Loading...
HomeMy WebLinkAbout11885 _�� _ CITY OF DIAMOND BAIi � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � �� . 21660 E.Copley Drive Suite 190 (909)560-3195 Fax(909)861-3117 PRESS ` �`'�'��� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �� ) APPLICATION NUMB R /� #f C o ADDRESS�•'%���� v.:✓'e,7�.A�J� '�i'j��%�� DATE 6-L�'�C�� l .�-2� ! �v � issue nrPe occ °.° APN LOT TRACT DATE �~ e�" � CONST. GROUP p OWNER .��i�r� i.���i /�r 0 ADDR SS �raSCO..>f��� .���/�/ ' ZONING SFTBACKS W CI . ZIP "TEL.��.-�-'�✓�I' FRONT RW n---- g APPLICANT ' ?/ ' > TEL G � REAR U_._,___ �a''�'�I SIOE/SIDE STREET_ RW ❑ � CONTRACTOR -�'�'� SIDE ❑____ � ADDRESS �,�� � CITY ZIP TEL. PROPOSEDUSE�`` �C�.� '���,•�y�%.r�/�.r!/~ �,� Q ARCH/ENG/ d .,�;;���-��,�;L/���.✓ DESIGNER �ii N0.DWEL. NO. NO. ? �DDRESS zIP 7EL, UNITS STORIES _BEDROOMS � .n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM p 1 HEREBV AFFIR\I UNDER PENAl7V OF PERJURY THAT I AM EXEMPT FFOM THE CONiRACTORS�I� G8f2QB/C8lPO17 W CENSEUWFORTHEFOILONlINGREASON(SEC.7037.SOUSINES5ANOPPOFEESIONSCODE:ANYCITYOR ((� C1 COUNTYWHICHRWUIRESAPERMITTOCONSTRUCT.ALTER,IMPROVE.DEMOLISH.ORREPAIFtANYSTRUC- � L,LJ PetIO/�BCk � TURE,PRIOR TO ITS ISSUANCE,ALSO REWIRES THE APPLICANT�OR SUCH PERMIT TO FILE A SIGNE� W ,� ST�TEMEM THPT HE OR SHE IS LICEN5ED PUR3UANT TO THE PROVISIONS OF THE CONTRACTORS LI� CENSE LAW(CHAPTER e(COMMENCING WITH SECTION 70W)OF�IVISION 9 OF THE BUSINESS AND PRD� � POOUSpa FESS�qNSCODE)OR7HATHEORSHEISE%EMPTTIIEFEfHOMANDTHEk3ASI5FORTHEALLEGEDEXEMP� � V 710N.ANYVIOUTIONOFSECTION7097.5BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPIICANTTO 'Z R8-ROOf A CIVIL PENIILTY OF NOT MORE THAN FNE MUNOHED DOLlAflS(550U�.): zOI.ASOWNEROFTHEPROPEPTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, '-� COfI7111BfC19I � WILL DO THE WOflK,M1D THE STRUCfURE IS NOT INTENDED OR OFFEfiEU FOR SAIE(SEC.7oaa,BUSI� J � NESE ANO PROFESSIONS COOE:TME CANTRACTORS LICENSE LAW UOES NOT APPL7 TO AN OWNER OF PROPERTYWIiOBUILD50PIMPqOVESiMEREON,ANOWHO�0ES5UCNWORKHIAISELFONHERSELFOR � ' � T1iHDUGHH160RHERONMEA1PlOYEES,PROVIUEDTHATSUCHIMPROVEMENTSARENOTINTEN�LDOR 'm ' � OFFEPEDFaRSKE.IF,HOWEVERTIIEBUIL0INGORIMPROVEMENTIS50lDWITHINONEYEAflOFCOMPLE� , Z 'TIOPI,THE ONMER$ULLDER WILL HAVE THE 811R0EN OF PiiOVMG TiAT HE OF SHE DID NOT Bl11LD OR = pAPROVE FORTHE PURPOSE OF SALE). U 1,AS OWNEROF TNE PROPERT',A1A EXG.USIVELY CONTRRCTINu WITM LICENSED CONTRACTORS — �� TO CONSTHUCT 7HE PROJECT(SEC.70u.BUSINESS AND PROFES310NS CODE:THE COMRACTORS L4 ValU9ti0n �L�U,C�D� ._...ADJ.AREA_...