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Home My WebLink About15700 �`` s.N� _!� CITY OF DIAMOND BAB `�1 ��/ DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �/� �� J 21660 E.Copley Drive Suite 190 ::w _ RESS P ;., c��s�o-3i9s��>s6i-3ii� FIF�IULY ;,.,_,. ��° BUII.bING,PERMTT APPLICATION . .,.. . _. , .. oN JOBSITE �,n�(J,��t ��E��y�� APPLICATION/�7 /^/� PERMIT P/C ADDRESS .L. �`�� DATE t " � '�" NUMBER� # c� ISSUE TYPE OCC APN LOT TRACT DATE � CONST. GROUP p OWNER ��`f U�9�Y_---��•f- LL ADD ES,Et S��ii ZONING SETBACKS � arv� ZI� TEL. �"'�2 '�� FRONT RW ❑ APPLICANT TEI. REAR ❑ � SIDE/SIDE STREET RW ❑ CONTRACTOR �i ,,,.�.5�� SIDE ❑ p� ADDRESS l� 2-• � CITY�r"�7 ZI lZ. 7E . �s PROPOSED USE o ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OOWNER-BUILDER DECLARATION SFRlA�O/REM � I HEREBY AFFlRM UNDER PENAL7V OF PERri1RY TWV i AM E%EMP1'FROM THE CONTRACTORS U� � Garage,�Carport W CENSELAWFORT1EFOlLOWINOREA50N(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYqTYOR S2 COUNTYWHICHREWIRESAPERMITTOCONSTRUCT,ALTER,IIAPROVE,DEMOLISH,ORREPAIqANYSiRUC- w pytl0lD0Ck VNRE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED S7ATEMEN7 iHAT HE OR SHE IS LICENSED PURSl1ANT TO THE PROVISIONS OF THE CONTRAC70RS LI- � CQISE UW(CHAP7ER 9(COMMENCINO WITH SECTION 7000)OF DIVISION 30FTHE BUSINESS ANO PHO- � POOU$p8 FESSIONS CODE)OR THAT HE OR SHE IS EXE4IPT THEREFROM AND THE BASIS FOH THE ALLEOED EXEMP- TION.ANYVIOI.ATIONOFgECT10N7a31.6BVANVAPPLICANTfOFA7ERMITSU&IECTSTHEAPVLICANiTo Z Re-Roof � ACML VENA47Y OF NOTMORETHAN FIYE HI/NDRED DOLURS(f500)J; � �I,ASOWNEROFTHEPROPERN.ORMVEMPLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � COfI1RIBfCiBI '" WILL DO THE WOPo(ANO THE STRUCiURE IS NOT INTENDED OR OPFEREO FOR SALE(SEC.7044,BUSI- J NESSND PROFESSIONS CODE:THE CONTRACTORS LICENSE lAW DOES NOTAPPLV TO AN OWNER OF � PFbPERTI'YYFIOBUILDSORIMPROVESTTIEREON,MDWHODOESSUCHWORKHIMSELFORHERSELfOR = � THROUGHHISORHEROWNEMPLOVEES,PqOVIDEDTHATSUCHIMPROVEMENTSARENOTWTENDEDOR m 0 OFFEREDPDRSALEIFHOWEVE(i,iHEBUILAINGORIMPROVEMENTISbOIAWITNINONEYEAROFCOMPLE- Z TION.THE OWNER-BUILOER WILL HAVE THE BUROEN OF pROVING TNAT HE OR SHE DID NOT BUIL�OR = MPROVE FORTHE PURPOSE OF SALE). ❑�,AS OWNEROFIHE PROPER'fY./Ul EXCLUSNELY CANTMCTING WITH LICENSED COMRACTORS � 70 CONSTRUCT THE PRQIECT(SEC.taM,BUS�NESG AND PROPESSIONS CODE:THE CONTRACTORS LI- V81u0�i0n ADJ.AREA W CEN3ELAW�OESNOTAPPLY70ANOVYNEAOFAPROPERiYWHOBUILD50RIMPROVESTHEREON.AND � Vh1000NTMCTSFORSUCHPRQIECTSWI7HACOMRACTOR(S)UCENSEDPURSUANTTOTHECONTRAP QUANTITY DESCRIPTION FEE � TOHS LICENSE LAW.�. ❑I AM EXEMPT UNDEF SEC. 8.a P.C.FOP THIS REASON Q 3 � � LL DATE OWNER U � LICENSED CONTRACTORS DECLARATION —� � w , 1 NEREBY�FFIRM UNDEP PENALTV OF PERIURV THAT I AM UCENSEO UNDER PROVISIONS OF CHAPTER � p - �u j � 9�COMMENCINO WITH SECTION 7000)OF OIVISION 30FTNE BUSINESSAND PROFESSIONS CADE,AND z MV LICENSE IS IN FULL FORCE AND EFFECT. m ?