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HomeMy WebLinkAbout14500 (19) _ . � _l�_ CITY OF DIAMOND BAx � DEPARTMENT OF COMMUNTTY&DBVELOPMENT SERVICES � � �� 21660 E.Copiey Drive Suite 190 � , (909)860-3195Fax(909)861-3117 PRESS �'A�"�.� BUILDING PERMIT APPLICATION ___ FIRMLY � JOBSITE .r APPLICATION( _ � . PERMIT J �� P/ � o ADDRESS B C7�I' A). CJ�AMQEV rJ B�� L�iLVD- DATE � NUMBER� � # � ISSUE TYPE aCC APN LOT TRACT DATE CONST. GROUP p OWNER ����,�L G�ONJ GO. — " ADDRESS �64Jr' ��ST CS�A-LE AV�. �j'.jE 2ZU ZONING SETSACKS W CITY t Nau s rRY ZIP 917�1'A TEL.671,-912•�?� FRONT RW ❑_ � APPLICANT ��►A2�5 S��rn�'(;. TEL. REAR f:l � ��'������� SiDE/SIDE STREET RW �I_ � � CONTfiACTOR � 1 O /�l 51DE _ � ADDRESS �72�.j llr� �Q�,,jf�,5T ti//1'T(� �D(�_ � � CITY_ t?Gj,$�",� Z!P 4LZ4B TEL�[.��83q•gt3� PROPOSED USE C2µAd� G�. !dL 7Cnl�l�M17 EAd��VEUEWT � w ARCH/ENG/ � � z DESIGNER�LZ"rFlf�l2S ESY ���lG4J W — " NO.DWEL. NO. NO. � d ADDRESS 4p1� GLJ� Cd� �iV�, `d151'Cli C-I�D ` UNITS STORIES BEDROOMS � CITY MAr�j/�frl bFl 2�Y ZIP�Q'�� TEL.�1.1_�BZ�-'S�¢ • — N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SFRlADDlREM �"�{;, � � O 1 HEREBY AfFlRM UNDER PENAL7Y OF PERJURY THA71 AM E%EMPT FBOM THE CONTRAC700S LI� - G8fe90/CafPO(t `x I' �k1; i �CENSEUWfORTHEFOLLOWINGREA50N(SEC.7037.6BUSINES6ANDPPOFESSIONSCADE:ANVCITYOR (n � U COUMYWHICHREOUIqESA7EFIARTOCONSTqUCT,ALTER.IMPROVE,DEIAOLISH,ORREPAIRANYSTRUG W pa110/DBCk WTUflE,DRIOR TO ITS ISSUANCE,AL50 RE�111RE5 THE APPLICANT FaR SIICH PEflMIT TO FlLE R SfGNED � W • STATEMEN7 T11AT HE OR SHE IS LICENSEU PURSUANT TO 7HE PROVISIONS OF TME CON7flAC70RS U• . �� � CENSE LAW(CFIAPTEfl e f�MENGNO WIlH SECTION 7000)OF UIVISION 9 OF THE BUSINESS AND PAO- � LL' PooUSpa Fy • ,� FESSIONSCODE)ORTHATHEORSHEISEXEMPTT:iEREFROMANDTHEBASISFORTHEALLEGEDE%EMD• � TION.ANYVKKq710NOFSECT10N7031.69YANYAPPIICRNTFOqAptRMI1SU8JEC75THEAPPLICANTTO Z Re•Roof ,;,r4^�R�14N� A.i��� � A CML PENALTY OF NOT MORE TFiAN FNE HUNDRED�OLLhRS(5500).): �' ^ DI,A90WNEROFTHEPROPER7Y.ORMYEMPIpYEESWITHWAGESASTHE1RSOtECOMPENSATION, Q '� 1 �5�' , r��w�v 5 "— s � WILl007NE WORK.AN�THE SiRUCTURE IS NOT IN7ENOED OR OFFEHEO FOR SALE(SEC.7044,BUSI- J COfnmelCiel :'a'A � ��Z�:. ¢ NESS N10 Fi�FE5510N5 CODE:TNE CONTHACTORS L�CEN6E LAW DOES N07AAPLY TO M!OWNER aF '('k �"e E � VI�PEflTYVhIOBUIL➢SORIMPROVESTHEREON,ANDVMOOOESSUCMWOqKHIMSELF�RHEpSELFOR '� TY �,:."