HomeMy WebLinkAbout16334 (22) �� CITY OF DIAMOND BAbi , �
DEPARTMENT OF COMMLJNITY&DEVELOPMENT SERVICES
a 21660 E.Copley Drive Suite 190
(909)860-3195 Faz(909)861-3117 PRESS
���'� BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE Z Z�� �/J,C CU 4�- APPLICATION /� .l1 PERMfT P/C
ADDRESS � � DATE � � �V 'V I NUMBER � # I
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A TRACT DATE ��D 'D I CONST. GROUP
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� ADDRESS �� �O. LOtiJ�t ..57.� �I�" C3(o � ZONING SETBACKS
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N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM '
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� 1 HEREBY AFFlRY UHDER PENALTY OF PERRIRV THAT I AM E%EMPT FROM 7HE CON�RAC70R5 LI� G0f890/CBf�MfI
CENSELAWFORT1iEFOLLOWINOREASON(SEC.7o31.6BU5WE55ANDPROFESSION5CO0E:ANYCITYOH (n
COUMVNMKXIREOUIRESAVERMRTOCONSTRUCi,�1TER,IMPROVE,DEMOLISH.ORREPAIRMIVSTRUC� W Petlo/DBdc
TUHE,PRpfi TO ITS ISSUANCE,ALSO RE�UIRES THE APPLlCANT FOR SUCF1 PERMR TO FlLE A SIGNED � w
STATEMQfT THAT HE OH SHE IS 110ENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI�
� CENSE UW(GUPTER Y(COMMENCWO WITH SECTION 7000)OF DIVISION 7 OF THE BUSINE55 AND PRO- � Pool/Spa -
FESSIDN9 CODEj OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOH THE N.LEOED E%EMP- (�
TION.ANYVIOLATIONOFSECTION7031.6BVANYMPUCANTFORAPERMRSU&IECTSTHE�PPLICANTTO Z Re-Roo(
� ACML VENALT'OF NOT MORE THAN FfVE HUNDRED DOLLAHS(f500).):
� ❑I,ASOWNEROFTHEPHOPERTV,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, 0 COrt1lI10fClfll . . �
WILL DO THE WORI(AND THE STRUCNRE IS NOT IMENDED Ofi OFFEHED FOR SALE(SEC.70N,&156 J
� NESS AHD PROFESSION9 CODE THE COHTFUCTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF j
PqOPERTV HR10 BUILDS OR IMPROVES h1EREOH.AND NTiO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THAOUGH HIS OR HER OWN EMPLOYEES,�ROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT MTENDED ON m
L}� OFFERmFOR&ALEIF,HOM�E1/E0.TNEBLAL.D�NOOR�MPFiOVEMBlTISSOL.DWITHINONEVEAqOFCqAPLE-
Z �•TION,THE ONTIERAUILDER WILL HAVE THE BURDEN OF PROVWO THAT HE OR SNE DID NOT BUILD OR .
