Loading...
HomeMy WebLinkAbout14413 (20) i �. 1� CITX OF DIAMOND BAI� ' �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21550 E.Copley�rive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 �'�^° BUILDING PERMIT APPLICATION FIRMLY y JOBSITE r,, APPLICATION PERMIT � P/CC� o ADDRESS � `�' �"���' ��..I�-� DATE �2 O7 NUMBER � (y �# r� � ISSUE TYPE OCC APN LOT TRACT_ DATE CONST. GROUP p OWNER Q �. ,A S ,b �t o ADDRESS' -��2-�N�CsS ZONING SETSACKS CITY�� ZIP q 17�5 TELS�DO-I�d-�C FRONT RW__ n__ � APPLICANT,fl�� _ TEI. REAR ;,______ SIDE/SIDE STREET RW f-1 a� CONTNACTOR CJ 4�S G,VS''T�VI O�_(,�__ SIDE U Q ADDRESS�Z'�� �lI�S[ __� M � CITY G{�IN-'d ZIPqi'7ta_ TEL. 4�4�QenOS PROPOSEDUSE��,L� o ARCFUENG/ --- ----- �ESIGNER_� L/.�G��. l�u N0.DWEL. NO. NO. o� ADDRESSI�.1•�_,�ZS��'LI�___•c��_ � CIIY���'1'��-1 M ZIP`(_2�� TEL.�a3'O-�o(E}Q i UNI7S __ S70RIES ___BEDROOMS cn i DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNEH-BUILAER DECLARATION SFR/ADD/REM O I HFAEBV AFFlRM UNDEq PENALTY OF PERJUflY THAT I AM EXEMPT FIiOM TNE COM1TRACTORS LI� G81�98/CBfpOf� � � W CENSEUWFCRTHEFOLLCWINGRFASON(SEC.7031.5RUSiNG55ANOFHOFG551GR5Co�E.AYYCiTVOii U �p{Jpn'yW{{�CHRE�UIRESAPERMITTOCONSTRUCT,ALTER.IMPHOVE,DEN.OLISH,ORREPAIRANVRTRUC- W TUflE,PRIOR TO ITS ISSUANCE,ALSO REOl11RE3 TXE APPLICANT FOR Si1C11 PEA�717 TO FIL[A SIGNED u� Patio/Dack r� STATEFIEYT iHAT HE OR SHE IS LICENSEO PURSUANT TU 7Hf PROVIS!ONS OF THE WN7RAC7ORS 11- � � ' � CEN3E LAW(CHAVTER 9(COMAAENCIVG WITH SECTION 7000)OF DIVISION 3 0F THF.OUSINESS ANU PR0- .R-0BYSPB FESSIONSCODE)ORTHATHEOR3HE13E%EMP'fTMEAEFflOMRkDTHE6A515FO5hiEA:LEGEDE%E1AP- � V TION.ANYYIOLATIONOFSEC710N7031.50YANYAPPI.ICANYfORhPERMITSUdJECTSTHEAPPLICAN7T0 Z Re-Roof ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDREO DOLLARS(£S0o).): � ❑I,ASOYRJEflOFThEPFlOPERTY,OHMYEMPLOYEES'vVI1HWAGESASTriEIR50LECOMPENSATIUN, C, COfI'IffIP.lCial WILL�O THE WORK,AND iHE STFUCTURE IS NOT INTENDEO OR OfFEAE�FOR SALE(SEC.7045.BU51� J � NESSANO PROFESSIONS CO�E:iHE CANTPACTORS LICGNS[LAW DOES NOT APVIY TO AN OWNER OF � , � PflOPERTVWHOBl11tD60RIMPfiOVESTHEREON,PND1Ni000ESfiUCHWORKHIMSELFORHER3F.LfOR ! m � TMi10UGHH150RHEROWhEMPLOYEES,PROViDE�THATSUCHIMPftOVFMENT5Ai7ENOTIMENDF00R F `p• , „9+l W OFFEREOFORSALEIF,HOVhYERTHE9UIl01NGORIMPROVEIIENTI550LDWITHINOPIEYE4RGFCOMPLE� f� V z TION,h1E OWNER-BUILOER wILL HAVE iHE BUR[7Fh OF PROVING TNA7 HE OR SHE DID NOT BUiLD OR � IMPROYE FOR THF PURPOSE OF SALEj. (y, ❑I.ASONMEHOFTHEVROPERIY.RIAEXCLUSIVELYCONTHACTINGWITHLICENSEOCONTflACTORS � TO CONSTRUCT iHE PRQIECT(SEC.�0{6,BUSINESS AND PFOFESSIONS COOE:THE CONTRACTOflS LI- V8IU8ilOf1 ADJ.AREA W CENSELAWDOESNOiAPPLYTOlWOWNEROFAPflOPERTYWHOBUILDSOFliMPROVESTt{F.REON,ANU ---- �"-'--'-- - --'--'----- e � NTqCONTRACTSFOR6UCHPRQtECTSWITHACANiRAC70R�S)LICENSE�PURSUrtN7707HFCONTRAC- QUANTITY DESCRIPTION FEE � TOHSLICENSEUW.). ` Q ❑1 NA EXEMPTUNUER SEC. B.8 P.Q FOR THIS REASON E Q I ,� � � -- -- ....._ � -dV- t� ' , 1 r`� rt � ..1'� : DATE OWNER � � � _-'_.._._.."-_""" W � LICENSED CONTRACTORS DECIARATION �u � IHEREBVAFFIRMIINDERPF.N0.LTYOfPERIl1HY1HATIAMUCF.NSFDUNUEHPROV1510\SU�CIfAV7ER � d 9(COMMFNCINGWITHSECTION'IoOa)OFpIVI510N30FTHr6U51YF55ANUVHOFE5510NSCODE,ANC .r, X MYLICENSEI5INFULLFOFiCEANDEFFECL m b, �__:�. r� i' l� � LICENSEC 5 �""���_LIC.NC.�1.�0 I �.'_"'_ � � '. �"�-��.� � ���•". � .y /����- � L DATE �� 1 �___CUN?RAC70R�"N31_.�M_� �- � — I ' � WORKERS'COMPENSRTION DECLAflA710N � � � � IHEREBYAFFIRMUNDERPENALTVOFPEPJIIq`.'ONEOF7HEFOLLOWINGUECLARA'I'IOYS z E p ___IHAVEANDWILl1AAtNTAtNACEFITIFICA7EOFCOYStNTiOSELF-INSUHEFORY/ORKERS � 2 1 Q COMPENSATION,ASPROVi0ED6YSF.CTION37DOOF7HElA.BORCODE,FORTHF.PF.RFORMANCE `U � OF THE WORK FOq WMICM 7MIS PF.Rhlff IS ISSUED. � W '_ _— Q �1 MAVE AND WILI MAINTTIN WORKERS'CqMPENSATICN IM1SUflM'CE,AS RECUIRED OY SECTION � � 37W OF THE LA60R COOE.FOR ME PFRFOANRNCE OF TN.�N10RK FOR WHICHTk!!S PEFMI7IS °'� � / 0 ISSUFO.MY WORKERS'COMPENSATION INSURANCE CAFPIER ANO PCLICY NUMBER ARE: CONSTFIUCTION � � °' S � �`' � �"""_'__"""—�° F Q �� �� '__"'____-._ _ ' FLAN FCViEV'J �,�- � CARFlIFR."_'— ' " '__ _ _ 'f "'__"_'-_""_',,�' "�— ZPOLICVNUMBER�—���?3_�-__---.-----.-------.,-- EL[CTRIC .------- -�-- (/ �4' . 4 �"--' . �`�"L V (iHISSECTK7NNEFDNOTBFGUA7LEfED0.7HEPERAUTISpiiOtJEHUNDREDfXMLRS($tac)CRtF.F�ti). PLUMBING . _��/��." _ �-' �: Z ICERTIFVTHnTINTHEPERfORMMCEOPTHEWORRFORWH:CHTH15PERMIT!SISSUED,I MECHANICAL _. ,_.