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HomeMy WebLinkAbout17265 (1544) — � ex CITY OF DIAM�ND BAR � -----�'�--- DEPAR'TMEIaiT�F COMMUNITY&DEVELOPMENT SERVICES � 21825 E.Copley Drive �"� (909)860-3195 Fa�r(909)861-3117 PRESS '`'%:;a»'�� BUILDINGPERMITAPPLICATION FIRMLY o DDRIESS�J Il✓/�����5 �0�� DATECATION��� �� NUMB R�#/C� � ISSUE p 6 TYPE OCC .- APN LOT TRACT DATE P����I ( CONST. GROUP I o AODDR SS PZ O `i✓ � �" /✓�i ZONING SETBACKS o FRONT RW ❑ oCITY �/GMO�/ �p�ZIP I7 TEL. REAR ❑ o APPLICANT TEL SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR �� � � jY SS. SIDE ❑ p� ADDRE S ^ /�V GI i� V/Qit/ S�7 f 0 C�'�y ZIP EL.S��•/� PROPOSED USE � w ARGH/ENG/ z DESIGNER ����N NO.DWEL. NO. NO. � ADDRES � �N � 0 � UNITS STORIES BEDROOMS v� , r d � CITYG /� S ZIP EL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cr� � OWNER-BUILDER DECLARATION . SFF/ADD/REM � O � '� I HEREBV AFFIRM UNGEK�PBJALN OF�PEFJUflV THAT I AA�EXEMPT FROMTHE CONTRACTORS LI- G8t890/C2�POfI � � W�� 'CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSAN�PflOFE551�NSCOOE:ANYGTYOR (n � G�� ��COUNTYWHICHRE�UIRESAPERIAITTOCANSTflUCT,ALTER,IMPFOVE,DEMOLISH,ORREPAIRANYSTRUC- ' w Patlo/Deck WTURE,PRIOR TO ITS�ISSUHNCE,AL$O REQUIRES THE APPI.ICANT FOfl SUCH?EFiMIT TO FILE A SIGNED STATEMENT THAT HE Ofl SHE IS'LICENSE�PUFSURNT TO THE PROVISIONS OF THE CONTRACTOR8 LI- ;��'„ '�CENSE LAW(CHAPTER 9(COMMENqNG WIiH SECTION 7000)OF�IVISION 3 OF THE BUSINE55 AND PRO- � Pool/Spa � FESSIONSCODE)oRTHATHEORSHEISEXEMPTTHEHEFROMANDTHEBASISFORTHEALLEGEDEXEMP- � 0����.TION.ANVVIOLATIONOFSECTION7o3t.5BVANYAPPLIGANTFORAPERMITSLIBJECTSTHEAPPLiCANTTO z Fe-Roof ' V �,A qVIL PENALTV OF NOT MORE THAN FIVE HUNDREO�OLLARS(SSOC).): — F�' SASTHEIRSOLECOMPENSATIO� - � �' ❑I,ASOWNEROFTHEPROPEFTY.ORMVEMPLOYEESWITHYJAGE � COR1rt10fCifll .Z�, �,WILL DO THE WORK,AND TH�STRUCTUFiE IS NOT INTENUED OR OFFERE�FOR SALE(SEC.�044,BUSI- , J � �NESS AN�PROFESSIONS CO�E:TIiE CONTPPCTOFS LICENSE LAW DOES NOT APPLY TO AN OWNER OF j PROPERTY WHO BUIC�S OP IMPFOVES THEP.EON,PNO WHO�OES SUCH WORK FiIMSELF DR HERSELF OR '�THROLIGH HIS OR HER OWN EMPL01'EES,PROVI�ED'THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m � �W: ���OFFEREDFORSALEiF,NoWEVER:THEBUILDINGORIMPROVEMENTISSDLDWITHINONEYEAROFCOMPLE- 0'� �'��.TION,THE OWNER-BL1lLDER WILL HAVE THE BUFiDBJ OF PROVING iHAT HE OR SHE DID NOT BUILO OR . Z ' = IMPROVE FOR THE PUFPOSE OF SALE)'., � � OWNEROF HEPflOPERTYAMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS ❑IAS T . W q c oas u- ADJ.ARE 044 BLISINESS AND PROF[SSIONS CODE:TFlE CONTRA T Valuation Q TO CON$TRUCT THE PRQIECT(SEC.7 - . UILDSCRIMPROVESTHEFEDN AN� W 'GENSELAWDOESNOTAPPLYTOANQWNEROFAPftOPERNWH06 � ��WHOCONTRACTSFOftSUCHPROJECTSWITHNCANTRACTOR(SjLICENSEDPURSUHNTTOTHECONTRAG (�UANTITY OESCRIPTION FEE Y 'TORS LICENSE LAW.). J ' r �j .. II�I� �� ❑I AM EXENPT UN�ER SEC. B.