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HomeMy WebLinkAbout15360 � " ��. C , � � CITY OF DIAMOND BAg � DEPARTMENT OF COMMUI�IITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 �w (909)860-3195 Fa�c(909)861-3117 PRES$ � '�' BUQ.DiNG PERMIT APPLICATION FIRMLY � JO�� APPLICATION . z O PERMIT �j P/C a ADDRESS_ � �0����Gl��'�' ��1 DATE � �/ � NUMBE J�� # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP °C OWNER � O � ADDRESS S• L ZONING SETBACKS �W CI ZIP°(��s TEL�i -3�7.(�� REAR RW ❑ APPLICANT TE�•�L� '�'Iy�� SIDE/SIDE STREET RW ❑ � CON7AACTOR � � �m��t�lt� SIDE ❑ Q ADDRESS �.,�� t.c.�. ,� rf'��r- � �7 � � CITY�� . 1-� ZIP`i�7\c� ra. 5�►��-14 63 PROPOSED USE w l� � . ! �B ARCI-UENG/ G�z�?9� ' DESIGNER NO.DWEL NO. NO. ADORESS UNITS � STORIES ' BEDROOMS� CITY ZIP TEL. u� DESCRIPTI�N SQ.FT. FACTOR PSF ADJ.AREANALUATIOW Q OWNER-BUILDER DECIARATION SFR/ADD/REM ! p 1 f�R�Y AFFlIM UNDEH PENILLTY OF PERJURY TUT 1 AM IXEMP�FR01d THE COMMCTOAS Ll- G9I8Oe�C8fp01I 11,1 �118EU1WFd1TNEFOLLOWINGREA80N(SEG7031.68USINESSANDPPOFESSIONSODDE:ANYCITYOR (n C�J OOIWTYWtlCHRFaHNESAP6MItfTOCONSTRUCT.ALTERiYAROYE.DEMOLISH.ORREPAIRANYSTRUP W PetiD/�BCk LL� 1UF1�PRqR TO fT8 ISHUNlCE,ILSO HEq11RE4 iHE APPLICANf WR SUCFi PERMIT TO FlLE A SIGNED W � BTATEAIEHT THAT HE OR 9HE 19 LICEHSED PURSUANT TO THE PROYISIONS OF THE CONiRACTOR3 U� ��l��ER Y(CDMMENCMN3 YATH SECfION 700D)�DMSION�OF 7HE BUSINESS AND Pf� � PoOUSpa FESSpNB C00�OR 7HAT NE OR SHE IS EXEYPT THEREFRCMI ANDTHE BA313 FORTHE ALLEOED EXE11P- TION.FNYYIOLATIONOi5ECT10N70J1.SBYANYAPPLICANTFORIIPEPMITSUBJECT5h1EAVVLICANTTO Z R8-ROO� � AqV0.PH1/1.T1 OF NOT MORE iTWI Fl4E HIINDRED DOLUfi$(76o0)J: � plA30NR1EAOf7HEPROPERTV,Oi1MYE1APlOVEESWI7HwAGES�STNEIRSOLEWNVENSA710N, O COmrilerCiel - Wlll DO THE WORI(AND THE STRUCtUHE IS NOT IHfEHD6D OR OFFERED Wq SALE(SEC.7044,BU51� J y I�SSS MO PROFESSIOtB(300E 7ME CON�MCTORS LICENSE LAW UOES NOT MPLY TO AN OYINEfl OF � PNOVERIY MRfO&RDS OR IYOROVES THEREdi,A!ID WXOOOES Sl1CH N�ORK HIMSELF OP HERSELF Op Q THROIIdi HI$OH HER OWN ENPLDYEES.PIqVIDED THAT SUCFi pJPROVEMENTS ARE NOT INTENOED OR m ,� W OFPENEDFORSKEIF,HOMIYER,71ff8UMDVN30fiBIPNOVFJIBVTI550LDWITUHONEYFi1ROFCtl/PLE- , ZTqN,7HE ONMER�UILDER VALL HAVE THE&JROEN OF PROVWO iHAT HE OR SHE DID NOT BUND OR IMPHOYE FOR ilff PURPOSE OF 5�11.E). ❑I,AS ONMEROF THE PROPERi1;AM E%CLV9NElYCOMRACTIN6{MTM LNN:ENNSEO CONTRACTORS d TO CONSTRUCT TNE iiIOJEGT f3EC.7oN.BUSMESS At�q PROFESSlONS CODE:THE CONTMCTOHS LI� VeluetiMl ���!'f��- ADJ.AREA � CIXSEUIWDOESNDTMPLYTOANO1NNEflOFAPROPERTYWMU8URO50RIMPROVESTNEPEON.AND w►iocor�rrucrsronaua�vnaecrswini�cartrucron{s>�rc.�naeowHau.vrrroniecoarww pUANTiTV �ESCHIPTION FEE Y tORS UCENSE LAW.�. � ❑1 AM EXE1JPi IIf�ER SEC. B.l V.C.FOR THIS REASON 4 U � � DA7E OWNEA U � LICENSED CONTRACTORS DECIARATION W J � W I HE(�BY 1�FIfW UlDER PENALTY OF VER�KIRV iHAT I AM LtCENSED UNDER PROYISIONS OF GHAPTER � � Y(CdWENCWOV/ITHSECTIONtWD)OFDIVt510N30Fh1E8USINES3ANDPROFESSpNSCODE,ANU Z LLl ��ENSE IS H FIAl iORCE MiD EFiECT. � ����,Ss �—� ��.