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HomeMy WebLinkAbout14853 (8)CITYOFDIAMONDBAR DEPARTMENT OFCOMMUNITY & DEVELOPMENTSERVICES 21660E. CopleyDriveSuite190 909) 860-3195Fax (909) 861-3117 BUILDINGPERMITAPPLICATION JOBSITE ADDRESS /020 APN _ LOTTRACT OWNERP11S ADDRESS22,04/1&92'y CITYQIZP1/773TEL. APPLICANTTEL. CONTRACTOR ADDRESS-799-5- CITYZIP177TE . ARCH/ENG/ DESIGNER ADDRESS CITY _ ZIPTEL. OWNER-BUILDER DECLARATION IHEREBYAFFIRM UNDERPENALTYOFPERJURYTHATIAMEXEMPTFROMTHECONTRACTORS LI- CENSELAWFORTHEFOLLOWING REASON (SEC. 7031.5BUSINESSANDPROFESSIONSCODE: ANYCITYOR COUNTYWHICHREQUIRESAPERMITTOCONSTRUCT. ALTER, IMPROVE. DEMOLISH, ORREPAIRANYSTRUC. TURE. PRIORTOITSISSUANCE, ALSOREQUIRESTHEAPPLICANT FORSUCHPERMITTOFILEASIGNED STATEMENTTHATHEORSHEISLICENSEDPURSUANTTOTHEPROVISIONSOFTHECONTRACTORS LI- CENSELAW (CHAPTER9 (COMMENCING WITHSECTION7000) OFDIVISION 3OFTHEBUSINESSANDPRO. FESSIONSCODE) ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- TION. ANYVIOLATIONOFSECTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO ACIVILPENALTYOFNOTMORETHANFIVEHUNDREDDOLLARS ($500).): 1, ASOWNEROFTHEPROPERTY, ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION. WILLDOTHEWORK, ANDTHESTRUCTUREISNOTINTENDEDOROFFEREDFORSALE (SEC. 7044, BUSI- NESSANDPROFESSIONS CODE: THECONTRACTORSLICENSE LAWDOESNOTAPPLYTOANOWNEROF PROPERTYWHOBUILDSORIMPROVES THEREON, ANDWHODOESSUCHWORKHIMSELFORHERSELFOR THROUGHHISORHEROWNEMPLOYEES, PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR OFFEREDFORSALEIF, HOWEVER, THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- TION, THEOWNER-BUILDERWILLHAVETHEBURDEN OFPROVINGTHATHEORSHEDIDNOTBUILDOR IMPROVEFORTHEPURPOSEOFSALE). 1, ASOWNEROFTHEPROPERTY, AMEXCLUSIVELY CONTRACTINGWITHLICENSEDCONTRACTORS TOCONSTRUCTTHEPROJECT (SEC. 7044, BUSINESSANDPROFESSIONSCODE: THECONTRACTORSLI- CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON AND WHOCONTRACTSFORSUCHPROJECTS WITHACONTRACTOR(S) LICENSEDPURSUANTTOTHECONTRAC- TORSLICENSELAW.). IAMEXEMPTUNDERSEC. B. & P.C. FORTHISREASON DATEOWNER LICENSEDCONTRACTORSDECLARATION IHEREBYAFFIRMUNDERPENALTYOFPERJURYTHATIAMLICENSEDUNDERPROVISIONSOFCHAPTER 9 (COMMENCINGWITHSECTION7000) OFDIVISION3OFTHEBUSINESSANDPROFESSIONS CODE. AND MYLICENSEISINFULLFORCEANDEFFECT. LICENSECLASC" 7LIC. NO. L432-. ) T DATE/ CONTRA C OR WORKERS' COMPENSATION DECLARATION IHEREBYAFFIRMUNDERPENALTYOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS: IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' COMPENSATION. ASPROVIDEDBYSECTION3700OFTHELABORCODE, FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED. IHAVEANDWILLMAINTAINWORKERS' COMPENSATIONINSURANCE, ASREQUIREDBYSECTION 3700OFTHELABORCODE, FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSUED. MYWORKERS' COMPENSATIONINSURANCECARRIERANDPOLICYNUMBERARE: CARRIER POLICYNUMBER THIS5ECTX7NNEEDNOTBEGi7MFLETEDOFTIEPERMITISFORONEHUI-DREDDOLLAAS ($100) ORLESS) ICERTIFYTHATINTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED, I SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESUBJECTTOTHE WORKERS' COMPENSATION LAWSOFCALIFORNIA. ANDAGREETHATIFISHOULDBECOME SUBJECTOTHERKERS' COMPENSATION PROVISIONSOFSECTION3700OFTHELABOR CODE, IALLFTHWITH COMPLYWITHTHOSE > VISIONS. DATE: APPLICANT. Joe WARNING: FAILETOSECUREWORKERS' COMPENSATIONCOVERAGEISUNLAWFUL, ANDSHALLBE SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND DOLLARS (3100,000), INADDITIONTOTHECOSTOFCOMPENSATION, DAMAGESASPROVIDEDFORIN SECTION3709OFTHELABORCODE, INTEREST, ANDATTORNEY'SFEES. CONSTRUCTION LENDINGAGENCY IHEREBYAFFIRMUNDER PENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLENDING AGENCY FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED (SEC. 3097, CIV. C.). LENDERSNAME LENDERSADDRESS ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. IAGREETOCOMPLYWITHALLCITYANDCOUNTYORDINANCESANDSTATELAWSRELATINGTOBUILDING CONSTRUCTION. ANDHEREBYAUTHORIZEREPRESENTATIVES OFTHISCOUNTYTOENTERUPONTHE ABOVE-MENTIONEDPROPERTYFORINSPECTION PURPOSES. rot? PEE (PRINT) SIGNATUREOFPERMIITEE 'eOATE WHITE-Department Copy, YELLOW-FinanceCopy, PIN PRESS FIRMLY APPLICATION1 PERMIT p C 1 f t DATE_ t NUMBSP ISSUETYPEOCC DATECONSTGROUP ZONINGSETBACKS FRONTRW REAR SIDE/SIDESTREETRW SIDE PROPOSEDUSEQQ s- zl A 1 e z7 aft .2 NO. DWEL. NO. NO UNITSSTORIESIBEDROOMS DESCRIPTIONSQ. FT.FACTORPSFADJ. AREA/VALUATION SFR/ADD/REM U)Garage/Carport WPatio/Deck LLPool/spa Re-Root Commercial Ib Valuation / 2410..'~- ADJ.AREA QUANTITYDESCRIPTIONFEE J U w w Z D7 a Q U Z 2 U w CONSTRUCTION PLANREVIEW ELECTRIC yy PLUMBINGPAID MECHANICAL INSPECTIONFEE y ISSUANCEAPR SMIPY z ENERGY P/C j ENERGY PER ' RETENTIONFEE: PRE-ALTFEE: TOTALFEESflq COMMENTS RECPTNO. PAIDBYVALIDATIONV L( CITYOFDIAMONDBAR INSPECTIONRECORD 1NSPECTIQN ' DATE ` tNSPECTC?RINSPECTIONDATEINSPECTQR FLOORJOIST a~~~ ~~c~c~~ ~~c~ a~ ~~ c~c~ ~ c~~ir ~k rugER~