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HomeMy WebLinkAbout13039 (14) ... EXPIRE'D _�.� CITY OF DIAMONLI BA�tt DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES Q�J � � 2OOD _ � 21660 E.Capiey ' Suite 190 ����«��� BUII.DINGPE (�) AP 11 CATION FIRM Y , _ ... ,,,� .,.�.,: , _.:.,: ._ . . . .,. , ., � JOBSITE �/�I�,..r'f�]��� APPLICATIO� ✓ �--�� NUMBER ��� #,C � o ADDRESS K• �'�6`� DATE_ c� ISSUE TYPE OCC -- APN LOT TRACT DATE CONST. GROUP °C OWNER J a�.' OO ADDRESS /�� � ZONING SETBACKS Z CITY >ZIP���EL. v REART RW O g APPUCANT _ TEL SIDE/SIQE STREET RW ❑ � CONTRACTOR - S d:��- SIDE ❑ ADDRES � ° � � CITY ` Z�P 2���, ;� •-� PROPOSED USE' w ARCWENG/ Z DESIGNER�._ ��� � '�`?������ NO.DWEL. NO. NO. � ADDRE,SrS UN1TS STORIES BEDROOMS � CI7Y le;j:���`�.'�� Z!P l.. L� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUIIDER DECLARATION 5FR/ADD/REM O Q I HEpEBY AFFlRM UNOER PENALTV OF PERNRY THAT I AM EXEMPT FROM THE CONTRACTORS 1.1- Gflf898/CBIFIDit � CENSEUIWFORTHEFOLLOWINOFiEASON(SEC,70.3150USISJESSAN�PROFESSIONSWDE:ANVCITVOR (/� COVNTYN1i1GHRE0UilE5APERMI7TOCONSTRUCT,AI.TER,IMPROVE.DEMOLI3H,D9REPAIRAIJYSTRUC- W Pg�iO/DBC{C TURE,PPIOR TO IT5 ISSUANCE,FLSO REQUIRES THE APPLICANT FOR SUCH PERMIT T6 FiLE A'SIGNED STATEMEM THAT HE OR SHE IS LICENSED PURSUANT TO TNE PROVISIONS OF THE CONTRACTORS U- � CENSE LAW(CHAPTER 9(CQMMENCINO WITH SECTION 7000)OF DIVISION 3 OFTHE BUSINESS ANO PRO- u" POOI/Spe FESSpNS COOE)OR THAT HE OR SHE IS EXEMPT TMEREFROM AN�THE BASI5 FOR'HE AILEGED EXFMP- TpN.ANVVIOLATIONOFSECTION7031.58YAMYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICAM70 Z Re-F1aof � ACML PENALTY OF NOT MORE TNAN FNE HUNDRED DOLLARS(SSoo).�: � ❑I,ASOWNEROFTHEPROPERTY,OflMYEMPIAYEESWITHWAGESASTHEIRSOLECOMPENSATION, Q COfTlTBfCI&1 - WILL DO THE WORK,RND THE STRUCiURE IS NOT INTENDED OR OFFERED FOi7 SALE(S£C.7044,BU51� _1 NESS AND PROFESSIONS CODE THE CANTFAGTORS LICENSE LAW OOES NOT APPLY TO AN OWNEfl OF � PflOPERTYWHOBUIWSORIMPROVESTiEREON,ANDWH000ESSUCHNbRKHIMSELFORHERSELFOR � OC 7HROl1GH HIS OR HEAOWN EMPLOYEES,PRONDED THAT SUCH IMPROVEMENTSARE NOT INTEND'EDOR m ^ Q ,OFFEREUFORSN..E.iF,HOWEVER,THEBUILDINOORIMPROVEMENTISSOLDWR'HINONEVEAROF(kiMPLE- Z �TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PRObINC�TNAT HE OR SHE DID NOT BUIID OR = IMPROYE FORTHE PURPOSEOF SALE�. � - � � w OI,ASOWNEROFTHEPROPFRTY,AMEXCLUSIVELYCANTRACY'INGWRHUCENSEDCANTRACTORS [C 70 CONSTRUCTTHE PROJECT�SEC.7a44,9USINESS NdD PROFESSIONS COOE:THE CONTRACtORS U- V01U8I1011 ADJ.AREA W GENS£LAW DOES NOTAPPLYTO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND - � MhIOCONTRACTSFORSUCHPqOJECTSWIikACONTRACTOR(S)LICENSEDPUASUAkTtqTHECONTRAF QUANTITV � iDESCRIPTION FEE � TORS LICENSE LAW.�. _ )� ^ ❑I AM EXEMPT UNDEF SEG `�— �.8 P.C.K'OR 7HIS REASON � G.