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HomeMy WebLinkAbout14601 _ _ _ ; - X� ^ .�� CITY OF DIAMOND BAx , DEPARTMENT OF COMMUNITY&DEVELOPM�NT SERVICES _ : � . 21660 E,Copley Drive Suite 190 .,.�. (909)86Q-3195 Fax(909)861-3117 PRESS �•�°A` BUILDING PERMIT APPLICATIO�1 ` , ; FIRMLY , � __ _. o ADDRESS ° �p'�'' �: (� DATE A2'N , PERMIT �,. /r�l( P/C JOBSITE e APPLIC `��i_� �\�— �� NUMBER r # � ISSUE TYPE OCC APN LOT TRACT DATE 2 » l�' '-�X:� CONST.�/�N GROUP�� Lt^� p OWNER " ADDRESS - ' ZONING SETBACKS � CITY sA ZIP� TE . 2-�s ,r FRONT RW ❑ APPLICANT ���� TEL S DE/SIDE STREET RW � � CONTRAGTOR. _ _ SIDE O � ADDRESS PROPOSED USE � CITY ZIP TEL. � ARCH/ENG! � W DESIGNER NO.DWEL. NO. NO. � A�DRESS UNITS STORIES BEDROOMS CITY ZIP TEL. �' DESCRIPTION SQ:.FT. FACTQR P SF ADJ.AREANALUATION O, _ QWNER-BUILDERDEQLARATION . �- �SFRIADD/REM- � � , � � Q I HEREBV AFFlHM UNDEH PENAI.TY OF PERNRY THAT I AM EXEMPT FflOM THE CONTRACTORS LI- GAI'9JB/C31POPf � W CENSELAVJFOR7HEFOLLOWIN�flEA50N(SEC.7031.5BU91N6S5ANDPfloFESSIONSCODE:ANYCINoq (n . �_ COUNTVWHICHRC-0UIRESAPE MIT7000PSTRUCT,ALTER,!MPROVE,DEMOLISH.ORREPAIRANVSTRUC- W-' pgtio/DBCk w� TURE.PRIOR TO ITS ISSUIWCEdAL50'REQUIRES THE APPI:iCANT-FOH SVGH PEHMIT TO FILE A SIGNED �W� . � STATENENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTqACTORS U• , c„ CENSE V W.(CHRPTER 9(COMM�NG�NQ WITH SECiION 7000)OF OIYISION 3 OF THE BUSINESSAND PRO- LL PocUSpa VFES910NSCODE�ORThIATHEOFlSHEISEXEMPTTHEREFROMANDTHE6A51SFORTHEAIIEGEDE%EMP- V TION.ANYVbIATIOIVOFSECTIO�Fl70315BYANYlePPLICANTFOR'APERMITSU&IECTSTHEAPPLIGANTTO '.Z Re-Roof � , � -A CIVIL PENALTY OF NOT MORETHAN FIVE HUNDflED OOLLARS(5500�.): �y ❑I,ASOWtJEROFTHEPROPER7V,ORMYEMGLOYEE5WI7HWAGESASTHEIRSOLECOMPENSA710N, �0 COmmBICiBI " � � WILLDD THE WOAK,M!0 7HE SRRUCTl1RE IS NOT INTEN�ED OR OFFERED FOR SALE�9EC.7044,BUSI- .J NE55 AND PROFES610NS CODE THE CONTRACTORS LICENSE U1W UOES NOT APPLV TO AN ONMER OF ^ � PROPEFiTYVAiDBUILD50HIMP�NIOVESTHEREON.FNDWHOpOESSUCHWORKHIMSEIFOflHERSELFOR �� Cr��- THIIOUGHHISORHEROWNEMPLOYEES,PROVIDE�7HAYSUCHIIAPROVEMEN75ARENOTINTENDEDOR � � �� ' ' � � � . �1A'. OFFERED FORSALE IF,HOWEVER 7}IE9UIL�ING Oq IMPROV�MENT 65OLD`MTMN ONE YEAROFCOMPLE- ��`TIDN,THE ONTIER�BUIIDER WILL�HAYE�THE BURDEN OF PROVING THAP HE OR SHE DIO NOT BUILD OR Z IMPROVEFOR7HEPUfiPOSEOFiSALE). � � � � � .., W, ❑I,ASOWNEROFTHEPRL�PEHT�;AMEXCWSIVELYCANTRACYINGWITHLICENSEDCONTRACTORS � - � TO CONSTRUCT THE PHOJECT(SEC.�044,BUSINESS AND PqOFESS10115 CODE:THE CON7RACTORS LI- V81110Si0n RDJ.AFEA _ LJ.J CEtlSELAWDOESNOTAPPLVTOPNOWNEROFAPROPERT'WHOBUILDSORIMPROYESTHEHEON,PND �, �WFqCONTqACTSFORSUCHPPOJECTSWITHACONTRACTOR(S�LICENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION FEE � 1OR51JCENSE LAW.). ., � ' o ❑�AM EXEMPTUN6ER SEQ. ' .C.FOR IS REASON U S � �ATE �� OWNER V . � ... ' . . . W � � LICENSED�CONTRACTORS DECLARATI6N ' ��j - � � � � '� � � I HEREBYAFFIRM