HomeMy WebLinkAbout14813 CITY OF DIAMOND BAB ��
` --- "��� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
� 21660 E.Copley Drive Suite 190 PRESS
(909)860-3195 Fax(909)861-3117
��'��'� BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE �1 G APPLICATION i ' �`i� PERMIT -�$��� P/C
ADDRESS � v • DATE �� V" NUMBER #
� � ISSUE �.,,! NPE OCC
APN LOT TRACT DATE � (�✓ CONST. GROUP
°C OWNER ��
O
"' ADDRESS O �/ ZONING SETBACKS
Z CITY ' IP TEL. ��� -S'�1.� REART RW u
g APPLICAN7 TEL. SIUE/SIDE STREET RW 17
� CONTRACTOR ''�+r t � SIDE U_
o ADDRESS � PROPOSED USE f/�iI�A�L YI{�(�' �
CITY `(k ZIP P!TEL. �� '4-T-' F—= 'u" '
o ARCWENGI —��'�'Q ��� `r�5���
�z DESIGNER NO.DWFL. NO. NO.
Q.; ADDRESS
� CIN ZIP TEL. UNITS __ STORIES _ BEDROOMS
N
rn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION ' SFR/ADDJREM
O
Q 1 HEflEBY AFFIRM UNDER PENALiY OF PEFLURV TMRT I AM EXEMPT FflOM THE CONTHACTORS Lt� Gd1dJ6/C3fpOff
W CENSEUWFOqTHEFOLLOWINGREA50N(SEC.7037.68USINESSANDPFiOFES510!15CODE:ANYCITYOA (/)
U COUPJTI'WH�p{q[-p�IflESAPF.RMITTOGONSTflUCT,qLTERIMPFOVE,�EMOIISH,ORqEPAIRANYSTRUC� W pyfi0/08Ck
� TURE,PRIOH TO ITS ISSUANCE,PLSO RE�UIqES THE APPLICAM FOR SUCH PEPMIT TO FILE A SIGNEO �
STATEMENT THAT HE OR SHE IS IJCENSED PUqSUANT N THE PROVISIONS OF TFIE COMRACTORS LI�
�� CENSE LAW(CHAPTER e�COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSMESS AND PNO- LL' Pool/Spa
FESSIQNSCOOE)OflTHATHEOHSHEISEXEMPTTHEHEFftOMAN0THE6ASI5FOR7HEALLEGE�EXEMP� �
V TION.,WYVIOLATIONOF6ECTION70.Y1.5BYANYAPPLICANTFORAPERMITSU&ILC7STHEAPPLICANTTO Z Re-Raof
� ACML PENILLTY OFNOi MORE THAN FNE HUNOflEO DOLURS(f5D0).��
� ❑I,ASOWNEROFSHEPflOPEH7Y,ORMYEMPLOYEESWIhIWA0ESA5THEIRSOIECqMPENSATION, C� ComnlerCi21 �
YlILL 00 TNE WORi(ANO THE SiRUCTURE IS NOT INTENOED OR OFfEFEO�OR SALE(SEC.7o4d,BUSb J
� NESS AND PqOFES510NS CODE:THE CONTRACTORS LICENSE I.pW DOES NOT APPLV TO AN OWNER OF j .,.s'^'"'
PimPERTV NM1q BUILUS OR IMPROVESTHEREON.AN�YMO�OES SUCH WOflK HIMSELF OR HEqSELF OR
� THROUGHHISORHEA0IVNEMPLOYEES.PROVIDF.DYHAT9LICHIMPROYEA7EMSARENOYINTENDEOOfl m
QOFFEHEDFORSALE.IF,NOWEVEf�iHEBUILOINGORIMPROVEMENTISSOIDWRHINONEYEA(70FCOM7LE
Z TION,IHE OWNER�BUILDER WiLL HAYE THE BURDEN OF PHOVING TXAT HE OH SHE 010 NOT BUiLD Oft �
W IMPROVE FOH THE DURI'OSE OF SALE).
❑I,AS OWNER OFTME PROPERTY,A/A E%CWSIVELY CONTRACTINO WITH LICENSFA CONTflAGTOflS
� i0 CONSTRUCT THE PPQIECT(SEC.7ola,BUSINE55 AND PROFESSIONS CAOE:7HE CON7HACTORS LI� VHIU8t1 P.DJ.AREA
W CHiSELAWDDESNOTAVPLY70ANOWNEROFAPROPERTYWHOBUIl�50RIMPROVE5THEREON,AND -- - --' - ---
�� WHOCANTRACTSFOflSUCHPRQIECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAC QUANTITY DESCRIPTION FEE
Y TOR$UCEN5ElAW.�.
