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HomeMy WebLinkAbout15867 (22) � CITY OF DIAMOND BAII DEPARTMENT OF COMMUNTTY&DEVELOPMENT SSRVICES � � 21660 E.Copley Drive Suite 190 � (9O9)860-3193 Faa(909)861-3117 PRESS "�'��� $UU,.DING FERMFP!ll'PLI�AT�ON FIRML,Y f } JOBSITE ��� ���L��/� ^� DATEICATION � � ' V NUMB R',y� 4 L^� #/C o AODRESS r� lJ � ISSUE TYPE OCC .- APN LOT TRACT DATE CONST. GROUP p OWNER FE-C��.�lt/IJlLeO ADDRESS ZONING SETBACKS Z CITY� I�AR/ ZIP� TEL. C' F REART RW ❑❑ g APPiICANT TE�• SIDE/SIDE STREET RW ❑ � CONTRACTOR G SIOE O � ADDRES PROPOSED USE CITY ZIP TE oARCFVENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDRQOMS � CITY ZIP TEL y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAIUATION � � OWNER-BUILDER DECLAflAT10N gFWADDlFiEM O p 1 HEtiEBY AFFlRN 11NDEH PENALTY Of PEfWRY THAT I AM IXEMPT FHOM 7HE CONTMCTOiiS LI- GeIfl00/C81p01t !lj CENSEIAWFOf1THEFOLIOWWGREASON(SEG7031.68USWESSANDPPOFESSIONBCODE:ANVCITYOq (� G1 COIMlfYNHIpiRFOlNRES�PEHMRi000N5TRUCT./�LTERIYVROVE.DEMOLISH.ORREP+IIRANYSTAUC (�J P2110�BCa( i� 7URE,PAqN TD RS ISSUANCE./LSO qEUU1RES 7HE APPLICANT FOP SUCH PERMIT TO FILE A SiCiNEU W STIqEYEHf THAT HE OR SHE IS LICENSEO PURSUMIT TO THE VROVISIONS OF hIE CONTMCT00.4 LI• CENSQ LAW(ClI/�PTER Y(COAIYENCINO YA7H SECTION to0n)OF UIV191DN e OF 7ME BUSiNE55 AN�FR6 � P��W FESSqKS ODD�Oq 7H�,T HE OR SHE IS EXEMPT THEREFHON AND 7HE BJ1515 FORTXE IU.LEGED EXEYP• TION.ANVVpLAT1DNOFSECfION7091.5BVANYAPPLICANfFORAVEPIAIT5U61ECT5THEAVPLICANTiO Z Rg-Rpp} � A pVp.PHiALTY OF NO'T NoilE TMAN FNE MUNOREO DOLIAR3(SSov�.): � ❑4150WNEROFTHEPROPEfliY,OflM7EMPLOYEESWITHWRGESR57MEiRSOLECOMPEtLSAiION, � Commercial -� WILL DO THE WORK,MD THE STHUCTURE IS NOT IMENDED OR OfFEPED FOR SALE(SEG 704,BU51- J � tffSB NU PRQFE.SSqN3 COOE:TNE CONTMCTORS UCENSE L1W DOES NOT APPLV TO/J7 OYMER OF � P(iOPERfY WRq&/1LDS OR NPROVES THEREON,ANO WHO DOES SUCM WORK MtYSELFOq HEfiSELF OR (C 71410UON HtSOi NER�MI EYPLOYEES,Pi�VI�ED TH�T SUCFi 161PROVEMENfS ARE NOT INTE1mEU OR m � L�1 OFF61mFOR5KEIF,FIONIEVER7FIEBU�LDIN/iiORNdPN�YFMENTI3SOLDMATHINONEYEAROFWYPLE- ZTION,T11E OWNER�U�.DER WILL FNVE 7HE BURUEN OF PROriNG TM�T HE OR SME DID NOT BUitD Ofi � YPROYE FOA THE WIPVOSE Of S�LEI- � ❑4ASOWNEROFiHEPROPERT;MtE%CLUSNELVCONTMCTINOWlfFILIGENSEDCOMMCfORS 10 CqLSTRUCT 7HE PROJECT(SEG 7PN,BUSINE55 AND PPOFESSIONB CODE:7HE CONTRACTORS LI- V21U8SiOf1 ADJ.AREA CENSE LAW DOES NOT AVPLV?O AN OVMEH OF A PROPERTV M1110 BUADS OR IMPROVES t}1EPEaN.Mm � yyYppONTpAC78(pqSUCHPROJECT5VATIACOMTRACTOi1(S)LICENSEDPURSUANTTOiNECPNTFAG pUAN71TY DESCRIPTION FEE � TORS LICEl6E IAW.). J p�AM EXEMFf UNDER SEC. B.6 P.G iOR THIS REASON U 2 V" DATE ONMER V � LICENSED CDNTRACTORS DECLARATION –r � w I HEAEBY�FFIRM IMDEA PENALTY OF PE0.tt1RY THAT 1 AA1 LICENSE�UNDER PiiOVI510N5 OF CHAPTER � �J '�r � Y(C044EN(yN�WIiH SECf10N 7000�OF DMSION 9 OF THE BUSMES3 AND PPOFESSIDNS CODE.M1� Z ! ��� MV LICENSE IS W FULL FORCE AND EFFECL m � LiCENSE CU1 J LIC.NO. � � J V oAtE CONTRAGTOii a c6 1 ��,���+� WORKEHS'COMPENSATI CLARATION