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HomeMy WebLinkAbout13452 ____�� CITY OF DIAIvIOND BAI� ` �(� DEPARTMENT OF C�MMUI�tITY&DEVELOPMENT SERVICES � _ 21660 E.Copley Drive Suite 190 w PRESS 9�,,,., (909)860-3195 Fax(909)861-3117 , BUI�DIN�PERMIT APPLICATION __ FIRMLY • JOBRESS LS��o� fa I�I.L�a� LFF��. SSUE ��t�-, rn/ ,TYPE ER � ��_ # O. � SITE APPLICATION .� PERMIT P/C o ADD � APN LOT' '�—,TRACT �"��C� DATE �� I�''"�"l CONST. GROUP ;::�.:� �O OWNER � � f�� _ `� _ _ " ADDRESS I��c.:� in�: :lN,ArPa ��'�0 �i�,CG'�e ZONING SETBACKS �W APPLICA� � ZIP'�'�TEL."7/�^��D�i�%+� FRONT RW ❑ TEL: REAR ❑ SIDE/SIDE STREET RW ❑ � TRACTOR��•4� ��¢gJ3��: �reC. . SIDE ❑ � AD�RESS�,°��, 4 rz?�'A-�i�T ` ' f�t� t � CITY �fi+-�E�a��'� ZIP�'�� TEL.�'a '�"�r.�A�/ PRQPOSEDUSE #P1�3S1'1.�5�y��l�f'l�� � ARCHlENG/ � � CDD ESS I� ZIP TEL UNITS EL. STORIES B DROdMS � DESCRIPTION SQ:FT. PACTOR PSF ADJ:'AREANALUAT ION - ,Q. , , pWNER-BUIL6ERDECLP.RATION ��: , � � � �. �� � ��� ,. 0 � l � . � SFR/ADD/REM .. . . . .. .... , . � p�„ 1 HEREBY AFFlRM UNDER PENALTY OF PEHJURY THAT I AM EXEMPT FHOM THE CONTFiACTORS LI- � �dl'898/Cd�Ofl � � � W CENSELAWFURTHEFOLLOWIN�RFASON(SEC.7031.581J$MESSANDPROFESSIONSCA�E:ANYCITVOR ' � ' ' -COUNTVWHICHREGUIRESAPEdMITiOCONSTRUCT,ALTER,IMPROVE,OEMOLISH,ORREPAIRANYSTRUC- QJ.� Patio/Deck � , ��, �TURE,PRIOR TO IT&ISSVANCE,AL60 REQUIRES THE APPLICAiJT FOR SUCH PERMIT�TO FIIE A SIGNED . � , W � FES510NSffX�E)OR7HATHEOf�5HEI5EXEMP7TriEREFqOMqNDTHEBA515FORTHEALLEGEDEXEMP•� � OVSpd ' � � � ,, ..,,�� .TIONSANYV�UTopNOTMORE''70 fNEHt1NY E�ANT OESA�,IMTSU&IECTSTH�EA P ICANTTO .; Z qe-ROOf � ❑I,ASOWNEROFTHEPRO ERT',ORMVEMPLOVEESWITHWAGESASTHEIHSOLECAMPENSA710N; O' � � Commercial ..;Z ,.WILL 00 THE W�RK,MlD.THE RUCTURE IS NOT INTENDED OH OFFERED FOR SALE(SEC.7044,BUSI- �:I � ' .� .NESS M!D PROFESSIONS CO�E:,THE CONTflACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF � � ' PROPEHTYN?iOBUILD50RINiP OVE57HEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � -��2 TNROUGHIiISOHHERaWNEM�LOYEES;PFOVIOEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR ' m '�, ' � '� .OFFEREDFOHSALEIF,FIOWEVE iHEBUILDINGORIMPROVEMENTISSOL�WITHINONEYEAROFCOMPLE- ' ' �z��'���TION,THE OWNER-BUILDER WlL�HAVE THE BUR�EN 6F PROVING THAT.HE OR-SHE DI�NOT BUILO OR � '�� . . ,_ �IMPROVE FORTHE PUiiPOSE Ofl SAIEI. - �� .. ❑I,ASOWNEROFTHEPR PERTV,AMEXCWSIVELVCONTRACtINGWITHLICENSEDCONTRAC70P5 � � d. �,���TOCON67RUCTTHEPRQIECT$6EC.'7o{4,BU6ME65AND�PROFESSIONSCODE:7HECONTRACTORSIi- ," ValUBtiDn ADJ.AREA � � ' iSJ, "CEN3ELAWDOE3NOTAPPlVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVEShiEREON,AND ' �� ' � -��=���i 'WFIOCONTMCTSFORSUCHPR�1.lECTSWITHACOtJTRACTOR(5)LICENSEDPURSt/ANiTOTHECON7RAG � QUANTITY DESCRIPTION °�� - . . �� -- FEE ~��'. TORS IJGENSE LAW.). � � .�: . . �i . . � .. �', � - . . . , . �� � � . , ... ..� ,�,� �, ❑I AM EXEMPTUNDEP SEC. B.8 P.C.FORTHIS REA50N Q .,.',�,���. . V i . . .. , ;I � . .. �, �".� �z� DATE OWNER .. . . V � . . . . ..O'�, . i . W . . � LICE SED CONTRACTORS DECLARATION W ', �'�, I HEREBV AFFWM UNDEH PENALIfV OF PERIURV THAT i AM LICENSEO 11NDER PROVISIONS OFCHAPTEA � �', �+9� z /'��� , � �, , � I � � p„ �.