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Home My WebLink About14986 (17)CITY OF DIAMONDS ' �'° :•�I DEPARTMENT OF C6:' . UNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive suite 19� \\\ PRESS . ax (909) 861-3117 BUILDING PERMIT APPLICATION __ / , FIRMLY JOBSITE ADDRESS Q 5 (th N APN LOT TRACT OWNERyU ADDRESS IV SyADy 1PLAC1, Ddk01V►7'ISRE CITY NA ZIP J#*jb< TEb^,3191 APPLICANT Q C 1fM9rt 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 EKEMPT FROM THE CONTRACTORS L4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.8 BUSINESSAND PROFESSIONS CODE: ANYCITV OR COUNTY WIACH REOUIRESA PERMITTO CONSTRUCT.ALTER IMPROVE, DEMOLISH. On REPARANY STRUP TUBE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED STATEMENT THAT HE OR aHE B LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER a (CAMME-NO WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7037.8 BY ANY APPLICANT FOR APERMIT SUBJECTS 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 LR 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 WIIO SULDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR TIFOIJGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE IF,HOWEVER. THE BUILDING OR IMPROVEMENTNS 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 SALEM O I, AS OWNER OF THE PROPERTY. AN EXCLUSIVELY CONTRACTING VAIN LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 704. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI• OENSE LAW DOES NOTAPPLYTOAN OWNER OF A PROPERTY WHO 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 BEC. B. S P.C. FOR THIS REASON 0&O-19 6"112foc GATE r`'� �Z� OWNER �, tP LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER e (COMMENCING WITH SECTION MIX) OF DIVISION 3 of THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N PULL FORCE AND EFFECT. LICENSE CUSS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HERESY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. I NAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PRIDMED BY SECTION 5700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAIN WORKERS- COMPENSATION NSUFUNCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER ! POLICY NUMBER (RSSSE-CTM 11C ID NDTBE CDNFLETEDOFTFE PEWATIS FORONEHUNIXIED00.1MiS 0100)0H LESS1 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'COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT F I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTIN 3700 OF THE LABOR CODE 1 SHALL FORIIAATH COMPLY WITH THOSE PROVISIONS. I 1 DATE: APPLICANT. WARNING: FAILURE TO YESECURE WORKERS' COMPENSATION CIVIL FINES UP T ISUNLAWFUL, AND SHALL USAND SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GIYIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (6100,0001 N ADDITION TO THE COST OF OOMPENSATKON, DAMAGES AS PROVIDED FOR IN 1 SECTION 3708 OF THE LABOR CODE INTEREST. AND ATTORNEYS FEES. L CONSTRUCTION LENDING AGENCY i 1 HERESY AFFIRM UNDER OFTHEPENALTY OF PERJURY THAT THERE B A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WH ICH THIS PERMIT IS ISSUED (SEG 9047, 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 BULDINO CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNO TO ENTER UPON THE ABOVE-MENTKNEO PROPERTY FOR INSPECTION PU S. 6 31 PERMITTEE 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 �J 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 PLUMBING MECHANICAL INSPECTION FEE ISSUANCE Miff 19 200OU SMIP VU ENERGYP/C CIS QF'I)JAMM 11 AR ENERGY PERMIT BUE6,DING A Al D C A TITV RETENTION FEE: tom= PRE -*LT ", / ' 10 gle -;;� TOTAL FEES O 3 ! e aso COMMENTS RECPT. NO. PAID BY VALJDAMON WHITE—Department Copy. YELLOW—Fhence COPS. PINK—ABaeSSOr UOPY, muLutnHw—rile Atopy. umt:N—nppncanra LOOPY y