Loading...
HomeMy WebLinkAbout15883 CITY OF DIAMOND BA8 ��� --- ' - - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES . � " "` 21660 E.Copley Drive Suite 190 1� w (v 1�� � PRESS (909)8G0-3195 Fax(909)861-3117 '`���H�^� BUII,DING PERMIT APPLICATYON FIRM Y _ _ . _ . , ,: _. ._:, � JOBSITE y' �g �,o'� /'J APPLICATION (� PERMIT ' P/C o ADDRESS r �ICl_��/.�_.,�,����,�� !X"�._./' • DATE " ' NUMBER�'�����,��# $ ISSUE TYPE OCC APN �OT TRACT DATE ' CONST. GROUP p OWNER ✓^ � ADDR S '� ' � � G � ZONING SETBACKS � CiTY ' ZIP l��4 TEL. ' XA" f - a FRONT RW ❑ APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ CONTRACTO • � �� ?� �/'�� SIDE ❑ q� ADDRE S N � p CITY t�' . , a ZIP_[_ " TEL.�'`��'�i-'���` PROPOSED USE � ARCH/ENG/ � DESIGNER — NO.DWEL. NO. NO. ADDRESS UNITS_ STORIES BEDROOMS NCI7Y__ � ZIP TEL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION OOWNER•BUILDER DECLARATION SFR/ADD/FiEM � I HEREBV AFFlRM UNDER FENALTY OF GERJURV THAi I AM EXEMPT FROM THe CONTRACTOflS U� G0Ie9B/CaR70ft W CENSEUWFORTNEFOILOW�NGHEASON(SEC.7031.58USINESSANDPROFE5SIONSCOOE:ANVCITVOR (n , � COUN�YWHICHREWIRESAPERMRTOCQNSTRUCLA4TER,IMPROVE,DEMOLISH,ORREPAIRANYS7RUC� W Patlo/DeCk NRE.PRIOH TO 1T6 IS&UANCE.ALSO REOUIRES THE APflLICANT f�OP SUCH PERMIT TO FILE A SIGNEO W � STATEMENT TNAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTPACTORS LI� � CENSEUW�CHAPTERB(COMMENCINaWITHSECTION�000jOFDIVISION30FTHEBU51NE5SANDPRO� � POOVSp3 fE55 WNS COOEI OR THAT HE OR SHE IS EXEMPT THEflEFROM AND THE BA315 FOR 7HE ALLEGED E%EMP� TION.ANYVblATIONOFSECTION7037.bB�ANYAPPLICANTFOHAPERMITSU&IECTSTHEAPPLICANTTO z Re-Roof � ACIN4 PENALIY OF N07 MORE THAN FIVE HUNDRE�DOLURS(SSoo).�: � ❑I,ASOWNEROFTHrPROPERiY,OqMVEMPLOYEE5WITHWAGESASTHEIRSOLECOMPENSATION. � CommBrCia� - WILL DO THE WORK,AND THE STRUCTURE IS NO7INTENDED OR OFFERED FOF SALE(SEC.7044,BUSI- J NESS M10 PROFESSIONS CODE:TFIE CONTRACTORS LICENSE lAW OOES NOT APPLY Tp AN OWNER OF � PROPERTVVhiOBU�OSOHIMPPOVESTHEREON,ANDWHODOE55UCHWORKNIA15EiFORHERSELFOR = .Q 7ifi0U0HHi50RHEROWNEMPLOYEES,PROVIOEDTNATSUCHIMPROYEMENTSARENGTINTENDE00fl m QQFFERmFORSAIEIF,HOWEVERi'NEBUILOINGORIM7R6VEMEN'ISSOLDWITHINONEYEAROFCAMPLE- � �TION.THE OWNER�UILDEF WIL NAYE THE BUftDEN OF PROVING THAT HE OR SHE OIO NOT BIJILD OR � INPFtOYEFORTHEPUHpOSEOFSAI..E� ❑I,AS OWNER OF THE PROPERTY,AM EXCWSIVEiYCONTFlACTING WITH LICENSED CON"RACTORS � TO CONSTRUCT THF PROJECT(SEC.]044,BUSINESS AND PROFESSIONS COqE:THE CONTpACTOFS LI� V21Uatlon ADJ.AREA W CENSELAWOOESNOTMPLYTOANOWNERQFAPFOPEHTYNM1IOBUIIDSORIMPROVESTHEHEON,ANO � Wf1000NYMCTSFQHSUCHPRNECTSW.iHACONTRACTOfl(51LIGENSEDPURSUANTTO7HECONTRRG QUANTITV PESCRIPTION FEE � TORS IICENSE LAW.). Q O i AM E%EMPT UNDER SEC._„__. _fl&P.C.FOR THIS PEASON U Y � � LL' DATE OWNER__ __ .. V � � W _.