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HomeMy WebLinkAbout14355 (19) �w�_ CITY OF DIAMOND BAA � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ._� 21660 E.Copley Drive Suite 190 PR ESS ' (909)860-3195 Fax(909)861-3117 � '�', BUII.DING PERMIT APPLICATION __ FIRMLY , _. _ �n JOBSITE ''���� hQ� �$���i,� �� DATEICATION � � �� NUMB R r ��� #/C o� ADDRESS �- ��� l.i C� �:'': APt� LOT TRACT ISSUE TYPE OCC �; DATE CONST. GROUP Oir OWNE���-- ' ou ADDRESS `�� � - ZONING SETBACKS w- � FRONT RW ❑ ! CITY �. ZIP�! `TEL. �� � APPLICANT l:l� TEL. REAR O � SIDElSIaE STREET RW ❑ CONTRACTOR C.�" - �` ; SIDE O ' � i Q'� ADDREBS Z�P E , TEL. �' PROPOSED USE � �`C � O CITY � �'' - w` ARCH/ENG/ d�� DESIGNER , ADDRESS NO.DWEL. NO. . ` UNITS STORIES BEDROOMS �" CITY ZIP TEL. �� DESCRIPTION SQ:FT. FAGTOR PSF ADJ.AREANALUATION ON/NER-BUILDER DECLARATION SFRtADD/REM O': . p� � I HEflEBY AFFlRM UN�Efl PENALTV OF PEFUUPY hIAT I AM EXEMPT FROM THE CONTPACTOHS LI- - .Gel'ege/C8fpoK W; �CENSELAWfORTHEFOLIOWINGREASON(SEC.703i.68U51NESSANDPROFESSbNSCODE:ANYqTVOR � (n -UJ COUNfYNHiChIREOUIpESAPERMITTOCONS7RUCT,ALTER,IMPROVE,DEMOUSH,ORHEPAIRANYSTRUG W P8ti0/DBCk �. - W� �.NRE.PRIOfl TO ITS ISSUANCE.ALSO HEQUIRES_THE APPLICANT FOR SIICH PEPMIT TO FILE A SIGNED i W 'STATEMENT lNRT HE OR SHE IS UCENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTONS U- ��' �CEN3E LAW(CHAPTERB(COMMENqN�WITH 6ECTION 1000)OF DIVISION 30F THE BU91NE93 AND PR0• ' u' POOVSPB - � � .FESSIONSCODE)OR7HATHEOR�IEISEXEMPTTHEREFROMANUTHEBlSISFORTHEALIEGEDEXEMV-: �� � �TpN.ANYVIOLl1TIONOFSECTION7031.60VANYAPPIICANTiORAPERMITSUBJECTSTHEAPPUCAHTTO ' Z Re-Roaf . F" 'ACML PFNALTY OF NOT MOHE THAN FIVE HUN�RED DOLIARS(S5a0).): � ❑I,ASOWNEROPTHEPROPERTV,OPMVEMPLOYEESWITHWaGE5A5THEIR50LECDAiPENSATiON,= `-- O CommefCidl - . �.;_�.WILL 00 THE W W�AND THE 3TRIlCTURE IS NOT INTENDED OR OFFEFiED FOR SALE(SEC.704d,BUSI- � J ' : NESS AND PROFESSIONS CODE:THE CONTMCTORS LICENSE LAW DDES NOT APPLY TO AN OWNEfl aF , j �} 'PROPERtYWF109UILD50RIMPflOVESTHEREON,ANOWHO00ES5UCl/WORKHIMSEIFORHERSELfOR ' - �- - ��, '-TNfWU6HNISORMERONMEMVLOYEES,-DROVIDEOTHATSt1CHIMPROVEMENTSAHENOiINTENDEDOR m - W+ OFFEAEOFOIiSALEtFtiOWEVER,7HE8U1LWNGORIMPPOVEMEN7ISSOLDWiTHINONEYEAROFCOMPIE- � 0-. `'-TIDN,THE OWNEfl�BUItDER WILL HAVE iHE BUHDEN OF PROVINO THAi HE OR SNE DID NDT BUIID OR � '��! ;pAPPOVEFOR7H<_PUHPDSEOF3ALE). �- - � ❑I,AS OWNEROFTHE PROPERTY,AM EXCLUSIVEIY CONTRACTIN6 WfTH IICENSED CONTRACTOPS ' - Q` ��TO OONSTRUGT TNE PRQIECT(SEC.7044,BU31NE55 AN�PROFESSIONS CODE:T17E CONTMCTOflS LI• � V81U9110f1 � � ADJ.AREA ' . W, CENSElAWDOESNOTAPPLYTOANONMEROFAPHOPEHTYWHOBUiLDSORIMPROVESTHEREON,AND �� �" KtiOCONTRACTSFORSUCNPROJECTSWI7HACOMTMCTOR(S�UCENSEDPURSUPNT70THECONTRAG . QUANTITY DESCRiPT10N - FEE - 'TORS LICENSE UW.). . . . O' ❑1 AM E7�MPf UNDER S�C. B.8 P.0 FOR THIS REASON �; _ . lL� .� . . . , OATE OWNEFI V - W �,:;- UCENSED CONTRACTORS�ECLAflATION W �� !