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HomeMy WebLinkAbout11701 R CITY OF DIAMOI�TD BAR f~ � --- - -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICE � '- / ,� ,,� 21660 E.Copley Drive Suite]90 � /, � (909)860-3195 Fazc(909)861-3117 �y.i PRESS � "'A�'''`' BUILDING PERMIT APPLICATION __ FIRMLY � JOBSITE ,: (! � .�i a ADDRESS ���.. '�- APPLICATION � �� CI � PERMIT 7 P/C gr �( � c� ` .� DATE � NUMBER //d I # �+ l °' � � ISSUE TYPE OCC APN LOT TRACT C) DATE / CONST. GROUP � p OWNER C'JA'!iI /1.PCJt/��w;S �//I� �r � LL ADDRESS�"7S�f�,���c�h,j��J '�� r_ ZONING SETBACKS � $ Cl7Y�c�J�t�.T R�,ZIP�� TE ���.�2;j�`i'?r FRONT RW fl_ APPLICANT TEL. REAR U ? � SIDE/SIDE STFEET RW fl �� � CONTRACTOR SIDE p _ ADDRESS � O • �f PROPOSED USE � �G'�t°�/.A�G- C�C.�/�� j & CITY ZIP� TEL. T (� w ARCH/ENG/ tg z DESIGNER /J!.)G- `� a ADDRESS NO.DWEL. NO. NO. s: � CI7Y ZIP�TE UNITS STORIES _ BEDROOMS ^ �, 1�'as��-�--� ;� � DESCRIPTfON SQ.FT. FACTOR PSF ADJ.AREA/VALUATION :� � OWNER-BUIL�ER DECLARATION SFR/ADD/REM ,� O ,� 0 1 HEREBV�FFIRM UNDER PENPLT'OF PEP.IIJRY THAT I AM EXENPT FROM TNE CONTRACTOflS LI- G2f8J0/C8f(]Dff .� 'W CENSELAWiORTNEFOLLOWIN�REASON(SEC.7031.SBUSINESSANDPROFESSbNSCA�E:ANYCItYOq (J� a C.1 COUHfYWHICHREWIflESAPEAMITTO�NSTRUGT,ALTER,IMPROVE.DEMOLISH,ORHFPAIRANYSTHUC- � I,J,J pa110109CK ' Z YURE,PRIOR TO ITS ISSUANCE,ALSO REOUIFES THE APPLICANT FOR SUCH PF.fiMIT TO FILE A SI6NED �s �w' S7AiEMENT THAT NE OR SHE:S LICFNSEO PURSUAN7 70 THE PROVISlONS OF TNE CANTRACTORS ll� W �i � CENSE LAW(CHAPTER e�GOMMENCINO WI7N SEC7'ION�000)OF�IYISION 30F THC BUSINESS AND Pfl0- �A' POOVSp2 # �� FESSIONSCODE�ORTHA7HEORSHEISEXEMPTTFIEREFROMIWDTNEBASISFORTHEALLEGEDExEMP- � (� j! V TION.ANYYKK.A710NOFSECTlON7Q71S8YANYAPPLICANTFORAPERMITSU&,'ECTSTHEAPPLICAH7T0 Z Re-Raof � ,�„� ACMLPENALTY OF NOTMOf1E iHAN FlVE HUN�RED DOLLARS(5500).�: c� CII,ASONMEROFTHEPROVEATY,ORMYEMPLOYEESWITHWAGESASTHEIRSUIECAMP[NSATIOY, ' 0 CORIR1BfCI0I � � VALL DO 7HE WOIi1C.AND THE&TRUCTURE IS NOT INTENDED OR OFFEREO FOR SALe(SEC.7041.BU51- . J �y NESu ANO VROFESSIONS CODE:TME CONTRACTOp3 LICENS[UW DOES NOT APPLV TO AN OWNER OF � � PROPERTY K'Fi0 0t11lBS OR 14fPROVES THEREON,AND WF40 DOES SUCH WORK HIMSEIF OR HERSELF OR ji7 '.