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HomeMy WebLinkAbout13123 (299) ° ^ _��_ CITY OF DIAMOND BAIi DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES - .d ai66o E.coPiey��e s�i�i90 PRESS y�ti,�. (909)860-3195 Fax(909)861-3117 . BUII.I�ING PERiV1IT APPLICATION __ j ;r'' FIRMLY � JOBSITE `' " � PPLICATION PEFiMIT �, �J P!C(� Q ADDRESS ,, ��a� �F� .. �I�$.� DATE ��c� ,,:' NUMBER�`-'' � LA� # 1��, R, � � ISSUE ; TYPE OCG ` -- APN tOl� - TRACT � - � DATE CONST. "" GROUP p OWNER _�,_ . � � ; . o ADDRESS �p I'�r�`�' ��s = ` ZONING SETBACKS � �' z CITY _ TEL. FRONT �'� .o,- RW _ ❑T �p APPLICANT iP.� EL. ^�"; REAR L7' c ,� r Z SIDE/SIQE STREET RW ❑ � CONTRACTOR i �7 SIDE ; ❑��„^ ADDRE � ' PR�POSED USE �� L- � � � Cf1Y ' � ZIP TE . � b �' f w ARCM/ENG/ pyp.PWEL. NO. Z DESIGNER ' �!i�. � � �, I pw,. ADDRES RIES BEDROOMS = CITY ZIP' ,�� UNITS STO �' � "' DESCRIPTION SQ.FT. , FACTOR PSF ADJ.qREA7VALUATION. � - , , NER-BUILDER OECLARATlON . - .� .. SPR/ADD/REM � - � � � � � �� O C.� COUNTVWHIqi REWIRESAPER 17TOCONS7AULT,V THAT.I AM'cXEMPT KROM THE CONTRACiORS Ll-�- G829E/C2fPOR ,.. ' W CENSELAWFOH'.HEFOLLOW N P SON SEC.�7 3R:58USINESSAN�PP.OFESSIONSCOD6lANYCITYOR � (n � AL7ERIMPROVE,�EMOLI5H.ORFiEPAIRANYSTHL'G .W P8t10/�BCk... '.�.. :. " �� �... . �'�.;:�. � Z TUqE,PRpR TO ITS ISSUANCE,AI�.SO FEQUlRES THE�APPLICANT FOH Sl1CH PERMIT TO FILE A SIGNE� � ' � - � w STATEMENT THAT HE OH SHE I LICENSE�PURSUANT YO THE PROVISION3 OF THE CON7RACi095 L4 � - - . ....� ��-� '� �` ,� .� ' �,„ �' �CENSELAW(CHAPTER9(COMM NCINQ�M�TH$EC710N7000JOFDIVISION30FTHE9USMESSANDPRO� 'V" POOUSPB "'"' �-- �� � ' �� '� N ., � � ,FESSIONSCODE)OR7HATHEO SHEISEXEMPTiH��REFROMANDhIEBASISFORTHEALLECEDEXEMP- (� ', ''TION.ANYVlOUTIqVOF5ECT1�70376BV/W7APPLICANTFORAPERMTSUBJECTS HEAPPUCANTTO Z RE-RO�f � '� r ACMLPENALTYOFNOTMORE HANFNENUN�REDDOII.RRS�gSao)) '�' - - � . ❑I,ASOWNEFOFYNEpRO ERTY�ORMYEMPLOYEESWtlTHWAGESASTHEIflSO ECOMPENSATION, �� COffIfI18fC13I � �� - g. WILL DO THE WOqK,AND THE 5 BUCTURE IS Npt INTENOEA�OR.OFFERED.FOfi SALE(SEC,7oa4,BU54 .J _ � �� �.NES9PNO PROFE5510NS CODE: E CONTMCTOr�S UCENSE UW DOE6 NOT ApPLY 70 AN OWNER OF . ,� '.PfiOPEFlTYW1in8U11ASORIM OYESTHEREON,ANDWHOOOESSUCHWORKHIMSE4FOHHERSELFOR � � '��THRIXJGHHlSORHEROWNEMPLOYEES,PRQVIDE�THATSUCHIMPROVEMENTSAflENOTINTEN�E00q C� �- � ' "' ' � ' � ,OFFEREUFOR5ALEIF,HOWEVER711EBUILOINGORIMPROVEMEN71550LDWfTHINONEYEAflOFGOMPLE• .�iION,THE OWNEfl-9UILOER WI �FIAVE THE 9JRDEN OF PRAYIND TMAY HE OR SHE DID NOT BUILD OR '- _,� IMPROVEFOf1THEPURPOSEOF AI,E). - ' � �'' SIV V fdT CTI G Wi H LICENS D CONT CT RS � O F E P O E R T Y E X C L U E L C D fl A N T E F A O . �,{� ❑I,ASOWNFR TH q, .AM .