Loading...
HomeMy WebLinkAbout11167 (7) .. ............. .............. .... .. . _...._.._. .... � .------�`'�--- CITY OF DIAh•tONU BAR � � COMML'NITY DbVELOPMENT DEPART'�4EN ��� ,'�_,rw . I 21660�.Copley DriveSuite 190 ��ES� ���`����� (909?860-319�Paxi9091861-3117 �';""" B UILDING P�R1�1IT APPLICATIO\ FO R M�Y o ADDRIESS L% ✓� I/1��O�li �• APPLICATION J�.-� --� 1 NUMB R j #/C DA7E_ l o ISSUE TYPE OCC , °� APN . rLOT TRACT � CAiE____!__CONST. GROUP , � � OWNER �✓�I�r�UIY}��_� �— o ADDRES � �A-ryI(J�✓� `'G ✓U� • � ZONING SETBACKS w cr I 36� �_���� ! FRONT -- RV�1- [ ----- z CITY /✓� G'rZIP TEL. �y -Q — � REAR C:Y. ' o APPLICANT !� TEL. _ � SIDE/SIDE STREET RW C: ¢ �,-- SIDE --- — i._.;----- ¢ CONTRACTOR _ - � A�DRESS� _ Q PRI�POSED USE � CITY ZIP TEL._ ; �w ARCH/ENGI � -- WDESIGNER _ NO.DWEL. ^ NO. NO. � ADDRESS� UNITS__ STORIES __ BEDROOMS � CITY ZIP TEL._ __� � DESCRlPTION � SQ.FL FACTOR PSF ADJ.AREANALUATION � OWNER-BCILDER DECLARATION ' SFFL'ADD!REM Q � p I�.EREBY AFFIRM UND'eR PENAL'V Or�PERJ:;R�'HAT!pM cX'c!A??FP,OM THE CON`RACTORS LI- I �� GarageiCarPOft I W CENSc'�AWFORTHEFOLLOWIKGREASON;SE:.?a31.5B::SIN'cSSAN�PROFES51045CODE:AN�CI'VOR E � 'U COUNTVVJHICHRE�l1RESAPER!AITTOCOIvST.aUCT,A�_TERiMPR.OVF.�EAAO�J'sr..O:lqcPA:RANYSTR�C� �� PaGo/Deck Z 7URE,PaIOR TO IT�i55UAM1'CE.ALSO REOl1iRE5 7HE APPLI�ANT=Ca S'JCFI�E.aNITTC F!lE A SIGN[D W STATEME�T THAT HE OF SH'c IS l;Cc\SED�Pt1RSUANT TO TFiE PROV1510N5 OF liE COIrYKACI'OFS C> - ' ' � CEYSE LAVd;CHpP'ER a(COMMENCIYG WITH SECTION�ooC;OF CIVISIO�3 OF i:�c'BUSINESa'hYD PRO- � PooVSpa ' _ FESSIONSCODe)ORTHATHEO,iSH'cISE%_�APTiHEREFROMANDTHE3A5:5FORTHEALLEGEDEX[MP� (�}��---- � TION.ANYVIOiAT�ONOFSECTIOV7o�1.5BYANYAPPLIGIN'FOflFPEfiMITSUa1=�iSTHEAPPLICANTTO �� RF-R00� f � ACIV:L PENAL'V OF NOT MO'�7E�HAN FIV=HUM1DnE�DOL�R51$SDOj.�: � � �:I,ASOWtiERO^THcPROPER'Y,O�4MYEM'LOv_ESWITH'NAp[SASTHE!R50'.ECOMPENSATIO.Y, Q C���a� � Z VlILL�O THE WORK.AND THE STRUCT:iR�!S NOT�N'EN]ED CR OFFEREJ FO.3 SALE 15_C,7De4,9�51� J NE55 A\D PflOFE5510N5 CO�E:TH=CO:\'TFACTOftS LiCENSE lAW�OES k07 APPLY TO�N OWNER OF I � PROPERTYWHOBUIL�SOR!MPROV'eSTHELiEON,AVDWHOCOESSU^HWORKY.IIJ.SE!=CRHERSELFOa m � THROUGNHISORHERONAJEh:PLOVEES,PROVICE�THA'SUCNIMAROYEA!ENiSAaEN07iN'.ENDEOOR W OFFERECFORSALE.IF,HOWcVER.iHE6l11L�1.