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HomeMy WebLinkAbout14813 CITY OF DIAMOND BAB �� ` --- "��� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � � 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 ��'��'� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE �1 G APPLICATION i ' �`i� PERMIT -�$��� P/C ADDRESS � v • DATE �� V" NUMBER # � � ISSUE �.,,! NPE OCC APN LOT TRACT DATE � (�✓ CONST. GROUP °C OWNER �� O "' ADDRESS O �/ ZONING SETBACKS Z CITY ' IP TEL. ��� -S'�1.� REART RW u g APPLICAN7 TEL. SIUE/SIDE STREET RW 17 � CONTRACTOR ''�+r t � SIDE U_ o ADDRESS � PROPOSED USE f/�iI�A�L YI{�(�' � CITY `(k ZIP P!TEL. �� '4-T-' F—= 'u" ' o ARCWENGI —��'�'Q ��� `r�5��� �z DESIGNER NO.DWFL. NO. NO. Q.; ADDRESS � CIN ZIP TEL. UNITS __ STORIES _ BEDROOMS N rn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION ' SFR/ADDJREM O Q 1 HEflEBY AFFIRM UNDER PENALiY OF PEFLURV TMRT I AM EXEMPT FflOM THE CONTHACTORS Lt� Gd1dJ6/C3fpOff W CENSEUWFOqTHEFOLLOWINGREA50N(SEC.7037.68USINESSANDPFiOFES510!15CODE:ANYCITYOA (/) U COUPJTI'WH�p{q[-p�IflESAPF.RMITTOGONSTflUCT,qLTERIMPFOVE,�EMOIISH,ORqEPAIRANYSTRUC� W pyfi0/08Ck � TURE,PRIOH TO ITS ISSUANCE,PLSO RE�UIqES THE APPLICAM FOR SUCH PEPMIT TO FILE A SIGNEO � STATEMENT THAT HE OR SHE IS IJCENSED PUqSUANT N THE PROVISIONS OF TFIE COMRACTORS LI� �� CENSE LAW(CHAPTER e�COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSMESS AND PNO- LL' Pool/Spa FESSIQNSCOOE)OflTHATHEOHSHEISEXEMPTTHEHEFftOMAN0THE6ASI5FOR7HEALLEGE�EXEMP� � V TION.,WYVIOLATIONOF6ECTION70.Y1.5BYANYAPPLICANTFORAPERMITSU&ILC7STHEAPPLICANTTO Z Re-Raof � ACML PENILLTY OFNOi MORE THAN FNE HUNOflEO DOLURS(f5D0).�� � ❑I,ASOWNEROFSHEPflOPEH7Y,ORMYEMPLOYEESWIhIWA0ESA5THEIRSOIECqMPENSATION, C� ComnlerCi21 � YlILL 00 TNE WORi(ANO THE SiRUCTURE IS NOT INTENOED OR OFfEFEO�OR SALE(SEC.7o4d,BUSb J � NESS AND PqOFES510NS CODE:THE CONTRACTORS LICENSE I.pW DOES NOT APPLV TO AN OWNER OF j .,.s'^'"' PimPERTV NM1q BUILUS OR IMPROVESTHEREON.AN�YMO�OES SUCH WOflK HIMSELF OR HEqSELF OR � THROUGHHISORHEA0IVNEMPLOYEES.PROVIDF.DYHAT9LICHIMPROYEA7EMSARENOYINTENDEOOfl m QOFFEHEDFORSALE.IF,NOWEVEf�iHEBUILOINGORIMPROVEMENTISSOIDWRHINONEYEA(70FCOM7LE Z TION,IHE OWNER�BUILDER WiLL HAYE THE BURDEN OF PHOVING TXAT HE OH SHE 010 NOT BUiLD Oft � W IMPROVE FOH THE DURI'OSE OF SALE). ❑I,AS OWNER OFTME PROPERTY,A/A E%CWSIVELY CONTRACTINO WITH LICENSFA CONTflAGTOflS � i0 CONSTRUCT THE PPQIECT(SEC.7ola,BUSINE55 AND PROFESSIONS CAOE:7HE CON7HACTORS LI� VHIU8t1 P.DJ.AREA W CHiSELAWDDESNOTAVPLY70ANOWNEROFAPROPERTYWHOBUIl�50RIMPROVE5THEREON,AND -- - --' - --- �� WHOCANTRACTSFOflSUCHPRQIECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAC QUANTITY DESCRIPTION FEE Y TOR$UCEN5ElAW.�. 0 O IAM IXEMPT UN�ER SEC._______ 9.