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HomeMy WebLinkAbout11044 „.,__.._� --- '-•”I CITY�F DIAiviOND BAR �„---� COMMUNITY DEVELOPMENT DEPARTMENT j� '� ..w 21660 E.Copley Drive$nite 190 ��� � PRESS (909)860-3195 Fax(9o9)861-3I11 ` "" BUiLDING PERMIT APPLICATION FIRMLY oJOBSITE / J �� 5� � , ii i . .,, :'.J7{; DATEICATION; J�"Z' � � NUMBE� � #/ ��� .�_ ADDR�SS (n�d �/O � f o ISSUE TYPE OCC °r° APN LOT TRACT DATE CONST. GROUP p OWNER �Io�.,rL"P I:a� Torr�s � ADDRESS C> OvP/ S T� ZONING SETBACKS � /�.�-T� FRONT RW ❑__,_ ocITY _kiaen�+/e Ba.✓� ZIP TEL. APPLICANT .��Y'/',j� TEI[.�e493S7-232( REAfi ❑ o SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR�o„�� SIDE ❑ � ADDRESS / PROPOSED USE o CITY 2.ii...,[TO ZIP��j� TE ._���=,.'��.�� � w ARCH/ENG/ �/ � � z DESIGNER��d/'���1 �lr/' �S NO.DWEL NO. " NO. � ADDRESS UNITS STORIES �_ BEDROOMS � CITY �Y1J�J/Y.O ZIP TE � �3.2 `n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BCILDER�ECLARATION SFR/ADDlREM O p I HEREBY AFFlRM UN�ER PENALTY OF PERJURV THAT I AM EXEMPT FROM'HE CONTRACTbRS LI� Gaf2g0JCdfpOR W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.5EUSINESSANDPROFESSICNSCODE:ANYCITYOR (f� U COUNTYWHICHREQUIRESAPERMITTOCIXJSTRUCT,A�TER,IMPROVE,DEMOLISH,ORflEPAIRANYSTRUC- W PdYiO/DeCI( W 7URE,PRIOR TD ITS ISSUANCE,ALSO RE�IJIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNE� STATEMENT THAT HE OR SHE IS�ICENSED�URSUANT TO 7HE PFOVISIONS OF TME CONTRACTORS Lb W —� � . ._..__.._..____..._.._ � CENSEIAW(CHAPTER 9(COMAAENCING WITH SECTION 7060)OF 61VISION 30FTFIE gUSiNESS A,ND PR0-� � II�Pa FESSIONS CODE)ORTHAT HE Oft SHE IS EXEMPT THEREFROM AND THF_BASIS FOP THE A�LEGEO EXEMP� � TION.ANVVIOLATIONOFSECTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICAN7T0 � Re-Roof ._..... ..._� ... . � ACIVILPENALTYOFNOTMORE7HANFIVEHUIJOR_DOOLIARS($Sad).1: � —+ O I,AS OW NER OFTHE PROPERTV,OR MY EMPIOYEES W ITH YJAGES AS THEIR SOLE COMPENSATION, p Q Comme[c�al---.._,..� _.___-,�_.__. z WILL�O THE WORK,AN�THE STRUCTURE IS NOT INTENDE�OR OFFERED FOR SAL'c(5EC.to44,BU51- J NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW OpES NOT APPLY TO AN OWNER Of � PROPERTYWHOBUILDSORIMPHOVESTHEREON.ANDR'HOOOESSUCHWORKHIMSELFORHERSEIPOR� � [[ THFOUGHHISORHEROWNEMPLOVEES,PROVIOEDTHATSUCHIMPROVEMEN7SAFFN071NTENDEDOR � QOFFERE�FORSALE.IF,HOWEVER,THEBUILDWGORIMPROVEMENTISS6L�WITH.NONEYEAFOF'COMP:.E- z TION,THE OWNER-BUILOER WILL HAV[THE BURCEN OF PROV�NG THAT HE OR SHE DID NOT BUILD OR - � IMPROVE FOR THE PURPOSE OF SALE). � W GI,ASOWNEROFTHEPPOPERTY,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS y (t TO CONSTR�CT iHE PROJECT(SEC.7044,6USINE55 AND PHOFESSIONS CO�E:�'Fi�CONTFACTC7R5 LI- V3IU2IIOf1 "� ADJ.AREA W CENSELAWDOESNOTAPPIYTOANOWNEROFAPROPEP7YWHOfiUILDSORIMPROVESTHEflEON,'ANU � WHOCONTRAC7SFOfiSUCHPROJECTSWITHACONTPAC7pR(SJUCENSEDPURSUAIJTTOTHECONTRAC- QUANTITY ESCRIPTION FEE Y TORS LICENSE LAW). � G