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HomeMy WebLinkAbout12007 i � CITY OF DIAMOND BAI� ��-, l - J� - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES / / ,w . 21660 E.Copley Drive Suite 190 � � ,/ (909)86(�3195 Fax(909)Bfi1-3117 �,/ PRESS � �""" BUILDING PERMIT APPLICATION FiRMLY 4 ADDRESS �� �� �,,�' APPLICATION C� �iPERMIT p/C � o DATE � � d NUMBER I�� � � -��- TRACT ISSUE �� . TYPE OCC � APN_� L07 DATE �d CONST. GROUP p OWNER 1 �C�P2[�// � p ADDRESS �A� ZONING SFTBACKS � z CITY Z!P TEL.— _ FRONT RW J g APPLICANT TEL. REAR �� SIQE/SIDE STREET RW _ fl I � CONTRACTO ! ,' ,�f�►!°Gf �. SIDE _ ^ ADpRESS C.� " — �--------- � CITY � - ' ZIp .3 TEL. '�� PROPOSED USE oARCH/ENG/I �� _ i z DESIGNER a ADDRESS NO.DWEL. NO. NO. � UNITS STORIES BEDRO�MS � CITY ZIP TEL, -. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p�; OWNER-BUILDER DECLARATION O' SFRlADD/REM Q I HENEBY AFFIRIA UN�ER VENpLTV OF PERIURV THAT I AM[XEMPT FROM THE CONTRACTORS LI- G0f2 B/Ca CfI �LU� CENSEUWFOR7HEFOlL�FVINaREASON(SEC.70.97,59USINESSANDPROFESSIONSCOUEANVCITYOR (n 9 � �C� COUNTYWMCHREWIRESAPEFMR7OCONSTHl1CT,ALTER�MPqOVE,DEMOLISH,ORREPAIRANVSTRUG ' �jJ PatiO/DBCk ; NRE,PHIDR 7o rtS ISSUANCE,ALSO HEQLIIRES 7HE qFPLICANT FOR SUCH PERMIT TO FILE A SIONED W �, STATEMEPll THAT HE OR SHE IS LtCENSEO Pl1R5UW1T TO THE PAOVISIDNS OF 7HE CONTRAC70R3�I. 1 CENSE LAW(CMqVTEft B(COMMENCINO WIiH SECTION 7oo0J OF DIVISION 3 OF THE BUSINESS AND Pq0- � PooVSpa '�' FE&gpNSCOD�OHTHATHEORSNEISF.XEMPTiHEREFROMANDTHEBA515FOHTHEALLEGEOEXEMP- (� I V TION.ANYVIOLATIONOFSEC710N70.37.6BYANYAPPLICANTFORAPEFMITSU&lECTSTNEAOPLICAMTO z R0-ap�} �, TCMLPEN7�LTYOFNOTA!ORETMAkFNEHUNORE�00L4.AR5(55ooj.): L]I,ISOWNEROFTHEPROPERTV,OqA1yEMPLOYEESWITHWAGE5A5THEIRSOLECOMPENSATION, L� COl�irtt9lClel � ��'. W�LL DO THE WORK�ND THE STHUCTUflE IS NOT INTENDED OF OFFEFEO FOR SALE(SEC.7U6l,BUSI- J �� �' NESS MIO PROFESSIONS CODE:THE CONTRACTOqS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � � DROPERTYN1iOBUILD50RIMPRDVESTHEREON,ANDWHODOE55UCHW[)qKHIMSELFOHNF.RSELFOfl Q iNROUGHHiSORHENOWNEMPLOVEES,PROVIfJEDTHA7SUCHIMPqOVEMEMSApENOTINTENO[DOR � n