� F, LICEN5ED CONTRACTORS OECUIRATION -� � W 1 HEREBV AFFIRM UNDER PENALIY OF PEF4IURY TMAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER (�` / /��'p� � Y(CAAIMENCINO WITH SECTION 7000)OF DIVISION�OF THE BUSINESS AND PROFESSIONS(YJDE,AND Z r`^�! /, ' ""+�"'�'�t �� MY UCENSE IS IN FULL FORCE AND EFFECT. .d�+^' � � LICENSE CLASS �� �B ^ LIC.NO. -> � �F j V DATE %Y' CON7RACTOfi_ r '+t �- Cil � WORKERS'COMPENSATION DECLARATION a � U - � 1 HEREBY AFFlRRI UNDER PENALTY OF PEiiJUFY ONE OF THE FOLLOWING OECLAHATIONS: z Q (� �IHAYEANDWILLMAMTAINACER7IFICATEOFCaVSENTTOSELF-INSURFFORWORNERS' �y Z COA7PENSA710N,AS PROV�DED HV SECTION 37o00F THE LMOR CO�E,fOR THE PERFORMANCE C.) Q OF`}iEWORNFORWHiCHTNIS7ERMITISISSUE�. � � W _I I�IAVE AND WILL MAINTAIN WOFKERS'COPriPENSATION INSURANCE,AS REOUIRED BV SECTION ~QU, 370o Oi THE LABOR CODE.FOR?HE PEFl WRMANCE OF TI-E WORK({?H WHICH THIS PERMIT IS ISSUED.MYWOR�}�COMPE IONINSURAN CAPP.IERANDPOLICVNUMBERAREj^ CONSTRUCTION � CARRIEF._,._._I__.L� � ��� 4��� -`�� PLANREVIEW zF'OLICY NUMBER - '�" ELECTRIC __. a (fIi1SSEGTKINNEEONDrgE000.1R..ETEDOFh�EPERhYlISR'NiCNEHIIN]REDDOLWl,�E1W)ORLESS�. PLUMBING Q r � w I CEflTIF1'THAT{N 7NE PEPfORMANCE Of THE MK�AK FOR WHICH THIS PERMIT IS ISSl1ED.1 MECHANICAL Z (J SHAL.L NOT EMPLOY ANY P'eR50N IN ANY MANNEfl SOAS TO BECOME SUBJ[CT'O THE Uj WOpKERS'COMPEN5A7�CN LAWS OF CALIF AGREE TFIAT IF I SHOULD BEGDME INSPECTIDN FEE SUBJEC?T4THEWORKERS'COMPEN ONPiiOVISlO . 'CTION37ooOF7HEV•60R ~ CAOE,I SHALL FOq�_HW�TH COMP4Y W� h109E PPOVISIONS. �S$UANCE _� �J �.-`I/li p DATE: /�'�'n� � APPIICANT: SMIP _ J ENERGY PIC J WAqNING:FAILUPETOSECUREWOfiKERS'COMPENSA7'IONCOVEftAGEISUNIAN'FUL,A4DSHALLB � SUB.�ECTRNEMPLOYERTOCRIMINALPENALTIESANOCNILFINESUPTOONEHUNDREOTHOUSAN� ENERGYPERMIT DOLLARS(5100.000).IN ADDITION TOTHE COSTOF COMPEN5ATIDN,DAMAGESAS PPOVIDED FOq IN � SECTION 3709 0F THE 1A80R CODE,INTEFEST,PND ATTORNEYS FEES. RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: . O � I HEREBVAFFIPM UNDER PENALTV OF PEFiJURY THATTHERE IS ACONSTRUCTION LENDINGAGENCY _ FOR THE PEftWRMANCE OFTHE WORK FOR WHICH TNIS PERMIT IS ISSUED(SEC.309],CIV C.). Z W � LENDER'SNAME ------- F— LENDER'SADORESS_ � I CERTIfV THAT 1 HAVE READ THIS APPLICATION AND S7P.TE THAT7HE ABOVE INFOPMATIDN IS CARRECT. TOTAL FE ES + � I AGREE TO COMPLY WITH AL4 CITV ANO COUNTY OF��NANCES AND STATE LAWS RELATING TO BUILDMG CqJSTRUCTION,pND HEREBV AUTHORI2E AEPRESENTATIVES OF THIS COUN7V TO ENTER UPON THE ZAgOVE�MENTIONED PERT.'fOR INSPECTICXJ PUFPOSES, COMMENTS � __�6� ���°A�c^-r'i'..'1r J m �7 ¢ VE AME ' J C/� �- -���'" � � ' � SIGNATURE FPERHITTEE DATE ! = RECPT.NO._ � PAI�BY VALIOATION ~ WHITE—Department Copy,YELLOW—finence Gopy.PINK—Assessor Copy,GOLDENROD—File Copy,CiF?EEN—ApplicanYs Copy .