Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
13435
' �; ��.. DEPARTMEI�TTOED`BAIt � �;, � �� p y COMMUNITY&DEVELOPMENT SERVICES CITY OF DIAIviON � , 21660 E.Co le Drive'Suite 190' `�� (909)860-3195 Fax(909)861-3117 PRE$$ ��°�� BUILDIIVG PERMIT APPLICATION FIRMLY a AD R'ESS , � . � DATE CATION P, o NUMB R I� �� #/C ISSUE f TYPE OEC � APN�r,LO� ' T T DATE �� l"�� CONST. GROUP p .OWNER ,. ` .. LL ADD SS ` ZONING SETBACKS Z CI P ZI TEL. FRONT RW ❑ g APPLICAN'f � TEL ' '"' REAR ❑ Z SIDE/SIaE STREET RW ❑ ¢ CONTRACTO . SI�E ❑ � ADDR r � PROPOSED USE � � G�fi�� w ARCHIEiVG! i ZI �� TEL. � �� z �'�DESIGNER �� _ � �NO.DWEL.� NO. �� , A � ADDRE3S UNITS STORIES BEDROOM5 �, CITY ZIP TEL. c.n, . cp ION DESCRIPTION SQ.FT. FACTOR'PSF ADJ.AREANALUAT �� � . .. OWNER-BUILDEq DECLARATION �� � $FRlADD/REM � � , W� CENSEL4WWRTFIEFOLLOWWGAEASON(SEC.�7'U3�1.Y58 SINESSANOPROFE SIONSCODGANVT�ASLI-�� �. G3Md90/CBfPOf1 �. CITYOH � . . C.S'� COUNiYWHICHRC-0UIRESAPERMITTOCON57RUCT,ALTERIMPROVE,DEMOLISH,OqREPAIRANYSTRUC- W PdS10/DBGI( '� . �, W�� -TURE,PRIORTO'ITSISSUANCE,IpL$p�REQUIRE57HEAPPWCANTFOR�SUCHPERMITTOFlLEASIQNED W A STATEMENT THAT HE OR SHE IS�,LIGENSEO PUFSUANT TO TME PROYISIONS OF TF7E CONTfiACTORS LI- y�'�,CENSE LAW(CHAPTEP e(COMM NQINd WITH SECTION 7000)OF DIV�SION 30F THE BU�NESS AND pR0- � POOUSp2 �Tj FFBSqNSCODE)OHiHATHEO�SW6ISE%EMPTTHEFEFROMANDTHE6ASISFORTHEALLEGEOEXEMP- .(� � ,U TION.ANYVIOLATIONOFSECT7 T031.5BY/WYAPPIICANTFORAPERM!TSU&lECTSTHEAPPLICANTTO ��Z RB-ROOf � '�'"A CML PEMALTY OF NOT MORB HAN FNE HUNORED DOLLARS�S5o0).)! ' � ❑I,ASOWNEROFTHEPflOpEPTY,ORMYEMPLOYEESVIITHWAGESASTHEIRSOLECOMPENSATION. ��� COrt1ffIBfC13I �', Z�., W�L 00 THE W�F1K,ANO THE S�i RUCTURE iS,NOT IN7ENDED OR OFFERED POR SALE(SEC.7044,BU51- J . � NESSAN�PpOFESSIONS CODE:THE CONTRACTORS LICENSE LAW�DES NOTAPPLY TO AN OWNEN OF �, � �PflOPERTYWHQBl1RDSOHIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFOpHERSELFOH 'i '� "�THRaUGHiIISORHEqOWNEMijLOY�ES,PROVIDEtiTHRTSUCHIMPROVEAAENTSARENOTINiENDE00H C�' ' ' ' '. QOFFEqEDWRSALEIF,HOWEVER,THE9UIlDINGOFiIMPROVEMENTI550LDWITHINONEYEAROFCOMPLE- ' �i '�TION,THE OWNER$UILDEft WILL�4iAV�E THE BUR�EN dF PHOVING THAT�HE OF SHE DIP NOT BUILq Ofl � - . j =; IMPROVEFORTHEPURPOSEOF�SA!Ey � ' �� ' � ' ' ,�yy , ❑�,ASOWNEHOFYHEPROPERTY,AMEMCLUSIVELYCOMRACTINGWITHLICENSE�CONTRACTORS �, �'� �'1'O CONSTRUCT 7HE PR0.IECT(.