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HomeMy WebLinkAbout17442 CITY OF DYAMOIv'D BAR r'� -----��—-- DEPARTIv3ENT OF CO1VIIvIIJNITY&DEVELOPMENT SERVICES �' I ^,+,:� 21825 E.Copley Ihive (909)860-3195 Fax(904}861-3117 PRESS `'�»ry'�' �UILDING PERlO�IIT APPLICATIUN FIRMLY JOBSITE q j9'� �,,� APPLICA710N PERMIT P/C o ADDRESS �d�'� , �_�>�� �tP�,/�,J�-- DATE 6 Nl1MBER���� �o ISSUE TYPE OCC APN LOT TRACT__ _ DATE CONST. GROUP p OWNER k'°i r (�°�1/ p ADDRESS�_��_�Lc��_��`_�;f� ZONING SETBACKS oCITY 1�fia�.� �h fA�snZIP TEL FRONT RW ❑ APPLICANT TEL. REAR ❑ 'I � SIDE/SIDE STREET RW ❑ _ ¢ CONTRACTOR �, SIDE ❑ � ADDRE S '" n , � CITY - .- 21P TEL.� ,__y���'�� PROPOSED USE o ARCH/ENCa/ �� G,'� 4 a;� e zW' DESIL�NER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CI7Y ZIP TEL. � DESCRIPTION SQ.FT, FACTOR PSF ADJ.AREA/VALUATION � O ��� OWNER-BUILDER�DECLARATION SFRlADD/REM p I HEf7EBY AFFIRM UN�ER PENALTV OF PEpJUPV iHAT:AM EXEMPi FHOM THE CONTRAC70RS LI- � GaragelCarport �W CENSELAWFORTHEFOLLOWINGREASON�SEC.7031.SBUSINESSANDPROFESSIONSCOOE:ANYCINOR U COUNTYWHICHREQUIRESAPERM17TOCONSTRUCT,ALiER,IMPROVE,OEMOLISH,ORflFPAIflANYS7RVP W patiolDeck Z. TURE,PRIOR TO 175 ISSUANCE,ALSO REQUIflES iHE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W �W STATEMEtif THAi HE OR SHE IS LICENSEO PURSUANT TO TH=PFOVISIONS OF THE CONiRACTOFS LI- � �� CENSE LAW(CHAPTER 9(COMMENGfNG WITH SECTION 7oDo)OF DIVISION 30F THE BUSINE55 AND PRO- LL' POOUSpO ' O'� FESSIONSCODE�'ORTHATH60RSFIEISEXEMPTTHEREFROMAN�THEBASISFORTHEALLEGE�EXEMP� I� V TION.ANYVIOLATIONOFSECTION7031.5BYANYAPPLICANTFORAPEHMRSUBJECTSiHEAPPLICANTTO Z Re-Roof � � A pVll PENALN OF NOT MOFlE THAN F14E HUNDRED DOLLARS(S6oaJ.): � ❑I,ASOWNEROFTHEPROPER7Y,ORMYEMPLDYEESWI7HWAGESASTHEIRSOLECOMPENSATIDN. � Commercial �� Z WILL DO THE WOAK,AND THE STRUCTURE IS NOT INTENDED dR OFFERED FOR SALE(SGC.7044,BU51- J ' NESS ANO PROFESSIONS CODE:THE CONTRACTOftS LICENSE LAW DOES NOTAPPLY TO AN DW�'EP OF � PROPERNWHOBUII�SORIMPROVESTHEREON,ANDWHODOE55UCHWOflKHIMSELFORHcRSELFOR � �' THROUGH.HISORHEROWNEMPLOYEES,PFOVIDEDTHATSUCHIMPflOVEMENTSARENOiWTENDEDOR m ' W� OFFEREDFORSALE.IF,HOWEVER,iHE3UiLDWGORIMPFOVEMENTIS50LDWITHINONEYEAROFCOMPLE Z��.�TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROYING THAT HE OR SHE DIO NOi BUILD OH �' 'IMPROVE FOR THE PUFPOSE OF SALE�. ❑I,AS OWNEH OF THE PROPEaTY.AM E%CWSIVELY CONiRACTING W17H LICENSEO CONTRAGTORS Q �TO CONSTRUCT THE PROJECT(SEC.7044,Bl1SINESS pND PROFESSIONS COOE:iHE CONTRACTORS LI- VdIUflIIOPI � �� ADJ.AREA W' CENSELAWDOESNOTAPPLYTOAN�OWNEROFAPROPERTYWHOBLIIL�SORIMPPOVESTHEREON,ANO ' � ,WHOCONTRAC75FORSUCHPHOJECTSWITHACANTRACTOR(S�LICENSEDPURSUANTTOTHECONTftAG QUANTITY DESCRIPTION FEE Y iORS LICENSE LAW.). � J � Q ❑1 AM EXEMPTUN�ER SEC.