HomeMy WebLinkAbout11206 4 f _.�
' ��
�� � CITY OF DIA690ND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
��� 21660 E.Copley Dnve suite 190 PRESS
<\������ (909)8G0-3195 Fax(909)861-3117
'"' BUILDING PERMITAPPLICATION FIRMLY
JOBSITE � APPLICATIQ N PERMIT P/C
o ADDRESS 2 �O j� c DATE C O3"-y� NUMBER #
� ISSUE TYPE OCC
APN LOT TRACJ DATE CONST. GROUP
p OWNER y n� t� lc���t
p AD�RESS�` 3Zy' yV/j P%t ZONING SETBACKS
Z CITY J��Sln�1 t➢N(�L�iY ZIP TEL. FRONT RW ❑
g APPLICANT TEL. REAR O
SIDE/SIDE STREET RW ❑
QCONTRACTO f G Pc✓ O� S. SIDE ❑
¢ ADORESS � • PROPOSEDUSE ��L / �(. ��
� CITY I , �c S ZIP 9D2D1 TEL `�5
o ARCH/ENG/
z DESIGNER NO.DWEL. - NO. ' . i ' NO. . '
a AD�fiESS UNITS �'� ��STORIES ' ' '� , "�� BEDROOMS
� CITY ZIP TEL
uNi DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BCILDER DECLAFiAT10N SFR/ADD/REM
O
1 HEREBY AFFIRM UNDER 7ENAL7Y OF�EFWRY TMAi I AM EXEMPT FROM TME CONTMLTORS U- GaragalCarport -
�W CENSEU'NFONiMEFOLLOWWGRE�ISON{SEC.70.71.SBUSWFSSMDPROFESSIONSCOOE.ANVGTYOR (n � ��' ' '�� - -
U COUNTVMMICF1fi'c�UIRESAPERMITTOCON5IRVCT.PITERUAPROVE,DEAlOL15H.ORNEPAIqANYSiRUF W PdI1C11DBCIC
TURE,7RIOR TO ITS ISSUANCE.ALSO REW�RES TFIE AGPIICANi FOR SUpI iERM1T TO FILE A SIGNED
w 57ATEA/ENT THAT XE OR SNE IS LICENSED VURSUMIT TO 7NE PqOV15lON5 OF TNE CONTRACTORS LL �
� CENSE LAW K�TER i(COMMENCNIO W1TH SEC710N 7000)OF DIV1510N�OF THE BUSINESS AND VHO- � P�VSpa
� FESSIONSCOOE�ONTHA7HEORSHEISE%EMPTTMEREFROMANDTMEBASISFORTHEALLEGEDEXEMV•
VTION.ANVVI0LAT10NOFSECTION7071.SBYANVAPPLICANTFOHAPEHM175U&IECTSTHEAPPLIGWTTO Z Re•Roof
AGVIL PENALTY OF NOT A10RE TMAN FIVE NUNORE�DOLURS�t50o)):
� ❑4�OWNEROFTNEVROGERN,OFMYEMVLOYEE5WI7HWAGE5A5THEIRSOLECAM7EN5AfqN, O COrt1mBfG131
z WILL DO THE WORK AND TME SiRUCiURE IS NOT INiENDED OR OFFENED FOR SALE(5"cG 70W.BUSL J
N'e55 MW PROFESSIONS OODE:iNE CONTRACTORS LICENSE lAW DOGS NOT ADttV TO AN OWHEROF
� PROPERTYWIqBURD30RWPROVESTIIEREON.ANDW}7000ESSUGiWORNNiMSEIFORHERSELFOq �
Q TMROUGHWSORHEROYlNEMPIOYEES,PROVIDED7MA75UCHIMPROYEMEN75ARENO7W7EN0EDOR m
w OiFEREDFOHSALEIF,IbwfYERTMEBUitAMGORUADROVEMENTl550lDVnTNWOr�EVEAqOFCOAIPLE-
� TION,THE OWNER-BUILDEH WILL HAYE 7HE WR�EN OF VqOY1N0 THAT ME OR SHE DiO NOT BUItD OR
z WPROVEFOFTMEPUPFOSEOFSALE�
= 04�+OWNEROFTHEDROPERTY,AME%ClU51YELYCONTRAGTWGWITHLICENSEOCONTRACTOqS
-W
Q TO GONSTRUCT TME PflOJECT(SEG 7oN,WSINESS AND PROfE5510N5 CODE THE CONiMCiOR$LI- VdlUdt1011 ' ADJ.AREA
W CENSEUWDOESNOTAPRITOANOWNEROFAVR07ERiYWHOBU0.A50RWPHOVESTMEHEON,AND
� NnqCONTRACTSFOqSUCHPR0.1ECT5WITHACONTMCTOR(5)LIGENSEDGURSUANiTOTHECONTfUG QUIWTIN DESCRIPTION FEE
Y TORSUGENSEUW.j.