�� iHflOUGHH150(tHEf10WNEMPLOVEES.PROVI�E�THATSUCHIMPROVEMENTSARENOTINTENDEDOR , m !i O,, .OFFEREOWRSPLEIF,HOWEYER711EBUIlDINOORIMPROVEMENTISSOLDWITHINONEYEAPOFCOMFLE- � Z �7}ON,h1E OWNER�BWLOER WILL HAVE 7HE BUR�EN OP vROYN�TMAi ME Ofl 3FiE DID NOT BUfLD OA IMPROVE f-0R THE PUflPOSE OF SPlE). ,w:: . ❑I,ASQWNEROFTHEPROpERTV,AMEXCLUSNEIYCONTRACTIN6Y/ITHI.ICENSEDCONTRACTORS I[ ,� �� TO CONSTRUC7 THE PRQIECT(SEC.]0�6,BUSINE55 AND PROFE3910NS CODE:THE CONTRAC70R8 LI- V9I110�10t7 ,_ V ADJ.AREA � W. CENSELAWDOESNOTAPPLYTOANOWNEqOFAGpOPERTYWH06UilA50FlIMPROYESTHEflEON,NND - - -- — _^ VI/1000NTMGTSFORSUCHPROJECTSWITHACONiRAC70R!S�LICEN5EDPURSIIANiTO7kECd,JTFAC• � �'"'� ioqsuc�SEuw.). — QUANTITY ESCRIPTION FEE �� ❑1 AM EXEMPF 11NDEH SEC.�_ B.d P.0 FOR iNIS REASON� -! d �, '• Ca � ry, _ , � �I1TE OWNEH_, F' � ..__' ' ..� W � �' � LICENSED CONTRACTORS UEGLARAT(ON " -� � � W _ ; IHEREBYAFFIRMUNDEAPENALTYOFPEflJURY7NATIAMLICENSEDU�DEHPFWVISION50FCHAPTER _- � '9n (,L^ 9(C6MMENCINQWITHSECTION7000)OfDIVI510N30FTHE�USINESSANOPROFE5510NSCA0E,AND , Z .,x'� MY LICENSE IS IN FULL FOHCE AND EFFECT. ' � a �a+ y � �,. LICENSE C--F-`�--�----'_----'�IIC.NO. C S,J ;s� J O. '� '> _�r.Z-�p � � � ;� U D A h �, CONT q A C T O R���%7�i Y A�r4�J�� {� a �� W q ' �' WORKERS'COMPENSATION DECLARATION _ ¢ � � I HEREBY qFFIRM UNOER PENPLTV OF VERJURY ONEOFTHE FOLLOWM�DECLARATIONS: ' Z � 0 __fNAYEAN�WIILMRINTAINACERTIFICATEOFCONSENTTOSEIF�IN.SUREFORWOqKERS' ¢ ���" 60MPENSATION,ASPROVIOEDBYSECTION37ooOFTHELA90RCODE,FORTHEPENFORMANCE 'U � � OF TNE WORK FOR WHICH TMIS PF.RMIY IS ISSUE�. � I �I HAVE AND WILL MAINTAIN WOHKERS'C0IAPENSpTION INSURANCE,AS REOUIflEO BY SECTION Q. 3700 OF THE LABOR C06E,FOA TFIE PERFORMANCE OF 7HE N'OFiN FOH WHICH THIS PEqM1T 15 �j � ISSUED.MYWORKERS'COMVENSATIONINSURANCEC�pBWFFFMlDPOLIC UMBER�pE: CONSTRIICTION �y�_ <�� � _ _. t�7 �'0 _ u J. � ���-./.��..�-- ��%'�J]�/✓� . T , L' i � CAflFIER��-f--=-S'�-'-t .-�� t✓�IJ' PLANREVI£W �.... '�._.. � ZvaicvNUMeea_ �7y ELECTRIC __.______ ____ Q y�/���r� . ._.._._.__ — ..—_ 0 (IHISSECi%7NNE�NOTBE00l�FLEhUOFhiEPEMS(ISFORONEFR.ti`AREDDqLWS(SI00)ORLESS� PLUMBING ---�.._ _------,--------.,--.