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HomeMy WebLinkAbout14351 � ^ 1� CITY OF DIAMOND BAA DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � � 21660 E.Copley Drive Suite 190 � �I� � �,� �.,�- ,,.,,; (909)860-3195 Fax(909)861,-3117 PRESS � "��". BUII,DING PERMTP APPLYCATION FIRMLY � JOBSITE a ADDRESS ��I � ' ��C��- � APPLICATION PERMIT //��C P/C p �U g'�;- DATE P2 �'3 I,T��i NUMBER s ' ��y # � ISSUE—T TYPE OCC AP�i LOT TRA�T DATE CONST. GROUP °C OWNER �t r�. C.j��c.l o "C„�,� �" ADDRESS �� ZONING SE76ACKS W CITY � ZIP TEL. FRONT RW ❑--- � � APPUCANT�' 4-y��nA1G�� TEL. SIDElSIDE STREET RW___ ❑ � CONTRACTOR "s G� C l)r:�I�l�� SIDE _ �_�_______ ADDRESS � '�-- i� �S-n..�p'Fr �: � 5'�,�� ��_� � CITY�3.� Y ZIP `�N+ TEL. PROPOSFDUSE �% J '(`�'' �L` O /_ �G.� �� r�r� 'v T �'�.!L G.� J � - '�L '�7� Ow ARCH/ENG/ �__ ,�V.�1 �-.A�,w �ti�^v� � DESIGNER N�.DWEL. NO. NO. � ADDRESS UNITS STORIES � BEDROOMS�� � CITY ZIP TEL. — � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADO/REM O I HEREBY AFFlRM UNDEFi PENALTY OF PERJl1RY THAT I AM EXEMPT iROM THE CONTRACTORS LI� GHfe90/C3fPOfl W CENSELAWFORTHEFOLLOWINGREASON(SEC.70.37.SBUSINESSANDPROFESSIOYSCOOE:AhYCITYOR (/� C.2 CIXIN7VNMICHHEIXIIRESAPERMITTOCONSTFiUCT,ALTER,IMPROVE,OENOLISH,ORREPAIRANVSTqUC- � TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRFS THE APPLICANT fOR SUCH PERMIT 70 FILE A SIONED W Pa��olDeck STA7EMEIVT 7HqT HE Ofl SNE IS LICENSED PURSUANT 70 7HE PROVIS�ONS OF THE CONTPACTORS LI� � CENSE UW(CHAPTER B(COMMENCINO WIT}I SECTION 7aoo)OF�IVIS�ON 3 OF THE BUSMESS AND PR6 � PooUSpa '� FESSIONSC6DE)OBTHATHEORSHEISEXEMPT7HENEFROMAN�THE6ASISFORTHEALIE�EDEXEMP- (� V TpN.MI'/VIOLATIONOFSECTION7031.58YANYAPPLICRNTFORAPERMITSU&IECT57HEAPPLICANTTO Z RB-ROOf � SL�J' F ACINLPENAL7V OF NOT MORE THAN FIVE HUNDRED�OLLARS(SSao).): � ❑4ASOWNEROFTHEPFOPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPEN6ATION, ❑ Commercial � YALLDO THE WORK,AND THE SiRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEG.7o4a,BUSI- J � NESu AND PROFESSIONS COOE:THE CONTflRCTORS LICENSE LAW OOES NOT APPLY TO AN OWNER OF ' PROPERT`/WFiO BUILDS OR IMPROVES 7HEflEON,AND YMO DOES 5UCH WORK HIMSELF OR HEFSELF OR p � 7HROUGHHISOflHEROWNEMPLOYEE3,PROViDEDTHAT9l1CHIMPROVEMENTSARENOTINTENOE�QR � � � OFFEREDiORSALE.IF,HOWEVERTHEBUILDINGORIMPpOVEMENTI550LDWITHINONEYEAROFCAMPLE- Z YION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE 01�NOT 8111.D OR � IMPROYE FOHTH`_PURG09E OF SALE�. ' ❑i,AS OWNER OF THE PROPEflTY,N.1 EXCLUSIVELY CONTRACTING WITH LICENSED CONTMCTOHS � 70 CONS7RUCTTHE PROAECT(SEC.7o/d,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VaIUeSIOn Y.�I.v 'ADJ.AREA W CENSELAW�OESNOTAPPLVTOANOWNEROFAPROPER7VWHOBUtLD50RIMPROVESTNEREON.AND ' ---- -'-- � WFpCONiMCTSfORSUCHPR0.1ECT5WITMACONTRACTOR{S)LICENSEDPUPSURKfTOTHECONTflAF QUANTITY DESC � ON' FEE 70R9110EN5ELAW.). O J ❑I pM EXEMPT UN�ER SEC. 8.8 P.C.FOR 7HI5 REASON Q � U � � . �ATE _ONRJER_"'_"_'—___--___.__'_ U � LICENSED CONTRRCTORS DECLARATION W � INENEBYAFFIHMUN�ERDENAITYOFPE0.IURVTHATIAAILICENSEDl1NOFRPROVISbNSOFCHppTER � B(COMMENCINOVAiHSECTION7000jOF01VI510N30FTHE6USWESSANDPROFE5510NSCODE,AND Z MV LK�NSE IS IN FIAI FORCE AN�EFFECT. ! f� � 0 IICENSECIASS `�-a�� LIC.NO._��`�G �._____.. � pqTE 2 R�A CONTRACTOR �'P��w.9..