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HomeMy WebLinkAbout15815 (23) ����Y�GC CITY OF DIAMOND BAI� f / -- " DEPART2�IENT OF COMMUNITY&DEVELOPMENT SERVICES �`.3�l, �'� 21660 E.Copley Drive Suite 190 w (909)860-3195 Fax(909)851-3117 PRESS � ��'���� BUII.DING PERMT�'APPLICATION FIRMLY �� ���"��� �, ._ .. : -- .: , .,. � ..,,. � o DDRESS�_� �`�� � DATECATION �l ���-�NUMBERl���`i ��. N,C 1 T� IJ � ISSUE TYPE OCC APN LOT TR 7 DATE CONST. GROUP p OWNER I�` �` ADDRESS � ZONING SETBACKS � CITY s ZIP ' TEL. � REART RW o APPLICANT TEL SIDEJSIDE 5TREEf RW ❑ � CaNTRACTOR � � SIDE ❑ ADDRESS � CITY ZIP `3 TEL. L $ PROPQSED USE o ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER•BUILDER DECLARATION SFR/ADD/REM O � I HEFEBY AFFlRM UNDER PENALTV OF PERJUHY THA71 AM FXEAIPT FHOM THE CONTRACTORS LI- � Garage/Carport CENSE LAW FOR7HE Fp.LOWINQ REASON(SEC.7o37.5 Bl1SINESS AND PROFESSIONS CODE:ANV CI7Y OR COUNTYWHIpIREWWESAPERMITTOCONSTRUCT.AI.TER,IMPROVE,�EMOL'fH.ORREPAIRANVSTRUP W Palio/DeCk llJqE,PpqR M ITS ISSUANCE,AL50 i1E0UIRE3 TNE APPLICAN7 FOR SUCH PERMIT TO FILE A SIONED .� STA7EMENT TNAT HE OR SHE�S LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRAGTORS LI- � CENSE LAW(CH�PTER 9(COMMENCINa WITH SEC710N 700a)oF DIVIS�ON 9 OF THE BUSINESS AND PRO- V' PoDUSpe FESSIONS�E)ORIHATHEOIi5HE15IXEMPT7HEREFROMANDTHEBA5ISFORTHEALIE�EDEXEMP- (7 7qN.ANYYqLATIONOfSECTION7o91.68YANVAPPIICANTFOqAPERMITSUBJECTSTHEAPPLICAMTO Z Re-Roof � ACML PENALTY OF NOT MOFlE THAN FIVE HUNDPED DOLURS(i500).): � ❑I,A60NMEROFTHEPROPER?Y,OHMYEM7LOVEESWITHWAGESASTHEIqSOIECAMPENSATION, O ComfflBfGiel ' WILI DO TME WOPoC ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR 3ALE(SEC.7oI4,BUSI- J NESSAND PqOFES510NS CODE TNE CON7RRCTORS LICEN5E LAW D�ES NOT APPLV TO AN OWNER OF � PROPERTYWF10BUttASORMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHEi1SELFOR � � 7HFi0UeNH190RHEROWNEMPLOYEES,OROVIDEOTHATSUCHIMPROYEMENTSARENO7INTEN�EDOR m QOFfERWPoR9ALEtf,HOWEVERTMEBUILAINOORIMPROVEMEMISSOLDWI7HINONEYEAROFCOMPIE- Z TION.THE OWNER�6lAL�ER N7LL HAVE THE BURDEN OF PROYING THA7 HE OR SHE DID NOT BUILO OR = MPROVE fOR TFIE PUFPOSE OF SALE). ❑I,ASOWNEROFTHE PHOiERfY,A41 EXCLUSNEL�CONTRACTING WITH LICENSED CONTRACTORS Q TO CONSTRUCT THE PAQIECT(SEC.7ot4,BUSINESS ANO PROFESSIONS CODE:TNE CONTRACTOqS LI� V81U8�1On ADJ.AREA W GENSEUWDOESNOTAPPLYTOANOWNEROFqPROPERTYNTIOBUIIASORIMPROVESTHEREON,AND � NhqCONTRACTSFORSUCHPROJECTSWITHACON7RACTOR(5)�ICENSmP�RSUAN7TOTHECONTRAP qUANTITY DESCRIPTION FEE � TOfISUCENSELAW.1. O �I AM IXEMiT UNOER S�C. B.8 P,C.FOH THIS REASON Q � U � � DAiE OWNER U Z W � LICENSED CONTRACTORS DECLARATION W .