HomeMy WebLinkAbout12489 (14) �� � _�,` CTTY OF DIAMONU BA� � � ,� DEPARTMENT OF COMMUNITY&D�VELOPMENT SBRVICES '�� r,�`3 ,; 21660 E.Copiey Drive 5uite��96 : . , ", ', ;;f '` � w (909)860-3195 Fax(909)861-3117 / �' PRESS ""' BU�[,Dnv'�P��rr Arr�.rCA'�'iO�t " , � � . FIRMLY � t, " �_r'' �,. .... _. .,-�:. �� �.::.�..,. t. : � � :.. �SSU{E,�� � ///��� � JOBSITE APPLICATION �` ERMIT �-/rIC , „ . o ADDRESS DATE ` � NUMBERC � � '# c� TYPE OCC APN LOT TR DATE CONST. GROUP � OWNER !` O ADDR S ZONING SETBACKS � CITY IP TEL. _ . . REART � ❑ APPLICANT TEL.. SlDE/SIDE STREET RW ❑ � CONTRACTOR S1D� ❑ � ADDR PROPOSED USE � CITY ZIP TEL. o ARCWENG/ y� DESIGNER NO.DWEL. NO. NO. N AbDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL, � DESGRIPTION SQ.FT. FACTQR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION . .. � , , SFRlADD/REM ' p I HEREBV AFFIRM UNDER PENAl7Y OF PERJURV THAT I AM EXE�NPT FROM THE CONTRACTORS fA- G8t89BJCerpotl � W CENSELAWFORTHEFOLLOWINGPFASON(SEC.7o31.5B115�NESSANDPR�FES510NSCODE:ANYCiTYbR (n . C� LOUNTYWFIICMREQUIRESAPERMtTTOCOtdSTRUCT,ALTEp.IMPROYE,OEMOLISH,ORREPAIRANYSTpUC- W PatiO/DeCk �LTUPE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANi'FOF SUCM PERMIT TO FlLE A SIGNEO � � STATEMENT Il-IAT HE OR SHE IS LICEN5E0 PURSUANT TO THE PROVIStONS OF 7HE CONTRACTOFiS LI- � CENSE LAW(CHAPTEfl 9�CCMMENCINO WITH SECTION 7W0)OF'bNISION�3 OF Y,lIE BUSINt�S$�AND PRO� � PooUSpa FESSIONS COOE)ON T11AT HE OR SHE 16 E%EMPT THEREFROM AND THE BASIS FOR THE AILEGED�EXEMP- 710N,ANVYqIATIONOFSECTION7oa7.6BYANVAPPLICANTFORAPENMI75U&IECTSTHEAPPLICANT70 Z RB�ROpf � A CMl PENALIYOFNOT MORE THAN FIVE HUNDRE�DOLIARS(t60o).�: '" ' ' '"--' � ❑4M`+�WNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSAtiDN, Q Co1T7tT78�Cia1 ' VfILL 00 TNE WORIC,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOf1 SALE(SEC.7b04,911S1� J NESE AND PROFESSIONS CODE:THE CONTRACTORS UCENSE lAW DOES NOT A7PlY TO AN OWNER OF � PROPEHTVWHOBUItDSOR�MPROVESTHEREON,ANDYVHODOESSUCHWORNHiMSELFOYiMERSELFOq m � THqOUpH HIS OR NEHOWN EMPLOVEES,'PROVIDED THAT SUCRlMPqOVEMENTS'APE No71N7ENDED Oq O ,OFFER�FOHSALEIF.HOWEVEFi.THE8UIL01NGOFIMPROVEMENTISSOLDWI7WINONEYEAROFCOh{PLE� TWN,THE OWNEH-BUIIDER WILL HAVE 7NE BURDEN OF PiiOVING THAT HE OR'SHE DID NOT&)IlA Oq � IMPiIOVEf-0RTHEPURPOSEOFSAIE� � "'� � '� � ' ❑1,AS OWNEROF 7HE PROPERTV,AM EXCLUSIVELV CANTRAC7ING NA7H LICENSED ChNTRACTORS � TO CONSTRUCT THE PRO.IECt(5EG 7044.BUSINESS AND VROFESSIONS CO�E:'THE CONYi1ACYOqS(4 Velu8tlotl ADJ.AREA W CENSELA�ND�ESNOTAPPLYTOANOWNEROFAPROPERTVWHOBl11LD5DRIMPROVESTHEREON.AN� Z WFI000N7RACTSFORSUGHPRQ/ECTSWIhiACANTRACTOR(S)IICENSEDPURSUANTTOTHECONTpAC- QUANTITY DESCRIPTION FEE �� 70RSUCENSELAW.). ' � ' � � ❑1 AM EXEMPT UPIDER SEC._ B.