\'GORIU?ROVEMEN'ISSO�DLY:THI�'OYFYEAROFCb`A�Le-� 0 71DN,THE OWXER-BUILDER 4YILL HAVE'HE 9UaDEN OF AROV;NG THAT HE OFl SHE�1D Nbl'BL'ILO OR ` — Z INPROVEFORTFIEPURPOcEO=SAL�_ W :J6ASOYJNEROFiHEPROPE�V,AMEXCLUS;VELYCOMRACTIVCWiT�LICENSEDCON'fiSCTORS — - � TO COkSTRUCT?HE PROJECT(SEC.704<,6US'.NESS A�'�P70FESSI0�5 COD'e:THE CONTRACTOfiS L:- V8ilJ8ti0f1 �DJ.AREA LLi CEM1SELAWDOESNOTAPPLYTOANON/NEROFAPROPERTYWHOBUILDSORIMPP.O`/ESTHEREON.AND� � � WMOCONCRACTSFORSUCHPRD:ECTgWITHACOMRACTORlSI_ICENSEDPl1RSilANTTOTHECO�iTRAC- Q�JANTIYY I DESCRIPT�OIV FEE Y TORS LIGENSE LAW.), 4 t� .I� � _I AM EXEMP'i UhFJER SEC._, __ B.A�.C. �H:S REASON � ,��"/� ' � _ �� // N 'i � DPTE��OWNE _!/l���� � . Z �v-r �-_—' . � LICENSED CONTRACTORS DECLARATION �— � � IHEREBYAFFiR.'�1UNDEa?'c!JALTYOFPERJURY�HATiA!AL�CEYiE��NJERPROVISIOM1'SOFCHAP?E9 � � 9(COM�AE�CING VJ�TH SEC7!O\�000)CF DIV.SIOti�3 OFTHE HUSt+lESS AND PROFESSIDNS CD�r_.,p\D � Z X MY UCCNSE 151\FULL FOPCEAND ErFECT. � w I � � LIC'eNSE CLASS__ _ LIQ NO...""__'_�_� _' � � J V DATE_. ,_, CONTRACTOR a I W � WORKERS'COMPENSATfON DECLARATION � � � IXEFEBYlv'FIRMUNDERPENALNOFPERJ::RYOYEOFTHE�O:lOWINGDECLARATICNS: � � IHAYEANDWILLMAINTAINACEFi��=1CA�EOFCONScNTTOSELF�i.VSUREFOiYlORKEFS' I z CAMPENSATiON,ASPROVIDED�YSECTION370GOF?HELASORCODE,FOqTHEPERFORMANC'c Q OFTHE WOPK FOR WHICH THS PERMIT IS ISSUE�. � � W _I HAVE A`lD WI�L NAIITAIN WORKERS'COM°ENSA'iON 14S'JRANCF,AS REQU:RED BV SECTION Q 37ooOFTHE!A60RCO�E.FORTH'ePERFORlAANCEOF7-,EWORKFOaWHICIiTHISP�RMI':5 ISSUED.MYWORKERS'COMPENSATIONiNSU.aANCECAfl(iIERAND?OL'.CYNU'.ABcRARE: CONSTRUCTION _,__.____ _ j caRRie�---._.._.. ------ -.._..----.,.--- -, � PI_ANREVIEW -----------.— � POL'CV NVMBER ELECTRIC � Z "' _— ' _"_-- _'�� Q � (IIiSSECTICMNEmt�A.-BE�.'Y]MP.ETeDOf?F.E�ERAYTISFGaONEHUN�fiE�DOLLARS(51oo)qiLE55;. LUMBING _____._ �P- _ W ���_..� J Z ICEFTIFYTuqTIKTHE7ERFORNAhCEOFiHEWO�KFORY!'nICHT.715PERMITs51SuUE'J.I I MECHANICAL __,__,_.,,_____ __ L$' SFIAlL1:OTEM?�OY�N�PERSON'NAhYNAN\'Efl�OASTO�ECOMESU3JECTTOT-F. �.-..q, Vj WORKERS'C0b1oEN5A?!ONLAbVSOFCAL'FCRNIA,.�N�AGFEE-4hTIFISHOUL]BECO!AE � IhSPECTIONFEE ____.__._'"'1 SU6JECTTOTFIEWORKEFlS'CO`dPEN3A'IOti�P,OVIS�O'�SO=SEC'ION3'IOOCFTHELACOR I � OCOUE,I SHALL FORTHWI7Fi COM7_V WI'H i�.OSE?ROVISiO�tiS- i i ISSUANCE ___.___.'�� �" _ i _ p DATE: _ APPLICANT: ____'. � __ _ SUIP .._.___---.---- — � ENERGY P/C -�. � V:AFWItiG FA!LURE TO SECUR=WORKERS'COMPGNSAT:�\'COVFRAGE IS UN'.A'NF�L,AN�SHAI'.8= — -- � S�BJECTAN'eMPLOVERTOCPIPA!NA!PEhALTIESANDCIV'LFIN"cSUPTOONEHUNDRE�THOUSAN� EIJERGYPERMIT �� '�'�"� � .