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HomeMy WebLinkAbout16848 _ _ �_ _ _ ���� �'�,�a�a. �G��� ���' ,,� , CITY OF I�IAMOND�AR -� --- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �i � y�21825 E.Copley Drive ' (909)860-3195 Fax(909)861-3117 PRESS '"'%.�ri�' BUILDINGP�'RNdITAPPLICATION FIRMLY o ADDRIESS ; � � �yt^� APPLICATION d �"yJ�jUMBER ��� �1C DATE c� ISSUE NPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER �1h/r►�.�_��3%X�' ADDRESS ZONING SETBACKS z CITY ZIP TEL. FRONT RW ❑ g APPLICANT TEL. REAR ❑ z SIDE/SIQESTREET RW �. � GONTRACTOR�I�Q°�� �U1Z+C. -I.�l� SIDE ❑ oADDRESS �"�i��+:i��� PROPOSED USE crrr ��4 ZIP�p�TEL���s��I`f�C� � ARCH/ENG! z DESIGNER NO.DWEL. NO. NO. a, ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT, FACTOR PSF ADJ.AREANALUATION cn O OWNER-BUILDER DECLARATION SFR/ADD/REM p 1 HEAEBY AFFIRM UN�ER P�NALTY OF PERJURY THAT I AM EXEMPT FROM Tf1E CONTRACTORS LI� � Garage/Carport W CENSEUWFORTHEFOLLOWING�,REASON(SEC.7031,56USWESSANDPPOFESSIONSCDDE:ANYCINOfl � CIXINTVWHICHREQUIFESAPERMITiOCON5TRl1CT,ALTER,IlAPROVE,DEMOLISH,ORREPAIRANYSTFUF W patio/Deck TURE,Pq10R TO ITS ISSUANCE,ALSO RE�NRES iHE APPLICANT FOR SUCH PERMIT TO FlLE A SIGNE� � SiATEMENT THAT HE OR SHE IS UCENSED PURSUANT i0 THE PROVISIONS OF THE CONTAACTORS L6 �� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 FNO PRO- LL PooUSpa FESSIONS CODE��OH THAT HE OR SHE IS FXEMPTTHEREFROM ANO THE BASIS FOF THE ALLEGED EXEMP- � TION.ANYVIOLATIONOFSECTION7031.56YANYA?PLICANTFORAPERMITSU9JEGTSTHEAPPLICANTTO Z Re-Roof AqVl4 PENALTY OF NOT MORE THAN FIVE HUN�RED DOLlARS(ESoo�.): ZC]I,ASOWNEROFTHEPROPERN,ORMVEMPLOVEESWITHYJAGESASTHEIRSOLECOMPENSATION, � CORIR70fC1&I � WILL DO THE WORK,AND THE STFtUCiUftE IS NOT INTENDED OR OFFERED FOrlSALE jSEC.7044.BUSI� J � NE55 AND PROFESSIDN6 CO�E:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNEq OF � , PROPEHTY N^ri0 BUIL0.S OR IMPqQVES THEREON.AND WHO�OES SUCH WORK HIMSELF OR HERSELF OR Q THROUGHHISORHEflOWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOq m QOFFEREDFORSALEIF,HOWEVER,THEBUILOINGORIMPROVEMENTISSOLOWITHINONEVEAROFCOMPL6 � TION,THE OWNER-BUILDEfl WILL�HAVE THE BUfl�EN OF PROYMG THAT HE Ofl SHE OID NOi BUILD OR � IMPROVEFOflTHEPURPOSEOFSALE). L]I.AS OWNER OF iHE PROp,EflTY,Ah7 E%CLUSIVELY CONTRAGTING WITH LICpNSED CONTRACTORS �. � TD CONSTRUCT THE PROJECT�SEG 7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VBIII&tlOfl ADJ.AREA ' W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPEPTYWHOBUiLD50RIMPROVES?HERC-0N.AN� � � WHOGONTRACTSFOFSUCHPPO.IECTSWIhiACONTRACTOfl(5)LICENSEDPURSUANTTOTHECONTHAG QUANTITY DESCRIPTION FEE - � Y TORS LICENSE LAW.). � ❑IAM EXEMPTUNDERSEC. 