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HomeMy WebLinkAbout12392 (13) i ^ _�,�� CITY OF DIAMOND BAI� I' DEPARTMENT OF COMMUNITY&DEVELOPMBNT SERVICES � .� 2]660E.CopleyDriveSuitel90 /�� PRE$S i (909)860-3195 Fax(909)861-3117 � j � .� "°�°� BUII,DING PERNIIT APPLICATION \.J.�� FIRMLY j o` JOBSITE '��'�� L�'��`,_(���i � DATE 1�� ��NUMBEA �� !� # i ¢' ADbRESS �f1��" APPLICATIQN � PERMIT p(C � �• APN LOT. TRACT DATE 1��� d pNST. GROUP p' OWNER �• c�'��IC� I, o ADDRESS_I�-I��� L��'�'�Jt d1�,.�.. ZONING SETBACKS z: CITY C�(��h1v�1�Yt� ��'a�l TEL. �G d ���'� FRONT RW ❑ o'; APPLICANT ('_�'ed.L'li.s1._ C�i.+G�-'e�� TEL. REAR ❑ SIDElSlDE STREET RW ❑ Q�� CONTRACTpR SIDE ; ADDRE S C' �, (,A. � , O: CITY � f ZIP x�� 't TEL. ' .i' :�l .+. = PROPOSED USE�`2�'11�11`1� ' �•�-,.��. , I ft � �y� ' j - w' ARCHlENG11 � "I � z t DESIGNER �+�� � � ADDRESS UNI SWEL STORIES � B DROOMS �� CITY ZIP TEL.__ - _ �� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � t �,.. . OWNER-BUILDER DECLARATION �. �� - � SFR/ADD/REM �; W�O 1 MEREBY AFFlqM UNDER PENALTY OF PERIURV TIiAT I AM[XEMPT FROM THE CONTRACTORS U- Q8t898{Ca1pOR �CENSEiAWFORTHFFOlLOW1NGAEAS(NI(SEC.703!.5BUSINESSANDPROFF.SSIONSCODE:ANYCITYDfl ' jn U' _COUNfYWHICHREQUIRESAPERMITTOCONSTRUCT,ALTFR,IMPqOVE,OEMOLISH.OqflE7AIRANYSTFIUC - W pp�io/Dack �� NRE,PRIOq TO IT8 ISSUANCE,A150 REOUIRES 5'HE APPL�CANT FOR SUCH�PERMITTO FIIE A S�GNFD W �_' � ;STATEMENT THAT HE OR SHE IS LICENSEO PUflSUtiV i TO THE PHOVISIONS OF THE CONTRAC70R5 LI � CEN$E LAW(CHAPTER D(O�MMENCINO WITH SECTION 7000)OF OIVISION 30F THE 6USINESS AN'J PflU L'� POOU PESSlDNSCODE)ORTHATHEORSHEISE%EMPTTHEREfROMMlOTHEBASISFORhIEALLEGEDEXEMP- (�. �- V �:TION.NNYVIOLATIONOFSECTION7031.5BYA.NYAFPLICA'v?FO9.4PEq4�TSU&�FCTSTHEAPP�ICANTTO � Fle-R001 I �- �-ACIV14oENALNOFNOTMORETHANiNEHUNOREDDOLtAHS($5oo).): - Z }__ 0 ❑I,ASOMMEROFTHEPROPERTY,ORMYE�APLOYEESWITNWAGESASTHEIRSOIECOMPENSATiON," ' �. COrtiRlOfCie� - �-- � �-WILl00 hiE WOWC,Mlp TME STFNJCiURE IS NOT IYTENDED OR O'rFEflED FOR SALE(SEC.7aa4,BliSl- J. - �-- .-NE55 AND VROFESSIONS CODE:TXF CWJTRACTGpS IICENSc lAW GO`e5 NDi APFiYTO AN OWNER OF- : � - � ,-PfiOPEATYN7106UliOSOAIMPROVESTHEPE4N,ANDWNODOE55UCHWORKHIAfSELFORHc'flSELFOq� � _ `�-:- �� -TNR9UGNHISORHEflOWNEMPIOYEES,PROVIDEDTHAi5UC111MPROVEMEhT6AREND7INTENDEDOR � -m g Q �OGFEREOFOqSALE.IF,HOWEVER7ME8UILbMGOqIMPROYEMFJ�71550�OW17HINONEYEqROFCOMPLE- z �TION,THE OWNEH-BUILOER WILL HAVE THE BURbEN OF PROVIYG THAT HE Ofl SHE D��7JOT BUILD OR . . �,-� � :-IMPROVEFOH7MEPURPo5EOf5AlEj. - € .� OI,ASOWNEROFTHEPROPERTY,AME7(CLUSNELVCQNTpAGTINGWITHLICENSEDCOMRACTORS- '� /^� E � TO CONSTpUC?THE PHQIECT(SEC.7044,BUSMESS ANO PROFESSIONS CODE:THE CONTRACTORS ll- � V81U8IIW1 �6F ADJ.AREA W -CENSEUWOOESNOTAPPLYTOANOWNEI70FAPROPERTYWHOBUILDSORIMPROVESTHEAEON,AND - " �:� _ �VhbCONTMCTSWRSU(YiPRR/ECTSWITY,ADONiflAC'fOA(SJUCENSEDPURSUPN7TOTHECQVTMG � FEE ~ ioasuceNssuw.