Loading...
HomeMy WebLinkAbout13308 :.�. CITY OF DIAMOND BAI� �' --���' DEPARTMENT OF COMIvIUNIT'Y&DEVELUPMENT SERVICES � 21660 E.Copley Arive Suite 19(3 , (909)860-3195 Fax(909)861-3117 PRESS .;� ,, BUII:D`ING P�,''R1NTT AP1'LICATTOl� �``.". _: , , ;;;' �I��LY IT L I� CR�r ". . . ;,._. :. _ ,DATECATION v'�t_C�G PERMIT.:.����,�. ., , ,. A� JOBSITE .Z� �d � r i NUM6ER� �. #/C AGDRESS d� � ISSUE TYPE OCG APN_ LOT� TRACT DATE CONST. GROUP p OWNER �_ J)11 TrW (�( _(,�J[�__ `p AC�DRESS���r�A/4�1I� , ZONING FRO TCKS qW � � APPLIC�6�/�� �_� El. S DE/SIQE STREET RW d � C4NTRACTOR G�I�, ��,r; � SIDE ❑ QC�RESS ��_��,,H'{,� �LrZ' � TJd..__E�_f'�� pFippOSED USE �w ARCWENGI � � / � DESIGNER NO.DWEL. NO. N0. ADDRESS UN1TS STORIES BEDROOMS � C1TY ZIP TEL. � OESGRIPTION SQ.FT. FACTOR PSF ADJ.AREAlVALUATION p� OWNER-BUILDER DECLARATION SFWApb/REAA O p 1 HEREBY AFFIfl7A UNDER PENALiY OF PEF'JURY THRT I N�.1 E%EMPT FROM iHE CONTFACTORS U- GafBgB/COfPOn W CENSELAWFORTHEFDLLOWINGREASON(SEC.703f.58USINESSANDPROFE55bNSCADE:ANVCITYOR (� _ SJ pq1NTyWHICHHEIXIIRESAPERMITTOCONS7HUCT,ALTER,IMPROVE,DEMOUSH,ORREPAiRANY5IAUC- W PytiWDeCk W NRE.PRIOR TO ITS ISSUANCE,ALSD REQUIRES iHE APPLICAN7 FOP.SUCH PERMIT TD FIIE A SIGNED W STATEMEM THAT HE OR 5HE IS LICENSEO pURSUANT TO?HE PpOVISKKJS OF THE CONTAACTOfiS LI- � CEIiSE LAW(CHAPTEfl i�COMMENCINa WY@i SECTION 7DW)OF OIVI$ION 30FTHE BUSINESS AND PRO- � POOUSPa FESSqNS COOE)OR THAT HE OR SME IS EXEMPT THEREFROM AND THE BASIS FOFi7HE ALLE6E0 EREMIP� TION,ANVVIOUTIONOfSECT10N7037.58YANVMOIICANTFORADERMITSUBJECT>THEAPPUCANTTO Z qe-RooP F, AdVIL PBJALTY OF NOT MORE THAN FIVE MUNDRE�OOLtAPS�;5a0).): � ❑I.ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHSVAQESASTMEIRSCLECPMPEMSATION. 0 COAIf11BfC18I -� WIIL DO TFIE WOAK,AND THE S7RUCTURE 1$NOT IN7ENOE0 OR OFFENED FbR SALE(SEC.7046,BU51- _I N NE55 AND PF�FESSIONS OODE:TF�E CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � ' PROPF.RTY WHO Bl11LDS OR IMPROVES 7HEREON.AND WHO DOES SUCH WORK NIMSELFOR HERSELF OP � THROUGH HIS OR HER OWN EMPIOYEES,PROVI�ED THAT SUCFI IMPROVEMENTS ARE NOT INT�NDE�QR � QOFFEREDFORSALEIF,HOWEVER,IME9UIL�INGOflIMPROVEMENT1550LOWITHINONEYEAROFCAMPLE � 710N,TkE OW4ER-BUILDER WILL HAVE THE BUR�EN OF PROVINC hIAT HF OR SHE DID NOT 6U![D ON IMPROVE FOR T}fE PURPOSE OF SAIE} � ❑I.ASOYrtJEAOFTHEPAOPERiY,NAEXCIUSIVELYCAMRACTINOWITHLI:£NSEDCANTWlC70fl5 (� TO CONSTRUCT hfE PRQIECT(SEC.)oI4,BUSlNE55 AND PROPESS'ONS C�D'e:THE CONTFlACYOq5 LI� � Veluaticn ,_„� ADJ.AREA . W CENSEUWDOESNOTMPLYTOANO`NNEROFAPROPERTYN'NOWIID&ORIMPROVE:7N[RCCKi,AND � NM1IOOONTflACT5FOR5UCHFPAJECTSWITHAfX1NTRACTOR(S)LICENSE�PURSUAHTT07HLCONYRAG I QUANTITY DESCRIPTION FEE Y TORSUCENSEL4W.