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HomeMy WebLinkAbout17467 (26) , _� . _ �� CITY OF DIAMOI�iD BAI,t � �;' -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES _ .. � 2166(i E.Copley Drive Suite 190 (909}860-3195 Fax(909)861-3117 PR ESS q�""��' BUILDING PERMIT APPLICATiON ; FIRMLY � JOBSIYE ,.p { APPUCATION +"�PERMIT P/C a ADDRESS �::� d.�•��x ��r-cr c°�r a-�.e1' 1 �_'i! � DATE NUMBER # � ISSUE TYPE OCC APN LOT TRACT pATE CONST. GROUP o OWNER p ADDRESS c�./�5'�� rvc c�--ru�' ZONING SETBACKS � C�Ty� , FRONT Z!P TEL.a�'2'a%�- .�).��`_4`, REAR RW ❑ g APPLICAIV'f .�_� L�i �T'_ ,1 a __� TEL...�'"�(y ❑ � SIDE/SIDE STREET RW p CONTEiACTOR SIDE � � ADDRESS �r� ' ' ` _ .i%i;�T' � -t-- � ARCHl�/ y ' , PROPOSED USE �P,;�{, -�I-� � CITY .�-.-�-,�n ZIP " TEL. _�'�e3. ��'��� � � .., z DESIGNEFt NO.DWEL. . NO. e . �.�J�. � i ADDRESS UNITS � ' 'STORIES � BEDROOMS � � CITY ZIP TEL. ' � ' DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION' I �'I p� ', � � ' OWNER-BiJlL�ER OECL4RA710N SFR/ADD/REM � � � � i p ' '�I .d ��� I HEHE9Y AFFlRM UNDER PENALTY DF PERJURY THAT 1 AM EXEMPT PROM THE CONTRACTORS L4 Gdfa E/Ca Od , '��W 'CENSEI.AWWpTHEFOl.COWINN�REASONISEC.7031SBUSINESSAN�FROFESSION5CODE:ANYCITYOR (n 9 � ' '�. �COUNTYWHICHqEIX11flESAPERMiTTOCONSTflUGT,ALTER,IMPROVE,�EMOLISH.ORREPAIRANVSTRUP � ��'W SURE;PRIC�A TO ITS I$SUWVCE,AL50 REOUIpE5 TNE APPLICANT FOR SUCH PERMIT TO Fl�E A SIGA�ED � PaTio/Deck � - �� �,� STATEAIENT THA7 iiE OR SHE IS iLICENSEO�PURSUAN7 TO THE PROVISIONS OF THE COMMCTORS LI� ��i'� CENSELAW(CHqPTER9{COtl.4MP�h1ClNaWi7N'SECTION7000)OFDIVISION3�F4HEBUSINESSANDPRO� V" POOVSPa �FES:dONSCQOE)OR�THATtiEOp�,BHEISEX�M1�PTTHEREFROMANDTHEBASISFORTHCALLEGE�EXEMP- �(� . , �.�,,V '.TION.ANYYIOLATKKJOFSECTIpN7b31.5BYAPiYAPPLtCAN7FORAPERMITSUBJECTSTHEAPPLICANTTO ry` RG-ROOf � ��,� A CEVfLPENALTY OF NOT MORETHAN FlVE HUNOR�DOLLARS(E500).): ' ��I,MSOWNEFlOFTHEPROPERT/.ORMYEMPIQYEESWITHWAGESASTHEIRSOLECDMPEMSATiON, � Commercial � ',� VIILL DO iHE WORK,�NO 7HE ST�,RtJCTUFiE iS NOT IN7ENDED OR OFFER.EO FOR SALE�SEC.7044,BU51- �.J - ' � � '� NE$S AND PHOFESSIONS C�WE:THE CONTRACT�AS UCENSE VIW DOES NOT APPLY TO/4N OWNER OF �? � PROPERTYWHO�BUILtSSORIMP,R�VESTFjfiREaF9;ANDWHODOESSIJCHWCRKHIMSELFORHEPSELFOq � ' ';'.