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HomeMy WebLinkAbout13047 _�� CITY OF DIAMOND HAx � : DEPARTMENT OF COMMUNITY dc DEVBLOPMENT SERVICES � , 21660 E.Coploy Ihive Suite 190 (909)860-3193 Fax(909)861-3117 PRESS �'�'�� aw.nnvc rE�rr a�.ic��ox . FIRMLY � JOBSITE APPLICATION` �J � ADDRESS � G OATE ��Z'� �� ` NUMB R L3�� .'� � APN LOT TRACT g DA EE �����q CO ST. GROUP � OWNER p ADDRES 3 I�If�'i a ZONING SETBACKS � CITY ZIP��TEL.3t0 S{IO�%^� FRONT RW ❑ APPLICANT ��, REAR p � SIDE/SIDE STREET RW ❑ CONTRACTOR � L SIDE p ADDFiES g CITY ZIP R177Z TEL. � PROPOSED USE S � ARCFUENGI � !_ C�u� � SOC DESIGNER . C� ` NO.DWEL. NO. NO. ADDRESS � UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUIIDER DECLARATION SFRlADpIREM O 1 MEAEBY AFFIRY UNDER PENALT/OF PE0.RIFIY TN7 1 AM EXEMPT FROM 7NE CONTMCTOpS LF Gara9e/Ceiport CENSEtAWFORTNEFOILOWINGREASON�8EC.70.97.6BU81NE53ANOPROFESSIONSODDE:ANYCT'OR (n COIRlTYWHIGIREOUIHESAPERMRTOOONSTRUCT,A�TERMPROYE,OEMOUSFIORREPAINANTSTqUG W Petip/DBCk IURE tRqti TO ITS 169UANCE,ALSO REpU1qE8 TNE MiLIGANT FOq BUCN PERNIT TO FlLF A SIONED W tTATEMENf ilNT HE ON SHE IS LICEN6W PUNSUANT TO THE PHOYISIONS OF iHE CONiMCTOl19 lE CENSE LAW(CHAPTER Y�WMMENqNO WRH SECTION 7000)OF DIVISION�OF T!ff BUSINE53 AND PRO � POOVSpB fESSIONS OODE�OH TMATXE ON SHE IS EXEMPT TFEHEFRORI AND TIE BASIS FOR TME 11LLEOEO E7(EAIP- TION.ANYVpUTI0NOF8ECTION7o31.68VANYAVPLIGNTFOqAPERMITSI.BJECTSTNEMPUCIWTTO Z Re-Roo1 �„� A CML iENALT/OF NOT MORE T1MN FNE HUNDRED DOLU�RS(t600).�: � 04���EROF7NEPROPERTY,ONMYEMPIAVEEBWITHWAGESASTHEIRSOLECOMPENSAipN, Cpmmg�Cl81 - NfILL DO THE WOFK,M1D THE STRUCIURE IS NO7IMENDED OR OFFERED fOR SALE(SEC.70N,BUSI• O � �NOPERTYYM1iOBUi.D50RYP�ROVES�T11nEREON,OMMOSUDE98UOCHNqANHIAI3ELFORHENSELFOR � ¢ 7Hfi0UC1N NIS Ofi NER OMIIJ EMPLOYEES,PpOVIDED liYlT SUCM pRVROVENEMg 11NE NOT INTENDFD Oti L� p OFFEAmPORBALEIFF10YfEVERTMEBUILOWOOR�iPiWVEMENT1880LDWITIiNONEYEAROFCON0.E- � 710N,TNE OWNER-0ULDER N7LL IUVE THE BURDEN OF PROVNO TliA7 HE OR SME DID NOT BURD OR �IPRDVE FOR TME Vl1HPOSE OF&LLq. yJ ❑4�01AMERDF111EVPOPEpTY,l1ME70CLUSNELYOOMpACTINOWIi}IUCENSEDCONTRACTORS � TO CONSTRUCr 7ME PRWECT(BEC.7oH,BUBNEBS AND PROFESSION9 ODDE:tHE CONTMCTOp9 LI• V8111lilOfl ADJ.AREA CENSE LAW DOES ND�APp�Y TO AN 01MJER OFA PROPEATV N1FW BUILD9 OP MIPRDVES i/1EREON,Nlp WIIOOO!lfRACTSFORBUdiPp0,1ECTSYNTHACONTMCTOR�S�UCENSEDPUR5WINTTOT1E00NTHhC QUANTITY OESCRIPTION �E � 1DR3 UCENSE UW.) � O 1 M1 p(EMPf UNpER SEC. B.i P.C.WN THIS REASON Q ' � " 25. /� � DATE OWNER U � !