� x.. ,,., ,., .. . , ... ,,. . .. ,�, ,. , ����- �� �.����,����"�.� ��.� . , �������`�`��:��� . .�,� �� �::.:.. . ,,r :�: .:�,� . � ��� ��. �� �"x��� �e�;;�� � �f�*"• � , :�Xsz" " a: ��`ah � � ' ��'��d�� }�*��n t � �.�;��� ' �� �� , � �; a ���� �. � � � ����'�+������ ����� ,. � ����.�o-`.�'����'�.�� ��` �.:�__�..-�'......_..:___..����,..,....___...-:� ..`_.�._.�.�. ���t� #� ��a;�°a� _. ��-_:.�em ..... �, n . :� �� �:a' . � ._......_�. � ..�........_.................._ �._._ ;___._.... ..,,.,�... �__ j � f ; . � ' i �F..� =4� ��J`��: � � L x � � � � � c � g 9 ''t' ^. � .'.'�_� E � _" - 7 £ { � ...�........_._...__... ......__._..,__. � � � � _n r .;„_. ++.....�.. t i : . . ____„_,3 _. .. . . .... .. . ._..... .. . z _ . _ .... .... _. . . . . .. . t � i"f"js j�k � .�m`�"' I 3�� „-a �t "3�{ j t bt �" � pC" .;a _. . ..._._.,......__ _�:..�..............__ ! :.._ ....__ . 4 . ' _ ... _ ... � � ... ._. - .. .�,..,,...._.... ., . . I .ea , r° �� � ' } �f .�.< � E( .�.._ i)d��. .�i i'f t�P�3":�L.�� 1v.7i� .. . � 3 't `. 6 : � ..�. .. .. ., ._.� ... ..m ......... _ . . . 3 ... ......... . .._..............,.. ..i........e.__.... . �_m_..... Y .... � .. �m.�.. . . . . i � ,,.„ +s � ..,- ,., :j � .. .. � _..n r ��j-X��.+� e'�i�s..@� ��°�: ?. � . . �.r,,. .�:. . ..........._. .. ._...!___�_..,.....- .t _._ — ___. __ ,.. . ....,. � �._.. �„ ...._...._ ........__.,..,..�._. ... � � _'i €f {§i .,'4 € � :- ; ..;i � l �i �'� _�a� �"'",'�\:j t �.a,f� f.. ._....�... _�____.._..................___._.e„__ � � _. . . . .... �_...�.____ - - �.......,....___._ ._ � _ � f s ��.-s-t sw ,t t- � i . . . I � :-.'d�j b--� �, a.°? 1'y�..��r� c. . F.: , . � . ... _.._. _._....._-.._.._ ....... ....... _ ..___ ____ � d-- __ ��- . -�... _�........... ......... ....__... _._..........,.,. ._...___...4-�--_- _-""" . �,� ,'_ -t�.., t t , _ .. . . � . � [ �'r�3 ���v�i e'�i--�+�`ai �.. .._..,..._ . .. ._...._ - ...._ . ............_ ._.__ ... � r � �.'"�3 r �i � 4 ,;' i �`. [..m !�6 �.� �€ ��'�`:u�:�........_...._�. _. _....... _.._.. _..._...___ �.. ... .... ..__ ......_....m.... . . � �j g � �,' i . ;..r, 9 �_...,. ( � FY.1.t° �.: � 3 S-9�.C _��.�.._..._.... ..._ _ � � — . .. ..,.,.._......___..._,........�_... ._ .. ..........�,_..__..._... � ...rv _.. .. _._> �_.. �. .. ��. . . 1^^" .. . _ ._..,.., g § � ,, ,� g ...� �C,' 3 ' i �'`�4 t`�� i� � ' Y . _S a .