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HomeMy WebLinkAbout15494 , G _� � _� CITY OF DIAMONTD BAI� � . DEP�#RTMENT OF COMMUNTTY�DEVELOPMENT SERVICBS 21660 E.Copley Drive Suite 190 (909)R6a3195 Fax(909)861-3117 PRESS $UILUING PERA�TI'APPLICA�(�11i FIRMLY � JOBSITE J �� ��/��r APPUCATSON /'/1 PERMR G P/C I o ADDRESS 7 y DA,TE V`� NUMBER # ' $ ISSUE �n 1 TYPE OCC g` APN LOT TRACT DATE (��J CONST. GROUP { � OWNER ��/'R' � ADORESS _`�f � .�4-/I✓ t/�C ZONING SETBACKS Z CITY_ J�'H���A.•Q ZIP�/ ,'!�"TEL. R�RT RW O g APPIICANT TEL. SIDFJSIDE STREET RW ❑ � CONTHACTOR f � SIDE ❑ � CITY ES %/l ZIP c �6� " � PflOPOBED USE t-' ` f 7!� � �:.L.- o �'17 EL.1 / , � ARChVENG/ ' ' S'iJJ DE51fNER NO_pWEL. O, NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNEH-BUf1AER OECIARATION �wqpDIREM � O p 1 HERE9Y AFFlRM WDER PENALIY OF PERIUAY THAi I AM EX'cMPT FflOM i i1E GONiRACTOqS ll� (�`gf9g8/C91POR $ IJ.1 CFli6EWNf-0RTHEfOILOWMGREASON(SEC.7031.58USWESSAN�PROFESSIONSCODE:ANYCITVOR (n p L•� COUMTYWN�HREd1�NE5APERMITTOCONSTRUCT,ALTEfl,IMVROVE,�MOL�SH,ORREPA!RANYSTAUG �UJ patiolpeck � 7UPE.PFUDR TO ITS 193UANCE,+LLSO REWIpES THE APPLICAM FOR Sl1CN PERMIT TO FILE A SIGNE� �� � ST�iEAIENT T}I�T ME OR SME IS LICENSED PURSUANT TO THE PROVISIONS OF THE WNTRACTOftS LI� CFNSELAW(CHAPTERO(C0IAMENCINQWItHSECi10N7000)OFDIVISION30FTHEBUSINESSANDPSiP � POOUSPB FE55pN5COD�Oq7HATMEOR5ME15EXEMPT7HEREFROMAN0TNE8R515FORTHEALLEGE�EXEMP• (� TION.MIYVIOLAiIOyOFSECTION70.11.58YRNVAPPUCANTF09APERMITSUBJECTSTHEAPPLICANTTO � �{g-F}pp} � AGYILPETULTIOFNDTMORETXANFIVENUNORE000LLARS�f500).): � �4�.^�FROfTNEPROPERN,OPMYEMPLOYEESWITHWAGESASTHEIR50LECOMPENSATION, �0 Commercial - NAIl DO THE MlORK,ANO THE STRUC7UqE IS NOT INTENOE�OH OFFERED FOfl SALE(SEG 704�,BUSb J Ni55 ND PPpF6&SIONS CODE:1HE CONTR�CTORS UCENSE LAW DOES NOT ACPLY TO AN OWNER OF � WIQDER7YNM110BUAD50(iAIVROVESTHEREON.ANDN7iODOE55UpiWOHIfHIMSELFORHERSEtFOR = (,[ THp0U0HMI5ORHENO'NNE4PLOVEES,PRONOEOTHATSUCHIMPROVEMENTSARENOTINTENOE�OR � WL,� OFFEflEDFOR&N.EIFHOMlEVERiHEBUttDINGORIMPPOVEMENTISSOLDWITHINONEYEAROFCOMPLE Z TION,iHE OMMEq�UItDEH WILL HAVE THE BURDEN OF PPOVING TH�T NE OR SHE 010 NOT BUILD Ofl = YPIIDYE FOH T!�PIIRPOSE OF SALE). ❑I,A9 OVMEq OF TNE PpOPERfI;AM EXCLUSPlELY CONTRACTINO WITH LICENSED COMrRAC70R9 � TO CONSTAUCT j'NE PR0.IECT(SEC.7�JU,BUSINESS AN�PROFESSIONS COOE THE CONTRACTORS LI. Valud110f1 � ADJ.AREA CElJSE LAW pOE$NOTIWPLV TO AN ONMEfi OF A PfiPPERTV wV+O 9UILD5 OR IMPRDVES THEREON,ANO wHocartAncTSFonsucHoao�Ecrswm+�caarAncroa�s)ucENSEovuAsunvrroTNEcouranc p�qNTl DESCRIPTION FEE � Toas��c6usE iww.