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HomeMy WebLinkAbout10248 . . . . �, ��' ---�- - -.. ------ . -- ".---�� � �yi�._ _....- .._ . . ,. . . . -��,.>-- _"""'+"'�,.:«.�.:;�.'°^. ':" • CTI'Y OF DIAM�ND BAR � COMMUNI'I'°i'DEVELOPM�NT DEPARTNfENT � .;,.� 2166U E.Copley Drive Suite 190 PRESS (909)660-3195 Fax(909)861-3]17 '""' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE /5,�/ , 'J�'��/�J �`���s APPLICATION i � �ERMIT Z /C o ADDRESS �/ �� DATE ! NUMBER ►k � ISSUE TYPE OCC APN L TRACT DATE _CONST. GROUP p OWNER , j ADDRE5 ZONING SETBACKS Z CIN Z�p L, . FRONT RW ❑ p �' REAR ❑ o APPLICAN TEl_. SI�E/SIDE STREET RW ❑ � CONTRACTO SIDE _ ' C ADDRESS � s, � / p ) PROPOSED USE � U. � ,�-,! o CITY ZIP TEL_. �—� wo ARC ����` iz DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY 21P TEI.. N DESCRIPTION SQ.FT FACTOR PSF ADJ.AREANALUATION Q OWNER-BI:ILDER DECLARATION SFR/A�D/NEM O 1 HEREBY AFFIRM UNDEfi PENALTY OF PERJURY THAY I AM EXEMPT FROM THE CONTRAC70RS LI- G8�8f�B/CBfPOR W CENSELAWFORhIEFOLLOVJINGREASON(SSC.7031.SBUSINESSAN�PqOFESSIONSCODE:ANVCITVOR (n U COUNTVWHIp7REOUIqESAPERMITTOCONSTRUCT,ALTER,IMPFOVE,DEAIOLISH,ORREPAIRANVSTRl1C- W patio/Deck Z TUHE,PRIOR TO ITS ISSUANCE,ALSO flC-0UIRES THE APPUCANT FOR SIICH PERMIT TO FILE A SIGNED W STATEMENT THAT HE OR SME IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll- � � CENSE LAW(CMpPTER 9(COMMENCING WITH SECTION 7o0D�OF DIYISION 3 OF THE BUSINESS AND PRO- �'�" POOVSP3 FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BRSIS FOR THE ALLEGED EXEMP- � 7ION.ANYVIOLATIONOFSECTION7037.SBYANVAPPLICANTFORAPERMITSUBJECTSh1EAPPlICANTTO Z Re-Root A CIVIL PENALTY OF NOT MORE TNAN FNE HUNDRED DOLLAPS(E5o0))� G 1,AS OWNER OFTHE PROPERTv,Oq MV EMPLOVEES WITH WAGES AS THEIR SOLE COMPENSATION, O � Commercial Z WILL DO THE WORK ANO 7HE STRUCTVRE IS NOT INTENDED OR OFFEiiED FOR SALE(SEC.70sa,BU51- J � NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOTAVPLY TO AN OWNER OF � PflOPERTY WHO BUILDS OP IMPROVES THEREON,AND WMO OOES SUCH NORK FIIMSELF OR HERSELF OR Q THROUGH HISOR HER OWN EMPLOYEES.PROVIDED THAT SUCH MPROVEAIENTSARE'NOT INTENDED OR m OOFFEREDFOfiSALE.IF,HOWEVER.THEBUILDINGORIMPROVEMENTISSOLCWITHINONEYEAROFCOMPLE• Z TION.THE OWNER�BUILOER WILL NAVE THE Bl1RDEN OF PROVING THAT HE OR SHE 01�NOT BUIID OR � IMPROVE FORTHE GURPOSE OF SALE). � 71,ASOWNEROFTHEPROPER7V,AME%CLUSIVELYCONTRACTINGWITNUCENSEDCONTRACTORS --- � TO CONSTRUCT THE PROJECT(SEC.7044,BUSINESS AND PROFESSIONS fADE:THE COMRACTORS LI- V8IUai1011 ADJ.AREA W CENSELAWDOESI�TAPPLVTOANOWNEflOFAPROPERTYWM09U1LDSORIMPROVE3THEREON.AND --- = WHOCANTRACTSFORSUCHVqOJECTSWRHACONTRAC70P(S)LICENSQIPURSUANTTOTHECONTflAC- QUANTITY GESCRIPTIQN FEE Y TORS LICENSE LAW.