HomeMy WebLinkAbout10944 �
CTTY OF DI1IMOND 13t�R �, � ��
�-- .1T_�—��� COMMUNI'PY DEVELOPMEN'I'llEPAR'fMEN"C / l ;i�``�
�
�;� 21(60 G.Cbpley Drivc Suitc 190 / �// PR��.�
(909)R60-3195 Fax(909)861-31 t�
''�"%""�� BUILDING PERMl'I'Al'PL1CA1'lON -� F�R�1.-�
� `=
� OBSITE � ��L�J ��� � — APPLICATION r � PERMIT �� P/C
4 A DRESS DATE_ � '' � L � ,
-- --—
���. �LAn£ �
__...._......_. ....---------....__._ NUMBER #_
, � - '— ISSUE TYPE OCC
.- APN LOT __ TRACT_._._______ DATE_____..___. __CONST. GROUP
� O OWNER V�F N �ii�R E.. - ---_------._........_...-- - —
-- .. ,
� o ADDRESS d�l Z k_4' �c'�������+ L '7✓C ZONING SETBACKS I
�� � CIN D_7 n �J� ZIP .0 TEL.��`��AI....,'�'G.� � FRONT ..._.._._._...._._...... ------ - RW------ � .... ......
REAR � �
— --- �
� APPLICANT .- , TEL.----.._._..._..-- SIDE/SIDE STREET....-.-.-.--.--.---.---. RW.-.--.---.--- ' �.-
.� ¢ , _ --................
� m CON7RACTOR_'" _ � SIDE ❑
---
— ----
- ----------
� � ADDRESS_ �. ;--- _.._ .. � I
---.._._...........___._. .. PROPOSEDUSE
' -_._..__ }
� CI'TY ' -_�_- - ZIP 2 6 TEL:�/S°'G�� `
----------
-------..._....---- -----..__...-------
wo ARCHIENG! _.__......--
z DESIGNER_.._._.._ _...._..._..._..---._................---------------
--- ---......--- -----�-- NO.DWEL. NO. NO.
� ADDRE55 ____._._.._.._.___.__ UNITS STORIES BEDROOMS
� CITY _............. ZIP... TEL. _
`n — DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� - -- -
� OWNER-BI:ILDFR DECLARATION SFR/ADD/REM
O
p I HEHCRY AffIfIM UNDER PENAL7Y OF PEHJURY THrtT I AM t%EMf�I�410M 7H[GOMRAGTURS LI� (�`y189L/C3fPOfI
W CEN5ELAWFORTHEFOLLOWINGHF:ASON(Sf_C.]o3t.58USINESSANOPROFE5510N5COUE:ANYf.ITYUH (n _._
U GOUNTYWifiC11HEQUIfiLSAPEfl�.11TTOCONSTRUCT,ALf[Fl,IIdPf10VF,01;M.OLISH,OfiI7[PAIRANYSTRUG � w Patio/Deck
Z TURE,PRIOH TO 17�ISSUANC[.AI.SO RLOUIRES THE APPIiCANT FOR SUG41 PERAIIT TO�IL[�SIGVf:D
w' STATEM6NT THAT HE OR SHE IS L�CFNSFI)VURSIIANT TO THf PIaOVIS:O�S OF TME CONTRACTORS LI-
�� CENSELAW(CHAPTER9(COMMENCINGWITHSECiIONlC00)Of-UIVISION30fTHfBU51NE55ANDPRO- LL' �QOVSPa
OFESSIONSCODE)OH1kIAfIicOFl511EISE%�NPTTMFflEFHOMANDTHEBA515FOril'FIEPLItGtUE%LMF�
TIOh.ANVVIGLATIONOFSECTION7031.50YANVAPPLICANT!-ORAPLftMIf5l18JECTSTHEAP�LiCANTTO z Re-Roof
U� A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDFED DOLLIRS�5500�.):
Q. IiI,A50WNEROFTHEPROPFHfY,OHhtY[A9PI.OYf.:LS'YlITH1NAG�SASTHEIRSOLELOMP:NSATION, �
WILlDO THEWOHK,AND THF STRUCTUFe IS NOT INTENU[0 Oi7()ffCfil=(1 FOii SP.IE(SEC.In4�,AUSI- , J COmmBfClal
Z NES9 AND AflOFES510NS COUE:THi COV�IiACI'Of1S I.IC[N'aE LAW DOES NOT�PPLV TO AN OWNER OF �
�' PROVERfYWH08UI1.D50RIMPROVESIHEREON,NM)WI1()D9fSSUCHV10fliCHIMSELFOflHEFSELFOR m __ ,
�. THROUGIiHISORHEHOWN[MPIOYCCS,PROVIDEDTHATSUC4�MPHOVEMENTSA�F.NOiINT[Ni)EllOfi
W OFFCRE�FORSaE.IF,HOWEVEFl,TH�fIUILbI�CORIMPROVEME4TISSOLDIVITHINONEYE4ROFCOAAPL[� '
