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HomeMy WebLinkAbout11671 n ' I CITY OF DIAMOND BAIt ----�`-�-- DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ��'��" BUILDING PERMIT APPLICATION FIRMLY a ADDRIESS :aC'7.��� �1.)'%AUC S✓p�� .�!✓C..� APPLICATION NU 8 R 1 ` #1C p DATE �_ �-� � � ISSUE / TYPE OCC APN LOT TRACT DATE s'� 1 � CONST. GROUP °C OWNER ,����� � � ZONING SETBACKS o ADpRESS '-��,�,�� �r-r�, Si s�1 E;= tS 5�+ +✓ j�t'�� oCIIY�)1/�l�Ueal^1 /?s7�'. ZIP�'�.,�,�TEL.�� e' FRONT RW L� APPLICANT TEL. REAR �_�____ � SIDE/SIDE STREET_ RW fl _ c� CONTRACT R���L (,' ����T�,J� ',�. SIDE ___._,__ p CITy E����;�`4 �'?,�ZIP���� T,E� .�,�,� PROPOSED USE - � .5 '7 o ARCWENG/ (J�� . z DESIGNER w - NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES ___BEDROOMS � v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFWADD/REM O 1 HEREBY AFFlRM UNDEA PENAITY OF PERJURY THAT I AM EXEMPT FROM TME CONTRACiORS LI� Gflfi19BIC8l�0l1 � � � W CENSEL11WFORTHEFOLLOWINGRFASOt7(SEC.7037.SBUSINESSANDPHOFESSIONSCODE:ANYGTYOR U COl1NTYyYF{ICHpEOUIRESAPERNITTOCONSTRUCT,ALTER,IMPROV[,�EAAOLISH,ORREVAIRANYSTqUG W Patiol�eck W TURE,PRKKi TO ITS ISSUMICE,ALSO NE�UIRES THE APPLICANT FOR 5UCH PERMIT TO FILE A SIGNE� W � S7ATEMEM THA7 HE Ofl SHE IS UCENSED PURSUANT TO THE PROYI&IONS OF THE CANTflACTORS�I- � � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7Wo)OF DIVISION 3 OF THE BUSINE55AND PRO� POOUSpB FESSqNSCODE)ORiHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEOEDEXEMP� (� � V TqN.ANYVKKATI0NOF5ECT10fi70.91.5BYANYAPPLICANTFORqPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof � ACIVIL PENALTYOF NOT MORE THAN FNE HUNDRED OOLURS(S5ooJ.): � ❑I,ASOWNEROFTHEPROPEHTV,ORMYEMPLOYEE6WITHWAGE6ASTHEIf1SOLECOMPENSATION, COfilrtlBfClal YALL 00 TME WOFlIC,AND THE STRl1CTURE IS NOT INTENDED OR OFFEREO FOR SAIE(SEC.70d4,BUSI� � y NESE AND PROFESSIONS CODE:THE CCNTRACTORS LICENSE LAW DOES NO7APPLV TO AN OWNEH oF � � PROPERTYWHOBU0.DSORIMPROVESTHEREIXJ,ANDNM1i000ESSl1CHWORKHIMSELFORHERSELFOq wTHFlOUGHHISORHEROWNEMPLAYEES,PROYIDE�THATSUCHIMVROVEMENT5RFiENOTINTENDEDOR m 0 OFFEREDiOH5ALEIF,HOWEYEp,iHEBUILDINGORIMPROVEMENTIS50LDWRHiNONEVEAROFC�iPLE- Z TpN,THE OWNER-6UILDER WILL HAYE THE BUHDEN OF VNOVMG THAT HE OR SNE DID NOT BVILD OF � IMPflOVE FORTHE PURPOSE OF SALE). w n1,A5OWNEROFTHEPROPERTY,ANEXCLU5IVELYCONTRACTINGWITHLICENSEDCONTRACTORS � TO CONSTiiUCTTHE PROJECT�SEC.)0�4,BUSINESS AN�PROFESSIONS CODE:THE CONTqACTORS LI� V81U8�i0f1 ADJ.AREA W CEN&EIAWDOE3NOTAPPIYTOANOWNENOFAPROPERTYWHOBUILDSORIMPflOYESTHEREON,NJO ""'�–'– --"' � NTqCONTMCTSFORSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPUflSUANrTOTHECONTflAG QUANTITY DESCRIPTION FEE � TOHSLICENSELAW). U TAM EXEMPT UNDER SEC. B.8 P.C.FORTHIS REASON � � U LL � DATE _oWNER__"'.__'— --' U Q W � LICENSED CONTRACTO�iS DECLARATION W � � I HEREBY AFFIRII UNDER PENALTY OF PER.IURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � G�n`{, �Yy. , �Iryy f���..r� ]y� ` � // /� ��+'^ d B(COMMENCINOWITHSECTION7000)OFDIVISIONaOFTHEBU5INESSpNOPROFESSfONSCODE,AND a �I✓ Aa.