Loading...
HomeMy WebLinkAbout12004 (14) CITY OF DIAMOND BAI� / (� ��` - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ' � J � 21660 E.Copley Drive Suite 190 � (909)860-3195 Fax(909)861-3117 PRESS ���`'A�' BUILDING PERMTl'APPLICATION FIRMLY � JOBSITE �/�Y��✓ �� • ,� APPLICATION!�� �� . �, PERMIT �Q D /C o ADDRESS FS��I� DATE NUMBER�_ # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER LL ADDRESS ZONING SETBACKS � � � FRONT RW___ I7 CITY f7� ZIP •' TEL. ���/ APPLICANT TEL� REAR ❑__ SIDE/SIDE STREET RW Ll_. � CONTRACTOR - - � � •�f` SIDE f7 p� ADDRE S Fi • � �' _ % � CITY '�' ZIPc '/' ` —TE �S�'.��. PROPOSED USE r %� oARCH/ENG/ � /J�,- �/� �{;is�"�� +— NO.DWEL. NO. ` NO. iz DESiGNER - a ADDRESS UNITS � STORIES _�.�� BEDROOMS � CIIY ZIP TEL. N � DESCRIPTION SQ.FC FACTOR PSF ADJ.AREANALUAT�ON � OWNER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEREBY AFFlRM�NDEft PENALTY OF PERJUNY THAT I AM EXEMPT FROM THE CONTRACTORS LI- � Garege/Carport W CENSELAWFORTHEFOLLOWINOREASON(SEC.7037.SBUSWESSANOPROFESSIONSCODE:ANVCITVOR UZ Cp1NTVWHICHREWIRESAPERMITTOCONSTRl1CT,ALTER,IMPROVE,�EMOLISH,ORREPAIRANY5Tfi11P W Patio/Deck TUpE,PRIOR TO li9 159UANCE,ALSO REWIRES THE APPLICANT FOR SUqi PERMIT TO FII,E A SIGNED W S7ATEMENT THq7 HE OR SHE IS LICENSED PURSUPNT TO THE PROVISIDNS OF THE CONTpAC70RS L6 � CENSE UW(CHAPTER e(COMMENqNG WI7H SECTION 7000)OF DIVISION 30F THE BUSINE55 AND Pfl0- V' POOUSP2 FESSIONSCODE)ORTHqTNF.OP5HEISE%EMPTTHEREFflOMANDiHE8A51SFORTMEALLEGE�EXEMP- (� V TqN.ANYVKKATIONOFSECTION7031.5BYANVAPPLICANTFORAGEHMITSUBJF.CTSTHEAPPLICANTTO Z Re-Roof _"�Ti�� � A CML PENALiY OF NOT MOflE THAN FNE HUNDRED DOLLAR5(f5o0).): � 171.ASOWNEROFTHEPROPERTY,OHMYEMPLOYEESWITHWAGESASTMEIFlSOLECOMPENSIITION, 0 COmfI1BfC18I " YVILL�O iHE WORK,AND THE STRUCTURE IS NOP INTENDED OR OFFEflED WR 5AlE(SEC.7044,OUSI- J NESS ANO PROFESSIONS COOE:'fHE CONTMCTORS LICENSE L1Ni OOcS PiOT APFLY TO IW OWNER OF � PROPERTYWFi09U1LD50RiMPROVESTHEREON,ANDWHO00ESSUCHWORKHIMSELFORHERbELFOR m Q iHpOUGHH130NHEROWNEMPLDYEES,PPOVIDEDhIATSUCHIMPFOVE6IENTSARENOTINTENOE�Ofi w OFFEREDFOfl5KE1FMOWEVER.THEBUIIDMGORIMPHOYEMENTIS50lDWRHINONEYEAROFCOMPLE- � 0 TION,7HE OVMEW9UILDEfl WILL HAVE THE BURDEN GF PROVMG YHAT NE OR SHE UID NOT Bl11LD OR Z IMPROYF FOR THE PURPOSE OF