Loading...
HomeMy WebLinkAbout15548 (23) CITY OF DIAMOND BAx -I�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SSRVICES _ ,� 21660 E.Copley Drive Suite 190 � (909)860-3195 Fax(909).861-3117 PRES$ ���'�" BUII,DING PERMIT APPLICATION FIRMLY o� JOBSITE a`�� �r',� APPLICATION ���I�� PERMIT � P/C ADDRESS 7 � (' DATE NUMBER� # $ APN LOT TRACT pATE �,�r �l�(} NPE OCC °C OWNER �` • 'Ci'Z CONST. GROUP O p ADD SS����T�LIa y' �� Y� ZONING SEBACKS "' CITY t�pq,�v.r.i��,< ZIP J�'�7,�`� TELy��r`) ..�_���53 FRONT RW ❑ � APPLICANT TEL. REAR � L • SIDEISIQE STREET RW ❑ a� CONTAACTOR�.�r���.� 4�ftip r'�S 1F,� n1{' SIDE ❑ � ADDRESS ����- Y+L(��+c2 v�n �,1,�. � CIT1F�firar�'�'Li-&L p�JK��,�, ZIP �`�i�2,� TEL;`�d)"fb?`7-I«/ed- PROPOSEDUSE o ARCH/ENG/ � DESIGNER NO.DWEL NO. NO. ADDRESS CITY ZIP TEL. UNITS STORtES BEDROQMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q�. OWNER-BUILDER DECLARATION .SFR/ADD/REM O d 1 HEREBY AFFlRM UNDER PENALTV OF PERNRV THAT I AM EXEMPT FROM TME CONTRACTORS LI� G8�9J8/C8f{10fI W CENSELAWFORTHEFOLLOWINOqF�SON(5EG7o31.5BUSINE&SANDPROfESSbNSCODE:ANVCITYOR. (n V COUNTVWHICHREWIRESAPERMI77000NSTAUCT,ALTER,IMPAOVE,DEMOLISH,ORREPAIRANYSTRUG� W pgtiO/00Ck W 7URE,PHqR TO 1T8 ISSUANCE,AL50 REQUTAES THE APPLICFN�FOP SUCH PERMIT TO FILE A SIGNED W hN � 3TATEMEM THAT HE ON SHE IS LICENSEO PUfl5l1ANT TO THE PROVISIONS OF THE CONTNACTORS L6� � �. CENSEUW(CHAPTEH9(COMMENCINOWITHSECTION7W0)OFDIVISION90FTHEBUSINESSANDPRO� POOVSPB FESSIONS CODE)OH THAT ME OR SME IS EXEMPTTNEREFROM ANDTNE BASIS FOR THE ALLEGED EXEMP- 71DN.ANYYIOUTIONOFSECTION7031.58YANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLiCANTiO�� Z R8-ROOf � ACIVILPENALNOFNOTMORETHANFIVEHUNDHEDDOlLARS(5600).): ❑I,ASOW,NEROF7HEPflOPEflTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSAiION. Q CommB�Ci81 � WILLOO7HE WORK,AND THE STRUCTURE IS NOT INTENDEO OR OFFERED FOR SALE(SEC.704a,BUS6 J �- NESS AND PiqfESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF. j OROPEflfY WFIO BUNDS OR IMPROVE9 iHEflEON,AND WHO DOES SUCH WOflK HIMSELF OR HERSELFOfl . � iHR0U0HH130RHEROWNEMPLOYEES,PROVI0E07HAT5UCHIMPpOVEMEMSARENOTINTENDEDOR m Q OFFE(iEDFORSAlE1F,HOWEVER,7HEBUILAIN60RIMPROVEMENTISSOLDWf(HINONEVEAROFCOMPLE- z �TION,THE OWNERAUIIDER YALL HAVE THE BUHDENbF PROVINa THA7 HE OR SHE DID NOT BUItD OP- = IMYROVEFORTHEPURPOSEOFSALE). W ❑I.ASOWNEROFTHEPROPEHfY,AME%CLUSIVELVCOMFiACTiNOWITHLICENSE�CANTRACTOHS � TO CONSTRUCT THE PRQIECT(SEC.7044,BUSINES3 AND PROFESSIONS COOE:THE CONTRACTORS U� VaIUOIIOfi ADJ.AREA W CENSEUWDOESNOTMPLYTOANOWNEHOFAPROPERTYWHOBUILDSOPiMPROVESTHEREON,AND� . � WFIOCONTMCTSFORSUCHPROJECTSWI7HACONTMCTOR(S)LICENSEDPUR3UANTTOTHECONTFiAG QUANTITY DESCRIPTION FEE - Y roas ucause uw.