Loading...
HomeMy WebLinkAbout17146 -----�"�---- CTTY OF DIAMMOND BAR ` � � � DEPARTIwIENT OF COMM[JNITY&DEVELOPMENT SERVICES � 21825 E.Copley Drive - (909)8603195 Fax(909)861-3117 PRESS '`%��r°" BUILDING PERMIT APPLICATION FIRMI_Y � JOBSITE �c '"'' �'�'" /�� � >- I APPLICATION �(� PERMIT P/C o ADDRESS.�.�� I� '` �-1 DATE �� V NUMBER i # �1 4� AP� ISSUE TYPE OCC .LOT TRA T DATE CONST. GROUP p OWNER � �� p ADDR SS � �,. '�., . ZONING SETBACKS z CITY � ZIP d� TEL. FRON7 RW ❑ o APPLICANT TEL._ _ S DE/SIDE STREET RW ❑ z m CONTRACTOR � � TEL � �� SIDE ❑ ADDRES , � :.;, � �-` PROPOSED USE ��G"' �-- � .,�� / ' � +�'�L.� fLW o � ,,� �-�, � � � ; � � AACH/ENG/ ` �;,� �, ����'y� I z DESIGNER � �� > -- - W y . y N�.DWEL. NO. NO. d ADDRESS �.'F ` "� UNITS STORIES BEDROOMS � CITY I(�' ZIP � �c"P...TEL � ' cn � DESCRIPTION SQ.FT. FACTOR PSF qDJ.AREA/VALUATION p� OWNER-BUILDER DECLARATION SFR/AD EM� � O I HEREBY AFFIRM UNDER PENAI:TY OF PERJURY THAT I AM EXEMPi FROM THE CONiRACTORS LI- G8CflJ0/C2fp01C W CEN5EIAWFtlRTHEFOLLOWINGREA$ON(SEC.7tl37�,3BUs'INESSANDPROFESSIONSCOOE:A�YGITYOR (n , I U COLNJTYWHICHREQUIRESAPERM¶TipCON$TflUCT,ALTEq.IMPR�VE,DEMO:JSH.ORREPAIRANYSTRUG I,J,f pytiOiDBCk W NRE,PflIOF TO ITS I55tJANCE,ALSb.REOU�RES.THE APPLICANT FOR 5UCH AERMIi TO FILEA SIGNEO W STATEMENT THAT HE OR SHE IS LICENSEO Al1R5llAN7 TO THE PflOVI510N5 OF THE GONiRACTORS Lb �' CENSELAW(CHAPTER9[COMMENCWGWITHSEC�ION]o00jOFDIVISION3OFiHEBl151NE55ANDPRO� V' PODUSpB O , FESSIONSCODE}ORTHATHEORSNEIS'�EXEMP?THEREFpOMANDTHE6A515FOflTHEHLLECEOFJ(EMP� � V ..TIDN.ANYVIOLATIONOFSECTIOry]o3}.58YANYAPPLICpNT'FORAPERMITSIJBJECTSiHEAPRLICANiTO Z Re-Raof � ACIVILPENALTVOFN07MORE'THAN��FIyEHUNDFEO�OLLAft$(S`+�)�J� �71,ASONlNEROFTHEPROPER7y,ORMYEMPLON6E5WITH:WAGE5A57HBRSOLECOMPENSNTION, � Commercial i Z, ��WIll00 THE WORK.AND THE STRUCTURE I$�NOi INTENDED Op OFFEqFD FOR SALE(SEC.7044,BUSI- J � ' NESSAN�PROFESSbNS CODE:.THE�COfvTRACTORS LIGENSE�L4W DOES NOTAPPLV TO AN OWM1'ER OF � 'PFOPERTV WHO 9NLDS OR IMPROVE5THEReON,hNp WH0 DOES SUCH WOftK HIMSELF OR HERSELF OR ��, ��.THROUGHHISORHEROWNEMPLOl'EES,'�PROVIDEpTHAT&UCHIMPROVEMENiSARENOTINiENOEDOR m . Q��' �'OFFEREDFORSALEIF,HOWEVER,THEBUILL114GORIMPROVEMENTIS501DWITHINONEYEAROFCOMPLE- Z. ,�.TION,THE OWNER-BUILDER WII,4 HAVETHE BURDEN'OF PROVING iHAT HE OR SHE DID NOT BUILD OR �, 'IMPROVEFORiHEPURPO5EOF5ALEj.� " � . �]I,ASOWNEROFTHEPROFEIiTY,AMEXCLUSIVEI:VCONTRAC7INGW;THL!CENSE�CONTRACTORS � TO CANSTRUCT THE PROJECT'(SEC..7p44;BU$INESS ANO'�PRQFESSIONS COOE:THE CONTRACTOHS LI� 8tion 0.�^� ADJ.AREA � W��� '�CENBELAWDOESNOTAPPLY70AN'�OWNEROFAPROPERYYWHOBUILDSORIMPROVESTHEflEON,Ah'D �.;',:NMOCANTRACTSFORSUCHPflWEC1'SWITHACANiFt4CTOR�$�LICENSEDPUR9UANTTOTHECONTPAC- QUANTITY DESCRIPYION � FEE � Y' 70RSLICENSELAW.). � ❑I AM EXEMPT 11NDER SEC. � B.