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HomeMy WebLinkAbout16942 �ITY OF DIA1si10NI�BAIt � -- -.�....__ q)EPEiRTNFENT OF��bllVfUN1T4'�17EVELOPIviIENT SERVICES I I I 21825 E.Copley Drive � (909)860-3195Fa:�(909)86t-3Y17 PRESS .,,?v��'A' BUI�.,DIIVGPEItIA�ITAPPLICAI°ICiIV FIRMLY � JOBSITE '° APPLICATIO PERMIT '°� P/C Q ADDRESS_� � ���- DATE �� NUMBER �' � "a�'# o� ISSUE TYPE - OCC APN LOT, T CT DATE CONSt' GROUP p OWNER - I a , a�'� � � p ADDRESS � °A� ZONWG FRONT KS RW ❑ � CITY ZI L. � APPLICAN � (� 7�- �. REAR ❑ O SIDElSIDESTREET RW ❑ z a CONTRAOTOR SIDE ❑ Oo CITY ES ZIP L.� PROPOSED USE ;3� �� re .: @,, Q ARCH/ENG/ • z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS � STORIES BEDROOMS = CITY ZIP TEL. cn � DESCRIPTION SQ.FL FACTOR PS� ADJ.AREANALUATION p� OWNER-BUlLDER DECLARATION SFR/ADD/REM O p I HEREBV AFFlflM UNDER PENALTY OF PERJUPiY TMAT:AM EXEMPT FROM 7HE CONiRACTOqS LI- G0�29E/C2fPOlt ' W CENSELAWFOR7HEFOLLOWINGRERSON(SEC.7C31.5BUSINESSANGPPO=ESSIONSCODE:ANYqTYOR (� , U COUNTYWHICHFE�UIRESAPERMITTOCONS7flUCT,ALTER,IMPROVE.OEMOLISH,OqREPAIRANVSTRUG W patiolDeck w TURE.PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED � STATEMENT THAT HE OR SHE ISILiCENSED PURSUANT TO THE PROVISIONS OF THE CONTFACTORS LI- � CENSE LAW(CHAPTEF 9(COMM�'NCING WITH SEC710Y 70o0)OF�IVISION 3 0F THE BUSWESS AND PR0- � POOUSPa FESSIaNS CDOE)OF THATHE ORISHE IS EXEMPTTMEREFROM AND THE 811515 FOR THE ALLEGED EXEMP- � TION.ANYVIOLATIONOFSECTIOP'�7031;SBYANVAPPLICANTFORAPERMI7SUBJECTSTHEAPPLICANT70 z Re-,Rooi A CNIL PENALTY OF NOT MORE T�1AN FIVE HUNDRED DOLLARS(y5oo).): Z ❑I,ASOWNEROFTHEPROPEflTY;ORMYEMPLOYEESWITHiNAGESASTHEIflSOLECOMPENSATIDN, � COffIrtlBfC12I -' WILL�O THE WORK,AND THE S'�IRUCTURE IS NOT INTENDED OR OFFEfiED FOF SALE(SEC,7044,3USI- � NE55 AND PROFESSIONS CODE:THE CpNTRAC70PS LICCNSE LAW DOES NOT APPLY TO AN OWNER O� � PROPERTY WHO B111L�S OR IMPROVES THEREON.ANO WHO OOES SIJCH WORK HIMSELF OR HERSELF OR � THROUGHHISORHEROWNEMPLOYE6S,PROVIDE07HATSUCHIMPROVEMEMSARENOTINTENDEDOR m '1, QOFFEREDFORSALE.IF,HOWEVE�iHEBUILDINGOR�MPROVEMENTIS50LDWITHlt30hlEYEAROFCOMPIE- � TION,THE OWNEFEUIL�ER WILy HAVB THE BUR�EN OF PROVING 7HAT HE OR SHE OID NOT Bl11LA OR � IMPROVEFORTHEPURPOSEOF�SALE�.: ❑I,AS OWNER Of THE PFi09ERTY;AM EXGLUSNEIYCON7RRGTWG WITH LICEIJSE�CONiRACTORS � � TO CONSTRl1CT THE PPOJE::T(�EC.706a,BUSINESS AND PROFESSIONS CODE:THE CONTFACTORS LI- V2IUellO�'1 ADJ.AREA = CENSELqWDOESNOTAPPLVTOrJJOWNEftOFAPROPERTVWNOBUILD50RIPo1PROVESTHEREON,AND � WNOCONTflACTSFORSUCHPROJECT$WITHACONTRACTOR(S)LICENSEC]PURSUANTTOTHECONTRAG QUANT�TY DESCRIPTION FEE Y TORSLICENSELAW), �, ., � Q ❑I AM EXEMPT UNOER SECi &d P,C,FOH TH!5 REASON � /� � �.i _ ( . "�. a.. �y � n ^ � DATE �' '� OWNER . � �� ^ . , �..._..._ � _.. ...____..___.____- _':- W -__ . —___-- � j � o LICENSE�bONTRACTORS DECLARATION W = % �� . � IHEREBYAFFIRMUNDEHPENALiNOFPERJURYTHATIAMLICENSEDUNDERPROVISiON50fCHAPiER � � � � ' a. 9(COMMENCING WI7H SECTION TOOOJ DF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,A'JD z � ,��L+�ia°°$ •� ', X MV LICENSE IS IN FULL FORCEAt�,�EFFE T. � ' d LIGENSE CLA55 �I LIC.NO. � ���� � ~ DATE + � . ' CONTRACTOR ' � a C.