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HomeMy WebLinkAbout16983 (44) CTTY OF DIAMONB BAR � ----�'�'�— i7EPARTNIENT C��'CG�MI'1�IyNITY&DEVELOPMENT SERVICES 1 I � 29 825 E.Copley Drive � (909)860-3I95 Fax(909)861-3117 PRESS �%Nn��� BUILAIlVGPEd2NIiTAPPLICATION FIRMLY o� JOBSITE � � � `� �� DATE CAT,_ P���d� NUMBER �� #/C ADDRESS o� ISSUE TYPE OCC APN lOT TRACT DATE CONST. GROUP °C OWNER MA.�� OO ' ADDRESS .✓�. � .°L�' �-�m ZONING SETBACKS z CITY.�ri4�+'l�sNra� •Js'�ZIP , TEL FRONT RW ❑ o APPLICANT !i _ TEL. S DE SIDE STREET RW ❑ I� ¢ CONTRACTOR , a�h�C- SIDE ❑ p� ADDRESS� � J S" � f" � CITY ��.�*r�n�l R f�7 S ��ZIP ��_��TE � '` , PROPOSED USE !�-��o' �i-�` "� o ARCH/ENG/ iz DESIGNER ND.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY � ZIP TEL. �I � � DFSCRIPTION SQ.FT. FAC70R P$F ADJ.AREANALUATION �� � O�MJER-BUILDER DECLARATION SFR/ADD/REM O �i ' p I HEREBY AFFIRM UNDEA P NALTY OF PEFJUFiY THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gfifege/CBfPOff W CENSELAWFOflTHEFOLLDWING�REA50N(SEC.7031.50USMESSANOPROfESSIONSCODE:ANYCIiYOR (n � � U COUNNINHICHPE-0UIRESAPEp I7TOFONSTRUCT,ALTER,IMPR�VE,�EMOLISH.ORREPAIRANYSTRUG {.j� pg[IO/DBCK W . TURE,PRIOH TO ITS ISSUqNCE,AL50 REQUIqES THE APPLICANT FOIi SUCH PERMIT i0 FlLE A SIGNED W STATEMENi THAT HE OR SHE IS LICEN$$$EO PURSUANT TO THE PROVISIONS OF THE CONTPACiORS LI- . � � CENSE LAW(CHAPTER 9(COMMENCINC�WITH SECTION�u00)OF DIVISIOM 3 OFTHE BUSWESS AND PRD- V' POOVSp9 FESSIONSCADE)ORTHATHEOR�SHEISIXEMPTiHEflEFROMANDTHE&4SISFORTHEALLEGE�EXEMP- (� � � TION.ANYVIOLATIONOFSECiIDh17o3150VANYAPPLICANTFORNPERMITSUBJECT57HEAPPLICANTTO z qe-Roof A GVIL PENALTY OF NOT MORE TWAN FI,VE HUNORE�DOLLARS(E500).): 0 ❑I,ASOWNEROFTHEPROP RTV,pRMVEMPLOYEESWITH�VAGESASTHEIFSOLECOMPENSATION, ❑ Commercial � - Z .WILL DO THE WORK,AND iHE ST�UCTIjRE IS NOT INTENDED OR OFFEflED FOR SALE(SEC.7644,BUSF J � � �NESS AN�PqOFESSIONS CODE:THE CQNTR4C70RS LICENSE LAW DOES NOTAPPLV 70 AN OWNER OF ? PROPERIYWHOBUILDSOFIMPROVESj HEREON.ANDWHODOESSUCHWORKH�MSELFORHERSELFOR [[ THROUGH HIS OR HER OWN EMpL�OVEES,PROVI�ED THAT SUCH INPROVEMENTS ARE NOT IN7EN�ED OR m WQ OFFEREOWRSALE.IFHOWEVER,ITHEBUB-�IN3�PIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THf DWNEF}BUIL�ER WILLIHAVE�THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE).'� W , ❑I,ASOWNEROFTHEPROPEATY,'PMEXQUSIVELYCONTRACTINGWITHLICENSE�CON7RACTORS [[� TO CANSTRUCT THE PROJECT(SEC.lop4,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS ll- V8IE12Si0Yl �� ADJ.AREA LLI CEN5EUlWDOESNOTPPPLYTOANONMEROFAPROPERTYWHOBUILOSORIMPflOVESTHEREON,AND �� 'WHOCONTRAC75FORSUCHPROJECTSWIiHACONTRACTOR(5)LICENSE�PURSUANiTOTHECANTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). �, � � ❑1 AM EXEMPT UNDER SEC.'.i � fi.