a � 'HEREBYAFFlWN�UI�EHVENALT/Of'PERNRYONEOFTHEFOLLOWINGDECLAMTIONS: J y Z Q � _IHIIVEAIAWILLM�RJTAINACENfIFlCATEOFCOPISEMTOSELf-WSUREFORV.I�RKERS' _ COMPENSATIDN.ASPiiOY1DEDBV5EG710N77000FTHELA80HCODE,FORTHEPEAPoRMANCE IU OFTNE WORK FORNM111di TNIS DERMR IS ISSl1ED. g � w �1 HAVE AND WILL NARlTANI WORNERS'CQWPENShTION�NSURANCE,AS REIXlIREO BY SECTION Q 370U OF 7ME UAOR CO�E,WR iNE PERFORMANCE OF TNE WORK FOR WMCH THIS OEHMI!IS ISSUEO.MY MORICERS COMPFNSATIDN INSURANCE p�RRIER M!D 70LICY NUMBEPARE: CONSTRUCTION juaRiER ��-P � PLAN REVIEW Z POIICYNUMBER /� �� � ELECTRIC � 5[crqr+r�IDw7eEm.ptFrIDOFtrE��+rrsro�arvE�ooa�R+w�ontes5} PLUMBING TT�,���� '.♦S L7 � I11.1.'J3�<1,1�y �,el�{1y,y--��--. � 1 RTIFYTi�TINTNEPERWRMANCEOFTHEWORKFORWH�CHTNISPERMITi5I55UED,1 MECHANICA � NOTEIAPLOYANYPERSONINANYMANNERSOASTOBE�MESU&IECTTOTHE �j]„)Q�AtnT,�T�/7�]/�y � �WCERS'COAIPENSATION lAM/5 OF C.LL�FORN�0.�0 AGREE TM�T IF I SMWt.D BECOME INSPECTION r�g Q ka4\/X y a 1 •��J �� ( UBJECTTOTiEYYORKERSCOMPENSAT Vi510NSOFSECT 3� OFTHEUBOR �SSUANCE QCO�E.1 S HfHWITH COMPLY W17H O,E PROVISIONS. ' Q DATE:�����Z���L,l.[L APPLICANT, . f7 SMIP � r — ENERGY P/C � Wl1RNIN(i:FARII il_TO SEWRE WORKEfl3' ENSATKKJ COVF.RAGE IS UNLANlFUL,AND 6HM.L BE /� �—y SUBJECiANENPLOVERTOCRIMINALPENALTIESANDCMIFMESUPTOONEMUNDPEDiHOUS�ND ENERGYPERMIT 9 ��S DOLLAR3(5100.000).�N ADDITION TO THE COST OF COMPENSATION.D��.7AGES AS PROVIOED f-0R IN � SECTION970lOFlHELA80HCODE,iNTEREST,MAATTORNEY'SFEES. RETENTIONFEE: d CONSTRUCTION LENDING AGENCY PHE-ALT FEE: � 1 HEflEBY AFfIRM UNDEH PENKiY OF PERJVRV THAT THERE IS A CONSTRUCTION LENOING AGENCY Z FOR THE PERFORMANCE OFTME WORK FOF WHldi THIS PERMIT IS ISSUEO(SEC.3097,CIV.C.�. W I � LENDEFY6 NAME �- �S LENDERSAODRESS O � 10ERTIFVTHATIHAVEREMT713APPLICATIONANDSTATE1HATiHE�BOVEWFORMATIONISCORRECL TOTAL FEES �/`+ 0. 1 A6HEE TO GOMPLY N77H ALL CIiY AND WUHTY OROINANCES AND STATE UWS RELATINQ TO BUILDINO CONSTRUCTION,M1O HERE9Y AUTFIOHIZE REPflESENTATIVES OF THIS COUNTV TO ENTEH UPON THE � ABOVE-MENTIONED VROVEHTV FOR INSPECTIDN PURPOSES. COMMENTS J � PER E NIWE(PRiNn 4 CA —--- � REOFPEWAtj,'fEE DAT � r�c�r nro. rao sr v�uonnoN WHITE--Oepenment Copy,YELLOW—F'H�ance COpy,PINK—Assassor Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy ci�v oF �c�►n�c�r�o BAa f�3�C�'1C}N ��Ct��� 4- IL 1 6 *.A '� A , p 7 SET BACK i ��QOfi JOIST 1=7'GS/FC7RMS/STEEL '— � i FHA R`�QMTS ELECTRIC CR£?UND t UNDER F�C70Fi DUCT taRt3UND P�tJMBt�tG � UNt�ER�LOC?R COPiDUiT_. SL,�B GR�DE F►REPLACE FOUNDATION TE�1P Pt)4VEF� FIREPLACE 80ND BEAM �'VATER SERVICE ; MiD HT. BUN1�B�AM ROQF SNEATNING 8 Ff.B�rND BEAfvi . FRAtvifhl(�,'VE�JTi�(ATlQN FlNAL�OND BEAM ROC7F CC?VER PRE-GRADING AC7UGH NEATING BERiCHlNG RClUGH ELEGT'RIC RbUGH GRADI�JG � ROUGH PLUM�IPvG FINISh!GRP,DING SHt�i�JEWTt.IB TEST i P0C3L ELECTRIC EXT LAiH1StDtNG P(?tJ�.FENCING WALL INSUL�iT(4N � � POC3L FINAL � CEILI�IG iNSULATIaN UfiF SITE IMPS. DFtYWALL NAILIPdCa DEDICATIONS 5��:�IER �lNAL�PVG. �EPTEC T�ONK LANDSCI�PEIlRRIG. 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