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HomeMy WebLinkAbout13932 (14) _1� CITY OF DIAMOND BAB .- DEPARTMENT OF COMMLTNITY&DEVELOPMENT SERYICES r 2I660 E.Copley Drive Suite 190 (909)66U-31A5 Faa(9�9)861-3117 PRESS �' BIJII.DING PF,RMIT APPLICATION FIRMlY � JOBSITE APPLICATION PERMIT �P/ o ADDRESS �36 R��n�� P���i� DATE � �� NUMBER I � ��-1F ��3a g issue rvPe occ APN LOT TRACT DATE CONST. GROUP p OWNER � o ADDRE S_/f7'�6 �" ZONING SETBACKS W CITY�dU/� ��Q ZIP �� T . ' 1_ FRONT RW ❑ � APPLICAN7�Y�Q��r t1�i�,ary- TEL. � REAR ❑ � SIDFJSIDE STREET RW O CONTRACTOR � SIDE ❑ ADORESS � PROPO&ED USE CITY �:a.rf�Q_L�� ZIP TE ��')3SJ^.�3�� � u9 ARCWENG/ r / # . DESIGNER IIJH14Lr'e.tl iQ/l�� /�SS[�G. ADDRESS C G s NO.DWEL. NO, NO. � CITY �L��27 + ZIP TE y�S—G'!�l(aS UNlTS STORlES BEDROOMS tn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANA�UATION � OWNER•BUILDER DECLARATION $FR/ADDlAEM O p �e+eneer�Fr'wM uNo�R vevKTr oF PE�unr nur i iva ExEMvr crm�n�E cor�raacToas u• Gamge/Carport Liyl CENBEUWfORiV�FCLLCM/M1f3RFA40N(SEC.7031.SBUSINESSANDPROFESSION9CODE:ANVCITYOR (n y� COIMflYNIIA[.7iqEIXlIAESAVEFIMRTilO0N5T(MJC7,ALTER,INPFOVE,DEMOLISH,pqp6PAtqANYSTHUC- W P���a�6�k �j TURE,PRIOA TO ITS 188UANCE,/�190 REdUIRES THE APPLICANT FOH SUCM PEFl417 TO FILE A 516NED W � STATEYENT THAT HE pq SHE IS UCENSED PUHSVANT TO THE PROVISIONS OF THE CONTMCTORS L6 � � CENSELAW(Q7AFTEqY(COMMENCINOWITNSECTION7W070FDIVISION30FTNEBUSINESSMAPR0. POOVSpO FESSIONSCADE)OqTHATHEORSHEISEXEMPTTHEREFROMANDTMEBASISFORTHEM_LEGEDENEMP- (' TAN.ANVYIIX/1iqNOFSECfIDN7m1.5BYMry11PGLN:�NiWRAPFRMI7SURlECTSTNEAPVUCANT70 Z Re-Roof � ACML PEN�LTY OF NOT MOqE 7W�N FIVE HUWpRED DOLUAS(t500).j: ^ ❑I,ASOVMEqpF7HECROPERTY,ORAIVEHPLOVEESWITHWAGESASTHEIqSOLECOYPENSATION, � CORIfI1BfClei � WILL DD TME WORK,ANO TNE STRUCNRE 15 NOT INTENDED OR OFFERED FOR S/1LE iSEC.7011.BU51� J � NESS A!p PROFE6SION8 CODE:lHE CONTFUCTORS LICENSE UW DOES NOT�PPLY TO�N OWMER OF PROPENTYYAIOBUILDSOflIYPf10VE5T71EflEON,ANDVAi000E55UCHWORKHlAASELFORHERSELFOR � ('L TIMIOUO{IHISORHERONRlEMPLOYEES,PROy10EO7HAT5UC/11MPROVEMENTSARENOTMlTEMDEDOq m � I�L OFFEq�Oi�i3M.E1F,MOWEVE0.1HE8UIL0iN60fl/dPiiOVEYENTISSOCOWfTHWONEYEAROFCOMPLE- Z TION,IHE QM�NEq-BUILDER WILL MAVE Th1E BURDEN DF PROV�NG lT1AT HE OR 5l1E DID NJT BU1LD OR � IMPNOVEWRTNEPURPo5EOF5AlE� I W O1+�80NMEROFTMEVR09EH7Y,AMEX0.USIVELYCONTMCTM'aWfi}�'IICEh5EDO0NTMGTOR4 � TO C04STRUCT T1E PROJECT(5EC.)aN,BUSiNESS MID PiWFESS10N5 CODE:'4E CONTRACTORS 