The URL can be used to link to this page

Home My WebLink About14986CITY OF DIAMONDS DEPARTMENT OF C6:' . UNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive suite 19i \\\ PRESS . BUILDING PERMIT APPLICATION __ / , FIRMLY JOBSITE ADDRESS Q 5 ith N APN LOT TRACT OWNERyU ADDRESS IV SyADy 1PLAC1, Ddk01V7'ISRE CITY A ZIP x jb< TEL[ 1396^�29► APPLICANT Q 1f 1fA9rt O TEL CONTRACTOR ADDRESS CITY ZIP TEL ARCIASNG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LM CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.SBUSINESSAND PROFESSIONS CODE: ANYCITV OR COUNTY WHICH REOUIRESA PERMRTO CONSTRUCT.ALTER IMPROVE, DEMOUSH.OR REPAIRANY STRUP TUBE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR aHE B LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS I.I. CENSE LAW (CHAPTER a (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS OODE) OR THAT HE OR SHE IS EXEMPT THEREFROM ANO THE BASIS FORTHE ALLEGED EXEMP- TION.ANYVIOLATI NOF SECTION 7031.8 BYANYAPPLICANT FOR APERMITSUBJECTS THE APPLICANT TO ACIVILPENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS %SOO).): O L ASOWNER OFTHE PROPERTY, OR MV EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, SUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO SULDS OR MPROVESTHEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROIA N HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE IF,HOWEVER, THE BUILDING OR MPROVEMENTIS SOLD WITHIN ONE YEAROFCOMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEL O I, AS OWNER OF THE PROPERTY. AN EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 704. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI• CENSE LAW DOES NOTAPPLYTOAN OWNER OF A PROPERTYWHO BUILDS OR IMPROVES THEREON, AND VA• 000NTRACTS FOR SUCH PROJECTS WITH AOONTRACTOR(S) LICENSED PURSUANTTO THE OONTRAG TORS LICENSE LAW.). O 1 AM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON 0&O-6"'t0foc GATE r`'� �Z� OWNER (1 tP LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER e (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N PULL FORCE AND EFFECT. LICENSE CUSS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. I WIVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 5700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAIN WOFiI(ERS' COMPENSATION NSUFUNCE, AS REGUNED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MY WORKERS' OOMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER ! POLICY NUMBER (RBSSE-CTM 11C ID NDTBE WNFLETEDOFTFE PEWATIS FORONEHUM)REDDOL ARS R1 W1OR UESSM I CERTIFY THAT N THE PERFORMANCE OF THE WORK FDR WHICH THIS PERMIT IS ISSUED, I V SHALLNOT EMPLOYANY PERSON IN ANY MANNER BOAS TO BECOME SUBJECTTOTHE j WORKERS' OOMPENSATIN LAWS OF CALIFORNIA. AND AGREE THAT F I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE 1 SHALL FORTMMTH COMPLY WITH THOSE PROVISIONS. I 1 DATE: APPLICANT. WARNING: FAILURE TO YESECURE WORKERS' COMPENSATION FINES UP T IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (81 00,000). N ADDITION TO THE COST OF OOMPENSATKON, DAMAGES AS PROVIDED FOR IN 1 SECTION 3708 OF THE LABOR CODE INTEREST. AND ATTORNEYS FEES. I CONSTRUCTION LENDING AGENCY i 1 HERESY AFFIRM UNDER OF THE WORK PERJURY THAT THERE B ACONSUED (SON LENDING AGENCY FOR THE PERFORMANCE OF THE WORK PDR WH ICH THIS PERMIT IS ISSUED (SEG 9087, CIV. G). LENDERS NAME LENDERSADDRESS 3 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT: I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCESAND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNO TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PU S. 6 31 PEW.IITTEE RINTI 31 D NATURE PERIATTE DATE C APPLICATIO J PERMIT/ (� P/C /' _. m V DATE NUMBE6 ` M ISSUE TYPE OCC DATE CONST- GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Garage/Carpon WPatlo/Deck LL POOVSPS ZRe -Root OJ Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U cc U W W 179 Z m �J C U_ Z W / - -sw CONSTRUCTION "' PLAN REVIEW .�7 ELECTRIC rte/ PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGY P/C CLU QF' ��MCD!M R AR ENERGY PERMIT BUILDING A Al n C A TITV RETENTION FEE: >E= PRE -*LT ", / ' ��`{1�� TOTAL FEES O 3 lea -50 COMMENTS RECPT. NO. PAID BY VALIDATION WHITE—Depriment Copy. YELLOW—Fhance COPS. PINK—ABaeSSOr UOPY, muLutnHw—role wpy. umt:N—Vpncanra AAoPy y