�. ❑1 AM E%FlJPT UNDER SEC. 8.d P.C.FOR TMS REASON � � U LL DATE OWNER � � U � LICENSED CONTRACTORS DECLARATION � J I XEqEBYAFFIRN UMOER PENALTY OF PEHJURY TMAT�AM IICENSED UNDFR PROVI51(NJS OF GH4PTEq � � 0(C17YyfYCINBMt1THSECTION70o0)OFDMS�ON30FTHEBUSINESSANO�ROFESS:ONSCODE,AND Z MY UGENcE IS M FULL FORCE/AN�D FFECT. � � LICENSECLA55 ��✓� LIC.NO. � � �� � F�- WDATE �G� -,���Q�_CONTRACTGf�_ � � � WORKERS'COMPENSATION DECLARATION a ! � U �i IMEFEBYAFFlPMUNDERPENALTYOFCERIURYONEOFTNEPoLIOWMGDECLARATIONS: ! y Q � _IHAVEMIDWILLI.UINTAINACFFlTIFlCATEOfCONSENTTOSELf-INSUREFORYlORKERS' Z � COIAPENSATION,ASPROVIDE�BYSECTION3'IooOiTHEUfinRCODE.FOqTHEPERFQRA!P.NCE W OFTHE WORK FOR WHICH TXIS PFPMIT IS ISSUED. � 0 � _IHAYEANOWILLMAIMAMYl�RKEP3'COlAPENSATIONINSURANCE,ASREWIREDBYSECTION Q 37000FTNE UNOR CODE,FOR TNE DERFORNANCE OF THE WORI(FOR WHICH THIS FERMIT 15 ISSUE�_1AYWORK S'CLOMPENSATIO�N IL,y�uRANCE CARPIER AN�POUCY NUM6ER ARE: CONSTRUCTION � c�RRIEA �G�J�l'' � ^� I PLAN REVIEW � POL�cYtiuMBER�{l~L- ���.J ELECTRIC y� 0 (lFhSSECIqNNEIDNaiBE00A+REfFDOFTI-EPERMltSinHaNEMR�ORFo0a1a1islS�m)�1LE'S5) PLUMBING _�r� !� Z 1 CEIRIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUFD,1 MECHP.N�CAL ���_ ('J SNALL NOT EMPLOYANY PERSON IN ANY MANNER SOAS TO BECAIAE SU5JEG7 TO THE ' � WORKERS'CAMPENSATION U�MS OF CALIFOFNIq AN�AGFEE iHAT IF I SHOVID BECOME INSPECTION FEE _ SU&IECTTO THE WOflKEflS'C061VENSATION PRo IONS OF SECT�ON 9700 0F THE IAeOH ` CODE,ISHALLFOR71-IWI7NCOMPLYWITHTHO� OYIS �SSUANCE _y�l (� ?'1 //1��� p DATE:_J�a APPIIGANT: ' _ _ SMIP �A A4e����s � 't� � W n�T`Y�'�"-�rtiz�'—A --� WI.pNING:FAILURETOSECURE WOFKERS'COAIOENSATION IX]VEqAAE i5 U.AWFUL.AN HALL BE EMERGY P/C ��(� _.��jh�x�� � SU&IECTANEMPLOYERTOCRIMINA�PENALTIE9ANDCIVIlfME3UPTOONEHUN�REDTHOU5M10 ENERGYPERMIT�L�TI.�1J�i � �� DOIL�RS(t70D,0ao),INPDDITION TO THE COSTOF COMPENSAr�N,Dn1AAGE5 AS PROVIDEO FOR IN � SECT%1N370BOFh1EL0.80ROODE,It1TERE5T,ANDATTORNEYSiEES. RETENTIONFEE: � CONSTRUCTION LENDING AGENCY PRE-A.LT FEE: O QI HEREBYAffIRM t1NDER 7ENALTYOf PERAIRY THATTHERE IS A CANSTRUCTION LENDINO AGENCV FOR THE PERWPMANCE OF THE WORN FOR WHICH TiIS PEHMIT IS ISSUE�(SEC.3oe�,GIV.GJ. � W � LENDERS NAME IH LEN�ER'SAODRE55 � � TOTAL FEES I � ICERTIFYTHATIHAVEHEAUTHISAPPlICA110NIWD5TATETHAT7HERBOVEINFORMATKKJiSCORRECT. 1 AOREE TO COMPLY WITH W.L CITY/ND COUNTY ORDINANCES AND STATE LAWS REUTINO 70 BUILDING , CONRTRUCTION,ANOMEREeYAUTFqRIZfNEVRESENT7�TIVE50FTMlSCOUNTYTOENTERUPONTfiE I,, � AAOVE ED PflOPERTY FOR INSPECTqN PUAPOSES. COMMENTS O � � m PERY E E(PN�N'n � �.. - � _��� �s�. �'' �' —�`a' N SbN�TUREOF ERMITTEE DA7E � RECPT.N0, � PAID BY VALIDATION WHITE—OePartment Copy,YELLOW—Finance Copy,PINK—As.sesawr Copy,GOLDENROD—File Copy,GREEN—ApplieanYs Copy � G�7 co C'S -� �n�',i -n � vr cr= v7 o c'� � m tn 'b 77 77 7� -n � g -i u�j� m � �n mrnm � t� � � OdOC� � O � mr�� r �m __ �'� �1 � 'r r r r b 'mei � � � � f � � L�"a {,�� � � � m '�it �i p � G7�,m b 3�* 3� � c � W i Ci U) � �� � m Ci '� C7 79 b ` S�_ �'rl S S {y V5 ?J � G� 2 � =ri D -o C"� 2' ,,.. r �s �I ,- c� � � _ �, a � p O r� c m�m Ca � �a r- _ in,y � � m S o �'r � � p. cs � x 7 � r r v a -�-i P?'1 2� � z c � rn c � i `z i �� � �'-E � .-�a ��'-a�`�,'.z� �� ci pw � c} � � 2 � � m� � � � �>f ""� = �' � �}t r � ff.� --i z �I�-? 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