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HomeMy WebLinkAbout13820 (14) _ ��.� _ CITY OF DIAMOND BAIt � DEPARTMENT OF CO1C�14fUNITY&DEVEL4PMEIVT SERVICES � 21660 E.Copley Drive Suite 190 ... . (909)860--3195 Fax(909)861-3117 PR ESS M�° BUII,DING P'�TtIVIIT A�Y'Y.ICATaION ' _,�.,. „, _,.�. , „..... ��..: �. , , -_ � : � ,r�.>„ � , ,, FIRMLY. . � o DDRESS. �/,�f���'���fi�?� G����. �l�%d�"'!C ; DATE CATIQN' ���°l��') NUMBER <'� #/ � 1 --��_9�_ � � ���� ISSUE TYPE OCC APN LOT TRACT l DATE CONST. GROUP p OWNER " ADDRESS ZONING SETBACKS e � CITY ZIP TEL. ✓ �'�}[ FRONT_'L'� RW ❑ APpUCANT TEL.�—�`'q REAA ��1 — ❑ � SIDE/SIpE STREET RW O � CONTRACTpl� � � � SIDE ❑ � ADDRESS . ��-„--�d.li►#3�1''� �i��l�l ll���'�N' � CITY�� ZIP � I. ' - PROPOSE�USE. w ARG G/ z DESIGNER ry � NO.DWEL NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY �,ZIP TE .��� cn DESCRIPTIDN SQ.FT: FACTOR PSF ApJ.AREANALUATION p� ONINER-BUILDER DECLAf7A710N SFRlADD/REM O �HEREBY AFFIFipd UNDER PENALN OF PERJUAY THAT i AM EXEb1PT FROM T1iE CONTRACTOAS U- �gfage/CafpOft W CENSEUWFORTF�FOLLOWndGREA.50Id(SEC.7031.SBUSINESSANDPF�FESSpNSCObE:ANYCITYOfl (n ODUNTY WHICH REQUIRESA PEeNYiTO CONSTRUCi,ALTEfl.IMPRDVE,DEMUL15h4 OR REPAIRANYSTRUG TURE,PRIOA TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANI FOfl SUCFI pERMIT TO FlLE A SIGNEO � �a}IO1DeCk W STATEUENT THAT NE OR SHE IS LICENSEII PUPSUANT TO iME PflOVI510N5 OF TNE CONTRAC70R5�I• W � CENSE LAW(GHA9TER 9(COMMENCIMG WITH SECTION 7000)OF OIYISION 3 Of THE BUSINE55 AND PRD- LL' PooVSpa � �- FE6SIONSCOOE)ORTHATHEOHSHEISEXEMPTTHEREfROFdANDTHEBASi&FORTHEALCfGEO�EXEMP- (� TqN.ANYVIOLATI0NOF5ECTION703i.6BVANYAPpLICANTWRA?ERMITSUBJECTSTHEAVPLICANTTO Z Re-Roof �, AGIVILPENALiYOFNOTMORETMANFIVEHUN�REDDOLtARS(85o0�.): �'" �y OI,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWI7HWAG[SASTHEIRSCLECOMPEN$ATION, �Gl CO�TltitefCi31 � � WILL W TME WORI(,FND TNE STRUCTURE IS NO7INTENDED OR OFF'ERED FOR SAL�jSFC.7044,BUSI- ,_.1 � NESS AND PHOFESS10N5 CODE:THE CONiPACTORS LICENSE IAbY DOES NOT HPPLY TO AN bWIVEF OF � PROPEflTV Vt}i0 BUItDS OR IMPROVES THERE�N,AND Mhip OOES SUC,H N/ORK HIMS£LFOIi FIER§EL.F OR Q THibUGHHI50RHERONM£MPLOYEES,PROVID'cDi'FIATSUCHIMaPOVEMENYSARENO7INTENCEDOR m �� Ll�B ,OFFEREDFOHSALE.IF,HOWEVEP.THE9UILOINGORIMPROVEME71Ti550lDWITNINCMIEVEAROFCbA1P�E- 5��. TION,THE OWNER-BUItDER WILL NAYE THE BUflDEN OF PqOYING 7HAT HE o'fl SME 010'NOT BU:I.D OP '�.� IMPqOVEFORTHEPURPOSEOFGA(.q. � � ❑I,AS OWNER OF THE PqOPERTV,AM EXCLUSNElV CONTAA.MlNG WITH 4�CENSE[/WNTRACTORS Q TO CONSTfIIUCT THE PROJECT(SEC.101t.BUSWESS AND PR6FE55!OMS CODE:TNF CONTRP.C?ORS�iI- 81U&tiOfi '! ADJ.AREA W CENSEUWOOE9NOTAPPLYTOANOWNEAOFAPROPER1YWHpBUILO50flIMPROVES7HERECSN,AND F Nf1000NTAACTSFORSUCHPpO.lECTSWITHACONTRACTpR(5)LiCENS�VURSUAh'TtOTHECOHTR/IF QUANTI7Y UESCflIPTION GEE � T�qS LICENSE LAW.J. . , O I AM EXEMPT UNDER�SEC. e.&F.C.FORTHIS REASON J __.