Loading...
HomeMy WebLinkAbout12887 (11) I � �� CITY OF DIAMOIVD BAR �, DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ,,�' � . ,�, 21660 E.Copley Drive Suite 190 ' ' �'"` (909)860-3195 Fa�c(909)861-3117 �� �� PRESS �`��"+ BUILDING PERMTT APPLICATIOI�T �_..-= FIRMLY o� JOBSITE . f^ APPLICATION �' � PERMIT f z, P/C ADDRESS ��. DATE 'dk ' NUMBER� # � APN LOT, TRACT_. �SSUE NPE OCC DATE CONST. GROUP p OWNER .,d[�P1�� �'�_— — � ADD S ZONtNG SEfBACKS Z CITY �� TEL.� FRONT RW f� g APPLICANT . TEL REAR �� ----- ' SIDE/SIDE STAEET RW t� i � CON7RACTOR_ . � SIDE ❑ ___ � � ADO � .� � . � C�TY�, � 21P TEL - PROPOSED USE�1!Gi- i o ARCH/HNG/ ^ � z DESIGtVER __ w NO.DWEL. p. NO. a ADDRESS_. � CI7Y ZI TEL._ UNITS STORIES BEDROOMS � y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � p� OWNER-BUILDER DECLARATION SFR/ADD/REM O � I MEREBV AFFlRM UNDEq PENPLiV OF PERJURY THAT I AM EXF.MVT FROM THE CANTRRC70RS ll- GflfflQO/CZfP01t W�� CENSEUWFOR7FIEFOLLOWINOREASON(SEC.�o31.50U3MESSANDVpOFeSSIONSfADE:ANYCITYDp �� (n U: CWFlI7WHICHRE�UIflESAPER!AITTOCONSTRUCT,ALTER,IMPftOVE,�EMOUSH,ORREPAIRANYSTRUF � W Patio/Deck �p � TIJRE,DpIOR TO IT3 ISSUANCE.ALSO RE�UIRES THE APPLICANT FON SUCN PER111T 70 FILE A SIGNFD .� W f � SiATEMEHT T'AT HE OR SHE 15 tICENSED PURSUPN'TO THE PROVISIONS OF THL"CONTRACTORS ll- — q CErySE LAW(CHMTERe(COMMENGING WITN SECTION 7000)OF 01VISION 30F THE BUSINF.55 AND PR0- � u' POOUSP2 � � FESSIONS�E)ORTHATHEORSHEISF%EMPT7HEREFROMANDTHEBASISFORTHEALLEGEDEXEMP• , (� TlON.ANYVtOUTqNOFSECTlOfJ7031.5BYANYAPpL1�ANTFORpPERA(I75113JECTSTH[APPLICANTTO ; � _RB-ROOI � ACML PENALTY OF NOT MOflE THAN FIVE tIUNDRED�OLURS(SSoa).�: ; �� ❑I,ASONMEROFTHEPROPERTY,ORMYEMPLOVEESWITHY/AGESASTHEIFi50LECOMPENSATION, CORIl/18fC18I � 3 WILI DO THE WORI(AND 7HE STRUCTl1qE IS NOT 19TENOED OR OFFEAED fOR SAI.E(S[C.Ycal,0uS4. �� J 3 N NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE lAW�UES�bT APPLV TO AN OWNER OF .�. � �� ? PROPERT'WF!OBUILDSORIMPROVESTMEHEON,qNDWHODOESSUCHWORKHIMSELFOqHEfiSELFOq � W THNOUGHHISORHEROWNEIAPLOVEES,PROVIOEO7HATSUCHIMPROVEMENTSARENOTM7EN�EDOfi ; m � O: OFFEREOFOflSALE.IF,HOWEVERTMEBUiLDINGORIMPROVEMENTI550LDW1THINOhEYEAROFCOMPLE- -. ' Z TION,THE OWNEq-9UILOER WILL HAVE TYE 6JA�E:N OF PROYING iHAT HE OR SHE D,'D NOi BUlID OR ;�: IMPiqVE FOH hiE PURPOSE OF SRLE�. t; :w. ❑I,ASOWNEflOFTHEPROPEFTY,AMEXC1.lJSIVELVCOMpACTINGWITHLICENSEDCONTRqCTORS � ; �Q[. TO CONSIqUCT TME PRWECT(SEC.7046,B�SINf3S ANO PflOFE551oN5 CqOE:THE CONTRACTORS ll�� � ValUdfl0fl ,_ _l_ ____/�DJ.AREA____.,_______..,_.