HomeMy WebLinkAbout11162 (5) --1��-- CITY OF DIAMOND RAR
COMMUNITY DEVELOPMENT DEPARTMENT
21660 E.Copley L)rive Suite 190
�� (909)860-3195 Fax(909)861-3117 PRESS
�'""° BUILDING PERMIT APPLICATION FIRMLY
��` JOBSITE ;+ -�y �� t,,� APPLICATION � .Z�,.""� NUMBER Y� P/C
` ADDRESS L••� /.� �!"761GiC� ' DATE
4� ISSUE TYPE OCC
� APN�_�LnO�T.��nn,s ClUb H.O.A, DATE CONST. GROUP
p OWNER
o ADDRESS C/O Cu[�rellensive Prop. Mgt./P,O. Box 400 ZONING SETBACKS
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m CONTRACTOR Teattt I,i h�' �nC. SIDE ❑_
¢ ADDRESS 151�8 �Si�a &m�ita Tanr�
p — PROPOSED USE
o, CITY C11i_r10 ZIP 91710 TEL. (909) SA7-773
w ARCH/ENG/ —
w DESIGNER�.1/a NO.DWEL. NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNEH-BI;ILDEFi�ECLARATION SFR/ADD/REM
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p I HEREBY AFFIRM UNDEF PENALTV OF PFRJURV THAT I AM E%EMGT FROM THE CONTRqCTORS LI- � GaregelCarport
W CENSEIAWfOH7HEFOLLOWINGfiEASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCITYOR
U COl1NTYWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER.IMPFlOVE.�EMOLISM,ORflEPAIRANYSTRUC� W Patio/Deck
w TuqE,PRIOR TO ITS ISSl1ANC[.A150 qE�UIR[S THE APPLICANT fOq SUCH PEHMIT TO FILE A SIGNED w
� STATEMENT 74{pY HE OR SHE IS UCEN6E0 PURSUANT TO THE PROVISIONS OF THE CONTRACTOflS LI- �
� CENSE LAW(CHAPTEfi 9(COMMENCING WITH SECTION�Oou�OF OIVISION 30F TH[BUSINESS AND PRO� POOUSPB
Q FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEIAP- �
V TION.ANVVIOLATIONOFSECTION7031.SBYANYAPPLICANTFORAPENMITSUBJF:CTSTHF:APPLICANTTO Z Re-Roof
� A CIVIL PENALN OF NOT MORE TMAN FIVE HUNDREO�OLlARS(5500).7:
0 OI.ASOWNEi70FTHEPROPERTV.ORMYEMPLOYEESWITHWAGESA57HF.IFiSOI.ECAMPENSATION, 0 COmrTi6fGial
z WILL DO THE WOFK,AND THE STRUCTUR[IS NOT INTENDED OR OFfERE.D FOR SALE(5'eC.7044,8U51- J
� N[55 AND PROFLSSIONS CODE:TNE GONTRAC70fl5 LICENSE LAW DOES NOT APPLY TO AN OWNER OF �
PROPERTY WHO BUILDS Ofl IMPROVES THEREON.AND WHO DOES SUCH WOFiK HIMSELF OR HEFSELF OR
� THROUGHHISORHEROWNEMPIOVEF.S,PROVIDEDTHATSUCNIMPROVERIENTSARENOTINTENDEDOR m
Q OFFEREDFORSPLE,IF,HOWEYER7MEBUILDINGORIMPROVEMENTISSOLOWITNINONEYEAROFCOMPLE-
Z TION,THE OWNER�BUIIDER WILL HAVE THE BUPDEN OF PROVING 7HA7 HE OR SHE UID NOT BUILD Ofi
� IAIPHOVEFOHTNF:PUqPOSEOFSAIE).
W LI,ASOWNEROFTHEPflOPERTV,AMEXCLU5IVELYCONTRACTIIiGWITHLICENSEDCANTflACTORS
[r TO CANSTflUCT 7HE PR0.IECT(SEC.1091,BUSINESS AND PROFESSIONS CADE:THE CONTFACTORS LI� V8IU8�lOn ADJ.AREA
W CENSELAW�OESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND '-----�--'-- --
� WHOCONTMCTSiORSUCHPROJECTSWITHACANTRACTOR(S)LICENSE�PURSUANTTOTHECANTRAC- QUANTITY DESCFIPTIDN FEE
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� LICENSED CONTRACTORS DECLARATION W
� 1 HEREBY AFFIRM UNOER PENALTY OF PERJURY THAT IAM LIC[NSEO 11NDER PROVISIONS OF CHAPTER � .
