HomeMy WebLinkAbout12866 CITY OF DIAMOND BAA
- DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES
2166o E.copioy n„�e suire�90 PRESS
� (9D9)860-3195 Fax(909)861-3117
��'��� BUII.DING PERIVIIT APPLICATION � 1� ,� FlRMLY
oy JOBSITE � � APPUCATION�/�r���Q p NUMB R� N�
ADDRESS • DATE -G LTJ
� APN LOT TRACT DATE IG-Z9'"�6 ONST. GROUP
� OWNER
ADDRESS ZONING SETBACKS
? CITY���_tYI ��` ZIP TE REART � �
g APPLICANT TEL. SIDFJSIQE STREET RW O
� CONTRACT� I � SIOE ❑
� ADORESS � � �a�,a PROPOSED USE
o CITY ZI
� ARCHIENG/
� DESIGNER NO.DWEL NO. NO.
� ADDRES5 UNITS STORIES BEDAOOMS
CITY ZIP TEL
�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ_AREANALUATION
Q OWNER-BUtIDER DECIARATION S�p/p�pp/�M
O
p 1 NER�Y AFRRM UNDEii vENALri OF iEtWm nu7�uA E7cE1�PT FaoM 7HE canruc7o0.s u- Garag!lCelport
C�ij CENSEIAWPORTMEFOLLOWNqRFA3qi(SEG7ai1.6�131NESSMI�PROFE8910NSCWEANYGiYOR (n
G� COUMYYIINCFiREOUIRESAVEFMlfTOCONSTAUCT,ALTE0.RAVNUVE.OENOUSH.ORREVAIRANVSiAUC. IW P8110/DBdt
� TURE,P190R TO fB k491lANCE,t150 REOUIRES TFIE MPIICAHf WR SUC11 PEWAIT TO F�E A 91GNC-0
BTATEIAEM THA7 HE OR SHE IS LICENSEU PUNSUNfT TO 7NE OiWVISldd3 OF 1HE OOMMCfOR3 LI-
� CEl�E LAW 1Q111PfEN Y(�MENGPXi WITlt SECTION 7000)Of OMSION 30F TME BUSttiE55 M1D PPO- LL' POOUSpO
FESSpN3 CODEJ ORTFUT HE OR SHE�IXEMPT TiEPEFqOM AND 7NE BA313 FOR 7HEALlE��D�MP•
ipN.ANYV1aLAT10NOF3ECilON7W1.6BYANT/WRICANTFOFiAPEFMNTSU&lECT37}gAPPLICAN770 Z R6-ROOf
� ACIVRPRY�INOFNOTA10AE11iANFNEINNDREDDOLLMB(t6oD1•). .
� DI,ASOMMEROF7HEPROPENT�:ONYYEMPI.OVEESYVITHWAGESASTMEIRSOLECOMPENS�TpN. ❑ (`,pmryl6fC�8I . .
M/Ry pp iHE yypFUC,µp iHE STimlClUqE IS PqT RfTENDED OR OfFERW FOR SALE(SEC.7ou,BUSI- J
lE33 AMf PI10FE8810N8 CODE:TTIE CONiMCTOR3 LICENSE U1W DOES NOT APPL170 N!OM7iER OF
� PIqPEXTYYVlIOMJIlD30NN/PFIOVE87HERC-0N.MqWHODOE55UCF1WdiKH1613ELFOR1iER&ELFOiI =
� 7MIOlK81MSdiNEFOVMEIMLOVEES.PHDVIDEDTHATSUCMWPROVE�IENiSARENOTMTEDAE00R m
Q .OFF6�DFOR8ALEE,M10NkYERT1EAULDRKiORWPPOVEA�BlT1980IDMATMNONEVEAH�O[XJPLE-
Z 'TION.ilff OMRIER�BUA.DER N7LL IUVE TFff BURDBJ OF PROVINO 71UT NE ai SHE OO NOT BURD OR
= NYlqVEWRTHEPURPOSEOF3A1.E1
� �I,A40NMEROFiHEPROPEHfY,AMIXCLUSNELVWNfNACTINAWRfILICENSEDCANfPo1CTORS
7p apP6ipUCi 7XE PROJECf(SEC.70/4,BUSINE55 M�PROFESSIONS COOE THE WNIAIICTOAfi Ll- VelUetlIXl AW.AREA
W CEN9E LAW DOES NOTAPPIY TOAN ONMER OFAPROPEHTY W/p BUILDS OR MAPROVES iHEREON.ANO
S wwmnrw�cra��rnwEcrswm+�ca+tracronts���ws�ruAsu�wrron+ecartw�c QUANTITY DESCRIPTION FEE
�•' ror�sucEriseuw.y
� o�ueo�uvru+oEnsEc. e.av.c.wnrwsaE�sor+ �
� ¢
V' pp7E OVMER V
Z W
� IICENSED COPtiAACTORS DECLARATION �
W Q
(� 1 XE{�BY/�RA U1pER pE1ULttOF PEMIRV 7M11T I M1 LICENSm UNDER PROVISIONS OF CHAPTEH Ur � O j O
p� �(006qAENCNO N7iX SECTION]000)OF DMSION 30F THE BUSINES4 AN�PF�FESSqNS WOE MN z
}� W UCElISE IB N HA/L� AND EFFEGT. m
� IICEN3E CLASS ` `�'�" L�C.NO. ` � J
� p�� CONTRACTOR ' 6•
� WORKERS'COMPENSATION DEC ATION Q
� U
� 1 HEAEBY AiF1NY UNDEH PENIILTV OF PEMINY ONE OF1HE FOLLOWING DEQAMTIDN9: Z .
