HomeMy WebLinkAbout12837 CITY OF DIAMOND BAI� ,� ` �
=�!`�
" DEPARTMENT OF COMMLTNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190 � _ —~
(409)86(�3195 Fax(909)861-3117 PRESS
B�JU.,�DIIVG P�RMIT APPLI�ATI�N FIRMl.Y
o DDR'ESS �75��1U�I �CIIA Q `�� ��. DATECATION��j�� NUMBE ✓� i� I
� ISSUE TYPE OCC
APN LpT TflACT DATE CONST. GROUP
0 oWt�R Q Y1G1U�n
p ADDRESS � p 7 ZONING SETBACKS
� CITY ZIP3��5 TEL OG d-3 FRONT RW ❑
APPLICANT TEL. AA ' 0- c- REAR ❑
� SIDEISI�E STREET RW ❑
CONTRACTOR S1DE ❑
� ADURESS PROPOSED USE
Q CiTY ZIP TEi.
t� ARCH/ENG/
� DE5IGNER NO.DWEL. NO. NO.
ADDRESS UNIT3 STORIES BEDROOMS
CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
cn
� OWNER-BUILDER DECLARATION SFfilADDIHEM
O
� I HEREBY AFFINM UN�ER VENALiY OF PEFW FY THAT I AM EXEMPT FROM THE CONTMCTOflS LI• GeIAg6/CBfPOA
�EpSE�AyyF'pq7NEFOLLOWCKiREASON(SEC.70.31.SBUSttJESSANOPROFES5�ON5CODE:ANVCINOR (/�
�(ry�{uCrvxucaAPEWIRTOCOt�LSSTAUCT.ALTEH.IYPROVE.DEWOLISN.ORREMIRANYSTFlUG LLI Pd110/DBGIC
iW1E,PRIOq Tp RS ISS{MNGE,11LSQ REOUIMES THE APPLICAM FOR SUCH P�91AIT M FlLE A 51ONE0 W
ST�T9IBR TNAT HE Oq SHE IS LICENSED PURSUANT TO TNE Vt�VI51W5 OF THE CONTPACTOPS U�
� CENSELAW(CHAFTER9(CCWYENCINOM'ITXSECTION7000)OFOIVISION30FTHEBUSINESSANOPRO- � POOV$p2
FESSIONS WOE)OR T1UT HE OR SNE IS E%ENVT THEREFROM ANO THE BASIS FOR THE ALLECE�E%ENP�
V 710M.ANYVIOlAT10NOFSECTKK17091.58V�NVAPPLICAN�FORAPEPMITSUBJECTSTHEAPPLICANTTO Z Rg-ROO}
r A CIVIL GENKTY OF NDT M�NE THAM FNE HUNORED 00l,Ufl3(t5001.):
^ ❑I,ASOVMEROF7HEPROPEitTV,OqNVEMPLOVEESN7THWACESASTHE1RSOlEC01AOENSATICM, 0 CORIR19fC181
� WILL p0 THE MIONC,AND THE 5T9UC1UHE IS NOT INTENDED Oq OFFEflED FOR SALE(SEC.7oN,BUSI� J
y IiEB$AND PqOFE86pN3 CODE:h1E CUMRACTORS UCEN&E UW DOES NOT APPLV 70 NJ OWNEP OF �
pppp(j�'yyµp8lJq,p5pqy1Piq11FS7HEREON,MI�WNODOE55UpiWORKHIMSEIFORMERSELFOR m
[[ 7i1ppU(iHl1�$pq1fEROYNYBIPLOYEE3,PpOV!DEDTHATSUp1tlAPROVENINfS�RENOTMITENDE00R
4J OFFEHFDFORSAlE�F10WEVERTMEBUp.DINQORMIPROVEAA@1TISSOLDWRHINONEVE�ROFCOMPLE-
Z7RXJ,THE OMINEFl.BIJILO€H YNLL HAYE TME 9UROEN OF PROVING THAT HE OR SHE DIO NOT 6UItD OR
= q{ppOYE FOp71iE PUpPOSE oF Sly_E�
� OI,ASOryqEAOFTHEPRODC¢ifY.J1ME%0.USNELYCONTRACTINOWITHLICENSFDCONTMCTOqS
TO CONSTHUCT iME PflWECT(SEC.70H.BUS!NESS ANO PFlOFESSIONS CODE:THE CONTRACTORS L1� VSIIIBlIOfI ADJ.AREA
CENgE LAW pOE3 HOT APPLY TO A!1 ONNER�A VROPERTY W1q Pl111D5 OR IMPqOVES 7HEfiEON,ANO
� Mt10CmiTR�CTSFOfi5tXx1PFWECrswITTlACON7H�C70f1(b�LiCEN3EDPUR9U�WT70THECONTMG QUAMTITY DESCRIPTION FEE
� TOR.4 LICENSE UwJ.