___'`� �A G� 9... CJ SHrLLLNOTEMPIOYANYP`cHSONINANYMANNCR$OASTGfi[CUMCSU9JCC1!OTIiE � (� (/J WORK[fIS'COMPENSATIDNIAWSOFCALIFORuIA,�N�7AGqEETHATIFISHOULD9EC0'AE �NSPECTION�[E ti'S� � ___ _....._'_' " - SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIO4SOFSECTIGY370oOFTM'eLA60R i,yf„ • � CO�E,�SFIALLFORTHWITHCOMPLYY r+ ovisroNsj.� � � ISSUANCE .__„_.._____�. ,_ ' • � �2��_ ���lJL7.- SMIP �.. . �. :i�,_ DATE:__" .' APPLICANT: -..,""' w -� �' � J WARNING:FAILl1RE TO SECURE WORKERS'COlAPENSA710N COVERAGE IS UNLAVJFUL,AND SHALL 8E FNERGY P/C ._ ,._,.__..__ y, . _......----._...------- � SU0.IECTANEMPIOYERTOCRIMINALPENALTIESANDCIVILFiNEuU1`TOONEHUh�HEDTHOUSAN� F.NERGYPERMIT �.(7., .�,. DOLLAHS(57W.000),INA�UITIONTOTIIFCOSTO�GOMPF.NSATIOY,OPMAG[SFSF`HOVIpFOFUHiY -- ��- ------ -�-�---�-- J SFCTION37080FT7{ELAE3URCA�E,INTEREST,ANUATfOflYEY'Sf[ES. �'1 ����jJ � ____ RETENTION FEE: _ OCONSTRi1CTIONI.ENDINGAGENCY PRE-ALTFEE: � _. „ _.,____.__,.____.__.,____ � IHEREBYAFFIAMUNDERPENl�LTYOFPEHJURYTHAT7H[FIL:ISACONSiFlUC110NLFN0INGAG[NCY __ FOR THE PE.RFORMANCE OF ThIE WONK fOR WHICH Th11S VEHIAIT IS ISSUED(SEC aoe'l,CIY C.). -- Z ` � •�� W - -�X- t.�- � LEN�EWSNAME__.,,_____,__ � -__""""___'__' Y'__ F- LENDER'SADDflE55 _ _ .___._ __ ___ _ --� � p C [+ � � ICEFirIFY7hiqTIMAVEREA�THI5A7PLICATIONANDSTATETHATTHEABOVEINFOFMATIONiSCAflRECT. TC.�Ti'1L.FC��7 � J ���...{{{ W IAGREETOCOMPLYWITHALLCIIYAN[7COUN7YORDINANCESANDSiATF.LAWSIiELATINGTObUILUiNG ///}yy /}Q [J � CONSTRUCTION,ANDHEREBVAUTHORIZEREPflESENTATIVE50FTNI5CUUNTVTOENTERUWNTHE (�,� '�-'I �.. X C7 - �.J Z. ABOVE�MFMIONED PflOVERTV FORINSAECTION PURPOSES. COMMENTS__.__.___...._.� "_—___'_ � C �l� G� � � --- — ----�---------�----------- � ------------------------- m P RMI (PRIN1] __ _._"_'_'_'____—__'---'-- � � -�� .----- -f�'��--- � SIaNANRE aERMITiEE ATE RECPT.NO! � PAID 8Y VALIDATION _ ~ WHITE-De artment Co YELLOW-Finance Co PINK-AcSossor Co �OLDENROD-File Co GREEN-A licant's Co P PX PY. PY, PY. PP PY � �m�.,_ _ � �_. .. .� __ . - -- -- . _� - . - -- _� i � ; ; � . � � � �„�; I � � i �.,.'