^.OLLARS(E��,^v00�,I.VA�D:iIONTOTFiECOSiOFCA"APEtiSAi:O.�I,DA!AAGESASPROVID_DFORIN -- — - J SECTION3�a80FTH'eUl30RCO�E,iNTER'cST.ANDATfOR\EY'SFEES. {3�7ENTIONFEE: � ' _-'___—_ — OCONSTRUCTION LENDING AGENCY i PRE-RLT�EE: _ _ __ _ _ � I HEREBV AFFIRM UN�cR PEt�;ALTYOF PEaJU3Y THATTHERE IS ACONSTFUGT:O'�':ENOING AGEIGY . � FOR'HePERFORIdANCCOFTNEWORNFGRWFIICHTH�SPERM1T15'SSUEDl5cC.30?],CIVG�. � ' '� � ` Z W _--_"__'___""—_'-__ � LEIDER'S NAN.E _ _ ___ _ _ H LENDER'S ADDFESS _____— � - — WICERT:FV'HAT!HAVERFAOTHISAPPLICAT;ON/64�STATETHA'THEAEOVE�N�oR�,�T�..oN�s�o�.a=�T. TOTAL FECS �/ � � � I AGFEE TO CO!APLY 1NI'H ALL CITY AN�CO:;M1TY O�ICIYA�'CES Ml�S7FTE:AN's R[LA-1\'C�O 6U:L'JING zCOM1'S�UCTI{N.FNDHEaEBVAUI'rORR'cRcPP.ESEN'A'NESOFTIi:SCC'.;NTV`:0=ti'EiUPONTHc I ABOVE-M�tiTIONED PROa: Tl'FOR INS7ECT!ON PURPOSES. � o � / i COMML=N79----..__.-----...---- �-- � J � f � — � . ._'__ _� __'__ ..._ "--__...___'___"_'—_"_-__- - m PEriMITTEE N N. (PR'N r J�/7 � Q r I --, � ---------. _._.._...----------------- � � : ����- _ � � .. � . � - - -- ----�------- � -----_._.. ~ SIG ATUREOFPERMITfE � � DkTE ! � � RFCPT.NO.�"=�� ..__ PAID BY � � �._,____VALIDATI ;` WHITE—Department Copy.YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Cnpy,GREEN—Applicant's�Copy � ,. , , . . : . _.. . ..: � .. ,: . .. . .�_ ,. �.�, -,� � ,.�,.::� .c?e.,.,,..�:.. a+,xt,a, .;.r,'�,r,.s�. a . .r§:�.,,h�s;.. � r•>�,. ��.e� .:f„?fl re ��. ,.�. � a� ..,f ....�ar �� � .. .�. . .: . ,. . . ,..- . .,.,.. .-- . �., , � , ... . �.. . . � . � ,� �,�... .°.! � � �� ��� ��"' ���«a�m��.,A�h`L��-7 �`��� '�.. � �, x� � �" �v6 .�"��' a � '..- F I i�.�.: g :V�;:"��,+ `�' � ��k �' � �r F�.� x.¢�s x� ,,,,:.�:y s 7.� . . ,- �: �.; �:: ;�����tk��, :�:"' �# � !�&�8 �t : � ' ��� �;��� �d6`I� '��� ` � -u�.�"�" �B .� �y�.��.�1,# . .i� ;l€TY A�.y�A��tki,{x .�a�a�� ��'H ��§ �'i,.,� :'k�4�i' �i���� $���� [ � � � t, 3` rE� :,a� � a �� �'�"4 � �t�nk� �` t � +S.I # � t .�Y � ':�� �b � r ! :> �� .�F'�x"� j;� ;,�'���,�H.tk{t�:x�.��ti °�#�$�.�.�-`s�����3:a•s�..s[r�..:,:�a�;�a��E3�i.��:�s�t�.zn..rh�.::.,xs ... �.r: ..c., „ k.,.,�.,, ......�.���-. ..:�,.,.:. ._.; .>...3; . ..: �., .�.:. . , . ; i __. .. ... A. - > � _t;i ;';.I:; ........A. .................""'..... ._. .,...._.._........._...... .... ... ... . . ..... .......... .._ .. . � '� )t.T ' " " " '. _ _ . .. .. .. ....,.. ....,i.. 3 � .� ....,.