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. .. .._. ..._..a.�...,. .._.,.. ;.... , . �:_:..,t - ,....;... ._,�; .. .. . .. � � .. .,.�,; ,� ..,,.... . � . .. - ....._.-„ •---�'"�--- CITY OF DIANIOND BAR � .:i'� COMMUNITY DEVELOPIvIENT DEPARTMEN`T' :.,.:� 21660 E.Copley Drive Suite 190 PRES+S (909)860-3195 Fax(909)861-3117 �''+�' BUILDING PERMIT APPLICATION FI R Ni LY � JOBSITE . /� �' " ? yO� �b � s � �� 3;} APPLICATIO � � PERMIT � � P!C o ADDRESS �.��� d D OATE � � NUMBER� # o - ISSUE TYPE OCC °r° APN LOT TR T DA7E CONST. GROUP � OWNER O "- ADDRESS ZONING SETBACKS W C��, Z�P � T FRONT RW G � APPUCANT TEL, REAR ❑ o SIpE/SIDE STREET RW ❑ ¢ CONTRACTOR SIpE ❑ o CDDRESS Z�P TE � PROPOSED USE f 4' C/ o ARC lENG/ SG C �/ — w DESIGNER NO.DWEL. NO. '"' NO. n. ADDRESS__ UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION vs o OWNER-BCIIDER DECLARATION � SFR/ADD,�REM Q I HEREBY AFFIRM UNDEP PENALTY OF PERJJRV THAT 1 AM E%EMPT FROM THE CONTRACTORS LI- � Garage/Carport W CENSELAWfORTHEFOLLOWINGREASON(SEC.7031.58USME554NOPROFESSIONSCODE:ANYCITYOp U COUNNWHICHflEQU1RE5APERMITTOCONSTRUCT,ALTER.iMPROVE,DEMOUSH,ORREPAiRANYSTRUC- W Patio/Deck Z TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PEFiMIT TO FI4E A SIGNED W STATEMENT THA7 HE OR SHE IS UCENSED PURSUAN7 i0 THE PFiOVISIONS OF THE CONTFACTOR5 LI- � CENSELAW(CHAPTER9(COMMENCINGWITHSECTION7a5o)'OFDIVISION30FTH�BU$INESSANDPRO- � PooUSpa � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTNEBASISFORTHEALLEGEOEXEMP- QTION.ANYVIOL4710NOFSECTION7031.5BYANVAPPLICANTFOR�APEpt�AITSUBJFCTSTFIEAPPLICANTTO „Re-Roof �'°� � ACIVILPENALNOFNOTMORETHANfIVEHUNCREDDOLLAf15(35oo),I: �� ��� � -� � p � ❑I,ASOWNEflOFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOIECOMPENSATION, COf17fflBfCifll Z WILL p0 THE WORK,ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SAIE(SEC.1a44,BUSI- J NE55 AND PROFESSIONS GODE:THE CONTRAC'ORS�ICENSE LAW DOES NOT APPLYTO AN OWNER OF � PROPERTYWHOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSEIFOiiHERSELfOR = � THROUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m WQ oFFEREDFORSALE.IF,HOWEVER,TNEBUILDINGORIMPROVEMENTISSOL�W17HINpNEYEAROPCOMPLE- z TION,'THE OWNER�BUIL�ER WILI HAVE THE 6URDEN OF PROVING TI1AT HE OR SFIE DID NOT BUII.D OR � IMPROVE FOR THE PURPDSE OF SAL�. �' . w �I,ASOWNEROFTNEPflOPERTV,AMEXCWSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS � 70 CONS7RUCT THE PfloJECT(SEC.7044,BUSINESS AND PROFESSIONS CODE:YHE CON7RACTORS LI- Valuation � �� ADJ.AREA W CENSELAWDOE5NOTAPP�YTOANOWNEROFAPROPEftTYWHOBUILDSORIMP�iDVEStHEREON.AND � WHOCONTRACTSFORSUCNPROJECTSWITHACONTRAC70F(S)UGENSEDPURSUANTTOTHECOMRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE UW.). � � � � ❑I AM EXEMPT UNDER SEC. - B.8 p.0.FOR THIS REASON � � s�'r . . . . � . � . .. ... .. . ¢ DATE OWNER_____._._____ _ _ U � . . Z W � LICENSED CONTRACTORS DECLARATION. W ¢ � I HEREBY AFFIRM UNDER PENALTV OF PERJURY