� IMPROVE FOR TME PURPOSE OF SN.E�
❑�.AS OWNER OF THE PROPEHTY,AM E%q.USIVELYCONTMCTWO WfTH 110ENSED CONTRACTORS
� TO CONSTRUCT THE PROJECT(SEC.7oN,BU91NES5 AND PROFESSIONS CODE:THE CONTRACTORS U� V01U8�{0(1 ADJ.AFlEA
� CENSEUWOOESNOTMPLYTOANONRlEROFAPROPERT'NRiDBUILD90FIMPROVESTHERE-0N,�77D �
WIqCOHfMCTSFORSUCHPROJECTSWfTHACONTAACTOR(5)LICENSEDPURSUMlTTOTHECONTRAG qUANTITY DESCRIPTION FEE �� !�
TOR�S LfICENSE LAW.1. . Ai
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� 1 HEREBY AFFlRM UNDER PENALTY OF PERIURV TIAT I AM UCENSED UNDER PROVISIONS OF CHAPTER � / �.(j/' '�,' / �
� a(COAIMENCYKl WRH SECTION 7000)OF DIVISION 3 OF THE BUSINESS ANO PROFESSIONS CODE,AND Z / /�[l[
MY LICENSE IS IN FULL FORCE AND EFFECT. m � �� �
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� WORKERS'COMPENSATION DECLARATION Q � ,///� � •
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� I HEREBY AFFlRM UNDER PENAI.TY OF PEHJURY ONE OF THE FOLLOWINCi DECLAMTIONS: Z /� � 1
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� _I HAVE AND NRLL MAMITAIN A CEHTIFICATE OF CONSENT TO SEIF-INSURE FOR WORKERS' _ / � /
COAfPEN3ATION,AS PROVIDED BV 9ECTION 3100 OF THE UBOR CODE,FOR THE 7ERFORMANCE U
O OF THE WORI(FOR HM1i1CN THIS PERMIT IS ISSUEO. � /
_I HAVE AND WILL MAIMAP/WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION // �) �� � /
Q370o OF THE UBOR COOE,FOR THE PERFORMANCE OF THE WORI(FOR WFiICH h115 PERMR IS �')1 !/.�J• /� rn
� ISSUED.MV WORKEAS'COMPENSATION INSURM{CE CARRIER AND POIICY NUMBER AAE CONSTRUCTION _ L� 7« � �•�
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� va�crriuMeER ELECTRIC �' • r� '
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Z I CERTIFY THAT W THE PERf-0RMANCE OF THE MfORK FOR WHIq1 THIS PERMIT IS ISSUED,I MECHANICAI
(} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SlJ61ECT TO THE
N WOW(ERS'COMPENSATiON LAWS OF CALIFORNIA,AND AOFEE THAT IF I SHOULD BECOME INSPECTION FE /
SUBJECT TO THE WOpNERS'COA/PENSATqN PROVISIONS OF SECTION 7700 OF 7HE UBOR �j� �
OCOOE,ISHALLFORTHWITHCOMPLYWITH7HOSEPROVISIONS. ISSU/1IJCE � — / � {J '
p DATE: APPLICANT: SMIP . .�"�=.: �y4�
w ENERGV P/C �
� wAANIN(i:FAILURE TO SECURE WORKERS'COM7ENSATION COVERAOE IS UNLAWFUL,AND SHALL BE
. �—y SUB.IECTAN EMPLOYEH TO CRIMINAL PENAL7IES AND CML FINES UP 70 ONE HUNDRED 7HOUSAND �� �)
DOlURS(f100.000�.IN ADDfT10N TO THE COST OF COAIPENSA�ION,DAMAOES AS PROVIDED FOR IN ENERGY PERMIT � /b VJ �
� SECTION J�oE OF THE UBOR CODE,INTEREST,AND ATTORNEI"5 FEES. ' RETENTION FEE: �� '���
� CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
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� I HEREBV AFFlRM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENDWG AOENCV
FOR THE PERFORMANCE OF 7HE WOflK FOR WHICH?HIS PEHMIT IS ISSUED(SEC.30Y7,CIV.CJ.
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� LENDER'S NAME � �
� LENDER'SADDRESS
� ICERTIFVTHATIHAVEREAD MFLICATqNANDSTATETHATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES � ��
w I AOREE TO COMPLV WI l C D COUNTV ORDINANCES M1D STATE UWS REUTINO TO BUILDINO
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� CONSTRUCTION,M1D H EBY AUTH ZE FEPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE '
Z ABOVE-MEHTIONED F ERTY FOR IN EC710N PURPOSES. COMMENTS � �
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ROOF COVER + PRE-GRADING
ROUGH NEATlNG BENCHING
ROUGH ELECTRIC • RDUGH GRADING
ROUGH P�UMBING FINISH GRADING
SWOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FEI�CING
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