf0,1 AIECHANICAL �~i1 � �� � � (,�} SNALLNOTEMPLOY/VJ'lPERSONINANVYANNERSOASTOB[COA![SUOJECiTOTME J � N WORNERS'Cp.1GEN5ATqNUWSOFC�LIFORNIA,ANDAGREETMATIFISNOVlDBCCOME INSPECTIONFEE SU6IECT TO THE WORNERS'LOMPENSATqN GROVISIONi OF SECTION]�00 OF TME UBOR (� ^ , s COOE.ISMALLi^ORT^MYITM-COMPLYWi TN SE/VR�OYi5�ON5 ISSUANCE ��P ll r; `10 11 d��] �U � �s i V !� ,� �l.l_� �(� SMIP p DATE: APPIICANT: / J WARNING iA RETOSECUHEWORKERS'COM�ENSATIONGOVEMGEISUNUYlFU�ANDSMALIBE ENERGYP/C ` � � SU0.IECTANEMP�OYERiOCRIMIYALPENA:TIESANDCNILFWESUPTOONEMINDREDTMOUSAND ENERGYPERMIT !�`�- •-- - � DOLLARS(5100.DC0),Pi ADDITION TO TME COST OF COMPENSATqN.OAMAGES AS PROVIDED FOR IN � SECT�ON]'IOlOFTMEU180RCOOE,WTEREST,ANDATTORNEY'SFEES. ��ENTIONFEE: d GONSTRUCTION LENDING AGENCY pRE-AL7 FEE: O � INEREBVAFFlHMUNOERPENALTYOFVERIURVTIUT7MEHEISACONSTPUCTIDNLENDiNGAG[NLY LOR iHE PERFORAIANCE OF THE WORN FOR WMICN TMS 7ERMIT IS ISSUED(SEG]oY7,qV.C.1. Z W Z� LENOER'S NM1E � F- IENOER'Sh^.DHE55 � TOTAL FEES .S�O ¢ I CERTiFY T//AT I NAVE READ T+IS�PDLICATION AND STATE T/UT THEABOVE P1FORu�T10N IS CORRECT. w IAGREE7000MPLYNATMALLCfTYANDCOVNTYORDiNANCESANDSTATEUwSREIATINCTOBVILDING � CONSTRUCTqN,ANOHEAEBYAUT110RIZEREPRESENTATIVESOFTHISLOVNTVTOENTERUPONTHE � AOOVE�MENTIONEDiROPERTYFORINSPECTIONVURPO5E5. Z COMUENTS � .�/l/ r;� m GER ' E(PflINT) � Q � � ���(_�- � SiGNAf HfOFPEAMi � O�TE � R[CPL NO. 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