Loading...
HomeMy WebLinkAbout16753 �� � _---.��<._-- CTTY OF D][AMOIVD BAR , �`�'_,�i AM � DEPARTIvi�NT C?F COMI�IIJP�ITY&DEVELOPMENT SERVICES � �� �R_ �,� 21825 E.Copley Drive (909)8b0-31�5 Faac(909)861-3117 PRESS ''`"�»Ky'�� BUILDING PERMIT APPLICATION � FIRMLY �� oJOBSITE �� � J� APPLICATION PERMIT a�e� P/C ADDRESS���� � " d.:,.�����'CV�! DATE '���'%�� � NUMBER �'°�'�� #� � ISSUE�p����� TYPE W..v.,,,, OCC APN LOT TRACT DATE r CONST.��`� GROUP p OWNER T� `` ADD ESS�� ~� � 6;., a ZONING SETBACKS a Z CITY O �4 :�1� �IP '��TEL. FRONT RW ❑ � APPCICANT I TEL. REAR ❑ Z SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR q SIDE ❑ ADDRESS � � ` c � CITY "y d' ZIP . TEL. PROPOSED USE o ARCHIENG/ �' � DESIGNER NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � ' v� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OIWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER P�NALTV OF PERJURY THAT f AM E%EMPT FROM THE CONTRACTORS U� G2fff JB/C2fPOft W CENSELAWFORTHEFOLLOWIN REASON�SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n C.� CWNTYWHICHFEQUIRESAPEF ITTtlCANSTRUCi,ALTER,IMPROVE,OEMOL'SH,OHflEPAIRANYSTRUG W TURE,PRIOR TO ITS ISSUANCE, L50 REOUIRES THE APPLICAtd'FOfi SUCH PERMIT TO PILE A SIGNED W Patio/Deck STATEMENT THAT HEOR SHE IS LICENSE�PURSLIANT TO THE PROVISIONS OF THE CONTRACTOPS L6 � CENSE LAW�(CHAPTER 9'(COMM NCING WITH SECTION 7000)OF�IVISION 3 0F iHE Bi1SINESS AND PR0- � POOVS(J8 � FESSIONSCODE)ORTHATHEOR�SHEISEXEMATTHEREFROMANDTHEBASISFOPTHEALLEGEDEXEMP� (� TION.AIVYVIOLATIONOFSECTIO 7037,52YANYAPPLICANTf-0flAPERMITSUBJECT57HEAPPLiCANTTO Z Re-Roof A CIVIL PENALTV OF NOT MORE T AN FIVE HUNDRED.DOLLAFS(55a0)J: ~ ❑I,ASOWNEROFTHEPRO ERTY,ORMYEMPLOYEESWITHSNAGESASTHEIRSOLECOMPENSATION, Q ' Z � Commercial - WILLDO THE WORK.AN�THE SfLRUCTl1RE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BUSI- J � NE5S AND PROFESSIONS CODE:�I HE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF PROPERTVWH09UILDSORIMPi'�VESTHEREON,ANDWHOOOESSUCHWORKHIMSELFORHEPSELFOR ��� ' � THqOUGH HIS Ofl HER OWN EMPtOYEES,PF70YI�Ea THATSUCH IMPROVEMENTS ARE NOT WTEN�ED OR m Q OFFEREDFORSPLE.IF,HOWEVEF�,hiEBUILDIN�ORIMPROVEMENTi550LDWITHINONEYEAqOFCOMPLE Z TION,THE OWNER-BUILDEH WILL HAVE THE 9URDEN OF PROVING THAT HE OR SHE DID NOT BUIL�OR IMPflOVEFDHTHEPUflPOSEOF$ALEJ. - 6T � ❑I;ASOWNEROPTHEPRO�EFN,AMEXCLUSNELYCONTRkCTMGWITHIICENSEDCONTRACTORS CE TO CANSTRUCT THE PROJECT(SE4 7044,BUSINES$AND PROFESSIONS CODE:THE CONTRACTORS LL Valuation ADJ.AREA W CENSELAWOOES.JJOTAPPLYTOfI NOWNEROFAPROPERTVWHOBUILDSOflIMPROVESTHEFEON,AND � WHOCONTRACTSFORSUCHPRu�.�ECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE - TORS LICENSE LAW.). � ❑I AM EXEMPT UN�ER SECI B.&P.C.FOR THIS REASON Q � � [9 .,� LL DAiE I�I OWNER F- � I W � � LICEN ED�CONTRACTORS DECIARATION � ¢ � I HEREBY AFFIRM UNDEfl PENALTIY OF PERJUFY THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTEF � . � e(COMMENCINGWITHSECTION7�000)OFONISION30FTHEBUSINESSANDPROFESSIONSCODE.ANO z �X MYLICENSEISINFULLFORCEAI�DEFFECT. m . � LICENSE CLA55, -�p���,�a.11 � - LIC.NO. ��A�.3��.s"Y Eil _ j . V DATE��"��,�-�-us� " CONTRACTOR_.