HomeMy WebLinkAbout11030 (5) -- _ ��
----���-- CITY OF DIAh90ND BAR
COMMUNITY DEVELOPMENT DEPARTMENT '
,�,..e 21660 G Copley Drivc Suitc 190 PRESS
(909)860-3195 Faz(909)861-3117
'"''� BUILDINGPERh41TAPPLICATION FIRMLY
o� JOBSITE ��_�] �[�L� �'OQ�� C�N\I/�A 1 APPU�I PERMIT_ O?� �PlC
ADDRESS � J �`i>> VIIJ DATE NUMBER J
c� ISSUE TYPE OCC
APN-�-}-�-�LOT��--�/��TRAC�TI DATE CONST. GROUP
°C OWNER t"t V 1�' T/��lrf L
O
" ADDRESS '� � ZONING SETBACKS
' Z CI1Y ZIP TEL. FRONT RW ❑ :
� APPUCANT TEL. - REAR ❑
� SIDEISIDE STREET RW O
� CONTRACTOR C • SIDE ❑
� ADDRESS _ PROPOSEDUSEY' L O(I � D A ` I
� CIN - 21P��TEL -
o AACH/ENG! ,
z DESIGNER NO.DWEL I � � NO. NO.
? CDORESS Z�P TEL UNITS STOAIES '�" BEDROOMS
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BCILDER DECLAHATION, . SFR/ADWREM
O - - -- , . .
p I NEREBV AfFIRM UNDER PENALT'OF PERA/RY TMAT 1 AA1 E%EMP7 FiiOM ME COMHACiORS LI• GdfdQB/Cdff10R '
W CENSEUWFORTHEFOLLOWYJGREI�SON�SEG7mf.5HU5WES5ANDPROFE55bN5CDDEANTGTYOR (n
U COUNTVWHICHHEOUIRESAPERMITTOCONSTRUGT,fLTE0.�MPROVEOE�AOLISN,ORREDAIRANYSTRUC W PdIiOI�BCk
W NRE.VRqF TO ITS ISSUANCE.AL50 REWIqES T1iE APPLIGWT FOR SUCM PERMIT TO fllE A SiGNED W
2 STATEMENT THAi HE Ofl SHE IS LICENSED WRSUANT TO THE PROVIS�ONS OF TME CONTMCTORS Lb
� LENSEUW�CMAPTERY�COMMENCWGVA7HSECTION7000)OFDIVISqN30FTHEBU5ME55ANDCR0. LL POOI/SP3
FESSqNS COOE)OR 717A7 HE OR 51/E IS ExEMVi TMEREFHOM AND THE BA515 FOR THEAILEGED E%EMP•
VTION.ANYVIOIATqNOFSECT10N7a11.5BYANYA7PlKANiFOH�PERMITSUBJEGTSiIiEAPPLIGWTTO z Re-ROOf IOU •
A GML FENAL7Y OF NOT 1.10nE TNAN FNE HUNDRFD DOLLMS 115co1.1: " -
0 D�ASOWNEROFTHEPHOPEFTY,01iMYEMVIOYEESWITHWAdESASTHEIHSOLECOA/PENSATqN, O �mercial '
Z N7LL DO THE WORK ANO THE STHUCTURE IS NOT INTENDE�OR OFFEfiED FOR SAIE(SEG 701�.BU51• J
NESS M1D PROFESSIONS COGE:7HE CONTRACTORS IICENSE LAW DOfS NOTAD7LV TO IN OWNER OF
� � FRODERiYNTq8ULLO50RIMPROYESTMEREON.ANDVAfODOE55UCNYIORNH:MSELFORHEfiSEIfOR m
CL THNOUGHWSORHERONMEM7lOVEES,7ROYIDEDT}NTSUGINAPROVEAIENTSMENOTPI7ENOEDOR -
w OFFFAEDfORSP1EIF.110wEVERTMEBU0.WN60RIMPROVEUENTI55olDWI7wNONEYEAROFCOfAPIE•
0 iqN,TME OWNER�BUILAER WILL HAVE TME BURDEN OF VROV WO TF1AT HE OR SNE 01D NOT BUUD OF
Z IMPROVE FOR TNE W RPOSE OF SALE� �
_ ❑4�OWNEROFTMEDROVEHTv,AAIE%QUSNEIVCONTRACiWCW�tMIICENSEDCONTRACTORS
� TO CONSTRUGT TNE DHDJECT(SEC 70N.BUSMESSAND PfiOFE551ON5 CODE TME CONTAACTORS L4 Y01U3t10(1 ND.I.AREA
W CENSEUWOOESNOTAGPIYTOANOwNeROFAPFOPERTYWFqBU1LD50RWPROYE57/1EREON,AND
� VAqCONTRACTSFORSUCHPRWECTSMAiFI�CONTMGTOR(SJLICENSEDVUHSUANTTO7HECONTiUG pUANTITY � DESCRIPTION - FEE �
Y TOFiSUCENSEIAW.j.
