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HomeMy WebLinkAbout12276 (11) � CITY OF DIAMOND BAI� �_ ,��`J'`�' �---���— DEPARTMENT OF COMMUNITY&DEVBLOPTVSENT SERVICES J }�-'� � 21660 E.Copley Drive Suite 190 " ` � , � (909)860-3195 F�(909)861-311'7 PR�SS BUII.D�'G PERMIT AP�'LICAT�ON '" . ` ", FIRMLY .__ _, � ...w _ .. u. � � , ,.. : � ,: .� �,�.,� �, .. .,y�,�,, o� JOBSITE �/ �J APPLICATION �-�' � RMIT /C ADDRESS�y�� Ntll���/ l7��-� �l��i�� DATE UMBER ��� # � APN LOT ' TRACT - ISSUE TYPE OCC pATE CONST. GROUP � OWNER 3�ff[,,.� li� �r /f�N �G%�"—�,: p ADDRESS f�� , l�'.'fl��t 1i i`G G /c�/1► ZONING SETBACKS � CITY �%1�N�},tl�f� !YA�E ZIP�� TEL.IO�I�J�.f'-tf�,,,f/ FRONT RW ❑ APPLICANT .-(� �t TEL.2� ' � -�'� REAR ❑ � SIDE/SIDE STREET RW p � CONTRACTOR SepE ❑ ADDRESS r o CITY ZIP TEL. ROPOSED USE�,�'� D�� ���?O V S��/Y°'_�_ w ARCH/ENG/ � z DESIGNER ` .. � r`. w , . N0.DWEL. NO. NO. n. ADDRESS ''�2� � C�TY ZIP TEL. UNl7S ��'" ' STORIES �° BEDROOMS � � c» DESCRIPTION SQ.FT: FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFRIADD/REM O p I HEREBY AFFIRM UNDER PENAL7Y OF PERIURY 7HAT I AM EXEMFT FROM THE CONTflACYdRS L4 �iyf090/Ce�Oh L6J CENSEUWFORTHEFOLLOWINGREASON(SECJ031.58USINESSANDPAOFESSIONSCOb�dNVCITVOR (n U COUNTyWHICHFlEOUIRESAPERMITTOCANSTRUC7,ALTEF.IMPROVE,DEMDIJSH,OqpEVAIpANV$7RUC- �jJ pyti0/DBCk Z TLIRE,PRIOR TO ITS ISSUANCF,AIBO REOUIREs THE APPLICAM FOR SUCH PEPMIT Tb FII.E A SIGNED W STATEMENT THAT HE Oii SHE IS LICENSEO PUftSUAN7 T6 THE PNOVISIONS OF YN�G�N7'q/C'YbR'S'LI. ' � � CEN6E UW(CHAP7ER 9(COMMENCINQ WI7H SECTION l000)OF p!VISION 3 Of THE BUSYNESS ANtl PRO• �'�' PooVSpa FE9310NSCODE)ORTH�THEORSHEISEXEMPTTHEREFROMAN�THEBASISFORTHEALLEGEpk'XEMP• (� TION.ANYYbUTIOPIOFSECTION7037.56YANYAPPLICANTFORRPERMITSU&)ECTSTHEAFPLICANTTO � Re-Roof /�� � A CML PENW.TY OF NOT MORE7HAN FIVE HUNDRED DOLtARS(SSoO�.): ��� ��. � ��_•�a����.!�_:�� ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECAMPEN'SArdN, C7 Commercial � WILL DO THE WORK,AND 7HE STRIICTl1RE IS NOT INTENDE�OR OFfERED FOR SAtiE'(SEC:;�oh4,9USI• J � NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE IAW�OES NOT APPLYTO AN OWNER OF � PROPEqN Nhq BUILA5 OR 1lAPROVESTHEREOµAND WHO DOE,$�SUCH WORK MMSELF'OR FiERSk`LK OR � THROUGHHISORHENOVJNEMPLOYEE3,PROVIDEDTHATSUCH1MPAOYEMEM3'ApENOYINT'ENtlEf!'OR m Q OFFEREDFORSALEIF,HOWEYER7MEBUN,DINGORIMPROVEMENTISSOLDWRHINONEYEAROPbOMPl:E a, TION,THE OWNER-BUItDER WILI HAVE THE BURDEN