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HomeMy WebLinkAbout11523 1 -�,�.--- CITY OP DIAMOND i3AR ���"'��"y�:C.� � � � � �� CUMMUNITY DrVLLOPMENT DEPARTMENT Q �`�,,.w 21660 E.Copley Drive Suite IJO (909)R60-3195 P.ix{y09)861-3117 ���� �, � ?��� PRESS �'"'' BUILDING P�RMIT APPLICATIOI�T FIRMLY � JOBSITE GJ ,�Q APPLICATIO PERMIT P/C o ADDRESS ��_,[�,__.r���� `� 'r '\ DATE_____ NUMBER S'�` # ___ o� -- ISSUE TYPE OCC APN O�T.�y- �'— TRACT DATE CONST. GROUP ____._ � p OWNER ���,PJ�U'�# ��I1I�� ----- �L ADDRESS��_.____ ��l��r' ?�6�- ZONING SETBACKS � ZIP f TEL. FRONT RW_____,_ f� � o CITY � ��c.S ---- ----- -- APPLICANT TEL. REAR ___ _ _ _ C7 _ � —' — SIDE/SIDE STREET_._.___ RW rl_,_..._ � CONTRACT L�' _ r�---- --- . � ~ SIDE --------- [' -- - o ADDR S - - CITY ZIP�[;� �TEL � PROPOSED USE� � G� ' � " _�,' � ^ u� ARCH/ENG/ -- - � DESIGNER NO.DWEL. NO. NO. � ADDRESS____ UNITS____ STORIES BEDROOMS__ � CI'fY-,--.----- ZIP----- TEL.-- - cn cn -- DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BI;ILDER�ECLARATION SFR/ADD/REM O [] I HEREBY AFFiRM UNDER PEYALTY OF PER.IURY THAT I AM F%EMPT FROU THE CONTRHCTORS LI� � Garage/Carport LLJ C"eNSFLAWfORTHCFOIiOWINGR[ASON(S�C.70315AUSIN[SSANDPROFC-SSIONSCO�E:ANVCITVOR !:.� CUUVTYW4ICHREQUIRE^uAPEHM1TlOCONSTHUCT,ALTEH,IMPROVE,DEMOLI51f,ONHEPAIHANYSTRUC- W patio/�eck � �' TUqE,f'R;OR TO ITE ISSUANCE,ALSO REQUIRES THE APPLICANT FlJR SUCH PEflM1T TO FILE A SIGNED W W S1'AIEMENTTI{qfHI;ORSlIf:!SLICtNSL'DPUHSUhNfTOIHFPFiOVISIONSOF'INECONIR0.f,TOH51I- � CENSELhW(CHAPTF_iYO�COAAMENCI4CWITIISECTION7000)OFUIVISION30FfHEE3USINE55ANDPRO- LL' PooUSpa_ FFSS;ONSC(ID�Jc)f1Ti{qTHF.ORSHF:ISFX�MPTTHF,PFFflOMANDTH[BASIS�Uf1iHF.ALI.EGFDFX[MP- � UiiOYAN`.'VIOI.AT�(7NOfSI:C11UN7031.5F3YANYAPPIICANilO(IAPfRMITSUI3J�"CTSfHf:APPLICANTTO z Re-Roof ACIVIL f'ENALTY OF NOT UORE THAN FIVE HUNDRE�DOLLARS(ESuu).�: � C'I,ASOWNEHOFTIi[PFlOPFRTY,OAMYFMPIOYI�SVIITHWA(+FSASTHEIftM1.FC0!APENSATIG`N, O Commercial � V11LL DO TNE WORK.AN�TH'e STRUC"fURE IS NOl INIENDED OR OFFEREU FOR SALE(SEC.7044.BUSI� J � NE55l�V[1 PROf�ES5:ON5 CU.`1F.�1'lif:CON IHAC.!'OfiS I ICI NSE lAW UOES NU�APPIV 70 AN OWNER Of- � PHOPERTY WI i0 UUI'..i7u OH IA1Pi70Vf:S THGR!:ON,AND WHO DOI:S SUCH VlOqK HIMSEL�OR HERSLI.F OH �',5,. THROUGHHISORHEFOWNEM?IOYEES,PROV!