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HomeMy WebLinkAbout14626 i CITY OF DIAMOND BAB � '� -�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES i : � , 21660 E.Copley Drive Suite 190 , ;,,� (909)860-3195 Fax(909)861-3117 PRESS \ '9N' BUII.DING PERMIT APPLICATIUN �� / FIRMLY. �4 JOBSITE APPLICATION Y PERMIT � P!C o: ADDRESS �� � �� DATE � NUMBER � # � ISSUE TYPE OCC APN LOT TRACT �ATE CONST. GROUP p OWNER G1 % _ �` ADDRE55 ZONING SETBACKS "' CITY�(� R�J� ZIP / TE . `� REART RW ❑ �. APPLICANT TEL. ��� SIDE/SIDESTREET RW ❑ � CONTRACTOR SIDE ❑ ' ADDRESS • p PROPOSEO USE ' 0,. CITY ZIP T . !f1 o; ARCH/ENG! �z; DESIGNER NO.DWEL. NO. NO. nj�,r ADDRESS UNITS STORIES BEDROOMS �` CITY ZIP--- TEL. y DESGRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p�' OWNER-BUILDER DECLARATION SFR/ADD/REM O' W� i HEREBY AFFlRM.UNDEii PENALN OF PERNRV THAT 1 AM EXEMPT FROM THE CONTRACYORS LI- Gflf8g8/CflfpOfl �:, CENSEUWFOR7HEF011CT4�NGREA50N�SEC.7031.58USWESSANDPpOFESSIONSCODE:ANYCIT'OR (/j , U�';�-COUNTVWHICHREWIRESAPERMiTTOCONSTRUCLALTER.IMPROVE.�EMOLISH,ORREPAIRANYSTqUG W P&tl0/DBCk � - �; 7iH3E,PRIDR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � STATEMEM THAT HE OR SHE iS LICENSE�PUR54ANT TO THE PROYISIONS OF THE CONTRACTORS U- �' -CENSE LAW(CHAP7Efl B(COFiMENCINO WITH SECTION 7000)OF DNISION 3OF THE 6USINE55 AND Pp0- �' PoOVSpa - � FESSpNSCODEJORTHATHEORSHEISEXEMPTTNEREFROMANO7HEBASISFORTHEAL�EGE�EXEMP- � ' TION.ANYYIOlATIONOFSECTION7031.68YANYAPPLICANTFOPAPERMITSU&IECTSiHEAPPUCANTTO Z Re-Roof F: A CMl PENALTY OF NOT MORE THAN FIYE HUNDRED DOLLARS(5500).): ❑�,ASOYiNEqOFTHEPHOPERT'.ORMYEMOLOVEESWITHWAGESASTHEIHSOLECAMDENSATION, � CO(I1filBfCidl � - ' ��'. WILL 00 THE WOfli(AND TiiE STRUC7URE IS NO71N7ENDED Ofl OFfEflEO FOR SAIE{SEC.7044,OUSI- J � �� NE53 ANO PROFESSIONS CWE:THE CONTRnC7oF5 LICENSE LAW�OES NOT kPPiY TO Ai!OWNER OF � - - DFOPERTYWF108UILDSORIMPR(SVESTHEREQY,FND`Mi000E5Sl1GiWORKHIMSELFORHERSELFOfl� m ' �' THROU(3HH180RHEHOWNEMPIAYEES,PROVIDEOTHATSUpiIMPROVEMEMSARENOTiNTEN�EDDR , � W� OFFEREDFORSAIEIFNOWEVER,THE8UILDINGOR�MPROVEMENTI550LDWRHINONEYEAROFWMPLE- - Z' TION,THE OWNER-BUILDER WILL HAVE 1HE BURDEN Op PROVING 7HAT NE OR SHE bib NOi BUILO OA � IMPROVEWRTHEPURPOSEOFS�LE). ❑i,AS OWNER Of TME PROPERTY,AM EXCLl/SIVELY CONTRACTiNG WITH LICENSED CONTFACTORS �TO CONSTRUCT hiE PROJECT(SEC.70/4.BUSINE55 AND PROFESSIONS COOE:THE ANTRACTORS LI- V81U8SIon ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTYNR109UILDSQRIMPROVESTHEREON,AND �� � WHOCONTRACTSFORSUCMPflOJF.CTSWITT1ACDfdTRACTOF(S}LICENSE�PUft3UANTTO'fHECONTRAG QUANTITY DESCRIPTION FEE � . � TORS LICENSE UW.). - ❑1 AM E%EMPY UND€R SEC. e.8 P.C.FOR THIS PEASON Q ' 3 � � �+ � E � UATE OWNER_ U � W �O UCENSED CONTRACTpRS DECLARATION � . _ . �. .IHEHEBYAFFIRNUNDERPENALNOFAERJURY7HATIAMLICENSEOUNDEFPROVISIONSOFCHAPTER �e , . . ^- � � p� 9(COMMENCiNOWITHSECTWN7000jOFDIVISiON30FTHEBUSINESSPNDPPOFESSIONSCODE,M7� z u�� MY LICENSE IS IN FULL E AND EPPECT. 0� LICENSECUS ��� LIC.NO.-���.