+✓ ' d W � ���—� � ���' WOFiKERS'COMPENSATION DECLARATION - , , Q � �' � ° V � IHEflEBYAFFIRMUNDFRPEkA�TYOFPERJUHVONEOFTHEFOLLOWING�ECUIRATIONS: � fA �'. �` Z � _INAVEAhDWILLMAINTAIHACERTIflCATEOFCON5EN7TOSELFdYSUREPORWORKERu ' _ COAIPENSATION,ASPROVIOEOBVSEC710N37000FTHELABOflCODE,FORTHEP[FFORMANCE U Q OF 1HE WORK FOR WHICM THIS PERMIT IS IS9UED. � W � �1 HRVEAN�WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION ���`JJJ � O 37000F THE LABOR CODE.FOR THE PERFORMANCE oF iME WORK FOP WHICH THI5 PF.RMI71S � `��� ��� _T � � � ISSUEU.MVWORKERS�PENSAT INSURANCECARRIERANDPOLICVNUMBERARE: CONSTRUCTION ,,_,__ � � canaiEn �' --------------------- PLANREVIEW _--- - ----.—_._. ZvoucvuuMaEa T_Q�5.�.�-�,L�--...----- ELECTRIC -------------- -------- ¢ 0 (fHISSECiIONNE�NOTBEO'JA�PLETEDOFT1EPEfUMlSFOHOtJFHJMREDDOl1MS(5700�ORLESS} PLUMBING _ __""_"'— ___"--_",....""___ Z �ICERTIFYTHATIN7HEPERFORAIANCEOF7HEWOHKFOAWHICHTHISPERMITISI55UEql MECHANICAL �' ''� (X'a —_.�_._,__„___,___ C7" Ct SHALLNOT EMP�OYANY PERSON IN ANY MANYER SOAS TO BECOME SUBJECT TOTHE -�'-°.`e,�,'�'-'. (�: \\ WOHKERS'COMPENSATIONLAWSOfCALIfOFNIA,ANDAGREETHATIFISFIOULDBECOME INSPECTIONfEE ___._ Sll&IECT 70 THE WORKEFS'COMPENSATION PROVISIONS OF SECTION 37ao OF 7HE LABOR '----- _. �j \ CODE,ISNALLFORTHWITHCOMPLVWITHTHOSEPROVISIONS. ISSUANCE .____.__,___ '� - . -..._���. , � � �� p DATE: Z a� APPLICANL � SMIP n ' �}�� ____ _ 1 '____ "_"_______— ��- � J� WARNING FAILURE TO SECUPE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P1G,-r,�ya -� �. ����-.�•-a'^� �^' ____.______ _____ �� SU&IECTANEMPLOYEflTOCRIMINALPENALTIESANDCIVILFINESUPTDONEHUNOREDTHOUSAND ENERGYPEW�}I p �J � v ' '�� �^+A DOLU1fl5(5700,000),IN A�OITION TO THE COST OF COMPENSRTION,DAMAOES AS PROVNEO FOR IN ` —�-��----�- --�---�---�--- J SECTION37080FTHELABORCAOE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE:1�����' "' • �... ,�� �:��=�V� — � __ _ __'— OCONSTAUCTION LENDING AGENCY PRE-ALT FEE: _____._ ,________ � I HEREBYAFFIfiM UNOER PENALTY OF PC-RJUfiY THAT 7HEFE IS ACONSTAUCTION LENDING AGENCY FORTHE PERFORMANCE OF THE WORK FOR WHICH THIS PEHMIT IS ISSUED(SEC.3097,CIV.CJ. �----���--��-��-��---- Z W -'-- -�---'--- LENDEH'S NI1ME_ ._.."—'_"'""____—_— F- LENDER'SADDRE55__.___—____._ � ICERTIFYTHATIHAYEflEADTHI3APPLICATIONANDSTATETHATTHEABOVEINFONMATIONISCORRECT. TOTAL FEES � IAGREE7OCOMPLYWITHALLCITYANDCOUNTYOt�DINANCESANDSTATELAWSRELATINGTOBUILDING � CONSTRUCTION.ANDHEREBYAUTHORIZEREPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE Z ABOVE•MEIiTIONF.D PROPEflT'FOfl INSPECTION PUfiPOSES. COMMENTS_ o �b� ►� ��,,,��c, / P�°� --.----�-- = y ___ m PERMITTEENAME�PflINT7 ..d ���.✓°��.. �Z�`3 ,a°i - -- - - � � SIONATUREOFPERMI ' DATE � _, RECPT NO. PAID 0Y _____,__ VAIIDATION_ ~' WHITE—Deparlment Copy,YELLOW—Financa Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy � t�y�'' �{_ � $��§4P „ ..._„ , ....,.,. ,......,,.. ...... ...,. ...._ .., j` ' � � F z 1 T � � � ' . � ( I. I � .� � L� I : � i I , . p�..rr5 i kM � ' I � . .. � � i � ^ { � ' ^ ! "9 �� , � � . � �'��a��' y '� � �'� f r ' �.I f t i ry .' 1 i � . at�`'iF+4' �� �°t k 3 � , ' . f 1.` 1_ # � ��,r�7 . � p� �%3 ; �Y.�1�,4 i .- y' : i ; • ' �[� � � � Y 7 1 � . � .S � " �j �L;`�Y� � E i � � A�j ( . . • _ I F _ J � r� I I -) � > ^ � , '� ���.' .{ � 3kts��� �-i,� 2 r u � y�t , �d: � i . : � . I i .� , ..� � I i �,y �y�� ¥ �{���, �ifrX�+�45���#4�� k� f � � � i , ; �,'r �. . .:_ I .. 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