HomeMy WebLinkAbout15427 G � � ::-�----
t F _�� CITY OF DIAMOND BAI�
DEPARTMENT OF COMMUrTITY 8t DEVELOPMENT SERVICES
: � 21660 E.Copley Drive Suite 190
(909)860-3195 Fa�c(909)861-3117 PRESS �
y�'"., BUILDING PERMIT APPLICATION _. FIRMLY,''/
o� JOBSITE �_�_ APPLICATION�( � �,�� PERMIT �� �- /C
ADDRESS_��J�I�L� ��`'� ����� I>I��.L'sAM '� DATE t, ' NUMBER � Y �
$ APN LOT TRACT �SSUE /^ � IYPE , OCC
� DATE i CONST. GROUP
p OWNER �Z MS4:'+
o ADD, ESS�;��Q 1--f��� �' �:.�`.' �' � ZONING SETBACKS
Z CITY��if-ilIl�� ��fC ZIP ' �l.,!> TEL� '6 S 'd�` 9 REART RW a
g APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
g ADDRESS -
CIN ZIP TEL.
PROPOSED USE
oARCH/ENG! Q
Z DESIGNER NO.DWEL. . / N .
� ADDRESS UNITS STOAIES BEDROOMS
� CITY ZIP TEL.
ui DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
Q 1 HEflEBY AFFlflM UNDER PENALTY Of PERIUHY TH0.T I AM EXEMPT FROM THE CONTRACTORS LI- Ggf890JC81pOff
W CENSELAWFORTHEFOLIOWINGREASON(SEC.7037.58USWESSANDPROFESSIONSCODE:ANYCINOR ' (� .
U COUMYNkitCHflEIXlIRESAPEFNAITTOCONSTRUCT,AI,TER,IMPROVE,OEMOLISH,ORREPAIflANYSTRUC- W patio/Deck
W TURE,PRpfl TO ITS ISSUMCE.AL50 HEDUIRES THE APPUCANT fOR SUCH PERMIT TO PILE A SIGNE�
� STATEMENT THAT HE OR SHE IS UCENSE�PURSt1ANT TO THE PROVISIONS OF TNE CONTRACTORS L4
CENSEUW�CHAPTER 9(COMMENqN�WITi SECTION)000)OF DIVISION 30FTHE BUSMESSAND PHO- �' PooVSpa
FESSpNSCWE)OR7HATHEORSHEISEICEMPi7HEflEFROMANOTHE8ASI5FORTHEALLEGEDEXEMP• , (�
TION.INYVIOI.ATIONOFSECTION7037.SBVANYAPPLICFNTFORAPERMITSUBJECTSTHEAPPL�CANTTO '�- Z pe-Roof
� ACMI PENALiV OF NOT MORE THAN FNE HUNORED DOLIARS(SSo�).):
�. ❑I,MSOV/NEHOFTiEPFOPERT'.OFMYEMPLOYEESWITHWAGESASiHE1R50LECOMPENSATION, . � CommBfCtal . �
WILL00 TNE WOPoC,ANU THE STHUCTUAE IS NOT INTENDE�OR OFFEfiEO FOR SALE(SEC.70M,BUSI- - J
� NE&S AND PROFESSIONS COOE:THE CANTMCTORS LICFNSE lAW DOES NOT APPLY TO AN OWNER OF � ?
PROPERTY VIl10BUIL�SOR IMPflOVES THERC-0N,ANO WHOOOES SUCH WOflK HIMSELP OR HERSELf OR
� THFlOUGHHISORHERONMEMPLOYEES,PROVI�EO7HATSUCHIMPROVEMENT5ARENOTINTENOEDOR � m �
-�, _OFFEAEDFORSFI.EIF,HOWEVE0.TMEBUIl01NGORIMPROVEME�iTISSOLDWITHINONEVEAqOFCOMPLE•
z. TKKi,7HE OWNER-BUp.DER WILL HAVE THE 6URDEN OF PROYINO THAT HE OR SHE DID NOT BUILD OR
_� IMVROYE fOR TME PUHPOSE OF SALE).
