Loading...
HomeMy WebLinkAbout10893 \ �� -- �� —� CITY OF DIAb10ND BAR' .' . •: • 'r/ ' _ COMMUNITY DEVELOPMENT DEPARTMENT `� � <'� ,x.,.� 21660E.CopleyDriveSuitc190 ; PRESS (909)860-3I95 Fau(909)861-3I17' '��' BUILDING PERM[TAPPLICATION FIRMLY � JOBSITE � �L�(� B PL� CAn c1�(� DATE CATIOf����U`�� , �. NUMBER/�(��j�� �l C ' o ADORESS . � � � Lsl-Ac-1�.• o ISSUE TYPE OCC , °O APN LO,T - TRACT DATE " CONST. GROUP p OWNER w�� . . - _ ADDRESS �m ZONING SETBACKS OCITY �w` � ZIP TEL, , . � � FRONT ._ __ RW � . _. APPUCANT TEL., _ _ . , A�R ❑ ' z SIDE/SIDE STREET RW ❑ , � ¢ _ __ Q G - - - -gIDE _ _ - � CONTRACTOR � ADDRESS � _ . • �4.�(' �"1(¢ _ , 0 .C�Ty- U ZIP. TEL PROPOSED USE � : ' � . .. . :. _ ' . . ��� _. S�n C�r �_�. . . . : o ARCWENG/ . .. _. . ' _' � ��� z DESIGNER NO.DWEL NO. N0. , a ADDRESS UNITS STORIES " BEDROOMS = CIN ZIP TEL ti ' � DESCRIPTION� SQ.FT. FACTOR PSF 'ADJ.AREANALUATION � � . _ . _ . OWt�ER-BCILOERDECLARATION .._ _ . . .- .�.� ��• . ..SFRlADO/REM.. . - . � . .. 1 . . ._ ... . . . .._. ... O �. � �. � - - - - p �HEkEBY AFFIW.1 UN�ER DENPLTV OF DERAIRY THAT I AM EXEMPT GROA1 iHE CONTRACiOfiS LI- � -G2f0f�8/Cafp0ll -- - - - �� - � � W LENSEUWFOFiHEiOLIOWWGREA50N(SEC.)O7t.58U5WES5ANDPROFE551QVSCOOE:ANYGTYOq (n , � U COUNiYWMIq1REWIRESAPEFiNITTOCOfJ51RUGT,ALiERIM7ROVE.DE�OlJSM.OF1FiEPNP/WY5Ti81G W 'paGdDeck '� ' � � � � ZTURE.PRWR TO RS ISSUANCE,AL50 REW WES iHE�PPL�GNT FOR SULH DERMIT TO flLE A SIGNED w - � STAiEMEM THAT HE OR SHE IS UGENuEO PURSUIW i 10 TME PflOV1510N5 OF 7�+E GONTRACTORS lL- . _ CENSE UW(GNAPTER Y(�MENGINO NnTH SEGTqN 70001 OF D�YiS�oN]OF 4fE BUSu1E5S AND PRO-- � � POOUSp3 � � iE55�ON5CODE�ORTMATHEORSME6EXEMDTiMEiiEFROMANOTMEBASISFORTMFAIEGEDEXEAIP- . (�} . O � � TqN.ANYVIOUTIONOFSECTION7071.SBYANYAPPUCANTFORAPERAlITSUBJECTSTHEAPPUCANTiO ' Z RB-ROOI � ' � ' F,., A GYII PENALTY OF N0T MOFE iHM1 FIYE HUNDRED DOl1ARs(S57o)}. . � O11.50WNEROFTHEPflOPENTY.ORMYEMPLOVEESWIiHWAGE5A5THEIRSOIECAMPENSA7qN, � � CpmmefC131 � � � � WILL DO THE WORI(AN�THE STRUCTUNE IS NOT INTEN�ED ON OFFERED FOR SALE(SEC.70a,.BU54 J , NESS AND VROFESSIONS COOE:THE GONTMCTORS UCENSE UW DOES NOT APPIY i0 AN OWnER OF � � � N PPOPERTYMRqBU�lD50RUdPROVESTMEREON.MI�YAI0DOE55UGH1MORNHIiASELFORMEiiSELFOR = ' � THROUGHHISORHEflOWNEM�IOYEES.PROYIDEDTHATSUCNWPROYEMENTSARENOTWTEN�EDOR m ' ' W OFFERED(ORSALEIF,HOWEVERTMEBUILDINGORWPROVEMFNTISSOlDW1THwONEVFAROFCOMPLE-' � ' � � • � TION,7HE OwNER-BUILDER WILL HAVE THE BURDEN OF PROYWC iMAi ME OR SME D1D NOT BUIID Oq . . . - . � � 7 WPROVEFORTHEPUi1PO5EOFSKFI. �' - � ' = OL�SOwNEROFTMEGqODERTY.MIEXCLU5rv0.YCONTFAGiWGYATHLICENSEDCONTFlAGTOHS W "._ ._ ' ' . " � - - � TO LONSTHUCT TME PRQIECT(SEG 7Wa,EUSWESS AND VROGESSIOKS CODE:TME CONTMCTOflS U-_ -Na{�a(jp() O� �D,).AREA W CENSEUWDOESNOIMPLVTOANOV+NEROLADqOPERiYWHO8UiD50RIMPROVESTHEREON,AND � mqCANTMCTSFOHSUCNiRQIECTSYATHACONTMGTOi1(SJLICENSEDWRSUANTTOhiECOH7FUG p�,q�.