Loading...
HomeMy WebLinkAbout11385 - '� I — CITY OF DIAb40ND BAR COMMUNITY DEVEI:OPMENT DEPARTIvIENT R •;,.�; 21660 E.Copley Drive Suite 190 (9D9)860-3195 Fax(909)8G1-3117 � PRE`SS �''�" BUILDING PERMIT APPLICATION FIRMLY o DDR'ESS �� T _�C�S c� �0�,. e,. ,�.i . pAPEICATION �� R NUMB R #/C o ISSUE TYPE OCG °O APN LOT TRACT DATE CONST. GROUP p OWNER � , � C. �4'P�.�S o ADDRESS ��j-�tC, ZONING SETBACKS QCITY D �9; ZIP�C���;� TEL.����� �RONT _ RW � APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ QCONTRACT R � �.b�bt`�: °�� SIDE � ❑ o ADDRESS_�l; -��- �^y�"CR�_ PROPOSED USE CITY �-d.-Q ZIP 7 7� TEL. ��%''I' ,�"� o ARCH/ENG! W DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BI:IL�Eft DECLARATION SFR/ADD7REM Q I HEREBY AFFIRM UNDcR PENALTY OF PERJURY THAT I AM EXEMPT FROPA THE CONTRACTORS LI- � Garage/Carport W CENSELAWFORTHEFOLLOWINGREASON(SEC.i031.5BU51NE55ANCPROFE5510NSCO�E�.ANYCITYOR C? COUNNWHICHRE-0UIaESAPEFMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUG W Patio/Deck z TURE.PRIOR TO ITS ISSUANCE,ALSO REDUIReS THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w W STATEMENT THAT NE OR SHE IS LICENSED PURSUANY 70 7HE PROVISIONS O�THE CONTRACT6R5 LI- � CENSE LAW(CHAPTER 9(CCMMENCING WITH SECTION 7C0o)OF DIVISION 3 OF THE At1SINE5S ANn hHO- u' POOUSp2 � FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROMAND'HEBASISFOFTHEALLEGEDEXEb1P- (� � T�ON,ANYVIOIATIONOFSECTION7031.50YANYAPPIICANTFORAPE�MITSU6JECT5TH[AFPLICANTTO Z Re-Root ACNILPENALTVOFNOTMbRETI1ANFNEFiUNDREDDOLLARS��5500).j:�� �-�"�" �" ZQI.ASOVlNEFOFiHEPROPEFiiY,ORMYEMPLOYEESWiTHWAGE5A5TMEIRSDLECOMPENSATION, � Commercial WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED POR SAI.E(SEC.7044,BUSb J NE55 AN�PROFESSIONS CODE:THE COMRACTORS LICENSE lAW DOES NOT APPLY TO AN OWNER OP � PROPERTYWHOBUILOSORIMPROVESTHEREON,ANDVlHO�DESSUCHVJORKHIMSELFORHERSELFOR � C[ THROUGHHISORH[ROWNEMPLOYEES,PROVIOEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m w OFfEREDFORSALE.IF,HOWEVER,THEBUILDIN(30RIMPROVEMEN71SSOlbW171�{�NONEYEApOFCOMPLE- � TION,THE OWNER�BUILDER WILL HAVE THE EUR�EN OF PflOVING THAT HE OR SHE DID NOT BUI�D OR � IMPROVEFORTHEPURPOSEOFSALE�. _ ❑I,ASOWNEROFTHEPFiOPERTY,AMEXC:.US'�VcIYCONTRACTIVGWIiHLICENSEDCONTRACTORS OWC TO CONSTRUCT THE PROJECT(SEC.7044,BUSWESS AND PROFESSIONS CO�E:THE CONTRAC70RS LI- Valuaf:on ADJ.AREA W CENSELAWDOESNOTAPPIVTOANOKRJEP.OFAPROPEftTYWHOBUILDSORIMPROVESTHEREON.AND � WHOCANTRACTSFORSUCHPROJECTSWITHACONTRAC`OR($�UCENSEDVURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS IICENSE LAW.). � J O ❑I AM EXEMPT UN�ER ScG B.