HomeMy WebLinkAbout11671 n '
I CITY OF DIAMOND BAIt
----�`-�-- DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES �
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
��'��" BUILDING PERMIT APPLICATION FIRMLY
a ADDRIESS :aC'7.��� �1.)'%AUC S✓p�� .�!✓C..� APPLICATION NU 8 R 1 ` #1C
p DATE �_ �-�
� � ISSUE / TYPE OCC
APN LOT TRACT DATE s'� 1 � CONST. GROUP
°C OWNER ,�����
� � ZONING SETBACKS
o ADpRESS '-��,�,�� �r-r�, Si s�1 E;= tS 5�+ +✓ j�t'��
oCIIY�)1/�l�Ueal^1 /?s7�'. ZIP�'�.,�,�TEL.�� e' FRONT RW L�
APPLICANT TEL. REAR �_�____
� SIDE/SIDE STREET_ RW fl _
c� CONTRACT R���L (,' ����T�,J� ',�. SIDE ___._,__
p CITy E����;�`4 �'?,�ZIP���� T,E� .�,�,� PROPOSED USE - � .5 '7
o ARCWENG/ (J�� .
z DESIGNER
w - NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES ___BEDROOMS
�
v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFWADD/REM
O
1 HEREBY AFFlRM UNDEA PENAITY OF PERJURY THAT I AM EXEMPT FROM TME CONTRACiORS LI� Gflfi19BIC8l�0l1
� �
� W CENSEL11WFORTHEFOLLOWINGRFASOt7(SEC.7037.SBUSINESSANDPHOFESSIONSCODE:ANYGTYOR
U COl1NTYyYF{ICHpEOUIRESAPERNITTOCONSTRUCT,ALTER,IMPROV[,�EAAOLISH,ORREVAIRANYSTqUG W Patiol�eck
W TURE,PRKKi TO ITS ISSUMICE,ALSO NE�UIRES THE APPLICANT FOR 5UCH PERMIT TO FILE A SIGNE� W
� S7ATEMEM THA7 HE Ofl SHE IS UCENSED PURSUANT TO THE PROYI&IONS OF THE CANTflACTORS�I- �
� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7Wo)OF DIVISION 3 OF THE BUSINE55AND PRO� POOUSpB
FESSqNSCODE)ORiHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEOEDEXEMP� (�
� V TqN.ANYVKKATI0NOF5ECT10fi70.91.5BYANYAPPLICANTFORqPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
� ACIVIL PENALTYOF NOT MORE THAN FNE HUNDRED OOLURS(S5ooJ.):
� ❑I,ASOWNEROFTHEPROPEHTV,ORMYEMPLOYEE6WITHWAGE6ASTHEIf1SOLECOMPENSATION, COfilrtlBfClal
YALL 00 TME WOFlIC,AND THE STRl1CTURE IS NOT INTENDED OR OFFEREO FOR SAIE(SEC.70d4,BUSI� �
y NESE AND PROFESSIONS CODE:THE CCNTRACTORS LICENSE LAW DOES NO7APPLV TO AN OWNEH oF �
� PROPERTYWHOBU0.DSORIMPROVESTHEREIXJ,ANDNM1i000ESSl1CHWORKHIMSELFORHERSELFOq
wTHFlOUGHHISORHEROWNEMPLAYEES,PROYIDE�THATSUCHIMVROVEMENT5RFiENOTINTENDEDOR m
0 OFFEREDiOH5ALEIF,HOWEYEp,iHEBUILDINGORIMPROVEMENTIS50LDWRHiNONEVEAROFC�iPLE-
Z TpN,THE OWNER-6UILDER WILL HAYE THE BUHDEN OF VNOVMG THAT HE OR SNE DID NOT BVILD OF
� IMPflOVE FORTHE PURPOSE OF SALE).
w n1,A5OWNEROFTHEPROPERTY,ANEXCLU5IVELYCONTRACTINGWITHLICENSEDCONTRACTORS
� TO CONSTiiUCTTHE PROJECT�SEC.)0�4,BUSINESS AN�PROFESSIONS CODE:THE CONTqACTORS LI� V81U8�i0f1 ADJ.AREA
W CEN&EIAWDOE3NOTAPPIYTOANOWNENOFAPROPERTYWHOBUILDSORIMPflOYESTHEREON,NJO ""'�–'– --"'
� NTqCONTMCTSFORSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPUflSUANrTOTHECONTflAG QUANTITY DESCRIPTION FEE
� TOHSLICENSELAW).
U TAM EXEMPT UNDER SEC. B.8 P.C.FORTHIS REASON �
� U
LL �
DATE _oWNER__"'.__'— --' U
Q W
� LICENSED CONTRACTO�iS DECLARATION W
� � I HEREBY AFFIRII UNDER PENALTY OF PER.IURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � G�n`{, �Yy. , �Iryy f���..r� ]y� ` � // /� ��+'^
d B(COMMENCINOWITHSECTION7000)OFDIVISIONaOFTHEBU5INESSpNOPROFESSfONSCODE,AND a �I✓ Aa.+ �lJ" �61 / G f .3
X MYLICENSEIS IN FULL FORCFPN�EFFECT. ��'p'^�WL m ���� �
/� y yP�,(� �i
� u L�CENSE CLASS_ 6.� IIC.ND. ��K% &s Z� f ` �
� /-�� J
V DATE_.���t�ra� CONTRACTOR_��L c--.;?��..i,__— a / //r -y��
W {'J C�'�!'` .l fe`.a`d"/� % �.
