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HomeMy WebLinkAbout12971 (13) � CITY OF DIAIvtOND BAit ��� �� � --��-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES w 21660 E.Copley Drive Suite 190 (909)860-3195 Fas(909)861-3117 PRESS ���*"��� BUILDING PERMIT APPLICATION .'.; FIRMLY � ,IOBSITE g ApPLICATIAN PERMIT t ^� `� P/C o ADDRESS�.F� � ��C h�ili �. 1"'`"� I� DATE NUMBER # � ISSUE �,_�v� TYPE OCC APN LOT TRACT DATE �. CONST. GROUP p OWNER r "" ADDRESS � �. ZONING SETBACKS Z CITY ZIP � TEL. REART pW ❑❑ g; APPLI AN'f 7EL. SIDEISIQE S7REET RW ❑ �, CONTRACTOR I ' ' � �, , SIDE ❑ � ADDR SS ' '" � PROPOSEO USE p CIN e ZIP �,TEL. o; ARCH/ENG/ z^ DESIGNER — NO.DWEL. NO. NO. Q,. ADDRESS UNITS STORIES BEDROOMS � �` 'CITY 21P TEL. �� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � �� � „�g. OWNER-6UILDER DECI.AHAT�ON SFR/AD�lREM 0p4�� I HEREBY AFFlRPi UNDEfl PENAL7Y OF PERNflY THAT I AM EXEMPT FHOM THE COMRACTOflS ll- ' GaragelCarpoR :�[ll'�:� CENSEUWF-0R7HEFOLLOWINRREASON(SEC.7031.SBUSINESSANOPROFESSIONSCODE:ANYCITYOP ��� (n '�Ui WUpflYW}ryq{REWIRESAPEFMYfTOWN3TRIICT,PLTER,IMPROVE,DEMOLISH,DRREPAIRANy57AUC 3 W Pail0ID8Ck � •Z`-- TURE,PRIOR TO ITS ISSUANCE,ALSO REQWRES THE AVPLiCANT FOR 3UCH PERMIT TO FILE A SIGNEO ' -V'�" STATEMENT THAT NE OP SHE IS LICENSEO pURSUANT YO THE PROVISIONS OF THE CONTqACTORS L6 �'-� � �'�+- -CENSE LAW(CHAPTER9(COMMENCIN6 WI7H SECTION 7WU)OF DIVISION 30F 7HE BUSINESSAND PRO � �'1' POoVSp3 '��'�" FESSIONSCODE)ORTHATHEORSHEI6E%EMPTTHEHEFROMANDTHEBASISFORTHEAILEGE�EXEMP ; TbN.ANYV10UT1ONOFSECTION7031.59YANYAPPLIGAMFOflAPEflM1TSU&IECTSTHEAPPLICANTTO a� � RQ-ROOf ,'u' ACIVILPfNALN�OP NOT MORE THAN FlVE HUNDRED DOLtARS(55aa).): - �- Z� . � ❑1A50WNEROfTHEPROPERN.ORMYEA�PIDYEESWITHWAGESASTHEIRSOLECOMPEN5ATI�N i:-Q� O'' Commercial - ;z,;, WILL DO THE WORK ANO THE STHUCTURE IS NOT INTENOED OP OFFEHED POR.SALE(SEC.7at4,BUSI ' .�' _.�_ NESS AND PqOFESSiON6 CODE:THE CONTRACTORS LICENSE LAW DOE3 NOT APPLY TO AN OWNER OF Pc_.-,j . .PROPEfl7YWH00U1LO50RiMPROVESTNEREON.�INDWHODOESSUCHWOflNHIMSELFORHEFSELFOq ' '�%CG'" .THROUGHHISORHEFtOWNEMPLOYEES,PROVIOEDTHAT6UCHIMPROVEMEM6ARENOTWTENOEDOP �"m :�O -OFFEREDWRSFLE.IF,HOWEVERTMEHUII�INGOHIMPROVEMENTI550LOW1iHINONEYE0.flOFCOMPIE �y:. - ,z :710N,THE OWNEfl-BUILUEH WILL HAYE THE 6Ufl0EN OF PROV1Na THAT HE OR SHE DID NO7 BUIID OR ; �IMPROVE FOR THE PURPOSE OF SALE). y�j '. OI.ASOVJNEflOFTHEPftOPEflTY.AME%CLU3IVELYCONTRACTMGWI7HLICEN9EOCONTRAC70RS �`- - �s� TO CONSTRUCT THE PROlECT(SEC.7044,6USINESSAND PROFESSIONS CODE:THE C-0Nl'PqCTORS U � V8IU8f10t1 ADJ.AREA � CENSELAWWESNOTAPPLYTOqNOWNEftOFAPflOPERTYWHOBU1LD50RIMPROVE5T71EflEONAtV� �� S �YrtfOCONTRACTSFap3UCHPfiRIECTSNMTFlACON7RACiOR�S)LICENSEDPURSUAN7TOTHECON7RAG QUANTITY - DESCRIPTION FEE � -:TDRSLICENSEUWJ. ._ ��" � OIMIEXEMPTUNDERSEC. B.BP.C.FORTHISREASON �'-Q � � ' ,.�. � � . �'' V . . . . a V"r -.DATE OWNER �' U rt.Z,:: � . •, .W v�'; UCENSED CONTRACTQRS DECLARATION � W .�� IHEREBYAFFIRMUN�ERPENALTYOFPER.%1RYTHA71AMLiCENSEDUNGERPROVI510N50fCHAPTEq �; � g� ��h, -� � .�. /"� A�;; B(COMMENCINfiWI"fFISECT10N7000)OFONISfON30F7HE6USINESSANOPROFE5510NSCADE.ANO r Z �'I �4 t..r �,X� MYLICENSEISINFULLFOflCEAN�EFfECT. - :,,_ m ltl 'a_ }��g LICENSE CLAS$s��LIC.NO. ���� � �� .� p / J . ",..� .DATE���`/ � ' CONTflACTDR � � - ' � �- - W� �y WORKERS'COMPENSATION DECLARATION ���_ Q �-� .,yt : .�.0 . - � tMEREBYAFFIRMl1NDERPENAl7VOFPERIURYONEOF7HEFOliAWiN6DECLAMT1oN3: 4 Z ��. �:Q- ._IHRYEAN�WILlMA1NTAINACEfltIFICATEOFCON5ENT705ELF��NSUREFOF1WOflKERS' _� Z . ;,-�; ��: CC/APENSA710N,ASPROVIOEDBY9ECTION3�OOOFTHElA90RCODE:FORTHEPERF�RMANCE "� �U OFTHE WOpK fOR WHICH THIS PENMIT IS ISSUED. � � ,W _I H0.VE AND WILL MAIMfAIN WOflKEP3'COMPENSATION�N9URANCE:AS RE�UIRED BY SECTION -;C-. 37000FTHE UBOR CODE,FOR THE PERFORMANCE OF THE WORN f-0R WHICHTHIS PERMITIS .'. 'o= - - ISSUED.MY ERS'COMPENSATIONINSUFANCECARRIEf7ANDPOLICYNUMBERARE: ¢�-� CONSTRUCT�ON - ,};,�'; �. . cnaaiEa_ {�i���� � . /n a _ PLAN fiEVIEW _. - - -0� Pa1CYNUMeER ' '" ~ '� ELECTRIC � :p. .. ..,((HISSECf10NNE�NDTBEOJM1�ETFDOFhIEPERASiISFORIXJEI-IU�URC-00.�UM5(Sioo)bRLESS} � LUMBIN .�+�g�) I�� . . . . - _Z� �.ICERTIFVTHATINTNEPEBFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED,I �� MECHANICA� � �-C,'ji - -��SFiN.LN07EMP�0YANYPERSONIMANYMANNER-,SOAST06EGOMESU&IEC7TOTHE ;�, WOflKEPS'COMPENSATION lAWS 0F CAII�-0RNIA,ANO AGREE THAT IF I SHOULD BECOME INS�FEE � SU&IECTTOTHEVlOHKERS'CO ATRI7PPR6WS�ONSOFSECTION37000FT11EtABOfl t� S�O (.-� �''� �:� -CODE,ISHNIFO(iTHWITNCOMP ITHTHOSy�,q_vE ^P.PROVI�S70N$�, ISSUANCE ___ �J .J.�-_____ '��.p DATE'��/_�� APPLICANP.. �_ -� q,g .SMIP. � � . +,.W'- g =:J; '-WRRNING:FAILURETO SECURE WOflKERS'COMPENSATION CAVFRAGE IS UNIAWFt1L,ANO SHALLBE ENERGY P!C fl ��LL���.SU&IECTANEMPL�VERTOCRIMINALPENALTIESANOCIVILFMESUPTOONEHUNDREDTHOUSAN� ENERGYPERMIT ��� � ^ i---�pp��.Aq3(§700,000),INADDITIONTOTNECO&TOFCOMPENSATbN,OAMAGESASPROVIDEDFORIN g� "..