Loading...
HomeMy WebLinkAbout13600 , ^ _�.�_ CITY OF DIAMOND BAI� DEPARTMENT OF C(7MI41UNITY 8i DEVEI�OPIVlENT SEItVICES „ 21660 E Copley Dnve Smte 190 "" � ��>e6o-3i�sF�4gos�s6i sii� _ . PRESS �' BUILDING PERMIT A1�p�Il:A1`ION , � FIRMLY � JOBSlTE _. (`'�...,.... t,_, APPLICATIO . .�..� � N pERM17 ��(„�/�, P/C Q ADDRESS v DATE NUMBER ' �� '�} # � APN TR DATE ���`���1 ONST. GROUP p OWNER "" ADDRE�SS � ZONING SETBACKS Z CITY ,� � Z_IP� TEI. • REORT RW O g APPUCANT ���Tk=— TEL. SIDEiSIDE STREET RW � � CONTRACT `� 1 C SIDE ❑ p� ADD SS � � � CI ZIP TEL. PROPOSED USE !"—" o ARCWENG/ � _ � DESIGNER� .� ,�� � —� NO.DWEL. NO. Np. ADDRESS UNITS STORIES BEDROOMS � CITY _ ZIP TE4. y OESCRiPTION SQ.FT. FACTOR PSF ADJ.AFIEA/VALUATION OOWNER-SUILDER DECLARATION SPR/ADDIRENT Q 1 HER66V AfFIRM UNDER 9ENAl1Y OF PERJURV THAT I AIA EXEMPT FROM THE CONTRACTOAS L4 � GaragelCarport ldJ CENSELAWFOR'fHEFOLLOWINGREASON;5EC.7031.56USAVESSANDPROFES510NSCO0E:ANYCITYOIi C�7 COUNTI'WHICHREWIRESAPEpMRYOCONS'rRUCT,ALTER.IMPROVE,bEMOUSH,ORAEPA1RhNVS7RUC� W patlo/DeCk � TUHE.PRqR i0 ITS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PERM17 TO FICE A SIGNE� STATEMENT THA7 HE OR SHE IS LIC�NSEO PURSUANT YO iHE°ROVIS�ONS OF TNE CONTPAbTORS LI� � CENSE LAW�CNAPTER Y�COMMENGINa WITH SECTiON 7009)OF DIVISION 3 0F THE�USIRES5 AIdD PRO� i'L' POOUSP& PESSIONS COOE)OR THAT HE CR SHE IS EXEMPT THEREFpOM AN6 THF_BAS�S FOR 7HE AlLEGED EXE.UP� TION.ANYVIOLA710NOfSECTION7031.68YANYAPPLICAN7FOFAPERM175U&lECT$YHEApPCICAN7T0 Z Re-Roof � AqNIPENALTYOFNOTMORETHANFIVEHUNDREDDOLIARS(SSouJ.j; ��' � � ❑I,ASOWNEROFTHEPROPERTV,OfiMVEMPIOYEESWITHWAG[SAS7HEIRSOIkCOMPENSATiON, C� COIT�m6�G1&1 ' WILI p0 THE WORK,AN�1HE 5TRUCTURE IS NOT IN7ENtiEd OP OFFERED FOR 5pCE'(SEC:7b44,BUS4 J NE&S N10 PROFESSIONS CODE:THE COMTqACTOqS LICENSE LAW OOES NOT APPLV?O AN dWNEP OF � PROPERTYWHOBUIIDSORIMPROVESTHEREOk,NtdD`M10CGESSUCHYlORKHlMSELFORHERSELfOR � � OC THROUGH HISOR HER ONTI EMPLOYEES,PROVIDED TNATSt1CH IMPROVEMENTS AR�NOT IN7END�OR m OOFFEREDWRSALEIF,MON/EVEP,THEBUIl01NGORIMPROVEMENTI550lAWITHINONEI'EAfiOFCAMPLE- � TION,THE ONRlEN-OUILOER Wlli HAVE THE BUROEN OF PqOViNG THAT HE OR SHE DIO NOT�BUILD OR = IMPqOVEFORTMEPURPO5EOF5ALE). �'-'� ' ""' ❑1,AS OWNER OF THE PRQPEFTfY,AM E%CW�VELY CAMRACTING WITrI LIC[W5ED C4F1TK1ACTOfiS � TO CONSTRUCT THE PRc]IECT(SEC.7044,OUSINE55 AN�PROFESSIONS CQbE'.THE�CON7F�AC'FORS I.I� � V2IU8�1 6 � _qDJ.AF3EA W CENSELAW170E3NQTAPPLYTOANOWNEflOFAPROVERTVWHd6UtLDSORIMPRO�l�ST!lF:aEON,AN� � W{}DCQNTRACTSFORSUCHORQfECTSWITHACCMTRACTOR(S)LICENSEOPUflSU0.".