¢ p I l�e ExEUPi UNDER SEG B.6 V.C.FOR THIS REASON � �
�
Q
LL" OAiE ONMER U - • .- . . -
� UCENSED GONTRACTORS DECLARATION � '' �
� . . . . w
IHEFEB7PFFIRMUNDEHVENAITYOFPE0.IURYTHATIAA1lICENSFAUNDER7ROVI5fON50FCw�DTEi1 � �r
d Y(COMM'eNCWO N7TH SECTION 7000)OF D�VISION 7 OF TNE BUSME55 M10 PROFESSIONS COOE,AND� Z
ye 1/YLICENSEISWfIA.LFORCEMIOEFFfCT. m
��] �
� LICENSE CUSS � � UC.NO. ' ✓ J
V DATE -I Z � � CONTRACTOH a
W
� WORKERS'COMPENSATION DECWiAT10N a
= U
� � 1 HE EBY AFFWAI UNOEH PENALTY OF PERIUHY ONE Of TME fOILOW WG DECU�FUTICNS:
� Z
� ��IfNYEANDtYiLLAWNLJNACERTIFIGTEOFCONSENTTOSEIGdNSUREFORWMKERS = ' "-- " -" "
� COMPENSATqN.ASPROYWEDBY5ECT10N]7a00fTMEL180RO00E,FOHTHEPEflFORMFNCE W
OG TME WOi1K FOR WHICH TWS FERMIi IS ISSUED. �
� _ '
W _INAYEANDWiLL11AINTAINWORKERS'COAiPENSATIONINSUFLWCE.ASREWIRFDBYSEGTqN
Q ]7000F THE 1.A80H CODE.FOR THE 7ERFORMANCE OF THE WORK fOR WHICi1 Tw5 PERAIIT 15 ����
lSSUED,AIYWO�FiN7�ERS'COMPEtISAT��/,IN NGECARRIERANDPOLIGYNUMBERIIRE: CONSTRUCTION
¢ URRIER�l r/R�� F"��. .
� , PLAN REVIEW
Zvacr�w3Er( � � ` EIECTiiIC - - . .
d �
Q (IH�SECfpNNFIDNp7gE(AI.q.E7maFlrEaERN�sfnRa�IEHLFortEDDaU�Rs(itao)oRtfss} PLUMBING
Z IGERTIF'!iMAi W THE PERFORNArvGE OF iNE YrORN FOR NMICH THIS PEHAIIT IS ISSUED,I MECHANICAL
�J SHALINOTEUVLOVANYVE0.50NWANYMANNEfl50ASTOBECOME5U8JECTiOTHE
� WORKERSCOMPENSATIONUWSOFCALiFORNIAANDAGREE�TIFISHOULOBECOME INSPECTIONFEE -
SUBJEGTTOTMEWORKERS'GOMPENSAiqNPF�V�5qN50F5EC710N]7ooOfTHEIABOR ISSUANCE � ` �1 /S. �'`7
QCOOE,ISMALLFORTMWITHCWdVLYYn THoSEPROYI5qN5. ♦ -
p DATE I z_� APPLICAN. SMIP ./ro _
� ENERGY P/C
WIANINO:FA0.URE TO SECUREKOFKER ENSATqN LOYERAGE I5 UNUwfULAND 5MALIBE `�
��—y SU&IECTANEMMOYEHTOCRiA/WAL�ENALTiESANOCMLFWESUPTOONEHUNDRE0T110U5AND ENERGYPERMIT n��.���!
DOLUFiS(Stoo.000l.W ADDiTION TO THE CAST OF CAMPENSATqN,DAAUGES AS PHOVIDED FOH IN
� � SECTION37oBOFTHELABORCODEP7TERE5T,ANDATTOWJEY5FEE5. RETENTIONFEE:- � �
W CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
a..