� IiON,TNC OWNf.:H�Rl11LDEli WILL HAVE THE BURDEN OF PFlOVING i'l1Ai HF OR SHE�ID NOT AUII.D OR � � --- ----
W. IMPROVE FOR Tf IE PUI7Vo5F OF SALk:�.
. 'l1,ASOWNEROFTHEPROP'cHTY,AIALXCI.USIVFLVCOYTRACTNGWITHLICENSEDCONTRACTORS — — "— —
Q TOCONSTFUGTTti[PflOJEGfISCG.7044,BU51NESSANDPPOFES51UN5CO�F.:'fNECONfRAC'�OF1S1.1- V8111d�iG� . ... . ......._'"'_—'"'_""—'—'"_'__..ADJ.AREA.'_'_'_"'_'_"'""........._...."_""_"_"_""_""'_____
W. CENSELAWDO'e5N01'N'PLY1'OANOWNEf10FAf'HOPERNWH06UIL�SORIMPFlOV[STH[fi[ON,AND --
� WHOCONTRACI'SFORSUCHPR0.IECTSYIITHACbVTfiACfOR(S)LI(:ENS[DPIJRSUANiTOTHECONTRAC- �QUANTITY DESCHIPTION FEC �
Y -roRsuceHse�nw.�. _ yyQ�y/— /]�
� C I AM E%[MPl'UNDER Sf'C. __._,, �.8 P.C.FOIi THIS REASON : Q � I�� n�^'C\ ���'`"r V L (.,,,.
'�� '....."__'__........_. � .
- — / �k C Zz u c t3 t� n/f r.a�•
� [1ATL ____............'__ OWNEFI ."''"_'__'._.......... ~ --
U
;�� LICENS[�CONTHACTORS DECLARATIqN � LL ;
CY-� IHEREBYAFFIHMUNOf:R('ENAI.7YOFPEHJURYTHATIAMLIGENSEDUNUE-RPROVISIONSOFCHAPTEF �
� d; 9(COUMENCING WITH SECTI0�+17000)OF DIVISiON 30f TH[BUSINESS AND PROFESSIONS CO�F,AND � �L__ ______ _ _
�'�X: MY LI(:[NSG IS IN.UI.L FO{(7iC[AND EFFECT. m I
W' r 7v ,�� 7 ys�
� ��; LICENSE CLASS �'"� "-" LIC.NO. _ .............. �
// f ._........_._._._... _ �y
'� ��V, DATE��_..,f..o-__��—CONTHACTOR____, .� /! J �
�_ a -
��--- -;
.W ��.
� ��� WORKERS'COMPENSATION�ECLARATION 2 '� U�—t- r`-�,.�(f '.,,,�, w�,�,�
� V
���' 1 H[REBY AFFIRM UNUEH NEYAITY OF Pi.fiJUAV ONE OF THE FOLLOWINC UEClAf1ATIONb!~
�: Q _
�� IHAVEANDWILIMAIN7AINACENTI�ICATEOFCONSENiTOSELF-INSi1REFOHV20f7KF..i7$' = i
�Z CUMPENSATION,AS PROVIUED HY SFGTI[1N 3lao OF THE LABOR fADE,FOR THE PEfiFOF1dANGE U ___ _ .
�' OFTHEWORKFORWNICI{�HISPENIAITISISSUEO. � ,
'��� _'_ _ _ '
'W' IfiAVEANDWiLLMAItiTAINWORKENS'CAMPENSATIONINSt1RANCE,ASFE�UIREDBYSECTION �
�.Q'' 37000F TIIF:LA60Ii CODE,FOflTHE PERFOHMhNC[Of ll-IE WOfiK fOR YlHICH T111S PERMIT 15
� �� ISSULD.MYWOP%ERS'COMPENSA'flOfyINSURANCECAHFl,IEs�H/A'NDPOLICVNUMBERAREq: CONSTRUCTIOI`!
' .�j-, CARRIF.ft �������'' ��3'`' /�vF � _ \ PLA VIEW �
�'� ----'--------f� -1 /�, �--.... . .
' .0. POLICY NUMfiEF !�t. .I....LJ�f__... . L- _ _' ���
l.
