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HomeMy WebLinkAbout14139 (657) �"'i CITY OF DIAMOND BAx ���� --- �� ---1 DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES j � . 21660 E.Copley Drive Suite 190 ' � (909)860-3195 Fax(909)861-3117 -�r PRESS �����M��� BUII.DING PEltM1T APPLICATION FIRMLY QJOBSITE ��.�ut�i', f�! � . ,J�`�, ,��1C..Y�r'"��. DATECATION %L�B �N-!I � NUMB R e�.. � #!C ¢ ADDRESS � APN LOT T ACT_ �SSUE • v ' TYPE OCC DATE CONST. GROUP p OWNER .��-�C�„j� /j-�E�'�✓ o ADDRESS � � ��'1�" S--r�'�+''`�--- ZONING SETBACKS � CITY <✓.�. �. 21P lty,S TEL. �I '"�r I"" "�"� FRONT RW ❑ APPLICANT�' ' - �� T�� ` 9 • ��z, S DE/SIDE STREET_ RW C � CONTRACTO �1���C 1 �-� �,C�;+�� I��� � -�- SIDE � ADDRES$ f���l.�`% ����GM� ✓+C _ �S-� � , � CITY �-�eia�-°'£' ZIP �9 af�` TEL. '�;�"�'S'�c,v�%/2� PROPOSED USE 'lf+Ct' sg�,._ �F . g: �5�,�.F> /` ��_ � � n'.2 t 'C.`.'>` .. w� ARCHlENG/ �- W DESIGNER - — NO.D1NEL. NC. NO. 4 ADDRESS UNITS_ STORIES BEDROOMS � CtTY ZIP TEL. — � tn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADDIREM O I HEREBV AFFIqM UN�ER PENALTY OF VERriIRY THAT I AM E%EMPT FAOM THE CONTRACTORS ll- G8BQ0/C3fPOrt W CENSELAWFOH7HEWLLOWINGREASON�SEC.7031.58USINESSANOPROFESSIONSCApE:ANYCITYOq (n ZCOtiNTYNM1IICHRE4UIRESAPERMRTOCONSTRUCT.ALTERIMPROVE,DEAIOLISH.ORPEPAIRANYSTRUC- W pgtio/�BCk T1RE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICAN'T FOR SUCH PERMIT TO FILE A SIGNED W STATEMENf THAT HE OR SXE IS LICENSEO WRSUANT TO TNE PROVISIONS OFTHE COA;TRACTOAS LI. W � CENSE UW(CHAPTER B(COMMENaNG WITH SECTON 7000)OF DIVISION 30FTHE BUSINESSlND PRO- � PODVSp9 FESSIa15CODE)ORTHATHEORSHEISE%EMPTTHEREFROMANO7HEBASISFOR7HEALLEGmEXEMP• (� U 710N.ANYYIOUTIONOFSECTIONTOEI.SBYANVAPPUCANTFORAPERMITSU&IEC7STHEAPPIICANTTO Z Re-Roof � ACMLPENALTYOFNOTMOi7ETWWFIVEHUNDRED�OLLAR5�55a0).): Q � ❑I.ASOWNEROFTHEPFOPERTV,ORMYEAIPLOVEESWITHWAGESASTHE�RSOLECObIPENSATION, COfi1R19�Cidl WILL DO THE WORK,MIO THE STRUCTURE IS NOT INTENOED OR OFFEflED fOR SALE(SEC.70a4,BU51- J � NE43 M1D PROFESSIONS CODE:THE COMMCTOpS LICENSE UW DOES NOT APPLV Tp pp�pWNER OF � PiIOPERTY Wl10 BUMSOR IMPROYES THEREON,AND WHO DOES SUCN N'ORK HIMSELF OR HEftSELF OR C[ THWOl1GH HIS OR HEi10WN EMPLOYEES,PROVI�E�THAT SUCH Il:1PpOV6MEN7SARE NO7INTENDED OR m � OFFERE➢FORSILLEIF,FiOWEVERTMEBUIIDMGORIMPROVEMENTIS50LDYATMNONEVEAROFCOMPLE- � TION,THE OWNERSl11LDER WILL HAVE THE BUR�EN OF PROVING iHAT NE OH SHE 010 NOT BIJILD OR pdPROVE FOR TFIE PUHPOSE OF S�LE). w ❑I.A$ONMEROFTHEPROPEHTV.AME%ClUS1VELYCONTRACTINGWITHUCENSEDCONTRACTORS � TO CONSTqVCT THE PROJECT(SEC.70N,BUSINESS AND PROFESfilONS CDDE:THE CONTRACTORS LI- V81U2hOf1 P,DJ.AREA 4J CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILOSORIMPROVESTHEFEON,AN� ---�"— � 1M1000MRACTSFORSUCHPN0.)ECTSWITHACAMRACTOR�S�UCENSE.DPURSU,WTTOTHECONTHAC- QUANTITY DESCRIPTION FEE OiORSUCENSELAW.). � �� /z �% i ❑IqrylE](EMPTUNDERSEC. 