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HomeMy WebLinkAbout14819 (17) � , �, CITY QF DIAMOND B�R � ; -- rt� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � . � 21660 E.Copley Drive Suite 190 (909)860-3195,Fax(9Q9)861-3117 � PRESS BUII.DING 1'�I�11%t�'1`AIj'��iCA'�'ION .. , . ' °'" FIRMLY ,: __- a � . . ..w._�. . { � .._. .� ..,, .... .... , � � � �e ,.., ,�� �,. � JOBSI�E ' s APPUC TION P�pMiT `.y�i� P/� ¢ ADDRESS o � � �ATE Z- d g NUMBER����� # �Q $ ISSUE� ."'TYf�E�• OCC � APN LOT TRACT � DATE �'���7 � CONST. C';�+� GROUP �.+t^Z p OWNE�I9F'�f�/NA " "::�:�'`' _ p ADDRESS���� /�NK�� ZONING SETBACKS � CITY�_� Z P TEL. FRONT RW ❑ APPLICANT C�C/� �/'rj TEI�!- Qi ��'� g DElSIDE STREET RW ❑ � CONTRACTORG��f+��✓1'i�¢ /�d/$f�$�i�S SIDE o ARDRESS O A ��f4v�` $o+v7"- F-�- ❑ CI7Y . o ` ' ' ZIP /9 7q/ TE�33��l� PROPOSED USE w ARCH/ENG/ z DESIGNER /^���C�-L" w NO.DWEL. NO. NO. a A�DRESS � CITY ZIP TEL. UNITS_^ STORIES BEDROOMS cn cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECIARATION SFR/ADD/REM O I HEREBY AFFlRM UNDER PENALTY OF PERJUHV THAT I AM EXEMPT FflOM THE CONTRACTORS LI- Gef3 JeIC8fp01t W CENSELAWFON7HEFOLLOWINGREASON�SEC.7097.58USINESSANOPROFESSIONSCODE:lWYCI'tYOR (� U COUNTYWH�CHREQlJIRESAPERMRTOCONSTf1UCT,A47ER,IMPROVE,OEMOLISH,ORFlEPAIFiANYSTRUG {J,J pgti0/D9Ck W 7UPE,PRIOR TO ITS IS3U/1NCE,ALSO REWIRES THE APPLICANT'FOR SUCH PERMITTO FILE A SIONE� , � .�, STATEMENT THAT HE OR�HE 15�LICENSED PURSUANT TO'fHE PROVISIONS OF 7FIE CONTRAC70Fi5 LI� � CENSE LAW(CHAPTER B(CqAMENCINO WITH$EC1'�N 90'So)OF�IVISION 9 OF TFI'c BUSWESS ANp PRO- POOUSpB {�? 7 FESSIONS COD�OR THAT'HE OA SHE IS O(EMPT7HEREFROM AND TNE BASIS FOR tHE ALLEOED EXEMP- TION.ANYVKK.ATONOFS�`CTION7o91,EBVANVAPPLICANTFOFiAPERMITSU&IECTSTHEAPPLICANTTO � RB-RDOf � ACML PENKTY OF N07MOREYHAN flV�HUNDRED DOLIARS(5500).): �- � ❑I.A30WNEROF7HEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSA710N, � Cornmercial - . VALL DO THE WpH1C,AND THE STiq1CTURE IS NOT INTENOE�OR OPFERED FOR SALE(SEC,704d,BU51� J � NESS AND PAOFESS�ONS CODE:THE CONTRACTORS LICENSE L0.W DOES NO7 APPLV TO AN OWNER OF PROPEHTYNh10BVILDSORiMPROVESTHEHEON.MDWHUDOESSUCHWORKHIMSELFOpHERSECFOR � � � THIiIX1OHNISOpHEROWNEMPLOVEES,OROVIDEOTHATSUCHIFAPROVElA�RTSARENOTINTENDEOOP m L�1 .OFFERED WRSALE�F,HOWEVER TME BNLDIN(i OR IMPROVEidENTIS'SpID WITHIN ONEYEAROKCOMPLE- � 'TION,7HE OWNER-BINIAER WILL HAVE THE BUR�EN OF PROVING THAT HE OR SHE DIQ NOT BUIID OR IM�ROYE FOR THE PURPOSE OF SALE�. yy� ❑I.ASONTIEROFTHEPROPERTY,AMEXCIUSIVELYCONTRACTINGWITMLICENSEDCONTRl�CTORS . . . . . .,.. ... ._ . . , .. Q TO GONSTRUCT hIE PRQIECT(SEC.7o46,BUSINESS AND PflOFE55ION5 CODE:THE CONYRACTORS l.l- V2IUffiIOI1 _ ADJ.AREA W GENSEUWDOESNOTAPPLYTOANOWNEFIOFAPROPER7YWNOBUtLDSORIMPROVESTHEFiEON,AND WHp CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTORiS)LiCENSEO PIJRSUANTTOTHE CONTRAG mnsucensEiww.