�EDTHATSUCHIUPROVEMENTSARENOTINTENDEDOR m L1-1 OI i F.I7f:D FOR Sill E.IF,i IOWNFfI,THL HU!I.DING Of11MNliOVC:MfNI IS SOI.O WITHINONE YEAR OFCAMALE- 0 T:ON,TNE OWNER-BUILDER WILL HAVE 1'i1E 3UHDEN OF PROVING ill�l I{E OR Sf{E DID NOT BUILD OR :� iMPHOVFFOHTII[PUHPOS[OFSALE). u� i:1,A50WV[HOFTHFPROVLRTY,AMCXCLUSIVELYCONiHACiMGWIi11LICENSEUCONTRACTORS � TO CONSiR�CT THE PP.OJECT(SEC.7040,BUSINESS N!D PROFE551045 CODE:THE CONTRACTOR5 U- VdllJd[i0l1 _____._____.__.. _ ADJ.AREA Ill C�NSLLAWOUCSNOlAPF1.YTOANOWNEROFAPROPEP.TYWHOBUILD50flIMPFOVESTHEREOY,AND -- = Y.'ViOCO4TR�CT5FOR5UCNVfiOJECT5W1Tl{�(;ONTfIACTOfI(S)iICC45F�PMSUANTTOTHECONTfiAC- Q�JANTITY DESCRIPTI�N FEE ~ TOFSLICENSELAW.j. Y ,�L � I i 1 AM EXEMPT t1N�ER SEC. B.8 P.0 FOR THIS REASON Q F.� � c7 � � _ ._.. -------------�-' - '' --- ---------...--- CL �"` DATE �' —____'__"" OWN�fI. . "'"_--'--"'_"—_____----""_"" ' U � W -�n'—. LICENSED CONTRACTORS DECLARATIOM W � d ; � � i HEAE9YArFIR�A UNDER PENALTYOF PEP.JUfiY THAi IAM LICENSEU UNUER PROVISIONSOF CHAPTER � � C.t 4(�x7'ANCNCINGYiITHSFCItOY7000�OF�IVISION70�TH[BUSINESSANDPFOfE55!ONSCODG.AND z� u� ; MYLICe�SEI5IVFU/�}.FORCEANUEFFEC�. �J �„ m o LICCNS[C SS`� ,� LIC.IvO. lY�" ��" � � }_ j_"' ' J i U DATF._ /� CONTHAG d W �i] WORKGRS'COMP[NSATI � CLARATION Q '� , 'P , v,,� �n IHFHeF3VAfFlRMl1�D[RP�NAI.TYOFPERJURYONEOFTHEFOLLOWINGDECL.ARATI0Y5: Z ��{ — � � !IIAVF ANU W.;l MAI.VTAW A CE.fRIFICATE OF CONSENT TO SELF-INSURe FOR WORKERS' _ � 7 MMPfNtiAIIUN,NSPfi.)VIDf:D13YSCCTIONJ]uUO�THELABORCOJE,FOriTHEPERFORMANCE U _, 4 Cf TI IL WUfiK fOR WlI:CVI THIS PFRlAI i IS ISSU'cD. W ri � 11 IfI�VEA�DWILLNAIV7�MWORKEHS'COMPFNSATIONINSUl7ANCE,ASREOUIRE08YSECTION `t�C 97U0 OF THE LABOR CODE,FOR TH[PERFOI7MANCf�OF TIIF;WOI2K FOH WHICH 7Ii15 PEHMIT IS � ISSU'eD.MYWOR�COMP SATI SUHANCEC IEHANDP(N_ICYNUMBERARE' CONSTflUCT�ON _ _ J _' _"_—__—"_"_ _'—'__ `���,, caqr��;;�.--.--- . ' e�/ .�/ PLAN REVIEW �r— -- !� PO:ICY NUTABER--l�F�6�� --T.'- --._.....---' "-"-'---------- ELECTRIC �--....-'-�---....'------- �-4 KT � � —�T ...._.._...-----_.-- � (1HISSECfIONNEEUiWT[3�Q%Nf'I.R[�OFTIIEPERMfTISFORQVEHIkDRFD00LLARS($100jOFilESS) PLUM6ING . ,_,_ � _ _ _ � I CEFTIFY hIAT IN THE PEHFORMANGL-OF TIIE WURK�Ofl WHICH TMIS P[RMIT IS IS,SUED,I MECHANICAI_ _.__ __ .