&P.C.FOR THIS REn50N Q U � LL --- ---�— ._-- � � OPTE____ OWNEfl___`____ U � W �. LICENSED CONI'RACTORS DECLARATION W � � I HEREBYAFFIHM UNDEH PENPLTY OF PERIl1NY THAT 1 AM LICENSED UN�ER PROVISIONS OF CHAPiEfl � � 8(COMMENCINO WITH SECTpN 7aa0�OF DIVISION 3 O�THE BUSINESS AND PROFESSIONS CA�E.AND Z �� YY UCENSE IS IN FULL FORCEANO EFFEC7. � m o UCENSEG S � LIC.NO. ✓� ____ j �t�� J �j �AYE 4� Uv CONTRACTOR____ _ a W � WORK[RS'COMPENaATION DECLARA710N Q — NI HEFlE9YAFFIRAI UNDEP PENALTY OF PERIUHY ONE OFTHE FOLIAWING�ECLARATIONS� � O _IHAVEANpWiLLMAN7AINACERTIFICATEOFCONSENiTOSELF-iNSl1REFOqWOHKERS' _ �� COAIPENSATION.ASPROVIDEOBY3ECT10N37000FTHELABONCOf7E,FORTHEPEfiFOflMANCE U OF THE WOqK FOA WMICH THIS PF.HMI71b ISSUED. � 0 W �rt HAVEAND N7LL MAIMAIN YJORKERS'COIAPENSATION INSURANCE,AS REIXIIRED F3Y SECTION j� d 37000F 7HE LABOH CODE,FOR THE PERFOqMANCE OF THE WOFlK FOR WNICH THIS PERMR IS ♦ �� ISSUEO.MY WORK RS'COMPENSAT IN URANCE CAFlq IERAND 1'OLICV NUMDER AP.E: CONSTRUCTION _,__ __ � t�__ , �/ " '_-' � CARRIEH����— �`� � ----- PLANREVIEW ---- ---.._..__ ..— --.-- . � POLICY NUM6ER W���I7� —__ ELECTFIC .` � — ---.. ..-- —.._. ---- • Q (fH133ECTICfJNE�NOTBEWM1PI.EfEDOF71-IEPERAtlTI$FpqpNtHUfAHEDD0UpR5�5100)Of1LESS� PLUMBING �� -"'_"_-'_ - "_-'.. '___ __ Z I CEflTIF1'THAT IN THE�ERFORMANLE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL� _„__ � (} SHALLNDTEMPLOVANVPERSONiNANYMANNEF150A5700ECAS1ESU8JECTTOTH[ ' (/� WORKERS'COMPENSATION LAWSOFClLLIFOPNIA,AN�AGHEE TMP�IF ISHOULOBEG�ME INSPFCTION FEE _______._. 1 ......—. .._ . � SUBJECTTOTHEWOflKERS'COMP[NSA'fIONPflOVI510N50FSECTIONa7o00FTHElA80R , �]`I� � CODE,ISHALLFOR7HWITHCOMPLYWITNTHOSEPROVISIONS. (SSUANCEpt�,}�(y ____ ____ _ Cf 1J/� � �1 IS � ���__ _-'_ '_'-�4.� . p �ATE: __ APPLICANT: ^_"__ _._ SMIP J WARNINGFAILURETOSECUREWORKEfl9'COMPENSA710NCOVERAGEISUNIlWFUL,ANDSHALLBE E����'y��' � - - -�- --- � SUBJECTAN EIUPLOVEH TO CRIAIINAI PENALTIES AND CIVIL FINES UP TOONE HUNOREO THOUSAND �jy�� � UOLLAflS(Si00.000�,INADD1710NTOTHECOSTOFCOMPENSATION,DAMAGESA3PROVIDEDFORIN E�g4�P7'S�7ST'(f��p� --- --- - J SECTION370BOFTHELABORCODE,INTEREST,ANDATfORNEY'SFEES. d.A1�%�,J f'A, � RETENTIOIV FEE __ _._ ,___.__._.__ _ OCONSTRUCTIDN LENDING AGENCY PpF-ALT FEE: ___.____ ,____ _,__,._ � IHEPEBYAFFIRMUNDERPENAIT'OFAEflJURYTHATTHEREISACONSTRUCTIONLENUMGAGENCY _ ___ �' FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED�SEC.ao9�,CIV.CJ. - � � -_'--_ ' '- s � LENDEH'SNAME______"____'_._____-. ►�- LENDEH'SAO�RESS -----'--' "'--" "- -'- w I CEFlTIfY ThIAT I NAVE REM THIS APPUCATION AND STATE TMATTHE ABOVE INFORMATION IS COFRECT, TOTAL FE ES � � �� � IAGREE TO COMPLV WITH ALL CINAND Wl1NTV ORDINANCES ANU STATE IAWS flELATING TO BUILOIN6 �i � CONSTRUCTION,ANO HEREBV AUTHOflIZE RF.PRESE.NTATIVES OF THIS COUNTV TO ENTER UPON THE Z A13nVE�MENTIONEDPHOPEHTYFORINSPECTIONPURPO5E5. 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