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HomeMy WebLinkAbout16169 (22) � i �.� � ' �, CITY OF DIAMOND BAIt - DEPAKTMENT OE COMMtJNITY 8c DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 y-" �� (909)860-3195 Fax(909)861-3117 PRESS ` "yN'� BUILDING PERMIT APPLICATION FIRMLY � - � � JOBSITE d„ /�,J �y �d ' p ADDRESS�__`�__���� (/ DATECATION ^���_� NU B R ��� ll' #/C i �? � � ISSUE 1YPE OCC � APN^_. . LOT TRACT ` DATE CONST. GROUP p OWNER _. f^ �Z�.i•s{f'�� � � "' ADDRESS ZONING SETBACKS � Z ClTY `--- P T'EL._ C�" FRONT . RW L.I__. g APPLICpNT �� TEL. 'Jt REAR ❑_ # Z � SIDE/SIDE STREET RW _ U__.___. � � CUNTRACTOR �l __ __ SIDE n ADDRE S 'Z ; o CI7`Y _ ZIP �TEL. � PROPOSEbUSE / �1.�'i_ `G�_ �i� M,+ � wn ARCWE / — --- -- Z W�. � � DESIGNEfi!_ �p,p NO. NO. � ADDRESS`_` �-- -- UNITS__ STORIES � BEDROOMS N c�TM ZIP_` TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREPJVALUATION � OWNER-BUILDER DECLAHATIOiV SFR/ADp1REM O [] 1 NEflEBY AFFIRM IINDER PENALTV OF PE0.IURY THAT I N.1 EXEMGT FqOM TH[CCNTRACTORS ll- G8r�9B/CflfPOR f W CENSELAWFOR7HEFOLLOWINGREASON�$EC.7031.58USMES^uAND7ROFE5510N5CODE:ANVCIT'OR : (n i U�. COUNTYWHICHRE�L1lRE5APcRMIi'tOCAN$TRIJCT,.ILTEF,IMPftOVE,DEMOLISH,OftREPAIRANYSTRUG � W Pd�lO/OBCI( Sa �� TURE,PRIOR To ITS ISSVANCE,AL50 REOUIRES TN5 aPPLICANT FOR SUCH PERMIT 70 FILE A SIGNED � W �� STATEMENT THAT HE OR SHE IS LICCNSED PURSUANi TO THE PROVISIO,VS OF TFIE CONTRACTORS L6 • � - � CENSEUIW(CHAPTER9�COMAtiENCIYGWITrySECPON7000JOFDIVI510N3OFTHEBUSINE55ANDPRO- PDOUSPB '�� FE6SIONSCODE)OR7Nq7HEORSHEISEXEMPTTHFRFFqOMANOTF/EBASI5F0liTHEALLEGEDExEMP� �:.(7 U TION,pNYVIqAT10NOFSECTION7o31.59YpNYAPPLICANTFOPAPEqMITSU2JECTSTHEAVPLICANTTO Z Re•Roof ` ACIVILPENALTYOfNOTMOpETHANFIVENUN�REOUOLUlRB(t5co).�: 0 IJI,ASOWNEROFTHEPROPERIY,ORMVEMPLOYE[SWITHWAGESA5THEIHSOLECOMPFNSATIDN, [� � Z�. 1N�Ll DO THE VYORK,ANO THE STRUCTUpE IS NOT INTENOED OR OFFERED FOR S4LE(SEC.70dd,131151- � J Commercia! � � NESSAND PROFESSIONS CO�E:THE CONTRAC'UfiS LACFNSE LAW DOES NOT APPLV TO AN OWNER OF �.' j PROPERTY 1Ni0 BUILOS OR 14DAOYES THEREUN.AND WHO L%1FS SUCH WORK HIMSeLF ORHERSF.I F OA d TIiROUGHHI50RHEflOWNEMPIOYEES,PpOV10fDTHATSUCH11APi70VEMENTSAqEY�TINTEN�F.DOR � � �"- J w OFFERE�FORSALEIF,NOVlEVERTM�BUIIDINGOAIMPRDVEMEYTISSOLDWITHIND�EYEAROFCOMPL.E- d�� �TION,7HE