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HomeMy WebLinkAbout15546 (23) IT F DIAMOND BAIt � --.1�_ C Y O � • "'` � DEPARTP�fENT OF COMMUNITY&DEVELOPMENT SERVICES � _ 21660 E.Copley Drive Suite 190 (909)SGO-3195 Fax(909)851-3117 PRESS ����9�'�.� BUII.DING PERMIT APPLICATION FIRMLY ¢ DDR'ESS �Z`Iv� �'+• R.�Q ���OS K M• DATEICATION--�� NUMB R�����C�' P!C 0 11 �� c� ISSUE �f �t1��� TYPE OCC APN LOT TRACT DATE 6 d CONST. GROUP °C OWNER 1 U�(lY1 �iCV1 O - �'` ADDRESS � � C9� l•%• .�CY �: �Y ' ZONING SETBACKS � CITY �' :i ZIP ' I��`7 TEL� �'r FRONT RW I i__ APPUCANT 'G-�' T��TEL.�./1 t��S�S"-I 31� REAR fl_____ SIDEISIQE STREET____ RW LJ.___..__ 4 � CONTRACTOR ' �' v�"1 Ll'+ �p't1CJ�'Z:���' SIDE f7 � ADDR SS I `#• s,C '` t.L ` � � CITY ZIP�2�� ' EL�ZjD`'; `� PROPOSED USE oARCWENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS_ STORIES BEDROOMS �. C17Y ZIP TEL. �� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cn ¢ OWNER-BUILDER DECLARA710N SFR/ADD/REM O �_ I HEREBY AFFIfiM UNDER FENALTV OF PERtt1RV THAT 1 AM EXEMM FROM THE CONTRACTORS�I� � Garage/Ceryort W CENSELAWf-0HTHEFOLLOWINGflEA50N(SEC.7031.SBUSINESSANDPFOFESSIONSCODEANVCITYOR C.) 'COUMVWHIGHHEOUIRESAPERMITTOCIXJbTRUCT,ALTER,IMPROVE,DEMOL'SH,ORREPAIRANYSTNUG W patio/Deck �• NHE,PRIOR TO ITS ISSUANCE.AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W STATEMENT THAT HE OR SHE IS LICENSED PURSUANT 70 THE PROVISIONS OF THE CON7RAC70R5 U- � CENSE UW�G7UPTER e(CAMMENGNO WITH SECTION 7ao0)OF DIVISION 30F THE 6USINE93 FND PRO• � P�USpa FESSIONSCOOE)ORTHATHEORSHEISEXEMPTiHENEFROMANDTMEBA515FDRTHEALLEGEDEXEMP- (� y� �� TION.ANVVKKATIONOfSECTION7031.5BVANYAPPLICANTFORAPERMIY5U9JECT5THEAPPIICANTTO Z pe-Raaf ,�,s�" F ACMIPENALTYOFNOYMORETHANFNEHUNDREDUOLUR5�S50o).): � C71,11SOWNEROF7HEPROPEHTY.ORMYEMPLAYEESWITFIWAGES/STMEIRSOLECOMPENSATION, ❑ Commercial � WILLDO iHE WORK,AND THE STRUCTURE IS NOT INTEN�EO OR OFFERED FOR SALE(5EC.7046,BUSF J � NE55 AND PfWFESS10N3 CO�E:hIE CONTRAC70R5 LICENSE LAW DOFS NOT APPLY TO AN OWNER OF � PqOPERTYVM1�8U1LDSORIMPROVES7HEREDN.AN�VM000E55UCHWORKHIMSELFORHERSELFOfl � � � THROUQHH160HHERONRdEMPIOVEES,PlIOVIDED7HATSl1CHIMIPROVEIAENT3ARENOTINTEN0E00R m Q 'OFFEREDfOR9AlEIF,HOWEVERn�EBUIL0INGOHIMPi10VEMENTI550tDWITHiNONEYEAROFCOUPLE- - � TION,iHE OWNERBUILOER WILL NAVE THE BURDEN UF PROVING THAT HE OR SHE 010 NO7 liUILO OH � � IMPROVE FOiiTHE PUR705E OF SALE). ❑1,AS OWNER OF THE PROPEfifY,M7 E%CLUSIVELY CONTRACTING WffH UCENSED CONTRACTOpS � TO CONSTRUCT TN[PROJECT(SEC.7044,BU3INESS AND PROFESSIONS CODE:7HE COMMG7oPS ll- V21 fl ______,_,_ ___,______.______ADJ.AREA______._.__._._______,____ � W CENSELAWDOESNO7APPLVTOANW�MEROFAPROPER7VWHOBUILDSORIMPFOVESTHEREON,AND ' Z NRi000NTMCTSFORSUpiPRQIECTSWI7HACCNTRACTOR(S�LICENSEDGUqSUANTTO7HECONTRAG UANTITY DESCRIPTION FEE � ��� TORSUCENSEUW.). � J O ❑i AM EXEMPT UNOF.R SEC. __.B.