�. g ❑IAM IXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U LL � . DATE ONMER V - - . � W s( LICENSED CONTRACTORS DECLARATION W OC IHEREBYAFFIRMUNDERPENALTYOFPERJUf1Y7HRTIMI�ICENSEDUNDERPROVISION60fCHAVTER � Q, 9(COMMENCIN(3WI7HSECTION7o00)OF�IVISION30FTHEBUSMESSANDPROFE5510NSCO0E,AND Z X, MY UCENSE IS IN PtA.L FORCE AND EFFECi m I1J c�v�1 �r � LICENSE CLAS[g �� LIC.NO. .�y i�'-!�� ! � j�� _ V DATE �f I���+��' CONTRACTOR� �L C'E- rL@.f � d `u `�s�"mJ' � WORKERS'COMPENSAT�ON DECLARATION I�py, Q � , y� ��1. !Y.J/a U � IFIEREBYAFFIRMUNOERPENALNOFGERJURVONEOFTHEFOLIOWINGDECLARATIOI•15 Z � IHAVEANDWILIMAINTAINACE�IFICATEOFCONSENTTOSElHNSUPEfOPWOflKERS' _ COMPENSATION,ASPROVIDEDBYSECTION3�ooOFTHElA80FlCODE,FORTHEPERFORMANCE W OFTHE WOHK FOR WHICM THIS PERMIT IS ISSUE�. � � � w IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONMSUqANCE,ASREQUIREDBYSECTION O 370oOFTHELABORCODE.FORTHEDERFORMANCEDPTHEWORKFORWHICHTHISPERMITIS � ISSUED.MY WORKERS'COMP SATION INSURANCE CARRIER AND POLICY NUMBEF ARE: CONSTRUCTION jCARRIEN PLAN REVIEW 0 POLICYNUM6EA �- ° ELECTRIC Z ' __.-_ Q � (nassecnavN�rpreeaor.��oFn�rEw�xrsroaauEi-aannEn �sao>on�ssa PLUMBING w y-�, Z I CEATIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH TNIS PERMIT IS�SSUED,I MECHANICAI �• .7// °�S SNNLLNOTEMPLOYANYPERSONINANYMANNEflSOASTOBECAMESUBJECTTOiHE Uj WORKERS'COMPENSATION LAWS Of CALI4'ORNIA AN�AGREETHAT IF I SHOULD BECOME INSPECTION FEE SUBJECTTOTHEWORKERS'COMPENSAT ROVISIONSOFSECT 37000FTHELABOR �-7 �j �coy�,isH ForrrHwmicmnr�rwi n+o art visrorvs. ISSUANCE c�,,��,�__ � / I� G� APPLICANT. SMIP p DATE: J WARNINGFAILURETOSECUREWORKER6'COMPENSATIONCAVERAGEISUNLAWFUL,ANDSHAIIBE ENERGYP/C LL SU&IECTANEMPLOVER70CFIMINFLPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSANO ENERGYPERMIT DOLLAH6(5100.000).IN ADOITION TO THE COSTOF COMPENSATION.DAMAGES AS PROVIDEO FOR IN � SECTION 37080FTHE LABOR WDE,INTEREST,ANDATTORNEI"S FEES ' RETENTION FEE: a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBYAFFIRM UNDER PENALTV DF PERJl1iiY THAT THEPE IS A CONSTRt1CTION LENDMG AGENCY � FORTHE PERFORMMICE OF THE WORK FOH WHICH THIS PEHMIT IS