OF PROVING THAT HE OR SH��IO NOT 6UILD�OR = IMPROVEFORTHEPURPOSEOFSAIE). � �'.,:,�'y;�;,,,�.,,,,3;��,", ❑I,AS ONMEH OFTHE PROPEiRY.AM IXCLUSIVE.V CANTRACTING WITH LICENSEb C0�7RA�'YbA�S � TO CONSTRUCT TNE PROJECT�SEC.)op,eUSINESS AM PROFFSSIONS COOE(iNE CbNTRACTORS CI� V81u0tiOn ADJ.AREA W CENSEV.WOOE3NOTAVPLYTOANOWNEROFA7ROPERNWNOBUILDSORIMPROVE'STHEREQN,ANO = VYFIOC9NTMCTSFOflSUCHPROJECTSWITHACANTRACTOR(5)LICENSEpPURSUAN?YOTHECOFJTRAC• �"' ror�sucENseuw.�. � s, QUANTITY DESCRIPTION FEE � �#I il�� Q �IAM IXEMP7 UNDER SEC. 8.8 P:C;FOR TMS b�ASD�N Q � U � � OATE �`�� OWNER b� � � 1— 0 W � LICENSED CONTRACTORS DEC�AATION - .... W � I HEREBV AFFIPM UNDER PENALTY OF PERJURY THA7IAM LICENSED UN�ER PROVISIONS OF CHAPTe'R� � a, e(CqMMENCINOWITHSECTION7000)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND��� Z X MY LtCENSE IS IN FVLL FORCE AND EFFECT. - m p UCENSE CLASS LIC,NO. _ �'��1�7"�.! � V DATE CONTRACTOR_ __,__�__�_� RJ.. W � WORKERS'COMPENSATION DECLARATION � � I HEREBV AFFIFO.A UNDER PENALTV OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: �� - Z ' � � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELFINSUREFORWORKERS' S COMPENSATION,ASPROVIDEDBYSECTICNJs7ooOFTHEIABORCO0E,F09THEPERFORMANCE C) Q OFTHF_WOFiI<FORWHICHTHISPERMITISISSUEP. � W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS RE�UIRE�BV SECTION Q 370DOFTHELABORCOOE.FORTHEPERFORMANCEOFiHEWORNFORWHICHTHISPEfi�AlTiS I�PI ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AN�POUCV NUM6ERARE; CONSTRUCTION (/�� '�y cnRnieR - ' ` � PIAN REVIEW Z POUCYNUMBER ELECTRIC Q 0 (iHlSSECiIONNE�NOTBEO�pLETmOFTHEPEMMISFORIXJEHUPYN,'E��IARS(Stm)OR�FSS). PLUNBING Z I CER7IFYTHAT IN THE PERFORMANCE OF THE WOPK FOR WHICH THIS PERMIT IS ISSUED;i'-` MECHANICAL �'� SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECONE SUBJECT TOTHE [/j WORKER5'COMPENSAT.ION LAWS OF CAUFOFNIA,ANO AGREE THkT IF I SHOULO�BECOME INSPECTION FEE 1 r SU&IECTT07HEWOFiKERS'COMPENSATIONPROVISIOhSOFSECTION37000FYHElABOR � -�+ = CODE.ISHALLFORTHWITt1COMPLV'vVITHTHOSEPROVISIOtvS. � ISSUANCE 0 Q DATE: APPUCANE SMIP � WARNINGFAILURETOSECUREWORKERS'COMPENSATIONCOVEflAGEISUNtAWFUL.ANDSHALL9E ENEF1GVP/C _ LL, SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUN�REDTHOUSAND ENERGYPERMIT DOLL4RS(5100,000),Pl ADOITION TO THE COST OF COMPENSATION,DAMAGES AS CROVIDED F-0R'W � SECTION 3708 OFTHE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: ..,.. .. .. .. O