Loading...
HomeMy WebLinkAbout15447 ����� _�,�,�_ CITY OF DIAMOND BA& DEPARTMENT OF COMMLTNITY 6�DEVELOPMENT SERVICES ���� / _� 21660 E.Copley Drive Suite 190 �o (909)860-3195 Fax(909)861-3117 PRESS � �A�°� BUQ,DING PERMIT APPLICATION FIRMI.Y .,:.. ., ., : � JOBSITE eJ"�'� *,. ��C+'�/��i1 Q�f DATEGATION "�O''(/V NUMBERC� #/C � ADDRESS � r �'L•� � ISSUE TYPE OGC APN LOT TRACT DATE CONST. GROUP p OWNE�� �a�� � ADD SFj�S Z�NING SETBACKS � CITY�-��y�"ti��'-� ZIF�f�Z�, TEL, - `EO.- FRONT RW � APPLICANT TEL. REAR O � SIDElSIQE STREET RW C7 � CONTRACTOH G ;� _ '�S SIDE ❑ � ADDRESS 3�"Y---�-�-.'�ZY�"��� CITY �Attx�l,.:�`':yC� ZIP��"� TEL.3"�S"�..> PROPOSED USE � ARCH/ENG/ DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O [, I HEPEBY AFFlRM UNDER PENALTV OF PERJUPV THAT I AIA IXEMPi FROM THE CONTRACTORS LI- GflfOge/CefpOfl W CENSEUM�FORTHEFOLLOVlINORFASON(SEC.7W7.5BUSINESSANOPROFESSIONSCODE:ANYCITYOR (n C7 COUNTyWHICHREWWESAPEWuNTTOCONSTRUCT.ALTER,IMPROVE,�EMOLISN.ORPEPAiRANYSTRl1C- W PetiO/DeCk W TURE.PRIOR TO IT5193UANCE,ALSO RE�UIHE9 THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED w � STATEMENT THAT HE OR SHE IS IJCENSED PURSIJMf�TO THE PflOVI510N5 OF THE CONTRACTORS U- CFNSE LAW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- V' PaoV5p2 FESSIONSOJDE)ORTHATHEORSHEISE%EMPT7HEREFROMAND7HEBASISFORTMEALIEGEDE%EMP- (!) TION,ANYVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORACERMITSUBJECTSTHEAPPUCANTTO Z Re-RooT � A CIVIL PENALTY OF NOT MORE TiAN FIVE HUNDflED DOLLAFS(5500)J: � ❑t,ASOWNEROfTNEPROPERT',ORAIVEMPl.0YEE5WITHWAGESASTHEIR50LECOMPENSATION, � CororoerCiel - WILL DO THE WORK,AND THE STRUGTURE IS NOT�NTENDED OR OFFERED FOR SALE(SEC.70I4,BUSi- J NE55 AND PROFESSIONS CODE:THE CON7MCTORS UCENSE LAW�OES NOT APPLY TO AN OWNER OF � PqOPERTYWNOBUiLOSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR = [[ TNROUGHHISORHEROWNEMPLOYEES,PROVIOEDTFIATSUCHIMPROVEMENTSARENOTINTENDEDOR m �1 OFFERED WR SALE IF,HOWEVER 7HE BINtDING OR IMPROVEAIEM IS SOLD WITHIN ONEYEAR OFCAMPLE- � �710N,1HE ONlNER•BUILDER NALL HAVE THE BURDEN OF PROVING THAT HE OR 3HE DID NO7 BUILD OR � IMpRpVE FOR THE PUPPOSE OF SAI_E). w ❑I,ASOWNEROFTHEPROPER'h'.MIEXCLUSIVELYCAMRACTINGWITHLICENSEDCOMRACTORS � TO CONSTRUCT THE PR0.IECT(SEC.70M,BUSINE55 AND PRQFESSIONS CA�E:THE CONTRACTORS LI- Va�UB�1Df1 ADJAAEA W CENSEIAWDOESNOthPPLVTOANOWNEROFAPFlOVERTVWHOBUILDSORIMPROYESTHEREON,ANO 3. yy�pCpNTMCTSFORSUCH7R0.1ECTSWIiHACONTFIACTOR(S)UCENSEOPURSUAN'fTOTMEGONTMG Q�JpNTITY DESCRIPTIDN FEE �' TORS LICENSE LAW.). J � ❑I AM EXEMPT UNDER SEC. e.8 P.C.FOR THIS REASON Q 3 `—' � � DATE _ OWNER__ V � LICENSEO CONTRACTOFiS DECLARATION w � ��,��"' � � �HEPEBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDEF PPOVISION6 OF CHAPTER � d Y�COIdMENCN(iWITHSECTION7000)OFDIVISION3OFTHEBUSINESSANDPROFESSIONSCODE,ANO Z MV IICENSE IS IN NLL FOFiCEAND EFFECT. ,—���.