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HomeMy WebLinkAbout16497 (22) ___.�.__._.,__. ._._...,, _,_.___ _ �,� �,r, . CITY OF DIAMOND BAI,2 � � ----�� —" DEPARTMENT OF COMMUNITY&bEVELOPMENT SERVICES � � ,� 21660 E.Co le Drive Suite 140 PRESS BUII,DING PERMIT APPLIC�i�YON " , > .;�» ' t t�r, ,: FIFtI11�L`Y. _._ �� _.. . ... _ ., .. . .. ., a ADDRESS � �': � 1crG� C .. ''� s DATECATION �---�� �� NUMBER �� � #/C � ,..- � ISSUE TYPE OCC APN LOT� TRACT�� �Z( DATE CONST. GROUP p OWNER �id � ,r�'1FzS ADDRESS O��G'/ L�z'3/V' ���-/b2.Aa✓S/'?.�' 2-G'' ZONING SETBACKS � CITY�.E'4��!/�r� ZIP Z�c �Z-TEL.�_�7 g 7 ��� FRONT RW ❑ APPLICANT TEL. REAR ❑ � SIDEJSIDE STREET RW ❑ CONTRACTOR SIDE ❑ � ADORESS -_ GITY ZIP TEL. PROPOSED USE � ARCHlENG/ z� DESIGNER G 5 �'"� NO.DWEL. NO. NO. d ADDRESS �" UNI'��� STORIES BEDROOMS � CITY ZIP *�'EL-Zt�L.��'�.� y S/e7 tir�,�,; . u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION $��p/ADD/REM O , p I HEREBV AFFlRM UNDER VENAL7Y OF PERtt1RV THAT 1 MI EXEMPT fROM iHE CONTpACTOqS U- � Ge.,rage/Caryort - W CENSELAWPoHTHEFOlLO'MNOREASON(SEC.7oJ1.5BU51NE5SANDPROFESSIONSCODE;ANYdYVOR �� ZCOUNTYWHICHREOUIRESAFERMITTOCONSTRUCT,AL7ER.�MPROVE,DEMOLISH,ORREPAIRANVSTRUC- W �gfi0/DBCk � TURE,PRqR TO ITS�SSUANCE.A50 REOUIflES THE APPUCIWT FOR SUCH PERMIT TO FILE A SIGNED w ,,,,., STAT6MENT THAT HE OR SHE IS LICENSE�PUiiSUANT TO THE PROVISIONS OF THE CONTPACTORS LI- CENSE UW(CHAGTER e(COMMENCINO WITH SECTION 7000)OF DIVI310N 9 OF THE BUSINESS AND PRO- �'�' �OoUSpa FE5510NSCODE)ORTHATHEOPSHEISEXEMPTTHEREFROMANOTHEB0.515FOftTHEALIEGE�E%EMP- (� � TION.ANYVIOLATIONOFSECTION7031.6BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPUCANTTO Z Re-�ppj � ACIVIL PENALiV OF NOTNORE THAN FNE HUNDRED OOLURS(5500).): p � ;;, � OI,ASOWNEROFTHEPROPEHTV,ORMYEMPLOYEESWITHWAGESASTHEIF150LECOMPENSATION, COffIR18fC18I � M/ILL DO THE WOHIC,AND 7ME STRUCTURE IS tJ�T IN7ENDED OR OFFERED FOR SALE(SEb.70A4,BU51- J � NE55 ANO PROFESSIDNS CODE:THE CANTMCTORS 4CENSE LAW DDES NOT APPL�TO AN OWNER OF = . PflOPERTY 4VFI0 BUIIDS OR IMPROVES THEREON,AND VR10 OOES SUCH WORK HIMSELF OFI HEFSELF OR � THqdIOH HIS ORHER OWN EMPLOVEES,PPOVIDE�THATSUCH IMPROVEMENTS pqE NOT W7ENDED OR � _, � OFFEHmFORSKH.IF,HOWEVEP.iHEBUILDMGORIMPROVEMENTI550lAWITHINONEYEAROfCOMPLE- � � - .Z TION,THE OWNER-BUIIDER W!LL HAVE TFIE BURDEN oF PROVMG THA7 HE OR SHE PID NOT BUIL�OR . � IMPROVEFORTMEPUqPO5EOF5ALE). "� '- O I.AS OWNER OF THE PR07EN7Y,MI EXCLUSNELY CANTRACTING WITH LICENSED CONTRACTORS Q TO COfdSTRUCT THE PRQIF.CT(SEC.7os4,BUSINESS AND PROFESSIONS CADC:THE CONTRAC'ORS ll- VeIU811011 ADJ.AREA 111 CENSELAW�OESNOTAPPLYTOANOWNFAOFAPHDPERTYWHOBUILDSORIMPROVESTHEREON.AND " 1- MhiOGONTMC7SFOR5UC11VHOJECT5WI7NAC6HTMCTOR(S)UCENSEDPUR&UANTTO7HECONTMP QUANTITY DESCRIPTION FEE F�-L TORS LICENSE UW.�. �' V - J r,�.