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HomeMy WebLinkAbout16532 (22) , ,.,,.��.._...__. .�;,. . _.�._.�,�— . ,..�•^°' _��_ CITY OF DIAMOND BAb2 � DEPARTMENT OF COMMLT1vITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 ti�'.,, (909)860-3195 Fax(909)861-3117 PRES$ BUQ,DING PERMIT APPLICATION ' _ , � �IRMLY ,. : . _. ... . � JOBSITE '��, APPLICATION " PERMIT ��1� P/C o ADDRESSC��f�(�L�L�-1�.�' ��� DATE �4 � NUMBER � L�'��� c� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GRpUP p OWNER p ADDRE S ZONING SETBACKS W CITY ZIP TEL.��9 FRONT AW ❑ � APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ CONTRACTpR � � �4 �� ;� SIDE ❑ � ADDRESS p ppOSED USE � CITY ZIP� TEL. 3 �,�.��w o ARCH/ENG/ � l � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OOWNER-BUILDER DECLARAT�ON SFR/ADD(REM � I HEREBV AFFlRM UNDER PENALN OF PEfL1URY THAT I AM EXEMPT FROM THE COMRACTORS LI- � Garage/Carport W CENSEUWFORTHEWL40WINOREA90N(SE0.7o97.58USINE55ANDPROFESSIONSCODE:ANYCITYOR CJ (bUMYWNICHREQUIRESAPEPM�TTOCON5TRl1CT,ALTER.IMPROYE,�EMOLISH,ORflEPAIRANVS7RUP 'W patio/DeCk �?� TURE.PRIOR TO ITS ISSUANCE,ALSO REW IRES THE APPIICANT FOq SUCN PERMIT TO FILE A SIGNED � STATEMENT THAT HE OR SME IS LICENSEO PURSUANT TO THE PROVISIONS OF THE COMRACTORS LI- CENSE LAW(CHAPTEH B(O�MMENCINO WiTH SECTION 7000)OF�IVISION 3 OFTHE 9USINESS AND PRO� � PooUSpd FESSIONS CODEy OF 7H�7 HE OH SHE IS E%EMP7 THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP� TION.ANYVIOUITIONOFSECTION7o31.bBVANYAPPLICANTFOPAPERMITSUBJECT57HEAPPUGAN770 Z Re-Roof F ACIVIL DENALTY Of NO7 MORE THAN FIVE HUNDRED�OLLARS�f5oo),J� � ❑4�OWNEROFTHEPROPERIY,ORMVEMPLOYEESWITHWAGESASTHEIRSOIECOMPENSATION, � Commercia� - N7LL DO THE WORK.AND 7HE S7RUCTUqE IS NOi IN7ENDED OR OFFEREO FOR SALE(SEC.7049,BUSi� J NESS AND PROFESSIONS OODE:THE CANTMCTORS LICENSE LAW OOES NOTAPPLY TO AN OWNER OF � PROPEFiTV1NFIOBUILDSORIMPROVE3THEREON,AN�NTIODOESSUCHWORKHIMSELFORHERSELFOR � � THROUGHHISORHEROWNEMPLOYEES.PHOVDEDTHA75UCHIMPROVEMENTSARENOTINTENDE00R m QOFFERWFORSRLE.IF,HOWEVEFLIHEBUIIAINGOFIMVROVEIAENT�SSOLDWI7HINONEYEAROFCOMPLE- z �TION,THE OWNER�SUILDER WILL HAVE THE BURDEN OF PROVIN6 THAT HE OR SHE OID NOT BUILD OR = IMVi�VEFORTH[PIIRPOSEOfSALE�. �I,AS OWNER OF THE PROPEHTV,AM EXCL�S�VELV CONTRACTINCi WITH LICEN9ED CONTRACTORS Q TO CONSTRUCT TiE PRQIECT(SEG.�044,BUSINESS AND PROFESSIONS CODE'.THE CONTR0.CTORS LI- V2IUflIlOt1 ADJ.AREA W CENSELAWOOESNOTAPPLVTOANONTJEROFAPROPERTYWHOBUILDSORIMPROYESTHEREON,AND � ViFIOCON7MCTSFOASUCHPe7WECTSWITHACOt�RHACTOR(5)LICENSEDPVRSUMI'rTOTHECONTRAG QUANTITY DESCR{PTION FEE Y TORS LICENSE LAW.j. O ❑t AM E%EMPT UNDER 8EC. 8.