OFFEpmFOp5q�E1F,{10WEyER,7HE8UILDINaORIMPROVEAtENTISSOtDW1TMINONEYEAROFCOMPLE- j Z iqN,7HE ONRJEfl-BU1lDeF WILL NAYE TNE 811R0EN OF PROYWG iHAT FtE Oq SHE DIO NOl 8UiL0 Ofl 7 =, IMPROVE FOR iHE PURPOS�OF SALE). ;I ;W f]I.A30WNEROFTHEPROP[RTY,MIEXCLUSNELYCONTRACTINGWIMLICENSEDCONTRACTOq5 � � TO CONSTqUCT iHE PRQIECT(SEC.7oa�,BUSINESS AND PflOFE5510`IS CODE:THE COYTqACTOflS LI� V21118f10I1 ADJ.AREA__ W, CENSEUWOOESNOTAPPLVTOANpWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,ANU -'-------- S �' WNOCOMMCT9F095UCHPROJECTSWITHACOMRACTOq(S)IICENSEDPURSUANTTOTHECONTRAG QUANTITV DESCRIPTfON roAs ucENse uve.�. FEE Q' fJ 1 AM EXEMPT UNOEH SEC._ ,_,___B.R pG fOR THIS REASON , Q � 3. ca � LL DATE OWNER..___' --__'_ _. � � I�- '� C1 � Z; _"'_ . �U - . �� L�CENSED CONTFACTORS DECLARATION � � 4" W � � 1 MEREBYAFFIRM UNDER PENALTY OF PEqJURY THAi l AM LIGFNSFD UNDEA PAOVISIONS OF CHAP7ER :� pj B(COMMENCING WITN SECTqN 700a)OF OIVISION 30f 7HE 9USINESS AND PROFESSICNS CAOE,AND .' � MY LICENSE IS IN FUtI,f ORCE ANO EFFECT. m �1 . ��� 'A���-- .o�.. LICENSE CLA � � � LIC.N0. ''- � � W�' �ATE � � CONTRACTO _.__ '� a � �; WORKEpS'COMPENSATION DECLARA710N U �� �C� � ���5 IHFREBYAFFlRMUNDERPENALTYOFPEfiJURYONEOFTHF.fOLLOWINqDECIARATroNS: z 3 `����� . c�"_ Q �, � . p � 0` _tHAVEANDWILLNAWTAINACEtiTIFlCATEOFCONSENTTOSELF-WSUHEFORWORKERS' ,z 'i COASPENSATION.AS PROVIOED BYSECTION 3'l0o OFTHE LABOR COD[,FOR THE PfHFOHMANCE U � r OFTHEWOflKfOHWHICHTNISPF.RMITI515SL1E0. � � O. � "W" �IHAVEANOWILLMAINTAINWORKERS'IX7MPENSATIONINSURqNCE,ASRF�UIFfiU0Y5ECTION � - �;0; 370POFT}iElABORCQDE,FOfliNEPERFOFiM,WCEOFTHEWOP,KFOHWHICHiMISPERM1T15 � � 133UED.MY(V�Q/�K///E���qS' PENS/Ay/O ryNINSUflANCA CARflIEpANDPOLICYNUMBEHARE: CONSTRUCTION ._____..___ �4 G1� -.-.'— � r � �� cnaaiEe... ...._. PLAyREV1EW -,--- � ' --- ---._.�, � 0� pOLICYNUMBEH ELECTRIC � ��p (iHISSECTqNN�NpTBEOJMB�TEDCFhEPEW.qrtSFORONEHUPDfiEDpq1l61g(S�ao)ORLESS� PLUMBING --_--...--_ --. W. --Z= ICERTIFYTHATINTHEPERFORMANCEOFTHEWORKFOflWHICHTHISPERMITI5155U[D,I MECHANICAL ��; SHALLNOT EMPLOV?NY PERSON IN ANY MANNER SO AS TO eECOME SUBJECT TOTHE - — `—'- --' (�: WOflKEfl9'COMPENSATION UWS OF CALIFORNIA,AtvOAGREE THAT IF i SHOIILO�ECOMF INSPECTiOPI FEE , � SUBJECT T9 THE WORKERS'COMf+ENSATION PROVISIONS OF ECTIOY 3700 0F THE LABOR -�'--�--"'-- ��-- � CAO�/I SHPLLj�q7HWlTH COMPLY WITH F I510 ISSUANCE �, Q� ':O Tg /(�� "_'___'___"_"_' '!''p* DATE:��S1f��/ /_v APPLICANT.