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HomeMy WebLinkAbout13973 (14) J� CITY OF DIAMONDBA& �� {.� DEPARTMENT OF COMM[INITY&DEVELOPMBNT SERVICES �,�,:O _ � . ait�o E.coPiey vri�e s��i90 pRES3 �`:�»°":�\� Buu nnvG P��iaT nPpiic�riorr ° FIRMLY . a� JOBSI7E / DATECATIO �� �p NUMBER �-���#/C ADDRESS "i 1 �'^ ifl �Qe ' ISSUE TYPE OCC � � APN--��-} OT TRACT DATE CONS7. GROUP � p OWNER t11� a ADD ZONING SETBACKS � CITY 4 ZIP TEL. . FRONT RW ❑ � APPLICANT �_ � � S DE/SIQE STREET RW ❑ � CONTRACTOR ' SIDE ❑ � � ADDRE �`' " PROPOSED USE �" $ � � CITY� ZIP r t TEL. �✓ w ARCH/ENG/ �t� z: DESIGNER ry������ � ADDRESS NO.DWEL. � . NO. UNITS STORIES BEDROOMS � CITY ZIP TEL. � �n DESCRIPTION S�.F7 FACTOR PSF ADJ.AREANA�UA710N -�- OWNER•BUIL�ER OECLAFiATION SFRIAD�/pEM � O` — 0: I tI�REBY AfF7RM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- G8IH98/C$(pOfl .W. CENSELpWWRTHEFOLIOW�NGPEASON(SEC.7031.5BUSMESSANDPROFESSION6CbDE:ANVCITVOR ' (n �U', 07UNTYWHICHRE011iRESAPERMRTOCONSTRl1CT,Al.TEF,IMPROVE,UEMOUSN,OFREPAIPANV3TRUG �'_ TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES 7}i�APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED ,; � PaPID/DBCk STATEMENT TiiAT HE OH SHE�IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI- '���- CENSEUW�CNAPTEfl9(COMMENqNOWITMSEGTION?000)OFDIVISION30FTHEBUS1NE65ANOPflO- � �'`' POOVSpd ;;� FESSIONSCODE)OqTHA7HEORSHEISIXEMPTTHERE�ROMANDTHEBASISFORTHEAILEGEDEXEMP- '. (� `,� TION.ANYVKJlAT1DNOF5ECTION7Q91.6BYANYAPPIICANTFORAPEAMITSU&lEGTSRiEAPPLICANTTO - z Re•Roof ::�'. ACMLPENALTYOFNOTMOflETFiANFNfHUNDPEDOaLIAFS(5506).): � — _�, OI,ASONMEROFTNEPROPERTY,OqMYEMPLOVEESWITNWAGE5AS7HElASO�ECOMPENSATION. �' O �mmercial . - WILI DO THE WORK,AND TFiE STRUCTUNF IS NOT INTENDED OR OPFEREO FOP SALE(SEC.7oaa,BUSI- � _I _��; NE&S AND PROFESSIONS COOE:THE CANTRACTORS I.ICENSE lAW OOES NOT APPLY TO AN OWNER OF� � � ' PROPERTYVhiOBUIIDSORIMPROYESTHEREON,ANDWHOWESSUCNWORKHIMSELFOPHEFSELFOR ��`':' THROU(3HHI60RHEROWNEMPLOYEES,PROVI�EOTHATSUCHIMPRW�MENTSARENOT�NTEN06DOR ���� � . �-LUji OFFEflmFORSALEIF.M��7EVER7HE8Ull➢IN¢041MPROVEMENTISSOLDWITHItJONEYEAROFCCMPLE- ' ''� ��TION,TFiE OWNER�BUILDEfl WILL HAVE THE 6UflDEN OF PROViNd TNAT NE OR SHE�ID NOT BUILD OR �wry; ;IMPROVEFDRTHEPURPOSEOFSALE). � ❑I,AS OVMEROF THE PROPEflTY,AM EXGLU51`dELY CONTRACTMG WITM tICENSE�CONYRACTOHS :;�;�-, TO CONSTRUCT TNE PRQIECT(SEC.Job4,BUSWESS AryD PROFESSIDNS CODE:THE CONTR�CYOPS U- ' .V91U811011 ADJ.AREA ::W�_ .�NSEUWDOESNOlAPPL7TOANOWNER�FAPfl�PEfl7YVfNOBU1tASORIMPROYESTHEfl[W,AN� - ��` WFfOCOMMCT&FOPSUCHPRPIECTBWIhIACONTRAC70R(S)LICEN&F.DPUR6UNNTTOTHEc#NTMG ' OUANTI �� �ESCfiIPT10N � � FEE �~�-�' 7Ofl51JCEN5E LAW.). Y�s ❑i AM EXEMPT UNDEP S�C. B.8 P.C.FOR THIS REASON, '_� Q ��'�. - � :. U - .'�`, `— ----------------- `- C[ "LL�' -.OATE OYMER ': U �£ ;:Z.� �; tli ,�°, LlCENSEDCONTRACTpRSDECLARATION ` W x.