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HomeMy WebLinkAbout17501 CITF OF DIAMOIVD BAR -�'�`-- DEPAIZ'�'�ENT OF C�MMUNITY�&DEVELOPMENT SERVICES - - I I � i - 21825 E.Copley Drive ' �`�` (909)860-3145 Fax(909)861-3117 PRESS "'%v��'"' BUILDING PER1dII'P APPLICATION FIRMLY � JOBSITE �2 APPLICATION ' PERMIT P/C o ADDRESS !7 DATE � !�� � NUMBER I� # � ISSUE TYPE OCC APN LOT T ACT DATE CONST. GROUP � OWNER O "� ADDRE�S ZONWG SETBACKS z C4TY ZBP TEL. FRONT RN/ ❑ � APPLCANT TEt. REAR ❑ � SIDE/SI6E STREET RW ❑ � CONTRACTgB S1DE ❑ o CDD E5� ZI TEL. � /-� PRO..��P�.�� w ARCH/ENG/ d���/��tm`/�� �z DESIGNER NO�WE� . a ADDRESS UNITS S ORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION � OOWNER-BUILDER DECLARATION SFFVADD/REM p I HEREBY AFFlRM UNDER PENALTY OF PEflJURV THAT I AM EXEMPT FROM THE CDN7qACiORS LI- G8f3JB/CB�Oft W CENSEI.AWFORTHEFOLIOVJINGREA5ON�5EC.7031.6BUSINESSANDPROFESSIONSCODE:ANYCITYOR (/� C�' COUNTYWHICHFEQUIRESAPERMITTOCONSTRUCT.ALTER,IMPROVE,DEMOLISH,OppEPAIRANYSTRUC- W pa?IOI�BCk W �TUPE,PPIOR Tb ITS ISSIIANCE,AL50 RE9UIRES THE APPLICANT FOR Sl1CH PERMIi TO FILE A SIGNED , � �STATEMENT THAT HE OR SHE IS LICEM1'SED Pl1RSUANT TO THE PROVISIONS OF THE CONTflACTORS LI- . � .CENSE LAW(GHAP7ER 9(COMMENCING Wihi SECTION 7a00)OF DIVISION 3 O'r THE BUSINESS AN�PRO- � POOUSPe FESSIONSCODE�ORTHATHEORSHEISEXEMpTTHEREFROMAND7HE8A51SFORTHEALLEGEDEXEMP- (� i V �710N.ANVVIOLATIONOFSECTION7031.50YANYAPPLICANTFDPAPEflMITSUeJECTSTHEAPPLICANiTO Z Re-Roof '�, F,� 'A qVIL PENALTY OF NOTMOflE�THAN FIVE HUNDRE�DOLIARS�EsoO),): O , r�,pS OWNER OF iHE PROPERN,OR MY EMPLOYEES WITH WP.GES AS THEIR SOLE COMPENSA710N, , Z� �'�WILL 00 THE WORK.AND THE STRUCTURE IS NOi.INTENDED OR OFFERED FOR SALE(SEC.7D44,BUSI- J Commercial -� �'�'' '�,NESSAND PROFESSIONS CODE:THE CONTRACTOFS LICENSE LAW OOES N07 pPPLY TO AN OWNEq OF � ' . �.PROPERTYWHOBUILOSORIMPROVESTHEflEON.AN�WHODOE55UCHWORKHIMSELFORHEFSELFOR � �. ��THROUGH HIS OR HER OWN EMPLOYEES,PROVI�ED THATSUCH IMPpOVEMENTS ARE NOT INTENDED OR � �, Q� OFFERmFORSALE.IFHOWEVFA,THEBUILDINGORIMPRWEMENTISSOLDWITHINONEYEAROFCOMPLE- Z� '�.TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVMG THAT HE OR SHE�ID NOi BUILD OR , �„ ,IMPROVE FOH THE Pl1flPO5E OF 5ALE). � ❑I,ASOWNEROFTHEPROPERTY.AME%GLUSNc'LYCONiRACTINGWRHLICEN5E0CCNTRACTORS �.'�. ',TO CON57Rt1GT THE PROJECT�SEC.7044,BUSINESS ANO PflOFES5IONS CODE:THE CONTFiACTORS LI- VdlUafi0fl _ ADJ.AREA � W"� ';CENSELAW�OESNOiAPPLVTOANOWNEFOFAPROPERTYWH08UILDSORIMPROVESTHEREON,ANP . ���',IWHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S�LICENSEDPUHSUANTTOTHECONTFAG pUANTITY DESCRIPTION � FEE � Y'.',TORSLICENSELAW.). � ❑I AM E%EMPT UNDER SEC. B.