CONSTRUCTION LENDING AGENCY pR&AlT FEE: � 1 HEREBVAFFIRM UNDER PcNALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCV , FOR 7HE PERFORMANCE OF iHE WORK FOR WHICH iH15 PEiiM1T IS ISBUED(SEC.30W,CIV.C.). Z lil � LENOER'S NAME . � .... . . ... .... F-- LENDEflSAD�qESS � ICERTIFYTHATIHAVEREAbTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORREC7. TOTAL 1-EES E � I AGREE TO COMPLY WITH ALL CITYAND COUNIY ORDINANCESAND STATE IAWS RELATINO TO BUILOING � - � � CONSTRVCTION,ANOHEREBYAUTHORI2EREPRESENTATIVESOFTHISCOUNNTOENTERUPONTHE '. � ABOVE�MENTIONEDPROPERTVFORINSPECTIONWRPOSES. . -�� . _ - � ,..�^^ COMMENTS _ !T l =-/��'� m ffT NAME(PRINT) ` v� G��' � �f'.Z- P�"' {/� SIO OF PER EE ,. , �ATE � ' ��� ����/ � _ ` RECPT.NO, _ _„ PAID BY ' �VAIIdAT10N�� V"� � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant'S Copy �� � < . � �� �� � � . �. ; :. e - � 4 � � r. , �. � � � � � � � � � � � � , , ����1" �����' ; , j ���C?�'��4�"�;�`� �,:,. . . � ..a.�. ��': �._._ .__ i__�__._ �_.�__.__ _ __�� _ �-rr-, ,� ri���,�, �`�`�g � � � 's �h#€1�"�����'� , �__� i � ._ ; ,_�.,., �._:_ _. .._.__ �__�..__.... . �___ ��___ ----- . - --- ____._ _____ _____ �:�_�-���?c�,� �ra,����s � ' ; �.1°����t ��.s���?�L.�,:a �— � �� i_ �� � r� �•::.. ._ � _�� _ �.. .e__._____.�� i--_ ___ �� ..�___ .�_w � ` ���a�t����:�i-� �%� �si�� i �[��.1�l�``r� �`�t?�3}"3 i..�?�II�"t��T� j _ F". ` �._�_�' � �_ _._��______�.e_______,�__._._ _____.___ _�..._ _ ,: . �w i �",�;�,„��`��'_�:, ' _m� .�.w.___�`i�rE��,_�°'��.�.�'..�,''�i9�3C��1"E�at�D ``T� � — ... ; E����;��'�`�J �: .d.LL,�,_..�..__._�. � �!F?E��,���.�����;����$�� �� �:� �_� � � �._�.��.�.. _w'.__._ ____ j ��� ,—E'�. ��?��Ca ���r��`���T��_______ ___�____�_________ g� �8�� ���— ___�. _— _____�.._ . --; _ , �P�",e������.-t'�,��� .� . ` � ��. ��;�L'��-�fi�r1 ' � _ --�—� --{ ���----�----j— ����4��s��'� �'�+��m����C� , �_n_____ --� ±•� __ i��1�1�� ��E'� �.=�`���- �--~ --- __._�_____�.a __� � ._. m�. � w �_ ;,.�r-.,,�g`%'�� ._��....-,��.�.r... 4" _.�_ ___��_r�i� �F�;� ,I'��� ._.__�� ; .... �,'�a�,��a-t>-��;��{�� i i �-? ���'t'�,€'��..4 ; t_.�__.�.___.�..__ � �C";c ���y a � -�.�r€� ______..€�...,..,._ r-_-.�-..� � �',;�t��r{;�F�.'��E�i� ._._�__� ---�---r- � rr --� _�I :--__ ' [ �_...__ ______._.�.. �__ _ _ ._.a_.._� �¢�E.�.���„a �''�.'�Y�� 7^�=..YB I i ...___�.__..-�......�....�.,. �i�'���t 1 '�.:t�$L�`a�a�� �� j ( � __r__..,_...�.. _-�'�--'_'-. 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