HomeMy WebLinkAbout13052 (17) ���� i
CITY OF DIAMOND BAhT 7`"� j
—� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �'�
_ _ � 21660 E.Copley Drive Suite 190 PRE$$
� (909)860-3195 Fax(909)86]-3117
''�"�� BUILDING PERMTP APPLICATION FIRMLY
� JOBSITE APPLICATION PERMIT P/C
o ADDRESS � �'�� • � DATE NUMBER��-#
c� ISSUE � .��„� �" TYPE. OCC
APN lOT TRAC7 DATE CONST. GROUP
p OWNER �'
" ADDRESS n n�.'+ ZONING SETBACKS
� CITY ZIP TEL. REART RW O❑
APPLICANT TEI. SIDEISIQE STREET RW ❑
n. CONTRACTOR SIDE ❑
�, AODRESS
� CITY •. a,.;�i,�_ ZIP' TEL��,Ih�"r� PROPOSEDUSE
� ARCH/E�4"u'+d �— v � �t. _
Z DESIGNER NO.DWEL. NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q� OWNER-BUILDER DECLARATION SFR/ADD/REM
- p i HEREBV AFFlRM UNDER PENALTV OF PERJUNV THAT I M1 EXEMPT FROIA YHE CONTRACTORS LI- Ga�ege/C8(POIi
W. CENSELAWWRiHEFOLLOWWGREASON(SEC.7037.66USINES5PN�PROFESSIONSCO�E:ANYCI7YOfl (n .
�J COUMVWHICHREOUIRESAPERMtTTOCONSTRUCT.ALTER,IMPROVE,DEMOLISH,ORAEPAIRANYSTRUC- W P1ti0/DBCk
W TIIRE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE AVPLICANT FOR SUCH PERMIT TO FILE A SIGNEO �
� STATEMEM THAT HE OR 9HE IS IICENSED PURSUANT TO iHE PROVISION3 OF THE CONTMCTORS LI-
c. CENSE LAW(CHAVTEfl D(COMMENCINO WITH SECTION 7000)OF DIVISION 30F THE 9USINESSAN�PRO- � POOUSp7
1 FESSpNSCODE)ORiHATMEORSNEISEXEMPTTHEREFPOMANDTHEBASISfOiiTHEALLEGEDEXEMR
V TION.ANYVpUTWNOFSECTION7o31.68VANYAPPLICANTFORAPEHAIITSU&IECTS7NEAPPUCANTTO Z p¢-FOof
r, A CML PENALTY OF NOT MORE THAN PIVE MUNDRED OOLLAqS(S600).): .
� ❑1,ASONMEROFTHEPROPERN,ORMYEMPLOYEESWITHWA6ESASTHEIRSOLECOMPENSATION, � CommB�Cl01 .. -
N9Ll.DO THfi WOFifC,M'0 THE 57RUC7URE IS NOT INTENDE�OR OfFERED FOR SALE(SEG.7044,Bt1Sl� �1
- NE33 AND PROFE9910N3 CWE:THE CONTRACTOHS IICENSE LAW DOES N01 APPLY TO AN OWNEq OF
- � PfiOPERTYNM1lOBU1lDSORiA/PROVESTHEREON,pNONMODOESSl1CHWORKHIMSELFORHERSELFOR =
�. .THHOUfiMHI50flNEROWNEMPIOYEES,PROVIDEDTHA73UCHIMPROVEMENTSAqENO71NTEt�EDOR m �
- 0 ,OFFBiED�ORSALEIF,HOWEVER7ME6UILDINGORIMPROVEMENTISSOLOWtTHINONEYEAfiOFCOMPLE-
'-- 'TION,THE OWNEF4BUItDEH V17LL MAVE THE BURDEN OF PROVING'lt1AT ME OR 3HE DID NOT BUILD OK
� � -UAPROVE FOR THE PURPOSE OF SALE). � �
❑I,ASOYYNEROFIHE PflOPERTY.AM EXClU51VELYCONTMCTIN411�THLICENSED CONTRAGTORS
�� 70 CONSTld1CT THE PROJECT(SEC.7ou,BUSINE55 M!D PPOFESSIONS CODE THE CONTRACTOqS LI- V8IU0tiOn ADJ.AFlEA
- 111. CENSEIAWOOESNOTAPPLYTOANOWNEflOFAPftOPERTYWMO8UILDSOflIRSPflOVESTNEREON,AND