_� WORKERS'COMPENSATION UECLARATION ¢
� I HENEBYAFFIRM UNDEH PENRLTY OF PERJURY ONE OF THF.FOLLOWING DECI.ARATIONS: z
� _IHAVEANDWILLMAINTAINACERTIFICATEOFCANSENTTOSE�F�INSUREFORWORKEHS' Z
� COAIPENSATION,AS PROVIUED BY SECTIDN 3�ao OF TNE LADOR CUD[,FOR TNE Pc11FOFMANCE U
Q OF THE WORK FDR WHICM THIS PERMIT IS ISSLIED. �
W �.I HAVE AND WIIL MAIMAIN WORKEFlS'COMPENSATION INSURANCE,AS RE�UIREO BY SECTIQN
O 37000FTHE LABOR CWE.FOR 7HE PERFOqMANCE 0�7HC WORK FOR WHICIi TFiIS PEqMIT 15
ISSUED.MY WORKERS'COMPENSATION INSl1RANCE CARRIEH ANU POLICV NUMBER AfiE: CONSTRUCTION
�/ --._ ..."'— _'_—.... :
� CARRIEH G�/2J;aY PLANREVIEW __.. .___.,,.. ___ '
0 POLICV NUlABEN .4��cJ�(,✓DC.`S��]�J_`7 ELECTRIC
¢� ---...__.. ----
o (nussEciiovale�rroTBEo�r,wi.E7EooF7NEaEati+rt�swaoriE�ux�naEODaisasrytoo�atLEss1. PLUM8ING _________.__ __""__��U�� �
- w -
Z I CERTIFYTHAT INTHE PERFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS I55UED,I MECHANICAL
(} SHALL NOT f.MPLOY ANY PEFISON IN ANV MRNNEF SOAS TO BECOME SU&IECT TOTHE � �� �
(n WORKEftS'COMPENSRTIONUWSOFCIILIFORNIA,ANDAGREElf1ATIFISMOUL[)9ECOME INSPECTIONFEE ____..,__._ �
Sll&IECTTOTHEWORKEFS'COMPENSATIO PROVISION50 SECI'ION3700 FTHEUIBOR
� COOE, SHALL RTI-IXJITHCOMPLYWITH OSEPROVISION. , ISSUANCE .__._____ ___ __ __�_�t�� ,
O
p OATE: � �� � APPLICANT: � 7` � .:�/X SMIP _.___
� ENERGYP/C ,___ ,__
WARNING:FAIIURE TO SECUFE WORKER PENSATION COVF.RAGE IS UNLAWFIII.AN�SHAIL BE
LL SU&IECTANEMPLUYERTOCRIMMALP IESAN�CIYILFMESUPTOONEHUNOREDTHOUSAND ENERGYPERMIT
OOLLhRS(f10o.000),INMDITIONTO7H OSTOFCAMPENSATION,DAMAGESASPROVIDEDFOftIN -- ---����----- -
'—_"'_—"_".,._.__...—
J SECTION3loBOFTHELA�ORCOOE,INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE:
¢ "'___---—_ _"' '_'__.._...—
nW. CONSTHUCTION LENDING AGENCY PHE-ALT FEE:
p -- -----
� I HEREBYAfFIRM UN�Efi PENALTY OF PLHJURY THAT THERE IS A CONSTRUCTION LEN�ING AGENCY _
FOR THE 7ERFOR4ANCE OF THE WONK FOR WHICH THIS PEqMIT IS ISSl1E�(SEC.3n97,CIV.C.).
W '__-- � � —i
� LENDERSNMAE,___ _ —__ C ___
f
H LENDERSADDFiE55___._.____________._.._. _._
W� T�TAL FEES
ICERTIFYTMATIMAVEHEPDTFIISAPPLiCATIONANDSTATETHATTHEABOVEINFORMpTIONISCOHHECT. a
� I A6REE 70 COMPLY WITH ALL CITV AND COUNTY ORDINANCESANU STATE LAWS FEIATING TO BUILOING , •t
� CONSTRUCTION,ANDHEflEBYAUiHOFIYEREPRESENTATIVESOFTNISCWNTVTOENTERUPONTHE ��rCnI��� I�a�� � .
Z r1BOVE-MEMIONEOPFOPERT'FOAINSPECTIONPUFPOSE3. COMMENTS � y��� �¢
� ��� _� R �
m .�T,4�� /��2�� - -
PERMI NAME(PRINT7 4
¢ � /
� A � `� __.
� SIG TUREOFPER OATE
RECPT.N0. PAID BY .� � VALIDATION_ ��_
~ WHITE-0epertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD--File Copy,6REEN—Applicant's Copy
i ;.'{ . .... � _ .�... , . . «.....,. ....r.� ._ ... ` I ' ` I . ' ... },�4� .
