Loading...
HomeMy WebLinkAbout17415 (23) CITY OF DIAM�ND BAR �,.,._.�:� �', �'--- DEPARTMENT OF CO1�RM[JNTPY&DEVELOPMENT SERVICES ''' . _'-- I 21825 E.Copley I)rive -- ^ (909)860-3195 Fax(909)861-3117 ' ,/ PRESS `"�.�riy'��' BUILDING PEy2MIT APPLICATION _..�..�-�-'""� FIRMLY � JOBSITE APPLICAT�O PERMIT r P/C o ADDRESS �i I S ��i� �✓ DATE �t'���� � NUMBER/� # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER ��Jki�Le�' �''- ADDR L4iS� ��:�' 1�✓ ZONING SETBACKS z CITY �3y�}�!" ZIP�f��,�TEL. �.��''TG7I. FRONT RW ❑ p APPLICANT TEL. SI�SIpE STREET RW ❑ z m CONTRACTOR G � a��yL E SIDE p oADDRESS � � PROPOSED USE ear �cFt' �' CITY ZIP g�� TEL. 9�3 1 � 3�0� T � �, o ARCH/EN ! �?G G t'N/2-�s•' , w DESIGNER NO.DWEL. � NO. NO, r a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS cn cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEFEBY AFFIRM UNDER PENALTV CF PERJURY THAT I AM EXEMPT FROM THE CONTRACTDRS LI- G8f89E/CBfPOfI W CENSELAWFORTHEFOLLOWINGREFSON(SEC.]037.56USINESSANDPROFESSIONSCOOE:ANYqTYOR (n U COUNTYWHICHRE�UIRESAPERMfliOCONSTRUGT,AITEF,IMPflOVE,�EMOLISH,ORREPAIRANYSTRUC- W TURE,PRIOR i0 ITS ISSUANCE,ALSD RE�UIRES THE APPLICANT FOR Sl1CH PEFMIT-0 FILE A SIGNED W PatiO/DeCk . STATEMEN�THAT HE OR SHE IS LICENSEO PURSUANT TO 7HE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTEF 9(COMMENCING WITH SECTION 7oo0)OF DIVISION 3 OFTHE BUSINESS AND PRO- LL' POOUSPB FESSIONSCODE�ORTHATHEORSHEIS.E%EMPTTHEREFFOMANDTHEBASISFORTHEALLEGEDEXEMP- (J � TION.ANYVIOLATIONOFSECTION7031.SBYpNYAPPLICANTFORAPERMITSU&tECiSTHEAPPLICANTTO Z qe-Roof � A qVIL PENALTV OF NOT MOflE THAN FIVE FiUNDREO DOLLARS(S5oD).); � ❑I,A$OWNEROFTHEPROPERTY.ORMYEMPLO7EESWITHWHGESASTHEIRSOLECDMPENSATION, � Commercial -- WILL DO THE WORK,AN�THE STRUCTURE IS NOT INTENOED OR OFFEREO FOR SALE(SEC.7044,6USI- J � NESS AND PROFESSIONS CODE:THE CONTRACTOfiS LICENSE LAW DOES NOT APPLY TO AN OWNEP OF ? PFOPERTV WHO Bl11LOS OR IMPROVES THEREON,AN�WHO�OES SIJCH WORK HIMSELF OR HERSELF OR � THROUGHHISORHEROWNEMPLOVEES,PROVIDE�THATSUCHIMPROVEMENTSARENOTINTENOEDOR m W OFFEREOFORSALE.IF,HOWEVER,THEBGILDINGORIMPROVEMENTISSOLDWITHINONEYEAHOFCDMPLE- � T10N,THE OWNER-BUIL�ER WILL HAVE THE BURDEN OF PROVING 7HAT HE OR SHE OID�'OT 9UILD OR Z MPROVEFORTHEPURPOSEOFSALE). � ❑I,ASOWNEROFTHEPROPERTY,AMEXCLU5IVELYCONTRACTINGWITHLICENSEDCONTRACTORS � TO CANSTRUCTTHE PROJECT(SEC.7od4,BUSINESS AND PROFESSIONS COOE:7HE CONTRACTORS LI- V21Uati0n ��� ADJ.AREA W CENSELAW�OESNOTAPPLViOPNOWNEROFAPROPEPTYWHOBUILDSORIMPROVESTHEREON,AN� � WHOCONTRACTSFORSUCHPROJECTSWITHACONTFACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS UCENSE LAW.). O ❑IAM EXEMP7UN�EFS�C. B.S P.C.FORTHIS PEFSON Q - '�i V W � DATE �OWNER U Z W o LICENSED CONTRACTORS DECLARATION W ¢ � IHEREBYAFFIRMUNDERPENALTYOFPERIURY7HA71AMLICENSEDUNDERPROVISIONSOFCHAPiER � - p_ 9(COMMENCINGWITHSE6TION7000)OEOIVISION30FTHEBUSINESSANOPROFESSIONSCOOE,AND Z X MY LICENSE IS IN FULL FOHCEAND EFF6CT, � � L�CENSE CLASSI�1�..