HomeMy WebLinkAbout15503 � � CITY OF DIAMOND BAht �
" � �"-�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES `�
_ , w 21660 E.Copley Drive Suite 190 PRESS
(909)SGO-3195 Fax(909)861-3117
��'�'�� BUII.DING PERMIT APPLICATION FIRMLY;
� JOBSITE f ,/� `� eJ����= APPLICATION ��� PERMIT ��) P!C �`
o ADDRESS �(� �!�-'YctK�agP DATE NUMBER �`� #
$ ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER � �fll�/7_ --
ADDRESS�/g7G ZONING SETBACKS
B' CITY ZIP TEL. FRONT RW ❑
�; APPLICANT TEL. REAR ❑
SIDE/SIQE STREET RW ❑
CONTRAGTO � ✓S /�w � " L_C3�✓�)"' SIDE ❑
�� � - -
ADDRESS LF'./ �`' '�P�''7"9' .'4 _
�' CITY �+'� � ZIP �� TE PROPOSED USE
o;: ARCWENG/
� DESIGNER NO.DWEL. NO. NO.
' ADDRESS _ UNITS STORtES �BEDROOMS
�� CITY ZIP TEL._
y' DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
y
� OWNER-BU�LDER DECLARATION SFR/ADD/REM
O'
Q- 1 HEPEBV AFFIRM UNDER PENALTV OF PEFYtt1RV THAT I PM IXEMPT fROM THE COMMCTOFS LI- � � Garage/Carporl
W� CENSEUWFORTHEPoLLOWIN6REASON(SEC.7037.58USINESSAN�PPOFESSIONSCADE:ANYCITYOft -�
� .COUMVNMICHqEIX11RESAPEHMITTOCON5Ti7UCT.ALTERIMPROYE.DEMOUSH,ORREPAIRANYS7fll1C- � W pdti0/�BCk
, TURE.PRIOR TO ITS ISSUA!lCE,ALSO REQUIRES THE APPUCpNi FOR SUCH PERMIT TO FILE A SIQNE� �
.j,r',,-STATEMENT THAT HE OR SHE IS tJCENSED PUHSUANT TO THE PROVISIONS OF THE COMRACTOR5 L4 �
CENSE LAW(CHAPTEH 9(COMMENCINO WITH SECTION 700D)OF DIVISION 3 OF THE 6USINESSAN�PRO- � Po0V5(fa
�� FESSIONSCOD�OR7HATHEORSHEISEXEMPT7HEREFPOMANDTHEBASISFORTHEALLEGEDE%EMP� -
'_ TION.ANYVIOLATIONOFSECTION7031.68YANVAPPLICANTfORAPERMITSU&lECTSTHEAPPUCANTTO � Z Re-Roof
�-: A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED OOLLARS ti5oo�.):
❑I,A&OtVNEROFTHEPROPEATY,ORMYEMPIOYEESWITHWAGESASTNEIRSOLECOMPENSA710N, ' � CORIRIBfC19I - '
$�� WILL�O THE WOAK,AND THE STRUCTURE IS NOT iNTENDED OH OFFERED FOR SALE(SEC.7044,BU51� � J
NESS M!D PROFESSIONS CODE:THE CONTMCTOPS LIGENSE LAW UOE&NOT APPLV TO AN OWNER OP
�� DfiOPERTYWFIOBUILDSORIMPROVE67HEREON,ANDWHODOESSl/CHWORKNIMSEIFORHERSELfOR m
._.__. .�1 ..7Hq0UGHHISORHEROWNEMPLOYEE$,PROVIOEDTHATSUCHIMPROVEMENTSARENO7INTENDE�OR - _..... _ ..._ . . . ... .. ... ._. _ .. .. . . ... ._ . . _... _ � _..
' Lt�l.i OFFEAEpFOfl5ALE1f,HOWEVER,7NEBUIIDINGOflIMPROVEMENTISSOIDWITFIINONEYEAiiOPt6MME- '�- - -- -�
z_ 'TION,THE ONMER$UILAEH WILL HAVE THE eURDEN OF PFOVIN�TH/T HE OR SHE OID NOT BUIID OR
W.• IMPPOVEf-0RTHEPURPOSEOFSALE).
