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HomeMy WebLinkAbout17578 CITY OF DIAMt)ND BAR �--�` --- D�PAR'FMENT OF CONIMUNTI'Y&DEVELOPMENT SERVICES I N M ,� � 21825 E.Copley Drive � (909)860-3195 Fax(903)861-3117 PRESS ''`-vK���" BUILDINGPERMITAPFLICATION FIRMLY o DDR'ESS � m DATEICAtI' • � NUMB R ���� #/C � ISSUE TYPE OCC •- APN LOT TRACT DATE CONST. GROUP p OWNER � � ADDRESS � ZONING SETBACKS OCITY TEE.�f��:,�^�� FRONT RW ❑ o APPLICANT � � , ��-�- REAR ❑ Z SIOE/SIDE STREET RW ❑ ¢ CONTRACTOR SIDE ❑ � ADDR S � CITY .. ' §�@� L.. a -� PROPOSED USE o, ARCH/ENG/ i S� iz DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O 0 I HEREBY AFFIRM UNDEfl PBJALTY OF PERJUHY THAT I AM EXEMPT FROM THE CONiRACTORS LI- � GaragelCarport W CENSELAWFORTHEFOLLAWINGREASON(SEC.7031.5BUSINESSAN�PROFESSIONSCODE:ANYCITYOR U CDUNTYYMICHREQUIRESAPERMITTOCONSTRUCT,A.7EH,IMPROVE,DEMOLISH,ORREPAIRANYSiRUC- W PatiO/DeCk � Z 7URE.PRIDR TO ITS IS5UANCE,ALSO REQl11RES YHE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w W STATEMENT THAT HE OR SHE IS WCENSEO PURSUANT i0 THE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHRGTER 9(COMMENCING WIiH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PRO- LL PooUSpa � FESSIONSCODE)OftTHATHEORSHEISE%EMP7THEREFflOMANOTHEBA5ISFORTHEALLEGEDEXEMP- � TION.ANYVIOLATIONOFSECTION7031.SBYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO z Re-Roof �; A CIVIL PENALTY OF NOT MORE THAN FIVE HUN�RED DOLL4F5(SSoajJ: p ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITH:WAGESA57HEIfiSOLECOMPENSATION, � CommefCial � . Z�, WILL DO THE WORK,AND THE STFUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,B1151- _I � NESS ANO PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW�OES NOT APPLV TO AN OWNEF OF = PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORI(HIMSELF OR HFRSELF OF �,. THFWUGHHISORHEROWNEMPLOYEES,PPOVIDEOTHATSUCHIMPROVEMENTSARENOTINTENDE�OP m Q; OFFEflE0FOR51LLEIF,HOWEVER,THEBUIL0INGORIMPROVEMENTI550IDWITHINONEYEAROFCOMPLE- - � TION,TME OWNER-BUILDER WILL HAVE THE BUHOEN OF PFOVMG THAT HE OR SHE DID NOT BUILD OR . � IMPROVE FORTHE PURPOSE OF SALE). W ❑I,ASOWNEROFiHEPROPEHTY.AME%CLUSNELYCONiRACTINGWITHLICENSE�CONTRACTORS �" TO CONSTRUCT THE PROJECT(SEC.7oa0.0115 WESS AN�PROFESSIONS CO�E�.THE CONTRACTORS LI- VfllUdtiOfl ADJ.AREA W' CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPEPTYWHOBUILDSORIMPROVE57HEREON,AND � WHOCONTRACTSFORSUCHPRO,IECTSWITHACONTRACTOR(S)LICENSEOPURSUANTTOTHECONiRAC- QUANTITY DESCRIPTION FEE � 70F3LICENSELAW.). �� ❑I AM EXEMPT UNOER SEC. B.&P.C.FOR TNIS REA50N � - � LJ_ � DATE OWNER U Z W � LICENSED CONTRACTORS DECLARATION W ¢ Q I HEREBYAFFIRM UN�ER PENALTY OF PERJURY THAT I AM LICENSc�UNDER PROVISIONS OF CHAPTER � �. 