(9Q S M� '''1 � LICENSED CONTRACTORS DECLARATION w �i.l O �L. � I IIEfiEBY AFFWIJ UNpER PENALT!OF PERIURY 7Ml{i 1 AM UCENSED UNDER PRO4ISqNS OF CHAPTEq � � •(COMNENCWOWfTMBECTION7000�OFD1VISqN�OFTHE8U31NE6SANDGHOFE9510NSCODE.AN� Z �C. �L DU N Y l 1 C E N S E I S M l F U L L F O f i C E A N D E F F E C T. � � UCENSE CLASS G�' O 4C.NO.___L_%T �Z � � w����carirAacroa JSL„�,c��' . a = WORKERS'COMPENSATION DECLARATION a N I HEREBV AFFlIIM IRDER VENALTY OF PE0.1U1iY ONE OF TNE FOLLOMANG DECLAMTIONS: V � ZQ � �I/UYEAHDWILLAMMITNNACEFifIFICATEOFCON3ENTT08ELFN5UREFORNOFlKERS' 2 COMPFHSA710N,11SPROVIDEDBVSECTION37000FTHElABORCODE.FORTHEVERFOPoAANCE CJ OF TXE WOFK FOR NM111CM TF116 PERMI718ISSUEO. � � �IHAVEANDNfILLMAIN�ANIVYOANERS'COMPENSATpNIN3URANCE.ASREWIqE�8Y6ECTION m00FT1ElABOROODE,FORTIEPERFOIIMANCEOFTHEWORKFpqWHIpiTHI3PERM1T13 � ISSUm.W WORKEpS'OpMPEN9AT�SURANQE CMRIER AND POLICY NUMBERARE: CONSTRUCTION � CANRIER J 1�lTt K.d PLAN HEVIEW � roucvMN�BER Z!� 9 o�3�h LECT I 8 f�e��+���Te���o�TME�w��swnar+��ooa.w�sR+WI«+�ss} PLUMBING �r. Z� I CERTIFY THAT N17HE PENFORMANCE OFTHE WORK FOR WHIpiTH15 GERMIT IS ISSIIED,l MECHANICAL FJ'� SWLLL NOT EMPLOY M1Y OERSON IN ANY MANNER SO A9 TO�COME SU&lECT TO iHE -� Vj NIORKERS'COMPENSATION LAWS OF GLIFORNIA,M1D AOREE hUtT IF I SVWULD BECOME IN CTION FEE SUBJEC7 TO TNE M�OFiNENS'COMPENSATION PROV1610NS OF 6ECTqN 370a OF TNE LABOR O caoE,�a�w�n�caa�r wmi rNose rnovisior+s. ISSUA C p DA7E: APPLICANT: SMIP ��,�� � �_�a` � WARNING:FA0.LNETOSECUREWORKERS'CdAPEN6ATIONCOVERAOEISUNIAWFUL,ANDSHALIBE ENERGVP/C _.ALy► L1��i',� �y SUBJECTANEIAPLOYERTOdiIMINALPENALTIE6MI�CIV�FN/ESUPTOONEHUNDREDTFIOUSMID v�i �r,t�sr` � DOLLARS(i7oa,0o01.INADDrt10N 70THE COSTOF WMPENSATION,�AMAOESAS VROVIDEO FOR IN ENEROY PERMIT �, n�a f. }, WBECTpN 7700 OF TFIE IABOq COpE.MVTEREST,MD�TTORNEY'S FEES. 1 3 �•� ta_i ' fiETENTION FEE: ��i�� O CONSTFUCTION LENDING AGENCY PRE-ALT FEE: �"" � IHEHEBVAFFIRMUNDERiENALTYOFPERNRYTHATTXEREISACONSTRUCTIONLENDINGIIGENCY PoR TME PERFORMANCE OF TNE WORK POH MRi1CH TNIS PERMIT I6 ISSUED(SEC.]w1,CIV.C.�. � � LENDERS NM1E �S LEN�ER'SADDRESS W �CEFT�FYTUITIHAVEREAD7HISAPPUCAipNANDSTATETYiATh1EMOVENIFqiNAi%NYISCOHRECT. TOTAL FEES � Il1OREE TO COMPLY VtlITX AlL CT'AND WUNTY ORDfJMICESAND BTATE I.�W9 qELATINa TO Bl10.DINQ � CONSTRUCTION,ANDMEREBY�UIFIORREREPFESENiAT1YESOFTHISCOUNTYTpENTERUPONTHE �ove��raovearr wa nasvEcran runvosEs. 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