J
Q O I AM E%ENPT UI'AER SEG. B.6 P.C.FOR THIS REASON U
�
LL DATE OWNE� � I�G `���1
Z J ! L
� UCENSED CONT ACTOflS � RA ION -�
� � 1 HENEBV AFFKW UNDER P6NN.TY OF VERNRY�HAT I AM UCENSEO UNOER PFOVISIONS OF CH0.PTER �
3 � 9(CO�//ENCWOWI7MSELTION7D00)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z
� �� MY LICENSE IS IH fill.l FORCE AND EFFECT. �
� � I.iCEKSE CIASS UC.NO. '
V pq7E CONiRACTOR d
i W
� �i WORKERS'CAMPENSATIDN DECLARATION Q
N U
� � INEREBYAFFlPMIN�DEROENAL7VOFDENRIMONEOFTHEFOLLOWINGDECLARATIONS: Z
O IHAVEANDWILLMAiNTAINACERTIFlCATEOFCONSENTTOSELF�INSUREFOHVKIRKERS' 2
t COMPENSATION,ASPPOVbEDBVSECTION370DOFTHELI.BORCODE.FORTMEPERFORMPNCE �U
� OF h1E WORK FON WNK)1 TH�S PERIAR IS ISSUED. �
� _IHPVEANDWILLMMdTAMM/ORKER9'COM7ENSATIWIINSURANCE,ASREQIJIREDBYSECTION
� 37o00FTHElABDRCODE,FON7NEPERFORMANCEOFTHEWORKWRWHICHTMISPERMITIS
� ISSUED.MY WORKEAS'COIIPENSATpN INSL/RANCE CARPoEF ANO POLIGY NIIMBERARE' CONSTRUCTION
� CARRfER P� �� J�.
� P0.ICYNUMBER ELECTRIC % p
� �S�y7pp��ppTgE�A�EiEppF7FEpE7iAMTISFOqpJEWMqEppIXlAits�lm)oqLESs). PIUMBING
Z ICERTIGVTHATMITHEPERFOPGANCEOFTMEW9RKFORWNICHTHISPEflMITI5155UED,1 MECHANICAL
(!3 SHALL NOT EMPLOY ANY PERSON tl'7 ANV MANNER 50 AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATIDNIAWSOFCALIFOPNIA,ANDAGREETHATIFISMOUL�BECOME INSPECTIONFEE
S SU6IECTTOTHEWOHKER5WMPEN511TKKJPflOVISION50F5ECTION31Do0iTNELABOR �SSUANCE �
cooe,i sn,u�coRn+vnn�canP�r win+nwsE anowsar+s.
O SMIP
� w DATE: APPLICANT: .
I J W�RN�N�:FA0.URETOSECl1REWDAKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANUSHALLBE ENERGVP/C
�y SI�JECTANEMPLOYEHTOCRWIMALPENALTIESANOCIVILFINESUPTOONEMVNOREDTMOUSAND ENERGYPERMI�'�.���������'
�� OOl1ARS(S1aa,000L�NADDITIONTOTHEC0.STOFCOMPENSATION,�AMAGESASPROVIDEDFORIN
i � SEC710N 370B OFTHE UBOP CODE,R�ffEREST,�NO ATTORNEY'S FEES. RETENT�ON FE�L� C A
W CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
o..
