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CITY OF DIAIVIOND BAI� "k ' , ` ` 1�-���— DEPARTMENT OF COMIVIUNITY&DEVELOPMENT SERVICES �, . 21660 E.Copley Drive Suife 190 ' (909)860-3195 Fax(909}861-3117 PRESS ... ' svu:b�r'c�i��n�rt�A��►��cafi�o�v FIRM�Y . . .. ��. . ..� , . , ... .,, ,. . . u . �y . . �u � ..,..� , » ....__. . �i;��:' v .ac:. . .. . � .. � �...a .':i� .<..�..._• .U:.,R . . . . .. .:ae>.n'.x.'..'.s-..:,.. � J�BSITE � _ { " o .�=.s �, ` APPLICATION :- �Q.� :�",." �.'f��RMIT P/C o ADDFiESS� � DATE ���� `' � NUMBE� � ��# �'����'� � APN LOT� TR T �i I���7 DAl`E CONST. GROUP p OWNEF �(�+}A.Fi�ND '���-�4� � . . ` _ ., ADDRESS ��," �D. G�.i�i2 ef-- C�f� �# (�d� ZONING SE'iBAGKS � CITY ZIP�7 TEL �� �"��'� FRONT RW ❑ AAPLICANT :i a�'� TEL �'?Q REAR ❑ SIDE/SIDE STREET RW_ p � CqNTRACTOR ."` � SIDE ❑ ADDRESS -" R�,, �ti ��� � CITY��f�j[Z�A ZIP�_I�d_`� TEL.$�,� PROPOSED U5E '� w ARCH/ENG/ �/ q�� � DESIGNER���� �"��I�.L�-I t I�C�I ���C.. � ! �� NO.DWEL. NO. NO. � ADDRESS ���� DL�k�—R I�'-�E d���' UNITS STORIES BEDROOMS � CITY /�RC.K��I.� ZIP�C�3(7?' TE�:.�'t�-�j'��r ,::. y D SCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION w O OWNER-BUILDER DEGLARATION. SF DD/REM Z.C�C� '�}2 . O�C�,b C� 0 I HEREBV AFFIRM UNDER PENALTY OF PERJUPV THAT I AM E%EMPT FROM THE CONTFAGTOqS LI� am af�Ort � ,� Li�y ��Q �� W C:ENSELAWFOR7HEFOLLOWINGRER50N(SEG.7o31.58USINE5$�ANDPROFE5SI(SNSCAbE:ANV�CITVOFi (n U COUNTYNMICHREq11RESAPERMITTOCONSTHUCT,AI.TER,IMPHOVE,DEMOLiSH;OHpEPAiRANY3TROG W PatiOlOeGk WTURE,PRIOHN ITS ISSUANCE,ALSO REQUIH�S THEAPPIiCAN1'FOR SUGH PERMITTO FILE'71 SIGNED w STATEMENT THAT HE OR SHE IS IICENSED PURSUANT TO TH�PROVISIONS OF THE CANTRAbTORS�b � CENSELAW(CHAPTERY(COMMENbINOWITHSECTION1oDo�OFbIVISiON3DFTHE�BUSINESS'IiNQ'PRO- �V" POOVSPe FESSIONS��ORTHAT HE OR SHE IS E%EMPTTHEREFROM KNb THE BASIS FOF THE ALlEOEd EXEMP- TION.ANYVIOLATIONOFSECTIDNYo31.68YANYAPPUCAN7FORAPERMITSUBJECTSTHEAPPUCAN7T0 � R@-Roof � ACdVILPENAITYOFNOTMORETMANFIVEHUNOREDDOLLAiiS(L600j.): ��� � '�� , . � ❑I,ASOWNEROFTHEPfl4PEiiN,ORMVEM7LOYEE5Vi1THWAGESASTHEIfiSOLECOMPENSATION, � Commercial ��- - WII,L DO THE WORK,ANU THE STRUCTURE IS NOT INTENUEb 6F1 OFFERED FOq SA(.E(SEC.7044,BU54 _J � NESS AN�PHOFESSIONS CODE:THE CONTRACTORS LICENSE IAW DOES NOT