�.1� SECTION 37D8 OF THE LABOR WDE,INTEREST,AN�ATTORNEY'S FEES. ' f: RETENTION FEE: y�,� ,_:�': ,p. . ,,;dy. CONSTFiUCT10N LENDING AGENCY PRE-ALT FEE: `�Q; I HEREBYAFfIRM UN�ER PENALTY OF PERJURY THAT TNEPE IS ACONSTRUCTION LENDING FOENCY ' +�a�' FORTHEPERFORMANCEafTHEWO(iKfORWHICHTHISPERMITISISSUED(SEC.3097,CIV.C.). � . . Z. � . :..� LENOER'S NAME__ �< F-+� LENOER'SADDRESS C . . . � j��� ICERTIF/THATIHAVEREADiHISAPPLICATIONIWDSTATETHATTHEABOYEINFORMATIONiSCARflECT h TOTAL FEGS - � .',�� IAGflEETOfAM7LYWITHALLCRYANDCAUNTYOF�INANCESANOSTATEtAWSRELATINGTOBU1L01NG }'- �� � - CONSTRUCTION,AND HEREBY AU7110F1RE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE , 'z�. ABOVE-MENTIONED PflOPERTY fOR INSPECTION PURPOSES. COMMENTS � j':.� ,-��.,I��-��1.�.�..�`.. -- m PERlAItTEEN E(PRINT) -'--__ - � �..;: ¢: --�-__�-__-__-L '��"��'�_ � , � � : � SIpNATUREOFPERMITTEE " DATE ' A �_ - ,� AECPL NO. � PAID BY � VALIDA710N WHITE—Dapartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Pile Copy,GAEEN—ApplicanYs Copy � � r d• �"`.g• ' ,�'+ E -r�-c; '*1 -n �va c � -r; ' I °`� rt s�, � € � � j � �� � � �E��r+� r~� � +� c� � cr ,��� ���t�a � ,�� �r�� , r cr, � ( � � 4 € �;�. �, s �.� -r �. ��.�� c� �' �te� ;.n �1�~ .� ;,� �, �; � � ��� �� � i � .� �� ���;� � �:��- ��� ``) � ��- ��� -���i��,�a � � � � � � � : � ° , � � ,�- �-�� �; �� � � �E I�k.� ���:��� -� I�;��,�-�, ,�1:�,,� � fi9 � � � -�;r�; C; °�y '� f� �- ,� � �r� "c ry � �'-� �'t � r`,r;� � � �I f � � � I rl�n ,r-�_, ,�..; .�i v I u; 1 � � � I i I,� � ,n ,,, � �62 1 c "' � :� � .r �i-�r r�? r �,��'3�� ,r J G�., � ! �t i �. �, Cl i r F P:€ �`I�� :��� s._ —�j . r'7� !'n tn � A� ..�,�C"i.� �; � - � � � -l3 (� 3 1'1 �� w7 I E � " � � ; ^s( i C�9 !`i l �i �� 4'' -�^�:'�� �� � Ci`�S'� . - jy R ? , ""'-�. 1 Y��"Tt �1." -�( 3'�s.I -`a .�^ E7 �I'>�C� � !�i G � (J3. � ( i t P� � � 3� ��: '_ �' ' r[z.l�l � � -"��� � i .. �� F �3� t � p � �1 �s.') �( +� '�S��z 'i;�,(i i � f j �� � 3 � ( {�. i��"'' �?�� n�. l��fs ���— �I � ��C �.�� .�6y. i i` _ �����C . � � � � � a _� E f. i� ` ';;7� y� � �,�'�1�,-.a. _i � I Z ` � i � I � �--� �'� e � �� { � � _� j ;_ � � e�: I : (� .�.� . � . i ; � i � � , � � _ i —_"� —f— � i —� � { �� ( �—3 .- °} I � j � ! � p � � d ,. { � ' � �,. � � � � � i. 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