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HomeMy WebLinkAbout14406 (29) � , � �, �� CITY OF DIAMOND BA8 � DEPARTMENT OF COMMLJNITY 8t DEVELOPMENT SERVICES � • 21660 E.Coplcy Ihive Suite 190 (909)860-3195 Fax(909)661-3117 PRE$$. "�'��� BUII.DING PER11Z1T APPLICATION FlRMLY � JOBSITE ^� �; APPLICATION ' PERMR P!C p ADDRESS(�QdS C'G.S�' �Im ���. DATE � NUMBER� # $ ISSUE TYPE OCC APN LOT TRACT DATE CONST. GFiOt1P S OWNER _ p ADD S ��1 1+f1 L ZONING SETBACKS CITY ti�'ZIP T . FRONT �yy p APPLICANT TE .� REAR p SIDElSIDE STREET RW ❑ CONTRACT H � r� � SIDE ❑ � ADDRESS • PROPOSED USE CITY'rno�(1�t.�t.�18 ZIP � TEL. } Z� '1 �I � ARCWENG/ DESIGNER NO.DWEL. NO. NO. AD�RESS UNITS STORIES BEDRO�MS � CITY ZIP TEL. � � DESCRIPTION SQ.Fl: FACTOR PSF ADJ.AREANALUATION Q OWNER$UILDER DECLAHATION SFRIAOD/HEM O p 1 NEREBY AfFlRM UNDEH PEWILTY OF PE0.IURY TNAT I M/EXEMPT FROA/THE OON'fMCTOqS U- QO�Q���R (JJ CENSE{AWFON7HEFOLLOWINGREA90N(SEC.7087.6BU31NESSANDPIiOFE5510NSCODE:ANYpTYOR (n ZOOUHTYNTiKY1REOUIRE3AFEHMRTDCONSTRUCT,ALTFA,IMPROVE,OEMOLISM,ORREPNRANYBTRUG W Pe}p/�BC�( u� lUR&�fOOlt TO ITS I65UIWCE,/�LSO REOUIRES TT1E APPUCMi7 PoR SUCM PERMIT TO FILE�BIGNED w � iT�TENENT hIA7 ME OII SNE IS LICENSW R/RSUAN7 TO THE PROVISIONS OF TXE GONTqACTOH3 ll• CENSE LAW(qMFTER i(COMMENCWO WITH SECTION 7000)OF DNISION 9 OF T1E BUSINES$AND PRO- � POOVSpB FESSIONSCODQOpTHATHEORSHEI9EXEMPTTHEREFROMANDTHEBl1SISFORTHEALLEOEDEXENP- (7 TqN.ANY VIOLATION OF BECTION 7W1.6 HYANY AGPLICANi FOR A PERMIT 6UBJECT$TNE MPLICANT TO Z qe-Raof �„� A CML 7ENALTY OF NOT MORE iHAN FNE HUrDRED OOtURS({5a0).�: � OL�OMMEROFTHEPROPEATY.ORIAYEA�PLOYEE6WI7HWAGESASTHEIRSOLECOMPENSA710H, Cp�imBfCl81 YYILL DO TFIE WOHIC,AND TNE STNUCTURE IS NOT IMFNDED OR OFFERED FOR 8�1LE iBEC.70N,BU51� � NESS ANU PROFEuSIONS OODE:hiE OON'fRACTORS LICENSE UW UOES NO7 MPLY TO NV OYYNER OF ? � PIqVERTYWFIOBUIDSOflMPROVESTHEREON,ANDWI1000ES5UCHWORKHIMSELFORNERSELFOR TMROUG/IMISORFiFFOWNEMPIOYEES,PRONDED7Y1�T9UCMIMPROVEMENT3A11ENOTINTENDEDOR m OFFEREV PORSAI.E IF,HOWEYERfNEBUILDING OR WFROVEMENf IB SOI.D WRHIN ONE VEAROFCOMPLE• TION.THE OYVIJER�l1LLDER VALL HAVE TNE&1RDEN OF PROWNG 7HAT HE ON BHE DI�No7 BWtD Oq MVROVE FpqTHE PURGQSE OF SAI.E)_ O I,AS ONMEROF THE PROPERiV,AM E%CLU9IVELY CONTRACTNO VATFI LICENSED CONTFlACTORS lb CONSTHUCTTHE P110JECT(SEG 70M.9USMEBS ANO PPOFESSIONS COOE:THF.CONTMCTORS ll- \/gIU8�1011 ADJ.ARFA CENuE UW DOES NO'TMPLYTO AN ONRiER OF APROPERTY W/p BUMDB OP MPROYES THEREON,MD YMIiOCONTRACT8FORSUpIPRQIEGT8W1hIACOMRACTOR(9)LICF.NSEDPURSUANTTOTHECONTMG Q�fANTITY DESCRIPTION �E ' � IORS LJCENSE LAW.]