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HomeMy WebLinkAbout17065 (42) _ . ___ _ -----_�'�.._�. �ITY OF DIAMd1�iD�AR � � DF.PARTMENT OF C01�IIvIilN1TY�r,DEVELOPMENT SERVICES �_ .,,� 21825 E.�apley Drive (409}860-3195 Fax(909)861-3117 PRESS •"-.v�'s BIUILDINGPERMITAPPLICATIOIV FIRMLY } JOBSITE �..�, � � APPLICA710N PERMIT �] P/C `�/��' o ADDRESS ��f�..i ,��:;d_��v'F rf ��'�''4`�� ��� Ci � �J 4e' ° DATE NUMBER # � ISSUE TYPE OCC APN LOT TRACT DATE t � CONST. GROUP p OWNER " ADDRESS ZONING SETBACKS z CITY ZIP TEL. FRONT RW ❑ � APPLICANT TEL. ��AR � � SIDE/SIDE STREET RW ❑ m CONTRACT � " � 'e�,�y �� .�Gn�. SIDE ❑ oADDRESS aL l ''' j PROPOSED USE �'y � � V o CITY FL P�r4mrdc� IP��/�.�'�'i'EL. ���^-�/S� o ARCHlENGA W DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. , � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION . � OWNE,R-BUILpER DECLARATION SFRlADD/REM O 1 NEREBV AFFiRM UNDER PENALTY OF PERJUqY THAT i AM EXEMPT KROM THE CONiRACiORS LI- GBfB JB/CBfQOf[ W CENSELAWFOR7HEFOLLOWINGIREAS�N(SEC.7031.5BUSINESSANDPpOFESSIONSCODE:ANYCITYOR (n , C.� COUNTYWHICHREOUIRESAPFAbV1TT0 ONSTRUCT,ALTER,IMPROVE,�EMOLISH,ORFEPAIRANVSTRUC- W pafl0/DOCk w TURE,PRIOP TO ITS ISSI/ANCE,RLS�fiE�UIRES THE APPLICANT FOfl SUGH PEAMIT TD FILE A SIGNE� W ' STATEMENT THAT HE OR SHE IS LICENSED PURSUANi 70 iHE PflOVI510NS OF THE CONTRAC70R5 LI- �� � CENSE LAW�CHAPTER 9(COMMENCINq WITH SECTfON 1000)OF DIVISION 3 OF THE BUSINE55 AND PftO� � POOUSPe FESSIONSCODE)ORTHATHEORSHEIS,EXEMPTTHEFEFHOMAN�THEBASISFOFTHEALLEGEbEXEMP- (� � TION.ANVVIOLATIONOFSECTION��31.5BYANYAPPLICANTFORAPERMIiSUBJECTSTHEAPPLICANTTO z Re-Roaf � A G1VIL PENALTV OF NOT MORE TF1AN FI�E HUN�R`cD�OLLARS(5500).): � , ❑I.ASOWNEROFTHEPROP�RN,ORMYEMPLOYEESWITHYJAGESASTHEIflSOLECOMPENSATION, 0 COfltm0fCi8I ' Z� WILL DO THE WORK,AN�THE STRl1CTUFE IS NOT MTENDEO OR OFFERED FOR SALE(SEC.7044,BU51� J '� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF � � PpOPERTYWH00UILOSORIMPROVESTHEREON,AN�WHO�0E55UCHWORKHIMSELFORHERSELFOR � '�. � THf1011GHHISORHEROWNEMPL'OYEE�,PflOVIDEOTHATSUCHIMPROVEMENTSARENOiIN`.ENDEDOR m Q. OFFEREDFORSPLE.IF,HOWEVER.KHEB IL�INGORIMPROVEMEN719SOIDWRHIN�NEYEAROFCOMPLE Z 'iION,THE OWNER-BUIIDER WILL HAVE�HE BURDEN OF PROVING iHAT HE OR SHE DID NOT BUILD Ofl IMPflOVE FOR THE PUqP056 OF