Loading...
HomeMy WebLinkAbout11155 (9) , * -�---- CITY OF DIA:VIONb BAR I I I � ! COMMUNITY DEVELOPi�fENT DEPARTMEtiT E, q�g .{�.w 21660 E.�opley Drivc Suire 190 �]RES'S' (909)860-3195 Fax(909)8(1-3117 ��"v�' BliILDING PERb1IT APPLiCATION FIRMLY o� JOBSITE /!� ,/Z, � �� �G' APPLICATI N.� i �(;"'— NU BER � IS�� P/G ADDRESS�� ���''�� '� DATE_ G� # o ISSUE TYPE OCC °-° APN LOT TRACT DATE _GONST. GROUP p OWNER �vr✓I l�' k w�,g�'7 � T ZONING SETBACKS o ADDRESS 7i� Di%a-N'►UK'1�_�����L�I1� o CITY W I� �tfLIP��-�Gs'TEL-�.�-��4,2 I^� FRONT RW C: o APPLICANT ,, TEL. REAR f-_ -�D�i� I SIpE/SIDE STREET RW C: Z � SIDE �__ Q CONTRACTOR � ADDRESS PROPOSED USE o C�Ty ZIP TEL._ � ARCH/ENG/ � z DESIGNER NO.DWEL. VO. NO. � ADDRESS UNITS 370RIES BEDROOMS � CITY ZIP TEL. `� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATfON � SFR/ADO/REM O p I HEREBY AF=1RM UNDEft?=NALTY vF PEFJURY THdT I AM EXE�'YT`rR0�1?HE CO\T�ACTORS LI� GOrdge/CdfpOtl W CeNSELAWFOHTHEFOL�OWIVGR'cA50N�SEG.'03!.SBUS'NE554�DPROFESS�ONSCO�E:ANYC17YOR (n -- U COUN?YWHICFR'cQUIR'cSAPERb'IT�OCONSTRUCLALTcR.lA1PROVE.DEh!OL'SH,ORBE?AIRANYSTRUG W °d(io/Deck z TURE.7RIOF TO I1S ISS�ANCE.A'_SO RcQU1RES THE A7PL�CA�T FOR SLCH PeR".9T TO FILE A S'GNED W W STATEMEN'i HA7 HE OP.SHE�S'ICENSE�?JRSUAM1T TO TH=PROVISIONS OF THE CONTRACTOPS�_1- � CENSEIAWICtiAPTEA9(COMMeNCINGWITHSECTIC�'70��)OF�1ViSION30FTHEBUSINESSANOPFiO- � Pool/Spa � FcSSIONSCOJE;05THATHEORSHEISE%EMPTTHEREFROMA.�CTH'c6A51SFORiHc'A:.LEGEDE%�`dP- V TION.AN`/VIOLA'IOYO�SECTION�03t.56YANYAPPLICA!�'TFORAPERMI'S�9.:EC'f57HEA'PLICANTTO Z Re-Root A C:WLPEKALTY OF!�OT MOftE TYN1 FI\'E H'J�'J�fl=D�CLLA9S('SOC;.j: 0 t�I.ASOWNEROFTHE�ROPEfliY,OR1.1VtMP_OYEE54VI'H6YAGESASTHEIRSOLECOMPENSA?ION, O Ccmmercial Z WILL DO THE YJOAK,AND THE STRUCTURE IS NO?LtiTcXDED On O:�FER'cD FOR SRLE(SEC.7Caa.BUSb -1 � tiE55AND?RGFESSIORSCAD"c:THECGN7RAC70qSLICENScLAWDOESNOihPP�Y7oAN�VdhE�OF � P.aOPER7YY�40BUILOSOqIMPROVES'HEFEON,ANf1WHODOESSUCHWORKHIMSELFORHERSELFOR m � TNROUGHH'SORHEPOW�ESIPLOVEES,PROVIDED'HATSUCHI!APROVEMENTSAREM1'OTINT'cNDEDOR LL! OF�ERE�FORShE.��,HOVIEVER,iHEBUILDiNGORIMPROV�MEKT�SSOLDWiT!ilNONC.YEAROFCONPLE� ZTION,THE OWNEa�BUIL�ER W;L'_HAVE 7h,�BUROEN OF PFOVI.\'G T::AT HE OA SHE DIJ NOT BUILD Oq � I!APROV[FOR?�+EPVR�JSEOFSALEJ. w ::]I,ASOWNEROFTHE?riOPERTY,AKEXCLUSNElYCU1rTRACTINGWI?HL!CENSECCONTRACTORS Q TO CON57riUGT THE?ROJECi(SEC.7aa4,9USIKESS AND PROFESS�CNS COOE:THE CONTpACTO�S LI� , V21Ualion .____ADJ.AREA W cENScLAWDOESNOTAPPC!TOANOW.VeROfA?P.OPERTVWHCBUILDSORIMPROVES'HEREON.AND � VlHOCONTRACTSFORSL'CHPROJECTSW�THACONTPAC?ORIS)L�CENSfDPL'RSUAY7707HFCON'RAC QUANTITY DESCRIPTIO�J FEE TOfiS LICctiSE�AW). / Q /�/. LL B.5?.C.FOR THIS REASON Q G n r�Q�j �� / /•'S`� � C"I AM EXLMPTUNDER SEC.