HomeMy WebLinkAbout11033 (5) �
�,' ..—_—
---���---� CiTY OF DTAMOND BAR - " %
% �, � ' ° COiViMUNITY DEVELOPMENT llEl'AR'I'MENT�-';--""`
nr -;.w� 21660 L'.Coplr.y Drive Sui�c 190 �,�
� ' (909)860-3195 Fax(909)861-31 I7 �f".,i� PRESS
y ''""° i3UII,DiNGP�RMITAYVL]CATION .�/ FIRMLY
JOBSITE z `� PERMIT �j�h`�.'� P/C
r APPLICATIO
� o ADDRESS_ � p� � DATE ,�
- _- .-----
� _-� NUMBER_ �
�—_. ----------- #
� m ISSUE -� z �/ TYPE
----
APN _. LO7 T CT-----. .._.______ DATE��--�P��____/---CONST.._.....----- GROUP
� p OWNER , —
o ADDRESS� e�,, y � C1� ZONING SETBACKS
w
�i -t"-+`- �
� Z CITY Q� ZIP TEL. FRONT RW I I_._
---
' p APPLICANT p�'� ` TEL.� REAR n_
------ ' -
• SIDEISIDE STREET------ __...------ RW U_....------------..
ma CONTRACTOR ��(fI L���'f' ___ SI�E __ _ __ _ ��
� ADDAESS --�—
� ��T�'a u ZIP� ��_ TEL.�A PROPOSEDUSE i bir (����,��}�/}'/�� ��(J�9��,�
� o ARCH/E G/ �p'T
' --- --.
� Z DESIGNER �J T
��������� �- �-- -�
------ -- -- NO.DWEL. NO. NO.
� a ADDRESS_,_._.... �
_. .- -----------
� � ZIP TEl. UNI7S STORIES __r_�___ BEDROOMS
� � CIIY------.._..----- ------ -
1 `n — - DESCRIPTION SQ.FT. FACT�R PSF ADJ.AREANALUATION
p� OWNER-BCILDER DFCLAHATION —
O SFR/ADDlFICM
'�� Q I HEREBV AFFIRfA UN�[fi PENAITY OI'VLItJL1RY THAT I AM EXEMPT�NOM IIIE CON7iiAG1UHS LI� GdIHJO/CfllpOR
W CfkSI:IAWFOHi!ILFO!.I.OWINGRE�,SON(SEC.�e31.5(3USINfSSANOnROrfSS10:V5COUE�pNVCITYUR (n__
� U ('qUNTYWHICHREQUIRF.SAV[qMf(TDCO:lSTRUCT,ALTEF.IMPPCVF.,UcMnilS!-I,OPREPAIIiAN1'STRUC�
�.,''� �� 'ftlll�,PRi(]R TO ITS ISSUANCE,ALSQ RE:(�UII7I:S}�H�APPLICANT FOfi SUC4i PEHM1II I(O FIL�A SIGN::O W �afi0/�BCk — — _
STA7'EMEN I 1'IiAT Hf:CN SHf:IS LICENSED PURSUhNT i0 1 Hf�HOVI:>IC/NS OF iHE CONTRACTORS L6
�� O CENSE LAW(CHhPTER 9(COMMGYC1Nf!.YI7FI SECTION 7JCOj CtU�VISlUN 3 0!'Tl lr'3USINF:SS AND PFO- � POOUSpB _
FESSIONSCD�E)ORTHATHFORSHEISE%EMV�TH[RI=i�HOMA4�THFBASI'sFORTHEALLE0E0tXEMi'� ; (� —
( .U. TION.ANVVXJLAiIONOfS[CT10N7U�t.5CYANYAPCLICANTFOf7qPfiiM17';U9JfCTSIHEAnpLICANTiO � z Re-Roof
1 � AGIVILPFNALTYOFNOTMORETHnNFIVF.hIUNUqEn�OLLARS'(SSW�.j:
LI,ASOWNEROi�7HLf'ROPERTy,ORMYEM7LCIVF.F,SVlI;IIYlAf('.SASTH[IfiSOLGCCMPENSATION, � COR1R1EfCi21
'� �� WILL f10 THE 4VORK,ANU TIIE gTfiUCi'URE IS NOT INTENDED Oq OFFFNEU FOfl Sr11_I=(5[C lUdq.FUS6 J
�E N NE55 HNU PROF[SSIONS CO�E:THE CONTqqC�OH51.ICENS[LAW f�Of.S NOT APPLY TO�N OWNER OF �
PROPERTY WFiO L7UILD5 Oq IM.t'ROVES THEFEON,/1ND WI IO UOLS 511GI I WOflK HIMSELF OR NERSELF OR
.� CC 7'fliiJUC.HHISCRHEROIYNEAI�LOYFES,VHOV!f)L'JTHA7SL'CHINAROVESlc'NTSAqENOi1NTF.Nf7fDOR � — —
a W OFFcRE��ORSALE.IF,HOWEVLq,THEBUILDINCOf11MPiiOVL:MENTI6SOtDWITHiNONEYEAROFCOMPLE-
�'' TION,THE OWNEH�BUILUEH WII.I.IIAVF.THf 9U.9DEN OF pROVMG T11nT HC.Ol1 SIfE U1D NOT 9UII.D OR
} ��- IMPNOVG�OR iHE PUFPOSEOf SALFj.
