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HomeMy WebLinkAbout12938 (11) � r.� 4--��--- CITY OF DIAMOND BAIt (�'��� -' " DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 7 2� � ,� . 21660 E.Copley Drive Suite 190 `�� �`,,,8�,,., (909)560-3195 Fax(909)861-3117 PRE$$ BUILDING PERMIT APPLICATION FIRMLY � JOSSITE l APPLICATION -- PERMIT ,�� pQ q o ADDRESS a�1�C�- Lb�-1 '��t3Q�' (J'C DATE NUMBER �� �-!Q��J' � ISSUE 1yPE O� APN LOT TRACT DATE CONST.` GRQUP p OWNER '�1 e b r�Y�b �4MSv�,Z p ADDRESS 1 l Ll�='� iv ZONING SETBACKS Z CITY DiG o a�C' ZIP �I765 TEL U 5 S.I gqs FRONT RW � g APPLICANT Rm o �Gt�iYe2 TE�� c2a S�4��a v� REAR �_ — SIDE/SIQE STREET RW O �. CONTRACTOR SIDE � ADDRESS � 0 p�Ty ��P TE� PROPOSED USE o ARCH/ENGJ z DESIGNER a ADDRESS NO.DWEl. NO. NO. y 'C�N Z�P TE� UNITS STORIES BEDROOMS y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATtON �� O. OWNER-BUILDER DECLARATiON SF AO EM S � .Q.. I HEREBV�FF7RM UNDER PENALTY OF pERNRY THAT 1 AM EXEMPT FROM h1E CQNTRACTORS U- G8f0 J8/CBfPD(I - ��W' CENSEUWWp7F{EFOLLOWINGREASON(SEC.7037.58USINESSANDPROFESSIONSCO�E:ANYqTYOR. '(n - - '��_ COUNTVWHICHqEWIRESRPERMiTTO�NSTRUCT,ALTEA,IMPAOVE,DEMOIJSH,OppEPAIRANYSTRUC- �. W Pa1i0/D9GK �.� - TUPE,PRIOR TO ITS ISSUANCE,AL30 HE�UIRES THE APPLICANT FOI{SUCI{PEflM1T TO FILE A&IGNED 6-� HE �� STATEMENT THAT HE OR SHE IS LICENSE�PURSUANT IO.THE PROVISIONS OF THE COt1TRACTORS L4 .S CENS6 LAW(CHAPTER 9(COMMENCINp WITH SECTION 7oao)OF�IVISION 30F THE BUSINE55 AND PR0- �V' Pa01/$P8 ' ' - �� V FESSIONSCODE)ORTHATMEORSHEISfJ(EMPTiHEREFROMANDTHEBASiSFORTHEALLEGEDEXEMR ,(� V TION,pNYyqLpTKK70F5ECTION7031,5BYqNYAPPLICANiFORAPEqMlTSV9JEC75THEAPPLICANTTO �z R6•ROO� - � ACML PENIIL7Y OF NOT MOpE THAN FNE HUNDRED D�IARS(y500).�: - � �� �❑I,MSOYYNEROFTHEPIiOPER7Y,ORMVEMPLOYEE&WITHWAGESlSTHEIRSOLECAMGENSATION, CommBfcidi " � iNLL 00 THE NORK,AND THE STAUCTUflE IS NOT INtENDED OH OFFERED FOR 5ALe(SEG 70ad,BU51• ��� NESS,WD PROF6SSIONS CObE:THE CONiqqC7pqS LICENSE IAW OOES NOT APPLYTO AN OWNEROF xi�,� �. PROPEHfYW1�10gURDSORIMPROVESTHEREON,ANDWHODOESSUCNWORKNIMSELFORHERSELFOq � � � � �CL': .TNfl0Ui31iHISOftHEflOWNEMPLOYEES,PROVIDEOTHATSUGHIMPROVEMENTSAqENOTMTEN�EDOH '�m� : �Q��. ,�OFFEREOFONSALE.IF,HOWEVER7HEBUILDINGORIMPROYEMENTISSOLDWRMNONEYEAROPCOMPLE - � - . �._.Z,��'�T�N,THE OVRVER-BUlLDER WiLL HAVE THE�BURDEN OF DROVWO TNA7 HE OR SHE DID NOT BUILt]OR � - .,��' .IMPROVEPoR7t1EPUHPO5EOF5ALE). . � . � � - . ❑I.AS OWNEROF THE PROPERTY,AM EXCLUSIVELY CONTqACTMG WI7H IiCENSED COMflqCTORS `��, �.TOCON6TRUCT h1E PRPIECT(SEC.704t,BUStNESS AND PROFESSIOIlS 0.70E THE CONTRACTOAS U� V91U8ti0f1 ADJ.AflEA � �.W ::CENSEUWDOESNOTAPPLYTOANOYYNEROFAPR�PERTY'NHOBUILpSORIMPqOVESTHEPEON,AND � ':�� iMYFbCONTRACTSFORSUCHPR0.1ECT5WfINACONTRAC70R�5)UCENSEOPURSUANTTOTHECONTRAP- OUANTITY DESCRIPTION � � FEE TORS UCENSE LAWJ. ', �0�� �L!M1 IXEMPTUNDER SEQ_ _e.8 P.C.FOR THIS REASON. � �Q� - .� . ./��. : ��`-' oar� �9 � � ..i �'T � - '�Z' OWNEfl . . � C� L�I C.+ � ! , r' � dti LICENSED CON7RACTORS DECLARATION < W ��t � `° �'C'" ���; IHEREBYAFFIRMUNDERPENALTYOFPEtiIUAVTNATIAMUCENSEOUN�EFPROVI510N50FCHAPTEfl f. O.