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HomeMy WebLinkAbout11686 (5) CITY OF DIAMOND BAhY ' ' � --��� DEPARTMBNT OF COM,MUNITY&DEVELOPMENT SERVICES „ Zi�oE.c Geynrives�A�17 PRESS (909)860-3195 Fae(904)$61-31 ._. , s`t�.r�i[�t p�i�trY" �.���,mto�r " i;. _ FIRMLY . ,.... .,�. .. .._ , , , .�, : , �. _ , . . .,,;.,., ; �. . ... � JOBSITE �' , : , �,.. ��; 4,,..;<�;�k s,. �,':v�w�: , . p APPUCATIbN t PERMIT P!C o ADDRESS 0�S � DATE ' NUMBER � # $ ISSUE TYPE pCC APN OT-y-- TRACT pATE CONST. GROUP p OWNER --� ,�itYYi" ADDRESS '� ' �f• ZONING SETBACKS g CITY . 'W^s�A.P ZIP TEL. FRONT RW ❑ APPLICAN7 TEL. REAR ❑ SIDElSIDE STREET RW ❑ � CONTRACTOR SIDE ❑ p� ADDRESS ' PROPOSED USE �f���° � ��� f�.J A.ELT w AR � p ZIP TEL. t- 8 a.. �� � o � s., �' A �' qw.. DDR SSR • NO.DWEL O. ; r NO. ! � = CITY ZIP TEL. UNITS '"'"` .'r � "STORIES ' BEDROOMS y �ESCRIPTION SQ.FC FACTOR PSF ADJ.AREANALUATION OOWNER•6UILDER DECIAFATION . SFRlADD/REM �� Q I HEREBY AFFlRAA UNDER PENALT'OF PEFUUHY THAT I AM f-XEMPT FROM THE CONTRACTORS LI- � GaragelCarport W CENSEUWFOR7HEFd.LOW�NGR�ASON(SEG7031-.58U511JE55ANDPROFE5510NSCObE:ANVCITYOfl COUNTYWHICHREWIHESAPEfiMtTTOCONSTRUCT,pLTER,IMPROVE,DEMOLISH,ORREPAIRANYSTHGP �,(� pytiO/DBCk TURE.PRIOR TO RS ISSUANCE.ALSO REQUIHES 7HE APPLIpANT FOR SUCH PEAMIT TO FILE 0.SICdJED W STATEMENT THAT HE OA SHE IS UCENSEO PURSUIWT TO THE PROVISIONS QF THE CON7RACTORS'Cf- W � S CENSELAW(CHAPTERD(COMMENCINOPftTHeECTION70DojOFDIVISiON§OFTNE�BUSIN�ESS�RNb�PRO- �'�' PaOUSp& SS FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANOTHEBASISFORTHEALLEGEOEICEMP- (� � TION.ANYVIOUT�ONOFSECTION7o31,58YANYAPPLICANTFORAPERMiTSUBJECT3THEAPPI:ICANT70 Z Re-Roof �„� ACMLPENALTY OF NOT MORE THAN FIVE HUNOHED�OLLARS(35oa)J: � � � � ❑t,ASOWNEPOFTHEPROPERTY,ORMYEMPLOYEESWiTHWAOESASTNEIRSOLECAMPENSATION, ❑ Cof11m0fCial ' WILL DO THE WORK,ANO THE STRUCTl1RE IS NOT INTEN�EO OH OFFERE�FOF SALE j5EC:74d4,BU51- ...1 NESS AN�PROFESSIONS CODE:TiE CONfRACTOHS LICENSE LAW DOES NOTAPPLV Tp AN OWNER�F � PROPERTYYh108U0.D50RIMPROYESTHEREON,ANOWHOdOE55UCHWORKHIl:1SELFOPHEWSEIFOR � Q TNRIX1fiHHIS4RNERONINEMPIOVEES:PROVIDEDTNATSUCHIMPROVEMENTSARENO7INTENDEDOR m � ,OFFEREDFORSN£IF,HOVJEVER,IHEBUILDINdOFIMFROVEMEN71550LDWRHINOhEYEAROKCOhYpLE- z �TIOFI,hIE 4NTlER�BUILDER WILL HAVE THE BURD6N OP PFOVING THA7 HE.bR SHE Olp NOT BUILD OR � = IMPROVEFORTHEPURPOSEOFSI,�E�. - " � � -� "�- : "� � ❑I,ASONMEROFTFiE PROPERfV.AM EXCWSIVELV CANTRACTING WITH UCENSED CONTRACTORS � TO CONSTRUCT 1}1E PRO.IECT(SEC.7044,BUSINESS AND"PROfESS10NS CODE:TNE CONTF7ACfOqS LI- V81U81iOn ADJ.AREA � CENSEUWDOESNOTAPPLVTOANOWNEPOFAPROPERYYWFIOBl1ILOSORIMPROVESTHEREON,AND WFqCOMMCT9FdiSUCHPRQIECTSWITriACONTHi�CTOq(S)IICENSEDPUP5UAN7TOTHECONTMG QUANTITY DESGFIIPTION FEE - Y TORS 110ENSE LAVd.f. QO I AM EXEMPTUNDER SEG, B,b P.C.fpR THIS REASON U F � . . . � , ,, ,.., . . .. .. DA7E OYJNER � �a� LICENSED CONTRACTORS DECLAAATION W 2 1 HEREBY AFFIRM UNDER PENAI.N OF PERJUR`I THqT I AM UCENSEO UNDER PROVISION50�CHAPTER � ' p_ Y(COMMENCIN(i WITH SECTION 7poo)OF DIVISION 30F THE BUSINE55 AND PROFESSIONS CODE,AN� z X IAYUCENSE IS W NlL FORCE AND EFFECT. m o LICENSE CIA55 Co.