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HomeMy WebLinkAbout12641 CITY OF DIANlOND BAR � -- ��'-- " DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� 21660 E.Copley Dxive Suite 190 (909)860-3195 Faac(909)861-3117 PRESS �'�%�'� BUII.DING PERMIT APPLICATION FIRMLY o ADDRESS � 3 Z• S . W EI- YE ST X'� W` __ . ....... ..... ... ..... � JOBSITE APPLICATION PERMIT �� P/C � � DATE �I"'�Z�Q� NUMBER # � ISSUE TYPE OCC A?N LOT TRACT_ pATE CONST. GROUP p OWNER K F I'rN� Ft (� ��-'- d ADDRESS lA�Z 4f�rt n"G ST/b-/� b/� � ZONING SEBACKS � �� FRONT --- RW ❑ CITY �1�4-w+�. !�i/k.� ZIP��_ Z S TEL. Z APPLiCANT TEL. REAR ❑ z SIDE/SIDE STREET RW ❑ � CONTRACTOR .�=. i- c�/,� - ' SIDE � � ADDRESS � CITY ZIP TEL. PROPOSED USE � o ARCH/ENG/ � W DESIGNER — NO.DWEL. NO. NO. q, ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � ca DESCRIPTION SQ.Ff. FACTOR PSF ApJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADDIREM O I HEREBV AFRRRI UNOER PENALTY OF PElL'l1RV THAT I AA1 E%EMPT FAOM THE CONTH0.CTOqS LI. (`ja�dg0/CdfpOff W CENSEUWFOR7NEFOLLOWINGREASON�SEC.7031.5BUSINESSANDPROFESSiONSCOOE',ANYC17ypp (� U COUNTY1MiICMREOl11RE5APERMITTOCONSTRUCT,ALTER,IMPROVE.OEMOLISN,ORREPAIRANYSTRUC� W Pdt�0ID0CI( z TURE,PRIOR TO ITS ISSUANCE.ILLSO REIXlIRES tHE APPLICANT FpR SUCN PERNR TO FILE A SIGNE� w STATEMENi THAT HE Op SHE IS LICENSED PUiiSUANT TO THE PFOYISIONS OF THE CONTRACTORS LI� W Y CENSE LAW(CHFPTER 9(COMMENQNG WITH SECTION 7000)OF DIYISION 30FTHE BUSINESS AND PRO� � POOVSPB X FESSqNSCODE)ORTHATHEORSHEISEXEIAPTTHEREiROAIANDTHEBASISFORTHEALLEGEDEXEMP- � t� TKKJ.ANVVIOLATIONOFSECTION7a31.5BYANVAPPLICAYTFORAVERMITSU9JECi5THEAPPLICANTTO Z Re-Roof ��p�Q � A CIVIL PENALTY OF NOT MOflE hiAN FIVE HUN�REO DOLLARS�5500�.): � G1,1130WNEROFTHEPROPERTV,ORMVEMVLOVEESWITHWACESASTHEIRSOLECO:IOENSATION. � Commercial � Yi1LL DO THE WORIC,AND THE STRUCTURE�S NOT INTENOE�OR OFFERED fOR SA!E(SEC.704a,BU51- J � NEw AND PROFESSIONS CODE:THE CANTRAC70PS LICENSE UW DOES NO7 APPLV 70 AN OWNER OF ? PROPERTVVJFIOBUILOSORIMPROVESTNEREON,ANDNMODOESSUCHWORKHIMSELFORHERSELFOR � TNfiOUGHHI50RHEROWNEMPLOYEES,PFlOYIDEDTHATSUf.NIMPROVEMENTSARENOTINTENDEDOR m w OFFEREOFOHSAIEIF.FIDWEVERTMEBUILDINGORIMPROVEM'eNT1550:DWITHINONEYEAROFCOMME- Z TION,THE OWNER-BUIWER WILL HAVE THE 9UROEN OF PROVING THAT HE OR SHE OID NOT BUILD OR � IMPROVE FOflTNE PUqPOSE OF SAIE). ' W ❑I.ASOWNEHOFTHEPHOPEfliY,AME%CL'JSIVELYCANTRAC7INGWITHLICENSEDCONTRACTORS � TO CONSTRUCT THE PqOJECT(SEC.7Daa,BUSINESS AND PROFESSIONS CODE:THE�CONTRACTOqS LI- VelUfltlOtl I c ADJ.AFEA W CENSEUWDOESNOTAPPIYTOANOWNEROFqPROPERT'/WHOBUIIDSOPIMPflOVEST?iEREON,AND — �-- F NM1iOCONTFACTSFORSl1CNPROJECTSWITHACOMRACTOR(5)LICENSE�PURSl1ANTTOTHECONTHAC- QV(�NTITY DESCflIPTION FEE � TOR..LICENSE UW.�. _ � ❑I MI E%EAIPT UNDEH SEC. B.&P C.FOR THIS REASOti J � 4 �} U u' DATE �"'�L�QS OWNER_ .Sy/ _�� U Z �— � LICENSED CONTRACTORS DECLARATIQN w � � I HEREBY AFFIRM UN�ER PENALTYOF PERJURY TNAT I AM LICENSED UN�EP.PROVISIONS OF CNAPTER � � 9(COMMENCING WITH SECTION l000)OF DIVISION 30F THE BUSINESSAN�PFOFESS!ONS CO�E.AYD Z ��� MY LIC@NSE IS IN FULI FORCE AND EFFECT. � 0 LICENSE CLASS_ _ LIC NO._ j 1-- � V DATE CONTRACTOF .