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HomeMy WebLinkAbout14476 (20) , ,. .�--._.�*`�.__... CITY OF DIAMi7�ND B.AI� • � I7EP'ARTIVIENT C?F COIvtMUNITY&DEVELt�PMENT SBRVICES !� � �, , 21e�o�.cori�yt�riv�S�,�i�o � ` . , l PRESS y (4Q4)854�-3195 Fa1c{909}861-3131 •.`., �vx[.�fNG���rz`APi�Ltc�`�[t�T , ,,. , � a � �.. � .. . .._�. ���m..�-� n .��,� �,. ...�. �,_ .. � , .�-=Fm . . >,�F.a .,,,.� _�� ��_ F�RM�Y � JOBSITE ��l�� .::. > ._. ,��! �'!ti- ..,:::- DATE CATIA �" � . �::r=r ?PERMI�''. _ ,. .. ��t�, .,, .,. Q ADDRESS �N�' � � � NUMBE #!C c� lSSt1E 7YPE C?GC APN LOT TRACT DATE CONST. GROUP �p CIWNER C �s+�t ADDRESS �.L �D'I�- ZONING SETBACKS � FRONT RW ❑ � CiIY �- ZIP l`� TEL. a� ��,��`�j APPLICAPlT ���. REAR ❑ SIDE/SIDE STREET RW ❑ � CdN'f RACTQR . SIDE � Q � ADDRESS �� ' �' C1TY ZIP TEL._�__ . . PROF�OSED US�,� ; ,, , . w ARCHIENG! , + z DESIG[VER NO.DWEL. , �'� NQ. NO. � AddRESS UNd'f8_,.,�.,=���=#"�—...- 6TOFIES ._�t�..,,�" BEDROOMS� � Gll'Y ZtP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION u> � CYWNER-BUILDER OECLARATICtN SFWADt3JREM d p I HEREBY AfFIHM UNPER P€NALTY�F PERJUFY TtiAT i AM EXEMPT FftOM TYf£CONTftRC70fl>(.i� �A�g���p�{ LLI GENSEUtWFOATt�fOCI.OWiNGREA$Oid(SEC.7o37.68USiN�59ANDPROFESSIONSCODE:ANYCi7Y0R (J) - - C.� WUNTYWHICHRE4UIRE8RPERMITTOGONS7RUCT,ALT&R,IMPfiOVE,DEMOLISH,OFlREPAIFlANYSTRUC• LLI pd4�0/D6Ck � TURE,FR�i TO IF5 ISSUANCf,ALSO REOUIRES THE APpl.ICAN7 F4t?SUCH GEf?tAiT TO FEt EA S(GNED � .- , .�,.- STATEMEN7 THAT HE OR SHE IS LfCEN5ED PURSUANT TO THE PROVIS�ONS OF THF.CON7'NAG74PS 41� � CkNSE LAW(GHAPTER 9�GOMMENCINC#WITH SECTIbN 7000)OF DIVISION 3 OF THE BUSINESS�ANO Pq0- U" PaoVSpa _ FESS%]NS fi,QQE}QRTNAT HE tJR SHE i$EXElAPTTHEREFR6M ANp 7H[8AS15 F�RTNEAl.LEGECJ EJtEMP- TION.ANVMOLATIONOF&EC710N7o31.68YANYAPPUCAN7�FORd.PEFiMITSU&IECI`STHEA?PI.ICANTTO � Ea0•RDOf � � AGMLPENAtTYOFN07�Ma�1ETHANFIVEHUhUREp4flLLAflS{SS�v).): - � � OI,ASOVdNEFl4FTHEPRPPERlY,4RMYEMP40YEE5WITNWAGESASTNEtiiSOLfCt76iP�tJSAT�QN. CS Cpl'nTBlGldl W'1LL 66 THE WORN,ANU TME STRUCTURE IS NOT INTENOED OR OFfERED�OR SALE(SEG 7044,BUS6 J NE557w0 PFlOFE53tOMS CODE:TNE C4NTR4CTOR5 LiCENSE tAW DOES uoT APP�Y TG aN ox+NER OF � PROPERTYWfi68UILDSO,RIMPROVE57HEREON.ANDt4F1066ESSUCHWORKHiMSELFpNNE{i6€LFOR � � THROUdHHISORHEROWN9�APLtlYEE9,�OpOVIDEb�THATS`UCH�AIPROVEKfEN7SP.FYENOT1N7f.N0EDOp � � O'�ER£O�OASALE#FFtOWE1�EA,SHE8U0..DINGORiFdPROVEfAEN7i55bt[}Wf7HiNflNEYEAROFCOMPi.E- �, �TIpN,THE OWNER-BUIIDER WILL.HAVE THE 9URD6N OF pFOYM�7NpT HE OR SWE DID N�T 6UILD OR � IMPROVEFOFlTHEPURPCI9EOFSALE). ❑I,AS OWNER Or TNE PROPEATY,AiA E%CIUStVEtY IX�NTRACTING WffN 4FC£NSED CONTRACTORS i,� �6, � TD GON5TRUCT TNE�PR0.1EC'f(9EC.lP0.a,BUSINESS AND Pl�OF�SSIONS CODE:7HE CONTRA�TORS LI- ValUatiaYt .,�l.'v�CJ•�+^'- ADJ.AREA � W CfiNSEVeWO0E5NC?T.4YPlYTpAN4WNEROFAPliOPERTYWHC�BUILOS�A�A?ROVESTHEREON,APfO � WHOCONTRACTSF6RSUCHPROJECTSWITIiACON7FAC70R(SyL�CENSE6PURSUANTTOri2ECON'fRAO- Q�J({Nl7TY DESCRIPTION FEE � TC1R5 LICENSE LAWJ. �.I _ „ � q I AM�(E1.1PT UNDEA S[G. D.