�EC.7044,8115MES5 ANO'FROFESSIONS COOE:THE CANTRACTORS LI- V81U3[fOP1 ADJ.AREA ''�� LtlJ� CEM9ELAWDOE9NOTAPPLY70ANO�MJEROFAPROPER7VWHOBUIL�SOryIMPROVE9THEREON,AND I '��^� "WHOCONTRACTSFORSUCHPRQIECTSWITF!ACAN7RACTOR�SJLICENSEDPURSUANiTOTHECONTRAG � Q�J,�JT'ITY DESCFIPTION � FEE� � Y �roRsucervseuw.D. '� , . . _ ..� . '; ', .�r A . . , J�. � ❑1 AM EXFMPT 11N�ER SEu. � B.&P.C.FOfl iH15 FEASON � Q / / � —V�- �$ '�: ' � p� i LL' DATE . ��. OVJNER U � � �'. ' ... � ,o,,,.'�r�,', Ltl �� LICENSEDCONTRACTORSDECLARATION W�� � . r'�,. � �i INEREBVAFFIRMUNOERPE TYLfF.PERJURYTHATIAM4ICENSEDUNUERPROVISIOtJSOFCHAPTEq� � i ��, .�y,': '. e(COMMENCINO WITH SECTION 000)OF UIVISION 30FTHE BIJSINESSANO PROFESSION3 CADE,APID Z " " �� 7�� MY LICENSE IS IN FUL.I FOH m�EFFECT. , � ' � .A � d. LICENSE 1A55 IIC.NO. '�� . . J . ' . �.. M���' �A7F � °"`�� CONTRACTOR d � . . i V W' I �'�i � NIORI4EF?5'GOMPENSATION�ECL,4RATION U . ' '�i �'i � IHEREBVAFF6iMUNDEkPEN OF,PERIURYONBOFTHEFOLIAWING�ECLAPATIONS: Z �- ' � I ��� ,IHAYEANDWILLMAINT IPoAGERTIFIGATEOFGONSEN7705ELF-INSUREFOqWORKERS' _ ' ��' COMPEN&ATION,ASPRQVIDED9YSECTION37aoOFTHELA9'ORCODE,FORTHEPERFORMqNCE U� OFTHcWOHK FOR WHIGH"HIS PFRM�TIS ISSUED. I ' � � I ',�1 HAVE AtlD WILLMAIfdTAIN WORKEflS'COMPENSATIOk IN£URANCE,AS REQUIREO 9Y SECTION I Q 3700 OF THF LABOFi COI�E,FpR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS � c CONSTRUCTION , ISSUED.MY WOR MPENSATIDN INSUPA RRIER D POLI 7 NUMB:fl ARE: il J aN _' y c.4aa�r7t < +.•`.. 1 . �� r LAN REVIEW .. . . . . � POLICYNUMBER LECTR ";:� 6.,/ �� I �� � �� � � ._.4:r�s . �� � (IIi53COTTJNNE�NOT�EO�A"FLETEOOF7HEPERNdf16FORONEHUNDREDDOl.LAi1S(S1ao)�RLESS�. !NG � � I Z 1 CERTIFY TMAT IN7HE PIE�RFORMANGE OF THE WOflK FOR WHICH THIS PERMIT IS ISSUE�,I 'MECHANICAL ', '�,$ SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESUBJECTT�THE +c' ���> � : p�, ' � WOHKEPS'COMPENSA7��ONLAWSOFCALiFOpNIA,ANOAGREETHATIFISHOULDBECOME II�SPECTIONFEE '�s�r � j�i;;,q"� � SIPBJECTTO THE WOFIqER3'COMPENSATION PROVISlONS OF SECTION 97 7HE LABOP ,. $ �`��. � ""�- ~ COj�E,ISHALI.FORTHW��IITHCOMPLYWITHT pOVISIONS. SUAN .��� .� �- n �-�,p� A �y�'gqy�� �,,o t , r a � - p' DATE: .~L.�{j�APPLICANT:��d�LRs"Y ��.�—.,� . SMIP `°` �-f��,��-...e,'t...i� �' p �t�'.�'��+ ,. . �� � � ENERGY P/C ::� '� �'-���"���� WPRNING FAILUFE TO SECUpE WORKERS'COMPENSATION COVERAGE IS�NLAWFUL,AN�SHALL BE �gj_ SV&IEGYANEMPLOYERTOCFI INqL'�PENAL?IESANOCIYILFINESUPYOONEHUNDREDTHOUSAND ENERGYPERMIT � � �,,. DOLI.ARS(51Co,0oo),iNADDITiO TOTHECOSPOFCOMPENSATION,DAMAGESASPpOV10EDFORIN � SECTION37080FTHELABOfiG DE.tNTEREST,AN�ATTOqNE`.