OWNER-9UILDER WILL HAYE THC BURDEN Of PPOVING iNAT HE OR SHE DID NOi NUILD O!i -`-'- - ;� �' IMPROYEFORTHEPURPOSEOFSALE} ^ .W O�.ASOWNEROFTt7Ef`FiOPEFiTY,M1EXCW5IVF.LVCONTRACTIN6WITHUCENSEDCC>MIiACTORS -' . QC TO CONSTqUCt THE Pa0.1ECT�SEC.70M,BUSIN:SS AND PflJFESSIONS COUE:iNF CON1flACTOR9 LI� V8IU8410f1 _ ,_ . AUJ.AREA_.,.,_„__ ..W'. CENSELAWWcSNOTAPPLY70ANOWNLROFAPpOPERTYWNO0UILDSORiMPROVF.STHEHEON,AN�' S� N7IDCONTRACTSFOASUCHPA0.1Ef.T3W17HACONTFACTOA�S)LICENSEDPURSL'/WTTOTHECONiRAC- QUANTfTY OESCRIPTION FEE � � ,� 70R5 UCEYSE LAW.1. _ --'_--'_ � .O'.. ❑1 AM EXEMPT UNOER SEC.____ _,_„_.____a.d P.C.FOq THIS RCASqJ�. �� e�( _ U � ----- -----------------._.. � .i u'.. OA7E oWNEii"- '.'.-__..._ � ` _ .. - _ � U: -- ----- - U� ,� �a� LCENSEO CONTRACTOAS DECLAqA710N �i �CC� 1HfFEBVAFFlRA1UNDc'HPEN.LLYYQF?tRJURYTMhTiNMLICc'IJSEDUN�ERPFlWSI::NSOFGiAp7.`R �'���- � ��:, 9(COMMENC!NG WITH 6ECTION 7a0o)OF DIVISION 30F�H[FIUSWCSS AND PROFF.SSIONS C07E,AYD �� � .^� � ` y� MY UCEtdSE IS tN FULL FURCE AND EFFEC7, � - � IJJ. ;_��'\ UCENSE CLASS_ rr=�_ UC.NO.��I� � ;; � -"-- ---'-' � �� DATE __��� CONTRACTOR___j�.q�q.�Q/�J/�'� '� a ' - (� �V __ � � ,�� '`��'.,J OFKERS'COb1PENSATION�ECLAHATION � — — 'g '��� � . AFFiRA1l�NDEfl PENILLN OF PEHIUflY ONF OFTHE FOI.tOWING OECIAflATbNS: Z � � __IN/tVEAN�WILLMAINTRl,4ACERTIFICATEUFCCt:SEU7:UEELF�INSUAEFOPWORKERS . _ ^ ! � COMPLNS�TKKd,AS VR]VIOEO BY 5[CT:ON 970U Df THE LA�Oft COOE,FOq TME?EHFORFAANCE U ___ _,_ _ � OFTHC-WOflN FOR WHiCH 1Nt5 PERMIT IS ISSUeD. W I � .W � _- _-'_ - I NAVE PVD WiL1.MAINTAIN WqRKERS'COMPENSATION IYSUflANCE,AS REQUIREU BY 5cC ftON ' n� �� 3700 OFTHE LNfUH CODF,F(1R THE PEi' RMM'CE DF THe WORN f;)R WYIiCH 7HI5 VEqMI'f IS � _ ISSUED.MYYlPHKENS'(:()lAPE ATION NSURANCECAHRI NI)FlOLI YNUM9EN�RL: CONSTRUCTION ___ _______ ��_ � � � CAHRIER__.___Q_./� �' �/��_ ."' I PLAN REYIEVS� __ ___"'_ - .- ....__'_... e . � POUCVNUMBEB_ 1 �_��.__..__..... _ ELECTRIC 1 . 4 , .......' ._— _'... . ._ ..."'__' ""'__ � (IHIS">E(.'iKYJNE�NU78EQ�M.'�.ETEDOFhFPEiFATISFOROKEtNKNY:D�.lAP,S(Et00)pRIC-SS} PLUMBING —...__.........— .—._.'____—..'