� m Q LICENSECLASS �°3� LIC.NO. �+ � `��� � � V DATE ��„�`��'��"� CONTRACTOR d W � WORKERS'COMPENSATION DEC�ARATION -� U � I HEREBYAFFIqM UNDER PENALTY OF PERJURY ONE OF THE FOl40WING DECLARATIONS: N Z 6 Q _IMAVEMlDNfIL1MAINTAINACERTIFICATEOFCON3ENTTOSELF•INSUREFORWORKEflS' _ L CUMPENSATION.ASVROVIDEDBVSECTION37000FTHELABORCO�E,FORTNEPERFORMANCE U Q OF TTiE WORN FOR WMICH THIS PERM�T IS ISSUED. � p _ I HAVEANO WILLMAIMNN WORNERS'COMPENSATION INSURANCE,AS FEQUIflED BY SECTION Q 3700OFTHELABORCDDE,FORTHEPERFORMANCEOFTH'cWORKFORWHICHTHiSPERM1715 � ISSUED.MY WOR COMPENSATION INSURANC`�E�1RIE�R AND POIICY NUMBER ARE: CONSTRUCTION jCARRIER_ ���Z�-� �_�`Lf.��Y��s PLANREVIEW � POLICVNUTA6ER �7��� �rp,o-�' ELECTRIC p (IFYSSECiIONNE�NOTBE�h1PLEfmOFh�EPEFMfISWR�MEI-R1NDIIED�OIINL.,(S7oo)ORLES6}. PLUM` 81 �NG �, �W I CERTIFYTHAT INTHE PERFORMANCEOFTHE WORK FOP WHICHTHIS PERMIi IS ISSUE�,l MECHANICAL SHALLNOTEMPLOYANVPEHSONINANYMANNERSOA5T09ECOMESUBJECTTOTHE � WOPoCERS'COMPENSATIONLAWSOfCPLIFOPNIAa`7�AC�REETHATIFISHOUL�BECOME �NSPECTIONFEE / � SUBJEC7TOTHEWORNERS'COMPENS 1�7Q'PROVt OFSECTION37o00FTHELA80R - � C�ADE��,/I�S.�HALLFORTHWITHCOMPIY THTHOSEPROVISIO ISSUANCE T � C7 W'"�> AP%.ICANP. SMIP p DATE: - { � ENERGY P/C t J WARNINGFAIIURET09ECUfiEWORKERS'OJMPENSATIONCOVERAGEISUNIAWFUL,ANDSHALLBE �y SU&IECTANEMPLOYERTOCRIMINALPENAlTIESANDCIYILFINESUPTOONEHUN�REDTHOUSAND ENERGYPERMIT .0�'�?�9+"a1l1 17') �OLLARS(5100.000).INMDITION TO7HE COST Of COMPENSATION,DAMAGES AS PROVIDED FOR IN --y,�—��+=���i� QSEC710N37a80FhiELABORCODE,INTEPEST,AN�ATTORNEY'SFEES. RETENTIONFEE: d CONSTRUCTION LEN�ING AGENCY PRE-AlT FEE: � � 1 HEREBV PFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LEN�ING AGENCV �- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3061,GV.C.�. — W � LENDER'S NAME W LENDERSADDflESS ��� � 1 CERTIFI THAT I HAVE READ TMIS AP7LICpTION ANO STATE THATTHE ABOVE INFORMATION IS CORflECT. TOTAL FEES � 1 AGREE TO CAMPLV W1TH PLL CRV AND COUNTV OROINANCESAND STATE LAWS RELATING TO BUILDING CONSTAUCTION,AND HEREBY AUTHQRIZE REPRESENTATIVES OF THIS CW NTY TO ENTER UPON THE ZABOVE-MEIirIONE OPERN FOR INSPEC710N PURPOSES. COMMENTS p ��--��-��.�`-� m PERMITTEE NAME(Pfil ` �/ � ` � L�?''