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HomeMy WebLinkAbout14708 (19) ; - . .,.,. _ _. _ ����. L CITY OF DIAMOND BAA l(/����� / , _ -1'��---- DEPARTMENT OF COMMLTNITY&DEVELOPMENT SERVICES /� ` � 21660 E.Copley Drive Suite 190 �%L/ PRESS '%o+�'� BUII.DINGSPERMIT APPLICATION FIRMLY � JOBSITE ✓'�/ C�L� C��/�{�� � DATE CATION � � NUMBE� � #,C o ADDRESS Q(�E� L�J ���–�.� c� ISSUE f TYPE OCC APN LOT T _ DATE _CONST. GROUP p OWNER � � + ZONING SETBACKS Q ADDRESS � CITY_,Q Zlp EL FRONT RW ❑ APPLICANT � TEL. REAR ❑ SIDE/SIQE STREET RW ❑ � CONTRACTOR M /' -fq SIDE ❑ � ADDFiESS_ �+ ^ —�=���� r � ZIP EL. c PROPOSED USE CITY_� � o ARCH/ENG/ � DESIGNER_, NO.DWEL. NO. NO. ADDRESS UNITS_ STOHIES BEDROOMS � CITY ZIP TEL. � D�SCRIPTION SO.FT. FACTOR PSF ADJ.AREr1NALUATION � � OWNER-BUILDER DECLARATION SFR/ADDlREM p 1 HEREBY AFFlRM UNOER PENAl7Y OF PERri1RY THAT 1 AM GXEMPT FROM 1'HE CONTMC70RS LI- � Garage/Carport W CENSEIAWfOR7F1EFOLLOWINGRFASON(SEC.70.71.59USMESSAN�PROFESS�WJSCODE:AN�pTYOR G2 CpUNT'/WHIpiREOUIRESAPERMtT70WNSTPUCT,ALTER,iMPROVE,DEIAOIISH,ORREPAIRANYSTRUC� W P3I10/DBCk V� TURE,VRIOR TO ITS ISSUANCE,ALSO REOUIFES THE APPLICANI"FOR SUCH PERMIT TO FILE A SIGNED W � STATEMENT THAT HE OR SHE IS L�CENSED PURSUANT TO THE PHOVISIONS OF'HE COMRACTORS L6 � CENSE LAW lCHNPTER a(COMMENCiNO WITH SEGT�oN 7000)oF pIVI310N 3 OF THE BUSINESS AND Pqo- LL' PoOUSpa FESSIONSCODE)OfiTHATHEORSHEISE7fEMPTTHEREFROMAN0THE6A515FORTHEALLEGEOEXEMP- (,� 7pN.�WYYIOLA?iONOFSECT10N7o31.5BYANYAPPLICANTFORAPERMITSU&IECTS7HEAPPIICANTTO Z q�Root r ACIVIL VENALTY OF NOT MORE TNAN FNE HUNDRED OOIUIRS(3500�.): � �I,ASOWNEROFTHEPROPEF'fV,ORMVEMPLOYEESwIiHWAGE5A5THEIR50LECOMPENSATION, ❑ ComfllBfCidl WILL 00 THE WORK,AN�iHE STRUCTURE IS NOT INTENDED OR OFFERED FOA SALF(SEC.7o4a,BU51- J NESSAND PqOFES510N5 CODE:TiE CONrRACTtlPS LICENSE LAW DQES N6T APPLY TO AN OWNER OF � PROPEflTYNTiOBUq,OSORIMPROVESTHEREON,AN�WFiOCOE55UCHY/OftKHIMSELFOftHERSELFOA m � THRq1OHHi50RHERONRJEMVLOYEES,GROV10EDTHATSUCHIAIPROVEMENTSARENOTINTENDEDOR � OFFEREDFORSAI.E.IF,HOVYEVERTMEBUILDMOORIMPROVEMENiISSOL�YJITHINONEYEAROFCOMPLE- Z TpN,THE OWNER$111L�CR WILL HAVE THE BURDEN OF PROYING THAT HE oH SHE OID NOT BUIID OR _y IMPROVE FOR THE 5'UflPOSE OF SALEj. � ❑I,AS DNMER OF THE FflOPERTY.AM E%CLL'SIYELY COIdTRACTING WITH UCENSED CONTRACTORS WTO CONSTRUCT7FIE PRO.IECT(SEC.7014.6USINE55 AND PAOFESSIONS CAC'e:THE CqNTRACTORS LI� V2IUHIIOf1 ADJ.AREA CENSEIAWDOE5N0(APPLYTOANOWNEflOFAPHOPERTYWMCBUILDSURIMPPOVEST`1EREON,AND � WHOCONTRACT5FORSUCHPRWECTSWITHACANTRACTnR�S)LICENSEDPURSUAN?TOTHECCNTRAC- (ZUANTITY DESCRIPTION FEE � TORS