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HomeMy WebLinkAbout15572 �,. ._..---_..�,....._._---- ,�„ _-�____•.. - - - - ---------- - - - .......��_..:�.,.�. . __ _ �,_r__.,.,_.r - , - - . C '� -----�`^-----� CITY OF DIAMO�ID BAR � �. � I 1 � COMMUNITY DEVELOPMEN'I'DEPARTMENT Ilf :,�-.,.w 216fi0E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION FIRMLY � JOBSITE `,��j_ �-•���y,��.� �E��a� APPLICATION _„ ,� — PERMIT ��� �/C ¢ ADDRESS �t! DATE �_(_d `�ZS NUMBER o ISSUE TYPE OCC r° APN—� LOT TRACT DATE__ �� "' ' _CONST._�T GROUP p OWNER G k�j�6.iv ��� " ADDRE S � � v ,. '-�- ZONING SETBACKS 0 z CITY :.0 `^- ZIP TEL.� � � - i�f FRONT RW ❑ o APPLICANT � �� 1A'►.ZN TEL.b 3y��, REAR _ C--- z SIpElSIDE STREET RW C ¢ CONTRACTOR u' �"�— SIDE _ C � ADDRESS "'! � �—�– pROPOSED USE r�i,at 6*. . � - E'ri J'� o CITY ZIP� TEL.�=� �_, U ✓ ��y� , o ARCH/ENG/ � � �� ��, � n -'�� L z DESIGNER NO.DWEL. j4~� NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. — cn cq DESCRIPTION SQ.FT FACTOR PSF ADJ.AREANALUATION p� OWNER-BCILDER DECLARATION SFR/A�D/flEM � -� O p I H'cREBY AFFIRA!UNOER o'cNALTY O:P'eRJURY THAT I AM E%ENPT FPOM THE CONTRACTORS L!- G8f8 JE/CdfpOlt W C'cNSEL4WFORTHEFOLLOWINGREASON(SEC.7031.53USMESSANDPROFESSIONSCODE:ANYq�VOR (f� z COUNTYWH:CHREQUIRESAPERNIT7000NSTRVCT,ALTEF,1`APROVE,DEMOLISH,ORREPAIpANYSTRUC- W PBLO/DBCk w TURE,PRIOR TO ITS ISS::ANCE,ALSO REQUIriES?Hc Aa7LICANT FOR SUCH PERNIi TO FILE A SIG\E�J W � STA'EM1!'cNT THA`HE OR SF:E IS LICENSE�P:IRSUAkT TD THE PROVISICNS OF'Hc CO\TaACTORS LI� � � CENSE lAW(CHAPTER 9(COMNEKCING Wlhl SECTION 7coo�OF�IVI50S�OF TilE�USINESS AND PRO- PO01/Spe � FESSiONSC�DE)ORTHATHEORSHEISEXEMPTTHEREFFO!AANDTNEBAS:SARTHEALLEGEDE%EMP� (� � TIO\'.ANYVIOLATIONOFSECTION7031.5BYAtiVAPPLICANTFORAPERMITSU&ISCTSTHEAPPLICANTTO z Re-Roof I� � ACIVILPENALTYOFNOTMORETHANFIVEI-UNDREDDOLLARSIe5C0).): 0 r'I,ASOWNEROFTHEPflOPERTY,OR!AYEA!PIOVEESWITHWAGESASTHEIR9OLECON.PENSATICN, � CORlffl@fC18I Z W;LL DO THE WORK,AND THE STRUCTURE IS YOT INTENJED Ofl OFFEP.ED FOR SALc!SEL.7044,BU51� J � NESS A�D PROFESS!ONS CO�E:THE CO.tiTRACTORS LICE4SE LAW JOES NO7 APPLY'O AN OWNER OF � PROPERTV WHO