HomeMy WebLinkAbout15073 (19) �'/''�lrc�-G<'
CITY OF DIAMOND BAI� � J/
w -"��� DEPARTI^ZENT OF COMMUNITY&DEVELOPMENT SERVICES �� -����'�
. a 21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
����� BUII,DING PERMIT APPLICATION FIRMI.Y
= - ' , __
� JOBSITE 1��� /����� DATECATION t�.,, PERMR J /')�P/C
Q ADDRESS { C � `C� NUMBER 1 �' #
� ISSUE �'�TYPE OCC
APN OT TRA T DATE CONST. GROUP
p OWNER
�` ADDRESS ZONING SETBACKS
Z CITY � ZIP��._ TEL. REART RW �❑
g APPLICANT TEL. SIDElSIDE STREET RW ❑
� CONTRACTOR SIDE ❑
� ADDRESS -.. PROPOSED USE
� CITY ZIP EL.
�� ARCH/ G/�
DESIGNER NO.DWEL. NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
� CiTY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
�
Q OWNER-BUILDER DECUIRATION SFR/ADD/REM
O
p I HEREBY AFFlRM UNDER PENALTY DF PERJURV THAT I AM EXEMPT FFiOM THE CONTRACTORS LI- � GaragelCarport
W CENSEUIWFORTIEFOLLOWINGREASON(SEQ7o31.68U31NE53ANDPROFES$IONSCODE:�ANYC1iYOR
U COUNlYWHIqiREDURESAPEHMRTOGONS7RUCT.ALTER,IMPROYE,D9ui0U5H2ORREPAIRANVSTRUC� w patio/Deck
W NRE,PRIOR TO RS ISSUANCE,AlSO REQUIRES THE APPIICANT FOR SUCM PERMIT TO FlLE A SIGNED
.` STATEMENT THAT HE OR SHE IS LICE�EO PURSUANT TO THE PROVISIONS OF THE CONTRAC70R5 LI-
� CENSE LAW(CHAPTEN V(COMMENCiNCi WITH SECTION 7000)OF DNISION e OF THE BUSINESSlN�PRO� u' PooUSpa
FESSIONS COD�UH 7HAT HE OR SHE IS F.XEMPTTHEREFROM ANO THE BASIS FOR THEALLEGED E%EMP-
TION.MJVVKK.ATIONpFSECTION7031.58YANYAPPUCAN7FORAPERMITSU&IECTSTHEAPPLICANTTO Z R6-ROOf
� ACIVILPENALiYOFNOTMORETHANFIVEHUNDREDDOLLARS(S5o0)J:
� ❑I,ASOYJNEROP7HEPFOPEHTV,ORMYEMPLOVEE6WI7HWAGESASTHEIHSOLECOMPENSATION, 0 COmmBfdal `
WILL�O TME VYOAK AND THE STRUCTURE IS NOT INTENDED OH OFFERED FOR SALE(SEC.7oI4,BUSI- .J
NESSAND PROFESSIONS CODE:7HE CANTRACTORS IICENSE lAW DOES NOTAPPLY TO AN OWNER of
� PROPERTYVYHOBUIL�SORINOPROVESiHEREON,ANDNMOU0ES5UCHWOHKHIMSELFORHERSELfOR m
� THRIX1fWHISORHEROWNEMP�OYEES,PROVIDE�iHATSUCHIMPROYEMENTSARENOTINTENDE00p
0 OFFERWFOPSALEIF,HDWEVER7NEBUIIDINOORIMPROVEMEN�I550LOWITHINONEYEAROFCOMPLE-
Z TpN.THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILO OR
= IMPl�VE FOR THE PURPOSE OF SAL�. �
❑I,AS ONMER OF THE PROPERTY,AM E%CWSIVELY CANTRACTINO WITH LICENSED CONTRACTORS
� TO CONSTRUCT 7HE PRO.IECT(SEC.7o46,BUSINE55 AND PROFESSIONS COOE:THE CONTHACTOqS�I- VdIUBIlOI1 ADJ.AAEA
W CENSEUIWDOESNOTAPPLYTOANOWNEROFAPROVERTVWNOBUILDSORIMPROVESTNEREON,AND
� WIIOCONTMCTSiORSUCHPROJECTSWITHACONTRACTOR(S�LICENSEDPURSUANTTOTHECONfRAC QUANTITY DESCRIPTION FEE
� TORSUCENSEUWJ.
J
O ❑I AM EXEMPT UNOER SEC. 8.8 P.C.FOR THIS(iEA50N Q
� U
�
� DATE OWNER U
Z W
F-ti_'- LICENSED CONTRACTORS DECLARATION �j
� I HEREBVAFFIRM UNDER PENALTV OF PERJURY THAT I MA IICENSED UNDER PROVISIONS OF CH0.PTER � �^° �
� B(COMMENCINQ'MTH SECTION 7000)OF DIVISION 3 OF THE BUSINESSAND PFiOFESSIONS CODE,AND Z
XL' MY LICENSE IS IN FULL FO F ECT. ��@ m
LLI \
0 UCENSE CLASS LIC.NO. J
J
�j oare caurancroa o-
w
� WORKERS'COMPENSATION DECLAFATION a
= U
� IHEREBYAFFlRMUNDERPENPL7YOFPEFiIURYONEOFTHEFOLIAWINGDECLARATIONS:
y Z
Q
� I HAVEANO LL MAINTAIN ACERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' S
� COMPE ION,ASPROVIDED6VSECTION37UOOFTHELABOFCODE,FORTHEPERFORAAANCE W
OF WORK FOR WHICH THIS PERMIT 16IfiSUED. � ,
�
W 1 HAVE IW�WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION
Q 370oOFTHELA90RCODE.FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS
� �SSUEO.bIV WORKERS'COMP NSATI INSURANCE AR R � uMs=_anAE: CONSTRUCTION
� CARHIER PLAN REVIEW -
�ZZ POLICYNUMBER ' ELECTRIC /� �
Q (IHISSECTIONNE�NOTBE(x1MPLEfEDOF7F�E RrM�SFORO1dEHUNORED (Siao)orj��cs} PLUMBING �'�'�F /'�.�
Z ICERTIF`/THATINTHEPEPFOfiMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED.I MECHANICAL
(} SFLILLNOTEMPLOYANVPERSONINANVMANNERSOAST08ECOMESUBJECTTOTHE /� Q"�
� WOPKERS'COMPEN TION LAWS Of CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTIDN FEE y �� T t �,a$�
SUBJEC OTHE RKEFS'COMPENS ROVISIONSOFSECTION97o00FTHELABOR `� � � -