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Home My WebLink About11955 �� CITY OF DIAMOND BAl� " " ry ' /�' b DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 W (909)8603195 Fax(909)861-3117 PRESS :,.,.�:''�' _ BUII.DING PERMIT APPLYCA'I'�ON.. � �r ,.... . ... ,.; �,, .;,.. .:, FIRMLY o ADD ESS f�/�� i� ��N,Q� APPLICATION�,� �� ERMIT , 1 q /C DATE UMBER 1 I, I_ # � APN LOT TRACT `l��J 15SUE TYP6 TT pCC DATE CONST. GR�UP p OWNER �'�Ct.1� E� .C7. � � ADDRESS �� !G E. ' ZONING SETBACKS � CITY ��'1'h�I ZIP 1 � TEL. - RE�ART RW ❑� APPLICANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR ��' C SIDE � Q ADDRESS PROPOSED USE � � • o CITY ZIP TEL �" � G/ (,r,h � cc.�TCC9�'" p ARCHJENG/ z� DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. v� y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DEGLARATION SFWADDIREM O p I HEREBV AFFlRM UNDER PENAL7Y OF PEfiIURV 7HAt i AM E%EMPT FROM THE cONTRACTORS IJ- G8r&9B/CBtpOR W CENSELAWFORTHEFOLLOWINGREASON(SEC7o31.58USWE5SANDpIiOFESSWNSCADE:ANYCITYOR (n U COUNTYYrt11GHREQUIRESAPERMtTTOCONSTAUCT,A�TEP.MPROVE,DEMOUSH,ORREPAIRANYSTRUC� W Paiio/DBCk W 7URE,PRIOH TO RS ISSUANCE,ALSO REW IRES THE APPLICANT FOq SUCH PERNIT TO FlI.E A SIGNEO W ' � STATEMENT TNAT ME OR SHE IS LICENSEO PUFtSUANT TO THE PROVISIONS OF THE CONTRACTORS U• � CENSE LAW(CNAPTER 9(COMMENCINO WITH SECTION 70a0)OF OIVIS�ON 3 0F THE BUSINESS AND PR0- � PooUSp2 FESSIDNS COOE)OR TNAT HE Op SHE IS EXEMPt711EREFROM AND THE BA313 FOR hiEALLEGED EXEMP- TION.MIYVIOLA710NOfSECTION7o9tbBVANVAPPLICANTfORA�ERNITSU&IECTSTHEACPLICANTTO Z Re-Ro0} � �CMLPENALTYOFNOTMORE7HANFNEHUNDRED�OLIaflS�S500�.j: � ❑I,ASOYVNEHOF7HEPHOPER7Y,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSA710N. 0 CommefCi81 - VYILL DO THE WORN,AND THE STRUCfURE IS NOT INTENDEO OFl OFFERED FOR SAIE(SEC.701�,BUSI- J NESS ANO PpOFESSIONS ODDE:THE CONiRACTOHS LICEN&E LAW DOES NOT APPLV TO AN OWNER OF � PqOPERTYIMIOBUNA50RIMPROVESTHEREON.ANDVMO�OESSUCHWORKHIMSELFORHEPSELFOR � Q THROUCiHHI50RHERONRJEMPLOYEES,PROV�DED7HATSUCHIMPROVEMEMSARENOTINTENDEDpR m QOFFEREOFOPSALEIF,FIOWEVERTMEBUILOINGORIMPROVEMENTISSOLDWRHINONEVEAROFCO.IIPLE- z �TION,7HE OWNER�BUILDER WILL HAVE 7HE BUR�EN OF PROVING THAT HE OR SHE DID NOT BUI�D OR � IMPROVEPoRTHEPURPOSEOFSAI.E). w �I.ASONRiEROFTHEPROPERfI',AMEXCWSNELVCAMRACTINGWRHLICENSEDCOMRACTORS � TO CONSTRUCTTNE PRQIECT(SEC.�ou,BUSINESS AND PROFESSIONS COOE�TNE CONTRACTOFlS LI� V81U9110n ADJ.AREA W CENSEUWDOESNOTMPLVTOAN�VINEROFAPROPENTYNhIOBI1RA30RIMPROVE3THEFEON;AN� � W/qCf�NiRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHEOONTRAG QUANTITY DE CRIPTION FEE � TOASLICENSEUW.). ❑IMI EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q 3 _ � � DATE OWNER � � U Z W � LICENSED CONTRACTOFS DECLAR ION W � 1 HEREBYAFFIRM UNOER PENALTY OF PERJURV TMAT I AM LICENSFD 11N0ER