<�� � " (,i� t W � � � � r N, � . .Q DATE ONMER E" � ,/ �� /_ i � Z � r7 o��C� aG �.e[ LiCEN5ED CONTRAGTORS OECIARATIOPI �j I ��('f� ,,_� r v '� �C I HEREBV AFFIRM UNOER PENALTY OF PERJURY TNAT i AM LICENSED UNDER PROVISIONS OF CHAPTER � r"%/ d ,. ��J'�" � B(COMIMENCIN(3 WITPt SECTION 9oao)OF DIVISION 3 OF7HE BUSWESS ANO PROFESSIONS CODE,AND Z �W / ?G MV UCENSE IS�IN'rULL FORGE AND CT y� /� � UCENSE CLR�,S � �� ��Lic.NO.T_c�,�� � " ��/p,�—.�,�-,—/��—/� � U DATE �� CONTHRCTOR 'y L,�✓ ,�j�+�(r�+�+'� A- W � WORKERS'COMPENSIITION DECLARATION '� a��,���� ,,, � � I HEREBY 0.FFIRM UNDER PEtdALTV OF PERJUR'/6'NE OF THE FOLLOWING DECLARAT�tdS: � _—� o,�-�-••� �� � e � _I HAVE AND NAIL MhINTA1N A CERTIFICATE OF CONSENT Tb SELf-INSURE FOR WORKERS' , CQACPENSATION,AS PH�VIDED BY SECTION 370o OF THE 4ABOfl COOE,FOR THE PERPoRMANCE OF THE WORK FOR WFIICH THIS PERMI7IS ISSL'ED. 0 W _I HAVE PAID WILL FhAiNTAIM WOpKERS'COMPENSATION INSURANCE,AS REOUiFED BY SECTION Q 37o00FTHELABORCODE,FORTHEPERFQRMANCEOPTHEWORKFORWNICHTHISPERMiTIS issuEo.�avw R' P NSA1071NSURA ec,�aai�rvo OLICYN e s y � CONSTRUCTION �-,� � `�.�'�+�v � CnRPoER� �' .�i. PLANREVIEW _ _��� [���� Z VOLICYNUMBER �' ELECTRIC "'Jh'y'ii✓ '.'r'� ¢ r _ � �tssEc�otmNe�rdo7eeux.�Er�ooFn��w�ur�aueN�ur�onEooalaas�sti�oa�ssl PLUNBING �d w Z 1 CERTIFY THAT M THE PERFORMANCE OF THE WORK fOYi WHICH THIS PERMIT IS ISSUED,I MECHANICAL ��� (,�J SHALLNOTEMPLOYANVPEPSONINANYMANIdERSOA5T08ECOMESIJBJEC770THE � WORKERS'COMPENSATIONUlWSOFCALIFORNIA,ANOAGREETHATIFISHOULDBECOME iNSPECTIONFEE � SU&lE���pppTTOT WORKERS'COMPENSATIONPROVISIONSOFSECTION37o00FTHELA6 p C�ODE/,JJJ SHR ORTHWITHGOMPlYW17TiTFiOSEPROVI5iON5. �SSUANCE � O �dTE:�LI �APPLICANP. � �� .SMIP � WARNING:FAILURETOSEC11flEWORKERS'COMPENSATIONCOVERAGCISUNIAWFVL,ANOSHA(.LBE � ENERGYPlC �y q � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND I ��� . �-yj ��sy�`aL�� � Dq.LAH5�5100,000),INAODITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPPOVIDEDFORIN ENERGVPERM�Tay. J� SECTION37080F7HELABOflCODE,INTEREST,ANDATTORNEY'SFEES. RETENTiONFEF�, �•� �=z����� d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMUNDEHVENALTYOFPERJVFYTHATTHEIiEISACONSTRUCTIONLENDINGAGENCY FOF THE PEflFORMANCE OF THE WORK f-0R WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z w � LENpER'S NAME t_ LEN�ER'SADDRESS W ICERTIFYTHATIHAVEREADTHISAPPUCATIONANDSTATETHATTHEABOVEINFORPdATIONiSCARRECT. TOTAL FELS � � ,�� � I AGREE TO COMVLY W1TH ALL CITY AN�COUNTY OP�INANCES AN�STATE UWS RF.LAI1NG TO BUILOING � cANSTRUCTION,Au0 HEREBV AUTHOHIZE REPRESENTA7IVES OF IS COUNTV TO.FNTERUPON THE ABOVE�MENTIONED VROPERTV FOR INSPECTION PURPOSES. - Z . r,:"� C�MMENTS--------- . d � ,�.. QPEflMITTEE ' �IPRI '� ���' t/) �� ,a���'e". / l°� � SIGNA EO PERMITTEE DATE = iiECPT.NO. 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