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Home My WebLink About16474 (34) _�� CITY OF DIAMOND BAl� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES _ . � 21660 E.Copley Drive Suite 190 ` - (909)860-3195 Fa�c(909)861-3117 PR�$$ ',.,�9�'•�., BUILDING FERMIT APPLICATION FI LY �, . ` a _ APPLICATION �� PERMIT �,� P/C�� o ADDRE5S �� —"�'i'�r'�.... }'�`� f DATE � NUMBER �� # c� �I ISSUE TYPE OCC APN LOTi TRACT DATE CONST. GROUP o� OWNER '7'�—' ��=t;1� O ADDRESS .� �� "' 'L�' n �l� n ZONING SETBACKS z CITY A I � Z ��TEL. ,� FRONT RW ❑ �j APPLICANT �"� .��a��'� TEL. SIDFJSIDE STREET RW ❑ � CONTRACT9R "�''.:. ``' �` "' � �e��',,A��se: � SIDE p � ADDRESS �2�,��i��''y��. ,•� ,� � , Q CITY��°1C:�" I ZIFf/� ��, TEL.�4'J��"i��`��",� PROPOSED USE � ARCHlENGI �, � DESlGNER I NO.DWEL NO. NO. ', ADDRESS I UNITS STORIES � BEDROOMS �' 'CiTY � ZiP TEL. � I� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION , QI, � � �MER-8UEL6ER DECLARATION SFR/ADD/REM - O' ��" I HEREBY AFFlRA9 UNDEF& NALTY OF PERIURY THAT'I ARq EXEMPT FROM THE CONTRACTORS LI- (y`g�a9pfC0fpOR � �W CENSELAWFORTHEFOLLOWIN RFA50N(SEC.7031,5BUSINESSANDPflOFESSIONSCOOE:ANYqiYOR (J� C]��. COIINZ'1'WH(CHAEQUIRESAPEA 1T'T'OCDNSTRUCT;ALTEF,iMPROVE,DEMOIJ$H2ORREPAIRANYSTRUC-. W P3i10/DBCI( ' ' � �'. �7URE:�PRIOR TO ITS IS$UANCE,� SO REQUIKES 7HE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED � � .'�S7ATEMENT THAT NE OR SHE IS IICENSE�PURSUANT TO THE pROVISIONS OF THE CONTRACTORS LI- � � CENSE LAW�CHAVTER 9(CO.UM 13CIIVG WfTH SECTitiN 7oao}OF DIVISION 3 OF THE BUSINE55 AND PRO- u' POOUSPB � � �FESSWPISCOOE�ORYHATHEO $NEISEXEMPTTHEFEFROMAN�THESASISFOPTHEALIEGEDEXEMP- � ,��710N,PNyV10LATIONOF3ECT10 7031.58YANYAPPLICANTFOfiAPERMITSUBJEC?STHEAPPLICANTTO � RE-ROOf � � � � .� ACINLPENALTYOFNOTMORE ANfiNEHUNDREDDOLLAR5�8500}): � ,� ❑I,ASON7iEFOFTHEARD ERTY,ORMYEMPLOYEESWI"MWAGESASTHEIRSOLECOMPENSATION, G CommBPCial � � ' WILLDO TNE WQRK,AND THE S�RUCTURE IS NOT INTENDEp OR OPFEflED FOR SALE(SEC.7044,BUSI- J „� NE$SMO PROFESSIONS CODE•THE CONTRACTORS LlCENSE LAW�OES NOT APPLY TU AN OWNER OF � ��,� �„p,�� ' ��,+>,�� '� ,_, ;�' ..,� t ,',Q;;��E��"'a.. �PROPFRTVVhIO6VIL0.50RIMP�.OVES7HBRE0µANOWIiODOE55UCHWOFKHIMSELFORHERSELFOR l4 � �T f '�� 'THR�DIJGHHISORHEftOWNEMPrOVEES,PROVID�.THATSUCHIMPAOVEMENTSAPENOTINTENDEDOR m ,,,.�-�a;�.;� ,�ft � , ,,Q. ��,OFFEREDFpR3AI.EIF,ryOWEVEFf;,1F,lEBNtDINOORIMPROYEMENTESQLDWITHINONEYEAROFCOMPLE- �,^�„��'(�'�' —�Q , �� '�` � �R�� -;� ,��¢�^�. /� ��; ',�', ',y, TION,TFE OWNER�SUILOEfl WILC HAYE TWE BUFbEN OF PROViNG THAT HE OR SHE DID NOT BllILD OR ��`^ �' '.IMPROYEFORTHEPURP65EOFIS�ALE}. � ' , .�i��, - ��R ' C I.AS OWNEfl OF THE�PROPERYY.�AAA EMCLUSiVELY CANTRACTING 4YITH IPCENSED CONTRACTORS .�� TO CQNSTHUCf THE PROJECT(9EC.7o44,BLlSINE55 AP10 PROK'ESSIONS CODE:THE CONTRACTDRS LI- V8lU2ti0t1 � ADJ.AREA � � '..LL1 „CENSELAWDpFSNbTAPT�Y.T dND4Y�.l�EROFAPROPERTVWH08UILD5ORIA4PROVE5THERFON,AND , �' �, ;�1YVIOCONTR4CTSFORSUCHPR ECT$WITHACQNTRACTOR(S)LiCENSEDPURSUANPTOTHECONTRAP i3UANTBTY DESCRIPTION FEE � �. � � 'TORSLICENSEUW.j. � �j' '� ��o ❑IAM EXEMFT UNOER S�. 9.&P.G FOR i HIS REASON � �. . '�g,'�`E'�1.`;��"�� ' '�, ]y�l$��.,. .. � � � �� t 3,12� .