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Home My WebLink About15493 (23) � ±`f f t O _!� CdTY OF DIAMOND BAB ,� - � DEPARTMENT OF COMMUNITY d�DEVELOPMENT SER'JICES ` � 21660 E.Copley Drive Suite 190 � (909)860-3195 Fax(909)861-3117 PRESS �'�'9N' BLTII.,DING PERMIT APPLICATION FIRMLY } JOBSITE '�� -* 1 � �� APPUCATION �` t PERMIT �'�-¢—r� � ��. Q ADDRESS I II�� i �I��i��'�' v.7�+ j L� �,;'C� ! P/C � p DATE NUMBER .� # $ ISSUE ' �� /°i7'� TYPE p� APN LOT TRACT DATE f,F i 1 CONST. GROUP °C OWNER � ' O o ADDR�SS „��' ' ` ti ZONING SETBACKS "-' cinr UK.�$4�,'/'iC� G1�3' ZIP 1 �' FRONT �� TEL. RW � � APPUCANT �i(:r'�f"c I`��.i"C E a" TEL.�`7-�i�-U.��t-s REAR ❑ � SIDE/SIGE STREEI' RW G � CONTRACT R _ '� �� , SIDE _ C � ADDRESS � "' � � ' _. � CITY Li .��11i1'-� ZIP��V TEL. �" . "�- �� PROPOSED USE �� ,S,T`��',(��, o ARCH/ENG/ �� DESIGNER ADDRESS NO.DWEL. �IO. NO. y UNITS :tTORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION p� OWNER-BUILDER DECLARATION SFRIADDlREM O I HEREBY AFFIflM UNDER PENALN OF PERJURY THAT I AM EXEMPT FflOM THE CONTRACTORS Lb G8f3 B/CBfFIOff W CENSEUWFOR7HEFOlLOWINGREASON(SEC.7031.SBUSINESSMl�PROFESSIONSCODE:ANYCITYOfi U COUNfYWHICHREWIflESAPERMtTTOCONSTRUCT,ALTERIMPROVE.DEMOLISH.ORREPAIRANVSTRUC� � \ �i Z TUHE,PRIOR TO ITS ISSUANCE,/�LSO REOUIRES THE AAPLICANT FOF SUCH PERMff TO FI�E A SIGNEO W Patio/Deck f• W STATEAIENT THA7 HE OR SHE IS LICENSED OUiiSUANT TO 7HE PROVISIONS OF THE COMRACTORS LI� w � CENSE UW(CHAPTER 9(COMMENCINO`MTH SECTION 7000)OF DIVISION 3 OF THE BUSINESSAND PRO� � POOVSP2 FESSIONSCODE)IXiTHA7HEOR5HE15EXEMPTTHEREFROMM107ME8A5i5FOR7NEAlLEGEDE%EMP� � TION,ANYYIOLATIONOFSECTION7o31.6BYANYAPPLICAMFORAPERMIiSU&IECTSTHE/lPPLICANT70 Z RB-ROOf � ACIVILPENAL7Y OF NOT MORE THAN FNE NUN�RED OOLLAflS(SSDO).): � ❑I.ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESA57HEIRSOLECOMPENSATION, O COmmerciel - WILL W THE WORK,AND THE STRIICTURE IS NOT INTENDED OF OFFERED FOF SALE(SEC.�oea,6USI� _.I � NESSAND PROFESSIONS CODE:THE CONTFlACTORS LICENSE LAW DOES NOT ADPLV TO AN OWNER OF ? VROPERTY Nh10 BURDS OR IMPROVES THEREON,MD WHO DOE6 SUdi WOAK HIMSELF OR HERSELF OR WTHqOUOFIHI50RHEROWNEMPLOYEES,PROVIOEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m � OFFEREOFORSALEIF,HOWEVER7HEBUILDINGORIMPROVEMEMISSOlDWI7HINONEYEAROFCOMPIE Z TION,THE OWNER�UILDER WILL HAVE iHE BURDEN OF PROYING 7HpT ME OR SHE DID NOT BUILD OH = IMPROVE FOR 7HE PURPOSE OF SAL�. �y,� GI,ASOWNEROFTHEPROPERT:AME%CIUSiVELYCONTRACTINGN'IlHIICENSE�CANiRACTORS � N CONSTAUCT iHE PRO.IECT(SEC.7o�a,BUSINESS AND PROGESSIONS CODE:THE COMRAC70R5 L6 VelUBtlOn � � A� ADJ.AREA W CENSEUWOOESNOTAPPLYTOANONMEROFAVROPER7YWHOBUtLD50RIMPROVESTHEREON,ANO � — � NM1IOCONTRACTSFOR&UCHPROJECTSWITHACON7RACTOR(S)LICENSEOPURSUANTTOTHECOMMG QUANTI?Y DESCRIPTIO�I FEE Y TORSLICENSELAW.). _ � O I AM EXEMPT UNDER SEC. 9.8 P.C.FOR'HIS REASON Q � 3 � � � DATE OWNER V O W F, LICENSED CONTRACTORS DECLARATION W � 1 HEREBY AFFIRM UNDER PENPLTY OF PERJUHY THA7IAM LICENSEO UNDER PROVISIONS OF CHAPTER � / I �Y 9I, N1�.