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Home My WebLink About14452 � ` t ,'^�a CITY OF DIAMOND BAx � � �y�--� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � . 21660 E.Copley Drive Suite 190 PRESS � ,, (909)860-3195 Faz(909)861-3117 '��•A�'�.- BUII.DING PERMIT APPLICATION FIRMLY � ._ _ -- ' a AD RIESS �� !1i �.�1G� ��-t/�1�i7 �� DATE CATION� � '�� 9 INUMBE� �" #/ I � i � � - g issuE rvae occ ' RPN�— LOT T�R,�A/C�T DATE CONST. GROUP + lrL.`'J .�� e�-l.i��'?-�f'� p OWNER n.rz.7 ' LL ADDRES5�,^/$% .R.1 (�3�- �'� �`�"� ZONING SETSACKS ' w `��— ��=-��- FRONT RW (-1_._ Z CITY D`��c�, ZIP d TEL. � — � g APPLICANT TEL. REAR U _ � SIDE/SIQE STREET RW Cl._...____.__ j CONTRAC70 __ "�=�L__ S1DE ____ LJ r � � ADDR S��°7 ,� ' � a. PROPOSED USE � �.:C�r ` � " � � CIN C.-... ZIP .../ �O TEL.L�� z�- f1�- 3 a ARCH/ENG/ �� z DESIGNER — NO.DWEL. NO. NO. a ADDRESS UNITS_ STORIES _ BEDROOMS } � CITY Z.IP — TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION UWNER-BUILDER DECLARATIDN � � SFR/ADD/REM � � I HEREBV AFFlRM 11NDER PENAITY OF PERRIRY THAT I AM LX[MVT f-IiOM TIIE CONTRACTOHS LI- � Garaga/Carport � W CENSEUWFORTHEFOLLOWINGFEASON(SEC.7031.SBUSINESSMOPROFE&SIONSCO�E:ANYCITVOR � U COUNTYYYHICHREQUIRESAPERMITTOCONSTRUCT,ALTEfl,IMPROVE,DEMOLISH,ORflEPAIfiANYSTRUG W paf10/DeCk Z Tl1pE,PRIOR 70ITS ISSUANCE,ALSO REOl11FE5 7FIE APPLICANT FOR SUCH PERMIT TO FILF.A SIGNED W � � STATEMENT THAT HF OR SHE IS LICENSED PUfl5l1ANT TO THE FROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER e(COMMENCIIVO WI7H SECTION 7q00)OF UIVISION 30F'TNE OUSINESS AND PRO- ��" POOVSPB '� FESSIONSCODEJORTHA7HEORSHEISEXEMP7THEREFROMANDiHEBASISFORTHEALLEGF.DfXFMP- (� Y�„�.�-- � 710N.ANYVIOLATIONOFSECTION7031.58VANYAPPLICANTF9RFP[HMITSU&IECTSTHEAPPLICANTTO Z Re-Roaf � ACINLPENALTYOfNOTh�REiH0.NFIVEHUN�REDOCLLAF515500J.): ~' ❑I,ASOWNEHOfTHEPROPERTY,ORMYEA!PLOYEESWITHWAGESAS7HEIFSOLEWMPENSATION, `� 0 � Wlli DO TNE WORK,AND THE STRUCTURE I5 NOT INTENUE.D Op aFFERED FOR SALE(SEC.7o6M1,BUSI- , J C0�11fI10fClel i � NESS AN�PROFESSIONS CODE:THE CONTRACTORS UCEfiSE LAW 00E5 NOT APPLV TO AN OWNER OF ? � PflOPERTYWH09UIlD50RIMPROVESTHEREON,ANOWFIODOESSUCHWORKHIMSELFORHERSELFOq a THROUGHHISORHEROWNEMPLOYEES,PROVIDE�THATSUCHIb1PROVEMENTSAflEN01'INTENDEDOFl ' m � Q QFfEHE�FORSPIE.IF,HOWEVERTMEBUIIOM�ORIMPROVEMENTISSOIDWITHINONF.YCAROF�AMPLE _� Z TION,7HE OWNER$UILOER WILL HAVE TME 9URUEN OF PHOVING TNAT NE OH SHE DiD NOT BUILD OR � IMPROVEfORTHEPURPO5EOF5ALE�. . � ❑I,ASOWNEROFTHEPR9PER7V,AME%IX.USIVELYCONTflACTINGWITNLICENSEDCONTRACYOPS � ' � TOCONSTRUCTTHE PRQIECT(SEG Taa4,BUSINESSAkD PROFES510N5 CODE:TNE CONTHACTORSII• VflIU8110 ___...NDJ.AREA._____ __._____._.._______.__ � W CENSELAWDOESNOTAPPLYTOPNOWNEROFAPPOP[RTYWI106UIlOSORIMPFiOVE:STHEREON,AND ��' WFiOCONiMCYSFORSUCHPRQIECTSWITHACONTMCTOR(S�LICENSEDPUFiSVANTTOTHECONfRAG QUANTITY DESCRIPTION FEE � iORS LICENSE LAW.). :j �o ❑I Ah1 E%EMPY UNDER SEC._____ B.E P.G FOR THIS R[ASON � U i a � _— tc � LL'. DATE OFYNER_'_ """_"_ .. U Z' w — � � i ` LICENSED CONTRACTOAS OECLANATION ; W ; QC IHEHEBYAFFINMUNDEfl�eNALTYOFPEfUUR'/7NATIhMLiGENSEDUN�ERFROYi510h50FCHnP7Efl , � �p, G jCOMMENCINO WITH SECTION 