HomeMy WebLinkAbout15057 (19) .�, ,
° CITY OF DIAMOND BAA C
� ---��- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 1
21660 E.Copley Drive Suite 190
(909)860-3195 F�(909)861-3117 PRESS
��'A�"~ BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE APPLICA710N PERMIT � P/C
o ADDRESS Z�S I � (,�FO`��`f �1VFt�i�`;. �n DATE- f,�"�L3P✓ NUMBER � #
� APN_ LOT TRACT ISSUE /' ` TYPE OCC
DATE_(/) �j^(�D CONST, GROUP
p OWNER �_i2f..�7�2�' �. =
WADDRESS��'7k � f �7�1 I���B�s � �°�. ZONING SETBACKS
� CITY �, t�[2 ZIP i�,�= TEL. !�"fr1i� < FRONT _ RW O
APPLICANT TEL. REAR ❑
� SIDE/SIDE STREET, RW ❑._
CONTRACTOR }���Vl.�i'e`}?.�+a�C. (�ir�y iu:f�_L„�j'"4 SIDE �I_
� .ADDRESS���� Wl�rs.k^s�d �s. 1!?
0 CITY �''f--.'1 a/��`",a!� 21P�� TEL.��e?"f'�'.�i�JQ'jr�� PROPOSED USE �� - � e�: �•�'� r ' . � �il�
w ARCH/ENGI .[;�C)?U f7z 2tt'
z DESIGNER ^ `�- �-�
� ADDRESS — '-- NO.DWEL. N . � NO.
� CITY ZIP TEL.____ UNITS STORIES _BEDROOMS
�n DESCRIPTiON SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION
� SFR/ADD/REM
Q 1 MEFiEBY AFFlHM UN�ER PENALT/OF PEWURY TNAT I AM EXEMPT FROM THE CANTRACTORS ll� Gara98/Cdfpolt
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7W7.5BUSINESSANDPRUFESSIONSCOU[:ANVCII'YOH (n
U OOUNTYWHICHREQUIRESAPEHMI7TOCONSTFUCT,ALTER,IMPROVE,DEMOlI5t1,ORREPAIRFNYSTRUC�
W 7UFE,PRIOR TO ITS ISSUANCE.RL50 REqUIRES THE�PPLICAN7'FOR SUCH PERMIT TO FILE A SIGNEO W Patio/�eck
STATEMENT THAT HE OR SHE IS LICENSED PURSU0.NT TO THE PROVISIONS OF THE CONTRACTOHS LI�
�� CENSE lAW(CHpPTER e(COMMENCING WITH SECTION 7000)OF DIVISION�OF Th1E�USINESSAND PRO- U' PooVSpa
FESSqN50DDEJOft7HqTHEORBl1EISEXEMPTTMEFiEFROMAN�THEBA515FOFiTHEALLEGEDEXEMP� (�
V TION.ANYVIOLAiIONOFSECYlON7031.60YANVAPPLICANTFORAPERMITSU&IEC�STHEAPPLICANTTO Z Fjy-Hpp} :��,'�
F, ACMI PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(E500).):
� C]I,ASOVlNEROFTHEPROPEflTY,ORMYEMVLOYEE5WIIHWAGESASTHEIR50LECAMPF.NSAiION, ❑ COfi1ff10PClel '
VALL DO THE WOFlKµ�THE STRl1CTl1RE IS NOT INTEN�LD OF OFFEREO FOR SALE(SEC.7064,BU51• _J
� NESS AND PROFESSIONS CODE:iHE CANTHACTORS IICENSE LAW OOES NOT APPLY TO AN OWNEfl OF =
PipPERTY Wl10 BUILAS OR IMPROVES iHEflEON,AND WHO DOES SUCM WOflK HIMSF�F Oq MEHSELF OR
Q THROUGH HIS OR HER OWN EMPLOYEES.PROVIDED THAT SUCH IM{�flOVEMENiS ARE NOT INYENOE.O OR m
W OFFEREDFORSAIE.IF,HOWEVERTMEBUIL0INGORIMPROVEMENTIS50LDWRHINONEYEAROFCOMPLE
0 710N.THE OWNER-BUILDEti YALL HAYE THE 9URDEN OF PfiOVING THAT NE OR SME DIU NU7 BuiLO OR
Z IMPROVE FOR7HE PURPOSE OF SALE).
