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HomeMy WebLinkAbout13447 (22) _�.� CITY OF DIA1VtOND BAI� ��,� ��"� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES a 21660 E.Copley Drive Suite 190 � w (909)860-3195 Fax(909)861-3117 PRESS ' �:A� `" ' BUIIyDING PEIdMIT APPLICATION ' FIRMLY �' JOBSITE �,a,..,f�� ��, - ���r� APPLICATION PERMIT ) P/b o ADDRESS "�� L��"°' ' I��' DATE NUMBER �3 � # , ; . ISSUE �_I I�% O ST. G OCC � APN LOT', T T DATE ROUP p OWNER� : ' , " ADD S ZONING SETBACKS W CITY , � ZI � TEL. FRONT RW ❑ � APPLICANT I - TEL. REAR rJ_�. Z SIDElSIQE STREET RW Gl � ADDR A�'(� '' ;�,.►--. .. SiD� ❑ O _ � rx , � � CITY �`� ��TE���i�� PROPOSED USE 7 w ARC NG/ Z'" �� �C � .. ' . . �rP���'� � . ��.. ��, . z -DESIGNER � N . p I ' a, ADDRESS Nfl. � CITY i ZIP TEL. UNITS STORIES BEDROOMS NO.DWEL. O �, � I � dWNEFf-BUILDER DECLARATION SPR/ADD/REM o DESCRIPTION SQ.FL FACTOR PS TION Q I HEREBY AFFIRM UNDER P�ENALN OF PERJURY THAT I AM IXEMPT FROM THE CONTRACTOHS LI- F � AD�.AREANALUA '� W CENSELAWFORTHEFOLLOWINCf1EASON(6EC.7031.SBUSINESSPN�hROFE5510N5CODE:ANVC17VOR ,'� � GBfdJE/CdfPOfl - ' CS COUNtYWHICHflEGU1RESAPERM{iTOCONSTRUCT,ALTER,IMPRDVE,DEMOIl�i3ORftEPAIRAryYSTRUC- . 'W Patiol�eck - � " �,W� .iURE,PRIOH TO ITS ISSUANCE;�4150 REQUIRES THE APPLICANT FOR SUGH PERMIT TO FILE A SIGNEO �W . � STATEMENT THAT HE OR SHE IS LICENSE�PURSUANT 7D THE PROVISIIXiS OF THE CONTfl!CTOfl5 U- g. CENSE tAW(CHAPTER 9(WMMENCING WiTH SECPION 7000)OF6IVIS�ON 3 OFTHE BUSINESS AN�Pq0• �' PooVSP3 � � �� FESSIONSCODE�ORTHATHEO�SHEISEXEMPTTWEREfROMANDTHEBASISFOfiTHEALIEGEDEXEMP- � � �.. TION.ANYVIOLATIONOFSECTI 7031.SBVANVAPPLICANTFORAPERMITSU&IECiSTHEAPPLICANTTD ��z Re-Roof , ��' ACML PENAL7V OF NOTMORE HAN fIVE HUNORED DOCI:ARS(S5oo�.): , �� o� ❑I,ASOWNEROFTHEPRO ERTI,OflMYEMPLOVEE6WI7HWAGESASTHEIRSOLECAMPENSATIbN, �� CommBfCidl � � . .,Z..:WILL DO THE WORK,AND THE S'�RUCTUfiE IS NOT IN7EN�ED OH OFF£PED FOFl SAI.E(SEC.7044,BUSI- ..J , �; ��NE55 ANO PHOFESSIONS CODE:THE(X)NTRACTOflS LIGENSE LAW DOES fVOTAPPLY TO AN OWNER OF ��_ � � . , PROPERTYWHOBUIL�SORIMP OVESTHEREON,MAWHODOESSUCHWORKHIMSELFOFHERSELFOR m . ��d� THHOf1GHHI50FHEROWNEM OYEES.PFOVIOEDTHATSUCHIMPROVEMBJTSARENOTINTENDEDOR � �� - , � '� �Ll�� .OFFEREDFORSALEIFHOWEVEF�i,iHEBUIIDINGORIMPROVEMENTI550LDWRHINONEYEAHO�COMPLE- 0'��'�TION,THE OWNER-BUILDER WI HAVE THE BURDEN 6F PROVING THAT HE OR SHE OID NO7 9UILD OR . . .. ��, ,IMPHOVEFORTHEPUHPOSEOF�SALE). � � . � � . � ❑B,A30VNNEROrTHEPR PERTY,AME%CLUSIVELYCONTMCTINGWI7HLfCENSEDCANTRACiORS ��Q�, �'.�TO CONSTAUGTTHE PRO.iECT(EC,7014,BUSINE55 AND PHOFESSIONS CODE THE CONTRACTORS LI- V3II1dSl�fl � ADJ.AREA . � W �CENSE LAW DOES NOT APPLY T AN OWNER OF A PROPERTY WHO BUlLOS OR IMPROVES THEREON,ANO ', HI���.�WHOCONTPACTSFORSUCHPR�ECTSWITHACONTFACTOfl(S)LICENSEDPURSUANTTOTHECONTRAF ANTITY DfSCRIPTI�N �' '� � FEE Y ..TORSLICENSEUWJ. ,, . � �� ❑IAMEXB.IPTUN�ER6EfC.