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HomeMy WebLinkAbout15580 ' �, � ,y � CITY OF DIAMOND BAB � � j V � �---��--- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES \� 21660 E.Copley Drive Suite 190 - - (909)860-3195 Fax(909)861-3117 RESS '�����°� BUII.DING PERMIT APPLICATION FIRMLY ��y � JOBSITE - � - / APPLICATIO PERMIT ���!� P/C^ `/� � ADDRESS � �'iJ's"`�i'���C�I� C- DATE � �� NUMBER� 4., ' #� issue rrPE occ � APN K � LOT TRACT r � DATE CONST. GROUP p OWNER M�►T��a LL ADDRESS ��� ` C�'t1�3.,=�:�'"<=L`• . - ZONING SETBACKS � CITY �• `'i ZIP""' �� � TEL. ���� " �..�: FRONT RW � _ � !� REAR � APPLICANT l:����.�� TEL. �r"�.�3 r�v" � -r � r SIDEJSIQE S?REET RW ❑ CONTRACTOR ..-r���. ��� SIDE O � ADDRESS "�' t • � � CITY �.-�+_+� ZIP�f j,i� TEL. ��..� _'"% PROPOSED USE w ARCH/ENG/ /+� Z DESIGNER - � � ���� +''"`���t- � NO.DWEL. NO. NO. ADDRESS • e ' `" �'� UNITS STORIES BEDROOMS � CITY ��iJ��i���:'� ZIP��` �TEL./1` ��'`'�� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION OOJ1fNER-BUILDERDECLARATION SFRlADDlREM � p I HEREBY AFFIRN UNDER PENALT'OF PERIUNV THAT I AM EXEMPT FROM THE COMMCTORS LI� GefB JB/CAfPDR W CENSELAWWRTHEFOLLOWWCaREA50N(SEC.7031.SBUSINESSANDPFOFESSIONSCO�E:ANYCRVOR (n _ Cj ��.JTYWHICHREOUIRESAPERAIRTOCONSiRUCT.ALTER,IMPROVE,�EMOLISH.OqREPAIRANYSTRUC- W P8I10/DBCk WNRE.PRIOR TO ITS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PENMIT TO FILE A SIONED W � STATEMENT THAT HE OR SHE IS LICENSEtl PUiiSUANf N THE PROVISIONS OF THE CON7AACTORS L:- CENSE UW(CHAPTER D(COMMENCING WITH SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PRO- � PooVSpa FESSpNS CODE)OR THAi HE OF SHE IS E%EMPT 7HEREFROM AND THE BA515 FOR iX'c ALLEOE�ExEMP� TIONAM'YIOLATIONOFSECTION703158YANYAPPLICANTFORAPERMITSUOJEC75THEAPPLICANTTO Z R2�ROOf � ACML PENALTV OF NOTMORE THAN FIVE HUNDREO DOLLARS(5500).): � �I,ASOYMEROFTHEPROPEHIY,ORMVEMPLOYEESWITHWAGE5A57HElASOLEGOMPENSATION, 0 COffIRIBfCifll WILL DO THE WOAK,AND THE STRUC7URE IS NOT IN7ENDE�OR OFFEilE�FOR SALE(SEC.70d4.6U51- J NESS AND PHOFESSIONS CODE:THE CANTRACTOPS LICENSE U'N OOE&NOT APPLV TO AN OW4ER OF � PROPERTYVYF106UILDSORIMVHOVESTHEREON,ANDMMODOESSUCHWORKHIMSELFOqHEflSELFOR � � 1Hqd1aN NIS 00.HEP OMM EMttOVEES,PROVIDEO THAT SUCH IMPROVEMENTSAFiE NOT INTENDED OR m QOFFEREDFORSALE.IFFiOWEYEFITFIEBUI�DINGORIMPqOVEA7ENi�SSOLDWITHINONEVEAROFCOMPLE- Z TpN.TNE OWNER�BUILDER YALL HAVE iT7E BURDEN OF PROYING THAT ME OH SNE DID NOT BUILD OR `� = IIAPpOVEFORTHEVURPOSEOFSALE�. w r'I,ASOWNERCFhIEPROPEiRY.AMEXCLUSIVELVCONTRACT�NGWITH�ICENSEDCOMRACTOFS � TO CONSTRUCT THE PRQIECT[SEC.7041,Bli51NE5S AND PROFESSIONS CODE:TY.E CONTRACTORS LI- ValUallOfl AQJ.AREA L�J CENSEUWDOESNOTAPPLVTOlWOWNEROFAPflOPERTYWHOBUILDSORIIAPROVESTHEREON.AND � Z WHOCOMMGTSFOHSUCN7qq1ECTSWI'HACON7MCfOR�S�LiCEN5E0PURSUANTTOTHECOMMC- QUAN?ITY ESCRIPTION o— FEE �- toas ucer+se uw.