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HomeMy WebLinkAbout14407 (653) �- �• �� CITY OF DIAMOND BAA DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � „ 2;660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ��p�', BUILDING PERMIT APPLICATION FIRMLY o ADDRESS Z��L�` ` ' V"4Fi+4�I�G'�� 11Y` • DATECATIQN����� �� NUMB R . • � #/C f � ISSUE T—TYPE OCC APN LOT� TRACT DATE CONST. GROUP p OWNER �i.1 pv'[x Yl �f " ADDRESS �S`�"LG �-� 'r�•7�t,�/4� ZONING SETBACKS W CITY�i 1�s'4 0 lii'r� 'rn I:1�'t ZIP�S�TEL.L���' �- ) FRONT RW � � APPLICANT TEL. � � REAR � z �'��— f SIDE/SIDESTREET RW '7 � CONTRACTOR_ _ _ SIDE � � A�]DRESS_ _ CITY ZIP__ TEL. PROPOSED USE '�' Q ARCHlENG/ W DES�GNER -- NO.DWEL. NO. NO. a ADDRESS � CITY ZiP ,_ TEL._ UNITS_._ _ STORIES BEDROOMS cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDEfl DECLARAT7ClN SFRIADD/REM O - I HEREBY AFFIRAI UNDER PENALTV OF VERM1IRY THAT 1 FM EXEMPT FqOM THE CONTRAC70Rs u- GaragelCarport � CENSELAWFOfiTHEFOLIOW�NGREA50N�5EC.7031.5BV51NE55A7dDPROFE5510N5CODE:ANYCITYOR (� COUNTYNRiICHHEWIRESAPEHMlTTOG7NSTRUCT,ALTEF,IMPROVE.OEMOUSN,ORFEPAIRANVSTRUC� W Patio/Deck � YURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNE� W STATEMENT THAT HE Oq SHE IS LICENSEO PURSIJAM TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTEF 9(COMME4CING WITN SEC"ION 70a0)OF DIVISION 3 OF THE BL'SMESSAND PRO- � PooUSpa _ FESSIO4SCODE)OHTHATHEORSFiEISLXEIAPTTNEPEFROMANOTNE8A5iSFORTHEALCEGEDEXEMP- (� V TqN.ANYVIOLATIONOFSECTION7031sBVANVAPPLICANTFORAPERMIT5U8JECT57HEAPPUCANTTO Z P.e-Raof � ACiVILPENi1L^/OFNOTMORETHANFIVEHUNDREDODILARS(SSoo).): � CI.ASOYMEFOFTHEPROPERTY,OFMVEM�LOYEESWIiHWAGESASTHE1950LECOMPENSATION, �� CORIf110fC18I WIIL DO THE WORK,M7�hiE STRUCNRE:5 NOT INTENOED OA OFFERED FOR SALE(SEC 7046,B1151- J — N NESS AND GFOFESSIDNS CODE:THC CONTRACTOqS LICENSE�AW DOES NOT APPLY TO AN OWNEH OF j PROPERTY WHO BUILDS OR IMPROVESTHEREON.AND WHO�OES SUCH WORKHIMSELF OR HERSEIF OR � THROU(IHMISORHEP.OWNEMPLOVEES,PROVIOEDTHATSUCHIMPROVEMENTSARENOTIN?c'NOEDOR � QOFFE0.EOFORSALEIF,HOWEVER7NEBUILDINGORIM7ROVEMENTISSOL�W!l'NINONEVEAROFCOMPLE- Z TION.THE OWNER-BUILDEH WILL HAVE THE 9UFDEN OF PqOVING THAT HE OR SHE DID NOT BUilO OR � IMVROVEFOR7HEPURPouEOFSALE). � CI,ASOWNEROFYHEPROPEHTY.AME%CiAlSi+�El1'CONTPACTIN�W�71+',.!CENSEDCDN7RACORS --- — [� 70 CONSTRUCT 1HE PflCJECT(SEC.)osa,Bi.'Sihf_^sS AhD AROFESSIONS CADE:Tn'c CONTppCTORS LI- V31U8iICt7 ADJ.AREA LL! CENSELAWDOESNOTf.?PLYiOANOWi:EROFAPRDPERTYWHOBUIL�50RIAIPROVESTHEREON.AND �-- -- --- � WHOCOMRACTSFORSUCHPRQI'cCTSWI'HACOA!7RAC70A(SiI.IC5N5e'DPURSUMTTO7HEC:ONTNdG QUANTI'Y DESCRIPTION FEE � TORS LICENSE LAW.). _ Q J ��y Q ❑IAMEXEAiPTUNDERSEQ_______, __,.�.SF.C.FOHTHISREASON .Q _ V � � OATE ���1_ --f-�- OWNER_����-_�.__" U�V . W _--- -�-�-.�--�.