� 6.8 P.C.FOR7HI5 REASON Q � U LL � �ATE OWNEft V W � LICENSED CONTRACTORS�ECLARATION �y ¢ � IHER[BYAFFlpMUNOERPENALiYOFPERJURYTHATIARIUCENSEDUNDERPROVI510NSOFCHAPTER � . d 9(COMMENCMG WITH SECTION 7aool OF DNI510N 3 0F THE BUSINESS AND 9flOFE55�NS CODE.AND Z X MY UCENSE IS IN FULL FORCE A�EFFEC7 m Q LICENSE CLASS � �� CONTRACTO��—�—�� d ~ DATE W °� .- r,T � WORKERS'COMPENSATION�ECLARATION��� Q � Uj U � IHEREBYAFFlRMUN�ERPENALTYOFPERJURVONEOFTHEFOLLOWINGDECLARATIONS: Z Q , Z _ IHAVEAN�WILLMAMTAIN�RCERTIFICATEOFWNSENTTOSELF-INSUREFORWORKERS' 2 GOMPENSATION,ASPflOVIDEDBYSECTION37ooOFiHELABORCODE,FORTHEPERFOFMANCE U Q � OF THE WORK FOR WHICH iH15 PEflMIi IS IS6UED. � W I NAVE AN�WILL MAINTAIN WORNERS'COM?ENSATION INSURANCE,AS R'cQUIRm BY SECTION p �" Q 37000FTHE LABOR CODE,'FORTHE PEHFORMANCE OFTHE WOAK FOR WHICHTHIS PEftM1T15 ��1� � ISSUED.MY WORK COMPE SATION INSURA � CARRIER AND ICV Nl1MBER ARE: CONSTRUCTION � F J j CARRIER PLAN REVIEW Z POUCVNUMBEfl� ` _ ELECTRIC a (MISSECTpJNNEmNOTBEfDMPLEfE�OFTHEP WMISWRONEHUN�R�)ort�Ess�. PLUMBING 1���� ^��`. �'� �-` � � j�..�._!_.. _. ..`�:.-...,., r.'•.1 � . _. - Z�, ICERTIFYTHATINTHEPERF-0RMANCEOFTHEYJORKFOP.WHICHTHISPEFIMITISISSUED,1 MECHANICAI � C3' SHAILNOTEMPLOYANVPER50NINANYMANNER50AS?OBECOMESl1BJECTiOTHE �y� (/� WOflKEFS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULO BECOME INSPECTION FEE R ` � �t r.C� ' � SUBJECTTOTHE'NORKERS'COMPENSATIONRROVISIONSOFSECTION37ooOFTHELABOR � V ���"`""` � � a � CO�E,I SHALL GORTHWI 9H",COlAPLY WITHTH SE PftOVI5�ON5. ISSUANCE _�_�� r�__ p DATE:�_=1:6J_—�A�P�bLICANT: SMIP �_. �___I_�� � . . W� � �f �s�� ENERGY P/C ��'�^ J' WARNING�FAIWflET05ECL1REWOflKERS'COMPE SAfIOVCO ERAGEISUNY6�'FUL,ANDSHALLBE _.-.._._.-.- -- .- -,. �y., SUBJECiAN EMPLOYER TO GRIMIN�pL PENALilES AND CIVIL FI�'ES UP TO ONE HUNDPED THOUSAND ENERGY PERMIT DOLLARS(S1a0,000J.INAODITIONTO THE COSiOF COMPENSATION.DAMAGES AS PHOVIDE�PoR IN /y,� J SECTION37080FiHELABORCO��,INiEREST.ANDATTOFiNEY'SFEES. RETENTIONFEE: / � � CON'STRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENALTY�j F PEFiJURY THATTHERE IS ACONSiRUCTION LENDING AGENCY FOR iHE PERFORMANCE OFYHE WORK FOF WHICHTHIS PERMI7IS 155UED(SEC.309],CIV.C.). � W S LENDER'S NAME � F-+ LENDER'SADDRESS � ICER7IFV'HATIHAVEFEAD7HISAPPLICATIONA,'JDSTNTEiHATTHEABOVEINFORMAT10NI5CORRECT. TOTAL FEES /��„ �� � � I AOREE'O COMPLY WITH ALL CITY AND COUNTYOR�INANCES AND STATE LAWS RE4ATING TO BUILDING � CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTA7NESOFTHISCOUNfYTOENTERUPONTHE Z FBOVENiEMIONEO PROPERTYFOR INSPECTIDN PURPOSES. � COMMENTS � � ��� r��� -� - PER ITTFENAME(PRII�fr) � � ��,�� ��� — ?� ` o f � SIGN - E DATE = RECPT.tv0. PAID BY� VALIDATION ~ `WHITE—Depadment Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy _.., z�.� w ,: � 3� q < �'� x"w•. . � i ��"' t +. F ,� '6 ., w .v . . 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