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HomeMy WebLinkAbout12691 � / , . CITY OF DIAMOND BAI� �i�. ��–— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 B.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS '���°�� BUILDING PERMIT APPLICATION FIRMLY a ADDR SS �"���I /�� p� � �Z i y APPLICATION � t� PERMIT � ��-[,I P/C o �, ,___T_—�/� � h� DATE�).�r.� ���_NUMBER K I # c� ISSUE � / TYPE OCC APN LOT TRACT DATE _CONST._ GROUP p OWNER !' ' � ' r�' o ADDRESS �+� �* , ZONING SETBACKS w FRONT RW ❑_,__ gCITY ' Z!P _ TEL. _ -- APPLICANT - TEL. REAR Il Z SIDEJSIDE STREET_ RW ❑ _ � CONTNACTOR y SIDE ._ l�_._____ � ADDRESS - o CITY ZIP '" TEL.Z. � PROPOSED USE,�:�C�'�.4T��al� ����� wQ ARCH! / ��,r o ,�� e� 's /':!6 i<t'�'Td�.w�.-"d� z DESIGNER _ NO.DWEL. —7�� '� ��O � /).C� a ADDRESS UNITS STORIES BEDROOMS � • � CITY ZIP TEL. -- � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFItiM UNDEH PENALTY OF PEP.NRY THAT I MA E%EMPT FROM THE CONiqACTORS LI� � Garage/Carport W CENSEI.AWFORTHEfOIIOWINGHEA50N(SEC.7037.SBUSINESSANDPROFESSIONSCOUEANYCITYOR U CIXINTYWHICi/REWIRE5A7EFMIT7000NSTRUCT,ALTEH,IMPR�VC,OEMOLISH,ORREPAIRANVSTRUC- W Pdf10/DBCK W TURE,PNIOR TO ITS ISSUPNCE,ALSO REQUIRES THE APPLICAMT FOR SUCH PEFMIT TO FILE A SI�NED w STATEMEN7'TNAT HE OR SHE IS LICEN5ED PURSUANT i0 THE PROVISICNS OF THE CONTRpCTORS L!� � � CENSE LAW(CFIAPTEH 9(COMMENCING WITH SF.CTION�OoO)OF OIVISION 3 OF THE BUSINESS AND Pfl0- �'�' PooUSpa FESSIONS�E)OR7HATHEORSHEISEXEMPTTHEREFROMANDTHEA.4SISFORTHFALLEGEDEXEMP- C7 TION.ANYVIIXAYIONOFSECTION7031.SBYANYAPPLICANTFOFNPERMITSUFlJECTSTHEAPPLICANTTO Z Re-Roof �.� � ACMLPENAL7Y OF NOT MORE THAN FIVE HUNORED OOUAFib(6500).�: o f11,A50WNEHOFTHEPROPERTY.ORIAYElAPLOVEESWITHWAG[SASifiEIR501.FCAMPENSATION, 0 COtt�mBroiBl � 14ILL DO THE WORK N'!D THE 9TRUCTURE IS NOT INTENDEO UR OFFERED FOR SALE(SEC.70a4,DU51- _J NE3SAND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PflOPERTYNRiOBUILD50RIMPROVESTHEREON.ANDWHD�0ES5UGHWU(iKNIMSELFORHER6ELFOfl � _ � THRWaHHI50RHEROWNEMPLOYEES,PROVIDEOTHATSUCHIMPROVEMENTSARENOTINTENAEQOR m QOFFEREDWRSALE.IF,NOWEVER7HEBUI�DINGORIMPROVEMEMISSOIDWITHINONEYEAfiOFGOMPLE� _ Z TION,THE OWNER6UIL�ER N7LL HAVE PHF BURDEN OF PROVING ThIAT HE OR SHE DID h'OT BUILD OR � IA�PROYEFOATHEPUHPQSEOFSALE�. fl I,AS OWNEROf TNE PflOPEFlTY.AM EXCIUSIVELY CONTRACTING WITH LICENSE�CANTMCTOqS � � Q TO CANSTRUCT THE PROJECT(SEC.7044,BUSWESS ANO PROFESSIONS CA�E�THE CONTRACTORS LI� V9If18110f1 __,._,_ (±� _ADJ.AREA W CENSEUWOOESNOTAPPLYTOANOWNEROFAVROPEflTYWH09URD50RIMPROVESTHEREIXJ,ANO � -- � NM1IOCONTHACTSFOqSUCHPROJECTSWiTHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTqAG QUANTITY DESCRIPTION FEE� � TOFlS UGENSE LAW.�. � f 11 AM E%FMPT UN�ER SEC. 0.R P.G FOR TMI5 REA504 Q i --" _._"'__—'__'"' U _ � LL DATE ___'OWNC-P'____ _." ___'_ U . � LICENSE�CONTRkCTORS DECLARATION � � I HEREBV AfFIqM UNDEf7 PENALT'OF PERIURV TY10.71AM UCENSED UNDER PROVISIONS OF CNAVTFR � ^ � . � 9(COMMENCINa WITH SECTKKJ 7000)OF DWISION S OF THE BUSINESS ANU PROFESSIOYS GOD[,A4D � X IAY LICENSE IS IN FULL�ORC[ D EFFECT. �' LU � 410ENSE CIASS_� � LIC.NO. � �,..