❑1,A30NMER OF THE PROPERiI;AM E%CLUSIYELY CONTR0.CT�NG NA7H UCENSED CONTRACTORS
��; TO CONSTRUCTTHE PROJECT�SEC.7a4,BUSINESS AND PROFESSIONS CO�E:iHE CONTflACTORS L4 V81U8fi011 ADJ.AREA �_
W��. CENSEUWOOESNOPMPLYTOANOVJNEROFAPROPEPNWHOBUILDSORIMPROVESTHEREON,AND :
�� WIiOCONTMCTSFORSUCNPROJECTSWITHACONTMCTOH(5)LICENSEDPl1R9UANTTOTHECONTRAG QUANTITY DESCRIPTION PEE -
TORS LICQISE LAW J.
J "^" L /�
��` ❑IAA1 E7(EMP'f UNDER SEC. 8.&P.¢FOR THIS PEASON - U r�
3 � �
. u' OATE OWNER ____ U �.
�. .. W «
LICENSED CONTRACTORS DECIARATION —�
w
- �- '1 HEREBY�FFIRM UNOER VENAITY OF PERIURY THA7IAM LICENSEO UNDER PROVISIONS OF CHAPTEfi � �ldfJy�/�,j y`/!J/7i
p�'� ;`p(CAMMENCINQWITHSECTION7000JOFDIVISION30FTNEBUSINESSANDPROFESSIONSCODE,AND Z
� . ?!'S-. �MY LICENSE IS IN FULL FOflCE AND EFFECT. m
o .UCENSE C,L,A,.�SS°��__°��—LIC.N0.__ � �
' �j �DATE�� �.+o �G'` _CONTFlACTOP n- �
W �
� WORKERS'COMPENSATION D CLAHATION �
Q
� IHEREBYAfFIRMUNDERPENPLTYOFPE{UURYONEOFTHEWLLOWINQDECLAFATIONS: U
(/� Q
� _IHAVEANDWILIMAINTAIfi110ERTiFICATEOFCONSENfTOSELF-INSUftEfORWORKERS' _
COMPENSATION,ASPPOVIDEDBVSEC710N3�oaOfTHELABORCODE,FORTHEPERFORMANCE U
Q OFTHEWORKFORWHICHTHISPERM�TISISSUED. �
0
_I HAVE AND WILL MAINTAW WORKEFiS'COMPENSdTION INSURANCE.AS RE�UIqEO BV SECTION
Q 37000KTHELABORWDE.FORTHEPERWRMANCEOFTHEWORKWRWHICMTNISPERMITIS
ISSUED.MY WOHKF.FlB�COMPENSAT 'NSUflANCE CARRIERANO POLICY NUMBER ARE: J y�l , CONSTRUC�ION �. ���
� CMRIER�T' ��'''� � PLANREVIEW
Z POIICYKIAIBER "e,� ELECTflIC —
Q
� (hAs5ECf10fvNF.�No78Emb1PLE7EooFiF�aEPow�ist�fiorEF0.N�OFlEDDOLtAAS(Sim)ORLESS? PLUMBING
w I CERTIFY THAT IN THE 7EFFONMANCE OF THE WORK F0 HICHT PERMR IS ISSUED.1 MECHANICAL ����'-
�
SHAILNOTEMPLOYANVPERSONINANYMANNER50 O E SUBJECTTOTHE _����
�-� WORKEFIS'CDMPENSATION LAWS OF CALIFORNI EE T IF I SFiWLD BECOME WSPECTION FEE
3U&IEC7TOTHEWORKERS'COMPENSATIONP I OF CTION37000FTNElABOR - �
s pp�� �RTHW�THCAMPLYWITHT E �s - .SMIPANCE .� � � d� }���� ��
Q. . ,e Esi 1... �. ,P
p pp7�;� APPLICANT: ,� �-✓ .
J� ENERGY P/C
WARNIN6:FAILURETOSECUREWOFKEflS' MPENSATIONCOVEflAGEISUNUWfUL,AN�SMALLBE ��-�r � � 3"�"�'d-
LL- SU&IECTANEMPLOYER70CRIMINAIPEN TIESANDCIVILFMESUPTOONEHUNDREDTHOIISAND ENERGYPERMIT �"'� ` �`�-
DOLLAHS(5100,000).IN ADDITION TO THE COST Of COMPEN9ATION,DAMAGES AS PROYI�ED FOft IN
�_ SECTION37o90FiHElABORCODE,INTEREST,ANDA7TORNEY'SFEES. pE'('ENTIONFEE: E f l �' ����
W CONSTRUCTION LENDING AGENCY pRE-ALT FEE:
O. --
O
� I HEREBYAFFIRM UNDER PENALTY OF PERJURYTHATTHERE ISACONSTRUCTION LENDING A6ENCY
�-' WRTHEPERWRMANCEOFTHEWOPKFOflWHICHTH157ERMITI5155UE0(SEC.3a97,CIV.C.). � � �
Z -
W
� LENDER'S NAME _
1— LENDER'SADDRESS -
� ICEflTIFYTNATIIiAVEREA�TMISAPPLICATIONMlOSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES - � . e ,
� IA6REETOCOMPLVWITHALLCIIYANDCAIJNNORDINANCE5AND5TATELAWSPELATINGTOBUILDIN6 - .
