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HomeMy WebLinkAbout13949 (17) !� CITY OH DIAMQND BAI2 ) DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES j �W 21660 E.Copley Drive Suite 190 � (909)860-3195 Fa�c(909)86]-3 t 17 PR ESS � ' �'•»N°'�� BUILDING PERMIT APPLICATION FIRMLY � � JOBSITE !" �.,.�.y APPLICATION '2� � PERMIT P/C . � 0 ADDRESS_ L � � c��_,�_=/lJ DATE �• NUMBE�`� ' k � � ISSUE ,. ...- " TYPE OCC APN LOT TR T�;' DATE CONST. GROUP p aWNER Ci 1� � t �� d�-i t� -- "" ADDRESS�• L � ZONING SETBACKS w �' FRONT _ RW_ ❑ Z CITY � ZIP�;�TEL. � REAR C:I g APP ANT_ TEL. SIDE/SIDE STREET RW C7 � CONTRACTO _ I • (�(s��� SIDE LI _ � � ADDRE o' CITY ZIP� F" TEL. •F�)�J7• d;r PROPOSED USE_ __.__ 0 ARCWENG/ — W DESIGNER NO.DV�IEL. NO. NO. a ADDRESS_ UNITS STORIES BEDROOMS � � CITY ZIP TEL. __ � N DESCRIPTION SQ.FT: FACTOR PSF ADJ.AREAIVALUATION O OWNER-BUILDER DECLAflATION SFR/ADD/REM i [] I HEREBY AFFIRM UNDER PENFL7Y OF PFRJUFY THAT I AM E%EMPT FflOM THE CONTRACTORS LI� C^BfBCJ2/C9fPOff W CENSELAWFOR7NEFOLLOWINGREASON�SEC.7031.56U51NESSANDPROFESSIONSCA�E�ANYCIIYDR (n � U COUNTYMMICHREWIRESAPERMITTOCONSTflUCT,ALTER,IMPROVE,DEA101ISH,OPREPAIHANYSfRUC- W Pg�10/DBCK ;W NRE,PRIOR TO ITS ISSUPNCE,ILL50 REWIqES THE APPLICMIT FOR SUCIi PERMIT TO FILE A SIGNED W _ 9 STATEMENT TiAT HE OR SHE IS LICENSED PURSUANT TO THE FROVI516Y5 OF TNE CONTRACfORS LI- ` � CENSE UW(CHAPTEH B�CAMMENCMG WITH SECfION 7000)OF I71VIS!ON 30F TH'c BUSIYESS AND PRO- u' Pool/Spa r � FE&SIONSCODE)OHTHATHEORSHEISEXEMPTiHEREFflOMANU7HE6A515FORiHEFLLEGEDEXEMP- - ; �' TION.ANYVIOUTIONOFSECTION7o31.58VANVAPPLICANTFORAPeHMITSUBJECTSTHEAPPLICANiTO z Re-Roof � .� ACML PENALTY OF NOT MORE THAN FlVE HUNDRED DOLIARS(SSoo).): ;� IJI,ASOWNEflOFTHEPROPERTY,OflMYEMPLOYEESWITHWAGE5A5THEIRSOLECON7FN5ATION, C.� COI71fIlOfCl81 K1LL DO THE WORK,Ml�THE STRl1CTURE IS NO7INTEND[D OR OFFERED FOA SALE ISEC.704a,BU51- _I � NESSAND PROFESSIONS CODE:THE CONTRAf,TaRS UCENSE lAW DOGS NOi APPLY TO AN OVJNER OF I -- -- � PROPER7YWF10BUIL�SORIMiROVESTHEftE-0N,AND1tt10DOE55UCi1WORKMIMSELFORHEflSEIFOR m � �C[� THpOU0H/11SORHERONTlEMPLOVF.fS.GROVI0E0THATSUCHIMPROVEMENTSARENOTIW7ENDEDOR '� OFFEREDFORSALEIF,HOWEVEFLiHE9U1LDIhGOqIMVROVEMEN7ISSOL�WITHINONEYF.AROFCAMPLE- � TION,THE OWNER-BUILDER WILL HAVE TF1E BURDEN OF PROVIYO 7HAT HE Oq SHE OID HOT BUILD Ofl = IMPROVEFOR7HEPUFlPUSEOFSALE} 9 ' Ll1,ASONTIEROF7HEPROPERfV,AMEXCLU5IVELYCONTRACYINGWITHLICFNSEOCONTRAC?ORS ' —^ — ' � TO LONSTRUCT 7HE PRPIECT(SEC.7044,BUSINE55lJiD PROFESSIONS CODE:THE CONTRACTORS LI- VdIUe(i0�'1 ,,._.._._._,____.__.__._..._..._..