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Home My WebLink About15183 (17) ,�� CITY OF DIAMOND BAht �.._'/ � " DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 � w (9�9)860-3145 Fax(909)861-3117 PRESS '�"�� BUILDING PERMTI'APPLICATION FIRML� � . _., . ... � JOBSITE �� /�� n��. � �� APPLICATION PERMIT � P/C o ADDRESS f� DATE NUMBER # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER G�✓��L"�� f-�c.�i�/ p ADDRESS-S� ZONING FRO TCKS RW ❑ � CITY Qi7�ll:� ZIP4r�`*S TEl.B�I��`".s'1 REAR APPLICANT TEL � .�a SIDE/SIDE STREET RW ❑ � CONTRACTOR �%�K-Cz�T3 '��C�.T SIDE ❑ � ADDRE$S Df3�i1�/ � CITY �•�� ZIP��- TEL.'S�'j°-��L.J PROPOSED USE o ARCHlENG/ z� DESIGNER NO.DWEL. NO. NO. a ADORESS � CITY ZIP TEI. UNITS STORIES BEDROOMS � v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNEft-BUILDER DECLARATION SFR/ADDiREM O I HEREBY AFFlRM UNOER PENALTY OF PERNRV THAT I AM EXEMPT FpOM THE CANTRACTORS LI- G8f8J0/CdlpOf� W CENSELAWFORTHEFOLLOWINOREASON(SEC.70.31.6BUSWESSANDAROFESSIONSCODE:ANYCI7YOR (n ZCOUN7YVNiICNHC4UIRE5APEqMITTOCON3TFUC7,A�TER,IMPROVE,DEMOLISH,OqREPAIqANVSTRUG W PytiO/DBCk �l� TURE,PRIOR TO ITS ISSUANCE,ALSO REDUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A S�GNED W � STATEMENT Tl1AT HE OR SHE IS LICENSE�PURSUAN7 TO THE PROYISIONS OF 7HE CONTRACTORS LI- CENSE LAW(CNAVTER e(COMMENCINO WI7H SECTION 7W0)OF DIVISION 30F THE BUSINESS AN�PRO- LL' POOVSpB FESSIONS�E)ORTHATHEORSHEISE%EMPTTHEREFBOMANDTHEBASISFORTHEALLEOEOEXEMP- (� 710N.ANYVIOUTIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITStI&IECTSTHEAPPLICANTTO Z Re-Roof � ACML PENALT'OF NOT MORE THAN FIVE HUNOf7ED DOLIARS(f500).)� � ❑I,ASO4MEROFTHEPROPERTY,ORMVEI./P�OYEESWITHWAGESASTHEIRSOIECOMPENSAiION, � C017'1I11BfC18I .. ' WILL DO THE WOPoC,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE�SEC.7aa,BUSI- J � NESS AND PROFESSIONS�DE:TiE CONTRACTORS LICENSE UW DOES NOi APPLY TO AN OWNER OF j . , PROPERTY WFIO BUILDS GR IMPROVES THEflEDN,ANO WHO DOES SVCH WORK HIMSELF OP HERSEIP OR � TliR0U6HHI50RHEROWNEMPLOYEES,PROVIDEOTHATSUCHIMPPOVEMENTSARENOTINTENDEDOR � Q OFFEREDPDRSALEIF,FIOWEVER,THEBUIIDINGOHIMPROVEMENTI550LOWITHINIXJEYEAROFCOMPLE- Z 710N,THE OWNER�9UIL�ER WILL HAVE THE BURDEN OF PROYING THAT HE OR SHE DID NOT BUILD OR = IMPROVEFORTHEPUHPOSEOFSALE�. W ❑I.ASOWNEROFTHEPROPERTI:0.MEXCWSIVELYCAN7RACTINCWITHLICENSEDCONTRAC'ORS � TO CONSTRUCT h1E PRQIECT(SEC 7oa1,B1151NESS AND 7ROFESSIONS CO�E�THE CONTR0.CTOHS LI- V81UBfiD11 ADJ.AREA W CENSEUWDOESNOTMVLVTOANONMEROFAPROPERTYWHOBUILDSORIMPROVE57NEREON,AND � W/iOCOMRACTSFORSUCHPR0.1EC7SWITHAODNTAACTOR(S)LICENSEDPURSUAN7TOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORSUCENSELAW.). � ❑I AM EXEMPT UNDER SEC. B.d P,C.FOH THIS REASON J Q Q � U � � � DA7E _ OWNER U � � � LICENSED CONTRACTORS DECLARATION W � IHEREBVAFFIIWUNDERPENALTYOFPEHJUAYTHATIAMLICENSEDUNDERPROVISIONSOFCHAPTER �.y ' d 9(COMMENCINCI WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,ANO Z _ L.