S�ALE).' - �? � �❑I,ASOWNEROFTHEPROPERTV,pMEXCLU5IYELVCONTFiACTMGWI7HLICENSE�CONTRACTDRS ��,i0 CANSTRUCT THE PflOJECT(S C.7049.OUSINE55 AND PROFESSIONS CODE:THE CONTRP.CTORS LI- V21UHt1011 ADJ.AREA LU�,:CENSELAWDO'cSNOTAPPLYTO�NOWjJEROFAPROPERTYWHOBUILD50RIMPROV6THEREON,AN� � ��.WHOCONiRACiSFORSUCHPROJ�ECTSWIiHACONTRACTOR(S�UCENSEDPl1RSUMTTOTHECONTPAC- QUANTITY DESCRIPTION FEE � TOPS LICENSE LAW.). ., '', ' � J � !�IAM E%EMPT UNOEF SEC.�' B,&P.C.FOR THIS REASON Q � � _ U � LC �A7E I�OWNER._ �' i � O' � -- --UCENSED QaNTRACTORS DECLARATION - - - - - � �' Q. �� I HERE6Y qFFIP.M UN�ER PENALTV OF PERJURY THAT I AM LICENSED LINDER PROVISIONS OF CHAPTEP . � d� 9(COMMENCINGWITHSECTION7o0o)OFlDIVISION30FTHE9USINESSANOPROFESSIONSCODE,AN� Z UX'J, MY LICENSE IS IN FULL FORCEANO EFFE�,CT. m � � LIGENSECLA55 ��r�� '� LIC.NO. 9�q I� / I r j V �ATE ��.�-�7 Cy 6 CONTR4CTOR���i�C��t- a _ W � �i WORKERS'COMPENSA710N DECLARATION Q � u�j U � I HEREBYAFFIRM UNDEq PENALTVAF PEi1JURYONE OFTHE FOLLOWING�ECLARATIONS: Z � � __IHAVEANDWILLMAINTAINACERIIFICATEOFCONSENTTOSE�FINSUFiEFQRWORKERS' _ CAMPENSATION,AS PFiOVI�E�B�SECTION 3�OOOF iHe LABOR CO�E.FOR iHE PERFORMANCE U Q � J OFTHE WORK FOR WHICH THIS�ERMIiIS iS5UE0. � C1' w J �HAVE AND WILLMAINTAIN WOW�AS'COMPENSATION INSURANCE.AS flEQUIRED BY SECTION _�..�o�, R! 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ISSUANCE C p DATE: �� �p APPLICA T:_ � SMIP _ ____ J� WARNING:FAILURE TO SECl1RE WOpKER$'COMPENSATION COVERAGE IS U WFUL,AND SNAL!BE ENERGY P/C �y SUBJECTANEMPLOVERTOCpIMINALPEryALilESANOCIVILFINESUPTOONEHUNDREUTHOLI5AN0 ENERGYPERMIT OOLLARS(St on,00o),IN AO�ITION T�THE COST OF COMPENSA710N,DAMAGES AS PROVIDED FOR IN � SECTION 370e OF THE LABOR CODE:�INTE�EST,ANDA7TORNEY'S FEES, RETENTION FEE: d CONSTR�CTION LENDING AGENCY PRE-ALT FEE: �, IHEREBYAFFIRMUNDERPENAl.TYOFPE JURYTHATTHEREISACONSTRUCTIONLENDMGAGENCY FOR iH'e PEPFORMANCE OFTHE WOqK F,R WHICH THIS PERMIi IS ISSUED(5=C.3og],CN.C.). Z LLJ. �� LENUER'S NAME ____ _'__ F- LENDER'SAD�flESS_._ ._.I � �� ICERTIFYTHATIHAVEIiEAOTHISAPPLIGfy�lIONAN�STATETHATTHEA90VEINWRMATIONISGORRECT TOTAL FEES ��� �� �, � � IAGREETOCOMPLYWITHALLCfTYANOGOUNTYOFDiNANCESANOSTATELAWSAELAiINGT09UILDING � CONSTRUCTION,AN�HEREBYAUiHOR12�RFPRESENTATiVESDFiHISCOUMV70EN-ERL/PONTHE Z ABOVE-MENTIONED PROPERTY FOq;INSP CTION PURPOSES. 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