__ y 'W., CENSELAWDOE6NOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROYESTNEREON,AND� � -- � ���� WlqCONTRAC7SFOR5Ur,F{pROJECTSWITHACONTRAC70R(S�LICENSEDPUR5UANTTOTHECONTqAF� �� QUANTITY DESCAIPTION FEE �, TOqSL�CEN5EUW.). . ..�: ❑IAMFJfEMPTUNDLR3EC.__'___ __B.BP.C.FORTHISREASON� ��'��� Q �1. � _ '_'_'_"'_ . :.�' � ;�. OI1iE _'__—OWNER .._.__... _....____'_ i..� U �' W � �; UCENSEU CON-tflACTOFS DECLA(�AT10N '�. W __� ' ��,. 1 FIEpEBYAF�IHM UNDER PENALTY OF PE(tlURYTHA7IAM UCENS'cD UNDER PftOVi510N5 OF CHAPTF.R ,�. U � .d; 9(COMMENCINOWITHSECTION7000)OFDIVISIDN30FTHE0USINESSAND ROFESSI�NSGODE,AY� { Z �[. MYUCENSEISINNLLF 'MDEFFECT. `. s �,� � LLl. � ..0'; LICENS �CLASS'. _" I.IC.NO.�� _ '_'__ .:<' .� '.—�. ..�.. � � � 'il,i J .U. DATE . _ CONTRACTOR — W. �.. ��� O KFRS'COMPENSATION D CLARATION .,�� d - �� IHEREBYAFFttiMUNDEflPENALTYOFOERJUflVONEOfTHFiOLLOWINGOECLAHA�"�,� � ���' _�_.I I1AYjjj'AND WILL PSAMTAIN A CERTIFICATE OF CONSfNT TO SELFINSURE FUR WOPKERS' S � ��, CyRIPENSATION,AS PROVIOED BV SECT!ON 37000F TNE UBOR MpE,FOq THE PERFORAIANCE W � , Q� �F THE WORN FOR WHICN THIS PEqM1T IS ISSUEO. � �� W'� SG IHAVEANOWILLMAINTAINWORKEflS'COMPENSATIONINSURA�CE,ASflF.QUiHFDBYSECTIOY Q�. 37oPOF 7ME L OR CODF,FOR THE PF.RFI)RMANCE OF 74E WORK F[)R WHICH iHIS PERMIT IS ISSUED.M (�i(R'COMPENSATION INSURANCE CARPoEq MD POLICV NUMB�fl ANE; I CONSTRUCTION � .�. . . ' ..._...___ _.....—""""_—"'_" �_'__._." y cqqRiEq_ � _,,,__.___ PLqN REVIEW .._ ��.f _. ._...._-- ---...---..._. -`-----..._ �� PDI.ICYNl1MBER__���� ll�-'�A ��� r _ � ZQ --^-:i�J "-7�s ELECTRIC -'- , - 0 (Mt4SE(.'iIONNE�t.OTBEGGVRFfFDOFhIEPE0.ti4TISF0(i(XJEMJWf+EDDOLU�AS(5�00)Of� ) PLUM8ING �� --- 4 ' ___.—...".—__ W _...._.__...__ � � Z I CERTIFY THAI�IN TN�PEfiFOR1AANCE OF THE WORK FOft WHICH THIS PE.qMIT IS ISSUFA,I MECHANICA� ___,.. "" -�-���. �SHAILNOTEM?LOYANYPERSONINr1NYMnNNFRSO�STOqECOMF.SUPJECTT071{E � ��� �— ""— ��(/7. WORKERS'COMPENSATIONUWSOfCALI RN�„AN�AGAcETHM1TIFlSHOULOdECOM � INSPECTiONFEE ��� SL'&IECTTOTMEWORKF.R3' PFNSATI PR VISIONSOFSECTION970GOFT ' R —�,��� ��—��-' i CODE,I SHALI; WI1N� APL �TH �S.R V O,I�, ISSUANCE d , � -- __._"_"" ' 0 {... �' . "' ' SMIP �y Y���y p�j � �" �- - - i OATE l � APPLICA � 1 eryY�F�-�J7.�STt7tY�c-.-.-.