HomeMy WebLinkAbout11240 �`=
/ --
•'�� CITY OF DIAb10ND IIAR �
E, *�� COMMUNITY DEVELOPMENT DEPARTMENT {�
. 2I660 E.Coplry Drive Suite 190 I
(909)860-3195 Fax(909)861-3117 PRESS
�'"" BUILDING PERMITAPPLICAT[ON FIRMLY
o AODDRIESS �tI�/ C►c[JU�-C=lJ G�P.���/� pA�CATION� ' I �� NUMBER � #/C
� ISSUE TYPE OCC
APN LQT TRACT DATE CONST. GROUP
°� OWNER /ll
O
p ADDRESS �' ZONING SETBACKS
z CITY ' IP c�i7�5TEL. i'J� �'-[3 FRONT RW O
g APPUCANT ' , TEL L�9� REAR ❑
SIDE/SI�E STREET RW ❑
� CONTRACTOR ' L SIDE ❑
� ADDRESS �
o CIN � ^�• ZIP TEL. - L PROPOSED USE
wo ARCHlENG!
z DESIGNER
w N0.DWEL NO. NO. .
� ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCRIPTION S�.Ff. FACTOR PSF ADJ.AREANALUATION
� OWNER-BCIIDER DECLARATION SFP/ADD,'REM
O -
p - I HEREBYAFFlRM UNDER PENALTY OF PERNHY THAT I/JA E%EMPT FROM T11E COHTMCTORS LF GaregeiCarport
W CENSELAWFORTHEFOIIOWINORE�SON(SEC.70J1.SBUSMESSiWOVROFE5510N5CODEMI'/Cf7YOR (n -
U COIMTyWNICHREWIRE511PERMRTOCONSTFiUCT,ALTER�PROVE,pEMOL15H2OqREPAIRANY5Ti1UC• W patioiDeck
Z NRE,PRqR TO 1T3155UANCE,hlSO HEOUIFES THE APVLICANT FOR SVCFI PERMIT TO FILE A SIGNEU
W STATEMEM 1HAY HE OR SHE IS UCENSED PUFSUMlT TO THE PROVISIONS OF TNE CONTMCTORS t4 w
� CENSEUW(CNMiERB(COMMENCIN(iWITHSECTqN70D0)OFDIVISION]OFTNEBUSINESSANOPRO- � PooVSpa
Q FESSIONSCODE)ORTMA7HEOHSHEISE%EMGiMEREFROM�ND7HEBA515FOHTHE/�LLEGEDE%EMP• (�J
V TION./�M'VIOLATpNOFSECT10N7071.5BYANYAPGLICANTFORAPERMITSUBJECTSTHEAPPLICANiTO Z Re-Rool
ACML PENAITY OF NOT MORE THAN FNf HUMJHEO OOIURS(f50o).�:
ZOI,ASONMEROFiNEPROOER7Y,ORMYEMGLOYEESwITMW�GE5A5iMEIF50LECOMPEN5AT10N, O COmmEfC�81
MnU.DO THE N'ORK AND iHE STRUCNRE IS NOT IMENDED OR OFFERED FOR SALE(SEC.7W�.BU51- J
� NESS AND DFiOFE55lDNS CODE:THE CONTMCTORS LICENSE LAW DOES NOT AOP�V TO AN OYIMER OF j
VROPEHiY Wr10 BURDS OR IMFROVES THEREON.ANDri710 DOES SUCN WOFK HIMSEIF OR HERSELFOR
Q THROUCHHISOFHEROWNEMPLOYEE3,PROVIDEDTNATSUCNIM7ROVEMENTS�NENOTINTENDEDOR m
0 OFLEREOFORSALEIF,FIOWEVER7HEBURDMCORIMOROVEIAEMISSOLDWITIANONEYFAFOFCdAPLE-
Z TION,THE OWnER�BURDER'MLL HAVE THE BURDEN OF PROVINO TNAT HE OR SHE DID NOT BVIID OR
= IMPROYEFORTMEPURPOSEOFSALE�
w ❑I,ASOWNEROfTHEVFOCERiV,A1AE%CLUSNELYCONTRACTMOVATHLICENSEDCONTpAttORS
. Q ro cor+srnucT n+e rawecT�sEa�ou,eusNEss vro emrEssror+s cooe rriE carrrucrorss u- Va�ualion ADJ.AREA
W CENSEUWDOESNOTAPPLYTO�NOWNEROFAVROPERT/W1qBURD50RIMVROVESTHEREON,MA .