� ❑I AA/E1cEMPT UNDER SEC. 9.�P.G FOIi TWS REASON Q
� U
LL ¢
�ATE OWNEfl U .. �ti` .
� LICENSED CONTRACTORS OECLAFiATION _ W +
� IHEREBY/�iFIRMUNOERFENALTYOFVERIURYTHATIAMIICENSEDUNDERCROY1510N50FUlAP7ER �
d Y(COMAIENGINO WITH SEG7qN 7000)OF OMSION 7 OF iME BUSINE55 AND PHOFESSqNS COOE.ANO Z
X uv 110ENSE IS W FULL FORCE MlD EFFECT.
LL y� �1 m
� UCENSE CUSS (-1 LIC.NO. /� � �
F--. �
V DATE ��^�� GONTPACTOH , �+ C - � a
W .
� WORKERS'COMPENSATION DECLARATION 1 _��,( Q
� �o V U
N I MEREBYAFFIRM UNDER PENAITY OF PERNRY ONE OFTHE FOILOWWG OECUqAT10N5: Z
� �IHAVEANDWILLIAAINTNNACERTIFIGTEOFCONSENTTOSELFdNSUREGORVAWCERS' 2
CpAPENSATqN,ASPROYIDEDBYSEGTION�7oaOFTMELABORCODE,FORTFIEPERfORMANGE 1U
OF THE WORK FOR WHICH Tw5 DERMIT IS ISSl1ED. �
G
W _IHAVEANDW�LLIAAINTAINWOFi(ERS'COMPENSATIONWSURANGE.ilSREWIRE08Y5ECTON ///���.`
Q 770oOFTMELABO CODE,F�qiHEPERFORM CEOFTHEWORKFORWMIp1TyyISPERMITIS �U�
LSSUED.MYWWyI/ryryp��77 R;GO ENSN IONP15 CEGWWERIWDP01.1CYNlM�ERARE CONSTRUCTION
j �qp�Eq (// G S �LZG'- pLANREVIEW
�� POLICYNUMBER ELECTRIC F �a
(nass�cnau,�noisew�+�T[ooFnfaeaMtswraor�Mru�noatu�sRwlat�ssl PLUMBING 1',a/Iti ��r�
Z I CERTIFYTMAT W THE PERFOfwANGE OF THE wORK FOR WMipf TMiS PERIAIT IS ISSUED,1 MECFUINICAL �
(,7 SH�I.L NOT EUFLOY ANY PEHSON W ANY A4W NER 50/5 70 BECOME S EC TO THE _ __
N WORNERS'CO/JPENSAiqNUw50FCALIFORN� AGREETMAi I BECOME INSPECTIONFEE
� � SU0.IECTTOTHEY/ORKERS'GOMPENSATqNP ISIONSOFSEC l� O�THElA80R 2J��/�
CODE,ISHAILFORTMNIIHCOMVLYWITNT PflOYI510NS �SSUANCE CCD n � l{j�]�[_ �
� �ATE:6 2_0 3_�'nv�icatJi: G ��I SMIP . J�JtI �
0
� ENERGY P/C
WARNING:FA0.URE TO SEGIJRE WORKERS' ENSATIJN GOVEMGE IS UNUWFUL,AND SHALI BE
� SUBJECTANEAIPLOYER70CRIMWALDEN �ESINDCNILFWESUPTOONEHUNDRE�TMWSANO ENEFGYPERMIT
DOILAAS�Sta0.0ooN W ADDITIONTOIHE OF COMDENSAiiON,DMIAGESAS PPOViDEO FOR W
� SELTqN]70lOFTHELABORCODE.WTEREST,/W�ATiORNETSFEES. RETENTIONFEE: '
a CONSTRUCTION LENDING AGENGY PRE-ALT FEE: -
O
� INEREBYAGFlHIAUNDERGENnL7YOFPERIURYTMAiTMERE15ACON5TRUCTIONLENDINGAGENCY
FOFi THE PEHFOWAANCE Of TNE WORK FOR KT11CH TH�S PERMIT IS ISSUE�(SEG 3097,G�V.G.).
