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HomeMy WebLinkAbout12391 ^ �� CITYOFDIAMONDBAI� �X�IR�[� DEPARTMBNT OF GOMMUNITY&DEVELOPMENT SERVICES _ __�, a i66o E.copiey v,��e s�c�i90 0 C T 10 2000 (909)860-3195 Fax(909)861-3117 PRESS � �*�'� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE .�ry ' APPLICATION,,,� � PERMIT P/C � ADDRESS �` �� �<C �a4f� f��il`C_.�� DATE��NUMBER� # om ISSUE /�p TYPE OCC APN LOT TRACT DATE I b " 7" '1 b CONST. GROUP p OWNER �A'v�T—P���6`�.�C'k°�� �'`� ADDRESS A�` �.. P� "� ' i+�`i-1�. ZONING SETBACKS �W CITY �9✓s.+,...,x_�. �'��'��ZIP TEL.a'S � REART RW ❑ APPLICANT TEL. SIDElS�DE STREET RW ❑ � CONTRACTOR �• ras� �etr-+ SIDE ❑ Q ADDRESS�� .. "" 3 : � i `=�.=" PROPOSED USE �I f:� "'"' ��'a.-'��,'v � 1d � � CITY���"�,�»a ZIP TEL.�i�� 1�"�_� ���..:.� ..---�-'-°—"„'': ,��� �•�a r�-n � 0 ARCWENG/ G�a' i '�T'�—'�c.�`ffi' z� DESIGNER NO.DWEL. NO. N0. 4 ADDRESS UNITS STORIES BEDflOOMS � CITy ZIP TEL. f N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � p� OWNER-BUILDER DECLARATION SFR/ADD/REM O Q 1 HEREBY AFFIRM UNDEH PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTPACTORS ll- GeBJB/C8�0(I W CENSEUWFORTHEFOLLOWINf3REA50N(SEC.7031.5811SWESSANDPROFE55lONSCO�E:M1YCffYOR (n . C� -COUNCYNMt(x1RC-0UIRESAPEAMITTOCONSTRUCT,ALTER,IMPROVE.DEMOLI$H2ORqEPA�RANYSTfiUC- W PatiO/DBCK W TUqE,PRIOR TO ITS ISSUANCE,AL50 REqUiRES TNE APPLICANT FOH SUCH PERMIT TO FILE A SIGNED W .�- STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF TNE CON7PAC70RS LI- � CENSE LAW(CHAPTER B(COMMENCiN6 WITH SECTION 7000)OF pNIS10N 30PTHE BUSINESSAND PR0. u- PooVSpe FESSIONSCODE�OR7#iAtHEORSHEISEXEMPTTHEREFHOMMIDTHEBASISPofiTNEALLEGEDEXEMP- � V TION.qNYYIOLATIONOFSECTION7031SBYANVAPPLICANTFORAPERMITSU&/ECTSTMEAPPUCANTTO.� .Z Re-Raaf r ACMLPENALiVOFNOTMORETHANFNENUNDRE�DOLLARS(E600�.} '' O ❑I.ASOWNEROFiHEPROPERT/,ORMYEMPLOYEESWIiHWqGESASTMEIRSOLECAMPENSATION: 0 �mmercial . 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'TqN,THE OWNEH�9UILOEH WILLHAYE iHE BUflDEN OF PROVING THA7 HE OR SNE OID f�T BUILD OR IMPROVE FOfl THE PURPOSE OF SALEy. � ❑I,ASOWNEROFTHEPHOPEf1rY.AMEXCLU51VEL7CONTRf�CTINGWITHLICENSE�CANTRACTORS - � � -� TO CONSTPUCT THE PHQIECT(SEC.7o44,BUSWESS ANO PROFESSIONS OODE:THE COMPAC70RS U- VdlUdliOn ADJ.AREA - W CENSEIAWDDE3NOTAPPLYTOANOWNEflOFAPHOPERTYWHOBUILO50RIMPROVESTHEREON,AND . h YhIOCONTMCTSFORSUCHPROJECTSWITFtACONTFiACTOR(S)LICENSEDPURSUANTTOTHECOMRAC- �UANTITY DESCRIPTION FEE- � TORSl10EN5ELAWJ. . .. . . . . , . _ ^ ❑I AA1 F�CEMPT UN�ER SEC. 8.&P.C.FOR THIS HEASON Q C S v LL ¢ OATE OYs'NER U W o¢ LICENSED CONTRACTORS DECLARAT�ON �j '�L� I HEREBYAFFIPM UNOER PENALN�F PERJUHY THAT IAM UCENSEO UNDER PROVISIONS OF CHAPTEfl � � �,�-. e(COMMENCINQWITHSECTION7oo0)OFDIVISIONSOfTHEBUSMESSANDPROFESSIDNSCODE,AND Z W i10EtdSE iS IN FULL FOflCE AND EFfECT. r�ej� �y m. • . . . .�.o�� LICENSECLASS ^"'� LZ..� LIC.NO.��.��4Gy��.