�� 'T1ROl1ON HIS OR HER OWN EMPLOYEES;PRQVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENOED OF m , ii OFFFAEO FOR 5�9LE IF,HOLA'EYEFL 11'1E BUIlDING Oq IMPHOYEMENilS SOLD WffHINONEYEAROF GONPLE� �0 I TION;THE OWNER-BUIt.�Eft WILL!HAYE THE BUqDEW OF PRONINC+THpP HE OR SHE DID NOT 9UILD OR �= IMPROVEFOHTFEPURPOSEOF$ALE), � , w ':❑I.ASOWMEpQFTHEPRQPF}?TY,AMEMCWSIVELVCAMTRACTINGWITHLICENSEDCANTRACTORS g✓'�, �,� TD CONSTRl1CT THE�PRi)JECT(S�EC:9tlAl,.6USINESS API�PROFESSIONS COOE:THE CONTH.R iCTORS li- V8IU8110� \6 ADJ.AREA_ ' ld.l. CENSELAWDOESNOTApPLYTOYWaNMER6FAPROPEAT'WHOBUILDSORIA9PROVESYHEREON,AND iWFlOCO,NTfiACi$FORSUCHPRWECTS`PYITHACONTRACiOR(S)LICENSEDPURSUANYTOYHECONTRAP FEE � ��I� mRS,uceNSEuw.). � � QUAN7I7Y DESCRIPTION ��'�,� ❑I AM EXEMP7 UNO�R 5ECi, _._. _B.&P.Q FOR THiS REASON e�( � � . � i.�.. �� . ., , � �. ..� . ��. .. . . V , . ' ���I � OATE � � .OWNER.. H �� Z U 'o � LICENSED Cf7NTRACTORS DECLARA710ld W � ,� � ��� :� . . . �H�RE9Y'�AFFIRMUNDER�PENALT�1'pf�PE0.JUfiVTHA'iIAMLICENSEDUNDERP3DVI510N5oFCHAPTeR � !,p„ B(CDMM€NCINf3W1PltSEGTION�tldJ.�KD1VISiON30FTHE8USINESSANDPROFESSIONSCADE,AND z ' '�[! MYLICENSEISINFlALFpRCEAPi7,EFFECT. m '.b UCENSE'CtASS___��, �..� . LIC.NO. � �i��r`�-� � ' �q,~j DATE� ' CONTRACTOR�g.�"L.s� o Q • Yi. �� OFEK�RS'COAAPEFISATION DECLARA710N � . � IHEREBYAFFIR@AVNDER;AENALT�'OppERJURYONEOFTHEFOLLOWINGDECLARATIONS: �—y` �o __iIiAYEANDWiLLMAINTAI�l�.CERTIF{CATEOFCANSENTTOSELF-INSURE-FORWOflKEFS' _ . � COMPEPoSpT10N,:45PqOVIOEUBY6EQT10N3TooOFTI1ES.P.BOP.C6DE,FORTHEPEHFORMANCE C3I ��:OFFHE690RKFORNyS9iC�MTHISPERMiTI5155UE6. W I ,��� ���IHAYE/WDIWILL'�FAAIP87AINWORK�'R9�,COMPENSATI�NItdSURANCE,A9REQUfREDBYSECTION ��I ,.�q -„ �°4' '.37d00F7HE LA@OR CYJ(S�,FORTHE�ERFOiiMhNCE QF THE WORK FOR WHICH TN95 PEflM1T IS � � •�.t'! �� ',ISSUED.MY WOfiKEHS f�.1p6P�ldS��IOM INSU NCE CARRIER AND POLICY NVMBEFARE: I CONSTRUCTEON I j��+° ¢ ,�. �.cnRP�ea �,-_I='�j��� � _,�..a:..s��.:�� PLAN FEVIEW ..�,' ���'�PoucvrivaneeR.'�.� �s�'"�,�����.