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HomeMy WebLinkAbout15190 CITY OF DIAMOND BAlt ^--�1�--- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � � , 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fae(909)861-3117 \�'�"' BUQ.DING PERMiT APPLICATION FIRMLY � J0651TE ��� C�� APPLICATION _ PERMIT '��p P/C } ADDRESS V -� r�--�.�.` �r o �� DATE �NUMBER 7 # $ ISSUE TYPE OCC APN LOT TRA T DATE , �y— . i�j . CONST. GROUP p OWNER C._�,L't'Try. � A Ct�M..-" p ADDRESS ��i �s. rc,,t— A, ZONING SEiBACKS gCITY L�tL�•{P..wue� �ar— ZIP 'TE /��'� �i�fc"►4�� REART RW o APPLICANT TEL. SIDFISIQE STREEf RW ❑ � CONTRACTOR��_� ' 4 � �f��c __._ SIDE ❑ Q ADDR�SS,�8"`� " o . f � CIN 'c -tS'�`t( IP`` r� TEL D +.� PROPOSED USE w ARCWENG/ �+- `n � DESIGNER 1oJ<k' NO.DWEL. NO. NO. ���,i, ADDRESS � CIN ZIP TEL. UNITS - STORiES BEDROOMS � tn DESCRIPTION SQ.FL FACTOR P$F ADJ.AREANALUATION Q OWNER•BUILDER DECLARATION SFWADD/REM O p �-1 HEREBY AFFIRM UNDER PENALN OF PEFitt1RY THAT i AM EXEMPT FROM THE CONTRACTOpS LI- G8fe9BJC31POK W� CENSELAWFORTHEFOILOWINGflEA50NI5EC.7031.58U51NE55AN�PROFE5510N5CODE:ANYCITYOR (f� . �� COIINTYWHICHREW11qESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORPEPAIRANVSTRUG W TUflE,PRpR TO ITS 188UANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMITTO FILE A 516NED W P21i0/DBCk � STATEMENT THAT HE OR SME IS LICENSEO PURSUANT TO 7HE PROVISIONS OF THE CONTRACTORS LF � �.., CENSE LAW(CHAPTER 9(COMMENC�NO WITH SECTION 7000J OF DIVIS!ON 3 OF THE BUS�NESS AND PR0. POOUSPfl FES810NSCODE)ORTliATHEORSHEISEXEMPTTHEREFFiOMAN�TNE0A515FORTHEALLE�EDEXEMP• � (� TIOy.ANVVKKATIONOFSECTION7031.66YANYAPPLiGANTiORAPERMiTSU&IECTSTHEAPPLICANTTO Z Re-Roof �,., A CML PENALTY OF NOT A10RE THAN FNE HUNDRED DOLLARS(5500).): � ❑I,ASOWNEROF15iEPROPER7Y,ORMYEMP�OYEESWITHWAGESASTHEIR50LECOMPENSATiON, COIfi1110fC181 -� WILL DO 7HE WORK,ANO THE STRUC7URE IS NO71N7ENDED OA OFFEPED fOfl SALE(SEC.7oa4,BU51- � � NESS AiJ�PROGESSIONS CODE:THE CONTRACTOflS LICENSE LAW DOES NOT APPLY 70 AN OWNER OF � Pt�PERTY NAiO BUILDS OR IMPqOVES TNEREON,PND WNO OOES SUCH WORK HIMSELFOR HERSELF OR (,�� THRDUGHHISORHEHOWNEtaPIOYEE3,PROVIDEDTHATSUp11MPROVEMENTSaRENOTINTEN�EDON � 0 OFFEFlEDFOHSALEIF,HOWEVERIME6UIL�INGORtMPROVEMENTfSS01DWtTHINONEYEAROFCOMPLE �: �TION.THE OWNEN-BUILDER WILL HAVE THE 6UR0£N oF PROVMCi THAT HE OR SHE DID NOT BWLD OH . IMPROVE FOR THE PURPOSE OF 9ALE). �y,�: ❑I,A30WNEROFTHEPROPERTV,PMEXCLUSIVELYCONTRAGTINGN7THUCENSEDCONfRACTORS � TO CON5TRlJCT THE PRWECT(SEC.7a{4,BUSiNESS AND P{iOFE5510N5 COOE:THE CAMRACTOAS U- � V8IUfllI0f1 ADJ.AREA W�, CEt�EUWDOESNOTAPPLYTOANOVMEROFAPROPERTYWFIOBl11LDSORIMPROVESTHEREON,AND L WHOOONTRACTSfOHSUCHPRQIECTSWITHAGONTRACTOH(5)LICENSEOPUR5UANTTOTHECONTRAG QUANTITY DESCRIPTION FEE � TORS LICENSE UW J. �� �I AM EXEMPT UNDER SEC. B.&R.C.FOR THIS REASON Q . �� — � � V � . . . �� — ---�-- . � fL DATE OWNER �. � Z W .