____ a ... W I � WORK�RS'.COMPENSATION�ECLARATION .¢ �� � IHEflEBVAFFiRMUNDERPENALT'OFPERJURYONEOFTHEFOLLOWIN6DECLARATION3: Z � Z _IHAVEANDWILLMAINTAI�1 ACERiIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' ¢ � a COMPEN6ATION,ASPRO�/IDEDBYSECTION37o00FTHELABOFlCODE,FORTHEPERFORMANCE .0 Q OFTHE WORK FOR WHIC�i THIS PERMIT IS ISSUED. '� � . � _IHAVEANDWILLMAINTAI`r�WOPKERS'COMPENSATIONINSURANCE,ASRE�UIREDBYSECTION tl ��\ Q 37a0OFTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWH1qiiHISPEPM1T15 f a J ISSUED.MY WOR qS' MPENSATION INSURANC CARRIERAN�POLICY NUM6ERARE: CONSTRUCTION y �.� � cARRiEfl � PLAN REVIEW � y � Z POLICY NUMBER 4 ELECTRIC I�V� F� Q `� � � �(�WSSEC�%NJNEmNOT6i GCMpLEfEDOFTYiEPERMfrIS WRONEHUMJREDDOLL4RS(§10D)ORLESS). PLUMBING Z ICERTIFYTHPTINTHEP RFORMANCEOFTHEWORKFORWHICHTHISPEFMITISISSIIED,I MECHANICAL (J'" SHPLL NOT EMPLOY ANY�PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE � �e - � WORKERS;COMPENSATI NLAWSOPCALIFO(iNIA,ANDAGREETHATIPISHOULDBECOME INSPECTIONFEE _ I r�� ���"""�"�"'" j SUBJECTT07HEWORK RS'COMPENSATIONPROVISIONSOFSECTION37ooaFTHELABOR " '' ���� !,f �✓_„Jr ; 1 C�E,I StlAll FOflTH W I�H COMPLV W ITH THOSE PROVISIONS. I SSUANCE � � p DATE: ,�PPLIGANT. SMIP � �' J � � ENERGY P/C E WARNING:FAIWRETOSECURE ORKFRS'COMPENSATIONCOVERAGEISLMLAWFUL,ANDSHALLBE � � SUBJECTANEMPLOVERTOCRIMNALRENALTIESAN�CNILFINESL�PTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(5100,000�,IN AD�ITION�TO TFiE COSTOF COMPENSATION,DAMAGES AS PROVIDE�FOR IN ° J SECTION3]OBOFhIELABORCO E,INTEFiEST,ANDATTORNEY'SFEES. �W...;,���'�--�`�` , �n � pC i � RETENTION FEE: �� d C�NSTRUCTION LENDING AGENCy PRE-ALT FEE: O � IHER[BYAFFIflMUNDERPENALi OFpERJURVTHATTHEREISACONSiRUCTIONLENDINGAGENCY , FORTHEPERFORMANCEOFTHEWORV(FORWHIGHTHISPERMITISISSUED(SEG.3091,GIV.G.J. Z W � � LCNDC-R'S NAME F- LENDER'SADDRE55 � ICERTIFYTHATIHAVEREADTHI`y APPLICATIONANDSTATETHATiHEA80VEINFORMATIONISCOflREGT. TOTAL FEES � ��� C���, � IAGREE TO COMP�.Y WITH ALL C17YAN0 COUNTY ORDINANCES PND STATE LAWS HELATING TO 9111L�ING � WNSYFUCTION,AN�HEFEBYAUTHORIZEflEPRESENTATNE50FTHISCOUNTVTOENTERUPONTHE Z ABOVE�MENTIONED PROPERTY FbR INSPECTION PURPOSES. COMMENTS - � � �, `,.�!"''�'�-.��� t m PERMI'?EE�NAME(PRIN� . � �' �� � SIONAT E MI EE �i DATE ' � RECPT.NO. __ _ PAIDBY � VALIDATION WHITE—Department Copy,YELLOW—Finance Copy.PMK—Assessor Copy,GOLDENflOD—File Copy,GREEN—AppliranPs Copy'�� - -�.� ..,. . . - . - .��......- . .._. .,... -....� ,.. � .: ,-. . . �. ,�y.., ,i ..}•r. w" :.. . .... . . . . .. .. .. . .-, .... . . 4 "" ,;:� � � . ,!'k � u.,�� , � .a , § .. Y. « ., . � ?�"'��^��.'m �.r�.*�.w��. � :� a � , ;,5 y � t w;�" � � '�a k ::h� � �' a § ; � ' s � �' ° � � � � `�`� �"�'�� �,��"4a qa,„�P �E � � t�€ ' ¥ s x, ,� ,� � �` � ¥ a. �.�' �ti �. :i �,� �.,{ g p � .,4 � a�.� � � '�p � � ^�� � �Mo Ha .,��+!�:WL�� ..,.��� ti�, e:.r r."�,_� �..�'�,_� ....'�3x._� �'���'�„� �� x. . x �. S.��.� , .� a�_� .. .. �,��,�"�.,��.a .�,.o-,',aw t �. " _. ,r t�,a<�,,, a : �.� s."�..�,�.a�".�'�..'�".x..�.x`.�... s.�a�: , �:. . . x , 9 � ' o Y--," .