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CITY OF DIAMON33 BAR ^---��'� -- DEPARTMENT OF COMM�JNTI'Y�DE`JELOPMENT SERVICES ,�.. 21825 E.Copley Drive ✓ - {909)860-3195 Fax(909)861-3117 � PRESS ''�vr��� BUILDINGPERMITAPPLICATION FIRMLY o DDRIESS I���-.� � � - � DAPEICATION �� ��ti�' NUMBER I�T #/C � ISSUE TYPE OCC APN LOT TH(!CT DATE CONST. GROUP p OWNER �("�L�����,E o ADDRE Y ZONING SETBACKS z CITY ZIP TEL�'3'0��� FRONT RW ❑ � APPLICANT � TEL. REAR ❑ Z SIDElSIDE STREET RW ❑ ¢ CONTRACTO '� SIDE � p� CDDRESS . t �Zf �L. PROPOSED USE ' ,t o' ARCH/ENG7 ��,-� z ;bESIGNER w NO.DWEL. NO. NO. d ADDRESS cn UNITS STORIES BEDROOMS � � CITY ZIP TEL. cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATIpN p� � OyVNER-BUILDER DECLARATION SFR/ADD/REM O I� p � I HEREBY AFFIRM UNDEF PENALTV OF PERJURY THAT 1 AM E%EMPT FROM THE CONTFACTORS Li� G2f090IC2f�JOft L!J '�CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSWESSFNDPROFESSIONSCO�E:HNYCITYOfl (f� ' C.� �.COUNTYWHICHREQUIRESAPERA�ITTOCONSiFUCT,ALTER,IMPROVE,DEMOUSH,ORREPAIRANYSTRUF W pafi0/DOCk Z, ��.TURE,PRIOR TO ITS ISSUANCE,AL50 RE�WIfiES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNE� W�'.�'.STATEMENT THAT HE OR SHE IS LICENSE�PLJRSl1ANT TO THE PROVISfONS OF THE CONTPACTORS LI- W ���'',CENSE LAW(CHAP7EP 9(COMME�ICING WITH SEC710N 7000)OF OIVISION 3 OF THE BUSINESS ANO PRO- � POOI/SP2 Q��'��FESSIONSCODE)OflTHATHEOR HEISEXEMPiTHEREFROMAND7HEBA515FORhiEALLEGEDEXEMP- '�TION.ANVVIOLATIONOFSECTI0�7037.5BYANYAPPLICANTFORAPERMITSUBJEGTSTHEAPPLICANTTO z RB-ROOF �_ � � � � '�,,�ACIVIL PENRLTV OF NOT MORE TMAN F{VE FIUNORE�DOLLARS(S50o).�: Z.'� L]I,ASOWNEROFTHEPROP�P7Y,OPMYEMPLOYEESWIiH�WAGESASTHEIRSOLECOMPENSATICN, � CommefCi81 ' -- � WILL DO THE 4VORK,ANp THE ST UCTURE IS NOT INTENDED OR OFFERE�FOR SALE(SEC.io44,eUSI� _i �,. .NESS AND PROFESSIONS CADE:tHE CONTaACTORS LICENSE�AW DOES NOT APPLV TO AN OWNER OF = '� PROPERiVWHOBUILDSORIMPRQVES'fHEREON,ANOWHODOESSUCHWORKHIMSELFORHEPSELFOR ' W :iTHROUGHHI50RHEROWNEMPWYEE6,PROVIDED7HATSUCHIMPROVEMENTSARENOTMTENDEDOR m Q� ���OFFEREDFORSALE.IF,HOWEVER1THEBUILDM�ORIMPflOVEMENTIS50LOWITHINONEYEAROFCOMPLE- z. TION,THE OWNER-BUIL�EF WILLIHAVE THE BURDEN OF PROVING TMAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THc PURPOSE OF�uALE): ❑I,AS OWNER Of THE PRO�LERTY,AM EXCLUSNELV CONTRACiMG WITH LICENSED CONTRRCTORS �:I TO CONSTRUCT THE PRQIECT(SpC.7044,B1151N'cSS RND PROfES510N5 CD�E:THE CONTFACTORS L4 V8I1181i0n ADJ.AREA W' CENSELAW�OESNOTAPPLYTOANONRJEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,ANO �� WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR�S)LICc'NSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE _ � TORS�ICENSE LAWJ. � � ❑i AM EXEMPT UNDER SEC,�i 8.S P.C.FOR THIS REASON Q - � � " �. � OATE OWNER H y - . , � LICENSED CONTRACTORS DECLARATION W . �� 4 ¢ � IHEFEBYAFFIRM�UNDEftPENALT}'OFPERJUflYTHATIAMLICENSEDUNDEAFROVISION50FCHAPTER � ' p:� 9�COMMENCINGWITHSECTION7po0)OFDIVISION30F7HEBUSINESSANDPROFESSIONSCODE,AND Z X �MY LICENSE I5 IN FULL FORCE ANb EFFECi: � LICENSE GLA55� �vc�II� LIC.NO.