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HomeMy WebLinkAbout10961 (5) �,. _ ��, .._��.��.�,.,�;,, ��. - -- - �_� . , �,� �� _ ..,._..-,� _ __ .:1 r..;:: .�.....-__. . .. -__ .. . y ,�::: . - . . "^�'�+,..:-�.e:_.u+�u�:.v^"""...��.---� -..-"'4'¢"�`-.S:','.�...�. :.:...,.�...,.<....T:-.-'-'_..y. �. . . .. . ' �. __ CITY OF DIAR40ND BAR � � ` ' CV�` I T I COMMUNITY TJEVELbPiVI�N'T D�'AT2'I�vfENT � { �e� R�D � �:�.�; . v x ,�k� ���,c: x�° .. �:��� PRESS 21660 E.Co ]ey Dnve Suite 1 9������ BUILDING PERMIT�APPLICATION Q�.� �.O ZOOO �IRMLY Y� � :-� ���;,.� . � JOBSITE �.-��-,r . � +'�� i' , ��a�� f'.� qPPLICATION r� PERMIfi P1� oAODfiESS'�L1C �`��..������Q�'�9�rf••�a.��T��A l 11� '' DATE ':.' .< r `V . -. NUMB�F�--����#... ��� o ISSUE TYPE OCC `� qPN_�LOT TflACT DATE_ CONST. GROUP � : . , . ', bWNER — . . _,.,. ,., .., . _ . __ . _ ._ . . _ � � � �z ZONlNG SETBACKS Q ADDRESS�� FRONT RW � r z GITY f"�nu.�.s LIYOI+�P�Jfy�EL. REAR `' ❑ . o APPLlCANT ` TEL SIDElSIDE STREE7 RW ❑ � GONTRACTOR I� V� CG'�S'�'S�I,A.C,-�t.�,Mt C� � SIDE _.. M� `Y ADDRESS .. � �; ..;,. ,; -��"�--� ;��-��� PRQP05ED USE���1�' �ci'M.t�i S � CITY Y�-y 1 i�.v+�_� ZIP �2��'s TEL.,��F1 `7""147-4 '. _....�' . � . _. � � ARCFIlENG/ i; , .' ',:I � DSSIGNER r# M. r: , NO.DWEL. N0. ,.. � .. , : , NO. . c�i.. ADDRESS v - UNITS STORIES ' BE6ROOM� ' ""'" � .u... � C@TY ZIP TEL. , _ ., _ ,..._...... ....:. . �..�,,;_„_,_ DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � a . . . . . . .... OWNER-BCILDERDECLARATION . � - - �� �� � � SFP,)ADD(RElA � � � � � � - � O - 1 HEREBY PFFIRM UNDEFl PENALTY OF PERJUHYTHAT I AM EX=MPT FROM THE CONTRFiCT6b�S LI� GB�eJC/C2�pOft _ �W CENScIAWFOftiHEFOLLONNGflEA504(SEC.?0?150USINESSANDPRCFESSIONSCO'JEA'dYCTYOF (J� . , , U COUNT"WHICHREOUIRESAPERMITTOCONSTRUCi.ALTER.IAAPFOVE.DEMOUSH,ORREPAIRAIJYS7RlJc'- � � . w TURE.PRIOR TO IT£ISSVANCE.ALSO-RE�UIRES THE APPLIL�AM FOR SUCH PERMIT TO FILE A SIGNEO � P8110/D@CI( �"'� � - W ..;:.._ . .. �- STATEMENT THA7 HF OR'SHE IS IJCENSEC GURSIiAN'TD THE PROVISIJNS OF9'.IE CbNTR'(.C'CR£'_I� �� � � . � �- '�-' CENSE LAW(CNAPTER 9(COMMENC:NG 4VITH SECTION 700a)OF DIVISI�N 3 0f THE CUSWL55"AN��PF1D- � POOVSpe O '�, u BJECTSTHEAPPDE%EMP- - � F (� FESSIONS C07E)OR`HAT HE OR SHE IS EXEMPTTHEREFFlOM ANO THE BASIS fOR THE ALLEGE � TIO4.ANYVIOLRTIONOFSECTION703t.5BYANVAPPLICANTFORAPERMT V ,ICANiTO � Re-Roof � A C�VIL PENALTY OF IVOT MOR�7HAN FNE HUIVDFED D�LLARS(�50b1 j � '���� � � QuI,ASo'NNEROFTHEPqOPEft?