&P G.FOR THIS REASON Q �, U � "-- onre _owN�R, �__ v z � w � LICENSE�'CpNTRACTORS DECLAPA7IQN W < �' I HEflEBYAFFIflM UN�EF PENALTY OR'�PEpJIJpX THAT I AM UCENSEO UNOER PROVISIONS OFCHAPTEfl � � 9(COMMENCINGWITHSECTION7000)'OF�NI$ION3pFTHEeU51NE55ANOPROFE5510NSCODE,ANO Z tX ' AAY LICENSE IS IN FULLFOPCEAND EFF6CT. ������ m Q LICENSE CLA55�_41C.NO.�„ j � F �ll��r' _�'L1� a V OATE���_CONTRACTOR W � WORKERS'.,COMPENSATION DECLAflATION Q � IHEREBYAFFIRMUPIDERPENALTVOFPERJURYONEOFTNEFOLLOWING�ECLAaAT10N5: Z � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENT70SELFINSUREFORWORKERS' _ , � COMPENSATION,ASPROVI�EDBYSECTfON370oOFTHELABORCODE,FORTHEP'cRFOPMANCE W O oFTHEWOqKFORWHICHTHI5PERMIT1515SUED. � . W ^I HAVE AND WILL MAINTAIN WORKEflS'COh7PEN5ATION INSURANCE,AS REC7UIflE�BY SECTION �yrF� /� � /.� Q 3]OOOFTHELABOflCODE,FQR'.THEPERFOflM17ANCEOFTHEWORKFORWHICHTHISPERMITIS �� L[ '�� J ISSUEf1.MY W0 ENSAT��pllN IN��[l�1AtNCE'CA ND POLICY NUMBERARE� CONSTRUCTION __O_�� � CpRRIEP ---y�"����^�- I—��� PLAN REVIEW 0 POLICY NUMBER Z ELECTRIC ¢ ( � (7HISSECTK)NNEmNOiBEWMPIFT�OFT7IEPERMiTISWRONEHUfJD.9E`J�OLIPASjy1W)ORLESS). PLUMB�NG � e\ ' Z I CERTIFY THAT IN THE PERFORM;4NCE OFTHE WO.�K FOp WHICH THIS PERMIT IS iSSUED,l MECHANICAL LJ' 3HALLNO7EMPLOYANYPEPSONiNANYMANNEFSOASTOBECOMESUGJECT70THE - rn WORKERS'COMPENSATIONUWSOFCA A,M EETHAT;'rISHOULDBECOME INSPECTIONFEE ' r SUBJECTiO?HEWORKEflS'COMPENS IONP VI OFSECilON97o00iTHELA30R ^1 1,(� � �A DE,1SH LFOqTHW�+'COMPLY�W TH EP � N5. ISSUANCE J•::i w � 4� � � p DATE:r� APPLICANT. � SMIP � � , � WARNING:FAILI/RETOSECUREWORKER�COMFENSAiIONCOVERA0EI5VN FUL.AN�SHALLBE ENERGYP/C _____ _ � �y SUBJEC7ANEMPLOYEftTOCFIMINALPENALTiESANDGIVILFINESUPTOON@ DREDTHOU3AND ENERGYPERMIT �„ DOLLARS(51oo,oW),INADDITION70THE'�C0.STOFCOMPENSA710N.�AMAG'c5� PROVIDEDFORIN p-.� '1 � J� SEC710N3]OBOFTHELAHORCO�E,INiEREST,ANDATTORNEN'SFEES. �ETENTIONFEE: J.� V� a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � ', IHEREeYAFFIRMUNDERPENALiVOFP�RJURVT,H0.iTHEP=I5AWN5TRt1CTIONLENDiNGAGENCY � � ��� � FORTHEPERFORMANCEOFTHEVJORI(FO WHICHTH��PERMITISISSUED(SEG.309�,CIV.C.}. Y � LENDEF'SNAME ���3 � ' . F— LENDE�45A�DRESS � �ICERTIFY7 IHAV REA�TNISAPPt1CATIONPNDSTATETHATTHEABOVEINFORMATIONISCORRECT TOTAL FEES "�, � '.IAGREE COMPLV 1THALLEITYANDCAUNZYOp�I 4NCESANOSTATELAWSftELAiINGT03U1LDING � �CANST CTION,AN HEREB AUTNO�IZ6 ilEa^ A IVES OFTHIS COUN7YTO ENiER UPON THE �I�'�I z 'ABOV�MENTIONE PROPE FOp INSP ION P, ES. COMMEIJTS � � � �� � � � �r . � `�' �liE�ft(•�`,��, � - " $ 6+s Y ' � � P� ,: II � SIGNA7UREOFPEfiMITTEE �ATE = RECPi f�0. PAID BY VAtIDAT10N '� ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy . .__ . _ _..- — - — . . . . . _ _. ,- . ,. .,. �,--� � ..��-: ,�s..; _. r � _ _ . ������_ , . . r _ . . � � � � � .� � �� � ;� � � � � � � € � � � � � �,# k,� . .-�f '�' ' �' d � " r :" �' °.: :� � � � . r''"�° € a s ,� t � : x �� - .. tx x� �,d�: ::� � t�c q� � s � ,�.� I � �, a � � � � � �.' 8 .S z.�Y�, �.� d .�'" s� � .� a �; F'„ ,�' j��¢ �i>��.4 ,�dh, �.��re &.�a..a.:, .�� r.,.a�= � t..�s ,. .a ,..t� #.. :�.,...'`�..a � � .. ..ra<,.� '�: .. ,�.: �. �.. ... r.,,�,�....�....�.. .e.:'�9:��k�......s.,....a�;m.. .,a�_^t^�.';,4C^ig c ' ( � t �.1, ' •,._ .._ .... . ....�� ,.._......__ ...,.._:"_'_..........._..,..,....... .._� ...._........ _� ,_........_..._...._..,.... ._..__........_............. ...._...._... _,_......_......_..._..,.........,.._ _ Xp � � q;�.� / . . . _, � �' # .. ,.._4 I .. ._...._ � .._._.... �..____._ ....._.__..._.... ._.., .,,._.. �. . ..... ... ......,...... __.._._.._,.._�._ _.___.—._._...._.____` —4 �_ ..... �,_. '�W. .... . ..... ' .,.,w.k. . .. '.� ��.= ' ' ..r � ��?.. 1,i..� :1 '. 1 £........ ....._"_........__..�.._... ......._.......�.....,,_.,,_....__... .... .............._ ...........,.......__.,...,,.........�._. , ....._.._._....._....._._.�..._.._ .._......�,..............�........._. r_f....__...., ..._....._......_.....�.._.._._... ..._........,.....�... .._._......_..__._...�......,, ,. R ���I. 6t i, � "`i d !. . ...•,"a ... 4` ' .. ', '�.LL� '�� ,,.-,.-. —._ ..._.._.�. .._..._._..._..,...�.. __.....__....._. ...._;....._. ......._..........._......,..._,_.._......___ ......_._..._ .............'�..._�._ . � i ............... . ..F......�....._....._......,....,....,..._.« ..�.,...._..�...,__..._. ......._.......�...-_.....�...... �,. "� i._.. k f�l � . � ..�.. r � "a.t "z a � r : . ...... . .....' ; .. ._...._...._..._.�...._. ................. .... ;,.,......._._......._,._...._.,.,..,_..........�__ ...._ ..�. . . _......�..._,........._...�.. .....,.-...._... __V.._......_._._.�.....,_... ._ _. � i�} '�x 9 .,w...� � .._ k- $ ` �_E ���.. .... _ s f .._..,,. ..._.__..._..., ..i'. < f�. �� ,E__ . ....... _w..__,._.._.......� ....._.. ._..._.............. . { ,..... :. .._.-.... __.._,._�........_......� ......u...,._......_.....�._.._.,.,..__.......�_..__. ! f a�n,.�w" .�',i^ � .� F ( .��y i i , ... ... . _.,. .....__ . .. .._. .. ... `. ... . - _......_ . ......... ... . ........... . _._ -•,�. $. 4 ' A.b"' , �." 1 ': . ' . i f ,,,",i ;.# � . _ t y.�.. . .... . J'�' _/�� / ...W .._._ ..� _ . ... . _._ ....., .. ..._ . . ..... ,� 3 t"`�=' t ",. � �,',,1 1 a�•�.. / F+Y.-.�l...'' . � . ,',.p � '' ,�.. t . . ; �_ ._ ..,._....