0 O IAM IXEMPT UN�ER SEC._______ 9.&P.C.FOR THIS REn50N Q
U
� LL --- ---�— ._-- � �
OPTE____ OWNEfl___`____ U
� W
�. LICENSED CONI'RACTORS DECLARATION W
� � I HEREBYAFFIHM UNDEH PENPLTY OF PERIl1NY THAT 1 AM LICENSED UN�ER PROVISIONS OF CHAPiEfl �
� 8(COMMENCINO WITH SECTpN 7aa0�OF DIVISION 3 O�THE BUSINESS AND PROFESSIONS CA�E.AND Z
�� YY UCENSE IS IN FULL FORCEANO EFFEC7. � m
o UCENSEG S � LIC.NO. ✓� ____ j
�t�� J
�j �AYE 4� Uv CONTRACTOR____ _ a
W
� WORK[RS'COMPENaATION DECLARA710N Q —
NI HEFlE9YAFFIRAI UNDEP PENALTY OF PERIUHY ONE OFTHE FOLIAWING�ECLARATIONS� �
O _IHAVEANpWiLLMAN7AINACERTIFICATEOFCONSENiTOSELF-iNSl1REFOqWOHKERS' _
�� COAIPENSATION.ASPROVIDEOBY3ECT10N37000FTHELABONCOf7E,FORTHEPEfiFOflMANCE U
OF THE WOqK FOA WMICH THIS PF.HMI71b ISSUED. �
0
W �rt HAVEAND N7LL MAIMAIN YJORKERS'COIAPENSATION INSURANCE,AS REIXIIRED F3Y SECTION j�
d 37000F 7HE LABOH CODE,FOR THE PERFOqMANCE OF THE WOFlK FOR WNICH THIS PERMR IS ♦ ��
ISSUEO.MY WORK RS'COMPENSAT IN URANCE CAFlq IERAND 1'OLICV NUMDER AP.E: CONSTRUCTION _,__ __ � t�__ ,
�/ " '_-'
� CARRIEH����— �`� � ----- PLANREVIEW ---- ---.._..__ ..— --.-- .
� POLICY NUM6ER W���I7� —__ ELECTFIC .`
� — ---.. ..-- —.._.
---- •
Q (fH133ECTICfJNE�NOTBEWM1PI.EfEDOF71-IEPERAtlTI$FpqpNtHUfAHEDD0UpR5�5100)Of1LESS� PLUMBING ��
-"'_"_-'_ - "_-'..
'___ __
Z I CEflTIF1'THAT IN THE�ERFORMANLE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL� _„__ �
(} SHALLNDTEMPLOVANVPERSONiNANYMANNEF150A5700ECAS1ESU8JECTTOTH[
' (/� WORKERS'COMPENSATION LAWSOFClLLIFOPNIA,AN�AGHEE TMP�IF ISHOULOBEG�ME INSPFCTION FEE _______._. 1
......—. .._ .
� SUBJECTTOTHEWOflKERS'COMP[NSA'fIONPflOVI510N50FSECTIONa7o00FTHElA80R , �]`I�
� CODE,ISHALLFOR7HWITHCOMPLYWITNTHOSEPROVISIONS. (SSUANCEpt�,}�(y ____ ____ _ Cf 1J/�
� �1 IS � ���__ _-'_ '_'-�4.� .
p �ATE: __ APPLICANT: ^_"__ _._ SMIP
J WARNINGFAILURETOSECUREWORKEfl9'COMPENSA710NCOVERAGEISUNIlWFUL,ANDSHALLBE E����'y��' � - - -�- ---
� SUBJECTAN EIUPLOVEH TO CRIAIINAI PENALTIES AND CIVIL FINES UP TOONE HUNOREO THOUSAND �jy�� �
UOLLAflS(Si00.000�,INADD1710NTOTHECOSTOFCOMPENSATION,DAMAGESA3PROVIDEDFORIN E�g4�P7'S�7ST'(f��p� --- --- -
J SECTION370BOFTHELABORCODE,INTEREST,ANDATfORNEY'SFEES. d.A1�%�,J f'A,
� RETENTIOIV FEE __ _._ ,___.__._.__ _
OCONSTRUCTIDN LENDING AGENCY PpF-ALT FEE: ___.____ ,____ _,__,._
� IHEPEBYAFFIRMUNDERPENAIT'OFAEflJURYTHATTHEREISACONSTRUCTIONLENUMGAGENCY _ ___
�' FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED�SEC.ao9�,CIV.CJ. -
� � -_'--_ ' '-
s � LENDEH'SNAME______"____'_._____-.
►�- LENDEH'SAO�RESS -----'--' "'--" "- -'-
w I CEFlTIfY ThIAT I NAVE REM THIS APPUCATION AND STATE TMATTHE ABOVE INFORMATION IS COFRECT, TOTAL FE ES � � ��
� IAGREE TO COMPLV WITH ALL CINAND Wl1NTV ORDINANCES ANU STATE IAWS flELATING TO BUILOIN6 �i
� CONSTRUCTION,ANO HEREBV AUTHOflIZE RF.PRESE.NTATIVES OF THIS COUNTV TO ENTER UPON THE
Z A13nVE�MENTIONEDPHOPEHTYFORINSPECTIONPURPO5E5. COMMENTS
O -- _ '_
J
� '_ "__ _
m PEliMITTEE NAME(PRINT) � - -
Q _.,'_.__'
�
'i�� vj SIGNAlURE Of PERIAITI'� � D � � �
�� = RECPT.N0. PAID 8Y _ VALIDATION
~ WHITE—De aAmant Co YELLOW—Finance Co PINK—Aasessor Co GOLDENROD—File Co GREE
`� P PY� PY� PY. PX —ApPlicanl's Copy
�;�'.
