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HomeMy WebLinkAbout14366 (19) .�----> �� CITY OF DIAMOND BAx .�--� j DEPARTMENT OF COMMUN[TY&.DEVELOPMENT SERVICES 1 k � 21660 E.Copley Drive Suite 190 ' (909)860-3195 Fazc(909)861-3117 PRESS k ; ���'9�° BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �" �y p ,�l APPLICATION PERMIT � rz� ' P/C o ADDRESS ��� �V ' �i�O�J�`'/d� F7�- f��� DATE � � NUMBER J � # E � APM1 LOT TRACT �SSUE TYPE OCC " DATE CONST. GROUP � p OWNER 1���/�a /�..b'.Gt+�;�•-'+,y� f. p ADDRESS ��n'1t 20NING SETBACKS � Z' CITY ZIP TEL. FRONT RW Cl_ g APPLICANT TEL. AEAR LI__ � SIDE/SIDE STREET _ RW rl � CONTRACTOR �L' �✓£°' C7�CtC''/s✓' G SIDE � ADDRESS c'o2 %'f�?G9 !/ L o' CITY �L�°i/�� ZIP ��Sf� TE� ` � PROPOSED USE -- � w ARCWENG/ i � ADDR SS NO.DWEL. NO. NO. � UNITS_ STORIES BEDROOMS N CITY ZIP TFL. _ ` tn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � O OWNER•BUILDER DECLARATION SFFVADD/REM � 8 I HEREBY AFFlHM UN�Efi PENALN Of PERJUflY 7HAT I AM EXEMPT FROM THE CONTRACTORS LI- GefB e/Carport � CENSELAWFORTHEFOLIOWINGqEASON(SEC.70.91.SBUSINESSAN�PROFESSIONSCO�E:ANYCITVOR (n g C� COUN7YNMICHREOUIRESAPERMRTOCONSTHUCT,ALiER,IM7HOVE,DEMOLISH,ORHEPAIHANYS7RUC• W P8ti0/DBCk �' Z TUPE.PRIDR TO ITS ISSUANCE,RLSO RC-0UIFES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED : W STATEMENT THAT HE OH SHE IS UCENSEO PURSUANT TO THE PRONSIONS OF THE CONTRACTORS ll� W � � CENSEUW(CHAPTER9(COMMENCINOWIT?ISEC710N700p)OFOIVISION30F7HEBUSINESSANDPRO- LL" Po0VSp8 � FESSIONSCODE)ORTMATHEOPSHEISEXEMPTTHEHEPFOMAN�THEBASI5FORTNEILLIEGE�E%EMP� V 71QV.ANYVKKATpNOF5EC710N7IXiI.5HVANYAPP1iCANTFORAPEflM1iSU&IECTSTHEAPPLICANTTO Z Re-Roof � � AqVIL PENALTY OF NOT MOflETHqN FIVE NUNDRED DOLURS(5500).�: � � ❑I,ASONR�EROFIHEPROPfRTV,ONMYEA1PlOVEE3WITHWAGE3pSTHEIR50LECOMPENSATION, C, COmrtICfCidl WILL DO THE WOpK,AND THE STRUCTIIRE IS N07 INTEN�EU GH OFFERED FOR SALE(SEC.704a,BU51� J � � NE55 ANO PFOFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOTAPPLV TO AN OWNER OF = PROPERTY YRiO BUIL�S OR:MPROVES THEREON,AN�WHO WES SUCH WORK HIMSELF OR HER6ELF OR WTHq0Ul3HHISOqHFHOWNEMPLOYEES,PROVIDE07HRTSUCHIMPRDVEMENTSARENO7IMENDEDOR CII � Q OFFERWFORSPLEIF,MOWEVER7MEBU�UINGORIMPHOVEMENTISSOLDWfTNINONeYEAROFCOMPLE� z 'TION,hIE OWNER�BUILDER