CONSTRUCTI ,ANDHEREBY THORIZEflEPRESFNTATIVESOFTHISCOUNTYTOENTEfiUPONTHE �
ZABOYE-MENT ED PROPE fF0 I PECTION PURPOSES. COMMENTS - -
OO
� _ �.�¢..j . .
QPE �TT E NT t -
� �``��'c-.�c� �.�..__�__
Vj SION RE PEFMITTEE DATE
RECPT.NO. �� PAID BY VALIDATION
�
WHITE�—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy
�. �.r._ ..�_�.
��_� _H.�
s_ I � ��� , � �
�� ' -� ��� � � i � � � , F� _ . _�� � � �
� �
� � � � �� � ' �� � � � `( � s ; , ; �� � � ,� E , � : €.
� � � � �i ` i � � � i � 'i � i �� `_ i i� � � � E� [ j �.
�,r� I� r � I ; � � ' t � � ' � �
� � :) � � �� � a I � ;� � a ( q" 3 I i� ! ��, � t 3
� � � � . " I � ' � j I
- p. � 1 � i ? � �, � r ` � � '' ( `�,��� !� � I- � �i � � . � !�� ���
, t � � � � E �� � € � ��� i � , i� i I � _ I :� � 1�� � '
�, �` i ( t��) � � � ( ( � � �.-� � �- � . � � F � i �: ' ( _' E I a !- � � �f
,� � � � � I. � � f I. � � � � I i i ' € � � i i E t� I { i i-�- � t.
E' ( E_ � i � � f� � � �ii� � ' � �t, � -� �� i � � �. � � � �� ( � j
� � � V _,����..� � _ i _3 .�/� � ' ,.....1�_.I i � I F. � � � -I. k Q
.. �� ( � j i �) i i � I � �� � � -� i � � � € i � i k � � i R � j E 3
� �� ! � � � �� i � I I i � E � � � � �
r � � i � � f , ��� � �� � � � � � � � � � , � '
� � � ' ,�.- �. � � € I
_ . � ' t ' � i ` i I , I 3 I ' � � i , - ' � ( � �
E � �i ( P
S. � �� _.� S___.I._� ( { � ( �I i . � �t 3 -( � ' i (� I ! � € 1
{ t j S � ' 4
1 �
_ P' .�....._-. � � I l : �
� ' i 3 � i C � + i � ' � � �_� r ��3 � � � � I � F � ` k � �g
� � l� � � � � � I ' � ( � � � ' � � � � f �
�;; � � i � ,
� i � 1 ' � � � � I � � � , � r �
� �i C � � � i � � "� � € � � � I � i � i ' r ` I I �
; r.�s ' �J j G �" t � � . � i � � �' � ( € � � � j i f '
�'`� � � �� (. I� ���I� �'.%��� F '�..i��.�� � � ���� I.� "3r�I E - I � I � i ( � t ' I j � �� ! �.
� �!�"3 a� � I� �!=� :�'E���..�°� �cn � ��r; i � � { � � � � i � ? � � � i !
� � U i,� ��r' � a � ..'� � {� �'� '�IC? J -"��.���� 1a Q(�I CS.�Ge � i ' , � i I � � i i 1 {
� � �� ` ;Cp �a�" � `7 �I��� � � � 7,� �.�`�� S� �4� C� -� �E � ( ` € a � i P�
; a� � € 1� n ..i�i�, ia ��_! �. � � � � � � � � r �
. � .� � �r _,.�. 1 3�'�.'3 �, . y,j ."I� � 4-.» � �� �'.9��i�.[ . "t �-�5 - � � � � d � - � �
}�� -,�� � ��R'..�JJ :L!�lf-�..�-e�J7E�f �;,..+i )!-�� 3J`a-C��s.t�f�.� .a1��3 �'� � - �� � � I � ? a � ! � � ; _ � � .