�. � ❑IM9EXEMPTUPlOERSEC.____�_______�S.aP.C.FORTHISP,EA50N .Qi � �� 2 � � V i� � ,� � o C�4 DATE . OWNER �,_ �I M� ` �y W t l l�°. � LICENSED CONTFAGTORS DEC�RATION � ' .�,;�;,,,,� � IHEREBYAFFIRMUNDERPENAtTYOFPEFiJURYTNATIAMUCEN3E�UNDERPpOVISIONSOFCHAPTER- 4�_v I'L (i B(COAIMENCWOWITWSECTION7o00)OfDNI510N30F7HEBUSINESSANDPROFESSIONSCODE,AND f..S X MV I.ICENSE IS IN FIM.L FORCE AND EFFEC7. ; �_ i.0 /1 (� ��(y Q UCENSECLA/55_ r�="._Lo____ LIC.NO._„�._pj�y�G/A. _ i 1r �" V �ATE,iy GONTRA,CT6R�� � W i � WORKERS'COMPFNSATION DECLARATIC�ya� I d • � IHE33EBYAFFIRMUNOEFPEtdAI.TYOFPERJURY�NEOFTHEFOLI,OWING�ECLAAA'�"IONS: � fn � L� __IHAVEANpWiLL1FAINTAIldACERTIFICATEOFCpNSENTTOSELF•INSUREFORWORKERS' �; � COMPENSATION,ASPROVIDEDBVSECTION37000fTHELABORCODE,FOR7HEPERFORMANCE CFTHE WORK FOfl WHICH THIS PERMIT IS ISfiVED. �� W _I HRYEAND WILL MAINT0.IN WORKERS'COP6PENSATION INSURANCE,AS REQ'JIRED 9Y SECT;ON Q 3�a00FYHElA80RCODE,FORTHEPERFORMANCEOFTHEW06iNFORWHICHTHISPERM1T15 1�3UED.MY WOpI�fiS'C:OM`P,E9NS�jATION INy^uU!RAPoCE CARRIER AN�POLICY NUFABER AflE: CONSTRUCTION ' CARR�ER �rH!F yJ��} P W n�°_. . _ .��_� .. 'l_s" '-"-r"--- �+ y- � POI.ICY NUM9FR � __` ___ — 2`��y�_ E . � 77-� LEC7RIC � ,_); l� ¢ ��� � T„�"" � (hUSS°CipPdNE�NOTBEW�PLEfFDOf'ff-'EPERJ.LfISFORCd�1EHU�DfiEDDOLtiViS(S7W)ORLESS�. FLUMBING ec z"�; � �CEATIFf THAY IN THE PERFORMANCE OF THE N'ORK FOR WFIICH TH'�S PERMIT IS ISSUED,1 MEC'rIANICA� _ ��_�"�;�°'a�d:�t�� �,% SHFLLNO7EMPLOYANVPERSONINANYMANNERSOAST�BECOMESUBJECTTDTNE ��� '`� t,;; ?' � WOViKERS'COIAPENSATIbNLAW50FCALIFORNIA,ANDAGREETHAT�FiSHOULDSECOM6 INSPECTIONFEE `���` � S 5UBJECT 70 TME MKJPKERS'COMPENSATION PROVISIONS OF SEC710N 37J0 OF THE LA�OR �SSUANCE "�''�;.F�.�`� ` CApE,I SHALL FOflTHWITH COMPLY WITH THOSE PRC4ISIONS �'��t 0 yM1�'n.,�'•."a.."' p DATE:� APPIiCANT: __.� . _(�.Je� SMIP ,��w y�,�,i" . � WARNINGFAILURETO�EWOHKERS'COMPENSATIONCOV6qAGEISUNLAWFVArvdsHa.ueE ENEFGYP/C ,�-�"s�r'�� LL SU&IECTAN EMPLOYERTO CRIMINAI PENALTIE5 PND CIVIL FINES 1JP TO ONE HUNDREO THOUSAND ENERGY PERMIT DOI.LARS(L10o.OW).IN ADDITION TO THE CO3T OF COMPENSATlON,�AMAGES AS PROYIDED FOR IN ----- QSECTION 37oa OF THE LABOR CO�E,IN7ERES7,ANO ATTORNEV'S FEES. RETENTION FEE: d CONSTRUCTION IENDING AG�NCY PRE-ALT FEE: O 0. I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTON LENDING AGENCY FOR THE PERf-0RMANCE OF THE W�RK FOR WHICH?HIS PERMIT IS IS5UE0(S'eC.3097,CIV.CJ. . 2 W � LENDEfl5 NAME . .'.:,.�..,..�....:... F,� LENUEfl'SA�DAESS �'') � 10ENTIFYiMAT1MAVEREADTMISAPPLICATIONANOSTATETHATTHEABOYEINFDqMATpNISCAFqECT. TOTAL FEES� � .