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HomeMy WebLinkAbout16156 �•�"�U CITY OF DIAMOND BAA 34�� ---�'�'–� DEPARTMENT OF COMMUMTY&DEVELOPMENT SERVICES `�� 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)8bi-3117 PRESS ��"9�'�� BUILDING PERMIT APPLICATION FIR Y y �/ � �^ � , 1 " APPLICATION ,� � � PERMIT f,� P/C JOBSITE a� ADDRESS � k� � �i 1r7'l,!' �'C DATE � NUMBER �Y� # � ISSUE TYPE OCC r- APN_ LOT TRACT DATE CpNST. GROUP 0 owNeR ���i�.E?.C��-n�ti` iv�.��;�:�e�.<�p,�..,. o ADDRESS 6°' il,i " ZONING SETBACKS z CITY��c3,1,-� ZIP�� (c TELG3C,:���'t 7/�"�(�j FRONT Ryy ❑ g APPLICANT TEL. REAR ❑ � SIDE/SIQE STREET RW_ ❑ � CONTRACTOR Lt'Yi��,titil�. `I:����7,'y� ' SIDE ❑ � ADDRESS �'+ i. G .` ' c.:. . � CITY-i�j���,;Gi���7 ZIP' TEI�1��7'j " ��;7,1j'. PROPOSED USE p ARCWENG/ z DESIGNER w NO.DWEL. NO. NO. n. ADDRESS = CITY ZIP__ TEI. UNITS STORIES BEDROOMS � cn DESCRiPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFWADD'REM O p I HEREBY AFFIRM UNDER PENALN OF PERJURV THAT I AM E%EMPT FROM THE CANTRACTORS LI- Gafage/CefpOit W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.S8USMESSANOPROFESSIONSCODE:ANVCITVOR (n C.� COUNTYWHICHREOUIRESAPERMITTOCONSTRUC7,ALTER,IA�PROVE,DEMOUSH,ORREPAIRANYSTRUC- W Patio/Deck W TUqE,PRIOR TO ITS IS6UANCE,QSO REQUIftES THE APPLICANT FOR SUCH PERMIT TO FlLE A SIGNEO W � 9TATEMENT THAT HE OR SHE 18 LICENSED PURSUANT TO iHE PROVISIONS OF THE CONTRACTORS LI- � C CENSE L4W(CHAPTEP 9(COMMENCINO WITH SECTION 7000j OF DIVISION 30F THE BUSINESS AN�PRO- POOVSpd f FESSqNSCOOEIORTMATHEORSHEISEXEMPTTHEflEFROMAND'fHEBAS15FORTHEALLEGEDE%EMP- (� V TION.ANYVIOLATIONOFSEC71ON7031.60VANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof F ACML PENALTV OF NOT MORE THAN FIVE HUN�REO DOLLARS�5500).): � ❑I.ASOVMEROFTHEPROPERTY,ORMYFMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION. C� CommerCiel - WILL DD THE WORK,AN�THE STRUCTURE IS NOT INTENDEO OR OFFERE�FOR SALE(SEC.704�.BUSI- J � NESS AND P�FESSIONS COOE:THE COMRACTORS LICENSE LAW OOES NOT APPLY TO AN OWN6R OF � PqOPERTY VlNO BUILDSOR IMPHOVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSEIFOq � THHOUGFI HIS OR HEROWN EMPLOYEES,GROVIOED THAT SUCH IMPHOVEM[NTCARE NOT�NTENDE�OR m � OFFEREDFORSALEIF,HOWEVERIHEWILOIN60iiMPROVEMENT18SOlDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDFN OF PROVING THqT HE OR SHE 010 P10T BUIID OH = IMPROVE FOR THE PURP05E PF SALE�. W ❑I.