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HomeMy WebLinkAbout13861 - _.._____._._.--�-.. .. .. .. _ . ____�\_ CITY OF DIAMOND BAA �� DEPARTMEI�T OF COMMUNITY&DEVELOPMEPiT SERVICES 21660 E.Copley IIrive 5uite 190 (909)86Q3195 Fax(909)861-311 i PRESS '�q�� BUILDING PERMTI'APPLICATION FIRMLY QJOBSITE 6� O ,�7Ow DATE CATION�' °'p1�����— NUMB R�� #/C < ADDRESS�_ €� c� ISSUE TYPE OCC -- APN LOT � TRACT DATE _CONST. GROUP p OWNER Z. c l�+ J' C hGi C D o ADDRESS�y /' J ZONING SETBACKS "' CITY. n"�e�� IP��.� T'�L.�(j(��Z FRONT RW �7 �j APP�I�ANT TEL. REAR _ ,J SIDFJSIQ�STREET' RW ❑ � CONTRACTO � E ' c SIDE ❑ � ADDRESS p PROPOSED USE__ CITY L o q Z!?�Q�TEL.���Q� ..�7 w ARCH/ENG! � �— �z DESIGNER NO.DWEL. PIC. NO. a ADDRESS__ UNITS £tTORIES BEDROOMS � CITY ZIP TEL. � �ESCRIPTSON SQ.FT. FACTOR PSF ADJ.AREANALUATION OOWNER-BUlLDER DECLAfiATEON SFR/ADD/REN! p 1 HEREeY AFFIRhI 11NOEF PENALN OF pEAtURY THAT I AM E%EMP?FROM?H'c CANTAACTOf15 LI� � Garage/Carport LL] CENSEUWFORiHEFOLLOWINGRE'ASON(SEG7037.SBUS:NESSANOPROFESSIONSCOUE:ANYCITY00. COUNTYWHICHRECUIRESAPERMRTOCONSTRUCT.ALTER,IMAROVE.DF.MOLISH.ORNEPAIRANVSTRUG W PBIIO/OBCK � 7UHE,PRIOR TO ITS iSSUMlCE.ALSO RE�JIRES THE APPLICANT FOR SUCH PERM�T TO FILE A SIGNED W _ � STATEMENT THRT HE OFi SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI• I � CENSE IAYJ�CHRPTER e�COMMENCINO X1TFI SECTION 7000)OF�IVISION 3 OF TFIE BUSINE55 AND PRO� �` PooVSpa FESSIONSCOOEIORTHATHEORSHEISEJ(EMPT7HEREFROMANDTF{EBASISFORTHEALLEGEDEXEMP� � V TION.ANYVIOLATIONOFSECTION7o81.5BYANYAPPLICANTFORAGERMITSUBJECTSTHF_APPLICA�RTO z�RO-ROOf F A CML PENALT'OF NOT MORE THAN FIVE HUNORED�OLLARS(5500).}. Q CI,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEFSWITHWAGESASTNEIASOLECAMPENSATION, COITIrtIBfCidl �. WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALF.(SEC.70Aa,6USI- �l F .— � NESS AND PROFESSIONS COOE:THE CONTRACTORS LICENSE lAW�OES NOi APPL"TO AN OWNER OF � PROPERTYVYFpBUILOSORIMPROVES7HEReON,ANOlVHODOE55UCMWOflKNIMScLFORHERSELFOF �� ___ _ CC THROUGHHISORNEROYJFIEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTS0.AENOTIfvTENOEDOR QOFFEREDPoRS/LEIF,HOWEVE0.THEBUILDINGOqIMPROVEMEN71S50LONITHINONEYEAROrCOMPLE Z iION,THE OWNER�BUILOEN WILL HAVE 7HE&JRDEN OF PROVINC,TIiAT HE OR SHE bID�OT BUILD OR = IMPROVEFORiHEPURPCSEOFSALE�. ' ❑I,AS OWtdER C�THE PqCPERYV.AM E%CLUS:VE.V CA+�TRAC?ING INITN LICFNSED CAN'RACTORS � TO CONS7RUCT'fF':P9W ECT(SEC.loa,eU51NESS Ak0 PROFESS�ONS f:ODE.TNE CCN7RACTCRS LI- � �/e1J0tIW� ADJ.ANEA_ � CENSELA�YOO�NOTMPLYTOANOWNEROFAPP.OPERTVWHOBUILDSOqIMPROYESTFiFREON,AND � .----�---- 1M1000NTRRCTSFORSUCHPHCJECTSWIi}IAGONfRAC70R�5)LICENS'cD^l}iSUANTTOTMECON'RAG QUANTITY_I DESCRIPTIO�9 FEE Y TORSLICENS�LAW.). — � __ _1 .._ � J I O ❑IAA1E%EMPI'UNDERSEC. _____ 3-Bp.C�ORTMISREASDN U _�____ S _- ___--__ —_ fL � � DA7E �WM'cR.._.__ _'_'_-"_'_._' - Z -- -.� C.' -�— pw'— -- --- � LIGENSED CONTRACTGP.S UECLARAI'ION W � IHEHEBVAFFIHIAUNDER7ENALTYOFPERIUNI'TNATIA�if_!CEkSe�JNDFAPROVISIONSOFCNAVT[R � d 6(COMMENCM7G V:1?H SECTIOtd 7CnJ)OF DIVISION e OF'NF.