1 .,�, `� y,w� w '
�; (IHSSECTIDNNEmNOiBEWV�PIF�EUOFTICPEM4fASfORONF.HUNDREUDpJ.N�15(S10DIORLC55). PLUMBING _._._............._._ ,t �
� w' MFCHANICAL n
'Z� IC[RTIFYTHATINTHEPERFORlAANC[(7�Tt1EWOf1K�C)�7YlHiCXTHISPERMITI5155UEU.l ......- --..._.---__—_r�'..,.___ '
';(3;. SH�ILNOT[MPLOVANYPF;RSONINANYMANNEFSOn5709t=COM[SU9JFCTTOTHE �/ � .
.(n;, WORKEfi5COMPENSATIIXJLAWSUFCALIiORNIA,ANDAGR'eETHqTIFI° ULl)L1iC()MI: I INSPECTIONFE[ .__ ��,
_.._...--�-----�-�--��-. `
r�. SUi3JEC7 TOTIIE WORKERS'COMPENSATION VHOVISIONS OI�Sf:CT1 7W OFTHE LABOR 1
,�_ COUE,ISHALLFORTHWITHCOMPLVWIIIITI105EVNOVISIONS ISSUANCE „ .____ , , _____„__,.___. _____,i_._______
'—'"_
o' Il lo •-�� sM�� ---- ---- --._ ---- '
�:p! DATE: _._..._ PPLICANT: _ ....---
'�f � � ENERGY P/C
� WAfiNING:FAIWRETOSECUREWORKERS'COMP� TIOYCOVEI7AG[IS NIAWIUL,AN�SHALLBE -"""""""' "'-
;:�„ SUB.IECTANF.MPLOYERTOCRIMINAI.PENAI'fIE DCIVILfINESUPTOONEHUhOREU7HOUSAND ENERGYPERMIT �
DOLLARS(5700,000).IN AD�ITION TO THE COS�OF COMPENSATION,OA�4IACES AS PROVIDED FOR IN
.��'J SECTION370BOFTHCLA60RCODE,IN7EREST.�N�AT10RNfV'SfCES. RETENTIONFEE: . ,,, �
;�.; — —_""— _—_._...."'—__"_ �
'��'� CONSTRUCTION LGNDING AGENCY PRE-ALT FEE: �
'�.0. -- -...----...._...-------.._..— -
' .:�. I HEHEBY AFFI(iM UNDER P'eN/�L1Y Of PLRJl1f7Y THAT THERE IS ACAN51 HUCI'ION 1 fNDINC AG[Nf,Y �
' FOH THF.VC:RFORMANCE OF'lHI:WORK�OR WHICH THIS PERMIT IS ISSUED(SC.C.�097,CIV.C.j. - -�- --- -�- ----- --
W .—_._... .....___—..... ........__.__._._..._._..—.__._.—......—..._.—.--_.......__--___
'2� LCNUER'SNAME_ ._..._—'_'_' "....."__'__' "— .
�}�: ._.—_.._.._.._.—....'___.._. .._""'—_'_—_......._'—... ..""'............_...__—_—_'_'_—____—"......__. ._...
F—� LENDER'S��UR[55.._ -- --'-------- -
'� ICEflTIfY�HATIHAVEPEAUTHI5APVLICA�IONqNUSTATFTHNTTHEA80VEI.VFORM�fIUYISCOf{fiF.CT. T�✓TAL FEES �
w IACFEETOCOMVLYWIT:IAILCITVANOCOUNTVORUIVANCESANDiIAif:IAWSRI-I.ATINGTO6UIL�ING '
� CONS'fiUCTION,ANDHEHEUYAUTfi0111lF.fiCPRCSENTAT!VESOFTHISCUUN'I'YTnI�NfLfiU(+ONl11F
A60VE�MENTIONEO PROPLRTY fOR MSPEGTION PUHPOSLS.
`Z. �I � e COMMENTS ---------._.. ..__...._. _... ......... .............---...._._-.._.........._._._
_ V/ _ . ...
�\
� -----—- _....----.. .... ._ _._. .. .. ..._. ... .......------._.
�m PERMITTEEhAME(PF __ . _ .___ _ .
a ��.. �_
� . .._
- . -- ----- __.__. . ....__ _�
.� 'SIGNA F PEF, T7�' )AT[ I �jJ
= RECPL NO. '" �PAI�BY _:"'�VALIDATIO _
�~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—AssessorCopy,GOLDENROD—File Copy,GREEN—Applicant's Copy
.�`'�
,. N .,3 ��.-n r ' ..._._ __ ,. � r _� �' k
r
! ~• ��kw y "`Y I _ � � E"k 4 F i -.1 9 tj�( - � � t �., I ] Y I
0 t 4 1 � � t T � � ) „i� 3 J �'
� �r � ��`1'! # � �'��� �i i �. i � `s � : x > 7� ; � I � r , ) � { � ��,
� � � �� �� � j � , � I I � a � i � 3 I _ie� � i ( �� �� ����
� �_ �b� _ � � � ' i i�� � �� � i �- ' 'a.� :
� , �
� ��.� � I � � �E� ( � r :��.I i ' '�� I ; ��
� r�y.�n�. '� l i � �� i � � s I � � � � � �'•,,'a�€
9 � �� �, � i � � 1 , � ` I � � I � � �
+y��.�������� [� �� i � � � , E x� `� V� � .)�" r�I I - i � i��
h � �� I � � i ; j !. I : �, i Ir`.. �
i � �e�x ' s � ��I f _ i � � I I ) i � � .