{TTOTHECONTMG � QUANTITY DESGRIPTION FEE � TORSLICENSEUW.�. -.__...- .-. J o ❑I AM EXEMPT UNDEP.S�C. �,._�B.S P.C..=OR 7H�S REASON U ,____ '�b � V' DATE OWNER______._-�'--- � o LICERISED CONTfiACTpFS DECSAAATIO�Y ���� � W � IHEREB�AFFISiMUNDERFENPL'VOFPE YTHATIAMLIf,ENSEDUNDERPROVISIpNSOFClikPTER � � L(COMMENCINGWITNSECTIQNTOOD OF ION3QFT RUSINE$SANOPROFc5^u�ONSCODE,AND � � X MV LICENSE IS IN FULL FORCEAND EFFE . m W d UCENSE CIASS ` LIC.NO._ � ���g� � V UATE CONTfi2ACTOR_�___.__-'__________ � W _ _ � WORKERS'COMPENSATiON DFCLARATION � �� � �^P.�;,� ',�e,�;� �„', � �. � I HEftEBV AFF�RM UNDER PENALN OF PERJURY ONEOF 7HE FOLLOWING OECLARATIONS � � - � Z. Q C,� i HAYE M1D WILLMAINTAIN A CERTIFlCATE OF COfd5EMT0 SELF-INSURE Fpq NlORKERS' S ' � ' ' � � � O�MPENSATION,A9 PROVIDED BY SECTION 3700 Of THE LABOR CODE,FOR THE PERfORMANCE w OF THE WORK FOP WIiICH THIS P:PMR IS ISSUED. � O � _I HAVEAND WILL MAINTAtN WOPoCERS'CAMPENSATION INSURANCC,A^u REOUIRED BV£F.CTION � Q 37a00FYHELA90RCODE,FOPTHEPERFORM'ANCEOFiHEWORKFORWHICH7HISpERM'�.TIS j � ISSUE�.MYWORNERS'Wh17EN5ATIONINSUAANC-CARRiF.RANDPOLICYNUMBEN0.RE: I CONSTRUCTION �� e � � . --,--- � PLAN REL+IEW _ CARRIER�_ ` � POLICYNUMBER - -_--_- ; ELECTRIC -_ Q I � m+�ssEci�r�EmnaTeem�Eoan�affrvrr�wnoniEHurnHEomiaas�,o�;oaiEss). ! Fi_UMaING W I CERTIFYTHAT IN7HE PERFORMANCE OFTHE WOfiK FOR WHiCH THIS AERF7IT IS ISSUED,I I MECHANICAL �'+' •". '�°""�3 Z � SHAlLNO7EMPLOVANVPERSONINANYMANNFRSOASTOBECOMESUBJEC7T�7THE •"' � WORKERS'COMPENSATIOIJ L4WS OF CALIFOFNIA,ANQ AGRE£TNAT IF I SH47ULD OECOM[ ` �1�1SPcCT10N FEE � SUBJECTTOTHEWORKERS'COMPENSA71ONPROVISIONSOFSECI"�ON37aoOFh1EU60R { ISSIJhNCE _ ���`� �� � (:O�E.I SHALL FOF7fHWITH COMPLY WITH 7HOSE PROVIulONS. I - � �ATE: AVPLICAiJT: SMII' '��,j� �� �-y,,.��', � ���? WWARNMG:FAIIURE TO SEGURE WORKERS'COMPENSA710N COVERAGG IS UNLAWFUI,AND SHAIL BE �NERGY P/C � µ�'{�t'F�,��� ��''����" __ � SU&IECTANEMPLOVER70CRIdA1NALPENAlT1E5ANDCIVILFINESUPTOONENUNDREDTHOUSAND' ENERGYPERMIT +'"''��°y� ��� '�� DOLS.ARS(11ao,000),IN ADDITION TOTHE COST OF COMPENSAT!ON,DAMAGES AS PROVI�ED f-OR IN �^ .'