.. ,�3` p�`p e �' C' C3 �„ f"��, �i 3�� t tf�,C'..+ U fa.=G, ���, `> :i-€ , "°� ; _ i .i � 1 , t
. �� e6 «.�7��.'�. s� �I J ,_! �1.��a ..3 `i�':J 3 E lJ G3_i i�"'d..�. .^�.� �," k:3' .� .a r _ .� I F � ( � I {
. �� � �. u � u.. u � �. r i rA �.. �._.....i�'3.. � t� J ��� . r v� � ( � 3 � � � � �6
a.�, � ��--r--�,—f ��� _+�. �. �--�-=� _ � _�{ -;�; , � k � � 1
� � �� i �. I ( 1 i �� � + �� � 1 I € j i �'�' 3 � I I � � f � � i '
�„ �'s� �9 � � ! � j I � ; 4 � �.� i � � ( � : i � i � ' � ' F I i � � �
� � i � � � t � j i ' � � i i ( ��_- �3 a � � � i { ` � I i I � � I j t � � � ` j�.
� 3 � i I i i,` � � i � � 3 I E � � i E � �
. � i � � ' � � i � �_'e � I I � � � � ; I $ ( I ( € 1 ! E �
` � � ' ' i ; i � : � ? � , j { � ! ' ' � � � f � 4 i
� � t � � � i , � i � i , � I ' ! ` i E j i � , � : f i � 3
� � , ( ' ; � � ' � I ; , � , ; 1 ; ' � , � 3 i •
-' E � .� � L. �- .:.. _ i �_.,�, �� � � €
t d I � j t
.. �__+ i. �_._�- _�:� —�"'-�__r�_.�._ -t-�-^—I E{( �` � �._�( � S.��.� f ( � . a � � � � � � I f � i ;� �.:
. ����� I � � I I� t� � � ( ! � � � i [ i # �E ` � . i � € � �.� � 3 �
` i � : I - �'.� �
'. .I � ` ' I � .
i
�: � _i_� � ' � ���� 3_ L.., �� ' i �- � � � f � � � - �.
� � �
�^ Y. �E - � #��
: � � � _ � � € _ � � P � � � k�E � P ( I � � � � �� 3 -
x>, w �` "�.._ I ! i�^ � I � � �r � ( � � 3 I � � � € � � f �';� � f E t"� �...
� � � � T '-� � .� I � � - ��. V � E t 3
. �� w) � _ .f`� �.re � (�i U � i i t , t � � ✓ � � � � i � � ,. �
a"� �9 t-� CY ^� i . � ; , .
�'� � � �� z� � 3 �„I,� �.I� -� � I �r �(.�I ; �t � i; I ! z�^
- ��I�JE��� °- ri�2E4f"i�,- ``� L I � ���'�T +� :�5� � -;� ( ��.°I 1�� � I ,. � i � �. � ' 4�'. �
.._ � � �r �..1�.jaci �..tsf�l �-_���� ..l���r"� _ ,�`� ��f�i f�.'I��� � : ; � � �. I � � :
([ r { i-a �
��t,ii�'�"� �_ °') ��.Pi-a e � i JI� r�..rlTl.,,��Ct.� i� I , ��G � 1 .,F�'„ � � ' ; i i r?. � $
� ir g.� -� -� a�ui i � i€�€ r'� i��u.. � �� �=..� z I � i � s � � �" I '1. : _ - . �
�c���.� �3�� � ��<e �- �( ,�� ��� ( �-�� � ���i� a� � 1 x,a � � E � t I �� r
,e��t- € IC�" ,�l iG � �`� � ' �'i""��. `� sj � ,� -r�� �'- � � i t a , � � . . ..
G- i.'v� L- +u <'J F' 'i�;�.',1.L 'L k'S."'�E. � t E"'-•.�. � � Cs .g0 .r. .J�S �3i� � . i �.e � �! r �...,.... � �. �� ��� �3 " � �e,.�
_ ��........�� �F,.._�,.ei_,w.E�..'._-�..._f.a{=,.._.(»<...�..._.i,..�s.>.,.1..._�..,..,,....L......t..�.»_.,�....»'�........,_._..._,�..�.�s.. _ a,z,....�_»-ai�,_..,�..,-».�.,....,,....��......_...._._.,_�.,_. .