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HomeMy WebLinkAbout13472 (22) CITY OF DIAMOND BA8 �� `�� � -- �-- DEPARTMENT OF COMMUNITY dc DEVELOPMENT SERVICES � . 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)8b1-3117 PRESS BUII.DING PERMIT APPLICATION FIRMLY } JOBSITE APPLIGATION PERMIT P/C � ADDRESS I �• DATE NUMBER �3��2 � ISSUE 2 (� TYPE OCC � APN LOT T ACT DATE ,"��-l� CONST. GR�UP S OWNER AODRESS '� ZONING SETBACKS � CiTY C A ZIP r'��TEL. I R�R RW O APPLICANT TEL. SIDE/SIQE STREET RW ❑ CONTRACT R A'. � / SIDE ❑ g ADDRESS ' � � Pu R FU�Nl3/kr,�-���� 21P TEL � PROPOSED 11SE DESIGNER NO.DWEL. NO. NO. = CIUnDRESS Z�P TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECIARATION SFRIADDIREM O p 1 HEREBY AFFIRAI WDER PENALTV OF PERIURY tHAT 1 AM EXEMP7 FROM THE CONTRACTONS LF GaragelCarporl LY CENSEUWFORTHEWLLOWINOHEASON(SEC.7091.66USINE99AN�PIbFE9510NSCO0E:ANYCITYOR (/� S7 COIRlT7YIMIGIIREOUIflESAVERMRTO00N5THUCT,►LTER,9d7ROVE,DEIAOLJSH,DRREP/UNNiTS7Rl1G (y� �?� IURE.VRI�1 TO fTS 6SUANCE,K90 REW IRES 1TIE APPLICAHT fOR 6UCM PENMR TO FlLE A SIONED W P0i�0/D6dc � MAIEUEM TNAT NE OH SHE IS LICENSm YURSUMT TO THE PRONSIOf�6 OF THE CONTMCTONS U- CENSE UW(CHJ�PTEF i(COL4AENCWO WI7H SECTION 7000)OF OIYISION!OF THE BUSINE53 AND PRP � PooUSpa iE5310NS00DE�OHTMATNEORSHEISEXE4P7T1EpEFpOMANDT1EB11SISFORiNE1LLE0EUE71EMP• (� TION.ANVVqlAT10NOF8ECTION7W1.6BYMIYAPPLICMITFONAPERMITSUB.I6CTSTHEAPVIJCANTTO Z Re-Rao1 � A pNL PENALTV OF NOT MORE TMN FNE XUNDRED DOLLAR&(t6oD).�: ❑�ASONfIJEROFTIEPROPERTY,OR4YEMPLOVEESYNTHWAOESASh1E1R50LECOMPENSAiqN, CDI11R1BfCl81 YALL DO TNE Y/OFM,M!D TlfE eTRUC7URE IS NOT INiENOED OR OFFERED fOR SALE(SEC.10a4,BU54 � NE55 AND YROFE590NS COOE:TME CONTRI1C70R5 LICENSE LAW DDES NOTl1VPLY 70 AN OWNEROF � PfiOPERfYYYFiDlU4�SOR14PHOVES7HER�N,ANOYMODOE9&ICHWORKftlMSELFORHERSELFOR � � iHROUOIi MIS OR NER OIMJ EYPLOYEES,VfpNDED TNAT SUCH MIPROYEMENTS AFE NDT NTENDED OH m OFFERm WHSALE IF.IIDWEVER iHEBUN�INOOR MPiIOYEMENT IB SOLD WRHINdJEYEAR OFCqAPLE- TION.TNE OWNER-0UttDER N1LL NAVE TNE BUR�BJ OF P110VWO TNAi NE OR BHE DID NOT BUqD OR IIAPROVE WR 1HE PURPOSE OF BALE�. ❑I.ILS ONMEf1 OF hIE P110PERIY,AfA EXCLUSIYELV COMMCTINO WRIi UCENSED CONTMCTORS M ODNSTRUCf TME PRWECT(SEQ MM.BUSINESS AN�PROFESSqNS COCE:7HE CONiRAG70q9 LF Veluetlon AOJ.AREA CENSE L11W DOES NOTAPPLY TO MI OWNER OF APflOPEHTV Wlq NJILDS OR WPRDVES TMEREOfy AND WFIOCOHTRACT6FORSUCMPROJECfSWITHl�OONTR�CfOR(S�UCENSEDPUR6UANT70TNEOONTfi�G pUANTITY DESCRIPTION FEE � lORS UCEN6E LAW.). � ❑I AU EXEY77 LNDER SEC. B.