APPCYTO AN pWNER OF � . �. PHOPERiYWHOBUILO50RIA4PROVESTHEREON,ANOWHO�OE$SUpHWORKHIMSELFOqHEFISELFOR = � THROUGHHISORHEROViMEMPI:CIYEES.OFOVIDED7HATSUCV{IhIPROVEbfENTS�AFIENOTINTEfJdE04R m Q ,OFiEREDWRSAL.E.IF,HOWEVER,THEBUILDINGORIMPROVEMENI'IS60LOWITHINONEYEAROFCOMPLE- � �TION,THE OWNER�BUILOER WILL HAVE THE BUROEN OF PROVINa THA7 NE OP SHE�DID NOT'9UIL0 OR = IMPHOYEFORTHEPURPOSEOFSALE)• . .. . .. ,.,r,;, '.-. ".:.,.�:.'.`. ❑I,AS OVlNER OF THE PROPEHTY,M7 E%CLUSIVELY CONTRACTING WITH LICENSEO CANT(iACTORS � TO CONSTRUCT h1E PRbJECT(SEC,9044,BUSINESS AND PROFESSIONS CbbE:THE CtlNTRAdTORS U- Valuation ADJ.AREA W CENSEUWDOESNOTAPDCYTOANOWNEROFAPROPEHTVWHOBUILDSbRIMPROYESTHEREON,AND S VM1IOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S�OCENSEDb�RSUAIJTTOTHECbNTRAG QUANTITY DESCFIIPTION FEE 0— TORSLICENSELAW.). . ' o ❑I AM E%EMPT UNDEH SEC. B.8 P.C.FOR THIS REASON � , . � LL .. � , ' �.,. ; .... ' � j*v,�i DATE OWNER U � W _ � LICENSED CONTRACTOR$DECLARATION W � IHEflEBYAFFIRMUNDERPENA�TYOFPERJURYTHATIAMIICENSEDUNDERPRDViSIONSOFCHAPTER , � .. �l d, B(GOMMENqNO WITH SECTION ta0o)OF DIVISION 30F THE OUSINESS AND PROFESSIONS CODE,AND - X MY UCENSE IS IN FULL FOFlCEAND EFFECT. ' m f.i , a o LICENSE CLASS_� LIC.NO. � �� � V DATE IZ'� �0--�8' CONiRACTOR. .., � � , ^- W � � WORKERS'COMPENSATION DECLARATION 0����'�i Q � . tn � U � IhEREBVAFFIRM�NDERPENALTVOFPEf11URYONEOFTHEFOLLOWINGDECLARATIriNS: Z � � �IHAVEANDWILLMAINTAINACERTIFlCATEOFCONSEM70SElF�INSUFEPopWORKERS' Z COMPENSATION;AS PROVIUED BY SECTIIXJ 3700 OF THE LAHOR CODE,FOR THE PERfORMANCE w OF THE WORK FOR WHICH hIIS PERMIT IS ISSUED. � � _I HAYE AND WILL MAINTAIN WOPoCERS'COMPENSATION INSURANC�,AS REQUIRED BY SECTION QQ 37000FiMELA80RCODE,FORTHEPERFORMANCEOF7HEWORKFORWHiCHTHISPERMITiS 4� � '� / 9^i, ISSUED.MY WOPKEAS'COMPENSATION INSURANCE CARHIER AN�POLICY NUM9ER ARE: CONSTRUCTION 6 / � b�a J _ PLAN REVIEW ��II 3 Z�s j CARRIER � .._�...:....._...._...,...._..__..__._.___._._.....,..._....�_- z POLICY NUMBER _ ELECTRIC � � �C� ¢ �a��c� o (niissECT10NNE�NoiBEo70.R.EfEDOFT-EPEiR+YTISFORonteFdlMnEODaLArtS(blao)atLEss�. PLUMBING p /� Z I CEATIFY THAT INTHE PEFFORNANCE OF THE WORK FOR SVHICH THIS PERMIT IS ISSUED,1 � MECHANICAL 1 ��o�4✓ � SHALI NOT EMPLOYANY PERSON IN ANV MANNEp SOAS TO 9ECANE Sl19JECTTO THE � WORKERS'COMPENSATIONUWSaFCAUFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE � SUBJECTTOTHEWORKERS'COMPENSATIONPROV�SIOMSOFSECTION37000FTHELABOR 1SSUANCE i C�� COOE,1 SHALL FORTHWITH COMPLY WITHTHOSE P�NSIONS. 