ISSUED(SEC.3a97,CIV.C.). . . _ W � LENDER'SNAME_ � � F= LENDER'SADORESS . . . W ICERTIPYTHA7IHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOYEINFORMATIONISCORRECL TOTAL FEES �. �V,; � IAGREETOCAMPLYN7THPLlCITYANDCOUNTYOPDINANCESANDSTATELAWSHELATINGTOBUILDING . . . - � CONSTRUCTION,pNDHEREBYAUTHORIZEREPflESENTATIVESOFTNISCOUNttTOENTERUPoNTHE . _ - ABOVE-MENTIONED VPOPERTY FOR INSPECTION WRPOSES. COMMENTS � �` ` _ �.� � .. � . _ `�t'� m AA1E(PFIM) ' . . Q CA 1 � SI 7URE R DATE _ � RECPT.NO. PAID BY VALIDATION ~ WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy .� - �.__ w �, � _ _;__e � _ ,��_ _ ' ��� . � �_., �. ..� ��_ � � �, _�-__ ' � � ��� , � i_ j i j � .I ( i E j � _., ' �� F � I i � � !` ' ; � � i ! 1 i 3 � I � I 3 I. f � � ¢ � i. � , :� �� � � i, � � 1 �' � .j � ;i �,. j I � t€€ i � ��� � E � a.. � -� ��{ (: .. � )� �� .�� � �� � 1. �� � � �� � � �- � j � -'� r (._ { ¢ � '� i � � �. I � .,� � � � �. .a �`"`� �:�_ � � � i I �� ` ' i� . ��� � a � � �� �� t ` j �_ � � � �� � � � � �.', � � � � � � .��. E i � ��' F I � ( i � i F i � � �: ; � � � � _ � .j_. � f t � � 7 � � � l 1 I � t .. . a � � I �� � ..� � � � �R ti i .� � Y � - � . �-( I � � � ? , �� � , � E � , ; s � ? � �� C � � ; � � � -� _;_�� _ _i---� .� �--�- � _��- _�_,:_�[ , _� � � ; _ ( � � � : � � � �� � � � � � ` � � � { � � �� 1 ` f � 1 � � �{ � � 1 � � � �' � i � I 4 � E 1 � � � { I , � � � i € i � I i 4, a : 1 � � � I � i i j — � � ; _ � �' �� � � � � . � ` ' I � � �� � � I � ( ` �` ' � I� I � ` ` ' ', 9 ( � � ' � , � , ( , � 1 � � , � i i � � � a � � ��� ' � i ' i � ' � �� ` ' � � I f ; 7 � � i :I �_1��� � � a—�—}__ —�—� :._,��_�_ � , � � � � � I v ; i � � ,___ _;� ;—, ; � � ,=a _�—`_; , , , ; r��-a, i ; �- , a , ,_ E � � , �- t� 3 ,� � � � � � _ , ;��� �; ' ; i i ; � + �� �� ;� i 1 ; ; ���� � i �!,� .., ' ,� � � ? � ; I . ` ' � � � � ( � i � 3 � i I , 4 � � � i 3 a��` I , � � � � � �'� � 1 �� � � � � i � � ( � t ( " I � � � �� �' � a� �� iC., i �,�3 � � � � i iL f 1 ; j.. i � � � � ( � '¢� '� C� C. � .E� �� �� .,.+�� i � �°t"' � °'a ���� _ I - � ( i � � _ � I :s � .� �-;!�.�i`�iC, �- �'�,�����i�) �� �i�'�' ���.�u,}I i`�i.�a C-I� ���) I.� ����,,' 1 I �. -'I-- � �. � i ' � . �- � .y . i �' ,��� C�.��. tt.ir,��,r� � (,�ECC�`� ��-' �r (�a�� ����= �� .,1 i � � j_ i . p � i � � ��.i� (� �s e'����. e���.,,ri�, e � �yf.u� -�"IY� �e I.,� C� 3��t i m � i . � � i � � I �- l3 � � �i u.i�L I._ .� C? �,.. 'C � �.1-�it. i,t h� c � t .. P i � �� .