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HomeMy WebLinkAbout15503 (20) � � CITY OF DIAMOND BAht � " � �"-�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES `� _ , w 21660 E.Copley Drive Suite 190 PRESS (909)SGO-3195 Fax(909)861-3117 ��'�'�� BUII.DING PERMIT APPLICATION FIRMLY; � JOBSITE f ,/� `� eJ����= APPLICATION ��� PERMIT ��) P!C �` o ADDRESS �(� �!�-'YctK�agP DATE NUMBER �`� # $ ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER � �fll�/7_ -- ADDRESS�/g7G ZONING SETBACKS B' CITY ZIP TEL. FRONT RW ❑ �; APPLICANT TEL. REAR ❑ SIDE/SIQE STREET RW ❑ CONTRAGTO � ✓S /�w � " L_C3�✓�)"' SIDE ❑ �� � - - ADDRESS LF'./ �`' '�P�''7"9' .'4 _ �' CITY �+'� � ZIP �� TE PROPOSED USE o;: ARCWENG/ � DESIGNER NO.DWEL. NO. NO. ' ADDRESS _ UNITS STORtES �BEDROOMS �� CITY ZIP TEL._ y' DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION y � OWNER-BU�LDER DECLARATION SFR/ADD/REM O' Q- 1 HEPEBV AFFIRM UNDER PENALTV OF PEFYtt1RV THAT I PM IXEMPT fROM THE COMMCTOFS LI- � � Garage/Carporl W� CENSEUWFORTHEPoLLOWIN6REASON(SEC.7037.58USINESSAN�PPOFESSIONSCADE:ANYCITYOft -� � .COUMVNMICHqEIX11RESAPEHMITTOCON5Ti7UCT.ALTERIMPROYE.DEMOUSH,ORREPAIRANYS7fll1C- � W pdti0/�BCk , TURE.PRIOR TO ITS ISSUA!lCE,ALSO REQUIRES THE APPUCpNi FOR SUCH PERMIT TO FILE A SIQNE� � .j,r',,-STATEMENT THAT HE OR SHE IS tJCENSED PUHSUANT TO THE PROVISIONS OF THE COMRACTOR5 L4 � CENSE LAW(CHAPTEH 9(COMMENCINO WITH SECTION 700D)OF DIVISION 3 OF THE 6USINESSAN�PRO- � Po0V5(fa �� FESSIONSCOD�OR7HATHEORSHEISEXEMPT7HEREFPOMANDTHEBASISFORTHEALLEGEDE%EMP� - '_ TION.ANYVIOLATIONOFSECTION7031.68YANVAPPLICANTfORAPERMITSU&lECTSTHEAPPUCANTTO � Z Re-Roof �-: A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED OOLLARS ti5oo�.): ❑I,A&OtVNEROFTHEPROPEATY,ORMYEMPIOYEESWITHWAGESASTNEIRSOLECOMPENSA710N, ' � CORIRIBfC19I - ' $�� WILL�O THE WOAK,AND THE STRUCTURE IS NOT iNTENDED OH OFFERED FOR SALE(SEC.7044,BU51� � J NESS M!D PROFESSIONS CODE:THE CONTMCTOPS LIGENSE LAW UOE&NOT APPLV TO AN OWNER OP �� DfiOPERTYWFIOBUILDSORIMPROVE67HEREON,ANDWHODOESSl/CHWORKNIMSEIFORHERSELfOR m ._.__. .�1 ..7Hq0UGHHISORHEROWNEMPLOYEE$,PROVIOEDTHATSUCHIMPROVEMENTSARENO7INTENDE�OR - _..... _ ..._ . . . ... .. ... ._. _ .. .. . . ... ._ . . _... _ � _.. 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PLUMBING w I CERTIFY THAT IN THE 7EFFONMANCE OF THE WORK F0 HICHT PERMR IS ISSUED.1 MECHANICAL ����'- � SHAILNOTEMPLOYANVPERSONINANYMANNER50 O E SUBJECTTOTHE _���� �-� WORKEFIS'CDMPENSATION LAWS OF CALIFORNI EE T IF I SFiWLD BECOME WSPECTION FEE 3U&IEC7TOTHEWORKERS'COMPENSATIONP I OF CTION37000FTNElABOR - � s pp�� �RTHW�THCAMPLYWITHT E �s - .SMIPANCE .� � � d� }���� �� Q. . ,e Esi 1... �. ,P p pp7�;� APPLICANT: ,� �-✓ . 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