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HomeMy WebLinkAbout13596 (14) __�,� CITY OF I3IAMOND BA� DEPARTMENT OF COMMIJIVITY&DEVELOPMENT SERVICES ,; 21660 E.Copley Drive Suite 190 �w PRESS (909)8G0-3195 Faa�.(909)861-3117 . ro�"` BiJIL'DIl�Ci PE'", APPLICATIbN "` FIRM�Y o ADDRESS � � DATE CATION PERMIT t-�.�} P!C JOBSITE � � APPLI NUMBER �-J"i # c.� ISSUE �"" � TYPE OCC APN�LOT _,,,T�CT _ DATE -.���—� I. CONST. GROUP p pWNER , D�"�..�� ADDRE � �� c �— ZONING SETBkCKS gCITY _ ZIP TEL. FRONT RW ❑ APPLICANT , 7EL. REAR ❑ � SIDE/SIDE STREET RW ❑ CONTRAC l � ''1 l SIDE ❑ � ADD _ -- PROPOSED USE � CITY_� ^ � ZIP TEL w ARCH/ENGJ 1�,p��q w i �tA 6��� z DE5IGNER P V '���`' A"� N0.DWEL. NO. NO. � ADDRESS UI�tTS STORIES BEDROOMS � CITY ZiP YEL. � — DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION d OWNFR-BUIL�ER DEC�.4RA710N SFRIADDlfiEM O � �HEREBY AFFlRM UNDEfi PENAL4V OF PERJURY THAT I AM EXEMPT FROP.9 TNE COMRACTOflS LI� (�^gle�B/C3fpOR LL8 CENSEIAWFOHTHEFa.LOW�NGREASON(SEC.7031.SBUSINESSAtJ�PROFES510N5CODE:ANYCITYOF (n 52 COUNTYINH�CHRE�l71RESAPERMlTTOCONSTRUCT,ALTER,IMPROb'E.DEMOLISH,ORREPNRANYSiRUC' W P81io/OBGk LTURE,PRIOR TO fT3 ISSUANCE,ALS'O RC-0UIRES THE APPLICAN7 F6R'SUCH PERMIT TO FILE A 51GNED W STATEMENT 7HAT HE OR SHE 15 UCENSED PURSUANT TO THE PHOVISIONS OK THE CONTR,4CTORS C.I� � CENSE LAW(CHAPTER B(COMMENqNO WITH SECTION'100o)OF DIVIuION 3 OF THE OUSINESS AND PFO- �'�' PooUSpa __ FESSIONSCODE)ORTIIATHEORSHEISEXEMP7THEPEFfiOMANDTHE8A515FORTHEALLEOEDEXEMP� (� — TION.ANVVIOLATIONOFSECTION703i.59YANYAPPLICANTFORAPERMIT5U8JECT5iHEAPPLICANTTO Z Re-Roof � ACML PENQTY OF NOT MORE 1'HAN FIVE HUNOqED DOI.IJeRS�(5500).): � �� ��� � � � ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPI6YEESWlTHWAGESA5T4EIRSOLECOMPFNSATION, C� COfI11Tte�Ciel - WILL DO THE WORIC,AND THE STRUCNRE IS NOT IN7ENOED OR OFFERED FOR SA'_E(SEC.7044,6US1- .�J NESSAND PHOFESSIONS CODE:THE CON7RACTORS UCENSE LAW pOES NOT APPLY TO AN OWNER bF � PROPEHTYWHOBNIDSORIMPROVESTHEREON,ANDY�IODOES5U6HWOAKHIM3'cIFORABRSELFOR -� Q TMROU(iNii1SOPMEROWNEMPIOYEES,PROVIDEDlHATSUCHIM?ROVEMENTSARENOTINTENQEOOR m � .OFFEREOFORSALEIF,HOWEVERhiEBU�tDINGORIMPROVEMENTI.SSOIDWITHINONEYEAROFCOMPLE �TION,THE OWNER-BUIIDER WILL HAVE THE BUR�EN OF PROVINfl�7HAY HE OR SHE Dld NOT BUILD OR � IAIPROVEFORIHEPURPOSEDFSALF). �.'. . -'..� � O 1.AS OWNER OF THE PROPERTV,AM EXCLUSIYE�Y COMFACTiNO WIYN UCENSEb CONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.7044,BUSINESS AkD PFlO�CS^uIONS CODE:THE CONTAACTORS ll- VelL3 � ADJ.AfiEA W CENSELAWDOESNOTAPPLYTOANOWNEROFAYROPERTYYdHOBUILD50RIMPROVE5h9EREON,ANO � NhiOCONTRACT5WR5UCHPRQIECT5WITHACONTRr1CTOR(S)LICErlSECPUPSU.4NTYOT!1ECQPITRAG Q�JANTITY DESCRiPTION FEE Y TORS LICENSE UWJ. � ❑i qM EXEMPT UN�E(i S�C. �.&P.C..FOp THIS qFASON Q � v — � � � ' _ OATE _._ OWNER___ _ V Z _. �_ _ I,1.1 � LICENSEU CONTAAC70RS DECL4RATION W, � 1 HEREBYAFFIRM UNDEP PENN_iY OF p R1URY THA71 A UCENSEp UNDER PROVISIONS OF CHAPTER �� � 9(COMMENCINO WITH SECTION 7000) MfSiON 3�E BUS�C��QFESSiONS CODE,APA � ��� MYUCENSE IS IIJ FULI FORCEAND E a+��/4 �e�,.