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r"' �� CITY OF DIAMOND BAA s�;w i DEPARTMENT OF CONiMUNITY&DEVELOPMENT SERVICES _ . � 21660 E.Copley Drive Suite 190 (909)860-3195 FaY(909)8613117 �RES$ °»��`� BUILDING PEBMIT APPLICATION , _., FIRMLY - � JOBSITE ,,� �- �dt Y ' "� DATEICATION � � NUMBE , eJ #!C o ADDRESS��� �°A c� ISSUE TYPE OCC r APN LOT T ACT DATE CONST. GROUP � OWNER A O � ADDRESS ZONING SETBACKS 6 CITY � ZiP f 7EL. FRONT RW ❑ APPUCANT II TEL. REAR ❑ � SIDElSIL7�E 3TREET RW ❑ � CON'I'RACTOR (, SIDE ❑ � ADDRESS:'�. .. 1 ,� p ✓���� PROPOSED USE CITY 21P�� TEL.�� w" ARCtilENGO �j z, DESIGNER � �� NO.DWEL. NO. NO. a ADDRESS �� UNITS STORIES BEDROOMS �, 'ClTY � ZIP TEL. �yjy, � DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION' � Q�, OhNNER-�UILDER DECLARATION - SFR/ADD/REM � d I�� 0' . I HEflEBY NFFlRM UNDER PkNAL7Y OF PERIURY 7"HAT I AM EXEMPT FROM-THE CONTRACTORS LI- GdtdJfi/C2�0�[ ��� �iCENSEIAWFORTHEKO�LLOWINGREA50N(SEC.?031.58USINESSANDPPOFESSIONSCADE:ANYqNOR (n . .COUNTYWHICHREQUIRESAPBR ITTOCON5T9UCLALTER,IMPROVE.DEMOfJSH.ORREPAIRANYSTRUC- W � Pdtlo/DeCk �TURE.PRIOR TO I7515SUANCE, LSD REQUIR'eS THE APPLICANT FCR SLICH PENMIi TO FILE A SIGNED W' STATEMENT THAT HE OR SHE IS IICENSED PURSUAN7 TO THE PFiOVI510N5 OF THE CONTRACTORS LI- � �' �'CENSELAW(CHAPTERB(C6MMNCINOWRHSECilON70o0)OFDIYIS[ON30FTHEBUSINESSANDPRO- � PooVSpa � � � :FESSIONSCODE)ORTHATHEO SHEISEXEMPTTHEREFROMANOTMEBASISFORTHEALL'eGEDEXEMP� (� '�, �'TIONA�'7YVlOLAT!ONOFSEGTI 7a315BYANYAPPLICANTFOflFPEFiMITSU&IECiSTH:APPIIGRNTTO Z Fj@-fl00f � � �,�i ACINLP6NALT'OFNO7MORE7 ANFIVEHUNDREDDOLLARS(55WJ.): - ❑IASOWNEROFTHEPR�ERTY�ORMYEMPLOYEESWITHWAGESASTNEIRSOLECAMPENSATION. L] Commercial - �,li �.WILL�O THF WORK,AND THE S RUCT�RE IS N07INTENDEO OR OFFERED FOR SAIE(SEC.7a46,Bl1Sl- J HES5 AND PHOFESSIOIdS CO�E�THE CONTRACTORS LJCENSE LAW DOES NOT APPLV TD AN OWNEfl OF �� ��I �'PROPEHTYV71-IOBUILDSORtMP OYES7HEREON,ANDWHODOESSUCHWORKh11MSELFOflHERSELFOR � �I ',THROUG.4 HIS OR FiER OWN EMP�QYEES,PFOVIDED TMATSUCM IMPHOYEMENTSAHE NOT iNTENDED OR m �� „OFFEREDFORSALEIFHOWEVER7HEBUILDINGORIMA620VEFAEM4SS01DWITHINONEYEAROFCAMPI.E- Z '�TION.THE OWNEA•BUIL�ER WIIL HAVE iHE B1IRDEN OF PROVW3 THAT HE Ofl SHE DID NOT BU�LD OR WI� ��IMPRQVEF0,9THEPUi1PO5EOF�ALEj. � � ❑I,ASOWNEROFTHEPRO ERTI;AMEXCWSIVEL.YC4NTflRCTINGWfTHLICENSEDCQNTRACTOR5 '�, .,TO CONSTRUCT THE PR0.IECT(EC,70LP,BUSINESS AND PHOFESSIONS CADE:THE CONTRACTOiiS LI- 1/g1Uali0Pl ' ADJ.AFIEA . ,'�WI .CEP1SElAWDOESNOTAPPLYT�ANOWNEAOFAPFIOPERTYWHOBUILDSORIMPFOVESTHEREON,NP1� ' �I ';WIIOWNTMCTSFCRSUCHPRdJECTSW9THACONTRAC70R(S)LICENSmPURSUANTTOYHECONTRAG QURNTITY DESCRIPTl�N ��� FEE � ��'� �,TDflSLiCENSELAW.). I a� � G I M1 EXEtAPTUND6RSEC. 8.d P.C.fOR 7HI5 REASON � � U �; � � ;�ATE I GNMER � , �. Z ' � L'J �'�i LICE SED CONTRACTORS DECL4RATION -� I LL! � ���� "IHER�YAFFIRNUNDERPENALTYOFPERJURYTHA7IAMLICENSED'JNDERPROVI310NSOFCHAPTER � �� � � .�I. �, '� ��i� !��.9(�.