The URL can be used to link to this page

Home My WebLink About18911 1�a�t�� <=�i?li�L��.�� .�E�-"i 5 j�'�"c �' �"�C'�'''`'�� CITY OF DIAMe�ND 8AR �� j � DF.I',ARTMTcN'I'OF COIvIlv1UNITY d'c DEVELOPIv�NT SERVICES � ,� ,� 21825 E.Copley Drive � .�� 9o9�sbo-3i9sF��9o9�s6i-3i» PRESS �o��" BUILD�ING PERMIT APPLICATION FIRMLY o DDRIESS�� /^� �' `/"1 �� DATE CATION � '' '- - l pU B R�_ #/C��- `�i J � �}_, � ISSUE � TYPE OCC APN L.OT_ TRACT DATE_ CONST. GROUP p OWNER _��r� ADDRE55 C U�n E� ZONING SETBACKS z CITY � ZIP TEL. �II' �� FRONT RW ❑ p APPLICANT �y. TEL. �G C i� � S D SIDE STREET RW ❑ z aCONTRACTOR� ) � _ SIDE ❑ � ADDRESS��/.� V r�� CITY _ ^./�n,�� ZIP�( .�h TEL `']� PROPOSED USE �' J J " L� w ARCHlENG/ Q�� .s z DESIGNER 1TU'�I 1�h �i�' � /�� d ADDRE S L�� - ' NO.DWEL. NO. NO. � CITY�j j�_ ZIP�"/TEL7�J UNITS STORIES BEDROOMS cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8f8JQ/CBfpOh W CENSEUWFORTHEFOLLOWINGREASONjSEC.]031.5BUSWESSANDPFOFESSIONSCODE:ANYCITVOfi (n U COUNTVWHIGMREOUIRESAPERMITTOCANSTRUCT,AITER.IMPROVE,DEMOLISH,ORREPAIRANYSTRUG w TURE,PRIOR TO ITS ISSUANCE,/1L50 HE�UIRES THE APPLICANT FOR SUCH PERMIT'O FllE A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUA47 TO THE PROVISIONS OF THE CONTRACTORS ll- � � CENSE LAW ICHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION a OFTHE BUSINESS AND PFO- POOVSpB FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREGPOMAh'DTHEBASISFORTHEALLEGE7EXEMP- (�J � TION.ANYVIOLATIONOFSE:CTION7031.5BVANYAPPLICANTFORAPERMITSU6JECTSTHEAPPLICANTTO Z Re-Roof A dVIL PENAL7V�F NOT MORE THAN FNE HUNDRED DOLLARS�f5ao;.�: ❑I,AS OWNEP OF THE PROPERTV OR MY EMPLOVEES WITH WAGES AS THEIR SOIE COMPENSATION, O � Gommercial Z WILL DO THE WORK,AND 1HE STRUCTURE IS NOT INTENDED Ofl OFFERED FOR SALL(SEC.7041,6U51- J � NE55 AND PROFESSIONS C:ODE:THE CONTRhCTORS LICENSE UW DOES NOTAPP�Y TO AN OWNER OF ? PROVERTY WHO BUILDS OFI IMPROVES THEREON,AND WHO DOES SUGH WOFK HIMSELF OR MERSELF OF Q THROUGHHISORHEFOWMEMPI.OYEES,PFiOV10E0THAT5UGHIMPqOVEMEN'SARENOTINTENOEDOR m � OFFEREDWFSA�EIF,HONIEVER,lHEBUILDINGORIMPROVEMENTI550LDWITHINONEYEAROFCOMPLE- Z TION,THe OWNEfl-BUILOER WILL HAVE THE BURD�N OF PROVING 1}iAT HE OR SHE OID NOT BUILD OR � IMPFOVEFORTHEPURPOSEOFSALE). fl I,AS OWNER OF THI=PROPER7V.AM FXCW SIVELV CONTRACTING WITH�ICENSE�CONTRACTORS � TO CANSTRUCT THE PRQIL"CT(SEC.]�9a,BUSINESS AND PROFESSIONS CO�E:THE CONTRACTORS U- V8IU8SIOf1 � �' AOJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTYWNOBUILDSORIMPROVESTHEREON,AND = WHOCONTRACTSFORSUCHPRQIECTSWITHACANTRACTOR(5)LICENSEDPURSUANT'OTHECONTRAC- QUANTITY DESCRIPTION FEE ~ TORSLICENSELAW.). � J �/ \ � LJ I AM E%EMPT UNDER SEC. B.9 P.G FOR THIS REFSON Q � U � � DATE OWNER U Z W � LICENSED CONTRACTORS DECLAAATION W < � I HEREBY AFfIRM VNDER PENALTV OF PERJURV TFAT IAM LICENSED VNDER PROVISIONS OF CHAPTER r � 9(COMMENCING WITH SECTION]000)OF DIVISIUN 3 OF THE BUSINESSANO PROFESSIONS COOE,AND Z �i9 !