-�-'•=,�a � SEGTION37000FT1ELA80R(mDE,INTEREST,ANDAT70RNEY'SFEES. P.ETENTIONFEE: �'�'�'�u�_+k�=��''� . � CONSTRUCTION LENDING AGENCY PRE-ALT FEE __ O � IHEREBVAFFIRMUnIDERPENALNOFPEFJURViHATTHEREISACONSTRUCTIONLENDMGAC+ENCY _ � � FOR THE PERWRMIWCEOFTHE WORK FOR WHICNTHIS PEqMI71S ISSUED(SEC.a097,CN.C). W � LENDEP'SNAME,_ P- LENOEP'SA��RESS__ � ICER71F1'hiATIH READ ISAPPLICATIONANDSTATETHATTHEABOVEINF N�S�aRE�r. TOTAL FEES � ., 9�.��� W 1 AGHEE TO CA V WITH CITV ANO COUN7Y OHOINANCES ANO STATE REIA ING TO 9UIL���MMM111G ppp��� t� � CANSTRUCT EBYAUTHOPI2EREPRESENTATIVESOF IS TO EFjy�{,�� � p -� -� ��- Z ABOVE-M GERTV NS CT N PURPOSES. � J,/ ��� OMMENTS_ � 0 _ - _'_ m PERMITTEE NAME�� T) - Q I ' � � SIGNATUREOFPERMRTEE pATE 'f � '' RECPL NO. 1 /� PAID 0Y �Y/�L1DA710N��� _ ~ WHITE-Deparlment Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Appticanf's Copy � �C 3���d� '��.�`_�.w��,�afS����..�§ ��a��� .. . , � .... .., . .. : , , ,: ����������� ���.������ � ��� � �,�� � � z ���� �< �� � �: ,.� � ����°��;;,���.�a��* �, � at�� � ��a�, �� � � � � � � � a� . � ,. � �' � ,:.��s.�� ._������."��u�.� �`F._ ��:�� ..h� :�� le'��"u�w `��• .�a�, - ����. .,. ��� �*^� ���.���� �"������. .��„ � ` t,'.�) t °`�. � ..� �� ' � ; I�i.. � '-a"l �, � : . } n : ( � . � ..,�... ..�. . � . _....._ ____. . �.._..._.. ......._ _ _ ._ _ _L ___ ! � .� ` f ('� `3�''aW t € i.. _ . � l Y`'��� } _�+. � ' ' ___..m�___... i_. .. . . _ .,,... ..._..........t._._._.........._..... 3........_.._�_,__._....w,,.—._..::1�.. ...._.. . .... ...__.__._... _ ...._....... ... .........,._ s � a"LmF � $S .✓t � ..�p_k � 3 f i��! � f � .�_c � __. _ .. , ; � . .. . _ _.� ._ . .. _ .._ _ 3 � '��at�'' �� Y� .., . � _- � I.�.,� s � " ?'.r ,��.�,^•,�a,.i .E`�" .. _... _ _..... � . ..... ....__; .__..�..,.�.._..._ � �m_.,.. �....w.. _ _. .5„_.._ .._..._ �...�......... � .a..,x d �..:,lg. � . ... , � $, � � :; � ,'„�1 3 , �..�.... .�,._._. _ .. - _.._� .._,__ _....__ _...._.,_. ..._.............._ .__ _ '_ ..= . 1 ..._....._..�._..._._..— —�. _ � ` �.=�j",,,y j� y..f �„� . _ . . � � - , ::. t , �`� ...... _-- �.. . .. _ ___— __... � . � , , i . � - � � �'-�...Y=�t> �'`?�S*,..� . �h€,� - � .:.w, -�...., ..._......�.,.,...� ..,.,...._.. ........_...'."'_ .....:....;.�.:..�.................:.... . -.T . ___"'_ .. ...__._ ..�,.._._... � _...�....�... :����� ::, ,4.- � � I .. ,' .:a � �`�,�3iw "i��;#yt ._. '._ . a � . � _ _._ _ __..