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HomeMy WebLinkAbout16534 (39) CITY OF DIAMOND BAI,2 f"" � �1, ^---��" DEPARTMENT ORCOMMUNITY&DEVELOPMENT SERVICES ti . 21660 E.Copley Drive Suite 190 ��""'�� (909)860-3195 Farz(409)861-3117 PRESS ��'•... BiJII:DING PERMIT APPLICATIQN FIRMLY o ADDRESS�,,����/'�,� .� DATECATiON �,,� �� NUMBER �� #/C c� , ISSUE TYPE OCC APPI LOTi TRACT DATE CONST. GROUP � OWNER O � ADDRESS � ZONING SETBACKS SCITY(,�j�j�y('�i�.,� ZIP TEL. FRONT RW 0 APPUCAM TEL. REAR ❑,_ Z SIDE/SIQE STREET RW ❑ � CONTRACTOR � SIDE p � ADDRE55 P OPOSED SETI � a�r(�yi�;1t�., ,�� z� ,, ��L. ' r- ���� , w ARCWENG/ W DESIGNER =' „ '... '' , '• � ADDRESS � NO.DWEL. N.O. � ClTY � ZtP TEL. UNlTS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q �� C�WiVER-BUlLDER DECLARATION SFR/ADD/REM O 1 HEAEBY AFFlRM UN6ER R,EtdALTY OF PERJURY THAT,i MA EXEMPT FROM THE CONTRACTOHS LI- Gflffl92/C2f{WfI �t,�LJ CENSELAWFORTHEFOILOWINGREA50N�5EC.7031.56U51NES5ANOPflOFE5510NSCODE:AN7CiTYOfl (f� .C.� � COUNTYWHICNflEWIRESAPER ITTOGONSTRUCT,ALTER�MPflOVE,OEMOLISH,ORREPA{flANYSTRUC- - LLI Py410/OBCI( � �W �TURE.PRI6R TO ITS fSSUANCE, SO REQUIRES THE APPLICANT POR SUCH PERMIT TO FILE A SIGNED W $TATEMENY THAT HE OR SHE{S LICENSED PURSVANT TO THE PROVISIONS OF THE CONTRACTORS LI- ��� "�CENSE L41N(CHAPTEiA 9(CbNMEPICING WfTH SECTION 7000)OF DIVISION 3 OF TNE BUSINESS AND PRO- �" POOIISPB � � � � �S.� FE6SIOI�COOE}ORTHATHEOF�5F7Et5E%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- ;�TION.ANYYIOWTK9NOFSECTI0�Y7091.6B'fANVAPPLICANT�ORAPERMlTSU&IECTSTHEAPPUCRNTTO Z Re-Roof � ACIVIL YEPoALTY OF NOT MDRE ikiAN FIVE Y,Uh'DRED DOLLAAS(55o0)J: CI,ASOWNEROF7HEPflOPFRTY,ORMVEtdALOYEESWITNWAGESASTHEIR50LECOMPENSATION, Q z Camm�reial - ",��WILL DO TWE WORK,AND TNE S F0.ICTURE iS NOT INTEN6ED OR OFFERED FOP SALE(5EC.704d,BUSI- J � i �: NESSMDPAOFESSIONSCODE:THECANTRACTORSLICEN$ELAWDOE540TAPPLYTOANOWNEROF = �, � . .PiiOPERTYVhIGBUiLDSORIMP OVESTHEREON,ANDWHOOOESSUCHWOFKHIMSELFORHERSELFOR '(� '.THROUGHNISORHEAOWNEMPOYEES,PROVID�THATSi1CHIMPROVEAAENTSARENOiMTENDEDOR � , �Q�. I,OFFEREDFORSALEIF,HOWEVE 7HEBNLDiNdORIMPROYEMENTI55oLOWITHINONEYEAROFCAMPLE- � ��YION,7FE OWNER-B1:11DEA 4NI' HAVE THE BURDEN OF PROVING THAi YfE OP.SNE DID NOT HUILD OR � � �,IMPROVEFOflTHEPUflPUSEDFISA3.Ej, ' � � CI,ASOWN£ROFiHEPA 6RTY,6SAE%CWSIVELYCONTRACT!NGN11TNlICENSE�CAP'TRACTOqS ��. �'TO�COPIS7RUCT 7HE PROJECT�EC.7D94,SUSIAI�S AND PflOFE5510NS CODE:THE CONTRACTORS LI- V8lU82i ADJ.AREA � � '�; .CENSELAWD065NOTAPPLYTC/���ANDWPeERtlFAPHDPERT�'MRi�6U1L�50flIMPROVESTHEREON,ANO ���,6VHQCONTRACTSFOH&UCHPA(SJECTSM/ITHACtrNTRPaCT66E(S)L�CENSEDPUFSUANTTOTHECONTRAG Q(j,4NTITY DESCRiPT80N FEE�� . i:',�,� .'