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HomeMy WebLinkAbout16633 (32) � _�` CITY OF D[AMOND BAR � � i DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES ' � ,��` 21825 E.Copley Drive � (909)860-3195 Fax(909)861•3117 PRESS `-:�' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION PERMI7 lr r,� P/C �/ o ADDRESS � S• � �� Iv DATE � ���"� �NUMBER I ` �F' N l/ � APN LO TR[1CT ISSUE^ /„`I� h I TYPE OCC DATE ��1 v CONST. GFiOUP p OWNER /`�� d- "" ADDF�SS S 1 ►- ZONING SETBACKS 0 z cinl��lA�'✓ 'r ZIp . TEL. FRONT RW ❑ o APPUCANT TEL�yE'> '7Gy 5' S DE/SIDE STREET RW p � CONTRACTOR . G SIDE ❑ Q ADO ES / o � CITY -r>r ZIP� TEL�� 6� PROPOSED USE o ARCHIENG/ iz OESIGNER NO.DWEL. NO. NO. n. ADDRESS UNITS STOFiIES BEDROOMS � CITY ZIP TEL. � �n DESCRIPTION SQ.Fi: FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADDlREM O I HEREBY AFFIRM UNOER FENALTY OF VERJUHY iHAT I AM EXEMPT FPOM THE COf�ITMCTOR5l4 Garaga�Carport W CENSEUWFORTMEFOILOWINOREASONI5EG7071.5BU5�NE55M1DPROFE55�ON9C0DE.ANYCI7YOR (n U �OUHTYWHIp/REOUIqESAPERMITiOCONSTi7UCT,ALTE0.PAPROVE.DEMOUSH,ORREPAIqANYSTRUG W PaIi0ID0CK � NRE PRqN TO ITS ISSUANCE.AL50 REOUIFES TNE MPIICANT iOR SUCH PERMIT TO FILE A SiGNED W S7ATEAIENi T/AT XE OR SHE IS IICEN5E0 W10.5UANT TO TME PROVISI045 OF THE CONTMCTORS LL � CENSE UW(CNAPiER 0(COMM[NCINO WITH SECIION 7000)OF DIViSqN 70F THE 6USINE55 AND PP6 � PooUSpa FESSIONSCOD�ORiF1ATHEOR5MEI5E%EMP7TNEREiROMANOTHEBASISFONTMEALlEGEOEXEMP• (� T�ON.MIYVIOLATIONOFSECTION7071.6BYANVAPVLiCANTFORAVfRAlIT5;181ECTSTHEAP7I,ICANTiO Z Re-Roof A CML iENALTY OF NO7 MORE THAN FIVE HUNDPED OOLLARS(f500)): � ❑I,ASOWNEROFTHEPHOPERTY.ORMYEMPLOVEESWITHWAGESASTNEIq50lECOM7EN5ATi0N. ❑ �,pmmBro(el Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDEO OR OFFEHED FOR SA�E(SEG.7W�,BUS�� J N NES$AND VROFESSIONS COOE:T/�E CANTRACTORS LICENSE l�W DOES NOT APPL�TO AN OWNER OF = OROPERTV WIIO BUILpS OR IIAPROVES THEREON,ANO WMO DOES SUCH WORK HII.ISELF ON HERSELL OR � THRWGH HIS OR HER OVl�1 EMPLOYEES,PROVIDED TUT SUCH IMVROV[MENTS ARE NOT MENOED OR m QOFFERE�fORSPLEIF.NOWEYERiME9UILDINCOflIMPFOVEMENTI550lDWfTHMONEYEAROFCOMRE Z TION,TME OWNER�BUILDER WILL NAVE TME BUHDEN OF�RONNQ TNAT HE O�SHE DID NOT BNLD OR � OAiROVEFOAlNEPURPO5EOF5AlE�. w OI.ASONNEROFTHEPRODERTY.AME%CLUSNELVCONTRACTMCIWRHLILCNSEDCONTHACTORS � TO CONSTRUCT TME PRQIECT�SEC.1at,BUSMESS AND PROFESS�ONS COOC.THE COPRMCTORS LI- VdIUOIlOf1 AQI.AREA W LENSEUWDOESNOTMPIYTO�INOMlNEROFAPROPERTYWMOBUROSORIIAPFlOYESiMEREON./�HD F KM1�OCONTMCTSFOqSIKHPRQIECTSWITNACDNTPACTOH(S)LICENSEDDURSUAHTTOlHECONTMG QUANTITY DESCRIPTION FEE Y TORSUCENSEUW). � OIAMEXEMPTUNOERSEC. 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'�, � � �W _INAVEMIDWILLMA�NTAINWORKERS'COMFENSATIOryMSUMNCE.A5fiE0UIRED8�5ECTION 77000FTHEtABORCODE,FORTHEGERFORAIANCEOFTNEM�ORKFORWHICHTHISVERMli15 ¢ ISSUEO.MYYlOpKERS'COMP SA _INSUfUN�GiCRiEflANJopoucrHUNeeRute: CONSTFlUCTION GAHRiER � ��-• PLANREVIEW Z voucr�eEa �� �7d�j ��� ELECTRIC ¢ - � �nusEcr��mr+oreEm.�tErmoFn�cEw.rrswaa:EMam[ooctu'sniro)a+�ss) PLUMBING Z I CERTIFV iHAT PI TNE PERFORMAN[E OF TME WORK FOH WHICN iHIS PEFMIT IS ISSUE�,I MECHANICAL C'} SHALLNOTEMPLOVANYPERSONINANVMANNEfl50ASTOBECOMESUBECTTOTHE (/) WORKERS'COMPENSATqNLAW50FC1LL�FORNIAMlOAGREETMAfIF15 DBEGOME INSPECTIO SUBJECT TO THE WORKER$'C0IAPENSA710N VRONSIONS OF SEClION JOF TME lABO S CO�E.I SHALL FOflTM/ITM COIAPLY WITH THOSE O 'ONS � ISSUA.NCE� t � � � SMIP p DATE:� APPLICANT: J J WARNING:FAILURE TO SECURE WORKERS'OO��PENSAT COVEHAGE IS UNU'NFUI,AND SNAIL BE ENERGY P! �y, SIAJECfANEIAPLOYERTOCHIIAINALVENALTIESANDCI .iINESUCTOONENUNORC�TF10U5AND ENERGYP RMIT DOLURS(f100.000�,INADDITIqJ70THECOSTOFCOMP NSATqN,D�ACESASDROVIDFDiORIN 7��) � SECiqN]70DOFTMEU�FiCOOE,IN7ERE5T.AND�TIORNEY5FEE5. 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