&P.C.FOP THIS REASON Q /� � � �`v � ���ATE OWNER w � � / � LICENSED CONTRACTORS DECIARATION iy ¢ '� i HEREBY AFFIflM UN�ER,PENALTV Of PERJURV THAT I AI�A LICENSED 11NDER PROVISIONS OF CHAPTER � d� 9(COMMENCINGWITHSECTION7oco)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCO�E,AND Z 'X, MY LICENSE IS IN FULI FOfiCE AND EFFECT. m r1 � LICENSE CLASS LI0.NO. w D � /pr � V DATE D �0 CONTRACTOR �D UOL � � W ' � WORKERS'CAMPENSATION DECLARATION � .�,�/ ��'v � I HEREBY AFFIRM UNDER PENALN OF PERJURY ONE OFTHE FOLLOWING DECLARATIONs: � Z Q '0 _IHAVEAN�WILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ �Q CAMPENSATION,AS PROVIDED BY SECiION 3]0o OFTHE LABOR CODE.FOP iHE PEflFORMANCE 'U THE WORK FOR WHICH THIS PERMIT IS ISSUED. � W � IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREO�IRE�BYSECTION I Q 37o00PTHELABORCODE FORTHE PERFORMAN CE OF THe WORK FOfl WHICHTHIS PERMIT IS TI N , •� � NSTRUC 0 CO � N INSURANCE CARFIEft AN�POLICY NUMBER ARE: „ ISSUED.MY WORKEFS COMPENSA�T'1IO 1� � jJ .ST�` .[/H�v PLAN REVIEW CARRIER L �Z POLICY NUMBER I � �" ��� ELECTRIC a � s +woa�Ess. PLUMBING T OOMPLFEDOFiHEPERNuTISWRONEHUNDREDD0IJ.AR (5 ) � (� ISSEGT%7NNEmNO BE � � W � � Z I CERTIFV THAT IN THE PEflFORMANCE OF THE WORK FOR WHICH TH'��S PERMIT IS ISSUEO,I MECHANICAL �))) (j SHALLNOTEMPLOYANVPERSONINANYh1ANNERSOASTOBECOMESUBJECTTOTHE INSPECTIONFEE / Uj WORKERS'COMPENSATION LAWS OF CALIFOPNIA,ANOACREETHAT IF I SHOUL�BECOME y�a, SUBJECTTOTHEWORKERS'COMPENSATIONPR NSOFSECTION37o00FTHELABOR �'rw+ \ � CADE,IS�iALLFOJ17HWITHCOMPIYWITHiH P VISIONS. ISSUANCE . � _ Q / /�/ SMIP / �/O/ � l T APPLICAN. �ATE: L��E�� � � __'_fT W ENERGY P/C - J � J WAftNING:FAIWRETOSECUPEWORKERS'COMPENSATIONCOVERAGEISUNL4WFUL,ANDSHALLBE � � SUBJECTANBv17LOYEflTOCHIMINALPENALTIESAN�CIVILFlNESUPTOOMEHUNOPEOTHOUSAN� ENERGYPERMIT . AS PROVIDED FOR7N . H COSTOFCOMPENSA710N,DAMAGES OW INAODIilON70T E DOLLARS 5100. , f 1 � . `6�.� CO�E INTEREST AND PTTORNEY'S FEES. � seciioN3�osoFiHE��soa . ETENTION FEE. � • R W TION LEN�ING AGENCY PRE-ALT FEE: �. CONSTRUC O CC I HEREBYAFFIRM UNOER PENpLTY OF PEFiJURYTHATTHEFE IS ACONSTRUCTION LEN�MG AGENCY ❑Z- FORTHEPERFORMANCEDFTH�WORKFORWHICHTHI PEFMRISISSUE�(SEC.3oN�,GIV.G.), ' 1 LEN�ER'S NAME l/' �� � � __ F LENDER'SA']DRE55 � yy�}f'�p9 w ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHAT7HEA90VEINFORMATIONISCOPRECT. TOTAL FEES �Q,d'� o -1 (�. ���'�� 1 AGREE TO COMPLV Wl'H ALL CITY AN�CDUNTY ORDINANCES AN�STATE LAWS RELATING 70 6UIL�ING '� � CDNSTRlJCT10N,AN�HEREBYAl1THOFiIZEREPRESENTATIVE50FTHI5COUNTYTOENTERUPONTHE z {y,� �//,yy + zABOVEMENTIONE�PROPERTYFORINSPECTIONPl1RPOSES. - COMMENTS - b • �" � �� � o � � J �r ^ — i G� � .( "- . _ �/ m I ENAME(PflINT ' Q e/^ � � � 0 � � � SIGNA'fUREOFPERMITTEE DATE ' = flECPT.NO. 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