�TORS UCEP95E WW.j. ��., , ' . . . . . �'o ❑f PlA EXEMPT UN�Efi S�C. B.fl F.G FOR TNIS REASON Q - '` ' - ` � {�, C� � � onaE owr�Ew V w O' ' w g L6CE SEDCONTAACTOASDECL4RATION J OC � W IHEREBYAFFIRMUN�ERPENAL?YOFPERiUFSYTHATIAMLICENSEDUNDERPflOYI510N90FCHAPTER ¢� � ','p:. I 9I�MENCINf3 WITM SECTION YO�a)OF OIVISION 30F THE BUSiNESSAN�P(1OFESSIONS CODE,ANG Z _ X '�PAYUCENSE iS IN FULL f'ORCEAND EFFECT. ,.0 �LICENSE CLA55 � LIC.NO, ?�/��� j - � -� .DkTE.Q���__------� CON1'RACTOR Y7l JL�����ji"Z' �Y�7s J �� YJOABC�ER3'CO�APENStiT10N DECLRRATION � ¢ �'�� IHEfl'cBVAFFiRPAUNDERPENRL71'OFPERJUfiYDNEOFrNEFOLLOWINQDECLARATIONS: � �, .�_IFIAVEAM1VQWILL�AAINTFyNACERTIFICATEOFCANSENTTOSEIF-INSUSiEFORWORKERS' S - COMFENSATIOi�1,RSPRdVIDEDBYSECTION37oCOFTHELABOR�O�E,FOR?HEPEFFORMANCE `U OF THE WORK FOA�NHISH?HiS PES3kS1T I6ISSUEO. � 0, �W �I HAVEAND%iLL�AAINT IN WQRKERS'COMPENSATiON iNSt1RANCE,AS REDUiRED BY SECTION gg,y� �, 37W OFTHE L49bR OD�,FOR THE PERFORMANCE OFTHE WONK fOR WHICHTHIS PERMIT i5 {n p Q 0�� ISSUEG.MYWORK {� PEN6ATI0�4IN5 NCE�CfAR.RIERANDPOLICVNUMBEftAftE: CONSTAUCTION e�-� 1 � j��� cnwaie� � !'t/Yw�+�.^r� Pl.AN REVIEW ��.�� aa.icv NUMeen � D.�I si_v ELECTP.tC � ,Q, (IH�SS'ECTK.WNEr'Dh'OT�EOOMPiETEU6FiNEPEPWl�ISFORCNEIaUK7REDDIXLARS(510D�OqLF.SS). PLUMBlNG 91J, I �, ', I CERTIFV TBiAT IN THE f�ERFORMANCE GFTHE WORK FOR WHICH THIS PERMiT I5 ISSUED,I fv1ECHANICAL (},i,'., SHALLNOTEMPLOYANYPERSONINA4YPflANNER50A5T09ECOME5U6JECTTOTHE ��,qfy����, WORKEHS'COMPENSA7�ONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOUL�BECOME !NSPECTIQNFEE Stl&)EGT?CTHEWOFK RS'CQMPENSATIONPRDYISIONSOFSECTfON37�00FTHELABOF ,C'Y, � ������ CADE,'ASHAILFJRTHW�7'HCU?A7LYWI?HTHOSEPROVISIONS. �SSUANCE �.J � SM�P �'�.� I DATE: � �1PPLICANT. � ' p ..J��.. WARNING:FAIWRETOSECVRE OAKERS'CDAAPENSAT!QNCOVERAGEISUNtRWFt1L,ANDSHALLBE ENERGYP/C - �—y� SU&IECT AN EMPLOYERTO CRI INAL PENALTIES AND C1VIL FINES UP TOONE HUNDRED THOUSAND ��" DOILARS(57o�,o0o}.INAO�ITIOI�TOTHECOSTOFCOMPEN6ATION,DAMAGESASPROVIDEDFORM ENEflGYPERMIT t _ __� ~ �i,, .SECTIDN3]OBOFTHELABORLOOE,��INYcREST,APIDATTORNEY5FEE5. ���� RETENTION FEE: � .m�l� CQNSTRUCTIONLENDINGAGENCY PFiE-ALTFEE: OI I ��;� IMEREHYAfFIRMUNOERPENAIMOFPERJURYTNATTHEREiSACON3TRUCTIONLEN�INGAGENCY - � FOR hIE PERFORMANCE OF TH�WORK FOR WHICH THI3 PERMIT IS IS3VED(SEC.909],CIV.C.). . � � , — — ,�', LEPdDER'S NAME � ' � ,}-^�� lENOEF°SADDf?ESS ��� ICEPTiFYTHPTfHAVER.EAD7H`I�5APPLICATbNANDSTATETHATTHEABOVEINFORMATIONISfARWECT. TOTAL FCES ' � 3�,>{ �W� I AG3iEE TO COMPLY WITHALLI:+TY AND COUNTY OA�INANCESAN�STATE LAWS RELATING TO BUILOING ' �'�; COtdSTRUCTION,ANDHEflEHY�VTHORREREPRESENTNTNE50FTHISCOUNTVTOENTERUPONTHE .�� RBOVE-MENTIONE�PR ER?Y FOR IhSPECTION PURPOSES. . COM1AMENTS - � � ��� � '�.',.' 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