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HomeMy WebLinkAbout14893 �"X,�%�-�� ���� CITY OF DIAMOND BAI+t G/✓�3-a�G'� DEPARTL>4ENT OF COMMUNITY&DEVELOPMENT SERVICES , _ w 21660 E.Copley Drive Suite 140 ....._...•. (909)860-3]95 Fax(909)851-3117 PRESS •�. BUII.DINGPERMIT'APPLICATION „ ____ FIRMLY o DDRESS �� � .:_ � .,:,,:,��} u:. SSUE ATION .TMP BE�`������-1�:.,�/C ., ,. ., � (�, � APN LOT TRACT ���, P E OCC DATE �CONST. GROUP p OWNER ��.➢Sj.� A�i,-d-iTl'�l�L,:�U1J o ADDRESS�S� ZONING SETBACKS � CITY�c`Ad-�c�3�'3� ZIP � TS TEL.�"—�'` REART RW ❑ APPLICANT TEL G � SIDE/SIDE STREET RW G � CONTRACTOR �-:�'�11.�Gc`�..� ��Tcte.�a.�'�.S SIDE C ADDR SS 2-� s�• j� p c�_ c-pa� PROPOSED USE Gt±l. o CITY ZIP �7C2 TEL. .>� wo ARCWENG/ , � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDRO�MS � CITY ZIP TEL. rn tn DESCRIPTION SQ.FI'. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER OECIAFiATION SFR/ADO/REM O p 1 HEREBY AFFlRM UNDER PENATY DF PERNRY THAT I PM IXEMPT FROM THE CONTRACTORS U- GaragelCOrport � CENSEUWFORTHEFOLLON%NOREASON(SEC.70.11.6BUSINESSANOPROFESSIONSCODE:ANYCITVOR (n , COUNTYWNICHREOUIRESAPERMITTOCONSTRUC'f,ALTER,IMPFiOVE,DEMOLlSH,ORREPAIRANYSTRUG W Patio/Deck � TURE,PRIOR TO ITS ISSUANCE,ALSO REa11RES THE APPLtCINT FOR SUCH PERMIT TO FIIE A StGNED W STATEMENT THAT HE OR SHE IS LICENSED PURSUhM 70 THE PROVISIONS OF THE COMRAC70RS LI- � CEN6E UW(CFiAP7ER B(COMMENCINO W�TN SECTION 7000)OF DIVISION 3 OF 7HE BUSMESS AND PRO- �- Pooi/Spa FESSIONSOODE)ORTHATHEORSHEISEXEMPTTNEREFROMANDTHEBASISFORTHEALLEOEDp(EMP- (� TION.ANYVIOt.ATqNOFSECTION7031.6BYANYAPPLICANTFORAPERMRSU&lECTSTHEAPPLICANTTO Z Re-Roof � ACMLPENALTYOFNOTMORETNANFIVEHUN�R�OOLURS(55Uo).): � ❑4��WNEROFTNEPHOPERTY,ORMVEMPLOYEESWITHWAOESASTHEIRSOLECOMPENSATION, ❑ COrtIrt18fCIBl - WILL DO THE WORIt,AND THE STRUCTURE IS NOT INTENDEO OR OFFEREO FOF SALE(SEC,704t,BUSI- J � NESS IWD PROFESSIONS CODE:THE CONTRACTORS LIGENSE LAW OOES NOTAPPLY TO AN OWNEii OF ? PFlOPERTY MIFIO BURDS OR IMPROVES TViEPEON,AN�NMO DOES SUCH WORKHIMISELF OR HERSELF OR � THRIXIOFIFIISORHEROWNEAIPLOVEES,PROVI�EDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m � Q OFFERWPDRSALEIF,FIOWEVER,TNEBUILDINGORIMPROVEMENTISSOLDWRHINONEYEAROFCOMPLE- Z TION,THE OWNEFlSUILDER WILL HAVE hiE BURDEN oF VqOVINO THAT NE OR SHE�I�NO7 BUIID OR � IMPROVE f-0R THE PURPOSE OF SALE). W ❑t,AS ONMEq OF THE PROPERT'AM E%CLUSIVELYCANTRACTINO WITM LICENSEO CON7RACTORS � TD CONSTRUCT 1HE PRQIECT(SEC.704t,BUSINE55 AND PflOFES510N5 CODE:iHE COMRACTORS L�- V8IU82IOf1 ADJ.AREA W CENSELAW�OESNOTAPPLYTOANOYVNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFOHSUCHPROJECTSWI'fHACONTMCTOR(S�LICENSE�PURSUANTTOTHECONTMC QUANTITY DESCRIPTION FEE � TORSIJCENSEUWJ. ❑I AM EXEAIPT UNDEH SEC. B.3 P.C.fOR THIS REASON q 3 c> � ¢ DATE OWNER V W � LICENSED CONTRACTORS DECLARATION W � 1 HEREBY 11FFIRM UNDER PEWLLTY OF PERJURY THqT I qM LICENSED UNDER PROVISIONS OP CHAPTER Z S� .