�,T - ?C MY UCENSE�S M NLL F09CE AND EFFEC7. p � IICENSE Gt/A�55 �� _ LIC.NO. �" J ��`� � ~ DATE b"Z� �� J V CONTHACTOR a. W � WORKERS'GOMPENSATION DECLARATION ¢ _ �,. � 1 HEREBY AFFIRM UNDEH PF.NALTY OF PERJUFiV ONE OF THE FOLLOWMG D�CLARATIONS: Z � _iFLWEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-MSl1REFORWORNERS' _ COMPENSATION,AS PPOVIDE�BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE `U O OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO. � � _IHAYEANDWIIIMAINTAINWORKERS'COMPENSATIONINSUFiANCE,ASFEOt11REDBYSECTION � O370oOF7HEl.ABORCODE,FORTHEPERWRMANCEOFTHEWORKFOFWHICHTHISPERMiiIS � ISSUEO.MY WORKERS'CqMPENSATqN INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION j cnapiea � ��/�� PLAN REVIEW 0 Pq.ICYNUMBEP C.�i �C�L�'r�O� ELECTRIC Q 0 (fHiSSECi1.'7NNE�NOTBECOf.1PLEfEDOFhiEPEPoNTISFORONEIiUt�pREDDOLLAFi�i(§100)ORLESSj. PLUMBING �- � - �� "� �_..s:._, Z I CERTIFV THAT 6J THE PERFORMANCE OF THE kYORK FOfl WHICH THIS PERMIT IS ISSUED,I MECHANICAL ____ (!S 5HAlLNOT EMPLOYANV PERSON IN ANY MANNER SOAS TO 6ECAME SUBJECT TO THE � y NbRNERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOIILDeECOME INSPECTIONFEE � SU&IECT TO THE WORNERS'COAAPENSATIO S OF SECTION 3'100 OF THE L480R ^ � fADE,ISHALLFORTHWITHCOMPLY HOSEPROVISI ISSUANCE RAA/� ��/,� � 71lliil-- p OATE: ��'�', APPUCANT _.'�"-"-'—��-"� SMIP —_�� (.,. L.Y4v WWARNING:FAtt11RE TO SECURE WORKEflS'COMPEhSATION COVEFAGE IS IJNLAWFl1L,AN��D SHALI BE ENERGY P!C r.:..,�>v�r raS A ��CSI`�C �—y SUBJECTANEMPLAYERTUCRIMINALPENALTIESANOqVILFINESUPTOONEHUNDRE�THOUSANO `+'��r-�r� ��TRJ DOLLARS�S1ao.o0o),IN ADDITIDN TO THE COST OF COMPENSATION,DAMAGES AS PNOVIDEO FOR IN ENEflGY PEflMIT � ♦ T41 C' 1 i � SECTION37aBOFT1El.ABOHCODE,INTEREST,ANDATTORNEI^SFEES. RETENTIONFEE: ��11V�q�L-a OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I NEPEBYAFFIRAI UNOEF PENALTV OF PERJtJRY THATTHERE IS ACONSTRUCTION LEN�ING AGENCY FOR THE PER�OFMANCE OF TNE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3D9/,CIV.C.). , Z W � LENDER'S NAME F- LENDER'SMORESS_ � I CERTIFV iHAT I HAYE READ 7HISAPPLICATION AND STATE THAT 7HEABOVE MFORMATION IS CORRECT TOTAL FE ES w IAGREETOC6MPLVWITHALICITYANDCAUNTVOR0INANCESAN�STATElAWSflELATINGi08UIlDING �/'L�' � � CANSTPUCTIDN,AND HEREBY AUTHOR2E REPRESENTATIVES OFTIIIS COUNTV TO ENTER UPON THE ABOVE-MENTION��P INS��iSE�� r COMMENTS � � z � � m PERAlI1TEE NAM� ^^-.,_`� \ �'y � �... 1 "1 ��°��{d � SIGNATUREOFPERMITTEE DAT� = RECPT.NO. PAID 6Y VALIDATION ~ WHITE—Depanment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--FIIe Copy,GREEN—Applicant's opy �,��a� ��" ��s��zaa�a,�� :� , � �� m � ,� .� �: 'v�"..,a w ,.' 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