�r 9(COMMENCIN6 Wlhi 5ECT10.Y 7aao)OF.OIVISiON 30F THEBUGINFSS AND PROFESSIONS CADE,NJD ;�', Z C'�, /��? � a`� ',}SM MY IICEMSE IS�N FULI iOpCEAA�EFPECL ,, UJ t m t �y� �„O': UCENSE CLASS LIC.NO. ... � � � . �� � �� . . J�� _ ., t �J 'V5: DATE � CpNTRqCTOR .. ,. d��.. . :tAJ*a . ,$ �� { . . �� WOflKERS.'COMPENSATION DECLAFiAT1pN �„ Q � ���� lHEREBVAFFIRMUNDERPENqLryOFVERIlJftYONEOF7HEFOLLOWINGOECLARA7iON5: x�-Z /� '-�� � �'�� Q � cl¢i.� � *"0� _�__IHAYEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSEIf-IN3UflEFOflWOFKERS - _ � , . - '�.,�'; � COMPENS0.TiON,ASPROV10E08YSECilON3)ooOPTHELABOFifADE,fORTHEPERFOFMANCE �;. 1U � �� � � - ;W OF TtiE WORK FOR WNICH THIS PERMIT IS I59UE0. ., � :O �1 MAVE AND WILLMAINTAIN WOflKERS'COMPEN6ATION INSURANCE,AS REOUIRED BY SECTION - ��� 37000FTHE LABOR CODE.FORTHE PERFORMANCE Of THE WORK FOR WMICH TIiIS PERMITIS ���r.� � J._ ISSUED.MYV.bRKERS'COMPENSATKKJIN9URANCECAqR1ERANDPOLICVNUMB£RARE CONSTRUCTION ��U � �`>�_ caaa�q � PLANREVIEW . `-0= aoucvNUMseR - ELECTRIC � I� •� � '�� fr�.l�`� . :.;.p; @+ssEc�aur+c�rroreEca.ptErEooFt�aEanar�sFoaoraEFuwqEoaou.vasryyao)Oa�ESSI PIUMBING �.,/�� : Wt �'Z; I CERTIFVTHnT IN 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PEHMIT IS ISSUED,1 MECHANICAL �Cj�� . _ �.:.-�:� SHALLNOTEMPLOYANYPERSON�NANYMANNERSOAST06ECOMESUBJECTTOTHE —'-- �p)'. WOAKERS'COMPENSATtONUW50FCAUFO.qNIA,RNDAGAEETHATIFISHOULOBECOME INSPECTIONFEE � � '�� SU&IECT TO THE WORNERS'COMPENSA710N PROVISIONS Of SECTION 37o00F THE LABOfl � / �O O CODE,ISHALLfORTHWIhiCOMPLVWITHTHOSEPROVISIONS. ' ISSUANCE ��L���� . .-'p;. DATE: � APP�ICANT: .SMIP O � 2, 2V' . UJ - WARNING:FAILURETOSECURE4VORKERS'COMPENSATIDNCOVERACaEISUNIAWFUL,ANUSHAlLBE ENERGYP/C � J J. �.��� SU&IECTqNEMPLOYER70CRIMINALPENALTIESMlDCIVILFINESUPTOONEHUNbqEDTHOUSAND � �NERGYPERMIT y ��JDOLLIRS(SI00.000).IN A�DI7ION TO THE COST OF COMPENSATION,DAMAQES AS PFOVIDEO FOP IN 'r � SECTION37oBOFTHEtA80RCO0E,INTEREST,ANDATTORNE'!'SFEES. � �O�O .�.[[ RETEN710N FEE: /�C 7 X ' �� CONSTAUCTION LENDING AGENCY PRE-ALT FEE: `�� 2 J .. � INEFEBVAFflFMUN�ENPENPITYOFPERJURVTHAiTHEREiSACONSTRUCTIONLEIr01NOA0ENCY f/l f- FOR THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT�S ISSUED(SEC.3097,CIV.C.). . Z W ",��� LENDEH'S NAME — _ / .�.1— LENDEH'SADDflE55 - � �,.� W ICERTIFYTHATIHAVEHEA�7MISAPPUCATIONANDSTATETriAiTHEpBOVEMFOf�MATIONISCORRECT. � TOTA�FEES � � � d IACRE4TOCAMPLVWITHALLCITVANDCOl1NTYORDINANCESAN�STATELAWSRELATINRTOBUILDING � :�� � COMSTRUCTION.ANDHEREBVAUTNORIZEREPFiESENiATIVESOFTHISCOLINTYTOENTERUPONTHE Z ABOVE�M�N ED PflOPEflTY FOR INSPECTION PURPOSES. ,��. 0 „ '� COMMENTS . ' m __�� e T c� �ra.M c tie Z ..Q AERMI A1N"p . � �� � SI4NA EO I EE DA7E — � � RECPT.NO. ' -` PAID BY�,�' • VAUDATION �� � WHITE--0eparimgnt Copy,VELLOW—Finance Copy,P1NK—Assessor Copy,GOLOENROD—Pile Copy,GFEEN—Applicant's Capy E �-�^ i � � � - °4' � t{9�'a j _ "� ( � C � �: 'i l 7� '1T(`1 �3�f.l` .fi� �'v � � ➢7'E ff f 7'F�� �7�3J ""'f."f7�,� 'f i Cb? i€" �� �, � -, ���ilh � -.d � � !� ��I'i"s'a!r i�' � '�'i,.�`°y �i��� '��� �.{� ',�.' �;� �'l��..���yy �"d$� � �� . � �. � :� � 1 '*� � � �'�"� „i I � '#�,,,, � :�,1"e`S Se'"? 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