SALE) � L]I,ASOWNEA�FTHEPROPEHfY.AMEXCLU5IVELYCONTRACTINGWITHLICENSEDCANTRACTORS d ¢ TO CONSTRUCT THE PflQIECT(SEC.7o4a,BUSINE55 AND PfiOFES5lON5 CO�E:THE CONTFAC70R5 LI- Veluafion '�f�� ____ADJ.AREA __________ W CENSElAW�0E6NOTAPPLYTOANOWNEROFAPROPERTYWHOBUILD50fl�MPROVESTHEREON,AND � K}IOCONTRACTSF9RSUCHPRQIECTSWI7HACONTRACTOfl(51LICENSEDPURSUANTTOTNEGONTRAG Q�JqNTITY DESCRIPTION FEE Y TOHS 110ENSE LAW.). � � J O ❑IhM IXEMPTUN�ERSEC. _,___B.8 P.C.FO(i THI5 FEASQN Q . � ------- U . � �=' D/1TE OWNER _"'__ U W � LICENSED CONTRACTORS DECLARATION W � INEREBYAFFIRMUNDEflPENALTYOFPERJURYTHATIAMLICENSEDUNDEflPROVISIONSOFCHAPTEH � d B(COMMENCINOWITHSECTION7oou�OFDIV1610N30FTNEBUSINESSANDPROFFSSIUNSCODL.AND Z � X MY LICENSE IS M iULL FONCEAND EFFECT. m lll y�..�t "q � o LICENSE CLASS �-,� LIC.NO. � �A �✓ � V DATE '� � ��_CONTRACTOR 5-¢E� ��'_�`-� C d W �j � � WORKERS'COMPENSATION DECLARATION '�`' ! � N IHEREBYAFfIqMUNDERPENALiYOFPERJUFYONEOFTHEFOLLOWINGDEf,WiFT10N9� gn Z Q � _INAVEANDW�ILMhINTAINACERTIFlCATEOFCIXJSENTTOSELF-INSUREfORWORKERS' _ � COMPENSATION.hSPROVIDEDBYSECTION37000FTHELABORfADE,FOR7HEPEflWRMFNCE W OF 7HE WOPK FOH WMICIi THIS PF.RMIT IS i55UED. � W C�_�HAVEANO WILLMAIMAIN WORKEFS'COMPENSATION INSl1qA�CF,AS REQIIIHED BV SECTION Q 37000FTHEL4HORCOOE.FORTHEPEHFORMMICEOFTHEWOqKF9RWMICH7HI5PERM1T18 � � ISSUEO.MY WOR 5%:OMP SATION INSUpANCE CA IER AN�POUCV NUM6EH ARE: CONSTRUCTION __....,....__—_....._....__. � _'___ ✓ y CARRIER.._.__._ s .`° / f�9�i PLAN REVIEW --_-........ ...-.-.--.'.-.'- ---.— Z POLICYNUMBER_ � �'�" - � � -- ELECTRIC _._..._.__._—_".' _....___....-'_...._ Q J � (twssEcr�r�mno7sE OFThEPEFY+YTISFORONEMN�OfiEDWlWi4R100)Of1LE93) PLUMBING . . ---- --...--------- Z ICEflTIfVTHATINTHEPEHFORMANCEOFTHEWORKFOHWHICHTHISPERMITI5155UE0,1 MECNANICAL ____�_,_____,...,— __...___—__ — �} SHp�LNQiEMFLOYPNVPER50NINANYMANNEflSOASTOBECOMESU&IECTTOTHE � WORKEHS'COMPENSATIONLAWSOFCAUFOHNIA,ANUAGREETHATIFISHOUI.UBECOME INSPECTIONFEE ________,.___,,,, - _.___ �'�J—Y�] � SUBJECTTOTHEWOftKERS'COMPENSATIONPROVISIONSOFSECTION97o00FTHENBOP �SSUANCE ���" ,�.y., � COOE SH FORTHWITHCOMPLYWITHTH SEPROVISIONS. a, -��------ --���--- • /� ^i �.; CJ/7 p DA7E: `�,sd� APPLICANT. �.��� �/�,�j0 ��� SMIP __.