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HomeMy WebLinkAbout13342 CITY OF DIAMOND BAB ' / � -- DEPARTMENT OF COMMUMTY&DEVELOPMENT SERVICES �,� 21660 E.Copley Drive 5uite 190 (909)660-3193 Fax(909)861-3117 PRESS �'°^'+ BUII.DING PERMIT APPLICATION FIRMLY o� JOBSITE APPUCATION�,..�Ci1��� PERMIT l�2 /C ADDRESS � DATE t NUMBER � If � ISSUE TyPE pCC APN LOT RACT DATE CONST. GROUP p OWNER 2- � " ADDRESS r... ZONING SETBACKS CITY � ZIP TEL. -- �'��7 FFiONT RW ❑ APPLICANT TE ' - '10 REAR p SIDFJSIQE STREET RW p CONTRACT R DO �.�1 SIDE _ p � ADDRES ar� ` PROPOSED USE �A Z � CI7Y C 21P,.�„•'� TE N �� t�t tc' ARCHJENG/ �-G� ��� � � � DESIGNER NO.DWEL I NO. NO. � CDDRESS ZIP TEL. UNITS STORIES �_BEDROOMS �` y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER•BUILDER DECtARATION SFR/ADD/REM O I MEREBY AFpfql UNDER PENALTY OF PERJURY iM�S 1 AM E%EIADT FICM THE CONTMC70R5 U- G8f9QB/C91pDIf COJSEUWFOR1MEfOlLOWINOREASON(SEC.7071.6BUSINESSANOVROFE651a15COpE:ANYCITVOq (� COUMYWFMG111Ea1fiESAPERMRMOONETRUCT.ALT6R,IMPROVE.DEMOU9H2ORREPAIRANYiTqllO W P8fI0/DBCIf 1tR1E,PRqit TO ITS 186UANCE,AL90 REWIRES THE APPLIGJWT FOR SUCH PERMIT TO FILE A SIQNEp 6TATENEM 7T41T XE OR eHE IS 11GEN5ED PURSUANT TO 7ME PHOVISIONS OF'R1E CONTMC70RS ll- CfliSE lAW(4MAPTER Y(OOMMENCWO N77H BECTIW 7W0�OF DIVISION]OFTHE BUSINE59 ANU Pq0• LL POpI/$p8 FESSqN5CO0EjOR1WlTMEOHSHEISIXEMFT7MEREFROMM1�7T1E8A51SFORTHElLLLEOEDEXEMP- (� TIDN.ANY VqLAT10H OF BECTION 7091.6 BY ANY AVPl1CANT FOR A PERMIT SUQIECT9 TFIE APPLICANT lb Z Fjg_qpp� � � � ACML PENALTV OF NOT YOHE THAN FNE HUNDRED OOLUq3(tSOD�.$ OI,A60WNEqOFTNEVROGERTY,ORMYB�IPLOVFESWITNWAOESASiHEIRSOIECOMPEN6A710N, CO(IfTBfCl81 WILL 00 TNE WORK ANO TME 67RUCTURE IS NOT IMENDEO OR OFFERED FOH SAIE(SEC.70M,BU31- �J � NE55 A!ID PiqF�S51IXJ6 OODE:7HE CANiFUCTORS UCENSE lAW DOES NOi APPLY TO AN OWNER OF ? PROPERTY N'HDBUILD90R MPROVEB 7TIEREON,ANO NR1000ES BUCH WORK MIMSELF 011 HEIiSELFOR 2 TMROUGHl9SORMEROWI�FAIPLOYEES,PpOVI�EU'MIITBUCXMIPROVEMENTSMENOTINTENDEOOR m 0 OFFEHEDWHBALEF,II�WEVER7HEmUIIDINOORIMPHOVEMENTISSqDWITHINONEYEAROFCOMPLE- � TION.7HE OYYNER�BUIIDER WILL NAVE T11E BUROEN OF PfqVINO iHAT NE OH 8HE DID NOT&IMD OR MPfqVE WRTNE PURP06E OF SALEJ. � ❑I.A40NRJEROFTHEGIbPERTV,AMEXCLUSNELYCONTRACTINOMATHLICENSEDCONTMCTORB TO CONSTRUCT 7NE VRRIECT�BEC.7ou,BUSINESS AN�PROFESBIONB OO�E:iNE CONTRACTOpS LF V91U8I1Of1 ADJ.AREA C9J9E UW DOES NOT MPLY 7G AN OWNER OFAPHOPERiY WHO BUKLS OR W PiqYEB 7HEHEON,AND W/IOCOMMCTBFORBUpiPRWECTeWIT1�00NiMCTOR(S�LICENSEDPURSUNYTTDTMEOONTMG ql1ANTITY �ESCRIP710N FEE � 70li8 IICENSE WV.