__,..,,._ W CENSEIAWDOEBNOTAFPLVTOANONRJEROFAPROGER7VWHOBUIL0.5ORIMPROV[S7HEflEON,ANO � WIIOCONTMCTSFORSUCHPROJECTSWITHACONTRACTOR(S)UCENSEDPUflSUANTTOTMECONTRAP Q�JANTITY DESCRIPTION FEE � TORS�SE L/�W.1. ' O IAA1 EXEMPT UNDER SE0. _9.A P.C.FORTHIS REASON . Q � U � DATE OWNER •� �-'w^-•� � ��-F�-�-`� � � .� _ — — . - �— � LICENSED CONTRACTORS DECLARATION W Q •-- Q' I I HEREBY AFFIRM UNOER PENALTY OF PER1UflY THAT I AM LICENSFD UNDER PROVISIONS OF CHAPT[R I� I 'p, 9(COMMENCINOWITHSECTION7000)OF�IVISION30FTHEOJSINESSAN�PROFESSIO�SCODE.AND Z �X MV LtCEN$E IS IN FULL FORCE AN�EFF'cCT. m .�� UCENSECLASS __UC.NO,_________._____________ � . � J V DATE_ CONTRACTOR.____ ,...._.._._.._._._. � W .� WORKERS'CUMPF.NSATION DECLAFlATtON � Q ' .N. IHEREBYAFFIflMUNDERPENALTYOFPENl1RYONEOFTHEFOLLOWINGDECLARATIONS: Z � _INAVEANDWILLMAINiAINACERTIFICATEOFCONSENTTOSELF�iNSUREFORYIORKERS' Z COAIPENSATION,ASPFOVIDEDBYSECTION37000FTHELABOflCWE,FORTHEPERFOFlMANCE W OF 7ME WORK FOH WMICH THIS PEflMIT IS I65UED. � 0 'W _�HAYE PND WILI MAINYAIN WORKEi:S'COMPENSATION INSURANCE,AS REQUIRED BV SECTION �� 37000FTHELABORCOOE,FORTHEPFRFORMANCEDFTHEWORKFORWHICHTMISPEflMITIS /� `' 0� ISSUED.MY WORKEAS'CAMPENSATION IN3l1RANCE CARRIEN AND OOLICV Nl1MBER ARE: CONSTRUCTION L�/�6/ ycaRRieR -------------------------....._ PLAN REVIEW .._- � --- L-�t�C� 0� POLICY NUMBER ELECTRIC Z� _'_'_. _...'—'__'_--___ ¢' _ p (IHlSSECfICNNE�NDTBECOMR_E�EDOFTiEPEia.M�ISFORONEFiHSNiE0DJLIARS�5700)OHLESS} PLUMBING ______.._._.._ .....'____'._'_.._—_--__.. Z I CERTIFYTHAT IN THE PERFORMANCE UF THE WORN FOR WHICN Tt115 PERMIT IS ISSUED,1 MECHAN�CAL __„_,___ __,____ ___ ,(�J SHALLNOTEMDLOYANYPEFSONINANYMpNNER50A5TOBECOME5l19JECT70THE ' ;�'� WORKERS'COMPENSATIONIAWSOFCAUFORNIA.ANDAGREETHATIFISHOULDBECOML INSPECTIONFEE _.._.______._._ SUBJECT TO THE WOfiKERS'COMPENSpTION PHOVISIONS OF SECf10N]]OOOF TH[LAdOR � CODE,ISHALLFORTHWITiCOMPLVWIiHTHOSEPROVISIONS ISSUANCE ��S1OD ____—_'__—_.._' O '.._—_.... �.y � G� DATE: AP%.ICANL .."'