��,E � .. - ❑I AM EXEMPT UNOER SEG. B.8 P.G FOR THIS REASON U � F , DATE OWNER� V � � W LICENSED CON7RACTORS DECLARATION �j � 1 HEREBYAFFIRM UNOER PENALTY OF PEfiIURV THAT i AM 410ENSED UNDER PqOVIS10NS oF CHAPTER � - � 9�COMMENCINOWI7HSECTION7000JOF�IVISION3OFTHE9USINESSFNDPROFESSIONSCODE.ANO Z e �� MY LICENSE IS IN FULL FORCE N1D EFFECT. m � UCENSE CLASS ^� LIC.NO.--S� �— � ,. ., W DATE F��_q�dr'`3"�� CONTMCTOR , if,al " a ��ti'('I.k i-T� � WORKERS'COMPENSATION DECLARATION � � 1 HEFEBY AFFWM UNDER PENALTtl OF PERJUflV ONE OF THE FOLLOWING OECLAflATlONS: U � z � r�IH�VEANDM�LLMAINTAINACERTIFICATEOFCON5EN7TOSELFINSUFlEFORWOFKEHS' T �i COMPENSATION,AS PROVIDED BYSECTION 3�0o OF THE UBOR COOE,FOR THE PERFORMANCE `U OF h1E WORK FOR WFiICH THIS PERI.IIT IS ISSUED. g tJ.l ✓ I HAVE AN�WILL MAIHlAIN WORKERS'COAIPENSA710N INSURANCE,AS REQUIRED BY uECTION / � � 37000FTHE�ORCOUE.FORTH[PEFFOPA4ANCEOFTHEWORKFORWHICHTHISPERMI7IS �J��. ....� ISSUED.MY KEA3'CQMPFNSAT70N INSUMNC/E�'CARHIER AN�POUCV N/Uy!�E R ARE: CONSTRUCTION � j CARRIER � 'C �'�'���!—�� L-U. PLANREVIEW � PIX.ICYNUM9ER� i/��� ELECTRIC � /� V p (I}iS5[C7pNNE�NiJTBECO�.PLEfmOFi1�E!'EI�,MISFOf7IXdEf1UWREDW1.I.fJiS(5100)OlilESs). PLUMBING �� �_ Z I CEtiTIFY THAT IN THE PERFORMANC'c OF 7HE WOAK FOH WHICH 7HIS PERMI7IS ISSUE�,I MECHANICAL � SHALL NOT EMPLOY ANY PERSON IN ANV M.4NNER SO AS TO�ECOME SUBJECT TO TME � NbRKERS'COMPENSATION(AWSOFCALIFOqNIA,ANOAGREETHATIFISHOULUBECOME INSPECTIONFEE � � SUBJECTTOTHEWOPKERS'CAMPENSATIONPROVISIONSOFSECTION370oOFTHF_L1BOR — �,� CODE.I SHALL FOFiTHWITHCOMPIV WITH TH E PROVISIONS. �SSUANCE � � p DATE: 3.7��APPLICANt C1 SMIP J WqRNING:FA0.URE TO SECURE WORKEfl3'COMPENSATION COVERAOE IS UNL4WFUL,AND SHAIL 8E ENERGY P!C �y SUBJECT AN EMPIOYER TO CRIMMAL PENl�ITIES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND ENERGY PERMI? OOLLAFS�if 00.000).IN AppITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDEO FOR IN � SECTI�N37oeOFTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: a CONSTRUCTION LENDING AGENCV PPEALT FEE: � IHEREBVAFFIRMUNDERPENAIT�'OFP'cRJUFYTNATTHEREISACONSTRUCTIONLENDWGAGENCY FOR THE PERf-0RMANCE OF THE WORK FOR WHICH TF113 PERMIT IS ISSUED(SEC.3087,CIV.CJ. Z W A`� � LENDEfl'S NAME -/5/// . ,��Y: � ... . F- LEN�ER'SADONE55 . �� .. � � 1 CEPTIFYTHAT I NAVE REAO THIS APPLICATION AND STATE THAT TNE ABOVE MFORMATION IS CORRECT. TUTAL FE ES ,�� W I AGREE TO COMPLY W1TN.ALL C17Y ANO COUMY ORDINANCES AND STATE LAWS RELATING TO BUILDING ' � CONSTPUCTION,AN�HEREBV Al1THORRE flEPRESENTATIVES OF THIS COUNTYTO ENTER UPON THE '- � � � ABOyE-MENTKKVEDPROPERT'f0 INSP'cCT10NPURPOSES. COMMENTS � � /,�-�' /,.l�:S� m PEiiMITTEENAME( INT) __ � u��--- _�GL � 5 TUqE OF VE ITT DATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—De artment Co YELLOW�--Finance Co PINK--Asaessbr Co GOLDENR06—File Co GREEN— licant's Co P PY• PY. 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