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HomeMy WebLinkAbout12670 ,_ ,. � . .. ,,� . ., DE AROTM NT�QFCOMMUNITY&DEVELUP ~ s.'�f�' ' —�� MENT SERVICES 21660 E.Copley Drive Smte 190 ` w (909)860-3195 Fax(909)861 3117 PRESS ��°'"`' BUtI,DI1e1�P�Eitl�tr�A��Y.�CA�t6N . �_ � '- �,." �` 'I���� � FIRMLY _ .:.�...... ,-. . _ �R Nu ..„.., , � JOBSITE ;.r;... ,r:.,: ,,n .w�u�k ., TM x- , . , . .•.�� (< 44�1�'�:�'Jw x APPLICATIQN �6 �J� PE M� r �SM17 .s,. ,.:-,,,, P/C. � Q ADDRESS � !� � r�� � DATE I 1�' d`�"1� MBER� # � APN LOT TRACT D TEE �����(.� CONST. GROUP p OWNER �� � ADDRESS ZONING SETBAGKS z CITY _-��r� IP��^ FRONT RW ❑ g APPLICAN'f TEL REAR ❑ SIDEJSlCE STREET RW ❑ � CONTRACTOR I.� U SIDE ❑ � ADDRESS PROPOSED USE � I � � � CITY ZIP TEL /I///_�„(:IiS1.%(J�} ,;,� , . w ARCH/E ! "� ��� z DESIGNER NO.DWEL. O. , NO. a ADDRESS UNITS " "'' STORIES �� BEDRQOMS = CIN ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ApJ.AREANALUATION � OWNER-BUILDER DEGLARATION SFR/ADDlREM 0 p I HEREBY AFFIflM UNpER PENALTY OF PEfWURV THAT I AM EREMPT FROM THE CONTRACTORS L'- G2fag01C8fpoR LL7 CENSELAWFORTHEFOLLOWMGHEASON(SEC.703t.68USINESSANDPROFESSIQNSCtlbE:ANYCI7VOR (n C3 CIXINTYWHICHREqUIRESAPERMITTOCONSTRUCT,ALTER;IMPROVE,DEMOLISFI,Op�R�I�AIRANYSTRUC- W PBIIO/DBCK '� TUKE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT 70 FILE A 51�NED W S7ATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROV1510N5 OF 7H�CCNTFtACYORS ll- � CENSE LAW(CHAPTER 9(COMMENCINO WITH SECTION�a0oj OF DINSION 30F TFIE DUSINESS AND PRO- V' POOVSpB FESSIONSCOD�ORTHATHEORSIIEISD(EMPTiHEHEFROMAN�THEBASISFORTHEALLEOEDEXElAP• (� TION.ANYVIOIATiONOFSECTION7W7.58YANYAPPUCANTFOflAPERMITSU&IECTS7MEAPPUCANTTO z {�@-Rppf � A C1VIL PENATY OF NOTMORE THAN FIVE HUNORED DOLLARS{E500):$ � � •.� ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEYRSOLECbMPEN$ATION. ❑ Comm9rcial � W1LL DO THE WORK,AND THE STRUCTURE IS ND7INTENDB�oR pFFERED WR'SALE(S�C�044,BU51- J ._ NESS AND PROFESSIONS CODE:THE CANfRACTOiiS UCENSE IAVJ OOES NOT APPLY Ttl AN OWNER OF � PROPERTVVRi08UILD50RIMPROVESTHEREON,M1O4hfODOESSUCHWORNNIb1SEI:FYSR1-1EpS�LFOR � � 7HRtlUGHHISORHEROWNEMPLbYEES,-PROVIOEDTHRT3UCH'IMPqOVEMENTS�AREI'JbYMTENbE00R m QOf'fEREDFORSALEIF,HOWEVER71iE8UILDINGORIMPROVEMENT1550LDWITMNaNEYEAROFC'dMPLE- iION,iHE OWNER�BU0.AER WILL HAVE THE 6UR�EN OF PpOVING THAT HE OR SHE ISIl7 NbT 8U'IlD 4R = IMPROYE fOR THE PURPOSE OF SALE1. ' � i �BP��,• �� W ❑I.ASOWMEROFTHEPROPERTV.AME%CLUSIVELYCONTRACiWOWiTHLICENS�GI�ANTRACTORS ,�.�- (r To CONSTAUCl'TNE PRO.IECT(SEC.7M4,Bl1SINE55 AND VROFESSIONS COISE:�1'HF CbNYPAC70R5 LI- V&lU&tiOn � a ADJ.AREA � � W CENSELAWDOESNOTAPPLYTOANONRJEROFAPROPER7YMHOBUI�DSORIMPR.7VES�'?IEi1EON,AND y WFiOCONTMCTSfORSUCHPROJECTSWITr!ACONTRACTOR�S)UCENSEDPURS[1ANTT6THECON7RAC- QUANTITY DESCRIPTION FEE � 70RSUCENSELAW.). '�d''; ��I�. , 0 ❑I AM IXEMPT UN�ER SEC. _B.8 P.C.FOR THIS REASON Q , . ' U ....� 4r�: #�a....