�9 �� LIG.NO. ������� � � - . V DATE I J�/��^ Q_I_ CANTFAGTO d W � WORKERS'COMPENSATION DE LARATION ¢ � � I HEREBYAFFiRM UNOcR PENALTY OF PEPJURV ONEOFTHE FOLLOWING DECLARATIONS: Z � � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELFINSUREFOflWOfiKERS' _ ¢ COMPENSATION,ASPROVIOEDBYSECTION37oaOFTHELABORCO�E,FORTHEPERGORMAN(� W Q OF THE WOPK FOR WHICN THIS f+EPNIT IS ISSUE�. � �W I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRE�BY SECTIIXJ ,. / 970aOFTHELABOFCODE,FORSHEPEPFORMANCEOFTHEWORKFORWHICHiFiISPERMITIS �o �7 t,/(',� J ISSUED.MYWOPKERS'COMPENSATIONINSUfi�AICECARRIERANDPDLiCVNUMBEFARE CDNSTRUCT�ON ��f,. � � CARRIER��'''��d�tv'�A✓l:" �i��:� PLAN REVIEW Z POLICY NUMBER��(Z��,l,��Q.A Pd,1�J ELECTRIC ¢ Q (I}i155ECT�ONNEmNOTBE�MPLETEDOFTHEPERMffISWRONEHUNOREDDOLLAFiS(SiOo;ORLESS). PLUM8ING W Z ICERTIFYTHATINTHEPEflFOflA7PIJCEOFTHEWORKFORWHICHTHISPEPMITI51S5UE0,1 MECHANICAL -���-'---""--�-���----�-- C,�} SHALIt�TEMPLOYANYPER50NINANYMANNER50AST09ECOMESUeJECTTOTHE -- � SOFCALIFORNIA,AN�AGFiEETHATIFISHOULOBECOME INSPECTIONFEE '� � � �'�', CO�^,I SHALL FORTHWITH COM{MPENSATION PROVISIONS O�SECTION 370o OF THE LABOR -��- ' °� WOflKERS'COMPENSATION LAW � SU&IECiTOTHE WURKERS'CO � P�vwirHrH viswns. ISSUANCE __�__ O {�(�q p DATE�.��APPLICAN: •+� SMIP /J _U O R _ ,� � WARNINGFAILURETOSECUREWORKERS MPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C __�//� ' � SU&IECTANEMPLDYERTOCFiIMINALPENAl71E5ANOqVILFiNESL1PTOONEHUNDRE�THOUSAND ENERGYPERMIT � E COST OF CDMPENSATION,DAMAGES AS PROVIDED FOR IN "�_ � � � W SECTION370 OFTHELABOHIOCOOEO,M�iEF1EST,ANDATfORNEY'SFEES. �---" '. '— -.... . ....."_"'_ �. � RETENTION FEE:, � O CONSTFIUCTION LENDING AGENCY PRE-ALT FEE: � i HEREBV AFFIRM UN�ER PENALN OF P,'cRJURV THAT THERE IS A CONSTPf1CTION LEN�ING AGENCV FOR THE PERFORMANCE oFTiE WORK'�FOR WHICHTHIS PERMIi IS ISSUED(SEC.9o9],CIV.C.). Z W � LFNDER'S NAME . H LENDER'SADDFtE55 TOTAL FEES �3�, f� � 1 CERTIFV THAT I HAVE REA�THIS APPLICATqN AND STATElHATTHE ABOVE INPoFMATION IS CORRECT. ' w I AGREE TO COMPLV W1TH ALl CITY AND'COUMV ORDINANCES AND STATE LAWS RELA-INGTO BUIL�ING � CONSTRUCTION,ANDHEREBYAUTfiORiZEREPRESENTATNE50FTHISCOUNTYTOENTERUPONTHE � ABO MIONED PROPEflTY FOR INSPECTION PURPOSES. � t COMMENTS - � � ` � m M E �P � Cfj / � "a � SI AT oFPERMITTE'c OAT y = RECPT.NO. 6� PAID BY� VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PWK—Assessor Copy,GOLDENROD--File Copy,GFEEN—ApplicanPs Copy .., _ ....,.. ., „ . -:.,., ; : .. � ; � .ff`_ .