—_ _.,._ . . .J. WARNING:FAILURE TO SECURE WOqKEHS'COMPENSATION COV'eRAGF NLAWF ., D SHALL BE ENERGY P/C 4�77 ._.�, _ SUBJECTAN EMPLOYER TO CRIMINAL VENqLTIF:S ANU CIVIL FINF.S UP T O.E HUNDRED N �" "` "� "��'����� LL I]OlLAH9(S70(1.aoa),INADDITIONTOTHECOSTOFCOMPENSATION,DA A SASPROVI�EDFOHIN �ENERGYPERMIT _.._ � _.._ ._...__...__. .._..—.._.. �: SEGTION370BOFTHEI.AOOFICOUE,INTEREST.ANDATTORNENSFF.F,S. RETENTIONFEE: ,__,____ � CONSTRUCTIONLENDINGAGENCY PRE-ALTFEE: .,... _..__. _.._. I � IHEHEBYqFFIRMl1NDEflPENAL?VOFPERJURYTHATTHC:REISACO ION�FN�I`1GAGENCY __ _ __. __ __ � FOp THE PEflFDRMANCE OFTHE WOFlK FOF WH 1 THIS P[ SSUE�(SEC.3007,CIV.C.). � Z W .—' "—.___- '_._.__ i . .� —"'" '—" LEN�ER'SNAME__� ,_,_' ' _. —...._ _"'—"'_ ' "'—' '...__.. _.._"__'_ __....._ I H L[NOER'SADORESS_ _.. _.___ __..__ _ W ICEHTIFY h AVEREAOiHISAPPLICATIONANDSTATETHATTHEA00V[INFORMATIONISCORRECT. TOTAL F�ES J { � d IAGflEE COMVLYWITHALLCINANDCOUNTYORUINANCF:SANOSTATELAWSFELATWGTOBUILDING 1 �� C1INSTRl1C710N,AND MEREBYAUI1qRfLL REPRESENTqTIYF.S 0F 7HI3 COUNTY'fO E4TE11 UPON Ti{E //�� J'� t ZABOV F.NiKKJED PROPEFTY FOR INSPECTION . � V 2�,•0 , o � COMMENTS ._____, _. � � ._. � _ -- — ----- - -_ ¢ PE ITT El7Fl/NT) __.__ .__ �� 4 .__���i�~ � A7 E E E A7E� i - = RECPL NO._ � __PAIDBY _____, VALIDATION�__.. '� ~ E ent o YELLOW-Finance Co PINK-Assessor Ca GOLDENFOD-Fila Co GREEN- licanl's Co PY. PY. PY� PY, MP PY ` / . _.. � ��' � i � � � ��� 3� i ¢� � a�i -_f 7 I � ��� �i*M�t i} �,�p t 7 � ', I , _ ; � � ��� �� � F �'���ra�;�. .�'w i , ' � j I I F i _ ..d ;I � �'a� ,�*�'R ` �� a° e 5 , :, ,, �', , � C M1� i ); i 7 R�M �' : � 4 � � j i I I . � � '. j f �x 3 �k _ v �4'� �� . 7 ! � `7 - j ' s �I ai_i x It, t �,� �� � , t ! . I i I � i i � , :� � � 1 n �y� , � r i ; � ;� � t�, � � �s�`� � , � u� i � � , , + � � � , '� , �� � t �� � �a t ; � , � I � - i I � � .: x i�� � i _ , � fi .�i � � i n y� �E�'i".G'� S � - _ 1 � f I ' ! I ; I ' I � "�• � r 7.F � k � k EF+�-1�, e�€ �fir. :, '-.. � �:'. � � ' i � { I � � . �i _ � � .c...eda tE ,:� I 1 s _ �.. I -�, i � I __ �_._..l .i - � - �n,_ .�.� � _ f �.°' .�: y �• .. ,_. t .... _�... , . � I ' � :�. ; , , , , G ; � : � ' �� -.4 � � ��� � " � •� , � � � ' � � � , , � � —� ` � � � � i A . �, � I ; � fi , i i _ � � , . j ! , i � ,. i ` 1 � �` n � , ' � � f i � t' � � ' f i I �� � ' ' � ��] , - ; ; _ - -- ' .. � C.' � i ; I` 1 - - -' ' �� ` ' i . . ....