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HomeMy WebLinkAbout10373 CITY OF DIF�MOND BAR COMMUNITY DEVELOPMENT DEPARTMENT .;.w 21660 E.Copley Drive Suite l90 (909)860-31951�ax(909)861-3117 PRESS �"'"' BUILDINGP]�RMITA PLICATION FIRMLY o AD RESS �"�`� Sr ��'"� ` DATE CAt?�J'��� NUMBER �J' #,C � APN LOT 7R � i � �SSUE TYPE � OCC A� --r{Z �� � DATE CONST.. � � GROUP p OWNER . r/.N1/+/i�-� ( �•��x.,k--� p ADDRESS ZONING SETBACKS gCITY ZIP TEL. REART RW p APPLICANT TEL. SIDFJSIDE STREET RW ❑ � CONTRACT � _ SIDE ❑ ^r— � CIIY li' ZIP TEL. �''i' • �e, PROPOSED USE�T' C– � �57-' � � �ry�t! w ARCH/ENG! ` , ^� : T -- z DESIGNER �� ��f,� ^"� �"tt''✓ w NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TE:. � cn DESCRIPTION SQ.F1'. FACTOR PSF ADJ.AREANALUATION p� OWNER•BI:ILDER OECLARATION � SFRIADD/REM p I HEREBY AFFlRM UNDER PENALT'OF PERJUflY TMpT I AM E%EMP"FROM 7HE CONTRACTORS LI• G81890/C81POfI W CENSEUWFORTHEFOLLOWINGREASON�SEC.703t.58U51NE5SANDPR�FESSIONSCODE:ANYCITYOH (n U COUNTYWHICHREWIRESAPERMITTOCONSTRUCT,ALTER.IMVROVE,DEIAOLISH,ORREPAIRANYSTql1C. W w TURE,PRIOR TO ITS ISS�ANCE,ALSD REC111RES THE AVPLICANT FOR S'JCN PERMIT TO FILE A SIGNEO W P8S10/DBCk STATEMEM THAT HE OR SHE iS LICENSEO PURSUANT TO THE PROVISIbNS OF THE CONTRACTORS U� � CENSE UW(CHAPTEH B(COMMENCING WITH SECTION 700�)OF DIVISION 3 OF THE BUSINE55 AND PRO• LL POOUSPa 0 FESSIONSCADE)ORiMATHEORSHEISE%EMPTTNEREFROMAND7HEBi45iSFOR7HEALLEGEDEXEMP- (� ` V TION.ANYVIOLATIONOFSECTION7031.SBVANYAPPLICANTFORAPERMffSU&lECTSTHEAPPUGWTTO Z Re-Roof � ^�} A CIVIL PENIIL7Y OF NOT MORE 7HAN FIVE HUNDRED DOLlARS(550061� 0 OI,ASOWNEROFTHEPROGERTY,ORMYEAIPLOYEESWITHWpGE5l.5TNEIRSOLECOMPENSATION, O COmRIBfGl81 Z VYlll 00 THE WORN,AND THE STRUCTURE IS NOT IN7ENOE�OR OFFER�=O FOR SALE(SEC.7oaa,BUSI- J � NESS AND PROFESSIONS CODE:iHE CONTRACTONS LICENSE LAW OOE�NOT APPLV TO AN OWNER OF j PROPEFYfV WHO BUILDS OR IMPROVESTHEREON,AND WHOOOES SUCH WORKHIMSELF OP HERSELFOH � THqOl16H Ht9 OR HER OWN EMPIOYEES,PROVIDED THAT SUCH IMPROVE MENTS ARE NOT INTENDED OF m 0 OFFEREDFORSN.E.IFHOWEVER7NEBUILDINGORIMPROVEMENTISSOL[IWITHINONEYEAROFCOMPLE- Z TqN,THE OWNER-BUILDER WILL F/AVE Tl1E 9Ufi0EN OF PROVING THAT HE OR SHE DID NOT BUI��OR IMPROVE FOR THE PURPOSE OF SALE). _ ❑I.ASOWNEROFTNEPROPERTV.AMEXCLUSIVELYCONTRACTING141THLICENSEDCONTRACTORS ,�.. � 70 CONSTRUCT THE PHOJEC7(SEC.70d�,BUSINE55 AND PROFESSIONS CADE:7HE CONiRAC70RS LI- V81U2liOn � F� i�-�s� ADJ.AREA W CENSE LAW DOES NOTAPPLV TOAN OWNER OFA PROPERTY WHO BUILOS OR IMPROVES THEREON,AND � NMOCONTflACTSFORSUCHVRQ1ECi5WITHACONTRACTOR(S)UCENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE � TORSLICENSELAW). � �I PM E)(EMP7 UNDER SEC. _B.6 V.Q FOR THIS HEASON Q � U LL � DATE OWNER U Z W � LICENSED CONTqACTORS DECLARP;fION W � I HEREBV AFFIRM UNDER PENALTY OF PEHJURY THAT I AM LICENSED UNDER PflOVI510NS OF CHAPTER � � B(COMMENCING WITH SECTION 7000)OF DIVISION 90FTHE BUSINESS ANO PROFESSIONS COOE.AND Z w MV LICENSE IS IN FULL�Fg7 RCE AND EFFECT. --���_^ �-�/ , CQ � LICENSE CLASS �-/ � LIC.NO. � :1 d r j U �ATE CONTRACTOR d W q � WORKERS'COMPENSATION DECLARATION �/.