_��c.� � � Vj SIGNATl1REOFPERMiTTEE � UAIt � RECPT.NO. PAIO BY VALI�ATION �'�" WNITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,6REEN—ApplicanPs Copy w� �..:.;, .�,a;..��r�. x. i�ae» .; a .�,r�-r r .;�.e ,�y,...;�.a t��+..;;:'�. sn. .,.,,: _.,n:�.,� ,,.� ,""" .. . . �' +r ,� .,,.^tv''`f, �e �::. . � �'.%;ns F`,., ,... . ,. , r*` - � , „ '� e.�i`��'��. �� �� ., �Rr� �'�'°'d t�18 � �'! . ��� �� ����� ��� ������� ��`��. � � ,.. ,..,� . � .; �: �1 ��� ��`$� � ���� � �� ��: � ' �4a � �-.&�'d �,.,::�� � :.�� � �j �. Pe�^S � `��a � ....�6 i�. - � k ... � � �Az` �� : . , . � . �..:. � -x� �'. � ��-� ^n :. � .�.a��n�t ,. ��� �. �.,�`�`c.s�t S: I 1 � g��..l`"�`.l�rl�t t��°�� I _� .._.... . ..._._.. ....._ ____....7........._.....�.._...___...._.._�.�...._..._,_._......� _._ 1_.. � _._._....._ -j ----" ---- . IDi��i�"�.k�-'�;J �..�� i i ��'i�-� ��. ��G��� � � "�._ _ . ..__ . .. .......�__. . ...� . _. ....... _.__�.....�.._._._ -4 ___ . . .... _.. _.__.. _..__. . _.._.._.. . ... . �C..:..'t i�'��u-� �.�=r�'i«�.� � � � � ��E �� i� l t.J�i� iJiJ%'; � .._..._. . ,._...�...-m....,,.....r..-'-....... . .. _ � i _.._. .._ .____.....__ .......�__.._..._... .........._...,.�........._____.. .... . _... � �...... . ... ;-v_ s �,� . £ � � � €0'��r, � `�t I"' ___"___ a .,. ..�iS r -t @ 3,�.+ . ( i �.l� .. ..tf�) -1� �. � . ..._ ..., ;.._.....--�_.._.�....,....r.._.�.._.�._..._.�.____._....... .� . .._. . _ ......... __. ._! ..,. .. .. ; . `� _.._'.. � ' '__.!�.___.._....._._._. __......__�...,..._.._..�.�_.....,. .... ��a ;��" -ti�3.: I ( [ i������ �����t���f'ti Qe'7a�9 � __ ... � �. .;� . ._�.. _,___ .__ �______ _�yp�^��^ �¢ �} ��)q y4� S t.t i' �? 14��b .p.� � - b� `S'?6.€'�L+iY,a.� L➢w„.��A "1$._f`4'S�¥ � ' ... _..i � __�___ _, .--� . �___._.. ' � _� __ = �._ __ ______ I � , --� � � : � i I �.�,�k? r s� ��e,�r r��.'�� � � l��a � F t �� � � � ""' i € _ ,. _._.._�______. .. �_ ___, _ .. �_._ �_- __ , ��,_ _<<._I �"°,�"�'`.€''. r:�''s ��� � � 1 �3� �3x����}�3 �'�� -- ! _ ._ .�...__ — � _... . _�.._�... _ .__� . __�_ ._ 9g }�➢i� n(�d :L?�.�y,I S}„" f'�}Pt - i J E-:�0j�� �p�.y'f �`' ����,� ! � j 3 '._....._�..»�___ ` _._...._,.__,____�..._..__ a . ... . ....., _.. .�....... . ...__ . _._ . ..__._ ......._... � . i r re.��� ���.;f s .., , E � � .at�k� ������ ��,...... __._....— . _e_..p_...�. �,. ....._.�......__ � � .... . ...;_�.._ ......._.. ______ ..._ _ . .;_ ,: � >�s.�,at�i�-��'�-r�h� .. t � �---._.._. ..._.�.____-_ , r3�Ik, � rl,� _m� __ _ s— _._._-___--_ ___.�...._.._.,----- � �____ _....