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HomeMy WebLinkAbout14309 (17) CITY OF DIAMONI�BAR �X � ��� R � -- — DEPARTMENT OF COMMUiVITY 8c DEVEL�OPMENT SERVICES w • 21660 E.Copley Drive Suite 190 ,,� ,,,, (909)860-3195 Fax(909)8613117 PRESS "�" BUIT;DING PERIVIIT AI�FLICAI`ION ,s,... - �: �,��., ��.�,,,�k�K '- _ FIRMLY �. , --- , . . , . q _. . .�% ... . . _, , , ,: ��.,.. � JOBSITE `. ������`�,�.��J`, APPLICATION ' PERMIT P/C o ADDRESS Z����-- �� ��1��� �C��`�1 DATE �� NUMBER � # � ISSUE TYPE pCp � APN L�T TRACT DATE CONST. GROUP p OWNER _ �,�CA,�'�H�L=�SL'T p ADDRESS�"�I�A.�.�'.-` ZONING SETBACKS � CITY ZIP TEI. REART RW O APPLICANT TEL. SIDE/SIQE STREET RW ❑ �� CONTRACTOR ��C.� �`l7a�C.L�'�2S` SIDE � ADDRESS��Z.'��`�T� " ' ` o ClTY V�Ac.e-�x�'3G.�`.S ZIP � Z TEL.E�'�Q '" ''/�' ""` PROPOSED USE o ARCH/ENG/ z DESIGNER � ADDRESS . . NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPT�ON SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BQIILDER DECLARATION SFR/AOD/REM O I HEH�Y AfFlRM UNOER PENALiV OF PERJURY THAT I AM D(EMPT FROM THE CIXJTRACTORS LI- G8(BQB/C8R701'I W CENSEIAWFOHTHEFOIIOWINOREA30N(3EC.7W7.5BUSINESSANDPPOFE3310N3(bDE:AN9qTYOR (J) U COUNryWMCHqEpU1RESAPERMITTOCONSTflUCT,ALTER,IMPROVE,DEMOUSH,ORREPAIRANYSiRUC- W PBtio/DOCk W TURE,Pii1DR i0 ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIpNED w � STATEMENT TiAT HE OR SHE IS LICENSED PURSUANT TQ THE PFiOVISI0N5 OF THE CqN7RACTORS'LI- � CENSE LAW(CHAPTER B(COMMENCINO WiTH SECTION 7000)OF DIVISION 3 OF THE BU5INESS AN�PRO- PODUSpB FE3SIONSCODEJORTHATHEORSHEISEXEMPTTHEREFAOIAAND7HEBASISFORTHEALLEGEDEXEMP- (� TION.ANVVIOLATIpNOFSECTION7o31.58VANYAPPUCAMFORAPEPMITSUBJECTSTHEAPPLICANT'TO Z RB-ROOf � ACIVILPENALTYOFNOTMORETHANFIVEHl1NOHE0DOLLIRS(S5W).): �- - � ❑I,ASOWNEROFTHEPRQPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, O COmffi0PCl21 -- WILI DO THE WOAK,MA THE S7AUC7URE IS NOT INTENDEO OR OFFEREO FOR SALE(SEC.704a,BU51- J y NESS IWO PRDFESSIONS CODE:7HE CONTRACTOqS UCENSE IAW OOES NOTAPPLV TO AN OWNER OF PROPERTYWFIOBUILpSORIMPROVESTHEREON,ANDWNODOESSUCHWORKHIMSELFORHERSELKOR � � TMRd10HFNSORHEROVJNEMPCOYEES,PROVIOE�THATSUCHIAAPROVEldENTSApENOTIN7ENpE00p m QOFFEREDFORSALEIF,HOWEVERTNEBlHL01NGOR1IAPROVEMEMISSOLDWITHINONEYEAROFCOMPLE- � TION,THE OWNER�BUIL�ER WILL HAVE THfi BUHDEN 4F PROVING THAT HE OR SHE OID NQT BUILD OR = IMPROVE FORTHE PURP0.SE OF SAL�. ' " ... . W OI,PSOWNEROFTNEPROPEHTI;AMEMCf.USIVELYCOMRACTIN6WITHLICENS�DCONTRACTORS pC TO CONSTRUGT THE PROJECT(SEC.7a4,BUSINE55 AND PROFESSIONS CODE:THE CONYRA6TORS LI- V81113I10l1 ADJ.AREA � W GENSEUWDOESNOiAPPLYTOANONTJEROFAPROPEHTYWHOBUILDSORIMPROVESTHER�OH,AtJD � WF1O CONTAACTS FOH SUCM PFOJECTS WiTH Af:ONTRACTOR(5)LICENSED PURSUANTTO THE CXJNTMC- rORs ucENSE uW.). , ; QUANTITY DESCRIPTION - FEE �� ❑I AM EJ(EMPT UNDEfl S�C. &A P.G FOR THIS REASON Q U � DATE OWNER ' � d —_-- W � UCENSED CONTRACTORS DECLARATION W � � I HEREBV AFFIRAI UNDER PF.NALTY OF DERJURY 7HAT 1 AM LICENSED UNOER PROVISIONS OF CHAPTER ����q,�� � Y(COIdMENCINCi WiTN SECTION 7DOD)OF DIVISI4N a OFTHE BUSINESS ANO PROFESSIONS CODE,AND � (.