� � I HEREBYAFFIRAI UNDER PENAITV OF PERJURV THAT IAM LICENSEO LINDER PROVISIONS OF CHAPTEN Ur � � B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z _ MY UCENSE IS Ml NlL FORCE E EC7. ^ m O � � LIGENSE CLASS � LIC.NO. � � � j V pqTE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION ¢ � I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLIOWING DECLARATIONS U N Q � __I MAVE D WILLMAINTAINA CERT�FICATE OF WNSENT TO SELF-INSURE FOR WORKER6' 2 ENSATION,AS PROVIDEO BV SECTION 370o OF THE LABOR CDDE.FOR THE PERFORMANCE C.) � THE N�ORK FOR WHICHTHIS PERMIT IS ISSUED. � � W - i HAVEAND WILLMAINTAIN WOflKEfl5'CAMPENSATICN INSUqANCE,AS PEOl11qED BY SECTION Q `37000FTHELABORCODE,FORTMEPERFORM/WCEOFTHEWORKFORWHICHTHISPERMI715 � ISSUED.MVWO pRS�'COMP UFAN /go u _RnRe: CONSTRUCTION � CARRIER G� - C, PLAN REVIEW � va.icvNUMsea ELECTRIC (IFiLSSEC7pNN�No7eECObMEfEi)aFhFPEM�xrISFORaME1rtx�DF1E��o�1nRsR+oo)OFlLEss). PLUMBING ( O ' Z I CERTIFY TlUT INTHE PERFORMANCE OF THE WORK FOR WHICH TNIS PERMIT IS�SSt1ED,l MECHANICAL ('j SHALINOTEMPLOYANYPEHSONINANYMANNEFS00.9iOBECOMESl1HJECTTDTHE INSPECTIONFEE r-'wu Uj WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME S SUBJECTTO T E WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOfl L�J �^1 � i CA+D ISH W�THCOMPLYWI SEPi�V1910NS. ISSUANCE d 'p DAlE:�I�I��APPUGANT: � SMIP _._��� � t'�'����3r Ak$f.'r�i`B�P'•,�� i�'+�,�t'Q 1l � GY P!C '� . J WAFlNING:FMWRE TO SECUfiE WORKERS'COMPEN50.TION CAVEflAGE I5l1NIAWFUL,AN�SHAIL BE s_�.o.r . � - �y SUBJECTpN EMPLOYER TO CRIMINAL PENALTIES AN�CIVIL FINES UP TO ONE HUNDRED THOUSAND ENcRGY PERMIT � L pOL1.ARS(l700.000).IN A��ITION TO THE COSTOF GOMPENSATION,DAMAGES AS PROVIDE�FOP IN � SECTION37080FhiELABORCODE,INTEREST,ANDATTOFlNEY'SFEES. RETENTIONFEE: � CONSTRUCTION LEN�ING AGENCY PRIE-ALT FEE: O � IHEREBYAFFIHMUNDERPENALTYOFPERJUflYTHATTiERE1SACONSTRUCTIONLENDINGqGENCV FOR THE PERFORMANCE OFTHF WOFK WR WHICH iH15 PERMIT IS ISSUED(SEC.3oW,CIV.C,�, Z W � LENDER'S NAME F� LENDER'SADDRE55 WICERTIFYTMATIHAVEREPDTHiSAPPLICATIONAN TATEhiATTHEA90VEINFORAIATIONiSCORRECT. TOTAL FEES ^� � I AGREE TO CAMPLY WITH ALLQTYAND COUNTY DINANCES ANO STATE LAWS RELATINO TO BUILDING CONSTRUCTION,ANDHEREBYAUTHORIZEREPRE ENTATIVESOFTHISCOUNTYTOENTERUPONTHE � ABOVE�MENTIONEDPROPERTYf-0R�'\ISPECTION URPOSES. ENTS � 7 J _ _"' �.�y m PE mE N J i"V� . .. N � i� � y SIGNATUREO ERMfTTE DATE �,°,� � AEC�L N�. � �AI�BY � VALIDATION WHITE—Department Copy,YELLOW—Finenc�Copy,PINK—Assessor Copy,GOLDENPOD--File Copy,GREEN—Applicant's Copy . ,. . :.:.. . .;.. , ,. : . .. , . . . J, , . � . . ... . _.. ,. ' . . ' . ,., .. , S'Y^'r.�-a , M.... . �.. . .. . . �� . � ���� . �� � � � �R . . 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