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HomeMy WebLinkAbout11878 (7) � ^ ��.� _l CITY OF DIAMOND BAI� • DEPARTMENT OF COMMUNITY&'DEVELOPMENT ERVICES ,; � 21660 E.Copley Drive Swte 190 (909)860-3195 Fax(909)851-3117,, ` 1 �� PRESS ,.�.�+�.�• BUII,DIIING 1'ER1dIIT APPLICATION _ ,:.: . FIRMLY w,;:,�-. f y JOBSITE ���)� � {��i1.A,s�in�� /g� C<�( , APPLICATION � '?�� ERMIT � P/C o ADDRESS �.e n��<<'� �-!1�'— DATE d UMBER # $ ISSUE !TYPE OCC APN LOT TRACT DATE _CONST. GROUP p OWNER ��r� � _ — p ADDRESS •` � � �' ' ZONING SEBACKS Z CITY ' ,_ ZIP L TEL. fi�"' FRONT _ RW � � APRLICANT EL. .` Cy S�-��- SID�IDESTREi_T RW ❑ � CONTRACTOR ,-t�/.YJ '9%�+R ' SIDE ❑ ADDRE�SS�I �f -��'�- 'r+ �j� � pITY�;f.� .Ga o ZIP�_�TEL. � �'�- PROPOSED USE w ARCH/ENG! z DESIGNER '�"'°' ` NO.DWEL. NO. NO. � ADDRESS - - """"' - UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.F7: FACTOR PSF ADJ.AREANALUATION N a OWNER-BUILDER D�CLfSRATiON SFR/AOD/REM O Q 1 HEREBV AFFIHM UNDEH PENALT'OF PERJURV TFIAT I AM EXEMPT FflOM THE CONTRALTOflS LI� Gfl[flQ6(CBfpOfl W CENSELAWFDRTFEFOLLOWINaNEA60N(SEC.]031.5BUSINESSIWOPROFESSIONSCODE:ANYCITYOR (fi U COUNiVW!-0CHRC-0Uf1ESAVEHMfriOCONSTRUCT,ALTER.IMPROVE.DEMOLISH,ORREPIURANY3TRUG JJ PaIlO/DBGk Z Tl1qE,PRION TO ITS ASSUANCE.AL50 REQUIRES THE�APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � gTATEMENi THAT HE OR 5l1E IS UCENSED PURSUANT TO TiE PROVISIONS OF THE CG4TFUCTORS LI- � GENSE UW(CHAPTER B(COMMENCIMO WITH SECTION 7000)OF UIVISION 30FTHE BU&�NE65 ANO PRP �'!' PooUSpa FESSIONS CADE1 OR?HATHE OR SHE IS EXEMP7 THEflEFROMAND 7HE BASI&FDR THEALLEGED EKEMP� 710N.ANYYIOLATIONOFSECTION7031.SBYANYAPPL�CANTFORAPEqMITSUBlECiSTHEAPPLICANTTO Z Re-Roof � ACINLPENAL7YOKNOTMOqETHANFNEHUNDRED00LUlRS(SSooJ.): . , � ❑I.ASOWNEROFTHEPROPERN�ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPEHS.ATION, � COf11R10fCi8i _ WILL DO THE WORK,ANO THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEG 70aa,B1151- J NESE AND PROKESS�ONS CODE:TNE CONTiiACTORS LICENSE LAW�OES NOT APPLY TO AN OWNER OF N PROPERiVNAVOBUAA50R�M7ROVE57NEREON,ANDYMODOESSUCHWORKHIMSELFOHHERSELFOR � � THHOIIGHMiSORHERDWNEMPLOYEES,VROVIDEOTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m QOFFERE�WR3ALEiF,HOWEVERTHEBUILDINOORIMPROYEMENTISSIXDWIiHINONEYEAROFCOMiPLE- � TION.THE OWNER�6UILOEP WILL HAYE THE BURDEN 6F PROVING�THAi HE OR SHE DI�NOT BUILD OR � IMPROVEFOR7TIEPUHPOSEOFSALEI. � � � C 1,AS OWNEROF TFE PROPER71;AM El(CLUSIYELY COMMCTING WI7H LICENSED CON7RACTORS � 70 CONSTRUCT THE PRO.IECT(SEC.7o1a,&1SINESS AN�PROFESSIONS CADE:THF;CONTNACTORS ll- ValuBtiOn ,ADJ.AREA W CENSEUWOOESNOTAPPLYTOANONMEROFAPROPERNWHOBUILDSORIMPROYE57HEREbfV;AND � WFiOCONTMCTSFORSUCHPRQIECTSWITHACONTRACTOR(S)UCEN5EDPURSUANTTOTMECONTRIIG QUANTITY DESCRIPTION FEE Y mws uceasE uw.