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HomeMy WebLinkAbout13125 w CITY OF DIAMOND BAI� � -� ���-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ,� 21660 E.Copley Drive Suite 190 " PRESS ���»���W BUII.DINGSPERMTTAPPLICATION FIRMLY JOBSITE , Jy y� f�. PPLICATION PERMIT � { P/CC� 0 ADDRESS �� ��/��°., � /�C��Ir) ��L�?7/` �qTE_ � r �� NUMBER �I �y # `�_��� , c� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER G11�JE. s� ei1� ` `'til. t � u' ADDRESS �� Z- ) ir rcy� C ZONING SETBACKS ' w z FRONT _ RW f7_. Z CITY c� . r ZIP` TEL. X��l��z g APPLICANT �' TEL. �Z-/._ ,�`/� REAR f.7____ � SIDE/SIDE STREET RW ❑ _ CONTRACTOR � !t� S � '�-�• r /e�/`1 SIDE L]__., Q ADDRESS � � ' " PROPOSED USE � � -� n � � CI1Y ' a e , ZIP �J 7 /TEL. G� ?-/ '— / -- � B ARCH/ENG/ DESIGNER NO.DWEL. NO. NO. ADDRESS '��' y UNITS STORIES BEDROOMS � � CITY ZIP TEL. � � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION O OWNER-6UILDER DECLARATION SFR/ADD/REM Q I HEREBY 11FFIFM UN�ER PENALTY OF PEFLNFV THAT I AM EXEMPT FfiOM THE CONTFACTORS LI� Gflf8Q9/C81POfI (yJ CENSEUWFOHTHEFOLLOWIN6RFASON�SEC.7031.SBUSINESSAN�PROFESSIONSCO�E:ANYCITVOfl (n C.� COUNfYHIHICHREOUIRE3APERMITTOCONSTRUCT,ALTER,IMPROVE,OEMOLISH.ORREPAIHANYSTRUC- W Pg110/DBCI( � WNRE,PRIOR TO ITS ISSUANCE.FLSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT 7HAT HE OR SHE I5 LICENSE�PURSl1AN7 TO hIF PNOVISIIXJS oF THE CONTRACTORS LI- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION�aao)OF DIVISION 30F THE BUbINESS AtJD PRO� � Pool/Spa FESSqN3 CODE)OR THAT HE OR SHE IS EXEMPT TNF.REFROM PND THE BA515 FOfl THE ALLEGED E%EMP- TION.ANYVIOUTIONOFSECTIIXJ70.91.SBYANYAPPLICANTFORAPEHMITSU6IECTSTHEAPPLICANTTO Z Re-Roof � ACML PENPLiY OF NOT MORE THAN FIVE HUNDREO OOLLAHS(=5oo).j: � CII,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTH[IRSOLECAMPENSATION, � Commercial Wtll00 THE WORK,ANO 7HE STPoJCTUBE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7064.BUSI� J NESSAND PROFESSIONS CODF:THE CONTRACTORS IICENSE LAW bOES NOT APPLY TO AN OWNER OF � � �HOPER'fYWhiOBUIlDSORIMPROYESTHEREON,ANOWHODOESSUCHWORKNIMSELFORNEHSELFOR m __ � YHRd1GHHISORHEflOWNEMPLOYEES,PROVIDEDTHATSUCHIMPFOVEMEN75ARENOTIN7EN�EDOR O OFFEREDWASALEIF,HOWEVERTHEBUIL'JINGORIMPHOVEMENTISSOLOWITHINONEYEAROFCOMPLE- � Z TpN,THE OVAJEflAUILDEfl WILL HAVE THE BUflDEN OF PROVINO THAT NE OR SHE DID NOT BUILD OR � IMPROVEFOHTHEPURPOSEOFSALE). � W ❑I,ASOWNEHOFTHEPROPEfiTY,AIAEXCLUSIVELVCONTRACTINGWITHLL`ENSE�CO!VfRACTOFl5 � TO CONSTRUCT lHE PRO,IECT(SEC.70N,BUSINE55 AND PROFESSIONS COOE:TNE CON7RACTOpS L6 VBIUal1011 .___._ '—_ ADJ.AREA.,________ CENSE UW OOES NOTI1PPlY TOAN OWNER OF A PROPERTY WMO BUILDS OR IAIPROYES THEHEON,AND ' ' __'....._.."'" � � W}IOCONTRACTSFORSUCMPRQIEC75WI7NACONfMC70R(5)LICENSEDPlJR51JANTTOTHECONTRAG QUANTIfY DESCRIPTION FEE � Y TORSLICENSELAW.)--' —"_'_ ___'_—____..