��C,/�, Q 1 AGREE TO CAMPLV W1TH ALL CRY AND COUNTY OROINANCES AND STATE LAWS R�LATING TO BUIIDING " •. , �-��-. � CONSTRUCTION,ANDHEREBVAUTHORI2EREPRESENTATNESOFTNISCOUNTYTOENTERUPONTHE . ... � ABOVE-MENTIONEO PflOPERT/FOR INSPECTION PVRPOSES. COMMENTS � —_(,�_��t��L �✓c.� , � PERMITTEE NAME(PRINI) Q - u' /��•p,'<�,c�d t��- — � SIGNA7UREOF MITT E '�— � ' � = RECPT.N0. PAlD BY VALIDATION ~ WHITE—De rtmont Co YELLOW--Finance Co PINK—Assessor Ca GOLDENFOD--File Co GREEN— Pa DY� PY. PY. PY. APPlican4's CoPY ����� �� ���.��������� ;�� ����������� ��`����� °`' � �,~~� ��-, a��� ��;,�, '�'�"y � : �,� �� �� �._ � tt�- :� `� *�«;r � .,� �`� ��4 � �` ��^�'q-� y�� ��� ��.'� ��`�:.�, .�. .._: ��� ��� �� ���.� .� r<,,,„ 'x� .. �.�:.���',�a'���r� . ��� � �'���`'�� � � ... ��,. .: ��.. . .� t � "�� i I . � �.t ,s^�4 C° ,. � i -, � ; . . .. � � �,.e _ .�.__ ._ i � ... ... _ ........�..�...,....�..__...._..._...__-,-_...__�..._-'--,�.'-'— ._..___._.. _ _ . ................_.. ._ ��.�.,,.. �. .�..:.....;,.. :_. . . � r-r r? r- E>.. 'q�'....... ( � .. . . � �-� �.... :, � _.3 T S . ?.:u J '. i ...._ ..a„ . ._.. .. ..__.__—__. . .r � ..�. ... .{.... .... � . .� ... � 6:.. e s f 'e� i� �k,., (.... .. ( - ... ( a�%� s "'� � ,, ¢`; ��°"` �t 4 � n T , i „„ ' I _. �. . ._ t. � --+�.—i .�95...a.'_, � - v -. ' €t � �,' 1 � _ ( � �3 t � �" `�°`�` � r, s . � � r i "" �, -. . .. _ � _. "� � � � � � �..___..._ __ _ _t =� k ' , �,� , , �"._t,� .,...�r ..:T. �I � - i �..._a. �7' r.•:. � :...._3 7'�._ � -;�-��. .�`� ,.�..,_+.:.,.,—�..:....�:..lm......_......,___. ' .. 'Y� .._.. ..� ._.,."' . � . __._ �-; . 3 . f%i� 7'� fx�r "€ . . _ � . i .. . .. �. . " ' I 3 s� L"l���^ �kS J3�.� 3� �S�j�� : � . . . �}E.... -Y 7 ._ S d __ ,........... ...,�..«... . . ..,..n....�...�.._...�.« . t . . .«... . -' `� . , � .ty},E �'- d� �'., E . . 1�'�`� ' ��,.�..,��"'' �M_ r �" �t 4 �J'�_. ..._. ' _ __. _ ._�_._......._.......�...._._._._,.__ � . __.�.�....._....._....... _..W.. '..._..�.r t �+ �. � L.-�' �'� ? ��.� . 4 y�; f �-=�.��t €�t.�i �� �� �,,�z:,�. � � ' ._. _...�..�_...,._.....�s,... ,: , ..-`--.�.._.. � _._ � . . . . .- fvm.,, #., L�........� -Y-,.� Y $ t;'.r P��rr :� � ?��..'€�,€�.�,� : � � �t g . ��E�=a3 C� �( � _---- �.,,_ _... .-----_.._.__�___.�__..�._ � � — . ___Y�._._._..__. L. .. _. _,��.�._� . �. _._._...__ _ .. � + � . � _ �. s ; I € � � r °,,.i ��',. � r r . _ ..__� ...__._ _... ... _._..__._ — ,: _ �__.��.__..._�. _ __ ---� ---- ��_ _._.� -` E € i.t'�Y _% ..� Ei qM. , � -- � � E '^�"ai��, � �s� �..,_.- . .. ..._ ,i„„„ _........._.w_ -€--....................._._..........._.._....____. '{ � _ .. ...._....,._.____._ , "_..._.._......__ ______ . ..... ..._ x.... 3 F .:. Y... 3 "'_ _ .,: � ?�..}g� .-�"� _4_L. 4a�� � .. t { r2�� � . ,u�`�? ?