�',OR�d'fENPLO��SWYHf14C SASTNEIRSOLECOMPENSATION, � Commerdai � � � - � WILL DO THE WORK,AND THE STRUCTURE IS NOT INT N�ED�OR OKFEFEO OR SALE(SEC.7ona BUSi- J � 4ESS AND PROFESSIOM1'S CODE:THE CONTRACTORS I ICFNS�LAlN DOES NOTA�FIV TO AN t7WNER OF ' ;� - : .. "'^' — PRrJPEnT'/VlNO£UILDSOR11.1FROVESTHEREGN,ANDWHODOES$UCHVJOAKHIMS£LFORHer�SELFOH m _. ` '�"' """ "'� � "� [� THROUGHNISORHE90WNEMPLOVEES,PROVI�EDTHATSUCH'MPRpV'cMENTSARCNOTIN'fEfJD�D�OP ��� L11 , OFFERE�FOfIS4LEIf,HOWEVER,THEEUIL�INGORIMPROVEMEN`ISSOLDWITHINONEVEARU�CONIPLE� ' n TION,THE OVrN=R�BUIL�ER WILL HAV'THE BURDEN OF PFOVMC THnT HE OR SHE DI�NOT BUII.D OR - ; " '-� �"' "" '- '� ' '`�--' IMPROVEFORTH£PURPOSEOFSALE. � ' ' � n_I,ASOVJNEROFTHEPROPERTY,AMEYCLUSIVELYCONTRACTINGWITHL�CENSE�CONTRA��'�ORS � . . . .. � Valuation Qtyd � � ADJ.AFEA � � (Z TO CANSTRUCT THE PFOJECT(SEC.7D44.BUSINE55 AND PROFESSIONS CODE THF CONTRACTORS LI- __ LkJ CENSEIAWDOESNbTAPPLYTOANOWNEROFAPROPERTYWHOBUIL�SORIMP{?OVESTFIEREON;AND � S V.hiOf.nNTF'ACTSFOR£UCG1�GFiOJEC?SVJITN'ACONTa(.CTOR(S)UCENSEDPUPSII'ANiTOTHE'GbM'RM- �QUANTITY DESCAIPTION - - FEE � / � �I AM EXEMPT UNDEP SEC. �S�REASON d L/u'��L aP.."-�j' .�� � ..... ...,�B.&F C.FOR TH,.. �� � U S's'�✓f J'Z-C s� . . . . s.. To S f.l .. . . ..._ _.. ,,� . . ... . � . � .�.,, u-- cnrE ow�veR U �°��f` v�I �+r'/'�.S p , ,., LICENSED CONTRACTORS DEQLAfiATION � � ` � � � � .. . . . �.�, .:- W . .. .. ¢ � IHcREB'�Ar�I�MUN�EftPENaLTYOFPERJ'JRYTNATIAMLICEN5E7UNCERPROVISIONSOFCHApYEp� 'V. f ���1'L(w �%.� s(COMMENCING wI7H SECTION 7000;OF�i`lISION 3 0F7HE BUSINESS AND PBOFESSIONS CODE,AND z P �- X MY LICENSE IS IN FULL FORCE AND EFFECT. .� f f�� .. ��" L`.7. . . ...... f���, w! � LICGNSE CLASS � LIC.NO __�-���..�{3�2_ _ _ � �yJ.�r��',� �,�� ... � fs , . < ,. �9"�. Cti� o: � Dn7E__�-�—�p�KERS'COMPENSATION DE�RA ON� (�///ryryry,'�.(}}�,�J� �__— ���„t� • ca � . .�. .// / (a_J P.�O' n J`GT'T e�f' � I HEREBV AF�IRM UNDER PENALiV OF I'EFiJURV ONE OF7HE FOLLOWING DECLARATIONSNr \i � z .: — . ¢ . G �_IHqtlEANDWILLMAINTAINACERTVfICATEOFCO�SENTTO� ELf-INSCREFORWORKERS' S � � � COMPENSATION,AS PROVIDEO BY SECTION 370o OF THE LABOR CODE,FOR TNE 06RFORMA�CF w _ OFT4E WORK FOR WHICN THIS PERMIT IS ISSUEO. ,_ � , Q . .. .. . _ . . . ......,. ....�. . . � �IHnbF:ANOWILLMAINTAINWOR(ERSCOMPEVSAYIONINSURANCE.ASREdUIREDBYSECTION ~ �700CFTHcLA80F7CODE.FORTHEPERFOPMANCEOFTHEWpPo(FOAWHCHTHISPERMIT:S ��� �� � ISSUED.MYWORKFRS'COMPENSATIONINSURANCECAR{iIERAND'pOLICY�NVMBERAFi�. � -"�� CONSTRUCT�ON -"-�"� . >� .,_,.,.cnaaiea PLAN AEVIEW � --. _.._.. ...__. _ . ._.... _..,......_....... ..........__............._,...�._. ....._......,..,_...:,... . . ._,......�.. .... ...._ ,.._........ � �y�^ � aoucvNUMe[a GLECTR�C - /J � g Q 2�" ."�' � �THISSECTIONNEmNOT9F�XNAPLE�'EDOF7NEPERMtTISFORONEHUNDREDDOLLl�FiS(51oo)ORLESSj. PLUMBING - w MECHANICAL *� ' �� � 1 CEftTIF`!THAT M 7FE PERFORMANCE OF TME VJORK FOR WHICN THIS PERPAIT IS ISSUE�,I � ' U.. ...,_.SHALL NOT EMPLOY ANY PERSUN IN ANY MANNER SD FS TO BECOME SUBJECT TO THE. . . 