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Home My WebLink About11956 CITY OF DIAMOND BAI� � �--��' DEPARTMENT OF COMMUHITY&DEVELOPMENT SERVICES C ` �'� � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS �.'m'..-. BUII,DING PERMIT AI'PLICA�'ION. -- . FIRMLY � JOBSITE y. � APPUCATION�...I�- ' PERMIT P!C o ADDRESS��S^ �d�t� ��AN.(��' DATE � NUMBER a � APN LOT " TRACT �SSUE TYPE OCC p OWNER �i'�iti-Ij�l��H f�,,, ��,iQ DATE CONST. GROUP p ADDRESS I�'/��C.� l�'1�'!LC ZONING SETBACKS � ciTv U�--A��+r-� ZIP 'r'�l�_TEL.��„'�S�? - REART RW p APPLICANT TEL. $IDE/SIDESTREET qyy ❑ � CONTRACTOR � SIDE p ADDRESS � CITY ZIP TEL. PR�P�SED USE__�C� t w ARCH/ENG/ � DESIGNER ��lC� �' �C.tl. /CfY+ NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. cn cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•6UILDER DF_CiARATION SFR/ADD/REM O I HEREBY AFFlRM UNDER PENALTY OF PERJURv 7HA7 1 AM E%EMVT FROM TME CANTRACTORS LI- Gefe96/C3l�JOR W CENSEUWF�iTHEFOLLOWINGREA50M(SEC.7031SBUSINESSANDPROFESSIONSCODE:ANYqTVOR (n ��7 GOUNTYWHICMREIX11qE5APEflMfTTOGONSiRUCT,ALTFA,iMPROVE,�EMOLISH,ORREPAIRANYSTRIJC• u� 7URE,PRIOR 70 ITS ISSUANCE,AL50 REQUIRES THE APPLICAN7 FOR SUCH PERMIT TO FlLE A SIGNED w Pa�io/DeCk STATEMENT THAT HE Ofl SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTEN 9(COMMENCINO WITH SECTION 7aa0)OF DIVISION 3 OF THE Bl1SME55 ANO PRO- �'�' POOUSpd �1 FESSIONSO�DE)ORTHATHEORSHEISEXEAIPTTMEREFROMANDTNEBASISFORTHEALLEOEDE7fEMP- (� � TION.ANVVIOLA710NOFSECTION7o31.68VANYAPPLICANTFORAPERMITSU&IECTSTHEAPPUCANTTO Z Re-Roof � A GVII PENALT'OF NOT MORE THAN FNE HUNDFED�OLLARS(tsOD).): DI,ASONMEROFTHEPROPEHN,ORMVEMPIOYEESWITHWA4ESA9THEIRSOLECOMPENSATION, � CORIfI1BfC18I g MALL 00 TNE WORIC AND THE STRUCTURE IS NOT INTEND6D OR OFFERED FOR SALE(SEC.7ou,BUSI- J � NESS AND PROFESSIONS OODE:7HE CONTRACTORS LICENSE UW OOES NOT APPLV TO AN OWNER OF � Pi�PEHTY N1FIO BUILDS OR IMPROVES hIEREON,AND WHO OOES SUCH WORK HIMSEIF OR HERSELFOR � THROU(iFIHISORHERONMEMPLOVEES,PROVIDEDTHATSUCHIAIPROVEMENTSARENOTIMENDEDOR m 0 ,OFFEREDFORSALEIFHOWEVERiHEBUiL�INGOFiIMPROVEMENTIS50LDWITHINONEYEAROFCOUPLE- Z �TION,THE ONMER�BUILDER WILL HAVE THE BURDEN OF PROVIN6 THAT HE OR SHE DID NDT BUILD OR = IMPROVEFORTHEPURPOSEOFSALE). W OI,ASOWNEHOFTHEPROPERTY,AMEXCIUSIVELVCONTRACTMGWIiHLICENSEDCANTRACTORS � TO CONSTRUCTTHE PHOJECT(SEC.70N,BUSINESS AND PROFESSIONS CODE:THE CONTRAC70RS LI- Vd�U811011 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANONRJEROFAPROPERTYWHOBUILDSORIMPFOVESTHEREON,AND � WFiOCONTRACTSFORSUd1PROJEC75WiTHACONTRACTOR(S)LICENSEDPUPSUPNTTOTHECONTMG QUANTIN ESCRIPTION FEE � TORS LICENSE LAW.I. � 0 ❑IAM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q 3 � LL' OA7E oWNER � C V Z � LICENSED CONTRACTORS DECLARA ON W J � IHEREBYAFFIRMUNDEflPENALTYOPPERIURYTIATIAMLICENSFDUN�ERPROVI510N50FCHAPTER � d, 9�COAIMENGINO WfTH SECTKKJ 7ooa)OF OIVISION a OFTHE BUSINESS ANO PROFESSIONS CODE,AND Z X MY UCENSE IS IN FUI.L FORCE AND EFFEC7. m � LICENSE CLA35 LIC.NO. � V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION a � I HEREBYAFF8IM UNDER PENALTY OF PERJURV ONE OFTHE FOLLOWING pECUMT10N5: Z � _IHAVEANDWILLMAINTAINACERTIGICATEOFCONSENTTOSELF-INSUREFORWOAKER&' a S Q CqMPENSATION,AS PROVIOED BYSECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE W Q OF TNE YYOPK FOR WHICH THIS PEHMIT IS ISSUED. � W _I HAYE ANU WILL MAIMAIN WORI(Efl5'COMPENSATION INSURANCE,AS REQUIRED BV SECTION / }� Q 3700 OF THE IABOR COUE,FORTNE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ' �^ '� t /� ISSUED.MY WORKEFiS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION tk� �f jcnaaieq - PLAN FEVIEW � POLICVNUMBER ELECTRIC � (iF�SSECfqNPIE�t�lO'TSEmMPI.EiEooFn+EPEw.qrtSinRoueFnlnlN+En�a.laa5(E1m)Oa�Ess} PLUMBING z ICERTIfVTHATINTHEPERFOHMANCEOFTHEWOfiKFORWHICHhfISPEMIITI5ISSUED,I MECHANICAL �j'� SMALL NOT EMPLOY PNY PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE (n WORKERS'COMPENSATIONIAWSOFCAI.IFORNIA,ANDAGFiEETHATIFISHOULOBECOME INSPECTIONFEE S SU&IECTTOTHEWORKERS'COMPENSATIONPqOVI51IXJ50F5ECTION37o00FTHELABOR CODE,i SHALI.FORiHWITH COMPLY WITH 7HOSE PROVISIONS. ISSUANCE � 0 p DAiE: APPLICANT. SMIP � J WpRNiN6:R11�UfiE TO SECUHE WORKERS'COMPENSATION COYERAGE IS UNLAWFUL,AND SHALL 8E ENERGY P/C LL Sl18JEGTlWEMPLOYEPTOGRIMINALPENALTIESANOCIVIIFINESUPTOONEHUNDREDh10USAND ENERGYPERMIT DOLLARS(5100,000).IN AODITION TO THE COST OF COMPENSATION,OAMAGES AS PilOVI0E0 FOR IN ¢ SECTION37080FTHEL4BORCO�E,INTEREST,ANOATTORNEY5FEE5. RETENTIONFEE: � a CONSTRUCTION LENDING AGFNCY PRE-ALT FEE: ' - O � I HEREBV pFFIRM UN�ER PENALTY OF PERJURY THAT THERE IS ACONSTqUCTION LENDING AGENCY FORTME PERWRMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.309�,CIV.C.). Z W � LENOER'S NAME � F— LFNDER'SA�DRESS .�7 � �GEHi�fYTHATIHAVEREA0THI5APPLICATKKJANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES '/'�J � w I AGflEE TO CAMPLY WITTi P1L CIT'NND COUNTY ORDINANCES AN�STATE UWS REIATING TO BUIIDING J l� d � CONSTRUCTION,ANDHEREBYAUTHORIZENEPRESENTATIVESOFTHISCOUNTYTOENTEHUPONTME Z ABOVEMEMIONEO PFOPER7Y FOR INSPECTION 7URPOSES. COMMENTS � Q sv� ��r2�/ �l3�di� m PERMITTE NAME(PRIN7) v�i c' �.- .�i�..%�'"__� -�.��.��-- � SIGNATVREOF i E onrE RECPT.NO. PNDBY VALIDATION� � ' � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN— plicant s Capy . . ..�„ .� .. r..'...., ti .,.,..-..4 .,:�„ .y,, ...'.. . �,: .. .a � .` �. � � � �' I _. . , ,,, ,.:... ,. �, . . .6 � , ,�.. .,.. .�,� . .. ,,. �. ... . - ,._.._....,_rt��.:_._ . .x� � � � _ � � - . � � � � _� �a. :�� .:..... _ s . ,_ _ �. , , ��-�� ' � ... „_ F��a��,�� .�.,..__d___ �._ .�_-- -__._ _ _ �-r��,:-��n�,� ��`�_ � � ! �ta�� ear�� P-��- � �- -- __�____�___.;w�_.�.___�_.____.. ._ ------- .!��c�� ; ; ' �� ___._ __ _ ___________ �_ _.. �__�___.___ _____�.. ��_. _,�.._�__:..�_ ;��,L3C�� t`�?a7i4?'r�li§ii 1 � J.�'�i�P�LC'C�F$CC.�i�{�i�a": � w_.___.r_�.. ,m..-__.�.._._..__ _, . 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