� �I LIC.NO.:� � � WOATE� �.�"'�' � CONTRACTOh�. .....,.�. � 0- � WORKERS'COMPENSATION DECLARATION ��•�'��%� Q � �HEREBYAFFIRMVNDERPENALTYOFPERJURYONEOFTHEFOILOWiNOOECI.ARAT10N5: U � 4 0 IHAVEANDWILLPIAINTAINACERTIFICATEOFCONSENiT03ElFdNSUREFORWORKERS' � � CAMPBJSATION,ASPiiWIDE08VSECTION''37000FTHE'LABONCODE,FORhiEPERFORMANCE W OF THE WORK FOR WHICHTHIS PERMR IS ISSUE�. � � � _t HAVE ANO WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION � � a70D OF 7HE LABOF CO�E,FORTHE PERFORMANCE OF THE WORK F-0RINFlICH THIS PERMIT i5 � L 0 ISSUED.MY WORKERS'COA ENSATKKd INSURAN E CARRIER AND POUCY NUMBER ARE� CONSTRUCTION j CARRIER � __.�____ PLAN REVIEW __ � � O POUCY NU Eri ELECTRIC Q � � • � (IFiISSECIIONNE�NOT�WNPLEfEDOFTHEPERMffISR?RIXJEHUNDRED (5 )ORLESS} PLUMBING ' Z 1 CEflTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ISS�ED,I MECHANICAL ✓„� SHAIL NOT EMPIOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO E (/y WORKERS'COMPENSATIONI.AWSOFCALiFORNIA,ANDAGREETHATIF SHO D COME INSPECiIONFEE � SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF S I 7o F E LABOR � � CODE,I SHALL FORTMW�MPLY WITM THOSE PR VISIONS. ISSUANCE o SMIP � p DATE:4� APPLICANP. �� , � EN&RGY P!C WARNWG�FAIWRETOSECUREWOAKERS'COMPENSATIONCOVERqGElS LAWFUL.qNOSHFLLBE LL SUBJECTAN EMPLDYER TO CPIMiNAI PENALTIES AN�CMl FlNES UP TOONE HUN�RED TFWUSANO EN�RGY PERMIT DOLLARS(5100,OW),IN ADOITIDN TO THE COST OF COMPENSATIDN,OAMAGES AS PROVIDEO FO�IN � SECTION3708OFTFiELABORCOOE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: a CONSTRUCTION LENDING AGENCY � PHE-ALT FEE: O qI MEREBYAFFIRM UN�ER PENAITY OF PEflJURY THAT 7HERE IS ACONSTHUCTION I.ENpING AGENCY FORTHE PERFORMANCEOFTHE WORN FOF WHICH THIS PERMITIS ISSl1E0(SEC.3097,CIV.Cj. —' ��� � � Z Lt.! � LENDERS NAME F„- LENDER5ADDRESS . p� . ....,.....�,.,,.:. ¢ ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTH�ABOVEINFOFMATIONISCORRECT. TOTAL FEES � E �/ . pW,_ IAGREE TO COMPI.Y WITM ALtCIN ANO COUMY ORDINANCES ANO STATE LAWS RElA71NO t0 BURAINO ' ' " � . � CONSTRUCTIaJ,APIDHEPEBYAUTHOR�2EREPRESEMATNESOFTHISCOUNTVTOENTERUPONTkE Z A00VE•MENTIONEDPROPERTVFORI ecrtor+piiRaosEs. 1 � COMMENTS - � L� /a�f.� v � � PERMiTTEENAME(PRINn . .. . .. � I (n SIO P � DATE ��---� .. • z RECPT.NO. � PAID BY VALIOA� � b F` WHITE—Depanment Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLAENROD--Fiie Copy,GREEN—ApplicanYs Copy .. ... . . .. .... ....... ,,....:-n�: ,:. .�..� .:.._...:, �,� :-�,,:: ' y; •. ..` e `.�'`'1 . .�lr.d�'iF I'. �'Cd' r�I � '.'.3p�.:i4 F . .,. . . ... .. . . . .. . . ., . . ., ,. . �:tr,r . ,. . �� * .^ .. . . ..... �. ,.... . . � ,., .: ' .- .. -- ::' .t .... :..,�1..r., . :.,:�`e . -..... �. �w' . '� �� .. . .. ." _ ' ' '_ .Y., � . .. .. ,., '�r'' :. t � . - . . . . . 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