4r� WOFKERS'CDMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT If I5H0ULO BECOME INSPEC�ION FEE /� � SU&IECTTOTHEWCRKERS'COMPENSATIONPROVISIONSOFSECTION3�o0C1FTHEtABOR ISSUAIVCE `+� �� � ._ CODE 1 SH4LL FOPTHWITH COM�LV WIT'a THOSE PR 1(ISIONS. � , G) ��A �( i'T ... �-y-��j�� � " � SMIP � � ��..� � . ..� � OA7E. =�__�j_ APPLIGANT '�Y`-.,�-,��'� '�j'������� {�(, � � - ENERGY P/C � ��V !�LJ� ! (�'�_ i WARNINGFAILURETOSECU3EWORKERSCOMFENFATIONCOVEfiAGEISUNLA'JJFUt..ANDSHhLLBE������ ' '� z � SUB.IECTAtd=MPLOVERTOCRiMINALGENAI.T!ESFN�C!VIIFlNESU TOONE4UN]REDTHOUSANO ENERGYPERMIT � DOLL4RS($�00,006�,IN ADDI710N TO iHE COS7 OF COMPENSATION.JAMAGES AS PROVIDEO FOR IN ' � --S[CTION37oeOFTHELA30E-CO�E;INTEREST,ANDAl70RNEY'SF�ES.� �"-''' '�� " �-'-' ' - RETE�NTION�F�E: �_ ������������� �-���� �- � � - ��� � � CONSTRUCTION LENOING AGENCY PRE-ALT FEE: � - � ' �� - - cti _ � . . . . . . _ ...... .. . ....... . ._ ..._ .. . . . � -. . , �,---: � I HEREBVAFFIRM UNDER PENAITV OF P[RJURYTHATTHERE IS A CCNSTRUC710N LENDING AGENCY _ n- FOR?HE PERFORMANCE OF THE WOFK FOR WH'"CH THIS PERMIT 19'SSUED�SEC.309�,CIV.C.). � . . .... � ,.., . . ,.�� ::^,?' .k ..:�.; Z _ _.. _. _....._._ ..._ . .. . _ ... .... . .. . . :� : . . . _...... ........ � . � �. W � LENDER'SNANE_ /'� ^_ -� . . . _...... .. ............. ...... ....... ... ... . . , • F- I.ENDER'SADDRESS_ ___—_— , . � �� � �. ' �. � - � ICERTIFYTHATIHAVEREAQTHISAPPLICATION/UJ�`STATETHATTHEABOVEINFORMATIONISCORRECT�� TO L EE �� � �F�� � I AGqEE TO COMPL�1YITN ALL CI fl'AND COU`1TY ORDINANCE$AND SYATE LAWS RELATING 7b BIIflGI1JG�� /�� � '- � -GONSTqUCT10N,TNU HE(iEBV AUTH6RIYE REPFE£ENTIS IYE50F"N S CWNTV TC FNTER VPON THE (,�.�.(`'j�J'y Z� ABOVE�M'eNTIONED?ROPERTV FOR MSPEC710N PURPO ES , ' C�M L"M11T �� � �� � � �� . . . .._.. ._.. ..... ,._._.. . .,..... i � . /+�.. p s�+ �' ' • . _ 9 Pt J .._1�-4+I�-i.��AA��LnJCI.��I e��Pr`L' �� , �— ... . , � �: k� PERMiTTFENAM FII:M1Tp's �/ J9 /,� yy� � . �? .'_'_ .. -� . . CI') / ��,/ /..+�v"��� /!.f'��%'! � .: . , , «..:. � SIGf�lfUAtO�P aE Mirre�`e�—="--"-�� . �— �f' .. ..,.� �.. � = RECPT.Np. PAID 6Y VALIDATION � i = _ �~ �� -� WHITE—Department Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant"s�Copy .. � .: u .�.,.,:: w .,. ..�..,_.. �.�. ... ..t:x..,,.. r , ,:,_. .. . :... _, .,,-.:.. ,. , .- , . ,_ ,.. , :.:, ,, . . .. . .,<. _ _ :� �1TY fJF DIAMf3�i� B�►�8 _� ,._ 1NSPI�CT ,.,.. .. : .:, . .._,:: , __ . ,.. dON F�ECC�►l�1� _ .. . �� � „ .; ��,. �� o � � y • � r r � � � � � � i SET BACK , � ; F�C}OR Jt�9�T � l FTGSl�C3F�MSISTE�� , �'HA FIEC�MTS 1 �LECTRIC C�RC3U�1�9 t1NDER FLO{�Fi DIJCT � G�tC3iJ1�D P�t��rI�ING C 2t' - � UtdDER F'"t30 ,�C){�4C)UIT SLAB C;RAC�� F(REPLACE FC)t3€�DATI{7N � `f'EA�P�U�V�R FiREPLACE BC7ND'BIEAfiui K XYTIk�8-1 L�C�1V'VL 4 '.'�.: � .. ... ' . . . 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