&P.C.FOR THIS REASON � 3 � LL DATE _OWNER___� ._ U � W LICENSED CONTRACTORS DECLARATION -� � w I HEREBYAFFIflM UNpER PENALN OF PER.�URY THAT I A!A LICENSW UNbER PROVISIONS OFCHAFTER �. � Y(COMMENCING WITti SECTION 7000j OF DIVISION 3 OF THE BUSINE$SAND PROFE5910NS COOE,AND Z X MY UCENSE IS!N FUIL FOflCE ANO EFFECT. LLl m � LICENSE CUSS��LIC.NO. �/ ,�_o � U DATE����L CONTHAC70R r��f�IC(�.�Y/Y a W � �l � WORKERS'COMPENSATION DECLARATION a � 1 HEReBY AFFlRM UNDER PENALTY OF PE0.IURY ONE OF THE FOLLOWINO�ECURATIONS: U � Z Q C� IMAVEANDNAI..tMAINTANqCERTIFICATEOFCONSENTTOSELF-IN6UREFORWORKERE' _ � G�OMPENSATIOIJ,AS PROVIDEDBYSEC'�.'ION 37000FTHE LABOR COC1E,FORTHE PERFORMANGE W OF TiE WORIf FOR WHICH TH:S PEAMIT IS ISSUED. � � _I HAVF M10 YWLL MRIf TAIN WORKERS'COMPEN6ATION INSURANCE.AS REqUIilED BV SECTION � O 3700 OF THE LPBOR CWE,FOR TNE PERFORM0.NCE QF THE WORK FOR WMIGH THIS PEflMIT IS , ISSUED.MYWOR�KE�R COMP[NSA:�ONINSUR 'CECARRIERMJDPOLICVNUMBERARS: CONSTRUCTION _ __ jcaaatEa,_(_S�SG.. ^_CJ__.v_ _.— PLAN REVIEW _ � POLICY NUMBE /\�� ELECTRIC � Rrassecnown��No7eecre+wtFrfocfn��ra.xr�swac�w�wAEooa..i.ans�a�oo�oa�Ess} PLUMBING . w MF_CHANICAL Z 1 CEFiTIFYTHAT INTHE P;RFORNANCF OF 7'HE WOFlK FOR WYICH THIS PERM�'IS ISSUED,I (J SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SOAS TO BECOME SVBJECT 70 THE � - � � . _ .. � WORKERS'COMPENSATIONlAWSOFCALIFORNIA,ANDAGREFTHATIFISHWLDBECOME INSPECTION FEE S SU&IECTTOTHEWbRKERS'CAMPENSATIONPROVISIONSOFSECTION37o00FTHELABOR ISSUANCE � COOE,1 SHPLL FORTHWITH COMPLY WITH THOSE PROVISIONS. 0 SMIP p pATE: APPLICANT: __._ _ J ENERGY P/C _. — J WARNING�FAILURETOSECUAF.WORKERS'COMPENSATIONCOVEflAGEISUNLAWFUL,ANDSHALLBE T�'(J� LL SU&IECTPNEMPLOVERTpCRiMINAIPENALTIESANDCIVILFMESUPTOONEHl1N�REDTNOl1SAND ENERGYPERMIT Cx-/d +"-- - -- __. D011ARS(5100,000),INADDITIONTOTHECOSTOFCOMPENSATION,�AMAGESASPROVIDEDFOAW ---._.._ __. J SECT�ON370BOFTHEIABORCOOE.INTERESTANDATTORNEI"SFEES. RETENTIONFEE: ^ ^ l � � CONSTRUCTION LENDING AGENCV PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTY OF PERJUFY THA7 TMERE IS A CONSTRUCTION LENDING AGENCY __ a- FORTHE PEFfORMANCE OF THE WORK FOR WHICH THIS PFRIAIT IS ISSIlEO(SEC.3C91.CIV.C.). Z W � LENDER'SNAME___ F- LENOER'SAD�RESS � ICERTIFVTHATIHAVEREADT}iISAPPLICATIONANDSTATETHATTHEF80VEINFORMATIONISCARRECT. TUTAL FEES � ����� W IAGREETOCOMPLYWITHALLCITYNJDCOUNTVORDINANCESANDSTATE�'NSREUTMGTOBUILOWG � CONSTRUCTION,rW�HEREBYAUTHORI2EREPRESENTAT!VESOFTHISCOUNTYTOENTERUPONTHE ZABOVE-MENTIONED PR PERTY F fl INSPECTION P�gp/pSE� COMMENTS � ���_••I����..�� Lfa�—f � ��/ m PERMITTEE NAME(RINT� � SIGNATUREOFPERMITT � �E�_�! = RECPT.NO. 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