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HomeMy WebLinkAbout13168 (16) CITY OF DIAMOND$AR � -- --- DEPARTMENT OF COMMUI�TITY dt DEVELOPMENT SERVICES �� . 21660 E.Copley Drive Suim 190 �� (909)860-3145 Fax(909)861-3117 PRESS ���%�'�" BUII.DING PERMIT APPLICAT[ON �IRMLY o ADDRI SS �GS'�Y / Z ���' � DA�CATION N MB R �)`�� �� � APN LOT TRACT DA EE J����R CONST. GROUP � OWNER ADDRES ZONING SETBACKS �� CITY 21P,��_t TEL. �34� RE�T RW � APPLICANT TEL. SIDEISIDE STREET RW ❑ CONTAAC70R SIDE ❑ � ADDRESS —� PROPOSED USE CITY ZIP� TEL. Pu ARCHlEN � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFRlADU/REM O 1 f1EREBY AFFlRM UNpFq PEN�LTY OF PERIURY THAT 1 AM EXEMPT FROM iNE COMRACTORS LI• GBfBgB/C@lpOn CENSEUWWRTHEFOLLOYIIINGNEASON(9EC.70]1.6BUSPIESSAN�PHOFESSIONSCO�E:ANVCITYOR (n COUHTYM4NqiqEDU1RESAVERMITTOCONSTRUCT.ALTE141MPfiOVE,OEMOIISH,ORREMIRANYS7RU6 W PetlOJD6Ck 7UfIE PRIOft TO IT8 63UMICE.lilEO REOUIf1ES TME APVLIC�Nf�OR SUCH PERMIT TO FILE A SIONE� iTATEMEM THl1T HE OR&1E IS LICENSED PURSWWT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE L11W(C1UP'fER 9(COMMENCING W(TH SECTION 7000�OF DIVISION 3 OF THE BUSINE55 AI�D PRO• � POO�$Pe FESSqNSCODE)OtiTFU1TM60F19ME15E%[MPTTiiEREFqpUANDTHEBA318FORTHElLLLEOEDEXEMv. (� TION.MIYVIOlATI0NOF8ECT10N7W1.59YAN'lAPPLICANTFORAPERMITSU&IECT9THEMPLICANTTO Z Fjg-AQp( F„ A CML VENKTY OF NOi GOR[7NAN FNE FNN011ED�OLLI0.5(l500�.�: O DI,ASOWNEHOFTHEPHD7ERTY.ORMVEI�LOYEESWITHWAGESASMEIRSOLECOMPENSATION, Q COmmBfCiel Z YYILL D�TME WORI(MO 1HE STIIUCTIIHE IS NOT INTENDEO ON OFFEREU FOR SALE(SEC.TM4,BUSb J � NESS A!D PADFESSIONS pODE:THE QOIiTRACTOtIS LICENSE LAV/DOES NOT APPLY TOµOWNER OF = ►FqPERTT NFiO&J0.DS OR pAPROVEe THEREON,M1D VAi000E5 6UCH WORK MINSELF OR HERSELF OX � TIYqUOFI1NSORNEROVINEMPtAYFES,PRONDEDTWITBUCHMAPROVFMEMSARENOTINTENOE00R m OFFFAm FOR SALE IF,IqN'EVER 7NE BURDINOOH IMPROVEMINi i9 501A WfTHINONEYEAROF COAIPLE TION.TNE OWNER$1MEA WILL HAVE h1E BUIIDEN OF PROVINO THAT NE OR 8HF DVD NOT BUIL�OR qPROVE F061 hIE PURP0.5E OF M1L�. � ❑I,ASOWNEROFTHEVROPERTY.A4EXCLUSNELYCOMMCTINOWI7MU.'ENSFDCONiMCTOR4 10 CONSTRUCT THE►RQIECT�9EC.7oN,BU81NES5 AHD PROFE9410N9 COL'E THE COMRACTORS LF Valuadan _ ADJ.AREA CENSE LAW DOES W�T MPLYTO AN OWNER OF A PROPERTY N710 9UIL�S OR IYIPROYE9 hiEHEON,AN� NMiOCOMMCTSFORSUCHGR6IECTSWIT1ACOfrt1MCTOR(S)LICENSE�i'UHSUMffTOTHECONTMG pUANTITY DESCRIPTION FEE � TOFlS 11GEN9E UWLI. � O 1 AM EXEMPT UNDER SEG B.