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HomeMy WebLinkAbout11352 (9) �. ...--- �...__...__:__.�._..__...__,..�..--��_..._.__.�___..._� .,.�..�..-R-A-�..._,-�--,,-�-:-,-:-�--�.--�-.�.�,.. ._ __ ._...___T_._.___ � �. —�--- CITY OF DIA;v10ND BAR � ' COMMUNITY DEVELOPMENT DEPAR'TMEIVT � lIG •�,'�`-=,.t;� 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS '""'Y BUILDING PERMIT APPLICATIO\T FIRMLY QJOBSITE �/ J �r�. A p�� �Zr�f DATEICATION � NUMBER /��5� #/C ¢ ADDRESS ( J �^'�-''t.1 00 � OCC � � APN LOT TRACT D 7EE _ONST. GROUP p OWNER �� r � — " ADDRESS ") Z.v' ZONING SETBACKS 0 z CITY � TEL._ r FRONT RW r. v APPLICANT _ TEL�� `z' �^ REAR -� z SIDE SIDE STREET RW i7 a CONTRACTOR � ADDRESS_ ,� � CITY ZIP TEL. PROPOSED USE ' • ' G—�f' /_ qz �w ARCH/ENG/ � �-�— L " 0 �/�!9 c�-CG! /o iz DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � — cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BI;ILDER DECLARATION � � SFR�ADD;REM p I HEREBV AFFIr7M UNDER PENALTY OF PERJURY THAT:AM EREMP7 FRD�A THEi CONTRACTORS L!- Gafdc�E/Cerpod W CE4SELAWFORTHEFOLLOWINGREASOY(SEC.7031.53USIYESSANOPROFESSIONSCODEA\YCI'VOR (n _ U COUNTVWHICHREOUIaESAPERMITTOCONSTR:JC'ALTER,IIAPROVE,DEMOLISH,ORREPAIFiANYS?RUC- W patio/Deck w TURE,PRIOR TO li£ISSUANCE,AL50 RECUiRES TH'c APPLICANT FOR SUCH P=R!AIT TO FILc'A SIGNE� W STATEMEYf THAT HE OR SHE�IS UCENSED PURSUANT TO'HE PROVISIONS OF iHE'COYTRACTORS LI- � CENSE LAW(CHAP i ER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BL'SINESS AND PRO- � POOUSPH FESSIONSCODE�ORTFIATHEORSHEISE%c!APTTHEREFROMANDTHEBAS!S�ORTFIE0.LLEGEDE%EMP� (rJ � TION.ANYVIOLATI�NOFSECTION7031.SBYANYAPPLICANTFORAPERMITSIIdJECTSTHEAPPLfCANTTO Z Re-Roof � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDn^ED DOLUlRS(ESOD).): Z ❑I,ASOWNERDFTHEPROPERTY,OR�dVEMPLOYEESWITHWAGESASTHEIFSOLECOMPENSAT10N, � COrtlmeroial WILL 00 THE WORK,AND THE STRUCTUR'c IS NOT IN'EN�ED OR OFFERED FOR SA�E(SEC.7044,B�SI- J � N'eSS ANO PROFESS!ONS CODE:THE CONTRAC'ORS LICENSE LAW�OES NOT APPLV TO AN OWNER OF � ' PROPERTY WHO BV ILDS OR IMPROVES THEREON,AYD WHO DOES SUCH WORK HIMSF.LF OR HEP.SELF OR CC THROUGHHISOflHEROWNEh1PLOVEES,PROVIDeDiHATSUCHIMPROYEMEN?SAREYOTiM'ENDEDOR � m W OFFEfiEDFOfiSALE.IF,HOWcVER,THEBUIL�IFGORIMPRdVEMENT:550LDWITHI�ONEYE0.ROFCOMPLE- � � TION,THE OWNER�BUI�DER WILL HAVE TYE 6UFDEN OF PROVING THAT H'c OR SFIE 01�NOT 9UILD OR Z IMPaOVEFOFiHEPURPOSEOFSALE�. �= CI,ASOWNEROFTH'cPROPEFiTV,AMERCLU5IVELYCORTRACTINGWIiHUCcNS=DCONTRACTORS TO CONSTRl1CT THE PROJECT;SEC.7C<C,BUSINESS AND 7ROFESSIONS CODE:THE CON7RAC70RS LI- ValUdtiDn ADJ.AREA_ W CENSELAW�OESNOTAPPLYTOANOWNEROFAPROPERTVWH08UI'_DSORIMPROVESTNEREOY,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S�LICENSE�PURSUAN'fTOTHECOhTRAC- QUANTITY DESCRIPTION FEE Y TOFSLICENSELAW.