�� � � ' �j� �DATE____� CON7MCTOR / . LL! /� � � WOflKERS'COMPENSATION DECLARATIQN U � � IHEREOYAFFlqMUN�EHPENALTYOFPERIURYONEOFTHEFOLLOWINGDECLA ATI �- Z 0� _IHAVEANDWILLMAINUIINACEATIFICATEOiCANSENTTOSEIF-IN^uURE R FlKE:RS' � CdAPEN5ATION.AS PqOVi�ED BYSECTION 37000FTHF.LAeOR CODE.FO HE PERFORMA OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 0. W _IHAVEANDWILLMNNTAINWORKERS'COMPENSA:IONINSURANCE,ASRE�UIRE ECTION q_ 37000FTMElA80flCODE,FORiHEPERf-0RMANCEOFTHEWORKFORWH' MISPE ITIS ._ � ISSUEO.MY WORKERS'COMPENSA710N INSURANCE CAflRIER AND POLI 11M9ER ARE GON RUCTION __._ ''� } — —__—.—'-__.--...__._.._._____— __ Q� cnnRieR �� �f� ` PLAN EVIEW > �-� PO�ICYMIMBER��_�� CTHIC - Q Q� (IWssEcrqtJNE�nniBEmJ�Pt.ErEooF"fFYcPEHhwfISFORONEFUt ��EDDoIw�sCico}oR - PLUMBING _.. . � � �. I CERTIFY THAT IN THE PEflFORMANCE OFTHE INORK FOR WHICHTHIS PEFMIT IS ISSUEO,I` MECHANICAL �' SHALLNOTEIAPLOYANYPEpSONINANYMANNERSOAST09ECOMESUBJECTTOTHE INSPECTIONFEE (p WORKERS'COMPENSATIONIAWSOFCALIFORNIANN�AGflEETHA11FI5HOUL�&ECUME r SU&IECTTOTNEWOFKERS'COMPENSATION?ROVISIONSOFSECTION37000FTHElABOR ISSUANCE �. CODE,ISHALLFORTHWITHCOMPLYWITiTHOSEPROVI510N5. ._,,-# �� �]. DATE: _ APPLICANT: SMIP l ,._ -��'� . � ENERGY P/C ��. J; WARNINO:FAIWfiETOSECUflEWOHKERS'CAMPENSATIONCOVERAGEISUNLAWfUL,AN�SHALLBE - �- Sll&IECTANEMPIOYERTOCRiMINAL7ENALTIESAfJDCiVILFINESUPTOONEHIINDRFDTfiOl15AND ENERGYPERM�T - OOLLARS(5100.00a),INADDITIONTOTHECQSTOFCOMPENSA7IDN,DAMAGESASPROVI�EDFORIN ,� �-�'a - � .� J SECTION37090FTHELABORCODE.INTEREST,ANOATiORNE1"SFEES. � �' �, RETENTION FEE: ��u v.) = d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: _� ____.__ � �- IHEREBYAFFIflMUNUERPENALTYOFPERJURYiHATTHEREISACON3TRUCTIONIENDINOAQENCY ��' �- - � FOR THE PERWflMANCE OFTHE WORK FOR WHICH THIS PtHM1T IS ISSUE�(SEC.3087,qY.C.), ' Z W � LENOERSNAME - ' F-- LENOER'SAOOflESS w ICERTIFYTHATIHAVEFiEADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCAFRECT. TOTAL FEES " �. I AGREE TO COMPIY W1iH ALLCRY AN�COUNTY ORDINANCES AND STATE IAWS RELATIN�TO BUILOIN6 , CONSTRUCTION,AND HEREBV AUTHORIZE REPflESENTATIVES OF TNIS COUNTY TO ENTER UPON THE z ABOVE-MENTIONED PROPERTY FOR INSPECTION PURP05ES. COMMENTS � ��'.!� / ��G�9''r�t' m PEfiMITTEE NNut P J� y ,y��y (/� . • �O ` ,�t`�f�bv ___ N SIONATU OF PERMITTEE �pTE � - RECPT.NO. � PAID BY � VALIDATION YJHIPE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENHOo--File Copy,GREEN—Applicanl's Copy a _ _ — � ,_,_.. �.� ,�a � _ ,� ._ _. , _,_ •� i _ !�� � � � � { � � � � �;. � � E � S k.� � '� .) 1 � ( ��� � . � � �� ..� � � � � �- �� �� . f � � I � ( _ - �`� i � !_ i � l, � � � � : a - i � ( � i �j � ; ` � ` � �_ �, ��� _P---^�.v� �°��� ` � ,� -' � � � � ( ( ` f �' � ' ; � � �` ! j , ;_ i 4 ' � i� � � . � � � " � � I � I � � � � I � ��� � �_ , i �� � r�� ( I _ I � ; � , _{ � � ;� �� � °� � I � � ' � I �` � � I i �' + j � i ( i � I � ( € -i 1 f, i; � � '` i- �' � � i ? � �_ i � � t ' � i �' � ' I . ` �I , � . � ; �� . � , 1 � ( 3 , --, ` � � � ,---�--�- � �-r- --+- ��� i ( � _ � � � ' � � � � !��� � � �� � ��_��� .� � �) � E � ' � �_:�� I � `I � 4 = i 1 ." k � � � � � ` .I F i -T�"_ � � � � j � � � � � � ( ,, E � � - ' � � � � � � E (. � � ' � � € � � I � i � � � r � i �, �. 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