._..._._.._... �Z� 1 CF.RTIFYTHAT IN THE PEFlFOfl�1ANCE OF THE WORK FOR WMCH THIS PERMIT IS ISSUEU.1 MECHANICAL (;j SNALLNOTEMV�.UV0.NYPERSONINANYAIANNEFlSOA3TOSECOMESUH�FGTTVTHE - ��������� "-"�"���7�'-' �(n 1NOflKERS'CCMIPENSATIGNI.AWSOFCALIFORNIAANDRGHfFT11A(IFISHOULOQE(X]ME INSPEC710NFEE j_ s��, F UBJECTTOTHEWOP.KFRS'CAMPFNSATIONPRC4ISIO�SOFSEGTION9'lo00FTHElAf10R ���� --���� ` � DE,ISHALLFOR'HlNi7Hc:UMP1.YWITHT1iU5EFROVISI0Y5. ISSUANCE „_____,,,_ ___....'-_'_'___" __' _..___ � A �^ p DAT.'_.'.�t7�V AP?UCANT: '___. _ '_ _ SMIP __.._—_���2....!}.(y..�{.�j- _1�_1.� � J ��y� ��'"'� ENERGY P/C ..... �!J U� ' ING AIURL: .E R WORKERS'GOMPCNSATIONCOVEF1kGE15UNlAWFUL,ANUSHALI.HE �--���---�-�' ____.... ;�� LL St18JECTAN EMPLUYEH TO CAIMINAI.PENALTIES AND CIVIL fINES UP TQ ONF HUNDRLO 1H0US�NC1 ENERGY PERMIT WLLqFlS(5�����.INADDITIONTOTHCCQSTOI'COMPENSATION,DAMAGESASPNOVIhi=UFOqIN ---..�- -.. ._'_'__-__'_.__'_ J SlC110N37080F'IF1EU1[30flCO�E.INTEREST,AN�nTTOqN[Y'SFEES. � � RETENTION FEE: _ . . .__-----` ----- � O CONSTRUCTIONLENDINGAGENCY PRE•ALTFEE: __ ....—.-.. -'---._ ._._..... n IHEHEI�YAFFIHAIUNDEFP[NALTYOFPERJUNYtNATTHERF'ISACONSTRUCTIONL[NOINGAGGNCY iORfNE�FRFORMANCEOF�'IN[WORKFORWNICHTHISPERMI7'ISISSUED(SEC.2qe�,CIV.C.). --"-"" -`--"" -�--- z ------- w ---_ ----•-- ----- � LEN�GR'SNAME__ __ '_'.... ."_-"'_ '__._ � .._._._.. ..'__"" __...___'_' ".__._.._..�.._.._ F- LENDER'SA�DRE95_'_'__..._'_____"-__ _'______ - w iCEFlTIFYTHATIHAVEAFMTHI3APVLICATIONANDSTATETHATTHEpBOVEINFOHMATIONISCARRECT. I�TALFGES � r () � � I AGFEE TO COMPLY WITVi ALLCITY ANO COUNiY ORDINANCF:S�NU STATE IAWS RELn'fING TO BUILDING � � CANS7RUCTI(1N,ANDHEREOYAUIHORIZEFtiFPRESFNTATIYe50F11iISCOUNTYTOENTEHUPON71tE AflOVE-MENTIONFUPROPEfi7YFOHINSPCCT���000NPUHPOSES. i z � COMMENTS_ .__, ....------. --�.` � � *—♦ j � � +�r-s Cn� _ —..--- -------- --- —...._._ ---- ------ � m PF,RMITTF.E NAMF(PHINT) i ¢ - _ ...___ _--' -_�. �,,,.'J �A./ _' � __�_' O - _ - _"�_' . _._. ., � SIGNA H60FPEF7MIiT_E DATE -`�� �Z,'j� - � 2 RECP7,N0._,�._�_I . - pA1DBY „_.._��_VALI�ATION ,, F WHITE—Oepahment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENHOD--Fiie Copy,GREEN—Applicanfs Copy . . .... . _.,. � . , . .,._� . . _ ; �- � :� ��_ ' i � . � �� ��� ` �� , . .. , r. �� ; � �� � ; ; ,+ > , t , ' _ , ' ,' 1 � _ �' , � , ; ; , � . , , , ; ; � � � � , , i � i , � � ;. _ ': i... „ ,. i . � � . _ � , . .ti .... i � § ,� �� � (� z. .'.. �� I '.'' , �` ; i . 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