�.e _ :, ..• :����: .�... ; ., : i �'.>I� � r,.,.. , ; ! �:, ..i < ; ' , �: ,e �:_____.�................._......,.........._.....,,,....__.._.._...__....._.-._.. _...._.. ___... .......... ......_:..__._ (._.._._,...........,,,,._ __......._.__.._._,.._.._...._... ....._ .._...._.._.._.... ...,_.. ..._._..._.........,. ....._.._.... ...,.....__...._..__.._..�._.�... .:6>'. J { € -�.e 4 :-'.I € . : - � �,'r: F �.....t":�{��� � � .� .:�., :;_ . '-----,_ . F____—__...._.�...._ ......._.__._.�.__.�...._...... ._........._....__.,...._�__._.....�...r..:. ._......... ._..__..._.._._,_..,_. ...._..._.....__._.__...__._._...._. _ ---_..._.. _...._.._. ...._,....._.._...___.�__._.,...._...._.. l. € �..v'� �E d��... �v� -,� 4 ��.L.r' � •,1�e X r .. . � _." .:..... ._ .._..._..__............ ................... ._�........_.........._.__...__... _ ........_.. ._._.......... ......................,.....,_..._.� ..... ................�..._:,. t " q ....-.I �4. 6���.c,. ...d:"' ' . ..�'.;b.e., , ` ..�„..,,1 .:,.3"_'��.. i...... . '...„, � 1 e � . .._..._ .........._. _...._ ....... G"6 �' t �'F',, .. .. .. .. ... .. ... t €3 i;. .. . . ._ ._.. . ._.. .. t .............. _.._ _..__ ....... ..._ .. . . ._ ..._ . . . ....,... ........ i g �r�ifi �P��i�'� � � �� .; � � . .@ . ' � .,..... ....__._ ,,.._.�._.�........._._.._ _....._.._......._.,`._�..._...._.,_......_. _.. .:_ '._ . .. ... .... .. . . . . ., ... .. . .�. . ........ .......� .����i��a'�', a�'���`c �;$�- - � � � i.' " �� .....`._� `' �� ; ,_,.._..,...,.�....._.. ..._..__..._..� .._,..,___.. ...._.._......_...._.......... ... ...._,_.,._. ..._._ _ `.._.,_�_..__... . ,�...... . __.,_....__.,.........__.............,_.._._,____..__,..._.___�......,i � _.. .._ _._. f . . ..., s> � i f`.. � � ::" i ?3�., �v'{ � � ��.. .. �_ ._. ._ .. ......_.._. . .... ... , .... ._. __ ____. . .. . .. __ _.. i M._.. � �.. � a .».� '3 �...s��.� �� �� r��.��' � .: . _...._._._.___._____ .e......._.'_'_�. .._.........__..........._.._...._.. .....� .. i � E C . � _� _ .._.-, - � _ __._.. ...._.. _ � __ u . n "``,,s�'���.. 4... „,..e ; E � h -�rv € o. I.� . . � _ .._ .._.. ._....:._�_._..a........._.... .€...._.......m.... ..m.,...._,,.....,....,._...,.,..__...__-_ ._ ._... ....._.__._._.__...___._._._...� .�...._. ..._._�____ ._,._.,.._.._.........___....,. _.__.,.,..._.... € � . y , E p. 7 a,� � :.,� t '.a ;���9 /�/ 4 ,.. . .. .. ... ._.....,E � ` �.� E �. & 3:.�____.....�.,..� ....._ _,_._..._.,_ .._.._...�_..____._..�. . .....�...�_ . . Gi �f� ..._.�-_-...-.._............. ... __._ E... _.. _... ..,... :�.__. . �µ_� . _. E�.:. € �..g : 9 Y�t f ; f 3 ,� ..-�' � °'d..:; : : tc.�;.�_...e , +.,.?..,a Y..��Y-�..;: : _._ .. ...... ;......._...,..__.......,._. .........._....__ ._....__.. _..._'__-. _._ ... .._... _W.........,__._ ,. ......_._....._.__.__. _ ._�.,_.�._.._......,...._..,._......._.___...._......._ _ ...F".�a:tt KF., t'':i xm�.":, i : ..s:''i�' 2- .': € �... ... : � ..w..._. �.� ..._ ....... _. ..�.........................__ __..........__........_.r_..�,.,_._ ..._.._""'._,... .... .. . ._.._..._..__.._.....__. . _......