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HomeMy WebLinkAbout16413 (20) � � � � CITY OF DIAMOND$AR � `- "''` DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)$60-3195 Fax(909)861-3117 PRES$ '��*�� BUQ,DING PERMIT APPLICATION �IRMLY y�, JOBSITE _,_ .. ..: _ APPUCATION � . PERM . .,.,: ... ,� . , .,_, ,._ ,,.,.. o ADDRESS Z�1�Y� C�a Ien �rcack �r DATE �� NUMBERI " #/C c� ISSUE TYPE OCC APN OT TRACT DATE CONST. GRQUP p OWNER C —� 1'�r _ � � ADDRESS V i') rGfi ZONING SETBACKS W CITY� ZIP "1 TE �1 'Ci?��S FRONT RW ❑ � APPLICANT TE . a '-I � REAR ❑ ~ � SIDE/SIDE STREET RW ❑ � CONTRAC R �C SIDE ❑ p� ADDRESS �'" 1.�A � CI7Y ZIP TEL Y t� �f � �J PROPOSEDUSE o ARCHlENG/ z DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROQMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION N � OWNER•BUILDER DEGLARATION SFRJADD/AEM O p I HEREBY AFFlHM 11NDER PENALiY OF PERJUqY THAT�AM EXEMPT FROM TNE CONTRACTORS LI- � Garage/Carport W CENSEUWFOR7HEFOLLOWNOREASON(SEC.7o37.58USINESSAN�pROFES510NSCODE:ANYqTYOR ZGOUNTYMhi1CNRE0UIRE9APEHMITTOCONSTRUCT.lU.7ER,IMPROVE,DEMOLISH,ORREPAIRANYSTqUG LL.I pat10/DBCk W TURE,PRpR TO ITS IS9UANCE,AL.SD REOUIRES THE APPLICANT fOR SUCH PERMIT TO FILE A SIGNED W � 3TATEMENT TNA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVI510N5 OF hIE CONTR4C70R6 LI- � CEPISE LAW(dUPTER 6(COMMENCINf3 WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRa- u' PooVSpd FESSIONSCODE)OFTHAiHEOR5NEI5EXEMPTTHEREfROMANDTHEBA5ISFOHiHE�ILEGEOEXEMP- (7 TION.ANYVIOLATIONOFSECTION7IXi1.58YANYAPPLICANTFORAPERM�TSU&lECiSTHEAPPUCANTTO � pg-ROOt � A CML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(E50o).): � �I.ASOWNEROFTHEPROPER7Y,ORMYEM7LOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � Commercial � YVILL�O 7HE WORK,AND hIE STRUCTURE IS NO7INTEN�ED OR OFFERED FOR SALE(SEC.70d4,BUSI- J NESSNiD PqOFE55lONS CODE:THE CONTRACTORS LICENSE LAW DOES NOTAPPLY i0 AN OWNER OF � GROFERTY1NiOBUILDSORiMPNOVESTHEREON,ANDWHODOESSUCNWORKMMSELFORHERSELFOR � � 7NFlOU(3F1 MIS OR NER ONTI EMPLOYEES,PROVIOED THA7 SUCH IMPROVEMENTS AqE NO7INTENDED OF � OFFEREDfORS/LL.EIF,HOWEVERINEBUIL�INGOR�MPROVEMEI�ITISSOLOWITHINONEYEAROFCOMPLE- Z TKKd,THE OWNER�BUILDER WILL HAVE THE BURDEN Of PROVING THAT HE OR SHE DID NOT BUILO OR � 1MPROVE FOR THE PURPDSE OF SALE�. ❑I,ASOWNEROFTHEPROPERTV.AM EXCI.�SIVELYCONiRACTINC WITH LICENSEDCONTRACTORS � TO CONSiAUCT THE Pfl0.1ECT�SEC.7011,BUSINESS AND PROFESSIONS CODE:THE GONTRACTORS LI- V81U2110f1 _ ADJ.AREA W CENSEUIWDDESNOTAPPLYTOANONRJEROFAOROPERTYWHOBUILDSORRAPROVESiHEREON,AND � WFIOCONTRACTSFOHSUCNPROJECTSWITHAGONYMCTOR(5)LICENSFDPURSUANTTOTHECONTPAG QUANTITY DESCRIPTION FEE � TORSUCENSEUW.�. �y ❑IAM EXEMPT UNDEH SEC._ B.8 P.C.FOR THiS REASON Q 7 � � LL OfTE OWNER .