Loading...
HomeMy WebLinkAbout13664 (14) �� CITY OF DIAMOND BAB �� ) DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ` �'��' BUII,DING PERMIT APPLICATION FIRMLY'` �� JOBSITE" r�j APPLICATI N PERMIT P!C o ADDRES� ��- f�` `' DATE � � �NUMBER �� #I � �' ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP S- r � . ' ,� .. p; OWNER p ADD S`^ �' .. �'� ZONING SETBACKS "': CITY . � ZIP 1`�L. -- REART RW O �; APPLICANT �%�_IY��'� TEL=� SIDE/SIDE STREET RW ❑ �„ CONTRACTOR r�- ^ i.��� " SIDE ❑ a ADDRESS PROPOSED USE � � � �1 � CITY ZIP TEL. � ,r �r w:: ARCH/ENG! - � DESIGNER NO.DWEL. N0. NO. � ADDRESS UNITS STORIES BEDROOMS �` CITY ZIP TEL. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION tn ` � OWNER-BUILDER DECLARATION SFR/ADD/REM , Op �HERFBY AFFlRM UNDER PENPLT/OF PERJURY THAT I MA EXEMPT FROM THE CONTpACTOR6 LI � GgrdJB(C2fPOff W- :CENSELAWWRTHEFOIIOWINOREA50N(SEG7031.56USM£SSANDPPOFESSIONSGODE:ANYCI7'YOR ,{� , �- U:��.COUNT'WHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMVROVE,DEMOLISH,ORREPAIRANYSTRUG �W patiolDeck � - �- ;7UflE,PFIOR TO li$ISSUrWCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED �. W �,- STATEMENT 7HAT HE OH SHE IS LICEMSE�PURSUMIT TO THE PROVI510NS OF iHE CONTRACTORS L4 CENSE UW(CHAPTER a(COMMENCINO WITH SECTION 700�)oF�IVISION 9 OF THE BUSINESSAND PRO LL' POOUSpa � �--FESSION3COD�OA7NATHEORSHEISEXEMPTTMEREFROMANDTHEBASISFORTHEALLEPEDE%EMP� _ ";_TION.ANY TIDNOFSECTION7037.5BYANYAP7lICANTFORAPERMI7SU&IECTSTHEAPPLICAN7T0 - Z Re-Root F;_A CML P RL7Y OF NOT MORE TifAN FNE HUNDHED DOLLAHS(SS00)J: � ,ASOWNEiiOFTHEPROPEflTY,ORMYEMPIOVEESN7THWAGESASTHEIRSOLECOMPEN5AT10N, �° O COfl11TlBfCIdI 'WILL THE WORK�D THE STRUCTURE IS NOT�NTENDED OR OfFERED FOR SALE(SEC.1044,BUSI- ,J ��NESS AND PROFESSIO!!5 CO�E TNE CONTMCTOHS LICENSE lAW DOES NOT APPLY TO AN OWNEfi Of � PROPERTVWFIOBUItD30RIMPROVESTHEREON,PNDWN060ESSUCHWORKHIMSELFORHERSELFOR m ('[;-7NRq1GN MIS OR MER OWN EMPLOYEES,PRONDED THAT 9UCH IMPROVEMENTS ARE NOT MTENDED OR , L�1.; ,OfFEPEOFORSAIEIF,FIOWEVER7TiE6UIL41NC+ORIMPROVEMINTI550LDWITHINONEYEAROFCAMPIE� � �-� TfON,THE OYJNER-BL11lDER WILL HAVE iHE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OP j� IMPROYE FOR TME PURPOSE Of SALE). - � ❑I,ASOWNEROFTHEPROPERiY.AMEXCLU5IVELYCONTRACTINOWfTHLICENSEDCONTMC7oRS � �� . TO CONSTpUCT 7HE PpOJEC7(SEC.'oM,BUSINESS AND PRbFESSIONS Co�F�.7HE CON7RAC70RS LI� ` V81U&fi0n ADJ.AREA W: CENSEUWDOE5NOTAPPLYTOANOWNEROFAPPOPEHTYWHOBUIL�SORIMPRtlVESTHEHEON,ANO �'. WHOCONTqACTSFORSUCfiPROJECTSWiT1iACONiAAGTOR(S)LICENSEDPURSUANT70THECONTRAG ' QUANTITY DESCRIPTION � FEE Y roas ucErrsE uw.). � � B.&P.C�POA THIS REASON Q ❑I A4t EXEMPT UNDER SEC. � p � LL' UATE /I OWNER __ _ — _ _ U Z W � - LICENSED!:ONTRACT RATION - W - � 1 HEREBYAFFlRM UNDER PENPLN OF PERIURY THA7IAM LICENSEO UNDEfl PROVISIONS OF CNAPTF.R �r � '9(QOMMENCUiB WRM SECYKIN 7000)OFDIVISION 3 OF THE BUSM�SSAND PROFESSIONS CODE,AND � X MY UCENSE IS W FULL FOflCE AND EfFECI m .,_.,, , _ Lf! � 0 �LICENSEClASS LIC.NO. __.._—. . J � � - . U -pp� CONT('iAGTOR d W � WORKEftS'COMPENSATION DECLARA710N -� - Q �^3- z. ��.i � V i , � 1 HEREBYAFFIRAf UNDER PENALTV OF PERIUflY ONE OFTHE FOLIOWING DECLARATIONS: z ., @ � _IMAVEANDWILLMAINTAINACfRTiFICATEOFCONSENTTOSEIF-INSUflEFORN'ORKERS' - 2 f i ;"j' CAMPENSA710N,A5 PFiOVIDE9 BV SECTION 37000FTHr LABOR CODE,FOA 7HE PERFORMANCE W OF THE WORn WH WNICH 7HI5 VEPMIT IS�SSUED. c� w v I HAVE ANO WILLMAIMAIN WORKER;'GOMPENSATION INSUFUNCE,AS PE�UIRED 8V SECTION � A Q 37a00FTHELA80RCO0E,FnRTHEPERWRMANCEOFTHEWOPoCFORWMICHTHISPEflM1715 �] ISSUEO.MY WOflKERS'COMPF.NSATION INSURANCE CARRIFRMID POLICY NUMBEHARE: CONSTRUCTION �� �---+ � caafl�EA ._ PLAN REVIEW � � �; O� roi.�cvNUMeErt ---- ELECTRIC ____._ p- 6 � (iFOSSECTIONNE�NOTBE00FdRETEDOF7F�PERhtlTISWRONEMIN)RFDDOLtMSI3100)ORLESS� PLUMBING �: w MECHANICAL � Z t CEATIP7THAT IN THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS I5SUE0,I '�j SHALLNOTEMPLOYANYPERSONINPNYMANNERSOASTO@ECOMESUBJECTTOTHE � � YVORKERS'CAM?ENSATIONIAWSOFCALIFORNIAANDAGREETHATIFISHOULDBEGbME INSPECTIONFEE _—__ p 3U&lECT70THE WORKEAS'COAIPENSATION GNO`lISIONS OF SECTION 3]oa UF THE LABOF � UANCE � � S COOE,ISHALLFOFiiHWIT{COMPLVWtiHTHUSEAROV15bNS. �.^� Q � ��l Q pA7E: APPLIGANT: � W Y P/C —J YJARNINO:FAIWRETOSECUREWORKERS'COA�PENSATIONCOVERAGEISUNLAWFUL,ANDSHRLIBE � -'--'�—'--- J LL SUBJECTANEMPLOYERTOCflIMINALPENALTIESRNOCIVILFINESUP700NEHUNOfiEDTHOUSAND ENERGYPERMIT �LARS(f100.0005.IN ADDITION TO THE COST OF COMPENSATION,�AMA6E5 AS PROVIOED FOR IN J SECTION 37oe OFTHE LABOA CODE,INTEHEST,AN�ATTORNEV'S FEES. RETENTION FEE: - -�- �-. w CONSTRUCTION LENDING AGENCY PRE-ALT FEE: 2 — � i HEREBY AFFIRM UNDER PENAITY OF PERJUFV THAT THEFE IS ACONSTRUCTION LENDING AGENCY FORTHE PERFORF/ANCE OF 7HE WORK FOR WHICH THIS PEflMIT�S ISSUED(SEC.9097,CIV.C.). z — w � LENDER'SNpME __ F— IEN�EH'SADORESS � � ICERTIFlTHATIHAVEREADTHISAPPIIGATIONANDSTATETHATTHEA00VLMFORMATpNISCORRECT. TOTAL FEES W IAGREETOCOMPLVWITHALLCIT'AN�COUNTVORDINANCESANDSTRTELAWSREIATINGTOBUIL��NG � CANSTRUCTION,ANDHERE6VAUTNORIZEREPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE � A60VE-MENTIONEOPftOPEFTYFORINSPECTIONPURPO5E5. y COMMENTS - _____ . 0 J � ♦ � � f. m PE ( INT) Q / � � SI F i EE ATE = RECPT.NO. �� � PAID BY � VALIDATION � WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Capy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy � �� �� � � �� ��� I ��� � �� I��r I _-��- -..�� �,.�_-,_-_...,.�. ., _ .�._,.�� �� '"�`� Y d � � � 3 � i I i � i � � � C 1 I; � i ' � i � � , p_ � �. I ( � i :i i,; I � I � �; I . j I ; ', ` ' � I- � ( � } �. �� . ' � I " �i� r 3 i �_�'. � � f � ' � , r ��� , ' ; � � ( i ( ; ` : , + �: � j E � i ( I i ` ; j ; I I ; � ; i � I , , i ; � � , p � 1- i € , � � � � i i I i . � � � � r �- i � '.�_ t , I � € � I i i i I ( i I � � � i � � 7 - -� k� ��` i > ( ' i � � � � � r i . �� � � � _ � � � �� 1 i � � t ; � : � - � i � � � � � � . � � ���_ � " � ; � ,- � � � I i .:, �� � ��� � � � � , 3 � 1 � , � � � � i �_ _�__. �� � � �� ��� �� �� ;- � -�- i � -- € - i ;—� , � , �-" ; � ' .3 r � � � ' I ! i - ! � r ; ! �e � � I � � ' � � I ' � 3 ��. J I� ! � ! � �� � ( ( i �. � � � � � � � ' i � ' ( -. � ( � � � j I � . � � 1 3� I ( � � � � _ � �i ; ' ( � . E � a :p � � , , � � � ( i � � f � �. � � .. . � i�.. .�._._..�: _..� 4 :--�—�_-*--�_ L��. �---�i . �---' � I � �, J i �-� j � ( � ( �� � i �.,. ; ! �. � i �- I � j � { - _. .� . ( �:�_ _�.. d � i .. . . _ ' �r ,�� ( � � E ��_ 1 t � � � . � � ' �� ' � � �- -) ( . (_ � � � , � i � ' � �� i� , ��� � � , �_ � � � � � : � � , � (� . � _ E , , , � , � , � � �� �a � � {� : .��'�,��� i ; i € ' � �� ' i �� ( l, ! i � � �,> � I � ��c: � ; ! � .� i �` � i � � ( � � . � ��.. ��� �,C a�s.� v� . ,`' - � j �.,(-� i � ��� � �°� i � � � ��� ; � � � i ! �� !. � '� � ��. "�� � Ca �, ( �Ct�C?_� ( v I � ( �m � � ' � r:�a va � � � �i '( � t_�� ; P;� �� ;;�c ���._�`�� ' �� � � i � E � ( � � � � i � �� i r ._ e^ n- r � � t E � °.� &�� a r � Cy �� � i"�- �4 ..,�i.y .:r i - �" '�-rL�� �� I � ; i , € ��� 'r°� � W1 �a Cj��' �� +"`��..I� r��-�� �-' EC`i '� I r � �`�i �` '� - � i � �' I ; ( _ - i �� i� " r ' ��� E G ( � � a I I 1 � f �-i � �',: � i � _ � ', � ,� . : . ; - � . � � .-+ � � t�.. � �-I T -.�' � iJ� ''�� ryl..�l-� E� �_.:_'�� � a:t'�� � r� i� i � I I �.., � � � ; � � ! i � ":q , � '��' �, � q G� wi z i,' � a r>�� I'"7,"c..3 r �3� a � � e(.€ ,� J3 �� � i ( ' � ; I � � ` � � Li:� .� '7�� t�.. � :�=t'�i����i�i��ti r> ..� ,� .{�S�_� i�� � ,� � ; � � a i i � ; � � �i � - I ' � � ,' - " � - � �� � � � � ; i � � r � ' �:, � �—�— -.,! "_ �__i� (_�_���� � _!. { ;� � ' � � iC { ' a � a_. � � �� � � � � � � � �, i � ' I �� �__� t - _ _. � � ( ( � F � i � . � � � � t f 1. �. � � � i � � f I � ` t ( .�� 3� , k � i i � � ' � ' ! � ) ; � �p� �� i � i i ( ( i { 1 � i � '� { i i ' ° + ' 3 ' ' � G � s � � � i �� � � � . ( � � � � ° � I € � I � '� i I ( � � I ( � �, � � � � I p [� � �� � �a (- . € 1 � � ( � � I � � �� C �` � I � f I ? - � I � � � ..' E � � � �pp. ��� � a �E t � � � I 1 a � �� � t � � ( � � � � ! � � � � {` � ' � � � � � i ! i j I � ; � -� ' � � � r � i i i [ � I � V � � � E--� � _-1 � ` ' � [., __�, �� �..r _!- ,-'{--�� _� _,_..'� t � , �� , � ' ! ( ' � ( 1 j �: ��...�� , `, E 3 i � � 1 [[[[ �, � � � � ..�g�. � # i ( - � � I t � ( �':i ��� � �, 1' � . � � ( � I � � � � � I � ��� .:� ' '� : � , 9�. �� �- � i ��� ! i N { ( � � " � � � � � l� � i � � � � � � � � k - ���. :� , ; ` � , ' � � 3 , ��n 1 � � 1 � � � ( , I ; � � . , _, _r--I.� � � �—i- :�-� � -- � -!---�—�f-�' I._.�_� � i � ,�,` F � �� � � ��. ' ' � � ! � � t � iI � � � � � I � I � � : x i�' ( � E ,� ` �i ia.' � � E � � E � � � `'� 6 ' � ` � ,� � � ;, g{ €t. `�I� �I�� e" a cu I � � .,�� i �L.Y� f i - ".r',;�� � �w� � G ry v F� , , i� �,-.-� : � �."° �! � ,��. � � i i �: :. . ; �c�- ��.�.. �€ a�:;., �fw.l�:!°" � .;1 � �: -,i`=��. _�i a�� F�E ;i�,c' � j 3 �� ` i j ���� f'�- - d. �; . +�� � � ' �'� F �' s CL � 3_ (`' a � i .l .�' � 7 : ��� �.. I.ri." "`-�EA. zi� � ,�;, � � � (S 7 E E E ( �� 3 i i E' i--¢ - ..� u- 3 t'; 2 . s^t ""i 1 €'? � "—�`�` 1 I i � !p � ,6ry`y' 9 � � {���3�v{ ?,�' �„i;� .€ � � h " s ; �.'_:, f � � ! s i. �� �� .. ,� _.�'� � .�.._ ��: c.�_._..,;, � . � � � .� c .. � � .� � I� �t! L�.I, � :.. � � y� �.a�..�ru S���._ ��(�. d�_�1,..�-�r . E � . �fi _.._ 3�. r � 1 �� +" . � t ( , ��� �! � . . . � _...._v, _ _..>..��..:..__'a._!...:.Cs.m._� I'.:. �.�.,... .,.�� �.�.��.._�.__::��.�__�.�..