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HomeMy WebLinkAbout16914 (37) CI'1'Y OF DIAMONA BAR ------� DEPAR'f'NIENT OF COMMUNITY&DEVELOPMENT SERVICES I 21825 E.Copley Drave (909)860-3195 Pax(909)861-3117 � �� q t ��� /�l+ PRESS "'`%yri�' ' �jJILDINf1`PERMITAPPLICATION J �� FIRMLY lfW" a DDRIESS �I��� � �n����' �tiv�d� DATEICATION ,y���l NUMBER #/_�,��'� �A W � ISSUE TYPE OCC APN LOT TRACT_ ��t DATE CONST. GROUP �_ a OWNER 1��"1�°�-��„\` G�s@�''�r �.�;ll11�i'�--'.� �'� ADDRESS �� "�° .a°'*�-" - '� ZONING SETBACKS � CITY �V�'���-. , Z!P TEL.�`�{' "���'"'li��� FRONT RW ❑ APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ ! a CONTRACTOR ��,�"i,�,.i�C�a:. �'-����'h�.��r k�tLY� SIDE ❑ ADDR ,S��t� f�,�u^���&'.�3� '�'e � PROPOSED USE � � CITY �l-" "" '''�"� ZIP `�'��TEL.Yf e1".::d��� � w ARCH/ENG/ ., y , z DESIGNER �' ��- � 0. ADDRESS """�`� ��i+�'r+� '� �r``� " ,(s ..-fa�f.°,` NO.DWEL. N0. NO. � CITY �R.i�'�a"q;i�' ZIP��,s..-TEL.�`'9�-d'L�°'1�=O�� UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION �. d O{fJNER-6UILDER DECLARATION SFR/ADD/REM i 0 I li p 1 HEREBY qFFIflM UNOEft PENALTY OF PEFJURY THAT 1 AM EXEMPT FflOM THE CONTRACTORS LI- � Garage/Carport W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031bBU51NESSANDPflOFESSIONSCODE:ANVCITVOR z COl1NTYWHICHREOUIRESAPER,1ITTOCONS7RUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- "I W Patio/Deck � NRE,PRIOR TO ITS ISSUANCE,�L50 RE�UIRES THE APPLICAM FOR SUCH PERMIT TO FILE A SIGNED � STATEMENT THAT HE OR SHE IS ICENSE�PURSUANT TO THE PROYISIONS OF THE WNTHACTORS LI- � CENSE LAW(CHAPTEH 9(COMME,CING'.WITH SECTION 7000)OF ONISION 3 OF THE BUSWESS AND PRO- � POOVSP& FESSIONSCO�E)ORTHATHEORSHEISEXEMPTTHEREFflOMANDTHEBA515FORTHEALLEGEDEXEMP- � . �. TION.ANVVIOLATION0=5ECTION7091.SBYANYAPPLICANTFORAPERMITSU&lECTSTHEA?PIICANTTO Z Re-Roof � ACIVILPENALTYOFNOiMORET�ANFIVEHUNORE�DOLLARS($500).)� Q . ❑I,ASOWNEROFTHEPROP R7Y,OfiMYEMPLOYEESWITHWAGE5A5iNEIR50LECOMPENSATION, � Gommercial I � ���„ WILL DO iHE WORK,AND THE 5T{iUCTIJRE IS NOT INTENDED OF OFFEREO FOR SALE(SEC.7o4q BUSI- ._I NESS AND PROFESSIONS CODE:hiE WNTRACTORS LICENSE LAW DOES NOTAPPLV TO AN O1M1'NER OF � �' PROPERTYWHOBUILDSORIMPRbVE�THEREON,ANDNMOCOE55UCHWORKHIMSELfORHERSELFOFI = CC. ,THROUGHHISORHEROWNEMPLIJYEES,PftOVIDEDTHATSUCHIMPROVEMENiSARENOTIN7ENDEDOR m Q� OFFEREOFORSALE.IFHOWEVER,�iTHE0UIL�INGORIMPROVEMENTISSOtDWITHINDNEYEAROFCOMPLE- Z .TION,THE OWNER-eUIL�ER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NDi BUILD OF � IMPROVEFORTHEPURPOSEOF�yA�EJ.'