�7�7y - DESCRIPTIO� �� � --�'-� �� - - � FEE . . , TORS UCEMiE UW.). . . . . . _ . . . . ._ _. . . J . ' _ '_. '_"_ ._. . .. . .. . . . .. . _ ; � �I AM EXEMPT UNDEFi SEG B.i P.C.FOq TFIIS RF.ASON U �- - , � . ._ _ _ ¢ -. . _. .._ . _ . _ . , . . . . _ _ . LL" DATE OWNEH � V . _ � . � � � .. . ' _ � , LICENSED CONTRACTORS DECLARATION .._ ' ' '� W � __ ' ' � IH'c0.E8YAFFIRAlUNOERDENALTYOfDER0.1RYTHA71AAlUCENSFDUNDERVROVISIONSOFGMAP7ER� Vr � � �-� �� ' p_, Y(COMIACNCINGWITHSECf10N700010F�M5KKd70FTMEBU51NE55M1DVROFE5510NSCODE.AND Z X MY LICENSE IS M FUIL FORGE ANO EFFEGL � m � ' ' ' llJ . ..._ p1y _ . __ ' /�q(,� /�.p ,. . . ' � LICENSECLA55 • LIC.NO. 1 V/�1� 1 V� �p "...� ._ � . . . . V DATE �� � . . . CONTRACTOR t%O��T� 4� a . W :.� � WORKEHS'GOMPENSATION DECLAFiATION Q N U , � IHERF.BYhFiIHMUNDERiENPL7YOFPERIURYONEOFTMEFOLLOriNGDECIAFiAT10N5: Z - — : ' ' Q _ . . . ._ . _. ._. . _______ ._ - ___ ' _. ' � _I NAVE AND W�LL MAINTAIN�GERTIFIUTE OF CONSEM TO SELHNSURE FOR WOiil(ERS' 2 ; � Cp.�FENSAiION,A50ROYiDEDBVSECTION37ooOFTMELA00RCODE.fORTMEPERFORMMIGE �U ' _ _ , ,.OF TME WORK FOR WHlpt THIS PERMIT IS ISSUEO. � , , Q _ _ .. . . . . _.. __ ..__.. . ._. _ ._. . w _IMAVEANOWILLMAINTAINWOFL(ERS'COMPENSATIONINSUHANCE.ASREWWEDBYSECTqN Q 3700 0F THE LABOR CODE.FOfl iNE PERFORMANCE OFiHE WORK FOR WHIGITM15 PERMIT 15 _ �3 f L� ISSUED.MYWOFLCERS'COc�ApPENSAT10NwSURIWCECARHIERM vou reuiusEau�E: CONSTRUCTION � j uawEq 5 E-�,r ��'�'Q•�Sd,,��p(� � _ PIAN REVIEW - -.... _ . --- - _ _. - -- . _.. . _. - - - _. . - --_ �Z aoucrnwueEA ELECTRIC ' d -�-titr;sFCm+taFIDwtBEWM�IE�mocnEVEm.ciswawEH.r�OiiE000uNasA�m�oatFsS) - ..PLUMBING . . . p � � w MECHANICAL Z ICERTIfYTHATWTMEPEFFOfUAANCEOFTHEWORKFORWH�CHTMISPERMITI5155UE0,1 Cry SrfALLNOTEA1PlAYANYPER50NWANYALwNERSOASTOBECOMESUBJECTTOTNE _ _._ ._ . - � , ._ _ __ � (n WORKERS'GOM7ENSATION UWS OF CALiFOPNIAAND AGREE TNAT IF I SIiG/LD OECOME �INSPECTION FEE� ' � - SU&IECTTOTMEWORKERS'COM7ENSATIONPRON510NSOFSECTIONS70oOFTMElA30R GO ' � GOOE,1 5 FO iH COMPLY WITM SE PAOV�S ISSU/VJCE o „�_ S. p DATE O �•'� APRICANT: . _.. � '.SMIP ...�. .. .... . . . •�.- w - ENERGY P!C � - �'�-/� ' -� WAqNiNG:fA0.UfiETOSFCUREWORKERS'COMPEN TqNCOVEMGE UNLAWFIR.ANDSNALLBE � �} ' - � SU&7EGTAYEMPLOYERTOCR�MINALPENAlTiESANDGViLFwESUPTOONENUNDREDTMOUSAND ENERGYPERMIT �� - • / DOLLARS(f f 00.0001.W ADDITION TO THE GOST OF fAMPENSATION.DMIAGES AS GROVIDED FOR IN , � SECTION770EOFiHElA80FGODE.WTEREST,ANDATfONNEY3FEES' "'- ' '---�- --"'- -- ' ' RETENTION FEE: - � -- .-_ - -- — — ------ - d CONSTRUCTION IENDWCaAGENCY PRE-ALT FEE: � p . . .. . _ . - ---- - - —... .. - ---- -.. _ . _ ... _. ._. . - -- . . , � IHEREBVAFFIqMUNDEF7EHAlNOFGERIUFYTHATTMER'etSACONSTflUCTIONLENDWGAGENCY '- - _ FOR THE PERFOFiMANCE OF THE WORK FOR WNlp/TNIS PEWAITIS ISSUEO(SEG 70G7,GV.C.). , Z .. . , � . .... .. .. ... . . .. ._..'_'__ _ _ W A�dN - � LENOER'S NAME i __. . '. .. . . . . _ _ __._ _ __ . _. '_. . h_- LENDER'SADDRESS � � ICEFTIFYTHATIHAVEREIDTHISAGPLICATIONANDSTATETMA�THE/�BOVEWFORMATqNISCARREGT. TOTAL FEES - I�I' ' w IACREETOCOMPLYWITr1ALLGiVANDCWNTYORDINANCES�NOSTATEL�WSFEIATWGTOBUILDING - - � � '- " ' ' . � � CONSTRUCTION,ANOMEREBYAUTHOR12EREGFESENTATIVESOFTHISGOUNTYTOENTERUPONTHE � , . Z AdOVE�1AENTIONEDPR07ERiYfORIN5PEG7qN7URPOSES. _ . COMMENTS � J �� _ m ,PERAIITTE NAME(PRIN � . _ _'.. .'" '_ .__.____' '_-._ _. � ��. � io yj���� _ ' uJ SIGNATUR F PERMITi'cF , � . � DA7F _. �+ . �_ . - • - RECPL NO. / PAI�6Y VALIDATION -~ � -- - WHITE—�epartment Copy,YELLOW—Finance Gopy,PINK—Assessot Copy.GOLDENRO�File Copy.GREEN—ApplicanCs Copy . . � j r Q h h � • v '. ��� . '� '1 q , - ,�' -• _ '{ � � � � r. � � I i � � Z _ _ - � � � � Q _. � . - ���� . - - , . �:��� � � � am: ' � _ r..a m0 • � o �• �d � c� a - O os> jz � aw z � o ¢ Q � ¢ ctoo wmc7 p ? ¢ c� o F- u� Q o u. m n z a � °C ui �7 Z t- ¢ 0 U cn r- OOwwZmoz aQ � � � gz u7azLLaa � ; � � Z W O � �. � V V O O Z O (7 � ¢ w Z d — Q C7 a � � F- W ui . - . . Q � LL lL il] Z p Q Z C7 Z W ¢ 2 � , • ' W ¢ ¢ � aJFom ¢ = = � w � LLHaw � W IV W xu�z } • ' � p � w w aa2m � � UC7 � .� JJCAV � p ~ � o Ju. ¢ Q Z p Qo ❑ ¢ ¢ oriZ WZ � ZOOOu. ❑ 6Z � ¢ W Q � W � - i - - O .� xzz ¢ wo 000LL- wZazzo� wwz � u_ � > > � LL � mu. am ¢ � aaaoou_ .� o � LLxo w !L C) ' \ W � . � a . � iA . � � I: � .. . � � _ (� '� � ' � i �� � � � ��. . �i ,�, . . . � . • G I � . � Z o: - o :�% v ` ' W z Z -- U � ' U Z W �, z � C7 N i • F � [Yl '� W Z U' ¢ Z O Z . � . U U` ' lO N - � o � n t� z m � 3 =, c� �r ? � Ym � �lj ¢ � W � j H Q F- (.~>�� m 0 ~ � Q Y � 1= Z m ��� H , � Y ¢ c� °- ¢ 3ww W > w -W' J = � � zz '� z � W Z � U � z i' :J Q�c � xwa � = u� -� ¢ ►- w � W I F-H Q � ¢ Z � aQv=izUxx = W ~ ? t7 ¢ a[ aa � � x w a � u � Un.' . ' � m (d U � [O n. W LL � ll. U CJ U � ��- J Z W� � a Q J J J J ' � F-4. �� � u�i ri w C¢7 g rw-� 3 ¢ u�. ¢ ¢ ¢ ¢ O w � U � v�i cWn vWi ta.7 u�—. LL � � . OU �. ` / m vWi