� ,. W � a g` I, �' - � ��'�;� WO KERS'bOMPENSATION DECLARATION -� � E Q Q �e�.�� �� U � IHEREBYAEFIflMUNOEflPENALT�OFFERJURYONEOFTHEFOLLOWING�ECLqRAT�YS: � Z 0 lIHAVEAN�WILLMAINTAI,�1ACE7iiIFICATEOFCONSENTTOSELF-INSl1RcFORWOFKERS' _ COMPENSATION,AS PPOWIDED BY SECYiON 37000FTHE LABOR CODE,FOR THE PERFORMANCE U QHEWOflKFORWHICi THISPE9IAITISISSUE�. � � AVEAN�WILLMAINTAI�JWOflKERS'COMPENSATIONNSURANCE,ASREQUIREDBYSECTION �� � �S Q 37000FTHELABORCO�',FCRTHEPERFORMANCEOFTHEWORKFORWHICHTHISPEPMITIS ' dB� ISSUEO.MY RK 5'C MP SATIOM1 SURANCECARRIERANDPOLICYNUMBERARE: CONSTRUCTION �d J , j CARRIEA PLAN REVIEW � aoucvNurnaeq . . ELECTRIC ; — — --_� �2' o_.y �\ :.�'� [i}iISSECTIONNEmNOTB'�MPLcfEDOFhiEPERMfTISFORONEHUNDRED�OLLARS(E10�)ORLESe'), �UM31NG ... ` 0 I � - I CERTIFY THAT IN THE PBfiFORMANCE OF THE W'ORK FOR WHICH THIS PERMIT IS ISSl1E0,l MECHANICAL ; � � SHAL NOT EM1IPLOV ANY�ERSpN IN ANY MANNER SOAS TO BECOME Sl1BJECi TO THE Y'� ,� � �� �j (/} WORKERS'COMPENSATI S OF CALIFOftNIA,ANDAGREETHAT IF I SHOlJLO BECOME��, . �NS�ECTION FEE � . . � � _. ! COD,I SHA L FORTH6VI MPENSATION PftOVISIONS OF SECTqN 3�0o OF iHE LA30'&� � ` �,,�ifJ � [] �PPLCPIYWiTHTH SEPqO NS_ , �„ � ,.. ISSUANCE t _..._ _. ____ '�_._�,A .. SU9JECT TO THE WORKE 5'CO � I DATE: �� A� ANT.- � � ��� � � SMIP _` Ta ���� � WARNING�.F IWRE DSECURE OPKE ' ��' �� � J SECTION3]OBOFTHELABORCO� o ' �"'��"�� �"�—N' J RS'COMPENSATIONCOVERAGE NLAWFUL,AN�SHALLBE y ENERGYP/C �—y SUBJECTANEMPIOYERTOCRIM�NALP�NALTIE6ANDCIyILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT .r DOLLARS(Eloo.000),IN AD�ITION�r0 THE COST OF GOMPENSATION.DAMAGES AS PROYIDED FOR IN , � �E,IN7eRES i,ANO ATTORNEV'S FEES. RETENTI ON FEE: � CO STI�UCTION LENDING AGENCY PRE-AL7 FEE: O � IHEREP.VAFFIflMUN�ERPENALTI�Y OFAERJURYTHATiHEfiEISACONSTRUCTION�ENDINGAGENCY FOR THE PERFORlAANCE OF THE IWORK FOR WHICH THIS PERMIT IS ISSUEO�SEC.3oaJ,CIV.CJ. � � W , ,. __'_ ' ' — Z� LENDER'S NAME � � IEN�ER'SA�UflE55 � � � . a � `�a W ICERTIFYTHATIHAVEREADTHISAPPL,CATIONANDSTATETHAiTNEABOVEINFOFMAiIONISCORRECT. TOTALFEES �� p I AGREE TO CCMPLV WITH ALLCITY ANQ COUNTV OFDINANCES ANO STATE L4WS RELATING iO BUIL�ING CONSTRUCTIIXJ,ANO HEREBYAUTHORIZE REPRESENTATNES OF 7HI5 COUN7Y TO ENTEfl UPON T4E ABOVE-MENTIONED PROP FOfl INSPE I6N PURPOSES. z �, , COMMENTS_ _ . _ p , � �-- ---_ -... -- J � � q � m PERM EE E(D,ElINT) � �� .� �' � q C1i � �OFPEFMITTEE �. ATE ���- `� � � RECPT.ND. �°- c PAID 5Y VALIDATiON ~ � ��WH TE—De ariment Co YEL�OW—Finance Co PINK—Asses<or Co GO�DENROD=File Co GREEN—A IicanYs Co P PY, PY. PY. PY, PP PY �� . , :i;:_ � ...;.:.;° r � ..r�� ,�:i". .:5 2-i, i,d�> � �.i�r. a.i�;;. .,k.�,w,,. ..,... ,.,:e..,tv . ,. .. �- ,s .. , .,, -. . .. . ...- � i,¢ � � " T"�' �� .: .� r . .. . >:'.�b u`. .;;.t. .. 9 . , � 4 .. � �� ., . o- � `�'m��%ar-r tY d"� s� e w�, r �"r"�� a � -� � ': § ��. 5 * s x � r � e b P �; wx•9` �.,�' § d .��".' 9 �`�; # 9` ':a : �� �*�� w �.�'*��� �i� J��. �; y r � i; s �&� �F" � � � 3 � � � � � � � � k �{� 1'�� 7 a � ��:: � ;�� � s. 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