� IHEREbYAFFIRMUNDERPENALTYOFPERIURVTHATTHEREISAWNSTPUCTIONLENDINGAGENCY
FOR THE PERFOPMANCE OF THE WDRK FOH WHlqi TMIS PERMIT IS�SSUED(SEC.3o97,C�V.C.J.
z '
w
� LENDEiYS NANE'
F— LENUERSADORE55
� ICERTIFYTHATIHMEREADTH�SAPPIICATIONMNDSTATETHATTNEA80VEINFORMATIDNISCOqRECT. TOTAL FEES ,
Q 1 AGREE TO CQMGIV WITH ALL CRV AND COUNiY OR�INRNCES AND STATE UW9 REIATINd TO BUC.DINO
' � CONSTRUCTION,M�D NEREBYAUTNOflIZE REGRESENTATIVES OF7HI5 COUNNTO FNTER UPON THE
ABOVElAEMfIONEDPROPERT'/f-0RIN5PECTqNPUR�S.( � �- 1 COMMENTS
j � ��,c1�7�4t-� �:,•—�-���
ma 7ERF6TTEE E(PRINT)
I �
y Si°runRE� P RECPT.NO. PAID BY YALIDATION
� WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assns.sor Copy�GOLDENROD—File Copy,GREEN—ApplicenPs Copy
CiTY i�F dil�IVl01'+iC) BA�
tNSPEG�'0�►IV ��Ct��� �
� i . � . . ! i , � � �
���`�iR�i{ I ( FLflQR J41ST � j
�TtaSiFC�Rt��SSOSTEEL � I FHA REQMTS C
ELECTf�IG GRQUN� � UNDER FIQOR C?UCT � �
G�i�Uiyp pLU1v9�ING ! UNDER FLOOR CGRIDUIT i i
SLAB Gt��D� i FfREPLACE FOUNDA7IC}N �
TE�d�F�F'D4�Ei� I � FIREPLACE BOND 6ERM �
V�S��i ER SERVICE � MID HT.Bt�ND BEAM I
FiC}C1�BHEA'f"i-i{�IC 8 FC. BQND BEAI�1
FF?R�4�I�dG/4rE1dTILIr�TtOt�j FlNAL BONb SEAM __ _
ROOF C(JVER � PAE-GFiADING — —
RfJU�H fiE1�i�(lVc,^.a � BENCHWCa _ �
��C?UGH ELEC7FilC � RQUGN GRADING '
ROJG�I PLUsu;Bi�IG ( � FINISN GRADIEVC
S}-iC7LVEF�ITU�T�ST I � Ft�OL E�EGTRlC � �
EXT'. I�TNIS19�Ittifa E i, i POOL F'EI�tClNG i
4'Vr:LL 1NSU1�Tl�h! - ___...-- r� PC)Q�FINAL �
C�.ILlNG ii�StJl�,Ti{�N OFF SITE Iiv1PS. �
[3RYL'U�eLLN,�ILI�JG i ._ �EDICATI(3N5 __.�.� .______.___ i
S���f cR
FINAL Ei�G. �_i �
S�P�"!�iAN�: j LANDSC,�PEtIRi�iG. ,
__- --- — — ---- '
_ _ �..._....._.__—___.�._____ _—__._ k
Sf����TiTf�..L. �� r C?�J SITE I'�,tPS. _ ' ._�_ �
GAS t�6�t T�ST � � FiN�L ZGNir�C3 !
FI�l���t�t�9�7 ; F1RE DEPT. FIP�lA� ;
� ' NEl�LTH DEPT. �`iNFaL_r._ �__�_---___. ______ �
�__.. _-, ----
FlfiV�iG F-��r�Tl�G i E
FIt�AL�L.�C i F�IC �. � I ' I D�V. FE�S PAID - --__.. i
� �i��aAL P�U��St*:C _ �i _ �—.__._�__ I ENERGY _. --- �
..�...�. �------�— _I
� � ' a�: � __�_ __— �
�✓��'v�i'�i��`��� � �.. .�
�
��`" —_..,.__ �
� __ �
�
�
�_st, �'.�� ..._.� ___—.__
. .s. ____�.._... __-�
a.�7����4.i iJ'itV��.�3���-.�.,:,.�....^.�_.....,......� - . . .,. : � t..
���:i�F'ITIU SIZ� ___.._