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HomeMy WebLinkAbout13593 (17) � CITY O�DIAMOND BAB DEPARTMENT OF COMMUI�TITY&DEVELbPMENT SERVICES 21660 E Copley Dnve Suite 190 ` � (909)860-3195 Fax(909)861 3117 �/ PRESS A�^.: BUII,DINGPERMtrT_ArP CATTOriT � � �,1� : FIRMLY .. �__....„ .�.�.,, .� : . .�....:.... .. .. o� JOBSITE �� �? APPLICATION PERMIT �j"f�P/C ADDRESS ��` DATE NUMBER # c� ISSUE G' TYPE OCC APN L TRACT_ pATE ' CONST. GROUP pOWNER' �' � . �e�' o AD . SS. f ZONING SETBACKS Z C{TY • ZIP TEL. FRONT RW O Q APPLICANT � TEL. =��=� SIDE/SIDE STREET RW ❑ � CONTRACT SIDE ❑ p� ADDFj1�..SS PROPOSED USE � cirv�.�^ IP TEL. w ARCWENG! � ^,�t r������.^„ z DESIGNER 'V"�-7"`�`� �-1`r'� ��^�' NO.D1NEL. NO. NO. � ADDRESS_ UNITS STORIES BEDRQOMS � CITY ZIP TEL._ � DESCRIPTION SQ.FT. FACTQR PSF ADJ.AREANALUATION «� � OWNER-�UILDER DECLARATION SFR/AOD/REM O p I MEREBY APFlRM UNDER PENALN OF PERJURY THA7 I AM EXEMPT FROM THE CUNNTRACTORS L�4 GdragB/Cdlport W CENSELAWFORTHEGOLLOWINGREASON(SEG70.31.SBl1SMESSANOPROFESSIONSCODE:ANYq'fYOR (n C.] COUNiYWHICIIREQUIRESAPERMPfTO�NSSTflUCT,ALTER,IMPFOVE.�EMOLISH,OqREPA1pANY5TRUC- W patiolDeck WTURE,PHIOR TO ITS ISSUANCE,ALSO REOUIRES 7HE APPUCANT FOR Sl7CH�PEfiM1T Tb FlLE A SIGNED � STATEMENi TNAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OFTNE CbNTHACTORS Lb � GENSE LAW(Gi�PTER e(COMMENCINO N7TH SECTION 7000)OF DIYISfON�3 OF 7HE BUS�NESS AND PRO- LL' POoUSpB- fESSpNSCODE)ORTFIA7HEtlRSHEISIXEMMTHEREFROMAN�THE8A54SFOqTNEALLE�EOEXEMP� (� TION,ANYVKKATIONOFSECTION7037.SBYANVAPPUCANTFORAPERMITSU9JECTSTHEAPPLICANTTO Z Re-Roof r ACMLPENALTYOFNOTMORETHANFIVEHUNDFiEDDOLLARS(45W)J: � � ❑I,ASONRJEROFTHEPROP'cRTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECbMPENSAYION, ❑ ComR1EIGi21 -� WILL DO THE WORIC,ANO 7HE S7RUCTUHE IS NOT IN7ENDED OR OFFEFE6 POR SALE YSEb.7o4a.BU51- J� MESS ANO PROFESSIONS CODE:1HE CONTRACTORS LICENSE LAW DOES NOT AOpLY TO AN OWNER OF � PKOPER7YWFIOBUItDSORIMPROVESTHEPEON,ANDNA1000E5SUCHWOFiKHIMSELFORHERSELFOR � � THfqUGHHISOHHEROWNEMDLOYEES,PROViDEDTHATSUCNIMPROVEMENTSARENO71N7ENDEDOR m � � ,OFFEREDFORSALEIF,HOWEYER.THEBUIl�IN00RIMPROVEMENT�SSOtAWITHINONEI'�A,AOFCOMPLE- Z TION,THE OWNER-9URDER WILL HAYE THE BURDEN OF PROVINO TMA7 HE OR SHE�Dib NOT BUIID OR � IMPROVEFORTHEPURPOSEOFSALE�. ❑i,AS OWNER OF T!{E PROPERTY,FM EXGLUSIYELY CANTRACTING WIT:i LICENSED CONiRACTORS � TO CANS7RUCT tHE 7AOJECT(SECJou,BUSWESS AND PROFESSIONS CODE:THE CONTRACTORS Ll� Valu8lio ADJ,AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROpERTYWFIOBUlLDSORIMPROVE�TLIEREON.ANp . � WFIOCONTMC7SFORSUCHPRO.�ECTSWI7HACONTRACTOR(S)UCENSEDP�'RSUlW7?OTHECONTtiAG QUMiTITY I DESCRIPTION FEE - f� TORS UCENSE UW.j. � ❑I AM EXEAIPT UNDER SEC. 8.