� NM1IOCONTMCTSFORSWI7ROJECTSWITHACONTMCTOR(S)LICENSEDiURSUAPlTTOTHECONTiUG QUANTITY DESCRIPTION �E
Y TORSUCENSEUw1. - �
� ❑I AM EXEIAPT UN�ER SEC. 9.6 PG FOR THIS REASON Q
� V _
u.. �
o�TE ovmEn V ,
Z W
� LICENSED CONTRACTOfiS OECLARATION w
IHEREBYAFFIiWUNDENPENALTYOFPERNRYT11AT1AMUCENSEDUNDERPROVIS10N40FCHMTER Z G O � �
d v(COUMENCMG Wi7M SEC�qN 70o010F DmSiON 70F TrE BV5�rvE55�wD VROFE55�ON5 CODE.AND
� W LICEvSE IS M FULL FORCE AND EFLECT. /� m
0 LICENSECUSS��� LIC,NO. � � � j
~ OATE �"'�� ��CONTRACTOR J
U
w
� WORKERS'COMPENSATION DECLARATION ��� Q
- - - - T - - - -
� IHEREBYAFFIRMUNDERPENALTVOFpERNRVONEOFTHEFOLIOwiN6DECUFATqr: . Z
� _IMAVEANDWiLL1AAMT/.MACfRTIFlCATEOFCONSENTTOSELF.INSURE�OAMpRKfRS =
COMOENSATqN,ASPROYIDEDBY5ELT10N]�DOOFTMEIABORCDOE,FORTMEiERFORMANCE �U
Q qyT1E WORN�OR WHid/TMIS DERMIT IS ISSUE�. , �
/
� V IHAVEANDWILLMAINTIIMWORNERSCOMVENSATqNINSURANCE.�SREIXI�RE08Y5ECT10N
Q 97000fTHEUBORCODEFORIHEPERWR�AMICEOFTMEWORKFORWHICMTNISPERMITIS
ISSVED.MYWORKERS'W�.IPENSATqN1N5 10EC�RRIERM1DPOl1CYM1MBEHARE: CONSTRUCTION
� `.`�
� CARRIER_ �[�-� PLANREVIEW �
� vaKvrnn�sEn LL7 �- • (�'"�D� ELECTRIC
� �ness�r��r+oTeEm.n�EnoFnEaEm�rsax�or�w�nm.wii iamoa�s! PLUMBING � 1 �
Z ILER7IFYTHATR17MEVERFOiiM�NCEOFTMENd1KFORVVHId1TM5PERM�T15155UED,1 v MECHANICAL
('} SIUll NOT EAIPLOY ANY PERSON P!NJY MANNER SO AS TO BECOME SUBJECT TO iNE .