�. � , . � , � � a � "�'�. � ,�� ��� ����.n �w�•i a�a� §,,�� r ', , ,� a "'��..( E., • .:,� � � �;� �.� .� � �,� �. x�� � � 4 '�:..s ,� x �m � x ,q�' �.F ;,��a r'�u: �m „, � � �,.x � s� s x � t; a �d, � �.� � � ,�..f ``"'�� � t:� �. a � `,,- a i'`� � ,� y �. � p �.k �,; v�-" g..:4 � h,' m � �,.x a p %„*. � � * 5 y 1 � � � a #x" a��rp "� �F , ti�,. .e.e. .= s.�,:a„'�„� �. r .�.... a „ >-.�. ...� . _: ,. . _ � n ._ � x c:. �-.. b -. _ . x. : ,s :��.s._ x r s�.�.�. .a.m. .�,�, �� g :o, ° ., � , : . :. *.. � _ � ` ;' ..".;" . ..., . . ; < >. a..�.. . ..,.�q _�.. - � � .�. .� �. ... � - .,_ r�. ..� �i .� , 'F .... _.. '.__ ..,_............................... ..........._...___ ......__...._ ,�� . .....,,..............,_ . .._.......... _,....,...........�,._._...._ _ ........._..__._ ......,......_.._..._...............�...� n ... t I-i�q` .µ., n.;..„1 , , v 6 L 9L,v., .0 ,�...�',e .i�:'.. E � a ... ._....... ,. .._ ....__.._._ .... ,._ . . .. .__.. . . ....._ ._...._ .. . , . . ...". ..._,. " .^ .-s 4 . ..'.� �'µf s .'r . . . »..........µ�=...__._...._.:_...,.__._....._. _....._t.,......_ ............_._......,...__.._ . ....__..._.__ _....._._.. . _ ..__�__.,..,......:_ _.,._.:...,. ........_._"_ ' , ._._. .._ _ ....._.. _u.�..._..........._.,._.�,...._._ ... ___._....�.,..� t ,. :,..,� i ' ,„ l,.��:�i`�.d�.,'�..3 ��'L.�e�'a �.�.•'le. ' � �� 3 � ; :"`i ". ,��- , ' �� � � r �.;'. ' +1 .............._.__......._�_._,....._..,....._..".. __.._,.........L._....,.,._..................._.:. ,�._.:_..,__..__.._._.__...._.._.... ...._ �_. '..._...._.._._ .. � ""._ ,__.,__,........"' _'___.._ _..._..._...._....____,,,.,................. �' : r'i ,1��..y::" i �.. "�:',.ti: ^'' .�y .. _ �3 � 1��.� ii; ��: � � c .«.�� ,.t -,,:.. ... - � _....._. ,�._.,.,...._............._ .._.. __.................,.... ._..._..._._........._.,......___......__..,,_.. .,... ...__ ._ ........ ._._.,....._..__........e.,..__ ......,_..'_ .. ... .... ....._ . t � . ... .m. i, ._-.......__.? t�':',.tf�'g � �`*£...:� i _ ` a',,, ��, f ,_ _.._ __.____._. ._.__ .......,.... .__ ___.,____._____ _ ___.__..____r..e._ _. ._....._�_._._ .. ._.___ ..__.,....._,r__.._„._..__._._____ .._ � �,#F.�.m ;„ .-�., : ' � . :�� ;, : i �...... �.�». ... ... a._ . _ ........ ....._. .....:..: _ .. .. �.__ __ .�._... �......�_.. . . ...... . � 1 ��_ 3 y . , d3 � ��t��- � �� -� � � .___�� /� D ' < �" ' '' i I � .��'�Pi .,� � a:- a P a�( .. . � .. . _ � .. t , ;i ��. x .... . .__ .... ... . .. - . tl f% r � t .... _... ._....._.. � .�:: ..__ � ���...y x- €& �� (4Kd�l �, � ° �' ' r -� _.__�___ _ .__... ..._ _...._.___..._ ............____.____._..._.....