>. � -. DUAN7ITY DESCRtPT10N � Q � � Q ❑�M1 D(EMPT UNDER SEC. B.a P.C.FOR i HIS REASaN �� T+ U � � � g DATE oWNER � F � F.: � LICENSE�CONTRACTORS DECLARATION W � � � -1HEREBYAFFIHMUNOERPENALTY�OFPE0.IURVTHATIAMLiCEN5E0Uh0Ei1PRON5fONSOFCNAP(EH . �.,�. � n. --=8(CqMMENCINGWITHSECTIOM7o00)OF�IVISION30FTHEBUbINE55ANDPROFESS10iJSCADE,AND � `i� /AYL�CENSEISINNLLWRCEAN�EFFECT, A m � � �UCENSE CL0.SS � IIC.N0.����� �` � ..:_ t-- r, �,��� J � -�are % cor+TrucToa b1.�'6 Pb�'Z��f "�' °� � �w t= ._ WORKERS'COMPENSATION OECLARATION Q �, C- � �IH�pEBYAFFIRMUNOERPENqITYOFPERJUtiYONEOfTHEPoLLOWINGDFCIARNTIONS: Z � � _IHAVEANOWiLIMNNTAINACERTIFICATEOFCONSEN'TOSELF-0NSUREFORWORKER&' _ �' � � �.. � _ CAMPENSATION,ASPROV�DEDBYSSCTION370oOFTNELA60RCQ0E.FORTHEPERFORMANCE U - Q - OFTHE WDRK FOR WMICH TMIS AERMIT IS ISSUED. � �- W "_i HAYEAND WILL MAINTAIN WQRKERS'COMPENSATION INSUFANCE,AS REOURE�0Y SECTION Q _ 370oOFTHELABORCO�E,fOR7HEPERWRMMCEOFTYEWORKFORNMiCHTMISPERM171S -� . . - -q/ ISSUED.MYWORK RS'(j0. ENSATION SUpANCEjCARRIERANDPOLICYNIIAAB�RARF: CONSTRUCTION ����F�� � � CARRIEF� � ���i fi- .�j PLAN REVtEW �. 0 POLICV NUMOER ' �� .���4 � - :��j Z ; � -ELECTRIC � Q - p : (I}A33ECl1U�NE�NDTBECOA�LETE00FThEPERANTiSFORONEFf�JM1DPEDDOLtAPS(yt00)ORLESS� PLUMBING W - - Z - I C[RTIFYlNAT IN THE PERFORMANCEOF THE WORK FOR WHICFI Try�S PEHMIT IS ISSUED,1 MECHANICAL _ �_ C3 SNALL NOT EMPLAY ANY PERSINJ W ANY MANNER SO AS 70 BECOME SUBJECT TO THE � . WORKERS'COMPENSATION LAWS Of CALIFORNIA,AND AGFEE THAT IF I SHOUl.O BECOME INSPECTION FEE 4 � SUBJECTTOTNEWORKEaS'COMPENSATIONPP.�VISIONSOFSECTION37000FTHElABOR µ� �. � GOOE,ISHALLFOfiTHWi'HCOMPLYWITHTHO�PROV FON ISSUANCE '{J � ` � : p�. �RTE:_j�����APPLICANT: ...____ -SMIP _._—— t € J WAANMG f UR TD SECURE WORKEHS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHAllBE ENERGY P/C I` � �y,-� SU&IECTANc'MPLOYEaTOCP,IMINALP[NALTIE6ANDC!VILFI4FSUPTOONEHUNl7RFDTHWSAND ENERGYPERMIT - ,� DOLLARS(S70o.000).W AD�ITION TO THE C0.5T OF GOMPElSATION,DqMAGES AS PROVI�ED PoFi IN -� �� SECTION37oeoFTHELA6oPCODE.MTERE57.ANDAT70RNE'f5FEE5. � RETENTIONFEE: __. - O. CONSTRUCTIONLENDWGAGENGY PRE-ALTFEE: �-: 1 HEPEBY AFFIRM UNDEfl PENALTV OF PERJUHY THAT THEftE IS ACONSTHUCTION LENDING AGENCV _ FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUE��SEC.3097,CIV.C.). - � W - ��. LENDER'SNAME - - - F� IEN�ER'SAWqE55 t � TOTAL FEES j � � 1 CERTIFY THAT I HAVE REA�THISAPPLICATION AND STATE THAT THEABOVE INFOqMAT10N IS CARRECT. } W I AGREE 70 CAA�PLV WITH ALL CITV AND COUNTY Oq01NANCES qN�STATE LAWS RELATIN�TO�UILDING �� � �� )-/- � �� ` � � � OONS7RLICTION,ANDHEREBYAUTFVORI2EpEPRESENTqTIVESOFTHISCOUNTYTOENTERUPONTHE / /� %` � ABOVE-MENTIONED PNOPEflN FOR INSPECTION PURPOSES. 1 1�'l % ? COMMENTS -__ �C�� � � o -���� .������ -�� ��-- , � � m PERMITTEENAIAE(Pfll - ' � �� � �� � . N SI�NANREOFPERMRiEE �TE � -# � _ - RECPT.NO. 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