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HomeMy WebLinkAbout12703 (14) _ �e _ ..... : _ a,. i . -"--....__ ...__..,, � 1��_ CITY OF DIAMOND BAA ��� ✓.Y'�' � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � ,�,/' 21660 E.Copley Drive Suite 190 ' ,J���/ �,.� � (909)860-3145 Fax(909)861;31,17 L_--••�"" PRESS . Igl,.�. Bi?ILTIT�TG P�Rt1�T A'h�'LICA'TIOI� . FIRMLY (! ...�_G ..�.., rve�.rv.aa ....,... n �..e�.... . . .,:r.... � . .. � ' - . . . .:,:. � � :�: ';:.. �^:: ' i "' . '. .. x ... ,•::. . .,. r x ..ri.,r v i... .:>...�. . .. � ' i.:� t �t�S;k., ,��`:�:�n n. Y� ..,..'!111 �.� d�.. � :-,. . ...:, ...� .-�. � JOBSITE ` ' APPUCATIfSN GJ PERMIT P/C o ADDRESS ��� I N�'/4N �k DATE ����� l�NUMBER �- d� # ������ c� ,�r ISSUE TYPE OCC APN LOT� TRACT .30�"�,I DATE CONST. GROUP p OWNER �1�P�►24�� T'32'V�""'r � ADDRESS SC�M� •�, i �� ' ZONING SETBACKS .-�/� ( W CITY IP TEL � � FRONT t�+�.� � APPLICANT 'TEL A'�zQ„�C�„_ REAR — 2C7' �— RW ❑ � ,. ; _�' ��� SIDE SIDE STREET � W a GONTRACTOR M Gw C� c--�., � ADDRESS ^ ,.,,., �� ; � N � , PROPOSED USE _ ��S t Q�t!'t�^- � CITY ZIP TEL '+ � �, w ARCWENG/ ; x �,�E�--�� �z DESIGNER �� � � + � I NO.DWEL. ' NO. � , NO. n, ADDRESS �L ' UNITS STORIES BEDFi00MS � CITY �sC��NCISLA� ZIP�',,ti�TEL._, _.�... "Z. ',, � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNEFi-BUILOER DECI.ARATION . ,. .,, ����"��� � �'„ SFR/AQD/REM O p I HEHEBY AFFIRM UN�EFl PENALTY OF PEPJURY 7HAT I AM EXEMPT FROM THE C�N7RACTORS LI� � Garage/Carport W CENSELAWFORTHEFOLLOWINGflEASON(SEC.7037.5BUSINESSANBPRdFE^afiIDN3CO0E11NYCMOp C� COUNTYWHICHREWIRESAPERMtTTOCONSTRUCT.ALTEfi:IAAPROVE,DEMOUSH;ORREP0.1FiANYSiRUC� W patio(DsCk 's– TURE,PRIOR TO ITS ISSt1ANCE„ALSeJ REOUIRES THE APPLlCAM fOR,SUCH PERMITTO FIIE A SIGNEO W STATEMENT THAT HE OR SHE IS LICENSED PURSUA.NT TO YHE PRtlVIS10NS bF"fFI�'CdNTAAC7dR5 LI• W � CENSELAW(CIiAP'TER9(COMM�NCINaWIiHSECTION-7000JOFbIVISION30F7�NE'9USIN�`S�IIND�PRO� �'�' POoUSpa FES910NSfADE)ORhiA7HEOFlSHEISEXEMPTTHEfiEFROMANpTHEBASISFORTHEALLEQEDEXEMP- (� TION.ANYVIOLATKNJOFSEG710N7o31.5BYANYAPPLICANTFORAPERMITSUBJEG'fSTHEAPPUCAM'O Z R8-ROOf � ACIVIL PENILLTv OF NOT MORETMAN FNE HUNDRED OOLLARS(3500�.): "'�'._' . . ' -- � ❑I,ASOWNEROFTHEPROPERTV,ORMYFMPLAYEES`MTHWAGESAS7HEIRSOlEC6MpENSATION, � COmm6fCi81 - NALL DO THE WORK,AND THE STRUCTURE IS NOT IN7END�D�R OFFERED FOR SALE(SEC.'7044:BUSI� _1 � NESSAND PROFESSIONS fADE:THE CANTRACT�RS L�CENSE LAW�OES NOT APPLY TO b"J��OWN�EH OF = PROPER'TY Wr�O BUI4DS OR IMVROVES7HEREON,AND WHO OOE'S SUCVi WORN NIAdSELF OR'FiERSE'LKOR � THROLIOHHISORHEROWMEEIpCOVEES,PROVIDEDTHAY'SUCIi1MPROVEMENTS'ARENOT1�t57EN��DOP m Q ,OFFEREDFORSILLEIKHOWEVER,THEBUILDINOORIMPR6VEMEN'YISSOIDVdIhIINOtJEYEACI�OFCOMPIE� TION,THE OWNER-BUILDER NlILL HAYE THE BURDEN OF Pq0`YING THAT HE OR SHE DID NOT BUII.D OR � IMPROVEFOR7HEPURPOSE�OFSALEj. � � � ' ' " �p�ig II I � ❑I,AS OWNEH OFTHE PROPERfV,AM EXCLUSIVELY CON i RACTING WITH LICE�ISEo C('S1.TRACTORS Q TO CONSTRUCT THE PRQIECt(SEC.7044,BUSINESS AN�PROKESSIONS CODEi'YHE CON7pACTdRS L4 Ve�ue9iOn A�J.AREA LL7 CENSELAW�OESMOTAPPLYTOANOWNEROFAPROPERTYWHb9t11LOSORIMPR6VE$YWER�ON,ANO � WFIOCONTRACTSFORSUCHPRO.IECTSWITkACONTMCTOR(S)LICENSEDPUHSUANTTOY,NEC,ONTRAC- QUANTITY DESCRIPTION FEE � TORS UCENSE IAW.I. .'