(n WOR1(ERSCOMPENSATqNUW40FCALIFORNt�ANDAGREETIUTIF131KKADBECOME 1NSPECTIONFEE -- - - -
S SUBJECi TO TNE WORKERS'COMPENSATION GROVI5pN50F SEttION�7oa Oi THE UBON —_ � �
COOE,IS ALLF TiC01AClYWIiHTFIOSEVROV1510N5. � UANCE iwns�
0
p DATE: APRICANT: SMIP
� WMNiNO:FAILURETOSECUREWORr(ERS'COM7ENSA7qNCOVER�GEISUNUWFUI,ANDSHALLBE ENERGYP/C
�y SUBJECTANE47LOVERIOCRIMINALVENhLTIESANDCN1LiINE3U0TOONEINNDRED7HWSAN� ENERGYPERMIT
DOlLARS(i100.000).M ADDITON TO TME COST OF COMVENSATION,DAMAGES AS OROVIDED FOR IN
¢ SECTqN�70lOF7HEU90NCWE.RREi1E5T,ANf17�TTOfWEY5FEE5. - - RETENTIONFEE: �
QCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� IMEREHY�tFIRMUNDERPENALiYOfPEiWRYTMATTMEREISACONSTRUCTIONLENOm10�CENCY
FOR THE PERFORMNICE OF THE WORK FOR NM1IK)H THiS PERAIIT IS ISSUED(SEG 3097,CIV.CJ.
Z
w
� LENDERSNAME
�— LENDERSADOAE55
W ICERTIFYTHATIHMEREADTH19APPLIGTqNANDSiATETHAT7HEABOVEMFORMAT10NISCORRECL TOTAL FEES 1
� IAGREETOCOMPLYWI�H/1LCIT`/�NDCOUNTYOROINMICESMIUSTATEUWSREUTIN0T06UILDINO '
� CONSTRUCTqN,ANDHEREBYAUTMORIZEAEP��TNESOFTN�SCOUNTVTOENTERUPONTHE ��Ll/���� /_i����/A^�•tii��T
z ABOVE�MEMIONEOPROFERTYFORMSPECTqN vosEs. COMMENTS
o .�1�
m PERMITTEE NAME(PR� �
¢ /
� V
(n SIGNANREOFPERMI EE � _. � - � OATE
� � '•. RECPT.NO. PA�D BY VALIDATION �
- WHITE—Depanment Copy,YELLOW—Fnance Copy,PINK—Assessor Copy,GOtDENR00—Flle Gopy,GREEN—ApphcanPs Copy
N� n � � T T � � m � ❑ n � m � � � � � � � g � � � m � ,
m� z Z z z D m m m � m y x x o o O O � o y m r � r �
v� � � � � � y v � m � Z � � � � � � � � � m v � D n � � �
b n � v rn x n � v_ � � a � � � m x x x � z m D v � Z � � n
�� f71 c m � � 1 � D r z c = � � � m � � m m � n � � � �
�� -Z-I � � z � � � � D � � o m � n � � z � < � m c � N
fn - z � . � r _I � m -i z ..� = C7 � O <n
m N � n � -D_i Z � � Z n Gl �,� m m z m � �
m _ Z 1 � -Di � � �
0
` I . , z ,
r - [.
` � .
' �• _
L7 � _
I ;
' ,'.�."
a � �
m o
[� -n
gr fll Q = T T p r T p Q 'D � 'O T 71 CO � T Q� � T T C C T 'fl � � ,
z m m � Z z q Z m T O O O Z p m 7� Z � � z z = '`
_ . - - . . - � m < D m q � Z y O �t O O O - C Z f�l D � � m m � O A � O D '
_ . _ _ - - . 37 .� � 0 1- � � (- n U7 1- r r = L7 n � r W 2 'D � Rl fil 77 � ,� z � �
� ��, j fn 2 �n N Rl C) m D -i T �l fn 2 = 37 W p � r 77 7] �77 7J ..
, � � ,-�iz° � vcZiomaZ "' � a � o � oo � � � � � o` m Z
� � ' 'a v �nz 'o �n ' z � r � � � D ZpmZmm:p O � cn • , (�
- - D "'� Z G> �' � N � z ]� o � m m o m -n a O m 1 'F i -�
: a �, D ' � c� � � Z Damzo � � O W
. y r L7 '� � � D p �O O � o v �
\ � � r � A �,0 � �
.` � � C
K - Z �
,• �
i � . I.
{�
�
I�
� � .
^ _ _ ' ��I