___ _ � 1- . U DATE�� _CONTFlACTOii_ � . ra r a -- ^ W � WORK RS'COMPENSA710N DECLARATION -� � Q � IHEREBYAFFIRMl1NDEPPENpLTYOFPERIURYONEOFTMEFOLIOWINGDFCLAHATION5: � � � _ -' � � IHAVEAkDWiLLNAINTA1NqC[RTIFICAiEO�CO45ENTTOSiLF-INSUAEFORN'ORKERi' 2I �COMPENSAfION.ASVROVI�E09Y5EC710N3�ooOFT���LABONCOOE.FORTHEPERFOqMANC[ w � _ OF THE WORK FaR WHICH TNIS PERMIT IS ISSUED. � � � � _'__ _I HAVEANfI WIL4 MNN7AIN WORKERS'COMPENSATION INSLiMNC`e.AS HEOUIRED BY SECTION � Q 370oOFTHEIA90FlCO0F.iOR7HEPF.flFORMANGEOFTHEWORKFORWHICHTHISPFRMITIS - -- � ISSUED.MYWORKEFIS'COMPGNSATIONINS�UMyNC G(AflRIEf7ANDPOLICYNUMBERARE: CONSTRUCTION 1 , � � Q CAflRIEP. ����Y��f� __-......_- . ._-.'...._ -_' -_..._� 1 7 -..—... PLAN REVIEW —..- --._. ..-- ------- � POI.ICV NIIMBER �!���� ► - ..._...-.---._.-- EIECTRIC ' � �� ' �'_. .__—__"_ .'—'.. __...— 0 (MSSECi1CNNE�NOTBEWI+WLElmOFTHEPERMRISFOR�NEFNJNDREDDOl1NLS(Slao)ORlE55) PLUMBING ...--.----. --.- --- W Z I CEflTIFYTHAT INTHE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSl1ED,1 MEGHANICAL _ _.__.. ___ (� SHALLNOTEMPIOYANYPERSOMINPNYMANNER50A5T08ECOMESIIBJEC7TOTHf. � WORKEHS'COMPENSAIHJNLAWSUF(:ALIFOMINIA,ANUAGHEEINpiIFISHOULDBECOME IIJSPECTIONFEE ___ __ __._ F SU[iIECTTO7HEWORKERS'COMPENSATIONPROVISIONSOFSECTI0Y37oVOFTH[IARUR - 7 (:O�E,IS ALLFOHTMWITMCOMPLYWITHTHOS RO��SIONS. , ISSUANCE ..._._-._ __. � � (,�(�, SMIP 0 DATE: . '. APPLICANT: ______— _—�-_ • . � ENERGY PIC --.- - '—- - -------.------- ,J WAPNINGFhIL ETOSECUREWOHKERS'COMPENSATIOYCOVERAGEISUNLAWFUL,AN�SHALLBE �—y_ SUBJECTANE ALOV[P70CRIMINALPENALTIESANDCIVRfINESUPTOON[HUNDREDTHOUS�NU ENERGYPERM�T DOLLARS(5��.�D),INAD�ITIONT07HFCOSTOFCOMPENSATION,UAMAGESASP(iOVI�EDFOHM '%'{j�+�f1L`D���� � J SECTIDN37080FTH[LA90RLYJOE,INTEREST,ANDATTORNEY'SFF.[S. RETENTIONFtL"�j �i � CONSTRUCTION LENDINGAGENCY PRE-ALTFEE:���I�������=r.��� .__ � IHEREBYAFFIRMl1N�Ei7PFNALTVOFPEFlJURYTHATTH[f1EI5ACON5TRUCT10NlENDINGAGENCY ____,_____ FOFi THE PEHf'ORMANCE OF"THE WOf1K FOR WHICIi THIS PEHMIi IS ISSUEU(LEC.3097,CIV C.). Z .,.'-' _"_ W � LEN�ER'SNAME "__'_"'_'- . __"_�..."_____-_ '__� _' ___ F- LENDER'SADOPF55__-'__...'""'_'_-__'"""'_"'_._.... � ICERTIFYTHATIHAVEPEADTHISAPPLICATIONANDSTATEhIATTMEABDYFINFORMPTIONISCORIIECT. TOTAL FEES ` � I AGHEE TO COM.PLY WIYH ALL CITV AND COl1NTY OfiDINANCES AND STATE lAWS P0.ATINO TO BUILOING CANSTRUCTION,AND NEREAV AI/TNOf71ZE REPRESENTATIVES OF THIS COUNTY TO EN7ER UPON THE zAOOYE�MENTIONED PFOPERN FOR INSPECTION PURPOSES. COMMLNTS / t �_�_ _ O - � � m PERMITTEE N�� -'--'-"_' - ----' ""' 4 '-,�-= } -�� � y =-�-�� --- 7 SIONATUFEOFPEflMITTEE ` DATE � � RECPT.NO.� PAIDBY !_✓__�10 __•� S ~ WHITE-0epaRment Copy,VELLOW--Finence Copy,PINK—Assessor Copy,GOLDEN OD--Fiie Copy.GREEN—Applicanl's Copy . ,, i; . . .., ....... ... . .... .. .., >... i ..' I ..� ... I � '.��a ..., �:Yfs*��� . v �'' °'. s ��� lE:� : � j � � � , �'`-r � � c e �� �i� ��, �s p� . i4� r F'i . I � E �� i �' a � f � .'� y, t , t x .�4 i , � . ..� . 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