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�� CITY OF DIAMOND[iAR � � DEPARTMENT OF COMMUNITY&DEVEI.OPMENT SERVICES �. �Tc 21825 E.Copley Drive (909)860.3195 Fax(909)861-3117 PRESS "���-� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE � �� � �oS CC-� /��GS pATECATION � I .-� NUMB fl I V �,C ADDRESS �__ $ ISSUE TYPE OCC APN LOT T A�T DATE CONST. GROUP p OWNE�i.��-C���I �> p ADDRESS�-y.�---.` ZONING SETBACKS oCITY /�7 /��i.h 21P TEL. FRONT RW ❑ APPLICANT TEL. REAR ❑ � SIDE/SIDESTREET RW ❑ � CONTRACT Fi � -� � T''�'G SIDE ❑ � ADDRESS Gi� �r- � CITY � C 21P �dTEL PROPOSED USE I c oARCWENG/ � . �- ��y^ ,,,-�f iz DESIGNER NO.OWEL. NO. NO. a ADDRESS UNITS STORIES BEOROOMS � CITY ZIP TEL. � DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION Q OWNEFi-BUILDER DECLAFiATION $FFi/ADD/REM O 1 HEREBY AFFIRIA tM�ER GENALiV Of DE0.IURY THAT I AY EXEYPT FHOIA TME CONTRACTONS LI� Gaf090/C3ryOR W CENSEUWFORTHELOILOYYMOREA50N(SEC.70.t1.58U5ME55ANDPFqFE55lON5CODE:ANVqTVOR (n U pp�Y.TYyh11Q1REW�qESAPERMITTOCONSTRUCT.AL7ER.0.1PROYE,DEMOl15M,ORREPNRANYSTRUC• W PdtiO/DBCk Z TURE,PRqR TO ITS ISSU+WCF,ALSO REWIRES TNE A�ttICANT FOH SUCH VENA�i TO FI�E A S�CNED w STATEMCNi 7MAT M[OR SHE IS 110EN5ED PURSUANi TO THE PHOVISIONS OF TME CONTRACTOfiS U• W � CENSE UW(CHA�TER 0(COMAICNCING WIlH SECTION 7ooa)OF OIVISION�OF THE B1151NE55 AN�GRO• � P��D� FESSIONS COOE)OR TMAT HE Ofl SHE IS EXCMP7 TNEREFHOM AND THE BA515 FOR TNE ALLECED ExEMP- VTqN.ANVVIOLAi1DNOFSECT10N7071.SBVANYAPP�IGANTFONAiERMITSU&IFCTSTMEAPPLICANTTO Z Re•Hool "'� A CML PEN�LTY OF NOT IAO{7E TWW FNE MINDRED�OLlARS�f�).1' Z ❑4�.+`OWNEROFiHEGRJ7ENTY,ORIAYEMFLOYEESWITMWAGE5A5iHEiA50LECOMPCNSATqN, � �ammor[ial WILI DO 7HE wORI�I.NO TNE STRUC7UR[LS NOT INTENOED OR OFiERED FOR SAIE(SEC.70U.BUSI� _1 � NE55 ANO VROFESSIONS CODE.THE CONTMCTORS UCENSE UW DOES NOT APP�Y TO AN OWNER OF ? pROVERTY YVF10 6URD501t MPROVES THCflEON,NVD MMO DOES SVCN N'ONN MIMSELF OR MERSELFOR [[ iMROUCNHI50RMEf70�M1R�EI.IGLOYEES.VPONDEDTHATSVCNIIIPROYEAIEMS/.RENOTNTENDEOOR m W OFiEREDFORSKE.IF.MOwEYERTNE8NL0iNCOflMPROVEMENTI55qDW17HINONEYEAqOFCpAPLE� � TION,TME OWNER�BUILDER MnLL XpVE TNE 6UROEN OF CFOVWG THAT NE OR SHE DID NOT BUILD OR Z MPFpVEFOqiHEFURPOSEOFSALE). w Olh50wNEHOFTNEPfqPER7Y,AME%QUSIVELYCONTMCT:NCYI�iMUCENSEDLONTiUGTOR; (= TO CONSTRUCT THE VROlEM(SEC.70la,BUSiHE55 AND PRO�ESSIONS CODE�TNE COMiUCTORS U• V2IUBIIOf1 A0.1.AREP. W CENSEUWDOESNOtAFPLYTO�NOMMEflOFAPROVERTYWHOBUILD50RIM�ROVESTHERCON.ANO � MAiOWMMCiSFORSUp1PROJECTSWITHACONTNACTOR(S�L�CENSEDPURSU�7JTTOTNECANTRAG QUANTITY DESCRIPTION FEE Y fOR5L10EN5EUw.). ¢ OINIE%EIAPTUNDERSEC. 