� � � � ; i . : ' ^ ! , i y ,. .I ' .I.,.. ' h ��` ' � 4 , I , I ! � � t i ��� I ' � I i,, f 1 j F � � � � i ( � ' , � i ���'� � ' � I ' i � ; ; i i � I � ;, � ' J � i' ' ! I � ;; � ; � � � � ( ' � j � r II I � ��r# x,, � i i I ! i ! � i � � � . � � , ' I _ � ,,�� ' � I F . + , I I 1 . '� i .� . I, I j I �A �' � '� ; i � I I I . I I i ; ' .a I � _ I � � I � � � I � riT'7' Y��' _ 3 � 3 .. ; i � ( . i ' � ;e .�. 1 r 1 a .{ _ J � . ' .__ �� '"�'S � i r I � ' f � ��;� � 'i � � � -� a t i i � �� J �.� � � ; �r �. � � " i. ¢ � . i � ` � i i , i , � r �, � i � � f i` i j ? � I i ' � �Fa i < < C i .. r^, -I � .-� �� ,-1 �" ;� ., '� f3 ' ' � I �y r i � 5 ; `1i`� �� � �� 1 :C a� �'���i �I � � � � ,, � I r i , : i ; ,! ' ' g`k 3� � ,R� L I ; ` ' � � 4w� '"�� �; i � I � � � , �`r-' I I { I � �I't r . i ,i�- .: 4 4 '� E � .1 � � I � . I �'� C 1.,.. � �p, I L t. I ,�,(Y ¢ I�� � � ,� u � i . � i F : � . i : v�� I �_' ,� �� �- t� "� 3 � i ���`v ��� � � 9 I � i i '. I. � � I ��� i i� ' � � ' �� � � t � � . � �. �� � i � �: �'. � ° � ✓� � ; � �. i :. � I � ' ���, � �'3� i � ' i i , ' ����i , . i ' '' I i . � I .�� ,� ';� S> 1 � � � ; � f �� i �� . 1 � 1 I i I 1 � � i � f y� � ��� ".�� t �' J . � � � � � � i f r��Y§ I I , I ',; ' ' '�;(' ' �s f � � : .� � � � j � �.,� ..I � y��:'�V ( ' � i � ;_ � ,, I ,�� I ' -V , ' � I F ' ' ' . , �,�¥ I.." I i_' i f..__ � i { i � } i+�,�� � � � � � � � � � I ,_�� � 1 � � � � F � � ° � i i I ' � ' � � =. � � I i � �. ' �� �°� � ! � ; � � ! � � : ; ' � � � : i i , � � i �� : � � ; I , � % I � � � � i i � � j �,� , � � � I ; � � I � ; : _ � - - a � , , ' � i ' ; ' � �� � -� � i ���� , � , � � (_ � ' i � � i _I i j i � � �� � ' � � , � � � i � . , , � � , � � ' � I � , � � � � E ' �,� `� i � � � ; i i I I � � � �` � i i � � , �� � ' i ; � ; ; � `s ,w i I , , : � � ; ; ' ! � -.f , � , ' I I ; � . � � �a,� � � � � E � I` � ! ' � ' I � � I � �a�� � s ' ' � I � ' � i ; � � � � , i . , ; i � � . � . � � , � ; � � , �� , , , ; �� � .._...... ... , .,. ..:..._. _._:.__.. ._. ,.... ., .a.__ . _---... .., .. .;_ I ; i__ ._ ! � i � � I ���, _._. .,_� ._ ; . R,._. . . ..�._ ._....� . .s.. _ _!__. ,..... - - _ � Y. „ ... ... . �r .:.. : . ,-' �:: � _. � 4;.:: ,.,. �'.j - ..... < '.. 4 � . . � � ' + �� • . p:". i � ' i t �: ...; _. -a . , t t ; l } ' ,. �i... � �, '- i �. ��1 y���s'' .:�. ; ,. :� ..: _.: �J� �.. 1.., f .. t 1.�: n .. . . . ..� .ar� . w .r+.e�ww�rm�w���nws*�ra�r�q . . . .�...--