&P.Q FOR 7HI5 REASON Q � � U � 2 DATE ONMER U W � LICENSED CONTRACTORS DECLARATION W � ¢ Ir, I HEREBYAFFIRM UNDER PENALTY OF PEFUURY THA71 AM LICENSED UNDEF PROVISIONS OF CHAPTER � �, (y_, 9(COMMENqNG WITH SECTION 7400�OF OIVI610N a OFTHE BUSMESSAN�PROFESSIONS CODE,ANO Z �X MY LICENSE IS IN FULL FORCE AND EFFECT. m � UCEN5E CLqSS LIC.NO. �,_ j � J � ��, DATE�'� CONTRACTOR �- W �� WORKEAS'COMPENSATION DECIARATION a � U � IHEftEBYAFFIRMUNDERPENALTYOFPERJURVONEOFTHEFOLLOWINGDECLARATIONS: z Q � _IHAVEANDWILLMAPJTAINACERTIFICATEOFCONSENTTOSELF.INSUREFORWORKERS' _ CDMPENSATION,ASPROVIDEDBVSECTION37ooOFTHELABOPCODE,FOFTHEPERFORMANCE U ¢ OFTHE WORK FOR WHICH THIS PEFMIT IS ISSUED. � Q W _INAVEANOWILLMAIMAINWORKERS'CGMPENSP710NINSURANCE,ASREQUIREDBYSEC710N Q �, 3�000FTHELA6oRCODE,FORTHEPERFORMAYCEOFTHEWORKFORWHICHTHISPERMITIS ���,I3�� ISSUE�.MYWORKEAS'C MPENSATIONINSIIRANCECARRIERANDPOUGYNUMBEPARE: CONSTRUCTION !` L � , CARRIER �� PLAN REVIEW , � POLICYNUMBER_ N��I�S.'C��;�_�,� ELECTRIC C/ Q. p QHISSECTION�EmNO76ECO1,dPLETEDOF7HEPeRMRISWRONEHUNDREDD0UM5($100)ORLESS). PLUMBING W� ICERTIfYTHATINTHEPERFORMANCEOFTHEWORKFOflWHiCHTHISPERMiiISIS5UE0,1 MECHANICAL �. (�'. SHALLNOTEMPLOYANVPERSONINANYMANNEFSOASTOBECOMESIIBJECTTO7HE � '' -' :,'�� --' � � �� WDRKERS'COMPENSATION LAWS OF CALIFORNIA,q�D AGREE iHAT IF I5Fi0ULD BEGOME INSPECTION FEE , � SUBJECT TO THE WORKEFS'COMPENSATION PROVISIONS OF SECiION 37Co OF THE LA90R �- -- � a � � COUE,ISHALLFOflTHWITHCOMPLYWITHTHOSEPROVI510NS ISSUANCE f �]� � DA7E: APPLICANT: SMIP e� � 7� ^ �� � � ENERGY P!C , �� J'. WARNWGFAILURETOSECl1REWORKERS'COMPENSATIONCOVERAGEISLINL4WFl1L,ANDSHALLBE �yy ','SUBJECTANEMPLOYERTOCRIMMALPENALilESANDqVILFINESUPTOONEHUNOREOTHOUSAND ENERGYPERMIT - '��DOLLARS(St0o,0oo),INADDITIONiOTHECOSiOFCOMPENSATION,�AMAGESASPROVIDE�WRIN ' Y ✓ J �� SECTION 3]aB OF THE LABOR CODE,INTEREST,ANDATTORNEY'S FEES. '�- ` S 4�e ..._:._ "_'_. � �, RETENTION FEEi - -------� - ------ £m pW., CONS7ftUCTION LENDING AGENCY PRE-ALT FEE O LG ' IHEREBVAFFIPMUNDERPENAL7VOFPERJURYTHATTHEREISACONSiAUGTIONLEN0INGAGENCY ' �-' FOR THE PERFORMANGE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.309],CIV.GJ. ' - � � _ — � LEN�ER'SNAME 1-- �LENDER'SADDHESS � ICERTIFYTHATIHAVEREAO7HISAPPLICATIONANDSTATETHA7THEA90VEINFORMATIONISC�RRECT. TOTAL FEES / �� ,� W I AGqEE TO COMPLY W17H ALL C17V AND COUN7V ORDiNANCES ANO STATE L0.VJS RELATWG 70 9UIL�ING �. CONSTRUGTION,AN�HEHEBYAUTHOflIZEREPriESENTATiVESDFTHISCOUNTYTOEN-ERUPON7YE � A90VE-MENTIONE�PflOPERTYFORINSPECiIONPURPOSES. 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