i WHOCONTMCTSFOHSUCHPROJECTSWITHACONTRACYOR�S�LICENSEDPURSUANTTOTHECONTi7AG QUANTITY OESCRIPTION FEE �
F- TORS LICENSE LAW.). �
o ❑IAMEXElAP'fUNDERSEC. 8.&P.C.FORTHISREASON U ' �
�► �
LL"� DATE OWNER V
Q W
.F UCENSED CONTRACTORS DECIARATION –�
� w
IHEREBYAFFIRAIUNDERPENAIttOFAERJl1RYTHATIAMLICENSE0UN0EHPROVI5lON50FCHAPTER � �,/
d D(COMMENCWOWITHSECTIONT�O)OfDIV�510N30FTHE8U51NES5AN�PPOFES510NSCO�E,AN� Z
?C_ MV UCENSE IS IN OflCE AND EFFECT. � m S
i31 l
-� �UCEN3ECLA9S��C". � IIC.NO. � , a . � _ j �
H
-� DATE CONTRACTOR d -
W
. _ .�. WORKERS'COMPENSATION DECLARATION - �- - � Q - - - - � � �
� 1 HEH AFFliUA UNDER PENALT'OF PER�URV ONEOFTHE FOLIAWING�ECLARATIONS U
� Z
G'2 _INAVEANDWILLMAINTAINACERTIFICATEOFCONSEKiTOSELF-WSUREFORWOPKERS' �
� COMPENSATION,AS PiiOV�EO BY SECTION 37000FTHE LABOR CooE,FOft TXE PERFORMANCE W �
OF THE WORK FOfl WHICH iH13 PEFMIT IS ISSUE�. �
0
W _I HAVEAND WiLLMl.�MAW WORKERS'COMGENSATION INSURANCE,AS REQUIflED BY SECTION
O . 37W OF'IHE LABOfl CODE,FOR THE PERWRMANCE OF THE WOflN FOR WHICH TMIS PEflMIT IS
...� . ISSUED.MY 5' PEN ION IN CE CARRI D POLICV NUMBERARE: CONSTRUCTION _
C OM
� - CnnR1EN �- _ PLAN REVIEW _
� POLICYNUMBER_R� ' E C
O_ . .. (IHLSs[crKxuNEa)NoreEmP.�LFrEocFTFiEVEahttlSrbHor�EttJWIiEODauas(Sioa)ortt.E55� LUMBIN �� .
z 1 CEPTIFV THAT INTHE PERFOR�NCE OF THE WORK FOR WHICH TNIS PERMIi IS ISSUED,1 MECHANICAL . -
_ .. ('J' �. �SHILLLNOTEMPLOYANYPEHSONINANYMANNERSOAST08EGOMESU&IECTTOTHE � - � � � . .
� . WORKERS'COMPENSATION LAWS Of CALIFORNIA,AN�AGREETHAT IF I SHOULD BECOlAE 1 CTION FEE _._—�,i��� �'y
F 'SUBJEC7TOTHEWORKEfiS'COMPENSATIONPflOVISIONSOFSECTION370oOFTHEUBOR ISSUAN E �� � ( -+
C�E,I SHALL F RMWITH COMPLV WI SE PROVISIONS.
p DATE•�� APPIICANT:��-- _ ..;�'„ "� .
� ENERGY P/C -�.
J' WAflNINO:FA��URETOSECUREWORKERS'COMPENSATIONCAVERAGEISUNLAWGULANDSHALLBE
'�y-' SUBJECTANEMPLOYERTOCRIMINALPENALTIESAN�CIVILFMESUPTOONENUNDR DTMOUSANU ENEflGYPERMIT � �" ¢w
DOLLAH5(i100,000).IN pODIT10N TO THE COST OF COMPENSATION,OAMAGES AS PROVI�ED FOR W ,�
-� SECTION37080FTHELABORCODE,INTEftEST,ANOATTORNEI"SFEES. ' RETENTIONFEE:
�- CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
�� IHEREBYAFFIRMUNDERPENALTYOFPERJURY7HATTHEBEISACONSTFUCTIONLENDINGAGENGY
d fORTMEPERWflMANCEOFTHEWORKFORWHICHTHISPERMRISI55UED(SEC.3097,CIKC.). -
Z
W
,�. LENDEWS NAME �'� ' -
1— LENDER'SADDftESS .