&P.G.FOR TMIS REASpN q ! Q � �i � � �,,,,.... U ,..:� � 'J�� � g �j�,j���'_"f""'-��-. _' OATF�/� "" OWNER/ .,,�„ �� i W �a� LICENSED CQNTAACTORS D� ION i j � � � ���e� CC I HEHE9V AFFINM UP10ER PENALTY OF PER,AIFiY THA7 i AM UCENSED UNDER PROVISIONS OF CHAPTER � �� � p,. 9�COMMENCINQWI7HSEC710N90oo)bF�IVlSiON30FTHE8USINESSANDPFiOFcS510NSCO�E,AN� Z ?t iAY L�ENSE tS 3td FUII�ORGE kND EFFECT. ,� 449 � � UGENSE CLdtSu UG.PdO. � �� � o*�s ok (t- �y c'� ��, �ee-t"C � DATE „_ C9NTRAC70R - __�—. 0. fp�.ar � �,�p r._ � Wt?RKERS'COAAPENSATICDNDECLARATION � ��. ��n a���p�.l� � ' � I HERE9YAFFlRM UNbER VENALTV OF PERJURY ONE OFTHE FOLLOWMG DECiARAT1oNS:� � �, - � z . . — ¢ - t':) IFICATE 06 CONSEM1I�"TO SELf.iNSURE FOR WOR7�ER5'�.... � ..„ �,,. ..��`,����� /�, ,. . � �-��u-O}FTHEW4RK�R?flWHtGH7N15PE5FGT1�bN�970oOFTHE�IABOR�CObE,FORTN�E�7ERKbR'SIANCE� U COMpENSl1TiON,/1S PF{pVtpFtl'BY �. � ��r�s�ssu�. � j � Y' w ,�1 HAVEANd Wl�L MAINTAIN WOHKERS'COMPEN3ATI�N MSURM7CE,AS SiEQUiREp BT SEC7ION . �f_ i� � � a7oo9FTHELABORCODE,WR�lHEPERFpRMANGEOFTHEWbPKFORWHICHTNISPERMITiS � .1� (,(aGd ISSUED.MY WORKERS'COMPENSA710N INSURANCE CARRIER AND Pb(JCY NUMR£P ARF CONSTFiUC710N �_ � CARaIeR PI,,qN REVIEW � FflIICYt,RlM�EF..._.__.......� ELECTF?!C ___.� Q � {TNISSEG110NNE3YN0T9ECC�U'N_ElEpOFittE�T25FORONEHUPDREDCLYlAflS($iW�6RLE55l. PLUd9RlNG � I CEN7IFY THAT IN THE pERFORMANCE OF TNE WORK FQR WHICH THIS PEfiM1T IS ISSUEp,I MECHANICAL (,� SWUGNO'EMPIOYANYRERSONMANYbiAtJFlERSOAST06EC4MrSU&tECTTOTfiE ( � wORKERS'COMPENSATION LAWS oF CALiFORNIA,AND AGAEE THAT IF I SHaULO BECOME � INSPECT'tGN FEE _ � SUBJECTTOTHEWORKERS'COMPENSATI4NPRQVISIONSOFSECTIG7�I37070FTNE�BQA � �SSUANCE ..,,_ sf. GQDE,3 SNAIt FORTHWiI'Ft CONPIY WtTH7N65E PqOVISKIidS. ~ � SMIP p DAT£:. APP�IGANT . . ry J ENERGY P!C __� WARNING FAI4URE 70 3ECURE WORKERS'COMPENSA710N COVEFIAGE IS UNLAWFUL,ANq SHALL BE {��} � .SUBJECTANEMPt4YERT4CRtM�NAIP£NAC�fiES�1NDCiYGFiNESY./PT06kEHUN6RE0TNQt}SANO EPIERGYPERMiT .�i] ��9AN" - pOlLAflS(Li0G,W0),INApp1TIONTOTHECOSTOFCOMP8N5ATIC?N,DAMAGE9ASPR4VIDEOFORIN — � . . � SEGTN?N37C80FTNELA9PRCQOE,iN7EREST.AR'QA'TOFlNEY'SFEES. RE7FNT1{)NFEE: �4 � � CCINS7FtUC7iON LENCIING ACENCY pRE-ALT FE6: d� � '��' '� i �� 4" � � I HEREOYAFFIRM UN�ER PENALTY OF PERJURYTHAT THEPE IS A CONSTFUCTION LF.NDING AGENCY �,� �:",�"d�""� i�'��'� FdR Th1E PEflFUHMANCE OF THE WORK FQR WNICH 7HI5 PEAMI7IS ISSl1ED(SEC.3n97,CIV.C.). Z W � 4ENDEH'SNAME ...._.._,_._ �' -� . F- LEtd08R'SAODRESS -y- p^P WICERTIFYTHATIHAVEREADTHISAPPIICATIdNANpSTATE7HA7THEd4lOVEINFORMATIONfSCOPtiECT. 9 V MAI.��GJ �� � '�� �, tAGREET Pf,YWfTF1ALlCITYANQCOUNTYOR�INANC.ESANdSTAiELAWSRELATIM4�TOBUILDIPIG . T AN�N£FIESYAilTHORtZE ENTATNESQFTNISCattfN7Y70EMEVit7PDNTtfE . � i, f �. A EMENTIO EDPROpERT"fORIN3PE {ON URPOSGS. 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