&P.C.FOR h1IS REASON U � a V' OA7E OWNER _ � Z W Q LICENSED CONTRACTORS DEGIARATION W � I HEREBY AFFIRM UNDER PENALTY AERJUFV TNAT IPM LICENSED UNpER PFlOVISIONS OF CHAPTEF � � 8(CQMMENCINO WITH SECTION 7 ) f DIVI510N 7 0F TFjF�BUS�SS AN��F�I�C�AND � MV UCENS61S N WLL FORCE FECT. i�r_- �� m LLJ t� A\ `� — Q LICENSE CLASS LIG NO. �/ � � � — DATE CON7RAC70R_ W � WOR�CERS'COMPENSATION DECLARATION Q N IHEREBVAFFlRMUNpERPENALTYOFPER.IURYONEOFTHEFOL40WiNGDECtARATIDNS: � � z a � _iHAVEAPIDWILLMANTAINACERTIFlCATFOFCANSENTTnSELF-INSUREF4PWORNERS' �_ � COMPENSA710N.AS PROVIDED BV SECTION 370U OF TME tRBOR CODE,FOR THE PEflFOflMANCE ±� OF hiE WORK FOR WHICH THIS PEFlMIT IS ISSULD. ,� 0 � _IHAVEANDWILLMAIMAINWORKERS'COMPENSATIONINSURANCE,ASRE�IJIREDBYSECTiON ) Q 370�Of THE I.ABOR COOE,COR 7HE PERFORMANCE OFTNE WORK FOq WHICH THlS PERMI715 . - g� ISS�EO.MY WORKcflS'CAMPEPoSATION INSURANCE CARR7ER AND POUCV NUMtlER ARG; ; CONSTRUCTION �!`� AN/"Jl� y c�RRIER_ _ � PLANREVIEW �'. �..R.�V.�~ . . . z POLICY NUMBER �LECTRIC Q qn� Sy.�i �',�. 0 (fHISSECTpNNE�NOTBE�71u�PLEfECOF7HEP�MTb^F�RONEM.R�DREDD7LU+A5(EfOD;ORLESS). PLUMBING �' t F'4�/:'�V� ��'� Z I CBRTIGV THAT IN h1E PERPoRMANCE OF THE WORK FOFl WHICH THIS PERMIT IS ISSt1E0,i MECNANICA'�""�y „}� �+„y, t '� �j SHALL NOT EMPLOYANV PERSON W ANY MANNER SO AS TO BECOME Sl18JECT YO TNE '��. 1'. C 7 d,~s.?;� �} ;.- �'�-'- � WORKER5 COMVEN50.TION UWS OF CAIIFORN�A.AND AGftEE TMAT IF I SHOULD BECOME i �NSPECTION'FE� �^�• -'�"� '���'�, � SU&IECT TO 7HE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o Of THE LABOP ��"`�'� �« a�.,.� n'x.J�E+" '«v� (� ) = CO�E.I SHALL FORTHWITH COMPLY WITH THOSE PRDVISIONS. �SSUANCE f`�L- p �ATE: _ APPLICANT. SMIP -� W ENERGY P/C � WARNING:GAILURE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNLAWFUL,AND SHAILBE . � SU&IECTANEMPLOYERTOCRIMINALPENA471E5ANDCIVIIFINESI1PTqONEHUNOREDTHOUSAND ENERGYPERMIT DOLLARS�5100.000),IN ADDITIONTO THE COST DF COMPENSATION,OAMAGES AS PROVIDED FOR IN --- � SECTION37080FTHELABORCODE,INTEREST,ANDATtOqNEY'SFEES. RETENTIONFEE: a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: / Q � IHEREBYAFFIRMUNOERPENALT'OFPEPJURVTH.M1TTHEREISACANSTpUCTIONLENDINGAGENCY 1`�1 ' FOR THE PORWRMANCE OFTHE WORK FOR WHICHTMIS PERM:T IS ISSUED ISEC.3097,CN.C.�. Z W � 4ENOER'SNAME �� F— LEN�ER'SADDRE55 w ICERTIFYTHATI HEA HISAPPUCATIONANDSTATETHFTTHEAB IN MATION!SCAPRECT. IOIAL F ES � � � �/�� � IAGREETOCO LYWI LCITVANDCOUNTYOROINANCESANOSTAT LAW RE:A41NyFryya,UUUTOBUIIPING / � CONSTRUC ,AND EBYAUTHORI2EREPRESENTATIVESOFTHI OUN7YTOEN7E�NTH — �r'�� ����, � �/'� z ABOVE- T PERTV FOR INSPECT{ON PURPOS . � COMMENT _ � �� � /� � m ' PERMITTE N IN) - � - Q N , � SIONATUREOF PERMIrrEE . pATE RECPT.NO. 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