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HomeMy WebLinkAbout11916 �� _ CITY OF DIAM�ND BA& DEPARTMENT OF COMMUIVITY&DEVELOPMENT SERVICES 21660 E.Capley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS �''�*'� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �� / �,,� o ADDRESS � I � � ` �l�(�T�"C. -�pf►�, APPLICATION � � PERMIT. ^FA 1. P/C �� � DATE r� NUMBER # $ ISSUE ` TYPE ' OCC APN�OT TRACT DATE CONST. GROUP °C OWNER �-�S ti.�� r-.� 0 Q ADDRESS (o Y-1' G..-y�..�` �f ZONING SETBACKS � CITY ZIP �.`L(%�=re�. fr6(-�37i�i RE�ART RW ] APPLICANT TEL. � � SIDElSIQE STREET RW ❑ � CONTRACTOR nsN r-�/\. SIDE C ADDRESS �� � CITY ZIP TEL. PROPOSED USE�'L- c�"�T=--- � aJ .�(� w ARCH/ENG/ o �-1 i c,i{, t� t�-f- . t"` z DESIGNER � ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES �_BEDROOMS�_ � — cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFr'l/ADD/REM O A I HEREBY AFFIqM UN�ER PENALlV OF PERJURV THAT I AM EXEMPT FROM THE COMRACTORS L'- G8f898/CefpOfl W CENSELAWFORTHEFOLLOWINGREASON(SEC.703t.58U51NE5SANDPROFESSIONSCODE:ANVCfTVOq (n U COUNTyNMICHREWIRESAPERMI7TOCONSTRUCT,ALTER,IMPROVE,DEM.0U5H2ORREPAIRANYSTRUC- w NRE,PRIOR N ITS ISSUPNCE,ALSO REQUIRES THE APPLICAM FOR SUCH PERMIT TO PILE A SIGNED W Patio/�eck � STATEMENi THAT HE OR SME IS LICENSED PURSUANT TO TFiE PflOVI510N5 OF THE CONiRAC70R5 lI- � , c CENSE LAW(CHAPTER B(COMMENCING WRH SECTION 7000)OF OIVISION 3 OF THE BUSINESS ANO PRO� POOUSpB � FESSIONSOODE)ORhIATHEORSHEiSEXEMP7THEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- V TION.ANYVIOUTONOFSECTION7097.SBVANVAPPLICANTFORAPERMITSUBJEC7SiH'eAPPLICANTTO z Re-Roof C�C� - � � ACIVILPENALTYOFNOTMORE7HANFYVEHUNDREDDOLLARS(55oo�.�� 0 � OI,ASONMEROFTHEPROPERTV.ORMYEAIVLOVEESWITHWAGESASTNEIRSOLECAMPEhSATION, � Commercial - WILL DO THE WORK,AND THE 6TRUCTURE IS NOT IN7ENOED OR OFFERED FOR SALE(SEC.7�aa,BU51- J � NES:ANO PROFESSIONS CODE:THE CANTMCTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERiV YM10 BUILDS OR IMPROVES TMEREON,AND NMO OOES SUCH WORK HIMSELF OH HEflSELF OR � THFlOUQH HIS OR HEfl OWfJ EMPLOYEES,PROYIDm THAT SUCH IMPHOVEMENTS ARE NOTINTENDED OP m � OFFERmWRSILLE.IF,FiOWEVERTMEBIIILDINGOHIMPROVEMENTI550LOWITHINONEYEAROFCOM%.E- Z TION,THE OWNER-BUILDER YJILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILO OR = IMPROYE GOR THE PURPQSE OF SAIE). �y,� L'I.ASOWNEROFTHEPROPEHf'l,AMEXCWSNELVCANTRACTINGWITHLICENSEDCONTRACTORS � TO CONSTRUCT hiE PHOJECT(SEC.70M,B1151NESS AND PROFESSIO4S CODE:THE CONTMCTOFiS L:- VeIUa1i0f7 ADJ.AREA W CENSEUWOOESNOTMPLVTOANOWNEROFAVROPEFiNWHOBUILOSORIMPROVESTHEREON.AND Z WMOCONTMCTSFORSUG7PR0.1ECTSWITHACONTRACTOH(5)LICENSEDPURSUANTTOTHECONTflAG QUANTITY DESCRIP710N FEE �— rau ucEHSE uw.