�.J C,�.i"'k'o�(��L C�� X MY LICENSE iS IN FULL FQRCE AND EFFECT. C p� `� LICENSECtfAS9S ��+ �� LIC.NO. `�'��""�� - � U �ATE ` %�(� CONTRACTOR, d 6J.7 � WORKERS'COMPENSATION DECIARATION -i � IHERWY/1FFIRMUNDERPENALTYOFPERJURYONEOFTHEFOLLOWMG�ECIAflATIONS: Z - � _IHAVEANDWILLMAINTAINACERTIFtCATEOFCONSENTTOSELF-INSUREFORWORKEpS' _ COMPENSATION,i1SPROVIDEDBYSECTION37a00F?HEUBORCbDE,FORTHEPERfOfiMANCE W Q OFTHE WORK FOR WHICH THIS PERMIT IS�SSUE�. L � 1 HAVEAND WILL MAINTAIN WORi�RS'COMPENSATION INSUqANCE.A5 REQUIREO BY SECTION � Q� 37000FTHE LABoq CbDE,FOR THE VERFOFMANCE oF THE WORK FOF WHICH THIS PERMIT IS ISSUED.MYK'OR�5'COMPENSATI�O�N�INqSURANCE/C'AyRRIEfl�ANyO'�POIICVNUMBERARE: COIVSTR�JCTION ... .j CARRIER �'C"'`'G�.+ I.Iead 4�-.�.'.J7G,►` � . ..... _.... ... .........__. .. ...._.........__. '-7�y' g PLAN REVIEW ZPOLICY NUMBER ,�{�J �,r ^ R , ELECTRIC Q Q (Mss[t,'noniue�raieeoo�_ErEooFi�aEaAur�sFoaa.EHur�aEo�uaas�siooloa�ss�. PLUMBING �� Z I CEHTIFVTMAT IN THE PERFORMANCE OF THE WORK FOF WHICN THIS PERMIT IS ISSUED,I MECHANICAL Cf SMALLNOTEMPLO7ANYPEfl50NINANYMFWNER50A5T00ECOMESUBJECTTOTHE � WORNERS'COMPENSATIONLAWSOFCALIFORNIA,0.NDAGREETHATIFISFi0ULD8ECOME INSPEC710NFEE * � SU&IECT TO THE VJdRKERS'COMPENSATION PROVISIONS OF SECTION 37�0 OF THE LABOR x3.d a � CODE,ISHALLFORTHWITHCOMPL�YJFPH�TROS@�PF VISIONS. ISSUANCE � t Q �,r�� 'y�g��qyy�g�q > �g-�. ?y � p �ATE: �'LC�-7 APPLICANT I--.._,—..�'- --.""" ,..,".'-,�.+ SMIP . ��i1L,1-�d-+71��"-n��'�d�•i3 4�'.1'�'i � WARNINO:FALURETOSECUREWORKEFS'COMPENSATIONCOVERAGEISUNIAWFUL.ANDSHALLBE ENERGYP/C ����,���,�°a-�?��'�'k�'��r�"� � SU&IECTANEAIPLOYERTOCRiMINALPENALTIESANDCIVILFINESl1PTOONEHUN�REDTHOUSAN� ENERGYPERMIT DOILARS(S1C0,000�IN ADDITION TO THE COSTOF COMPENSATION,DAMAGES AS GROVI�ED f-0R IN � SECTION37080FTHELABORCODE,M7ER[ST,AN�ATTORNEYSFEES. RETEI�TIONFEE: QCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBYAFFlRM UNDEfi PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV FOP THE PERFORM.4NCE OF THE WORN FOR WHICH THIS GERMIT IS ISSUED(SEC.3oe�,CIV.C.). � . � Z W � LENDER'S NAIAE , � P- LENDER'SADDRESS � TOTAL FEES � ICERTIFVTHATIHAVEREADTHISAPPUCATIONANDSTATETHATTHEABOVEINFORMATIONISCARRECT. � IAGREETOCOMPLVWITHAILCITYANDCOUNTVORDINANCESANDSTATEIAWSRELATINGTOpUILDING ��". ��e �� I � CANSTRUCTION,ANDHEREBYAUTHOfl2EFEPRESENTATIVESOFTHISCOUNT'TOENTERUPONTHE . Z ABOVEMENT10NE0 fl9RF$TY FOR INSPECTION PURPOSES. COMMENTS _ _ �(�..•'J_" �.�'�I�cC-� � PERMITTE NAliiE(P 1 ' ¢7�^.�. ' Cn �i �;�i__-�r, ���\ �l 3 �� — — . . .. �.: ,.-�.:� � SIQNATUREOFP6RAUTTEE DATE ����� � . RECPT.NO. PAID BY '� . 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