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�� CITY OF DIAMOND BAx �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� _ . w 21660 E.Copley Drive Suite 190 PRESS � (909)860-3195 Fax(909)861-3117 �'�'�"�' BUILDING-PERMIT APPLICATION FIRMLY:`=. 0 DDRESS �3 c�� �-' �+ ' DATE CATI N J _:G� NUMB R ���'� #/C c�': ISSUE TYPE OCC APN LOT_�_ TRACT DATE CONST. GROUP p OWNER �✓ _ �` ADDRESS "`i t �' - ZONING SETBACKS w' CITY ZI� ,�. �"" RE�RT RW O � APPLICANT ��C' �, ���� TEL. - SIDE/SIDE STREET RW ❑ �` CONTRAGTOR �" ' SIDE ❑ � ADDRESS � �. � � CITY P EL PROPOSEDUSE GiGP-�n W� ARCH/ENG/ � �� / z: DESIGNER NO.DWEL. i NO. O. �; ADDRESS UNITS / STORIES �BEDROOMS � _`. CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ' �- O" OWNEF•BUILDEft DECLARATION SFR/ADD/REM ��' ' 1 HEREBV AFFIRM UNDEq PENALTY OF PERJURY THAT I AM EXEMPT FRQU THE CONTRACTOflS LI� G8f2Q6IC8IPOA W�. CENSELAWFOR7HEWLLOWINGREASON(SEC.7031.6BUSINESSAN6PROFESSIONSCODE:ANYCITYOR � �(n , U: ((bUUNTYWHICHREWIRESAPERMITTOCON37RUCT,ALTEFi,IMPROVE,OEMOUSH,ORREPAIPANYSTRUG . W pyt10J�8Ck . �: ,TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES TME APPLICPNT FOR Sl1CH PERMIT TO FILE A SIGNE� �_: STATEMENT THAT HE OR SHE IS LICENSE�WRSUANT TO THE VPOVISIONS OF 7HE CANTRACTORS LI� �� GENSE LAW(CHAPTEP B(COMMENCINQ WITH SECTION 7aoD)OF DNISION a OF THE BUSMESSAND PRO �': FESSiONSCODE)OR7HATHEONSHEISEXEMPTTMEHEFROMPNDTHE&4SISFORTHEALLEQEDEXEMP- TION.MIY ibNOFSECTION)o37.59YANVAPPLICANTFOPAPERMITSUBJECTSTHERPPIICANTTO Re-Roof r� A L ALT'OF NOT MORE THAN FNE HUNORED DOLURS(SSOOIJ: � �,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITNWAGESAS7HEIRSOIECOMPENSATION, � COfflrtiBfCl01 - g:: VA THE WORK AND TNE STRUCTURE IS NOT�NTENDED OR OFFEfiED FOR SALE(SEC.7044,BUSb � J _ � �-.. NE3S AND PROFESSKKiS CODB h1E CONTRACTOFlS LICEN6E LAW�OE&NOT APPLY TO AN OWN6R OF � . . 'VROPERTYWhIOBUR.DSORIMPROVESh1EREON,ANDWHO00E55UCHWOHKHIMSELFORHERSELFOR m LC:. 7HFqUd1 HIS DR HER OWN EMPLOYEES,PROVIDE�tHAT SUCH IMPROVEMENTS ARE NOT INTENDEO OR W- .OfFEREDFORSALEIF,HOWEVER'�NEBUILAINGORIMPROVEMEMISSOLDWITHINONEYEAROFCOMPLE Z-� �TION,THE OWNEfl$WIDER WILL HAV'E THE BURDEN OF PROVINCa TMAT HE OR SHE�ID NO7 BUItD OR � ' _. IMPROVE fORTNE PURP0.SE OF SALEj. ❑t,ASOWNEROFTHEPROPER'TV.M1ExCLU51VELYCONTRACTINCiWtTHLICENSEOCONTRACTORS �' �� 70 CONSTRUCTTHE PRQIEGT(SEC.7044,BU91NE99 AND PPOFESSIONS COOE:7HE CONTRACiORS LI- � VdIU2IlOf1 ADJ.AREA � W CENSEUWDOESNOTAPPIYTOANOWNEROFAPROPERTYN'F108UIL�SORIMPflOVESTMEPEON.ANO F-. WIiOCONTRACT3FORSUCHPROJECiSWITNACON7RACTOH(S)LICENSEOPURSUANTYOTHECOt�TRAG - QUANTITY � DESCRIPTION FEE-- - TORS UCENSE UW.�. �� ... ... J ` . . . �:�. 0 ❑IAM EXEMPT UNDER SEC. 8.