�. � O I AM IXEIAPT UNDERlEC. B.R P.C,FOR THIS REASON � ' ` U W OATE DIYNER F Q W � LICENSED CONTRACTORS DECLARATION W � I NEREBYAFFINM UNUEfl PEN.4LTY OF PERR/RYlTU71AM LICENSED UNOER PFlOVISqN50F CHM7FR � f�COMMENCPKiWRHSECTION7000)OFDIVISION70FTHEBUSINESSANDVROFESSIONSCODE,ANO Z MY LICENSE 61N FULL F[+RCElWO EFFECf. A � � � � � ucvase cuss r_�� uc.rro. � o�re_3�31 — d O r—conrrAnncroA 1701� a = WORKERS'COMPENSATION DECUIRATION ��3 t`" � a yIXEqEBYAFFlpGUNDEHPENALTYOFGEiUUMONEOFTHEFOLLOVANODECU1HAlONS: Z � �IWIVEANDYYILLMAINiA1NACERTIFlCATEOFCONSENTTOBELF-INSUREWRYYORKEFS' a ��F'COMPQISATpN,AS PROVIOED BY SECiION 8700 OF7HE LABOR CO�E.FOF THE PERFORIIANCE U Q OFTIEWORICFOPWNIClITHI6PENMIT18135UE0. � I IMVEAND WI�IMAW WORKER9'CONPENSATqN INSURANGE,AS REOUIRED BV BECTION I�,�O � 57oDOFTNEIABORCOOE,FOR7NEPENFORMANCEOF7HEWORKFORWHICHTHISPER1AR15 ISSUED.MYKtl E S'COAIPENSAT SURANCE RRIERANDPttICYNIIMBERME� CONSTRUCTION � CARpfEN VLN PLAN qEVIEW � vo�crNweER ELECTRIC p (n+seEcnor+r�wreEao�maFnFpEw.rr�sra+or�ru�mocuxtsg+mlon�tssA PLUMBING w 2 ICERTIFVTHATNTHEPERFORMIWCEOFTHEWORKFOHWMICFITHISPERMITISISSUEO,I MECHANICAL SHUINOT EYPLOY ANY PERSON IN ANY YMNER 80A5 TO BECqAE SUBJECT TO TME y MIORKERS'COMIPENSATIONUWSOFCALIFORNIA,ANDAaREETFI�71F16Ma1LOBECOME INSPECTIONFEE 6UBJECT TO THE WORNERS'COA/PENSATION PROVISIONS Oi SECTION�700 OF THE LABOR rj CODE.IBHALLFORf1iWITHCOMPLYWITHTl109EPROVISION3. ISSUANCE t O APPLICAM: SMIP ,O DATE: � WMNINO:FAILURETO SECURE WORKERS'COMPENSATION COVERM3E IS UNLAYKLIL,AND BHALLOE ENERGY P1C � � BUBJECTANEM%AYERTOCRpAIN�LGENALTIESANDCIVI�FWESUPTOONEHUNDREDTFIOUSANO ENERGYPERMIT y DOLLAFi�(i700,000�,IN/�ODITION 70 THE CQ4TOF GOMPENSATpN,DMIAQES AS IROVIDEO FOR MI � BECTION 9708 OF THE LABOH OOOE,piTEREST,ANU�TiURNE1^b FEES. (j�NTION FEE: CONSTRUCTION LENDING AGENCY pRE-ALT FEE: � IHEREBYAFFIRMtKdDERPENALTYOFPERRIRY7HATTXEREI6ACON57AUCTIONIEN�INGAfiENCY FOR THE PERFORMANGE OF TFIE WOpK FOR WHICH THIS DERMR IS ISSUED(SEC.JOoi,CIV.C.�. � � LEPIDER'S NAME �S IENDER'6ADDRE59 `� ICERTIFYTIUITIIUVEREADTHISMPLICATIONMIDBTATETIIATTF7EMBWEINFORMATpNISCOHRECT. TOTAL FEES � � 1 A6REE TO COMPIY WRH ALL CfiY AND OWNTY M�iDINMlCES M!D STATE UWS XEUTNO TO B:ALUINq � � ^ ��� CONSTRUCTION,AND HEREBYAUTHORQE REPqESENTATIVES OF 7TY5 COIINTYTO ENTER UPON THE �J � A6WEaAEN710NE�PROPERTYFORINSPECT PURPOSES. 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