HomeMy WebLinkAbout16266 �, ,
� ICITY OF DIAMOND BAx i-� + �
'��" DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES r''� � '
21660 E.Copley Drive 5uitc 190
��w (909)860-3195 Fax(909)861-3117 PRESS
����Y�� BUILDING PERMTT APPLICATION ' FIRMLY
o D�RiESS!J'I�lJ"J v/�IV M ��"" DATE CATION ��.. NU B R ,�� #/C
$ ISSUE TYPE OCC
APN LOT _ TRACT_ DATE CONST. GROUP
p OWNER �-�
ADDRE��SS�Z�''�"I'`�'b� ( f..F ZONING SETBACKS
� CITY�v_i�h.D� , IPy� TEL. REART RW u
APPLICANT EL.� SIDE/SIDE STREET RW O_
� CONTRACTOR I�Wlrj � G(2.� . � SIDE L 1_
� ADDRESS G� � PROPOSED USE ' '
� CITYG ZIP��.f TEL �
w qRCFUENG/
z DESIGNER �A�,,�fG NO.DWEL. NO. NO.
� ADDRESS �n� _._ ._ .
UNITS STORIES BEDROOMS
� CITY ZIP TEL. --
y DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� OWNER-6UILDER DECLARATION I
� . SFR/AD�/REM k
� I HEREBY AFFIfl►1 UNDEF DENALTY OF PEHJURY THAT I AM EXEAIPT FROA1 iHF CONTRACTORS L6 GBf�ge/CalpO1S i3
W CE�ELAWFOflTHEFOI.LOWMGREA50N(SEC.7o31.58USINESSANDPROFE5510N3CADE:ANYCITYOR (n
U COUNTYNMICHNFAUIRESAPERMITTOCONSTHUCT,ALTGR,IMPROVE.OEMOUSH,ORflEPAIRANYSTflUC- W PafI0/DBCk �
�L IURE,PRIOR TO ITS ISSUANCE,AL50 REQUIFlES THE APPLICANT FOR SUCH PF:fiMIT TO FILE A 516NED w �����
� STATEMENT THAT HE OR SHE IS LJCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LL ����
CENSE LAW(CHAPTER 9(COMMENCINC WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS ANO PRO� � POOUSpB
FESSqNSCODE)OR7FI�TNEORSHEISEXEMPTTHEREfROMAHDTHE�A515FOR7HEAlLEOEDEXEMP� (� �
V TION.ANYVIOUTbNOFSECTION70.91.5BYANYAPPI.ICANTFORAPEflMITSl1&IECTS7HEAPPLICMITTO z RE-RODf
� pCIVIL FENALTY OF NOT MORF.THAN FIVE HUNDRED DOLLAR3(SSoo�.Y
� ;]I,ASOWNEROFTHEPROAERTY,OflMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, ❑ Commercial
Y/ILL DO THE WORK,AND THE STflUCTURF:IS NOY IMEN�ED OR OFFERED FOq SALE(SEC.7046.0U51� J
NE33 AN�pROFESSIONS WDE�iME CONTfiACTORS LI�NSE LAW DOES NOT APPIY 1'O AN OWNER OF
� VpOPEHTYYVF10BUilD50RIMPROVESTHEREON,ANDWHODOE55UCFiWORKHIM50.FORHERSELFOH =
Q THROUGHHISOflHEROWNEMPLOVEES,PqOVIDE�THATSUCHIMPHOVEMENiSARENOTINTENDEDOR m
OOFFEHE�iORSQE.IF,MOWEVERIMEBUILDINGORIMPHOVEMENTISSOIDWI7HINONEYEAROFCAMPLE-
Z TION.THE OWNER�BUILDER WILL HAVE 7HE BUqOEN OF PqoVIYG YHAT HE OR SHE OID NOT 8lll!D OR
� IMPROVE FOP h1E PURPOSE OF SALEJ.
