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HomeMy WebLinkAbout12785 (14) ^ _�,�� CITY OF DIAMOND BATt � T � DEPARTMENT OF COIVIIVIUNITY&DEVELOPMENT SERVICES �� 21660 E.Copley Drive Suite'190 ` i � � , (909)860-3195Fax(909)861-3117 PRESS "„_,... BU�1[,Dri�G�RMIT APi�.��ATtbN _ . �� FIRMLY _. ,. ,.-, ._. ..y,.... ,.,..,�.z u. .H��.. � JOBSITE .��.:;;: ,.�>�;� ,� +,,,a�.e ��.a.;:m ��..�,�v;� R;;,. , /� APPUCATION r C(J� PERMIT C 1_�J P/C o ADDRESS�����HCIZ�ST DP• � DATE_ NUMBER U l �t � ISSUE TYPE OCC APN LOT__�_ TRACT ���I rpT �� DATE CONST. GROUP p OWNER �'fl7Gl��t�S�-� 1/JVF'�.T1U� CfS'f} —�J 1 n ApDRESS_ L�.� 5' lU C����T/��V�'. ZONING SETBACKS � CI7Y �.,A�._ ZIP�4 TEL.(y2�����,C),� FRONT RW ❑ APPLICANT �3Q, t�O TEL.,�y;�).����,��' S DE/SIOE STREET RW ❑ � CQNTRACTOR Pf4C',��=�� (^j� SIDE ❑ l�. ..— O ADDRESS � hL��T�' Q R.� L U� CITY �-QC�Q(f� ZIP q f('30`]TEL.��Z6)$2�,.��iP.Q PROPOSED USE � ARCH/ENG! z DESIGNER NO.DWEL. NO. NO. � ADDRESS UNiTS STORIES BEDROOMS � CITY Z1P TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFRlADDIAEM O � I HEREBY AFFlRM UNDER PENPLTY OF PERJl1RY THAT t AM E%EMPT FRON THE CONTRA�CTOpS LI- � Gdtage/CBfpDf[ W CEfdSELAWFORhiEFOLLWVINOREASON(SEC.7a?7.5BUSINESSAaDPROFESS(ONSC710�:AMV�INOR � COUNTY WHICFI REQUW ESA PERMITTO CONSTRUGT,ALTER.IMPROVE.�EM011SH.Oq REpAIRANV$'[RUC- TURE,PqIOR TO ITS ISSUANCE,QSO REqUIRES THE APPUCANf fOR SUCH PERMIi TO FILEA$IGNED � Pat�o/DeCk STATEMENT THAT HE OR SHE�S LICENSED PURSUANT TO 7HE PROVISION9 OF YHE CdNTRACI"OR3 CI- � CENSE LAW(CHAP7EH B(COMAAENCM�WITH SECTION)000)OF DIVISION 3 OF THE 6USCNESS"AND,PR0. � P006�$pa FESSIONSOJD�ORTFIATHEORSHEISIXEMPTTHEREFROMAN�THEBASISFOqTHEALIEQEDEXEMP• (!�j V TION.MIYYIDLATIONOFSECTION70.97.5BYANYAPPLICAM'FORAPERMITSU&IECT5THEAPPLICANTTb Z qe-Root � ACMLPENALTYOFAEOTMORETHANFtVEHUNDREDDOLLAR.S(;5oo).�� � �� -��•�°�.�. . ❑t,A30W.NEROPTHEPROPERT;ORAiVEMPLOYEESWIYHWAGESASTHEIqSOLEQOMPENSATION, � Commercial Z Wlll.DO THE VYORYC,AND THE STRUCTURE IS NOT INTENUE�OR OFFERED FOR SALE(SLC.7044.BUSI- _J NESS AYD PqOFESSIONS COOE:THE CONTR4C70RS UCENSE LAW DOES NO7 ADPLV 70�AN OWNER OF � VROPER7VNR108UILDSOfl�MPROVESTMEREON,ANDNhiODOE5Sl1CHWORKHIMSELFQqH�'RSELFOR = � THROUGHHISONHEROMMEMPIOYEES,PROVIDED�THAT�SUCH�IMPROVEMEMSApF.NO7tt17ENtiEDOR m OOFFEHEDFORSALEIF,HOWEVERTNEBUILDINOORIMPqOVEMENTISSOLDWITHINO'NEVEAROFd'tlA1PLE- � �TION,iHE OWNER-BUILDEfl WILL HAVE TME BUADEN oF�PROVMO THA7 HE OR$HE bl6 NOTHUIlO OR = IMPROVE FOR THE PURPOSE OF SALE�. ' ' ❑i.AS OVYNEH OF THE PROPEFiTY.AM EXCLUSIVELY CONTRACTING WITI�i L16E.1�SEtl CA�AC'fOq$ - � TO CONSTRUCTTHE PROJEC7(SEC.70{4.BU5INESS�ANO PPOFESSlONS CbOEi YHE CdNTRAE ORS U�- V21118tI0n i ADJ.AREA W CENSEUIWOOESNOTAPPLYTOANOWNEROFAFROPERTVWHOBUIL0.SORIMpRnVESTHEdEON,M10 S WFIOCONTRACTSFORSUGHPFOJECTSWITHACONTRAGTOP(S)LlCENSEDPURSUANYTOTNFCONTRAG- (]�JqNTITY DESCRIPTION FEE f� 70fl5 LICENSE UW.). . oG i MA E%EMPT UNOER SEC. 8.8 P.C.FOIi THIS fiEASON Q � U e. � � DATE oWNER �V Z W o LICENSED CONTRACTORS DECLARATION -.W � IHEftEOYAFFIRMUNOERPENAITVOFPERJURYTHAiIAMLICENSEDUNOERPRDVIS:ON50FCHAPTER� '� � 0(GOMMENCINO WITN SECTION 7Doo)OF DIVISION 3 OF 7HE Bl1SWESS AN�PROfESSIONS CODE,AN� � z �� MY LICENSE i51N FULL FOPCE AND EPFECT. �, m o LIGENSE CUSS �__p� LIC.NO. �.