Z
W
� LENDER'S WudE
F- IENDERSADDFESS t-�
� TOTAL FEES L U
W ICERTIFYiNAiIHAYEREAOTHISAPPLICATIONANDSTATETMATTHEA80VEWFORMATIONISCORRECL J���
� IAGREETOCOMPLYNALr1ALlGiYANDCOUNTYORDWMICE5AN�5TATEUWSRELATWGIOBU1L�iNG
� � CONSTRUCTION.ANDHEaEBVAUT110F12EREDRESENTATIYESOFTM15COUNTVTOENTERUPONiHE . '
. Z ABOVE•MEMIONEO PROFERTY FOR 'SPECTqN PURPOSES. COMMENTS '
O �
� � ��
m VEA TT ENUAE(PRINn
� � � l�� 02-03- ` t�
� qE (qA11 - DATE
= iiECPT.N0. PAID BY VAUDA?I�
~ WHITE—Department Copy,YELLOW—Finance Ca PINK—Assessor Copy,GOLDENROD—Fiie
py, Copy,GREEN—Applicant's Copy
i
_ _ __ - -- - -._ . ._ . _ _
. - - _
�
,, - '� ~
� � „ ; ;
� - � �.
�� ; �
j
t
- �
� f� �\
a �
� ^
. .. � � . ' - _ ,'.
� O a � �'. r ' � , /`
- Q � e � O Z p ¢ � � (7 . J Z � �� ✓.
{p p� ❑ ojzm ¢ w ? Zo � � a � o '" . ' :��
0 - � cn � o o m � m m Z '� ¢ a F Z a u, � vi c7 LL � Q � -- , '�
❑.(� v� F- z o _ � z u7az n. • .
� W o � o o � � ooz ❑ cz ¢ ¢ wz ¢ � oc7 �- � zHocn
-� O � LL m Z p ¢ z � C7 � w Z W F- Z a O a W > e. �
�' o CC � wcc � � 5 � om ¢ = = u, � u. � awtiWniW = w � _
m x v� r or- LL
F Q Z � a � � ¢ ¢ o �iz W z � Z000 ��i. ozzZz ¢ w w z - -
� �Ji LL > > u_ � � oou- am ¢ � aaaOOLLJou. � xow
O �
LL W 1
�;�-- � i
U z
3� - - -
�.� � t
, -
�: - '`
;, � `.' c�:
� .: ,
� \ � ;, _ -
` � M ', ' r' . .
� CJ M # '��
_ � iv
�,
Z
� W � Z �� � ` ' � � O � � . N
i�' � u� O � � U'� J z t.�.. to � z � J J - C7 V z �� Y N
�. iA � J W W � F- Y"j Q 4 W = _ � � � a Y J � � Z F- m '~ Z�-�7
� Y ¢ U Q. Q S� W W ' > W J J � = 7 2 J Q c� F Z 4 W � �1J _ � F C.
O ¢ O �n = C7O = � o- � � F- � O W J J
' Q � ¢ Z � a � �nzt� xxxWg ? Za � c] n. ¢ c� xwo. � Ua
� r ' m coc~> � maw � � u_ c� c� cs3 � - � � awvia ¢ a ¢ � aw
' . , t- C7 w a ¢ � t- o Q O � � � o � � _
� W J � J W ¢ O � O O O O S � ¢ W LC W W W Q Z 2 Z Z �.O W W �
;�- . . cn �i w c7 m I- � ¢ u.. ct ¢ ¢ ¢ u� w � U o �n u� u� c7 u. LL � u. U - cq tn