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HomeMy WebLinkAbout15804 (20) �� CITY OF DIAMOND BA8 � DEPARTMENT OF COMIVIUNITY&DEVELOPMENT SERVICES _ � 216fi0 E.Cmpley Drive Suite 190 ,� , (909)860-3195Fu(909)861-3117 PRES$ _ BUII.DING PERMIT APPLICAI'�UN` ``° "" �' FIRM�Y . � JOBSITE �� I f , APPUCRTION PERMIT I� "` P/C o ADDRESS � � � f�'r��Y���FL-�..�`�.�., DATE /J�'d�" ��; NUMBER °� # � � � �, �, � 15SUE TYPE � OCC APN LOT !{z �" TRACT �-r�� DATE f i �"i ��V CONST. GROUP p OWNER �6qJ-1-.0 , �'t�k����T l�. � lt?.�f2rIP�I;i�1 �'- ADDRESS i�'�1 �/O/�9��/)�/�t�- ��', ZONING SETBACKS � ) .,� r y� c� FRONT RW ❑ irv�;�an�r.vE s 3 �'.�� ziP u `� TEL�r�-v y4-�s? A CA TE �' -��.7�C}1 REAR ❑ � ` _� � SIDE/SIQE STREET RW ❑ CON RACTOR �( �rJ.��a. t_5 SIDE ❑ ADDRESS �G��i�i �z�� �e.e6n?e�77r� FSe�.µ'_! � CITY,2.:2'�S ,�,Ca4�'ra t�r .5 ZIP LA � TEI.`,'��.•`��:�'e�ti"�'� PROPOSED USE ��//t.°�:�.� FiQ�'Il1..Y ��.~.�it�RJtF.� p AR6H��tdFJ l"'�V�1. CkP5i��c ��:1� � r,_ z DESIGNER 3`L�dJ�� /'�'90l��T�9/s�l W -, NO.DWEL. NO. NO. d ADDRESS .>- B 7 �.r�',�-F:�'/Jf� �'b''. UNITS STORIES � BEDROOMS� � CITY �:I�t.:G'K°E�i � �'#�: 21P�fl'?_LG� TEL�,�,•tai%�L`6p�1% � DESCRlPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-SUIL�ER DECLARATION SFR/ADD/REM O Q 1 HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AA1 EXEMPT FpOM THE CONTRACTORS LI- � Garage/Carport W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINES6ANDPROFESSIONSCA�E:ANYCITYOR U pqJNTYWHICHREWIRE3APEfiMRTOCONSTqUCT,ALTER.IMPROVE,DEMOLISH,ORREPAIRANVSTFUC- W P21i0/DBCk " � Z NRE.PRIOR TO ITS FSSUANCE,Q50 REqUIRFS THE APPUCANT FOR SUCH PERMIT TO FlLE A SIGNE� g W S7ATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO TNE PROVISIONS OF THE CON7FACTORS-LI- W C CENSE UW I�APTER B(COMMENCING WRN SECTION 7000)OF�IVISION 30F THE BUSINESS AND PRO- �'�' POOUSpB }F. FESSIONSCODE)OHTHATHEORSHEISEXEMPTIHEREFPOMANOTHEBASISFORTHEALLEGEDEXEMP- (� y TION.ANYVIOLATIONOFSECTION7037.6BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Root � A CMl PENILN OF NOT MORE THAN FIVE HUNDRED DOLURS�5600).j: � DI,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIPSOLECOMPENSATION, � Commercial - WILL DO THE WOFiFC,AND THE STRUCTUi�IS NO7 INTENtlED Oq OFFEqED FOR SALE�(SEC.7U44,BUSI- _.I � NESS AND PROFESStONS COOE:7HE CANTRACTOPS UCENSE LAri DOES N4T APPLY To AN OWNER OF = PROPERTY NhiO BUIIAS OR MIPROVES THEHEON,AND WHQ DOES SUCH WORK HIMSELF OR HERSELF OR � THiiOUGHHISORHEROWNEMPLOYEES.PflOVIDEOTHATSUCNIMPROVEMENTSARENOTlNTENDEDOF m L111 OFFERED�OR SALE IF,HOWEVE0.TNE BUILOING OR 16WROVEMEIJT IS SOLD WITHIN ONE YEAR OFfbMP�E z TION,THE OWNEP-6UILDER WILL HAVE THE BURDEN OF PpOVING THAT HE OR SHE DID NOT BUItA OR � IMPROVE FORTHE PUHPOSE OF SALE). - W �I,ASOWNEROFTHEPftOPEHTY,AME%CLUSIVELYCAN7RACTINOWITHLICENSEDCANTFACTORS � TO�NSTRUGTTHE PRQiECT(SEC.7041,BUSINE55l��D PROFESSIONS CODE:THE CANTRACTOflS LI- ,VflIUB2i0� ADJ.AREA W GENSEUWDOESNOTAPPLYTOAFlOWNEROFAPROPERTYWHOBUIIDSORIMPfl4VE5THEREON,AND � WHOCONTRACTSFORSUCHPH0.IECTSWITHACONTBACTOR(S�LICENSEDPURSUANTTOTHECONTRAC QUANTITY DESCRIPTION FEE Y TORS IJCENSE UW.). � ❑IAM p(EMPT