LI I,AS OWNFROFTHE AHOPERfY,AM E%CLtJ31VELY CONTRACTIN�WITH UCENSED CONTRACTORS
� ¢ TO CONSTRUCT THE PHQIECT(8EC.1ou,BUSINESS AND PROFESSIONS CODE�.THE CONTPACTORS LI� V81U8t1011 _._.__.,_ ADJ.AREA__
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPFOPERTYWHOBl11LDSORIMPROVESTHEHEON,AND
� WFIOCONTMCTSFORSUCHPROJECTSWRHACONTflACTOR�S)L.iCENSEDPURSUANTTOTFIECONTRAG p�qNTIIY DESCRIPTION FEE
TOflSIJCENSe IAW.). _
J +
� ❑IAM EXEMPT�NOEASEC._. — 8.&P.C.FOR THIS flEA50N U `�
Q
� UATE OWNER ___.'_"-.__'.._..__ U
� W-
� LICENSED CONTRACTORS D[CLARATION W
� 1HEHFBYAFFlRMUNDERPENALTYOFPERJURVTHATIAIALICFNSEOUNDERPROVISIONSOFCHAPTER �
� e(COMMENCINGWITHSECTIIXJ7000)OFDiYI510N70F111E�U51Nk:55ANOPHOFE5510N5CODE,AND Z __.
�j� MY LICENSE IS M FULL FCRCE/J1O EFFEGT. m
� e�Q' ' �
F LICENSE C 5 G liC.NO.yJ,(7 _ � y—
V DATE_ CCNTMCTO .
W __ _
� WQflKERS'COMPENSATION DECLARATION Q
� U
� IHEP RFFtNMUMDERPEMALTYOFPEfiJURYONECFTHEFOLIOWWGDECLARATKKJS: — -
� Z
� __IHAVEANDWILLMAINTAINACERT�FICATEOECONS'eNTTOSELF-INSl1REFOFWOR%ERS' _
� COMPENSATION,AS PqOViDED 9Y SECTION:i�Oo OF THE IABOR CODE.FOR THE PERFORMANCE w _
�THE WORK FOfl WHIGM Tl515 PERMIT IS ISSUED. �
� ` ISSUED.MYWOfiKERS'COMPENSATKK�J�INSURANCECARRI,ER/AN�Upp REUUIflEDBYSfL'TIOY
- __1 HAVEAND WILL MAINTAIN WORKERS'WMP[NSF710N INSUFANCE.ASp WHICH THIS PERMIT IS �- '
> 37o00F TH�R CODE,FORTHE PEHFORMl.�CE OF THE WORK FO`ICY NUM6ER ARF� CONSTRUCTION .,__ � ��
' ._.._..__"_ _____-__"-
� CARqIER___��''g^/� e'�/� PLANREVIEW �'
_ . _ ' _--......."—_"""" ""_"_"'_'_
ZPaICV NuuRER�.�.G.-� __Z�L__—__...�-�.'."..'.._ ELECTRIC ...___._....._ ."___."_ �. � ,.
� SCi:710NNEEDNOTBEIXaVPLETEDOFTFiEPERAtlT{4FOfiCNEHUN:fiE�0�.W1.+I5100�OF1LL55� PLUMBING ---------.._ _.._--���.. 1�. .
� RH6
Z I CERiIFY THAT INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAI ,_.___-...._._
(�} SNAlt.NOT EMPLOY.4NY VEflSON M ANY MANN[R S�A`i TO OECOMG SUB�ECT TO T E
� WORKERS'COMPENSATIONLAWSOFCALIFORNIqAN�AGREETHA �FISHWLDB E iNSPEC710NFEE _ __ ._
� SU&IFCTTO7MEWORKEflS'COMPENSATIONP. VI 10 E 10 aoUFT dOR ����----��------����yy//��--��``�\....�l
� CADE,I HALL. O 7HWITHCOMPLY'NITHT ISSUANCE [ -�-- -'-_,.�
� SMIP
p oATE:� �� APPLICANT�. -- ----- .
' _ '___'_— i `; '
W ENEHGY P/C (
J
WARNINO� ILURE SECUREWORKER5'COMPENSA710NCOVERAOEISUNUIWFUL,ANDSNALLBE T---"!" y�-"'- -
�.
jy SU&IECTANEMPLOYERTOCRIMINALPENALTIE9ANUCIViLFINESUPTOONEHWDi1F.�THOU5AN0 ENERGYPERMIT I i
D011ARS(5100.000),INAU�IiION'fUTH[C0.5TbFCOAiVENSqTION,DAMAf,ESASPROVIDEUFOFIN '"-'- ""'"-" ' "' --
'_"'_'__
_
� SECTION3108OFTHEIABORCO�L-,INTEHE5T,lWDATTORNEY'SFEES. RETENTIONFEE: �
'-_...__- __..._.....— ..