Q
� _11UVEANDNALLNAMTIINA�NTIFlCATE�G�DNSENT705ELHNSUREFORNORKEflS' _
COMVENSRTION.ASPRDVIDED8Y3ECTOH97oDOF7HElMOHtOOE.WHTHEPERPoRMMIC� W
�TNE WOPK FOH YYFiIQiT/il5 VEMNi�ISffi1W. �
NAVE iJA WILI WIRYTIUN WUFB(ERS'COYVENSRTION INSURANCE.AS REOV�RED BY SECTION
� 37ooOFTHEL�BOFiCAOEWRTHEGERFOHMAN�OFTHEWORKFOHWHICMTHISPERMRIS
s�Eo.nn nainasu�cucu� POLN�YMIM9ENME: CANSTRUCTION
� � r 1 Oh PLAN REVIEW
� c�aram
� pa�cr ra�,reEn ' ELECTRIC /f
� QHs9Ccfl0t�rEIDta7�mARETEDOF'n+EPEf�.(fSFOaaJEHIJ�oF�OouAFsR+mIoRLESS? PLUMBING �`r �
� I CERTIF1'iHAT NTHE PEPfOPAIANCE OF TNE N'OiK fOR WHlqi 7H�5 PEttl�/17151551)ED,I MECHANICAL
$HALLNDT EMPIAY ANY PERSON P1 ANN M�ANNER 50 AS TO BECOME 9U61ECT TO THE
Uj WORKERS COMPF1/3ATqN UWS OF CAL�FORN�AN�DAOflEE THAT ff 1 5110ULD BECdAE INSPECTION FEE /�
S $UBJE(.77pTNENqRKER6'COMPENSATIONPROVISIONSOFSECfION�7000F7HELABON ISSUANCE v
COOE.1 SHAl1 FOHTNMIITH COMPIY W1TT1 TTiOSE YROVISIONS.
O SMIP
p DATE: APPI�ICANT: . -
� ENERGY P/C
WAPoItti(t F1RUi�TO SECURE WOPoCEH8'COl�1?ENSATqN COVERAOE IS UNIAMhVL.AI�SMQL BE ^ n /� .^
LL SU&IECTµ6MplpyEq7pCqMINALPEW1LflESAlAGVIlFR1E3UP700NEHUWRED7M0415N�D pyERGYPERMIT IIF�4�
ppWwS itl W.oOD).W AODfTION TO THE GO3T Oi COMPBiSATION.DAM�GES AS PiiOVIDED fOR IN y 1�V �r tl I V
J SECiWN3��7NEU80RW0E,NTEHEST,ANOATfORNEVSiFES RE7ENTIQNFEE:
�
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �TY nF nT AMQ�R AR
� I MEPE6YAFF�RM 11NDER PENALiY OF PERRIRY THAT THERE S AOONSTFRICTION LEND�NU AC�ENCY I3I Tn nnvr,�ArTD SAFETT�'
z WRTHE PERWPMANCE OF 711E WOFiK FOR WHICH 7HIS PERMIT IS ISSUED(SEG 3097,CIV.C.).
W
� IEnDER'S NM1e
� LEI�ERSADDNE55
� ��p��7AHpyE�H�T�7����5TA�7��5ANO5T�U�A�ro��E'� TOTAL FEES �� �o
� CONS7AUCTpN.N'm NEPEBV NRFqH1iE REPRESEMATNES OF 7HI5 COUNTV TO FNiER UPON 7HE
� �gpyE-yEN{qF�mpqppERiYf-0RINSPECIIONWNPO5E5. �MMENTS
� �'G`PH�?'/?�[)__,/�JESSc..I�a,�
� GERMfREEN1UAE PPoHn
�
� PERMRTEE �TE
qECpT Np. PAID BY VALIDATION
� WH _ ent Copy,YELLOW--Fhanca Copy.RNK—J��r Copyi.GOLDENROD—Fib Copy.GREEI�ApplkenPa(`.opy
�� n � � m m � � � � � n g m� � � � � m � g � � � rn �
�� O 2 z z z � m � � � m y � s O O O d � O A m a � m � �
A S� DD• .,.`' � � r OCCCO �' U -� � O
'�Ci � - "z m i Cr? n�-�o c�ri � s Z �-'� � G� G? G� � � m � � � z � '��n,a .
� � ...1,.. � m a3 � � � G7 z ,� m � s Z n 'Z tn � � � O C7
o - cn v � x o a
m o
-i-1 R1 m -t -, r x
s
e� Z, � � � z � r z' z C � r" ,- m C � m m � D .� C) 9 T .
(fl X � � � Z -i � r 7C D C � p � � CD Z 'S'? � � C7 � � � {7 U�
� G7 . r p��� 2
mN G� n � � OGym � � S'9' � {,Zjm Co Zm •
z � z
'- m z � � � o ,-r"-
D "
- z�
_: �'
.: : .,,:
• � �
• t'�ff Q
(� '11
� R1 p S 'fl T O � "YI C7 O � -0 'O T ?J W � ?1 0] � T T C C TI 'Ti +' � �
z m m � Z z z m -n O O O Z p m 77 z o � � z z s r" (�
, � m < Dmy � zpo -n000 czm7, �
- � -n -r-i Cl r -i [�A r n in r r r = � n G'� r m = v � rn m JJ O Z � ..
2 -i r r 77 7J rn 7�
+• i �C m � � � m n Z -a1 rn Z i'�il trn-" � � z �y � 4:� D D � -n fJ ` � �
� -i Z Z m 31 n n r r O -
m � -o � O � � nc� y � G� ozppmmQ � � Rt �
. • D � Z � � � � � z ; � o c� � � o � „ ooi � � O
� � y, zi � Cyzz msom009 � � m
yr � � � � � � � pO � __ O � �
- D =� Q �
. � Z �
- i --
r �
� I
•
. �