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HomeMy WebLinkAbout13516 (24) �� CITY OF DIAMOND BA6t DEPARTMP.NT OF COMMUNITY dr.DEYELOPMENT SERVICES 21660 E.Copley Drive Suite 190 � (909)86Q3195 Fax(909)861-3117 PRESS 'M".� BUII.DING PERMIT APPLICATION FIRMLY � JOBSITE � / Q ADDRESS l S � SQ�PI7 f� ��'1 Q APPLICATION PERMIT � P/C o DATE NUMBER K � APN T TRACT �V D TEE S` I`�'�q CONST. GROUP S OWNER r QL s i C � ADDRESS ZONING SETBACKS CITY G K ZIP�_ TE / FRONT RW ❑ APPLICANT TEL. REAR p SIDElSIDE STREET FiW ❑ CONTRACTOR !�(� �'tC• SIDE p ADDRESS g CITY ZIP� T �(�j PROPOSEDUSE � ARCWENG/ DESIGNER NO.DWEL. NO. NO. � CDDRESS Z�P TEL. UNITS STORIES BEDROOMS �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-B�ILDER DECLARATION SFWADplREM O I NEHWY AFFiRM UNDER PENILLTV OF PE(LAJRY THAT I M1 F](EMP7 FROM THE CONTMCTORS�F GeregelCarport CENSEIAWFORTHEWLIOYYWdREA50Nf6EC.7037.6BUSINE55ANOPHOFE9SKKiSCODE:ANYCITYOR (n WUNI'YWHCHIIEOUIRESAPEflMRTOOONSTRUGT,ALTERIMPROVE,�EMOLISH,ORREMiRMVYSTRUC- � �gSIO/DOCk TURE.PRGR TO IT8 193UANCE,ALSO REqU1RE3 THE APPLICMIT FOR SUpi PERMIT TO FILE A 610NED w iTATEMENT TF1AT ME OR SXE IS LICENSED PUq,.WVlT TO TME PROY1910NS Of 7HE CON7RACTORS LI- CENSE UW(CliAPTER 0(006iMENCINO VYITI6ECTION 700D1 OF DIVISION 7 OF THE BUSINESS M10 PRO- � POOUSp9 FESSpNSC00�OR7FIATHEORSHEI9IXEMPTTHEREFROMMI�iNE811315FORT11EJ1LLE0EDEXEMP• (� TqN.ANY VIOLATIDN OF SECrION 7037.6 9Y M1Y APPL1CMff FOR�PEFMIT SUBJECTS ME APPIICANT T0 Z Re•Roof � A CML VEN�L7Y Of NOT MOqE TNAN FIVF HUNDRED DOLURS(tGca4k . O OI,A60WNEROFTHEPROPEHTY,ORMYEMPLOVEESNA7H4YAOESASTNEIq60lECOMPENSATIDN, O COfI1�lIBfClel - Z WILL DO TNE WORK AND THE BTRIICTURE IS NOT INTENDED OR OFFERED FOR 6ME ISEC.TOH,BUS�- J � NESS M�D PRDFESbIONS CODE:7NE GONTRACTORS UCENSE LAW UOES NOTAPPLY i0 AN OWNFP OF j PNOPENTY W1p BUILDS OR MPipVEB TMENEON,M1D MMO OOES SUpi 1YORK HMSELF OR MERSELF OR 1NRODUFi 11150R MER OWN EAAPLOYEES,PN0V10ED 1Hl�T BUCX MPROVEMENTS ARE NOT INTENDED OR m . OFFEREDFORSAIEIF.IqWEYERTHEBULdN40111A1PROVEMENTISbOlD4VITHINONEYEAHOFC01AVlE. . ' , , � 'TION,TNE OWNER�UIIDER MALL HAVE TNE BUR�EN OF CRONN�7HA7 ME ON SHE d�NOT BULLD OR YACROVE FOR7HE PURVOSE OF SALE). O I,AS ONMEROF iME PROPERTV,AM EXClUSNELY COMRACTMIG WfTfl LICENSED ODN7AACTOq3 TO CONSTRUCT THE OAOlECT(SEC.7a1,BUSINESS AND PHOFE5910NS COUE:THE COMTqAC70RS U- VSIUAtIOfI ADJ.AREA CENSE LAW DOES ND'f APPLYTO AN OWNER OF A PII0PER7Y NR10 9UILD5 OH W PqOVE3 TMEREON,AND � NM1�OOOHfR�CTiPoflBU�CYIVROJECTSN77HACONlRACTOR(9)LICENSEDPUR6UMRTOTHEOONTMO pUANTITV DESCFIPTION raas ucasE uw.