___ _ � � ZDpTE_ �Z I �.- "' ON:NER�Y� ������� W S/' i.� � LICENSED CONTRACTORS DECLARATION -� , w ¢ I �ER�UR`/THAT I AM LICEN6ED UtiDER P:90VISIONS OF CriAPTER � I HEREBYAFF:PA!UN7ER PEYALTV OF � 9(COMM.ENC,NG Y{ITti SECTION 70Co'�OF DIVISION 3 OF TH_BUSIM1ESSAND PROFESS!0\S GODE,AND� X MY LICENS'c:S W FULL FOFC-A�rD EFFECT. W 0 LIC'eNSE CLASS__.. _ LIC.NO. _—___ U DATE�'___ CONTRACTOR W � WOFIKERS'COMPENSATION DECLARATION � � � i HFRE9Y AFFIRM U�DER PENALTY OF PERJURY OYE OF THE FOLLOWiNG DECLARATiONS: Cf7 � !HAVE A\D WILL MAINTAIN A CERTIFlCATE OF CONSEM1T'O ScLF�INSURE FOR WORKERS' . ¢ CAldPE45ATION.ASPROV�0E0BYSEC�'Oh370oOFTHE:.�80RCA�E,fOft�HcPEP.rORMANCE OFTME WORK FOR WHICH Tn15 PeR1AIT IS�SSUED. 0 � _I HAVE AN�WILL�IAIVTA!N VJORNERS'COMpcN5A710N:NSUFANC'e,AS REQUINED 9V SECTION Q 37COOKTHE.A60RCODE,FOHTHcPLRFORMANCLO.='HEWORKFORWHICNTHISPERMITIS ISSUEJ.MY WORKERS'COMPEKSA:IOY IY�UPANC_ChRRIER AND PO:�CY NUM.BER ARE: CONSTRUCTICN �J PLAN REVIEW GAFR�ER, - — � POLICYN�4EER__, �—. — ELECTRIC _„ ���� Z Q O (iHIS5EC110NNEFDWTBEOJl!PLE7ED0=TN'c�EFdJRISF�RONE'nU\��R_DDOLVUiS(5!�)O:iLESS). PLUV!BING tu MECHANICAL Z I CERTIFY THAT 1\'H`c 7ERFOR`.ARNGE Of T'rE WORK FOR WHICH TH'�5 PERN�IT IS ISSU=D.I --- Lj' SF.'A�'_�OTEM.PI.OYA:�'YPERSONfKAh'V.4.ANNE.35�AST08=COh1ESUB.;EC"TOTHE INSPECTIONFEE � YJORKERS'COMPENSATIONLAWSOFCALIFO�NIA,AYDAGREETNAT'F�SHO'.:LDRECOME ----- �{� � SUfi:ECTTOTHEWORKeRS'COMPENSA?IONPaOV:SIONSOFSFCTION3�Co/1:TN=LA30P ISSUANCE �.J'�� � COJE,�SHALIFORTHWITNCOA!PLYWITHTHOSEPROVISIONS. O SMIP _ -�`. ': ~ ��i p DATE:__ APPLICANT: ,____ �__ - ���1 ha� � w ENERGY P!C ---- �'�"�'=d'' �`�� � WARNING:FAILURE TO SECi1RE WORKERS'COMPENSA`ION COVERAGE IS U��UWFV:,AND SHALL BE _ .+ � SUBJEC7ANEMP'_OVERTOCR'MINALPENALTIESA\�C:VI;F'�M1ESU?TOONEHI:NDREDTY.OUSAND ENERGYPERMIT „__._._ OOLLARS;E100,000),1N A�71TION TO'f 4E COST OF COMP'cNSATION.CAAIAGES AS PFOVIDE�FOR IN /�'� ._yl SECTtON37oeO�TFELABORCOD'c.l\TEREST.ANDA7TORfJEV'SFEES. RETENTIONFEE: _,__ �[ p� � _' ' �.j�9 . w CONSTRUC710N LENDING AGENCY I I PRE-ALT FEE: d --- - - � I HEReBV ArFIRM VNOER PENAL7Y OF Pca.IUR�T�A�TNERE 4S ACOYS'.fluCTION LENDING AGENCY I _ _,___ _ d FORTHE PERFCRMR`!CE OFTHE WORX FCR WHICH TNIS P:RM�T IS ISSUED(SEC,309�.C:V G.). Z __ w ? LENDER'SNAME_ _. — —� ' ' __"__'___.___—'__ . . ............... .......... !_ LcNJEH'Sh7DPE55_ —__ — � TOTAL FEES `�� • �Q wIGE�TIFYTHAT'.F'AVcPEADTHISA?PLICATIOFIANOSTATETHATTNEA90VEIhFORYtA�lON�SCORftECT. � IAGREE?OCph1?