`.' w MY LIGENSE IS IN FVLL FOf{GE AND EFFEGT � m 0 LICENSE CLASS�� LIC.NO. � �, j U DATE �� i�I1 Z. GONTRACTOR d W � WORKERS'COMPENSATION DECLARATION Q J� , � � L f `\ dt J � I HEREBY AFFIRM UNDER PENALTV OF PERJURV ONE OFTHE FOLLOWMG DECLARATIONS: Z � 0 IHAVEANDWIL�M4INTAINACERTIFICATEOFCONSENTTOSELF�INSIIqEFORWORKERS' a _ COMPENSATION,AbPROVIDEDBVSECTION3�D00FTHELA60RCO0E,FORTHEPERFORMANCE U a OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � � I HAVE AND WILL M4INTAIN WORKERS'COMPENSATION INSIJFANCE,AS REOUIRED BV SECTION r, , h Q 3]OOOF THE LABOR CO�E,FOR THE PEFFORMqNC.E OF 7HE WDRN FOR WHICH THIS PEFMIT IS �� 1 � ISSUED.MV WORK-RS' OMP NSATION INSURANCE RRIER AND POIICV NUMBER ARE: CONSTRUCTION � -�- a, ' �'� j cnaaieR�>��11�Q �l/✓�� PLAN REVIEW L -} �1�-� Z Poucv uuMsea_ IT��,��_ n� ELECTRIC � ¢ ' � (�HISSECTIONNEmNOT6EWMPLETmOFTHEPERMfTISFORONEHUFAREDDOLLARS(5100jORLESS). PLUMBING . t�' W �Z I CERTIFY THAT IN fHE PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL �� C} SHALLNOTEMPLOYANVPERSON'N.iNVMANNEFiSOASTOBECOMESUBJECTTOTHE � WORKEqS'COMPENSATION LAWS OF CALIFOftNIA,AND AGREE THAT IF I SHOUL�BECOME INSPECTION FEE SUBJEGT TO TME YlORKERS'COMPENSATION PROVISIONS OF SECTION 3100 OF THE UBOR � CODE,I SHALL FOFlTHWITH COMPLY WIiH T PROVIS N5. ISSUANCE �� • O J�r- p DATE:,�__1(_(��. APPLICANT. SMIP ��_�� V J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION C EflAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SUBJECT AN EMPLOYER TO GRIMINAL PENALTIES ANO CIVIL FlNES UP TOONE MUNDRED THOUSAND ENERGV PERMIT �OLLAFiS�5100,000),IN ADDITION TO THE C0.SI OF CtJMPtNSATION,DAMAGES AS PflOVI�ED FOfl IN J SECTION 37oe OF THE LABOR COOE,INTEREST,AND ATTORNEY'S FEES. FlETENTION FEE: 4/-�. �„� Q � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � �� HEREBV AFFIRM UNDER F'ENALTV OF PERJURV TMFT THERE IS ACONS7flUCT'.ON:ENDING AGENCY .� �- FOR THE PERFORMANCE OFTHE WOPK FOP WHICH THIS PERMIT IS i55UED(S=G.J09�,qV C.). �/� ; Z �� W � � j LENDER'SNAME_ � � F- LENDER'SADDRESS I'� � IGERTIFVTHAiIFAVERENOTHISFPPLIGATIONANDSTFTETHATTHEABOYEI�FORMATIONISCORRECT. TOTALFEES • ,�`•�� ,`;' .+.! I � � I AGREE TO COMPLY WIiH FLL GITY AND COUNTY ORDINANGES AND STATE LAWS FELATING TO BUILDING J � CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTATIVES�FIHISGOUN7Y10tNIEHUPONIHE ��._�`— z ABOV NTIONED PROPLRTV FOR INSPECTION PURPOSES Q � COMMENTS J ` � I�/e ��.— _ --- ¢ PE I NAM N � n ��j— .Zh=t��L Uj IGNATU E I 1= ' DAT J = RECPT.NO. PAID BV VALIDATION ~ WHITE-0epartment Copy,YEILOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�FIe Copy,GREEN—ApplicanCs Copy ,� �� li��"' � � j >' � �;� iS �` I i� �; � h. �/ �,t�.w� . . . . . . �'{� . d < "�....�,..�� .1�%�� .�l��a� ��,,� 3/��/�o R.��, �� 3 .�� i�� 9 _ � �� ti. _ �,��-o.� N�r��' �x�c� �� _ y �� . i t r3 . s _ _ _ ,�.K,� a� �,�� p :n, .;w��., = �� t � �a r � ��, e, ; r, „ � _ CITY OF DIAMf�ND 8AR VI ES iENT SER C 0 ADDRIESS� �/^ ��'�/'1 � APN L.OT TRACT OWNER �� ADDRESS_.