�r�
--. ._ . .
, �.._a r ;....�.......�.� , _ _ _
��r"��- ' �t �` � � r i ; • r a � ��� ! � _ �..
� � ,� ��wt � � r i t � '. � �7 C � _�t i �� 7�u�
j § �
� ��bz E��;ty� �+¢ �: i � { I � i � ; E T I '� _ i�E
�Y , �a i � I ,��i� ( '�� ���T - {"� I , �',�
#1���'i .,� ; �. i , € �' �:
# !.t f • � . k- ' � ��_ � i .i� r : : �1
3 . -
t x a$t�.` � ` � , � , 1 I� _� �. ' � r� -:+~� r n i �t�"��.
�,Lr�z ;. � .;� � I �' I E � � I �, � � �"�i i i
s� t� , � � � I I � � � ` �� � �y� ��i
d� ��FY` i � i - � ' . ; �� � _ � a li . � �: i, �^ ��'
� � �a i I
� , � - .��
� � � � � € � � �
, r (y � � ; , , , '� '( ' ,�,3���
I � � � r j
� ��S ,� .�6d',k. ; � l�. � . � '� : � _ � '. #... ., _ ' .�. n.1 __ . . s?�N!'
�
z i..-..�.... .. . .....:z, i ., . � i i , t ` �:� I�� � 13 I . � YfA
� ,
' r
� � ' : , . r . If ( � r • ' ' , � I ! j � �� ( I ' i p�".5
, , � � � � i � � � � ' � � ' ' ! I i� : I �J�L� ..
�
. � ' � - I � . � � ' - �
� � I i ' � ' �� i I 1 � ��3
� i
. � , — - - - f
. � I ' �.._� ' -
�
i ' R I i
� � , � � � � � � � i , --� � ! � �`�
� � ' i � ��
i � i ' i ; � I i � I �^ j , �.� �
_ � ' � � � 1 � � - . f ``, � � � k
�� � �'� i � � . � � � � �� I � i �. � _
€ � � I I � ! i � ' , � � �
j � I i � � `�
; i ' i ! i � ' I I j i � ` ' i � � i I i � �� � ¢
� , � �
.
. �
! � � � � i � , ' � � � W�� � s
�� � ! � I I � ' � { I �' I-i--� i: , � c� R 1 F3
: I � � ' ' I ' , ��: ,�, _ s� ;�j,, ,I �r ; , # �;� ,!,P� -_ i '�i � � `"
d: � , . ,. ,, i � : r: � �r. ` � �
i T �
� �
(i � ! , ' �: ' � � � � + '� ... �r � � I- �t 7 r [�i � � _ �r (� = .J� �'' �.0
� � � � I . � r �s� �� � _. � m � , .� � .� i r �'�� " �� .
I k I � � , .� s .i �i l I i �7 i r -tc "'
- � � �� g�...� i � (; � .. [ ') ��� � �� ��
' i � I ; � r��' ' ; — I.�� � j �� �,�a' s
� � � � � � � � � _� � �r�.
$ � f i � I 3;� �� � , j � I ` ;' ��. �-, � �,
t � � � � � ,�. , ; , �, � , �. R_�� :.
i , . , I �*.
f , ` � � , i!'� I � j ( � _� i
i ( � '� � + ' . � ,
� � � � � � �� � ( ,��„' , � I � r
,
,
� � � ( � � ' � � ' � -�1 � "`', _ � _. � _ — --' � ' 1 � !
; �
,
, ;
, , , . !
� �
, � _
� � ' � � � ; � � � i � � � � i � � � � I � ; �� ��
� � j � i". � I j ; '� � ' t ' ' � G + �,�
� �
I ' � ; ,
;
. , , , , I 1 , %'��F;
:� 7 , � ��� i , I � : � ; � � � � �
! � ; ; I � � �- , -� — � � ' - --- r F —� I _
� ` R
I ' i ,
, � , � � ' ; i ( � 1 �� : ' �
� � � � I i � � � ; , , � � � � I � ) , I � ��
' i ' i E � ': i 7 I , i � I i ; ( I i: � �' ' ��'
� � � � I i i � �- i � � , i ! , ( � i � �,, � � � ; � �`
; � ( : I
� � 1 � �� � � � � � � .. � i � � � � i r � �'��s�g
( , � j ( i ' � � i i � , � � 1 i . � � ���
' • j ( i ., I � , �
. . . .. � I :' 2��
i �
�..��... .....:... :.......... . ..._ � � . � � �� � � ! � � a
j � i
. . ... .._... .._, ,._.... �. ..,.�.._ �.,,.-,`--_ . ..'.,..� ... . . .. � , .., ,. .w.:_. ' ' � � .N �
'
.. I .