+ �lJ" �61 / G f .3 X MYLICENSEIS IN FULL FORCFPN�EFFECT. ��'p'^�WL m ���� � /� y yP�,(� �i � u L�CENSE CLASS_ 6.� IIC.ND. ��K% &s Z� f ` � � /-�� J V DATE_.���t�ra� CONTRACTOR_��L c--.;?��..i,__— a / //r -y�� W {'J C�'�!'` .l fe`.a`d"/� % �. _� WORKERS'COMPENSATION UECLARATION ¢ � I HENEBYAFFIRM UNDEH PENRLTY OF PERJURY ONE OF THF.FOLLOWING DECI.ARATIONS: z � _IHAVEANDWILLMAINTAINACERTIFICATEOFCANSENTTOSE�F�INSUREFORWORKEHS' Z � COAIPENSATION,AS PROVIUED BY SECTIDN 3�ao OF TNE LADOR CUD[,FOR TNE Pc11FOFMANCE U Q OF THE WORK FDR WHICM THIS PERMIT IS ISSLIED. � W �.I HAVE AND WIIL MAIMAIN WORKEFlS'COMPENSATION INSURANCE,AS RE�UIREO BY SECTIQN O 37000FTHE LABOR CWE.FOR 7HE PERFOqMANCE 0�7HC WORK FOR WHICIi TFiIS PEqMIT 15 ISSUED.MY WORKERS'COMPENSATION INSl1RANCE CARRIEH ANU POLICV NUMBER AfiE: CONSTRUCTION �/ --._ ..."'— _'_—.... : � CARRIEH G�/2J;aY PLANREVIEW __.. .___.,,.. ___ ' 0 POLICV NUlABEN .4��cJ�(,✓DC.`S��]�J_`7 ELECTRIC ¢� ---...__.. ---- o (nussEciiovale�rroTBEo�r,wi.E7EooF7NEaEati+rt�swaoriE�ux�naEODaisasrytoo�atLEss1. PLUM8ING _________.__ __""__��U�� � - w - Z I CERTIFYTHAT INTHE PERFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS I55UED,I MECHANICAL (} SHALL NOT f.MPLOY ANY PEFISON IN ANV MRNNEF SOAS TO BECOME SU&IECT TOTHE � �� � (n WORKEftS'COMPENSRTIONUWSOFCIILIFORNIA,ANDAGREElf1ATIFISMOUL[)9ECOME INSPECTIONFEE ____..,__._ � Sll&IECTTOTHEWORKEFS'COMPENSATIO PROVISION50 SECI'ION3700 FTHEUIBOR � COOE, SHALL RTI-IXJITHCOMPLYWITH OSEPROVISION. , ISSUANCE .__._____ ___ __ __�_�t�� , O p OATE: � �� � APPLICANT: � 7` � .:�/X SMIP _.___ � ENERGYP/C ,___ ,__ WARNING:FAIIURE TO SECUFE WORKER PENSATION COVF.RAGE IS UNLAWFIII.AN�SHAIL BE LL SU&IECTANEMPLUYERTOCRIMMALP IESAN�CIYILFMESUPTOONEHUNOREDTHOUSAND ENERGYPERMIT OOLLhRS(f10o.000),INMDITIONTO7H OSTOFCAMPENSATION,DAMAGESASPROVIDEDFOftIN -- ---����----- - '—_"'_—"_".,._.__...— J SECTION3loBOFTHELA�ORCOOE,INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: ¢ "'___---—_ _"' '_'__.._...— nW. CONSTHUCTION LENDING AGENCY PHE-ALT FEE: p -- ----- � I HEREBYAfFIRM UN�Efi PENALTY OF PLHJURY THAT THERE IS A CONSTRUCTION LEN�ING AGENCY _ FOR THE 7ERFOR4ANCE OF THE WONK FOR WHICH THIS PEqMIT IS ISSl1E�(SEC.3n97,CIV.C.). W '__-- � � —i � LENDERSNMAE,___ _ —__ C ___ f H LENDERSADDFiE55___._.____________._.._. _._ W� T�TAL FEES ICERTIFYTMATIMAVEHEPDTFIISAPPLiCATIONANDSTATETHATTHEABOVEINFORMpTIONISCOHHECT. a � I A6REE 70 COMPLY WITH ALL CITV AND COUNTY ORDINANCESANU STATE LAWS FEIATING TO BUILOING , •t � CONSTRUCTION,ANDHEflEBYAUiHOFIYEREPRESENTATIVESOFTNISCWNTVTOENTERUPONTHE ��rCnI��� I�a�� � . Z r1BOVE-MEMIONEOPFOPERT'FOAINSPECTIONPUFPOSE3. COMMENTS � y��� �¢ � ��� _� R � m .�T,4�� /��2�� - - PERMI NAME(PRINT7 4 ¢ � / � A � `� __. � SIG TUREOFPER OATE RECPT.N0. PAID BY .� � VALIDATION_ ��_ ~ WHITE-0epertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD--File Copy,6REEN—Applicant's Copy i ;.'{ . .... � _ .�... , . . «.....,. ....r.� ._ ... ` I ' ` I . ' ... },�4� . - - .�. 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