��� 7�"S�,1 � V DATE I Z—�,�,_�ATX _ CONTRACTOR �E'��L FLJ O n-� � W � WORKERS'COMPENSATION DECLARATION ;Q i. . = V .�., -. :, .�,.: ,: . . _,.., ,,� � IHEP�EBVAfFlRMUNDERPENALTYOFPERIUPYONEOF7HEfOlIDWINGbECLARA710NS: ��- � 2; � �IHAVEANDWILLMAR.fiA1NACERTIFICATEOFCONSENTTOSELF�INSUREFOflWORKERS' _ COMPENSATION,AS PROVIDED BY SEC710N 3�Do OFTHE LABOR CODE,FOP THE PERFORMANCE U Q OFTHEWORNFORWHICHTHISPERAlITI5155UE�. � � W _I HAVEAND WILL MAIMAIN WQFKERS'CAMPENSATION INSURANCE,AS REOUIREO BV SECTIDN Q 370o OF THE IABOR CO�E,FORTHE PERFORMANCE OF iHE WORK FOR WHICH iHIS PERMIT IS ] lSSUED.MV WORKERS'COMPENSATION INSl1RANCE CARRIER AN�POLICY Nt1MBEfl ARE CONSTRUCTiON Q _ . . .. . . .. . .... _.._ . . .. ...... ......_ . i � cnaqieR PLAN REVIEW y � POL�CV NUMBER CT o (IHISSECTIONNE�NdTBEWMPLETEDOFTHEPEWATISFORONEHUMRWDOLI.M5�51oqORLESS� I PLUMBING � I CERTIFY THAT IN THE PERFORMANCE OF THE VJORK FOR WH�CH THIS PERAAIT IS ISSUED,I � MECHANICAL ('} SHALL N�T EMPLOYANY PERSON INANY MANNER SOAS TO BECOME SUBJECT TO THE � WnRKERS'COMPENSATIONLAWSOFCALAfORNIA,ANOAGREE7HATIFISHOULDBECOME INSPECTIONFEE .•�_ . SU&IECT'fOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION OOF LA80fi - fl+ pCAPE,ISHALLFORTHWITMCOMPIYWITH7HO5EPROVI510N5, �` ISSUANCE + � �p DATE:�2-10-9,F APPLIGAIVT: __�.� K,) lO SMIP o.� J WARNINGFAILUftETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C � SU&1ECiANEMPLOVERTOCR1I�AINALPENALTIESANDCIVILFINESUPTOONEHUNORE�THOUSAN� ENERGYPERMIT DOLURS(5100,000).IN AOD�TIONTOTNE COST OF COMPENSATbN,DAMAGES AS PROVIDED FOR IN � SEC'T�ON37oeOFTHELABORCODE.INTEREST.ANDAT70RNEV'SFEES. RETENTIONFEE: � CONSTRUCT70N LENDWG AGENCY pRE-ALT FEE: O � I HEREBYAFFIRM UNDER PENAI.TY OF PERJURY THAT THEflE IS ACONSTFiUCTION LENOING AGENCY FOR THE PERFORMANCE Of 7HE WORN FOR WHICH THIS PERMIT IS ISSt1ED(SEG 3087,CIV.C.j. Z W � LEN�ER'SNAME � �� F LENDER'SADDHE55 � �� �<... � ICEflTIfYTHAT�HAVEREADTNISAPPUCATIONIWOSTATETHATiHEABOVEINfOflMAT10NiSCORRECT. TOTAL FEES � � W IAGREETOCAMP�VWITHALLCITVANOCAUNTYOR�INANCESA�STATEIAM)SRELATINGTOBUILDING � CONSTRUGTIdJ,ANDHEREBYAUTFIORI2EREPHESENTATIVESOFTHISCOIJNTVTOEMERUPONTHE � " � � Z ABOVE-MENTIONEDVROPERTYFORINSPECTIONPURPOSES.� COMMENTS___ _ � ��G �� � � ,� m PERk11TTEE NAME(PRIN'� ' . � �,�-��,�,�A, 1��-1 n-��— ,ye � S16PIATUFlEOFPERMITTE DA1E - ' ' = RECPT.N� PAID BY �VALIDAtION� � ~ WHITE—Dep9rtment Copy,YELLOVd--Finance Copy,PINK�--Assessor Copy,GOLOENROD—File Copy,GREEN—Applirant's Copy �. ,� _ ... .. _ .. -, . ,., _ , g. � �� 9� �� � 6��� . , .. . .� ,,:,,�� ��r�� ��- . �.�� . . . . ,. __.�.s ,.�. :. . :.,..:,. .,,,.. .:.;..,,..:._ � � ',.::,�.:... �r., : "; .�.::��i��,- �: � . .. ..., ..-- . . �. ... ,........ . . . , � • . . . ,. "�. ',��.:�. . :�� ... � � � ��.. � :� ' � �� � � : � 3. . .. � i � �.w �.�' � " �� ' . . .. � -:, ,� . . �A,; . _ �. ,'.- . . ' .. . . ._ . - � -. � '.� �.. (y^� �y�^' �+ �� ,.i:.6 t`dTl1 �„"b : '., _. E _ 3 3 �€..Ld€JS-i e.��,e��r..�S� . ,. . 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