BU I_DS OR IMPROV'eS T:^EREON,AND WHO DOES SUCH WORK F:IN.SELF OR HERS`eLF OR � TFIROl1GXHI50RHEROWNEFA?LOYEES.PROVIDEDTHATSUCHIMPaOVcMENTSAPENOTINTEN�EDOR m OOFFEREDFORSAL'e.IF,HOWEVEP.THEB::�LDINGORIMPROV'eMEN'icSOLDWI'HINON'eVEAROFCOMPLE� ,z TION,THE OW\ER-B:1ILDER WILL HAVE THE BUADEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � UAPROVE FOR TH'c PURPOSE OF SALE). f.'I,A50'NNEfl OF TH=PROP'cF1V.AM cXC:U51V'eLY CONTRACTING WfTH LICENSED CONTRACTORS Q TO CANSTRUCTT��iE PROJECi(SEC.7CC4,BUSIhE55 AND PROFESSA�S CO�E:rH'c CONTRACTORS LI� C� Valuation ' •� ADJ.AREA W CENSELAWDOEStiOTAPPLYTOANOWNEROFAPROP'eft7YWHOBUILDSORIMPPOVESTHERE04,AN� — � WHOCONTRACTSFORSUCHPROJEC7SWITHACONTRAC?OR�S)LICctiSEDPt;RSUANTTOTHECONTRAC- QUANTITY DESCRIPTICN FEE Y TORS LICENSE LAW.�_ � J O ❑I AM EXEMPT UN�ER S'cC. B.B P.C.fOR THIS REASOM Q � U � —'--- OC DATE_ ONlVER ___ U � W � LICENSED CONTRACTORS DECLARATION w ¢ � I HEREBV AFFIRM UYDER PE\ALTY OF PERJURY THAT i AM UCENSED I:N�ER PflOVIS�ONS OF CHA?iFR � � 9(COMM£`lCING W:TH SEC'10\7ao0jOF DIVISION 30F'HE BUSINE55 ANO PRO=ESSIONS CODE.A`iD Z X R1V LICENSE IS IN FU:L FORCE AND EFFECT. v.,,�.���.�-�� e�� m � LICENSE C.ASS�~ ���__ LIG.NO.__ �"�"' •�~ � � U DATE_�?I � GONTRACTOR ^ �� a W � WORKERS'COMPENSATION DECLARATION � -� � I HER'cBV AFFIRA�UYDER PENALTY OF PER.:URY ON'e OF THE FOLLOWING�ECLARATI04S: [�'y(p/ � .+G.,�.';y,Qy,Ka4' � _INAVEANDW!L'_MAINTAINACEaT:FICATEOFCONSE'2TTOSELF-�NSUREFORWORKE�6' • _ a COM?E.1'SAi IOY,AS PROV!DEJ BY SECT:ON 3700 OF 7HE�ABOR CODE,r'OR THE PERFORMANCE U n Q OFiHEWORKFORWHICHTHISPERMITI51S5UE0. � ' p �� �,;�.. .� ��'.:pY's/ � /tHAV`cANDW:LLMAIN�AI\WORKEFS'COMPENSA'IONINSURANCE,ASREOJIr7EDBYSECT'�OV ' O 37ouOFTHELABORCAD'c.FORTHEPERFORldhNCEOFTHEWORKFORWrACHTHISPER!AITIS +�"'''�' %�`;,?Yy;(';ziJ;"���i�'z`���; ''�' /� N'� '`� iSSUc'D.MYWO��N�ERS'CO!APENSA►?/IO'NI.VSURANCECAaP.!ERANDPO_ICYNUMBE9ARE. CONSTRUCTION ��a'�' �' � 'y,� �`%"�tA� ;��'�I«:��L yg��� Lp� � _V.�^ �'_I�QM�� —"_ , '`l�J..�:.:�i�e �yi14��ir.,�.',�`..