O ,
� IHEREBYAFFIRMUNOER7ENAlTYOFPERIURYTMATiMERE13ACON5TRUCTIONLENDWOAGENCY
d FOR THE PERFORMANGE OF iHE WDW(FOR WHICtI TH45 PEFW�T IS ISSUED�SEG 3oY7,GV.G�. ,
�
� LENDER'SNAME
F_– IENDER'S ADDRE55" /�
W IGERTIFYTHATIMAVEREADTHISMVLICATIONANDSTATETHATTMEABOVEWFORAIALqNISCOqRECL TOTAL FEES � ! � v O
� IAGREETOCOMPLYVATiIALLGiYANOCOUN7YOR�WANCE5ANO5TATEUwSREUTWG708UMING �
� CONSTRUCiION,MiDHFREBYAUi1qR12ERE�RESENTATIVE50FTWSCOUN7VTOENTEHUPONTHE '
Z ABOVE-MENTIONEDPROPERiYFOflW5PEC710NFURPOSES. COMMENTS
� t��l�� R- e�c�r�2 coNS7,
m iF �i ENAIAE(PWNT�
� �v-�-�
N _s�c aE e in t , ti o�rE_ -
_ •- . . . _ RECPT.NO. � PPJD BY VALIDATIO
~ WHITE—Departrnanl Copy,YELLOW—Finance Copy.PINK—Assassor Co GOLDENRO�File Co GFEEN— , ,
- -- PY• PX APP�icant's Copy ,
,',
_
., ,. . ,. �, : , _. :- , _ .
� - - - -- - --- - -- -- -- -- -— -- -- - - -- -
_ ._. __. .. . _. - . . , .
, . - - '- .. . - . (��p\
� ,.. - -- - \_
. �
-• �
. . � ' -� � , ' , \"
. .`� _ - - - , - ' \
� ' _ �-
_ "� `:il
� ... . " e ' _1 . , '_ � `�
. -' r Z � -
o -
<c
f' � Q W J
!' �,Q � o � � O Z p ¢ � � (7 � Z . � _ ' �
�c (r . ' � U � Z m Q W ? � U � � Q ¢ ti � .
0 � F- mo o � m � m °' Z Q ❑ � Z � °' Z . u7aZLLda ' a ' -
; Z W O � o Ov � oozoc� � ¢ wza � Oc� a � z � W m _ I'
:. �� -, C3 lJi t�i m z O ¢ Z �` �ry � w Z W F= z a O a � ul �"
�_-_ O OC . I � w ¢ cc5g � om � = x w � � rawUWni Wm rLL } � -- - -
Q W W n. d' m J C7 U = J J J (�7 U J � F- J T �:S i . _ ' � " ' ' '_ � . _ _
i.. � Z � d � � W W ' '¢ W Z � � O O O LL � Q Z � Q LU Q '! W �a' � _ i
. .. "'"_'._ "' "__'
' a�Q � = Z Z Q � � � Z � W O Z O O O LL W z < Z 2 W W Z �'� _ _ _- _
�� � � lL lL � � LL IL � CO LL n. O] CL LL a a d � ❑ LL =7 Q LL = O W '
�:: � LL (� �
i+ O a _ , _
;: � z I fi� _ - _ _ -
U �
.: i -
i� _•\
� �� - �� � !'. �
� .i �� `'= .
� j �
���' � �
f: '\ � i �`
a "' _ � ,, I I I c -, c�' ,i,
„ .t. '•.r '„ I
� �
� - � z �� '
, O
i u � Z ;�'�. Q ��. �� F �-._ -- O ',� - �j I � . . N�
' e I-W- � [0 W Z J I � � z W Z O ~ Z ' V � �� (n N
�n o � � zr- z � m � � 5 � ' c� Q z tn Ycn
�: i � ¢ � W W_j'r W � F= c� � mo � ¢ x � � r= z F m F- ' z
� � ao ¢ a WaW � � � g � Z z � w � t= U � Z ' ,- ¢�
Y Q U Q � LLJ W Z > W J J � Z J Q F- Z Q W 7 W � � F-F-
;. o ¢ O�.z C7 O x w a � = cn
� r � owJ J ��
�! a � QZ �,yn. �.v� zUxxxwyg ? Zc [cUa ¢ Uxwa. � ' Ua-'
• m f/1 U 7 fD d�W LL � LL CS U U y J — � W � d Q J J J J � ��. . F'-n.
I' . � C7 W O g,H Q Q O > > > O � --� J � n. W f� 4 Q Q Q ' a.W
� � SwQo � 0000s < w ¢ wwazzzz 0 ww
m � w c7 <n H � � u. ¢ ¢ cr ¢ �n w � c� ❑ v� rn u� c7 u. � � u. U v�u�
\