�. J Q ❑I AM E%EMPT UNOEH SEC. B.&P.C.FOR THIS FEASON U 3 � u—` DI1TE OWNER V � W — � LICENSED CONTRACTORS DECLARATION —� � w IHEREBYAFFIRMUNDEFPENAIn'OFPERIURYTHA7IAMLICENSEDUNDERPROVISIONSOFCHAPTER � �� � Y(CdNMENCIMOWI7HSECT�ON70C0)OFDIVISION30FTHE6USINESSANDPROFES510NS��CO�E,�AND � —��y �j j W LICENSE IS IN FULL FORCE AND EFFECL �-, m , � .f�YL.:�f 7"�/ P h � JL //"t��T 0 UCENSE CL455 LIC.NO. �^ J � OATE � ��� CONTRACTOR i�J � WORKERS'COMPENSATION DECLARATION ¢ � U � I HEREBYFFFIRM UNOEF PENALiV OF PERIURY ONE OFTHE fOLL01NNG DECLAFATIONS: Z Q � ,IHAVEANDWILLMAINTAINACERTIFICATEOFCONSEN7TOSELF�INSUREFOflWOflKERS' _ COMPENSATION,AS PROVIUED BY SEC7ION 3'Ioo OF THE LAeOR CODE.FOR THE PERFORMANCE W OF 'ORK FOR WHICH TH�S PF.RMIT IS ISSUEo. � � . . . ..... ._. ... w _IHAVEANUW�LLMNNTAINWORKERS'COMPENSA7IIXJINSURANCE.ASRC-0UIREDBYSECiION Q 37000FTF7EU4BORCOOE,FORTHEPERFORM/WCEOFTHEWOqKFORWHICHTHISPERM�iIS 0 ISSUED.MY WOR/KER'S•'COMPENSATIO INSUflANCE CARRIERAN�POLICY MINBERARE: CONSTRUCTIOIJ _ j CARRIER_��� �* ��/�( PLAN REVIEW . Z POLICV NUMBER� �� ' �_ �-{� � �---�—' ELECTRIC . a 1 O (MI45EC710NNE�NDTBEaOM�LE7EDOF111EPEPowiISRMONEHIA�DAFDD�LI.MS1570o)qtLESSA PLUMBING ��,�T— W I CERTIFYTHAT IN iHE PERFORMMICE OF THE WORK FOR WHICH THIS PEPMIT�S ISSIIED,I MECHANIGAL � '_ SHALL NOT EMPLOV AfJY PERSON IN IWY MANNER SO AS 70 BECOME SUBJEC7 TO iHE �� y WORI(ERS'CAMPENSATIONLAWSOFGLLIFOaNiA,aNDAGREETHATIFI5MOU4DBELOME INSPECTIONFEE _ .�T�- SU&IECT TO THE WORKERS'COMPENSATION PROYISiONS OF SECTION 3100 OF 7HE IABOR � CqDE,ISHALL.FORTHWyITHCOMPLYWITHTHOSEPROVI510N5. �t ISSLSANCE ._. � DATE:7i��=La � ^��.. SMIP _J��51lt �. � r'. � APPLICANT: __� � dPulr n. J w ENERGY P/C � WpRNING:FAIIURE TO SECURE WORKERS'WMOENSATION COVERAGE IS UNLAWFtJL,AND SHALL BE V ❑ 7'�t� �{�� l� SUBJECTANEMPLOYERTOCRIMMALPENALTIESANDCIVILFINE5'OPTOONENUNDIiE�THOU5AN0 ENERGYPERMITCTTI Ol'l�if'11YL�i\i-!�/i� DOLLARS(5107.000).IN ADDITION TO THE COST OF COMPENSATIINJ,DAMAGES AS PROVIDED FOR7N j� , ry � SECTION37080FTHEL4BORCOOE,INTERESiANDATTOFNEV'SFEES. RETENTIONFEE:++������1� �� . . . ......._ _......... ............ a CONSTRUCTION LENDING AGENCY PHE-ALT FEE: O � IHEREBVAFFIflMUN�ERPENALTVOFPER/URYTHArTNEREISACONSTRUCTIONLEN�INGAGENCY FOR TrIE PERFORMANCE OFTHE WORK FOR WNlpl TMIS PERIJITIS ISSIJED(SEC.]087.CI4.CJ, Z W � LENDER'SNAME -- ' ....�... .... .. F— LEN�EFl5.a�DRESS WICERTIFY7HA71HAVEREA[]TNISAPPL'CATIONMIDSTATETHATTHEABOYEINFORMATIONISCOflRECf TO�AL FEES � � ( � IAGREETOCOMPLYWITMALLqT'ANDCOUNTYORDINANCESANDSTA7ELAWSREUTINGTOBUILDING � CONSTflt1CTION.ANDHEAEBYAU7HORREREPRESEN TIVESOFhIISCOUNTYTOEMERUPONTHE Z PBOVEMENiiONEDPNOPERTYFORINSPE�TWNPUR OSES. 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