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HomeMy WebLinkAbout15449 -p - � �� � - � CITY OF DIAMOND BA� / �- DEPARTMENT OF COMMUNITY 8t DEVELOPMENT SERVICES ��� 21660 E.Capley Drive Suiu 190 �) ( � � (909)8603195 Fa�c(909)861-3117 PRESS 'x"� BUII.DING PERMIT AFPLICATION FIRMLY � v% �ossi� $,�D�dZ� �. � APPLICATION PERMIT P/C � a ADDRESS �� �� . � � ' Z��i� DATE NUMBER �� # ISSUE TYPE OCC � APN LOT TRACT DATE � � �d�� CONST. C,ROUP � OWNER [��iir i.5 SrY1�'f'�1 ADDRESS 1 ZONING SETBACKS z CITY `"- ^ Z �f 7�'� TEL. `!�'-��� -1 FRONT RW ❑ g PPUCANT CC. :^4 l!��"'�"�� TEL."�,`�._�i-►.�11; S DE/SIDE STREET RW ❑ g � CONTRACTOR SIDE ❑ � ADDRESS g CITY �p T�. ROPOSED USE � � w ARCWENG/ � � DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS � STORIES _�BEDROOMS � � CITY ZIP TEL. � <n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AFi�ANALUATION Q OpVNER-BUILDER"DECLAHAT70N $Fp(ADD/REM O p I MEREBY AFFlNM tRbER OENALTY OF PE0.URY THiR 1 AN E%EMM FAON TXE CONTRACTORS L4 G8l99B/Ci81pOA �}i CENSEUWfqiTHEFOLLOWRIOREAEON(SEC.70.91.68USM1ESSANDPf10FESSWN3CODE:ANYqTYOR (J� G,7 �(}�yyWq�q[�qEgrpE(W(�'(ppppgTpUC7.�ySEq,pdPROVE,DEYOLt97,ORREPo11flNlYSTRUC• W Z TURE.PRpR TO ITS ISSUANCE.ALSO REqlIHES THE APPLICANT FOH SUCH PEREtIT 70 i1LE A SIGNEO Paip/DBCk � STATFJ,1ENf TNAT HE OR SHE IS LICENSED PURSUNJT TO THE PHOVISIONS OF 7HE CONTR4CTORS lF � ! fEl�LAY/(GFUPTER Y(COYYENCINO WITry$EGTpry 7p0D)OF�IVISKKI3 OF THE BUS�NE55 AND PRP PooVSpa g FESSIONSCOOE)ORTHATHEOli5HEI5E1fE1JPTi}IEREFHOMANDiHEBASISFORTHEALLE6E0EXEYP• (� { V TION./W'/VqL�T10NOFSECT10N70D1.56VN1VAPMICANTWHAPERAIITSUBJECTS7HEAPPIICANTTO Z Rg-Rpp} y�IJ A CIVIL N OF NOT AIDHE T/WI FNE HUNDRED DOLLARS(i600).): � ^ .J150WNEROF7MEPROPEFin:ORMYENPLOYEE5W17HWAGESASTHEIHSOLE�AIPENSATION. O COmmBfCidl - � YALL iHE WDAI(AND THE STRUC7URE IS NOT IMEI�DED OR OFFEREO iOR S�LE(SEC.701t,BU51� J � NESS AND PHDFESSION.4 COOE:TNE CONTRACf00.4 UCENSE LAW OOES NOT APPLY TO AN ONMER OF � PHOY9if�W1#OBl/ILD80FitAPROVES7HEREON,MAWi#ODDESBUqiWORKHIMSELFORHERSELFOR � � THROUGHHISORHEqOWNEYDLOYEES,RiIOVIDE071UTR1tliN1PROVEYENTSAqENOTINfENDEDOR m OFFERED FOR 511LE IF,1iON1EVER��GOfl MWipVEMFNf FS SOID W11'M�N ONEYEAftOFCOM%.E- � iION,THE ONMEHEURDER WILL MAVE iHE BURDBi�PROVMIf3 iMAT ME OR 311E��NO7 BUIID OR YPFiDVE FOR T11E PuimasE oc SM.EI. O I,AS tlMAffR OF TE PROPERTY,MI E%CLUSNELYCOHTRACTNO`MT}1 LICEN6ED COHTRACTOR3 � TO CONSTRUGf TME PiqJECT(SEC.7014,BUSM/E55 MA PFOFESSIONS CODE 7}tE COMMCTORS U- Vfl1118t10f1 ""� ADJ.AREA W GEltlEUWDpESNOTAPPLYTOANONMEROFAPROPERTYWHOBULLD50RMAPHOVE3IHEREON.ANO � WMDODHTMCTSFORSUpiPRDJECT5WIh1AWNfRACTOf1�S)LICENSEDPURSUANTTOIHECOMRAC� QUANTiTY DESCRIPTION FEE � T�Oti8l10ENSE I.AYY.