I AM EXEMPT UNDER SEC. e,8 P,C.FOR TH15 REASON J � ¢ }� U � � DATE OWNER � . Z � o LICENSED CONTRACTORS DECLARATION , W ¢ � IHEFiEBYAFFIRMUNDERPENALTVOFPERJUPYTHATIAMLICENSEDUND[RPI'IOVISIONSOFCHAP7ER � � 9(GOMMENCMGWITHSECTION7o00)OF�IVISION30FTHEBUSINESSANOPROFESSIONSCODE,qP70 Z �X MY LICENSE IS W FULL FORCE AN�EFFECi. m O LICENSE CLASS LIC.NO._�f' iC 7�� � L--. _I U �ATE CONTfiACTOft_��(�L'e✓� n- W i � WORKERS'COMPENSATION DECLARATION� '�'�1,pp � /' a _ 'V U � 1 HEREBY AFFIRM UNDER PENALTV OF GERJUPY ONE OFTHE FOLLOW'�NG DECLARATIONS: Z Q � IHAYEANOWILLMAINTAINACERT'FICA7'EOFCONSENTTOStLF-INSUREVORWORKERS' _ Z CAMPENSATION,ASPROVIDE�BYSECTION37DOOFTHEIABORCODE,FORTHEPERFORMANCE �U QOF RK FOF WHICH THIS PERUIT IS ISSUF�. � ' ' � QW IHAVEANOWI�LMAIVTAINWORKERSCOMPENSATIONINSURANGE,ASREQUIREDBYS£GTION J 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WOR�C FOF WHICH THIS PERMIT IS / � ISSUE�.MV IVORKER'COMPENSAT�iON I RANCE CAR EF AND POUCY NUMBER ARE: CONS7RUCTION �,.. __ � (' �t J j caaRiEa _ PLAN REVIEW 7 _ z , voucvNuueEa � ' } ELECTRIC � � �' "� ¢ I Q (�FIISSECTIONNEmNOTBECOMPLEfEDOF7HEPERMffISFORONEHUNDREDD�'J.ARS(S10DIORLESS!. PLUMBING __ W z 1 CERTIFY THAT INTFE PERFORMANCE OFTHF WORK FOR WHICHTHIS PERMIT IS ISSUED,I MECNANICAL �' . SHALL NOT EMPIOY ANY PERSON IN ANY MANNER SO AS TO�ECOME SU�JECT TO TI1E � WORKERS'COMPENSATIONLAN50FCALIFORNIA,ANDAGREETHATIF SHOUIDBECOME INSPECTIONf-EE � SU&IECTTO7HEWORKERS'COMPENSATIONPROYISIONS SE N oaOFTHELA80R a-.,a;,,, —� � � CODE.I SHAL�FORTHWITH COMPLY WITH THO E PROVI N ISSUANCE _ ''f � SMIP 'a' [ p �ATE:� � APPLICANT � WARNWGFAIWRETOSECUREWORKER COM?ENSAT'�.ONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYPIC � SUeJEC7ANEMPLOYERTOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNDRE�THOUSAND ENERGYPERMIT DOLL4RS(5100,000),IN AODITION TO THE COST Of COMPENSATION,�AMAGES AS PROVIOE�FOR IN � SECTION37oBOFTHELABORCODE,iNTEREST,ANDATTOFNEY'SFf:ES. RETEN7IONFEE: � CONS7RUCTION LENDING AGENCY . pqE-ALT FEE: � IHEREBYAFFIRMI;NDERPENALTYOFPERJUFVTHATTHEREISACONSTRUCT�ONLENDWGAGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIi IS ISSUED(SEC.308],CIV.C). Z W � LENDER'S NAME _ ' �� F— LENDER'SADORESS — W. � TOTAL FEES /� � I CERTIFYTHAT I HAVE READTHIS APPLICATION AND STATETHATiNE ABOVE INFORMATION IS CORRECT. �, t w I AGREE TO COMPLY WITH ALl CITY AND COUN7Y ORDINANCES ANp STATE LAWS flELATING TO BUILDING /M.�Jl � � � CANSTRUCTION,ANOHEREBVAU7}iORIZEREPRESENTATlVESOFTHISCOUNTYTOENTERUPONTHE � t �,%'df�9 ��D� � � � ABOVE�MENTIONEDPROPERTI'FOfiINSPECTIONPURPOS=S. ✓ � � Z COMMENTS � � � � � � — m PERMIT NAME(PR ) '. Q � / /�— � _� ..�t _ �ry` ' � `� REGPT.NO. __ PAID BY ,V'ALI�ATION. f � IGNATUREOFPERMI7TEE �� DATL� , y� � f�, _ ~ WHITE—Oepartment Copy,YEILOW—Finance Copy.PINK—Assessor Copy.GQLDENROD—File Copy.GREEN—Applicarlt's Copy�' � ' � '��� . 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