�. � 0 ❑1 AM XE R SEC. 8-6-PC:fCRF4i15 REASON Q � U � � �A7E OWNEH __ U Z W � LICENSEG CONTRACTORS DECLARATION W OC I HEREBY AFFIFUd UNDER PENALTV OF PERJl1RY THAT IAM LICENSED UNDER PROVISIONS OF CHAP'ER �, � 9(COMAAENCINOWITl7SECTION7000�OF�IVISION3OFTHEBJSINESSANOPROFESSIONSCODEAN� Z �� MY LICENSE IS IN FULL FORCE PND EFFECL m 0 LICENSE CLASS LIC.NO. � � J _ V DATE CONTRACTOF . _ �- W � WOfiKERS'COMPENSATION DECLARATION Q � I HEREBYAFFIRMUNDEflPENALTYOF PEiLIURV ONE OFTHE FOLLOWING DECLARATIONS: Z � I HAVE ANO WILL MAINTAIN A CEFTIFICATE OF CONSEP7T TO SELF�INSL'RE FOR WOFKERS' 2 � COIAPENSATION,AS PROVIDEO 9V SECTION 37ooOFTNE LABOR CODE,FOR iHE PERFORMANCE 'U OFTHE WORK FORYYFiICH THIS PERMIT IS ISSUED. � � � __I HAVE ANO WILL MAINTAIN WORKEFlS'COMPENSA710N INSURANCE,AS FE�UiREJ BV SECTION _,/n ) ^ QQ 37a0 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS --_- _ f"� `/ �/; ISSllEO.MYWOP.KERS'COMPENSATIONINSURANCECAflRIERANDPOIICVNUMBERARE�, CONSTRUCTION �•�/ � � v Q � �- > cnraaiea __ PLAN REVIEW __ Z roLICYNUMBER --- ELC-CTRIC Q � (twssEcnoNr��noTeEmaRt�EooFn+E�anur�sFoaorieFnx.oa�ooxin�as�ximioa�ss�_ PWMBING __,____ __ w Z ICERTIFYTH0.TIN?HEPERFORMANCEOFTMEWGRKFORWHIGHTHISPEHMITISISSUED,1 MECHANICAL ___.___, _ _ (J SHFLLNOTEMPLOVANYPERSONINANYAIANNERSOASiOBECAMESVB:ECiTOTHE � WORKERS'COM?ENSATIONLAWSOFCAUFORNIA,ANDAGREETHATIFISHOULDBeCOME INSPECTIONFEE ____ _ SUBJECT TO THE WORKERS'COMP'cNSA710N PROVISIONS OF SEC710Y 3700 OF THE LABOR f � COOE,ISHALLFORTHWITHCOMFLVWITHTHOSEPROVISIONS. ISSUANCE /��� O SMIP a p DATE:_ APPLICANT: ____"_'"__'_'___ ---- � J WARNINGFAILURETOSECUREWORKERS'COMPEhSAT!ONCOVERAGEISUNLAWFUL.ANOSHAILBE ENERGYP/C ____ _ � SUBJECTAN EMPLOYER TO CRIAIINAL PENALTIES AN�CIVIL FINES llP TO ONE HUYDREO THOLSAND ENERGY PERMIT OOLL4RS(5100.000).IN AODITION TO THE COST OG W MPENSATIDN,DAMAGES AS PFOVIDED FOR IN - $� J SECTWN3i0BOFTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: '._ �i:, � � . a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � p .." � ._ ---� � I HEREBV AFFIRM UNDER PENALTYOF PEPJURV TNAT THERE IS ACONSTRl1CTION LENDING AGENCv �` FOR iHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED�SEC.309],CIV.C.�. , , Z W � LENDER'S NAME _,.___ __ F- LENDER'S.1�DFE55_ � TOTP.L FEES "�� L-� � I CERTIFY THqT I HRVE READ THIS APPLICAiION AND STA7E THAT THE/100YE INFONMATqN IS CCRRECT. � IAGREETOCAMPLYNATFIALLCIiYAkDLWNTYORDMANCESAYDSTATEUW3RELATINGTOBUILDING � � � � CONSTRUCTION.ANDHEREBYAUTHORIZEREPRESENTATIVESOFTHISCOUNTVTOENTERUPONTME ��7 ��� Z ABOVE�MENTIONED PROPERTV FORINSPECTION PURPOSES. ,�/�v COMMENTS_ � _ '(Z�c �GL�S� — — - m PERMITiE N T) �7 � / �3 S� -_ _ � 9 TURE F PERMITTEE - E = RECPT.NO. PAID BY �' VALIDATION � � ~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROo--File Co GREEN— IicanYs C p %� PY� PY� PY. 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