� w i71,ASOWNEROFTH[PROPER7Y,AMEXCWSIV�LV(:ONTIiAf:TINGWiTHLICENSEDCONTRACTORS
� � TO f;ONSTHUCT THE PROJF.(:T(SEG.�ona,I3US'NE:S AND PROFESSIO�S CODE:'fHE CONiHACiOf1S I.I- , VdI1131i0l1 ) �'� ADJ.AREA,.._.,,,,._..__
. W CENSLI.AWUO[SNOTAPPLYTOANOVlNE410�A�'HOP[f1iYYlHOBUILDSOHIMPFiOVESTHLI7C.Oh,AtiU .--....__.__._.__.__..._..
� WHOCONTRACTSFORSUCHPHOJEc:TSVJITHACONTRACTON(S)LICC�SEUPU(1SUl+NTTOTHECONTRAC. QUANTITY DESCRIPTION
`� Y roas!iceNs�ww.>. , F[E
� ,� :.I I AM EXEMPT UNDER SE^.._____ ,.,_, ___,. ..__il.F P.C..foR 7HIS REASON . Q
� , U
.....—._ ..._..__. -.-.,--------- —
� —.__.....
l Z DA7E _._.........—._.....___OWNER___._...."_... ....__ U
i
; .�� UCENSEDCONTHACTORSDECLARATION W
¢ ¢ —
t CL I HERF:BY AFFIR'A UNDER PEN�LTY OF PCRJUIiY THAT IAM LICENSEU UNDEti PHUV!SIOIJS OF CHAPTEP � �
� �d� B(C04AMC'NCI,VC.{V17HSCCTION%ODU�(7FDIVISION30i�lifcp;ISINESSAN�PROFESSIDYSCODF,AYD , z _
,3 `X, !dV LIC:IVSE IS IN FULL f-0liCi:AND Fff[CT. _ ---
} /` � . �s- .. � fn
� � LICCNSE CLASS.,'4.'� IIC.NO. • u _.....�........_.._._ �
. �.'_..
�U DATE J� . '� CON'fRAC'OHI�11���__I.��(,G�� � a
�.w�, �� �•e�i r �T
i �� WORKERS'COMPENSATIOA'DECLARATION � J � .
� � ¢ 4 .
� INERECIYAFFIRMUNDERAENALTVOFPERJUNYON[OFTHEf-0LLOWiNGDE(;LARATIO�S: V
� � Z
� � _, 1 HAVC ANp WII,1,i1A1NTAM A CERTII-ICAI E Of CONSENT TO SeLF-INSJHE FOii WORNCHS' ¢ .
Z =
¢ COMVcYtiATION,AS�RO'JIDE06YSECi17Y97J04F7HCLABORCOGE,FORTMEPE�iFOft�AA\CC U
OFTHfWOHKFOIiWHICHTHISPEH1Al7'ISISSlIGO. � -- • S
y � ��.
� W _I HAVE�ND WILL MAW fAIN VlOfli(ERS'COU,VFNSAI'ION INSi1fiA\CE,AS REQUIRE�UY ScCI lON — y, ///}
:¢. 370�OF THE LABOH CODt:,FUft TME PERFOqMANCE OF TkIE WURK fUR WHICH THIS PEFMIT IS �j/��
��� ISSUED.MYWOqKEi1S'COMPENSATfOYINSUFANCEC0.HPIERANDPOLICYNUMBERAqE: ONSTRUCTI�N
J �/�i
' :j� cni{mna,—_ ' ,. PLANREVIEW
N;y -' ------......._ _�-
� ,�Q�," POUCYNUM��_��1�� � ELECTRIC __..�..
!
ji —"......._ "_'___._'_'_..__'_"'____'_'_'___'_'__._......_ ,
' �' (IHISSLC'IKNJN[fDtJO70EOJMPIEIEpOfiIiLPFRMITISf4(tON:HUM7ReUUG�lAHS(S��%1)UI{�F.55�. PLUMBING
d „W_
.�Z �CERTIFV THtti IN THL V[FlfORPdANC'c OF fH[WOI�K fOft WMCH TH!5 PERMIT IS ISSU[O,1 MECHANICAL ..