�_.__....¢._ ....m___..�__�____w ....�.___.._..__. � c ..... ��. ---i-_ _ _.____ . . ' ..__ ._w ... � , a � . ` � ? ., - « ,.r. , _ ...... � { 3 i. °'"' �' 9 4m�.. �.a.........:...,....._n-..— _�..............^.��._ '��_�._........._ .. � .3 .7.,� '�f�..'^t€' _._..__ .._._. . ...: "� .�.? R t I n�4 P"��� . '' � ' .. '�. . F .- . € �:"s 9A : :�¢ra 5 g � �,.�i�. i...._ -. .. .._____._._ —....,....„.....,„., .. y � r : _ ._.�._ .....�. �, ___..�__._..._......_._>..._____.�.. _, ° E .�,. _. _._ �... ... _.__--�---__--- � � �..� � r; , . � i ' �, t-��.� sl��a .� �._ .____ ._ mA. I__._____. � � . . _..,. � �. . _ ° _ __ _ _ __. � _ � et : � � �cr �ew: � �..:;�q � .... ..._,€_._"""'"___.�... � 4.�a o �.1 ; i � . , . ......�..,....................... ..._.,..__.�:..,.._._...n ....,..�.._............,..,..__..............,-.....::..-r__.. ..........,i_....-..W...,,._ _._._'_._.�.......,......._....,._.........,.._....... .-,..._._.._..,,...�...._.�.�.....,..,....w...�_.,._.... _.......,..�_�_ .em......_...............-,....,,.�..� : ra .i � - S - , �'tiF, �it., ; _. � � � s� a. ��� �,;� j � ,._ ___ � . . ___.__ __._ ._ _______._. �..._ .�___ � ._.... � € _ s� 4^�l� i � 4- s '' (�d'"r@ 4. j , � _. _ �_�__ _T __ � .� ___. � � � � � �� �� # � 1 ... :n . _.__.'_._..�_n.,_. ..,____...._._... _ m �__ _� .___�... _ _ _._.e._.__..._.m. .. ,._ � *i ., mm� �:� a �,�°:� i i � _ ��ka t `r��'�� __ _ _ . __.. ..__ ___....... . ---__-___—___ __ ...... ------_ _ _�__W__ _.__... ..____.__.__ __.... .�-- � ¢ a � ,_ ` :�e° ; r�t,¢ ? � i.a � s i`��' � � �. _ ____._.�......_ '__-�_____ e..____.___ ���. ._....,�.,__.__w-__ _m_....._..V. __. �µ.__. . _.. .._...__ .._ � p .'4_i_ _ .. . .. � (—g. .,.,... .._.: _._..: .� _ -_i .6-'. t '- ': . � - �d`4 9 .�._... ; .. ,.._�_'"__-___«_..._._... t ..........._..__..__.,.. � .y_... .... ....... ._ I �_I .__ �,.,..._ p _._.._ . �... _._.�. _ .... � �` . 3�` ,.�-. ,e_. ... i �,` �� �. �..�4�'� k � � . I , -.. .. .�..,_............_._._._..... ._. ._' ____mm__ .......__.._..�� .. . __..._..�_. ....__ . _..._ ,.............__...�_"__ __... _.....,.. .._.._..____,__...._......_._._..._�.. s € � � �_. r q �_�_.. ..�..� ,.,_,� .._ .. .. �� a �w 6��, s _ .. . � .�.... ............._.,�... , ........„ .; . _ .�.. . . _....__ . .._... . . ... ..._..�.... � . . .... . 3 ( .. i.. ..; \ :.