__ _ . , .__�_.___._,_. -€.-._:...____ __ __—._ __ i w_ _x , ,-��'.s .4 �._� r � rw � 6 ; I .::�r, ,�a � : �"�I��; . _ . � �__. ? .._.... _. __._____. . .. € . _.. ;... �_.� .�_...___.... .... ---__.__—_——� -- , _ __ __._... _� � �'^ �;. 7 ..�,r3€ .r� daz I �: � �.��t 3 r�� l.a� 'z t��f��.tik ,. �7 ( - .�,. . �... ..�......_..,.. ..__.._.._. ._.,..._...:__..,.�._....�._..� - ...._. . . . __� .� .._.._...... . ._ _. . ...._._ ...� .�`,i:,..d� sx.,.. .������ c.:x7 : ..__. , . . . : . .'d:.1S.J1._:..:_�...s. 1 f=t]�` ._..y.___"_- � . ..... .... ... .. ..{.-._.,,.__.,........_._ .,.___" ._.____�,..,_ ...,.__..___.� . �. .._� � `-""'"-" _ t- I '� d -t^.� II9rL-� �' i i a���°"eC 3"'��E���'a;�� i € 'L. _. �P � . ._.._... � __. _....,,.. . ... ._ '...w. ........ ;.�..w... ._ � __._. � . ., ,�P.a' yt na:lg ri-� ' j . . �' ��3�t .,§p�'z____� .. j . .�� . �_r .,�..._. _ ' ._..___�__ ._..... _ u_' ..___ _ i _._ �_ .._._ �.�..�..,.:_,.....s_.__..._$ . ... ...._ _ _..a....�... ........... _c...,..�...,W_ _................._.......__ ._------- . .- � j �q � ", � i a-- s s � € � ''��"f� t t a r`�z,,. _�..... -_.. . . . � ... ... ... . .. .. ...b. ____ ____....__....�..� . --� Y.__... ................. , . � � � g� � � { �i"LJS°� ; a��' � . __.._......._.._ _;---___._.._. � .�_�._....._.. ._..a._ ,� _ .. _._.� ....._._._ . w�._. _ ._.a�_.. _ .�....__... . __._n._.. __�_�-�- __ _. � _. � �� � i�ats ; i?.k 4, i .�. �I s : F g ,�.,.........e....�...._.............._.....,,. '...._._....._.._�..w_.._............_ -. _....,.. _._ .... ..._.....,. ...i..._ ._............ ........... ......,.,......_ __.....- .� .._ _ i.f f �r�-�.4� $ ..�.... . . : � �� i P—Y� ..,� t9 E" �„h ' l � x ? k ._ <_ ....,...._.....___"'��_ _._.�__W.._..�.....�......w,m... �_ Yy—w... ..�.�.... .........._....�_u...�.m._«....._..�._' ....«....._............-.�......��.............w..,........,..........__.......... .......... � '. �. 3 j .-._ 3 €p' �S k y. 9 p� . j.. .-. ` i. Lt .; . , 6 � .....,... .._._ .............,._........�..7.._. _...�.�_. _....... .._....t _ . ._...........................�......d�._..,......M.. ,......_.__.a_.m_..__.�,...............,,..... ........_ . ..____..�.„.."__ ",�...._.....___..._ .. _ t ..*f-°�.. i � : j ;-� '4 �'. ir; , � 1 h�`� . . . " ' . � 1 ' 's n , .-�. .. ... �.. . w, .... � 3 __.�»..,. : . .....,._.. . . .__...-.. . . ...... . . _ _.. . ._ _.. ... .___. � .... . . .. _... � .._. ._.�..... j : �'., C" r� . - e. ' � � �� � :` ..aa..� "'�e� � . � . o- �e. � _.��.__ I ( _._( a _ __._..� a....___ __ ._.�__ ._..�. ... �_._.... __ ....r._ ___ .._..____.� _.___.. .._ _ _... __. _� € ',�i�" -� �-` 4.