� ❑I,AS OWNER OF THE PFOPERT:AM EXCLUSIVELY CONTRAC fING WITH LICENSEO CONTRAC�ORS �. TO CONSTRUCi THE PROJECT(SEC.7044,OUSMESS ANO PROFESSIONS CODE:THE CONTRACiORS LI- VdIU3flOf1 ADJ.AREA CL', ' CENSELAWDOES�iAPPLVTO:ANOWNEROFAPROPERiYWHOBU1L�50RIMPRO4ESTHEREON.AN� _ ,WHOCONTFACT3FORSUCHPRO ECTSWITHACONTFACTOR(5)LiAENSEDPUflSUANTTOTHECONTRAF QUANTITY DESCRIPTION FEE ~ TORSUCENSELAW.�. � /'� � ' ❑IAMIXEMPTUN�ERSEC.� 6.&P.C.FORTHISREASON U �� `�' � � � DATE OWNER �' Z �j QLICEN�ED CONTRACTORS DECLARATION w � IHEREBYAFFlRMUNDERPENALT�'OFPEAJURYTHATIAMLICENSEDUNDGflPROVI510N50FCHAPTER � Q 9(COMMENCMIG WITN SECTION 7am�OF DIVISION 3 OF THE BUSINESSAND PROFESSIONS CODE.AND Z X MY LICENSE IS IfV FULL FOFCEAND EFFECT. "' � `""'` `� � � LICENSE CIASS I LIC.NO. ���� J � ,,�+=���, U DATE �,'��j�-+��-'"� CONTRACTOR �L�LyP`�' �.'D(��4 y �- W ���,� J � WORKE,RS'COMPENSATION DECLARA710N ¢ � IHEREBYAFFIRMUNDERPENALTYOFPERJUFYONEOFTHEFOILOWWGDECLARA71CN5', U U'j Z 0 _IHAVEAN�WILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSl1REFOflVJORKERS' � COMPENSAiION,AS PftOVIDE�BY SECiION 37ao OF THE LABOR COOE,FOR THE PERFOaMqNCE U d OFTHEWOflKFOpWHiCHTHIS?ERMIiISISSUED. � W .�I HAVE AND WILL MAINTAIN�,WORKERS'COMPENSATION INSUpANCE.AS REQUIRED BY SECTION Q 3700 OF THE LABOR CODE�FOR THE PERFORMANCE OF THE WORK FOR WHICH iHIS PERMIT IS C�_ '�j ISSUED.MV WORNEAS'CO�MPFNSAilO�INSURANCE CARRIER AND POLICY NllldBERARE GONSTRUCTION ] _ � CARRIER ��`���,i��� � i�� �-s �-�y�- PLAN REVIEW Z POLICYNUMBER '�D� 1��.'�.Y,`,+���.3 ELECTRIC `�..� Q ����� � (I711SSECTKKJN�NOTBEWMP�EfEDOFhIEPERMITISFORO.VEHUNOREDDOLLIRS(5100)ORLE55) PLUMBING Z �CERTIFYTHAT IN THE PERFORMANCE OFTHE WOFK FOfl WHICH THIS PERMIT IS ISSUED,I MECHANICAL �' ' SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECiTO THE � NKIRKERS'COMP_NSATIO�ILAWSOFCALIFORNIA.ANDAGREEiHATIFiSHW�DBECOME INSPECTIONFEE � SUBJECTTOTHEWORKE S'COMPENSATIONPROVISIONSOFSECTION37000FTHELA80R � � CODE,I/SH'ALLF-0RTHWIT�COMPLY W'ITH THOSE PRDVISIONS, ISSUANCE �. � � DA7E: ✓ Ci��✓l AF�PLICA - � � ' �� �"' � ` � SMIP Z.J J WAflNING.FAILURETOSECUFiEWORI�A5'COMPENSATIONCOVERAGEISUNLAWFV4.ANDSHA E ENERGYP/C (�q �_? ��'��_ ,,,_ � SUBJECiANEMPLOYERTOCpIMINALPENALTIESANDCIVILFINESUPi00NEHUNDREDTHOUSA 0 ENERGYPERMITb �04LAR5(51o0.oC0�,W ADDITION TOL THE'COST OF COM?ENSATION.DAMAGES AS PROVIDE�FDR IN --- � S�CTION 3]tle OFhIE LABOR CODk„IN7EREST,AND ATTORNEY'S FEES. £ y' f" ' � RETENTION FE�:� ��3i"��,,.�TT� � GOI�STRUCTION LENDING AGENCY PRE-ALT FEE �'y, d IH6REBYAFFIqMUNDERPENAL7VIOFFERJURVTHATTHEREISACONSTRUCTIOkLEN�MGAGENCV � / .S zFORTHEPEflFORMANCEOFTHEY�'OFKFORWHICHTHISPERMIT151SSUED(SEC.309].CIV.C.). �� �`[� — — — � W S LEN�ER'S NAME � 1_ � LENOER'SA�DPE55 _...__ .. � ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHAiTHEABOVEINFORMATIONISCORRECT. 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