���:: � € . � ..,.. ... . . . n--_ ....._.....:.W_ ..6._...__......._._......__...,....._'-'...�__. . �_ . .._ .__. _� .� ..___�..,�...._.....�_.,.....__.. , §— � z l � A�� �.m � I � 1 � ,,wL� �,� � _ ____—_ � .. _ _�._:.._...__.—____ _.� ..._..._�__ _.w..__�. � _. _ _ � ._ _.__. _ _ i. �"��-.�.r � .��i��"Y'� ��-r 3 . �. � f�'±"9"�a ��..� "�[�� j � .; .. �.e:' [ .... .�. _...._..�._..__.._..._-._._. ..g_......___._........... ._._.._...�..._._...�._ .. ...... ... _.......___.�_......_.._. ..__ . . . .. „ ...;' ._ .,1::" tr 3�"; . € f r�;. �r�'a i. ve . . . � �.. , . _. . � ^ ..:.en.� r ; kB4. S �'�bJ.�-.i: j .. ._._._e.........,.._.,....0 ..,.,._. ' �_.._,..._..._�.»_.__..,...___.�..._ ry ....._�...�_....... ..........e . .._ __.._ . .,,. .v �--.....,,..... ; ._,.._� .. .„�.��..._.�«...«., . .. 1$'� d � .P� �s.�ia��'. . .. ` �s�E % ��3��:,Y.-�'f 3 ' _ � ..�E,...�m, � ( . . �'... a t �a... : ^ : :,.,,, � . ... .. �.._ _..___._ . __ _. . �... ._ . . ..,_.. .,_.............._._..__._._.. _.,...,.....�..w .._...........,.._._....�...,._ , x .i �.;: 7 ..�1<•' g ' . : "�"`.�`a�� 's"';: �h�:. 3x a�: � �: , � ,. � . � ..... . .. .. .._ _....._.� ._ ._ g�- ..-.._.____m._m_____ .____ _ .._ . �^�^�. .�.W. � j. �� €'�i_A 3 f ..... {� '�q £�F 1 eZ�'h� . € F ��. .._ f ...:.....e..�..__................................�__.............,.�...�...._.,,,�._.,e.. ............... .... .. _.,,_,..e_...__........................,,.._.__._..�....-...........,_...,,...,.... _ �........«.....�«.:....,u...��_._........�.... �-...,� �' � z �P�}. �.. E - � ..__,_...... ._...__.. ..m_...�.��.__..__..J.�.__....____..._..__d.a.n._��._ � �_ � _ _ f .__.. .�. � i� ..��a- . . , � ' 1°"� � .�.r`- r't..?r r.� ' € � , ; .�. € � _. _ ...._. _.......,_..___. _......_._._......__.....�..,_......�. .___._.., _._ .._. ...._k .... ....._ ,.�_.»,_._._..�__,....,y.._..._ �.._..�� ....._ � ._._.a :: °� .gc:._...... ... �._ i , 9 ��' S � � t :_:�4a. :w, s .. , �, _�.___ ... _.�3...n.�M._..�...._�___e..._ ___ ... .�.._ ____ .___.._ ..___ ...._----__---.� ............. _..______ - _ ..... , n:. �i��,�,€ i_ .: ..� , ; : . . .._�_a r `:__._ _.. � .:.... _.. . _ ___. _ � ��� ..wFY'm«�. .� � . � .... � � i.�.._ ` � . , � � ,.£. .. . _ .. .._..._.___.__ ._ _. I, ..-.; .. . : � ¥ . . � _ R ....-: _. . .....-.---..._ ..„._ ...... €w_.._.__.......___....._._._ "...._ _ �., _ .....,.. ._...........,.._...... .�............... '- f�-s� d`" . . � �i�-. t.. � �� ' i i��,'. . `-� �'�, ?'� ��'� :� � : 0 �. �.. .. jp_�� j�[ � ..7.....,.{�/Y}T1.''//77`` � . .....__.._ -".__.._.......��..y„..„.�..._.. . .___.�..� S T .. "�t't�✓�K.-P..�.`R� � ..�..... ""?�. .�.•�.�. _ ____' _ _......._._�_ ,......... ......