—___._ ._.s.l�-w W " ' ' ENERGY P/C WApNIN .FAILUR[TO SECURE NIOFNERS'COYPF.NSATION COVEf7AGE IS UNLA'N�UL,AND SHNLL 6E """"'-'- --"--"-" � LL SUOJECTANEMPLOYERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUN�REDTHOUSAND ENEflGYPERMIT DOI.LAFS(i100,000),INADDITIONTO7HF.COSTOFCOMFENS0.TION,OAMAGESASPROVI�E�FORIN -"""""'- "'--""- -'" J SECTION37080FTHELABORCaOE,INTEREST,ANDATTORNEYBFEES. RETENTIONFEE: __. , __ '__'____""_�� _'_ �r,.: 0 :�' i � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �`-! 's� � ::�. x „ _..... y'f ....___ � ��v...�'�-'. "'_"' � IHEREBVAFFIRMIJNDEflPEPoALTYOFPERJURVTHATTHEflEISACONSTRUCTIONLFNDINGAGENCV FOF THE PERFORA�ANCE OF THE WORK FOP WHICH THIS PEflMIT IS ISSUED(SEC.3oe�,CIV.C.). ,/ Z . ....'_' W usww i ,w�,� —' — � LENDEH'S NAME ___"_"_"_'—__'___ F' LENOERSADORE55_.__.__.__.. --""""'— wICERTIFVTHATIHAVEREADTHISAPPLICATIQYANUSTATETHATTHFABOV[INFORMpTIONISCORRECT TOTAL FEES � � y � � I AGREE TO CAMPLY WITH ALL CRY AND CAUNT'ORDINANCESAND STATE LAWS RELATINO TO BUILDING CANSTRUC110N,AND HE(7E6V AUiNOHIZE REPpES[NTATIVES OF THIS COUNTV TO ENiER t1PON THE ZABOVE�MENTIONED PROPERTY FOR MSPEGTKKI PURPOSES. ' COMMENTS _._._... � ���.�_ �!� ✓� --- � -- m PERMITTEENAME(PRINT) — Q � .y7 9 c1� ` "---- � 510 TU OFPERM EE DAT V I = e RECPT.NO._���_PA�D BY VALIDATIO� ~ WHITE—Oapartment Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy � ._[ _.. ......._ � . i ,� .� ' ...' i i `.,,.. .I .. I ,`.. �..i i ' I i..._ .,.,_..' .. . I.... � .._'......... � ._...I. j ; f "�y I � ; ` � � ' ' . �`il�9 . I ( � i,, �.' I i � � � � I i � � ����,fi : . .� � 3 . � � � f � � i � ; i .. � ���� . �� I i '.i i I � i � i i � ( � � i� � � � t i . . `f� �� ' i � ( I i � � i � � i , - ��f � -; i � � I � i ( .I i , , I � I .I � � � i � � -. "� �i � : , i , � , i i � i i � � i i � � , I t � , i ' � `.- 1 !� �� � !.' � ; j � i ,I �, � �: f € ' I � : � r - ''� j__' '"J � #, � i � � ( � - � i I I � I �i � t i � i i �' � � � i ) ' J i � � ' 1 � i � � ! � v �� i i .j � � , � � � ' � ; � � .! I ; I ; n:� � � � i I I � � ' ; i ,' �� � ,� i f I � , '_...I_ ; '. I � . i � ;.,� � ..'_� _(_ _ _�__;,� ; {, ' I i I I ( � � t , � i fi ' � i i : , � � � j .: M . j . . . � _ � � �� �� .. � . � i � ' � k i :. i. .