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Home My WebLink About15174 (20) �� CITY OF DIAMOND BAIt ,� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �w . 21660 E.Copley Drive Suitc 190 (909)860-3195 Fax(909)861-3117 PRESS ��"9K" BUQ�DING PERMIT APPLICATION FIRMLY y JOBSITE APPLICATION /�J? PERMIT o ADDRESS� g5� ��.TL/�G��L DATE � v NUMBER �� P/C # � — ISSUE �-y� TYPE OCC APN LOT ofRACT __ DATE_ �f CONST. GROUP p OWNER VY� LL' ADDR SS� r � v� ZONING SETBACKS W CITY�✓�n��f1 Q,a vw� ZIp� TEL'�i '° ` FRONT RW ❑ � APPLICANT 1.-..R CJ REAR ❑ C`�_lP Gr�. TEL`1�'/lv3i�(�+i''7� � SIDE/SIDE STREET RW L7 CONTRACTOR u� SIDE ❑ ADOR SS �' "J�, ��C'3�'V'Se� �- "�� o CITY ZIP '� TEL.'11'P-Iv�`i' PROPOSED USE o ARCH/ENG/ z DESIGNER � ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn - DESCRIPTION SQ.Fi. FACTOR PSF ADJ.AREANALUATtON Q OWNFR-BUILDER DECLARATION SFR/ADD/REM O 1 HEREBY APFIRM UNDF.R PENALTV OF PERJURY TMAT 1 AM EXEMPT FROM THE CONTRACTORS LI- G&f89B/C8fP011 W CENSEIA'KFORTHEFOLLOWINGfiEAiO!1�SEC.7o3t.5Bl1SINESSANDPROfESSIONSCOJ[:ANYCITYOR (n • U COUNTYWHICHREWIRESAPEflMITTOCANSTNUCT,AITE(i,IMPROVE,�EMOLISH,ORREPAIflANYSTRUC- W Patio/Deck w 7URE,7RbR TO RS ISSUANCE,AL90 REOUIRE9 iHE APPLICANT FOR Sl1CH PERMIT TO f-I�E A SIGNED W � STATEMEN7 THAT ME Ofi SHE IS LICENSE�J PUR511ANT TO 7HE PHOVISIONS OF 7HE CONTRACTORS L4 � CENSE LAW(CHAPTER 9(COMAIENCW�WIiH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOVSp3 FESSpNSCODE)OqiHATHEORSHEiSEXEMPTTHEREFflOMpNDTHEBASI5FOR7MEALlEGEDE%EMP- (� 710N.ANYVKKITIONOFSECTION7031.5BYANYAPPUCANTFORAPERMITSU8JEC75THEAPPLICANTTO Z Re-Roof � � ACMLVENALTYOFNOTMORETHANFIVEHL'NDREDDOLLAfiS(5500).): � ❑I,ASOWNEROFTHEPROPERT`/,ORMYEMPLOYEESWITIiWA6ESASiHEIR50LECOMPENSATION, COtt1fIlBfCl81 — WILI DO THE WORK,ANO THE uTRUCTUNE IS NOT INTEftOEU ON OFFERED FOA SALE(SEC.704�,BUSI� � � NESS AN�PAOFESSIONS CODE:THE CONTRACTORS LICENSE lAW DOLS NOf AGPLV TO AN OWNER OF � , PROPERTl1Ni0BU11DSORIMPROVESTHEREON,AN�WHO00F.S5UQiWORKHIMSELFORHERSELFOR � TMROUGMl1150RHEHOYMEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSAHENOTINTENOEOOR m OOFFEREUFOPSILLEIF,HOWEVERTME6l11101NGORIMPROVEMENTISSOLUWITHINOYF:YEAROFCAMPLE� Z TION,THE OWNEH-BUIL�ER WILL HAVE THE BURDEN OF PROVING THp�HE OR GHE DID NOT BUILD OR � pAPfiOVEFORTMEPURPO5EOF5�lLE). W fll./SOMMEROFTHEPROPERTY,AMEXCI.USIVEL.YCONTRACTINGWITHIICENSE�CONTHACTOR5 � TO CONSTiUC7 THF PHOJFCT(SEC.luaa,BUSINESS ANO PROFESSIONS CODE:THF CONTflACTOR&LI- V8IU0IIOf1 ADJ.AREA W CENSEUWDOESNOTAPPLY7DANOVfNERCFAPROPERTYY/HOBUILDSORIMPROVESTMEflEON,AND ---�'�"""- -"--- -- ,y,�. � WHOWNTRACTSFORSUCHPRQIECTSWITHACONTFiAC70R(S)LICENSEDPURSUA�4TTOTHECON7pAG �UANTITY DESCRIPTION FEE , Y TORS LICENSE LAW J. � f�I AM EXEMP7 UND[R SEC. B.&P.C.FOR THIS REASON Q J ,�~(� „ ��}(�.� � U - u' DATE ON7JLff_ � _'_" -_ � � LICENSED CONTRACTORS DECLARATION w � I HEREBYAFFIRM UNDEFl YENALTV OF PER.IURY THAT IAM LICENSED UNO[R PHUVISIONS OF CHAPTEN � (y 9(COMMENCINO NA'fH SEGTION�o10o)OF DIVISqN 30F THE BUSINESSAND PROFESSIONS GODE.AND Z ]C MY LiCENSE IS IN FULL FORCE AND EFFECT. LLI �.I�� LICENSE CLASS _�____. LIC.NO.