�= C]I.ASONMEFlOFTHEPROPERTY,AAIEXCLUSIVELYCOMRACTIhOWI7HlICENSEDCONTRACTORS
TO CONS7RUCTTHE PRPIECT(SEC.70ti,BUSINE93 AND PAOPESSION3 CODE:TFiE CONTRACTORS LI� V8IU8IIOf1 _ r"}^ � __..,ADJ.AREA..,,,._.._
W CENSELAWDOESNOTAPPLYTOANON?JEROFAPflOPERTYWt10BUILDSONIMPROVEuTHERC:ON.ANO
F WFIOCONTRACTSFORSUCHFRPIECTSWITFIACONTRACTOR(S)IICENSEUPUPSUANTTOTHECONTRAC- QUANTI DEuCRIPTION FEE
Y TOFiS LJCENSE UW.�. __,Y
O ❑IAM EXEFAPT UNDER SEG B.&P.C.FORTHIS FEASON Q _ _
� U
— .--..._...-- CC
�
ZDATE .—__ oWNEP_'__...._—..._._...._.._...'_._......_..._.—___ U
� LICENSED CONTRACTORS DECJ+RATION W
r
� I IIEREBYAFFIRlA UNOER PENr1L7Y OF PERJURY THAT I AM LICF:NSE�UNDEfI PROVISIONS OF C�i�PTER �
d 9(COMMENCIN(3WITHSECilON7000)OFDIVISION30F7HE6USINESSANOPROFESSIO45CODE.MID z _
X MY UCENSE IS IN FULL F(YiCE AND EFFECf. �
llJ l � r � ^ / �
� UCENSE CLASS �^-��J _"___ L IC.NU . I��n,�� _��j,_",�"�_,.�..._ �� � --
V DATE ��/� CONTRAC70��L�[��,R+:3 ..F'�7 Ll- -
��L1=✓
W
� WURKERS'COMPENSATION DECLARATION Q
� V
� IHEREBYAFFIRIAtJNOERPFNRL1YbFPERIURYONEOFTHEFOLLOWINCDECLA.RA'fIONS: Z
C� IHAVEANDWILlMA1NTAtNACEqi1FICATEOFCANSENTTOSELFANSURFFOFlWOpKERS' a
� x
fXlA1PENSATION,AS PR041DE0 BV SECTIIXJ 97000F THE LABOR CAOE,FOfl THE PERFORMANCE `U _
_ OG 7HE WORK fOR WHICH THIS PEP,MIT IS ISSUED.
p �
W .�I NAVE ANU WILL FIAMTAIN WORKEFlS'CAMPENSATIIXJ!NSURANCE.A5 REQUIRED BY SECTION fff
� 3700 OF THE IABOR CODE,FOR THE PERFORMANCE OF THE WOR�(FOR WHICN TFIIS PeHM1T IS � /�� O
.� ISSUE�.MV WORKERS'GCMP[�TION I45URANCE CARRIEF NVD PCLICV NUMBER AP.E', CONSTRUCTION . .__._.___.,,___ [
. � ' _.................._"_' -
Q �_�jy iUdJ'.7 ,-"---" ..._ PLAN REVIEW ----------.._......_....-
� CARRILR �'1�
� POLICYNUMBEH 7�'�I(j �7���_.............._._ �'
Z ,Z{�„3tt, ...�J�.�,��.3----._...._. _. ELECTRIC
� ---..----.-.._...--._...
� (f1iIS5EGfICNNEmNO76EOJhtl'LL7EDOF7HEPEf,Y.+11'A4FCI�ONEHUPDRE'�DJLLPRSISi00)ORLESS). PLU�ABING ___....._'_'_—._._.'...._,—
W
Z I CERTIFVTHAT IN THF.PERFORMANCE Of?HE WOflK FOR WHICH THIS PEP.A�IT IS ISSUED,I MECHANICAL
�r(:) SMALI N9T EMPLOY ANY PERSIXV IN HNY MHNNEfl 59 nS TO BECOM[SUB:ECT TO THE � �
.�
� WORKERS'COMPLNSA7!bNLAW50FCALIFORNIA.ANOAGftEF.THATIFISHOUL[7HcCOME INSPECTIONFEE k'""�';-� • ____
SU&IEC?TOTHEWDRI(ENS'COMPENSATI OVISIONSOFSE O�37UOOFT LABOR -���'��"
�,.�.
� I;ODE,ISHAU.FOHTMWITMCOMPLYWIT HOS PiiOVI510N5. "'� ISSUANCE ,_._.,_....__'��.;�!{�_.._..__.__ �U
0 /�l ..�y�,.f••y ,. . SMIP e`�'"i, /�)
poAiE:V"t� GAL,� pPPLIGANT: . . � _ . ........_ ,.., ........_._�_S2.V_
W _ �::;:i !( ....._.__ .
J WARNING:FpILURETOSECURE K'��1KERS' MPENSATION COVEHAGF_IS UNLAWfUL,AND SHALLPE ENERGY P/C ..__..,.__..._•`�• _ '.�_,,�.s�_
— SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILfINESUPTOONEHUN'vREDTHOUSAND �f � � �°�
u. ENEFiGY PERMIT ..... '.. tz�__��.�_.;:__.--.-...-.✓
DOILAiLS(E1oD.DW).IN ADDITION TO THE COST oF COMPENSATION.DPMACESAS PROVIDED fOR IN '-�., . .. . � ' �l� -
J SECTION91oeOFTHELABORCODE,INTEfiESi,ANDATTORNEV'SfEES. RETENTIONFEE: .�;��'`'�r:'�' '�"'��'
� =Y]L.��-:...:_��.•.',::�:�.._-.._.. ___"-"__
: ., ..� �.:'.,..�•:
� CONSTRUCTION LENDING AGENCY PRF-ALT FEE: -� '�'> ��:��
— � -- ' -- -----
p .... "e.�,SY---�---'..