��n @_ CITY ZIP - TEL.�F:� APPLICANT i�. (rn !: 7 1�;).�/r-TEL S g C i :] )_T CONTRACTOR�J a� ADDRESS��',,,r��r�� CITY^./�n,mo't'ZIPS(f��I TEL GJ S I ZI ARCH/ENG/�i DESIGNER v'0/ 1� h�f�' �' h �� ADDRE�S Y^'°6�J� CITY�°k-�-�j�-ZIP"ITEL7/ OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSELAW FOR THE FOLLOWING REASON(SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT,ALTER. IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 15500).): ^ I,AS OWN ER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OFI IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOYIEVER,THE BUILDING OR IMPROVEMENT IS SOLD W(THIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPO:tE OF SALE). ^ I,AS OWNER OF THE= PROPERTY,AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WMO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^ I AM EXEMPT UNDER SEC. B. 6 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISIUN 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FOFICE AND EFFECT LICENSE CLASS�� LIC. N0. � �� DATE�� i � �L CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL M�4INTAIN A CERTIFICATE OF CONSENT TO SELF-INSUgE FOR WORKERS' COMPENSATION,A:5 PROVIDED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ATION INSURANCE CARRIER AND POLICY NUMBER ARE: ISSUED. MV WORK;RS',pOM �NS f n CARRIER� N C� � �jl POLICY NUMBER � �R�-T� .A7 (tHIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNARED DOLUIRS(5100)OR LESS). I CERTIFY THAT IN'fHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE YIORKERS'COMPENSATION PROVISIONS OF SECTION 37000E THE LABOR FOFITHWITH COMPLY WITH T PROVIS NS. CODE,ISHAL L r DATE:_�_�(�Q�,APPLICANT. WARNING: FAILURE TO SECURE WORKERS'COMPENSATION C ERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER F'ENALN OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE CIF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOV NT ZONED PROPERTY FOR IN SP ECT ION PURPOSES. / / � O U�Q vl c.�/t's' PE I NAM N �/ �� IGNATU E I I. DAT vi 0 oW 0 0 w z 0 z m 0 IS 0 w U Z W U 0 Z Z 0 Q a X W U w Z Q W Q Z Q w Z C7 H 0 D W J LL J W d 0 IS d Z W 1 C3 Z 0 m Q UJ f PIv c DEVEL DF.I,ARTMIcN T OF COIvIIvIUNITY d 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY APPLICATION PPERMIT P/C r" DATE � �°NUMBER� # �� ISSUE TYPE OCC DATE_ CONST GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE .1 J L, N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM � Garage/Carport W Patio/Deck � PooVSpa Z Re-Roof � Commercial m Valuation �'ADJ.AREA QUANTITY DESCRIPTIO FEE N Q Q T- U H U W W a � . Z m d v JV,_�'� Lr' IJ Z Q U W rl .. Y CONSTRUCTION --�. a, PLAN REVIEW �-�� 1-� ELECTRIC � PLUMBING �- MECHANICAL L INSPECTION FEE ISSUANCE r�, �• SHIP iT� ENERGY P!C ENERGY PERMIT RETENTION FEE: 4�„ � �„� PRE-ALT FEE: ?�! ./ .� TOTAL FEES 'a C��°��, ;7� �. J COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy -441-A l..zy-03 Nvr i Gojc��Goa/I-.-04