� i i � ? � ' ; , � �� � � , I � � �` I ` . - � � , . I , � 1 ; ���' � � � � �V, � � � i � � " ' ' ; - '� , , i ! ! , � , � � � � i �_!z � _ � i � ; � ��� I ; , i �� . ' � ' ' , � �� � ; . , , �§ � - �� � �� . ; - - � -, � ; � � i � {.�� ' � � � � ' � � ' ' � • ry �» i � �� .' . I ' ' ' � � . i � � I . i ' ��. .� ' ',- _ .. : i � �� � j � : � � ` ' i ' :. ._ ._.__'.. �._.. � � i � N �\"1 I - —(- �,#. t� ! � � ' � _ a� � i. , • , , � � � v�,..'� � � --i � � i ' � 1 �Y' ; ! � . : � �sx� � � : ' ' i I t � T> �w�� �t I � � . � i � ' }� � � � � � � � �� � .� ��. ' i � 4N.. '�. i 3 � � �i' - �y` I . . I ' i '� j , - ' , � � � y � s� � _ y� � ' - � _ � _ I ' _ i aF� c.�. I t � � - f : . i � � ; �n �`� �;� �n, ta � i _ �� �� v�° 4��- f i � I ' , ; i I"�°"`` - fC - � ,�� - 1 . € �f> Y iLT f�f ' L ._} I L ei - . �� � � � . � � � �-' ��i r'i< c;# �,' � S � � qi ; ; ' j ; ! ���� � I , i ' i _ —- � ° � �� j � � 6� :r� �'�� -, � �� (--. ° , � �� � I i ( � � � I � �� I . i � i � ,t+ '-L § � q� i ' f � � ' t i fn,Y.�� � i �; �( ; ` <� �,€�. I . ' _ ` I I � , t ( i i i��" �; a � i ! � ���� , ' ; . I � ��' �� �fY�: r ' ' � ��� i i i ! � ; � j �� , i ' j j . � \ � �.,� .. � � . ��a� < i)J - i : � - , ' - �', lu: ' � � : j i , i , : ,�r��,z� ...� ��'. . �-- i � ��-- � - '. . ti - - � , � i • ' ' � � � � i , ��. � I i ti',�(�Q `1' � � � i f�-#' ,f" ' i 6'-� � i ��1 � �f -� � ��j' . � . � � � 'a ` � , � �: � � j . ��� . � . � I ( - � - 1 � ��}�� - 1 - , — i ; t `� D' �} ( ! tj'S�$�- s'� , ��, �" � ��r� . ' ! . . ' � - _��"� , , � 2,�,��,��3..-r�i,�.�i^�.—.A y sro � i _ i . . , �-1�1 � I t� «"�`� � '� c�.s� i I : � r� (: � ��c����;��c4� �Z�.,� y �r�`�i � ; _� ( �! At S�a�,���e''��s�fs��[-- . . . i � � . �_ ; �. . . 1 a��' ��'� n" �.�,'���a s, '� . V' �i �. � y 3l'S�`rt'v�S'Z,..i 5: 4 � � � - � � i ��� i �: �#4g� � rc � � � . � � _ g � /i�� �. ��e°�ea". '�� X�p t � ..f, � ? � 1 ( .��.� I � � � �'�i't `�'�� 4"3�,A�'# f k . ; � ' � ' � .-1 �.. .: � `i Y.'�� ��'��i;}�. ����� �"35;�4yP�:Y _ ' i,yil�.c�' . _ ' _ . �.:� . . . _. -,. .'. : . �. : .� : .1 � : e �t��'fi�.Y�x .y¢`�' x'� �� .3,_.�:,_..._..._ .. _. � _.,....�----_--. � : _�...,.._�.. :. ...._._�._� .. .�. ___.... __. _n.._: _. _. . _ �___ _ _. .. . _. . .�__. _ �