__...... .....'....,.,... .t_.._._.._........ .._... ....... .. . . � . � � .,.. . . . ..,. . ._... G I ._ ... .. _.. _ .. .- -"'y "�.. .. ..-"--'— --' ...3 ( .' :.. ._s .�'.: # 1 � � _ . tl�[`R =.�..� . � 1. .. , } ,._.._ ,... . _ ..,_. ._._.._ _.... _.._ _. _.. ..�r _ � .._. . _....... ..... . ... . . . n : • ,,.L "� ..��_j� I � i i � i t E) .:t i i � . � i �.: .: . . .. ' _. ..... 1. , .,"" ._..,... � . _ ., . ... ..._ ..... a• '.: � � 1 .�... �'r)'..�r� , . � �,.; . ._...... _....... . .... r........ , .... .__ ... . . . .. " " .,.._ ........ ... .... t �� _ ._. f "" '..... ... ...... ___.... .._. _____ . . Y i � ':�G�L� ii.rt �,.�'; ���t� . _ . . ... __.. .� .._. ._ ..... .._ .. ... ��. 5 f Aa{ " , "f {" . ' �: �F . S. IIS3 -, ' . ..: ...._,. .. .... -. ... .. ._._ .. . .. ... . ..... .,.. . .. ,. �. _..._ ... _._ .. . �" D.� { .'"' - 7 -t � � � . . _ . ,__._ +._.. __.. _._. � _� [�J,.S_.,z- -,...__ ._.._- . . _ _._..... .,.._. . r _ 3 C '` i t •. � �. � � t• i s � - -- -- _ ._ ___...._ _._. ....._. _ _ ....._ _.. ------- .---- _ +.__.___ ....., _` _.._,....-�----, _..__ ; ---- ---. . ___ _ _--- - _ _ t . ;' r '�` � iF E`� a .._.�,..___ ....,_:_.. .. ..._.............. ..........i_..,.,................. """..___ ...,.....,.......""'""'_"__. .. ..:..._.._ ...... ... ..... ..._._....._..._..,._. ..., . . _.._......_ _...........,. ...._.._..._...... . .........._........,,,,_ . ( _} .�� i . i t'„ - � � i, 1, .:.f"!, t , . .... . . _ , ...... ,:_.s.,""....,__. ,.....r.............'_"....._.__.............____ . _. . . ......_.._..... ......_..........._ . ......._ _ . . ......, ,_...,..""'""'-i y'. ..I. � . i :#1£',_. {.., 7 ., �. .�. . ..... ....... . .__. ..... ' . . .. . . _ ... ._.. . .. . ..^ . .. __.. . ... ��.�� J. i�i . .. ..� _ .... _. .. ....... } � � _ ""'"' ._ . .,.._' '"....._ .,_"'..._ .... '"'._, .. . "'..,.__' "' '" ",.,..... __._. �""""""_.. _"' '._..,...... _ � :_ .i ( � , $.��i � _..._..... . ... ..,... _._....:...�.-' ...."'"_... ....__._....... ............._................._.__.....'"".. .: ......�. .._ __,.._..._._._._._. '"_....._,.'_""�... .._.._ .,.,..._.._...._.._........_ .._.. .., { ° K � ....._._...�....... ..._ ' "" ___. ,.� � ,� _: ..n —• (+ . . ... ; { ..7^lL € ..�t2 !14 � __ __. ......,_._._ _ ....._._._._ _.. ....,. ___._.._.... ." ... ..._ .r .._.. :'�. . € . ' � ..�' .. ' .. .. .. ' .. f .. .3� ..�.. _. . .'. ..... __ _. . _..