--__'.. ._........"_—'___'_'__............_'_"_........_'__"—_.......
SHAI,I NOT EMPLOY ANv Pff1SO4 IN ANY MANNEfi SU�5 TO f7hCOMf Sl1AJECT TO THE
.: .:'._::. .
�'(/j N'OFKEHS'COMPF.NSATIOY LAWS OF CAI.IFpfINIA,AND AGREE THAT IF 1 EIinULD Fl[COMI: - INS{�L'CTION FEE .
—_"'...,"'_' "_'_........._._._.....--.""__'______' .:.
'?. S118lECTTOTHEWUi1KI�:NS'COM�('ENSATIONPqOVIilU4ti(�I�SF.C110N3NVOFTHELAOOR `� ,Y
CAbE,1 SHALL FONfHWITN CONPLY WiTll t'Hp5[pROVISIONS. ISSUANC- /
Q r � .
Q,� —___......_._.....'_'_--"_'_'........_.._...'--""_........._''__.._.,__
p DATE:_�.._.. � APPLICANT: � • —_. ....__---_.._............____—_--_ �T.
_......._—._—_.. _...�'___
JW � ENERGY P/C
WAHNINGFAI Uf7[TOSECUREWOfiKtRS'CUMPENSATIONCOVf:fiAGF.I511NUNlFU�,ANOSHl�LLBE �---.....
...... . ... ._____.___
___._'"'......__
� � EMPLOYEfiTOCI1IMINALPENAL(I[SANUCIVILFIkESUPTOONEVIUNUNFUTHOt15ANU ENERGYPERMIT
�OLLAfiS(57 W,0 WI,iN Ap�1110f�'70 TM[COST OF CUMPf;JSATtON.DAMAGES AS PROVIDEO FOA IN --_'._. ..'__._..._._... .. .._—_.__""_"'"__'__'__..._. .
�J' SECTION 3700 OF THE LAElOP COUE,IMEREST,ANU ATl'OfiNEY'S ff:ES. '
' � RETENTION FEE: _
--__.._... ..._._.._...._........._.—'----�-----
O CONSTHUCTION LENDING AGENCY PRF-ALT FEE:
� —........ ..._.._ ..—..........--...-�---
____---
� IHEREBYAFFIRMtiYOCNP[NALTYOFPE(iJUNYTffATTHEREI5l1GONS7fiUGTIONIfNp(NGqG[NCY
FORTHEPERFONAAANC[OFTHEWOHKI'�Of1WHICHTHISPEFiMITISISSUED(SLC.3087.CIV.C.). --- -- '-- -�����.--- ��-._..._...____.....__,
......—_""_"'—'_"'_""........_._.
W
. ._._....... ._. —__...__.......,._..."._..'...-.._.____._''._".'..__
LEN�ER'S NAM[._
. .._ . .._'_
� -..__........
'__'_... _ .. __" '__... .."'_--__
._.......__'_'__
_ LEN[1[ft'SADORE55 . ___. ..__ ..__ __ —
�
-.W ICERTIFYII{ATIVIAVEHEADTHISAPPUGAf1UNANLlS1ATETHATTHEA60VEINFORMAIIONISCOIiRt:l:(. TOTALFEES j,/�' � ,��
-�, I AGHEE TO COMPLV WITH�LL CIl'Y ANp COLINTY OqDiNANCES AVD STA�E I.AWS Rfl ATING TO BUILDIhG /�+ ✓� ,�
� CONSTRUC,110N,AN�HEfiEBYAl:7H0171ZE1i1:PIl��fNTAT!VE$OFTHISCOUNI'Y7'f)f.:Nl!"IIUPUNTI{[
,� AROV[-MENTIONEO NH(7V[HIY fof11N5PECTION PUriPO5E5. COMMENTS
� •.
J � �' \ _—'__'""..........._.—__.............__.'____.._.._....._..___—
�. _ .....
_..
.... ..___' —'____ . ...._.. ._..__.__ ..._—
_. ......"'___'
; ,a VE lIT7eENAM. PRM7)
_..__ " "_ _.....___
� 1- � �
- -- - _ -.
,;� SIGNnTUR OFP 1 EE p�E -- " �1/'� _
'� RECPT.N0._._......�_�--..._.._. . PAID BY VAUDATION �-
-�--...,_.