WILL NAVE THE BUROEN OF PROVING THAT HE OR SHE DID NOT BUILD OF � IMPFqVEFORTM:WflPOSEOF3qLE�. � W ❑1,l450WNEROFTHFD{OPfR'TV,AMEXCLUSIVELVCOMRACTINOWITHLICENSFDCOHTRACTORS �, Q TO GONSTRt1CT THE PFWECT(SEC,7014,BUSINE55 AND PROFESSIONS COOE'.THE CONTFACTOR5 LI- V01UetI0f1 ADJ.AREA„___„_„_ W CENSELAW�OBSNOTAVPLVTOANOWNEROFAPROPERT'WHOBUILDSORIMPROVESTHEPEON,PND "------- � z N71000NTRACTSFOHSUCHPR0.IECTSWIMACONfRACTOp(5)LICEN5EDPUR5UIWTTOTHECONTRpG QUANTITY DESCRIPTIDN FEE YTOHS LICENSE LAW.j. �* y� / y y.) � ¢ ❑IAMEXEAIPTUNOEflSEC. B.BP.C.FORTHISREASON Q �� /C:aJ��y �L'FF�P/4/�S • (� ' �! '_'__'_—'_____' — _'_'"_'`— ¢ � d Ct�1�J°�l�.� G LL DATE __ONTJER _"—""'—_ U J �C'�C`� �� n '� W ' � LICENSED CONTRACTORS DECLARATION W � I ri�i�T Oi saf.+R1l�//4d � I HEHEBV AFFIRM UNDER PENAITV OF PE0.IURV THATI AM LICENSED UNOER PROVISIONS OF CHAPTER � � � e(CAMMENCINON7TMSECTION7000)OFDIVISION30FTMEBUSINFSSANDPROFE5SIONSCODE,AN� Z AIY LICENSE IS IN NLL%FOIRCEAND EFFECT. .9 /' � O (r`/ � UC_NO. tY� /ld��/ '� � 1 UCENSE CLASS _ � {; y������� � � OATE ���T✓_ GONTRACTO �{ �y,3�". J _ .`._` 'i W / � .� � WORKERS'COMPENSATION DECLARATIO�:'��� f /� I HEHEBV AFFIRM UNDER PENALTV OF OE0.IURV ONE OFTHE FOLIOWING D "LARATIONS: �/� v � � ¢ r�r� � � _IHAVEANDWILIMRINTAINACEIiTIFICATEOFCONSENTTOSEIF NSUAEfORWORKERS' "~ .----. � COMPENSATION,ASPROVIDEDBYSECTKKd370oOFTHELABO CA�E,FORiHEPERPoRMANCE. ��" =-�� Q OFTHEWORKKIRNTIICMTHISPERMITISISSUED. ' •"`�� 0 " � � �_._.........' _. $ W �1 HAVE AND WILLMAINiAIN WOFlKERS'CAMPENSATION INSUMNCE.AS HE�UIRE�BV SECTION ' 1 Q 37000F THE LA90R COOE,FOR TNE PE�RMANCEOF iHE H'OFK FOR WHICHTHIS PEFMIT IS '� � _ ISSUED.MVWORKEPS'1COMPEt�SATICyT}10SURAN CARRIEFPNDvoUCYNUMBER�: � '� � TION/� ___.,,___.___._ , �� ;r y �✓��T�'� ��.�..�'t- � 'p� r��w ------.._..-- -------- _ � �- CARAIER__ � ._-. `) �p� . . _ ._—_._.. ....._._—_—. 0 POLICYNUMOER fw�✓�'�' f����_� � '� . --_- ��ECTRIC ��d '� Z ' _ � , '__' _""���—.- ' 4 � 0 (ttisSECipNNEmNo78EoobRETEOOFnEPEfKtlrlSwaIX(V�FM1NAREDoouMs�Stoo) ' PLUMBING ,. � ,a`��'•.?e:%i� n Z ICERTIFVTMATINTHEPERFORMANCEOFTHEWORKFOflWHICF�fA15"PEFMITISISSl1F.D,1 MECHANICAL . _._,_._ ___ � (,�} SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECAAIESU6JECTT0T41E 3 � WORKEqS'COMPENSATION LAWS OF CALIFO NIA,ANO AGR[E THAT IF 1 SHOUTA BECOME INSPECTION FEE .. n�'1 t d4' g SUBJ6CT TO 7HE N'ORKERS'COMPENS ROVISIONS OF SECTION 37000F LA80Fi !;�•�� §;,.