- - .�. I .#_ E .,� . �
� � �,,. ��.. _I, - � - � � � � � I� � � ���
na ��� ' : 1 , �{.,. ' , 1 i
�g� r. . ' . - I t �
$ 'e4 2 , , -.. ..r � I �p � ... '.,, t �.{ � '` .i ,� '.
� iy�� x .; F l�:il - � � - k i ' i � �it „� � � '�7 ��
� �i r� �k'' �^�}E a � � . � �" � :,a ,I , . ( - . ..? l i� . i � � 'T� .
�� _� ; � �
�`a ��.'� �� � t � ,. i ' ! I i � � ily � t .. .. � ' �'�y} _
Jt
� ' �u � ,, � t �
k ��q � � , ��� �� I r � � � - � � ' ' N �g��
� ��� _ , i I r��� ` � . ..
� r r< < � I � � .�� , : ( , �t � ,
Ef � , � � � ' � � � ���
F z �� i ,
�s�r ��s�xu r� '� � ` � � i � : - � � ;. _ _`.� � � ' �� , �
r��. . � „ , � , � �:'�i`ss �� vi� � � � ��
i , '�.; �� � � � � � m �
� 3� I I, i ��:� �J' ' i I v'I � ' , I ` �
� ; � � ; . . . . : � i i � � i �' , � ( � ; � '. . �'F�� �.
� � i � �
� i ; j f . i —"G`"�; i ��i +-- =� — -� � �
C � �: � �
;.. �.
� ( � I � ' � i �� . , ' , i . � �
I i i . F,��; ! i i : ' t�;
� { � ' � i �I , � , i
� c � � ' ' � � i �� �� � i � �� � ! i ; ; , I , E� �
' �''�°�, � � i ' � i u a
s I � � ! j i ( �V ° � . . Q' , i �h; �:
' � � ` � � , �', � � . �W��. i � 1; . , �. 1 . � �I , : �en ' .
, � � i � . I � � ; , . 1 �� ; �� � � .
i � � I � � � �f� i � � ��� ( i � � � �'#� �
� ' , �i . � . I ���! C � i �, , , , � I ; � C � � � f � .,,'� � .
. � L!'� k r ' I k I I t�" .. f _ � �_ -.T i._"I I — t.� iY
� I E !. i. .. _.i � I,. �
� w
� ��;I I � ` I 1! L � ") � $,z ( t
i � `��E, , � � �"� � � i � I - �
i r � � r
� . t � �,
� . � �.�z � - t . s r- r � i - t7 a��ri O.� ,� .
. ; � � � ' . � : .. �.� } � . , i .
r I +I � (tZ" r5 S � r l�,� _ �
I - i � _ } ��� ;;
1 I '� � � I � ' . i�� � .:j � �r �_ ..'�r r .�. � � ,„,�
' � ' ! : � - �d� t ; a � i� � �:i 4 ; i � i � r= � �,
� I � � � � { � � , . : T.s >>� I ' � - ��'ri�� �� W *� �y��. + �;
; i ; j � , ; � ; ; ' ; ��, � , .; _ � �; ;� � i � � � �,
� ��, I ' ' � ' � � I ��#k . ��� ( : i ' � � i � - � �I� r I .C�t
� ' ' � ! � ; � i }+�- . f ; ' � . - � � ; �t 'C �`" . �
�i : � I : ; . 1 ..�" , I .Y� �� .
� _y i : � . 1 E `. . ��'$'3 � i t I �. I _
i �
i 3. I I .- i ,. � ; { �; � it ( � I � � � I I
I I
� 4..j , , � �. . , � � � .� �..._ ' ' i"' , ' ".�'" ' 'I"' � .' _ i
�v
1: , ` ' � , i � I i . I � 1 .. ( � .
f � � , ; , i _ . � -
C � � � ' 1 I � � II I �I ; i ���a
1 � � � . '. i 1 � � I ' ' ' I � � i � ' � ��: � ��,
i
- E : ; - ' _ �. ' . I � � � I � . .
� � � � � , � � : . i -
t � � � _ _
�` � � i � - � I . , _ '__ � � { f G ' " .� .�...... � �. ..y._.
3 `:' � _ . ; � - i � � . i ' I
; , k ; ; � , , , !, , , . � ,
a � : ; , � ; � � ���
�; i i ; � � , � � � , , , �
i �I � � � ' '� � � ,. � i . ' � ��� i i . f . I. � ' i . ��' �. i I 4��
I . i �. � . , �� i � j � ' �x.
. G'°'� � - � � � � , � ' � I :� � , ' � � � � � ( '�#'
; � �'� i � � ; , i � : _ � i � i . � ' j � '4 I � ( : • � g �
�
�
� '
; i ; i ; � ; i ` �..�«t 3
i '
, ._.._.._. .._i,_ ... ..-...._
_..: .�. ,_ . ...,_ . . ..... ... .:.... :.. _...._ .. .,,.�.... .......,.
_ ._. ..._. . _'_._.. ... ,