."P } � THflOUGHHISORHEROWNEMPLOYEEB,PftOV10EDTHATSUCHIMPROVEMEN79AAENOTIN7ENDEDOR m —� .' ' QOiFEFEDFOHSN.E1F,FiOWEVEq,T1EBtNlDINGORIMPqOVEMEM1550LDWI7HINONEYEAROFCOMPLE- � Z TION,TFIE OWNEFL9UILDEii'N�4.HAVE THE BURDEN OF AROVINO TNA7 HE Oq SHE OID NOT BUItD OR = IMPROVEWRTHEPURPOSEOFSALE�. - �y,� OI,i1SOYMEROfTHEPROPEFfY.AME%CLUSIVELYCON7MC71NOWITHLICENSE�CONTMCTOR3 - � TO COWSTRUCT THE PROJECT(SEG 70N,BUSINESS AND PROFESSIONS CODE:THE COMNACTORS LI, VdIUd11Df1 ADJ.AREA___. � CENSELAWOOESNOTAPALYTOpNOHT'EROFAPNOPERTYWN06UILOSOqIMPROVESiHEREON,ANO �—�- � NM1qWNTMCTSFORSIiCMPRQIECTSWITHqCONTRRCTOR�S)LICENSEDPl1R5UANTTOTHECONTfiAP QUANTITY OESCRIPTIO FEE ��� � 1C)ftS LfCFNSE UW.), ` �y ❑t AM EXEMPT UNDER SEC._ _ _B.&P.C.FOR THIS FEASON , Q , V � 7 _ ' _ ' _—"___' U . f � Q �.- DAlE ._ONMER .,'_ .'_.'� U �a LICENSED CONTRACTORS DECLARATION W � PL 1 HEHEBY AFFIRM UNDER PENALiY OF PERIURY TNAT 1 AM LICENSED UNOEFl PflOVISION50F CHAPTER � ' � � "I� , � /y B�CdAMENdNOWRHSECT10N7000)OF�IVI310N30FTHEBUSINESSANDPROFESSIONSCODE.ANU Z (J ; j� MY LICENSE IS M�LL FORCEAN�EFFECT. m O ! �% � r CICENSE CLA'S�`�LIC.NO.—��d�t., 5�--�.— � U pp7E I ���� CONTRACTOR__ v�'�E�'"���U'�.._ C � W � � WORKER5'GOMPENSATION DECLARATION Q � � � y IHEflEBVAFFIRMUNDERPENALTVOFPEHIURVONEOFTHEFOLLOWINRDECLRRATION3 U Cn � •.O •,�IiIAVEANDWILLMAINTAINACFATIFICATEOFCON5EN7TOSELF-INSUHEFOPWORi(ERS'� � . Z COMPEN5ATION,ASPROVIUEOBYSECTION37n00F?HELABOFlCOOE.FORTHEPERFORMPNCE� U Q OF THE WORK FOq WMIpi TMIS PEflMIT IS f55UL0. W a � w __IHAVEANDWII.IA�AINTAINWORKERS'COMPENSATIONINSUMNCE,ASHF.111/1REDBYSEC710N � � 37oDOFTHEIABORCO�E.FORTNEPERFOqMANCEOFTHEWOflKFORWHICHTHISPF.RMITIS `�� �'� ISSUED.MY WOR<ERS'COMPENSATIIXy IK$URANCE CqflRrlE�fl AND P041CYNl/fNB_E�fliARE: CQNSTRUCTION/ 4,-� .