����� j �~j' 'DATE f� "�� I COMRACTOR y a�`����i*��_ d � '�✓" ` WORKE,RS'COMPENSATION DECLARATION ¢ ��, �I HEREBYAFFlRKI UNDER PENALT OF PERJURY ONE OFTHE FOLLOWING DECLAFATIONS: z � �_IHAVE�RNDWILL,MAINTAI�ACEqTIFICATEOFCONS'cNTTOSELF-INSUREFORWORKEFS' a � , CAMPENSATION,ASPfiO�IDED�'BYSECTION3IOOOFTHELABORCODE,FORTHEPERFORMANCE U Q OF THE WORK FOR WHIC TH15 PERMIT IS ISSUED. � Q� r �HAVEANDWI�L'MAINTAII WORKERS'COMPENSATIONINSURANCE,ASREDUIREDBYSECTION n /� 37000FTHECA90RCOD,FORTHEPERFORMANCEOFTHE ORKFORWHICHTHISPERMITIS �7 7� l l ISSUED:MYWORKERS' �MP .SATIONINSU NCECARRI ANDPOLICYNUMBERARE, CONSTRUCTION � {y � J � CARRIER ` ��'' _ PLAN REVIEW ZPOLICY.NUMDER � ELECTRIC ¢ 0 (fFIISSECTIONNEmNOTB�COMPLEiEDCfTHEPERMfTISWRONEHUNDRED00LlI�RS(5700)ORLESS). PLUMBING � WORKERS'COMPaNST�FORMANGEOF7HEWORKFOftWHICHTHISPERMI-1SI55UED,1 MECHANICAL �^^^- � ICERTIFYTHATINTHEP -- �PERSONINANYMANNERSOASTOBECOMESUBJECiTOTHE p � � °�. �'�, � S(j tlN LAWS OF CALIFORN AND AGREE 7HA71F I SHOU:�BECOME INSPECTION FEEI a _ � = SUBJECTTOTHEWORKE S'COMPENSATO VISIDNSOFSECTION37000FTHELAB�R , / �-- ' COU ISHALLFpRTHWI COMPLY,WITH O PROVI51 ISSUANCE Y ca ' - g � ��`� % r�.� � DATE: � A�L�GA T� �� - SMIP t� �� .� D s y q� ~ � ENERGY P/C i _ WARNING FAI U SECUflE ORKERS'CO ENSATION COVERAGE IS UNLAWFl1L,AND SHALL BE -- J SEOCTON37080foTHELABOIRICOOE,?ryENALTIESANOqVILFINESUPTOONEHUNDRE�THOUSAN� �NERGYPERMIir� '4i. SUBJECTANEMPLOYER�TOCRIM ALP r STOFCOMPENSATION,DAMAGESASPftOVIDEDFORIN „ � r w qI E COSi,AtiDATTORNEY'S FEES, 3` '- --_.............._ 'teRe RETENTIONFEE��"` � .�,...�...� . .._.�_,�:__::-_ � �� O �CO�VSTRUCTION LENDING AGENCY PRE-ALT FEE: � 'IHEREBYAFFIRMUNDERPENALTY�OFPERJURYTHATTHEREISACONSTRUCTIONLEN�INGAGENCY � FOR 7HE PERFORMANCE OF THE,YJORK FOf�W HIGH THIS PERMIT IS ISSVED(SEC.3G9],CI V.C.?. � � L.LI ' � �LENDEfl'S NAME � . I'= LENDEfl'SADDRE55 ' __..____ � ICERTIFYTHATIHAVEREAD7HIS�APPLICAT70NANDSTATETHqTTHEABOVEINFORMATIONISCORFECT. TOTAL FEES � ��, �U � .I AGREE TO COMPLY WITH ALL qTY FND COUNTY OFDINANCESAN�STATE L4W5 RELATING TO BUILDING ' �f � WNSTft ION,ANbHEREeYAUTHORIZEREPRESENTATNE50FTHISCOUN7Yi0ENiERUPONTHE Z�''ABOV. EN ONE�PROPERTV FbR INSPECTION PURPOSES. COMMENTS � '_ - � � �°` iu� � �' EENA� (PFtI ' � '. v� � P . � �'9 A . , EE �� � D E . _ - RECPT.�O. 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