❑I,AS ONTIER OF THE PqOPEHTY.AM ExCLU51VELV CONTRACTW6 WITH tICENSE�CONTRACTORS
- Q TO CON9TflUCT iHE PRQIECT(SEQ 7014,BUSINESS AND PROFESSIONS CO�E:THE CONTRACTORS L�- V8IU8II0� ADJ.AREA .
LLI' CENSEUWDOESNOTMPIYTOPNOWNEROFAPpOPERlVWHO8UILDSOflIMPROVESTHEFEON,AND
�-- -N7iOCONTRACTSFORSUCHPRQIECTSWITHACONTRmCTOR(S)LICENSEOPLIFSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE -
� TORS tJCENSE LAW.J.
� ❑1 AM EXEIAP7 UNDER S�C. B.&P.G FOR THIS REASON � � - '
� V
i e _ �
LL DATE OWNER `'+ �-�, ,., U , . ,
Z W
} � LICENSED CONTRACTOAS DECLAFiATiOiV , w
i .�- IHEflEBYAFFlHM UNOER PENALN OF PERJURY THATI AM UCENSED UNOEfl PflOVISIONB OF CHAPTER �� �
g ��- 9(COMMENCING WITH SECTKKJ 7000)OF OIVISiON 30FTHE BUSINESS AND PROFESSIONS CA�E,AND _ Z
���' MYUCENSE151NFlAl(-0RCEANDEFFECT.
�
.o,. LICENSE CtASS UC.NO. � a J � �
-�j-. DATE__�__ CONTRAGTOR ' a
LLl
_�� WORKfiRS'COMPENSATION DECLARATION . -. ¢ . . ;
-�� IHEREBYAFFIRMUNDEHP6NALTYOFPER1UtiYONEOFTHEFOLLOWINGOECLARAT10N5: �
� zQ
�- �IHAVEANDWILLMAINTAINACEHTIFICATEOFCON5ENT70SELF-INSUREFORWORKERS' ��. 2
Z COMPENSATION,ASPfiOVIOEDBV9ECTION37000FTHElA00flCODE,FORTHEPEflFORMANCE �� U
Q OF THE WORK FOR WHICH 7HIS PENMiT IS ISSUED. � �
0.
'�-. _I HAVEAND WILLMAINTAIN WORKEfl3'COMPENSATION INSUflANCE:AS REQUIREO BY SECTION j
-Q,. 37000FTHELABORCODE,FORTHEPEAFOFMANCEOFTHEWORKFORWHICH7HISPERMITIS . f� _
IS5UED.MYWORKERS'COMPENSATWNMSURANCECAflR1ERANDPOLICYNUMBERAflE: CONSTRUCTION - �
��- CARRIER PLANREVIEW
.z_ PIX.ICYNUMBER ELECTRIC "��
¢ (I}4SSECTpNNE�NDTBECOAiPLETIDOF7HEPEFi�.STISFORONESdN�OREDDOl1AR4(Si001�LESS� PLUMBING
..�� .. . . ��� �
�Z; I CERTIFYTHAT INiHE PERFORMANCE OF THE WQHK FOH WHICH THIS PERMI7IS I5SUE0.1 MECHANICAL -�a1�31�1 �
.(;}� .5HALlNOTEMPWYANYPEN60NINANYMANNER50A5T08ECOMESUBJECTTOTHE ��'���
•N WOHKERS'COMPENSFTIONI.AWSOFCALIFORNIA,ANDAGREETNATIFISHOULOBECOME INSPECTIONFEE .� J L ^
SUBJECTT07HEWORKEHS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR ����'� ry, ��� ����
.�; CODE,ISHALLFORTHWI7HCOMPLYWITH7MOSEPROVISIONS. ISSUANCE ¢3�-_ a'9. t)��' C
¢ �^ j
'.�- SMIP ���I��q �
�p-� DATE: APPLICANT: . ������ �y-��r,� .