. �
9 �,M �S § � � - .
� I �
i
� i � _ �..j _�. _�.:.._- �- i �' - - —- '.
�� � I I � � -r �� �3 i . � l � , ..' . �... ' .... ....... . ... � '. � �i
�, ss�� ..p._�w� i 7 � � i .,i -.
i ,�„ �0 i I � `� � � � .,,, �II i ,,,. I �a�`
, ; � I � � ' �
° , �j , ��' i � �� ' 1.._ ' � ��
� � � � , � ,
� � '� - - '- -- � �,
�, �
, � � �Y i ; , i �
al ' i � ' ; , � ; � � �l
�
„ ( ; ' i ' i ' ' ; ` 1' ; i ' :._ I f i ' � �-
, :. ' � �
� � �
�� j i � I i ( �
� ( i � � I � I � i i � ; ;i � i � �rg�s �4
� i � : � � ! ; � i � � � �s„��i .� �:�
� �
� � � ( � �
� � �., � I ' � �'. I I , � I ' i i ' ( � i � i i � ���ry' � �
.,__ � �... _ ,_,._... .."".. "_'�"'.
I �� I "_......._ -:___ ...
� I , � � � I _� ! i , i ; �. I �' �i... � - Y .�_ I-� ; `-T . ' '� *� �'�
� i I ( x j � i - _ � � � �
� ) � I f � i �� � i � I r I �� c d � rt� � �
i � � � � � i'� � ' s � i���' , i r� � i
i i t� '�
i I � �� � � i ; #� rya €._ r ��j� �f t �I ) i { � , ¢ t i i { � �� �i
� � I � 7 7 � ;-k`� I7 _� f t'i I�� � � � Til� 7 1 � f3 �-I ( �S� �� ��'� �,: .
; � ` I � �� � � �� �iFT ( � ���) �^1I('I a ': S^�� ,IC..i � � � � T
' I ; ' , � � a�^� ii t7 I �{� 77 p � ;I ( �'r e�� � �i .
I i i � � : � I F� � .
t
I � � � ma� ; i '(�� � ?� � i i�� �� '�i �i -�"p� ��a
N � ' i I � � � � � � �I` � i '�� � It � ,�'', � ' i���_ � �� � � �� �
I � C � I � � � �,` � _ � , ��£� ��
' I j ; , I ( ; I i 1 ; ; � � � � `� �
I i � � , , , � ;, �
R � i ! � ( i � � � I ; � � � ���'�
;
! � � ' ��,�' � 7 I i i �.,; i," I I � II, I.._ ,1__f f .'_'. � I ....I I__._� ; ..I ��.
F � � I � ' ' ; _ ��
� , , ' i i I � i i � I , i i i ; ' � ���
{ • ' � I � � � ' � ' f I � I � � I I �9�
I ' 1 I _, � ;__I ' I �__� j I g�
i I I i i , i ( ' �
. � ; � i 4 � , i i i I i �
g i I
i I
' � � � I
I , � i i � I ,, r t__. � I t � t I — i _._I ! I ' ��
' � : 1 i ( f � � i i i I i ., ��,.�:
i � I i � '� f : `. �
! � I I � � , ' i j ; I � � I j � � • � I h � � I �"�
� �,,���' ' � � ' ' � , I I �l. ' ��' � I � i i .' ; I � ' I i I � �roG�
i I � I i , ; ' ! � � I i I � i � i � ���
1 � �i �I _ � � ' i � ,i : ; ' � ( : 3 ' � i :, �,1 �I) i I �NA
I � . . I ..._ .. , � ._ .._
6. ..__....�.._.�.. _�._ ._..__.............. ._-._ ..�. ,._.�_.._..i.._..f. ._1.,.._.__, .. .I........� _,_ ._...__.. 1___i_.._.._ ._�_....,_.� .._...�.�,, ..,.___.� ..__._...._.. � ,1......�.--., �,.__I. .. �__.'. �..;
I i
.,,,,,,^_ — ..___.._.......____.._...�._m_._......_..._._____,.-..._______._._.-__.__ _ _— —__._...._-�__-.,....-....