&P.C.FOft THIS qEA50N Q � v_ � � DATE OWNER r Z U W � LICENSED CONTRACTOR$DECLARATION W CL IHEREOYAFFIRMUNDERPEVALTYOFPeRJURYTHATIAMLICENSEDUNDERPROVI510NSOFCHAPTER � �+ p. 9(COMMENCING W'RH SECT'.ON 7000)OF DIVISION 30F iNE BUSINESS AND PROFESSIONS CODE,AND Z P S "f I � C X MYLICENSE IS IN FULL FORCEAND EFFECT. O �"�?, -� LIC.NO. ��� �� � ! m ,.... ._ . . . .. � UGENSE GLA55 s �7 � ~ DATE ��'I�'C� � COMfthCTOR I'�. '�1�.���(^�_ ��Z. 0- V � �'���� /� � � WGRKERS'COMPENSATION DECLRRATION –� + ¢ � IHEREBYAFFIRMUNDERPENALTYOFPERJUftYONEOfTHEFOLLOWINGDECLAPATIONS I '�1 Z V Q 0 IH0.VEANDWILLMAMTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _ COMPENSATICN,AS PROVIDED BY SECTION 3�oa OF THE�ABOR COOE,FOF THF PERFORMANCF, U Q OfTHE WORK FOFl WHICH THIS PERMIT IS ISSUED. - � � W �I HAVEAND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BYSECT.ON Q 3�OOOFTHELA80RCO0E,FORTHEPERFORMANCEOFTHEWOfiKFOflWHICHTHISPFRMITIS ISSUED.MV WORKERS'COMPENSATION'�INSJRANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION Q / �. CARRIER �S"���y��y etlq`'l<`r11.4�I� PLAN REVIEW zPOUCY NUMBER W'V.[_�a I-�°�� ______=� EL� � Q � (IHISSECTIONNEmNOTBECO��dPLE7'EDOFTHcPERMfTISiORONEHUt�DRF.�ObL1AR5(E10�ORIESS). P�UMBI � z f CEHTIFY THAT INTHE PERFORMANCE OF THE WORK FOR WHICHT:-IIS PERMIT IS ISSUED,I MECHANICAL (,'3 SHALLNOT EN�PLOYANV PERSON IN ANY MANNEP SOAS TO BECOME SUBJECTTOTHE � WORKERS'COMPENSATIONLAWSOFCAL'�FORNIA,ANDAGFEETHA'I-'ISHOULDBEC061E � INSPECTIONFEE - � SUBJECTTOTHEWORKERS'COMPENSATIONPRCVISIONSOFSECTION37000FTHElA80R '�+�y� 111►, s�.� [,,-.� � CO"O�E,ISHAf'�_pLFGO,RTHWITHCONPLYWITHTHO}�EPROVIS�ONS. ISSUANCE ��*a. _l._ ._.._..._._____ _Jl � �d`l E��P 47 APPLICANT: .Jv' '""^'^'+.—�^^^'" SMIP �IM�" p DATE: J WARNING:FAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C LL SUBJECTANEMPLOYERTOCRIMINALPENALIIESANDCMIFMESUPTOONEHUN�REDTHOUSAND �! DOILARS($1oa,Coo),INADDITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPROVIDEDFORiN ENERGYPERMIT �� � SEGTION 37G8 OF THE LABOF COOE,INTEflEST,AND ATTORNEY'S�ees. RETENTION FEE: �� � a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEREBYAFFIRMUNDEFPENALTYOFPERJURYTHATTHEREISACONSTFUCTIONLENDIN�AOENCY � FORTHEPERF09MANGEOFT�-IEWORKFORWMIGHTHISPERMITISISSUEO(SEC.309],CIV.CJ, Z W � LENDER'S NAME _ . . . F— LENDF_R'SADDRESS w ICERTIFYTFATIHAVEflEADTHIS/1PPLIGATIONANDSTATEI'NATTHEABOVEWFORMATIONISCORRECT. TOTAL FEES � �/� � �, 7 � I AGREE TO COMPLV WI7H ALL CITY AND COUNT'f ORDINANCES AND STATE L4'NS REIATMG TO Bl11LDINC, � `� �„ CONSTRUCTION,ANDHEFiEBYAUTHORI2EREPRESEN7AT!VESOF7HISCOUNTV70ENTERUPONTHE , ; . - � z ABOVE-MENTIOM1E�?ROPERTYFORINSPECTIONPURPOSES. COMMENTS � � �7 — � k� ✓�a9"S � m PERMITTEE NA��RINT) { Q ��a _-- . -�..,.I!,'. Cn /4_ ��}�py�- � SIGN RE OF PERMITTEE � �� � DA7e� �' ' � �� - 4 �.