� ¢ �'TO CONSTRUCTTHE PRQI�CT(EC:'lOIC,6USINE55 AN�PROFE$SIONS CODE:7HF CON7RACTORS LI- V31Ufl�1071 C ' ADJ.AREA� � �� � W 'CENSELAWDOESNOT LYTO OWNEflOFAPROPERTYWHOBU�LD50RIMPROVESTHEREON.AND . ' � ��,:WFiOCONTMCTS SUChpP ECTSWITN.ACONFRACTOR(9)LICENSEDPURSUANiTOTHECONiRAG '.. QUANTITY "�DESCRIPTIpN ' ' ' FEE- �, " � �TOR9 LICENSE )• � - . . . OC. . I� .. . . Q � ' �. o EXEMPT UtJDEH SEC{'�� B.8 P.C.F R 7HI5 REASON . �.. U . . . . . . LL pAiE � ¢� , � � , OWNER U �' I W � . - . UCEN E�CONTRACTORS DECLrARATION -� . . .. — W 9Q-- �' �C �S HEREBYAFFIRM UNDEH PENALT�If OF PERJUftYTHAT I AM LICEN9ED UNDER PHOVISIONS OF CHAFTER � . . , , I�i � ...B(COMMENCINOWITHSECTKKJ7p(p�OFD1YI510N30F7HE.Bt151NES5ANDPROFESSIONSCO�E,P.ND Z ' I MY LICEN6E IS IN FU.L FOFCE ANp EFFECT. m , ��� 0 IJCENSE GLA65 �, LIC.NO � . � - .. � U. DAiE � CONTRACTOR �� d � ; �. L6! il I J � � RS'COh9PENSATPON�ECLARATION � � WOR� p �� IF�flEBVAFFIRMUNDERPENqL OFPERJGRYONEOFiHEPoLLOWINGDECLqRAT!ONS: � � -��-�� "" ' I� 0 if4AYEANCNALLMA1NTAlI�ACERTIFlCATEOFCANSENiTOSELF-INSURE�POPNfORKEqS' _ '�,- - ' �� COMPENSAYION�,ASPRDVfDEDB`75ECTION'37ooOFYHELA90RCODE,FORTHEPEflFORMANGE U� , OF THE WORK FOR WFIICF�THIS PEHMI715ISSUED. � �. t„�_, _IHAVEANQWIILMhINiNt�WORKER3'WMPENSATIONINSURANCE,ASqE�UIRED6Y9ECTION � ' ' �6� 37000F THE LA80R CODE`FORTHE PERFOPMANC�OF THE WORK FOR WHICHTHIS PERMIT IS - ' . �• ' ISSUED.MY WOAKERS`c'�MPENSATION INSHRANCE-�CAf�RIER AND POUCY NUMBEF3 ARE: ..,CONSTRUC)TION��� II I �1. : ' � .. . ' � ... � j CARRIER 'F P'�AN REVIEW � I'�. �� A „_ � - � � �. Z, voucvNuneert . . '� ELECTRIC . il � pqryry � (RiI55:CiMJNN�NDTBE�OMH.EiEDOF7}1EPEFiMi7SPJRONEHUNDRED�OLtqFIS(5700)ORLESSj. PLUMBING e�41 I �� �IkMM � I CERTIFY THAT IN THE PE I ORMANCE OF THE WORK fOR WHICN THIS PEPMIT IS ISSUED,l - MECHANICAL � � �(!S �SHALLNOT�MPLOYANY�RSONINANYMANNERSOASTO,BECOMESUBJECTTOTHE " � � WORKERS'COMP6NSATIC� LAWSCIFCALIFORNI'A,ANDAGREETHAT�IF'ISHWL�eECOME INSPEC,TION-�FEE . ' ' ��. ��'` �° ' -�' � Sll&IECT70?HEWORKER'CONIPENSATIONPflOVI510NSOF5ECT10N37ooOFTHEIABOR - ISSUANCE }� "+aT��t��S��a , . = CADE,ISHAIFORTHW COb1PLYWITH7HO5EPROVI510N5. ��_. Q I �r,ir^nT r� ' � DATE: '� APpLICANT. SMIP .. � � WAHNING FAILURE TO SECVRE WOqKER3'COMPENSATION COVERAOE IS UNIAWFUL,AND SHALL 9E ENERGY P/C _ _ ' - � � SU&IECTANEMPLOYER70CPoMIIVALPENALTIESANOCIVILFINESUPTOONEHUNOREDYHOUSAND ENERGYPERMIT � DOLLARS(Si W,000),W ADDRIOPI Y T6iE COST OF COMPENSATION;�AMAGES AS PPOYIDEO FOF IN , i;,. J SECTIOM 3708 OF TH'e LABOR COD,INTERES7 AND ATTOftNEY'S FEES._ I, . , p�, . RETENTlON FEE: _ ' - �� CONISYRUCTION LENDiNG AGENCY PRE-ALT FEE: � � ' I� — O �... I HERE6Y AFFIflM�NDER PENALTY�F PEqJIIHY 7HAT THERE IS A CONSTflUCTION LENDING AGENCY ' FOHTHEPERF9RMANLEOFTXE ORKFORWHIGHtHISpERlAITISISSUED(SEC.308f,GV.C.). . Z W , i.� - � � ' -. . - , � .. . . , � '� � ... '. . ' � . . � LENDER'SNAME I II�II, !— LENDER'SADDRESS � ,. ' � i � . . . . ' , ._ -. ,,. �.. I.,I ' ..' ' I�I� � �ICERTIFYTHA7IHAVEREADTHISA�PLICA7IONANDSiATET}iATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES �, � - - . � IAGREE70C0 1THALlC17Y NO NANCESAND57ATEL4WSRELATINGTOBUILDING � CANSiqUC N, HEpEBYqUIliO ES ATIVESOFTHISCOl1NiVY0ENTERIIPONTHE . Z ABOVE•M IONE ROPER TIO. POSES. COMMENTS � , ' � II .�� A . . �� , II �'. , ', m PERMIT7E (PRINTJ I ` � � � II . � :ak0 �.�L. �; V� � , I � SIGNANREOFPEFVAIT�E , DAyE ' � '� �� �. . . . f � ECPT.NO, PAID@Y � - �� � �VAUDATION ���I� . 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