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HomeMy WebLinkAbout14671 (17) . � ����-� .�r��d,�U/ .� ,�, .. _��_ CTTY OF DIAMOND BA& ���i:/ DEPARTMENT OF COMMU1vITY d�DEVELOPMENT SERVICES : � 21660 E.Copley Drive Suite 190 (909)86a3195 Fax(909)861-3117 PRESS �����'� � BUILDING PERMTT APPLICATION FIRMLY Q JOBSITE �/'� 5/ /� �A-'- ^ q �Q ¢ ADDRES ��/I��-/ �Y�f/�,��� �1 DATE CATION �Z� �O m NUMBER� � S � #,C l c� ISSUE TYPE OCC APN LOT�-,, RA T DATE CONST. GROUP p OWNER IS L� /'// /L p ADDR ti" S` ZONING SETBACKS Z CITY T . � FRONT FiW ❑ S APPUCANT,�� REAR O ' SIDE/SIDE STREET RW ❑ � CONTRACT � / � SIDE ❑ ADDRES PROPOSED USE �o CI I ZIP �G�����-�'"�� ARCWENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORfES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUILDER OECLARATION SFR/ADD/REM O p I MEREBV AFF�RM UNDER PENALTV OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI� � Gar¢ge/Carport W CENSEIAWFORTHEPoILOWMGREl150N(SEC.7a31.58U51NE55ANDPROFE5510N5CODE:ANYCITVOfl � COUNTYNMICHREWIRESAPERMRIDCDNSTRUCT,AI,TER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG W P8ti0/06Ck TUHE,VRIOR TO ITS ISSUANCE,ALSO RECIUIFES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � STATEMENT hiAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� C CENSEUW(CHAPTER9(COMMENCIMOWI7HSECTION7oD0�OF01VISION30FTHEBUSINESSANDPRO� LL' POOUSpe g FESSIONSCODE)ORTHATHEORSHEISIXEMPTiHEREFROMANDhIEBASiSFOFTHEALLEOEDEXEMP� V TION.ANYVbLATIONOFSECTION7031.5BVANVAPPUCAMFOFAPERMITSU&IECTSTHEAPPLICANTTO Z RB-ROOf � ACIVIL PENALN OF NOT MOflE TI-V�N F7VE HUNDRED Dq.LAFS(S60o).7: � ❑I,0.50WNEROFTHEPROPERTY.ORMVEMPLOYEESWITHWAGESASTHEIRSOLCCOMPENSATION, � COffIf118fC18I ' WILI DO THE WORK,AND THE STRUCTURE IS NOT INTEN�ED OR OFFERE6 FOR SALE(SEC.7044,BU34 J � NESS ANO PROFESSIONS CODE:TME CON7RRCTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF ? PROPERiYYVFlO BURDS OR IMPROVES THEREON,AND WtiO DOES SUCH WORK HIMSELFpR HERSELF OR � TMROUGH HIS OR NER OWN EMPLOYEES,PROYIDEO THATSUCH IMPROVEMENTS ARE NOT INTENOED OR m � OFFEREDI'-ORSALEIF,FiOWEVERIHEBUILAINGORIMPROVEMEMISSOLDWITHINONEYEAROFCOMPLE- Z TION.THE OWNER�BUILAER WILL HAYE THE SUROEN OF PROVING THAT HE OR SHE DID NOT BUILO OR = IMPROVE FOR THE PUNPOSE OF SALEJ. W ❑I,AS OWN[R OF THF_PROPF.R'TY,AM E%ClUStVELY COMRACTINO WITH LIC[NSEO COMRACTORS (�[ TO CONSTRUCT THE PRQIECT(SEC.7w4,9USI4ES5 AND PROFESSIONS CODE THE CONTMCTORS LI- VflIUBIlOf1 ADJ.AREA W CENSEUWDO65NO7APPlYTOANOVMEROFAPHOPEPTYWHOBUIIDSORI/APROVE5THEAEON,AND -- � VAIOCONTMCTSFORSUCN7RQJECTSWI7HACONTRACTOR�S)LICENSED?UqSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE � 70R9LICEN9ELAW.y. � ❑I AM EXEMPT UNDEF SEG�, 0.