__..._.__. _ ; „„�.. ._.. .�..__�___ _+__.„. . ��� ._ 3 €, i i " �.t ! �w"' � .�'. ? ? 4.'.�,, � ,�_ •a _. .,..,.._._.___._ .n _......_ _ �,_ :. ..__, _.M . _.._ _._._ _ _ � r'� E i=�._!. Y ` ' •, I ^l (1 : .� v„._, �..�tW a . , :.. � � _. M ._..'.. :_._�_„__ , ....__..__._ .......___.._.... € __ _. _ .____ --._. ____,_._.._.�__......__._ �. ._ .. ' _ <m c € s � i _ ' h � ..,� t =. �. ,.>r� € � � 3 ' i ,� _._._._ _._.._.,_._,m____._.m. . , ._..__w.__. . .__� .___,,....__., ___. ...... ._._.._�__._.� __..._____.___.,___ ..., _ & ..._... 4.�.k€ ��� ) 8 I. Y" .�. ... . - � &..'s'� k � S ;. t. j t'. . i _ � ..... _ .. ..�_._�...__._.._. ... . .._..._._._..._................ _.,.....,.._._ .... _ . ..,....__............._ ........_......_..___. ....__�.._.,._,,....,.._..,...,..........._..,._.� a ' € e i � se�`,; i - � �.'�� €- �n t : � -: 9 J i � € 1 � a � .. _. _ _.__�._. ._.�. ,_.�_,_.. ... ,_... _ i _ _ ._ _ . . . . __�_. . ._.�__ _ ...p x'� ; i....;^ � �, ,.._ .. ... ��"e.<�e n. 3 6......�€._ .. ...d Qa : � E-s �Z.: �;� ...... �.., .,.... . �_,..._...................._..._..._ .�_......__..................,,,,..._.........,..._.............�.,.... � .....__ _..�___..... ._._ ..............__..,......_..... .._..... . .«..._......�.�_ ......._..._...�___: � � :......_., .. - "_._. I �.,��_a�II'c.. €.:'i.., .x.� .L°`.� ':.f I .. r.Y P��:.m. ;k .""?_ ' � �'a M .._.,.......___._._.'�______.__ ............._'_ ' '.. 1_. ._._........,._ _� _._.._ ...,""........__�.._,_.."__"_'"_ .__...v._..�..._�_......_... .....__.._._. .._..._.�.,,..._.. ._..F....__�.._ ..... .._...__ _.�._..._..,.__................._._��_._.__.� _ � i ''�"."*';" s s :.',i P 8 8-;. ; € ;'..6 � ;; �� �, �'; .._..1...._...__.._..�......................,.._,_...,....._.__..4._.__.: _..._ .�._......_......._..�......... � ,_�._.,..�._,_,..._........ ,_._,__._._ �. __..._.....__.....___�__ . . __._.__.___.... Y_�__._,__. _ j_ . . �; _ € ; � �_�' ,4� � . . € � P ',� R �'.a � e ..e.. ' ..... _.._. . . . .. . ...., .. ,. _ . ..._.__ i.. .._. ... .. : _........ .. . .._�._�_."_�.._ r i' ,'„, � ,�,'.� . .... .. ., . ... . I , .".i �� ' , '. : ...,� �, .. _____ .a. .��,_. �.�.._....�.. . .____� _. , . , .. , ,,._...�,.m_.......__.A __ .. ...... _..—..m._. y � _...� s 3€� �y S ,, . .. .... € ' _ ...* . m. � ..... = ___ - i- --- ---.�._..__.. .______._ � .,. _.. ._._________.�.._.__.___ F _.._�---.___ ---�__ _..� � �� .. M C ;-p; �; s i 'l � t c� ( ! {. v . ._ �....._,_ .,......'....,:._......,.._.._... .e.-.._............................_..,.�....u.�,.,.....,................., ..... ._. .._ ..__..._.e.�. _....._... ...... . .................._..�...�...�._...._.�..__........ ..�.____3 �. f. ,..E^ . .E.» _.,.,�.,......