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HomeMy WebLinkAbout10636 - 1370 VALLEY VISTA (2) CITY OF DIAM�ND 8AR COMMUNTfY DEVELOPMENT DEPARTMENT � 21660 E.Copley Drive Suite 190 (909)86U-3195 Fax(409)861-3117 PRESS �'*", BUILDINGPERMITAPPLICATION FIRMLY � J0851TE � � APPLICATION �tf L�� PERMIT /G 3 P/C A ADDRESS DATE � NUMBER� N � APN LOT TRACT �5SUE TYPE OCC � OWNER � �A�—���y��� CONST. GROUP � /�%,� F.� c ADDRESS ZONING SETBACKS CI7Y ZIP TEL. FROPiT RW ❑ APPLiCANT TEL. � R�R � SIDEJSIDE STREET RW ❑ CONTRACTOR�� �_��.c.'i1'�-lG �"w/L SIDE ❑ gADDR S pROPOSED USE GG�'{x�G'�L" d N Fp�'� CITY TEL.SG'r�1_Sa-�Yv7 �;r,�r� ��,,��,.,�y . ` , 8 ARCH/ENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS � `STORIES 6E�ROOMS � CITY ZIP TEL. DE5CRIPTION SQ.FT. FACTOR PSF ADJ.ARFJWALUATION p� OWNER-BI;ILDER DECLARATION SFq/AOD/REM O p I HEREBV AFFlRU UNDER PENALTM OF PERJUAV THAT I AM EXEIAPT FROM THE CONTMCTONS U- GBI}q6/Ca7f011 CENSE lAW FOR TIiE FOLLOWNG REASON[5EC.7097.6 BUSINESSMIO PROFESSIONS COOE;M1YpTY OR COUNiYWHICHpE0URE5APEHYITTOCONSiRUCT,AL7ERMAPROVE.DEMOL16H,diRFPAINANY87AUC `W Pi11p1D�Ck TURE.PNIOR TO RS ISSUANCE,ALSO RE4t/IRES THE APPLICMI7 FOR SUCH PE�AIT TO FILE A SIGNE� BTATEMEM 7WS ME OR BHE IS LICEN3E�PURSUAHf TO THE PROVISIONS OF TXE CONTRACTORS LI- GENSE tAW(C1IAPTEN P fwMMENGINfi N7TY1 SEG710N 70ao)OF D��/�S�ON f OF 7NE O1151NE53 MIC PR6 � POOV.Spe •FE3910NS OODE)OH 7NAT HE OR BHE IB EYENGTTHEREFROM ANO THE 6A816 Fdi 711E ALIEpED El(EMP- TIDN.ANYYIOIATqNOFSEC710N70lt.68YANYMPLICMlTFORAPERAl1T6U8JECTiTHEMPLIG1N7T0 Z RB-H001 � ACNIL VENlLLTY OF NOT AIORE iMAN FlYE NUNDiiEO DOLIANS ItAD).1: OI,ASONMEROGIHEPROPERTY,OHMYEM7IAYEESWITHWAOE6JISTHEIHBOLEOOMPENSATION, CpmT91Ci61 1MLL OD THE WORK,ANO TNE STRUCiURE IB NOT MTENOED OR OFFERED FOR SALE(6EC.7Wa,BU81- nJ NE65 ANO PROFESSIONS CO�E:THE CON�RAC70RS LICEHSE lAW�OEB NOT MPLY i0 AN qNNEA OF = � PqOPEPTYYY1pBUq,USORMPROYESTNENEON.AN�VA70DOE9�UCNYYURKNIMSELFORNERSELFOR Q TFiROU�MNI50R116ROWNEMPLOYEE9,70.0NDED1MAT8U[YVUAPqOVEMENTSMENOT4RENDEDON . m L�1 OFFEHED FOHlALE If,lIDWEYEI�7NE BURDIHfi OR IMPROVEMENT IB SOID Wrt1tlN ONEYEAROFCOMPLE• � TION,THE OWNER-0UIL�ER NnLL W WE TME BURDEN OF VROVMNl TtUT NE Oq SM8 OID NDT BUILD OR � MJPRDVE FOR THE►URPOSE OF!!LLE). 