_._ ._......._,... __.__�._�._._._..._._.,.,.........,..._....,,.. �. i ' ^ i � , ....- .�a" '-. '�; �.�. ; ' P_.r a.. €.�.�, .:�.. „'�.� 3 ; . ..::,.�. �_ ��;.>, ,:! , . _... ....................�:...._........._..........__.,._ ._..,_..._..__.....__........._...._.............. �,. _.. _.... ,__.____.__ ....,.........._.... _..........._..._.......-...........>.........__..._____..__.,....__. ..._....,.....,..................�. . t '�4.. �..3 ¥d".e,t��. �1 �i:... � . 'iv � g"�;_ - � „ __...._�...�.. ._.�.'......,_,......,..__......,... ._,r........................_.,..... . __ . .._. _,a... ............_......... ... ...... ». .....-«._..,.,, .............»,.,.........u._........_........................... ..... � � �{ .;..i € g�}� . �'^µ .. '..� �d l ;^ ...� i �, . ........ ._... B.n. �% �... .._.� _ _..... .. ... . . . .. ...... . .. ..... .. _ .. _T�.>' !}" � ��5� i f ^^9 P �v".� �/ k' `€ S � � � . � �«I . �_.__. i t ...... ...........�.e_ ... � �_.. ._.._� _. .�.......____._,.,_.._.- ,.��—...._ _. _._._..._.. .......,.,_..,, . .. ._._...... _ ........ ........._......_....._,...._....................._.__...,,....... _ .. � � .m �.- �a'^ . ;_... ....' i" . , ' ' . _... ._.. ..... _...... ........,...._.....,.��� i.�.....,._................_........� .p._..............._ ...,.....,,....,,,..._.._ _......._._....... . .... .�.. ..._........__._�" _'_.._ ._.,. ....�..._... .........._._....._...__..............,...,................., ...., '�: !f�" .a:��h , �:. � { n"� �`".# 8 ._.._�� . ... . .. .... . . . �'', ....... . . ........... _... .......__. .. . . . . .. .........._...... .., ..«.,. ......,.__... . �. —�, � .. �%8 . .... � �F� { V E 6 � m� � w . ._,..n .�.�.w yy 5 --. y .,, : V � _ E. $ . . . . . "� ����/� � � � , ,2 :; �' .. . . ... .. . . .._,_ _._..__... ,..... . .�. ..„.... ._. . ._ �-."_ ;.�.�.. - �. r a. n:.,,� �/�/ / � ` � '- ' � �" � _. __ � .. __ _._r_f_../_._ _ ,�.__._�. ._,__ _ __.._ ; __ ___..___---__________ .__. __._... _ . � 4 4� t, .. z z `^i . F ;xi ^t a��: t�d . s �.a .:�� . � _.._,__................. ., ....... -� ....... . _. .. .. .._.. __.. _.____ 3__,_.. ___.�. .� ._.._.,_. . ..,.,..___� , � E � �,f�a..,.a..�.:-.��`":.{..: � � � �^ �' � 1 ..........._._._ ..�....; ..�,_.. ...�. .._,....,.,....�.... .....w._...._. ....,.,�.....,_, ...n....._..__..........._....__... ..r . ............. __ . _._____ �'__.._ _..__....,..,._ _.._...... .—..... .. . .: .. � .i�� .:; - .. .. :+�. �����t,.. .,a�,s;._ �d, d � � ;„ � i � _ _.:_ _. . _ ' ... _ � .._..__ _ �___ . ___.__ _.,.__ _ .�. . � _ _ , ' � �� � �, � � �� �4�'���� '� �"� ::�,.„� r 't ` ..W.......,w.._......................__..___.......__ ,» _......._�..,,,............�..: ,..�_ _......,........,..W..._ .:..... ..., .-.,.:.4.:.F-w,�,�<°`."„'�-.�.s�",,'�'..:--+�R,,.�=,s.,"z,e�_. ..G�s_.,�.4r.�. ,,._......__.._.._ .._. ,._.,._._.__m.._...._,.._......___. . _ _ .. s � � � ' � a"' � :..� ._; ��� . � � 'z� ;� �^ _� _°1___..._N� d1.�5,�'�SC.__� D�I'��ct� _�f�, ����1'��.�,� � � �,�mw � d�.: .__ _ _ __ _._�.�_..�_w.�_._ � .m....�,.._�"�t_e, e��..___._!"!:_'�._.�.���__,...e!