\ .. £ �M . } [. S „k�-�.&�� 1_.-.Y""� _ . . ....,.___ ..... '. � � . ...� . _...._ � _.,._ F .e� � , .. � �.. ��� _3 3 . � c �, sa ._.. _ � �'. ..,... ._•-_..__�___.,.........�..........m....�........ ....._,__�........,....«_.._...__..�.,.,._.........__._L__ __ � _. �._ _._......,....,.. ........_�-�._...........,�,,.,._:�..._.._�......_ � :, x.a? ' f ,.. . . . a:.3 ) �. Rn'o.et ,fm'�� � ' ' ..�$ .. � _.... . .. . .,_ ..... __.a.�.....:.___.,..,... ��,,._...........__.ve.....e...................._... . ... .. . ......,.,._....._._ ., .._.........._...._ ____....__._...._....___..................,... ... ....... :. �--..r.r.w,...�e... [, , . '_i 9 � '., ..� � ,,'"' .,.,,. ., ._� . :-. . ...FY f. � f... .. . �.. ?,..C'i �)'e� _ < � .. , ._ ..._ ............,...........�J'_.,.,..,,.... .:..::�.-:... -,:.;..;..__.-.-...._,_.__..........:..._.�,_... 3 _ _ __... ..., .,�....__._._ ............�.._..,._....... ..._..,.,..__..... ..._._ � .< , §E_,i�l .,..a . 3 ._ � E,3_.,x....� ": . ..._€-"'. �€:�,... �� .' . 3 _ `� -' 3 .. ._ .._...,......._._,._i.,..,.. ....._.._ .____..._..,,......____ ....-.....,,,._.._... ....,»......... .�...�.. ....__....... ....... .:......�_.�..�...: ........,..�.._.._.._ _...... ._-...�.._.v .: i ,.. ... .... �,..... ...,� ___ ' ; s....�.�:� L.t.s � ._ _. . ,. . .. . L.� $�` ':k' t"r(..7 € �..� � � .. . . � ..... ._......._... .,..._ __......,._......_—:.............. ....<<____.....____.__—........� .) ......._ .___._ __._`____..__.. ....____'"_..........:_.___�—__._.�..W..._...._.._...... . . _..._-•— __._. ...._, . E B�P, f'�, Y n_ 3 � ' � L I€ 1�. t .€€. .. . ' ....___........._..,_....... �<_...,...-...,�__.;.._ ..`._.�.�......,.�._»...._._�...._ ..,...._._......._..�.., ........e..___.... ...._............�.......... . i .....�.�..._.�.�.............. ....,...,...,.:.�. ._....__.._.�,�.,....�.....,._��___. ..,„._ 3 j � ' � � . . -�i ....... __ ..._... ... ... . .......... ... . .- .__....... . �. � .�._., �"'d��, � ' ... . ......_...... - - � �'�*3$'°� +��"�. R�q.�' :: �A : �--_ _ � . .� :�:. .....� . , ..._....�.w.�.R�m.. ,..�..._...�.,_......: � ' ����..'�'.,������..- s� �- ' ; re.._ /� ✓J n� :. ..�. � ._. . ...._ ._ .. --P P.. � _... . ... -.. . ... .. . ...._ _ ,��___ ._._..�.....�......�... .,..,�...,. { ..a't. `'a�'�. .,� ___�.._�,.`.��':�{"�_���µ��7su-,,:��- n ,.y�__r�..a.. �r , 3�� . .......... . ___ _ t' . ..,.e..... .e ..