TFIAT I AM LICENSEO UNDEfl PROVISIONS OFCHAP?ER � ,,, � W9(COMMENCING WITH SECTION 7000)OF ONISION 30F TNE Bi1�5�PROFES510NS CODE,qN� m X MYUCENSE IS IN FULLFORCEANO EFFECT. �/ � LICENSE CLASS LIC.NO. O� � � Qt^� J V DATE _9,= 7.I' CONTRACTOR W �r� _ � WOFKERS'COMPENSATION DECLARATION� � �� � � � IHEREBVAFFIpMUNDERPENALTYOFPERJURYONEOFTHEFOLIOWINGDECIARATIONS�. Z � _IHAV�ANOWILLMAINTAINACERTIFlCATEO:CONSENTTpSELF-INSUREFORWORKERS' _ '-- � CAMPENSATION.ASPqOVIDEDBYS'cCTION370oOFTHEIABORCO�E,�ORTHEPERFORMANCE U ¢ OF THE WORK FOR VJMCH THIS PERMIT IS ISSUED. � � (-// � IHAVEAN�WILLMAINTAINWORKEPS'COMPENSATIONINSURANCE,ASREOUIREDBVSECTION � ,��� QQ 37aoOFTHELABOFCOOE,FOFTHEP2flFOflMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSUED.�NY WORKERS'COMPENSATION IN �ANCE C �IEFAND POL.ICY NUMBEFiAFE: � CONSTRUCTION J � CARRIER �y"f�p PLAN REVIEW Z POLICYNUMBER�f' _(C Y � '� ELECTRIC Q ! o„'I�J 0 (i}iIS5ECT10NNEmNOTBE�MPLETEDOFTHEPERMRISWRONEHUNDFiEDD01.lARS�6100JqRl SS PLUMBING Z ICEPTIFYTHATINTHEPERFORMANCEOFTHEWORKFORVlHICHTHISPERMIiISISSUED,I � MECHANICAL � SHALL NOT EMpLOV ANY PERSON IN ANV MANVER SOAS TC BECOME SUBJECT TO THE �/j WOPoCEFS'COAAPENSATIONLAWSOFCALIFORM.A,ANDAGREETNATIfISHOUlDBECOME INSPECTIONFEE � SUBJECTTOTHEWORKEFS'COMPENSATIONPROVISIONSOFSECT OCOFTHELABOFl CODE,IS LLFORTHWITMCOMPLV,WIiHTH PROV 10 . ISSUANCE 3 � p DATE: ��PPLIC . SMIP � J WARNING FAILURE TOSEC4RE WO ERS' PENSATION CpVERAGE IS UNL4VJF ,AN�SHALL BE ENERGY P/C � SUBJECTANEMPLOYERTOCftIMIN P LTIESANOCIVILfINESUPTOONEH REOTHOUSAN� ENERGYPERMIT ''i DOLLARS(5700.000),IN ADDITION T COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SEC710N37o80F7HELA80RCODE,INT"eREST,ANDATTORNEY'SFEES. RETENT�ONFEE: � � CONSTRUCTION LENDING AGENCY pRE-ALT FEE: O — � I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION L=NDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715 ISSUED(SEC.3o97,CIV.C.). Z W � LENDER'S NAME____ � : .:�. .. F— IENDER'SAODRESS � ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETNATTNEA80VEINFORMATIONISCORRECT TOTAL FEES � ` `J � w I AGREE TO COMPLV WITH ALL CITY AND COUNTV OFDIIJANCES AN�S'fATE L4W5 REIATING TO BUILDING � CONSTRUCTION,ANDHEREBYAUTHORIZEFEPRES[NTATIVESOF7HISCOUNTYTO�NTERUPONTHE � � - � ABOVE-MENTIONED PROPERTV FOR ON PURP Z ' COMMENTS � "� �'`��. � � _ , � � � PE E��2e �� � �g' �� --- ---- ' ° � � �� , C, SIGNATUREO PERMITTEE �DATE - = RECPT.NO. PAI�BY `r , VALIDATION' b � ~ WHITE—De artment Co YEILOW—Finance Co PINK—Assessar Co GOLDENROD—Fila Co GREEN—A IicanYs Co ' - P pY. PY� PY. PY, PP PY ,, , ., t.. .,. :�„ .. x �.,.: �.�. >. ,_., ,. �. ,, ..., � R '+ ., ' � ,. .;,. .r . ":. . ,. 'i,ti4 t �.xV;�4+ �;';F 'R^•3�:} ,w. Y.'.nta zG,,:.::. ,� . '�,ti'� r" � . � ..�.�. � �...,.:..-r:.in�..l . , �. ,��. , <,..A _ . ,.. � ��� � � � � . . , , , . �. -. �� , � �_ ������ ���. �� � �,,. , , � �.. � ''� � � � ���� . 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