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Home My WebLink About16821 (37) _ _ _ _ .___ .. ...... "__ __-_ _ ________ ___L_ .—_.. .____ . . _ . CiTY OF I)IAMONTJ BAIR �---��' — DEPARTA�iENT OF COMMUNTI�&DEVELOPMENT SERVICES � � - 21825 E.Copley Drive (909)�60-3195 Fa�c(909)861-3117 PRESS "'-�� B�ILDING PERMIT APPLICATION F LY o DDRESS�OS� � � � �� DATE'CATION � �� NUMBER ' #/C � ISSUE � TYPE OCC APN LOT , TRACT DATE CONST. GROUP � OWNE� 1�. O p ADDRESS r` i►M' � ZONWG SETBACKS z CITY ZIP TEL. � FRONT RW ❑ o APPLICANT ��7�`_� TEL. �' SIDE SIDE STREET RW ❑ �Z Q' p,$�+�' � SIDE ❑ CONTRACTO ADDRESS • c� � CITY ZIP/��G TEL.�!�+� PROPOSED USE w ARCH/ENG/ ' z DESIGNER a ADDRESS �/� NO.DWEL. NO. NO. = CITY ZIP TEL. UNITS STORIES _�_BEDROOMS cn cn � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OVJNER-BUIL�ER DECLARATION SFR/AOD/REM O p I HEREBY AFFIFIM UN�ER PENALTY OF PERJURY 7HAT i AM EXEMPT FROM THE CONTRACTORS LI- G9f290/C3�{IOfI W CENSELAWFORTHEFOILOWING EASON(SEC.7031.SBUSINESSANDPflOFE5510N5CODE:AN7CITYOP (n U CqUNTYWHICHREQUIRESAPEH ITTOCONSTRUCT,ALTER,IMPqOVE,DEMOLISH,ORREPAIftANYSTRUC- � w TURE,PRIOR TO ITS ISSUANCE, LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO W Pdtio/Deck SiATEMENT THAT HE OR SHE IS�ICENSED PURSLIANT TO iHE PROVISIONS OF THE CONTRACTORS U� �.. CENSE LAW(CHAPTER 9(COMMENCWG WITH SECTION 7aoo)OF DIVISION 3 DF THE 9USINESS AND PRO- �' POOVSPH 0 FESSIONSCODE)DRTHAiHEOf76HE1SIXEMPTTHEREFROMANDTHEBA5ISFORTHEALLEGEDEKEMP- (� , V TION.ANYVIOLATIONOFSECTI01�7031.5BYANYAPPLICANTFORAPEFiMIT3UBJECTSTHEAPPLICANiTO Z RB-ROOf � � ACNIL PENALTY OF NOT MORE THAN FIVE�HUNDRED DOLLARS�5500).j: � ❑I,ASOWNEflOFTHEPROP RTY,ORMYEMPLOVEESWITHYJAGESASTHEIRSOLECOMPENSATION, � COfI1rtIBfC18I . - � Z WILL DO THE WORK,AND THE ST UC7URE IS NOi INTENDED OR OFFERED FOR SALE(SEC.7044,BU51- J � NESS AND PROPESSIONS CODE: HE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN oWNEfl OF PROPER'fVWHOBUiLD50RIMPR�VESTHEREON,ANOWHODOESSUCHWORKHIMSELFORHERSELFOR � � THHOUGHHISORHEROWNEMPL.�OYEES,PROVIDE�THATSUCHIMPROVEMEhTSAREYOTINTENDE00R m Q OFFEflE�FOqSALE.IF,HOWEVER,ITHEBUII�INGOflIMPROVEMENTISSOLOWITHINONEYEAROFCOMPLE- Z TION,THE OWNEH-BUIIDER WILLIHAVE THE BUFiDEN OF PROVING iHAT HE OR SHE DID NOT BUILD OP IMPFOYE FOft iHE PUflPOSE OF SALE). �j ❑I.ASONTlEROF7HEPROf{ER7Y,AMEXCLUSIVELYCONTRACTiNGWITHLICENSEDCONTRACTORS � TO CONSTRUCT THE PRQIEC7�S�C.7a44,BUSINESS AND PRDFESSIONS CODE:THE CONTRACiOFS U- ValUation / ADJ.AREA W CENSE LAW�OES NOiAPPLV TO,N OVdNER OFAPROPEPTY WH0 8111LDS OR IMPROVES THEREDN,AN0 � WHOCONTRACTSFORSUCHPROUECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECON7RAC- QUANTITY DESCRIPTION FEE TORS LICENSE LAW.). ��L� o ❑I AM EXEMPT UNDER SEC.�', B.