U�ENSE LAW.). J 71 AM EXEMPTUIdDER SEC. 8.5 P.C.FOR THIS FEASON Q � _'_ � u'" DATE ___OWNER U � J � LICENSED CONTRACTQRS DECL4RATION W � I HEREBY AFFIRM UNDER PENALN OF PEFlJURY?HAT I AM i.ICENSED UNDER PROVISIONS OF CIiAPTER � � � � B(COMMENCINQ WITH SECTIDN 700D}OF OiViSION 3 OF THE B115lNESS ANO PPOFESSIONS COOE, � �� MV LICENSE IS IN FULI FORCE AN�EFFEGT. � � UCENSE CLASS q�r`���'� LIC.NO. � � � � � DATE�__�.—�-±sy=.�= GONTRACTUR _ _ W � WOFKERS'CpMPENSATION DECLARATION . � d � U � IHEFEBY�FKIRIIUNOERPENALTYOFP[RJURVONEOF'HEFOLL9WING�EGLARA710N5: z Q Oi __IHAVF_.WDVMLLMAMTAINACEHTIFICATEOFWNSENTTOSELF�INSURF.F�RWORKERS' S � COMPENSATION,ASPROVI�EDBYSECTION3'looPFTHEIADORC00[,FOqTHEPERFORMANCE C� Q QF THE WOR%FOR WHICH THIS PERMIT IS�SSUFD. W � V I HA`J£/WO WILL MAINTAlN WORKERS'COMAENSB.TION INSURANCE,AS NEOIJIRE�0Y S'.'CTIDN � d i 37b00FiHELABORW�E.FORTHFPERFORMANGEOFTHEWORKFORWHIC4THI5PERMITIS � 19S1/ED.MYW�ORKER�^uy'COMP.NSATION NSl1RANCEC/�R IEHANDPOLICYNUMBERARE: CO�ISTRUCTION ,..___ . � caaRiEa__t„�_LG� - PLAN REVIEW _—. y� z POUCYNUM9EF��e�- — � �= �--- ELECTRIC a./+�*Y1 � ¢ /�y � (iHSS'EC110NNF.mNOTBEa0A7FlF1FDOFTNEPEFANTISFORONEI�RN�OFlEQLL'ItAHS(S7o()ORLE55). PLUMBING �_ (,L� � ICERTIFYTHA7INTF+.EPERFORFAANCEOFiHEV:ORKFOflWH'�piTHISPFRMITISISSUED,� MECI-IANICAL (;j SHALL NOT EMPLOYANY PEflSON IN M1V MANNER SOAS TO BECAAlE SUBJECTTO THF. � � WOPo(ERS'COMPENSATI6N L4WS OF CALIFORNIA,AND PGREE TH0.T IF I SHOULD BECAME INSPECTION FEE SU&IECTTOTHEWORKERS'COMPENS OVISIONSOF5EC(ION37o0UF cLA90R � O ��I$sAIL_Q,�V7l N COMPLY`M 7Ho' floV15� NS. — ISS� � -- / 718B13 � DA _� Q���r APPLICANT. J ENERGY PiC _ WARNING FAILURET6 SECURE WOqKERS'COMPENSATIDN COVERAGF.IS UNLA\NFUL,AND SHAIL 9E � SU&IECTMIEMPLOYERTOCR!MiNALPENALTIESANDd`FlLFMESUPTOONEHUNDREOTHOUSAND ENERGYPERMIT DOII_ARS(51oa.Um�.IN ADDITION TO THE COS?Qf COMPEM1'SATION,DAMhGE5 PS PROYIDED FOR IN � SECTION 3708 OFTHE LABOR<.'ODE,INTEREST,ANO ATTORNEI^5 FEES. RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-AlT FEE: O � IHEPE6VAFFIPMUNOENPENALTYOFPERIURYTHATTHEREISACONSTHUCT!ONLENDINGAGENCV __! FOF THE PERFORIAANCE OF TNE WORK FOR WHICH THIS PLRM7T IS ISSUED(SEG 3oe7,CIV.G.�. Z _ W � IENDER'SNAME —_ —. _ h- LEN�EFTSADDRE55_____.�-- � �` WI GF.RTIFY THAT I HAVE READ THIS AVVUCATION AND STATE TMATTHE ABOVE INFORMATION IS CARRECT. TOTAL FE ES 0. 1 AGREE TO COMPLV WITM ALL GITY AND COUNTV ORD�NANCES AND STAT[LAWS RELATING TO BUILDING CONSTFUCTION,ANOHEHEBYAUTHOR2ERE?RESEN TIVESOFTHISCOUN�VTOENTEflUPONTHE �� � Z ABOVE�MENTIONEDPROPEFii'Y�OFlINSP TIONPVR OSES. 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