�P.C.FOR 7HI5 REASON � U � MTE OWNER � Z W � LICENSED CONTRACTORS�ECIARATION W I NEREBY AFFIRM UNDEH PENALTY OF PEiUURY 1HAT 1 AM UCENSED UNOEH VROVISIONS OF CHAPTER V. � / ��COMMENCNWN7hISECTION7000)OfDIVISION]OFTMEBUSINESSANDPROFE35!ONSCO�E,AND z LL C � � W UCENSE IS N FIAL FORCE AND EFFEC7. � � � LICENSE S �LIC.N0.� J �j DATE � CONiRACTOP . IL C W � WORKEHS'COMPENSATION DECLAiaAT10N a � 1 HERFBY AFflRM IMDER PQiKTY OF GEILIUM ONE OF TNE FOLLOWINO DECLAMTIONS: Z � _I WIVEAND WILL IMRITAN A CERTIFlCATE OF CONSENT TO 6ELFaNSURE FOR WORKERS' _ CdIPENSRTION,AS PROVIOE�BY BECTION�70D OF THE LABOR CODE.FOR THE VER W RMANCE tU Q OF 1Hi WORK WH NM1/ICFI THIS PERMIT IS ISSUED. � � �IWIVEANDYMILLMAIMAINWORKERS'COLIPENSATqNIN5UR0.NCE,AfiREWIREDBY6ELTIOfJ Q i7000FiHEU1BORCODE,FORTNEPERFORMMICEOFTHEWONKFORWHICFITHISPERMIi15 I63UEU.W 1M1'ORKERS'OOLIPENSATION INSURANCE CARRIER AND POIICY NUMBEfi ARE: CONSTRUCTION � CARRIER �� PLAN REVIEW � �OLICY NIIYBEP t��1 , "� ELECTRIC p' (RISSECfIWeE��'ATe[WRREI'�OFTEP�Bf�O�IEM�IEDWLLM4R��%ORIESSI PLUMBING i" �, Z I CEATIFV TMAT W THE PERFORMANCE OF THE W011K FOR WHICH THIS PERAArt IS ISSt1ED,1 MECHANICAL �� SHALL NOT EAIPLOV ANY PERSON N ANY AMNNER 80 A6 TO BECONE Sl1BJEC7 TO 7HE WOfIKER5 COMPENSATION UWS OF GLIFORNIA,AND�OREE THAT IF I SNOULD BECOME INSPECTION FEE . n ��J � SUBJECT TO THE NfORKEN3'CdAPENSA710N P110VISKKJ3 OF SECTION�7ao Of TNE UBOR �,� . t 1 caoe,i sHua.FoarNvnrn ca��r s. ISSUANCE 1- 1 1� � n� --T1�' �,.1.�} :,� • p DATE:�1 S'7! APPLICANT:��T SMIP =� ����1 f... , � ; � [^�n , nS.'y5.• • WARNINO:FA0.URE TO SECURE MroRNERS'GOMPENS�TION GOVENAOE IS VN.AWFIK,AND SMML BE ENERGY P/C S, 7. t�tl r � SUBJECTANEMPLOYERTOCRIMINALVENALTIESMVOCMIfINESUPTOOf/EYUNOREOT/pIlSAND ��yl �_�' OOLWi5�i700,000),qiADDITIONTOiHECOSTOFCOMiENSATION,Dl1MI1GESASPROVIOEOfOHIN ENERGYPERMIT �"�Ul`�' � BECTqN 970oOF THE LABOR COOE,IMEREST,NlDATTORNEV'S FEES. RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-AL7 FEE: C� INEREHYAFFIRMUNDENPENJILTYOFPEIUURYTHATTNEREISACONSTRUCTIONLENDINOAfiENCV Z WR7HE PERFOFMANCE OF THE WORK Wfl NMICH 7HI5 PERMIT IS ISSl1E0(SEC,30%,pV.C.�. 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