____—.---"__"___—_._ SMIP , _'__.--."_,.____ ) v ,_"'�j� WAflNIN6:FAILUPETOSECUREWORKERS'COMPENSATIONCOVERAGEISLINLAWFUL,AN�SHALLBE ENERGYP/C __....___.__... �LL� SU&IECTANFMPLOYERTOCRIMINALPENALTIESANUCIVILFINE5UP700NEHUNUREDTHOUSAND ENERGYPERMI7 DOLLARS(SI Oo,Oao).IN ADDITION TO THE COSTOF COMPENSATION,DAMAOES AS PROVIDED FOR IN �--- -�-- J SECTION77oeOFT1iELABORCADE,INTEFiEST.ANDATTORNEY'SFEES. RETENTIONFEE: �d�� CDNSTRUCTION LENDING AGENCY PRE-ALT FEE: � ,�. - --- -- , .,�. IHERE9YFFFIRMUNDERPENALTVOFPERJURVTHAT7HLFtE1SACONSTRUCTIONLENDINGAGENCY _ _ ___ ____ ____ FOR 7HE PERFORMANCE OF THE WORH FOfl WHICH THIS PERMIT IS ISSUED ISEC.9097,CIV.C.). Z W; ___".'. _._'. _____...._.__'...." �� LEN�EH'SNAME 'F—'I LENDER'SADDRE55_'__"_...---'_'_"____ — '—'—"'— "—"'----' ��� I CERTIFY THAT 1 HAVE FiEAD THIS APPLICATION AND STRTE7HATTHE AEIOVE INFORMATqN IS CCRRECT. TOTP L FEES ��� IAGREETOCOMPLYWITHALLCITYANDCOUNTYOHUINANCESANDSTATELAWSRELATINGTOBUILDING //�� ��jjq ,�; CONSTNUCTION,AND HEREBV AUTI�IOflIZE REPRESENTATIVES OF THIS COIJNTV TO ENTEfi UPDN TH£ _ -- I / ]� � / } A90VE•MENTIONEDPROPERTVFORINSPECTIONPURPO6E5. L. � r� Z COMMENTS__.____ Ef �'' �°' � i-1A,�,��" �,�i��,��%,.. � --- ---- ---- m'� PEflMITTEE (AHINT) /' `cn` 'F-�.�--=—� '�� �� ---- rt-�--- � �-------- ���� TUflEOFPERM� EE �ATE ��y T _. RECPT.NO. PAID BY _��,�}.�_VAUDATION�y.�r ~' WHITE-Depertment Copy,YELLOW--Finance Copy,PINK-Assessor Copy.GOLDENROP-File Copy,GREEN-ApplicanYs Copy � � ' ' ' � � � s '�� '-r� -� , �� �' ,��;� � ' w � � � ��r������'� a�"�� . <7 .. ..�.,.. _^_� ."� i i �i e ° - i i . t � r �s�sa� � �' �" �4�� � m� �4 � '". � � � ,. ,. � :' i �F �.. t i { I i n � �����ra'��'�3n't�� �k s��r� 9 a � � 1 f ',€ s � e � i{_ 7 � i �� r I� I i x,�r��1� �� s �9�G �7 E � a � S i r � ; � � . .. � �"'�'F'. � w"���gt��ut� r�a- �'�t io"" � i i � ( i � � � � � �j � �1 T r f � �' � � �v � -�.� ��.a�»r s �xs �ns �� ( I { ', � a� � � I �m � ( � � r, � i ���� r��� r�; +���a �� �i � i � r" i � t ;I � I � � � ��5 J� e�;;�� a,��mr��ik.E�g�`�$`���'��� � P ! � � i i % �� ' I �` , t �i � ,r' � �� �,y, ����f���"�' k �� I � ' I ? � , I f �, � ' 1 E� . a ��w�s�;���'� � a§t �.