-�lr� �� ��j - � J �:V� DATE � �e� ' CONTRACTOR- . ... . . - . n- . W. ;� WOflKERS'COMPENSATION DECLARA710N Q �� I HEflEBY AFFIRM�NOEP PEtJAtTY OF PERJURY ONE OF THE F-0LIOWING DECIARAT10N5: � U � Q _CS _IHAVEANDWILLMAINTAiNACEflT�FICATEOFCONSEN770SELF-INSUREFORWORKERS' T Z COIUPENSATIDU,AS PN�VIDEO BY SECTION 97a00F TME tA80R CODE,FORTHE AEHFORMANCE U Q OFTHE WORK FOR WMICH THIS PERMIY�S ISSUED. � Q — -W �I HAYE AND WIILMAINTAIN WOPKERS'CON.PENSATION INSURANCE,AS PEQUIRED BY SECTION - ,,,///�hh��y - .Q 37000F7HELA60RCODE,FORTFiEPERfOflMANCEOFTHEWOPKFORWHICHTHISPERMITIS ��+ �� ISSUE�.MY WOpKERS'COMPENSATION INSURANCE CARflIERAN�POLICY NUMBER ARE: CONSTRUCTI C� r ��� cnaaiEa -�`(,��^'"_ �u�a.-...er � PLAN REVIEW - '.� MxIGYNUMeER d_�2 7��,T�9 ELECTRIC ¢ ��:0 (fHIBSECiIONNE�N0T8EWMPLETIDOFiHEaER�Nt'ISt7�RONEMX�Ofim00LtARSlS10%oRtESS� PLLIMBING w ICERTIFVTMATNJTHEPERFOHMANCEOFTNEWOflKFOflWHICHTHISPERMITISISSUED,1 MECHANICAL Z � -,(!f- SHALLNOTEMPLOVANVPERSONINANYMANNERSOASTOBECOMESU&IECTTOTME- ' - - __ . . . . . . -,'(n� WORICERS'COMPENSATIONLAWSOFCALIFOfiN1A,AN0AGflGETHATIfISHOULOBECOME INSPECTIO EE - ,v7 �^ � SUBJECTTOTHEWOHKEFiS'COMPENSATIONPROVISIONSOFSECTION37000fTHELAeOR AN v�-.J��� �. CODE,ISH0.LLFORTHWITHCOMPLYWITHTHOSEPROVISIONS. f 0 l�+C? p�. OATE:�#��� APPLICAN� �• ����e�� . MIP r � GY P/C �, WARNIN6:FAILURETO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL.AND SHALLBE ;W_�. SU&IECTANEMPIOYERTOCRIMINALPENALTIESANDCIVILfINESUPTOONEHUNDREDTHOUSAN� ENERGYPEFMIT OOLIAFiS(5100.000),IN A�DI110NTOTHE COSTOFCAMPENSATION,DAMAGESAS PROVIDEO FOR IN ,_a'_ SECTION37080F'fHELA00RCWE,INTEREST,AND0.TTORNEYSFEES. RETENTIONFEE: ��� CONSTflUCTiON LENDING AGENCY PRE-ALT FEE: � O' ..0. I HEREBYAFfIFM UNDER PENAL7Y OF PEFiJURY THATTHERE IS A CONSTRUCTION LENDING AGENCY f-0RTHE PERFOPMANCE OF THE WOflK F�R WHICH THIS PEflMIT IS ISSUED�SEC.3097,GIY.C.�. Z W- ���� LENDER'SNAME � ' 'F-- LENDEH'SADDHESS --�. ICEflTIFYTHATINAVEREADTHISAPPLICATIONANDSTATETHRTTIiERBOVEINFORMATIONISfARflECT. TOTAL FEES j �J /� �"� IAGREETOCOMPLYWITHALLCITYANOCOUNTVOR�INANCESANDSTATELAWSRELATING706UILDINP / �S %� CONSTFlUCTICHJ,ANOHEREeYAUTHORIZEREPRESENTATIVESOF7HISCOUNTYTOENTEFiUPONTHE � � C �t / ,Z ABOYEMEN71ONE0 7flOPERTY iOR INSPECTION PURPOSES. � COMMENTS �' r '�_`: `� tr'�� (r�ri �+'�-'+^,sri'1s'�.. . . �'m� PERM�TT�NAME(PRItJT) �' ���.����—t—�,..--- f� ���'-- - SI6/ EOFPERMITTEE DATE ^7 ,�^� ��� RECPT.NO. � / PAID BY �. � VALI�A710N I ,�. _ �- _.' '~'' WHITE—OepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy „�„ �_ .�..�_ � "�`�”--;-._ --�--�-- { i i �"� . � m C�:;d3 y "�t�`TE i'S"'� fY Pt�[,e"j(J9 �.'3':.y`( �'�"."R fl3��:7 J3 I.Z �w '�9'7.9 ,�r i�G'3� T "7 i C:3 � � t","_s'�� ��;,.. � � �.'_' � c.�� - 1 6[9��t's��V 6TE �x- `..� a.t t"� C� t'� C, �'S.s 20 �` 3�Tt�� -0�'."� . .�� 1"'B3 i � '7 ..��`,, SA � '� .,� ^�� �" '� C"-C�. 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