� I HEREAV IIFFIRM UNDE(i PENALTV OF PERJUHY THA1'7FIEPE IS A CA4STRUCTION LENDIhG AGENCY ^
FOR TNF.P[RFORMMCF OF iHE WORK Fnf7 WHICH THIS PERMIT IS ISSUED�SEC.309�,CIV.C:�. ---"' --------�� -'-'��- -""
Z
W .....- — '------".---
� I.ENDER'S NAIAE __'.______ '__"..._._.._'__'_"__"'_"".....'-'_"'-_-
� LENDER'SAUURF.SS _.-_.._.__ _. -
� ICEiiTIFYTHATIHAVEHF.ADTH!SAPPLICATIONANUSiATETHAT-fHF.ABOVEIN�ONMAfIONISCAFiRFCT. TOTAL FEES �
W I AGHEF.i0 CAMPLY W1TN ALL CITV AN�COUNTY ORDINANCES AND STATE LAWS RELATING T00UIL�ING
� CONSTRUCTION,ANUMEflEBYAUTHORIZF.REPRF.S[NTATIVESOFTHISCOUNTVTOENTERUPONTHE '
Z 0.[10VE�MENTIONE�PROPEFlTY FOq INSPEC710N VIIRPO5E5.
COMMENTS_. __
o .rmy ��A ----------------------
J . � �f�',; .m u
� i' -r�iT e __..._"—._. .._.._ _ _
m R ITTE NNA[w " _'
Q . ,� � —
� . J���M��r ~ � -,._�"�_. .-- — —�------ —
Uj 'SI, EOFPEH EE DATE '
= RECPL N0..._ .n"�._� ___ PAID BV VAUDATION
~ WHITE-Dapartment Copy,YELLOW-,�inence Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-ApplicanCs Copy
._ _ —- — —
� .._
' ' i � � i , i � � , � � � I
3�, ; � ' j , I � � 'i ' , � � � � ➢
i � �
r � � I
r , ( � � I . �. � � � � � . ' � , . I , � ..
� y � . i I I I i � � . I . ., . �� �,.
w � � � ,
z , ' { i
,
� � ; � , : I � � � �� � I
;
�, ;
, ,
, . , � ,
,
, � _. , _. � � + �� ! � 3
� � ,,._ .
r � � � � � . � ; . , , .
� ' , �. � a , i �� , i
� �. � .. . ( � � � � 1 ; ' � ��
; ��r�� � � ' ' ;_ I � _ � �� � � ( � '
�
� _ . .. _ , i , '=s�
� �� � � •� i � � � �
a�,� i— � �� � ��� � � i � � i i
�,, i
^ x � , ' a� � � ; ! �
£ 6 �� , i , �$, , , �
� � ° �, I 6 ' I I — ' ' �, I ( a �,
- � ( '}� ��t€c . . j I I � � i .d,�
. - € t �"� { "t. .''E ' I i , I (
; 1 ; �
, — - � ' ' '
� , ;� : ( ' � '� � � — ' �
� ki�,� � �. r„ C��� � � i �
' t ._ t �_ ._ _ .... :. � _ I ..
. '� W"k4 .. i_... l ...._ _.__. 4. � _ _ � . � `
'�, �� � _ I ( i , i� � I I t � � i � i f
1 I �
. I
_ Y r
. } �. ' • i 1 �' ��i. � . . • �'. �
' 1 I
_ I
�. ,,, , � � ' i .
� . � � I
� ( � � � ' � I � i
� � � � c�I i I � � ; � � l � ` �' i t
- ti � � � � � � j � i
� : � . � I � I � I �
.�
, �y ' i � I
� ;
� � ;
— _ '
i i � ` `
����, ' � � ( � '�_ � � ' ; j
,
� � � �
; + i ,
, , ' , ; =----- , (
� � i ' � �
� . �� , � .
,
� i `� a
, , ,�.�
,_ .� ___�
, , , _. _._ � �
� � � � x �� a
9 � � , , � i � ' � '�k ��� �. ��,
ti
I i ' ' i d � � ' � �� �
! , � µ � � €
. �
�
� � r i, , � � � ���� b_ ,
,> , a � ,�.. .�,����.�: �
� ,
� '� � i � � t — i _ � ' , � .�m+ t�d"� F�. a
' ¢'' i � _ _ � ' z ix �� ', ��
� � '� � �� '4 r E 1 z "
.. �.,a a,c � a ���; � � y i � . a �,'9�z � ��M �
� `�� � 4. Y 1 . ' � � S t '.. �R a..' . �
� � . i .J� . ;3 I � ' - i . ., . 1 i i � r��?�x F'., Y"l , ,� � }
.�.��_.__..__ ., ..�, _..._. �t...�__e .. ._..__,, .. ._. .,_. ,._,.. __ ,_..... . _ ... .. .�.., _.'.._._ _._,. .,1.�. .._..._ ._._._.� _ ........ .. .. .. .. ....�_
F