� � 3 I'---` � �� , : i , ! , � ! ' I �� ; , , , � � � : ��� , _ I ; . i ' u , -� , ' ., � . � � � , , � r ! I , ' I ' x i i t � t i� � i: , � � i ; + i.,; � ' �. l. i � � � , �� � -�� < i n � � i ' ' �� � � ; � � � e+ � i i r,� _ ; � � i � , ( ; hr'� � i ; i '� � ��. �� �� � 7: � i � � ' 7 .� � � � ,,�� ( @ i f � , i i � -� �� � � � r � f � � I � i � � I i I i � E � a ct � a ,� � ( . � � , i , I ¢�� i � � � ��N `�� ,, � r� �I�t —� t ' � � �r I� I ' �- r I i �..� i ' ' I � I � P� � ta�, i I 'aa E � E 1 a _ �a ax� ��,��� I ., F� � t1 _t � �f �... � �a� u � � . � ; �i i I � i � _ �� ���� r � I� ' ��`� � ��t L, J •' '�� �A �I� � � �0 � � � , � � ' � � �aB �.r � �I4� � � � �` �� � _� _� •. .A� __ ���, . � , �� 1 ; � ��' � 7 _ { ' .�_.. �—r � 1 - .l ` 1. , r � � i � ' I � ' I � �;. � , i � , � � � . , , i � , � ( � � , � � ��, � � ; ; � � � � , ; , , � � ! � � � � ' . � � s� .e �'�� �` ',� '! i ' ; , I � � I �1 � �f I I ' I � ; � ; _ � ' � � �.� � � � � _ � � , ; �� ; "}����� � ! ' I j' ' ' i ' � i ' � � ' q � ; � i k�jA� f G , I � � � ' . ' I i I � �� � � I I , � 3! I i � 5 ^ � I 1 �..__ � ..�..' �__I_ j_'. _ � ' � �� :� � �� I � I ( _��� � O _ � i 4 � { - � .. \\ � ._ � .� l.. � - � � i -, i ��,��. ... �..C l 7 I f 4% i I ����. � ; , ; , , ' I I ; � ' F . r�� � �.._� � a � � � � , ; I ,�� , + '; ( ; ; � � ; � �; � � ;: � � � I � f , � � � !.__ f � I I ' � i f f � � � �; l ' I �. I �-I �� ��� ' � � .. � "1 . � _ � � � ;, � i i � r��F�.ta��'�'�f�f 3t�$�'� � # � d � ' ` � � � ;.....' �. + .. !.. � ,. �"� � ������ �� ' I t ' j� �' .�� � 9 � � ��%x� � f j't, t ' k ! ` � ` i� � i � I '� ��� -'���������5`�� f ��, ' ' , I �,� � ' i � ' I ,� ; � � ( � ����� ��������' ���'� � i ..' �� i � ^i i � � � `� � ' � I �'�,�'-� .'��""�� ;���"�^ �'� f �a � �i I� e� ! � -� � ! 1 � ... � i_ , � i ��f „ ��� � i�� �, i � � i ( i � I � � � i � � ' � � s x����"'�y�a� ��� � � � �"�� �t � t..t I i �.I..l ( I �� � ; ' � ' I h � r ������ ����°''�} �.�� � S f � . 1 X : I,y �r� � � u"� . � � '�,� }a`5'��p's`� � �C �5 ��.,r3 I �'1 r �i � "" r� �_� ,. 1 I i.M c � i � `� � � 4 i'�3��2�'"y{o-'-,,��'p7 1 - '�I � � � � (5 3 I ( t: � n� \�' I � I N � �'�����b�� �rs��� 4""C'"3 , �t •,�r �� f I �-: � x � t _ a . l � �. 1 . -. �.� �� a����r .���m .. .���... i �.. � i r�.. .�E G � � .a � . , . .. l 3 t� . � . . p t��t g �. . e3�'t�..�. [ kt�, s�_.�..�...me.___. ,_._._�.t__v _..__.e__ .1,_:_ _ __,,.__ , _ 1 � ,