__,._ f'�Y� �} SHALL NOT EMPLDY ANY PEftSON IN ANY M�NNER S()A:TO ft[COMI:SUUJF.C7 I O II IF �� � \YOIiKLi15'(:OMNLNtiA7fOYLAW50LCALIFORNIA,ANDA3P.EETHATI�ISHOULDBECOME INSPECTIONFE[ ___._.._____________ ' � ••� SUBJECTTO THE 6VORKERS'COMP�YSA710N VHUVI"IONS OF SL(:T ON 3]�0 Of TH[1 OR � _y � CO'JE,ISHA FOFTHWITHCONVLYWI Illl05� VIS NS ISSUANCE i� `� - G � ..C'i._(�. .� C.'� �ATE.�r�L APPLICANT: c _ _.�.(r(e--___ SMIP �t' " _._.—' —__..__..'___'_ p �—_ .� .'.. _-- _._'.._ J WAf1NIKG:FAILUPETO SECURE WORKERS'GOMPENSATIOY COVF.RAG�IS UNLAWFUL,hYD SHqIL[i[ ENERGY P/C _ _.._._.____ __.___ ._______ � SUBJECI AN EMVLOVEH 10 CRIMINAL VENAI.TIfS AN�CIVIL FMES Ui TOO4E HUNDREDTHOl1SAN0 ENERGY PERMIT , ! U(11.I.ARS(f1P�,OCO�,INADDITIONTO'IIIECC)Sf01'COMPENSATION,(1AMAGLSASPf10VID�D�OFlIN - -� ---- ----- �1 >I:CTION 97U8 OFTHE LABOR COUE,INI[RCST,PNI7 ATl'nI1N[Y'S F�f.S. RETENTION FEE: � � ,... ._""__ __'_""__ '. n CONSTRUCTION L[NDING AGENCY PRE•ALT FEE: _ ....,. ...._ ....----- -'-'—'--------- O � IHEHEL1YAf�INMUNOf:IIVENAITVOFP[flJUFYTHATTHEREISACANSTRUCTIONLENDMGAGENCY � FOR TI1E PkHFORMANCE O("1 H6 WOHX FOR WHICH THIS PERMIT IS ISSUE�(SEC.30J/.CIV C.). - - -"---- '"'"�--'—"""------ :Z LLI ...._. —_'__ ___ � LENDi:Ii'S NAM[_ � S "—_—""'___"'_"_ ' "—'_ '_____—'" � '___"_ ' = LF.N�Efl'SADDRE55 ._. ... ___"_"'_--_'"'—_ ' "_' '' " '__--__ �y� . � ICEFi;FYIHATIIIAVI:REAI)71IISAPPUCATIONANDSTATFTHATTHFABOVEINFORMATIONISCORRECI' TOTAL FEES � ��' (J'✓ �L IAC,Nf:[TOCOlAPLYWITHALLCITYANDCOUNIYOHDINANCtSANU$TALEL�WSFlFLATM(.fO�UILUINC � COM1�Tf7U(:TIf)N,ANI7HGIifHVAUTHORI2EFEPRESENTATiVESOFTflISCOUNTVTO'eNTERUPOYTHE � APOVE-MENTIOi PqOPEHiY FO NSP[Cil N P RPUSe� z �� COMMENTS o �/�',g7�°�� .--------------- � � , � - -- - - - - -- ---- - ------_----- cn . a[arnir� r� �. � ,� ��� .�Z,�� -�----- �". --���G�``-�--- ----. . . -- --�- � G I'UN[ 'HMITTEE DATE L RECPT.NO. _ �_�, PAID BY ____._ VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy _........�....�....__ � i _..._,».�._�.._.�. i. _� � 1� _ en t,�a� � t � I i 7i }�n � �s ry u: c+� aa � t;�� i'EIcn `o � �r�.s� �*j� 5 tn i�y m�-n ✓r [1"i YY'Y � j I ! . �"i��S tn r r � 7�tr,i� �°IS -� v J �'G T If. �'� r I m iTi'�'- 1 I �'� .,�*{.a��:r T..�1�rtT c �'�'I r��tT -,�Ci �-_ C O� G�-i � �C7 i � �� ""� I � . m, x � � x t iC) ..P�i. 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