^pMM1ENCINC3 WIiH SECTION�0(U)Of�IVISION 3 OF THE 911S113E5S ANQ PROFESSIONS CODE,ANO z � 9EI '.,MV LICENSE IS IN FULI FORCEp D cFFECT. m '��, LLI o� LICENSE CL,�A`S`Sff� g�,g LIC.NO. � / , j � � � ��DATE �^"'//^i�i 'i� CDNTRACTOR Q. L6:1 �� WORf6,ER3'COPv9PENSA710N DECLARAT{ON --� � �., IHERFBYAFFIAMUNDERPENALTYOFPEiiJUfiYON�CFINEWLLOWiNGOECiAflA7�NS: z C:1; �IHAV5AN6kliLLMAINTJ1YNACERTIF�CATEOFCONSENTTOSELF-INSUREFOAWORKERS' S � �'� COMPENSATIOPl,ASPRqNIDEDOYSECTION37ooOFTHELRFIORCOOE,FCFTFiEPERFORMANCE U �� OF THE WOP,K FOR WNV¢F4THl5 PERMiT IS ISSUEQ. � � I F�„ �I HAVEAND WILL MAI7dTl�N WORKERS'CDAiPENSATlOPI IRISLIRANCE,AS REQNRED BY SEC710Y � 57UOOFTHELA£DRW E,F-0RTHEPERFOftMANCEQ:THEWORKWRWHICHTHISPERMiT15 � ISSL'ED.MYNdOR;CEPS' AAPEN5AT!ONINSURANCEGARRIERANDPOLICYNUMBEHAFE: CONSTFIUCTION �^+-..a,..__ ,y�, cAAWi�R � � � � PLAN REViEW „�P._� - a Pa.icrNurnee� �` ELECTRIC � � t C3 . f��&':CfiONNE�NDT EOOA�IPtETED�fii-iE�RhffTbFGRQ'JEIiIIrDPEDWLLNi..(SiW�ORLES6�. � p�jjm�p}(�•�-`_ 00 � !CERTIFY THAT IN THE RARMANCE OFTHE WORK FOFi WHICH THIS PERMIT IS ISSUE�,f MECHANICAL ' C3�. SHALLNOT'EMPI.OYAN�P'cRStlNItdANYlAANNERSOAS70@ECOME5UBJECTiOTHE �'� ��� WCRI(ERS'COP.IPENSATONLpNY'OFCALIFOFNIA,AN�AGREETHA7IFISHOULOBECOME INSPEvTIONFEE �__„— I��.i SUEJEC7TOTHEWORN RS'C:JMPENSA7l6NPROVISIONSOFSECTIQN37o00F1NELA.BOA �"`�—i�—� I, �', COClE,iSHALLFORTkfW HCOMPLYWITHTH�DSEPRDVISIONS. ISSUANCE ..� ' ` � � SMIp Cj� DATE:��� PPLICANT: - � _—_ � ,_�j, WAFNING:FA!lURE TO SECURE�"JOHK'cfl5'GOMPEN5ATION COVERAGE i5 U� WFUL,AND SHA!�BE Eh1ERCaY P/C ''.. ,� SV&IECT AN EMPLOYERTO CR�INAt�PENAITiES Ah1D CIVIL fWES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT �I ''� DOLLARS(510D,o0o),IN AD�I710 T0711E COST OFCOMPENSATION,DAMAGES AS PROYIDED FOR IN �� SECTION37086FTHELA00R DE,INTEREST,APDRTTOFNEY'SfEES. ' RETENTYONFEE: ��'i �pw,.:'' C PIS7RUCTION LENDING AGENCY PRE•Ai.T FEE: '� O I i �; IHERE6YAFFlflMUNOERPENAaR1'OFPcRJURYTHAT7HEREISACONSTRUCTIONLEN�INGAGENCY �.�, FOF THE PERWFMANCE OF TiiF,WORK FOR WHIG71 THIS PEFMIT IS ISSUEO(SEC.30S],CIV.C.). LL1��. I . . . � T� LENDER'S NAME . . �� � � i �', LENDER'SAD�RESS I p C �✓,/� ��'. ICERTIFYTNATIHAVEREADTHSAPPLICATIONA�OSTATEiHATTHEABOVEINFORMA710NI5CORRECT. TO�l1L FGES (�f��� ,,�',;, I AGREE TD COAIPLY W17HALL TY ANO COUNTY ORDINMCESAND S7A7E LAWS REtATING TO BUILDWG � . ��, CONSTRIJCTION,AND FlEREBY�THORIZE REPRESENTAT{VES OF THIS COUNTV TO ENTER UPON THE � � , �'� ABOVE-MENTIDNE�PROPERT' OR INSPECTION PURPOSES. (�`OMMENTS � � �'i J, ��,I �� PERMITf NAME(PRINfD ' . . �,; � � �� , �;i SIG TUREOFP RMITTEE OATE ;�"; RECPT.P10. PAlD BY VALIDATION ~ � WHITE—Department Copy.YELLONi—Finance Copy,PINK—Assessor Gopy,GOLDENROD--File Copy.GREEN—Ap licant's Copy ��_� �� �s � �3�,+,� rs � f .:�' � � ,'. � t,.?.,!ati;r'"�; - �„� di;:,�" ...�:.s�'. a �a'';'�x,. :.,�''A,�,���, . �� x��� � � �� � �z:��.�� � t�..�;," . . 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