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HomeMy WebLinkAbout17497 (23) " . _ ._ .. .. . . �. � y� ----`�`---- �ITY'OF ISIAMOND BAIt ,r°`� � DEPART�El�TT OF COMMUNIT'Y&DEVELOPMENT SERVICES - 21825 E.Copley Drive �' (909)860-3195 Fa�t(909}861-3117 PRESS '�'%v��' BUILDINGPERMITAPPLICATION FIRMLY o AD RIESS` . � f��'�C't S 1��'�- � DATE CATION a��� ���� NU BER �e��� #/C `^ APN LOT TF,�ACT ISSUE • TYPE OCC —�Q DATE CONST. GROUP p OWNER G, !Y1�n � s.9 �s `�`' ADDRESS ' 3� J�t�. � ` S �— ZONING SETBACKS oCITY ��,�,y_�°pA�,� ZI — TEL. �,�,'�SG '�S�/� FRON7 RW ❑ APPLICANT TEL. REAR ❑ Z SIDE/SIDE STREET RW ❑ m 'CONTRACTaR " t [�,,�, SIDE ❑ � ADDRESS C��- - 5'�`} �' �' PROPOSED USE �t� � r��f^��a ��s�` ' '1'� � a-rr C�'v'�'[�t d�—i°3� ziP t'7 L,�e�. ' ► �,���,.� � � —°3? � ARCH/ENG! n z DESIGNER N'� r's. W N0.DWEL. NO. NO. d ADDRESS UNITS STORIES 6EDROOMS � CITY ZIP TEL. c� cr� DESCRIPTION SQ.FT. FACTOR PSF ADJ,AREA/VAlUA710N �� � OWNER-BUILDER DECLARATION SFR/ADD/REM O 0 I HEFE6V AFFIRM 11NDEq PENALTY DF PE0.IURY THAT I AM EXEMPT fqOM iHE CONTPACTORS LI- GNdgZ/CdipOfi 13J CENSELAWFORTHEFOLLOWINGREASON(SeC.7031.5BU51NE55PNDPflOFE5510N5CODE:ANYqTYOrI (n _ U COUNTYWHICHREQUIRESAPERM1IITTOGIXJSTftUCT.ALTER,IMPflOVE.DEMOLISH,ORfiEPAIRANYSTRUC- j � �.TURE,PqIOR i0 ITS 135UANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PEflM1T TO FILEA SIGNED W PatiolDeck SiATEMENT THRi HE OR SHE IS GCENSEP PUflSUANT TO THE PROVISIONS OF iHE CONTflACTORS LI- �� CEN&E LAW(CHAPTER B(CAMMENCING WITH SECTION 70oD)OF DIVISION 3 OF THE OUSINESSAN�PRO- U" POoUSpO FESSIONSCODE�ORTHATHEOfiSHEISEXEMPTTHEREFftOUAND7HE8A51SFORTF'.EALLEGEDDfEMP- (� � ��TION.ANYVIOLATIONOFSECTION7031.5BYANYA?PLICAMTfORAPc'qMIi5U8JECTSTHEqPPLICAN770 Z qe-Raof '�A CIVIL PENALTYOF NOT MORE THAN FNE HUND%EO DOLLANS(E500).): 0�� ❑I,ASOWNEROFTHEPROPEftTY.ORMYEMPLOYEESWITFLWAGE5A5THEIR50LECOMPENSAiION, � C0t111T1eIC181 -' Z WILL OO THE WORK,AND THE STRUCTUfiE IS NOT IN7ENDE�OR OFFERED FOR SALE(SEC.7a44,BUSI- ,J � . NESS AN�PROFESSIONS CODE THE CONTRAC70RS LICLNSE LAW DOES N0T APPLV 70 AN OW�'Efl OF = y� C.„+�1 "�'J j PROPERTVWHOBUILOSOPIMPROVESTHEREON,ANOWHO�OESSUCHWORKHIMSEIFORHERSEIFOR m !� 7vx, �G LC THROUGHHISORHEqOWNEMPLOYEES,PROVIDE�THATSUCHIMPROVEMcNiSARENOTINTENDE00F �., � � � �OFFEREDFQRSALE.IF,NOWEVER,THEBUILOI4GOftIMPFOVEMENTI550LDWITHINONEVEAROFCOMPLE- ��. d�s° �. �.TION,7HE OWNER�BLIILDEfl WILL FiAVE 7HE BUFDEN OF PflOVING iMAT HE OR SHE DI�NOT BUILD OR , � �IMPROVEFORTHEPURPOSEOFSALE). �� W � ❑I,A50WNEROFTHEPROPERTY,AMEXCLUSIVELYCONTRACTINGWIiHLICENSEDCONTRACiORS [[ �TO CONSTRUCtTHE PROJECT(SEC.7af4,Bl1SINESS AND PROFESSIONS CODE:THE CIXJTFACTORS LI- VBIUdf10� t �"�" AD.I,AREA W '.CENSEL4WDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPflOVESTHEREON,AND � '•WHOCONTRACTSFOASUCHPROJECTSWITHACONTqACTOR(S)LICENSECPUR5UANiT07HECONTRAG QUANTITY DESCRIPTIDN FEE Y TORS UCENSELAW). � ❑I M1 EXEMPT UNDFA SEC.