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HomeMy WebLinkAbout14775 (19) �� CITY OF DIAMOND BAF. DEPARTI�,3ENT OF COMNIUNITY&DEVELOPMENT SERVICES � _a '.� 21660 E.Copley Drive Suite 190 :� � (909)86d-3195 Fax(909)84L3117 PRE.S.S , BUILDIN,G PERIGITT A��YCATION ',, T FIRMLY ` , , ': . ..,,�;� . .. . .... � � JOBSITE y"` " � APPUCATION PERMIT � /C � f� o ADDRESS �" r�. � DATE NUMBER � # �s`f - � ISSUE TYPE OCC APN LOT TiiACT pATE CpNST. GRpUP p OWNE�(����� " ADDRESS Z- ZONING SETBACKS �°L CITY � ZIP l 7rwr� EL._.l -�_+u� REART RW O APPLICANT �t+?rJ"`�+ �c..m�-,B.T' T�Ct`�.9�"1�:�,"t,/ SIDFJSIDE STREET _,�___.._T-..___ RW n � CONTRAC70R 6 -� ; �r SIDE ❑ p� ADDRESS �'� PROPOSED USE1� d' "' o CITY :r.. ZIP L. .2� �y 7.. � wo ARCH/ENG/ aDESIGNER ' ADDRESS -� NO.DWEL. NO. ,� � CITY ZIP TEL. c5S'" � UNITS STORIES _�_BEDROOMS y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BIIILDER DECLARATION� . � SFR/ADD/REM O 1 HEREBY AFflRM UNDER PENAL7V OF PERJURV TNAT I AM EXEMPT FFlOM THE CONTRACtOH§LI- Gefa<Je/CefpCR CENSEUWWRTHEf-0L.LOYJIN6i�ASON�5EC.7031.58�51NESSANOPROFE5510NSCODE:ANVGITYOR (/� , C.� COUN7YWHICHREOUIRE9APERMITTOCONSTRUC7ALTERIMPROVE,�EMOLISH,ORAEPAIRANV�SYf1UC- W PaSIOJL)f3Ck Z TURE,FRIOR TO RS IS3UAFfCE,ALSD REOUIRES THE APP�ICANT FON SUCH PERMIT 70 FILE A 516NED W STATEMENT 7HAT HE OR SHE IS LIGENSED PURSUANT T6 THE PROVISION3 OF THE bONTRACTOFi3 Lb W � CENSE LAW(CHAPTEq 9(COMMENCINO WIT4 SECTION 7oCo)OF�NISbN 3 OG THE BU$INESS AND�PRO- �'L' PooUSpa FE59pN5OD0�ORTHATHEOR5HEISEXEAIPTTHEREFROMANDTFIE8A513FORTHEALLEGEDE7(EMP- (� 710N.ANYVbLATkJNOFSECTION7a91.6BYANVAPPLICANT�FORAPERMITSUBJECTS7NEAPPC�C'AYJ1'To Z Re-Roof � A CMI,PENALTY OF NOT MORE THAN FNE HUNDRE�DOLL4R5(S5W).�:� �-�� � ❑I,ASOWNEROFTHfiPROPE0.TY,ORMYEMPLOVEESWITNWAGESASTHEYRSOLECOMP�N5ATI0N, O Commarcial - NALL p0 THE WOAK,AND TF�STHIICTURE IS NOT INTENDED Op OFiEAED FOq SALE(SEC.704`I,`�USI- J � NESS AND PROFESSIONS CODE:hIE CONTRACTORS LICENSE LAW�OES NOT APPLV TO AN OWN6R'OF j PROPERTY WIiO BUM:DS OR IAlPROVES THEREON,ANO WHO pOES SUCN WbRK HIMSELF OqlIERSEI.�OR � THtWU0HH180RNEFiGLVN�ERIPCOVEES,PROVIOEDTHAYS`UCHIMPROVEfAENTSARENOiINTEND�EDOR m Q ,OFFEREOFORSAL61FF10fNEVER7ME8UIL01N��RIMi'NOVEMENYi55t]L�WITHIN�NEYEAROKWAIE'LE- z TIDN,THE OWNER-BUILDER WILL HAVE hiE�BURDEN OF PqOVING THAT FIE OR SHE DID NOT BUICb OR = IMPFlOVEFORTHEPUHPOSEOFSALEI. . ���" O I,AS ONMER OF THE PpOPEFlTI;PM EXCLUSIVEIY CONTRACTING WITH LICENSED WNTkAL"1"bFiS Q TO CONSTflUCT Ti[PRQIECT(SEC.7P14,BUSMESS AND PROFES$I(SIVS C6bE:THE CbNiflACTDaS LI• V8I118�IOP1 ADJ.AREA LLI CENSEUWDOESNOTAPPLVTOANONMEROFAPROPERNWI�IOBUILOSORIMPROVESTHEqpdN,ANO WFKICOMRACTS FOR Sllpl PROJECTS WRH ACONTRAC70q(S�LICENS�PURSUANT TO`fHE CONTRAG roRSUcer+seuw.�. � �,:• QUANTI – DESCRIPTION FEE - � J 0 �I AM E%EMPTUNDEfi3�C. 8.e P.C.FOR THIS REASON Q '"� � U . .. .._. . 