�s� "C� � � CAOE, SH FORTMWITHCOMPL ITMT. SEPROVISIONS. �SSUANCE •�i..�' � _,_______,_____ _,_, , __ p DATE:, a �� APPLICA � 4 d�wR7;���r uMIP �?,t���.S'..,� ,''x: . �-z. -.��.L<'V''_�._._"'._. — S � . . ��.�.:;: .F '__— '� WAflNING FAILURL TO SEq1RE WORKE(75' MP SATION COVERAGE IS UNLAWFUL,ANO SHALLBE ENERGY A/C ',_+'�T� c t'� �y SUBJECTANEMPLOYERTOCflIMINALPENALTIESPNDqVILFINESUPTOONEMUNDREDTHOU3AN� ENERGYPERMIT �rta" .� g DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,OAMAGES AS PROVIDEO FOR IN ---------- ---�----- J SECTION 3708 OFTHE LA80H fADE,INTEftEST,ANDATTORNEYS FEES. RETENTION FEE: � � ____ ___—"_"__ � O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: _"'__"'_" __" ` � I HEREBYAFFIflM UNDER PENALTY OF PERJURYTHAT THEHE IS ACANSTRUCTION LENDING AGF.NCV __ _ _____ _ FORhIE PEHFORMANCE OFTHE WORK FOR WHICH iH15 PEflM1T IS ISSUED(SEC.3o97,GIV.C.). � � �F W '"'__ —____--"_"_ _—_ � � LENDEH'SNAME."'_—'_ "—__"'__ —.. _'_""—__""'_ J {= LENDER'SAOORESS _ ._..__ -- � � TOTAL F'EES � ' � � ICERTIFYTHATIHAVEREIIDTHISAPPLICATIONPNDSTATETiPYTHEABOVEINFOFMATIONISCARRECT. G � IAGREETOCAMPLYWITHALLCfiYANOCOUN7YOftOMMICESANDSTATEtAWSRELATINGTOBUILDWG P � CONSTRUCTION,AN�MEREBYAUTHORIZEREPRESENTATIVESOFTHISCOUNTVTOENTERUPONTHE '� Z ABOVE-MEN110NEDPROPERTYFORINSPECTIONPURPO5ES. COMMENTS_ _______ _ Y _ � /'2 �., ��,��r'i>>�/�'�._ — — -- � m ERM17 E NAME 9 _ _ Q �"T'�:� .� --- �.�.. l ,�� _ _ � _ Cl) 1�'V Ji-"Yrl/o'aP•.?OL-. � NATU OF DERA/ITTEE UATE = RECPT.N0._ PAID BY �______ _VALIDATION_ ~ WHITE--0epartment Copy.YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Cnpy �,,......-.—�--, - -��_ _...-_,__ _..._ ..-- - - - - - _..�. _ _ ....- - .. ... ..._ _ ---,..,.. . � - ,_ . , _� ,�� , : s � , �.„ ( � i � _ � i � - � � e�,� � � � � r �� ' I � i . � i � ' ' - � � � � � ' � i € � � � � ! I � I � , ' � � � i �� , ' , � � , i � i , i ` i , � �� ' , ' ' , � ! i , � ' �� � , , ' ' I � I i � i i ��� , , , , --- — '— -- - -- � ��.�� � i - � i- . t -• ,--� ._. i � � _ . � ; , . j � �z�� : . ' , , ; . • � i I : i ; i ; . , � - � � �� � I ! 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