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HomeMy WebLinkAbout16345 �;,����.. � CITY OF DIAMOND BAI� ,�''�`�`''��� ---��'' DEPARTMENT OF COMMUNITY&DEVELOPIVIBNT SERVICES ' � 21660 E.Copley Drive Suite 190 �- -"'-� ' (9U9)860-3195F�(909)861-3117 � a�,.� PRESS �.�. ` BUII:DING PERNIIT APPLICATION __ , „ ' FIRMLY „rd pJOBSITE . � �. � ' DAPEICATION "`� `� � NUMBER�� � #/Cl�*° �...Y� .�°�;� � ADDRESS � ISSUE � ` TYPE OCC , � APN LOT�_ TRACT DATE � CONST. GROUP p OWNEF �.. W ADDRESS ZONING SETBACKS Z CITY I ZiP Ye TEL ` � REART RW ❑ g APFLIC NT TEL. SIDE/SIQE STREET RW ❑ � � CONTRACTO'R '� ' ^�: SIDE ❑ � ADDRESS �,V^Y5`�`M-fi�-".., �� � � � CITY��r�, I � ZIP�i'�Y c�TEL._r��S"^�� PROPOSED USE � w ARCHlENG/ /v WDESIGNER ' <<- NO.DWEL. NO. NO. = CDDR SS " Z'P UNITS STORIES BEDROOMS y �.� "a T L.lr,`��iol y I DESCRIPTIOiV SQ.FT. FACTOR PSF ADJ.AREAMALIJATION' � QWNER-6�ItDER bECLARAT SFR/ADD/REM O ',.8'� I HERE6V AFFIRIr/UN�ER P, NAI7Y OF PEflJ,URY THAT I AM E%EMPT FROM THE CANTRACTORS LI- G8f29E/C8f(10!I �CENSELdWWRTHEFOLLOWiN �REASON�SECr7037.59U51NE5SANDPROFESSIONSCODE:ANYCIT/OR (n _ �. U '�.'�COUPRYYh91CHREQUIflESAPEfl IT�TOCANSTRUCT;'ALTER,IMPROVE,�EMOLISH.ORASPAIRANYSTRUC- W P8ti0/D9Gk ''�. TURE.?ij14H TO ITS ISSiIANCE, 'R�(RJIRES 7HE APPLICANT fOR SUCH PERMIT 70 FILE A SIGNED � STAYE1:19JT hMT HE OR SHE IS LIC6NSE0 PURSCJANT TO FWE'FROYISIONS OPTHE CON7RACTORS LI- :�� CENSELAW(CHAPTEF9�COMMENCiNGWITH5ECT10N100D)OF�IVISION30FTNEBUSINESSANDPfiO- ' � PooUSpa�- FESSICNS CODE)OR THAT FSE OR SkIE j5 EXEMPYTHEFlEFRQM AND THE BA515 FOR THE ALLEGE�E%EMP- TION.RNNVIOI.ATIONO�$ECTI 7tl31,6BYANYAPPLICANTFORAPERMIiSUBJECTSTHEAPPLICANTTO Z Re-Roof � �,ACIVILPENALTVOFMOTMORET AN.FIVEHUNDR£QDOLUFS(SSW).): ����� ', ❑I,ASOWNEROfTHBPRO ERT;OFlMYEMpLOYEE5WITHWAGESkSTHEIRSOL6COMpENSATION, ❑ ComrlO�Cifll . � � I WILL DO THE 41'ORK,AND TH6 S RUCTURE IS NO7INTEN�ED OR OFFEREO FOR SALE(SEC.7o4a,8U51- J ',�' �,NESS PND PP.OFESSIONS CObE:'HE CONTPAGT6RS LICENSE LAW DOES NOT APPLY YO AN OWNER OF � � �"PflOPERTY`NHO�UIlDSORIMP VE9THEREON;ANDNlHO�OESSUCHWORKHIMSEIFORHERSELFOR Q'� �'THROUCiHHISORHEROWIVEMP OYEES,PR9YdOEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m � �,Q� ��,OFFERE�PJRSAL6IF,HOWEYE IHE'BdRLpINGORI�P90NEMEN7iSSOLDWIPHINONEVFAROFCOMPLE � , � �.TION,THE OW67EFl�BUlIDER WI HAVE THE dURDBN OF PROVING THAT HE Ofl SHE�ID hOT BUIID OR , �;.�,._,� ;'�IMPROVEFORTHEPtlRPOSEOF ACEI.. . �. � .❑�,AStlWNEROFTHEQPO�EF�TN,AMEXCLUSiVE'_YCAh7RACTMGWITkLICENSEDCONTRACTORS [G.� 'i TO O�MSTRUCT THE PRGIECT(S�EG.704M1,BUSIRJESS AND PROFESSION5 CODE:THE CONYRACTORS LI- �/y��yt1011 � � ADJ.AREA �� � W�, i CENSEUIWDOESNOTRPPLY?O�ANOi^/NEROFAAROPERTYVdHoBWL�SOfliMPROVESTHQiEON,PND ��'�.I ����WFiOCONTRACTSFOliSUCHPR ECTSWITHA�COPLTRACTOP(5)LICENSEDPUflSUANTTOiHECO1JTRAG .C]UANTITY D�GCRIPTICN.� - - � FEE � ~' ���70RSLICENSEIAW.). - ✓� `� - � � o' .� ❑1 AM�XEMP7l1NDER SE .. . . 8.&P.G FOR YWS REASDN Q � ;I �����."." � N �� �. ��"'�, ,� .. .. '. V � . � � —T— � ' DATE � �. � 6WWEH� . U �'� LIC�'vSED CONTRRC70R5 DECLARATION W IHEREHYApFIRMLINOFRPENALI OFPERJUFYTHATlRMLICENSH)UN�Efi?P.OVISIOMSOFCHAPTER � � �� ,d� �f�t �; 4(COMMENCiNG WITH SECT{ON qOb)OF DIVISION 3 OF 7FiE BUSIN'cSS AND PROFESSIONS CODE,AN� Z � a � O '� MY LICENSE IS IN FULL FORCE A D EFFECT. � � � � �. �� � �"� 9 � g,, � � LICENSE$Ct�A,y$i5 � LiC.NO._ J _ � � � . „FB `��.. ���� DATE�J,J�� ��CS COPJ?RACTOR .3�.. � ❑- 6� W. . t � � �', � lA���13fkRS'COIAPENSAT9Uh1DECL.AFATIC7Al� . . �¢ �. . � . ° ' � , � 1 HER�YAFfIRM UNDER PENALI OF PERJURY ONE OF THE FOLLOWING OECLARATIDNS: 2 � � �IHAVEANDWILLM6,INiANACEFiTIFICATEQFCOWSEN'TbSELF-YNSUREFORWORKEAS' , �¢y . 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W. � LENDER'SNAME__,_._ _ � - � . _r. f�- LENDER'SA��RESS I �I � �, � I CEHTIFYTHAT I HAVE REA�THI APPLICATIDN At�STATE THATTHE ABOVE WFORMATIdN IS CORRECI TO�AL FEES �"�M' � � �e ��y' IAGREETOCOMPLYW7T49ALLCryANOCAUNTVORDINANCESANDSTATELAWSAELAT;NGTOBNL0ING �� B � '�� CONSTRUCTtON,AP3DHERE9V THOflIZEREPRESENTATIVESOFTFiISCDUNTYTOENTERUPONTHE ' , , �� A80VE-MENTIONEDPROPERTY ORINSPECTION�uAPosEs. 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