�.,71i �I� � � I HEREBJ(AFFIRM UNOER PENALTY OF PERJURY ONE OF THE WLLOWING OECLARATI�5: {� 6 Z z �I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR YJORKERS' a _ _ ¢ COMPENSATION,AS PROVIDED BY SEC110N 37000F THE LABOfl CODE,FOR THE PERFORMANCE W Q OF THE WORK FOR WHICM THIS PERMIT IS ISSUED. � QW _I HAVE AND WILI MAIMAIN WORKERS'CAMPENSATION INSUqANCG,AS RE�UIRED BY SECTION 37000FTHELABORCODE,FORTHEPERFORMANCEOFTHEWOR'(FORWHICHTHISPERMITI$ �} J ISSUED.MY WORNERS'COMPENSATION I�SURANCE CARRIER ANC'P LICY NUMBERAHE: CONSTRUCTION l%�� j CARRIER�'j��-�� ��I�S�Y:� PLAN REVIEW � POLICY NUMBER ���a��� �` � ELECTRIC a � (fHIS5ECT10NNE�NOTBEWMRETE�OFTYEPERMffISFORONEHUIJ�REDD011A45(yt00�ORLES$), PLUMBING Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL (� SHALLNOiEMPLOYANYPERSONINANYMANNEHSOA5708ECCMESU&IECTTOTHE � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETN,\T�FI,,,pppHOULDBECAME INSPECTIONFEE � ,/ A � SU&IECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SEC Oyyyppp 7o00F E IABOP F}� P �� O cooe,i s�TH coMr�v wir aao ioris.�//�� ISSUANCE �. �� ¢.�+ -� ` � f 1 ^�e p �ATE: � , APPLICANT: SMIP P �� J WARNING:FAILURE TO SECURE M/ORKERS'GOMPENSATION COVERRG 5 UNLAWFUL,AND SMALL BE ENERGY P/C LL SU&IECT AN EMPIOYER TO CRIMINA�PENALTIES ANO CIVILFINES UP CNE HUN�REO THOUSAN� �J DOLLARS(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMA�3E5 AS PROVIDED FOR IN ENERGY PERMIT .s . 0 J SECTION370BOFTHELABORCO�E,IMEREST,ANDATTORNEV'SFEES. p� RETENTION FEE: _ OCONSTRUCTION LENDING AGENC'/ PRE•ALT FEE: � 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THATTHERE IS ACONSTR�JCTION LENOING AGENCY FOR TXE PERFORMANCE OF THE WORK FOR W HICH TNIS PERMIT IS ISSUEO�SEC.3097,CIV.C.). Z W � LENUER'S NAME — H LENDER'SADDRESS � ICERTIGVTHATIHAVEREADTHISAPPLICATqNlWDSTATETHATTHEABOVEINFORMATIONISCORRECT, TOTAL FEES � �'( W IAQREETOCOMPLYWIhiALLCITVANDCOUNTYORDINANCE3ANDSTATELAWSREUTINGTOBUILDING � CONSTRUCTION,ANDHEREBYAUTHOR2EREPflESENTATIVE50FTHI5CO�JNTYTOENTEHUPONTHE ZENTIONEO PROPERTY FO N E�N�POSE��� COMMENTS O � QL�NMA RIM) -p � fn " 9 ��~� l. ��� � � St NA REOFPEfl i DATE — � RECPT.NO. � PAID BY • � VALIDATI•N � WHITE—Department Capy.'fELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy . .. . .. .. �.�.:�.tu,.....�. :ti,,�.:�,�.. ... •ny' . .. � . �.V6".� . N i�. -v�a W i .1..` Q F � yh:5'4 �3 .y..,`��::�'s'1:ii=:lM.�} •Py, J:t^{.,.: �v�'�„>.�;, t , . . ..,-.... ...._.... � w, ��.. . . . . ,. 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