�ISOWNEROFTHEPROPEHTY,AME%CLUSIVELYCONTRACTINGWITHLICENSEOCOMRACiORS [C 70 CONSTRUCT THE PRp1ECT(SEC.70�4,BUSINESS AND PROFESSIONS CODE:THE COP7TpACTORS U� ValUatiOn ADJ.AREA_ LLI CENSE LAW�OES NOTAQPLY TO AN OWNER OFAPROVERN WMO BUILDS OFl IMPflOYES THEREON,AND � Vh1000NTMCISFORSUCHPR(EIECTSWITH.4CQN7RACTCR(S�LICENSEDPURSUANTTOTHECON7FAG QUANTITY DESCRIPTION FEE � TORSUCENSEUW.J. __ �I AM EXEMPT UNpEfi SEC. B.d P.G FOR THIS REAS4N Q T! v _ i.1 W � DATE_ __ OWNER_ __ � � W � LICENSEO CONTRACTOFS C7ECLARATIpN W � IHENEBYAFFIRAIUNOFRVENALTYOFPERJURYTNATIAMLICENSEOUNDERPROV�SIONSOFCHAPTER � i�COMMENCINQ WITH SECTICN 7000)OF DIVISION 30F THE�USINESS AND PROFESSIONS COpF.,�ND z C 1 �:- �U, ��� MY IICENSE IS IN FULI FORCEAN�EfFECL � � LICENSE CLASS�,���_ L{C.NO. � !`� � � ]�.�".�^; -i J V DATE�_!.'ity��..,J_____— CON7RACTOR__�;����c�� � n- W �� � WORKEFS'COMPENSATiON DECLARATION ¢ � 1 HEHEBYAFFIRM UNDER pENALTY Of PERJURY ONE OF THE FOLIOWiNO DECLARATIONS: Z C1 INAVEANDWILIMAMTAINACERTIFlCATEOFCbNSEN7TOSELF-INSUREFORWORKERS' _ '— — � �COMPENSA710N,AS PROYI4FJ 8Y SECTION 3700 OF TME LABOR CCDE..FOR THE PEPFORMTNCE �U Qf THE WORK FPR WH!CH THIS PF.RMIT IS ISSUEO. � � � I HAVE�ND W1L MAIMAIN WORKERS'COM?ENSATION MSURANCE,AS PEOUIRED BV SECT'ON Q� 37o00F7HELA430Rt7JDE,F4RTHEPFRFORMANCEOFTH[WORKFORWHICHTHISPERMI7IS ISSUED.MY WUNKERS'COI.It�E11SA7lON INSU,RA��N,CE�CARRIER ANO POLICV NUMBEp ARE: CONSTRUCTION � CARRIEH_� �� �1�% _ PLAN REVIEW Z ao�icv uuMs�a_{i�Lry � EL..CTRIC ;�T.� ' -�i'-�'t'+ c Q 0 fni�sSEcrx�rv�.eFnrroreeQ���EoaFn�aEas�7urcaonEr,urcnmoa.w�s�a,w�oaiEss�. PLUMBING W i CERTIFV THAT INTHE PENFORMANCE OFTHE WORK FOR WHICH THIS PEflMITiSISSUED,1 MECHANIGAL Z -- � SHALL NO7 EMPLOV ANY PERSON IN ANY MANNER SO AS TO 8ECAME SUBJ�CTTO THE � WCAN&PS'C:tkAPENSAT�pNUWSUGCALIFORN�0.,ANDAGREETHATIFISHOULABECOME INSPECTIONFEE � SUBJECT TO THE WORKERS'COMAENSATION PROVISIONS OF SECTICN 370o OF TNE tABOR j� = C'.ODE,ISHALL.FORTHWITHCQMPIYWITHTHOSF_P30VIiIQYS. ISSUANCE ___ _ 9 � ��✓� ' SMiP � �ATE:t�"� kPPUCANT: _..� . . J WARNINO:FAILURE i0 SECUPE WOFKERS'CONPENSATION CAVERAC�E IS NLAN'Flll,AND SHAL(.BE ENERGY P!C _ � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDqVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLUR6�5100.000),IN AODII'ION TO TNE COST OF COMPENSATION,DAMAGES AS PROVIOED FOR IN J SECTION31990FTHF_LABORCADE.INTEREST,AN�ATTORNEY'SFEES. RETENTIONFEE: � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRIA UNpER PFNALTV OF G[RJUaY THAT THERE IS ACONS7RUCYION LENOING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3097,CIV C.). Z W � LENDER'SNAME_ ___ . � � F— LENDER'SADOFE55____. � TOTAL FEES � I CERTIF4THAT 1 HAVE READ THIS`APPL.ICATION AND STATE THA7 THEABOVE INFORMATION IS CORFECT. � IAGPEETOCOIAPI.YWITHALLCIiVANDCOUNTVONDINANCESANDSTATELAWSRELATINGTO8UILOING � CANS7RUCTION,AND HcREBV AU"fHOFIZE REPFiESENTATNES OF 1'HIS COUNTV TO EN7ER UPON THE � ABOVEMEM�NE�PROPERTV FOR INSPECTION PURPOSES. Q COMMENTS J m —���---��-' � ¢ PERMITT E NAME(PRIfYT � / cn ''� L� ` .-�Ir`�����R�_ - Lq SIG �UREOFP RMIiTE �7A7E " Z RECPT.NO. 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