�f iHEREBVAFFIRMUNDERAENA6TYOFP'cRJUPoY7NATiAMLtCENSEDUNDERPROVI510NSOFCMqpTER ,� � - -� -�Qy 9(OORSMENCIfJ�WITHSECTK7N7000�OFDIV�S�ON30FTNEBUSINESSANDPROFESSIONSCOOE,AN� ';Xk 1AYUCENSEISINFllLLFOFCEANDEFfECT � lll, - ' C�/ � �.;�'� UCENSEC S�_��_LIG.NO._4? -- __,,�`d' ' � :�y'_ DA ._ GONTRAGTOFi _ � � ,,��� � ��� WORKERS'COMPENSATiON DECLAFiA710N � Q . . .. ��'. IHEPESYAFFIRMUNDERPENALT'OFPERJURYONEOFTiiLFOLLO'NINQDECIAFlA NS: tn< Q ��0" ,,,_IHAYEANOWILtMAiNTAINACERiiFiCATEOFCOYSENTTOSELF-INSUREr R4YOHKERS � � �.,��•, CqAPENSATpN,ASPHOYfOEDBYSECTION37ooOFTXELA@OfiCODE,FO MA E U� OFTHE WOflK FOR WHICH THIS PERMIT IS ISSUEO. � W �I HAVE ANO Wltl MAINTAIN WORKERS COM?ENSATION INSUflANCE.AS REOUIRED BY SECTION � _Q� 37ooOF 7HELA80fl COOE,FORTHE PERFORMANCE OF THE WORK FOR WNICH iHIS PERMIT IS ]]]�_^ I_��y a � ISSUED.MY WO ENBAT INSURANC€CARRIER AND POLICY Nl1M8ERARE: �NSTRUCTION l LTC.d �. �!. i j:- CARPoER `t--CJ ..,i _ N REVIEW ' � �-�' poucr ra�MaeR_ LECTRIC - d ��� (iHISSE[:iqNNE�NOTBEGON1tEfFDQ`TFfPEPoNTiSWROi`1EHUt�DREDDOl1PR5(Sao)URt��1� PLUMBING ���� . . .,.�_ 'ICERTIfYTHATiNT}iEPERFORMANCEOFTH6WORKKORWHICHTHISPEPMITISI�UEO,I+ . MECHANIC,AL "('}'�. SHALL NOT EMPIAYqNY PERSON INANY MANNER SOAS TO BEGOME SUBJECT N NE r � -� WORNEflS'COMPENSATIONLAWSOFCAI.IFCfINIA,ANDACpEETHATIFISHOUL�B�ME �NSPECTIONFEE . ._�,a����� � �-�' SU&IECTTOTHF.WORKERS'GON�PE�4SATIONPPOVISIONSOFSECTION37000FTHE 00R � .y � �t„�,f„ �.� ._! .�; CODE,ISHALLFORThIWiTNCOMPLYWITHTH05[PROVISION3. ISSUANCE �. .' �.:p:. OATE: � APPLICANT. � SMIP „"�Y'!�r � .... • �,,w Q� tqu. �y'�_.j_��_�'_13 s J1��Y"H - .w. ^�j' WAflNING:FAIWHETO3ECUREWOflKERS'COMPENSATIONCOVCRAGEISUNIAWFUI,AND6HAlL8E ENERGYP/C � : a � j , _.____ ______.. , �. SUBJECTANEMP�OYERTOCRIMiNALPENALTIESANDCIVILFI�IESUPTOONEHUN�REOTHOi15AND ENERGYPERMIT A �,��'i��J`��' pOLLApS{S1C0,0001.IN RDDITIONTOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOq IN ,,,�_ SECTION 3708 OF 1}iE 1ABOR CODE,INTEREST,AND ATTORNEY'S FEES qtTENT1ON FEE: .. pw._ CONSTRUCTION LENDING AGENCY pqEALT FEE: CO . � aIHEREBYAFFlPMUNDERPENAITYOFPERJURVTNATTHEREi4ACONSTflUCTIONLENDINGAGENCY - FOP THE PERFORMANCE OF l HE W�RN FOR WHICH TMIS PERMR IS ISSUED(SEG.3oa7,CIV.CJ. z < w _ � LENDER'SNAME . '.-.�F—' �ENDEfl'SADDflESS /��// r - w ICEf1TIfYTHATIHAVEREA�THISAPPLICATIONANDSTATETNATTHEAHOVEINFORMATION15CqRRECT. TVTAL FGES (�'J"�� �.� .. .p_. IAGPEETOCAMPLYWITNALLCITYANDCOUNTYOHDINANCESANOSTATEIAWSRELATIN6TOBUILUING � j � � CONSTRl1CTION,AND HEflEBV AUTViORITE REPftESENTATIVES OF THIS CAUNTY TO ENTEH UPON THE - Z ABOVEM ED P OPERTY FOR I SPECTI�N PURPOSES. - � ��� q �� COMMENTS � '��i�Y � � PEHMI7i EIPRI� /'y � � � - Q �I� .. � �L,IC.491_'_'__ _'—__ __—__" '__"_ � SIGNA7UR PERMITTEE AT ' _� S RECPT.NO. PAID BY VAIIDATION F` WHI7E—Department Copy,YELLOW—Financa Copy,PINK—Assessor Copy,GOLDENROD--file Copy,GREEN—AppiicanPs Copy �..�„,_�. ..,.. ,..___»""--�� _ �...,� -,_, _ . ... �.- T..-.- 4 . � � �� .. , � , � j� � 1 � , � r 'r �r C5 ��€ �.= 7 nr�� � „5 � c,7 E j a ` �� ' r�r _ �. x ,E,y r a z i t� `�I �a r �� rn � - � �i� � j ' f ..�'1 _ I � � �. 3 � ( ��-e�1m ::J —I �^ � �5 Ct`i""� --E . i -3�. 4 .� � ( f �7 r� �"�n F� " "�y -� 'T{'-' � ,��,� ��7s�� �: � . f; r}; F � �. �r � I �, � � � f '�i� i s��.., � � { Y � ' t �- i i ' f I.� { � i I�.0 .0 I��...3 � � . 1 "�,�,��, —c §� � ��.i � ! � � i � (^..�. 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