+�! ELECTRIC ¢ i� (14iI5SEG"�1IXVNEf37NOY9F��qOMPLE'l'EDOFTHEPEM�MfISFORONEHUtQ1AEDDd,lAPS(§i00)CRLESS), PLUM�ING �`" --e'z-- ----- . _ W �� '� � �' � !; a L ;:.k ' \ 1 F :"-- ;� �: ICERTIFVTHATIR�IFY�p�F{FORMANC�OFTHEWORKFORWHICH7HISFERAAITISISSUED,1 MECHANICAL -� -'^'� '�._� � _ �i:9 C:T SHetL�N4T EMP4.D�'ANY P�,EISQN INlJVY MANNER SOAS TO 9ECOME SUBJECT TO THE �o �'(f)'�. VISIRKE�j�'COP�9P�NSpYYQNLAVif�$lSFG�FOPNIA,ANOAGREETHpTIF19HOULDBECAME iNSPECTIONFEE '� , � �'� ,SyBJEC'�7pTME';'N10RK�P'§:041P,�t�SA'tIqVPROVISIONSOFSECTqN37000FYHELABOR ' r.l ' C,C(JE,I SHALL F�IRTHYdfkT CORfiPL�'WITFITHOSC PROVISIONS. ISSUANCE � a � �` � W..� . � � # � . p. OATE. ..; �.. Pl&CAi�T: `��a�� �__ SMIP , . �_ �� b S �1 J'I WARNih}tl:'�AILU ETO5�i[1Ufl� IW�iICEV�iS COMPkNSATIONCOVERAGE15lRJLAWFUC,ANDSHALLBE ENEWGYP/C Iryr-�-�o � �, SU3JECT'�d,tdEMP�.QYER70�,,'ilMh,IA��PENALTIESANOCIVlLFMESUPTOONEHUNDREDTHOUSANO ENEAGY?ERMIT � �"" '"— ' oau�#s�s�oa aqo),iN Ab��710N ,O Tli�qOSY OF COMPENSATION,DAMAGES AS PflOVIDED FOR IN � � ����� � " �"", SECTION 3Yoa O�iITHE CqBb CO ,IN7E�dE$T,ANO/1TTbRNEV'S FEES. � � � �� P.ETENTION FEE: O��. �; w0 S�TRUC 510N LENDING AGENCY pRE-ALT FEE: �I, IHER�SYAKFIflp�1,UNbEfi;PFNA1l/�10��',P�R�UjiYTHdTTHEFiEISACONSTRUCTIONLENDWGAGENC7 FOR'HE PERW;flMANCE OF 7HE IM�ORK FpiR WHICH THIS PEflMIT IS ISSUED(SEC.3081,CIY.C.J. � WI ���". LENDER'SNAM� . . . IF-.�. LEN06P�S)40ppE$S �'�, ICERTIF`I"PHAY�HAVEREpb Hf9�APPLICAT�CJ�NN0�5TATETHATTHEABOVEINFORMAitONISCARRECT. TOTAL FLES � �.� ��', IaGPEETC7COMPLYW7iN,A�L�CIiI�AIANC''�CAU TYORDINANCESANOS7ATEL0.WSRELATMG708UILOMG � �., GONS�`pUCTfpN.WN�NEFiE6YAUfHbF71ZERF,PRESENTA71VE5OFTHISCOUN7Y70EMERUPONTHE - ' , ABOVE�M�wTfOWED P504?ERYY FQ�ft INSPcCTION PURP4SE5. COMMENTS � - ' �''i .�1 ,/� ��.'�i ,���c `Y'7����''�u � t:.��"{�, �-, i�+ . ��i PERMI NAI�E(pRIN�� f/�I . .p,; g / . � . �'� �i��� -�2 �r ��f"e�"aJ .� J/f d /C� � . � fj}'�, SIG 'N OFPERMITT£E �ATE - �I � � , , �,�. RECPT.NO.�PAID BV � VALIDA'f70N WHS�iE—Depanment CoAY,YELLOW—Fin�nce Copy,PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Appiicant's Copy � �� �,.ra" �„�P dx�'k�.�'is �,���^��r° �?"a,��� � . e % �:� ,� .:4"€� t :��.,t'� t�'w . ,. , . ., €�5�,�,.,a u., .:,�. .. . . . _ , . -n .., . . . � ����P" .,�'T�.� �. 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