�. � �5 � � � pATE CONTRACTOR � � d �,'P;� � WORKER3'COMPENSATION DEC TION Q � �"i U � 1 HEREBY�FFPN UNDER PEN�LTY OF PE0.RIRY ONE OF THE FOLLOWING DECLAMTIONS: (/� a G I HIWE AND WILL MAMTAM A CERf�FlCATE OF tONSENT TO SEIHNSURE FOR WORKERS' _ � CONPENSATION,ASPROVIDEDBYSECTION37000FTHELABORCWE,FORTHEPERWRMANCE �U OFTiE WORK FOR WMNF7 TH15 PEfW1T IS ISSUED. � � ��HAVE MID WILL M�IIHtA1N WOiNCERS ODYPENSATION INSURMICE,AS REW IRED BY SECTION O Q 3700 OFTHE LABOH CODE,FOR THE VER W RMANCE OF THE WORN WR NrtiICH THIS PERMiT�5 �/� IS3Um.MYNORKERS'COMPENSATIONINURANCE RHIERANOPOLICVMI{ABERRRE` CANSTRUCTION 1 I Q ��l l 1Y jCARNER S-�"�.��L���� rn \ PLANREVIEW � Z POLICYNwaeEn Z��^ I� L ��� ELECTRIC � � a o �rasgccrcNr�Nort�oomqFt�oFn�pEaMiswqouE�voaw�s�s�oo)oq�ssy PLUMBING � I CERTIiVTHAT W THE PERWP0.UNCE OF THE WOiUC fOR WFiICH T1i1S PERMI7IS ISSUED,I MECHANICAL � � SWILLNOTEMPI.OYANVCERSONMIANYLIMJNERSOASTOBECdAESUBJECTT07HE �j WOflNEP5COMPEN9ATqNUW50FCAL�FOFiNi�ANDAGREETHATIFISMOUL�BECOME INSPECTIONFEE SIR.IECT TO THE MKMNERS'OOMPENSIRpN PFOVISpNS OF SECT%NV 370o OF TME UBOR CODE,I SHALL FORTHVA7H COMPIY WITH 7NOSE PROVI IONS. ISSUANCE � �y�,� • p DATE:os 1�.'� APRICANT: SMIP .� i. W ENERGY P/C � WAfUJINO:fAIURETOSEWREYAFiKEHS'COMPE TpNCOVER�GEISUNUWFUL,ANDSHALLBE � SUBJECTNIEMMOVERTOCRIMINALDENALTIESANDCMLiME5l10TOONEHUI'�AREDTHOIJSANO ENERGYPEHMIT I�I � � I�/� fl OOlUfl3(=tO0,000j,INMDITIONTOTHECOSTOfWMPENSATpN,OMMGE6A5PROVIDEOFORIN 4� �r-ryxid J SECTpN370lOF7HELABORWUE,MITEPEST,ANDATTOfWE1"SFEES. RETENTIONFEE �� � �� Q � OCONSTfiUCTION LENDING AGENCY pRE-ALT FEE: _ DJ/�M���7A�� Q IHEREBVAFFlRMUNDERPENAL7YOFPEWURYTHATTHEREISA(bNNSTRUCTONLENDiNO�UENCY DING A�7D�;q��Zi n- FOR7HEPERFORWWCEOFTHEWORKWRN?i1qiTNI3oERHiTI51S5UED(SEC.3a87,CIV.C.�. � Z W � LEImEFYS NAME F- LENDEN'SADDNE6S W ICERTIFYTMATIHAVEREADTHISMPLICATIONPNDbTATETHATTHE�BOVEMfORM�tN)NISCORRECT, TOTAL FEES ( (. � � I ACiREE TO COMPLY WRH ALl CRY AND COUNTY ORDINANCE3 MID STATE UWS REUTk70 TO BUUDINO � ^ CONSTHUCTION.M1�HEREBY 1UTFiORiZE REPRESENTATIVES OF THIS COUNlY TO ENTEfl UPON THE I�� ^ Q l �. ABOVE�MENTIONED PROPERTY FOH WSVECTION WRPOSES. COMMENTS �� ' � ��-z�_�p�-. �l..e� m PEPIARTEE NAME(P tNT) - � �, � � 13,1 -� _ .�, .� �.� � , � SIONA EE � � RECPT.NO. ' PAID BY _ VALIDATION WHITE—Depertment Copy,VELLOW--Finence Copy,PINK—Aasossor Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy /e � G�i{ni a � i s �c''r ulrrl�, ri� ' 'C)��I������Im��iw � m -nicn _ _______�.._.�__��.._._._..,o '-,� � I r ,n Cr�'L7 '� � rn Cn T,;� � ] -n?� �—! cn � I� mrr,�� I � � �� � � zt r�s �. �I� " 'Q ''4�0� � �4 .�'r�I�' m G�i`�` �I�l�C3 E � ( f' !, - & I _1{ I�� � � � �J �-� i � ' E 'Gl�:i t9 �'..Jl r��-I +S'7'��=t If71'...� S: �(;jL Et51�I-Ci�i,? 2 � T F - _ ri c' :r-� rr, ?�-+� mi IC f�7 S c n.r 7 � a=.�i 4 n .i ..:.:9 � _ '1 . _ 3 . -€.,-2 1 f„ � }:1 7 � r�.:�_ Yi i ,�� :._� a� ��_ r. i.?tIC�� �r�;n�� � �-� : � .:�� I.,. _ L. f�.i„�'1' fI �:C. t;; , 'P- S+ � ' �n'y �' -.'' I i I . --a+_- u: �t�,r . c �, i 3, i „m ..�!r, nt t` � . 41 t�_.-� 7:. 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