� B.BP.C.FORTHISREASON Q �� � � � � e� e`a d- ���I � � DATE OWNER ' U . � °�',��, ',�... �,. , ' ' �, 1. . ' W ,. .� , ��,' �.. o LICE SED CONTRACTORS DECLARATION d j '�� i I � �.' IHEflEBYAFFIRMUNDERPEN N'OFPENURYTHATIAMLICENSEDUNDERPROVISIONSOFCHAPTER � �. � ai B(COMMENCINfi WITH SECTION�7000)OF DIVISION 30F THE BUSINESSAND PROFESSIONS CO�E,AND Z � ?C�,', MY LICENSE IS IN FULL F AN�EFFECT. '�, ia, i - m C7,,- � . � , . LICEN lASS LIC.NO. �� . H'. I �I �',. .. a . . , �y DAT � CONTRACTOR ' IJ.! � a� WORI�ERS'COMPENSATION DECLARATION B , . �'i ' . U . . . . , . �., � IHERE9VAFFIRMl1N0ERPENAL�fYOFPE0.1uRYONEOFTHEFOLLAWING�DECLARATIONS: Z �� _IHAVERNDWILLMAINTqiNAGERTIFICATEOFCAN9ENTTOSELF�INSUREFORWORKERS' y � - �, CAMPENSATION,ASPR�VI�E�BYSECilON37000FTMELABOflC��E,FORTHEPERFORN�ANCE �U � OF THE WDAK FOH WHI H THIS PERMIT IS ISSUE0. � w"' �'IHAVEAND'WILLMAINTl�INWOPoCERS'COMPENSATIONINSURANCE.ASREQUIREDBYSECTION � �� � aC 37WOFTHELA90RCODE,FORTHEPERWRMANCEOFTHEWORKFORWHICHTHISPERMITIS � ISSLIED.MYWORNFBB�MPENSATIONINSURANCE RANOPOLICYNUMBERARE: CONSTRUCTION �'t y� r-�'j. CAPHIER�V��� �d PLA VIEW :,•�� � �y.j ��� POLICYNUMBER �y� ELECT �� �'1'S n�.p' Q I � (IHISSECfIONNE�NOT�E07du1RfTmOF�fHEPERhY1�I5FORIXJEHIADRE�WLIARS�SiGJjORLESSJ. PLUMBING - W I � � "� �' I CER7IFYTHAT IN THE PyEAFOPMANCE OFT41E WOAK FOR WHICH iH15 AEAMIT IS ISSIJE�,I MECHANICAL .v fi.k° � � �'�"� � � WORKEFS'COMPEN3AtIONIAW90FCALFORNIAANDAGfl E7H TEF SHOULOBECOME WSP - FEE �� � �. �� b��S�',�� � �.n ��� Sll&IEGTTOTHEWOR1�ERfi'COMPENSATIONPROVISIONSOFSECTION37a00FTHELABOR �JMIP"—"""' � � � ��o� CADE,ISHALLFORTHV�ITHCOMPLYWIiHTHOSEPROVISIONS. SUANC ��'��3 A� �" -« s.��_,�'�v.� &�;� ��,� -I�� - '�' �' �i ��k� Y tp &�0,., 'i.4�� p��.' �ATE: � IAPPLICANT. �.n, . �,�' WAFNIPlGFAILUFETOSECUREIYVORKFAS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERC,YP/C �,� SUBJECTAN EMPLOYERiO CR�IPIAL PENALTIES AND CIVILFINES UP 70 oNE HUN�RED THOUSAN� '�NERGY PERMIT OOLLARS(5100,000),INADDl71 TOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORIN � . �J�',�� SEC110N37aeOFTHELABOR DE,INiEREST,AN�ATTORNEV'SFEES. ' RETENTIONFEE: � ' o'�, CibNSTRUCTION LENDING AGENCY PRE-ALT FEE: C�., I HEREBtlAFFIRM�N�ER PENA�TY OF PERJLIRV THATTHERE IS ACONSTRUCTION LENDING AGENCY Q'r„ FORTHEPERFORMANCEDFT EWORKFO4iWHICHTHISPERMITISISSUED(SEC.3097.CIV.C.�. . i � ' , Z. I W' ���.'' lENOER'S NAME . '' ' � h LENOER'SAODRE55 I , /M� W�' TOTAL FEES [� ' ICERTFI'THATIHAVEREADTF{ISAPPLICATIONANOSTATETHATTHEA90VEWFORMATIONISCORRECT. '�, ;,�./'Y9 � I AGREr-TO COMPLY WITH ALL @IiV AND COUNTV ORDINANCES ANO STATE L4WS RELATING TO BUIL0ING . . �ya1�F . '', �,,�j .�� CANSTRUCTION,ANDHEREBY�U7HOFiIZEREPRESENTATIVESOFTHISCOUNTYTOEIdTERUPONTHE , ; , ' � .�.' ABOVEMENTIONEDPROPERTYiiFOR1N5P TIONPURPOSES. . �. . . . .. COMMENTS � J. . m PERMiTTEE N 1 - .p�..� �I. � '�� ..CJa.: .. .. `� -�s ' ' � - �, . g/j SIGNATUR RMITTEE I OAT , ' - , ,�:.; RECPT.NO. 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