__..._ADJ.AREA___ j __ _`_. �W �NSElAW00ESNOTflPPIYTOFNUWNEHOFAPROP`eRTVWHOBU1lDSORIAiPflOYESTNEHEON,AND � F W/lOCONTRACTSFORSUCHPHQIECTSWITHACONTRACTOR{SJUCENS[UPl1R5UAN7TOTHECONTRAC� QUANT�TY DESCRIPTION FEE �� TORS UCENSE LAW.). '� ,� U T AM E%EMPT UNDEp SEC. __.,,_.____._.B.8 P.C.FOR 7HIS tiGASON U I � S —._ __..__.......__.'__.__ ¢ ; � U .S Z OATE OWNEH_'__'_..__._'___—'_ _ W h ��,� UCEiJSED GONTRACTORS DECLARATION �� � �' i MEREBY AFFIRM UN�ER PENPLTY OF PEfiJllfiV ThiAT I AM LICENSC-D Uk0[R PROVISIO4S OF CHAPTER � � j �d 9(COMMENCIkCiWITNSECTIDN7000�OF01VI510N30FIHEtiUSI.N[SSANUPHOf�SSIC�SCO�f.,AND Z -- — -- ___� � �X, MYLICENSEISINFUi.LFURCLANUEFF[CT. � ! ;: � K� y ,. �.�ypy �. (�r a LLJ �y� _ si6� �G.� ? ;� UCENSE CLASS��`��Y LIC.NO. .._ �._���� ;� 7 � . rL�at° ��J ' y�,.—� // �+�/J� J7 1A' :W� DATE _.._ CONiRAC;TOR��.g�. �"� a — --- .� �. WOFKERS'CO�dPF.tJSATION DECLARATION ° C�L� Q i �, �����' � c� — � I HERE�Y AFFIPM UNDER PENALTY OF PL0.IURV ONG OF TH'c FOLLOWING DECSR�TFJ �: z a - .� IHAVEANDWILLMA!NTA!NACER7IFICRTF.OFCONSENTTOSELF�IN5UHEFOHWOHKF:f15' -L � COPAPEYSATION,ASPROYIDED81'SECTI!NJ3�oDOFTHEUBCRCODE.�OqTHEPERFOFlM.ANC[ W L.__ �FTHE WORK FOR WHICH THIS FERMIT IS ISSUEO. �I W ;HAYEANDWILLMAINTAI;JWORKEfl'u'CAtAPCNSATiOMINSURANCE,ASRE�:iIRE08Y5ECTION Q 3]OOOFTHELA.80fl�DE,FORYKEPERFORMANCLOFTHEWORKFORWH!CHTHISPEHMITIS '0� ISSUED.MV WORK RS�l'WMPE/NSRT!Ok INSURANC:CARFlIFR AND POUCY NUMUEH hFiF-: CQNSTRUCTION ____ ___ i �.j� cnRniEfl----�g�-.--� L� -- -- .._ PLAW REVIEW - —--- ,Z�� POLICYNUMBER._� ' �� ' ELECTRIC `' ___......__.____'_._.-___._.'_._..._'.__-- � Q v� �� (�11155ECilONNLFDfJl�T6ECb4PLETEDOFTI£:I'ERMTASf+JfiONEhA.�DREDOC41Af15(Ft )OR�f".,5)1 PLlJA481N6� __--.__---_________. ,.'l•."'-._""'_ :� I CERTIFY THAT IYTHE PERFORMAhCE Of THE WOFlN FOR W41CH THIS PEAMIY IS��D,I MECI'IANICAL _._ ���(�J SHkiLNOT EMPLOYP.NY PEl�15(HJ IN ANY MANNER SO AS TO Bi�GOMF.SU9J[C?TO THE �,/" ',�� WOHKEHS'CAMPENSAl70NLAW50FCALIFORNIA,ANDAGflEETHATIFI5F10ULUHCCOMF. INSPEC7IONFtE _ ,.t�-� , - -- --- .. SUBJECT TO THF Y10HKEHS'CJMPENSATION PpOV151ONS O1�S �'.JIO�97�LA[3 i � CODE.}SHALLFORTHWITMCOMPLYWITMTHOSEP < � ISSUANCE � ______._..__.—_. . ' __..__� ...""__"._.................... "�.. a' �/''Jiw /'� ' J } .�Lp DA7E:�C�. APPLICANT: •_ SMIP _.___._ _�_�i _.__._-__- . � � �! .. � �� ENERUY P/C ._...._ -- --�- ._.....-- :J WAflNINO:FAILUHE TO 5[CUPE\YOHKERS'CAMPENSATION COVEPACE I&UNLAW L,�N .f1ALL UE '� 'LL' Sl1�JECTANEMPLOYERTOCRIM:NALPENALTIESANOCIVIlFlNESUP'i00NEMU DR HOUSAND ENERGVPERMIT � DOLLAHS(S10o.o00),IN ADDITION TO THE COST Of COMPENSATION,DAMAGFS AS VIOF:D fOii IN -'-"'— � """—' i ,,,,� 5[CT10N3]oBOFTXELA80RCODE,INTERESi.ANDATTORNEY'SFEES. — RETENTIONFEE: ` ' ��"""'_ � �. d. 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