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HomeMy WebLinkAbout11695 CITY OF DIAMOND BA& � ^--1�� DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES _ �; . 21660 E.Copley Drive 3uite 190 ,,,, (909)860-3195 Fax(909)861-3117 <" .. BUIL.:tiT�YG�'�I'l'Al��"�'.rCATI01� .q«, , ,, , -- .,, . ,..� � _ . ;.: __ . � .. . ., a .,,,�, ; � FIRMLY _ r,�.,.w �. .,� ,_r� �� .,. . .: .,n ,;.,,:,� :., . ;:,. o� JOBSITE r� APPLICAT1bN' . � »' pERM1T' C���"'h/C: � ADDRESS ��� /7�� SA�` DATE —�- NUMBER����i pv # � ISSUE�'�'I��t,o ,��p TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER a.u' � "' ADDRESS � � ZONING SETBACKS � CITY � . ��_ ZIP TEL. +S�{ FRONT Ryi/ ❑ APPUGANT TEL. REAR ❑ � SIDEISIQE STREET RW ❑ � CONTRACTOR r� SIDE ❑ o ADDRESS ' � C ' PROPOSED USE �i i' d�i �� C'� CITY s ZIP TEL. r ' c ' � ARCH/ENG/ �� S� �n z DESIGNER w N0.DWEL � O. NO. n. ADDRESS � CITY ZIP TEL. UNITS `" `''�`"'" 4 ' STORIE�S BEDROOMS � v� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION � OWNEA-BUILDER DECLARATION SFPJADD/REM O p 1 HEREBY AFFIpM UNDER PENALT'OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI� Gd29B/CdfpOlt W CENSELAWWR7HEFOLLOWINGREA90N(SEC.io31.58USINESSANDPRaFESS10NSCb�EiANVdTVOR (n . �.7 COUMVWHICHREOUIRESAPERMtTTOCONSTAUCT,ALTER,IMPROVE,DEMOUSI{ORREPAIRANYSYRUP W peilp/DBCk Z TUR6,PRIqR TQ ITS ISSUANGE,ALSO REQUIHES TME APPLICANT FOR SUCH PERMIT TO FlLE A&IGNE� � STATEMENT THAT HE OH SHE IS LICENSEO PURSUANT TO tHE PROVISIbNS�OKTHE CONTRACtOh15 LI� � � CENSE lAW{CHAPTER 9(COMMENqNO ri1TH SEC710N 70oD)OF�NISION 3 OF TME 9U51NES5AND PRD� P0011SP8 FESSpNSCO�E)ORTHATHEORSHEISEXEMPTTHEREFflOMANDTHEBASISFORTHEALIEGEpEXEMP• (� � TION.ANYYIOLA710NOFSECTION7037.6BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z RB-ROOF � ACMLPENALTYOFNOTMORETHANfIVEHUNDREDDOLIARS(SSOD�.): - - � ��- - � ❑I,ASOWNEROFTHEPROPER7V,OHIAVEIJPLAVEESWI7HWAGESASIHEIRSOLECOMPENSATION, 0 Comm6fCi&1 - WILL DO THE YVORN,AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7044,�BU51- J � NESS AND PROFESSIONS COOE:7HE CONTRACTORS UCEN$E LAW DOES NOT APPLV TO AN OWNER OF � PROPER7Y WFiO BUILDS OR IMPROVESTHEREON,AND N1i0 bOES SUCH WORN HiMSELF OR HEf15ELF OP � THROUOliHiSOHH6qoNM`EMpI;OYEES,pR9vIPEDTHAT�SUCH'IMPROVEMENT5ARENOTIfVTENDE�Op m Q ,OFFEFiEUFOflSILLE1FHOVVEVER7'NEBUIlDIN60RIMPROVEMEN71550LDWIhIINONENEAROFCOMPLE• Z TqN,TFiE OWNER�BUILDER WILL HAYE TriE BUFDEN OF PROVINO THAT HE OR SHE DID NOT BUICD Op � IAIPROVEFORTHEPl1FPOSEOF5ALE1. . '�. . . '..; . _ W ❑I,ASONMEROF7HEPROPEHI'Y,AMIXCLUSIVELYCONTRACTINGNAhIUCENSEDCONTRACYORS � TO CONSTRUCT THE PRQIECT(SEQ 1044,BUSINESS ANO PROFESSIONS CO�E:7HE CONTRACTOIiS L4 VelUaliOn ADJ.AREA � CENSE LAW OOES NOT APPLY TOAN ONMER OF A PROPEHTY WNO BUILD3 OR IMPROVES THERE�ON,ANO — � - � NRIOCOMMCTSFORSUCHPRQIECTSWITHACANTRACTOR(5)LICENSEDPURSUANTTOTHECONTflAG QUANTITY DESCRIPTION FEE � roRsucEwseuw.�. Q ❑i AlA EXEMPT UNDER SEC .__.. ..._...,. ............_.........B.8 P.C.fOR THIS REASON � �. . � �. ..., � ., �; �.n . , .