`:.. Y�aF=-. CARRIER � �, PLAN REVIEW � POLICYNUMBER ,���'�V���(� �� �J l 3+ ELECTRIC Z Q 0 (iHISSEC7Y)M1NE�NOiBEC]A�'.RET'rAOF FEPERMITISFORONEHUMREJDOLlPd5�E100)ORL 1 PLUMBING Z :CERTIFV THAT IM1THE�ERFOR4AM1LE OF TNE WORK FOR WHICF7 THIS PERMIT 15155'JE�,I , � MECHANICAL (J SHA'�LNOTEM?LOYANYPERSON:NANYMAN�ERSOASTOBECO4ESUBJECTTOTHE � WORKER5 COMPENSAT!ON LAWS OF CALIPORNIA,ANC AGREE THA71G I SHOULD 9ECOME � �NSPECTION FEE � SUBJECTTOTH'eWORKEfiS'COIAPEKSATIONPROVI'IONSOrSECTI0Y37oeOFTHEIABOR �_.. p�''� � COD'e,ISHpLLFORTHWITHCOMPLVWITHTHOSE VISIO . ISSl1ANCE ___ �� (,J� p DATE: ~�� APPLICANT: ` �� _ SMIP ___ � �� J WARV:NG:FAILURE TO S'cCURE NlORKciS'COMPENSATION COVERAGE IS 11NLAWFUL.AN�SNALL 9E ENERGY P!C _ � SU&IECTANEMPLOVERTOCRIMIUAIPENALTiGSAVDCIVILFINESUPTOONEHUNOREDTHOUSANO ENERGYPERMIT DOLLARS(E1o0,0�a),IN AD7ITION TO TNE COST OF COMPENSATION.DAM.AGES AS PROVIDED FOR 1Y - � SEC':ION 3�GB OFTHE LABOR CODe,INTERcST,ANDATTORNEY'S�ees. FETENTION FEE: ___ � CONSTRUCTION LENDING AGENCY � PRE-ALT FEE: k ✓'^ i✓ � I HEREBYAFFIP.M�NDER PENALTY OF PERJURV TF.ATTHERE ISACONSTRJC'IOti LEN�ING AGENGY I FOR�HE PcRFORMANCE OF THE WORK FOP.VlHICH THIS 7ERMI?IS ISSUED ISEC.3097,CIV.C.). Z W � LENDERSNAkE___ __—_--_---- H- LENDER'SnDOP.ESS � TOTAL FEES �- �-' � ICEFTIFYTHA7IHAVEREAOiHISAPP.ICATIOtiANDSTATETHATTHEA60VEINFORMATIOiVISCORRECT. W I AGREE TO COMPLY WITH ALL C'�TY AN7 COUNTY OR�!VANCES AND STATE LAVJS R'AT'NG TO SUIL^4G d � CANS'RJCTION.ANDHEREBVAUT-ORIZEREPRES'cN�AT�VE50FTHISCOUN^/�f:TERiJ�O\'� ' A80VE�MEN710NED PROPERTV FOq INSPECTION PURPOSES. .�����- � /�/j,/�✓�"•F�°�'�a`•,� g COMMENTS----'------ — — J e�� r+I � [/c��eA,1 � / � _"_'_'_'__ '_ m PERMITT E NAME PRI'T� � � JL, G ` -�,�,-��S % ---------- -- -- � 5: .AT E O PERMI - DATE �•— = RECPT.NO. PR,ID BY _ VALIDATION_ ~ WHITE—Deparlmenl Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDEN OD=File C:opy,GR N ApplicanY,Copy ��'�����' ����=� �:�j�,'���'��:�s� ��,��;�' Y G.�G ty�•J,�v F+a a�yx:y m�j} .«3�� �s':, ` ?`F.t'�, YSA'`se 4. T ;FPt. _ .. ..�a:. . , �u� �mbiw.�'�- :5��'.�& a ...- �c.s4�'�@-�T�a�..y..,. ..r.,.w.e - ... - ................ a-.. �'. .:�.� �,� £ �� E'&�FgYb� i5�,§�� _ '�' -ro{-frr ...�,...prrrsr..�� "s 4 a ���R •gk ? 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