�a,`;. ""r€nj � � • i a �'�. L. a�.d'a `" : = 3 ., " � " ' I < . ' . ... . ....... . ...._._...3...«..--..__.__.._. . E.._...a_....-...._...__.._.�_...........,..«.,..... ' - ...,,.... ....... .....r... ..........._.� ......_.. ..._.�.........._............. - ......�....................... �......._. ............, ._ ( �..._._ .._y-«... _._ �a e 'e��-. , t_�_a._°`,, x;'at..* 1 ; ; ! is._b. ��?��...t` "ss",7`� � , . � . . . � ' ¢ , - - . ...�._ .... .... ....,...............__e._..............................W,.__. __.._......... ...,..;......_.._._'___...._.._..............._....._.,....._.,..w -...._.._....__ .........._. ....___"_ _.._. �_._.:_..._...._.....,.,.�,.... .....__ .....,.............._._____ ............ .. e-,'.: � ."_�' :�t �:�, . ' ' ... y .:. F � ,���5 f a ,. , �.., �... a ; _ ____ . ,,..�a_ ...__.�......>. >. _..�__...��...>._.-� �_._.�_�. __._� .,.. .._ _.._ �___.._ . . � ._}._.._ _._ ...-.. ___ _._�.._ _,_._.W. ..._ 4 � ; i 'i. , . � ... ... ......._.___..... ...._...._........ ..... ._;_.... ._.._........... .:,............__......._..........µ...._r..,........ ..�,* ,.��,��`" ,�- .._ _._...._ . . . . , � �;��� �����o-���.. �������� � i ' �� .�+�.. a���z��•��'� �� _� _... __w _�_, �........P.__........_..._....�.e.,......._........._........�._.......__.._.........�...�.... .._.........__._.._._.._.__ __ . �.�. �.�'x:�� €�..��'�.__ , _. .. .-_......._._ :.r.. �, ,�»:. :...�. w.. h� .��•.,,t .s�;��;�, v� ....e........... ._._,._....e.w. . ;.........:......_..........,..�n...... ._......_.....___..,........_..__,....,_.._._.�. ... _._...__... . _..____...._._._____._._._..__.___�_...�,�..._..w_.... ...._.._._.�__._.........._...�..........W.,' 'e........n....,,,.. ......_....___.._.___._......�..___.._.�......_..,._�..,.�._; . s _.._F ; # q y._..........____.—_ �_..._..........a............._...........�....�__'____�_.. _�,_.a.._-___.._........._._.__.____....._._.. ._..,..._...._ ....._.._..._......_ .......__......_.._......__._._-__. ..._...._.... �.__.._.... ......._.._.... _...__�._.. i � � y�_...._..____.�.»...._._......__„.,..._.......... ...._..._........ ._......._.__,.__.....,......_....-...�...e.e... ._.._....,.....,..._.,.......... .__.......__._.___,._.......,..._._......................_... ..._._ ....._._.,.._. ....__....._......_......_....._._ .....:._.:...__. ..:_.........__ ..._-...,.....:�, . �v....__'.___......_...._,_.�..........�.._......._...............d...�....___..._._.._.�_,._..._.....,..._Y"'"__"___.....:....�__...,�........__._......._..... _...._.�...._`"___.�_... _.............. ._...__.........�.. ....__._..._........_._.....