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HomeMy WebLinkAbout14136 (22) i ��_ CITYOFDIAMONDBAB EXPIRED DEPARTMENT OF COMMUNITY dc DEVELOPMENT SERVICES �� 21660 E.Capley Drive Suite 190 �,,,,,, (909)560-3195 Fax(909)861-311? N O V 2 9 � ���� PR Ess �'�^'�� BUII.DING PERMIT APPLICATION - FIRMLY Q DDR'ESS S SO� N.. Q �u � APPLICATI�N .-�� PERMIT r p o DATE NUIHBERI 1t �-33 e ISSUE . ; TYPE ' , OCC APN LOT TRACT DATE CONST. GROUP °� OWNER �D Q-►.s l Pil. 2G..1.L p ADDRESS_- ��.-��---� ZONING SETBACKS W CITY_ ZIP TEL.� FRONT RW ❑ APPLICANT_ ~ '��v.1 co�vEtVL�cL�yELiG Z Z5� SI�E/SIDESTREET RW ❑ CONTRACTOR C� `� b SIDE ❑ ADDRESS 'Z3 Z.L� Li R.K.re-'ZT �¢-++ � CITY E.j B-[�S�J-�� ZIP�� TEL.f 1 2�S PROPOSED USE � ARCH/ENG/ C �ESIGNER NO.DWEL. NO. NO. j CDDRESS ZIP �L UNITS STORIES BEDROOMS � H DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLAflATION SFR/A�O/REM O � p 1 HFPEBY AFFlRM UNDER iENRITY OF PE0.NRY THAT I AM EXEMP7 FIpM TNE LONfRACTOq3 LI- 8�899lC8R70R tL CBiSEU1WFOR7T1EFq10WINOREhSON(SEC.70J1.iBUSINESSANDPROFE5310N5WUE:ANYCITYOR COlJNi7WNICHREWIRESAPERMR7000NSTRUCT.ALTER,IMPROVE,DEMOIJSN.pRREPAIRANYSTRl1C• W atlp/D6Ck TURE,�RqR TO 1T9 ISSl1ANCE.ILSO REWIHES THE�PVLICANT FOFi SUCH GERMIT TO FILE�SIONEO � 6TATFAIEM THAT HE OH SHE IS LICENSEO PUFLSUANT TO THE PROYISIONS OF TME CON7qACTOqS U• CEM9E LAW(CMAD'TEq a(CO/AMENdNO WfTH SECTIONlooO)OF ONISION 9 OF 7HF BUSINESS AND PFtO- POOUSp9 FESSqNSOODE)ORTHATME00.SMEISEXEMPTTHEREFROMANDiHEBASIS�ORTHEALLEOEDEXEMP- (ry TION.ANY VIOlAT1ON OF SECTION 7031.6 BV ANY MPLICANT FOR A PERMIT 8U8JECT9 THE 11PPLICANT Tp z Re-Raof � AGVILPENAL7YOFNOTMORET1iANFIYE/HMDREDDOLL�RS�iGoo),): OI,ASOWNEROF7HEPROPERTY,ORMYEMPLOYE6WITNWAQESASTFIEIRSOLECpMPEN9ATIDN, CORIrtIBfp9i 1YILL DO TF1E WORIC,AND THE STRUCTURE IS NOT IMEPDED OR OFFERED FOR SALE(SEC.7011,8US1� O N NESS AND PROFESSIpNS CODE:iHE CONTMCTORS L�CENSE UIW DOES NOT APPLV TO Ml OWNER OF � PROPFAiY YYFp BUIDSOR IYPROVES THEREON.AND NMO OOES 9uCH WOqK HIIASELF OR HERSELF OR � TIWOl1f3HHISORNENOWNEMPLOYEES,VROVIDEDTNAT9Ud11MPROVEMEM911R6NOTIMENUE00R n OFFERED i�XiSALE IF,IIDYV'VEf�I}IE BUILDINOOiI MOROVEMEM IS BOLD WITHIN ONE YEM OFCAMP(,E- TIDN.THE OWNER-BUMER WILL FiAVE 7HE BURDEN OF P0.0VIN0 7HA7 HE ON eNE DID NbT BUqn OR NIPRDVE FOR THE VUHPOSE OF BKE} W �I.ASOWNEROFTHEPROPEATY,AME7(CLUSIVELYCOMRACTNOWRHUCENSEDCOMR11CfOH3 � TO OOIiSTNVGT TME PRQIECT(SEC.70a{,BUSINE58/JYU PROFES510N9 CWE:TXE COI(TMCTORS LI- V8IU8�10 ADJ.AREA CEHSE lAW OOES NO7 MPIY 70 AN ONMEFl OFA PROPEHTY WMO BUXDS OR IMPRpyES THER[ON,Mp WHOOONTMCTSWRBUCHP(�7JECTSWITHACONTMCTOpIS�LICENSEDPURSUANTTOTHEWNTMG UANTI DESCRIPTION roAs ucersE uw.