UNDER PENAL7Y qF�PERIURYTHAT I AM LICENSED UNpER PROVISIONS OF CHAPTEP � . �" � ��, Q� 9(COMMEkCINf3 WITH SECTION�OOOj.OF OIVISION 3 DFYHE 0t151NE55 AND PROFESSIONS CA�E,AND � - k MY UCENSE IS IN FULI fOiiCE D EFFECL m LLI '�' o LICENSE CLASS IIC.N0. � � , �J � , ~'. -OATE - CONTRACTQR d � - - � U w , � WORK�RS'COMPENSAqION DECLARATION Q C�'T�.d j� ,�, ��, � IHEREBYAFFIRMl1NDERPENAL1'VdFPER1URVONEOFTHEFOLLOWINC+�ECLAfiATIONS U v� Ir Z __ G �IW6VEANDWILLMAINTA4o\CEflTIFICATEOFCONSENTTOSELF•INSUREFORWORKER5 ,Y /� �r y Q �� COMPENSATION,ASPRO IDE08YSECTION3)UOOFTHELABORCOOE,FORTHEPERFORMANCE� �U `� ��y � OF TNE WORK FOR Y9HI�H THIS PERMIT IS ISSUED. g � -W' �IHAVEANDWILLMAINTA{N'WOHKERS'COMPENSATIONINSURANCE,ASREOl11R�BYSEC710N - ' Q3700 0F THE LABOR C00,E.FQR 7HE PEflFORMANCE OF THE WONK FOR WHICH THIS PERMIT 15 • �; ISSUED.MY WORKERS'('AMPEN9ATKKJ INSURl4NCE CAPRIER ANO POLICY NUMBERARE CONSTRUCTION g cARAIER PLAN REVIEW _ Z noucvwuMeEa ELECTRIC ¢ � �rw�ss�cnavNE�rioraEmr.rixr�aw7r��wari�sror3onEhtroaEooalnRs(SiaoloFl��ss). PLUMBING W Z 1 CERTIFYTHAT IN hIE PERFOfiMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECI'IANICAI. �_ 2�� ,�a — (..'4 SHAI:LNOTEMPLOYANYIPEA50tiINANYMANNER50ASTCBECOMESUBJECTTOTHE � WORKERS'COMPENSATIPN LAWS OF CALIFORNIA,AN�AGREETHAT IF I 5HOUL�BECOME INSPECTION FEE �g�y�gp� .7 SU&IECTTOTHEVIORKERS'(X;lAPENSATIONPflOVI510N50F5ECTION37ooOFiHELABOR �SSUANCE ���_56996Y1 L+�� � CADE,I SHALL FOFiTH1Y1171 GOMPLV WITH THO3E PROYI510NS. -�. � S��P �� � p � DATE: � � APP6ICANT. . . - .. . � - � ENERGY P/C � �- �- � ^ -� WAHNING:FAILl77ETO5ECUREWORK9i5'COMPENSATIONCOVERAGEISUNUWFUL,AN�SHALLBE _ .� �� Sli&IECTANEMPLOYER70CFIM�NALPENAL7�ESANDCIVILFMESUPTOONEHUNDRmTHOUSAND ENERGYPERMIT � ����'� ��� DOLLARS(L100.000).IN ADDITION'iTOTHE COST OF COMPENSATION,�AMACES AS PROV�ED FOR M � J SECTION37080fTHELAAORCODE,INTEFEST,ANDATTORNENSFEES. ' RETENTIONFEE: � a CQ'NSTRUCTION LENDING AGENCY PRE-ALT PEE: O ! ' �. IHER�YAFFIF7MUN�ERPENAL�70FPERJURVTHATTNEREISACONSTRUCTIONLENDINGAGENCY _ FORTHEPERFOAMANCEOFT�IEIWORKFORWHICHTHiSPEAMIYISISSUED(SEC.30V],CIV.G�. , , � W ��, LEN�FA'SNAME - � - ' - ' F- LEN�EFfSA�RE55 � . � � ICERTIF/THATIHAVEREPDTHI$APPLICATIONPNDSTATETHATTHEABOVEINFORMATIDNISCARRECT. TOTAL FEES � ��{7 �.�[ O � IAGREE7DCAAEPLYWITNALLCITYANUCOUNTYOROINANCESANOSTATELAWSRELATMGTOBUILOING ' � � ♦ � IbNSTRUCTION,ANDHEHEBYAL{TI�iORIZEREPiiESENTATNESOFTHISCDUNTYTOHJTERUPONTHE . . . . , . Z ABOVE-MENTIONEO PHOPERTV FOR INSPECTION PURPOSES. COMMENTS � , 0 � �j��`�//1�-�' J�-°�-"T�: �� m PERMITTEE NAME(PAIN'� � � �L�-(" ,=�� � 5iaw�ivae F �a eE Dr I on7E qECPT.NO. PAID B`C K�f I � Fn 1/ALIDATION � � �� � �� "�WHITH-0epartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOI�ENRO�File Copy,GREEN—ApplicanCs Copy � � � � � .. � . .,, .. . . - �-... . ' .�i' ' ' . , �...-. , (':.- ,;�'_ .,.__ . . - . 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