&P.C.FOR THIS PE0.50N Q J _ �=" DRiE OWNER Z � LICEN5EDCONTRACTORSDECLARA710N - � ' � IHEREBYAFFIRMUNDERPENALNOFPEH.IURYTHATIAMLICENSEDUNDERPRO'JISIONSOFCHAPTEA � . d 9(COMMENCIN6 WITH SEGTION 7000)OF P�VISION 30FTHE BU5INESS ANO PFOFESSIONS CO�E,AND X MY UCENSE IS M FULL FORCEAND EFFECT. ' LIJ � UCENSE SS UC.NO. - � OATE � � CONTRAG70R�- � a w ///: ��,�� � � WORKERS'COMPENSATION DECLARATION rJ�e-y Q � � �/ �d'1 � IHERE AFFlRMUNDERPENALTYOFPERJURYONEOFTHEFOL!OWINd�[CLAYiATIONS:"' �. �( (+''� CP� - I_O __IHAYEAN�WILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ COMPENSATION,AS PROVIDED BY SECTION 37000FTHE LABOR CO�E;FOR THE FyERFORMANCE U 4 OF THE WORK FOR WHICH TM6 PEflMiT IS ISSUED. , � � � �1�. W _I HAVE AND WILL IAAWTAIN WORKERS'COMPENSATION INSU CE.AS flEQUIREO BY SECTION n 37000f THE LABOIi CODE,FOR THE PERfORMANCE OFTHE RK�OR WNICH TNIS PEFMIT IS� ISSUED.MVWORN S'COM ENSATIONIN tlR7�IG�ECARflIE ANDPOLICYNUAAB�RARE� �''{ CONSTFIUCTION 'J � 6 7 CARAIER � � PLAN REVIEW � POLICYNUMBER � ELECTRIC , Q Q (fNI5SEC7%]NNE�MOTBEWIrPLE�EDOFhEPEFUMISFCFiONEHINAREDUJUARS(51oo;�ORlE55�. PLUMBING � �ANICA � r � i CERTIFYTHAT IN THE PERFORMANCE OF 7HE WORK FO�'NHICH THIS PERM ISSUED.I (3' SHALL NOT EMPLOV ANY PERSON INANY MANNER SOA TO BECOME SUB CT O THE � � WORKERS'COMPENSATION LAWS OF CALIFORNIA.A GREEyi T IF I .OU 6ECOME INSPECTION FEE SU&IECTTOTHEW6RKERS'COMPENSATIONPRD NSOF CTIO 3�00 FTHELA R � r' issuANCE , � � CADE.I SHA FO W TM T ROYI510 r �,,,� � DATE: '��P�PPLICANT . �.� . . SMIP YHA YT � / '" ENERGY P/C � WMNINO:fAILURETOSECUREWORRERS'COMPE ATIO4COVERAGEIS LAYdFUL.ANDSHAlLBE � Sl9&IECT AN EMPLOYEfl TO CRIMINAL PENALTIES AN�CIVILFlNES UP TO [HUNDflED THOUSANO ENERGY PERMIT OOLL ARS(57 00,000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES A5 PROVIDED FOR IN �'q(� A/� /� J SECTION 37oe Of hIE LABOR CODE,INTEPEST,AND ATTORNEI^S FEES. RETENTIOPI FEE: B B I.T 1 � f 4Q7'f � —P�v_T--.4 q _—'_'_�_— ,p CONSTFUCTION LENDING AGENCY PRE-ALT FEF_: � IHEREBYAFFIRMUNDERPENALTYOFPEitIURVTHATTHERE13ACq�ISTFUCTIONLENDINGAGENCY �LTV I1Fi T,TA��_�� FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUE�(SEC.3097.CiV C.). aT�a'��-�s' W rr_ �* �"�'�' _ � LENDEFY5NAME _ ' h- LENDER'SMDNESS --� [� � �,/f �� wIGERTIFVTHATIHAVEREADTHISAPPIICAT1ONpNDSTATETHATTHEABOVEWFORlAATIDNISCORRECL TOTAL FEEa7 . . . I i 0. I AGRE'70 COMPLY WITH ALLCRY AND COUNTY ORDINANCES AN�STATE LAWS flELATING TO BUILOING CONSTRUCTION,ANDHE(iE8 Al1THORIZEAEPRESENTATIVE50F7HISCOUNTI'TOEMER�PONTHE � PBOVE-ME TKKJE�PROPE FpqINSP� 'u^POSES. COMMENTS p � ' � i�� . . . _. . .. � m EIPRINT � � � � � OF PEFOAI EE �ATE � , S RECPT.NO. _PAID BY _ .