.-.,., �. ^`{ 0 ❑I AM E%ENPT UNDER SEC. B.&P.C.FORTHIS REASOIv - Q � ����T{ � � � � c.> � - ' p � � t M � � DATE OWNER � U � � � � • � QQ LICENSED CONTRACTORS DECLARATION �� W f' � r�, ( b CC I HEREBV AFFIRM UNDER PENAL7Y OF PENURY THAT I AM LICENSEO UNDEfl PROVI310NS OF CHAVTER � � e(COMMENCWOWITMSECTKKd1000�OFOIVISION30FTHEBU51NE55ANDPPOFESS10N5CODE,AN� Z ?� MY UCENSE 15 IN FULL FORCE pND EFFECT. o LICENSE CtASS �`�^v`�{ LIC.NO. �"��� � � - � U DA7E '`�`��� CONTRACTOR N�-'UV�A S"C�...0 a w � WOFKERS'COMPENSATION DECLAAATION Q � 1 HEREBV AFFIRM UNDER PENAL7V OF 7ERJURY ONE OFTHE FOLI.OWING DECLdRA7lONSi��� � - � � _IHAVEANDWILLMAMTAINACEFiTIFICATEOFCONSEMTOSELF-INSUilEFORWORKERS' _ CAMPENSATpN,ASPROViDEOBYSECTIqN37000FTHEU1BOfiCODE;�F'ORTHEPERFORMANCE U �� OFTHE WORK FOR WHICNTHIS PERMIT IS ISSUEO. � 0 W �I MAVEANO WILL MAINTAIN WORKERS'COMPEN9ATION INSURANCE,AS REOUIqED BY SECTION � 37COOFTHELABORCODE.FOR7NEPEflFORMANCEOFTHEWOflKFapWHICHTHISPEFMITIS � j� ISSUED.MY 6YORKERS'COMPENSATION INSURARCE CARAIER ANO POLICY NUMBER ARE: CONSTRUCTION g 7Y"�"� j CARRIER ���� ��� PLAN REVIEW � aoucrNUMaER , , , ELECTRIC � � (iWSSECTKXJNE�NOTBEOJMPLEf8JOF7NEPERN7rISFOflONEHUMfED(KAIARS($tO�JORLESS} I PLUMBING � ICERTIfVTHATINTHEPERFORNANCEOFTHEWC7RKFORWHICHTHISPERMITISI5SUE0,1 MECHANICAI (°J SHAILNOTEMPLOYANYPERSONINANYMANNERSOAS708ECOMESUBJECTTOTHE {� WORKERS'COMPENSAT�ONLAWSOFCALIFORNIA, �AGREETNATFISHOULDBECOME INSPECTIONFEE SUBJECTTOTHEWORKERS'COMPENSATIONP NSOFS I N77000FThIELA86R /"� � CODE,I SHAU.FORTFIWITH COMPLY WITH TH P ISIONS. �SSUANCE /"D(/ � �o . Cj �ATE:�� � APPLICANL � SMIP f J WARNINO:FAILURETOSECVREWORKERS'COMPENSATIO GEISUN NFUL,AN�SHALLBE ENERGYPIC ___ p� SUBJECTAN EMPIOYER TO CRIMINAL PENALTIES AND CNIL FINES U UNORED TH4USAND ENERGY PERMlT �OLLARS(5700,000),IN MDITION TO TME GOST OF COMPENSATIbN,DAMAGES AS PROVIDED fOR IN � SECTION370BOFiHELABOqCODE,INTEREST,ANDATTOftNEV'SFEe'S. RETENTIONFEE: OCONSTRUCTlON LENDING AGENCY p ALT FE�,}!_ f_,., � �HEREBYAFFIRMUNDERPENALTYOFPEPJURYTHATTHERE150.CONS7RUCTIONIENDINGAGENCY ��L,�/ FORTHEPERWRMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED(SEC.3o97,CIV.C.�.� Z w _t � LENDER'S NAME ��`V� � . � . 1— IEPJDER'SA�DRE55 W� TOTAL FEE ¢� / - / f ICERTIfVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATtONISCORRECT. ��� �� �M� A (� � I AGREE?O CAMPLY WITH ALLCITY AN�CAUNTY ORDINANCES AN�STATE LAWS RELATIN6 TO BUILDING r � �� � ,���� � CONS7PUCTION.ANDHEfiEBYAUTHORIZEREPRESENTATNE50fTNISCOUNTYTOENTERUPONTHE 'y'� /����j Z ABOVEMENTIONED PROPERTV FOR INSPECTION PURPO5ES. 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