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HomeMy WebLinkAbout11828 (5) ' CITY OF DIAMOND BAA � ---�� DEPARTMENT OF COMMUrTITY&DEVELOPMENT SERVICES , 216b0 E.Copley Drive Suite 190 � � (909)860-3195 Fas(909)861-3117 PRESS F�;°�', BUII.DIIVG PERMIT APPLICATION FIRMLY aA ADDR'ESS ! / �� ��' ���,i �+t-�7_ ,�j� APPUCATION-- � 1.�, PERMIT � � P/C q DATE � NUMBER # � APN LOT�TRACT �SSUE TYPE OCC � DATE CONST. GROUP p OWNER � p ADDRESS 1 F '� _ ZONWG SETBACKS W CITY La t � > I ZIP�sTEL. "' FRONT RW ❑ � APPLICANT � TEL. �`i -�1'Ls�l, SIDE/SIDE STREET _ RW ❑ � CONTRACTOR s _ �--L� �y SIDE ❑ � ADDRESS �� ' .7�! � CITY �--��•- ` ZIP TEL. � PROPOSED USE o ARCH/ENG/ DESIGNER y�j NO.DWEL. NO. NO. o„ ADDRESS � UNITS STORIES BEDROOMS � CITY ZIP TEL. � ui DESCRIPTiON SQ.F7 FACTOR PSF ADJ.AREANALUATION -_ �. OWNER-Bl11LDER DECIARATION SFR/ADD/REM O 1 HEREBY AFFlRM UNDER PENALTV OF PERJURY THAT 1 AM EXEMPT FROM THE C0117RACTOR6 LI- Garage/CBfpOR W CENSEUWFORTHEFOLLOWINGRFA50N(SEC.7o31.5BUSINESSANOPPOFESS10N5CODE:ANYCITYOR .(/� - �- COUNTVMMICHflEQU1HESAPEflMRTOWNSTRUCT,ALTER,IMPFiOVE.OEMOLiSN,ORREPAIqANYSTRUC- - 'uf Fatio/�eck - � ' TUflE.PRIOR TO ITS IS5UANCE,A150 flEQl11flE5 THE APPLIGANT Wfl SUCH�PERMIT TO FILE A SIGNED w� Si�TQAENT THAT ME Ofl SHE IS LICENSED PUR3UANT TO 7HE PROVISIONS Of THE CONTRACTORS U� �W �. CENSELAW(CFUP7ERBtCOMMENCIN�WITHSECTIONi000jOFDIVIS10N90FTHEB�SINESSANDPRO- ��'i' POOUSPB - FES$pNSCODEJOfl'fHATHEOASHEISEXEMPTTMEREFROMA1vD7HEBA51SfORTHEALLEGEDEXEMP- (J - TION,,WVypLAT10NOFSECTiCW7031.59VANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICAN7T0 " �Z Re-Root ACMLPENALTYOFNOTMORETHANFNEHUNDREDOOLLAqS(5500).�: - - ❑I,A50NMEROFTHEPiiOPEFTY,ORMYEMGLOYEESWITHWpGESASTNEIq50LECOMPENSATION, ' Q� - O� Commercial - Z_ N7LL DO THE WOAK,M!D 7HE STRL1GTUflE I5.NOT IHiEN�ED OR OFFERED FOR SALE(SEC.7046,B1J56 .J y� -NE551W0 PFiOFESSIONS COOE:THE CONifiACTORS LICENSE LAW DOES NOtAPPLY TO PN OWNEfl� �_ PppPEAiYWH09tlItASORIAiPROYESTHEREON.ANOYlHODOESSUCHWORKNIMSELFORHERSELFOR �� �`. - � iHROUGHHI50RHEHOWNFAIPLOVEES,PflOVIDEDTHATSUCHIMPROVEMEMSAqENOTINTENDEDOR - m - � OFFERW WR S/LLE IF HOWEVER,THEBUILDING OR IMPpOVEMENT IS SOLD WITHIN ONEYEAROFCOMPLE' --TOION,THE OWNEN-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE OID NOT BUILD OR � � � �'w`-�IMPFlOYEWRTHE%1HPOSEOFSAI.E). . . - �=y(�,� OI.