PROVISIONS OF CHAPTER � � 9�CONMENCINOWI7HSECTpN7000)OFDIVISION30FiHEBUSINESSANOPROFESSIONSCADE,ANO Z �� MV IICENSE IS�N FUIL FORCE MID EFFECL m � UCENSE CLASS LIC.NQ � V pAiE CONTRACTOR �- ' � - 0- W � WOHKERS'COMPENSATION DECLARATIDN Q = U � IHEREBYAFPIRMUNDERPENALTYOFPEiUURYONEOFTHEFOLLAWINGDECLAqATIONS: � N Q � _IWWEANDWIILMAINTAINACERTIFICATEOFCONSENTTOSftF-!NSt1REFOPWORKERS' _ COMPENSATION,AS PROViDED BY SEC710N 870o OFTHE 1A60R CODE,FOR THE PERFORMANCE `U OFTHE WORK FOHN?11CH THIS PERMIT IS ISSUED, � � W _I HAVEMID WILL MAINTAIN WORKEpS COMPENSATION INSURANCE,AS REdUIRED 9V SECTION ('� /� Q 37000F7HELABORCODE,FORTMEPERFORMANGE�FTHEWORKFORWHICH7HISPERMITIS V� / 7 ISSUEO.MY WORNERS'COMGENSATION INSURANCE CARRIER AND POLICV NUMBER ARE� CONSTRIICTION � t I �� jcARRiER PLAN REVIEW � POLIGYNUMeER ELECTRIC � (iFBSSECtqNNE�tJ�TBE00AYlEfEDOF1FEPERIMI5fOF1IX�EFNPDRE�O�LtAFU^(51001��1� PLUMBING Z ICERTIFVTHATINTHEPERFORMANCEOfTHEWORKFORWHICHTHISPERMITI51S5UE0,1 MECHANICAL (J- SNAU.NOT EMPLOY ANY PERSdJ IN ANY MANNER 50 AS TO BECOME SU&IECT TO THE y WORKERS'COMPENSATIONLAWSOFCPLIFORNIA,ANOAGREETHATIFISHOl1LD6ECOME INSPECTIONFEE SU&IECT TO THE WOHKERS'COMPENSATION PftOVISIONS OF SECTION 3]00 OF THE UBOR OWDE,ISHALLFOi7TNWITHCOMPLYWITHTHOSEPFOVISIONS. ISSUANGE _ p OATE: APPLICANT: SMIP � � ENERGY P/C WARNING:FAIW RE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS VNIAWFUL,AND SHALL BE �y SUBJECTANEMPLOVERTOCRIMNALPENALTIESAN�CIVILFINESUPTOONEMUNDREDTHOUSANO ENERGYPERMIT DOLLARS�CtoD,Doo�,IN AD01710N TO THE COS70F COMPENSATION,DAMAGES AS PFOVIDED FOR IN � SECTION37080F1H'etABORCpDE,INTEREST,ANOATTORNEV'SFEES. RETENTIONFEE: L. d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEREBYAFFIFiMUNDERPENALTYOFPERIURYTHATTHEREISACONSTRUCTIONLEN0INGAGENCY FOR THE PERWRMPNCE aFTHE WOFiK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3097,CIV.C.). Z '" W �Z LENOER'S NAME - "� > F— LEN�ER'SADDRE35 � � ICERTIFYTHATIHAVEREADTHISAPPLICATKKJANOSTATETHATTNEABOVEINFORMATIONISCORRECT. TOTAL FEES W IAGqEE1000MPI.VWRHALICITYANDWUNTVORDINANCESANDSTATEL4WSqELATINGTOBUILDMG � � CONSTRUCTION.ANDHEflEBYAUIHORIZEREPRESENTATIVE50FTHIS�UNiYTOENTEflUPONTHE S�. A60VE�MENTIONEDPpOFERTYFORINSPECTKKJ�URPOSES. COMMENTS � C f%' l./ h`�`{", L/4�2 1 . _F r ¢ PERMITTEE NpME(PRINn fj ...,. e , UJ � '`/ '� J � .. � SKiNATUREOFP EE DA7E 1� " � � REGPT.NO. PAID BY `-� VAUD'ATION� � WHITE—Department Copy.YELLOW—Finarroe Copy,PINK—Assessor Copy,GOLDENROD�--File Copy,GREEN--Applicant's Capy _ .,. , . ; ,, .-_ , - .. ,. ... . .,- ". .. , J'�2:�;;'<]. . . ;ifx.5�1�.4'n L r'f(� . ., . ' � .. . ' � � S 3� ■ . . � .,l� .. . ,��: .:. ... ...,:,.. . ... . _,..- �. . ... :�,.....,,�: �..,.... . . .'.�.:,,r. .�- . � ...�,',.,.- ..:..;' ' . . . . "' $ � y :. �-��. �.... � : . � .. .�. 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