�.i 5 �P � �/_ ) _ �� • � - � RECPT.NO. PAID BY ` VALI�ATi�f� L.�"�� ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD--File Copy,GREEN—ApplicanPs Copy'�� ` �' '.' ..�:�'�' .�.,'' -,,: .. „ .. . . h, .,,. , ;. , ,: . . . . .. . ' ' . .. . ..� R ... ,-.1-'." .i..,9:�- ,. �'.�. . ..�. �+` i��Ft' x .. . v. , � � . �# � �!ti ��Y�.. .•, e_.. �� ��������� ���: � � r; i '.�� ; , .. :. �.. � . � � �°` � ��� . �� � � � � �� � � w �� �, �' ,�� , �, .:. , .: _ � �';=� �rk�;�" i I ��'��� :£" ; � ..�, , __�_ '.._._.__. ___ �. �_.� _ __._ _ _ _._._.----�...�.� �'=1`��� a���x � ...r-I I � ����-��L���!'!_� � __��___ � . .... _-..,�.�....�_ _____..._..__...�_ ....._____w......�.....,_ ..---r— . __.._....� � �!�. ��"ii+,.� .z.�i.t'�..���,✓�� t l_`"t�x,✓�� �'E c.:1�'':d .�e�..�L�r� { � - - � . � r M1 _4...__.. . �g . �"____._w_._.. ..--�-,-,""'-»--. __.. ._._ . _ _ . . } �t�s�z�t de� : s {:�1���ia,.'� � � � �,€`���- � ��.��- v�+'�1������ —_`--'-�__ ..,..... �.� E__"..«_.......y..�...,.._—... _....�...._. ' ' �._ g {� _._. p�^. ..�.g_....._....__ � �'d.at�� �r""��S' �. - ([ i"S�"`k�Ck4 � C—�.dL.YP`Rw.1f9'�S�I� .._...,.w.....� _.. ➢ _....... ..._a..{.._M �_-,.,,. .._—....._,.�......,.. ...�._,..�..u�.. ....__ __,...._.___.� ....�,. _ ..p...._-..�....,,...e�. . �;rms�,�x> ����;1r�� f - � € ��F3'��a1.�t�`��''�.1"����ri�1 � w ____ _ �-_..__ _..._____.._�.�____.__�_ �l _._� _ ^, s � q�R�Y� �--d.?=...�42€�„.+s�".0 � .. i i a n�iz,d�"��, C'i4,.r[�;@,� ���3�1 ._ . � _V . . �. ... �.,_i.,-.s_.._...^._.s. .._-�� ..�..._._��_..._.�._'_'_._____..�._b..,z—._.. � � #=�s.�+ "����rai ���1t� � �_.. _.__�.._.....� 1 i � I ��;�i?�'_.��'J�� �� � __._.�._. m._ . __. __,...,._� ___. ___ -r-_... ____ ----- %�~i�a����""��J ��'� i�,'x i a� � � i 1~a �,�g ���'�: �s�,'��� .__.____.._. � .� T �._._._ p _ � �'8"`����� ��=�i i� �s �Q-� -- -_____._. ..�__._._. � ,� � `�� �Bi�I�'�� - ---- , y � �-,a�;,t� ,��t�:'?"6"��i'.� ; T ` ;��'0;� r�l3i�?"' i � � -. � —___.�.�_.. ___-.____ _._.._ ... c rv ( � i ... ""—�- __ ! r;'�;.sa.a�- �'e ��.s"r�E�t t€��.3C :'%i��tl 7?�EC`3 � � �.__�. a m._. _._.. � '��`<$� N �r'�,�.,���,����:,��� j �'6�'�I���E�a��°tL;i��:� _.._._ ___., _ � r°v z'�`-T" � . ��� �.'�" �. ._._ __ ; ��''at�a- �.Lu.�,�.�%�F���.:: � ._... _ � ��., �=�I!r �� � : � � �. _.�______�_e____-�--- .� ____�_ } ��,? ���~:r�'�'���� � � __i..�_ c���"a ��Dti�l�'-a� _l_____-- __.�.� '~�`�'�.��.������3�e�b°v m� �� .._._._.� ___�. ��'�� �-�i��i� — �.__..�_._ �.�._ �___ gi �_._M...__� �� .._ __._._...�..._.___.