-�: ICERTIFYTHATIHAVEREADTHISAPP4ICNTIONMIDSTATETHATTHEABOYEINFORMATIONISCORRECT. TOTAL FEES �
-_�� I AGREE TO COMPLY WITH ALLCIT'AND COUN7Y ORDINPNCES AND STATE LAWS REIATING TO BUILDING _
�; CONSTPUCTION,ANOHEflEBYAUTHOflIZEflEPRESENTqTIVESO�THISCAUNTVTOENTERUPONTHE -
.Z- N80 �MEMIONED PROPERTY FOR INSPECTION PURPOSES!� COMMENTS
S F�
m�� PE EE NAME(PRINn �
� ��� -
y� SION URE PERMIITEE DATE s
._. RECPT.NO. PAID BY � VALIDATION.
~ WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—Assessw Copy,GOLDENROD---File Copy,GFEEN—Appli�nYs Copy
_... .. 1..._" . . _. .� , i T..... .._ .,., .r . � .
,������'�� " € i�- s � �� i �, � �:r-+ � r � � _: � at�-'� � ' �in��i'�-s��.r
� . �a � " . - i P � � � i Y � 'F� � "'s i .7 4 �o�;� a {�� � t i Sa � E =m 1 � E ��--`f «
� 4 #���." � � "i � f _ ' � '`� � � h � 'I ; 4; �.i �`' � ! ;�j�� _.�, ^ cf '.
, � �s'�' ,�� � ,� � � � { i �y�I ,.� iay t� � t �.� ) W� � I 1 .`t � s � "7 � �,'t , v�"•, .
a
� " C..i i 1 . s> �T? �^� t � a Yi { �T*t :',F c
� � "�� r�.,� ' ; 1 � � i, � +' � �E"t' i � �,"t t i, i J i;-^ '- .
-c� , , , i't t .� C_C -`s '•.,r r Y � �
� � ,� - `� ' ; I � : � 1 i ��� � �._�'s �W } ('"� -s i i i-'� E � r� � �... ':
+� -��,„�-- ' � I_ � i � �.�� � s� i _ �� t _� � i ��
� ` =r �y r � � i � � � { �� €i� a i �� =i E€ � { ( t �� a� � � ��-i _ r�����a �
( ... E,� � �"t I i { .i ; Y 5 ;i � - � i €.� � i ;r7 � . .,` i (.�, �' � J i „�, .
d �§ ���` . �k �a�� , � ; . l j �t � � ' j _ ' � 3 ' ( i .� �� -. � � � � .-y� ( � _� -
� , ���� s. � � ; � V ; i , ( k F _�._; � � � i � �_1_ �__�I__ �=- i--';— -
i
. _ �. :a�".� i = j ' ' '� }__' �,, a �R 1'---€ � —�`- ,I ( � � ,� € � ! � � ���-�
` � j I
� , i � �- ' � ` `�' .q; i� ; � 3' ' , �! � ; j I � r � � i � !� � f �,.�
� �
y� E _ �.. � € �'i . '� I�� � ��i � I ` j � ; � i � � ( ( i I .
i �
� i ' , , ' € 4 � € .
� , , . �. ' I ; i � TE � < I �., _
€ i i � E ; � i � � i ! i j N _ { __i E j . �-f ( C�_� � .a .� �,_J� _�_ j_�... _
� i
� � � � ( � �� i � i �I i E .
� i � �
� � � � � � ( a.. V I i I i E � � ��; � i j i � 3 i : ' ! , i i � i { ' � I ��
� { � � • � ' E.. � � i € ' i � r i ; � , � � : � j � g�
1 i E € i t I t
E � � � ( � % � I E 3 ! 3 I� i ' � a ' I i � � FI ( � � t i i � ( k � -i� ,� �.� � .