___. ............_ ._tl _'., . .. ,,..__a-_...."'"" ........... ..'"_'....._.. _...._..... -�" ' " "_....._.... ._......' '_'"" '......_..__...__ .__...... ...,.....,.._._. __.... : : I' . �- .. :J t F C., ,... ..: t ._. _ ..... �.,..,.._._ .........""'.._ ....._ ._"'""".........__...._ _ . ... � € i"� 0 -' � :" : I i i i i S�. i , _ ..,.._. .. ........ .._. �..... .' ' ...� , � �, �.� ._,- ......."'"""......__..� .....'""'" " . _ .....,. ._.. .. .. _._....""" "" , " "'. ...... __.....' '"" .._...... .."" v.�. ....... , t 1 .... t r�y & M � � .....�. _ �.. � _i � �f P F(_ ........_.... .._..., .. . ... , ....i.._...._.... .. 1 .. _ ........... .. .._.._...... .......,....__._ .,....""'., h _._ ,.. ._. _..._......, ..""""'"'.... "'.._ ..._ ..__., �... . , .-� . . :E.. ;" > , . � i : . -,.:. .,�._ >. . ..... _ .. ,...... . ..... .. ..._. __. _.... . � ;� � �r G�Z�✓���i.�__..�.__.. i P �' �� 3� � . __,...__��._. ' -- — - --- - --••-- ._ r... _...---- ,! �:, 3 �� 9 ( ... �,. , � � �. € t i,-fi �. �� � ... � � ? P L"".. .. .............__._..�.,_ _ .._,.,_.�,.._.__,,.,,.__._,_:. __ ...., _.............."'........ ..,..:._._. . ... .._"... _" ' i...' "__._.._... _ ... ..._.......,., ......._.....__"' � � �,n � �. a . � 7 i � �'�t {- "; . - u r .+ t: _ _- _.._, __..__._ __,..._._ ..... _..... - - ___ � �. l " � . ..� .. . � {_.- y � ..C k ry. . ___ _ ...__.... , ........ . .. .. ....... ........... __....,..._._.. 'S"'..._..............'"".... _.._ . ._ ..... ..._"""'.... __ _ .... .. .__....._., "'""""'.._."" ""....,.' _ ... . .r � '° ��4::; ; � s ,. , q ,_,. . ." ""' .. ._. ..._.__ ..."..' . '.'._ . . � . . .. �.__.. ._ ... .........._ .. .... .,.. ' t ... ..,. __. ..._ _. .... } _._ _..... ...... �ptr�t� l ��f ' x���1'^�.�,� �� � ., � . ..... . _._ . .._ .... .... � u...._. __._._. --- -- ....., ._ �----�-------__.__ .;...---._... .._ ._.-------......'�°M.._..� <?�a;�� �s��� �������x<���s,.... 1. _... € --._ ..... _. .. ..._ . , ...._. .---.,..__ _.......... .. . . . .. .... . ._..... , % i C .,:. ..r...� . ,....,. , . ,. . . . ; - �.', :::. . .i� ......__....._..,.... ._.__.............__........_.._..._.., _._.__._,...,..,._.____..,.,...... _ _'.___.....__._.__._......"'..__._. _............. __........_...__.._.__._ ....._._.._ ........._... _ �__.__. _.__-.f: 1 E �____._.__ ._.___.. __..._....._._......... _____. _......._......_....._.W....__._.__...,_ _...... ,.,_'."