0.&P.F FORTHIS REASON U S � � � F i Z oare owNea U �,� w , a LICENSED CONTRACTORS DECLARATION W � Q IHEREBYAFFIRMUN�eRPENALTYOFPERJl1RYTHATIAMLICEN5E0UNDEFPROVI510NSOFCHAPTER � a, 9(COMMENCIMG WITN SEC710N�ODO)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,A��1D Z X MY LICENSE IS IN FULL FORCE AND EFFECT. � � � LICENSE CLASS ��,_LIC.NO. ��O l 3 ��_���,,Ty ` j � V DATE GONTRACTOR���_S;jj.Ty_� a � � � RKERS'COMPENSATION DECLAFlATION a = U � IHEREBYqFFIRMUNDERPENALTYOFPERJURVONEOFTHEFOLLOWiNaDECLARAilONS: f� a � _IHAVEANOWIL�MAINTAINACERTIFICATEOFCONSENTTOSELFINSUF7EFOAWDRKERS' _ COMPENSATION,AS PflOVIDED 6V SEC710N 9�0o OFTHE LABOR CODE,FOR THE PERFORMANGE U a OFTHEWORKFORWHICH'THISPERMIiI5155UED. � ' 0 W IHAVEANOWILLMAINTHINWORKERS'COMPENSAiIDNINSURANCE.ASRECUIRED6Y5ECTION Q 37aoOFTHELABOflCODE;FORTHEPERFORMANCEOFTHEWORKFOflWHICHTHISPERMiTIS ' ISSUEO.MYWORKERS'COMPEN6ATIONINSU�RAnNC�E�CARRIEAANDPOIICYNUMBERAFE: CONSTRUCTION j cARaiEa - �l pp�.� �t_J�p� PLAN REVIEW � POLICYNUMBER (.�HH�_�'��/ ��� ELECTRIC �-- � � (iHI55EC110NNE�NOTBEWhPLEfEDOFhIEPERMffI5F9PONEHUNJREDDOLLAAS(5100)ORLE55). PLUMBING ���,� '�,�- p� ����`..�3<� Z I CERTIFYTHAT IN iHE PERFORMANCE OF TNE WORK FOR VlHICH THIS PERMIT IS ISSUEO,I MECHANICAL' . _ _ , , [� SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESl1BJECTiOTHE � �j ¢• � I V-j WORKERS'COMPENSATIONLAWSOFCAUFORNIA,ANDAGREETHATIFISHO'JLOBECOME INSPECTIONFEEE I S Sl1BJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION3]OOOFTHElA90P f /'� . G'O�D�E,I SHALL FORTHVJITFI GOMPLY WI . PROVISIONS. ISSUANCE i / J ,/1 ,� . p DATE:yN.ajZ�J�Qi APPLICANT: SMIP �.�.�,��,` —� . .�. _.—Y� . , � �a��j ENERGY P!C � -"""'.a�".""".._-� WAFNING FAILURE TO SECURE WpRKEflS', PENSATION COVERAGE IS UN L,AND SHN.L BE � SU&IECTANEMPIOVERTOCRIMINALPEN IESAN�CIVILRNESL1P700NEHUN�REOTHOUSAN� ENERGYPERMIT DOLLPRS(S7oo,oW),IN A�DITION TO THE COST OF COMPEN9ATION,OAMAGES AS PpWIOED FOR IN J SECTION 37oe OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, RETENTION FEE: � d GONSTRUC710N LENDING AGENCY PRE-ALT FEE: O CC I HEREBYAFFIRM UNDER PENALiY�OF PERJURV THATTHERE IS A CONSTRUC.TION�EN�ING AGENCY � FOR THE PEftFORMANGE OF iHE WORK FOR WHICH TFlIS PEflMI7 151SSUE�(SEC.309'!,CIV.C.). Z W S� LENDEfl'S NAME F- LEN�EP'SA�DRESS � ICEFTIFYTHA7IHAVEREADTHISAPPUCqTIONANDSTATETHATTHEABOVEINFORMAiIONISG0�9REGT. 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