�_VWITr{ALLCITVANDCOUTTVCRD:NA�C[SnNDSTATEiA'KSRELAI'INGTOB�Ii.CIM1G � CONSTFUCT!ON,ANOHEREBYAUYHORIZEF_PRESENT�T!VESOFTHISCOUtiTYTDENTER�?ONT'rE Z ABOV'e-MENTIOtiEDPRO?c4TYFORINSPECTIDN?URPOSES. COMMENTS _ _ � _._4r�[l��L_. ��`/�"�/ "_ "_—_—.--- m P�RMII7EE N E(P ) — ---�- � �C``� .—�ar.-�� _ � - � Se NAiUREOPaenenirr= �� oniE ����___ pqIDBY�,� VALIDATION _ _ RECPT.NO. _ ~ WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessa Copy,GOLOENROD-File Ccpy,GREEN-ApplicanPs Copy r.�,,�: . ..: �,�..,:,...v.ep.e4. � � ,. . � . .. �.�,. .:. . .� .v.y... ..s�: ......:. ".n..'� .�J . .:,r.v.a.W.. .., 4 ..:.�`.."5,&4 ,. .ri -�.i41�.i,'�L' �- ..`�.F . .. � i :J�:k. ... 1t..0 . . . .,� 1 �.:i ' J' 7:.`s:- t-' .:... .--.'; . ��s`� �. -. .. ,. „�. .�_ � � .. . ... . . "„jI � ���� �N� ,..d�a' ��;�€f Eg.i'� 0.� &'..:.�:. T�``� �y' 3��fi"1�::���� � x ��: z�, :x� t�r;..r a'��,.�.. �¢�. .: ...:- . . . �t �3�,�� �T��.�'�u�`7�' � �' k���" a:"��t��d �'"r.�d *[ ��.r 1� ir :� + �r p ���� r + �' � �r .. �� F..�: x, ��.F s�'��� �T� �sb ����� ��,. �l „� �'�� ' �� � �� �p�y�[ 'x u x � �3� ��.g��i� �;J�r� � � z t �;� 3r� �r�� �°�� ���,�� � ��r�'��rat�a a � �� �� a �� � ,� :.�� , �� a�` ,, a � y � , r$ � � ••� � , � ,� �R �� ��� � Z�'� %�i3 �9rP"��'�*�x�� A,t�t�.�aa u.3<,.�2:��.�'�; S , L .' •: ..... . ...,,�. .. ,.. . ,_,. .. ., � .. ... �r ..'._., .� ..,�E�:r 5 A} '.i: ,4�.. ,�. Y Y.r.S,t.x....- iF -..: �^ .. --. „ .- • ' . f T ` + .. 6 ... �Y. � i �� 3 " : .. , ........._ ,._......_. .. ...._......,""............. .......... . _ ..... ._._.. .._,._...... . , _._ ........_.... .... _.. ....... ....... .....__ ... .. _. _ c r . - .r.> , � t i : .. . ...._ .. _ _ , a i � j � r• , , i . , _.. _.. _ ___. _ _.__. _. __ _ __ ; ( �✓ � E - l�'i . i.... T�.��, 3 : � -'� ......( ,-.` 1.. /..�.:�.�.6.�1,.41l ��.. x.:;,., ' . _.._ ... ..,............_._.......�._...,....._____ _..........._.. ._....�....,..._ ..._.......... . _". . .,. . . . __ ..v . _ ....__' ................ �.:'., .:. i r.', r ;', y . '� ! ! 1 3 1_ � � _ � _ _. . . _,_..__ .. _. .... . ..,__ .....___. �. : � .... ._.... .... . _......__._.._._ ----- , . . i [� 'Y f'*y 1 C �.�. 1 .. j .. . �I�C Y . i3r1, a L'.Y"�I � AL'M ._.. .. .. � ..- � ...._ _. .._... �._._,___. ._—___.___... ._____. I .� .._. ._ _.._.. ...:....... t .... . _._... y . ...___. _._... ..._...._._.. _._...... .. .. ......... '''.... � � " . � ' t F.�.: ; I �: � � a e�{. 3 I � � ,:_ ., .......... ....... _._.._._..,..__ .... ___..__ _ .. _ _ ---,._.._ ,.__ .._.,.. ----- -----.._. .... .--- ---. , . k, j ' ,.. ;. �,. , . f ..o -. , J P�, l �' 3 -._ -_ . _ .. ...,.....,.__.., .._. ..____........................_.__..._ ... .. .. ._. ....._.__._ ... " '_,_............... _...._...._........_,.""