6d- � DATE oNRJER U W � LICENSED CONTRACTARS DECLARATION `'' W I HEREBYAFFIRM INiDER PENALN OF PERJURY 7HAT1 AM LICENSEO UNOER PROVISIONS OF CHAPTER � d B(COMMENdNO WI7H SECT�ON 7000)OFDIVISION 30FTHE BUSINESS AND PROFESSIONS CADE.AND Z X. MY LICENSE IS IN FULI PORCE AND EFFECT. m N � �� ����� � � � LICENSE CLASS LIC.NO. U �ATE ��^�..�"'G�7 COMRACI'OR; �- W � WORKERS'COMPENSATION DECLARATION Q � IHEHEBYAFFIRMUPIDERPENALNOFPERJURYONEOFTHEfOLlO'MNGDECLARATIONS: �� Z' � ,,,,w�IHAVEANI]WIILA/AWTAWACFRTIFIC?TF.nF[�NSFNT7pSFI,F.IN$IJRFFf1RWORKFRR' _ COMPENSATpN,q5PFiOYIDEDBYSEC?ION37aoOFh1ELA80RCODE,FORTHEPERFOPMANCE W OF THE WORK FOR WHICH THIS PERMI7IS ISSUED. � 4 � _IFIAVEANDWILLMAIMAINWORKERS'COMPENSATIONINSURANCE,ASREOUIqEDBYSECTiON I ' /N Q 37000FTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICH7HISPERMITIS / I 0 ISSUED.MY YJORKERS'ODMPENSATI�OAN INSURANCE ARRIER AhD POLICV NUMBER ARE: I CON5TRUCTION �e' - j CARRIER_��T�`�,C' Y^y'U^�.�"✓� ' PLANREVIEW - � POLICYMIMBER_ EI�I Q,z'3/�,,,,, ,_„�,.,, .,,,_,,,_,,, ELECTRIC � (IF95SECfIbeaNE�NOTBE�I.Ef�OFTHEPEFd�NTiSFORONEliUN�REVDJI.tAiLS(Sto�)ORLESS�. PLUMBING W Z 1 CER7IFYTHAT IN hIE PERFORMANCE OF iHE WQRK FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL (J �SHALLNOTEMPLOVPNYPERSONINANVMANNERSOASTOBECAMESUBJECTTOiHE Uj WOflKERS'COMPENSATIONUWSOFCAL�FORNIA�'DAGPEETHATIFI6HOU4�BECOME INSPEC710NFEE SU&IECTTOTHEYlORKE0.5'COMPENSATIONPr70VIS10 F N37000FTHELAB �� OCODE,ISHALCFOflTHWYTFiC4MPLYWITHTH PRO SIO . ISSUANCE _ Q OATE:�G���'APPLICANT: , .~� _d�^__.___ SMIP I I P J WPANING FAILURE 70 SECURE WO 'COMPENSA710N CAVERAGE IS UNLAWFUL,ANO SHALL BE ENERGY P/C � SU&IECTAN EMPLOYER TO CRMINAL PENAL7IES ANO qVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS({10D,000),IN ADDITION TO7HE CQSTOFCOMPENSATION.DAMAGES AS PROVIOED FOR IN ,�y �q�y g*p 8� ¢ SECTIDN37080FTHEU160flCODE,INTEPEST,ANDATTORNEV'SFEES. RETENTIONFEE: 1-�����+���'d�l.�'NV�a�+` OCONSTRUCTION LENDING AGENCY PRE-AlT F E. � d � 1 HEREBV AFFIRM UNDER PENALTY OF PEPJUflY THATTHERE IS ACONSTpUCTIDN LENDING AGENCY FOft iHE PER WRMANCE OF TME WORK FOR W Mlqi THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z W � LENDER'S NAME F— LEN�ER'SADDRESS ` ,Iy � I A6R E TO COMP VVNAhI ql:CIT'ANO COU�NTYuO�WAANCES A�STAT�E LAW RELATING TO BUILO NG TC�TA L FE ES �,���P R 6L' � CANSTRUCTION,ANDHEFE9YAUTHORREflEPRESENTATNESOFTHISCOUN?VTOEN7ERUPONTHE Z ABOVE�MENTIONEDPROPEHTYFOFINSPECTIONPURPOSES. COMMENTS _ ..��r'�°'/ �-�. ,�, ¢ PERAAITTEE Np41E(PRI ' �] l� - `�° •I"• S PEOFPERM OATE RECPT.NO. PAID BY VALIDATION WHITE-0epertrn�t Gopy,YELLOW—Finan�Copy,PINK—Assessor Capy.GOLDENROD--File Copy,GREEN--Applicant's Cnpy � ��� �� ��� �,������:�� � ��������� ������ ,. .;. ��`r M�� , �_� � ��� � ., :�:;�., ��:r�� �. _.. .:s � .. ..,.;tn, A��..:. . . . .. . � . .. .... .... ., . 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