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HomeMy WebLinkAbout13271 CITY OF DIAMOND BA� 1/��� -- DEPARTMENT OF COMMiJTTITY 8t DEVELOPIVIBNT SERVICE 21b6D E.Copley Drive Suite 190 �,,. (909)8bQ3145 Fax(l09)861-3117 PAE� � '�' BUQ.DING P'ERMIT APPLICATION FIRMLY � JOBSITE APPLICATION � PERMIT ��f P/�9 G � p ADDRESS ���� IkKrc�M�MbLptV DATE ���� NUMBER �� I � # -V�Y $ ISSUE /+ NPE OCC APN �(��LO�3T TRACT DATE `''� CONST. GROUP p OWNER �.1^ve. I`{�L�/�Q� �II��Sh��1� � o ADDRESS � lo CJ F ZONING SEfBACKS � CITY f� i �3�2 Zlp \ �TEL. REART RW ❑ APPLICANT SL�jT V�C-25 TEL.G 1L n�i SIDE/SIDE STREET ❑ � C�NIRACTOR CV Q hSS�'G SIDE ❑ ADDRESSJIb�_lM.�t41R.a1lC-k� ' 1 g CITY p ICC.A�l ZIp 6.�/1�'7 TEL. /.2���</ 1�,� PROPOSED USE ��-`S f D�N�� �'1c�1 S t d� a ARCHIENG/. � DESIOlJER T�iL2S11 V A7�(t./'�S NO.DWEL. NO. NO. ��Y E" Z�P TEG UNITS STORIES BEDR40MS cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � ONMER-BUILDER DECLAfiATION �q/ADDIREM p 1 NEqFPY AFFMiM UNDfiR PENALTV OF PERRIRY THAT 1 MA EXEMPT F7iOM 7HE WMiRACfORS LI- Ll� CENSEUWFONTMEFaLLOWN�RFASON(SEC.7671.6&15PlES3ANDPROFE5510N5COOE:AMYCITYDR � Garage/Carport �' �7 COIYlfYWFiCFiRE0UW6S�PHWRIOCONSTRUCT,Al7ERMPqDVE,DEMOUSH,OqREPNIqANY5TAU0 W Z TGHE,fqqli TtJ ITS ISSUANCE.K30 REOVIRES 71tE MYLICAIMT FOA 8UG1 PERY17 TO HLE A&QNE� Petio�Deck �� STATBdENT TW1T HE OR SHE IS LICERJSED PUqSUMJT TO THE PPOVISKKJS OF THE COHTMCTORS U- LL � CENSE lAW�QIADTEN Y(COAl1�NCINO WI7H SECTIOH 7000)OF DMSION 3 OF THE BUSINE55 RN�PRO- PooVSpa FES8qN6 OOD�Oq THAT HE di SNE IS E%EYPT THEREiROM AWD THE&1415 FQRTHE ALLEOED D(EMP• Z Re-Rooi 710N.�NY VI(7LATION OF SECTION 7031.6 BY�N'!APPLICANT FOIi 11 PEWAIT SI�lECTS THE APPIiCANT TO F ACML PENALTV OF NOT NOqE THAN FlVE HUIJDRED DOUARB(fb�IJ: � ❑lASOYINEROFRiEPROPERIV,ORMYBAP�OYEESW11HW11GE5A5THEIR50lECOliPENSATION, CORITBfCIBI -' WILI DD THE WOW�AND TFIE STHUC7UHE IS NOT IMENDEO OR OFFERED FpR SPLE(SEC.7CM,BU51- � tE5$MD PA[lFES570NS G(1DE:TIiE CONlMCTOR9 LICENBE LAW DOES NOTAPPLY TO AH ONMEA OF ? . � PROPERiYMF10BUR.D80H�/PRDVESTHEAEON,At�YAiODOESSlICF1WORKHIMSELFORHERSELFOR • Q TWOUON WS OR HEfl OWN EYPLO`/EES.Pf�VIDED TMAT SUCN MPROVE#IEHTS ARE NOT P/TFNOF�Oq CO U� OFFEflE�PJRSIiLEIF,IWYtEVEfL7HEBUIIDINfiOq4APRDVFLBATI3SOlDWffHWONEYE�HOFOOYPLE- � TION.TiE ONMER.BUItDER WILL iNVE TME BURDEN Oi PPOVINO iMl1T ME ON SHE DID NOT&11LD Oq MPRDVE FOR iHE PURi'OBE OF SALE} W ❑1,�►S OWI�q OF iHE PPOPEpTY,AY E71QUSIVELV CONTR�CTRNi WITH LICENSED CONIARCTOR4 Q TO OONSTRUCf THE PIIQJECT�SEC.70N,BUSINESS ANO PPOFESSIONS CODE THE COHTMCTOqS LI- VelUetlIXi U ADJ.AREA W C6fi5E LAW 00E3 NOTMPLY TO AN ONR1Efl OFA PROPEHTI'MIF10 BUlAS 0fl MIPflAVES iHEREON,ANO f WNOCOMRACTSFd15UWPRWECTSWrt}fACtONTRACTOR!g)LICENSEDPURSUANfTOTHECOf1fM6 pUANTITY DESCRIPTION FEE � TORS 110ENSE LA1YJ. ❑I AN O(EMP�iMDFA SEC. B.1 P.G FOR THIS HEASON v ' � ;J� LL � OATE OWNEN U � � LICEMSED CONTRACTORS DECLARATION � J ' � W IF1EREBYAFFIPMUNDERPEM1NLLTYOFPEiWflVTHATIAMLICENSEOUN�EflPROVI510N50FCHRPTER � � Y�0011YENCRKiWIRi5ECf10N7000�OFDM510N]OFTHEBUSINESSANOPROFESSIONSWOE,AND Z ��� MYLICENSEISNFlR1FORCE/W�EFFE� m � � UCENSE CU55 ��e�� LIC.NO. �[J�Z� \ j ( t� DATE �,`���� CONTMCTOR a � . SJ . � WORKERS'COMPENSATION�ECVIRRTION � 1 �� yf N J � y INEREB�AFFlRIAUNDERPEN�LTYOFPE0.IUHVONEOP7HEFOLLOWINGDECURAT S. Z 7 � _I HA�E M1O NIILL AWMTNN A CEPTIFlGITE OF WNSENT TO SEl£-INSUFE FOR NSXtKEFS � COMiEN3ATION,ASPROVI�ED8V9ECTON77o00FTHEU90NCWE,FORTHEPERFOR►1MlCE U � �OFTHE YVORK FOR WN�CM THIS VERMIT IS ISSUED. � / ` � ' Q _�lUVEANDWILLMAMTNNMlOHKEPS'COMPEN9ATIONINSUMNCE,ASREWIflEDOVSECTION t''G � a7ooOfTHELABORCODE.FORTIEPENWiUAANCEOF7HEWOPo(FORWHICHTHISVERMRIS �i� �70 � 155UEU.MYWOPISEP.9'WMPFNSATIOt11NSUiLWCECARRIEHANOPOLICYNUM@ERARE' CONSTRUCTION } c�wwEn PLAM REVIEW � �����+ ELECTRIC � � QtasEC11oN1�Nof�aTFLErEDOFifEPESMitsFORaPF_ t5� Ia+�E PLUMBING .. ^ Z ICERTIFYTHATINTHEPERFORNMICEOFTHEWORKFORWHIqiTHISPENMITI5ISSUED,1 MECHANICAL N i (� SH�LLNOTEMPIOYANYVEflSONINANYMIWNER50A5TO8ECO1dESU&IECTTOTHE � WORKERS COMVENSATION lAWS OF CALIFORNIAµDAaREE TH�T IF 1 SiKKJI.D BECOME INSPECTION FEE , � SUBJECTTO THE MI�DHKERS'COIAPENSATIDN PROVISIONS OF SECTpN 37000FTHE UeOfl ' copE, sHu1 car�c�vNn»inaSEvaowsa,�ra5i. ISSUANCE fe� ✓_ � '���� C V � f+)SO�.... SMIP W►�U . p DATE: APPLICANT: '�� � ENERGYP/C ,: .,�";.