•, ,�` •� , d 91�MENCMJCiWITH5ECTiON7000)OFDIVISION30FTHE8USINESSANDPROFESSIONSCODE.AND z '�r 7"� !'�' X 1AY LICENSE 61N FULL FORCEAND EFFECT. '�. �.. m �V . LLl /7 y �� IICENSE CLqSS � �� LIC.NO.� 1�� j V DATE_��j��' �C� CONTRACTOR �� _ OJ- — W ,.y` � WORKERS'COMPENSATION DECLARATION�C��l-pc�;.',�`�i M Q � IHEREBVAFFIAMUNDERPENALTYOFPERIURYDNEOFTHEFOLLOWINGDECLARATIONS: Z � _IMMEANDSMLLMAINTAINACERTIFICATEOFCANSENTTOSELF-INSUREFORWORKERS' 2 CqA{PENSATION,ASPROVIDED6VSECTION3�OOOF7HEL480RCOD�FORTHEPERFORMANCE `U O FTHE WORK FOR WHICH THIS PEFL7IT IS ISSUED. � QW 1 HAVE AND WILLMAINTRIN WORKERS'COAIPENSATION INSURANCE,AS HEOUIRED eY SEC710N 3700 OF THE LABOR CO�E.FOR 7HE VERFORMANCE OF TNE WORK FOR WHICH THIS PERMIT IS / � i55UE0.MV Y�K RS' PENSAT INSURANCE CARqIER AN6FDLICV hLMBER ME: CONSTRUCTION � n �/ V C� Q � CARRIER � � � /V'� � PLAN flEVIEW � E F z POLICV NUMBER � ELECTRIC Q Q (fHISSECIIONNE�NO7BE00A.4�LETmOF7}�PEfMMSinRRONEHUWRED00WiRS�5100;Oq1.ESS7. PLUMBING ___ � r W Z ICERTIFYTNATINTHEPERFORMANCEOFTHEWORKFOqWHICHTHSPERMITI515SUFD,I MECHANICAL _ C,�} SHqLLNOTEMPLOYIWYPER50NINANYMANNER50F5TOBECAMESUBJECTTOT.HE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGNEE THAT IF I SHOULD BECOME INSPECTION FEE _ S'�� 1�F = SU&IECTTOTNEWORKERS'COMPENSATIONP�iO41SIONSOFSECTION37o00FTHELABOR ---- A ' . .�–� C�E,ISHALLFORTNWITHCOMPLVWIrTy�oscaaovisiows. ISSl1ANCE `p �ATE��`✓ APPLICANT.(��/�'iCiLiC SMIP _ ,7 ;a. �C , � � ENERGY P/C _�.�`� C.< ° l� WARNING:FAILl1RE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNIAWFUL,AND SHALL BE I bZ �,y � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAN� t�, g]� Dq1ARS(51oa.000�.INADDITIONTOTHECOSTOFCAMPENSATION.�AMAGE&ASPROV!DEDFORIN ENERGYPERMIT .. •• �•e' / � � SECTpN37080FTHELA80RCO�E.INTEREST,ANDATTORNEYSFEES. f� � g��a � - .�� q _ RETEMION FEE: .��'!� T° � � � �s I��_' d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �� i,j..h,. a'�" � / ��,- � I HEREBY AFFIflM UNDER PENALTV OF PERJURY THAT THERE IS A CANSTRUCTION LENDINO AOENCV v%• FOR THE PERFOfiMPNCE OFTHE WORK FOR WHlqi THIS PERMIT IS ISSUED(SEC.3o9'I,CIV.C.). W � � LENOER'3 NAME — �— LENDER'SA�JDfiESS I w �CEFTIFYTMATIHAVEftEADTHISAPPLICATIONAPID5tATETFUTTMEA80YE1NFORMATIONISCORFiECL TOTAL FEES � , Y � IAGREETOCOMPLYWITHALLCINANDCOUNTYORDINANCESANDSiATElAWSRELATINCTOBUIL�ING f / � CONSTRUCTIIXJ,AND HEREBYAUTHORRE FEPRESENTATIVES OF THIS COUNTV TO EMER UPON THE �G�,r+^]� ��Y'1 �-G,,,�,,.� S . OABOVE-MENTKKJED PROP,HfV FOR INSPECTION PURPOSES. COMMENT� r t' '`� � vv�� ••-� � � ' ITTEE NAME�P ys; � ��q�9, �r, r�� . ��..��,-� . f Uj ATUREOFPE MITTEE � DATE = RECPT.NO. PAID BY VALIDATION ~ WHI7E—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File C�py.GREEN—Applicant's Copy _. . .. .., . .. , . . , . .. . . .., ..,.•.�51.'��.,.,,:i •y: ,.a„�,;....0.'.:.� , ,i. r,'• , � . , a � , .. . . . ..,., . ,. .,. , .. •. : � � rv •n��r .�.,;..,n.•��:��•.:,,;+ , . . .. �-:�zr .. - . , . � .. , . . i .. . _., r •. ... . . , . .. 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