�... �._.._..._._ . ....... . ..,.....-._._..,.�..�.x... . ...... .. ..._.' ...... _..._ ._ . r ' �y, € � , ? � €4.s't..� �' ' �`, x 'u� '._ } a-`:P �'j.. t � . ... . . ;. . .. _ '�.._._.��. - .,��,. .. ..-, � � � ' .�..., ..'.,,� ��� .. . . .. . . . .......___.'^ _.._...__. .', —� --k�� w-.� � s�.:''i � � .: � .... .. .. � [� grq t+ :. 3.# + ..��'��.�.�m;'Y"--L�....:.. :...............�................. .. ...,_.,......«...m \-,—'m--.-It. ._..._.__ �s5 w�w & �. � ` � �� 3 ...��...._...._.... ........_......._..._._ _ ........ ......... . j .....................«.....,........:.. _ - . . . t.. � � ' . . . . __{ ��.� F .; t�- :�. . . . .. -. �__. . . . - . .. t . . �yq � F��`>p.. � s d�a g 1.""^y )-. ,. .�.. __...___......__._..._._.__��__.. ., _......_ _____ ____._....._._._.. ., ._,___.._.,...e.e.. ....._..._.... ,.__...._.,....,._ . __.,...._..._......,._ ._....,.._._.. ..e...__ ... ...... ..__......... a 4+ � �g ' ��___... ._......_.��__..__..__.___.__._ _.....__..._...___m.________..__.�__ ___. _...,��____.__._.�_�..,.....� .....___.__ ....___._.m..__�____._.. _�,. _... _ti s i � 9 ......w.�.m..-_.___'_'_._'_._....__._>_____..._....__ _......n.w...w...�.�..��..u._.......-.,..............�..�.�_................�_____.......,....,._..... ,..__.._"'._.._�_.._...............__,.._... ...._._.__....... ...___....... _.__..........__w ..._........... ........� � ' n� � . . . . , . . .. . . .. . . .. . . �. � 3 ;.ee....e..»..,...._._......_�_.�...............m�.__._... ...._.._.�..,_..........�._.__....,,a_...._�_.�.......v........-.e...n.a......>.___rv.,..._.__......,....._.....,._�....,.__.......,.......... . ..._.___""_mT__.__. _.__..,,..... __�_"._ __._._... _ ........... ..__.._,._�.: 4 - .. � .Y �.. . . ... .. , . �� �..-. .....e......................_._..__....................,......,.....................m........�.._..____.__..____. ......... ........._...�...............,.........._.._.....,........___........«....................... ......................,....__._..._..._..,., f....�..w....T ...�.�_........�...-......,,..,....... ..._...... ..............._.3'. 1 �', � .� . .. ... 3 ...._....._._.__._. ......,......�....................................... ..._._.._.....�................._,..........,,..,,.._._....__.....>....�_..._.....,......,.........„...,,..._�.,._,,........_..._....., ..._.._..............�__.,_,.___.._....,.........� ..........._.........._.......,......__._. __........_........... ...w...,......,,...._._._._.._..._..._ '........_...� � . � 9 �_,..�--.__.'...... .»............................_.....»..-._.,__......«.......r..,..........�._.....................�..._._....