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Home My WebLink About13928 (14) n �..t � d��.---�;�� . _!� CITY OF DIAMOND BAB �C� e �?�� DEPARTMENT OF COMMUNITY 8t DEVBLOPMENT SERVIC-+ES � S : w 21660 E.Copley Drive Suite 190 (909)860-3195 Fa�c(909)861-311? PRESS '��9N°� BUILDING PERMIT APPLICATION FIRMLY _.. __. DATE ... I 7 NUMBER :, ,. �._:_,,. , __. ... � JOBSITE s G APPLICATIO PEflMIT 1�=�Ca7{,�/ P/C � A�DRESS �� . J/�7 # � ISSUE �TYPE OCC APN LOT TRACT DATE CONST. GROUP � OWNER " ADDRES�j � � ..�G,�.�G�+i •�'=['[�__ ZONING SETBACKS � CITY _J�/,�.t� ��.P 1��TEL RE�RT � G APPLICANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR L" � '� y h' �" SIDE O � CDDRESS ZIP TEL PROPOSED USE ��_L-I�L-l.- �E✓67"� � ARCW N / �� DESIGNEA NO.DWEL. NO. NO. ADDRES5_ UNITS STORIES BEDflOOMS � CITY ZIP TEL. � DESCRIPTION SQ.Ff. FACT6R PSF ADJ.ARE�ilVALUATION � Q OWNER-BUILDER DECLARATION SFR/ADDlREM O � I HEREBV AFFIRM UNDER PENALN OF PERri1RV THAT I AIA EXEMpf FROM THE CONTRACTORS LI- � Garage/Carport W CENSEUWFORTHEFOLLON/INGREASON(SEC.70.31.5BUSMESSANDPROFESSIONS(:ODE:ANVCINOR V GOUNTYWHICHREWIflESAPERMITTOCONSTRUCT,ALTER,IMGROVE,DEMOUSH,OflREPAIRANYSTRUG W patio/Deck W TUpE.PRIOR TO ITS ISSUANCE,ILL50 REOUIRES THE APPLICAN7 FOR SUCH PERMI7 70 FIIE A SIGNED W .� STATEMENT TMAT HE OR SHE IS UCENSED PUfiSUANT TO THE PROYISIONS OF hiE CONTMC70RS U- � CF.tiSE LAW(CH�P7EFi B(COMMENCINO WITH SECTION 7000)OF�IVISION 3 0F THE BUSINESS ANO PR0- � POOUSPB FE6510N3�OE)OR THAT HE OR SHE IS EXEMPT THEREFROM MIO THE BASIS FOR THE ALIEGED E7CEMP- TION.lWYYKKATIONOFSECTIONR131.5BYANYAPPLICANTFORAPERMITSU&IECTS7HEAPPUCANTTO Z Re-Roof � ACINL VENALTY OF NOT MORE THAN FIVE HIINORED OOLLARS(S5o0).): ^ �I,ASONTlEROFTHEPROPERN,ORMVEMPIOYEESWITHWAGE5A5THEIRSOLECOMPENSATION, � CDffllIlB�Ci2I - �� WILL DO THE WORK.M70 TME STRUCTUflE IS NOT INTENDfiD OR OFFERED FOR SALE(SEC.70a4,BU51- J NESS AND?qOFESSIONS CODE�TNE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN�WNER OF � PROPERTYN'FIOBUILD50RIMPROVESTHEREON,ANOWHODOESSUCHWORKNIMSELFORHERSELFOR m � TMRd16HHI50RHEFOWNEMPLOYEES,PROVIpE�THATSUqiIMPROVEMENTSAFENOTIN7ENDEDOR � OfFERmFORSALEIFHOWEVER,7HEBUILDINGORIMPROVEMENTISSOIDWITHINONEYEAROFCOIAPLE- Z TpN,THE OWNER�UILAER WILL HAVE THE BUROEN OF PROYMG TMAT HE OR SHE PID NOT BUILD OR � IMiROVEFORTFIEPURPOSEOFSALE). ❑I,AS�VMER OF THE PROPERTY,AM EXCUISIVELY CONTMCTINO WITH UCENSED COMRACTORS a TO COMSTftUCT THE PRQIECT(SEC.704t,BUSINESS/WD 7ROFESSIONS GODE:THE GONTRAC70R5 U- V2IU8tlOf1 __ _ADJ.AREA W CENSEUWDOESNOTAPPLVTOANONMEROFAPROPERTtlWHOBUILOSORIMPRpVESTHEREON.AND � VM1iOCONTRACTSFOPSUCHPROJECTSWITHACONTMCTOR(3)LICF.NSEDPURSUANTTOTNECONTMG qUANTITY DESCflIPTION FEE � TORS LICENSE LAW.). ❑I AM EXEMPT UNDER SEC._ 8.8 P.C.FOR THIS REASON Q � U li � DATE OWNER�__ U � W � UCENSED CONTRACTORS DECLARATION —� � W � 1 HEREBYAFFIHM UNDER PENALIY OF PERIURYTHAT I AM UCENSED UNDEH PROVISIONS OF CHAPTER � � 9(COIAMENCWOWITHSECTION7000JOFDNISION30FTHEBl1S�NESSANDPROFESSION5C0�E,ANO z dC AIY IICENSE IS IN FULL FORCE AN�EFFECT. m liJ � � LICENSE CLASS_ _LIC.NO._ J V DATE CONTfiACTOR �- W � WORKERS'COMPENSATIpN DECLARATION Q � U � I HEPEBV AFFIRM UNOER PENALTV OF PERJURV ONE OFTHE FGLLOWING D,ECLARATIONS . l� . . Z B _I HAVE AND WILLAIAINTAM ACERTIFICATE OF CONSENTTO SEl.F-1NS�URE FOR WORKERS' �."' 