���..._. �� `3c)_�"N.___..�a.__._.._ __..�...____:._____.____�_�...______�.........._.__._...._.._.... __. ' i .. ,...._..�.._.�rv,. .. .._..._....,..._'�"'__._�.�........_.�. �_..._....�� , ':..:...................__...._......-,p_._:_...__.......,,..........�...�,u...,....._,.__..__...._........_._......m___.......__.....,.,,......_._.._...��� . i'. _- �..-�.„„,_._.�._..,,,.._,:.�.........e..__...........................�..�.......-...... . ........__,,._ _._....____��_.,__._....,............,,........,,.........,,._'_._.. .....,......._................._......._._._ _ .._.__..�_�_.�.._............_.............,,_.._...,......_.__.._�_....___._"_'"'"'__"E � � S Y, J�.__„«........................_._....a....�..,m__,..e....._._...........,............__.w___�..__�......._.........,......,..,,,.........,..............._...,._._......._.._.�._,....._................,...> .. . ............_.«....,.........................._..._.....<................_,....._..-_.._._.__..�_..._._...........,..,.........._.........,.......�._..__._ _ .__... __� ._ ...... ._. �_._ . .._..�.�.................._..,...�.........,..._._.e........_.........�.�.�...................._. ......_.._ ,......_........... ....._._.__..........._......«..__.�.�............,....._...........,.....,..._.....,._.� �..._........ ..._............. .:...........,� � g € *::wa..�� }'�s €d{�`,. Stl� ..:�A���� '�:�.. .. .....__....,.. � ... � �. _ ,_._.._...__.._ . ....._....__.m.._........_........_.,.,.._..._......._,_...__._._,....._.._m._�_..........._................... ........................................._.�____...,..._....,..............._........._�._.....__.. ....__.�........__..._«.. ��» ���°� � f��' mm� � . �. � � ct �;,a�a"�H"L�s�,�x t ce§ ;,�-�'�w�'a',�w g�,. . . . . ., . . .7+.. t. .___ --_ .. .__ .... ..._ ....� �",.,�, �i��d��TM��sPo�''a�k��������'��i y, . _._..... . __ ..,_ ...m.. . . . � a $ �� a�"� �������� �*& �� ����i� _.__..____�.,_._..m. _,.._._ ._.._.__._ ._.___._.. ._.._,. µ .. _ -_ __._..,. ------_._---..�.__.---� ������ ������������ � , , ����.�����' ����,������ ���r�� � " ���� �,������,������ �� � � . ..____ _� __..___...___ ___._.._ �_ � ��������� ��"��� ���°��������� � __ __, � t} ; �� �`��� �a��a"� ������ �' ����-�" __.. ...__._... _.__.__._._. �... a._..__,�__ _w,��..._.... �..... _W.� _._ __.. __._ .. }�������� �"����� ���� ����� � }� �� � ��i'` ��.7���� ��.#���_ � �,�p��,;: ..._.�._.._.._.._..___..�..�.____.__......._..__.._...�._....____.m....__....�.___._..._�..._ro.........................w...,...._.....�._�_.M..._...._._...._...�� ._.._.....�._�.... ........... .....--.._..�,_._ ��� ��� �"����y����*�s� �*� ��,"�� � H �A�"k�'�d�,g' q �d���$ ��8.��;�' � �4��� ..................,,,...._.�_._.»...........................,......,......._.,,,..._......__....»,.,„_...._.__......_....n...- .,..__1. ._.............. _...__.......,..._._......�_�_�. ......,._._....___.__..._.........,M�_._.............. . ��n��:��..�.r'�`a�'�Y..����������"���f��:&are���,���r; ' �' .. .. .. . .. ._.______..._.-- .__,._. �._�.... ... _...... . . . ....... ._..... ___.. ,. . �