«................,_...._._u...... _.._.._...........................__•_.__..__� . .._.__"_____.-____............�.�.._.,._....._..._..........._.....�...'....,..................�... -._............_ ...._._..........� . n ._ . , ...�.w......... ` ....., .__....m.... ..._._.................._..,_ ......: ..........._... ..._......__r�. _..._._ ........_-_........«................_�_..__.......-........„.,..... ............... . . � gy.._._.�,....,..� . ....................___............................_.._._. ........_..._...._..._.___' . l .5, . . .� . . , �;!. `� #f 1„_W........._..__....�...... .._. .......e..-«...:...............__.�.......,,.. .....,..._........,,.,....._......_.......u,.._.__.............................,...........�_.�........ .,.,. ............._.. ....-....��..__ __.�<'.'. _ '_.... . ..«.....,..�...�_.r._._.............«..,.,__... ..... . 4 � ...;.,.a .. .._ 3.. . . . - � "__....,. .... . ._ _ ` _. .... �; 4 F.'�6�`A�`+�:..,.._ P ..�...,...,�.�. . ...w _.,._.....,,._..._..._. ._......______�_. . ......._.._ . _.. ._ _._........,.,_.. . _......._...�..� _....,._ __ _........, �........ ._ . .,.... -.. t $ .,� ........._........................._.____..,._. � i � �,� ' ,[ �t1's f �-. .":� . _ . - I d a�..3�.F...� � ?.: . e e_'�.. .__.... ...,._ .............. ! � �..:.� . �.�'�",�� � .. ...__.... ........ ___.. ...._.... .,............. .__.�. ....... . . . .. . . . ... ��� � . :h-�'�"'§�' ...._. ..... . x, �� g �41::� ;,� : >.. � ��';« � �� ..._ _....._. ......__... � ��� ' _..__ ____ _ _ ; t �... � �� � � q �� , � �����������°� ���� � _.-- _...___ .__ ..�,. ..w .. ._........ _-____� ...._ . .�..�.__ ____..._.._.._.. ...__ _. .._.._. ...,...__ __. .,�._. _ __-! " �� �`�� ����� _ � 3 �}�� ! � ���.������ ''��" ����' _.__ a�_... ...w. ...�._ _. _. ..... . � r� '� a��. `. ��� ' .._.__..._ _. ....._.._._.._.___ ...�.�_—____._ _ ...__...___ �. , ��� � _ � .A� � � _.. .. .. ._.. .._ ,_. ... .,. . � ` �� � �*,�- ��� � .. .. _........._... _. .. ._............ ..... _.....___ : • � � �� � .... ...._..._......,,,.... ......,_ ..�.. ......_. .... . � �� ��� �� � ���a��� "1�'1 1 �` - B t '.,� „�:r.�":��=:a,� ,�;� ���'�= �� .. :� ._,_ - _— _ _ .......... ..............._.__...._....._. _...,.....__.�__. ...._..._.. . .._v .ssL ..............��.. .�µ.....-_. w.�.,}_.... ...._ .,......... .�:,.... ..5�._:__._._... . ' , , , . _,. . ' . .� +....... ,, . - ' . .... .__..._�_.—_ ._.�_. ; _. __. .� ....e�,:..�:.,......»..-,,.,�.�.......-.«.«...,..�....m...:.,... «....�..::...:».»_.....,:,,.:�., � ........ ...__...n �...�:,.,,..-«..,.ffi..::,a,m�,.:«�..,,„..,,*.�«,:- ....::»,..,�.�-. . ...:::::..>...,., .,.a.=m.,-_ ....,..,_ _.