2 "" ' �-* ' ` � �"5'�� ' " �' ``' � COMPENSATION,AS PROVIDED BYSECTION 31000�THE LABOF CODE,FOR THE PERFORMANCE W OF THE K�ORK FOR WHICH THIS pERA9T IS ISSl1ED. � W ' . . . ' . ' . .. . �1 H�YE AND`MLLMAIPITAIN WORNER6'COAdPENSATION INSURANCE,A�REQUIFEO BY SEGTION /' ((,,//�� /'� Q 3IDo OF`ME IAf30R CODE,fOR TH£PEftFORMANCE OF THE WORK FOR VJNICN TH�S PERMIT IS . , /�,.� ) (,J(� n ISSUED.MY WORKERS�COMPENSATION INSUFANCE CARRIER AN�POLICY NUMBER ARE: CONSTRUCTION ' C/ I, '"- � '" '!> PLAN REVIEW .� �� . CAFFIER_,�_ � �Pd.ICV NUAIBER�� r� .� 7 Z" ELECTRIC Q (iH6SELTONNE�NOT;.EOCMPLEfEQOF77-iEPEFiNlTISFORIXdEHUPAREDDOILMS(57oo)ORLESSF PLUMBING �_�� . � I CERTIFY THAT IN THE PCRfORMANC�OF THE WORK FOR WHICH THIS PERA�IT IS ISSUED,I MECHANICAL z ---- �;—ZLr [.�S SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SOpS TO BECOME SUBJECi TO THE � W04iKERS'COM7EN5ATIONUWSOFCALIfORNIA,ANDAOREE7HATIF15HOUL�BECAME INSPECTIONFEE 9��y '"'� �^' S SU&IECTTO7HEN/ORKERSCOMPENSATIONPROVISIONSOFSECTION37o00FTNELABOR ISSUANCE � 9�'b �C$R.!"� a��f .G� fADE,I SHALL FORTHYdITH COMPL�WITH T OS PP.OVIS�ONS. {� �3�a,A � �--- pOATE�'6� '~ APFLICANT: �� SMIP �„",� �—r�� . ;. �� W ENERGYPlC y�� `J'4,�L"��`�°`"-i`�'iid�-� J WRRNING:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL 8E '- LL SUBJEC7ANEMPLOVER70CRIMINALPENALTIESANDCIVILFWESl1P700NEHl1NDRE�TFi0U5AND ENERGYPERMI7 � -�� ""}� � w'�� i�x DOLlARS(ft W.000),IN ADDITION TO THE CO3TOF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 3708 DF THE IA60R CODE,MTEREST.AND ATTORNE`fS FEES. RETENTIQN FEE: � � CONSTRUCTION LENDING AGENCY PqE-ALT FEE: � I NEREBYAFFIRM 11N0ER PFNALTV OF PERJURY THAT THERE IS A CONSTRUCTION IEN�iNG AGENCY FOR iHE PERFORMANCE OF THE WORK FOR WHICH THIS PERM1715ISSUED(SEC.309'/,pV C.). Z W � LEN�ER'S NAME ..__-- . h LENDEFYSAODRESS / f d I CERTIfY7HA71 HAVE READTHISAPPLICAT!ON ANO STATETHATTHE A90Vff INFORMATKKJ IS CARRECT. TOTAL FEES I � �✓ �" w I AGHEE TO COMPLY WITH ALL CIiY AND CWNTY ORDINANCES PN�STATE fAWS REUTING TO BULL�ING � (bNSTRUCTION,AND HEHEBYAUiHORIZE REPRESENTATIVES OFTHIS COUNTYTO ENTERUPONTHE z ABOVEMENTKKJED PROPEf3TY FOR INSPECTION PUPPOSES. COMMENTS J � r�i��-��.�'�,r� � PERMITTEE N PFINTj p �, �"f7 � SIG T OF P � 0 E � RECPT.NO. _PAID BY VAU�Al10N WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROO�—File Copy,GREEN—Applicant's Copy , . � , � _ ��" ��° ��.�� .�� :"�`�''° �� t�'� �„��`-� �, :x�� ,.� �'��a�' :�� y c�. .. .3� � i;.� - .r�+ :" � �� 'i $ '� �� € �."`� m e �� ' �� "' � �.�g - � �r,�. � ;�.., �;: ' � �+a , � ��, � .,� �� r:��°,� '� � ��'� �� " � � � �� ¢ `"" �� ,� p � � .:� am�� - � ,�� .. '� '� �� ._� w , ,� ��;�� °�;�a�.nx� �..ux ��x��'�_ �� ,� "��. � � t p ;t:� � .: ��`�, { . �� .. :: E �-i t„sr Ca,�+ � x, � ..,..__�_..�.�_.._.....�....._ �. i.. i ._ � i_ . __ . ,.....�_..m.�.. ._.__ ..�...,._�_t ..., ,. �...u.... - . . �... 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