&P.C.FOR THIS REASON J � ' ¢ — � _ U � �" DATE ONMER�._._ � Z � W �s[ UCENSED CONTFACTOAS DECLARATION � 2 I HEAEBV AFFIqM UPDER PENALTY OF PERJUFlV TNAT I AM UCENSED UNDER PFlOVISIONS OF CHAPTEa �,� a, G(COMMENCINO WI7H 3ECTION 700d)OF DIYIuION 30F ThE BUSINESS AN'J PRCFESSIONS COOE,AND Z /"YI.a"��� r�"' X MYIICENSE IS IN FUL FORCEA4D EFFECT. e w � i � � LICENG CLA ."� LIC.NO� � _ j � J U DATE � ��, CCNTRACTOR_ _ d W � WORKERS'CUMPENSATION DECLARATION � Q � 1 HERFBYAFfIRM UNDER PENALTY OF PERJURY CIVE OF THE FOLLOWING DFCLtPA710N5: � �n Q Q IHAYEANDW!I.LMAINTAINACEHTiFICATEOFCA�'SENTTOSELF-INSUREFORWORKEP5' _ � COAIPENSATION,ASPP.OVIDEDBVScCTION37000FTNEU90qCODE,FORTHEPFRFORMANCF U Q OF TiE WORK FOR WFiICH THIS PERMIT IS ISSUEO. � � � _,IHAVEANDWIilMAINT/UNWORKERS'COMPENSATIONINSURANC[,ASREQUIP.E�BVSECTION Q 37WOFTHELkBORO00E.FORTHEPE3IWRM.'+NGEOFTHEWORKFOFlWHICHTHISPERMITIS � LSSUED.My yyORKEHS'COMPENSAT70N INSl/RANCF.CAFRIER ANO POLICV Nl1MBFq ARE CONSTRUCTION __ J j cnRRiEa �_ _ PLAN REVIEW � Px�;YNUMeEH___ __ ELECTRIC Q �rtaS�E��c:rirvEr�noreEoon+Rt��c�n��,rr�sx,�qon�eriuror��oainAs�siao�on�eu6 PLUMBIN _ LI.1 + Z I CER7IFY TNAT M THE PERFORMANCE OF THE WOflK F WHICH 7HIS P IT IS ISSl1ED,1 MECHANICAL _ ' �7� (3 SHALLNOiEMPt.6YPNVPEftS4NINANYMPNNF.R S BECO _�lJ CTTOTHE � WORKER5 COMFENSATK#J LAW50�CALIFORMI ,AN6 REE T OULD BECOME INSPECTION FEE � 5lIBJEC7TOTHEWOFKERS'COMPE4SATION OVIS SOF 37000FTHELAI30R J, GODE,I HA1.L RTHWITMCOMP'.YWITiT SCP Vlu^IO ISSUANCE � nAT��`.=5.�APPIiCANT, _ s SMIP _ M�_,�Q� � � � ENERGY P/C J WARNING:FAtLURE TO SECUPE WORKERS'CpMPENSATION CAVERAC IS� AWFl1L,AND SHALL BE � SU&IECTANEMPLOVERTOCRIMINALPENALTIESAMOCIVILFINESUP OONE NDREDTHOUSANO ENERGYPERMIT DOLIARS(f10o.o00),IN ADDRION TO THE COST OF COMPENSATION, AMAGE AS P�OVIDEO FOq IN J SECTION370BOFTHELABORCODE,INTEREST.ANDATTORNEY'SFE s. RETENTIONFEE: CL - a CONSTfiUC710N IENDING AG PRE-ALT FEE: O � I HEREBYAFFIRM UNOER PENALTV OF PERJURV THATTHERE IS ACONSTRUCiION LENDINGAGENCV � FOF7 THE PERFORMANCE OF THE WORK FOR WNICH THIS PEPMIT IS ISSL'E�(SEC.3097,CIV.C.J. Z W � LENDER'SNAME_____ _� i_— LENpER'SAD�RESS_, � ICERTIFYTHATIHAVEREAD7NISAPPLICATIONANDSTATETHATTHEABOVEWFORMATIONISCORRECT. TOTAL FEES � � I pGPEE TO COMPLY WITH ALL CITV AN�COUNTV ORDlNANCES ANO STATE LAWS RELATING TO BUILOkJG t � CO45TNUCTION,AND HEREBY AUTHOq!ZE REPRESENTATNES OF 7HIS COUNTV TO ENTER UPON THE ZABO�PYF,eAi1ENTIONEDPRUPEFlTVFORINSPLCTIONPURPO5E6. COMMENTS O I /�/ Q l� `��'Z�G,.... � m PEFiM1TT 6NAM RINT Q � ��t Uj SIO R OF E DA7E = RECPT.NO. � PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--Fila Copy,GREEN—ApplicanYs Copy , ., ,. , .,,, , . . . n. ,. . �"-,�... �;..tl ,:.:. . .:,:..... . .<,. '..;`., .,,�. .. 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