[iUS!NESS h�D�ROFE5510NS CC�F.,AND Z , ____ X MY UCENSE 13 IN FIA.0 f-0HCE AND EF:ECT. /�� � `Q LICENSEC�LyASS��O___ LIC.NO._�(/�_�Y�D � —'—' --- � � DATE�,.j{�Z��_ _ COMRACTOR�_���� '-L ' -- -- � VdOHKERS'CG`M?ENShTIUN DECLAaATICN �_ / — 41C �J_. G l .�v�'V,l N G-L— L�. � 1 HEREBY AFFiR1.7 UTCF.A VEN�`SY OF PERJUH�OP:G OF THE FOLLONIING DECLARATIQNS: � L -_ � M 0 �� �'�� Q W � i HAVE M1D WILL MM�;TAIF!R CERTIFlCATc OF CCNSEYT TO 5E1.F-I!JSl'rlE FOR YlORKL:F:S' � _ � COfAPENF.4i�ON.ASPROVc�EDeYSECT,0�3�0DOFTMELPBOFlCOCE,FOFlTHEPERFORMA^iCE � Ci ___ ___--- OF THE'F/OFK i�OR WHICH THIS PEP.MIT IS ISSUED. �I W 1 ' '_ � _I HAYEAND WILLldAIM',S�Pi WORKERS'CAMPF.NSATION INS:JAANCE AS REOUI9EC PYS£CTION � @' 3TOOOFTMElf9CRC'JDE.FURTHEVERFJRMFNCEOFTF:[WGPICKORW�i1C4TH:5PEP.M;T15 i � i5SUED.M;'YiOPX RS'COMPENSATYJNINSUflANCEChR iE�F6.TiCPO!ICY':�hidEqARF.: ; � i CGNSTRUCTIO� ______.____ ____________ � CAPHIcii_ /I Q/��.v'___'_'-____--_-- � I PLANREVIEW ------- --- --- � POI.iCYNUMBER_�e��7�0-_-_-'—'______ � I ELECTRIC __."'_____'__--__'._"_.—___ _-_ � (fHSSi�Ia'NREL•N'.)TBECC+APLEhZOFTn=vF�d.iffiSFOFiCN�:EV,u`AR2l:7CtiiYiS�S"�0!OqL�S). PLUP�BING '�"' L —_--�,1�__—____—',-�� , Z ICFA�IFYTHATINTHEPEFFORMANCEOFTHESYOP.KFOF.WHICH7H!SPEP.IdITI5155UED,l MECHANICAL ____..._____,__._ T��f �} SY.P11 NOT EMFLCY,'',4y pFRSCh IN ANY MNJtif.N SJ F.S'TO 9ECOME SUBJF_CTTO THE � � WORN5R5'COMPFNSATIOt�LAW50FCALIFORN'l4,PNDAGREF.THATIF�SHOULDflECAME INSPEGTIONFEE ___ 3U&IECT TO T;=E YlORKERS'COF1PEkS�TVCY F4iGVISIQ!1S OF SECTION 37Jn Or TNE L1BOR I ^ - � CODE,ISHAILFCRTHWI?HGOMPLYW�THi}10:rc?RGVIilONS. IJSUANCE __ }-���,�- °� _ _ u� .-a ��� � a��—�^e��'sG�G�-�V -- ! I SM{P ---�-�- �sL3`a � �[�'L�. J DRTE:���9/�� APPIICANL '" " .— � Y. r'j_�,`s�^"y�_�ld--�-�.��__- � ENERGY R/C �'y�,�y��'s" .. 'a=< _ J WAflNING FALURE TO S'cCURE WORKERS'COM,PENSATION COYEflAGE IS UNUIYFU;,AND SHAIL�G �:-t�.?'�-s'-- � SU&IECTFNEMPLOYER?OCFiIMINALPENALTIESANDGIVILFINESU?TOONEHUNDfiEDTHOUSAND I � ENFRGYPERMIT �,?�Sr..,T� r. � .. OOLLAHS(51CA.000).IN PD'JITION TO THE GOSTOF COMPENSqT:OY,DAMAGES AS PROYI�E�FOR IN I ��- J SECTION 3)OB OFhIE LABOR CODE.INTEREST,AND ATTOHNEY'S FEES. � RETENTION�EE: � -_ d COidSTRUCTION LENDING AGENCY PRE-ALT FEE: ____ _____ O Q IHEREBYAFFIflMUNDERPENALI'YDFPEPJURVTHAT7HEFlF_ISACONS7RUCTIONL[NDINGAGENCY � FOR THE PERFGRMANCE OF"HE WORN FOR SNHIL'H 7HI5 PERMI715ISSUED(SEG 3c97,CIV.C.), �-- ----� — Z lL! _— --' � LENDER'S NAME ___.___._--'---__""___— _ __ _ .. � F_ LENDEH'SADOAE55_____ .__ ..__— � 1 CERTIFv'iiAT I HAVE READ THIS APPLICATION AND STATE THAT THEABOVE INFORMA'!ON IS CARHECT. TOTt1�F LC� �.� �•���/ � IAGREETOCOMPLYWITHALLCIiYANOCOUNTVOFi�INANCESANDSTATELAWSRELATINGTOBUILDING � CANS7RU�104,Fh0 H[REBV AUTHORI2E FE?RESEN iATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE�MENTh7NED PROPERN FOR INSPECTION PU9POSES. 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