7000)OF DIVISION 30FTHE BUSINESS AN�PHOFESSIONS COUF.ANU � Z M`(LICENSE IS M FULL FOftC'eANO EFFEC7. ' m + o �.5�7=-�---- � F LICENSE CLASS G `�,�__LIC.NO. � . � � �-. DATE_ CONTPACTO _ ...._ T W ` _ � �- WORKFRS'COMPENSATION DECLARATIO�uj Q 'y Uj. U 6 � I NEflEBY AFFIRM UNDER PENALTY OF PERJURY ONF DF THF PoLL.OWING DEC�MTIONS: � � 0 _INAVEFNUIYILLMAINTAINACEFli1FICATEO�CONSLNTTOScLF�INSUflEFORW�HKF_FS' � .'QL� COMPENSATION,ASFROVIOEDflYSEC710Na�noDFTMELA60RCGDE,FORTNEFF.Fl�ORMANCE W � � OF THE WORK FOR WHICH THIS PF.RMIT IS ISSUF.U. g � � — '�W __1 NAVE ANU WILI MAIMAIN NiORKEflS'COMPFNSATIU�I IYSl1RA':CE,AS REQUIRE�BY SECTION � Q 3700 OFTHE LABOR COOE,FOR'ME PcRfURMAtJCE C1F THE WORK FOR WHICH YHIS PERMITIS � � � 0 ISSl1ED.MYWO NE, ' PEN5ATIOt�JdSU ANCECARFiIE ANOPOLICYNUM9ERARE CONSTRUCTION ______ _,,,__ ______ �' "" '" _ t! ,j CARRIER _""_—"'____� PLAN REVIEW �� "'•��s�"�'"� ----- � �.� Pa.ICVNUMeER � C a � ELECTFIC �"`��'� --'-�.�..-_�._. _.- � (fHI65ECilONNC�NOT6E�m�F11iEPERA9115fORPV:iN.1[NiF.ODJL1A0.51b700)ORLE55), PLUMBING _._..,...._.- 0 6 ; il P � -W� MECHANICAL ��.�_— °�':�'�� . ------ Z I CERTIFYTHAT IN THE PERFORMMCE OF THE WORK FOA m11CH THIS PERMIT IS ISSUED.I -�-.'+=t� j �(�� SHALLNOTEMPLOYANYPEFSOtJINANYMANNER50ASTOF3ECOMESU9Jf_Gf10THE �;a„� WORNERS'COMPENSA710N LAWS OF CAUFOHNIA,�NO AGREE THAT IF I SHWLD BECOME INSPF_CTION FEE (�p4 � � Sll&IECTTO THE WORI(ERS'CAMPENSATION PROVISION50�SECTIOY 3looOf THE LABOR ' ' ` y '''-') (J S # ��-�iE''..i�i'+..y3�13"e y !� V CODE,I SHALI FORTIIWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE _ `S-•'.+.%�": . � o .� *� ...;+,�r�-4�;;.,_,., dR � � , ,�:�'�'v e:.�•1✓ .p DATE: APPLICANT. SMIP '..':�.;'•'. ----- ------ -------�.. . _��-a---�--a � W ENERGY P!C -� WpqNING:FAILURETOSECUREWORKER5'COMPENSATIONCAVEflAGEISUNIAWFUL,�NDSHALL�E -- ""- "- "- _.J. __- � ' LL SU0.IECTANEMPLOYERTOCPIMINALPENALTIESANDCIVILFIHESUPTOONEHUN�flE�TMOUSAND ENERGYPERMIT DOLLARS(5100,000),INADDI7IONTOTHECOSTOFCOMP6NSATION,DAMlGESASPHOVI�[DFORIN - ---'-"" -"'- - -"""' m J' SECTION37080FTHELA60RCOUE,INTEREST,MUATTORNEYSFF.ES. RETENTIONFEE: _ _ __ _.__- � ..W, d CONSTRUCTION LENDING AGENCY p{�FJ'ALT FEF1 � _. O V � �� IHEPEBVAFFIHMUNDERPGNALNOFPERJURYTHATTH[REISACON6TRUCTIONLENDINGAGF.NCY �J� i �.f. FOfl 7HE PERFORMANCE OF TMF WORK FOR WHICIi THIS PERMIT IS ISSUED(SEC.309'1.CIV.C.). {, � �ti./� "f Z. �{�"'_ - _-- � W .. �' LENDEWSNAME_._ _ _"'_—"'" '__ "_' _...___ �� H LENDFR'SADDFESS_.__ .- ------- ' � ICERTIFYTHATIHAVEAEADTHISAPPI.ICATIONANDSTATETHAT'fHF.ABOVEINFORMATIONISCAFFECT TOTAL FEES -� Y � � I AGHEE TO COMPf.Y WITH ALLCITY AND CWNTY ORDINANCES AND STATE LAWS RE�ATING TO BUII.DING CDNSTPUCTI�.1,AND HEREBY AUTFIOFlIZE REPFESENTATIVES OF THIS COUNTY TO ENTER UPON Th1E � ABOYE�MENTIONED PROPERTV FOR INSPECTION PUf1POSES. _- ___— ---_---_- __ _ _ Z COMMENTS___ O � � m P MITT E NAM (PRIMT) r � �� -- "'-'-"-- � �-�� (n R�,�i7o� � L -- , � SIGNATUflEOFPEflMITf�E � DATE -�� _�� RECPT.NO. v PAID BY VALIDATION_ i ' r ' ' WHITE-0�artment Copy,YELLOW—Finance Co PINK—Assassor Co GOLDENROD—File Co GREEN—A licant's C P PY. PY. PY. 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