6.&PC.fORTHISREASON Q j`� ��,Sn'„'�"' �^�'.�- .. � U � — ¢ OATE OWNER___ ___ U Z W Qd LICENSED CONTRACTORS DECLARATION W 2 I HEREBV AFFIRM UNDEN PENALTY OF PERJURY THAT I q0.1 LICENSED UNDeR PROVISIONS OF CNAP i Eq � � B(CAMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUS�NESSAND PROFESSIONS GODE,AND Z MV LICENSE IS N FULL FO{RCE AND EFFECT. J ( � LIGENSE CLA55 i �� LIC.NO.�"' ��I ✓ _ � p � �-.:-•--.�-_'�'a wDATE I�/ � B � CON7PqCTOR �'' _�__L!�� -•.. d - 3 � WORKERS'COMPENSATION DECLAfiATION �•���� ,q,r' �� • � � I HEREBY AFFIRM UNDEH PENPLN OF PEiiJURV ONEOF TNE FOLLOWINO OECLAFAilONS: �� � � _IHAYEANDWILIMAIkTA1NAGERTIFIGTEOFCANSENTT03ElF-INSUREFOFWORKERS' _ � � C0IAPENSATKKV,A57ROVIOEDBVSECTION37000FTHELABORCODE,FORTHEPERFORMANCE U � OF TME WORK FOH WHICH TMIS PFRMIT IS ISSUED. � � � W IHAVEANDWILLMAINTNNWORNERS'CAMFENSATIOIriNSURRNCE.AS'REpUIRED9Y-5EGTYON Q 370o OF THE LABOR GODE,FOR lHE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS � ISSUEO.MY WORKERS'COMPENSATION WSUR4NCE CARRIER 4ND POLICV NL1Mg'eR ARE CONSTRUCTION __._,_,__„_ J j caaaiEA _. ____—— PLAN REVIEW ___ ZroucvNUMeEq —� ELECTRIC ___ � � `� 0 (iHISSCLTKXJNE�ND7BE�7EDOF7HEPFRlM6FORaNEF0.NDRE0D�llARS(Stao1�LESS4 PLUMBING .___ ��� W i CERTIFYTHAT M THE PERFORMANCE OF THE WORK FOR WH:CH THIS PERMIT IS ISSUEC.I MECHANICAL Z — (} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOMF.SUBJECT TO THE ��`�' ��n � WORKERS'COMPENSATIONLAWSOFCPLiFORNIA,ANDAGREETMATIFISHOIk.OBECOM INSPECTIONFEE _ � � 6dQ F SUBJECTTOTHEWORKERS'COMPENSATIONPROVIS!ONSOFSECTION 7000FTHE r�.y � CODE.I SHALL FORTMWITH COMPLY WITH THOSE PROVI NS.�� ISSUANCE .Cr 6d'�.� _ ^7 �.� 1r .t, �,7p�y9 0 OATE: •� ✓ ���� APPLICAN7: �'�vE" _ ��' J SMIP 5 Ll'1f1 1!'RS A J WARNMG:FAIIURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFl1L AND SHALL BE ENERGY P/C _.._._...�___ ��r�i�•� _ LL SU&IECT AN EMPLOYER TO CFIMINpL PENALTIES AND CIVIL FINES UP 70 ONE HUMRED THOUSAND ENERGY PERMIT DOLLARS(410�,OOo),IN AD�ITION TO TNE COSTOF COMPENSA:ION.DAMAGES AS PROVIOED FOR IN �------�-----�-- ----- — � SECTtON3loeOFTHEIABORCODE,INTEREST,ANDATTORIvEV'SFEE3. RETENTIONFEE: _____ _.__ _ OCONSTRUCTION LENDING AGENCY pRE-AlT FEE: _.__ _. � IHEREBYAFF�flNUNDERPENALTYOFPEflJURYiHATTHEREISACONSTRUCTIONLEry�MGAGENCY � FORTHE PERFOPMANCEOFTHE WOFK FOR WHICH TNIS PERMIT IS ISSUED(SEC.�097,CIV.C.). •�� � �•��•� �� ��+••�•.� Z iJ.l — - .. ... � . . .. � LENDER'SNAME_ ___ ... .,..,....m.,....... ..v... ......,�.......r.,.," F- LENDEq'SADDRESS ___ _ i , „ �, W 1 CERTIFY 7HAT I MAVE RE/1�THISAPPLICATIONAND 57ATE TNAT THE ABOVE IYFORMAT�N IS CORRECT. TO i AL r E ES n + + I � IAGREETOCCMPIYWITHALLGTVANDCAUNTVOR�INANCE5AN�5TATELAWSRELATINGTO8UIL01NG �� 4 �' � CONSTRUCTION,AND HEREBYAUTHORIZE REPRESENTATIVES OFTHIS COUN7V TO ENTERUPON 7HE Z ABOVE-lAENTiONE�PROPERTY FOR INSPECTION PURPOSES. 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