�� � d Y(COMMENCIN(i WITH SECTION 7000)OF DIVISION S OF THE BUSINESS AND 7ROFESSIONS CAOE,AND .i-y.� X MY LICENSE IS IN FULL FORCE AND EFFECT m 1� LICENSEC/L�AS.S �3� I�C.NO. �✓���� j V DATE - 6�"�X.� CONTRACTOR� � d W � WORKERS'COMPENSATION DECLARATION - Q � IHEREBVAFFIRMUNOERPENALTVOFPERIURYONEOFTHEFOLLOWINGOECLARATIONS: Z � _IHAVEANDNALLMAINTAINACERTIFICATEOFCONSENT705ELF�INSUREFORWORKERS' T COMPENSATION,ASPROVI�EDBYSECTION37o00F7HELABORCODE.FORTHEPERFORMANCE W Q OF THE WORK FOR WHICH THIS PENMIT IS ISSUED. � � _I HAVE AN�WILL MAINTAIN WORKER9'COMPENSATION INSUqANCE,AS REQVIRE�BY SECTION Q37000FTHElABORCODE,FOR7HEPERWPMANCEOFTHEWORNFORWHICHTHISPERMiT15 � ISSUED.MY KEAS'COMPENSATIONINSURANCECARRIERANDPOLICYNUMBERARE: CONSTRUCTION rj CARPoER ��t � �;-�i.'�.T�-�-�'���{7C1�'/C..""�� PLAN REVIEW � POLICYNUMBER \A3�-1'-a �+�.71[n:��� ELECTRIC �j � (IHISSELTOfJNE�NOTBEWATLETEDOFTHEPEMMISFOAONEFlNAfiEDDOl1ARS($100)OF2LESS} PLUMBING Q ! � Z ICERTIFVTHATINTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED,I MECHANICAL � � CIJ SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SOAS TO BECAME SUBJECT TO THE y WORKEAS'CONPENSATION LAWS OF CALIFORNIA,AND AGREETHAT IF I SHOULD BECOME INSPECTION FEE ._ - SU&IECTTO THE WORKERS'COMPEN S OF SECTION 37oa OF THE U1BOR y� y� s CAOE,ISHALLFORTHNHTHCOMPLY ITHTHOSEPROVIS N T �SSUANCE __�)a '�+'I��V�g ��` �..r�U 0 DATE�`� APPIICANP. �p '' SMIP ���pa�r�iJ�r„__.. J WARNINGFAILURETOSECUREWORKERS'COMPENSATIONCOVERACaEISUNLAWFUL.ANDSHALLOE ENERGYPlC �� 3�- �y SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFMESUPTOONEHUNOREDTHOUSAND ENEAGYPERMIT . *+,. DOLLARS(5��.�W�,IN AODITION TO THE CAST OF COMPENSATION,DAM�GES AS PROVIDED FOR IN /y ¢ SECTION 37oB Of THE LABOfl CODE,INTEREST.AND ATTORNEV'S FEES. RETENTION FEE: R OCONSTRUGTION LENDING AGENCY PRE-ALT FEE: I HEREBVAFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A C�NSTRUCTION LENOING pGENCY � �� � � FOF THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSllEO(SEC.3091,CIV.CJ. . � W � LENDER'S NAME F-- LENDER'SADOflESS � ICERTIFVTHA7IHAVEHEADiMISAPPLICATIONAN�STATETNATTHEABOVEINfORMATIONISCARRECT. TOTAL FEES W IAGREETOCAMPLYWI7HALLqiYANOCAUNTYORDINANCESANDSTATELAWSREUTINOTOBUILDING � CONSTRUCTION,ANOHEHEBVAUTHORIZFREPRESENTATNESOFTHISCOUNTYTOENTERIJPONTHE ZA@OVE�IAENTIONEO PqOPERTV FOR INSPECTION PURPQSES. Q COMMEN7S J �r�..D;�'1���.��-� _ 4 PERMITTEE IPRINT) . ......�'"`�, . . . 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