� O "C — � — �___ Y— U � � OATE ObVMER � � LICENSED COM7RACTOR5 DECLARATION w � � I HEREBYAFFIRM UN�ER PFMALTY OF PERIIIFiY THAT I AM LICFM5ED 11NnEfl PAOVISIONS Of CFIAPT[R � � D(COMMENCNOWITHSEGTK1N7o00)OFDIVISi0N3OFT11E91JSINESSANDPqOFES510FlSCbCE,AND � ilt MYIICENSE IS IN FULI FORCEAND EFFECT. � � LICENSE CLASS_ �� LIC.NO.�ci Y r c_�_.J � h � DA4E � _� CON7RACTOR_ . /�� jy�Y",}�4' 0. ' WORKERS'COMPENSA?lON DEG_ARATION;���§�" Q � INEREBVAFFIAMUMDERpENAISYOFPERJURVONEOFTHEFOLLCW'.�GDECLA'nATIONS: � Z � _�IHMF_ANDWILLMAINTAINACERTIFICATECFCONSENTTOSELf�INSUflEFORWORKERS' 4 CO!APENSA710N,AS PRQVIOED BYSEGTION 3'ooOF7HE 1A80R COO[,FOP 7NE PEflFORMANCE C.) OF THE WOFK FOR WHICH THIS PERMIT IS ISSUE�. �� Lll -~— _,1 HAiIE AND lNl.L MAIMAl1J WORKERS'LbMPENS0.T10N tNSURhNCE,AS REQUIRED BY SECTION ✓✓�77� Q 37o00F74iELABOPCODE,F-0F1'HER[RFORMANCEaFTHEYJORKFORWFIICHTHISPERMiTiS ^'�,��� �fs� � IESUEO.MY WOPKERS'COARPEASATION INSOHAPlCE CAPqIER ANO PO�ICV NU?ABER AftE� CONSTRUCTION r�' rT'\ � caRRIER_ �P�.(�� ��..� ��e PIAN REVIEW 4 . � aa�cruuue=a _� ELECTRIC Q (iHSS[-Ct10NN[�JNJTBF070.AHFfE00FTNEPERHA71SFnRCA�141fiDRE0001.(.4HS�51W)ORIESS). PLUMBING �� � Z I CER71fY 7HAT M THE PEPFORMANCc OF THE WORK fOfl WNICM TN5 PERMIT IS I5SUE0,l MECHANICAL __ , (,�} SHALLNOTEMPLOYhPJYPERSONINANYMANNERSOASTPBECOME9UEJECT70THE � WORKERS'C0AIPENSATION LAWS OF CALIFOPNIA,AN�AGBEE THAT IF I SHIXICD BECAME INSPECTION FEE -�� r SU&IECTTOTHEYdORKk'flS'CAMPENSATIONPROVI N O SECTi0�3]OOOFTHELA90R .« � COOE.ISHALLFORTHWITHCOIAPLYYATM O P VI 5p.� ,� ` ISSUANCE �� a� d vfs�a� G''� SMIP _./_��_�_¢s� Q OATE: ✓ PLICANT. 9__ J WAflNING FAIl.UR6 TO SECl1RE RKEFS'COMPENSATION COVERAGE IS UP: UL,AND SFlALLBE ENERGY P/C �I 4 A �'l �y SUBJECTANEMPLOYEftTOCRIIAINALPENALTIESAN�CNILFMESUPTOONE NOREDTHOUSAND ENERGYPERMIT w DOILARS�§1a6,000),IN ADDITIOfd 70THE C0570F�qMAENSATION,DAAAAGES AS PRCVIOED FOq IN " ��� � SECTDN 37oe OFTNE IABOR CODE,INTEflEST,AND ATTORNkI"S FEES. � .�..a 'i ) RETEN ON FEE: ��g�- ,e,� ./ W $�",�����'.i v�X#�s..pd��;Y,i°S,t"��.. d CONSTRUCTIONLENDINGAGENCY pR�E ,., � IHERES�APFIRMUNDERPENAUYOFPBRJURVTHATTHEREISACONSTRUCTIONLENOING'AGENCY i>�; ' FORTHE PERFOFMANCE OF THE WORH FOR WHICH THIS PEFMIT IS ISSUED(SEC.30B�,CIV.C.). , . Z W � LEN�ER'SNAME ___._____ _ _ ___ / F-- LENDER'SADDRESS w I CERTIFY THqT 1 HAVE AEAD THIS APPUCATION ANO STATE THATTHE ABOVE INFORMATIDN IS CORRECT. �O I C1L FE ES � '� �� �y IAGR6ETOCOMPIVWITHALLCINANDCOUNT�OR0INANCESANDSTATE�.M1WSREUTiNGTOBUItAING � CONSTFUCTION.ANOHEqEBYAUhiOPIZEREPflESENiqTIVE50FTHISCDUNNTOENTERUPoIJ7HE � ABOVE-MEMIC�NEDPROPEftTYFOf31NSPECTIONPURPOSCS. COMMENTS___ �`_! � _�"' -�r� m PERMITfEE NAME�PRINT) �+,� � . ,.�'� /��// y . .. � S�GNATURE OF PERMITTEE �� ATE i � �, � RECPT.NO. � PAID BY ` VALIDATION� WHITE—Qepartmant Copy,YELLOW—Finance Copy,PINK—Assessoe Copy,GOLDENROD--File Copy,GREEN—ApplicanYs Copy �r ., b .� -..,x y a.;�`� ��.�«'�t'r��1�at�,3'g;..r�-s�a ,,ro- ".;nw ,."a_,,_.x,.: +�.t9.��tF',:, .nt.,,s�sa,k.,,,5, •:7,'�;.& as;.:,xa x ,. . - ., �,:..,,�. :... .r: .. .. :.„ ... . . ., . .. �...,,�� .. .......,. ... . „ ,,v,�, . . . . . ��,.�rt .. 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