�. FEE �� ❑1 AN EXEYPf UNDER SEC. B.{P.G FOR THIS RE�SON Q U �=" DATE OYYNEP U � LICENSED CONTAACTORS DECUIRATION w � tHEREBYAFfIRMUHDERPEN�LTYOFPE0.X1RY7HATIAFILICENSEDUNDERPHOVISIDN50FCHAPTER V, ,�yv� /. �?� � �ICOIAMENCWOYfITH6ECT10N7000)OFONISIOM30FTHEBUSMESSANDVROFESSIONSCODE.AN� Z l J ?C 1AY 110EN5E IS W FULL FORCE IN�EFFEC7. m � UCENSE CU55 _L1C.NO. � j � �ATE � CONTMCTOR � d WORKERS'COMPENSATION DECUIRATION ¢ y1 MEHEBV AFFIRIA UNDER PENKTY OF PERJURV ONE OF THE FOLLAWING OECIAMTpNS: Z � _IMAYEANDWILLMNNrA1NACER71FlCA7EOFCONSENTTOSELFdNSUREFOHWORNERS' a2 ODIAPIXSATION.IS PROVIDED BY SECTION 87oa OF THE LABOR COOE.FOR THE vERFORNnNCE U Q �7MEViORIfFDRWHICHTNISPERMI713153UED. � � ,�IIMVEANDWP.LMAIMAWWORKEfl9'COMPENSATIONINSUMNCE,ASREOUIFEUBYSECTION Qn 77000FTNE LABOH ODDE.FOR THE PERPDHMANCE OF iHE WORK FON WHICH THIS PERMR IS LSSLIE�.II'/WOqKERS' 04P/E�t+/�TIDNIKSURANCECA/qRIERAN�POLICYNUMBERARE: CONSTRUCTION � ��p ���I�+� G Le PLAN REVIEW � POLICYNIIIABEH_���C� � Q O ELECTRIC p (fH68ECfI0N1�E�NoiaEa�I.EimOFnEaEw.ftsrORaNEMIPpR�00lURS(��ooIORLESS4 ING � � Z ICENTIFY7W1TqJTHEFERFORMANCEOFTHEWORKFORWNICHTHISPEAMITI5ISSUEO.I MECHANICAL .-r ' SNALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME BUB.IECT TO THE �' � 1 � F'���' y WORNEHS'COMPEN6ATIONLAWSOFCALIFOpNIA,ANDAOflEETHA7IF18NWLABECOME IN ONFEE �•'��� � 6U8JECT TO THE WOHKERS'COLIGEN9ATqN PqOVISION3 OF BECTqN�70o OF TME LABOR ' ~j OOOE,ISXALLFORTiWITiGOMPLYWITNTMOSEPROf�VISIONS. IS ANCE ,��������f�i�:'�1� 3��`: . �� t�1 ���, � DATE:��APPLICANT R1 GYIq� � .�e II�� 1.y,!��� , .� . � WARNINO:FARUflE TO BECURE WOflNERS'OOMGENSATION COVERIW E IS UPRAYVFVL,AND SXALL DE ENERGY P/C " ry BUB.IECTANHAPLOYERTOCRIMWALPElOALTIESMIOCNIlFWESUPiOpVEMUNDREDTFpUSANO ENERGYPERMIT � DDLLARS(i100.00D�.IN IIDORION TO TNE COST OF COMPENSATION,DAMAGES AS PROVIOEO FOR IN 8ECTION370lOFTIiELABOHCODE,INTERE3T,AN0ATfOHNEY'6FEE5. RE7ENTIONFEE: 4 CONSTRUCTION LENDING AGENCY 0 PRE•ALT FEE: � I HEREBY AFFIRM UNDER PENILLTY OF PERJURY THATTHERE ISACONSTRUCTION LENDINOIIOENCY Z FOR THE PEHWRNANCE OF TME WORK FOR N711CH iN15 PEPAAIT IS ISSUEO(SEC.30h,CJV.G�. W � LEfIDEWSNAME , C LENDERSADOfiE3S � ICEfiTIFYT1iATINAVEREADTHISMPLICATIWM103TA7E7W1T71iE11BOVENJFORMATIONISCOqRECT. TOTAL FEES I/UiREE TO COMPLY N7TH ALL CRY AND COUNTV OROINANCES AND STATE IAWS REUTNO TO BUILDINO � CONSTRUCTION,MIDHERE9YAUTIiORQEREPRESENTATNESOFTHISWUNTYTDENTEHUPONiHE ABOVEdAENTIOMm PIIDPER7Y PDR WSPECTqN PURGOSES. 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