� VALIDATION r WHITE—Deparlment Capy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy . . . �-..�.:., .,:.,,,..� �y,r.: r.`<�_�-.v�,.x ...-.�:,;,.. ., , .., � .., . . .. . r . , .. , .w a-..,. 3 �.�.,..r'V '"..e i��.ti�... ..:� . '.'l . ..:. . , " 4 ,. .. `M::'.':! M S���.:.. y.i��. ,:: �.�::ti � �...xi"'�M� `SA'..iK , �,r.u���R ., �...n...r\% , ••lt., ��`�'�" � �� , : ��, . � ���.N �: .� .'. ." _ _ _ ... . .:,. ._ _� ..,. .. , . : � � ��� � . � � � � � ; � : � � .. � � . � �_``� ���� _ , _, , �-������s��f--- .. � � � __� _.____..� i �. rq za-�c-� � . . . i . ._ �._.,.�_. ��� {. , I t �'i�t"[,.� .:,r__5_. 1 � �'=F'� �$. �'3��' 1, ;_._�.. ._ _._._y_._... _ _._a.._..__� ... .__._.r_ -- ••- _ _� , � � �-L� �., t-"$�a���'�'s''�`�-' _. !',� � �_�_____ 4 �,�;��F' �="��s�.-`t��.���` �� ' �� € �s .,-» � - � � �—_. � t _ � .�_.._. . .--- , ���"� � � €�� ��.: 1 � �,�t���� �E�C�?���'J€�1�?s t�'t` ' � -�___M_. , ..�... _ ._._..� ; ._.w.�.._�_�___._ x�_ _ _-___-- , _P ..�._...._.__� ��`°��_.a�r�3"",���;���-� � � �!�c����:�F�'?l;;'?�:��'l���a � `�`� _��-----._..�.e�.�, , � �� 1___ __�_ �:__ .___.�.�� � �__ r , _ �E`"�-' F`�1�f��-t , a Fs�€=�"..r`�E;s~°���'dt.������r� � � __...___--- �m___ . --- . __ i Q��t��� t 4 �°: �r€c�'" � : Rlt L� -?�. ��'���k�r�iP� ^ ___ . �_.. ..�_� . �� � "� � � ��� ��3 i� �=a� �-��,�� �__ __��._..� 3 P;� ` ��}�€�,���.4v� _ ._ - - ,..«..»,........ .. _.�.._...._,.......�_...f_...�_ ...�..�... . ,m._. � � f.______.��..._._...__A.._..._....�_ � ;�,�����!��ai"�c�''�t����"��`�(-�� j � °�"�����'.°`_:�Ed� ..��°<�h� � � � � -�-- ___.-_� _ _..�__ � _ _ -�._____ _ � _.__ _. _. _._.........�—_______� �_ ..�._ � ��:��r � t��: � ` � ���a� ,.����at�� ' �_ �� �a�J��3-" "��-�' t�a� �/�� �`h_� � -- € j r��ta��€3�� � �� ___._.�__.�_----� � �� �--��✓ -�� __�__.__._._.._.�� �___{_.�.�_. �. ___ __ ---,.,�.�. .._�.� E �`��; � 4--€ �"'' � "�"�ad� � i � .P,�`�.7��l��d"�'E?s{�; ? i _.y___M_ ._.__� _�� .....� .___.�.__�__..e._ � �'t�O: r'�AB"�.t'n�€zar,+.��„v..e.�._ � __..._._..-t __.__......_��.��...�..._ , � �`(�1!����,.�.ai'�6a�.rr�ai.< �#� �----�� � :,a r,a ___W__ ._ _ . __ �, � ��'1�`'�;�"a�I`�. t� ��""��°'.`� 1 ; � ��'%:aL E`,[_�3,:i�I��.: --_____. " , �.�.. �.. _ �_�.�___...�_.� _ _._____� .� ____�__.�.__._____. r� �� r:r� .-� �. .: ± � F���"t �Ei°v�.€��� � — __ __,__ ____ __._____._ � . ��� _ __ _.. � t �xs��, � ���� �� 4�� � i . � � ��+� ��€V�s�_ ----�-.._. �..