�8(CObAMENCINOWITHSECTic�Nb00o)OFDIVISION30FTHEBUSINESSANDPRDFESSIONSCOOE,ANU g , �, _X_,,' MY UCENSE IS IN PULL fORCE�D EFFECL m , ���� i. �� w ���q +-� . O .�.LICENSECLASS � � . LJC.NO... L�IG4Jst'76 ' . � �, {'� �o. ��ap � p - J IYG' ' � ' , V �.� .W �.I DATE �� CONTRACTOR 1.F 'fY�t'.' �� .',p.,� - �- , . .� �' ' i23 � �'�; WOAl�ERS'COMPENSATION 6ECLARATION a . '. N �. 1 HEAE9YRFFIRM UNOER PEN OF PERIURY ONE OFTHE FOLLDWING DECLARAT10N5: Z ' ' ' ' ' � ���� �'�, � � _IHAVEANDWIlLMMNTINACERTtFICATEOFCONSEMTOSELFINAIREWRWORKERS' a .; '������ _ CAMPEN9ATION,ASPRQVIDE�9Y3ECTION37000FTHELABORCODE,FORTFiEPERFORMANCE W ' ' � OF THE WORK FOR WHI�Ii THIS PERMIT I515SUED. � '�' _I HAVEAND WILL MAIM�.IN WORKEFiS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION '- - � � � � �� ;. � 37000FTHELABORCO E,FORTHEPERFORMANCEOFTHEWOFKFOFWHICHTHISPERMITIS J ISSU�.MYWO�RpKERS(' OMPENSRTIONINSURANCECARRIERANDPOLICYNUMBERARE: CONSTRUCTION �� y. CARR�ER � 4.".�'B' 'lJiilfl� PLAN RF_VIEW � ,�, PoucrNunteER '�,' �97� s' ELECTRIC < �y.��ry '�, Q, (IFiISS[C110NNE�NOT�E07bPLEPE00FTh�PEROMISFORONEHUrUHED00l1ARS(S7oo�ORLES41. PLUMBING .���+`V(,J �. ,Z i CERTIFYTHAT IN"fHE EFiFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL - "^'`v�g '', �, SHALLNOTEMPLOYAN PERSONINANYMANNERSOASTOBECOMESU6JECTTOTHE ��'�'�§-F����� ' ��' WORKERS'COMPENSA ONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOUL�BECOME INSFECTIONFEE :?�-'"� ' SU87ECTTOTH'cN/6R R5COMPENSATpNPROVISION50F5ECTION37U00FTHELABOR *� � '�', CODE,I3HALLFORTHW+THCOMPLYWITHTHOSEPROVISIONS. ISSU/WCE S+t�t�� '.�,4i o� DATE � � �y�PPIICANT: .SMIP . �i a��''""�� �', ��. WAflNING FAILURE TO SECURE�NORKERS'COMPENSATION COVERAGE IS UNLAWFUL,ANO 9iAlL BE ENERGY P/C �. .}�`�'�d � .` J +�`} af �� ���� 9U&IECTAN-EMPLCYERTOCRIMIINAL'PENALTIESANDCIVILFME9UPTOONEHUNDREDTHOUSAND . , -�. x ��� �� � ��` DOLLARS(510o,000),INADDITI TOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORIN ENERGYPERMIT - 5,�. '�� � k : '� ,�w4'Y"` � J� SECTION37oeOFiHELA60R ��E,INTEREST,ANDATTORNE'PSFEES. q,,d.� � - � s"�°i� � ,�� Ly RETENTIONFEE: _ ���a� � ��,0�, C{.�NSTRUCTIONLENDINGAGENCY PRE-ALTFEE: "'�`��`�� � �. ',�„ I HERE9YAFFIRM UNDER PEN TY OF PERJl1RYTHATTHERE IS ACONSTFUCTION LEN�MG AGENCY ' - � FOfl THE PERFORMANCE OF TH�WORK FDR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). , . Z . . ������ i,, . . . . . . - . , . LENDER'S NAME F-�� LENDEH'SADDRESS I '�,�,�. I CERTIFY THAT I HAVE HEAD TH SAPPLICATION ANU STATETHATTHE ABOVE INFORMA710N IS CAHRECT. TOTAL FE ES � ���'� � � � � . � � ��:", IAGREETOCOMPLYWITHALL��INANDCOUN7YORDINANCESANDSTATELAWSRELATINGTOBUILDING . � . � . - � �;�i,, CDNSTRl1CTION,ANDHEHEBV 11TNORIZEFEPfl6ENTATNESCFTHISC011NTV70ENTERl1PDNTHE. ' - . , , � ��.. ABOVE�AEMIONE�PRaPERTV.OR INSPECTIpN PURPOSES. COMMENTS �- ' �'� � ;� � _ � �O 1.. �`�,1- �'� PEHMITT AME��— . QI': � +--�..- � `. , py' SIGNANWEOFP MI '. UA7E ��� � � ,��: i .. 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