11- VfllUetiOrl ADJ.AREA W CENSEWMWESNOTAPPLYTOANOWNEpOFAPROCERTYNRI�BUN.D50P^IVppVESTNEREON.AN� � � Y1M1iOCONTRACTSFOflSUp1PRNECT3WITiACONiMCTOR(S)LICENSEDPURSUM(TTOTHECONTMG QUANT�TY SCRIPTION �E � Td�S UCENSE UW.). O I AN E%EYPT UNDER SEC. 8.8 P.Q FOR THIS REPSON J Q U t�. ¢ DATE OwNEq V � LICENSED CON7RACTORS DECLARATION W J � 1 HEREBV AFFIRIA UNOER PENALtt OF PENURY?HAT I A�A LICENSEO UNDFfl PROVIS:ONS Oi CNAPTEP � � 9(CO►WF.NCIH(3WITNSECTqN7000)OFDIVtSION]OFTHEBVSINE49PNDPROFESSIONSCOCE,AND Z W UCENSE IS Ml FULL FOfiCE MYD EFFECT. qQm�� � UCENSE�rCJLASS � �+ 9 LIC.NO. b C%f`�� � .--. � Q4TE Y7 —jeZ ��� C�NTRACTOR C81�._S±��U4'f�' d �ASS __. = WORKERS COMPENSATION DECLARATION Q ` n � � I HEREBV AiFlHM UNDER PENFLTY OF PERJUFiY(N1E OF TME FOLIOWMG DECLaRA?IONS: Z �f�Y �- �� � _IWVEMIpW1LLMAINTMNACEIiTIFICATEOFCONSENTTOSEL�-INSUPEWqWORKERS' x �j``'>';' _ y�,T�.,,x ATIdl,�S PRONOED B'I SFCTION 3lao OF THE LAB�R COLE,FOR THE PEtiGORAAANCE �U 7ME WORK FOR WHICM THIS PERMIT IS ISSUED. ` 0 W IHAVEMIDWILLMAIHTA�NWQRKENS'WAIPENS�TIONINS�MNCE,ASREOUIREDBVSECTION j�� �\` 0 3T0.10FTHE LABOH CQ7E,FOH THL VEqFORA1MfCE OF THE WORK FOR NMICH TNlS PE4M17l5 ` 1�/ ) L`,SUED.MY WOPoCERS'CGAPENS�T�ON INSURANCE CARRIER AND POLICY NUMBER AAE: CONSTRUCTION S (a� � G1qqIEq�T��tG F'U�J�n^ pLANREVIEW I � POLICVMI�.+BEn �1�.ir 3 "1`�+ ELECTRIC � p (Il#SSEt,'fcMtt�F�NOTfl.'_O]I.PLEfEDOF7HEf'FPu�siaRauEM,N1R!�DOl1At�S(SiooJOHtESs? PLUMBING � ICERTIFYT}IATINTNEPERFORMANCEOFTHEWOHNFbPMMIdiTHISoEFMiTI5155UE�,l MECHANICAL () SHALLNOTEMPLOYANYOEPSONINANYMANNERSOASTOBECOMESUPJECTTOTNE � PrOflNERS'COMPENSATION UWS OF CN.IFQRN10.ANDAGREE THAT IF I SFKKR➢BECOME INSPECTION FEE SU9JECTTOTHEWON(ERS'COIAPENSATIONPROVISKJNS SECTKKJ37ooOFTHEtABOR �, C�OjDE,1 SHALL FqOPqT}IWITH C0IAPLY WITH THOSE V . NS. �� �SSUANCE p �ATE: C7`/�'/ / APPII��nN�rr+ � - �- SMIP J WApNINO:FA0.URE TO SECURE WORKERS'COIAVENSATION COVERAGE IS 11NlAWFl1L,AND SHALL EE ENERGY P/C � SU&IECTPNEMP�OYERTOCflIMINALPENALilE5ANOCIVILFINESUPTOONEHUNDREDTHOVSRND ENERGYPERMIT DOLURS(f1ao.0o0�,N ADDIi10N TO THE COST OF COMPENSATION,DAMAGES A3 PqOVIDEO FOR iN � SECTIDN 370EOFTiE LA90ft CODE,INTEREST.ANDATTORNEVS FEES. RETENTION FEE: y d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HENEHY AFFIflM UNDER PENALTY OF PERJUflY TMATTMERE IS A�NSTRUCTION LENDINO ROENCY Z FORTHE PERFORMANCE OFTHE NIORN iOR WHICH 7HIS PERIAIT IS ISSUED(SEC.3087,CIV.C.j. 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