__ �. _______ .._ �..� �7 �_ [R g.� Sx w�_ � 8 �'�y^,€i �#'k4 �� ��.Sc�-e^�y°^v',nS1� ! I � � 4..1�& �,.?�E� �€c�E�a.�.. f _ tl_...e....�..-.-�-,....,....._�..e..�.. � �..w ..«-- .._�.�-.�..a -.,... 1 p�'9L."; xv t - $� � � I ' �• � .�-rt r s+ T€..�"..` ..__ ..___. G &ts'�. �4.1^SSs... �..� � I ..._.�.L. l' ��ra� ��eu _____..�....-_......�.! ..�.._ i . .. ...�.�... _..._.. _ . .._.___»_..____-'--..f.—.___...._... . �h � _ # ��.,��?YF�'W�; � I Y»j�`u. � �,�°tl."d. t ...� ��_ �� ._� .............._.-«_...� .._-__� _-.._.,.��,:. _ ._.._. ,........,.,. _.^.....�.._ .,.�p^��°g�a.� �a . q _�..��. € _ .. ___.._ i `�..`Ha:..z' s� 3Fat¥8��. 1 ''". ( �.m�'"4`s�';:,.�vL^f'i''`CP�, '{I"'SS{'�:< ' ( ..,,.. . �.µ.�... . . 7 ss , ....._,-..;.__.._.._.. ....... __._... a..�..,.._;I ..........,.. �.,...��.�.� __ ._ .__._ { _..... _.._ ..._.__�__..�... -�. � � ,�„�ti:• 4z�:a��J�_ : � I ;�.y &�i-r,�g .r�� � 1 i_.. . "."""B � �g p.q . - .p _ _�.�.�. _..�..,�.n.-..... _.._._._ ? _,___J ._.m. � "�i_ � �.t�i.� 'C't 8KKp^.'8'T.__Ty_�___.__a.4� .a._ � ..,. _...._..... .......�'�� , ��-aP ��t.✓�t( st�� � .�_.........�......�.....__�..__ .wnE ¢ �� � �� � 2�� � .��, � E a-6� �s ?�� �s��;�; � _.._._� �._ � __�_,���, �_. . m.._ ____ .� t i ?`�1�!'�:', tl���`�r''. : ; ... �°i��? ;-i .";�-ia i !;`.K[�,5--, _._.i_ _._,___ � �. . .� �. �... _ ---� -�' � - �__.__...__ -� , � � � �—,;. � � , � � —��--- ----- , __.n_w__ ____.__ � ��� �-� v ��sa.g � � , E���' �=���i .�? �_��.__�__ ,_..._____._�.._ ._ .���._ ____. ..,..___�.�_�___.__ �e_.__ _e.____ ___._..__._ .__� _.... ._____..._.. ��.�_ .,._ _�_ _. ���� � x � i � c �-r .�,� _. ._._.�. _ ?'°c��---�- C..a..� t� ""�� d i ; �a 4... , �__.._,,._......._ . :____.._... �....�.._ �.,.... x_ _.._.. .. _ . . :�___..,�„......,..__�__..____ , � -..�--- ..�..«..... �,.....-,.-.._...�>i_�.. 3_ �� . l.r :'.. � A...' _.............«............ L J_.._..__._._........... _.... < • ____�....,.,�._. _.�.�.�............._ �_....._: ..� n� .::,�„ .:. _. .. .� „�._.�.._.._.�,.. � _.. ... ..:..._. . �=_ . . .. .,_:._ .. - -:--._.'----� .... �_.,,,, r._Y... � � . ....... _ . -.._... � ,. .�:�-, ..__.. __�..:. ._.... _ . . .�___-,_ . _<.,...,-c. _-.� - f:-•-._ . ._-. _._. ..__.,_..-._.�5 �.'`���1Ra.��$'.i $� .'_..�. ' '. ' � � ' . ,._�� , ,. ... . . .. .. . . . . .... __ __... __._. i �,��� }_.._._ ! _ __._... .w___.m.,�a_._. _.__...... �._......... � . ,�y,� �. , , . �_.���� .!.`..'.....�_..f..V'af.� � o�.•`�'�s._....,.....�.`�'7---�uli..�.,.,.�'G�'f� ��'����� . _� __ .�.,,.. .�.__"______.—_.____.._ ___� � ,�.,��..�._...._ . . ... ....r _., , g � - .... .� . � ... . � � . .