&P.C.FOR THIS REASbN U 3 ""_""" � � LL DATE_ OWNER________ V W � LICENSED CONTRACTOflS DECLARATION W � � 1 HEREBY AFFlflkl UNOER PENALTY OF PEflJURY THAT 1 AM LICENSED UNDER PHOVISIONS OF CFIAPTER � � E f�a P^/�. r y� � ` /�"t (� d 9(COMMENCINGWITHSECTION7aao)OF�IVISION30FTHE6USINESSRNDPROFESSIONSCADE,ANO Z �ytp F'� ' ' v � u� MY UCENSE IS M FUL OFiCE AND EFFECT. { �j ' - .y�7�,, � ��'"�C'd t'�,�" ' C)i C � LICENSE CLASS � ✓ LIC.NO._ � ��a�f J� � U pp7E_ � �U CONTRACTOR U `4'��_H-CL � � ua � WORKERS'COMPENSATION DECLARATIDN Q EF � I HEREBY AFFIRM UN�F.R PENALTY OF pER1URY ONE OF THE FOLLOWING DECLARATIONS: U i N Q � � _,_IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWOPKERS' _ [ COMPENSATION,ASPROVIDEDBYSECTION3looOF7NE!ABORCO�E,FORTHEPERFOAMANCF. W E OF THE WDHN FOii WHICH THIS PF.RMIT IS ISSUED. � � O w _I FIAVE AND wILL MAIMAIN WOPKERS'CAMPENSATION INSUfiANCE.AS REQUIqF:D 6Y 5[GTION Q 9700 OFTHE LABOR CO�E,FOR THE PERFOAMANCE OF THE WORK FOR WHICH THIS FEHMI715 � 0 ISSUED.MY WORK6`RS'COf7a-PENSATION I,NSURANCE C RIEfl AND PO.ICY NUMBER PRE: CONSTRUCTION __ � � �'.,,'7"r'C%(T , d°-4*l�d C . PLAN REVIEW j - - 4" Z aouavNUMeeR ' " ���' ___---.- ELECTRIC 'l ....-------...----------'- � �� � : 0 (fFtlSSECIIONNE�NOTBEOO�WLETEDOFTF�PEPM'7'ISFORIXJEF0.N�REDOOIIAPS�5100)ORLESSj PLUMBING �.__ � Z I CERTIFY THAT IN THE PERFORMMICE OF TNE WORI(FOfl WHICH THIS PEFMIT IS ISSUE�,I MECHANICAL . _.___._- i; (J SHALL NOT[MPLOY ANY PERSON IN ANY MANNER SO AS TO�EGOMF.SLIBJECT TO THE F: � WORKERS'COMPENSATIONLAWSOFCAIIFORNIA,MI�AGREETHATIFISNOUL�BECON.E INSPECTIONFEE � ' SUBJECTTO THE WORKERS'COMPENSATION PROVISIONSOF SECTION 37000F TFIE LABOR x� � S CADE HALLFORTHWiTHCOMPLYW�T THOSEPROVISIONS/ �,/� ISSUANCE ______.,_.__,___._._— _—..— O r'd� ei 1 (�/�■i���i����.fJ SMIP — ----- � � OA7E�.�__. APPLICANT: �,�__� M•�°' _..""__'____-- J ENERGY P/C J WARNING:FAILURETOSECUREYJOHKEflS'GOMPENSATIONCOVEHAOEISUNUWFUL,ANDSHALLBE '-- —""— � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANOCIVILFINF.SUPTOONEHUNDREDTHOUSAND ENERGYPERMIT Y DOLURS(E700.o0o),INAD�ITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPHOVIDEDFOHIN -""--"'-'----""-- —"— � SECTIDN37080FTHELABORGODE,INTEfiEST,ANDAITONNFY'SFEES. RETENTIONFEE: _._.. ._ —__—._.._ Up - _ __ 9 dCONSTRUCTION LENDING AGENCY PRE-ALT FFE: ____,____.__-__--_...__._..______._ �P�' � IHEREBVAFFIRMUNOEflPENALTYOFPEPJURYTHATTHEREI5ACON5TRUC1'IONI.ENDINGAGENCY __ ___.___.,_ F a- FORTHEPERWHMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED�Sf:C.3o9�,CIV.C.). � � `Z _._--__."_"__— _" � � LENDER'S NAME .__. --_' . _'___ '_"_'_'_"—_____'_'"'"'__ � y F� LENDER'SADDRE55_, —. �- �'+ WICEPiIF'lTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATKKJISCAHRECT. TOTAL FEE�7 •�I�� � 1 AGREE TO fAMPLY WITH ALL CT'AND CAl1NTY ORDMANCES AND STATE LAWS RFLATING TO BUILDING CONS7RUCTION.AND MEREBYAUiHOPIZE REPRESENTATIVES OF THIS COUNTY TO F.N7Efi UPON THE Z ABOVE�MENTIONED PER7Y FOR INSPECTIO`N PUNPOSES. COMMENTS ,____..— . — 0 ��� /�f'"� � ' __ � �- _—_—__ m PERMtTTEE NAME(PRINn .� — -- — ^�` //�'/) � � 91ONATUflEOFPERMITf�J --- �ATE � -- ---"'��'— ' �— t � RECPT.NO._�L_PAID BY VALIDATION p WHITE--0epartment Copy,YELLOW-Flnencs Copy.P�NK-Assessor Copy,GOLDENROD-File Copp,GflEEN-Applicant's Copy � � .._. . _..,. _._,. � ' - � .. .a, , _.. . - -- ._ j.., _. �.... . _.. . . , __. . s� . i , � � � � �� , � j� �� � s I � I I ' ' ' , I '� x I f , i I � i � , � i I I , � ` vsr� � � i � C , ! � ( i ' , � ( , � � i � I � I ! i �l � i ' � � i � � � � ' � '� s, I � ' � � , ( . I � ! I I j i ' i . , �, i i ' � I � I � � ; . 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