—.._._.._. ¢ J ^ C71 AA1 E%EAIPTL7NOCR 5EG B.8 P.C.fOR THIS REASON U S � � DATE __OWNER_._____ _ � ,�G U ;( F LICENSED CONTRAC.TOr�S DECLARATION i j � � I IiEflEBYAFFIRM UNDEfi PENALTY OF PEFUURY THAT!AM LICFMSED UNDEfl PROV!SIONS OF CHAPTER � � B(COMMENCINCI NATH SECTKKJ 7000)OF OIVIS!UN 30F THF DUSINESS AND PROFFSS:ONS CODE,AND � p / m �� IAYUCENSE IS IN NLL FOHCF.ANO EfFEC7. � LICENSE CL4SS IIC.NO. ___I(L~ S � ,. j ^ OO �^ / V� UATE J ��___ CONTRAGTOR dj.aw J. C��l/�� �- W � ��' WORKERS'COMPENSATION DECLARATI04 �'3D- '�' -r U }� �, IHEFEBVAFFlRMUNDERPENALTYOFOFRIURVONEOFTH[GOLLOWWGOECIAFiATIONS: � �� �� IHAVEANDWILLMAMTAINACEq4iFIChiEOFDDN5ENT705L'iF-iNSUHEFOR`NORKERS' S � � COI�IPENSATION,AS PROVIOEO BV SECTION 37o00F THE LAeOR CODE,FOA THE PERI=ORMANCE W _ OFTHE WOHK FOR WNICH THIS PERMIT IS ISSUEO. � � � _ W I HAVEAND WILLMAINTAIN WORKERS'COMPeNSATIDN INSURANC[.AS REqUIRCD BV SEC710N / � Q� 37000FTHELA60RCODE,FORTFIEPEflFORMMICEOFTHEWOAKFURWHICHTH�gpERS71TIS \�,� ���� �'. ISSl1E�.MY WORKERS'COMPENSATION MSURANCE CMRIER ANU POI.ICY NUM6Efl AHE� CONSTRUCTION 3� �� cnnpiEp._. .--'-- --- PLANREVI[W zPaICYNUraeEA_ ---._____ ELECTRIC _.___".'_..._......"'..._.._..... -_"..__--__"___ ¢ � (fHiSSL"CTI�NNE�NOTBECOMPETEDOF7HEPEfiMflSiL�RONEFN1rDFiED�OWASCefaDJORLESS�. PLUMBING __.__. ._.__..___'_'.-'_"_'__-_'_'_-__.____-._"."_--..___. W _Z_ ICEflTiFYTHATIN7HEPEflFORMANCEOFTHEWOHKFORWHICHTHISPF.RMI115155UE0,1 MECHANICAL _____ ��. SHPLLNOT EMPLOYANY PERSON IN ANY AIANNEN 50 AS TO BECAME 3UE3JECT TO THE Y �,,... � � WORKERSCOMPENSATItlNLAWSOFCALIFOf1NIA,ANDAGREFTHATIFISHOULDUEC:OME INSPECTIONFEE ___.____......_.__ �,�+,�___._�__.G'/►__��._�_ � SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 UF T11E LABOR ISSUANCE � . '� � "�/�/�/ //' � / Cf'�/ � COD ISH�-�t FORTHWIll1COMPLYWITHTMOSE ROI51 S. �J -'-".._.-- �-.._.."""...._"'—'___""... ' p �ATE:��/7_� APPL�GANT: ,�.��""` r SMIP _-____....-.__..-__..-___. _ _- ..___-____..._ � J � T ENERGY P/C _ __.._ J W�RNING FAILURE t0 SECURE WORKERS'COMPENSAiION CAVERA6E IS UNLAWFUL.AND SHALL BE �y SUBJECTANEMPLOYEflTOCRIMINALPENALTIFSlNOCIVILFINESIIPTOONEXUNDREDTHW9/1ND ENERGVPERMIT e .. ' l _ DOLLARS(f1oo,000),IN AD�ITION TO THE COST OF COMPENSATION.DAMAG[S AS PROVIDED FOP IN �� SECTION37080FTFiEIABORCODE,INTEREST,RN�AiTOFNEV'SFEES. RETENTIONFEE: N�y'�X'✓i"�Y:Y. ���f�oh.TY�9TAA�J• '_____ W �.,..r s�. .: '.�1 .'Tn��S'.11}�iFS�T� CONSTRUCTION LENDING AGENCY pR ALT FEE: p jF' O � " ----�'-��+.-:-y't:�7'��'-..r CL� IHEREBVAFFIRMUN�ERPENALTYOFPERJURVTHATTHERE�SACON57ql1CTIONLEN�INGAGENCY ^ � __._,__ __ �� FORTHE PERFORMANCE OF 7HE WORK FOF WHICH THIS PERMIT IS ISSUED(SEC.]097,CIV.C.). � 1p �, � �, � � IVi�G.'t.L yZ��_—"'".._...._—_ "_ � LENDEFYSNAME__._. _—_____ ""_""' _""__'_ _'..._— F�- LENOER'SA�DRESS__. __ _.—__--.-- I r'� /�'�� WICERTIFVTHATIHAVEREA�THISAPPLICATIONANDSTFTETHATTHEABOVEINFOFMATqNISCARRECT. TOTAL FEES /, eJ�- .� { � � � I A�REE TO COMPLY WITH ALL CITV AND COUNTV ORDINANCESANU STA7E UWS RELA7ING TO BUIL�ING ��'�� � CONSTRUCTION,ANO HEflEBY AUTHOHIZE R[PRESCNTATIVES OF THIS C�UNTY TO ENTEH Uf'UN THE Z ABOVE�MEN710NE0 PROPERT'FOR INSPEC710N PUNPOSES, COMMENTS" , '_'_—__'_—_'_"'_ � t � //��/K. 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