___,......,...__ ,„;�.._ k.... ._ _.._...,_.__._�. _. . _ _ _ ___.....:_...__...� __� . �_..._...,.. _._._.,._.._....__..._.. ..__........__� i ; _ ` � � f' € ! ^i .0_ _ . _ _ � � i€ a u� � i . � _ .. �.__._._. _.��_,.___.__��.__._..e.�__.__.,_. __m._�.._ ...__..__. _..__�_., .__.,_..W _ _ __ __._..._._ � � ti �°a K ���.�:.� ,. t i...,_ �� � ...._. _. _,_.._ ..�_._ . ....._. _._._._. _ _...___. ,_ r ,_ ':_ �_ ._. _.. ..�._._.,_ .__�.__..__.._�__._ .�_.._ M _._ _._.._�__ _ ; .._ .__.__.._,. _�_�__�_.__,.�__._. .. _.___. i � � � ;ry � € i. ��� �i ..ua., _.. .: ,a:�" , � , ,.. .;,:. ,:,,. „.._., ..... .._ ._....._,. i.._._.. .�.. _..Y....__.....__.._._........,.,_..__._._.. _... ....__...__..-, ..e .... ...._.._....._.. .._......._..__......_.._........_....__......_ _ ,.,, ... , ._. ,� __ .. _. r_ ��'�, ..s w . � - .. . �,-"- ,i ; � �- . �.w , .. ..... . . �.., :__ _�_..�..._ _..,.___..._. ._�............_..._........._.._.... ._.._...._.�.. _.,..._ _ ..._............._,.... �_.. _....._....._..._,_.,._ �.�..._�......___..__._�.._,�..._._.....___'_-_w . .._ : ... .. :� _;'.. �' f_ , ;_,� k. , - ._ . ,, . . + t� a=, f t r � € ; �_. _ __ � �� �� i r -'. , �._._ � � ,—.�'�.__._'....::.._3'_:�.:_...._.._._.,.._.,...., ___! _ ..,. . _,...._ .. �...� ', _.. :.._�..s � .. a � � ;. ..s.,_��_�.._��_._..._:._......_.........�..w_ ..,...,.._�"_........., i .. ......___..�'.,._. ........._ _ . ........_.. _.._......_....._.._......,_...,............._...............�__._.;i :� �. t��t�! 9_,_�� � -.k h.�-l--. � t.? . �„�»,,.. ( . - 6 : ." __, ._._„�..�......._.,.__..�.. ' � _�.�,�'.'_ ...,.. __. .. _._ ,� . .........,.�......._..._._. _ ....____...._,.._... .___..__..._...,.._....�._.,._,...__.__._._... � ..3 i€ . � � i, , .,4 "� . . i. � s 1 ` � �., . : '� . .., . � : {._ _ ___""'"'__"......._,..-.. a.R_.._._..._�....... _.�..�......._-__..........�„_ _...>,....._ ...._, . ...__.._ _.. _.._._,,.__.._._..._ ...._....,._......_........_.,..,._....._....�....._........._, . .. . : "�P 3 .�., � � " , . ' � .. . �... .� & g ��� b Y'. � . Y '.. �..� ,. ' ��, :� " N..-. �. .........,ee.u._.....�_..,.._..�.._u...._._�. _..............�...__....,....._......_.. _.............«,. �__ ., .,.._._...�_.._._...,.._...,__._ ,,.......e._..._....v_ .._..._.�...........v...__...,......_...._��...�_... 5 �..vl .. .� I � � � Q'!� Y. .. �_.. �_� ;;._.._ .. .�-_,-....__.�.,....-�-.�,......e�� _..:............_�._._...-.._....._ ....._...,_...m-....... ._..�_ .� __.._,_..._......__... ....._.......,........�.... � ....�...._...�............v........._,......,........,._.,.._.........,y € x >-., ......w ":� "i .,. �.�...^�'ti. .-. - ._,.3__ �;,.,.. _ . . .. ....._.. . ......