UNDEP S�C._ 6.b P.C.FOR THIS REASON Q � U � � DATE OWNER _._ V . � LlCENSED CONTRACTORS DECLARATION W J � 1 HEREBV AFFIRM UNDER PENALTY OF PERJURY 7HAT IAM IICENSED UNDER PRONSIONS OF CHAVTER � 4 9(COMMENCINGWITHSEC710N7000)OFOIViSIONaoF7HEBUSINESSAtJDPROFESSIONSCOGE.AND z 9G MY LICENSE IS IN FULL FOFCE MiD EFFECT. � LICENSE C �y�Fif'�I���,,, IIC.NO. �� � V DATE � _l..'S .An� CONTNACTOR a, � � W � +" c� WORKEFiS'COMPENSATION DECLARATION -� ¢ � U � I HEHEBYAFFIRM UNOEH PENALTY OF PEfUURY ONE OF THE FOLI.OWING OECLARATIONS: Z � _INAVEANOWILLMAINTAINACER"IFlCATEOFCANSENTTOSEIF-INSUFEFORWORKERS' _ COMPENSATtON,AS PROVIDED BY SEGTION 3�00 tlF TiiE LABOR CODE,FOR THE PERFORMANCE W �OF TME WORK FOR WHICH THIS PERMIT IS ISSUED. � � __ I HAVE PNO WILL MAINTNN WORKERS COMPENSATION INSURANCE,AS REQUIRED BV SECTION Q 37000FTHELAHORCODE,FORTMEPERFORMANCEOFTHEWORKf-0RWHICHTHISPEflMITIS ISSUm.MVWORKERS'COMPENSATIONINSURANCECARRIERANDPOUCYNUMBERARE: CONSTRUCTION j CARRIER�/�"iY� �ip�... .__.�IY�"d�_ �.R�'T�yt_� %/e.P�: PLANREVIEW ,�_1:+ � POLICY NUMBER /��t',,�J y��� �9�`1—_��� r���� ELECTRfC 1 1Gl � 6 ��'}�. �"f�1^ ioo4".r?1 {y���� � � (IHISSEGiIONNE�NOTBECOM,MI.ETEDOkTFIEPERMfTSFC)RIXJEHUNDREDOCilAFig(51p0) RLESS} PLUMBING Z i CERTIFVTHAT fN THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUEO,I MECHANICAL (�� SHPLL NOT EM7LOY AfdV PERSON IN ANY MANNER 50 AS TO 9ECOMf SU9JECT TD THE Vj WORKERS'COMPENSATIONLAWSOfCALI NIA,ANDAGREETHATIFISHOULOBECOME INSPECTIONFEE � SU&JECTTO7HE WORKERS'COMPENSATIO ROVISIONS OF SECTION 3700 OF TFIE LABOR --� � COD ISHlyLLFORTNWITHCOMPIYWI -T SEPRO IO . ISSUANCE • o '�� s� SMIP ;-� p DATE: f�Q .. �A�l�ei APPLtCANT: ________� � r�=� J WAflNING FALURE TO SECURE WORKEflS'COMPENSATION GE IS UNLAWft1L,AND SHALL BE ENERGY PIC __,_________ � SU&IECTANEMPLOVERTOCRIMINALPENALTiESANDCIVILflN PTOONEHUNDREDTHOUSAND ENERGVPERMIT DOILARS(5100.000),IN ADDITION TO THE COSTOF COMPENSATION,DAMAGES AS PROVIDED FOfi IN � SECT10N3�OBOFTHELABORCODE,IN7EREST,AN�ATTORNEY'SFEES. RETENTIONFEE: d CONSTRUCTION LENDING AGENCY � ALT FEE: � • � I HEREBV AFFIRM UN�Efi PENALTY OF PERJURY THAT THERE IS A CONSTfiUCTION LENDING AGENCY FOR7HE PERFORMANCE OF?HE WORN FOR WHICH THIS PERMIi IS ISSUEO(SEC.30B7,CIV.C.). . . . Z w �T LENDER'S kAME C 3 F— LENDEH'SADDRESS � TOTAL FEES w 1 CERTIFY TH I HAVE READ THIS APPLICATION AND STATETHATTHEABOVE INFOFMATION IS CARRECT. � tAGREETO PLYWITHALLCITYANDCOUNTYOROINANCESANOSTATF.lANSREI,ATINGTO8l11LDING ZCONS Rl1CT N AND HEREBY AUTHOflIZE REPRESENTATNES OF THIS C�UNTV TD ENTEii UPON THE - �,�{�i,,��J^ f� �� q�,�� p ABOV MEN b E�P��ERTV FOR INSPECTION PUHP� COMMENTS� �M " y � /L'V Y"�IZ.A�- A`Y�,—.-�'°' � m . P NA}AE(PqIN'n ��Y� � � R PEPMI OA7E "7 = RECPT.NO. �..f PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy _ . . ,,.,.. . . , „•� �. �.t.,..,. .. . . - .. ���� �� �������°� �� � ���'������ �������� ..� . � �q d° %Y ...� �..:. ' ,.q .. � . 'sa� E9r .-: �§ � �� �c.6�. ��+,% �- `.�� , � •.. �"=Y.@ � ..: ��' • d 4 99 . .b. ... ..� � . ,�� .:' . �;"..� .,6., n�,',�''.,__ :.... "� .,.,.. �..... 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