/'` � � LICENSE CLASS �r�NtQ _LIC.NO._�� ' J V DATE i��.%`��X�� CONTRAC70R a W � WORKEAS'COMPENSATION DECLARATION Q � IHEREBY�FF�HMUNDEHPENPLTYOFPERIURVONEOF7HEWLLOWINOOECLARAiIONS: � y Z Q � �IHAVEANDWILLNAINTAINACERTIFICA7EOFCONSENTTOSELF-INSUREFORWORKERS' _ COMPENSATION,AS PROVIOED BV SECiION 3Yao OFTHE LABOR CODE,FOR THE PERFORMANCE U � OF 7HE WORK FOR WHICH 7HIS PERMIT IS ISSUEO. � � W _I HAVEAND WILL AIAIMAIN WORKEFS'COAIPENSATION INSI/RANCE,AS R[-0UIRED BV SECTION Q 37000FTME LABOR COOE,FOR THE PEflFORMANCE OF THE WORK FOF Yrti1CH THIS PERMIT IS ISSUED.MY WORKE COMPENSATION INSURANCE�C RRIE,R^ANO POLICV NUMBERAHE� CONSTRUCTION _ jcnqptER �S��l%�4.��'�'�.^� v"+'i.�'yC�`jZ',S PLAN REVIEW Z POI,h'.YNUMBER � `�'�� ELECTRIC Q � (M55Ec7qNNFIDNo78EeoMa�EfEDOFn+EaEahttisrataNEMH�ORmooUaiS(b�cala+lEssl. PLUMBING Z ICENTIFYTHATINTHEPERfORMANCEOFTHEWOqKFORWHiCHTHiSVEPMITISISSUED,I MECHANICAI (J SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESU&1ECTTOTHE �� " y WOiiKERS'COMPENSATIONL4WSOFCALIf-0RNIA,ANDAGREETHATIFi5H0'JLDBECAME INSPECTIONFEE S SUBJECT707HE YJORKERS'COMPENSATI. IONCI� SECTION 310o OF 7HE LA80R CODE.ISHALLFORTHWITHCOAAPLYW THOSEPpOVI510N5. ISSUANCE 0 SMIP p DATE: �� APPLICANT. ��C� ---�—� — � ENERGY P/C WMNING FAIIURE TO SECURE WORKEFS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE �y SU&IECTAN EMPLOYER 70 CRIMINAL PENALTIES ANO CIYIL FNES UP TO ONE HUNpRED THOUSAN� ENERGY PEFMIT y� 7f T1tlsT '�[' DOLLARS(5700.0001.IN ApDITION i0 THE C0.5T OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN �I�� "'7�T9a�F� � SECTIDN370BOFTHELABORCODE,INTEREST,ANDATTORNEI"SFEES. RETENTIONFEE: pW_, CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIHMUNDEAPENALTVOFPEqJURVTHATTHEREISACONSTRUCTIONLEN�INGAGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). Z W — � LENOER'S NAME 1_ LENDER'SADDRESS �� ICERTIFYTHATIHAVEREADTHISAPPUCATIONANOSTATE'�'�ATTHEABOYEINFOFMATpNISCOflflECT. TOTAL FEES � IAGREETOCAMPLVWITHALLCRVANDCOUNTYORDINANCESANDSTATEL4WSRELATINGTOBUILDING �� CONSTRUCTION,AND HEPEBY AUTHORIZE REPPESENTATNES OF THIS COUNTV TO EMER 11PON THE , � AB�VE�MENTIONE�PRO FTV FOR INSPECTION 7URPOSES. COMMENTS � � CN�-�{,..rt�,�. � m PERMITTEE AME(CRIN'T) _ u4i ��r ZC) � SI�NATUREOFPERMITTEE DATE � , RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOI.�ENRO ile Copy,GREEN—ApplicanYs Copy ,;: _ , � . , . . ,: .,:,, � , �: . , „ , , �� _ _ .. � . � � � x� � �s� ��'�i � .. � � � � � ��" � ��`� ��y #P � �� , ` ,. � �'�� ; x ��.:.: �,'�: a� � . � ��u _' �S �j.�,� �_�� _ � . � a : ca�' E�.._�^� � � r � � F� `�i`�" �i� . i .__ _._ a.:..__._.._..__ _.._�---:},.-�--_.,.__...;._ _._. "� ... __.__.�_..� ---_____�_.____- _____._...3 �T'�"`� C�� >�'�� ; ( !_''��k �i''"z'�`,;�u1T ,� ' �I� � ' �______ _. 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