__�_,__ ~ Z � w � LiCENSED COMTRAC70RS DECLARATION ' � w I HEREBY AFFIRM UNDEH PENALTY Of PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEA �� Y �y, 9(COMMENCUJG WITH SECTION 7000)OF OIVISION 3 OF THE BUSINESS AN�PROFESSIDh"a COOF,AND Z x MY UCENSE IS IN N FtlRCE RND EFFEG?. m � W '�/` �} d LICENSECLASS �� �`�j _ LIC:.NO.� �"� � � F- L.> �r �1�K9__��1r � a V DATE �'"�____ _ CON7RACTOR W � WORKERS'COMPENSATlON DGCLARATION d � I HEREBV AFFIRM 11NDER PENALT/OF PEFiJURY ONE OF TV',E FOLLOWMG DECLARATIONS U�— � Z Q L _IHAVEANDWILLMAINTAIN.4CERTIFICATEOFCONSENTTOSELF-INSl1HFFORWORKERS' _ � COMPENSATI�N,AS PRGVIDEu BYSECTION 3TaoOF TME LA80R CODE,FOR THE PERFOHMANCE W OF'HE WORK FOR WFiICH THIS�Ei7M1T R ISSUEC. � O ,�HAVEN7D WILL MAlN7AIN WORKEPS'COMPENSATION INSl1RANCE,A5 REQUIFlED BY SE^TION Q� 3�0o OF THE L6BOR CAOE,FOR TNF.PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MYYIOP.KERS'GOMVENSA'iONINSUR rECARRIERANDPOIICVNUMBERARE: CONSTRUCTION � CARRIEN ��� _�. PLAN REVIEW Z POLICVNUAABER '��_____���'_ L— ELECTRIC _ Q �0 {{HISSCfK)tJNE�NOT6F.COA�(iETEUOFl1EPEPoMISfORIXJEI�tNAREDCOIiNtS(St00�0iilESS). PI.�AIG- / T— Z I CEAT�FY THAT INT1�E PERFORMPNCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSU�D,I MECNANICAL �R, SHALLNOT EfiAPI.�Y ANY PER50N IN ANY MANNER SD'1S TO BECOME SUEJEC'TO'HE � WOPoCEflS'CC�MPENSATKKJLAWSOFCALIFORNIA,ANDAGREF.THATIFISHOULDBECOME INSPECTIONFEE _ Stl&ECiTO iHE VJORKERS'COM9ENSATION PROVISIONSOF SECTION 37oP OFTHE LABOR ~ CO� ISHALLFORiHW�tHCQMPLYWITNTHOSEPROVIS NS. + 1 ISSUANCE ��f'y�('�__�/� p DAiE: �L� �� AP%.lCANT.t!_S_,1_.L��-L�CL'1�LSr�ALi��" SMIP "" �� W ENFFGY P!C J WMNINGFAILURE705EWREWORKERS'COMGENSATIONCOVERAGE�SUNUWFUL,AND5r1ALLBE � � SU&IECTAN 9.�P!OYERTO CRIMINAL PENAlTIES ANO CIVILFWES UP TOONE HUNDREDTHDUSANO ENERGY PERMIT ,�,�� � DOLURS(St00.o00�,tN ADDITION TO THE COST OF COMPE45ATION,DAMAGES AS PHOVIDED FOR iN �.�_•,� ,� J� SECT�ON3]aeOFTHELA80RCODE,INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBY AFFIflM UNDER PENALTV OF PERJURY THAT THERE IS A CqNSTRUCTION LENDING AGENCY n- FOR THE PERWRMANCE OF 71'7E WORK FOq WHICH THIS PEPMIT IS ISSUED(SEC.3o8�,CIV C.). Z W � LENDER'SNAME�__ F— LENOER'SADDFE55.__ W I CERTIfY THAT I HAVE READ TNIS APPLICATION ANO STATE TNATTHE A90VE INFORMAiION IS CARRECT. TOTAL F E ES � � � d I AGREE TO COMPLV WITH ALICRYAND COUNTY OROINANCES AND STATE LAWS RELATING Tp 9VIlDING CONSTRUCTION.AND HEPEBY AUTHOAIZE REGRESENTATNES OF iHIS COUNTY TO EMEF UPON THE ZA00YEMENTIONE PPOVERNFORINSPECTIONPVRPOSES. COMMENTS � .�/l v/`✓' C� °e,.� � _ m PE MITTe N (PRINTI �y p�� 1 � � a.`.^C � � SIGNAU OFPEflMIT�E �A = REGPT.NO. 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