• � . :. ,�.,.. � � ,- � ...n. �,- � � _ � ,. .. .. _". .._..._.... �ATE OWNER � Z W � LICENSED CONTRACTORS DECLARATIQN � , .., ... . ..... ,. .._. ....._....... 1 HEqEBYAFPIqM UNDER PENALTY OF PERJURY THAT IAAi UCENSED UNDER PROVISIONS OF CHAPT'cR � � 9(COMMENCINB WITH SECTION 7000)OF�NISIDN 3 OF THE Bl1SINESSAND PROFESSIONS CO�E.AND Z � 11J MY LICENSE IS IO!FUU.FORCE AND EFFECT. m 0 UCENSE CLASS ��*�-+ r LIC.NO. ' �i���� � V DATE � ��C.^ �'a CONTRAC'TOR_�� d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBYAFFIRM UNUER PENALNOF PERJURY ONE OF THE FOLIOWING DECUIPATIONSi-� - -- - - � ' � � _INAVEANONILI.MAINTAINACERTIFICATEOfC�.ISENTTOSELF.INSUREFORWORKERS' ¢ S COMPENSATION,ASPFOVIDEDBYSECT10N3700pFTHELABORCODE,FOR7HEPERFORMANCE 'U O OF TME WOFK FOR WMICH THIS PERM�T 5 ISSUED. � W _I HAVE ANO WILL MAIMAIN WORNERS'COMPENSATION INSURANCE,AS REOUIREO BY SECTION /'�^- � 3'!0o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK fOR WHICH THIS PERMIT IS ,{�� Z`i ISSUED.MYVlORKERS'COM$BiSATIONIN9VflANCECASAIEFANDPOLICYNUMBERARE: CONSTRUCTION �! � ¢ CqRR1ER GLh��=h r/ �� PLAN REVIEW � POLICYNUMB �M:� ��-���-�-j ELECTRIC 0 �ussEenoNN�rdoreEa�ErEoaF'n+erew�'�sFoaoHE�ooa.iws�Sioo�oa�Ess). PLUMBING Z 1 CER7IFY THAT IN iHE PERFOpMANCE OF THE WORK FOfl WHICH TNIS PER IT IS ISSUED,I MECHANICAL QJ SHALL NOT EMPIOY ANY PERSON IN ANY MANNER SO AS TO BECAME SUB CTTO THE � C/� WORKERS'COMPENSATIONLAWSOFCAUFORNIA,AN�AGREETHATIf15 LDBECOME INSPECTIONFEE � Sl1BJECTTOTHEVJOfiKERS'COMPENSATIONPROVISIONSOF � 3 OFTHELAROR CODE,I SHALL FO ITHCOMPLV WITH THOSE PROVISI �SSUANCE , � cS"-�G� '�5%`�" p OATE: APPLICANP. SMIP C> J WARNING:FAILURETOSECUREWORKERS'COMPENSATIONCOVEHAG UNIAWFU4AND5HALLBE ENERGYPIC � LL SUBJECTANEMPIOtlERTOCqIMINALPBJALTIESANDCiYILFINESUP ONEHUNDREOTHOUSAND ENERGYPERMIT OOLIARS(=700,000�,IN MDITION TO THE CAST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SEC7�ON 3708 oF TiE LABOR CODE,INTEREST,ANO ATTORNEY'S FEES. RETENTION FEE: QCONSTRUCTION LENDING AGENCY PRE-Al7 FEE: � IHEREBVAFFIRMUNDERPENALTVOFPERJURYTHATTHEREISACONSTRUCTIONLENDINGAGENCY � FORTHEPEFFOHMANCEOFTHEWORKf-0RWH�CHTHISPERMIT�SISSUED{SEC.30B7,CIV.C.). -� ��� � � -� Z W � LENDER'3 NAME � � i— LENDER'SADDRESS_ � TOTAL FEES �06 ,.o� w I CERTIFY THAT 1 HAVE f1EAD THIS APPUCATION PNO STATE THATTHE ABOVE INFORMATKKJ IS CARRECT. , ' � � IAGREETOCAMPLYWRHALLCRYANDCOUNTVORDINANCESANDSTATEIAV/SREUTINGTO8UIL01NG ' � CONSTRUC710N,ANDHEREBYAU7HORIZEREPRESEN7ATNESOFTHISCOUN7Y70ENTERUPONTHE � � � - ABOVE�MENTIONED PROPERTY FOR INSPECTION PU�ES. COMMENTS o �s � PER ITTEENAME(6RfNT) � " -�� �� ,_Q - � � G � VJ _ . ........ . . �. y SfONA ER E � �ATE �� , ,.. - ;�.: � . .,. . _ � REGPT.NO. P/UD BY � VALIOATION ~ - WHITE—Department Copy,YELLOW—Finance Copy,PINK-Assessor Copy,GOLDENROD—File Copy,GPEEN—ApplicanPs Copy �� � � . .,;.< - :,. . ...;, , �u;:� �.-. � � ��'"� �� °_ . "�'' .< ,:. �;'°��t*�.,���, , p . �.., _ � ��� �m. . 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