__ B.8 P.C.FOfl THIS REASON Q - � v W � '. 'DATE OWNEfl U � LICENSED CONTRACTORS DECLARATION � . ��, 1 HERE6Y AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNOEfl PROVISIONS OF CHAPTER � p`� � 9�COMMENCINGWITHSECTION70W)OFDIVISION30FTHEBUSINESo^ANDPROFESSIONSCODE,AND Z 7f. MYLICENSE IS IN FULL FORCEAND EFFECT. �, LICENSE CLASS �� e �✓��p���L� /� � a .r� _.LIC.NO,____ � � V DATE I��� dl�� CONTRACTOR I��'� T'1�, d . W � WORKERS'COMPENSATION DECLARATION J Q � IHEREBYAFFIRMUNDEFPENALNOFPERJUpYONEOFTHEFOLLOWINGDECLARATIONS: Z C3 _I HAVE AN�WILL MAINTAIN A CERTIFICATE OF CONSENiTO SElHNSUR'c FOR WORKERS' _ Z COMPENSATION,AS PROVIDED BV SECTION 3l0o OFTHE LABOR CODE,FOR THE PERFORMANCE 1U � � OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � W .�I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION IN6UflANCE,AS RE�UIRED 6V SECiION g ♦ '�, Q� 31oa OFTHE LABOR CO�E,FOFl THE PERFORMANCE O.'TF!E WOFK FOR WIiICH THIS PERMIT IS �� y f a,,,,y p ISSUED.MY WORKERS'COMPEN59TION INS�UR,,A�NCE�CpARRIEfl ANO POLICY NUMBER ARE, CONSTRUCTION � �p�� jCARRIER �{,����^q���'-'V� PLAN REVIEW Z POLICYNUMBER \���l K� ELECTRIC Q � (IHISSECT%INNEmNOTBE�OMPLE7�OfTHEPERMTISWRONEHUWREDDOLtARS($700)ORLESS). PLUMBING . Z, I CEFiTIFY THAT IN iHE PERFORMANCE OF iHE WORK PoR WHICH THIS P'cRM171S ISSUED,I MECHANICAL ('3' SHqLLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOME'o'JBJECTTOiHE ' � WORKERS'COMPENSATIONLAWSOFCALIFORN:A,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE ' S�BJECTTO7HEWORKEflS'COMPENSATIO PFOVISIONSOFSECTION37000F EL490R �� ��. CO�E.ISHALLFORTHWITHCOMPLVWITHTH EPROVISIONS ISSUANCE ��r��y��/ d �ATE: J�''��" �APPLICANT: � � SMIP '�I�AC �. J" WARNING:FAIWRETOSECUqEWORKEHS'COMPENSATIONCOVERAGEISl/N1AWFi1L,AN�SHALL9E ENERGYP/C �y SIJBJECTANEMPLOVERTOCflIMINHLPENALTiESAN�CIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT � OOLLAflS(5100.000),IN ADDITION TOTHE COSTOF COMPENSATION,DAMAGESAS PROVIDED fOR iN ' J��'. 'SEC710N3lOeOFTHELABORCODE',INiEREST,ANDATfORNEY'SFEES. RETENTIONFEE: �' . p�„' CONSTRUCTION LEN�ING AGENCY PRE-ALT FEE: � � IHEriEBYAFFIRMUNDERPENALTYOFPERJURYTHATTHEflc'ISACONSiRUCTIONLENDMGAGENCY FOR THE PERPoRMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3o97,CIV CJ. . Z W — — � LENDER'S NAME I—' LENDER'SADDR[55 � TOTAL FEES � ' ICERTIFYTHATIHAVEREADTHISAPPLIGATIONANDSTATETHAiTHEABOVEINFORMAiIONISWRRECT. w IAGREETOCOMPLYWIiHALLCITYANDCOUNTYORDINANCESANDSTATELAWSRELATINOTOBUI�DIN� � �� . CONSTRUCTION,AND HERCBV Al/THORRE REPqESENTATNeS 0F iH15 COIINTY TO ENTER UPON iHE ,,r� � ' z�' p6OVE-AAENT NE�PpOPER7VFORINSPECTIONPURPOSES. COMMENTS - � ���'�� � q �.�,°v"^�G/� �1 � � �� m� PERMITTEENAME(PRI . ' � Q.. C/J � SIGNATVREOF MITfEE DATE , = ftECPT.NO. 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