ENERGY P/C r��
�;�J:',- -WRRNING:FAILUftE TO SECURE WORKERS'COMPENSATION COVEPAGE IS UNLAWFUL,ANO SHALL BE � �^
-,LL- SU&IECTANEMPLOVER70CPoMINALPENALTIESANDCIVIlFMESUPTOONEHUNDflEDTHOUSAND ENEiiGYPERMIT ����
DOLLARS(57oo.oa0).IN ADDITION TO THE COSTOF COMPENSATION.DAMAGES AS PROVIUED FOH IN
-¢_� SECTIONJ7080F'(HELABOflCODE,INTEREST,ANDATTOHNENSFEES. ' RETENTIONFEE: ___
��:. CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HLf1EBV AFFIRM UNDER PENALTV OF PERJURY THATTHERE IS A CONSTflUCTION LEN�ING AGENCY � - '
�- FOR THE PEFFORMANCE OF TH[WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oB],CIV.C.). �
Z
;LLJ. --_� . ,
�- LENDER'SNAA/E ____.___ �
F- LENOER'SADURESS____ - � +�
�� ICERTIFYTNATIHAVFNEADTHISAPPLICATIONANOSTATETHATTHEABOVEINFORMATIONiSCORRECT. TOTAL FEES -
� IAGREETOCAMPLYWITHALLCITYANDCAUNTYORDINANCESANOSTATELAWSREIATING708UIL01NG
CONSTRl1CTION,AND HEREBY AUTHORI2E REPFESENTATIVES OF THIS COUNN TO ENTER UPON THE �
� ABOVE�MENTION[b VROflERN FOR INSPECTION PURPOSES. COMMENTS
p �Cl � 1�1 A'1�_�.1�'C`�
-m PERAy EE E( IN'� ' � y��
� f �y � ^ \L
� SIGNA E PERMITTE DATE
RECPT.N0. PAID BY VAUDATION
� ~ WHITE—Department Copy.YELLOW�Inance Copy.PINK—A�essor Copy,GOIDENROD--File Copy,oREEN—AppiicanCs Copy
,�_ �_ '�'^ __. � �
�.,.....��� -�.� C ..P7� � � ��+' 1 ;�'f � 3�v t i x r t+✓ �-�'i'" v3�3.�..L3 �'°i�`r��"i ^-,�� s"� 1 'Y� U
� � � .� E ! E �� ; �i , . n� i+c � � �I� n �, '��,�I �� t� � "• xi;-�-d�rr;
+� ca� ; � � �" c��r�-� �"` ,yI � �, �c� t-�r� i:.� -^� ��' C., m(�^r,
. ; -. � - i� �� � ,€�� '�� a i�t-I��„ r-.---�: '7.C� �'^^� . -�,['��'�z;�'�i �C'� t� �
� _ ��� � ,�;� 1 �� ' ��'-� � �� .� � �� ���,-�,.� � � �(� �� ti,:� t � I��
� �� t -i� i . � i �t � I� � � ;,� I f j "a �,ri r `'I��rr,��.i� ( � � �`� '�i�a'� �� � ,_�.
.,T.� ; C � _s � �� t:.,�` -�� ��.i�J E l� ;"� ;I €. � � i I
� '� '�'n�".� F3"�E I E , I � � Rr . � (ry.a,7 ..-ii -t ��-#I (Er�'� ���.vk �.�.�i i E���� i�( i ir3E„5
� - � "�a E ' � ( � j ' � ' i�:'%i•°"7�;.';I 1 9f r � � � y Y,.1 r ..�=I`?� r:- ,�„�Pi, j �+- •� .