} . i ❑�M1 DfEMPT UNDER SEC. B.l V.C.FOR THIS RFASON Q U ¢ � OATE � OwNER V � J � �_, LICENSED CONTRACTORS DECLARA710N W � I HEREBY AFFIRM l4qER FENALtt�PElWRY TNAT I AN IICENSED UNDER PROVISKKiS OF CHAPTER � � �t001lIENCNO N7TH SECfION 7000)OF OMSIDN 30F iNE�SINE55 AND PROFESSIONS CODE,/�ND z X MY UCENSE 45 W FlJLL FORCE tND EFFECi. � LL1 � LICENSE CUSS UC.N0. j V DATE CONTfUCTOR a lL WORKERS'COMPENSATION DECLARATION Q � IHEREBYAFfIRMUNDERPENKNOFPE0.NH1'd�EOFTHEFOLLDWING�ECLAMTIONS: Z � �_IlUVEMDN�LLAIAMJTM7ACERTIFlG7EOFCONSENTTOSELFJNSUFEFORWORKERS' s LOWENS/RpN.ASPROV!DEDBVSECilON37WOFTFIELABORCODE,fORTHEPERFORMANCE w OF TiE WORI(f-0q WHipl THIS DEPIAIT IS ISSUED. � I HAVEAND WILL NAflJTAIN WORCEfi3'COIAPENSATIaJ INSIIPANCE,AS REOUIHED BY SECTION � 97000FiHELABORCODE,PoRTNEPERFORMANCEOFTHEWORKFORWMICHTHISPERM1T15 �^�, ISSUED.MVNqRNERS'COMVENS�TIONINSLJ(UNCECARRIEHANDPOLICYNUMBEHME: CONSTRUCTION 1[✓ � CAHPoEN PLAN REVIEW Z ��Y�p ELECTRIC �C � (I}6SECIIONtEIDNOTBEoo�RETIDOFTHEPEP►IffSroitoNEMAOPIDOotUx5gt001oRLFSsF PLUMBING ���-`����1,�1�iiu[ii 1G; ZI CERTIFY 7HAT MTHE PERFORNANCE Of iHE WORK FOH wHICH THIS PEtiMIT I5ISSUED,1 MECHANICAL �'lY/T A i(�y}����,L�� �S' SHALL NOT EMPLAYANY FERSON W ANY MAfJNER 50 AS 70 BECOME SU&IECT TO THE C�-[.T4'�J Uj WOi1KERS'CONPENSAiIONUwS�CAL�GORNI/�ANDAGREETHATIFISHOULDBECOA/E �NSPECTIONFEE t'� 3UBJECTTO7HEWORKERSCOM7ENSATIONPROVISKKi50FSECT10N�7000FTHEL180R ( ' �- �.,; s 000E,i swul wrrnMnni cbua�v vnrn nasE vRohsaNs. ISSUANCE .I�f `.i � � SMIP � �� p DATE: 0.PPLICAM: wWAWIINO:FALIWETOSEWPEWORNERS'COMPENSATIONCOVERAGEISI/tMWNL,AND9HALL8E ENERGYP/C �y SUBIECTANEYPLOYEflTOCR1111NALPENh1TiE5ANOCMIFMESUVTOONEHUNDHEDTHOUSAND ENERGYPERMIT i �:. DOLURS(f100,0oD).W/�ITION TO 7NE COST OF COMPENSATION,DAMAOES AS PROVIDEO FOR IN � SECTION 37oe OF TNE LA60R LODE,MJTEREST 11NO A770RNEY5 PEES. RETENTION FEE: Q CONSTRUCTION LENDING AGENCY o PRE-AlT FEE: � IHEREBYAFFliaAUNOERPENALTYOFPERIURVhIATTHEREISACONS7RUCTIOHLENDINOAOENCY Z FOHiNE PER(ORM�NGE OF iHE WOHK iOR WHICH Ti13 PERMR IS ISSUEO(SEC.3087,CIK C.). W � IENDERS NAA1E 1�- LENDER'SAWRESS � IAG EETOWNPLVWITHN.LnC1iY�N�COUNNORDNAN ESANDSTA7EUIW&REU71N(3I70BURANO TOTAL FEES 1��� lo V � CONSTRUCTION,ANDHEHEBYAUTlqRIZEREPRESENTATIVESOFhIISCOUNTYTOENfERUPON7HE �BOVE-MENTIONEU VpOPERTV FOR INSPECTION PURPOSES. ( � COMMENTS � , 1 � ��-Il f� : _S jy�y Q oEawrtrE�lr �- � � � ��� � REOFPEMAITT � D�TE � RECPT.NO. 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