. ❑IIW EXEMPT UNDER SEC. B.i P.C.FOR THtS REASON Q U V" OAiE OriNER V � LICENSED COP�THACTORS DECCARATION � � W � . INEHE6Yi1FFIRMUNDENPEWLL7YOFPERIURYTHAT1AMlICENSEDUN�FRPROYISqNSOiCHADTER � . � f(COYYENCINOWITHBECTqN700D)OFOIVISION]OiTHEBUSINESSANOPROFES510NSC00[.AND,.�� � Z � W LICENSE IS W FULL FORCE MID EFFECT. � �-�+��-'�C - 7t�3�i 3 m i � LICENSE CUSS IC.NO. � w� 12-14—�i�, coruT � • `� � `` c WORKERS'COMPENSATION DECLARATION / � I HEqEBV AFFIRM UNDER VEN�ILTV OF PERJURY ONE OFTiE WLLOWING DECIARATpNS. - � —. .� � _�IYNVEINU'MLLMMNrNNACEfiTIFICI4TEOFQONSENTT06ELF-INSUREFORWOflKERS' 004PENSATION.A9 VRONDED BY SECTION 87aa OF THE LABOR CODE.FOH THE PERFOfW ANCE Q OF 1HE M/ORK FOR WMICN Ti15 PERMIT IS ISSUED. � 1 NAVEANO WILL MAIIVMPi WORKERS'COMPENSATION INSVMNCE.AS REIX/IR .SE O l7o00FTME LABOR OOOE.PoRTHE VERFORIAANCE OF iHE WORN FOq WHI HIS PE R I lS3UED.MY WD RS'C� PENS�710N INSl1RANCE CARRIER ANO POLI UMBER ONSTRUC ON � cuw�A_ � � I PLAN RE W � vacYNt�aER ELE IC �dT� p fnssEcno�+��noT���ocn�vErafTrw�«aE oou�r�sRiroloqtEss4� LUMBING � z I CERTIFY i{iAT N TNE DERFORMANCE OF 1HE WOFK FOR WHICH iH15 PE , MECHAN�CAL (�S SWLLL NOT EMOLOY ANY VERSqJ IN ANY MANNER 50 0.5 TO BECOME SUB.IECT TO TFIE (q MpNNENS'COMPENSATIONUWSOFCM.If-0RNIA,ANDAaFEETYUTIFISHWL�BECOME INSPECTIONFEE S BUBJECT TO THE WOAKERS'COMPEN9ATION PROVISIONS OF BECTION]700 OF THE IABOH cooe,�sruuwr+nann+caav�rw r sernovisions. �SSUANCE O /� p DATE:��-�y"�1� APPLICANT: J-� t�. ��_ SMIP � ENERGY P/C IN T AND SAFETY WARNINO:FAILURE TO 9ECUHE�hORKER3'COMPENSATqN COVERAOE IS UNLAWFU�,AND BHALL BE �'y SUBJECTANEMPLOYERTOCflIMWALPENALTIE5MIDCIVILFINESUPTOONEl1UNDREDiHOUSAN� ENERGYPERMIT DOLLARS(f100.OW),iN ADUITION TO TFIE COST OF GOMPENSATION.O/UAAOES AS PROVIDEO FOR IN ¢ 8ECTION 370!OF i11E LABOR CODE,WTEREST,ANO ATTORNENS FEES. RETENTION FEE: q CONSTRUCTION LENDING AGENCY 0 PRE-ALT FEE: � INEREBVAFFpiA1UH0ERPENIITYOFPERJURYiHATTHEREISACONSTRUCTIONLENDINQ/UiENCY a FOR TME YERiORMANCE OF THE WOflK FOR WHICH THIS PERMIT I5 ISSUE��SEC.3007,qV.G�. Ll] � LENDER'S NM1E �S LENOER'SMOHESS W I CEflTIFY THAT I MAVE READ THIS APPLICATqN ANO 5TATE THAT 7l1E 11BOVE INFORA/ATION IS CORRECT. TOTAL F E ES 3� d 1 MiHEE 70 COMPLY YYI7H ALL CITY AND COUNTY OH�WANCES AND STATE UWS REUTINO TO BUILDINO � CONSTqUCTION,AND NEREBY AUT110RQE REPNESEN7AiIVES OF TVpS COUNTY TD ENTER UPON iNE ABOVE•MENf10N W PqOPE0.7Y FOR INSVECTION PUFPOSES. COMMENTS � �a�Y-�fi11 11e t!/��C--Z.� � E �TTEE NAtAE(VRINTJ � 19... �2 a u-�� g,�_ � (/j R ITiEE DATE --� � RECPT.NO. PAID BY ✓ vet inennu WHRE--0epartment Copy,YELLOW�inance Copy.PINK—Assessor Copy,GOIDENROD--File Copy,GREEN--AppliranCa Copy ��..��...�.......�. ------- ---- � ' � .. . . � , . .�.. � • .M.�. .n ... ' ' . . 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