_, .._. a__.,....__. _�. .._. . . ., .. . _ , . .. .._ .. ....... r i� , 3 �' ..,�''S "` h,:_ . :_ _n___�_ �.��-� �___�.,��_ � _._ _ _ __� _ __ �_. ���__.___ � n �� �-k :_ ✓ ____ ' _. _rv__. � 6 .�, :3t':v..., v. w.i. . .,�.. ..,a t ..e a... > . . < ..,.. � ' ....... .. . ....._._.......... .... ._...___.._ ...�...__.. ____.._...._...._..._,..., � . �� l . j ._ ..._. ___��_ _.._......._,.�. _...�_ .......�..- . . .. .-�.._. _...�_._..__ ._.� ig� i�`d T,`„'.6-,..M e ,'�'� �_.,. �e ��..�e ���.€,'v% � '�.i.,. .g . ... ..,...__._,,,,_...:�...___.._.. � � ._'....._.....r _._......_ .._._.__.._. .� .� .._.._...._.._.__...__ . ,. _....._ .......__...,__"... _._'_..._'__...."_,�.-..._ _..._...._. . 9 `*ur �YL. a ✓.6.a . � �'ft t '__ . :.._.. . .. ._ .,...... ._.._ _.....__ —_ .._._ .. __ ,._ ,_-7� S "` , �t�y,�� � �_ ..�_ _.._. :, € �;� � R� ��� '� ;___...._..._.._._.. __._._�._�_._ _.____ __ --_ . ._,__ . _ ..._. _..b��. ,.��'.'.__-�.w+.t ..,. ..d.."„:�_�.t.�.et.�.3.. ,s�.1__�. ....._.. _—.�_ � .._ � -.__ . ____ . .___.__.�_. _ , r' . 6''- . � I'�_ t,��:� ..._._..,..,...............,....._.,_._...................._........................�.�....._..H__..m..._._......_...__.'"___......,.,.,...� .�:� ..,€g'�da� -. � .._.._.. ....._.>....._,_. ..s,.. ,�.__.�...__.. � ..�._ . _........_.._._ .., ..__..._.._.,e.,. ..._.._....:........... . _..........._._................,.,..... ._ . �1 � r�.,...._..�,....._. ... ,,._'_.__... _._.�..._..._.._..,._.._.........._...._.�........_,..,,v.......,....._................._.... ....................,..,................._....,.....,...,.._..._..._...,.__...._._.,._.,,........__..,�...�.._.._�_..._._..__......._...._.._...-..«_...._..„_...,.........___._._.,..._...._........._..._.._....._........; , +..w�..._.....e.....�...�.-....._..._.....,_..._a...u..a._._�... ...,_..,..__..._..-........_.__......__..._.,...._..._.,_.....�.,.�.._.........._,.._.__._:.._.:...._»,.._.._._._......_..._ ._._...:_......._..-..._..._.,.__..,.,�..._._.,.__.�__�......,._r. .._.__._,... ._....._........__.........�..........,.�...J A, � . e ': .,.y...._....�.....f...�...,__,.._..,,.._..-..�.............._....._._....._..__..,.._...._,............._._.._...,_.._.....�...,..._..,..............._,....._,.___..�....._.__.__..........-._._..�..,._.__.._.._..�_._...._.....�....,..._....,...,...._....._......,.e,..........__...._......_,..._..........._..._,..�....,_....._.._......._....e_...._......_..._....�...� i $ p v ry � �_._..,......._;..__,....�___....:__._,...._ �_._�._...__ ...._._._.____ ,. .._.__...... .....e ..__.__.___,....,._._..._.,...._....._.___._.___._.......,..._.__......_......�._`___ ,.._....._......_..,..... ._...,_....