�. . c,......».,..�..�.».,.....».:.w ,. ___. a� ..., .. .,. . :. ... ,�:.. . j . am�._._._�..,.......�. ._.._.m�,..,...._.,....„.� .. . ,..�:�_-.���..�_ ��...::.`...m_.��._._.. � ., ,. . , �.. . .. ... , , . .. s � . : .. .. . . . ., . .. � . ... e �._. �._.....�....:.._._._.. r_...._..._..�__,... . . � � �� .. ' . �._....__> .._.. ... . . .. �% - , . 'k �..».�....�. � r� �� ."��-� �...:....«.......,..�r .,.m_... _._,�..�._»�.�..�.... _._- .. . . __�..__���._ .�._..»...__.. � ._._.._.-�....�..�,.,_.�_q` _ 3 �,-....__.r_ .....r....,_..._,.."__...��...,m. _ '". .. . .. . , , ., . . .. . � .. . , . ......--...._...._�. --.__.9 �.".-•---�_.....�.......:......-�-__..,..,.�,.__......,.�.-.........,..�,..._.�.........�.... ....M......�.-___._...._.....,"___. .,......»........_._.:,..,,.,....mo...e� � � a �..�, ....., . . . . `. ... , x..�,_ �..-....._.n�,�..____.«..-..__. '. .. � . . �... . _ : i : ._...w..w..-.=«.,____.__. _....w.__e.�_ , . . � . .. ' • . .a .. . . _ .. . , ._. m"'""'^"_'-..^,-� .....�,._ .� .___......_ ...._. ..... _ __.._. t�g r [ + , j ��.`?�C^� ¥sys'+� H.�: 1 ____""`�s. ; '.. �'.. . : - . . . . . . .. .. �."_. .._ _ . . . . ...._.��-...� �_.____. .. S .a,g�„ �..... .:� � i ., � : �� ' ' ���€ � b k L»k.«,� Y"E�:I{8 a✓�w�.�.,� _.._ ._ ..,�. ;'......_.. -:......�.....__...._.._ »._..._-.._._�. _.� _ "_ �....«......._..--�.._.. .__[ '. . , 1` d..... � � -�.. ._ : y x� { �� � �._...,.... ........___._. _._._.,_ ._'_ . �__" ..._.....�..... �...�_� ... �. , ., ..... �p �j :.:- a: � .�'. C Yi\w-k�„'�-^� F4�... x j�._� '�'_x ..:.. .. ^'-' ` -. ..._..e.-,,...._..._. 9i`,'r� :t� � +1i'�7�S..A4�.Jr - . .,...e.,_.�e�_..,....�............r...,.._........_................e.:.d...-.»..-......__,_.�� ._.......>......:..._._._.Y_._�. ........�.,..,.W_ ._.�� a �'' "� .:.. . ':.. . 6 ... ' �� -......_.�.___.__ .�_.........................�__•-____..__._..._.,.�_.. _.�_,_ T.� ...__...�...................-..._.....,......,........._..e,.......,e. � .. s ... .. . �:� . � . . . . ......... . ......... . . ... ... ..... . .. . ,� '... -:., . .. .... . .� .., � ... � ..............-,.�...._..........«.......�....mPe........�..,.. ...�.«.........._....,.........,.e..._....�..,.».... .._....,.�v..........._.�._ -«.....� ,..e_,..... _..._......._ � �� y _ � � � � . . , _ . � , � ... . .._______ ____.._ _........___ __ _.__.�__�__---- ..��.._._..M.m_a�__.__._...__ ...�.__ ___� , � ,. - ff � ; _V. _ �, ___ __ _--�_,._ �._�.�, _____��__. �. ..___ ..._ ___. , _...._._ , � ,. ,;. _ � .� _� , m _ __________._ __._ ......�__ _.__,.._.. � � .. ___ �tt:�.. -— �� �_ ---�- -----