�...: , �; I � I i � -t -- �� k - i �; � -_,'� '� : � � � I 4 1 :_ � , E � ' � �..". �, fi._ , { � � � I , f �_ ` �� ` ' i ' ' �� �^ ... < : : i i � I ; ., � � � I ; i�l1�l ' ` , � f : �T i �' p� j , ; ; i , � I ,I 3 i , -- I - �� '� ' ' � � .I . : � . � �� � , : .i i , ,,._. i.._ ��, ,.. ,... r ,. ! � ���� � ` � ; � , � I � �. , : , 3 � p� i �- ' r � � � ' � ' t j � ' ! ' .. : i � ; "i i ' ��� . 1 I 9 ' , i `� � i � � � � � ! � ( �� I I I !� �, . j ! ; . � ' I �- I 1 � �\ y��fi, . � I , ` � : � � � � �i � ; � �4 y�; i I , � i � � � i I ' � � , 1 { ( � I ; , I , � � r*���3 ., I� I i , i �,, I �, . � � ; � � i � � � ( : � ' ' I � k ( ��� n � . , . I = i � I 1 � ` � � ' I � f � I i f Sa � I � ` � � f � 4 � i � � i � � � � � �n �`•� i i � � � � � � � �. '� 1 � _i � ..� � _ � � F T �:.�� � I € { ! �' `q� x I t - -t .+ ..r i I.°( � "..' ., � C��77 L . � l � I � � _ � '��, 'f� � ;*- _ ;1 � �..=�i �� �:J�� � c 7 �a . � ` , , i . i � � k : e -' �,`r � � � : tt : ` � 7 -�� � ( ; � i � � F � : � i`�I � �i c 'i_ rr ,- '�� ' � , � i }I -� � I �: r#� � Et � � ' � � �:� -� i �9 � I I i i i ��� , ,` � � � I �� � c�� -�1 E , � �� a i -�� � 'ir- I;� �i J � ,�ar � �i !� , i E� . � r ; � ;( I � ; �h�: �� �'&F i � � � ,i i i j y �� I� i � '.:" j�..( I ;. ��"'" g�� �` �. !.' I � I �� y���f . 3 � , _ ., l^'w I � {, I ir'J .�� ,.�r� � i � � � � � ��*�� :I If � � ( I i �,. I ��((� i � . , 4 '`� � ..� � ��, i ����F 3 ! . . ' I �I I ' I �� i � �� . � � � ' � � � ,.--T � - - --- � -� - __.j- � I � � � � , ' � � ,, ' { ' `, � ; ' � � , � ; ��� . _' ........ � � � , � � , I. � a � �_. � � , i , a � , j ' � i ����,� � , , � , � . . � � � ; � , , � � � I ; °�� � ; � � � , , — - - — - -- - � , ; -- s y , , � � � , ' , ! � ! : � � � � � l � , ; ; ' ; , ; �; , , ' , . i � � ' , � , I � I i � � � ' ' i ( �� :� . �. i � ' ' `� . � ' � , � � � . � ' i � { i ��, .. 3 ' i I j I j : ' I � i � � E ; .I � I ��� i ' 3 � � � j � � itLC ' ; ; C ci � � � , ; , � ���. � ' �' � i i ; � i �,'.�� , i , � �. I ' - ' ., . � � . i �i I � �' i . i. I G I .; I � � � � � ' � I , f ; I � _... I_._ .....�_�.`.� .._ . .,, _�._�... . _._! _�. _.._.. _ i .�,_.__L_ _..'...�, ..�_i..,,� ._.: _. _.� .._ _._I�_.�.. .__..�_. �.....�.nw ._._ _�. . ._... �--...__�_.fi ��y