�1 i I �i I i � � ' � '�� � � � . t � I � � € � ,
- $p � ( � � € I � i I � 1 i i i � � I-..�i '� i �� F � � � � i I� I a�.� � � .
! s � � � i �'- � .�� � � � � � � € ` � i � i � .
�
I � E € � � � � � t � � � � �
; ,
� < < , i � ( � +n� ? --�---� � � : � ��� a .� _�_
� ' - �— �
� i ; � ; � I � ( ; ; i i � ��s �� �,,. �j ,i��.� �,�" ��I. � 4 � �i � �� '. �� � �
� � , ` � ( � i ? ( i � � j r'�r` r a"'�;a t� r r` C: �a �rn i � —i -� ���� � � ` � � �-�:
i
� j � � i� ; ti � 'r -r i ,� � I . +� �,.[�i i�;� i�, �.i v,�����C� � �
I
� E ( , i-y.. p r-�r.� " � = i � 1' '€ � �
� ,� F �y G _ r ; � � � '_'� � 5. �3 � r ia �-7 r E ,� I�T��� I �r� .S:I � `�.� t� q� �i--+��- �T,Y � � .
� ; . � ��� t � : � ; € 4 ,�,�, 51 ; � �°�� �,�(,t }"' ..� s� c���.� 7{ ,"1i ;� '� g�"d '� �_
� ; � .i � ! , � � ' � i• j � C, 3� i-�- I ' �� , �'`3 I "t„ �"1: %f ��' W -- r .
� � � � r i � � �1 �, + � 3 r i � a � 3� €� Wr r� ' � '�a � � �
3 r�o n �; -'��
I • ; � ' �J � a �
� � � € 1 � [ : j ; i E ' � ( � �� � ' �: � : 7 �� �,7� �� iy � �{��r ��. �i�`J �; �i, : „� a�,'�
� ; ._ t � :�
�'., ' I � ; � � � � � � I i � � �: � ; I��� � ? j t t �� iq, � '�;i �i3� ` � � �
� � .." � ! � � � � j � � 1 i '� � � 1� � [ �� t �� ��i
� ( �F � � � � ..�,, � i _� � � ' I i.. � � r � � _�a � � �.
" .
i �
� . ,' '' ' { i i _ s; � �� � � � . i � � ' , � � ; � � � -='• i )� �-'-�'. . .
� � .
ti I � � � �` fi �
� I � I s � � _s_.—, � L -�--�--� �_�_— _� �---� �—a �— �—
; � � � '. ' � � � .:i � j + � � ; � � � �_� � t 4 ; � , � �,� � � ` � '� �_ � �
� � � � �g I f , �I' f I {. � � � .i , 4, i � � � ! > i �, i� � I �
', � , a
[[ 1 ! .� H F 3 s � ' I � ! � i �
'
.
� � ( ....-j ' � f ! � f �� i I � � � ..I .t � ��t�7 � I_..i i i:."",f'"'i 1 � __�.._ E _T � i--,�� 3...,.1�.,.�_i � � . .
. .
i : , � �
�
..1 _ � _ � i i { � � I
� �� f ' -I 1 � 1 I j f �_� � i � � �t i , � � .� I�
( � .. ' =- i ( ' -- , i I -� � � � ( � i� -t � �
! � 1 `� � � � + ( �- ( i f -; ` 4 ' I ' ' ` E � ' �� � ! � ',�� I 1
� ' i� i � � E , ` � , i � '_ , � �
�� ( '� E i � � i ,.i ' ; i � � � � + � i i � i ? { � . I � aj � I ! ' ( �
� � � ' � ��" ' � i , i � ' f � � (� � i . �. � ,
F_
E . 7_
� � j � —` � ' , . ��� `�� � I f � ' �' I ' �- s = � ij ' ; ' E � ri ` `'� �
��_�_:aw.w._€�'__.._.�t�;.__a�_�_:_'..�__.__��_.1.�....i. _:��__:._._.;_...�_._L__ia.!t<._.�_r1�.m�.�,'�I_��._'..- , , i.,_�.._� � �__�,.V i i � E �;
� t !
� ...� _�_..w.�_.! ..