}. QUANTITY ESCflIPTION FEE - �� O 1 APA FJ(EMPT UNDER S�C. 8.&P.C.FOR THIS REASON Q � 6�.. � DATE OVYNER � z W �A[ LICENSED CONTRACTORS DECLARATfON W CL f NEREBVAFFIRM UNOER PENALN OF PEiUURY THAT IAM LICENSEO UNDER PROVISIONS OF CHAPTER � � B(COMMENCIMB WITH SECTION 7000)OFDINSION 9 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� MY IJCENSE I5IN NlL FOiiCEAND EFFECT. m o uc�syecuss G� LIC,NO. �07���` ^, � �j � DATE 7"�^7^� CON?RAC70R.�Nj'�F 0`�S pJ. . . .. ... ....,__.___,_.... ..__._'_ . _,._. � WOAKERS'COMPENSATION DECLARATION a , � IHEREBYAFFIRMUNDERPENALNOFPERJURYONEOFTHEFOL�OWINGDECLARATIONS: Z � _IHAVEANDVYILLMAINTAINACERTIFlCATEOFCONSENTTOSElFINSUREFORWORKERS' _ , . ,_ ,,,_, _ .� , � COMPENSAT�ON,AS PROVIDEO�BV SECTION 3700 OFTME LABOR LODE,F9RTHE PERFORMANCE W Q OF7HE WORK FOR WHICH THIS PERMIT IS ISSUED. � � 1 , W _,I HAVEAND WIU.MAINTAIN WORKERS'COMPEWSATION INSURANCE,AS REpUiREO BV SECTION � (� � � Q 370oOFTHEtA80RWDE,FOHTHEPEf1FORMANCEOFTHEWORKFORWHICHTHISPERMITIS jl� ISSUEO.MY VIORpKERS'COMPAENS��N INSURANCE CARqVER ANO POLICY NUMB£R ARE: CONSTRUCTION �„y � � j CARRIER_ /T�C�n�� ���- "— PLAN REVIEW � PaICY NUMBER IuN�� "—��I ,Z 1^ O`�^ � � _ ELECTRIC - � . � (iH133ECT%7NNEmNOTBE00APLEtEDOFhiEF£RMRI3F9RONEIiIX#7EDCq.W3S(S70o)ORLESS} PLUMBiNG �� Z i CERTIFYTHRT IN THE PERFORMANCE OF PHE W4RK FOA WHICH THIS PERMIT IS ISSI/ED.I MECHANICAL ��� �- � F � C3 � SHAL NOT ENIPLOY ANY PERSON IN ANY NANNER SO AS TO 9ECOME SU&IECT TO THE y , WOqKERS'COMPENSATION LP.WS OF CALIFORNIA,AND AGREE THAT IF I SNOULD BECAME 1NSPECTION FEE n � ' � SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION370oOFTHELABOR A� � � ��OiI �v�n�^ � CODE,1 SHAIA.FORTHWITH COMPLY WITH HOSE PFiOVISiON� ISSUANCE Q `�- � .,. p OATE:��"'8'��` APPLICANT: ' __ �SMIP � e � J WARNING:FAILURETOSECUREWORKERS'C PENSA"fpNCOVERAGEISUNLAWFUL,ANDSHAlLBE ENERGYP/C _ � �� SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINE$UPTOONEHUNDREDTHOUSAND� ENERGYPERMIT OOLLARS(E100,000),IN AD�I'IYON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR M ¢ I SECilON37080FTHELABORCODE,INTEREST,AN�ATfORNEY'S�EES. RETENTIONFEE: f OCONSTRUCTIONLENDINGAGENCY PRE- FE : � � I HEREBV AFFIftM UNOER PENALTY OF PERIURY TMAT THERE IS ACONSTflUC170N LENDING AGENCV � FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMIT�SISSUED(5EC.3097,CIV.G}. �� - - , W ,,,�I � � LENDER'S NAME ' F— LEN�EP'SADDRESS � . . � � . . .. . . . ICERTIFYTHATIHAVERE/WTHISAPPLICAT�ONANDSTATETHATTHEABOVEINFORMATtONISCARRECT. TOTAL FEES �� g� W t AGREE TO COMPLV W1TH ALL CIN AND COUNTY ORDINANCESAND STATE LAWS i1ElATING T09UILOING � CONSTRUCTION.ANDHEREBVAUTHORIZEREPRESENTATIYESOFTHISCOUNTVTOENTERUPONiHE S � ABOVE-MENTbNEO PqOPEHTV FOR INSPECTION PIIRPOSES. ��. 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