�. FEE � O IAM 6%QA7f IMJ�ERlEC. B.f P.Q FOR TNIS REASON Q t =ZZ DATE ONMER U � u 1 � � � W UCENSED CONTRACTORS DECUIRATION � � w I MEREBYAFFIRAI IMDER PENALTY OF PE0.IUNY THAT IAM LICENSED UNOER PROVISIDNS OF CHAPiER � •(CqAMENCWO VRTH 9ECTION 7000)OF DIV1610N 3 OFTHE BUSINESS AND PPOFESSIONS COOE,AND Z W UCENSE t5 IN FlAL WRCE AND EFFECT. � LICENSE CLASS� ��� ��LIC.ND. ��� � � pA���_a ! ` t��+_ ca�rra�croa�� � = WORKERS'COMPENSATION DECLARATION •/i a Jf' y I ME�RM UNDER VENALTY OF PERRIRY ONE OF THE FOLLOWING DECLAMTION9.� " z � IHAVEAkDM/1LLYlANTAINACEHfIFICATEOFCONSENTTOBELF-INSUREFORWORKERS' _ COMPEN80.TION,AB PFiOVI�ED BY 6ECTION�TOo OF TNE LABOH CODE,FOFl TME PERFORMANCE U Q h1E Nl011K FOfl WMICH THIS GERMIT IS ISSUED. � Q �HAVE AND WRL MAMRAIN WORKERS'COMVENSATION INSUMNCE,A6 REQUINEO 8v SEC7'ON P f7000FTHELABORCODEFORTNEPERPDRMANCEOFTHEWORKWRWHICHTHISPERMI 3� � ISSUE�.W WOIIKERS,WMPENSATKKJ INSURANCE Cl1 RIER AND 70LICY NUMBEH � CONSTRUCTION 4 � CMRIER �S G— e. C> _� PLAN REVIEW � POLICY NUMBER � ELECTRIC � (IFi6SEC110NNE�NO7BE001�LETEDOFhEPEFiMTI6fnRONEHU1�OfiEDDOtLtFtS�ta�OqLESS� PLUMBING � Z I CERTIFY T11AT INTNE PERFORNANCE OF 7NE WO(iK FOfl WHIp1 TF715 PERMIT IS I55UED,1 MECHANICAL SMMINOT EMPLOYANY YERSON N M1Y MANNER SOAS TO BECONE SUBJECT TO THE � WORKEH5 COMPENSATIdJ UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE � S SUBJECT TO THE WORKERS'COMPENSAT OF 3EC710N 7Tao OF THE IABOR COOE,1 SHALL FONTMMTH COMPLY E PROVISIONS ISSUANCE 0 ' p DATE���APPLICANT: SMIP W ENEFQY P/C WARNING:FAILURE TO SECURE WORNERS'COMPENSATpN COVER�GE IS Vld.AWFUL.AND SMALL BE �'y SUBJECTANEM%.OYERTOCRIMINALPENALTIES/JIOCMLFINESl1PTOONEHAIOREOTHOU9AN0 I ENERGYPERMIT UOLLARS(S1a0.00o).W 14DO1710N TO iHE COST OF CAMPENSATION,DMIAGES AS PROVIOED FOR IN � SECTION970lOFTiELABORCO�E,MTEREST,ANDATTORNEV'6FEES. RETENTIONFEE: w CONSTRUCTION LENDINGAGENCY i _CITY nF DIAM�ND EAR � PRE•AlT FEE: INEREHVAFFIHMIINOERPENALTYOFPE0.1UqYTHATTHEREISACANSTRUCiIONLENDINGAOENCY � RUII.i)lNC:AND�AFFTy � � FORTME 7ER�ORMANCE OF THE WORN PDR WNICH THIS VERYIT IS ISSUEO(SEC.9oY7,CIV.C.). - Z W � LENDEH'S NAAIE � LENOER'9ADORE55 � ICERTIFYIHATIFI�VEREADTHISAPPLICATIONMIDSTATETHATT/EABOVFWFOR1AATqNISCORRECT. TOTAL FE S � IAOREETOCOMPLVN7THALI,CITYANDCOVNTYOROINANCE6ANOB�ATELAWSHEIATINOTOBUILDINO � � CONSTRUCTION,ANDHEREBYAUT)K)RREflEPRESEMATIVESOF�HISCOWTYTOEMERUPONTNE � I�� ABOVE-ME IONEDPROPERTVFORINSPECTqNVUpPO5E5. /� (�`QMMENTS � 9 � � m PERM NAN � � B� �� � � � SIG RE O ERLIITT� DATE � RECPT.NO. PAID 8Y VALIOATION W E—Oeperlment Copy,YELLOW-f'vience Copy.PINK—Assesew Copy,GOLDENROD—Fib Copy,GREEN—ApplicenYs Copy . . . , . .� . . . . . .� . .. . ' �. . . � .. . .. . . . . � - � � . .. - ' •�Y!. , . . .e . , .. :. . . . 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