�. ¢ G IAM E%EMPTl1NDER SEC. 8 8 P.C.FORTHIS REASON 0 — �i '_ � DATE_ ___ OWNER_ Z � LICENSED CONTRACTORS DECLAFA7"ION w � I HEREBY AFFIRM UNOER PENALTY OF PERJJRY THAT I AM UCENSED UNDFR PROVISIONS OF CHAPTER � � � d 9(COMMENCING WITH SEC710N 7000)OF�IVI61ON 3 OF THE BUSINESS AND PROFESS!ONS CADE,AND Z ____ �X MY UCENSE 191N FULL FORCE AND EFFECT. m " Q l � � '____ � LICENSE�S ��LIC.NO.�.. � � J U DATE CONTRACTOR d W � WOflKERS'COMPENSATION DECLARATION a � I HEREBV AFFIRM 11NDER PENALTV OF PERJURY ONE OF THE FOLLOWI4G DECUIRATIONS: � � _1 HAVE AND WILL MAi!JTAIN A CERTIFICATE OF CONSENT TO SElFdtiSURE FOR WORKERS' Q CAMPENSATIDN,AS PROVIDED 9Y SECTION 37000F THE LABOR CODE.FOR THE PERFORMANCE (� flF THE WORK FOR WHICH THIS PERMIi IS ISSUED. 0 ��/ W ���I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCI_,AS REQUIRED BV SECTION Q 37000FTHE LABOfl CDOE.FORTNE PERFOflMANCE OFTHE WORi(FOR WHICHTHIS PERMIT IS � ISSUED.MYWORKE/pc��C.-O E N SU NCE ARpI P YNUMBERARE: CONSTRUCTION � CARRIER u PLAN REVIEW ZPOI.ICV NUMBER ' — ELECTRIC _ Q Q (IHSSECiKNJhEmNO70E07MRE7EDOF71iEPEP.WTISFOHONEHLI�7E0DOLt.ARS(5700)OfiLESS). � PLUMBING Z I CERTIFV iHAT IN THE PERFORIAANCE OF THF.WORK FOR WHICH 7HIS PERMIT IS ISSUED,I i MECHANICAL �t:w � �e (.'J SHALL NOT EMPLOY ANY PERSON Iti AYY MANNEfl SOAS TO BECOME SUBJECTTO THE � WORKEflS'COMPENSATIONLAWSOFGALJFOflNIA,AhDAGREETHATIFISHOULDBECOME � INSPECTIONFEE • e = SUBJECTTOTHEWORKEflS'COMPENSATIONP Vi IONSOFSEPT N37DOOFTHELA60F I �SSUANCE L� COOE,I h9�LF iM NCOMPLYWITHT P I � gy I�p � DATE:� ✓' • � APPLICANT: SMIP _�.d��__/�� ��,�� � WARNING:FAILURE TO SECURE WORKERS'COMPENSATION CAVERFGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �y SUBJECTANEMPLOVERTOCRIMINALPENALTIESAhOCIVILfINE5l1PT00NEHUNDRE�THOUSAND ENERGYPERMIT DOLLARS(5��.�),IN ADDITION TO THE COSTOf COMPENSATION,DAMAGES AS PROVI�E�J FOR iN � SECTION 3�OBOF THE LABOR CODE,INTERESL AND ATTORNEV'S FEES. RETENTION FEE: __ d CONSTRUCTION LENDING AGENCY PRE•ALT FEE: O � I HEREBV AFFIRM UNDER 7ENALTV OF PERJURY iHATTHERE IS ACONSTRUCTION LENDING AGENCY __ FORTHE PEFiFOFiMANCE OF TiE WOPK FOR WHICH THIS PEqMIT IS ISSUEO(SEC.3D6l,CIV.C.). Z W �Z LENDER'SNAME_ � F- LENDER'SFOORESS _ _ � TOTAL FEES //'�/ /jg ¢ 1 CEflTIFV THAT I HAVE READ THISAPPUCATIOk AtrD STATE'HAT THE ABO:�E INFORMATION IS CARRECL `n� J � w IAGflEETOCOMPLVWITMALLCI7YAN�WUNTYOR0INANCESFNDSTATElAWSRELATINGT08UIlAING �[:. ) � CONSTRUCTION,ANO HEREBY AUTHORIZE REPflESENTATIVES OF 7HI5 COUN7Y 70 ENTER UPON THE �_'�"' z ABOVE�MENTIONED PROPEHTI�FOR INSPEC710N PURPOSES. COMMENTS � J � aPERM E � 5 _ . � SIGNAT E F PERMITfEE ATE I = RECPT.NO. `� P��ID BY` VALIDATION ~ WHITE--0e artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File(:o GREEN— P PY. PY. PY. PY. 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