8.8P.C.fORTHiSpE�ON U � l�. � DA7E OWNEN V Z W � LICENSED CONTRACTORS DECLARATION W � 1 HEREBVAFFIRM UNOER PEN,t�TV OF PERJURV THAT IAu LICENSED UkDER 7RO�n5qNS OF CNAPTER V, d y(COMMENLINOWITMSECT10N7��OFDIVISION]OFlMEBU51NES5ANDVROFE55iOH5CA0E,AND Z `�� WLICENSEiSWFUILFORCEANOEFFECT. m � LICENSE CUSS LIC.NO. J V OATE CONTitACTOR d W � WORKERS'COMPENSATION DECLAfiATION Q = U N IMERFBVAFFIRAIUNDERPENALTYOFPERRIRVONEOF711EFOLLOwiNG0ECU1RATpNS. � Z Q O �_IHAVEANOwILLMAIN7AtNALERTIFIGTEOFLON5EN7705ELF•INSUREFORWOPoCERS' $ � - CpMPENSATqN,ASPiqVIOEDBVSECTION]'lOCOFTMELABORCOOE,FOlITMEOfAFORUMICE IU OF THE WORK FOR NM1UCH TMIS PEM��i IS ISSUEO. � � W _I HAVE ANO V1ILL MAINfA1N MlORKERS'CO�APENSATION INSUMNCE.�S REOl/IRED BY SECTiON /��O Q 97000FTMEUBORCODE,FORiHEPERFORMMICEOFTH WORKFOflWH�C41THI5PERl1iT15 �1 ISSUED.MYVrC) NSATIONINS� . CEGR RANOPOIICYNUMBFHAR[: CONSTRUCTION �_J � CARR:ER �� PLAN REVIEY! Z Pq.ICVNUI�DER ` � � ELECTRIC ¢ (15#".,SECnONN[mN0T8ECa.6lfTEDOFhEPEiU.�rt6Wiid:[�4f�DRED00LLI1L5R+oo)OqlFSS} PLU6101NG 0 ^ ""� ��' ._.� ...,_...... Z 1 CERTIFY THAT P!TNE OERFORMANLE OF iHE W011K iOR WHIG1 THIS PENAiT IS 55UCD,I 1�lECHANICAL (�} SHALINOTEMPLDYANYVERSONPlANYMMINENSOAS108ECOMESUl7JEGTTOTME Uj WORMERS'CO1.�PENSATIONUWSOFCALIFORNIA�NO�GREETMAiIFISMOULDBECOME INSPECTIONFEE� S SUBIECTTOTMEWORKERS'COMPENSATiONiRON5KK150F5ECTION7l0aOF7MEU80R 7 ON COOE,I SMALL iORTMMTH CMAPLV VnTH iNDSE VRONSIONS. ISSUANCE I • �— � SMIP DATE: ?FPLICANT. w WARNINC:FAILUR[TOSEWREWORNERS'COAAPENSATIONCOVEMCEISUNLAWFULAN�SM/�yyBE ENERGYP/C �)3��� J `/ � � SVI3JELTMIEMVLOVEpTOCRIMINALPENALTIESANOCIVILFWESUPTOONEMUNDRE0TNW15AN0 ENERGYPERMII"i"'— "�-'—•- DOLU10.5�f I00.000).Ml MDITION TO TME COST OF�pMPENSAiqN,DAMAGES AS PflOY:DEO FOi11N .. ¢ SECTION7l0EOFTMEUBORCODE.NiEREST,lWDATTORNFYSFEES, (iETENTIONFEE: � � CONSTRUCTION LENDINC AGENCY pRE-ALT FEE: O � IHEREBYAFFIRMUNDERPENALT'OFFERNR�7HAiTHEREIS�CONSTRt1CTIONLENDING►GCNCV a' fOft THE VERFORMANGE OF TXE WORK fOA MMICH TNIS PERMiTIS ISSUE�(SEC.7oa1,CIV.C.�. Z W � LENDERSNAME F_ lENOEA'SADDRE53 w ILEHTIFYTMATIHAYEREA07HISA�CLILAT�ONANDSTATETMAliHEACiOVEMFORMAT10NI5CARf1ECL TOTAL FEES � ��O d IAGRCETOCCMPIVWITMALICITYANOCOUNTYOfi�INANCESiWOSTATEUN5flEU1TNGTO8UILDING CONS7RUCTION,AND MEREBY AUi�+ORRE REPRESENTATIVES OF TW 5 CW NTY TO EMER UPON THE Z MOVE�MEMKKJEOVROPEflTVFOFINSPECTIONPUqPOSES. COIAMENTS � J � m PER TEE�: [�PRINn � .r � ,^ �,- �2�a N 5 ur tn ITiE ' ATE � ' RECPT.�0. . PAID BY VALIDATION WHITE—OepaM1ment Copy.YELLOW—F�nanee Copy,PINK—Assessor Copy.GOLDENR06—File Copy.GHEEN—ApplicanCs Copy , . .. .. _......--- . ,.._._..._ . . ... . . ,_ _. , . , ._ . . . , .. , • :. —__-- . ��I I 'o` �?F= [Jil����C�I�f� i�l;t� 9i��Si=c�:.A'�iC����! �':c:�J`:�► __.. ._.___._..___ _ , _..._.-- (►��`i'i=�`�;I�1►1 ;l,t:�,_.._.----�►��`4t!::a;--��.: .........___.____;�:ry�.c:����j,,----------- c)���i�= :I�`�.�:d� y.�cl:f � .. � - .. , �� :.. . � _ ,. . . .: . � . . . _. , _., _ � - __ - - -- - --__-— . ..- -.. _ ... .. . _ . _... .. ..... ................. .- --.....---.-.....------......__----.._._ . _ ---- .._.. 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