�'SFEES. RETENTIONFEE: p.,, �CQNSTRUCTION LENDING AGENCY PRE-ALT FEE: , �� !HEREBYAFFIRM UNOER PENA IIY,OF PERIURY THAT THERE IS ACONSTRUC710N LENOING AGENCy � - FORTHE PER WRMANCE OFTH�WOPK FOR WHICH THIS PERMIT IS ISSVED�SEC.309�,CIV.C.). . . � ".� LENDER'S NAME ,' F-' Le`NDER'SADDRE55 �i , �� ICERTIFYTHATIHAVEREADTh�ISAPPUCATIDNANO5TA7E7HATTHEABOVEINFORMATIONISCARRECT. TOTAL FEES . ����,,jj � IAGAEETOCAMPItlWIiHALLQINANDCOUNNORDINANCESAN�STATELAWSRELATINGTOBl11LDING , - ' � ���" CONSTRUCTION,ANOHEAEBVAUTFlORIZEREPRESENTATIYESOFTHISCOUNTYTOEh'TERUPONTHE . � ' � � ' _ � PBOVE-MENT NE�PRDPERTY FOR INSPECTION PURFOSES. COMMENTS �- _ `�/�J ^"/w�.—S.� I /�..L� . . . � - . � PER EN � �l �� �� IGNANR F PERMITfEE I DATE '�" ' - _�� . RECPT.NO. PAIDBY VRLIDATION�` �'�"' � WHITE—DepartmentCooy,YELLOW—FinanceCopy,PINK—AssessorCopy,GOLDENROD—FiieCopy,GflEEN—ApplicanYs�Copy _ _ , :; ,_ ; •>, ,,.�-,,, <:,. . _ _ _ _._ __. _.__ _ _ �T� � ��� � ���� ��� � �� � ���n� .�� : � � � �„� u �� � � � � � � �;:. 3 � ��'�r�bt 3 4 ! L"'�r�.��.;��fi ' ; ti,. � ....... _,.._�. m_�_ _._..__ ����. � -_i______.�...�; �_ � �,""c r�.,r° 'i�fi,��-r+„ � � �-.� � , , ��¢..{ Cr^� � � ... � � � 3-��. .��� ��„�'i� .� . , t� �- a�1T,� � ____.� � — _ �__ _ ______ ...� ��' �������.� .��lr,�f��'� �j _, _.�.�_. �`�����" ���C�����,� T' ��� �'; � � � � � � � , �"� < �..�C�'`J,"t; �3 �����;���� E�`�_� L�,.-�.������,�',�!,Y° k� � � ' �� �� ��� �'�t.� � i � �.;� � �4� ` .,� � � ,� s;�. f � ^�,.. �—� �� �� F�����.�at��� �".T��r���?,� � � .��._ ` � � � ����.�'�-`��'��� � _ � _ � . ;�'� x;a,�*� ���d���.���€ „ �. —� e ��IF:�('��������"'� � � --- ��St��� ��' ���a���-P�"r�E�' �—� �'�' � �_�__._ C"?.'�.�.�R,.�B"_Cn��rif4§i 3€2�4-.�~ � �.`��,....,_:'.._._ _.... _"' '. . � j :•.1!"m t. §..?SwF('V���8`v8'J�'.,.�s..,�...__.._�.,.�..... a . �-4 .. �.', �.w-^r ,",...,..�.0 g; ..,..Y� �...........g..y.p... �_...,__ ,,.� y .. .. .«�.�.._.---F.a..�' ' .„„. .��'. � � ��E"�4��A�"�L�.�s`rf�'�"���Si"'4��sdf`� ., . . . 3�_ �@��t'3L°'v�`�t.fb°i� G'����Vi ., � ...�.�., .,....„�.. . y I �l,.��r efi.t�DN� t�R" ,.....,.. .e,.....»� f.,_,...�.�_:...._ � 3 d'-0�"i€._"3.�s��'S.£.J��a=: __4___ ..�._.. —, � - .�..._......._ I S»-,_........,_....�. � y,rw...... .