�_____� __._____ i ._. �'�Y "i �f�s s � r-,�{eq ( � i :� -., -�wJ„t.�'`"� ����a��i����. _._�. 3 - ....._......,....�.�.._._ ..,....,,._... .. ._. . ? Y'i..�...� � . _�i._.,,.....�..�� � ......_._,. .._ � s..,....-........, . , �Y ' �. � " � _ '��[��"� t���fl./�a�,.;3 �- � � {i $ S i.�: �1 a� 1��..2 I ; � _. _.. _"'......�....W_'"__�...,�......__..___.a_ _r.. _.........__�,__�_._.._.._._..__.......,��_i � . . . ..r_._............._.� ,...._.._.._...e...,.. ......._'"� I .._ ......._ _ _ �.. . _ ¥ ,3i-��.��} `-��-- � ��'a-;; � 3;.��a �� ��'i�':��__.._. � n_w...w�,�__...m.��m.��._���.....M.� . �_ . . _ �;.__w___. ... _�_ _ ��i ; � �-.,y €;l tae ; � ( � `���s F-����Eg�-�.;..,-ti ��� I . . ._.__. _�� ..... �,. $( ._. . . :.....,.,.._...""..._._ ,.�_ ___.n.........._............._.r____...._.} ....� . ._......�.._�.__ .. ..___�_.._. � ,_ ' . .{ y "4Rr�L� t�.a���i�,, €�'_�S - E � ` '�l.'i�a...�;�t�&��.. . . _._�_.____— � .,� .� � . E ' .. ` . .� _ . .. 3 �, ...�., _......w . r _ ..�._... . �...__....._m�..�.a.�.E ....._...� . _____"_ ._ r � n,. .: �s�St 3}�; � s f.s.g FS�?`k� 3 € � j . .';d�a 5��. t� :�+��1: `J, E.____' ... .. . � `' __ ___ _____..t.._....__.._____•.__.____..� _--__—_�t ___ y _.__ ...__._...._.... __ _._ . � ....�__��.... �3�'_?�3�`1i?.� ���� .�€93§_a i � ;.i'��.� ; : '��+�3 ? . � ___ ___.�.____ _,._� ...__—__.___.__..�.,� �l�__. _____T_ —'-------- --.�. ... �_.... .. ____._ _ ! r��„�,�'s, j r � °s��' ��3�a i t � ° _ � . .___.__......__ ___... � ..._.._..............._ _.. _.�_._____m_. . _.,..._ �� --_�__,..._�........__. � r _ �.___._.__.._._._.� i �,.�:-� �''r �,�.�`��°: ; ` .. . I � ..,� a� s s+ 'nc,,�.�,.�'Aj...~,, ' ( � �.,..� !....__._... ._._ ._.....w.�........_._.._�.� , ".._,__--o-.�.._.__�._._._._._..._'___.v_....... t _ �.... _...___...,....�.......__...�...w._.__...._...�_..... .. .....�_.. - s f . �. F � f . : 'i �`(' P i � l.1 a .> . � � � c{'..l..w..k Y�-.._.L.. , I ,z... >E°<r_ o_�e : t � w.._...� ,._�,. t._._._.e.�__......¢__.._ �.m.._.._. �__ . __ _.�._____-__�_. �._.{_�..._-`___...._ ._.._.._._ _._. y r : .5 ...::t'� , � � � �j ,� -r� .€�:sr.�� : ' g �..w : � � i, E � - a9� t ..... .- .....,.. �............. ,_.. ..__..____.._ _.___.,...__.. _._._.._._.._.._ .�..__. _.,,-i—�.�_..�—�.—_ —.—""'�-_----(-�-f.-- _ . _ _ �._. ; �"€ :_, . �,✓i�, ."�" .: .. € . �: )C P` .1 �`'s } -�a�.� � � � � ; ... � _........__........._-_.�....._...._._�.........._...,�,,....€�._._.�...�.......,..,...._......____._._"____ �.. .... . . .__ ._.....�..m._,....._.