�P.C.Fai THIS PEh50N Q U la. � DATE OWNER U � LICENSED CONTpACTONS DECLARATION w � t NEREBY AFFIqM 1MDER PENALTY OF VERIURV TNAT IMI LICENSEO UN�ER vROVI5lON5 OF CHAPTER � i�COMMENCMHiW1TH9ECTION7000)OFOIVISiON70FTHEBUSINESSANDPF�FES510N5CO�E,AND Z W IJCENSE IS tlJ R1LL FORCE AND EFFECT. m � LICENSE CLA39 IIC.NO. ��� _ j � DATE ' r CONTRACTOR _ a WORKERS'COMPENSATION DECLARATION � a y1 HERWY 11FFIqM UND6R PENhLTY OF PERIURY ONE OF THE FOLIAWiN6 DECLAMTIDNS: Z � �IYIhNEANGWILLMNNTAINACERTIFICATEOFO0N5ENTM8ELFJNSUREFORWOflNERS' _ CONPENSATION,A5 VqOVIDE�BY SEC710N 7700 OF TNE LABOH CODE,FOR 7HE PEAFORMANCE W �i/E WORK FOR NMlql THIS PERMIT IS 199UED. � V ��HAVE M!D WILL MAINfAU7 WORKERS'Ca61PEN5ATION INSUMNCE,AS REOUiFEO BY SECTION QQ 9'!00 OF THE IABOR ODOE.FMi THE PERPDRM:WCE OF TNE WORK iOR WHICH THIS PERMIT IS O�. �O � ISSUEO.NYYYDFiNFAS'COMDENSATIDN INSURANCE C %ilEfl MI�PDLICI NUMBERAHE' GONSTRUCTION b � c,wnien _ �LAN REVIEW � ����R--�� ELECTRIC �1��"�__ �y,r-� 0 (nass[c�rpNr��rroreEaasLErmoFn�t�r�.�rt�swnan��ooaWtsaim�aq�ss� PLUMBING � �CERTIFY TMAT IN hiE PERFORNANCE OF THE WORK FOR WHlpi THIS PEfWR I$ISSUED,1 MECHANICAL �� SNALL NOT EMiLOY ANY PEFSON IN ANY MANNER 50 AS TO BE(T7ME SUBJECT TO THE (� WORKEH500A1PENSATpNLAWSOFCALIFORNIA,ANDA�REETNATIFIBNOULDBECOME INSPECTIONFEE _ S SUBJECTT07HEWORKERS'COMPEN511TqNPRONSIO1V50F5 CTION37oDOFTHEIABOF _—� � r''] COpE,I6MJW.WRTHWITHCOMPLYWITM SEPROVISKNJS ISSUANCE � L� � ,����, SMIP p OA7E:_�Jif� APPLICANT: � � �v �� ENERGY P/C WARNINftFAIWRET09ECUREWORKERS'COMPENSATION NAOEISUNIAWFUL,W109NALLBE � SU6.IECTAN EMPLOYEN TO CRIYMAL PENALTIES MID CNII ES 11PTOONE HIINOREDTHOUSANU ENERGY PERMIT �, DOLURS�i100,000),MJADDITIONT0711ECASTOFCOMPENSATION,DAMACESASPROVIDEDFORIN �� --- .,J BEC71(7N770BOFTIEUIBORCODE,INTENEST,ANDIITTORNEY'SFEES � RETENTION FEE: CONSTRUCTION LENDING AOENCY PRE-AlT FEE: S- 1 HEREBV AFFIRM UNDER PENAITY OF OERAIRY THATTHEFE IS A CONSTRUCTION LENDINO/L7ENCY fOR THE PENWHMANCE OFh1E WORK FOR WHICH h16 PERMIT IS ISSUED(SEC.aoi7,CIV.Q�. � LENDER'S NAME Q �=i�.� � IENDER'SADDRESS � ICERTIFYl1U1TIWWERFJipiF115APPLICATIDNAN�STATETIMTT1El180YENfORM11TqNISCORREGT. TOTAL FEES � IAQREETOCOMPLYN7THALLCRYMIDCOUNTVORDINANCESANDSTATELl1W5RElATWOTOBU0.01NC � GONSTNUCTION,AN�NEREBYAUTFIORIiEREPRESENTATIYESOFT}IISCWXTVTOENTERUPONTFIE ABOVE•YENTIONEO VROPERIY FOR INSPECrION RIRPOSES. COMMENTS � �,"'S��G� �-�5`7�Q � PERMITT� RINn N ` � N SN3 OF P DATE � RECPT.NO. PAID BY VALIDATION WHITE—DepaMmant Copy,YELLOW--Firunco Copy,PINK—Aasassa Copy,GOLDENROD—Fila Copy,GREEN—Applicent's Copy . . . . . � , .. .. . �. . . .�.. ' • . . . � .�. r . . - ' �:i'. . �r n.k• • .. � +�.� t�, �y ..� • GlTY O� UI�AN9Q1'�li� F��R ' � II�v'�PIECTIC�t°�t F�ECU�C3 — t» � -,- �_ .�, �i °� gyg g _ ����.°��#��'��� —�� ,, !� ` r �� .`.. ,.�. , �I#�� � ',�'*.."F, ..�+.�.�F � �u�"""' ��d�' �M�,�a��.�.,:"1"����.�y _ . . .. ._,,.. . , ;. ".-r ,".,a.,ri..,. .. .e�+arr . . . .t ' - . 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