WHITE—DepartmeN Copy,YE�LOW—Finance Gopy,PINK—Assessor Copy,qOLDENROD—File Copy,GREEN—ApplicanPs Copy
a �a���'��k��C������������z��� E � i _ . ' . � __ _ � �� E � f � k .:
.t r� I
o �
xx � ' t �
t ��s �' ��k��� �,� j = 5, I�k� �
� � s t r , y
� �� i a
�4#'�� � :� � w i , i I 1 a
�v��x�r u�t��5�'�.y � ' ( I � �-� �`�
�e:�����r������{ �` ��fi� ' ' � ' i � � � '' �� �
de-�a�'�s�1�{��c� �:t�o� ,„ � � � i � � �tx i{ �'r' r�� I r�� � - ���
� � �a-'�.��e ���n�€� �n"�� � t;o i ! j . , .,'„ � , ' '' r, ^ t,' , i . ��:
��� � :1 � ; �+i
� 'ex�E�i� r� i I " �s_,
,��, ������ , � � ': I i I � ,; � ;� � i,�, � � ���
+ � ����� � � � , � 3 � - .'
�
' ��������;��� , �� � � �
� �� �� i
� �$ a�� �s . . �...� i j � - - - _. ,.- �- -_'._..__� � � �
� € � 1. '�' t� I i i i � i ,�C' ?� I ' ,�
� �- � � � � '
� I ' � _ � ' �` i . ...� ;�' �` � ����,
��. . � i I , j � ,
. ; , , I w ? ! j ; �
7 � , � i ! i � ; ''; ' '- - � ' - ' -� �` � - � � I ���:
__ . .. , , . � �
� , -� �
, � � ; � , i , { � j Y���
f � i zr
� ' ! : ��� ; ,; �i I � i � � �
` � � � • �I � � �,
, i , � � � i I ' h,
� • , � I ( I � '� , � i ,, � �I � ] 4
� I � � I � f �I I I I .',, � � I ( � ,.' '' I � . I � ' GF+`!�.' ,.
i i 1 � � . I� ( �' � j I E i I � 'i ' � ��
. I � : .�_, I � I i i � � i � :, � ! i �."j�`'. m �
� �' ' � j i f ' jI _.1.�_.... 1 �� � '+
. i ' i i j Y .... _I � I I �'�
� ' I 1_.'...�_..€ 1 �5
, i I ' � ! ,1 I i �� �' ' .. � �.) i� � _ .. i � _ � � �j � ��
! � � �a�;b _ � �,` �
. � , . I ',. 's .� �#..id�� � . .. .�` .., �,.�i I _;! ��.- --( i �� —
: � ! ; ; j j , � ,d ,,,r ,. ,. , �;<� r ; , Ic , t I, i�
� I � � I I � �.�,= i � i; i. , �z.,, �� s�µ
� I r � �� �� „�,`ry ' f��_I � � � ,I r � i I, � �;
l � ' i ' ! rr - i r� � rr i I � �' , � Er
I ` �'� � � , ��- ���.��� 7 I ' 2 { i � f" f� _i I I 1 r i•� f A � 7 i� d
� 1 ; I � � ���.r i- 1j i '�7I ) J. ( � -� SI(^ � I j .,� i IIT I ', � � ¢ S�,
� i ( � I i . '�„ j 17 1 � 7 . i 's "
I i I � ���k ( .� i _ E �" �T I� � �� � � .i I a� i ��t �
� : � .� , -` � i � .I � .� . �#' �� �0
: i i - + � I � i ' z �
j I i � � ( �� �� t � � � � R � �, I � `��� F ( � �� � ,�k
; ( ! � i 7. � ; i � , � ' ; � I�, C s ' i �'+'�'�
' j I ' i ..I_ I �, I � . " i I i '��,��
i
r � . I � • I _ I � � � , i i i � i k���
� ; �
, .
, f
, , � i ; � , , ; , � � �
, , � . ; � -- —— — � — �
� ;
� � � , , � i ��
.
; i
, a
� � � I � ' i
, , , , , '..
�_ I
�� � ' i � � � � � �. I I . � , � � ��
', I I r � � i , � '
�
� � I i I I i ' i I I I I I �
� t ,
� `
. ,, � j L - .__ I i � , j
� � �
� � �; I , � - — � � t
� I 1
� � °. . � � � � � ..' I __ ; i '_ ' 1
)
� � \ ,. ' I � � i � _ I I � I � i
f 7 � � ` � i i � � � � 1
I
a ( i , ,
� � ; i I i i � � , ; � i , . � � � � i � , � � ', ��
� ; i � � � i i � � I I i � 'I ���
i �' j � , � ' ( � � ; i i I ; ; � � ; � j � ���
' �� ; , I � I � I � i � � i ��'r
,
� � � I ( � � � i j j ' i ( ` � �
r ; ,
� � � ;
�._��„_. .. ,___,_._.�_ ,1_._,.. ...__.__.� � __ �_.._ ......___ . ,_._,._a .�_�_._._ � � � u � . . '�
____� .....�._. __....__.. ._l . .. � t