__... ._.._._......,...._�...._.--:...,:._ . .. .... g $ < .a�:s`�o: 3 ":.�a E , ; "�i��-5�. `-' x:��..i =� � 'k E , . ,. .._ E , __.�_..�___.____..a�._. . __ w___�-�----..._���___.. .._._.�_� �._,..____ �_�____ __.__. �.____w_� ..�._ _-_E�_,____�.__•___..__�. .. ..�. � -� ,�, __� . 3 �� �.. .� € �iiv�.t��::.�,.e�.:s,..=�.�'<.t� : ; . : j ' � � ........_....,...._.....,._�_..,.._...,...._...._.._._�.._......_....�.s_._....e—�v�a.._.. ..._... F--:_.........._ ...�.._...._�.__��.�.._..d........_._..�....._v....._..,..._..,............................._� .....,..,.._.........._ 3 � � � i :. y��.m. . . ....... W ., � «. :�.,. , � '''I��3�S�• � . ... .. . :;$i h`�..' �£7{"`$&L.., I 1 � �... ' . �.. :.� . ' ..._._............._..,.._.n......._ .�......�.___...r............_....... ,_....,,,»�.._..._...,..,..,............ ._._.�_..__....... .......,....._.....«....................,.....,... _. .,...._.. ............,.....�..............�..,._.._..__.._....,.,.....».._..2..,.._.._.........,... .. ....................____._...._.._.......___. _. . � t �..._....�..__..._..,.... _..............»a._......___��--4 1'3 5. ��- ._ ___ "___. __._....,_ ...... .......��.__,,.__....�......�....w_____�_ . . � ,; ` - � - :�.,n����.'��° .�i� .d'��- �� �..._ ..._., _._........,�.................. ..._...._.,....__ ...� 'a ...., .._.... _ .. .""...__,�.._._......_._......_.,.�._-.__ __........_,_z___. ..�._._..:............�,___.._�._�_...�__�_..�__ ..,,.......�. . . ..� . .: - . :. ; : .. ,�,^x�,.>a� �� �a".r`cw.:. :: ` ,.._.._.._._.._..._..__..,.... ._.__..._ ..�; . I.rr$,,,4..�..��.:s.ta� ��...� ...._._.._._._......._�...�.�._._-'__._............___._.--_.__._._..____._.,....._....._......._...,,....._...........................u.........�...._._......_.,__...�.....,._. ; _..,..-....._...�_m....,._._.........._.._......,b�... � a ... _.._..._.,_. ....____..___...__._�_�__.._......,,... _ .___; ......______.............._.. ... .......�.......__..__._._..�....._,.._....�._.._.......... ...................�m._______...,.,..._........._._.._ ._............_.... -„__„__..__.___.�...,....__.._�...__...M._.._..........__.-,__...... . : � � . , $ ¢_�.>___......_ ..�.�__.._,.._._�_._�.....,.._..._..._. _...._....._....... ______..__ -_----._,......._.... ._....,..._...__._......�..__.........__.........__�..............___.._ .,..........,._.,.._ ._. .......... ..: � . . �______.._. ........_...._._____..___.._.._,.._._...._,__.__,.�__�....._�....�...__.._..___..._.__...�._..w,.....____..._..... . .._.__.____�............ ....._._........ ........_._._._..._...__...._....._�...__...,.....„„�.,.._......._..........�...___..._. _ , _................. . ....._.-j z € L.._._.........,_.e...._..._...�...._........._..._..._...,_............�..........-.........__..._.._.......__...._.,__._.......,.......,.__.__...._.._..._..�__.._._.__,__�_�................_ .._._.........._......__..__..__.... .._.._.._._ ....... ..__.___._...�__._...........__._...__ _" � ( I { �.. ... . . . . � � r' � � .._..,._........_..._......_...._.._..Y.�_..,..,.�.... ,✓._-�._.._."_'__�__ . ..__:.___....... ..........._....._..,...,......-.........,.,......_....._..__...,...,._.__ ._�......_........�.......,.._...,..,..__._._........,.._......__....._..._w._........_. �^--"-_°-_—' . .,. __.__.__.§ �_..�._»_...__ .......................... _,.__......_........__....�..__.___.,_.......__..._......._..._..._�.�.._.__�._....,.._..___....__._.��_...._.............._.__....__._....... ........_._..__..._.,..,,....,..........................__ .. .._......... . . . ....j # � 1 i .... _._ ___ . _. .__._......_ _. ._�._._, ______ .. ..._.__._ .........._.. __ _.. _ __.... . ._ _ __ _ 9 �:.,,.ar am r »»,�- �x €r�.... „�, . , . ,��� , . . . . . . . � �....�'6�� a:� ��;r.� __�.. _.._ .._m..�. . __ �. _ .. _ W ____._�_____... ...__ ....__._�___... _.__-- -- _..._ ._�_----_ _ �_.. .. ., __( , , j ���..` �t: �� �,� _ � � 9 .. ' e � ';�.. � � .#.r 3� ::: _.............._..__.�...��_..._..__.....,..__............_..........................__...._....._......................_........-...._ _......n._..... .........._....._ ......................_................,.... ..._........._.__.._.._...... a-._.__.... ( �k� � �sS s,� �,�,. ' � -� k � � � ,� ' �:: E � . _.......,. ,_._.._ . ; _. __.___.._____..,_____ _�_.._.___.._...___ ___ __._ ------_ _. .._.._ _...._.. .� _.._._._ . _. _ � �:. a � �' r� � ��: � � o-'��'�`��4� .: � �"_,� ; � _ � � k� �' _, __w_....._. _ ._____ . _ _._ ... _____..� .. _. _ __... __i ���' �::. y � € , � i . .��� � � _ _._ 3 � '�., � � .__.__.__�._..u.._.___�_...�_ ___._. .__ _._....._..._-__--____�...__.____.__ ._�__.,......... .. _. ... ����� � ... �___. _ .1 � � � '�� t �� � , � , . _._____. __ �__ . d :� "�'�'r��� �� ;�. � � _ ...... ---- � � p�q�s. ���,�' �r;4�"� . .._ .. . .. ___ ... . .� � _,.....,..._�.__.�.....�....�..�.....w._, _ _�__ ___..._.,_..___..._.�..._ ..___,. .. � '�' ��� #��,�. � � � � �'� ���; .. � ���_.�r� ��. ��� � _ _.___.. _ ...__— ___.. . � . _........................_.... ...,..,........ __. .._�_. __._ g