HomeMy WebLinkAbout11026 (5) .
- -�� ---� C1TY OF D[AMOND BAR �' .
COMMUNITY DEVELOPMENT DEPA
X_,.� 2t660E.CopleyDriveSuite190 - PRESS
(909)860-3195 Fax(909)86I-3117
''"'� BUILDINGPERh11TAPPLICATION FIRMLY
� JOBSITE ZZV Gr��lK. NW� O �C APPLICATIO �G� _NUMBER //0� #/C
d ADDRESS DATE o
0
o ISSUE TYPE OCC �
� APN LOT TRACT DATE CONST. GROUP
p OWNER D/VZ�
ADDRESS L N - / ZONING SETBACKS
w FRONT r v n 1 fl� ❑
zo CITY ZIP TEL. REAR v �
o APPLICANT � ��14lyctll TEL.� SIDE/SIDE S7REET RW ❑
� CONTRACTOR �� � (� UD //t/ SIDE ` � O
o ADDRESS _ PROPOSED USE
o CIN�(//I N� � ZIPy'!7:`/ TEL�l�27�`1- - -
o ARCWENG/
z DESIGNER N0.DWEL. NO. NO.
a ADDRESS UNITS STORIES � BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF - ADJ.AREANALUATION
Q OWNER-BCILDER DECLAFtATION - - SFR/ADD/REM
O
p I HEREBY AFFIRIA UNDEH PEWLTY OF PEKAIRY TMAT I/Ud E%EIAPT FHOA1 11iE CONfMCTORS L4 -Gd�dg9/�fpOfl � -
W CENSEIAWFOfiTHEFIXIOWWGREA50N(SEGT037.SBUSWESSANDPROFESSiOtJSCODEANYGTYOR - (n
U �pUMYWHICHREOUIRESAPEiUAITTOCONSTRUCT.ALTER�PA�.DEAIOUSM,ORREPAIRM/YSTRUG' W patiolDeck
w ilIRE,PRIOR TO RS ISSUANCE.AL50 REWIRES THE MPLKl�N�FOR SUQ/GERMIT TO i1LE A SIGNED W
, � STATEMENT TNAYME Ofi SHE IS 110EN5ED WRSUANT TO TME PHOVISWNS OF iHE CON?qACiORS U- �
, _� GENSELAWICHAPTEFG(COMMENCWaW17M5ECT10N700010FO�V45qN30fiF�EBU51NE55ANOVHP
0 FESSIONSCODE)ORTMATHEORSHEISEXEIAPTTMEqEFHOMAN�iMEBAS�SFORTNEKLEGFAEXEMP-
V TION.ANYVIOIATIONOFSECilON70.71.5BVANYA7PLIGffTFORAPERMIT5U&IECTSiHEAPPLIGANTTO -ROO� � Q (.�(,7.OC�
� A CML PENALTY OF NOT AIORE THAN fIVE MUNDRE�DOLLAHS(i5D0)I: � �
0 O1�50NMEkOiTHEPROPERTY.OHUYEMGLOVEESWITHWAGE5A5iHEIR50LECAMPENSATION. 0 (�`pmm0IC181 .
Z Mll DO iHE WORN,AND THE STRUCiURE IS NOT WTENDED Oq OfGFAED FOp SALE(SEG 7W�,&151- J
HESSAND 7NOFESSIONS CODE:TNE CONTRACTORS LICENSE UW DOES NOTAG7lY TO FN OWNER OF -
� iROPEfiiYYMOBUILD30RWPROVE5h1EREON.ANDWIWDOESSUCMWORRHIMSeIFOqNiRSELFOq � '
CL THROUCMMi50qHEROWNEMVIOrEES.DROV�OEDTNATSUCNWCHOYEUENiSARENOiMEN�E00ii m .
- '.-'" _WQ .OfFEAEDiORSKEIF.HON/EYERIMEBUILDINOORWVPOVEMENTISSOIDWITHINQVEYEMOFCOMPLE- '
Z TION.TME OWNER-BU4DEH YnLL HAVE TME BURDEN OF 7ROV WG TMAT ME OR SME��D NOT BWtD OR
� IMPROVEFORTHEGURPOSEOFSALE).
