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HomeMy WebLinkAbout13939 \ ��_ CITY OF DIAMOND BAB DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ��'� �� 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ���;��` � BUILDING PERMIT APPLICATION FIRMLY o D R'ESS�-1 � y�OF�iiv D,e4�rS APPLICATION �,j �� PERMIT ` .� �' ,) /C ( � � DATE �/ �, �' NUMBER t'-^� � ISSUE ' TYPE OCC j APN LOT TRACT DATE COtdST. GFOUP I p OWNER �T� �����r' i1 p ADDRESS/Fi/[�. /'�''a !UFl�,�l11� ZONING SETBACKS t � CIIY�n4A'n(yt/QZ ,�i� ZIPg l7S�TEL�' - � � REART RW n^ p APPLICANT TEL. f � SIDE/SIQE STREET RW _ ❑ ___ CONTRACTOR SIDE _ l�_ � ADDRESS� /�,��/y��,�.� `� PROPOSED USE 0 CITY l7�•km n,v4� �R2.. ZIP�7� TEL.���� 0 ARCH/ENG/ �� �� � DESIGNER NO.DWEL. , N�. {AJ! ti,R,� sN9:. ADDRESS UNITS STORIES BEDROOMS�r � CITY ZIP 7EL. — � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILOER DECLARATION SFR/ADDlFlEM O 0 1 HEREBV AFFIRM UNDER PENALTY OF PE0.IURY THAT I AM E%EMPT FROM THE CANTRACTOHS LI- G2f89BIC3fp�f[ W CENSEUWWRTHEPDLLOWINGHEASON�SEC.7a37,5BUSINESSANDPfiOFE5510+1SCO0E:nNYCITYOR (n U �M'/Wry�p{{REWIqE6APERAIITTOCON57AUGT.ALTERIMPflOVE,UEMOUSH,bRHEPAIRANYSTRUF W paSiO/DBCI( � TURE.PRIOR TO IT5 ISSUANCE.�L50 REWIRES THE FPPLICANT FOF SUCH PERMIT TO FILE A SIGNE� W � SY�TEMENT iHAT HE OR SHE IS LICENSEO PURSUANT i0 THE PROVISIONS OF THE CONTflACTOFS LI� CENSE LAW[CHAPiEfl 0(COMMENCINO WITH&ECTION 7Wa)OF DIVISION 9 OF 7HE Bl1SINESS AND PRO� � POOUSpe FESSpNSCODE)OR7HA7HEORSHEISEXEMP7THEREFROMANDTHEBA913FOFTHEALLEGEDE%EMP� (� TION.NHYVIOLATIONOFSECTION1a31,5BYANVAPPLICANTFO(iAGERMITS�&lECTSTHEAPPLICANTTO z Re-Roof • F AqNLPENA4,TYOfNOTMORETi{WFIVEFIUNOflEDDOLUIRS(35W).). � ❑I,il50WNEROFTHEPROPEPT/,ORIAVEM7LOYEESWITHWAGESASTHEIRSOL[CAMPENSA710N, ❑ COmmefCiel WILL DO THE WORKµD THE STRUCTUflE IS NOT INTENDEO OR OFFEflED FOR SALE(SEC.]Od4,BU51� ,�J � NESSAND VROFESSIONS CODE:hIE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPEfliY YA10 BUILDS OR IMPROVES THEREON.AND WHO DOES S1JCM WORK HIMSELF OR HERSEIF OR CL TNROU6HHISORHEROWNEMPLO�EES,PqOVIDEDTHATSl1CHIMPROVEMEN7SARENOTiNTENDE�OR m W OFFEflE�WR5l1LE1F,MOWEVER7MEBUIL�INGORIMPROVEMENYISSOLDWITHWIXJE7EAflOFGOMPLE� Z PION.THE OYMEH�UILDER WILL HAVE THE 6UR�EN OF PROVI4G THAT HE OR SHE�ID NOT BUILD Ofl � M7PFpVEPDRTHEPURPO5EDF5ALE), Ll I,AS OWNEfl OF THE PROPERT;AM EXG.U���FLY CONTRACTING WRH LICEN^uED CONTHACTORS � TO CONSTRUCT 7HE PRQIECT(SEC.7a6d.BUSINE55 ANO PROFESSIONS CAl]E.THE CONTRpC70R5 LI� V9IUeH011 .