__.,,,."". ... , . ...,... ! . _. • - � ��.,...Aa .<.��; .. .(I,:_. P 1-...�. . I ���r 3.1�.�.fl� ����.Y .� f .. .. .. ,__ -._._t .. .. . ... _ ., ... .._ 1 .. .. .._ .. _ .. .... ..,. . _ ......_ .. K .. � � i i ..,, i �ir� P S��, � . �`� ._.__.�_. k . _._ .-_ ... _,_ . .._._--- ....,...__...._ __.._. _,__,.....__, _. __,. - ."- --" ",........._ .__ .._ ..,.,.--' ---'._..___....._ ...._... . � �.� � � j 1 4 t�'�' .�.� ..�'�-,. :: ;�_ ... . ..2 . .... - . _.,.,..._._.._... .. ' . .. . , . . . ... , .. , . ...._ .t. ! : ' t } � . . .. 3:,. �. ? y, .. ' ... . _ ._.... _... ."_'. ',, ..., ,. .'_ '_ . ._.._ ...._._ ... ._ , .... ., . . � ,, � ,� I � , �r , • "C �i��l:a `. __. � a-� �.__..�__.. . ... ..� --- ,.,.,.. ___..:...__. ... , _,._ _... _ r_L _ — - — ____ ___:._— _ , ___ . __ .___...__.._.._.; " ,.:�f, ir �..,.�p ,," >� , � ,s t�. Fi �C'! s � ) ... ............._ ........_ ....._... .. .�."'._..... .... __ .......... ."'._.,_.._ _ ... . . _ .._....._."_ ' .._.._..__._. ............."' _'.,...."'_.._.... _.___ ,i � .._ .. -I � I . � > �cf _ _ � <j ! i�.:;i �'Vi..s.�,� �: . _ _. _ � ( � ' � i t- ���,� _.. ; � € _ _ _ ..__ ,_---... -----_.. _.__. .._.. ` _ _.. -- ----.,._. .. ___. ------..._. _._.. , .-- _ : .._. , ._..... �J � - .. ` 3. _ ! _ . _ , ri. ' ; _r, . :::i3�Frc ,. -'� g ; _ ____ 1 _ __....... ..,.... ...----......-------- A —� ---- -. _ _.. _. � _.._-__ ___ __...__ - .. ..;_ _ , � -� , ',� a ..'... ':-P ..,..... I .` . . �j7.� sR�rv.� . .. '... ..... ..i .. ... . .. . ., . ...... . . , . - ... . .. . . ...'"_,. ' V � ��� i I +• + t ! x � I F ... . .. ..__.__ . _.. ._ .. . . __ ......... ' "". ... ...._._ ...._. _...._ ,... � �"��.. . � ...__� . , ..�t �� ��"'�_ ..__. ,____. � 1 � 'y. ...f . _� _.. . ..._ ... . .... I .1 '. � i � f...._ ..... .......... . � .. � ,. .6 \ {. i .... ..... .� '.. .. ._ .. � .. ..... .,..... . ... .. ...,., ,., . _. .... ... ........._ '. _"..... ...............,_ ..,. _ ...�_........"_.....,.._ ._._. .,.._ _ .. ..._ ......._._...__ ......... ......... _._. .. ...._.... ....._ .� � v+� ( p E �7 :.` ;3,�- I ; � __. . . __..._.. __I ,,.,_. . ---- __.__ __...._.. . �. . _.._. __._... -- .- ._......_ _. ....... __._# _. .. . ... � . , _ � � � ..- � ' _;,' I � : 6 ; I���L � j __ . _ � _ . _ ..-- ---- -- i: , � , x` � � � �{k y _ . <..._ ....,-- .. ----.,,,-....... . ...... ._.. _---- ...__ �_•____...____ .. --------------. ._ . .... ...___... ___... _ . � i: ` , �.�'r C-t�E€ � a '�� r � .... �.,. .__... _..�.__ _,,:__... ___.---.. ., v--___ ..__ __ . .__-- - ,...._.. ._...._...... __..._ _.._...... ....... _........----._._ ; , t . � __ . .�.�����L��_����,�'����;�������`��������� , __._._ w,.