__��[ � r "'"'_"_" J V DATE � CONTRACTOR � w C� WORKERS'COMPENSATION DECLARATION � � I HERE6V 0.F�IRM IJNDER PENALTV OF PERIURY ONEGF THE FOLLOWING DECLARATIO4S. Z � __IHAVEluYDWiLLA!AINTAINACERT�FICATEOFCONSE47TOSELFINSUP.EFORWORKERS' � COlAPENSATION,AS PFOVIDED BY SECTION 37o00F THE IAEfOR CODE,FORTHE PERFORMANCE W _ �OF THE WORIC FOflYJHICH TH!S PERMIT I5ISEUED. � QW �I HAVE AND WILL MAINTAIN WORKERS'COMPENSFTAN INSURANCE,AS RE�UIFED BY SECTION a7ca OF THE LABOR CODE,�OR THE dERFORMANCE OF YHE WORK FOR WHICH THIS PENMIT IS � ISSUED.MY WORKERS'CON.FENSAT INSUR E CARRIEH PND POLICY NUMBERARE: CONSTRUCTION J -""_-___"" � CaqRiER�-_ . PLAN FlEVIEW ,... .� Qn.. . -----'-'-.._----��--------- � POLICVNUMBER C.3`�p_- ^ �+�y____"._"'_ . .. ... _.."_. -iK7_.__l=f.'-��_Z 1�._��-- . ELECTRIC . -------- -- � — ¢ 0 frH�sSEcnowNEt3�no7uEawvr.ElcooF'n�rEw�rr�swr�cxa�HuwraFouauas�Siw7on�Ess1. PLUMBING , --.._..._—. ---_.— w MECHANICAL � 1 CEH1'IFV THAT IN THE P[RFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED,I .._..._ _ ....._ �� 6 Cj SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TU BECAME SUUJfCT TO i111 (p WORNEFlS'COMPENSATIONLAWSOFCALIFOFiNIA,PNDAGFEETHATIFISHOULDB'cCAME INSPECTIONFEE __.________ S SU&IECT TO THE WOHKERS'COMPENSATION PROVISIONS OF SECTION 9l0o OF THE LA90R — CAUE.I SHALL FORT}ryy��M COMPLY W R}7 THOSE PflOVIS10NS. I SSUANCE j� p DATE:_ _ APPLICANT: .,...______ _ SMIP -��-�Q�l�._._.'_.__- _ J WAflNINGFAILURETOSECUREY/nRKERS'CAMPENSATIONCAVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C R ___._._._____ _._____ � SUQIECTANEMPLOYERTOCRIMINALPENALfICSAN�CNIIFINESUP100NEHUNDfiEDTHOl13AN� ENERGYPERMIT�T,y..y�� t'9 DOILARS(5100,oW),INADOITIONTOTHECOSTOFCAMVENSATIOY,DAMPGESASPHOVIDCDFORIN �� ------��--------�-- � SECTION37080FiHELABORCCDE--1NTEREST,ANUATTORNEYSFE[5. l+�� l�,� _ • RETENTIONFEE: r'(r�lY��_�Sy____ � CONSTRUCTION IENDING AGENCY PRE-ALT FEE: �"`bg'�� 0 ._.. .--------------..,.------------ � IlIERE[�VAFFIRMLJNOER ENAL7VGFPERJURY7HATTHEREISACONSTqUC710NLENDINGAGFNCY R• FOR1HCPf.RFORMANC FTHEWOFKFOHWHICHTHISPF:RIAITISISSUE�(SEC.3aB],CIV.C). ----"-'-- '--"-'- Z W � LENDER'SNAME G�_�_,_. _""'__""__"'__' "'— H LENDEH'SADDFFSS ___..._-"_'___'-_'_'_..._..___'_"_""_"" � ICERTIFYTHATIHAVEHEAUTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES " �� IA(3HEETOCOMPLYWI7HALLCITYANOCOUNfYOHUINANCESANUSTAT[fAWSRELATW(:TOBUILUING d� ( �6 � CONSTRUCTION,ANO HGR[8Y AUTHORIZE REPRESENTATIVE&OF THIS COUN fv TO ENTER UPOY THE Z ABOVE�MENTIONED PROPERfY FOft INSPFCTION PURPOSES. COMMENTS Q _—__ � ��=�-__s �.e.' ' ----------------- ---�-- m PER TTEENRMf(PR . . '_' ' '"-'—_�� '��-- , 5 NATUHEOFPEFlMITTEE , DATE RECPT.NO.__,__ PAID BY ____. VALIDATION ~ WIiITE-Department Copy,YELLOW-Finnnce Copy,PINK-Assessor Copy,CiOLDENROD-File Copy,GREEN-�ApplicanYs Copy - ---. .. _ _. . . _. _ �� , � . i ' � : 4 , i k j ' , ' xt � � �� , � I � � . ' � , , _ ' , ' ! • . i . ' ' . � I , � � �r• , ; s .... . .. .. _.._ _ _;. ._. _.. .,{ ' � . ' . , :i�: . � - . . , . ' � ' . .: - . -r � . � - i . : - � ... . - ... -. � - - ' , ._ . _ .. _ . ._ . � .� � ., - . ; . . � . . � : . ; � . .._ . . _ - , . _ . . � � . . i � -. -- ' � - . . � . , . � , : . . `"c{ x � � . - , [ . . : � :� � ' � . � � . � : . � � . . � � � , ' . . �; .. �� `� . , . � . 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