� 9(COMMENCING WITH SECTION 70(q)OF DIVISqN 3 0F THE BUSINE55AND PROFE5510N5 CODE,M10 Z
MY UCENSE IS IN FULL FOflCE AND EFFECT.
� LICENSECLASS C10 ----- ��c.No.---729594 --- - . � �
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DATE___ CONTRACTOR / d
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� WOAKERS'COMPENSATION DECLARATION a
� IMFR[BV AFFIRM UNUER PENALTY OF FERJUfiV ONEOFTHE FOLLOWING DECLARAT�ONS: Z
� ,____I MAVE AND WILL M�INTAIN A CEHTIFICATE OF CANSENT TO SELF�INSUflE FOR NbRNER3' _
CAMPENSATION.AS PiiOVIDED BY SECTION 37000F THE LA90p CODE,FOfi THE PERFORMANCE U
� OF THE WOflN FOR WHICH Tt115 PEflMIT IS ISSUEU. �
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W _I HAVE AND WILL MAINTAIN WOnKERS'COMPENSATION INSURANCE.AS REQUIRED BV SECTION
Q 31000FTHELABORCODE,FORTMEPERFORM/WGEOFTHEWORKFORWHICHTHI5PEftMIT15
ISSUED.MV WORNERS'CAMGENSATION INSURANCE CAPRIER AND POLICV NUAIBERARE: rA CONSTRUCTION __.__.
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CARRIER__—___. y '___"_—".__ � __—___._ —�
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� POLICY NUMBER ___'...—..." 1
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� (fHISSECTqNNEmNOTOENMPL[TEDOFT1iEPEMMISibRONEFRNJCFiED00UARS(S1W)O61L[SSJ. PLUMBING _ ____
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Z I CER71Fv THAT IN THE PERFOHMANCE OF THE WOFlK FOR WHICH 7HIS PERMIT IS ISSUE�.I MECHANICAL : � _
� SHALL NDT EMPLOV ANY PERSON IN ANV MANNLR 5 TO BECOME SU�JECT TO TI1E ' Fi 1
� WORKEflS'COMPENSATIONLAWSOFCALIFOHNI G ETHATIFI HOULOBECOME INSPECTIONFEE ___,...�..�__ .— s ____
SUBJECT TO iHE WOR FS'COMPENSATION P ONS F SECTIO 7000F TfiE IABOR L
� CADE,I SHALL FORTk M COMPLY WITI 'PROVI s. ISSUANCE ,_____._ ___ �� �
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�ATE: APPLICANT:
w -0.� -�—I�:a�r— --
J WARNING:FAILURE TO SECURE WORNERS'COMPENSATIO VERAGE IS UNUWFl1L,AND SHRLL BE ENERGY P/C _._ _____„__..
� SU&IECTANEMPIAYERTOCRIMINALVENALTIESANDCIVI MESUPTOONEHUNDREDTHOl1SAND ENERGYPERMIT
WLLARS(f100,000),IN AODITION TO THF COST OF COMPENSATION,DAMAGES AS PROVIOEO FOR IN —�--------�---
J SECTION37080FTHELABOFCADE,INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE:
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a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� 1 HEREBV AFFIRM 11NDER PENALTY OF PERJURY 7HAT TMEHE IS A CONSTRUCTION LENDING AGENCY ___ ________
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEU�SEC.3087,CIV.C.�.
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W _.__.____.___ _ ___—.__—
� LENDER'S NAME __...____.._..
f— LENDEF'SADDRESS ______
� I CERTIFY THAT I HAVE REA�THISAPPLICATION AND STATE TMAT TMEABOVE INFORMATION IS CORRECT. TOTAL FE ES t
W IAGPEETOCAMPLVWITilALLCITYAN�CAUN7VDRDINANf.ESANDSTATELAWSRELATINGTOBl11LDING — �
� CONSTflUCTION,ANOHEREBYAUTHOfi1ZEflEPRESENTATIVE50F7HI5COUNTYTOENTERUPOYTHE '
ZABOVE�MENTIONEO PROPEflTY FOR INSPECTION PURPOSES.
o COMMENTS
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