�..�................................ � �,.«.�k.............,.�_�.��.`___i.__»L--'•rp,,;^�- .w....«. �,.... .Y�. .�. . �� � � �d4w'S .. � , § �x� ��t4d4'�'3°LL.S ......� � .,.,.....,.�W � �k� v�5�%x"e �": 3F� f ; ,�i��`�t-s �%..��t -�irG✓ _�'.`'C`��..�_. ,___�..._�.. &�L,�'�`3�'i��ra�E�s9: . ... ' k � �� �. r �"� t � ��f��3°�"° ��. �r���a�4��.. .�.,� � �.w_ ��E:..F-� �'�e�!'��Ri:.� m=. � � �" ��� � 8. a�.,�"6t�.r��r£�.�����t.�"'� ���: '`+J :~� : � �.{�.+"'i s.�.t':=� �4-i�s., � . . . � , . � ___..___—__. ..,._.._.� `' __._.�_. � �� �.��'`i-'�`�.�� �� �7 �j� �� �{��3= `=��� 'i�`: l ' � , 3 ..,.� �-�— 3 � �J'�,^"aL w.:S`iv�� :�E;..e�"°�'...,._.A 3 � �;j"��r 1ry��A,� � �m---"-------"^� -�. _.__._ ......_.,..........� �."� ___-��v������������� ; � ---€, ; � : � ��°�����`�6�:'�� �...__�,_ ; � �;.; �. �,�€.n �a,� ��. __ �__ ' � �.�.—.,� __I�._.�_ �.�'�°�',L,� �,�, ;�� ��L'�.��i�3 �� � ; ,,� _ �____ .�._ _,_..._ _ .__. �.___,.._.,�� � F E:V'� F ��������,' �,ws�a� � €��.._ ,.._.�.�_�..._._g._..._.___.._._ E . � _.__.____�_._�____ ..._.�., . _...a � ���� :� �a�O�:�'a', i' ? � �r'`� ���x..���a��'�C���;'s a, q ,�' � ;�,.�__...�����._�___ r � a _ .__._ ���-""���,� .F*,'. ' � �. � . � i -. �� and� +,.����-�a��,. _ .__�..._...._,.,w.m_.. 3 . �'� ..._j_,..�.._. �. _____�.�� �� ��r���"���' �re ,_�__._.�..�.. �__..._��.�.� �.�..�.�._. � }'t�G � ja,"a*i� � I _._.. ,��,�.,� ......,..�._..�.. -„�.,�,=..,, F i.......^^""".' ... ""-- �. '�.._._.N �._ _ ...�...��.._, .,......«..,..,. � g�,��€ p� g+��'.C'ff -- ... . . . € ' �� � . "' �,��8�7 P.a : `�_.._v .�_...a S ES"[�."i V �`a...°+b,�" � ' � ...�, 6 ,L ..�.._....� � - y E _.?.�._.._...�.._.�....-...._......r._......�_.. "IT���°��L. �..`�`���i�� i � ..w....__�_ ��.,�`�..�§��'.',�'° ����.. . j�'ld,:; _._�__ � a t��..::.mm.�. ` ....��_.�i-y /�_f�_- � , �.,� -���_.____ .�.�.__W._ ...._..�.Y..�._!�._�._.�. � �"�}Sa, � .���a"3'Sst,o� b I.F�`�"4'. � _.___.,:�....�..._..... � i �-�'�'� ` } _:�.5 �,.�:.2"� � ...�..._.......� � ?: ...�_..�_ � �, ..s......�,.....�...,,.. ......�..,.,......,_ . � �"'��*��.,"����€��$J;� , � �° ���~��C�� �� � .�._(..�_,.____._�_..� Q � _ �_.____ .__�.� � • _., �,_._.._._..���._�..-.—__��._ _ � I _.. � �----- —_ ------€ i � F ( rv= � �_---- ' I �� ," .4,.... '. .�,.�..__.._.�.W. _�.� � �..__. .._._� _ ,_._ ��.�. � :�__�._._.�.,._�.......� � , �� �� ��• , �_�.�.....�.._.._ ' �_�_.�._____�m__�..,�.� , . _ ,_, � , e ..