��_ ____ SMIP _ ______ W T—' __ J' WARNIN�FA�LU TOSECUftENK)RKERS'COMPEN5ATIONCAVEflAOEISUNLAWFUL,ANDSHALLBE ENEHGYP/C _.__^, �� ' SUB1ECTpNEMPLOYEFTOCRI4WALPENAL71E5ANDCNILFINF.SUG7oONEHUNDREDTHOUSAND ENERGYPERMIT ^ � :`�t OOLLARS�Si00,00U),INl��iTIONTOTHECOSTOFCOMPENSqTION,OAMAGCSASPRDVIOEDFORIN ------_.-- _. __ �_l SECTION37UBOFTHELABORCODE,MTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: j �O' CONSTRUCTION LENDING AGENCY PRE-AlT FEE: ___ _____� ^ I � :•0.: 1 MEREBY AFFIRM UNDER PENALTY OF PERJURV TIiAT THEflE IS ACqNSTRUCTION LENDING AGENCV _ _ ^ FOR THE PERFORMANCE OF THE WORK FOR WhIIGH TMIS PERMIT 19155UEb(SEC.309],CIV.C.). "-- - -- ------ � W � "^•� LENDER'SNAME , _ ' '_— ' . _. "_-" __._.._ { . F- LEN�ER'SA�DRE6S i_, _,_,_. _._ ' � IGERTIFYTHATIHAV[REAOTHISAPPLICATIONPNUSTATETHATTHEABOVEINFOpMAT10NISCOHRECT. IO�AL FEE� `T�4� gC?� ^ .� � � IAGflEEiOCOMPLYWITMALLC�TYM1GCOuNTVORDINAF:CESi.NDSTATEUWSR:Ia!I!:C?08U!LDI�!G �r�', �y'.�'� �,.'s��,�� � - CONSTRUCTION,ANOFEREBYAUTHOAiZEREPReSENTATiVE50FiNI5COUNTYi0EN7ERUPoNSHE �"' � }�x. [�� s';r� � / L V � Z ABOVEdAENTIONED PROPERN FOR INSPECTION PURPOSES. COMMENT$__ �� � �C��4 � `'-'� ��J G�/�� _ �� :_�.. aPE TTEE N P y ,,..++�) ' ____ —" � � � � '����� �–�y�— � SI(3NATURE F PFRM E DAT rJ� .��,'J � F , RECPL NO.���=—.�=-�PAID BY VALIDA710N 'WHITE—Department Copy,YELLOW—Finance Capy,pINK—Assessor Copy,GOLOENROD—file Copy,GAEEN—Applicant's Copy ! _ �._._. ,. � .t . . _ � ._ _ � �� + �,b{tg s-. t ..$.,� .... .' I ,� � Ea � . ' .� I 1, _ r. � x a � � I ! ' i � , '`' �� i ���� Y��p �' � f I �� r ' �� i ' 1 n � 4� . + ? ; k � . , '� ,', • E � � T y � ���{�e ��y ��� I `, ' 1 1 � ?k y zk" � ;,d^ . . � 1 i ! - � _ Y. ,� ' �, C it .. �t � � i : ,. � x���'� � F� r ; - I �.+I&ibr.'¥ � � _ . ' L {i I �� .� _ I ' _ry, � �, 3 C � ,y%V• � - : � ' � . � 1 � .I }�.G� I' a �J �5Y 1 ,��}4�'��3: � ' f : , : f I i . 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