�. a J O G�Mi EXO�APT UNOER SEC. _U.e P.C.FOR THIS REASON � � Q LL OATE ONTIER ~ � I W 4 LICENSEO CONTRACTORS DECLARATION �j C (Z IHERE6�AFFlRMUNDERPENALNOFPERJURVTHATIAMLICENSEDUNDERPROVISIONSOFCHAGTER �. r��^ � B(COMMENCINO WI'fH SECTION 7000)OF DNISION 30FTHE BUSINESSAND PPOFESSIONS CODE,AND Z � X MY LICENSE�5 W FULI.FORCEAND EFFECi. m �!L ' ' iI ` r C L1J •' -> . ,,,>�4, � G: A\ � LICENSE CUSS - LIC.NO.�� T� �✓ S 1 � } 9 n � DATE � ���� CONTRACTOR. �'✓° ' *-` _ W )) � WORKERS'COMPENSATIOND ARATe�r/��.y"} . Je ' � y ��% YJ � I HEREBY AFFIRM UNDER PENALT'OF 7ERJUiiY ONE OFTH FOLLONiING 0 NS.� Z r � _�I HAVE AND WILL MAIMTPJNA CERT�FICATE OF CONSEN ELF-INSURE FOR WORI(E '\� _ OOMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR E'FOR' F CE U � FTHEWOPoCFORWHICHTHISPER6AfTISISSUED. � � W IHAVElJJDW�LLMAINTAINWORKERS'COMPENSATIONINSURAkCE.ASRE�UIREDBYSECTION 4 37000FTHEIABORCODE,FORTHEPERFORMIWCEOFTHEWORKFORWHICHTHISPENMRIS �r� � � ISSUED.MVW00.K 5'COMPENSATIONINSl1RANCECARRIERANDPOiJGYNUMBERARE C NSTRUCTION +� "^����� 4 �� C__ � LA EW � `-�� 'f � CMRIEH g �' - / � POLICV NUMBER � ^ � � ' ' __ � +L CTR� �' r? 0 (R165ECf10NNE�NOTBEO�AAPlE7'mOFTFiEPERMTISFORaNcHlXd7RED 5100) f.'� �b9[. � __' `�„�� �I W ICERTIFYTHATINTHEPERFOFMANCEOFTHEWORKFOAWHICHTHIS, RMITISISSUED. N� �hICAL (�j SHALLNOTEMPIOVANYPEN50NINANYAAANNERSOASTOBECOME BlECTTOTHE , �' l� � WORKERS'COh1PEN5ATION1AW50FCALIFORNIA,ANDAGREETHATIF HOULDB'cCOME � INSP FEE ___. t S SU&IECT TO TNE WOPKERS'COMPENSATION PROV:SIONS OF SECTION 3 L480F — � CODE, SMALLFOfiiHWfiHCOMPIVWITHTHOSEPflOYI510NS. �SSUANCE r @y � p DATE: r�� APPUCAN7: ��'"'a•,�'�� SMIP ____� �� '') �9�3@ W � y� LLWARNING:FAILVflE TO SECURE WOFlKERS'COMPENSATION COVEAAGE IS UNLAWFUL,ANO SHALL BE ENERGY P/C f�T' �� SUBJECTANEMPLOVEflTOCflIMINALPENALTIESANOCMLFINESUPTOONEHUNOREDTHOl15AND ENERGYPERMIT _ t���w $`��~ ��`fA'�'�—��Jf..z �OLVAS f5100.000).IN AbDIT10N TO THE COST OF COMPENSATION,DAMNGES AS PROVIDE�FOA IN { g y �( /y � SEGTIONJ7oBOFTHEI.ABORCODE.PITEREST,ANDATTORNEV'SFEES. _ ���J.AS-.S.J%+�;-� t�^'x'�"���'"b��� � RETENTION FEE: _� pW., CONSTRUCTION LENDING AGENCY PpE-ALT FEE: � I HEREBV AFFIRM UNDEH PE�ALTV OF PERJURY THAi THERE IS A CONSTHUCTION LeNDING AGENCY _ FORTNE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT�S ISSUED(SEC.30B],CIV.C.�. Z _—" W � IENDER'S NAME _—___-- _ F- LENDER'SADDRESS T /y� WI CERT�FY THAT I HAVE FlEAD THIS APPUCATION AND SiATE TNAT THE ABOVE MFOflMRTION IS fARRECT. TO I AL FEES �(/L/}�'��� � IAGREETOfAMPLYWITHALICITYANDCOUNTVORDINANCESANDSTATELAWSREIATINGi00UIL�ING CONSTRUCTION,AKD HEREBY AUTNOHIZE REPRESENTATIVES OFTHIS COUNTV TO ENTEFl UPON THE �� /� 1 C/"!-y�. T-�� Z ABOVE-MEN�A PROPERTV FOR INSPECTION 7URPOSES. 1 COMMENTS__�„v_V���r_�L..j S"'L''"��� �� .�r ._'LJ�[ �( L � � !. f.i (�.� �Ci�'--'v — � st3• � n.,•.. ,Y,.��,.,,.� -.S — m PERMITTEE NAME(PRI --- �. ¢ �.EO�`�`_.�-�� '/� ' � N F ! f:%C:` °i � �Ra`ry'Tp UREOFPERM�nEE D E � RECPT.NO. 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