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HomeMy WebLinkAbout12782 CITY OF DIAMONIS BAR' -���'- DEPARTMENT OF COMMUDTITY&DEVELOPMENT SERVICES � _ � 21660 E.Copley Drive Suite 190 (909)860-3195 Far.(909)861-3117 ,� � PRESS ...�`�' BUrLnrr��r��vtrr���.icA�ION FIRMLY . '°�° s , ,.,. _, ..,. � . ,...., , �..�,. , � .� -, . . ,..: , LL.. - �.� ,. -.. . ��..,: .a�:k::':' �SY9?I��:"y&�k�.,.:3�9rbp.sr_r:.wY:;s ... , .. .... . , .. , ..._ ..n.::: � JOBSITE � ""t'` p APP�ICATION � � PERMIT ''� �,�P/C o ADDRESS 2 �R� �y�y�CR�'S� D . I.�'' _ J�— DATE ��� NUMBER��-# � ISSUE TYPE OCC APN LOT 2� TRACT 3�,9rI�_ DATE CONST. GROUP � OWNER �LDCc�L�S� II1N�i�J£-�T ��(SP AGDRESS (.1"i9.r'i' �. /�C'�{-��RL/✓ .�.E�rV�. '' " ZONING SETBACKS z CITY �, �. ZIP Rt7'5d TEL CZI3)�T2220� FRONT qy�/ ❑ g APPLICANT F.�b EClSD TEL (6���� REAR ❑ � SIDFJSIf�E$TREET RW ❑ CQNTRACTOR ' SIDE ❑ Q CITI' ES�CA�R�tg ZIP�(�.?.S?�TEL.(,���_�� ' C2L1f�R T� RD.� o� °,. �'� �p� PROPOSED USE 4Q.Q . . . ,. . w ARCH/ENG/ ,;, o z DESIGNER NO.DWEL. NO. NO. � AODRESS °'�'' � CITY ZIP TEL. " " UNITS STORIES BEDROOMS v� � DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION � 0 - . SFR/ADO/REM 0 I HEfiEBY AFFlRM UNOER PENALTY OF PERJUftY THAT I AM EXEMPT FROM THE CONYRACTOFIS LI- G2f89B/C&(POfl LL CENSELAWWR'MEFOIIOWINGREASON(SEC.7031.SBUSINESSNAPROFESSIONSCODEANVCITYOR (n V COUNTVWHICHF�WIRESAPERMITTOWNSTRUC7.ALTERIMPROVE,DEMOLISH,ORREPAIPANYSTRUG W PatiD/DBCk Z TUPE,VRIOR TD ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERfAIT TO FILE A SIONED W STATEMENT 1HAT HE OR 5HE IS LICENSED PUqSUPM TO THE PROVISIONS�OF`fHE CANTR4CTOIX5"L4 � � CENSE LAW(CHMTER 8(COMMENCiNd WITH SECTION 7oob)OF DIVISION 3 OFTHE�BUSINESS AND PRO- �'�" P��USpa � FES910NSCODE)ORTNATHEORSHEISEXEMPTTHEREFROMANp7HEBA515FOPTHEALLEOEDEXEMP- (� �� TION.ANYVKK.ATIONOFSECTION7031.6BYANYAPPLICANTFOHAPERMITSU&IECTSTHEApPL1CdNTTO � Re-ROof �, ACML PENALiY OF NOT MORE TMAN FIVE HUN�RED�OLUFlS(5500).�' �' � '""' ' . � ❑I,ASOWNEHOFTHEPROPERN,oRlMEMPLOYEESWITHWAGESASTHEIRSOIECOMPENSATfON, ❑ Commercial � - WILL DO THE WORK,AN�THE STRUCTUFiE IS NOT INTENDED DR OFFEREO FOR SALE(SEC 76d4 6US6 J � NESS AND PROFESSIONS CC�DE:THE CONTRACTOAS LICENSE LAW DOES NOT APpIY TO AN OWNF.R OF = PROPER7V WFIO BUNAS OR IA/PROVES THEREON,ANUNMO DOES SUCH WORN HIl:f'SEIf 17R�HEfiSELF OR [G TH{10UGHHISORHEROWHEMPLOVEES,PROVIDEDTHATSUCHIFAPROVE{.1ENTSAt1ENOYYN7EtJDE00R � 0 ,OFFERmFOR9AlEIFHOWEVERTMEBUILAINOORIMPROVEMEN71SSOtDWIh71NONEYEAROP80MPlE� TION,7HE OWNER�BUILOER WILL HAVE THE BUHDEN OF PROVMG THAT HE OR$'NE DID NOT AUILD,OP = IMPROVEFORTFIEPURPOSEOFSALE} :.'.. " tF',� "�:.. :.. ❑I,AS OWIVEN OF TNE PROPERIY,AM IXCLUSIYELV CANTRACTW�WITH LICE'NSEC1 CANTR'AC�bHS � TO CONSTRUCT 7HE PR0.IECT(SEC.7aa,BUSINESS AND PROFESSIONS CODE:THE tlON7RACTOqS L4 Valuation ADJ.AREA W CENSE UW DOES NOTAPPLV TOAN ONMER OF APHOPERTY WHO BUILDSOR IMPROYESTHEREnN.AN� � VM1iOCONTRACTSFORSUCHPAOJECTSWITHACONTRACTOR�S)LICENSEDPoIRSUANTT6TNECtlNTRAG QUANTITY DESCRIPTION FEE � TORS UCENSE UW.I. .,.`. ..