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B.i P.C.F011 T115 REASON U L � � � S DATE OMMEH Z W Q LICENSED CONTRACTORS DECLARATION d � I HEREBV AFFlP/.l UNDER PENALTY OF PE0.IURV THAT I AM IICENSED UNCER PRONISqNS OF CHAFiEH � • ' d �[COI�WIENCWOK7TMSECTION700o)OFDIYISIDN70FTNElUSINE85NVDVROFE8910NSCOOE.ANO z X MY IICENSE IB W RRL FORCE AND iFFECT. m p LICENSECLA S y,��s LIC.NO. .�V�67 J'e jJ �"j DI1TE CONTMCTOR_iatb�Ll.t /C a W � WORKERS'COMPENSATION DECLARATqN � � I NEREBY AFFIRAA UNOER PENALTV OF VEiL1URY ONE OF THE FOLLON7N6 DECLAMTIONS: Z � _1 MAVE AND WILL MAINTAN A CERTIFICATE Of CONSENf TO BELFaNSURE fOR WONKERe' _ ODMPENSATqN.ASPqOVqEDBYBEC710Nl70oOfTHElA8011000E.F0ATiEPERFORMAIJCE W OF TME WOIiK FONNMICM TMIS PEPMIT IS ISSUED. � G 1 MAYE AND YYRJ.MAINTAIN WORKEFS'001APENSATIOAI INSURAMCE,AS HEd110.ED BV SECTION � a700 0F TTIE L1160H CODE,WH 7F1E PERPDHMANCE OF THE WORN PDR WHIp1 TH16 PEFW T 15 IBSl1E0.MY Wl7RKER3'OOMPENSrATIO�N IN�SURANCE CARAIEH MID POLKY MIMBERAqE: CONS�UCTION � CARRIER_ ��C1AT�Sl.Jn C� _ VLAN FEVIEW � va.�crNuueEa O�,^ �Ua!�"-��.(o�01 �Ec�t (IY��CTbNxE�WoiBE0olA1Er�OFiNEVEaRar6fnliaNEFi1H1aEUQiIJFts{t+ao)a�LE�} PLUMBiNG �_ I CERTIFY THAT W TiIE PERFORMANCE OF THE W�ONK FOR WHlpl TMS CERAIIT IS ISSUED.I MECHANICAL 'C,,,� SHALL NDT EMPLOY ANY PERSON W ANY MANNER 00 A8 TO BECOME SUBJECf TO TIiE � WOIIKER3'COMPENSATION UWS OF CALIFORNIA,AN�AOPEE TNAT IF I SHIXAD BECOYE INSPECTION FEE S BUBJECTTDTHEWONKEiiS'COMPENSATqNPqOVI510NSOF8ECTI0Na7000FTHElABOq is canNwin�cour�rwi sans. SUANC }C� � � • ,;!i.�., p DA7E:! ���� APPLICANT. $MIP � ENERGY P/C _ WARNINO:FAILUNE TO BECURE NOHKERS'COMPENSATION COVERAOE IS UFM AND SHAL4 BE �y &18JECfIWEMPLOYERTOCRIMINALPENKTIESlWDCIVILFINESUPTOONEF6IMDREDiNOUBAND ENERGYPERMIT y COL1.M8(ifao.o001.WADpTqNTOTNEtOSTOiWMPENSATION,DAMAClESASPRWIDEOFOqIN �J 9ECT10l�FOOOFTHELABORCOOE,INTEHEST,M10ATfORNEYSFEES. RETENTIONFEE: � OCONSTHUC710N LENDING AGENCY PRE-ALT FEE: ��� � �� � INEREBYAFFIqYUNDENPENILTYOFPER0.IHYTHAT7MEREISACONSipUCTIONLENDINOA6ENCV 2 FOH THE PERWRMANCE OF THE WORK FOR WHICH T/IIS PERAIIT 15185UED(8EC.00W,CIV.C.). CL7 � LENDERB NAME � LENDER'BAODRE65 � ICERfIFYTXATIXMIEREADT113APPLIC�TIONlWDSTATE7WRTXEABOVENJFOfiMATIONISCOMECT. TOTAL FEES ��. �� I AfiREE TO COAIPLY WITN All CRY AND COUNTY ORDINANCES AND BTATE UWS iIELATWG TO BURDINO � CONSTRUCTION,AIAMEREBYWTNOqREqEPqESEN��71VE50FTNISCOVNiYTOEN7ERUPONTHE A80VE•MENf ED�RC�EHTY FOR WSPECTqN OURPOSES. COMMENTS C + J � PEftAll ffn � / N y '.81G URE P I •. � . �. . 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