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HomeMy WebLinkAbout16976 (669) � � �,j�y�g�`,;k.�«��ti�="7`.�,� .r,r ;.�7»:- � y Pn� CITY OF DIAMOIVD BAR "�'�'' �'" �" ----�'---- DEPARTMENT OF COMML1NlTY&DEVELOPMENT SERVICES �`� � ^ I �_ : ti 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 � �--�''� PRESS '"'%.�r�'��" BUILDING PERMIT APPLICATION '� FIRMLY � JOBSITE Jf'��� 6,� ���� APPLICATION � �� -�� NUMBER ' #/C " o ADDRESS /a� ir DATE � ISSUE TYPE OCC -- APN LOT TRACT DATE CONST. GROUP � OWNER � ' � OO > ADDRESS �� �'� ZONING SETBACKS oCITY '�'� G/� ZIP TEL. ' '�d�'�.' � FRONT RW Cl p APPLICANT ,�wl° ��.E�v7si�- TEL. -',��' ��",/' REAR ❑ z SlOE/SIDE STREET RW ❑ m CONTRACTOR � SIDE p � CITYR'�' z.r�i� s�- Z{P �� '�TEL. �s'''a�t�e �`�"�' PROPOSED USE D"+'� t'' /'� �l�C��%//� � � � ARCH/ENG/' ������ 'I Z DESIGNER � �C`�%`"' /'' NO.DWEL. Nd. NO. a ADDRESS `�� a �`C ,��-- UNITS STORfES SEDROOMS � CITY �'"` ' 'C�' ZIP /� TEL.� � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION OOWNEP-BUILDER DECLARATION SFRlADD/REM � �, p I HEREBY AFFIRM UNDER PENALTY OF PERIURY THAi I AM EXEMPT FROM THE CONTRAGTORS LI- G3Y3(JE/G&f(JOR W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.56USINE55ANDPROFE5510NSCODE:ANYCITYOR (J� � COUNTYWHICHRE�UIRESAPERMITTOCONSTRl1CT,ALTE,9,IMPROVE,DEMOLISH,ORAEPAIflANY5TF7L1C- W patlo/Deck i� � ,w 7URE,PRIOR TO ITS ISSUANGE,ALSO REOUIRES TNE APPIICANT FOR SUCH PERMIT TO FILE A SIGNEO W STATEMENT THAT�HE Oq SHE IS IICENSED PURSUANT TO THE PFOVISIONS OF THE CONTRACTORS LI• '� � CENSE LAW(CHAPTEft 9(COMMENCMG YJITH SECTION 7000;OF DIYISION 3 OF iHE BUSINE55 AND PRO- V' POOI/Spa iES510NSCODE)ORiHATHEORSHEiSEXEMPTiHEREFROMANDTHEBASISFORTH=ALLEGEDEXEMP- (� i, � TION.ANVVIOLATIONOFSECTION7031.58YANYAPPLICANTFORAPERMITSUBJEC75THEAPPLICANTTO z Re-Roof ' � ACIVILPENALTYOFNOTMORETHANFIVEHUNDRE�DOLLARS�ESoo),): � � ❑4ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWIiH3NAGE5A5THEIfl50LECOMPENSATiON, 0 Commercial - z WILL�O THE WORK,AND THE STRUCTUI7E IS NOT iN7EN�ED OH OFFEFiE�FOR SALE(SEC.70A6,9L151- J �' NE55 AND PROFESSIONS CODE:THE CONTRACTOR$LICENSE LAW DOES NOT APPLY TO AN OWNER OF � Pi10PERTY WHO BUILDS OR IMPROVES THERE-0N,ANO WHO DOES SUCH WORK HIMSELF OR HEPSELF OR II' �' iMROUGHHISORHEROWNEMPLOYEE$.PPOVIDE�iHATSUCHIMPflOYEMENTSARENOTINiENDE�OR m QOFFEREDFORSALE.IF,HOWEVER,THEBUILOINGORIMPROVEMENTISSOLDWITHINONEYEAROFCDMPLE- Z TION,THE OWNER-BUILDER WILL HAYE THE BURDEN OF PROVING THAT HE OR SHE�ID NOT BUIL�OR � IMPROVEFORTH�PURPOSEOFSALEj. ' ❑I,ASOVJIJEROFTHEPROPERTY,MAEXCLUSWELYCONTRACTING4VITHLICENSE�CONTRACTORS Q. .TO C�f�TRUCT THE PROJECT(SEC.7044,B1151NE55 AND PROFESSIIXJS CODE:iHE CONTRACTDRS LI- V21118fi011 A�J.AREA W' 'CENSEIAWDOESNOTAPPLYTOANOWN[ROFAPROPEfl7VWH0➢UILDSORlMPqOVESTHEflEON,AND �� WHOCONTRAC75FOR5UCHPROJECiSWITHACONTRACTOR�S)UCENSEUPURSUANTTOiNECONTRAC- QUANTITY DESCRIPTION FEE OTORS LICENSE LAWJ. m�` '. ❑I AM EXEMPTl1N�Efl SEC_ 6.8 P.G FOfl THIS REASON Q ���f �C.a"'� � � � �r �� � � u"� DATE OWNER F" e� V �v° � K /�kf � ,2��J ��.a � z' w ¢ LICENSED CONTRACTORS DECLARATION w /`�C�1�td? �� 1" �If� � � I HEREBY AFFIRM UN�ER PENW.iY OF PEFJURY iHAT I AM LICENSED UNDER PFOVISIDNS OF CHAPTEF � � �y,�..�r p_, 9�COMMENCINGWIhiSECTION7oa0�OFDIWS10N30FTHEBU51hE5SANDPROFE5510NSCODE,ANO Z , /��'� X MYLICENSE IS IN FULL FORCE AND EFF&C-. � }��}By�yg„�/ dJ �3 a w'Jf�T� m f 6f! b`f' 0 LICENSECLASS `��� LIC.ND. ����� �� j c vv`• �f �� y,�. ~ ✓p � , '2� � �� .1�A7-.if-8i's UDATE �,��4'�� CONTRAGTOR � `��'�L` a W � �l�� � � WORKERS'COMPENSATION DECLARATiON a P� �.ee��,� i p � IHEREBVAFFIflMl1N�ERPE�'ALTVOFPERIURYONEOFTHEFOLLOWINGDECLARATIONS: z � "� �d°/�p f�u' � __IHAVEANDWILLMAMTAINACERTIFlCATEOFCONSENTTOSELFINSUREFORWORKERS' _ p� Z CAMPENSATION,AS PqOVIDED BV SECTION 3�0o OF7HE L4BOR CODE,FOR THE VERFORMANCE U � ' , ��;��A` � I°�� Q OFTNE WORK FOR WHICH iH15 PERMIT IS ISSUc"D. � J ���"'O/` r �,{��.�zs�" �2'.�°e!a � C'f v�«;.� � 6 W �HAVENID WIILMAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIftE�BY SECTION Q ^37ooOFTHELABORCODE;FORTHEPERFORMANCEOFTHEWORKFOPWHICHTHISPEFMITIS ' ISSUED.MYVJORKERS:COMPENSATIDNINSURANCECARRIERqN�POLICYNUMBEFAflE: CONSTRUCTION __ __ � CARRIER ,1°�,���.�'=��lte� ��' �� PtAN REVIEW C� Z POLICYNUM6ER � �,� � �`m� ELECTRIC ��l��a C� Q 0 (�HISSECTKKJNEmNOTBEWMPLEfEDOFhiEPERMRISWRONEH�NDRE�DOLLARS(§100)CRIFSS). 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