°' 0 ❑1 AN EXEMPT UNDER SEC. 8.6 P.C.FOR THIS REASON Q ?! U 4L ' � � �ATE OWNER U � LICENSED CONTRACTORS DECLARATION � w � - � I HEREBYAFFIRM UNOER PENALTY OF PERIURY THAT I AM UCENSEO UNDEfl PROVISIONS OF CHAPTER � (,� D(COMMENCIN(i VYITH SECTION 7000)Of 01VISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z X MYUCENSE IS IN NLL FORCEAND EFFECT. O UCENSE CLA55 � LIC.NO.�;�- ��'�"� /��.���,� � V �ATE '�"'t l:1�Q8 GONTRACTOR ���L J�V tl- W � ��. WOflKERS'COMPENSATION DECLARATION (I"�O ZOC�f�J ¢ � U � 1 HEREBY AFFIRM UNDER PENALTV OF PERJUPV ONE OfTHE fOLlAWING DECURATIONS!' Z � �IHAVEANDWILLMAINTAINAGERTIFICATEOFCONSENTTOSELF-INSUREFORWORKEftS' S COMPENSATION.AS PROVIDED BYSECTION 370o OF THE U180R CODE,FORTHE PERFORMANCE W OFTHE WORK FOR WHICHTHIS PERMIT IS ISSUE�. � 0 w _IHAVEAND6VILLMAINTAINWORKERS'COMPENSATIONIN5URANCE,ASRE-0UIREDBYSECTION � 37000F 7HE LABOR COOE,FOR THE PERF-0RMANCE OFTHE WORK f-0R WHICH iHIS PEFMIT IS ISSUED.Mv WORKEHS'COIulPENSATION INSURANCE CANRIER AND POI.ICY NUMBER AflE: CONSTRUCTION ___ � . . . �-- . . .. .......... � CARRIER PLAN REVIEW ZP�ICV NUMBER — LECTRICe� Q •"'_ � (f}iISSE(.'ipNNE�NOTBEOJA�LEfEDOFTHEPEWWTiSFORONEHUt�DRED0."%lAAS(51W)ORIESS). PLUMBlNG Z I CEHTIfV THAT IN TNE PERFORMANCE OF THE WORK FOA WMCN 7HIS PERMii tS�SSUED,l MECHANICA� (;} SHALL NOT EMPLOYANY PERSOPI IN ANY MANNER SOAS TO BECOME SUBJECT TO THE ///'''^^^ ` � WOflKERS'COMPENSATIONLAWSOFCALIFORNIAAN�AGREETHATIFISHOULDBECOME INSPECTIONFEE —/ /s-�1 SUBJECTTOiHEWORKERS'COMPENSATIONPROVISIONSOFSECTION3]OOOFTHEIABOR '��j(i iJ " Qcooe,isHnuFoqn-iwirt�coMa�vwrrrinrosEPao�nsioHs. ISSUANCE p DATE:�'j.�=�� APPLICANT: � ���yL{� SM1P �____y�_ J WdRNMGFAILURETOSECUREWORKERS'COMPENSAT70NCOVEflAGEISUNLAWFUL,ANDSHALLBE ENERGYPlC y� SUBJECTANEMPLOYER70CRIMINALPENALTIESANDCIVILFMESUPTOONEHUNOflEDTHOU5AN0 �NERGYPEf?MIT DOLIARS(StoD.OW).IN AODIT�ON TD THE CAST OF COMPENSATNSN,DAMAGES AS AROVI�ED FOR IN � SECTION 3708 OF THE LABOR COOE,INTEREST.ANDATTDRNEV'S FEES. RETENTION FEE: � CONSTRUCTION LENDINGAGENCY PRE-ALT FEE: O � IHEREBYAFFIflMUNDERPENALiYOFPERJURVTHATTHEqEISACONSTRUCTIONLENDINGAGENCY FORTHE PERFORMANCE OFTHE WORK FOR WHICHTHIS PERMIT IS ISSUEO(SEC.3097.CIV.CJ. . Z W � LENDER'S NAME . - 1_— lENOER'SADDRESS , , �, ¢ I CERTIFV THAT I HAVE REAO THIS APPLICATION AN�STATE THAT THE A60VE INFORMATION IS CORRECT. �OTAL FE ES ✓}� �.� W I AGREE TO COMPLY WITHALICiTV AND CAUNTY ORDINANCES AN�STATE IAWS qF.UTING TO B�11LA�NG �/ � IX)NSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OFTHIS COVN'iYT4 ENTER UPON THE '� ZABOVE-MENTIONEDPROPERNFORINSPECTIONPURPOSES. COMMENTS ' _ �O R-� k�JC� m PERMfITEE E(PRINn - ¢ _—�i�� �, ►a��-� . {n SIGNATURE F PERMITTEE DATE — RECPT.NO. PAID BY VALIDATION � S ~ WHITE—De ariment Co YELLOW—Finance Co PINI't—Assessor Co GOIAENpOD—File Co GREEN— licant's C P PY, PY, PY. PY� APP oPY .,.� �� � ., ., .. . . . ,. � ., ,, ..:� . . . _ .. ,.. _ 1 � � r�;, . ..,, _ . , �... ,.� � �. �. ....__ ��� ....: . .y � y - 4 ' � :: �,� ...�':A�� � � �:.�� �'. 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