� .._�,..__.....�._ ....,._...__.....,....,.,__...�.�..__._....._...._......__.... .._._,� � $_.._ _ ..._.:.._..____�____. ._____....... ...._.....__.__.._.._...,_...�.......__,....�..._......_.__..._:..,,_............,,...,......._..,..__.._._..._.�..�.................................._,,..___.._.__..........^.....,._....,_.._......_...�..,,._.____.._..,..._....._...._....�_ �........�...._ � � f.._ ... _m .... ,..... .,. . ...�._._........_.....__.._.,.._._.._.:...._...._.,...._:.._.....,_.�._............._..._..:.4_...,_^.._._.. ..._„__,..�.-..._...._...._..._...__._._�.._..._..._...,.......�.____..�.._._4.�.�....'__.._. .� ...,.._.�__.� � �'; r,. e...�:':. f "..f ,,: e���x �n,..F. _._...._..__.___. � � 1 �., �., �.� ;;. ..._ ...._._....__.n......f._.....,.._.� 'w ..:.,._':.._.__....._._..�,,.M ��._.___ ___........_.. ..� g .:4. . . ,,.,s Ik - .......,._._.._..F....�............ , . ""_" _ __._.._._....._.._.._..� �— _ , �� .ya�`+ ��-.g � �� � � ' d� .......__. ._..._.: � _...._.....�.. ....._:__ '. � a � � � .� . _ . .�.�...._..M.,...-._.....__...�.._....�.�,..._...._. ....,...� � r a � � .. . ....._,..__ .. . . � ° �"��� ���� ��c�����...��,�����.�;°�- � �r _..._.._;._._..w_......,.,..__. ....,.,._..._,,.._,..�.:..._....._..�..._.__�.._......._. .___..,__..,_.__..._,__..__._....._..,.�................�..._...�._......_._. _. i. � r� A � @ � � p �,"�� �t�rr ��-� ��¢ sa - � Y : �� � � � ?r� � a� � � �� `�'�s��« ��.;.��� ���� ��,� . . _.__.�.__._... ...._....._.._,,,. ------ . ., __...._.__._.._..._.._...,,...._ .�_._.._.._..,__.,.._._..__....,_...,..._,_.,._...._.._ ..._._._.._.._....._ _ , r; � c °�,� ,� °'a ..�. '��,,,a.�v,„# ��; . . . & E�# r� �,�,:.�',p ���� ^°..m^av„ � ' '�.. . j ...........,__........,......_..,_....... .._.m.,.__ ,._.e.,_.._ _ _ ..__...._ '__"_'__...._..___._ ._.._.__._ __.._.___ ._____.._.._..__._. ....._.___.,.__. . �. . ;. �� § „.t �'�. �� _�„ �� �m�.� t� � i ry � h �,�,�� �' �,¢��«� '6'����� ���� � wr�; ' . " ...___.._.� _.., ._.,_..__...� '. .._..._..____..._._._._.�._...._.._.._....M................_�..�._...._............_...._......._.___.._ � j � ���.s�. �� �+",��,..�+"�" '�`�A'�,: .... . .. . .__,., ... __._.,_-.._......_._... � c , . � 4���� �$:� : . . , � '� � . . . \ e. ...w........._...._ .,,.... .._............_�n,... ...._.... _...,,._..._d--...�_....�...._.� ....._,......_........._..__..._,_._ ._.,..�_.�.....�._. _.�..._�... ...._, . '; p ``�'�;� � i�.p��, �' . .._ ., . ..._ qo � ���q�s�"�.�:"'S���'"" ! a�������� . � � � : � . � a � _ ' d >k�"��.�..'�a�sa�t�aa_�.w�-�,±;z..x��". �� ,,..____•....__._,..�......s...:;_...�..?,___.A.._�.____..,,:,....�...__,,:�..._.m..__ _,....__._..._._..__._.. :