��'�D ADJ.AREA_ W CENSELAWDOESNOTAPPLYTOANOWNEROFAPf10PERTVWMOOUILO50RIMPROVESTHEREON.AND -- �--- "' � WFqCONTMCTSFORSUCHPHQIECTSWITHACAN7RACTOR�S)LICENSEDPUR9UANTTOTHECANTRAG QUANTITY DESCRIPTION FEE Y TORSIACEN9ELAW.). _ � ❑1 AM EXEMPT UNDEH SEC. __ �.B P.C.FOR T:115 HEA50Y Q � U LL __'_"_ � DA7E__ OWNER _______ __ U � J � IICENSED CONTRACTORS DECIARkTiON �� � Il7EHEBY AFFIRM UNOER PENALTY OF PEKIURV THAT I Mi IICCNSE�UNOeR PRO\'ISION&OF Ci7AVTcfl �, p� 9�COMMENCINaWiTFiSECTION)ooOjOFDIVI5�ON30FTHEBU51NE5SANDPFOFESSIONE(bCE.NJU z __^_ X' 11Y�ICENSE IS IN FULL FORCEAND EFFEC7. ) � � LICENSE CLAS �� LIC.NO._���'�� ._ J V DATE��-�CONTRACTOR�t(@��/��t�7i�r C a -- — W � WORKERS'COMPENSATION DECLARATION 4 �� I HEPEBV AFiIRAI UN[7ER PENALTY OF PERIIIFY ONEOFTHE FOLLOWING UECLAMTIONS: Z � ,IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSI!RFFOPWORK[I3S' _ COMPENSATiON,A5 VROVIOED 6V SECTION 370a OF THE LA80R CO�E,FOq THE PERFORlAANCE U Q Of iME WORK FOR WHICN 7h115 PERMIT IS ISSUED. W p � i W _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONI�SURANCE,ASNfOUIR[DLiVSECTiON '� �� Q 37000F7HEI.ABORCWE.fOqTHEPERFORMANGEOFTHE�NORX�ORWHICl�17'HISPERMITIS . _ 155UE�.MY NlOflKEHS'COMPENSAT IN UFUNCE CARRIER ANU POLN.V NUMBERARE: CONSTRUCTION _,___,_,_,_ f .; ---� ..-_..... C. � -' '" _ PLAN REVIEW � � CARRIER�� ��" _... -_.. -. _—' -'_-"'_"_ >' Z POLICYNUA1Bf:R.��.�C_C �=��----- — -- ELECTRIC ---- ---- ----------- ¢ � (IHISSECI%xJNE�NOTdE0.X.8'LEfIDOFTNEPEPMilSWfiQYEFM1NVOREDDOlW15(blao)ORLESS} PLUMEIING --- ------- _--- Z I CERT:FY THAT IN THE PERFOPMANCE OF THE WORK FOR WFIICH THIS PERMIT IS ISSUED,1 MECHANICAL � ______ __ - �} SMALL N(1T EMPLOY ANY PEASON INANY MANN[R SOP.S TO 6ECOME SU&1ECT 70 TFiE , l. �'� N> :' (ry WORKERS'COMPENSATIO�d LAWS OF CALIFORNIA,AN�AGREE THAT IF I SHOULD�ECOMF W SPECTION FEE _ � ___ � '_ S SU&IECTTOTFIEVJORKF.RS'COMPEN3ATIUN7qOVISIONSOFSECTIONa7�a��F1HELABOR J ,. CODE,I HALL ORTHWITHCOMPLYWITHTHOSEV>R ISI S. 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