�.. .. ..., a . .. .. . - -- ........ .......___..... .._ ..�...____ _._�__.._---------- ---- ...... ----- --- ._..__ . ___._.� r � � ,�_ -• � t. � � -�. � � ,,. ... _� � _ . --___ .__ ._,..__ _....___ ______.._..._ .._...___ - ---. • _..---.. .___. .__... ._ .__..._ _ _.�.�,. __....___ _ . .._...._.._ .._. .„ , ....:., ._ ___...___...__, .., ---..----- ._.._ ,._._._ -----.... ._--------. ..._ . __....-- -; �" ' r �-_.._._.._ ew.................... ......... _ ...___.... .__ ._...__. __ .._.... ___._ �_ __ ........ ; _ . _..._. ...,.«. ,._. ____.._._ __._ ..__._ _____._ __._.._.___. ,.---"--..... ... _... � .._... __.. ----.. ..-------..,..___�__._-----..- - �_.._ __,. - - ---...... ._._... .__� �._............. ..._. . ..-----.---..___.._----._.----__ ._ ..v __.___ , .._..----.. ._.. � • . ....__._..__._.,.---.,.... .._.....__ _._....---._...---_ _ ...�._. .. ..,.-----.�._._ _ . ... _. ,___� .............. ... . ........ ._.. .-------__......__. ,.._-- _...._.__.._ . ........_..---� ! :............_, . .._..__.._ ..._---- .. _ _........__.. __..... ---.....--...... _ ...__., ._..---,. _.. _. ....----_.. . .._ .... � ...._. . _..___............. . .._.........._._ k; 1':. 9 Q a � :____..... ....................,..__ ......... .,_.......__... ..._.:..._...._____,...,_....... ......._.__...�.._._..... ...__......_....._. ...........,... _......,.... ......... ............._.... _.......__..... ....__..._ ,_-____ __.._. . � ^ .�. ....� � P_._____ �� ___.._.___._,_....._..._.. ._......'J.'__ _._..,..___.... ...___......_._ . ....._.......... . ._....,....._..._._.....__'..._ ._._.__....._ ___._.__._ _._.._.. ...____ . ._.. � �9 � _,. .'_'_._,_.. _ ._._...__ ._..._ _......_..""' .,.._... . . _. _ , y,,� - ..��� 'S'. . ' . _ . : . .. .. �,: r "'... .... . . . N . � ,.. � ...-__"_ ____.._.__..._". _____ ...._...._..__. _ . .. __ . ._. . p ..�__._ ._._._.._ ..._._._ ____.__... ..._ __ ! B .F.; � ii . B _._._.. F�'E �r �r# �i�x �' S ` ...,.._ .__. — ...,.. ......_ ._ . ...... _. ..._.. ..._._ ._.... ........_ ..... . .... . 1 i '������`����"'��'� ��+� ������ ' _... . _ - --�-- - .......__..... .. . . � � � � _ _ _-- --.�_... __ ,___ _.. _.._ . _. . . � : _ ; _ _ a � ������ � ���� ���,� ---. .___ . _. � r �� ��;;�� � ����. ..._.. _ .. _..... ... .__ _. .. --. . _....__ _----.... ___. __.... .._ � ���)�� }� � ���� � �` i'����k������ � � ; � ���� �� ���� ��� � _ � � yg �������������� �� �� � __ _ ..---- _ ... _ .. _.__.._ ..._� .............� . , _.....,.. .... .. .... ... _ .. k C � � y� � ���3.��'�� :: ��#� �.� . .. � :� +Y. �i ��� �$ � p � �� , � ; �'��� ����°� � ,._.. --- _ � , � � � � , ,:���,. � �����������.��