� CYS 0 UCENSE CLASG UC.fd0.�'J . . .. ..... . . . .. � _ �—_-- � J� Ly OATE CONTRACTOP _.�, _ �- W � WQR.KEFt5'COMPENSATI6N�EClARATION -� � . � ,. _ . . . . d �.�..;:.�.. ��,: . .. �. _., , � ..... �. .�. .... ...,i� U � I HEREBV AFFlRM UNUER PENRLTY OF 7ERJUFY ONE Of THE KOLL�W WG D�CLARATIONS: Z � Gl �kAtiE0.N0WILLPAAINTAINACERTFICATEOFfANSENiTOSEIf-INSUREF4RWORKERS' � � COMPEMSATION,AS?ROVi0E0 BV SECTION 37Do OFYHE LABOR CODE,FOR THF PERPORMANCE W OFTHF WOGMC FOR WHICH 7HI5 PcRMIT IS ISSUED. , � � W _IHAVEANUWIILMAIN;AINWORKEPS'COMPENSATIONINSURANCE,ASREQUIREDBYSECTION / Q 37o00F TF+,E LABOR WOE.FOR THE PEflFORMANCE OF THE WORK FOR WHICH THIS PERMI'IS ( /��[ �p� -�y, ISSUEO.MV WORKERS'�AAPENSATIOYJ INSURANCE CARqIERAN�P(k.ICY NUMBERAPE� CONSTRUCTION �-§' �.� J� 7 jCARRIER _. �._�__�_ PLAN REVIEW Z aoi.icrNuus�a_ -- ELECTFiIC � �,^:,w, (fHISSECTIQYNEEDNOTBE0Q7�PlEIED�THEPEPAYfISF�ftCMIEFIUM1flREDCCV..tARS(510010FtLE55;. PLUMBING ` `�..�'r,: -:�� W �_.. Z ICERTIFYTNATlNTHEPEflFORMANCEOFTHEWORKFORWFIICHTHISPEFiAAITISISSU[D,i MECHANICAL (}' SHALL NOT EMPLOYANY PEfl50N IN ANY MANNER SOhS TC BECAME SUBJECT TO THE � WORKERS'CAM9ENSATIONLAWSOFCALIfORNIA,ANOAGREETHATIFISHOU�DBECOME INSPECTtONFEE � � SUBJECT70THEWOHI(ERS'COMPENSATIONPROVISIONSOFSECTION370oOFTHEtABOR � r yC`-� � COOE,ISHALLFORTFiVdITHCOMPLYWITWTHOSEPROVISR7NS. ISSUANCE �+`�F�.� � �'S Fa�+'�� � �C O ffi��— ° 5� �Y� DATE: APPL.ICANY. SMIP g ( � Y t. & � >��a-e�°a.. w ___ . — W.:3.� � °1...�����aS.t�,�' xi ��:a'3,� —, WARNING�FAILURE TO SECUFtE WOqICERS'COMPENSAT�ON COVERAGE IS UNLAVdFUL,AND SHAIL BE ENERGY P/C t"��n � SU&IEC7ANEMPLOYFRTOCRIMINALPENAI.TIESANDCIVILFINESUPTOONEHUNDRE�THOUSANO �NERGYPEFtMtI`�""��"'�`�'�''�${'�.� ~g��'�"" ' � � ' OOILARS(5700,0OO�.IN ADDITION TOTHE COST OF COMPEN5ATbN,DAMAGES AS PqOVIDEO FOR IN J SECTqN 37oe OF THE LABOR CO�E,INTEREST,ANO ATTORNEY3 FEES. RE7ENTION FEE: � �� pW_, CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � 1 HEREBY AfFIRM UNDER PENALTY OF PERJ'JRV THATTHERE IS ACONSTflUCTiON LENDING A6ENCY ��� � �" FOflTHEPERFORMAMCEOFTHEWOFKFORWHICHTHISPERMITISISSUED(SEC.9097,CIV.C.). ����J-�— W — — � LENDER'S NAME _ _—�—���-� F— LENDER'S ADORESS __� . ... � �'(3TAL FEES W I CERTIFY THAT I H THISAPPLICAT�ON AND STATE THAT THE ABOVE I AATION IS COftFECT, �P . � IAGREETOC9 WI7 LLCINANDCOUNTYORDINANCESANDST 5 LAYINGTOBUIL�ING . � �� CONSTRUCTI ,AND AEBY AUTHORIZE REPRESENTATIVES OFT�� C TV T ENTER U NTHE` � �+P� ZABOVE- OPERN F I PECTION PU POS ,�� � // COMMENTS p " � ` � � � r�� ��i __ . . .. . . ., m PERMffTEE IdAM RINT) � ¢ SJ � � SIGNATUREOFPERMITTEE DATE � �' � ' ��„ _ _.__ __.—� RECPT.NO. _ �-�PAID BY - VAIIDATION, ~ WHITE—Department Copy,VELLOW—Finance Copy,PIMK—Assassor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy "�'� � �`ffi�a�r ^�;� �-� �"s�^,�*3 � ...�n ��� �� � �u,�-4,hs��,,;� �.�a.� �.^'�„ ;r: , g .. . . . � �. ���.- ,:, .. �_,: -..... . . 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