ii M � y � ,� t" 7 I�iTI
� �� I � I ( t i W �f 7 � � � ] � I � �. �., i���I�F� ` �( (� I f � �����
� ��' r�Y Y ��� € � � �. ' j ' �' ( � i r � . i 3 I��l ( 1
3 3 � �
4 ' � Q � ; � , I
� � �_' �. ' � � � f � �
� vz �. � � � I i � -�--�-_I— ��' i � ����� �� a � �i__ ,�
. e .n� � � i I ry � � { �, � ��1 � i j
N � 1 � { 1 � ! `` ' � I � 3 €—`y � � � � � � � � E , 3 I �
e ! � ` ; � r ( ! � � I � � � � ' �—�_� ' ' � �_�_�I—
k i � � � � �_ � � ( I ,I y ,� € � ��- �— _�;_�--j�_�- i € r__ i � ; i ( i
� ' � '� �. ' � I O �. i I � � i '„ I � � ; .i i ?, ; I � i
� i i ( r � i ! ' � ' ; , � ( j � i � i � � � ! i F �
i � � ! i � ± _ i j � `N � � � i i � I � ; . ' � � i i : _. ' �
� � ' ( ' ° 4 ' �- I r € ' ! � ; � f I ' ; � ' ; r� �
� ' i ' ' ' � , ' 1, � � ' , ' , I � �
� � '` ! , +� ' � � ( k j i � I ; ; i � � �
�
'; � f ,, , � � � j � ; ; � I �; �
i ' � � i � �-_s ' ' __I_ � __ I C l. ��
1 i � 1 � m� �.' 1� 9 .�.. ... _ ..�' r � ,�y
F i� � � '$€ � � ..� I ( � � �•T�r�.'] 1 i'f`1 -Y(,� �E'7�f'� I%E"�7�T$ �.' fT��_ �¢GC`i I�T� I C..'I.,'i�°{i '�.0
� �. € � S ` � � ( � �� �+ '� �'rl � r�'�iYj� �'lit•dJ �) C��I�t,";3`T� � i`i'il�t��;'.'� ['��' - � �
� ; � � � � ' � I " ` ! � � ��� `�'�r '�,� ��) ��� ;:�� ' ��_� ; i� ��� �,r�i� � �I�-��I�;,; � � �
' ' p i � i I ( . . i { � .�� � y 'c�`>���r��.iH3i7' � � �"i "'i- �"r ��..s O �I�Ir� ��,��- � �
�� I . �I � I � � I ��' �} � ' I r� �. - � C.'3 :�. 1� �
f t � a ' � , � � � c � ( „'r-� ;� -� -� -� ��� � � � ,i c� �' r m. �� � �
�� ,- �
� . . ' � i ( �. i � � � � .� i .�e,l ' i �.�., � -�? r�-�fr�-���I ��E�a�i� �'j�I� �. � � �
� � i 3 1 f � ' � i � � j� ' � � ' ; � ! �f €� �� ��� ( � .�� � �"'
7p ' � � ! � ( i �� � ; i ; i ' � i � � � � � ( `E i �J � i �"" �if{. f. � �1
6 � i � � � .3 � i � i � f ' � � k s i � I � [ I E i! i � I � � I I�1���E �
�
6 i ( , . � i i � � ( , ; � � � : d � � � � I � � �; _��
,� E _ � i i � � � i � �� _ � � E ` 1 � f I r (��
� { � I ' � ` k i , ,'a L :__ � � � I `' ( __ � I -�___�_-
� a � i � � �+_i _� —+- � `I -5 �-
; � _� � C � ; � � � � � � � i � ; ; ' i ' { � � ' � ! � 1 ' � � � � �
° ; , ' � 3 !. . �. i � � � ; ( �.3 ; ' i (i � �j i` � `( ' �) �' ; � , i � � � -
i ��� � �€� � ( j i 3 ' 3 1 I ' i � �� I j i� I �1 � . ' �.
� ':N ` �_ ; � i � ' � { ; � i ... ° ..�i 4......_..4 ..;.___---��- (-�—�--� .� �__� i l__� � _;_�
+ ' � <
t I i i � �.:. � ..�_.
E � I a � I � t � � 1 E r �
� � � ' � f � �� � � � ! i �_ � � � j ( � , � � I � � � �
� + : ; ! , � � � �! � � r i ( � , � ( � r , —
, � j I 1 � i i � i i 3 � � i � � � i I i j i j E
6 � -� i [� I � � 1 � I i � 3 ( � � €� � � [ . I i I
3 a..
S �• �( i I �� ! � ,, � '� � i i � ( � � ..� I � j, � � ` I I: i� i I ��. .
I' ! I i
' (_ � 1 � ' � � ' � I t ��- � : � ' ( � a i � ' � r� �� �� ��
* ;
,
�! � � � � �. ..�___z_ � a.___..�.-.�._,=.� _,._.�..� _..�.._. �...,..._._�.�. ��,� .�_�__t�...�___�_� !_._t
3
V .) �. i €.. � � ( F� I � 1 ..� ? � � € � ( � x
d ..��._�—� '__ ,_....J.,._�t� �.�... + 1 � .e.. . le�.�._,�__ �_I �. -