____ _� _i.� � CARRIEN--�r L� ..r� � ��.t I.. �L•"V v'i f7 L�C_! PLAN REVIEW �--�1 n�--- --- � ,C:.���Z� -- --- " Z � POLICY:NUMBEA ss�..h� . �✓£� J C —.— •ELECTFIC `..— ------ -- ---��� a / . 0 (11-0.5s[ciIONNE�NoiB6t�moFTHEaEfY�Mil5waa4EraR�OitEDnroLuasl5�wla+LESs). PLUMBING -- '--- ._.. . �/`,J__. –� ZI CENTIFVTHAT INYHE PERFORMANCE OFTHE WOitK FOR WHICM TNIS PERMIT IS I55UE�.l MECHANICAL __.__. ._— ..__—__._._—�__�_l�_— (,'} SHaLLNOTEMPLOYANYPER50NINANYMANNER50ASTOBECOMESUBJECTTOTHE � WOftNERS'COMPENSATIONLAWSOFCRLIFORNIA,ANOAGqEETHATIFI3HDULDOECOME INSPECTIONFEE __ _. _ ,_ j SU&IECTTOTHEWORKERS'COMPENSATqNPROVISIDNSOFSECTION370oOFTHELAeOR — — ��� � CA�E,ISHALLFORTHWITMCOMPLYWfiHT SEPFWISlONS. ISSUANCE +1 r�.��o p DATE:�,U I C C�C ��PPLICANL ..__ __ .SMIP f 't��y ___.. ._ _" � � '� ENERGYPlC V� / .__ ___ J WARNING:FAIlURE70 SECUFE WOFKEHS'CAMPEN VERA IS UNLAWFUL,AND SHALL BE — ^� ��` ; V_ SUBJEGTANF.MPLOYERTO�RIMINALPENAITIE OCIYILFlNESUP ONEHUNDflEOTHOVSAND ENERGVPERMIT ('�. � �7 ; DOLLARS(5700,OOo�.INAD�ITIONTOlF�F.COSi FCOMPENSATIO4,DAA GESASPflOVIDEDFORIN --'--^—"---'—�-------`�—��'-d`� ¢ SFCTION37080FTHELA60RCODE,INTERES ANDATTOPNEY'SFEES. RETENTIONFEE: _ _._ ___ _ .._ • G ! __.__�—..—_ OCONSTRUC71 ENDING A CY �p/�l EL�r/�f.T FE� _,. .____ ,__, __ ,___ � IHEREBYAFFIRMUNDERPENALTYOFP[RJURYTHATTHEREISACANSTRUCTIONLENDWGAGENCY Y_ i�� J ., _,_ „_ _,__ FORTHE PERFORMANCE OF7HE WORK FOR WHICH TM3 PEFhttT�S ISSUEO(SEC.309i,CIV.G). /J ' G�— W !� �as '_ '_ _ '_ I � LENDER'SNAME___"._ ___--.—' `— _' ' '__ __'__ '_ F= LENDEiYSADORESS__ � -- �--- -- TOTAL FEES �� . � � �. 'i �����1 W 1 CERTIFY THAT I HAVE REM THISAPPLICA710N AND STATE THATTHE ABOVE INFORMATION IS CORqECT. � IAGR[ETOCOMPI.YWITHALLCITYANDCAUNTYOf701NANCESANDSTA7ELhW5AELATINGTOBUILDING CONSTHUCTION,AND HEFE6Y AUi}iOHRE REPRESENTATNES OF 1 h115 COUNTY TO ENTER UPON THE � ABOVE•MENTIONEO PROPEHTY FOR INSPECipN PUFPOSES. COMMENTS. � /�`� � _ —�-�'____ '__ � �,�-L`�`�'-> (��`_SGj���'1.,����=•.'!.� __ -- m PE ITTEENPAIE(PRINn . . 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