\'..� ..�.. . ,.......__ _...�..._..........�..w..............__ . __. _ _ . _y _... " f � � ,' ',�.J ,. i_..t`Ld`Z-9�__��`�`"�-.�___�..`_(__.n�..__ _�.._ .._____..w _. ._. ,... . ��_________._... ._.._ __..,�. . _ _..._____.____._____.�_-. __ _ � � _._. � � �_...__...__...�._._____._ .__.._�. __..�_w.�_ ___._...____._r._._ _ ____..�_..�_.__� _._ __...___. ..._._���__._..__._ .. __._.. w ._ _____._ �..._., � _ - _ � . , _�___ u_..__._��. ._.— __---�___�._._ ____— _---�._� .._, __.�_ ---._______ __________ __ ��� _ . __—_._.___�_ � � ..._..,�. ..._.. ..�_w.�.....__�.4. . .....�_�.__._.._ �.e�_____._.__� __�._ .._�._.._�_�_�_w_____� �.�____.�. ___...: .._...W_________...._. ._�__.._.�_.__... __ ....... _� � __.,____�.�._. __�_ _ .. .._____._ ._.._.__�_.�u_._____.__._.__�_ . .._ ._ �__� �.______�. .__ --- ._ __ _ ____�_._...__ ___ .._.__—,_�. _..---.�._._.__ __�..____ _ _�__—__.- — � � s ; �.__.___�_w.� �.._..___.,____.�__.____W_�_�_._.�._.__....____..___�_�._.__M...�_...---_.___.____�� �.__� _.......� ..___._.____.�_..___.._. �__ ___w._____ __.._.. � i $ � w� _. _._.�.. .____.._._—___.._._.�__ __._.�__.__..,._ �.._�..... . ........... __.___.___.. _ _._..._. ..._.,_� ..___.____.___�.___ __ ___ m_ � &�� �E�: .�. �� ,; , . , � _...:_ _... ._.._.... _ - w__.__.. __�._._.�.___._�___.__ ___.__. ..___-- � ��� r ; � � �....__. _..._____.___ ____—._..._.____�_.____ _� ..._.._.._�..__....�__._W._-- —; � � - � � ����. ��� ��� _ . _ -___- ; �. ��, � ��� ����������� __-__�___� .,__ .... .��_.. _ _m__. . . _.._ _„ . _ .._._� ._ .... __�._�__._____ ___.__ . � � ��� � � ` ' �� �� � __ ... �.. '��� � �� ��� ��� . .�. �_ ... _._. _ ____ �< � v . �`� � �� � � �� �' ����. -�.�._.._. . _.._...�.�..� .. _._ .� : r t � ___ �;_ _ w..�.� . �� j .,\ `- � � �� ; �.�° .r._ , ���i � d.",-: ,, .�'�,,� .,, .,� i � ', � � ��� �� �� �:,. _ ..___ __ _. _. __ .. ,_ `�,.'�, � r � , � �'�a� �y� � t'� � w, �. � g� 3 � _� � � � � -� ......n�.P<..._..._._ ._.... .....�.._............._ ......_.�...... ...... __.._. _._.._.._._...... . n r '�'S�p, t £ ���.. .._. .....__. .. � �,.�.g�:,.,. �. �� .. .. ......._ . ... .........-.. `M . , . . : , 3. : y �.�.. s�'�a��'�.'�� ..�� ��'��€��'� _ _...._.._..__...._�-...__ i � .. , .. .. . . . . .. _.. _ . ....,___ . ........._.__.._........ .�_...._......._..�__'-_. _.___'._�.