�IHEflEBYTfFIHMUNDERPENALTYOFPER1UPYiHAT1AMUCENSEDUNDEflPROVI310N30FCHAPTER-- � . -. (L,;:Y(COMMENCINOWITHSECTION7a00)OFDIVISION30FTHE6USINESSANDPROFESSIONSCOOE,ANU� Z X �MVl10ENSEISINFULIFOR EANDEFFECL . ��� � �u /� . � �:IiCENSE CLA 5r� � Q�^� LIC.NO. 4; ���� . � j , U.. -.�ATE � �7 - COMRACTDR �.U'!.. • ���IV�'�J � 0-� . . w �'�' WOAKERS'COMPENSATION DECLARATION � = U � �IHEREBYAFflHMUNOEflPENALTYOfPERJURYONEOFTHEF-0LLOWINGOECLAHATIONS: ' ' �' �� � C� Q G _IHAVEANOWIILMAMTAINACEPTIFlCATEOFCONSENTTOSELWNSUREFORWORKEPS' Z Z COMPENSATION,ASPROVIDEDBYSEGTION37000FTHELFBORCODE,FONTHEGERFORMANCE U Q FTHE WORK FOR WHICH TH65 VEPMIT IS ISSUED. � � _IHAVEANDWILLMAINTAINWOPoCER3'COMPENSATIONINSURANCE,ASflEQUIRE08V-SEGTION �Orjr /Jj� �yl �� (�� � Q 87o0�THELABORCODE.FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS y %(Jr r�, ��j ISSUED.MY HKERS'COMPENSATION INSURANCE CARRIEft AND POLI NUMBERARE: CONSTRUCTION ( ¢ cc��t�'�t��i'�� ���t�F�(�1'� >. CARRIEN PLAN REVIEW Z Po��crnuMaFa { �� ���� ELECTRIC ,���� < � (I}pSSECTIDNN�N�TBEWMPLE(E��FTF�PERhSTISFORO�'EM.H�DREDOIXINLS(5100�IXiLE55} PLUMBING ' Z.. I CERTIFY TMAT IN7HE PERFORMANCE OF THE WOHK FOR WH�CH THIS PERMIT IS ISSUED,1 MECHANICAL (,�J SHALLNOT EMP�OYANY PERSON IN ANY MANNER SOAS TO BECOME SU&IECTTOTHE �y 3 �: d1 A �j WORKEHS'COMPENSATONLAWSOFCALIFOFNIA�DAGREETHATIFISNOUI.�BECOME INSPECTIONFEE ' S SUBJECTTOTHEWOflKEflS'COMPENSATIONAPOVi510NSOFS TION37000FTH LABOR ISSUANCE � - . COOE,1 SHALl.f-0RTHWITH COMPLY WI1H 7H0 E PHOVI5 N5. � ��' 0- ���j � .SMIP ��° y�` dz�Y bi�!� .'33;..F � p:� DATE:�j."'a._1_ APPLICANT - . J: f ( ENE.RGYP/C - "'� � �.' --+a,;�`'�i� WARNING:FAIWRETOSECUREMIORKERS' PE SATIONCAVERAQ ISUNLAWFUL,ANOSHALLBE �� Sl18JECTANBAPLOYERTDCRIMINALPENALTI � �CIVIlFMESUPTOONEHl1NOREDTHOUSAND ENERGYPERMIT - DO(.LAfl&�i100.000),IN AODITIONTOTHE COSTOF COMPENSATION.DAMAGES AS DROVIOED FOH IN .�_I SECTION3�a80FTHELABORCODE,INTEREST,ANDATTOFNEYSFEES. � RETENTIONFEE: _ a� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: Q 1 HEREBYAFFIRM UNOER PENALTV OF PERJURY THAT THERE IS ACONSTRUCTION LENDMG AGENCY n- FORTHE PEFFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3o97,qV.C.). . Z __'—' ___ W —_ _ - � LFNDER'SNAME F- LENDER'3ADORESS —'—__ , . _ � � ICERTIFYTHATIHAVEREADTHISAPPUCATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES - - � w IAGREETOCOMPLYWITHALtCiTYANOCOUN7YORDINANCESANDSTATEtAWSRELATINGTOBUILDING � CONSTRUCTION,ANDHEREBYAUilK1FllZEREPflE5EN7ATIVESOFTHISCAUNttTOENTERUPONTHE . � � ABOVE-MEMIONED PROPERTYf-0R INSPECTION PUflPOSES COMMENTS � � � �.,C� � ; �...� (��' �'�� � m I EE k � � ,� f L � .. � , p � . � � �� . � . . � NATUREOFP I7T E DA E - = RECPT.NO. PAID BY VALIDATION � I7E—Dapartment Copy,YELLOW—Pmance Copy,PINK—Assessor Copy,GOLDENR ile Copy,GREEN—ApplicanPs Copy � I. � t� � , I ; � �.....E .�_„._.,.._.,i �__ i ( _..€��. f � ( ( �.� . — �----�",�-- i. , {{ ' �� �`f ��� , € :4 ' € �.1 � � � ' � � ( � € � I � � � � � j � i � i � � � � ! � � , E � ; j � � ; j ; € i � 1 � I ,� � �.� � 1 � � � ' � � � � ' � � � � � i � F + � � ' � , � � ; ',• � i � ( j i i ; , i i � � 3 ; ! 3 ! 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