&P.C.F�R THIS REASON �- U , � � � �= �ATE OWNER __ U � LICENSED CONT9A ORS DECLARATION W �� �IMEREBYAFFIRMUN�ERPENALTYOFPER.IURYTHATIAMLICENSEDUNDERPROVISIONSOFCHAPTEfl d �0(C011MENCINCi WITH SEC710N 7�00J OF DIVISION 3 0F THE BU51NE5SAND PROFESSIONS CODE,AND Z � yc A/Y LICENSE IS IN FULL FORCE AND EFFECT. m � LL! � �UCENSECLAS3 lIQNO. g� H �. � pq7� __. CONTRACTOfi � �_ Ve+ORKERS'COMPENSATION DECLARATII;N d � N U � I HEREBYAFFIRM LINDER PENALTY OF PERIURY ONE OFTHE FOLIOWING 6ECLARATIONS: Z Q � �IHAVEANDWILLAfAINTAINACERTIFICATEOFCONSENTTOSELFdNSUREFORWORKF1iS' S CtNFPENSATKKJ,l15PRVVIDEDBYSECTION970oOFTHELA00RCODE,fO(tYHEPERFORFiANCE W � oFTViEWORKFORWHICNTNiSPERMITISISSUEO. � W _I HAYF AtdD WILL MAINTAIN VIORKEftS'COMPENSpTION INSURANCE,AS flEQUIRE�BY SECTION ��•� Q 3�e�OFiHEIAflOR�'ODE.FOATFiEOEFF-0AMANCEOFTNEWORKFORWHICHTNIS?ERMITIS ..� , 0 ISSUED.MY140RK�H5'(pMPEN5AT10NINSURANCECRRRIERAFlDPOLICYNUMBEfiARE: CONSTRUCTION 7 s ={ -- >t ] > car�RiEH_ - _ PLAN REVIEW �'`F =„�� - - � POIICYNUMBER ELECTAIC � � " _ � .. ci n�stcrravhemnoreema,uters�a n�r�w.rruxhta�i�urnrtEoociianslS+co)aa�ss� PLUMBING � �CERTIFY YHA71N THE PERFORMM'CE OFTHE WORK FOR WHICHTHIS PERMIT IS ISSl1ED,l MECHANICAL (,�' SHALLNOTEMPl.OYANYPERSONiNANYMANNER50AST09ECAME5U8JECTTOTHE INSPECTIONFEE Vy WORKERS'CUsdPENSAiION tAWS Of CALIfORNIA AND AGREE THAT IF I SHOULD BECOME SU&IECT TO THE WOPKERS'COMPENSATION PROVISIONS OG SECTICNJ 3]0o OF TNE LA80R � C4DE.ISHALLFORTHW�iHS:OMPLYWiiHlliOSEPROYI510N5. UANCE G � [,> DATE:� APPLiGANT: , � w PIC � . � WARNINGFAILUHfTOSECUREWOFlKERS'COMFEN6ATIONCAVERAGEISUNLAWFUI,ANDSHALLBE . �y SIJBJECTANEMPLOYERTOCRIMINALPENALTiESANOCIVILFINESUPTOONEHUN�REDTHOU3AN0 ENERGYPERMIT __.—___ OOLIARS(StDo,oOa).IN ADDITION TOTHE COST OF COMPENSAT�ON.DAMAGES AS PROVIDED FOA IN �� J SECTION 3708 OF TNE LA80R CODE,INTGIiEST,ANDATTORNEY'S FEES. RETENTION FEE: � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O �� I NEFEBV AFFIRM UNDER PENAITY OF PERJURV iHATTHFRE IS ACANSTRUCTION LENDING AGENCY d- FOR THE PERFOftMANCE Of THE WORK FOR WHICH THIS PEAMI7IS ISSUED(SEC,309�,CIV.G}. � Z W � LENDER'SNAME .._. ►— LENOER'SADDRESS_...._ � ICERTIFYTHATINAVFAEA�THISAPPlICATIONAN�STATETHATTHEABWEINFOFUAATIONISCORRECT. TOTAL F��S � IAGREETOWMPLYWITHAILCIIYANDCOUNTYOHDINANCESANOSTATELAWSRELATMGTOBUILDING � , CONSTRUCTIUN,AND HEPEBY AUTHORIZE REPFESENTATIVES OF Tf iIS COUNTY T6 ENTER UPON THE zABOVE-MENTIONF.O PNOPERTY FOfl INSPECTION PURPOSES. COMMENTS ' � J --- � �. m PEfiMITTE �E fP - /'. -- a � N IG URE P MITTEE� � �TE RECPT.NO. � PAID BY VALI�ATION _ --- - WHITE—Department Copy,YELIOW--Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applican!'s Copy " . -�'-r-`�-,--`-�--"'-T---�t -..»-,., ...- � � E �....->-........ .e.o....sm .�...::s._ ,� .,v._ rc-.-�...- �....�, ..,� � — ' � � � �......�..._ �«�..�. f i o_ ' L '..�..�e.f. 3 � 1 a � _( � -j.. � � � F _ -� � � '.. ry�.....I � � � , i E I � ,,' � ; E � F � ; � ._�� � , �{� _ � � ,. , � � .:: � � � � � � �. �..� I: � �''�� ` i �. . � ' -� � � i �, It �,��. � ! � i ` —( � 4 ;I I �" �— � i s i � i � € I, i � � � � , i: � 3 �r� ,k j � � � � � � � � _ � � i�� � � 7� � '�� � a i t � i � -� � I � I � �.,� � � _ I r.� -� �� ; � �.7.._ � � .E � �E � � i � � � � � , � .J � ( ' � i ' i _ � i �F � i I � : � :! ( � � ��� �r � i ! I � � � ' � � � � I.' � I � � �_� i f � E i :I ; ( � �r ' �; � � ( k € ' i�_ � � � ;i i � �'�__:��� �_ ; i � { ! ` ( � � ii '- ; { � ;. 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