�� . j � I i i � i i � �'i r a - �i. ."..� ��c � C.�, �r a� ,�.�� _I�i '- : I ' � ��.- � �_ � �. � � �i� ..`.'-� � �,,_ �' � ...�!� U�� '�.1 CS i`"�,�,.� .�' �'`, L F � . . .i � � i - � � � � - � � h.; .�(-�i�" �- �� L.�) _i"Ul � .E.(i_.t . i.., . �� �.. � . ! � i � .. ; I � � ( �V � i s.,.. €_ ' . , A� i ' f ; � .- `� � I � 3 I i � ' � � u'�`. �� .�) (u� "�.� c�� c� r � ai _��'aI � .� � �'n i. � � � t i i � � � � � � t_ � E � .a � � ..�j_, ! .��, _ � � i � }� � � � �� - - _il I._,�. � i -t. . -f__ �r i f 3 � i I 1 � � , � � I � I. � I E � � i I 4 � � � F ( ~� f � i 3� { i � I _ 3 ( � E � e� Rue"�u. e � . I i I � � � � -� � ` i' E �� � � I ? � � i i i � I � � . „�' � � �.._ � � i � � � i ' � i I � � �i �� � � ���: ( , . � i � i i i ; � .� ; .� � � � i .. � �' � • i � i i� �. � i E ".1 �. _. , a € f i � ' i � ;. I ( � € i � � i ` ; ,i ! ` , � i i � i � ; � � ; � � � 1 ; ' i � i i I � I � � ;� � ` I ' ' � ' ' � �€ �:� � E i 1 � � � i, '- s i �{ � !� � � �i ( i 3 � � € � _ I + ,: ,. ! ! � ._ I__' ' ' °... i i � � I � � i ' � � ' : ! � � �. i � � I � � � I � i f i �i { � � � k' i y � ..� I 4�.i � '.�.� ( � { � 4 ..j__� �..,..... .__.�{ ....�_� � � ,— � �-� � I ` � � t ( . � $ I � S � � � � € � _ � � . �� � � � � � �� � � ' � � � � �� � �� � ��� � � � 1 � � 9 � ;� i t t - ( � j _ > - � � � ( � i � , ( � " t i _ � ; i ` � � ' _ � . - � ( €_��� ' ' ,z�"_ � � ; � � ��a . ` {... � 1 ' � iy � .. ; < ! I i � � i I { � €.. ���� ��C� ' ' ��� � � € ����, � !� �� l � � � � � � I � I � I 3 ) v .,� I � � � � ' � � 3 ' , �. �, i � ,�� � j � } �€ ; t € � � ; a, � 3 � ,� i ! ' 3 � ; �� i i 1 ( I �'"!�..� = o �� � � � �: f 3i:.���� �C'f�� � ii�, ���;:tC.< . ! i � � E J Ca' _.i �. . i , i r�¢ - � � � ��, � �� ; �� �1 � � , � � �' � �' � � � � �< ;r.^ ; �`3'�,�� :� -1� � �� � � �i� �E .�s �. ' _E'.n�� ,� E ` � 1 �� � �� � �� � .�� � i i 3 } . � �;s�'"', "�}'�' � CJ i'?�G��C�'�,`a� � ��ji�i� '�� � � � �'� , � � `� � � � � : �'r ` � ,�t �Ec �, c�'� �, �,.��� �� �i,s � � 1 � �- �� �'� �; � � � 1 1 , �' u.�-� r�l��,�,��r.� �4.� � �5�s; i {� � wi ,� �� � � i t � � ; , � r� � � - r-I C. 1..7_ � r-• � �., "�!'"�,� i �.�'" I - � - ' .� „� x � i r� � i'�=�` � '��L3�� � �c� �3.t �� �� �� u a� �i r � � '� � � ��u.i � ri;�� ia '��t� � s��'�,x � ,tF,�.e �;) i�a t� _ � '�In_ ��i � , I � I � Ics�c�3 � `� ... �L..__...�.�.v.H_..���__e.� .�... �L___�_. ._. _.6..__._...�,ao..J.._���w_� _�a;.��.1..>.� ,., ._:a__.�__..