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 - ' � °! I : �I � ' 'y � i � ( �; i � � � � � ( � � �� ��'"a^ �..
� � ! E - I E � I � i � � i -) ( ' I � .E ; �
� . � ' ' � � � � I ! � � ` i j �I ( i � � f ( � �s� �
I � i i � � I . � i � � � � I i {{ . p6.
I I � �� I � � � � I � t � � ( � �, � � � , � � i �i�r� i�� .
� i � � €'' L I ( � i i. s I I i ! i ( � � f � � i ' � i , I � !' � :i
,
, �
I 3 1�.^ i . � i j i �._ � �.. �_ �L �.._ .. ( � � € ' I._� - �?
� � _
i � � � �
� � � : ; � i� f � i r � 1� �l y-"L 3 � - 7) 1�C„ 'n�� r G'�_ i� m
� E i : i i � � �" i _t � _� � C'Y( i � . � ��- '"
� � � � T I , � � €� J � {,� i_� I �� � �,� �C��� I � � �
� �� ( i � ! � � � ' � € «,��--'` � r,i �' r cr ! r^ �n� >� � �+
� i ' � f ' � �ilr�) � � _-� , .IR `��� I I �[�� t � . i ( i ..�4 ' "� ���
c
� � ; � .5t ��� . � I��i ,-� �� �r. r �� C i P°"'f °�
{ � � i � � � , ;I i . � r =� i � I �ca f " � o oE=. �n
i i ; i ': ' _ --i i'v I� I �`
� i I i : � € � ; � " r. �_ , � i �z. � �,tr, -� �
� ; � € i � i � ' f� i� � ,� � � � �� �' � ��� �� � �i� I I �� �
i � ! � � � ' i � � ' u� � Ix• �` �L'��r,i I �i
� � � � ' �I I I � � � I i r �� �� �' �
� � ,
� �� � ' � � ( � � �� i� 3 ��! ����!
� i . : i ; i 1 t t G a 7�� E :
�' ,
i � i � i
I � �) � I , i �� �- I � _� � � (
,
i
i i
t . � � . � � ; i . ;-._.I _ � _ .L.._ _I_ _
y i j
! . .� � : i , � ; � i �' � , � 1 . i ' I '.
i
t � . ; .�� . � i - � 1 � .
�
� : ,. � � _ , . � . i � . . I �
� ' `��. ' � ., i � � I i � � � I � � � I I � � +� I
' � ( i , i � � I �
, . ;
, . ,
� � � ! I i � i � ` - � - _ -
�
, 1
� ' � i I � I � i
� ,
� � � ( + ; i
�
i �' ,� 21 � ; , � -
, �
s I � , I � ' 1 � � ( I I I
j � ?� �� a1 � ' ( � j , ' 1 ! ! � � ' i
t "� ,� ' ; i � j a ' i i � � ! ' , i i ,
I � �„'{.' ' �. . � ', � ' i ' i � ' I � ( i . f
� �� � � : I - � � ' (
I ���� I � € :l I ' � � G � � i �' � I p,.;.
._ �i (��� � i , � � �'� � ' � ' � � �, 3.
� 1�� e� '.� � �� ; � , ' � � ,.ii I I
i
' �.�_�� ` i , . i . I . I 1 I _i � � ' � � � ' I �� ' I � I
a�_.._ _ _.�_ ._�__;.___._�._ ___.�___.__�__� _ � �
,