, �y„� - ❑4�OWNEHOFTNEDRODERTV./JAE7(CLU5IVELYCONTRACTWQWITHLICENSEOfY]NTRAGTORS _ _ _
� TO GONSTRUCT iHE GRQ1EGi(SEG 7a1,BUSINESS M!D PpOGE55lONS COOE TME CONTMCTOfl5l4 VdIU8lWf1 �1Q�.�ifl�
W CENSEUwDOESNOTAPttYTOANONMEROFAVROPERiVWHOBUILD50RWPROVE3MEREON.ANO
� VMOCONTMGi5FOR5UGIGROJELTSYAiHACONTRACiOR(5)LICENSEDPUfiSUMlTTOhiECONTFiAO QUANTITY DESGRIP710N FEE
� TOHS LICENSfi UW.). �
0 O 1 AA1 EXEMPT UNDER SEG B.l i.G FOH THIS RcA50N Q / •
u' DA7E OWNEH , V - . . . �L�V4f�' ���ITj � .
Z W
�¢ _ LICENSED CONTRACTORS DECLAFATION ' ' W _ '
LL IHEREBYAFFIqA1UN0ERPENALTYOFVE0.7JRYTNATIIVALICEN5E0UN0ERDROVI5qN50FCw�iiER V. y �L//S�
Q Y(CONIdENCW(3WITNSECTION70o0�OFDM5lON70FTMEBU51NE55ANDPROFE5510NSG00E,At� Z
X MY UCENSE IS W FUII FORCE M�EFFEC7.
. � LICENSE CU1SS �•��LIC.NO. y^�� _ �
�7 y� � NG O✓
~' DA7E �G"V_Q� � J
V CONTpAcioR ! � �.
W _ _.
� WORKEftS'COMPENSAT�ON DECLARATION 0��,�] Q ��� ��/G
� IHEREBYAFFWMIMDEH7ENALTYOFPERAINVONEOFTHEfOLLO�MiNGDECUMT10N5 /I �
N Z
� _IMAVE/fIDN7LLAwNTAW1ICENTIFlCATEOFCONSENTTOSELfaNSUREFORWORKEfiS S
COAIPENSATION,ASPROV�DEDBVSEGTION�7ooOFTHEIABOHCOOE.fORTNEDERFO W
OFTHE WORK FOR WMiCH TMIS iERMIT IS ISSUED. _ _ �
�
w �IHAYEMIDYnLL�NTAINWOFLCERS'COMPENSATIONINSURANCE./SREOUWEUBVSFCTqN
Q77ooOFTHEIABORCODEFOIiTHEDERFOfWANCEOFTMEWORiCiORwHN]ITHISVERM1T15 �� LlC� G�)
J ISSUE�.MYWOMERS'WAIPENSA710tiINSURIwCEGARRiERM6�POl�CYNUMBERAHE: CONSTRUCT�ON �=r -�
� �Eq PLAN REVIEW
; Z ro��crwuua� ELECTR�C
¢
0 �sEcriorrr��norsEaons�rEnoFir+¢vEw.+rswac�rirc�ooalfnsR�oo)oR�ssl PLUMBING �y-v-nv��'-.—��^
z I GERTIFYTHAT W TNE DERFORMANCE OF TNE N+Ofu(GORYMIb1 iHiS DERA/I715155UED,1 MECHANICAL
C7 SFULINOiEA1PLOYANYPER50NWANYIMNNEH50A5TOBECOMESU&IECTTOTHE . _
� � WORKERS'CGAPENSATqNUWSOFCALIFOqN11AN0AGREETHATIFIS+iWLDBECOME �NSPECTIONFEE 7�T
SUBJECTTOTMEWORNERS'CAMPENSA710NPROWSqNSOFSECTqN�70oOF HELABOR , ..� _ ////
' O CODE.ISHALLfOH7MVJIiHCOMPLYWITHTIq PRO i0N5. ISSUANCE _ .... _ , -- -v -
I � �,�� � SMIP
p �ATE: APPLICANT. T--
w ENERGY P/C
� � WAIiNIN(S:FAILUFETOSECUREV�IORKERS'COM7ENSA1qNCOVEfUGE15UNUWFUI.ANOSMALLBE
� SUBJEL7ANEMPIOYERTOCRIMWALPENALTIESANDCIVilFWESUPTODNEHUNDREDTHOU5AN0 ENERGYPEflMIT
DOLURS(it0o,000�,W IDDITION TOTHE CAS70F COMPENSATqN.DMIAGES AS PFiOYIDED FOR W
� SECTqN77oBOFT1fElABORCODE,wTERE57,ANDATTORNEY5fEE5. RETENTIONFEE:
oCONSTRUCTION I.ENDING AGENCY pREALT FEE ��_�� �
� IHEREBYAFFIqMUNDERPENALTYOFPERIURViNATTHERE15Af.ONSTRUCT10NlENDW(iAGENCY
FOfi 7HE PER WRNANGE OF TME WORK iOR WhIIGM TMIS PEMnT IS ISSUED(SEC.9oW,GV.G.�.