&P.C.FOR THIS REASON Q �/I�{J�V� � U � ¢ � � DATE I' OWNER H � Q w � LICEN$ED CONTFACTORS DECLAAATION W �� Q • � I HERE6YAFFIflM UNDEF PENALT``((OF PERJUflYTHA71 AM LIC'cNSED UNDER PROVISIONS OF CHqPTER � � 9(COMM�NCINGWITHSECTION7�00)OFDIVISION30FTHE6USINE35ANDPROFESSIONSCO�E,AND z X MY LICENSE IS IN FULL FORCE AN EFFECT. /1 J� � LIGENSE CLASS ��/ LIG NO. O{�Jc/� ! � ~ DATE GONTRACTOR C.�i/OSQ6I� J � a w � WORK�RS'COMPENSATION DECLARATION Q � �HEREBYAFFIRMUNDERPENALT�/OFPERJURYONEOFTHEFOLLOWINGDECLARATIONS: z z _tHAYEAt�WILLMAINTAI ACERTIFICATEaFCONSENTTOSELFINSUREFORWORKERS' a ¢ CAMPENSATION.ASPRO�I�EDBYSECTION370oOFTHELABORCODE,FORTHEPERFORMANCE U Q OF THE WOFK FOR WHICi 7HIS PERMIT IS I5SUE0. � F 1 HAUE AND WILL MAINTAI�1YDRKERS'C0IAPENSATION INSURANCE,AS REQUIRED BY SECTION Q 37000FTHELABORCODE,FORTHEPEflFORMANCEOFTHEWORK ORWHICHTHISPEHMITIS ISSUEO.A7YWORKFAS'COMPENSA710NINSl7RANCECARRIERAND OLICVNUlABERAFiE�, CONSTRUCTION �� Q �1�J/"�� - y CARRIER �T�jc. PLAN flEVIEW ZPOLICYNUMBER��j J !� ELECTRIC Q � (MISSECiKKJNEmNOTBEWMPLEfE�OFiHEPEHMITISFORONEHUNDRED00LLAR5(S10G)ORLESS). PLUMBING W TM_ Z I CERiIFYTHAT IN THE PEkiFORMANCE OF hiE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL �•.6�m:'`e m�:^�C�~` �m)� �' SHALLNOTEMPLOYANYPERSONINANYNANNERSO TOBECOMESUBJECTTOTHE i�I {�"'"-r";,,r;%'"'��'`.� �''-- ' �'-^""`""' (p ORK 5'COMPENSATIC}N LAWS OF CALIFORNIA,AN AGREE THAT IF I SHOULO BECOME W SPECTION FEE 8 � J TTO THE ORKERS'COMPENSATION PROV ONS OF SE ION 3700 THE LABOR �� ' � ,I F RTHW NCOMPLYWITHTHOSE OVISION ISSUANCE I oaBl �' � p �AT. , ;� A�PLI(SANT: 1 � SMIP � � �� `.—�j WAFNING:FAILURETOSECUREN�ORKERS'COMPENSATIONCOVERAGEISUNLAWPUL,AN�SHAILBE ENERGYP/C �,'� � ENALTIES AND CIVIL FINES UP TO ONE HUN�RE�THOUSAND ;�Gj. `Y ��_:;'; SUBJECTAN EMPLOYER TO CRIMWAL P, ENERGY PERMIT r DOLLARS(E700.000),IN AODITION YO THE COSTOP COMPENSATION,�AMAGES AS PR�VIDED FOR IN „_...__.. ---� J SECTION37oeOFTHELABORCO E,INTERESi,ANDATTORNEY'SFEES. RETENTIONFEE: 4•`�=V•n�'.��-"- �— OCONSTRUCTION LEND W G AGENCY PRE-ALT FEE: � I HEREBV AFFIHM UN�ER PENALT�'OF RERJURV THATTHERE IS A CONSTRUCTION LENDMG AGENCY FOR7HEPERF-0RMANCEOFTHEYJOflKFOR HICHTHISPERMRISISSVED(SEC.309],CIV.C.). Z , �I�� w _ � LENOER'S NAME F— LENDEfl'SADDRES�' / � ICERTIFVTHATIHAVERE4DTHIS�,APPIICATONANOSTA7ETHATTHEABOVEINFORMATIONISCORR[CT. TOTAL FEES �� Y{(/ W I AGREE TO COMPLV WITH AlL CIM AND COUNTY ORDINANCES AND STATE LAWS RELATINO T08UILDING V�� CANSTRUCTION,ANDHEREBVAUTHORREREPRESENTATIVESOFTHISCOl1NTYTOENTERUPONTHE � ABOVE-MENTIONED PPOPERN FOR INSPEGTION PURPOSES. Z � COMMENTS J Sco ' 6L�►'" � --- m PERMITTEE ME(P ) �' Q �!I . � � SIGNA REOFPERMITTEE , DATE Z � RECPT.NO. PAID BY VALIDATION ~ ' WHITE—De artment Co VELLOW—Finance Co PINK—Assessor Co GOLDENROD—Fle Co GREEN—A Ilcant's Co P PY, PY, PY. PY� PP PY �� ,.• . ;� —.,. ... , ..;::: >r<., .. ,-. — Y -� —. � �:� s ,..,. .. _ . ,.: _ ,, .. —�- _ —..,. .,,�� ,,-.;,. _. ,.:. 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