_,�._................ ..... � ���:'f. �j�. : . � i'az t ��-�' t 1, � ' i ' �_. _ ..,.�_.___._._..._.................,........,..... '.__....�_._...... ..,................__.,.,....�,.v.� ..... � ....._.............................. ...._�___........_...._.__..._.�..�---� �..� r...._�..,��" ?.:" € '�`.�.. . t''. �..., ,. , ..'. _t'.�._........ __..._. .... , 1 _. _._........._.._...._-(-...,,...e._._...............j.......,.._.__..._.�.._.._,.........,�...........,...... .._ .. :___._—.___.__.__ ....'___�_._ ............._ .._...._y .� .— ....... . F 2 te''a �'� � � _ ' { € . _ e_. __- --<_ __._,_ . � ._..__.___ __,,...,___........ _ __...___.__._. _..... . .. _�__.______�_ __..._..�_ ____.. _..._�._,__.� � a��°�.'.. __t�o'rb �-;,, ' i .: f',,E.` " ' ., ��?.. ;,.,.._......._�..._............::................_.�,_., ..e..._.n_..._...._._.._.._._ ............._.,._..__._.._._.__.�.._�...�._........ .'�__.._�...._:._...__._�..._ _ ........_..__........_,.�_.._..._._..M—'-- ".` , a, ....�............._._. _._...._...._._.._....,._.._..._........__......._.._..._. € � ....._.. .._.._...,.. . ;,...».�......Q:__.._._..,......._..,r, ...._...�... , . .. . ... .. . ..,.... p. e .� fi'"�. � a. �,_....._ _._._._ . ...___ -d - ( z�. �i p ::`m �a��z;�� n �a"a� x. �t € - '�__.�.._._.,...,_._..___......._..__.._.;�:._.:.__.... _..._..:..�_......._..�... _.. _...............__..._. ........_ ,_....�.._?..� &.i.�.a�_�'n..3��.,..�...&.r"i--'s;9�", _�, a-,a., �;,.'�: �_:. _._.. _..___.. .T. ._...__._ ..___ _- �.�.,� , �, ff�� ;: ,>'l�r�G;r �G</C'. '��,- �. a�4 � 4 w,.`a...9, ..P�.., :. . ,; .� _........ �,.._ ._...............�__.r..._ _. ......_....._._..._......�.. �.. ..._.._. _...__.._..._� ..,,. , ...,._._.._....... __.__.._.,_.......,,...,...,.........._.....,.�____.____'�__.___._._........_....a..__..,,......_...-,.— _,.._.__�.....„� � � � a _..„.�..._.._........,__........_..._.....,...____,...,.._._........_...,.._._...,........,�......_........._,_....__......,__.._....m..____._..._................_........,...,.__.....,__............_,-._..._.�..._...___...,W._.........._........ .._.. ......_,..—._T,.___........_.............._...,.,....._..........._........_..,._._...._...._..........__.1 '�.._.�.....___---_......._.............................__..._ „_r__..._. __._.,__._�.,_.----�...___,...__.__._..____.._..___. ..�,........_...�___.__...�_.._.__. . ......_.._._. ..._,.._.,._.._,._.__....._.._.�._._�_�.��—'--- , .._.... ... � ........_....__.._____.^ § ( i�'�._._...__.,.,..,-___......�...�...�.....__...._,._...-.._.,._,...,..,_.....W_...�.._.._....._...._..,.......__...�_.__..__..._._.._.._......._..__._._._,_,_..._....___.._....._... .._...