� . , �- LlCENSED CONTRACTORS DECLARATION W - . . � � , I HEREBYAfFIRM UNDER PENAITV OF PERIUNV TFiAT 1/J�LICENSEO UNDER VROVISIONS OF CHAP7Eft � � Y(C�OMMENCINQ SVITH SECTION 70W)OF DIVISION 9 0F THE BUSINESSAND PROFESSIONS CODE,AND z X_ MY UCENSE IS IN FULL fORCE AND EFFECT. p�,j N lll /,1-'� l• �`p����V � CL� o� UCENSE CLASS ����� F�LIC.NO.�� /� � j �j�� DATE ��:�� �e'� CONTRACTOFi d �� � � �sE� WORKERS'COMPENSATION DECtAflATION ¢ �� IHEREBYAFFlRMUNDEfiPENALTVOPPERJURYONEOPTHEF-0LLOWIN�DECLARATIONS: Z C1- _IHAVEAN�WILLMAINTAINACERTIFICA7EOFCONSENTTOSELFINSUREFORWORK� ¢y Q COA/PENSATION,ASCRDNDE�BYSECT�CIN370oOFTHEIABORCODE,FORTHEPERF'O PNCE W Q OP THE WORK FOR WHICH THIS PEflM1T IS ISSUED. U � � ' _I HAVEAN�WILLMAIN70JN W6AKERS'COMPENSATION INSUMNCE,AS RE�UIflED BY SECTION Q 37ooOFTHELABOftQ7DE,FORTHEPERFOPMANCEOFTHEWORKFORWHICHTHISPEHMITIS -- ���7,�A.A-.j'���� ISSUED,MV WORKEAS'COMPENSATKKJ INSURANCE CAFRIER AND POLICY NUMBERARE: CONST tt��tvaU �^e. j caaaiEa__.�_.--- --- ---.--_._._--- PLAN R��.:'�j�� 1�.���t-�s��� '- z ao��cvNUMSEa ELECTRIC ¢ Q (fF8S6ECf10NNEEbNOTBE�EfEOOF'fi�PEPAMTISFORCNEHUrDREDIX%1?37S(S�oo)ORIE&S} PLUMBWG z 1 CERTIfV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSllEO,I MECHANICAL __ ($ SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJEGT TO THE (/j WOfiKERS'COMPENSATIONlAWSOPCALIFORNIA,AN�AGREETHATIFISHOULDBECOME �NSPECTIQNFEE � � SUBJECTTO THE WORKFAS'COMPENSATION PPOVISIONSOF SECTION 37oo0f THE LABOR a CO�E,1 HALLF f1THWITHC0IAPLYWI7HTHOSEPROV IONS. �SSUANCE � (' �!�' s p OATE: � G��, APPIiCANT. !ti„�r SMIP- -_-.-_- . - J WARNING�FAIWRETOSECt/REWOF7KERS'COMPENS IONCOVERAGEISUNLAWFUL,ANOSHALl6E ENERGYP/C LL SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDf1ED(HOl1SAND � ENERGYPERMIT DOLI.ARS(5700,oW),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR IN � 3ECTIDN 97080F'tHE LABOR COOE,INTEREST,AND ATTORNEY'S FEES. RETENT�ON FEE: ____ � CANSTFiUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENAI.TY OF PEFJUflY THAi iHERE IS ACANSTflUCTION LEN�ING AGENCY � FOR THE PEHFORI.IANCE OFTHE WORK FO{i WHICH THIS PEFMIT IS ISSUE�(SEC.3097,CN.C.). . Z W � LENDER'S NAME F— LENDER'9ADORES3 W� TOTAL FEES ��� ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCOflRECT. � IAGFEETOCOMPLYWITHALLCITYAN�COUNTYORDINANCESAN�STATELAWSREIATINGTO6UILDING . � CANSTRUCTION,ANOHEFEBYAUTHORREREPRESENTATIVESOFTHISCWNTVTOENTERUPONTHE � Z ABOVE-MENTKKiE�PROPEFN FOR INSPECTION PUflPOSES. p � �i�� COMMENTS ' � VL��¢.t,�.i �„�t.r`T lLt_.E'.� m � PERMITfEE � � � �y —..________ U� � .. ��-we..... !S�� � SIGNA7UflEOFPERMITTEE D E � � RECPT.NO. � PAID BY VALIDA"f10N WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessa Copy,GOLDENROD—File Copy,GREEN—ApplicaM's Copy ° �_. _�. ._ , .��. ��� . i.�._� _ ..� ., � _�� E � I� �` �� �- E � � i �� � ' � �� � t � � �N � � �I € I��-� � ��. ; � � � w-, � I � � '.. 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