&P.G FOR THIS REASON � U �. I LL py` � DAiE ' ti/P I OWNEFl ¢ �� U � LICEN�ED¢ONTRACTORS DECLARATION W �� ��'IHEREBYAfFlRMUNOERPENAL�OFP�RJURYTHA'fIAMLICENSEDUNDERPFOVI510N50FCHAPTER � p: '��9(COMMENCINGWITHSECTION7,00)O��IVISION30FTHEBUSINESSA��PFOFESSIONSCODE,AN� .z X '�MY UCENSE IS IN FULL FORCE AND EFFECT. m � LICENSE CLAS. � <✓�I � LIC.NO. /�J�.�.Z� j sq J U �ATE�-^a� `�P�I C�9 f ��i I CONTRACTOR � n- . W � WORK�'IRS'COMPENSATION DECLARATION Q � 'IHEREBYAFFIqA1UNOERPENALTMOFPERJURYONEOFTHEFOLLOWINGDEC�AflATIOM1'3 Z z _IHAVEANDWILLMAMTAII�ACEFYTIFICAiEOFCONSENTiOSELF-INSUREFORWORKEpS' 2 COMPENSATION,ASPROVDED�YSECTION37ooOFTHELABORCODE,FORiHEPERFORMPNC'c U Q OF THE WORK FOR WHIG�THIS EflMIT I5 155Um. � 0 I �' W _I HAVE AND WILI MAINiAIµWORICERS'COMPENSATIOY INSURANCE,AS RE�UIRED BY SECTION y� r � Q 370o OF THE LABOR CODE�FOPtHE PERFORMANCE OF iHE WORK FOR WHICH THIS PERMIT IS �']y�� /'�' �i J ISSUED.MYWORKFA`5GdMPEN}�ATIONINS:!I�RANCECARRIEflANDPOLICYNUMBERARE: CONSTRUCTION /�r a GARRIER S�W 1�� �l^°���J PLAN REVIEW � ,�J t q 0 POLICY NUMBER y�l��Q F ����p �� ELECTRIC Z Q (fHISSECTIONNEmNOT06 P4ETEDOFh1EPERMfrlSWRONEHUN�RED�OLLARS(5100)OFLESS). PLUMBING p I ��5--� -y.� �.:i�-. Z . i CEflTIFYTHA7IN THE PERFOR NCE OFTHE WORK FOR W!{ICH THIS PEflMIT IS ISSUED,I MECHANICAL I �--' .-..� (!$ SHALLNOTEMPLOVANYP�IER50 INANYPAANNEPSOAS709ECOMESIl8JEC7TOiHE @`°i� . - - ^' ��C�� I (n WORKERS'COMPENSATIONLAW OFCALIFORNIA,ANDAGREE7FATIFISHOULDBECOME INSPEC710NFEE s SUBJECiTOTHEWORKE 5'CO PENSATIONPROVISIONSOFSECTION3'o00FTHEL4BOR O � i SF��4{�.F�RTHwii�coMp�v witN sE�ovisi s, ISSUANCE . y . . . � � � � p-� s � bATE:CJ L� G� A IPLICANT: �'l.f'Z/ SMIP i - I � �� J WAHNING FAILUPE 70 SECURE WORKERS'COtAPENSATION COVERAGE I5 UNLAWFUL,ANO SHALL�E ENERGY P/C �T M`� � SVBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESl1PTOONEHl1NDflEDTHOl1SAND ENERGYPERMIT - ----- -_- DOLLARS(5100.000�.IN ADDITION TO THE COSTOF COMPENSATION,DAMAGES AS PflOVIDE�FOR IN p - � SECTION37080FhIELA60RCOD,INT�REST,AN�ATTORNEY'SFEES. RETENTIONFFE: Y^ OCO�VSTR�CTION LENDING AGENCY pRE-ALT FEE: . � IHEREBYAFFIRMUNDEPPENALTYOFP RJURVTHATTHEREISACONSTRUCTIONLENDINGAGENCY FOR THE PERFORMAN TH oRK FO HIGH T IS PEflM1T IS ISSUED(SEG.3os�,CIV.C.). Z 8 I Lil ��� � � LENDERS N�� � I-'- LENDER'SADORESS � � ICERTIFVTHATIHAVEREA�7HISAPPLI�iIONANOSTATciHATTHEA60VE1N'rOftMATION150.74'iRECT. TOTAL FEES ���e �� 0. I AGREE 70 COMPLV WITH ALL GTY�AND OIJNiY OROINANCES AND STATE LAWS RELA7MG TO BUtLD11�G CONSTRUCTION,AND HEREBV AUTrORI E REPRESENiATIVE50F THIS COUN7Y TO ENTEF UPON THE '� zABOVEMENTIONE�PROPERTY FO�7INSPEC710N�URPOSES. COMMENTS � d I J I � I ¢ PERMfTTEE NAME(?RIN?) , � I Uj SIGNATUREO�PERMIiTEE �i �ATE z � ��. ftECPT.NO.�¢_. _ . PAID BY ��� � VALIDATION ~ ' HITE—Department Co YELLOW—Finance Copy,PINK—Assessor Co y GOLDENROD—File Co GflEEN—A IicanYs Co YV PY. P� PY� PP� pY - . . -- . :'... ;.� , ,..'.. .. :--�-. . ... �'.'...-, , .��. i t . 'a' 7, .::��;--`( �''@:,,�,NH::,:' .. -., . .. . . . ., . 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