........._._"' "". ....... _......._ ..._..........__ ..............._ ._......... . 3 �._._.,.._.. _______. ...._.__..... .............__ _____ _._.._.._...... ..____..__. .__.__""' � �.._____...._... __. ...._ .__........._. __..._.__ .._.____ _.� .._._ _ __.__... . __..__.. . ' e . _.... ...._�,.. �..... ..._ ..... .. _. . ..... .._ ._ . . , .._ . .. ..,. .....,._ ..... ... ,... ...� e 9 . . . .... .. ' �..�� �� C......�._......_ ..,.. '__....._.._�.'"_...... .__... _.._'___....__ ....... ......_� _.. ... ... ._....... ... . ............ ...........__ ,.,. ._.._. . ........... . _.......""' "'"._ ......"'_'_""". .......... � ' . ..... _.,...., '_" ,.........._... . ..�_.........'__..,.r�,.�.._, __.,..... __._...�..____'"�..�'"'_"" ._ . ..__._....„..... ........... ..___._ .._... , ....,....__...........,.. ._.. _ ........,_.._...... .. ...._..,...._..._..""'__" ' ........ .... 3 .._...._...__..... _.__..__.."'_"_"._,...._.__... .............._.. .._....,..., ....... . ....... .._.._..__"""'_..._""_._.,..._.__....._.............._......... _. . . _efi .. ..' . ....... . ... . . �1?r ; 9 ia�. :..7f 7 �,: . .._.___...." '. "' '......, ...._..__..... . .................... ......_. .... ................................... ... ._ . ..... ...... ........._...,._,_.""... ....,`:. � --- _. ......._._...."".... ......_......_._._........... � .�::,_.�. ,,. ;�` .� ,.;:!.i._ . _....__..... �,�',�,�tt�sn k£��� ���� ��'� �"�� �� .,. : � k � 5`ss �s!` � _ # � �� ������ �� �� � . ,.. ...__.._. .. ......., .... _ � ���� � ��������.���, � ..... _ .,.... ..._. ....._. , .. _ .�__...----..... . .,_ _ ____ ... ����������"� �� ����-���������'� ._ ---........._.._.. . .. .._..__ ....._...�..__ ..._.,, .. ..... _... . _. i ' `��rt���������� �����:���������i _ _...._ . __ ..._.. ----....-----.._._ ._ . . _.. .._. ..._ ..... ' � ��a�= s � � +� � . __ ._.., _ _.... . ._._ __. .�. _.,.._ ___ _...--- -- �r ����������� � ��� 3 � �„��,��r �� �� ��, .___.,... _.._---.. .._...... ._ _....___...__.___ ___. ----_._ _._.... .._ _:.._ _.....__ _,_.. � � ��������fii��x���`���r� ",�'�;� ' - . . .__.... .._i K��;��: � �����-.��� i���5.����'��r �� � _._._.......,._._.__:..... _._...........,._...._... ..........._...._ ..._.....,.. . _ _....._...__ .,_ .. � ... ..... ...._ ��; ��-��� -� ���������� �.� , ., ., .. .... ...,.... ... ..� � :�����T., s��.. tmwrs€;�3� "��:-�' .___.. __-"- .' .--, .....,,.._. .