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HomeMy WebLinkAbout13793 �� CITY OF DIAMOND BAI� • � � , DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ` � �w � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS � 'A�'� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE }_ Q'�j2 l p/s f� APPLICATION PERMIT � /C � ¢ ADDRESS�c"/ J �8��GK{��Ts R.i�- �) �, � � �'Z� p DATE NUMBER $ ISSUE TYPE OCC ¢ APN_ �O �.L TRACT _ DATE_ CONST. GROUP p OWNER "� .,{� � ''`� ADDRESS �,�r73 +�1��y�lh "tt��, �' ' '� ZONING SETBACKS �� y FRONT _ RW C CITY� � � �IE 7 ZIP�[�_ TEL. ��'.� � ,� REAR �_. APPLICANT•_ � � TEL. • '� SIDE/SICE STREET RW C. � CONTRACTOR ��i� �< i�� ^ SIDE L ADDRESS J- ' ( '� � PROPOSED USE_� �t�f` �'L��� � CIIY �lV �✓ Z!P g' ". rEL.�-' (' :. - ' ^� v' i:4� ';� o ARC�H/ENG! z DESIGNER - NO.DWEL. �. NO. � ADDRESS UNITS STORIES BEDROOMS � ClTY ZIP___ TEL. � y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADDlREM O p I HEREBY AfFlRM UNDER PENALTY OF PERIURY THAT I AM E%EMVT FPAM TNE CONTRACTORS LI- Gdf8J2/�CdfpOf[ 11J CENSEUWFORTMEFOLLOWINGfiEA50N(SEC.7031.SBUSINESSAND�ROFESSIONSCWE,ANVCITYOR (n C7 COUNTYNTiICHREWIRESAPERMITTOCONSTRUCT,ALiER,iMPROYE,�EMOlISH,OFRE?AIRANYSTRUC- W Patio/Deck W 7URE,PRIOR TO ITS ISSUANCE,AL50 RC-'�UIRES THE APPLIC/�YT FOR SUCH PERMIT TO FILE A SIONED W STATEAAENT THAT HE DR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACiORS LI- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 70001 OF OIVISION 3 OFTHE BU514E55 ANO aR0- LL' POOUSpB_ FESSIONSCODE)ORIHATHEORSHEISEXEMPTTHEREFROAAANDTHEBAHSFORTHEALLEGEDE%EMV- � — TKK7.ANYVIOlR710NOFSECTION7o3�.5BYANVAP?LICANTFORAPERMITSUEUECTSTHEAPP.ICANTTO Z F{B-Fl0o1 � �qVIL PENALTY OF NOT MOFE THAN F!VE MUNDRED DOlURS(f5ao).�: � �I,ASOWNEHOFiHEPFYOPERT.;ORMYEMPLOVEESWITHWAGESAS'HEiR50L'cCOMPENSATON, � Commercial 1MLL DO 7HE WCRK,MD 7HE STRUCTURE IS NOT INTEN�7ED OR OFFEREG FOR SALE(SEC.7Q44.BU51- _I NESS ANO PROFESSIONS CODE:THE CAN7RACTORS LICENSE LAW OOES NCT A?PLY 70 pN OWNER OF �y� / ,R� i �? � PROPERTVYhiOBU!LDSORIMPROVESTHEREON.ANDWHO�OESSUCHWORKHIMSELFORHERSELFOR � � � � �` ��4,v CC THRIXIGHHISORHEROWNEMPLOVEES,PROVIDE�THATSUCHIMPROVEMENTSANENOTIN7ENDfDOR � m OCFFEREDFORSALEIF,HOVJEVER,h1EBUILDINGORIMPROVEMEMI550LDWITHiNONEYE0.ROFCOMPLE- �� �R zJ"� � iION,THE OWNER-BUILDER WILL 11AVE THE BURO[N OF PqOVING THAT HE OR SNE DID NOT BUIID OFl � � IMPROYE FOR SIiE aUNPOSE OF SALE). ❑i,AS 01HNER OF TME PROFERTY,AR7 EY.CLUSIVtLY CONTRAC'��G WI?M l�CfkSEJ CANTRACTORS ,.��.q � TO CONSTRUCT h7E PRQIFCT�SEC.7014,OUSINE55 AND PROFESSIONS CODE.THF.GONTflACTORS LI� V0IU8LI0� _�__V�4'" C� ADJ.AREA lL CENSE UW DOES NOTAPPLYTOAN OWNER CF A PROPERTY W}IO BUILDS OR IMPROVESTHEREON,MA — � YYFiOCOMMCTSFORSUCHPROJFCTSWITHACONTRACTOR(S)iICE!15EDPURSIIANTTOTHSCONTRAC- QUANTITY DESCRIPTION FEE Y TORSLICENSELAW.). � {� � � ❑i AM EX'cMPi UNDER SEC.__._ _.__B S P.C.FOq THIS HEASON Q , � "4.i.'./`�' i 3 — ---------- — U �l � LL cr� _ A e DATE _—___ OWNER_'___ __"'__ V i a✓ — �Z — —- -- --- �i--- LICENSef CONTRACTORS DECLARATION w � IHEREBY1IFFIRIdUNDEnPENALTVOFVE:JURYTHATIAM4Cc'NSEDUNDEFPROVISfD�50FGhAPTER �� � Y(COMMENCINO WITH SEGTIWJ?Oa010F D!VIS�ON a OFTHE OU5INESS AND PROFESShNS CCCE,ANO Z� MY UCENSE IS IN FULL FOR.