-s --��- � LICENSED CONTRACTORS DECLARATION W � w i � 1 HEREBV AFFIAM lWOEH PENFI,Tv OF PE4JURv THAT lAN'.ICFNSED UNDER PRCVIS!ONS OF(;hpPTER � , , , p� 9(ODMMENCINOWITH^ECTION7000JOFDIVIS�0�30FTHE9USINESSANOPROFES510NSCODE.AN�J Z ____ ___ X MY UCENSE IS IN FULL FORCEAND EFFEC7, m 11J � LICENSECLASS___,___.____ !.IC NO. _ � F J� __ V DATE ._____._ CONTFiACTOR____.__. ___ i a W � WORKERS'CQMPcNSATION D[CLARATION Q � 1HEqEB'(AFF!RMUMDEFlPENAL�/Oi-7E0.JURYCNFOFTHcFOL_OWING�ECI.AFAI:GNS. U � Z � IHAVEd�tif]WI:LMAINiAMAC`cH?.FICATc'OFCONSENTiOSELF-INSL'FErOq4YORKERS' _ � COMPEkSAT10N,AS PFl�Y?lED 8Y SECT��N 3]OJ OF THE LA90H CODF,FOR'NE PERFORMANCE i W __ _ OF TNE VrORK FO!i WHI.^.M TI�iS?EAM�T IS ISSUED •` � � � I Y.AVEANO WILLi.1A1NT/IN WCRKEHS'CAAIP[YSA'iON�NS::RANCE.AS RE(IUIRF.�3V SEC'ION Q 3lW OF TS1E LABOR GOD'c,F09'Y1E F'cRFOFlMANCC-OF THF WORH fOR Yh'ICN:NIS PERn11T IS ' ISSUCO.MYY�/CflKERSCLhnFENSATIJM111N5UHANCEGARRIF.RFtiDPOLiGYYUM�ERFqF., CONSTRUCTION � ___ jcaaaieA.----.------ ---._._..__...--.-- PLAN REVIEW � uL� 1 `4 � POLICVNUMBER_._'__ ".'______'."'_._'___'__ ELECTHIC __ 4 �^a. 0 (nctsEcllaaraEc�araTEe�'lE1F�O�n�aF�r.rr�sr�cxa�vunoAEDaxiu',ss��;atLEss: PL.UMBING ���_ � �-+ w � : p]A Z �CERTIFVTHATINTHEPERFORMANCEOFTHEWOPKFO!iWHiCHiHISPcRMITI5155�CD,l MECHANICAL � S3/s!� __ _____ ��7 SHALLNOT'cMPLOYANVP[RSO4iNANY,UANNERSOASTOBECOME5U0JECT?9THE ���r�*� sATTn� �. �/] WUAKERS'CAMPENSATIONIAWSOFCALIFORNIA.ANCAGfiEETNATIFISHOUL�BECOME II�ISPECTIONFEE _ ___ �BrL _r � SU&IECT TO THE WORKERS'COMPEtiSATION 7,iOV�SION50F SECTIC4 3�0a OF THc LABOR — — — — CCDE,75F'ALLFOHTHWITHGOMP!YWIhITHOSCPROVI510NS, �SSURNCE u� o SMIP p DATE:_ ___ _ 4?PLiCANT. ___.________'__________ _ ---_-_"__ __-- J WMNING:FAILUREI'OSECUP.FWGiiKE9S'COMPENSATpNf.'OV[RAGE'SUNJWF'.IL,ANDSHALLBE ENERGYP/C _,_._____ _,.,____ LL SU&IECTANEMaLOYERTOCR�MINALPENALTIESA4�CI41L�IKESUPTOONEHUNDflEDTHOUSAND ENERGYPERMIT DOLLARS(51oG.ODO�.IN ADDITKKI TO THE COST OF COMPENSATION,OAMA�ES AS GROVIDED FOR IN ---- — ¢ SECTION37WOFTHEIOBORCAOF,'N?EFEST,ArvCATTORN`ev'SFEES. _ RETENTIONFEE: __._________ t�L CGNSTRUCTION LFI�DING AGENCY PRE-ALT FEE: � I MEREBY AFFIRM UhDER PENAL'V G�PERJURY THAT:MERE 75 A CON3TRUCTION:END:NG AGEhCY I __ __ ________ Z FORTHEPERF�RMANCEOF?HEWORKFORWHICH'l115PERMITl5155UED(SEC.30Ai,C:VG;. I W � LENDER'SNAME__"'_'""___—_"_'____""_"'_ F- LENDER'SAD�RESS__'_"'____'_"_..."_' � W I CEfl'IFY THAT I HAVE REAO TH:S AP7LICATION ANJ STAi E THATTHE ABOVE INFORMATION IS CORRECT. �OTAL FF ES ��� � I AGReE i0 I:OMPi.V NITH AiL C'TY ANC COLINTY ORDI4ANC'e5 AND STAT'e lAWS FEtATiNG TO BUILOING U, CONS7RUC71C+J.ANOHEREBVNUTHORI7.ERePFESEMATIVESOFTHISCOUN'YTOEMERUPONhIE Z ABOVE-MENfiONEC PROGEFN FOA INSPECTION PURPOSES. Q COMMENTS__,____ _' ��;r"K% ��% i _ -- — — — m -- PERMITTEE NAME P ) � . � / -2A/�— l '� -- -r� --��-- --- - -- � SIGNAiURE OF P MITT� DAT� ° = RECPT.P�O. �__PAID BY VALIDATION ~ �M WHITE-i7epartrneni Copy.YEI10W-�inance Copy,PINK-Assessor Copy,GOLDENROD-Fle Copy,GREEN-Applicant's Copy .. . 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