�?�'�-_� ,� � .�DATE�.. I . OWNER � . . . . „ LtJ ��, �,�.Q �� . � LICEP{S�DCONTRACTORB DECLARATION W . . � . �, '�,2 , IHEREBYAFFIflMUNDGRPE(�Pll �F�PER7URYTHATiAMLlCENSEDUNOEHPAOVISIDNSOFCHRPTER � . ' � . � 4(CONNFENCING WITH SE..TI�7 6o0y OF OIVISIOM 30f THE BUSINESSA40 PROFESS{ONS CA�E,AN� Z � X MY LICENSE IS IN FULL FLf CE �EFFECT. uJ �1 � .o, , LlCENSECL45S �'�i9� LIC.MO. �`'� � � � .� �,. ' '�V DATE�_ a� • � CONTRACTOR r�-- � Llil . '��,; � �WO'� F15'COMPENSATION CECLARATION - a � � - . �� IHEHEBYAFFIRMUNDERPENAIJOFPEFi.IIJqYDNEOFTHEFDLIOWIIdOQECLARATIONS: Z Q ��. _lHAVEMIDWILLMAINT�kACERTIFICATE6FCANSENTTOSEIF�INSUREFORWORKERS' T COMPE9dSATN?N,AS PR VI05E'J BV SECYION 37na OF THE IABOR CODE,FOR T'riE PEFF6RMANCE � OFTNE WORK FQR FVHI M THIS PEFiMl7 iS ISSUED. � '' ��id.6 . .. .'� . .. � � �� _I HAVEAMD WILLMAINT PI WORKERS'COMPEMSAT�ON INSURANCE.AS REQUTAEO BY SECTION ��y�@'T I' 37o00FTHFLA'f3C7R� E,FDaYnEPEriFORNANCEOF7HEWOFKFORWHICHTHISPERMI7iS `� 765UED.MYWORKER'E' MPENSqTIONINSURAN ECARRIEFANDPOUCYNUMBERARE: CONSTRUCTION � cn�ieA � `�`�� PLAN REVIEW ' Z�'... aoucvwupnaEA��, �� ELECTRIC � � (T9�14S:ECf1aJldFIDNOT EPf.�.;9PI.ETEDOFlH'ePERf.YC4SFOAONEHUAqRE6IX#lARS($100)ORLESS). PLUMBING . 'C�1'�� ' . .. .. . . Z� � ICERT�F(THA7�INTNE ERFORMANCEOFYNEYJORKFORWHICHTHISPERMITISISSUED,I MECHANICAL �v__� �, �(�,�' SHALL NOT EMR�,bY AIJ PEft50N IN ANY�PAAIVNER 50 AS TO BECOME SUBJECT TO THE �--� _,_ .,� �_,.. ,..,e . �y�� WORKER$'COFAPENSATpNLAWSOFCAIIFORNIA,ANDAGREETHAYtFISHOULDBECOME INSPECTIONF � SU&IECPTQ THE WORK PS'COMPENSRTIOPI PFOVISIONSOF SECilON 3100�F THE LA@OR ' ! � � C0�6 15HALL'�i-0HTHW H COMRLY WIT4 H E PpFC�`` lJS. � ISSUANCE � k � ,�' h..a+° . . �V'\ {� � -"�% _. µ }p CATE:_._.s �f_^�_ PPLICANT. p✓=K SMIP � ��.� WARNING:FAILURE TO SECURE.�ORKEA5 COMPENSATION COVEflAGE IS LINLAWFUL,AND SHAiL 9E ENERt',,Y P/C E �y SU&IECTANEMFLOVEPoTOCRI�INALPENALTIESANDCIV�LFINESIJFTOONEHUNDNcDTHOUSPND ENERGYPERM'I��T' DOLLAflS(51 W.oW),IN?.�Di710 70 THE COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR IN --'� - ,�� SECTIDN370dOFYHELABORC OE,�,INTEREST,ANDAiTORNEI^SFEES. RETENTIONFEE: ^ �,a��, C�STRUCTION LENDING AGENCY RRE-ALT FEE: 4� IHEREBYAFFIflMUNDERPENA OFPERJURYTHATTHEREISACON3TRUCTIONLENDINGAGENCV ' FOflTHEPEflFOflMANCEDFTH WORKFORWY.ICHTN�SVED(3EC.30a�,CIV.C.), . �', '.�,� LEN�ER'S NAME .!--� LENDER'SAD�FE55_,__I� __ �`�� ICERTIFYTFiATINAVEREADTFiSAPALiCATIONANDSTATETHATTHEABOVEINFORMATIONISCARREG7. I OTAL FEEJ �y� �,��„ IAGREETOCAMPLYW}THALL TVANDCAUNTYORDWANCESANOSTATEL4WSRELATINGiDBVILDING � . � ,� CANSTRUCTION,ANDHEPEBY UTHORIZEREPRESENTATIVESOFTNISCOUNTYTOENTEflUPONTHE '. ' .a... ABOVE•MECVT�NEp PROPERN Ofl IIVSPE'CYION PURFOSES, COAftMEIVTS - � j , , � �_ m�, PEFMI E MF(PP�.� ' J� . . 6.. ��. . �,' �' ��r�� ' � �. .,��. .SIGNA',F -FPERMIYT i DATE ' � Z � � � � RECPT.NO. PAID BY VALIDATIQN ~ '�. WHITE—�spartment Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENR06—File Copy.GREEN—AppliranYs Copy ,, - . ,, ,.. „. ;, r. ,,,.� i ,:.., .. . � �� :' �:t� i��;� �m;A� �' �;�:.� 'm ' ' � �� a c t�..:rt�x;S°;�1•'""� �.. 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