�. 0 C;IAM EXEMPT UN�ER SEC._ ___ B.&P.C.FOR THIS REASON Q � :> U � LL' DATE r' OWNER , � U � . � LICENSED CONTRACTORS DECLARATION W ¢ � I HEREBY�FFIRM UNDER PE\0.LTY OF P"cRJURY THAT I AM LICENS'cD UNDER PROVI5;ON5 0F CHAP-ER � � 9(COMMENGINGWITHSECTIOK7aoo)OFD!VISION30FTHE6USINESSANDPROFESSIONSCODE,RNO Z X MY LIC'cNSE IS IN FULL FORCE AND EFFECT. -- W m � LICENSE CLASS LIC.NO. __ j I F, J U �ATE GONTRAGTOR_ d W � WORKERS'COMPENSATION DECLARATION ¢ � I HEREBV AFFIRAI UN�ER PENALTY OF 7ERJUR`/ON'c OF THE FOLLOWIYG DECLARATIONS: Z � _IHAVEANDWILLMAWTAINACERTIFICA'EOFCONSENTTOSELfdYSUREFORWORKERS' ¢ Q CO�dPE�SA710N,ASPROVIDEDBVSECilON37o00F7HELABOfiCOD'e,FORTHEPE(iFORMANCE W Q OFTHE WORK FOR WHICH 7HIS PEFU+tIT IS ISSUED. � w IHRVEANDWILCMAWiAINWORKERS'COMPENSATtONINSURA�CE,ASR'c�UIRE08VSF.CTION Q 370o OF THE LA60R CODE,FOR THE PEF.''OFiMANCc OFTHE YlORK FOF WHICH TliIS PeRM1T 15 ,r�� f� ISSUED.MY WORKER5 COMPENSATION INSl1RANCE CARNIERAN�PaICY NUMBERARE: CONSTRUCTION ?,V,��✓ J � CARRIER PLAN REVIEW Z POLICV NUMBER ELECTRIC , Q � (R1ISSECTIOt�M1L�NOTBE00k?L�eDCFTFiEPERYR15FOROtrEiiUWR7J00LiNt5(SiWjORLE554 PLUMBING ___ Z I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WH:CHTH!S PERMIT IS ISSLiED,I MECHANICAL _ C3 SHA�LNOT'eM.PLOYANVPERSONINANYMANNERSOAS'.06cCOMESUBJEC�'OTHE y WORKERS'COMPENSA?ION IAWS OF CALIFORNIA,A4D AGREE THAT IF i SHOULD BECOME INSPECTION FEE __,__._ _ � SU6JECTTOTHEWORKERS'COlAPcNSAT10NPROVISIONSOFSECTION37CaOFTHElA30R — /,�^ CODE,I SHALLFOfiTHNfTH COM.PLY WITH THpSE PROVISIONS. ISSUANCE f J . �� � SMIP ; 6� p DATE: _ APPLICANT: _ — J WARNINGFAILURETOSECUR'cWORKERS'COMPENSATIONCOVEqAGEISUN;AWFUL,ANDSHALLBE ENERGYPlC _____ � SUBJECTANEMPLOYERTOCRIM:NAIPENALTIESANOCIVILFINESUPTOONEHUNDR'cDTMOUSAND ENERGYPERMIT DOLLARS(Slaa,o0a),IN ADDITION TOTHE COST OF COi1PEti5Ai ION,DAMAGES AS 7ROYIDEO FOR IN ¢ SECTION 37oe OF THF LABOF CODE,INTERE57,AND A7TORNEY'S FEES. RETENTION FEE: __ OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ � �HEREBY AFFIRM UtiDEF PeNALTY OF PEflJURY THATTHER=IS A CONSTFiUCTiON LFNOIYG AGENCY '-.y� � FOR THE PERFORMIWCE OFiH`c WORK FOR WHICn TMIS PERMIT IS ISSUED(SEC.3097.CIV.C.). — � - ,-- iz _ ;:./..:', .��-��. � LENDeR'SNAME _ I — — _ � 'x ��l__� N LENDER'SAODRE55 � ICEF7IFYTHFTIHAVeREADTHISAPPL:CATIONANDSTATETHAT'HEA90VEItiFORMFTIO�ISCORRECT. 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