�� � WARM�NO:FARURE TO SEWPE W�ERS'COMPENSATION COVEflAQE I$UNUNVfIR,AND SH/�1�BE � SI�JECTANEMPLOYEATOCAINWALPENALT�FSMI�CMLfINESUPTOONENUNOREDT11IX15A1J� ENERGYPERM�T DOlLARS(i1 W,o00j,M AWITION TO THE COST OF COMPENSATKXI,DAMAGES AS PROVIDED FOR M ' J SECl10N 970!OFTHE U�CODE,INTEREST,AND A7TORNEY'S FEES. REIENTION FEE: � CONSTRUCT�ON LENDING AGENCV PRE-/1�j FEE: / � IHEPEBVAFFIRYUNOERVENILLTYOFPERIURYTHATTHEPEISACONSTRUCTpNLENDINGROENCY 1�� � l'"'-',_ _ Z PoH THE PERFORMANCE OF 1HE WORK WR WHICH THIS PERIAIT IS ISSUEO(SEC.3097,CIV.C.). ' W - . - .. , , . � � LENDEFMS NPAIE i � LE110ERS/�UPES3 � ICEFTIFYTHATINAVEREADTH�SAPPLICATION/WOSTATEM�.TTIEABOVEINFORMIITqN15COPPECT. TOTAL FEES • W IAOREETOCOMVLYWfTHALICfIYAN�COVN7YORDINM7CE5AND5TlITEUW5PEI.ATINOTOBUILDING � WNSTRUCTION.AND HEREBY AUTFIORlZE AEPRESEN7A71YE5 OF 7HI5 COUNTY TO ENTEA UPON iHE � ABOYE-MEM10NE0 PROPERT'FOR INSPECTION PURPOSES. COMMENTS = S cn rr N��,2g °O ve eE wwE wyr�, ' � � b'(�—' 3�I l �r°j y SIGtL�NREOFPEHMITTEE DAT � RECPT.NO. P1UD BY VALIDATION WNITE—Depertment Capy.YELLOW--Finance Copy,PINK—Asaessor Copy.G LDEN D--File Copy,GREEN—ApplicanYs Copy �_ , _ , , , ' ` f; � � F . �� �, � �: � i E , i � � ' ��_ � E �_ � �I 3 7 F `i _ ; i .. , . _. ' _ - "1 ! � . i , � , _i_ _ - 1.- � � i I � �i �` 4� ��) '�( '� �g f ,�� t ,� � � 1 � I1 � �i t� ��� ; I E ' I � I � � ' I , c ir f „ � � � � - j � -' -- E ' � � � � ! � � � �_� i ! � ' ( � _ �.. =`� ; 3 �,,. � . . ..,_. � i I - � i - � ' � j � 'l� � t7� .�� . � -Etv �h a , E ' ' ' '_ „ , ' _ p. i ; � � ; �� � � � i� , � � ' i , ; : ; � I i I�� � � ; � ' �� , , � ; � � � � i � ;: ; ( ; � ; ; � ; ; ✓��� � , � ; 1"'� I� : �'� s ; i ; I ti�: i ;, � ; ' � , ' ! i � ; � � - ', ; j—. .�— ; � � I � I I � i � i i � � � .� �; � ; � i i - �� � , , , �' % ' , 1 i_. F .. ....... � v� � = I ' j ; ! � � ' � ; i f ' r '; � ' � �, . t i i - ' � °! 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