0 p �ATE: 2^ O'� APPIlCANT: � ________ � SMIP y � . JENERGY P/G ��l ��- WARNiNp:FA0.URE TO SECUflE WOf1KERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE � SUBJECTANEMPIOYERTOCRIMINALPENALTIESANOCIVILFINFSUPTOONEHUNDREDTHOIISAN� ENERGYPERMIT � OOLLAR5 ISt 00,000),IN AOOITION TO lHE COST OF CAMPENSATION,DAMAGES AS PROVIOEO FOH IN � SECTHlN37aeOFTHELA80RCODE,MTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: ���� a CONSTRUCTION LENDING AGENCY PRE- T FE : � IHEREBVAFFIRMUN�ERPENALTYOFPERJURYTHATTHEREISACON5TRUCTIONLENDM�AGENCY � ZFOR hIE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMtT IS ISSUED(SEC.3097,CIV:C.). �r D �✓II"��� ul °-1- . .. . .. . . . � LENDER'S NAME � - � - � F_ LENDEiT$ADDRESS ., pp .,„ W ICERTIFYTHATIHAYERElDTHISAPPLICATKKJANDSTATETMATTHEABOYEINFORMATIONISCORRECT. TOTAL F�ES � � �)� �/7 a I AGREETO CAMPLY WRH AlL CITV AND CIXINTY ORDINANCESANO STATE LAWS REUTING 70 8UILOWG // q�� CONSTRUC710N,ANDHEREBYAUTHORIZEREPqESENTATIVESOFTiISCWNNTOENTERUPONTHE (F � z A80VE-MENTIONEOPROPERTYFOflINSPECTIONPURPOSES. COMMENTS � � D �4L �i1� . �� PERMITTEENAME(PPIN'T� ' ' �� Q � � ���. l�-�o-�� . �; Er � SIONATUREOF PERMRTEE pATE ;-L - = RECPT.NO. PAID BY � VALI�ATI6N ~ WHITE—Department Copy,YELLOW—Finence Copy,PiNK—Assessor Copy,GOLDENROO--File Copy,GREEN—Appl'icarn's Cupy . .. ::'�.� . �,:. .":.'....� ..'0,... s��.�:i� ,�.....» . . ..,.,i. ••.,,•.r '� .!.'iI dq 4 � .... ...:�. ,�.i.. �u n �� .i-•ye �.... . .�.. ..;...... . ..,:., .... .r:.� .,_..-, �.. . �� ...nj:�,� ., ...� . .. a�t�^� r. ,. � . .., :",�. .� . . . . . '. . '. .....� . t �. . .,, . .. . . � ......- . . . � +, /�- i ��� � � , , � , .:., , ,: x � : _r.:::. ,- a ��'��: ��� �� . :,� .,. . a..;;.�r..,: • - ,,.-. 5�ax�. �, � � , � a ,. r� . � � m � � � � � � w, �: � `:. . ��:� � . . ,?� . , ,.. �,�?�r'�� ` ` . ` _ " t �� aI C�s3�.��'I`a� � � _ k9 ^:,���+� g �+ � ..._, w., .......,.. ' ...�..0 .... � � . i ._..... _. f�. � �g � E Y^1 t.:;e."3�i.�'.d;�C�i��f""�_ .'�.��,... . 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