Z .
W
� LENDEfi'SNAME
F— LENDER'SADDFiE55
� ICERTIGYTHATIHAVEREADiMISAPPIICAT�ON�NDSTATETHATMEA80VEWFORMATqN15COFRECL TOTAL FEES -
Q I AGREE TO COAfPLY WITN ALL GTV/ND COUNTY ORDINANCFS AND S7AtE UWS PfUi WG TO&14DING . ,
CONSTRUCi10N.AND NEFEBY AU7ilORIZE REPRESENTA71VE5 OF TM�S COUN7Y TO ENTER UPON TME .
z ABOVE-AIENTqNEDPRO�ERiYFORWSPECiqNPURPOSES. COMMENTS
a /I�IA.�.�. /Y1�0/�0�
QVE0.MI7iEE� R� ) �� I^^�^M . � .' '
cn i.![� � v 7 i
� SIGt1ATUREOF7EFWITTEE OA7E '
� RECPT.NO. PAID BY VAUDATION
WHITE-DepaAment Copy,YELLOW--Finance CoDY�P�NK-Assessor Copy,GOLDENROD-fiia Copy,GREEN-Applicant's Copy _ _ �
�
. .
: . - - _ - - - - - - -- - - -- - - --
. ,
_ .- ,
, �
:` i _
�
, i ,,,
- , .
0
: - ,
� o ¢ ' ;
� o � W
a a " ' o � z � W � ¢ , � � � z /
m 0 . � ¢ pomwmc� � � v � vi ¢ z � o " ,
`I- tn O O t� m o � � z a u� vi �7 F= Q '"
❑'V � �n rOO wwZm � Z � ¢ UU � � z u7azu- a a re ' ;
Z W O � J J OOZ � C7 [twZ ¢ 0C7a � zH "' v� F� ._
� �-� C5 � LL V4 .V m Z O c Z � � � w Z W 1- z ¢ O a�� w
. O � ¢ CL W W LL� ~ m m C� = 2 S W LL LL H Q W � F N WO � � � O '_ . i
.. � Z '� ' O 2 , U C7 N J J J U) U J � J J � . ' , '_ _ _ ' ' ' _ '
Q p o = z z � � � ri z � w o Z O o o � w z Z z z ¢ w w z - —
— u. � � � � ti � cou. am ¢ LLaaao ❑ u. gotiu. x ❑ w v
� '
� �� �
. t ;
- �r- � ,
�
� � � , � - ; -
. j ., � i - � - ' ; i �;
�, ., ,
,
_ I N,
e _ �� ��
J I�� � �� 1
,_ z ,; '
o I
w o � Q � � p ' I� W.
' � � O � � U�Z F- Z ¢ m � z Z ~ � -' , U CJJ N�.
� ¢ � W w � � WwQU � � og � Q ' Y � � t= Zam F- zdl
� C7 p ¢ ¢ w � � u� z ; Z a� t= c) � ��z � �
k y Q U a ,Q � W W Z � W J J � Z � Q � � Z Q W � W I-F-
'��rc� o � ¢ Qv� xc70xwa � Fu� � � i-- �- Ow .� �
, �a LL, ¢ Z Ly, n. p� r7 z U 2 2 2 w z C7 ¢ � U a. � U x w d � U n-
- �. m (n (] O m a H O � O � � � Q � J J W F_ d Q.J J J J � ��, F-d �
c7 w � a � � a. w cn a a a a a w
� � � 3wao ¢ 0000 = � ¢ w � Wwwazzzz � ww
�cn ri w c7 cn E- 3 r[ LL ¢ ¢ ¢ ¢ v� w � c� o �n cn cn C7 � � � u. U ' tncn