__ ,�_ _._ __ .m , �., � �' �� �.. °�� � r'� ��7-,p ( .✓�'a �r s i���it'� � __�--___�__ �___ � � - _..�_ _. _... ____._.___.._ �__ 3 :-S �IY �,e.. �:�4,$-( �� ! �� C'""}h� E .... �srw:q,v � ( �, , � � s...r�s���l�.`v ..�._s._ -�.. ..�..r. �. _<_ _..�._....___.V._t _....._,,.........._`---- - L..___ �..... .... . . .....,... _...,..,....._—�.......�»,.„ � ��:rt_�.� .. _�.._. 3 � ���,g�`�''ti ���.a::_ ` W�_ ---_.._._._ �� � �'���t�a a""e��?� �� - t , �.`�13,���%�'.��Itfi�s�a. ' �� � �.�.�.....,�. . _. ___..__... � ....�....,�,;w._.....__. ._. .__� �,w._..... i ,,����� � '�x'€_.?,�. I € . '. �..'?v�a��:,: .�4. �.______.._. ...._._.�....___._ ` � 9�"" . ��z� ' i ' ... _.._,._.�...�..e. _....�........_ _........�m�.. --!.....,.�. ...,,..___.V__._...,.�-.-__"�___.�,._' . 3 ��� �-t r� .: r- ..._.--_�.._._�_._ , ; � s��m� i � ;.�E��,% aa'iVsi'��a ' C. £�._� _�..__�__.,�. � dw._ � ( __,___.____ _��_ _--_.� :������ �{��'�'�. i ��� �F'i���'�.,�'T". �Cs�a,��_ ,.��.j.____ � � �._____�____�._n_..... � � ,. _ __ , r��r�l�"������� � � 4�W�?�s��.;� �3��" �- e�,:�.� -_ _---�--�-_—�--� � �. ;��. � �..��.,� p ..�� �...__... p��^ y ''b3YA'A&..�� �.: �� �.. � .. ' f � E . �f6...�� �. �+:).�p��� a.. .._.........._.. _�.�........_. 6 . �.,.^ . . �.... �..`I�....m..a`y.._� ...-{ .'"" '.�.' � _.........,...�� gn �'''+ y � r#a��''s.' € �t,...d .��t#re� � j/f/�/ � �' �9 7�� $ - ' � �...i �__:�.� , _����. _ __���_____ ____ . __________ _ .____________� __�_� � � ; _ �� : �_ __�_ __ � , _____ ._.__� � �_ � � �� ��� �„ � � �.���������� � � � = ;__..�_�.._._ ��. _� .___.�.____� � ._.___._ , ___ .______ _..___�____� ___ , ___..—___ ! _ �_______— __ __---_.� .. _ _,s___ -- ____._._ _ __..�._ F �______ ___-- �________ , --- —_ __ - — --_ � _�..__ .� �___ �_._ ___ _______.W.wY_____ ____.m � �—� _ __-�---_ �,r."`" �. ;�" .. . , � ��_______.______.____ -�.a_ �• ___� ___.�____ __ _____ _______ ___ _ __._ .�.___ �..__..�.._.._Pn_w..._� __..._._ �__ , .----� ����g�,T.. _.��._._..�.`��"� � ��.�� :...___--____—_,,__-___._...__ ' ' _.:......� -------� ��'�a' �"�����i�_� �_ 3. � ����r'€°�"',� �d�`� ____. _.__.__._ _ �__�_ � __ —_�_�_ . ____�_..__�Y______ �.� �� ����� ��� � �: � ' , , ___�..�_�. ,_.�_,.�.�_---_ w_W.._ � �.�. _.._ _. _.� � .._...._,..�....-----� .__..___�.__...�.._.__.��._�___ _..__. ___�--____----m-_ ` �_� } ... � E g �__ ___.�..�e.e__.___._._ .w....«_._ �._�___ �. -� �_........_ ..__....___.__ _�__.__4_____�._.....______w__ �� �.______._ .....d. .d � _ ._._ � , ::,; � __....____._.�.._.__�. ,...___..�_..-- -_.._...... � __._ __--------__._.� � � ' � .� _ . _....V...� _� ��_._ _. � _._.. � � -_.�___ ������ � _.,�..� a�.� �.. _ ��..�� �--4�-�.n��