---,- �Z� I CERTIFY THPT IN THE PERFOflMANCE OFTNE WORK FOR WHICH TNIS PERMIT IS ISSUED,I MECHANICAL ______,_ i ":'(3' SHALL NOT EMPLOY M!Y CERSON IN ANY MAYNER SOAS TO BF.CAME SUBJECT YO TME ��-- —'—�-�-- WORKERS'COMPENSATION lAW3 OF CALIFOPNIA,ANO AGFlEE THAT IF i SHOULD BECOMi: INSPECTION FEE � r SU&IECTTOTMEWOHKERS'COMPENSATIONPROVISIONSOFSECTION37ooOFTHELAAOR — — � - -- r' — Q CODE.ISHALLFORTMWITHCOMPLVWITHTHQSEPFOVISIONS. ISSUANCE � S �OO 'p DATE: APPLICANT: SMIP I � 3/� ; J WAqNING:FAILURE TO SC-CURE WORKLRS'COMPENSPTION COVERAGE IS UNLAWfUL,AND SHALL BE ENERGY P/C .._____ _ ___ _ ,. i � SU9JEClAMEINPLOVEHTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAhD - � ENERGYPERMIT DOLLARS(f700.aoo),IN PDDITION TO THE COST Of COMPENSATION,DAWAGES AS PROVIOFD FOq IN ------- .___.____ _.—_..,. � � SECTION37aeOFTHELABORCO�E,l4TERE5�,ANDATTORNEY'SFEES. RETENTIONFEE: � �.______,__ __ !� � � � � d CONSTRUCTION LENDING AGENCV PHE-ALT FEE: e� � 1 HFflEBYAFFIFiM UNDEF PEN�L7Y OF PC-RJURY THAT THERE IS ACONSTHUCTION LEN�ING AG[NCY __ _ _�___ � iORTHEPERFORMANCEOFTHE'NORKFORWMIGIITMISPERMITISISSUED(SEC.209�,CIV.C.�. IW _'_...' _'"__ '_" { � LENDER'SNAME__ _ _'__"_ ___ ( _'_ _—_' "'— —,— _ .� F— LENDEltSAD�FlESS„ ,_ _. _ ._ _,_____ � � I CEflTIFYTHAT I HAYE READ THISAPPLICATIONAND STATETNAT tHF ABOVE INFORMAlION I5 CORRECT. TQTAL FEES '��' I� W IAGREETOCOMPLYWITHPLLCIIYlWDCOUNtYORDINPNCESANUSTATELAWSPELATINGT�AUILDING � � OONSTFUC710N,ANOHFAEBYAUTNGHIZEREPRESEN7ATIVESOFTHISGOUNTYTOEN7ERUPONiH[ � Z ABOVE�MENTIONEDPROPERTYFORINSPECTIONPUflPO5E5. _ — --_ _-- — Q r, L` ���� COMMENTS_ r � � � ¢ PERMITTEENAME ) � y SKiNATUHE PEflMI�i���"��- �AT�/ �� _'— � RECPT.NO. �PAID BY ��_VALIDATION_� � WHITE-Depertment Copy,YELLOW-Finance Copy,PINK-Assessor Capy,GOLDENRpD--File Copy,aREEN-Applica�t's Copy . _.__ _._�. �_. _ r �� ! +A'��{31.�. � � � ' �� � 4 - � � `� ��Y I 'i � � � `{ `I-;�r � ' ' � . � 1 .�i y ��y� - ' '� I � �r� 1 ��� I � I � .�iy V � : �,� � �� � �t §� E � - F 1 1 I � � +� ' t � � .�+� � � � . � Y� �'�4 ' ', � � �'f �� s � 17 ry� ( t � � � i� A i -I i. _ I I ' ' ~,� �; 1 L_ *tE p MYe . I ! i � i i . � '�'� i i � �: I ._'ir _ .,i ,." I �� �� j � :� � ( � I !. ! � �_._.� .. i '__;_ i I � � ' `�.` � o- _ i , , t .�.: �,i . � S :'.5 F i : � ;: 1 4W . . I " \n, `^1, '�" _ . I . 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