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HomeMy WebLinkAbout17060 (39) �� CITY OF D1AM0�1D BAR DEPARTMENT OF CO?vII�9UNITY&DEVELOPMENT SERVICES � X�` 2I825 E.Coplry Drive (909)860-3195 Fax(909)861-3117 PRESS �`-:� BUILDING PERMIT APPLICATION FI RMLY � JOBSRE /� �� APPLICATION � � PERMIT ����� �D P/C o ADDRESS�7�� �t'.��V-/' ,f-�L(�'�r,4,G�� DATE � l NUMBER_1 Iv�' N c� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER ��,1j A!?: ) •f�i� � ADDRES J -. T1 [. "' ZONING SETE3ACKS z CITY � ZIP�/7GS TEL. �L^�-o;� REART RW O❑ g APPLICANT " - - TEL.�'G^-��QT7 SIDE/SIDE STREET RW ❑ � CONTFiACTOR j ' �'�' 1NCA SIDE O Q ADDRESS' U" �` < <� pqOPOSED USE � CITY ZIP�� TEL.��-�4<!/� w ARCH/ENG/ � DESIGNER '�a' ADDRESS NO.DWEL. NO. N0. � CITY ZIP TEL. UNITS STORIES BEDROOMS � DESCRIPTION S�.Ff. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SFR/ADD.'REM O p 1 HEREBY AFFIPu UNDER OENALTV OF DE0.n:RY THAT 1 AM E%EMDT FROA1 THE CONTRACTORS�I� Ga�'dgB/C81pOfl W CENSEUWFORTHEFOLLOWPlOREASON(SEC.70]I.SBVS:NESSANDpROFE55lON5CODE:ANVCITYOR (n U �pVMYN?11CHREWIRESA7ER6��TTOCCNSTRUCIALTER,M?ROVE,�EMOl15H2ORREPAIRNJYSTRUC- W patlol�eck WTURE PNIOR TO RS ISSUANCE.AL50 REWIRES THE APPlIG1NT FOR SUCN PERMIT TO FILE A SICNED w � STATEMEM iNAT ME OR SME IS LICENSED YURSU�NT TO THE PRONS�ONS OF THE CONTRALTORS LI- T CENSEUM�(CHAPTER9(COMMCNCWOWI7MSECTION7W0)OFDIVISIONIOFTNEBUSINESSANDPRO• � P��Fa V fES510N5C00[I��THEORSHEISE%EMPTTMERCFHOMANDTHEBASISFORiHEA�LEGEDEXEMP• V TqN.ANVViOtA710NOFSECT10N7a71.6BYANYA7PLIGWTFORAPERMITSUBJCCiSTMEMPL�CANTTO Z RB-ROO} � A CML GENAL7Y OF NOT A�ORE TNAN iNE FRJNOREO DOLUR.i(f50o�.�� , � ❑LA+�NEROFTMEPROPENTI,OR1.AVEIAFLOYFESW�iNWACESASTNEIH50LECAMGEN5AT10N. � COmm0fC�31 Z 1N�LL DO TNE WORK,AND TNE STRUCtURE IS NOT INTENDED OR OFFERED FOH SALE(SEC.7W�,BUSI- J NE55 AhD VROFESSIpNS COO[:ME CONTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWN[R OF N VflOPERTYYIMOBURD50RIMPROVE57MEREON.l1N�N'MODOESSUCNWORKMIMSEIFORMERSEtFOR � CL THFiOUGHM150fiHEROWNEM7LOYEES.FfiO`/�DEDTHATSUCHi4PRDVEMENTS�NENOTIN7ENDED013 m W OFFEREUfOH5ALEIF,NOWEVERTMEBUIL0INOORIMPROVEMENTISSOLDWiiHNONEYEAROFCAMPLE• 0 t10N,THE OwNER�BUILDER WILL HAVE 7NE BURDEN OF PROVING TMAT HE OR SHE Oi0 NOT BUILD OR Z MPROVEFORTHEPURVOSEOFSILLE). = OI/SONRIEROFTHEPROPERTY,AA/E%CLUSIVELVCONTMCTINCWITMIICENSEDCONTMCTORS Q TO CONSTRVCT THE PRQIECT(SEG 70N.BUSINE55 AND FROFESS:ONS CODE:TNE CONTMCTORS LI- VBIUBtiOf1 ADJ.AREA W CENSEUWDOESNOTMPLYTOANOWNEROFAVROPERTVW/qBU1LD50RMPqOYE57H[REON.ANO � WNOCONTMCTSFONSUCHVROJECTSMnTH11CONiMCTOFl�S�LICEKSEDPURSUANTiOTMECON7R�C• OUANTITY DESCRIPTION FEE Y T00.5lICENSE UW.). ¢ OIAAIE%EMP7UNOfRSEG B.6V.C,FORTHISREASON Q / � � � O V � � � i•�- '1 � DATE OWNER F' W �4 LICENSED CONTRACTORS OECLAFATION w CC INER[BVhFFIRUUNOERCENAITYOFPERAIRVTHATIANLICENSEDUN�ERPAOVIS�ONSOFCHAPTER V. d Y�COIAMENCCIOWITMSEC710N7000)OFDNISION]OF7HEBUSM[SSANOPROFESSIONSCODE.AYD Z X MYLICENSEISNFULLiOfiCEANDEFFECT. � 11J 0 UCENSE CUSS r�� LIC.NO. � S'� � J V DATE�_�d�— L�/ cowr�ncron 1f.�tA1 f'�� f�l.:' a w � WORKEFS'COMP[NSATION DECLARATION a � U N INEREBYAFFIRMUNDERVENALTYOFVERIURYW:EOFTN[FOLLOW�NGOECUM7iON5: Z Q O �IMAVEMAWILLMAtN7AMACERTIFICATEOFCONSEHTTOSELF�INSUREFORWORKERS' 2 Z CpAPENSATION.ASiROY�DEDBYSECTION�7o00FTHEUDORC00[.FORiMEDERFORMANCE U � OFTHEWORNFOHWHiLHTH�SPERMiTI5155UED. � O W �IHAVEANDNALLIAA'NT�iNWORNENS'COIAPENSATIONI�SURANCE.ASREWIREDBYSECiION � '/�/(1 Q �7000F THE LABOR CODE,FOR TNE PEFFORM,WCE OF 7HE WORK FOR WMICH iH15 pEfWIT IS d �� ISSUED.MYWUNKERS'LOMVENSATIONINSURANCECARRIERANDPOLICYNUMBEHARE: CONSTF�UCTION jG1RqiER STA��T�/�=[ FV�� PLAN REVIEW � POLICYNUMBER(�,=j] ��� ELECTRIC d 0 (M1GSECiqNN[mNpie[OG.a�E'iE�OF71E7EM�T5PoROtiEHlFIN1[i]OOLL�1iL�"(f'OCI���1 PLUMBING w MECHANICAL Z I CEATIFY THAT IN 7HE VERFORM�NCE OF THE WORK fOR WHICN THIS VERM17 15 155UED.1 (J � SHALLNOTEMVLOYANYGERSONIN�NVMANNERSOASTDBECOMESU6JECTiOTHE �_� ; �T =.— — � YK7Po(ERS'CAMPENSATqNUWSOFCALIFOfUJV�AN'JAGREETMATIFISHOIh�BECOME INSPECTIONFEE S SU0.IECTTOTHEWORKERS'COYPENSATIONPRONSIONSOFSECTqN7700UTNEUBOR �SSUANCE J I � �/""-"•� � ' �!! 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