_...—___.'_
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: .-"""""^—•-��---�-�---:�._,—_.:.--,�:..�I
� INEREDYAFFlFMUNDERPEN�ITYOFP[flJUFY7HAiTHEREISACONSTHUCTIONLEN0INGAGENCY �
FORIHEPFRFOq1AANC[OFTIiEWORKFORWHICHTHI5PEfl1iAITISISSUED(SEC.30B7.CIV.C.). �� ����
Zw --.'._'_-"'.__-._....._. ..__�'.-�
� LEN�ER'SNAME___ ---� __________
F- LEN�EH'SA�OHE55 "'____ __.._._."".,_._....._."__"""_'-_--_"-___'_"__"__'-_ �/`�
wICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFOflMATIONISCORRECT. TOTALFEES lr ��C� ���� �
� IAGRfiF:TO COMVLY WITFI ALL CITV ANO CAUNTY OFiDINANCES ANi]STATE LAWS PELATMCi T08�11LDIYG �"�
GONSTflUC71 .AND MEHEBYAUTHORI2E RF.VRESENTATNC:S OF TNIS COUN7'Y TO ENTEF7 UPON THE ��
� ABOVE-M PRO�[RTYfOflINSPECTIONPURPOSES CDMMENTS_:__..____. � _ .� �-
. '
'_� -__.._ .
� -- -- ��//''--�� ._.._�°`�- ----- .
m PEFMI NRME N� _.q/ '-.—"-"' - "
d ;
(/j �'�_-
_ _..�. -
� A7UFEOFPER ITiEE � DA7E • '
= RECPT.NO._.. ..__._____PAID BY _ _,,,__VALIDATION__,______.__
~ W,HITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOL�ENROD-File Copy,GREEN-ApplicanYs Copy
� y') /U
` .. . ........ _._ _ , . ' ' �_- - ,. ,-.. .. ... .. ..._. .. . . .
� • . , , I �, i ', .. i g
,
;
i
, � I . t I ,
.`� � � � , .. �. � . �. � � ' _' 1
� •� � �I � .� ��� � � � . , � f� '' � � � _
� � (� � � ; -{:, �
. � i - ._. ��,,, � I : i � .
_
._ ._ ,.....
f � � �r _ I ' ,�,� I �� � ,. i � �I`' . � ; .. . �
' .. '
�
.. H .� :, , . �
.. ��� . ! , .k .-� ��, � �`� i ', i � .
; � E � .. . ..i_ iA ' ;- - _ i
i
ri.- . . i —,. , _. i ,
� ' . . , � . ���,� ; � i � �.
a .�. - ` , i � �•,R i i � y
��q, _I � I i i i , " y , � I � ��- ` i -
. _ . I 1 �� �, i'' f
_ rv� ;. ...; I � . I � I ,,,� I .
I t � I
�� tr� �� i ' � ..� i � _ `r � I ' ��' i � ,'
., _ r :4 ? i � i � " , i . 1
-� i I i I. i
3` �� � _i ct �i � _ � ; ... . �i �I. a
s = �
� � � � �� I - `5 a � � � t i ; �
I " � _ ' 1
. � �I I I t - � . j �
� t I I
� �, , ' i , � � } ''
�� i I � � �� � � � I
r , ���, � _ ' � ; ' � ' i 1
, , , _ _[: . _ ;
� � '
:. � ., '�}�� I� I � ! � �f � . . I ' .
� Q`� � # �. � , :� f. � ; ! i I , i 'i �. . � '. '' 1 f
.:: � F�� �' � . � �,;� ' ( ! 7 � � � i ; :. i
� � I � � �
� � ., � ' i , � 1 ' �� i � � �
� ` �� , � �� i � I � I � �� ' ��� I , ,
� ",
� � � � � � � ' �
��� , , , , f , �
s � _ _....._ ,_.__ , .,. , k -! , � �
,
� �a ; ��� 1 � , � , ,
,�� � � � � , � 4 I �j � , �
��, i � ( � � � i , � � , i
� �� � �� � ,
I .r � �t.
�z.
:; � . i_ _ � � �
. , _.._
, �� I I I i ' i � s � � � S
a . i � � i � , - I � ' ��
i
� o� � � � i , � � , ' � x �
, ; .
, ,
t i i = � i i �. � �� � � � � � �
., ; , �: '. �,,
,, �, , . .. 1 : ��- 1.
l 3 I -� � i ���� � :
� � i� . i , :` � � �" 4 �:e i
� i :� . r
�
�� � i .;i � � i � i j k s � �
; ,
.t , ; . ,� g
*.o � I a � r * � �
�; ��� � � � I � � ,
,
�^� ,i i � � i , , a _ �. . .. __.,.. .. __ ,, ..._.._.._.....,. .. . . _.. �... . .-• -. .._..
.) .. . ;_ .� c �