�.., k � . � . . .. .. . DRTE OWNER U W � LBCENSED CONTRACTORS pECLARATION , __� � +�� W I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PPOYISIONS OF CHAPTER � � 9(COMMENqNO WITN SECTION 7000)OF DIYISION 30F THE BUSINESS AND PROFESSIOyS CDOE,AND Z X" MY LICEkSE IS IN Ft1Ll FORCE AND EFFECT. � Lll / O UCENSE C4A,S51 .�� �' L-���UC.NO.__�y��f � j V DATE�.�.! � CONTRACTOR__�j�_��� p- - 1,iJ D! � ���y,I�� � WORKERS'COMPENSATION DECLARATION I i���N -� � B � IHEREBYAFFIRMUNDERPENALTYOFPERJUNYONEOFTHEFOLLOWING�EC4ARATIONS: Z Q � _IHAVEANDWILLMAINTAINACERTIFICATEOFGONSENTTOSEIF-INSUREFORWORKERS' _ �� COMPENSATION,AS PROVIDEO BV SECTION 3�oo0i THE LABbR CODE,FOR TNE PERFORMANCE W OF THE WOHK FOA WHICH THIS PERMIT IS ISSUED. � O W ''�� I HAVEAND WILL MAINTAIN WOFKERS'COMPENSATION INSURANCE,A5 REOUIREO BY ScCTION n 370o OFTHE LABOR CODE.FOA 7HE PERFORMANCE OF THE WORK WR WHIf.H THIS PFRMIT IS �I} ISSUED.MV WORKERS'COMPENSATIO/N�I�NSURANCE CFRRIER AND POLCV NUMBER ARE: CONSTRUCTION I�"'j�� j CARRIER__��/ �-U'��� �^q PLAN REVIEW � POLICY NUMBcR�„_v,��}_[_ y.Cj,� � ��� ELECTRlC Q �� �� � ��ssEcrmuuE�wo7eEoxa�.EreooFn�aEw�nrr�swaoraeNunoa�na.was�Eiro�oaiEssl. PWMBING Z I GERTIFV THFT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERNIT IS ISSUED,I MECHANICAL C;3 SNlLL.L NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS N BEGOME SUBJEGTTO THE � WOHNERS'COMPENSATIONLAWSOFCAUFORNIA,ANDAGFEETHATIFISNOVI:DBECOME INSPECTIONFEE � SUBJECTT07HEWORKERS'COMPENSAiIONPROVISIONSOF CTION370oOFTHELABOR � �.A = CODE,1 SHALI FORTHWITH COMPLV WITH THOSE P�VISIONS� ., �SSUANCE _ __ ! p DATE:�.1!_�.��APPLICANT: �, ,��I�-i P SMIP J S C � WARNING PAILUflE TO SECURE WOFiKERS'COMPENSATION COVERAGf.IS UNIAWPUL,AND SHALL BE ENERGY P/C _ �—y SUBJEC7ANEMPLOYERTOCRIMINAL7ENALTIESAN�CIVILFINESUPTOONEHUNOREDTHOIJSAND � EIVERGYPERMIT Y Oa.LARS(5100.00D),IN AODITIQN TO7HE COST OF COMPENSATICM,�AMAGES AS PROVIDED FOR IN � � SECTION3'1oeOFTHELABORCODE,WTERESi;AN�ATTORNEY'SFEES. RETENTIONFEE: oCONSTRUCTION LENDING AGENCY PRE-ALT FEE: ��,�� � I HEREBV AFFIHM UN�EA PENALTY OF PERJUqY THAT THEPE IS ACONSTRUCTION LENOWG AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3037,CIV.C.}. Z W � LENDER'S NAME _ .. . � ' ' � ...- F— LENDER'SAODRESS - -�-� � TOTP����NDIAMOND B,AR . /�`" �� ICERTIFYTHATIHAVEREADTHISAPP�'CATIONANDSTATETHA77HEABOVEMFORMATIONISCOflRECT. ,��m ,��+�,/�'1� / I IAGREETOCOMPLYWITNALLCITYANDCOUNTVORDINANCESANOSTATELAWSRELATW�TOBUILDIN6 G K1VL SL'11'lil j f 4.� � CONSTRUGTION,AND HEREBY AUTNORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE ("� / ) Z AOOVE-MENTIDNEO PROPERTY FOft INSPECTION PURPOSE5. � -� .,"' p � ./ Q � � �� COMMENTS J m � PERMITTEENAMElPPIM) ' '�.�y<�:�,.�.:. ., ., .. , ... . ., ,:.,a C/� hr�:1 . ,. . ,, . � �:.q, r,�;.t.,. .....:.�, . :��. ;� ..-�. qn SKiNANREOFPE EE .. � � '� DA1E , / �' 4� � RECP2 NO. 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