__ ____ d W � WORKERS'COMPENSATICN DECLARATIqN a � I HEREBV AFFIFMI UNDER PENAL'fV OF�ERIURY ONE OF THE FOLLOWING DECLARATIONS: z � _IHAVEANDWILLMAINTAINACERrIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ '— Q CAMPENSATION.AS PROVIDED BY SECTION 3'1000FTHE LA60ii COOE,FOR THE PERGORMANCE W Q OFTHEWORKFDRWHICNTNISPERMITISISSUEO. ,� W _I HAYE AN�WIIL MAINTAIN WOFlKEflS'GGMPE45Ai IOti INSURANGE,AS REQUIRED BY SECTION Q 37000FTHELABOFCOOE,FORTHEPERFOqMANCEOFTH6WORKFORWHICHTHISPERM1T15 _—_-- --_ �� `i� ISSVED.MY WORKERS'COMPENSATION INSURANCE CARR�ER M1D POLICY NUM6�R ARE: CONSTRUCTION l�f jcaaaiEa---- --- ----------- PLAN REVIEW ----------- - — ZPa.icvnuMaeR _ _—_.._______.._ ELECTRIC _,_ ¢ 0 (fHI55E(.Y%NlNE�NOTBEWMPLEfEDOFh�PEF1MfTI5FORONEHUNCREDD.7LLAR5(S�OOIORLESS) PLUMBING ._________,___,___ ____ _. Z I CEflTIFV?HAi IN TME PERFORM4NGE OF TNE WORK FOR�NHICH THIS PEFMIi IS ISS'J'cC.l MF_C'r1ANICAL _�� ________ _ C7 SHALL NOT EMPLOV ANY PERSON IN ANY MAYNER SOAS TO BECAME SUBJECT TO THE � WORKERS'COMPENSATIONIAWSOFCALIFORNIA,ANDAGFEETHATIFISHOIADBECOMF. �hSPECTIONFEE „_ j SU&IECTTOTHEWORKERSCOMPEN5ATI04Pf10VI51IXJSOFSECTI0Y370GOFTHELABOR --- — .. CODE,I SNNL�FORTHWITH COMGLV WITH THOSE PAONSIONS I SSUANCE � SMIP . � n ..,nn � p DATE: APPLICANT. __,__ ._. __ __ -- J WAFiNINGFAlU1RETO5ECUFiEWORKERS'COMPENSATqNOJVERAGEISUYLAWFIJI.PNDSHALL6E ENERGVP/C _.__ _.___. _ 6—y SU&IECT AN EMPLOYER 70 CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDFED TFIOUSANO ENERGY PE 'Q DOLLARS�5100,00c).IN ADOITION TO THE COSiOF COMPENSATIOh',DAMA6ES AS PROVIDEO FOR IN �Y�-����D� � SECTION 3��e OF THE LABOR CO�E,IN?EREST.FND ATTOA.�'El"5 FEES. RETENTION �p [�A L'L'TV _ _ OCONSTRUCTION LENDING AGENCY PqE-ALT FE : �Lli�v� � 1 HERE9V AFF�RM UNDER PENALTY OF PERJURV THAT T4ERE IS F WNSTRUCT!ON LENOING AG`eNGY ___ _ FOR TNE VERFOFMANCE OF 7H'c WOqN FOR WHICH THIS OERM:T IS ISSUE�;SEC.309).CN.C.7. Z W __ '.. —.._... . .. � LEND�R'SNAME _'_ ' "'_'"'_"'_'_' '"_ __ _ F— LENDER'SAD�RE55 '"_ _'___ __ . ... ,,. ^. . ..,.. .... , � TOTAL FEES � ICERTIFYTMATIHRYEREADTHISAPPLICATIDNANOSTATETHATTNeA90YEINFORMATIONISCORRECT. w IAGRESTOCOMPLVWITHALLCITVANOCAUNTYOq01NANCESA4DSTATELAlVSRELATINGTOBUILOWG � CONSTRUCTION,AND HEREBYAUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE f�,C � /yp Z ABOVE-MENTANF.D PROPERTY FOR INSP`cCTION PURPOSES. � COMMENTS � ./n-�` v d /°'�' � �Prac-_ r2- 3�a a�,�--r�c,�t- 1- . �- .� _ , . � _ , m PERMITTEEN0.UE(PRINn T s '� - Cn �Iu/1/� / ���1]_— _j �� '� ' - -� .• s ~ � S�GNATUR F7ERMI EE �--'��� DATE = RECPT.NQ. _PAID BY _� VALIDATION ~ WHITE—Department Cqry,YELLOW—Finance Copy,PINK—Assecsor Copy.GOLD NR D—File Copy.GREEN—Applican s Copy �u:P' k...,�. `�.�°�"� . �.��:�:a;�.� �`c��w" i�•,���:� ' Ir.�'�,�`L`.'�A' .L.a.Z�F4¢��!j����.� �"}',1,���r�.,r°;;°""',�f�"� y 4R.' sta r�.....t ,w' ' 'r,y:�s�€.«iiys. ,u,e..+bkd.' •�+�°�#�� .s� ��5�" �'s�SRF''lik�'""a�'.'.,,� ;`r, �fi,�..p g�Y g,�... ��-•-����7 Y�.'n-:.at:�".•,,, ����:�'.u� � L "z' "y'�'-��- 'k _ _ ���q�''�'�' ���raas,- :P��`�.r w,�&�.. �:�'b �..:0.� 3��"�r �s�s� � �,, z �i��.,� �w,w;>1 �`� � � ya rc .',�' . � "� �' ,. � � �`�.; �,�.,��C. �t�� �.#'�"�a��ti .,��,.:"��. , ��� �.� xee � µ � a i�'..+: . ;.,, e � , . . 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