�SOWNEROFTHEPROPEFifY.M1IXClUSIVELVCONTRACTINGWITHLICENSEDCOMflACTOflS _ - �-. TO CON3TRllCT THE PROJECT(9EC.7as,BUSINESS AND PRO'rES310N5 CODE:iHE CONifiACTORS Li. . V81tlHlion ADJ.AREA .W: CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPEHttVlHOBURD50R�MPRDVESTHEflEON,AN6 . -��WFIOCONTRACTSGOfiSUCHPROJECTSWITHACONiRACTOH(S�LICENSEOPUNSUANiTOTHECONiMC- ' Q�JANTITY DESCRIPTION FEE � TORSUCEN6EUW.). . . . .. . . . � . O 1 A1A D(EMPT tJNOEfl SEC. 8.&P.C_'r'ORTHIS REASDN� ; - Q --��.-: . :�. U . .. � - . - . �� . � : DATE OWNER � 2: W �-- LICENSED CONTAACTORS DECLARATION - � . �-" !NEREBYAFFIRM UNOER P'cNAltt OP GERIURY THAT I RM LICeNSED UNDER PROVISIONS OF CNAPTEF � � . . L , \ d.. B(COMMENCUlOW17H5ECT10N7000)OFOIVISION30FTHEBUSINESSANDPROFESSIONSCOD[.AND Z - J �'C� A1Y LICENSE IS�N FULL FORCE PNO EFFECL i� . � s_J� .. -r9' u.� �ry � L/( �4� UCENSE CUISS � � LIC.NO. C�J - � � . - J �ja OA7E �� CONSRACTOR d W� �r� WORKERS'COMPENSATION pECLARATION Q �= U _ �; IH�REBYAFfIRMUNDERPENALTVOFPERJURYONEOFTHEFOLLOWiNGDCCLAMTIONS - Z - - �'` JIHAYEANDYVILLMAINTAINACERTIFICA7EOFCONSENTTOSE�f-1NSUflEFOqWORKERS' _ - � COMPENSATION,A9PROYIDE�9YSECTION97COOFTHELAOORCDDEFORiHEPERFORMANCE W �E WORK FOR WHICH 7HI5 PERMIT IS ISSUED. � Q° Q� �I HAVE AND N7LL MAINiAIN�WORKERS COMPENSATION INSURqNCE.AS REWIflED BY S[CTiON -- 3700OFTHELABORCODE.FORTHEPERFORMANCEOFTHEWORKFORWHICHiNISPERMITIS . �' ISSUED.MYWOflKERS'COMPENSATIONINSURANCECARRIERANDpPOI},IC�Y-NU�A7BERAqE: CONSTRUCTION � .j�-- CMRiER__�i�!„ - � -- �L.�(✓ . � PLANREVIEW �� POIICYNUMBER � - � _ _�� ELECTRIC j 0-. (1HlSSECIpNNE�NOT6EaoMPLETmOFi}�PER1iT15FORIXVEMFDREDWLLARSl57oo70RLES5� P�UMBING L ( Z� I CERTIFY7Hq71N iHE PEPFORMAhCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL ��� (J-, SHALLNOTEMPLOYANYPERSONINANYMMlNEHSOASTOBECOMES�BJECTTOTHE - - - � �-_< WORKEflS'COMPENSATIONlAW50FCALIFOflNIA,AN�AGFiEETHATIF�lSHOULDBECOM1iE INSPECTIONFEE _ �' SUBJECTTOT WORKEfl5COMPENSATIONPflOVI51ONSOFSECT10N37ooOFTMEIABOR ISSUANCE ...��1 ����Q � �"'��� CODE,1 ALL OR7FIWITHCOMPLYWIhITHOSEPROVI510N5. � a.�ii N .1 v D_—.__—_—_ . W,r DATE:_,�'Z�� APPLICANT. .— �-.. 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