__._.,.__.._. __ .. — _ ' -- °,-._.....,._,. .....__...._ .............._.... .....___�__.._ . ___...___ ............. ............._._._._..,_..�_..__.,_...._.,_._............ __ ........._... .._.___._.... . '._.._'.. __.._._.__ ...._..........__._ ..............._.._.__......._.. ....,._.. . _ . .. ....._. - _... , � 1 . �b„.'....._............................. .........._..... ... ._.__-__._:._.._._._._...............__..,............_.,......_..._..._.......,._._....._.�.,._____......_.__.....-_...___..,,..._..�.,...:__..,�.,�....._...,,...�.......,.._.... .._.,........__'__.,_._.........,. .. . _':. "'_ �_ � ....,�T- , . .. . � ._.. �e ..>�m. �a. ...e.F.+t '� `...��r`.a'. ... . . �. , i 1 £ . .__._._... ........_....P . . , - € � . .a.,� .�} ,o.� L .-8n - . ....,.._.,....._..._____...._._....._...._..._.:._....�......w...._..........,,._..... . _..___. .. . .. . . . . _ . '-.`"� . .._... _._ ___... .__'.__ _...,._.._ _..._______. . _..... : :..at;e,�... � , ��.. ,� .1 ::..c.,.. .... Y � 3�t2��%.'� ^x �`�� � aF'.�`9`z`�� . _...._........,.._,.._..__._...... ..............._.....___.,........... ........_.........._....__... ... a...... . ._............. .._.._.._.. ...... ,.. � ..� I .... � z ,�3��.3 �a.a��,�� . _ € t ,.`������ ����� �:.x� �"�� � q ���,y�y�:��`�.���z� �� `�����` . ................._.._�............ ..._...._...__...,_.._...___. ..._...___... ____._.__.... .._._...... . ........... ....__...... .. �.._.__ ... . --.". � l �;�'���'v ,p��'��g �i* � �,� �,., .. ....,. . .._� 4 ��`��e'��'>s '�����,�����b�� ����" :: _ . _.....�._.. .�________- _._,_ . _..._ .._ _ . ............�_ ...�_ __ ...--------- _,_._...._.. _ _._ _ � � ��4 ����� �� 3 � ��' ��� ����� � � � ������� ���� �' _ ._... . .....�. ..w _,... � $ a�� �� �,� #�����'�� � _._ _ � �L��� ���� � ���� ___ _ _ _ __ � ,;.at�s'�w���._"��. ' �s_: . .... ._ ._... __..... ......., � ��* ���������E��:.��� . .... . ..�._. w....._. .. .. .... . - . . _..��. . ._. . .. a��� s x � .:�.e�� -'��, � .& ��.@'��€�"F' €"� .u..i��`���� . : . .._ ........_m_ mm.. .._.,..... . ._......... ... ..._ .'�.. _ ._.._. _.__...�.,...w.... ..._.. _. ..__._ .�.. ..._._._ ... .._..__ ..... . . ........ ._....... i , ....-,,,... _ . ., ., ,: .... ., .. . , . . .. _ ._.,... ... ' ;..:_r„.:..�.m...n,,.a_......R.,_�..�..,..,._:,,.__,_.......�.......__.,.,,...�...A.�.,....�.,.,....:.ro»............:�.,..,.,.m...:.,...,,.-�--,......o.e..n.,.,...:...,.......,�,:�,�.....:....m.,._.....�....:.,.�,x:,...._...a:....a..�,.,..,,..,...,....�,.�,.�..:�...,.m..m...........�,,.,,:,,.-..».-»�-...�,..�.....................�..,.:..:...».- ,._.._....,.�,..a...,.,»_...,: