Loading...
HomeMy WebLinkAbout14112 (14) �t / �CITY OF DIAMOND BAx � ' - DEPARTMENT OF COMMLTNITY&DEVELOPMENT SERVICES �.�� _ � . 21660 B.Copley Drive Suite 190 (909)864-3195 Fax(909)861-3117 PRESS ���'�^° BUILDING PERMIT APPLICATION FIRMLY � JOBSITE APPLICATIO�`f (� {° PERMR L � P/C o ADDRESS �/ DATE /�"�r"I� NUMBER ��� # $ ; ISSUE TYPE OCC APN LOT TRACT i DATE CONST. GROUP � OWNER � o. ADDRESS ZONING SETBACKS 3 W' FRONT RW ❑ F � CITY .Q. �L ZIP�TEL. ' APPLICAN7 ^ TEL. � REAR ❑ SIDE/SIQE STREET RW ❑ �. CONTRACTOR SIDE ❑ � ADDRESS � � � PROPOSED U$E �'� C - C � �� cirv ZIP��TEI. � .Y�%� �' /°.�' o; ARCH/ENG/ � pESIGNER NO.DWEL. NO. NO. a.' ADDRESS_ � CITY ZIP TEL. UNITS STpRIES BEDROOMS ��. v� DESCRIPTION SQ.FC FACTOR PSF ADJ.AREANALUATION - 0;;-_ OWNER-HUILDER DECLARATION - SFRfADD/REM Q '; I HEREBY AFFIHM UNDER PENALTY OF PERJUFiV THAT I AM E%EMPT FROM THE CONTFlACTORS Li� GBffiJe/CBfPOfI W. 'CENSEUWFORTHEFULLO'MNdREASON(SEC.7031.68USINESSANDPROFESSbNSCODE:ANYCITYOR _ (n - 'GOUNTYYMICFIHEIXIIHESAPERMfiTOCONSTRUCT,AI,TER,IMPFlOVE,DElAOLISH,ORREPAIRANYSTflUC- W py1i0/DBCk �� TURE,PRIOfl TO ITS 139UANCE,ALSO REQUIRES THE APPLfCAN7 FOR SUCH PERMIT TO FILE A SIGNED W �;'STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVi810NS OF 7HE CONTBAC70RS U- . � � �GENSE UW(CHAPTER 8(COMMENqNG WITM SECTION 7000)OF DIVISION 3 OF TME BUSINESSAND PRO- POOVSp2 �-FE&SpNSCObEjOR7FIATHEORSHEiSEXEMPTTHEREFft00.1ANDTHEBASISFORTHEALLEGEDEXEMP• - ,(� • TION.ANYVIOLATIONOFSECTION7031.58VANVAPPLICANTFORAPERMITSU&lECTSTNEAPPIICANTTO Z Re-Roof � � +„_,'. ACML AENALTY OF NOT MORETHM7 FlVE HUNORED OOLLAFlS(6500).): tlI,A50WNENOFTNEPROPEP7V,ORMYEMPLOVEESWITHWAGESA57HEIR50LECOMPENSATION, 0 CommBfClal � g: WILL00 THE WORK,AND THE STflUCNRE IS NOT INTENOED OR OFFEHE�FOfl SA�E(SEC.7046,6USI- _I �: NESSANO PFWFESSIONS CODE:TiE CO�'IfRACTOFlS UCENs�LAW DOES NO7 APPLY 70 AN oWNEp OF � - PqOPER'iYWFiOBU0.DSOFIMPHOVESTHEREON,ANDWHO�0ES5UtliWORKHIMSELFOqHERSELFOF ��=-THROUf3HHI30RHEHbWNEMPLOYEES,PROVIDEDTMATSUCHIMPHOYEMENTSARENOTINTENDE00R m 0-, ,OFFERWFORSN.EIf,NOWEVERTHE9UIlDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE� - - _ ."TION,THE OWNER�BUILOER WILI HAVE 1}IE BURDEN OF PROYING iHAT ME OR SHE DID t/0T BUIID Ofl - Z'� IMPROVEfORTHEPURPO&EOFSALE). � �'� � ���- �_` ❑I,ASONMEROFTHEOROPEH7l;AMEXCLUSNELVCONTNACTINGWffHLICENSEDCONiRACTORS �'- .-. TO CONSTRUCT THE PqQIECT(SEC.7044,BUSINE55 AND PROFESSIONS CODE:THE CANTRACTORS LI- V81U8tiOf1 i.+� ADJ.AREA � �� W, CENSEUWDQESNOTMPIYTOANOWNEROFAPROPERN4VHOBUN.D50RiMPROVESTHEREON,AND - � +:_' Z WliOCONTMCTSWRSUCHPflQIECTSWIiHACONiRACTOR(5)IICENSEDPURSUANTTOYHEIXJNTRAG QUANTITY DESCflIPTiON FEE - - TOq$LICENSE LAW.�. �`. �` OIAMEXEMP7UNDERSEC,__ __e.&P.0.FORTHISPEASON � - Q - I�.- � � �, � � • OATE OWNER� - _ U � � LJCENSED CONTRACTORS DECLARATION . W :IHEpEBYAFFIPMUNDFRPENAL7VOFPERJURYTHATihMLICEN9EDUNDEFPROVI510N50FCHAPTEfl � _ � :0(COMMENCIN6WIhISEC1WN7aoD)OFOIVIS!ON30FTHE8USWESSAN�PROFESSIONSCOOE.AND Z : 7C�.�.�MY LICENSE IS IN FULL FOflGE AND EFFECT. '` _ m "' � -UCENSE CJLASS �a�:� - LIC.NO. L/�l��� b"'� r _�. j - V DATE/�'�__Y"��_CON7RAC70R�r ..���c��� :�� � � WORKERS'COMPENSATIONDECLARATION fj� � � � . � IHEPEBYAFFIRMUNDEHPENALTYOFPERIURYONEOF7HEFOLLOWMG�ECUMT N5: V � � 2 � __IHAVEANOWILIMNNTAINACERTIFICATEOFCANSENTTOSE�F-INSUREFOR�ORKERS' . CC�MPENS�TION.AS PflOU1DE0 BY SECTION 37D0 OF TNE LABOR CODE,FOR TM FORMANGE OF THE WORK FOR WHIGH THIS PERMIT 13155UE�. W O � � _I HAVEAND WILL�IAIMAIN 1YORKERS'COA7PENSATION INSUFANCE,AS pEQUrREO'�Y SECTION �.,.,q�� �� Qn 37000FTHELABORCODE.FOHTHEPEHFORMANCEOFTHEWORKfOR W(CHTHIS?EHM�T ' P , ISSUED.MY WOAK 3'COMPENSATION INSURANCE CARPoEflAN�P Y NUMBEfl E>� QONSTRUCTION l � j cnr+aiEn - � �� � �� � N REVIEW � � va.icrwuMeEa � �` r � �' ' � `� ELECTRIC Qw,,.=' —---�-- Q �srcn�hE�rioTaE��ooc'n�aErw�n'sw�aa 3�5i�Ess1 PLUMBING z I CERTIFYTMAT INTHE PENfOAMANCF.Of THE WORK FOH WHICH YHIS PERMIT IS ISSUEO,I MECHANICAL �;} SHAL(,N6TEMPLOY/WYPERSONINANYMANNERSOASTOBECAMESUBJECTTOTHE . (q' WORKERS'COMPFNSATIONLAWSOFCALIFORNIA.ANDAGREETMATIFISHWLOBECOME INSPECTION���'+�1��(������ ,� �- SUBJECTTOTHEWORKERS'COMPENSATIONPflOVISiONSOFSECTION37000FTHELA0041 ����� ���� .�. Jy.. � CADE,I SHALL FOFTHWITH COMPLY WITH THOSE PROVISION� ISSUANCE _ , p. OATE:�_/�._..�APPLICANT. ��„ SMIP ti' - � � ENERGY P/C �- WARNING:FAILVRETOSECUREWORKERS'COMP�NSATIONCAVEFAGEISUNLAWFUL.ANDSHALLBE � 5l�,lECTANEMPLOVEflTOCPoMINALPENAlTIESANDGIVILFINESUPTOONEHUNDREDTHOUSAND ENEPGYPERMIT DOLLIRS(it00,OW),�NADDI710NTO THE COSTOF COMPENSATION,DAMAGES AS PROVIOED FOR IN �; SECTION370BOFTHELABORCOOE,INTEREST,ANDA7TORNEI"SFEES. RETENTIONFEE: ____.. _-____._.__..... �� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O 4' �HEREBV AFFIRM UNOEH PENALTY OF PFR.Il1iiYTHpTTHEHE IS ACONSTFiUCT10N 1EN01NG AGEt4CY FORTHE PERFORMANGE OFTHE WORK FOR WHICH THIS PERMITIS ISSUED[SEC:aus7,CIV.C.). . � W �, LENDER'S NAME __-_____ � IENDER'SADDRE55 � TOTA�FEES � ,�� � I CERTIFY iHAT 1 HAVE READ TNISAPPLICAiION AND STATETHATTHEABOVE INFORMATION IS CORRECT. i� � � IAGREETOCOMPLYWITHALLCITYAN�COUNTYORDINANCESAN�STATEIAWSRELATINGTOBUIL�ING , b � CONSYRUCTION,AN�HEREBYAUTHORIZEREPflESENTATNESOFTHISCWNTVTOENT[RUPON7HE Z PBOVE�MENTIONED PROPERTV fOR INSPECTION PUflPOSES. COMMENTS � 0 �/ f � 9� '��7 F'J,'L [-����"' m PERMITTEENAME,,.(P.q,I�NT)� � __�p / N � �i'�'..�(�� � �"3"'��- )� s'1 ��i'� �/�a " r�.fi�: �/j SIGNATUflEOFPEflMIttEE E ' „ _ = RECPT.NO. PAID BY VALIOATION ~ WHITE—Department Copy,YELLOW—Finenca C�y.PINK—Assessor Copy,GOLOENROD--File Copy,GREEN—AppiicanYs Copy :: � � � __ _ _ . . __�. . _ , __, : ,� i � �`� E , � � �E t r �,� � �_.. r ( ; , � ,w � .( � ' �� r i � ...�= ' ��� � � r I , � � � ; �� � � � , � 3 � € � ' , � ° i � ? ' ' � ` , q, � . � � � �: -�s � � � � �� � � � ' � j� � � � i � ( � � �, I '� '� � � � � � ;, i � � � j � i E � f F € � ' I � � � � `: � ; : � � J � � ,� , �' �' E E (����� ' � G � � ,� ; � , t [ � i �:%`r � i ( ` ; E � f � � ( i i f �;, 4 , � i � � . � � ,� ! , , � �.,..y. .._. �_�. �...�..."'t. � �' _-_1 `--�-l--- ; - � -1 �..�:i { ; €. . ' i j ' � � ` � �� €' ` ,� � ' :' , d � � � � �. � t a i � i i � � i �_ � �, .i � � � � .�� � �� ��= E r , � � � ` - i ; 7 i � i t i ; I � � � � � f � i � � � f f� , � , . .� � t j �� � � I � ? � F 3 � . .i E .I� j j i i r � � i � � ' -- . . � , � . . � � � I i € ! � e "�--� __ ,.>'� i-� � __� „� � �. � � --;---�-��— � �-- ` ��� , E j E� � � i � r ` � (, � , , ' ' , �_ � , ' �: , I r_�� ! ; .�- ~� , ; � , `�`� , �_ , � � z � � � � � � � ' �� a-� � j_ ,. E � ��� � � � , ��i E � t �"` I � � � � , �� i: , , i �� i, � � � � � � a ' � I ` E { �, �� � ' 3 ; I i � � : � j . � ; , � , ��� ��r� � �' � � . ��� � a i—� 3 � � �P _ ��7��^,4�'I�� a"'e� � E � ' � f� - � � i i� � � !.' � ( ( I � 7 � ( � � Il.: � � �- C5 f��:as �,� ur - ��. E ' _ � �.. .�' �.i �. i i.. � � � ! , I r . � _ i� ec � c �r�l � � � � � s r` � �� e�."c- r 'y �'" rr' �` � � (= ��' � , �_ i �,�= �. � � � � � � : � � � 5 � ..�r i�; r I �� c�j 'c^ c �u��2 `�E � .. , . I � � ,� �-� � 1,__ ; 3 I ; � � C �� � _,t� � �, � � � � -� i I Y�� , f � i : ��� � � � �t , 3 f €� � c ' � 6 ` ��-, n�i� �` ;��v � � c I� � -`i � _ j 3 �� �i 3 1 I 7 i� _ � � � { �` ` l` `� �;��i�.r ���;� �� �1u. � �� t � j y � i �. , � �t i i �t� � Ea: G� i �r � ' � I 3 � � `c�u 3 � a � � U � � , �,, � � f�., r��u. °��e��u � } i� i �' ; I � �� i �` � ���y � �� � � � 7�y ' � � $ � � . � _._'L '`j !, ...c_.,.. � �—V � � L,'b s '�S.:� � �� ] � 3 i = �� l 7 I` T`" i � '} � ' > � 4 ' �- 1 , � �� �� � � -� � 1 .�, � .I� � � � ( � � � 1 � ; � , . ., ( '� � i i E: 3 3 � � a � .. � � � i�. f � � j ; � t � `1 �_ I � ' � ( � � E ' ' � ��� � ➢ 1 3 � � �' � :i �� � `� � � ' .�:..' � ' � � E � � � � �' ~�( . ' - . ' � �a�� � �a i �� j � � � .� � � � � � � � i. I i i, .j E i .� �i � . I i ,� � � � ' € i � 6 . �'�"� .1� � .� � � ' � � � � � F ' � ���'� � � � � � � i i ' � � �. � � ; f (r., � I e s ,;� ? j i ; �,"�� ' I = � � � ; � � � �: �;-� ' � � ! ! "�+ i , s E ! j �� � � € � i �� i � I k � i � i �.,; i a a { ; � � � �a: , , E . � � '�� ' �,p'� i � !�-� ' � ` T— � .J...j _ I __'3 .i � ? [ � � 3 ( . � � � �� , . � ! _1 � � ' � � , ���E a � ` ; i� � � i i j 1 a ��."� ( i E ` j � � � ' � . � ,~,�? � � 3 + � �. � � �� t � i � ; f '�" t i �� ' € _ � ' �,, � r � i i � � � ' � ( E � i � � ; € j � a � i i �* i -` i 1 -I--- � _-_ � �= r : ' ` , �� t �, f-T � : � ( ' i r i ! j t 7 , ; �' � , ' �, � � � ���� � i ' � r � � � � -F I � � : r i ' . � ��iJ � si`- t i, ���, �� {_ � � -E {` F �' } € � E � ; - �;�. ^�-� t�. ,� ,�,t € � ,��c,`7 E^i ' .f r 'F �� '� ��" � ' r i 3� ��� : E 7' � - s ..�� i rt ��� �- ; �' � �-. i�.. � L � �.� �r .+ �.. ^i � -� � � :� �y ., !r . � �..Cf: � ; ti _ �"w� -i � � ..r-�-'- L �T.,. 3 �:ry. 7 a �_' f! . a ,+�- �..�.� i � c --: €"c _ a'�:� � ,� � �- '� _r u. �,. �r -'- P� _t! }'-E.` r t�.i�1 t "J I i 'd� � � � � ,h-�-r- � � �. .. ��� i l� '� ��� !� � �' iL � �1 �� I � � . ; � *� � � � � : :�' i,� C i. 1 � . ��.. �J��^i� ^� t . -4"� � _ � �. .�dI' C.� 3 ¢. ,r i Lf I "L 1 -���i kp,.z i i"'� a i 4 raJ� t _ °� . - fi C' ...,.._.._.,.r-�:. � .. ��.�� ��� . C LS 1 j I_.. . -'�'�a.'� .,.�.r�._,.�. _.wr_.< � - � . � � _ .�...._ r._.L._.... ....��.��__ _,,._.,_.,_.._�... ._._�,1 i ( � `