*�q.m�,,. �g m-.,r,�. � �.._� �.� ��?'�J��&���G'�'�. ��d _�. �""... .�_.._.._.,_.� ._..p_._...:,_.,.�.. �.,............:.�,...m.�...-..,.,..._..m...:.�..-.��m ' �� g t...._....«.»_.....____W__..._..___.'_.._'________ .,....Y.,.� �. .'_....___m__..,.. ..�..._.....__. . . """'"'.-..�7 ���...,.�...._.M. � ._..,,.n �......,.�._.__�_.. ___"__v.�. �, �, ._.� ._..�_ . _.....-.� � �, . .-_..i z �'_______,._:,� ..�. ,......�-.,_._�._._._._.,._................................�._.._.�...,�......:.....�..,.�.�.� , ..: .._.............._......�...,........�.._..............__.__.>........�_.._....�:__............:_.__.... �.�....,..._.-4 �, . '� . � . . . ... , , . _, - _. .:� ...._ . € a ,..�.....�.;:�..�.�:,.a.�.....,�,......�...�......�.... � � f 'd ...a - ._.._. ____��._._. _ - �, _._,._._..w.,..__.�_ _--.-'-..�..-. „ .„.� ._. _.._._...._.......�...._..__.._��,........._.___„_..-- . . . . '-""'_" . ' . - . ".— , . � 1 �-', , , ,_ .._.., - �,.,......�......_.� __ _: . ,. _ .�.,.,....�... ,._.,____V,_._... .�....... � . � .....,. __ w�. ., _. � , ` ' .,.. �,�- ... . . ��.�.....�..,.,..._,.�.,�-.,...�...�. .v.� � .�....._..,_..� . .� ' . .- _ — � � ���&e4m? id'�'i:'v�.�;a'.k€�2: _ �... .........m,�...�_...._,� . . , t r.�.,, ,.., ___...`...___.__................._.,,.__....__—�� ' �°;.a���" �3$�g�� ''.sa;�.� ,.,.,..__�_.�._.., .,.._. ... _..__._�_.. � � � �,�'�� ..� .�............._._._.�.��.�w,m.�.�..,� .�..___,._....� �...�..._._..__ � . � � : :. .. � � w r� � _.__.�,� �..__--___.___.._,._,._._._.. �._�. ,, � _... �.._....___�. � �, �,: : __�..__.�.__.�� ��.... �_��__ _._,__.__�._._._.�..,_..m..�._._._..,_. ,,_,�_._.._4__,_,_._. �� ��� � ; � : .��.P� .:n ��r . . " .,�, :. -�__..,..._.__W...m__�___.�..»..w.A..................._.�..__._,_..�.- - ..v._._�__� ..�_____._ ._.._._._._....�,..-�.��,_ . ...�'� � . . . �i � •.. . ..- . . .M...._._m.'-'_._.,��... �...__....__._...........,,......_...,_._�__-.�-,.—_ ..._._.....,....„� � . . �. . . .. . , ^'" . , _..j; � a fr`9 J�( .........,�..,.... _�.� _ ._ __..____._ . . __._—.................._.� '.. ' , ` . .. ' . . � ., . .: . __... [ ' .. .. a �� a ; '.� . . . ' . , . . � .. . . ' . . " �'. > . . . _.:.._,_.._.w..,,..v....,,,_...._._._.,.—. _. � .....-:� . ...,�.a..���a. '� ' .._.�.�.»�»a.�..��� ...._��.....�..,.........m..�o:m«...Q...��..�.,,,«.....A.....m........�,. .....�..��,�........e..�,.o..�„m,�._._...7. .w...