__..�.,........._._,. ....:._.._.____...__...�,_._._�......................._....__._.._..........,........._.. �: ...._._....____..�..--� 1 P �._.W_,.m ., ..__........._._._�_.__.�. _____- - ___ _._._..____ _____ ----__ _. �..�. _ ...._.--._.��___v�_�_ .__._----- - � --�._------- ____�_. ',___._.._ .__..____._.__._.�._ __...__._�.__..__,_..��____-.--- ._..._______.. _,r., ,__�._.____._.._._._.._.___._._ _....___._�._..��_ _._______.._�__._....�_.___.__._ �r�'d�� ,., �':�� o- a"",.. j @ - _ � . ..... , _._.____..__.__..___m,._�..__._._ .M�_.,__-.___ _._._ �. _ � w �Y .» __.___.._�_._�._____. ._.________�._. ._....__..__�._____._..__....�_.. � >.. ,.m.� ...__________._ ___._._�...__._.__�._._.....__ _.. r �� i � �����,��"��$a t e��+*v�s�� �„����, _ __ . . ___ _ _ ��,��5����t &� � ���.��� t� s= � ��� �������''�^� ��'a ���f�a�;� �aa,�� ,,w�rk�- t �k�.��r$ i'� �.,�w �c� a��a m "s a�� ___._.,_..................._...._............_......__.._.._._...._._..,....._.......,..__ __.__..,...____,..._..�__..�,.._ .._........._._............._�._._��,...__..__._._._..._.�._. .......�.._..._.__ ._.,, � ���a���� *��a��"����a���*��"��������"�� � ���������a�,��i�g�s�:"�. ������•� _.v __.�.__ _.__,,_._.__..e.�._..._..... __m,__.__M_M_..a._..__...._..._.____K.___._.__...._.....___._._.__. _.... ____ .__�. fi r�,��ei�o����a�a��� �5 m��1�d�,� ��� �� � d # 3� If.r� .r � r�.� ��',�,°��.w� �" �s�..i - ' h,�`�`��,8,���p'r�.�:�',na4�6� &���.°ix,�� �.��`.ip.; ..,,....,......._.,�_.. ..� ...._...__.,_.... __...__._...,__.._.____..,._..._,_.__.._.._...._...__....�.. ..._..__.._.....,.._„M,,._......._.........._...,,......._...._....._....__..._.......... .... .............................__._.....__'_.� ��'��� ���'�� �r ��� �a a,� p � ,��a:��� �r�:r#��,���������a��"� _..___,._M_.___,._. .. ._--------�__ __....__.._. _....---__w._.__..__.__..__�__.____.__�._ ._ ___...._.....__,,.,.., ._ ,$g �y��������.5° b&4�8a���,.k����3��%r,�P - ....._8 �,����'�.���*..� r�4�'� �r a������ � g �,������ ������� k'�&��i' r�.�,. _.,.............,.__........_,..__.._...__........................_......_._..___..._..�_.�_.,__ �?a pt B F .�._.�__._.._,_ ... .. . .. .. ..... ._ . .. . . . . : . . .,.. -P �`��.�a�4 +��"�"a� :rg�w'���a��W�w a�,��; � � � ��."�&���d.e �����"����a& i ai re x..rk.��..�.����'a+�..'��':� '� �'�'.::� .. . . . . . . . _ . ._.., . .. . . . .. .. . ,.A�._,..�.,..�,m.._.:_.��:_ _n.....F.....,. ....�._...........................�:...�.yv�.11_,,,,,,.......:.,�. ..�«�,ffi,......,<..�.n...>....�.:�....o..�,.,......,..:,..,..::,.e= e>.r,,.,. ,,,,.,.:_,.,..,.m._..,m.....�:.�...<..-..:,...,„..�....-.:.,...:>.-».. .......,.»-..�,,........�...�.....w,.,�..,,.-,..�.,..,,�,,...,......�. �.,,