9(COMMENCINGWITHSECTIDN700o)OFDIVISION30FTHEeUSINESSANDPROFE5SI0N5CO�E,AND Z X' 1AY LICENSE IS IN FULL FORCE ANO EFFECT. . � LICENSE CLASS �„�.+ LIC.NO. v ���" � j � V DATE CONTFACTOR.�-� ,X � ' a w dg � � �m WORKERS'COMPENSATION DECLARATION i� 4 r=n � �" �� A U � IHEREBVAFFIFMUNDERPENALTYOFPERJURYONEOF7HEFOLLOWWGDECLARATIONS: Z � I HAVE AND WILL MAINTAII�A CERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' 2 Z CAMPENSATION,ASPROYIOEDBYSECTION3]ooOF7HEL4BORCODE,FORTHEPERFORMANCE U a OFThIEWORKFORWHICFTHiSPERMITI51S5UED. � � w _IHAVEANDWILLMAMTAIMWORKERS'COMPENSATIONINSURAhCE,ASRE�UIREDBVSECTION � � 37a�OF THE LA90R CO�E,FOR THE PERFORMANCE OFTHE WORK F R WHICH THIS PERMIT IS ISSLIED.MVWORKERS'COMPENSATIONINSURAf�GF�ARRIERANDP�LICYNUM9ERARE: CONSTRUCTION � CAflRiEfl PLAN REVIEW Z POUCYNUMBER ELECTRIC Q v 0 (iHISSECTIONNEmN078ECOMPLEfcDOF1HEPERlMISFORQVEHUNDREDDOLLAi15(5100)ORLESS). PWMBING �q W OJ Z ICEflTIFYTHATINTHEPERFORMANCEOFTHEWORKFORWHICHTHISPEFMIiI5I55UE�,l MECHANICAL �J ShiALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSATIpNLFW50FCALiFDRN1A,ANDAGREE7HATIFISHOULDBECOME �NSPECTIONFEE � SUBJECTTOTHEWORKE�iS'COMPENSATiONPROVISIONSOFSECTION37oGOFTHELABOR �15, �`•-wr� �,IS��OR� iHCOMPLYWITHTHOSEPROVISIONS. ISSUANCE ,���. l ! � SMIP p �ATE: PLIGANT: W � WARNING�FAILUPETOSECl1FiEVyORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANOCINLFINESLIRTOO�EHUNDRE�THOLISAN� ENERGYPERMIT OOLLAflS(5100,000),IN A�OITION 707NE COST OF COMPENSATION,�AMAGES AS PROVIDED FOR IN J SECTION3]OBOFTHELABORCODE,INTERE9T,ANDATTOftNEY'SFEES. RETENTIONFEE: � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEPEBV AFFIRM UNDER PENALT'OF PFAJUflY THAT TNERE IS ACONSiRUCTION LENDING AGENCY fOR iHE PEPFONMANCE OF THE�WORK FOq WHICH THIS PERMIT IS ISSUED(SEC.309�,CIV.C.). Z W S LENDER'S NAMc �S F= LENDER'SADORESS � TOTA� FEES �`� � ICEflTIFYTHATIHAVEREADTHISAPPUCATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. � w IAGftEE TO COMPLY WITH ALL GTYAN�GOUNTY OriDINANCES AND SiATE lAWS RELATING TO BUILDING ���� d � CONSTRUCTION,AND HERE6Y AUTHOflIZE REPRESENTATNES OF THIS GOUNTV TO ENTER UPON iHE ,Z A80V M NTIONEO PROPERTY FO SPECTION PUflPO5E5. COMMENTS � � � —-- m P MI EE AME(PRMT) �' � � � � 51 AT ITTEE DATE � . z RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Co PINK—Assessor Co GOLDENROD--File Co GREEN—A licanfs Co PX PY, PY� PP PY . , . . _ . ..� _ _ .. ,._ ... _. . .. .. � - �';w `�` , � . ` .' : � 3 g k.. �...,i � � '..f = m s ., x ��..'� . ... .. ._ 3:'ar�",.a �+�'�.�a%� �i��� � � 3.,,y � `.� " � ' � "� '� * ��.t� t d,� „'' � `� e � � u". s= �' s � '� C a ,,.-, �'��r �.: t �� +� � s���^�' ^� � k# �" � + ,:�� a �." 9 '".q ��;r ,°��� x s� �',i � � ����.� c � „�: � �� � � � �- �� �m �„� '�� �,�� ..�. .. : "';�w'. ,� � ,� .� .�.�mi. 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