^,E AND EFFECT. m � LICEN9ECLASS_�G 1�G7� �IC.NO._�� � � � J U DATE__ n�, .� CONTRACTO �_. I/���� d ,� � �-6--�--- -,�,� � -- - - � WORKERS'CUI+hPENSATIQN�ECLARATION Q y U ---- � I Y.ERFB�AGFIRM UNDER PENAtTV OF 7cRJURY C�IE CF 1 NE FOLLOWI.9G DECLAAATIONS � 0 _;_i NAVE AND WiIL MAMt11iN A CERTIFIC 1TE OF CONSENT TO SELx�l4CUFE FOft WORKcRS' � Z - � � COkIPEYSRTbN.A5 PROV!DEO BY SECTICY 37ooCF THE LABOfl::0'JE,FOR THE PERFORAIANCE `UL I ___ OF iHE WORK FOR WHICN THIS PEflM!7;S ISSU[U. � W I HAVE AND WILL MRINTFIN WCRKERS'CUMPeNSA:ION INSURANCE,AS REOJIRED BV SECYION I�� � � 3]ODOFTNELABORCODf,FOR'Fi[PERFORMl.NCEOFTHEWORKfiJP.W�IL4THi5PEFM1T15 � ISSUED.MYYJO KER"CO-PENS.�.'fl INSURAP!CECARP,IERANDPOLICY'JUMP.EFARE' CONSTRUCTION __,______________ /�� � CMPIER���- L��� -------- I PLAN REVIEW ' � .l Z PULICY NUMR[R � j ELECTRIC �__,� _ ��� Q -�-��°� —��-----�-- > � �H55ECi}7NNF�NOTBF.O�.iPLE;IDOFTIEPEW.H71Si{N;ONcF0.MOREDDOLIFFS(510D�ORLESS� 1 PLUMBING -. -- ---- Z I CERTIFY THAT IN THE PEFFORMANCE OF 7HE WORK FOR WHICFI'FNS PERMIT IS ISSUED.I :'dECHANICAL ________.._ ___. � SHALL 1:0T EM?LOY ANV°ERSON IN dNY AIANNER 50 AS?O BECOMF SUlJF��p THf � WORK.ERS'C(iMPFiJSATIONIAWSOiCALIFORNIA,AYDAGSEE�NATIF�SFipU:D�ECOME INSPECTIONFEE ______ � SU&IECTTO THE WORKERS'COMPENSATON P:7OVISiONS OF SECTIOV 3]CD OF:H'c LABOR , � � ��M���V:ITF1 COMP:.Y`MTi 1'405E PR��n�,—�— — ISSUANCE __.._ ---- i -- , � 0.4TE: ��� 'i 6L��� SMIP e �''3 APPLICA : � WARNINO: LUREiOSECUREWORKERS'COl.MPENS/.TICNCOVERAGEIS NiAWFL'L,AA'M1DSHALLBE ENERGYPIC _____ f � SU&lEG�AN EMPLOYEft TO CRIM:NAL PENALTIES AND CfVIL FINES UP TOONE HUN�flED'HOUSAN� ENERGY PERMIT _+' � DOLLARS!S10G,000l.IN ADDITION TO iHE COST OF COMPENSATION,DAMAG[S AS PROVIDED FOR IN �------ � SECTION 370P OFTHE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. _ RETENTION FEE: ___ � '`_ OCONSTRUCTION LENDING AGENCY p�-q�FE�Z____._: s � I HEREBY AFFIRM L'N�ER PENAL'Y OF PEFiJJRY THA�THcRE�5 A COtiSTflUCTIOPi LENDMG AGENGY �� ( d FOR�HE PERFORMANCE OF TNC WORK FOR WHICH THIS AERMIT IS ISSUED(SEC.90W,CIV.C�. '• �z � 1� ti`� � r.-° � —._—_ __ E LFNDER'S NAME'_____'_"_"___"__ F_ LENDER'SADDRESS__...._____' _'_'"..."'___—_"'_____ , . � TOTAL FEES W I CERT;FY THAT I riAVE REA�THIS APPLICATION AND STATE TH0.TTHE ABOYE INFORMA'ION IS CARpECT. �{ � I AGHEE 1'O CON.PLv WITH ALI.CITY AND COUN7V ORDINANCES AN�S?ATE LAWS REIATING TO BUI:�ING n � _�� (J , t� • � CD'JSTRUCTION,AND HEREBV AUTHORITE REGRESENTATNES OF THIS COUNTV TO EMER U?ON THE 1/ � Z ABOVE-MENT;ON'c0 Pi70PERTV:OR INSPECTION PURPOSES. COMMENTS o �� a � y �� � _ ----J-J- 5 — --------------- m PERMITTE A E(PRINn � C R• '_'-------- ¢ 44.=�-°L.--^-- C:' �" �� ---- � �� �-- -�''-'']]�q.�._ = SIG REOFPERMI7 E D [ / � / / •--" � REC?T.NO.�PAID BY VALIDATION --'� ~ WHITE—DopaAment Copy,YELLOW—Financo Copy,pINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplicanYs Copy . .. . . _ . . ' , . . .. . .. ' , .. . . � .. 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