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HomeMy WebLinkAbout15250 (20) -- �y CITY OF DIAMOND BAB -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Capley Drive Suiu 190 (909)860-3195 Pa�c(9Q9)861-311'7 PRESS ��'�� BUQ.DING PERMIT APPLICATIQN FIRMLY JOBSITE APPLiCAT10N f,� PERMR / p2 P/C o ADDRESS �- SL DATE � V NUMBER ��# c� ISSUE �j � TYPE OCC APN LOT T T DATE � � CONST. GROUP � OWNER ADD E�S� ZONING SEfBACKS � CITY��3` ZI TEL. � REART � p APPtICANT T��• SIDE/SIOE STREET RW ❑ � CONTRACTOR SIDE ❑ ¢ ADDRE S e��RpppgQD S — Q CITY ZI TEL. !' D � ��,� w ARCHIENG/ Ul(l� DESIGNER NO.DWEL. NO. O. + � AODRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. u' DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION � I O OWNER•BVIIDER DECUIRATION $�?/qpD1REM p i���sr�FFlwe ur�oER re++utv oF rEauar nur�ua¢xEn�ar c�n+E cor�rancToas u. Garege/Carport � CENSEWAIFONilIEFOLLOWINGREA90N(SEC.7031.SBUS�NESSANOPROFESSpN5O0DERNYCITVOfi (n �Ol9iTyNkCQ1R6�IW1E5APEIWITTO00fL•7flUCT.P1TERhIPflOVE,�EMOU3N.ORNEPAIRANVSTRUC- W P8fi0/DBCk iUli�PRION TO IT5 IS6UMICE.AL50 REOUIFlE5 TME APPLICJINT fOR SUCM PERGIT TO FlLE A SlQitlEO w � BTATE►IENT TIUT HE OR SHE 19 LICENBEtl PUflSUANT TO THE PROVISIONS Of THE CONTMCTOFS ll- � CENSE UMI(CHAPTEp Y(COYYENCIND M/ITH SECTION 7000)OF OIVISION 3 OF TNE BUS�NESS AND PRO- LL PooVSpa ! PE981MlSOOD�ORiHATHEORSHEISE%EAMTh1EREFN�MANDTHEBA515FOR1NEALLEOEDEXEAIP- TION.,WYVIOLATIONOFS6CTION7071.58YANYAPPLICAHiFOfiA7ERMITSU&lECTSTNEAPPLICANiTO Z F�g.ppp} - � 11GM1 PEN�ITY OF NOT MOFE TNI�N fNE HUNDRFD OOLURS(f5oo7.), � ❑�A40NMEqOFTHEPR07ERTY.ORIAVEIJRDYEESWITHWAGE5ASh1EIRSOLECOMPENSATION, C� CORIRIBfCIBI IVXL DO THE YY�RK M!�THE STRUCTURE�NO7�NTENDED OR OFFENEO FOR SALE(SEC.7ou,BUSI� J � lE55 NO PROFESSIONS COOE:TNE CANiqACTORS LICENSE UW DOES NOT AVPLV TO AN OWNER OF � PROPERTY WNO BUILDB OR pAPN0VE8 THEREON,AND WHOOOES SUW WORK HIMBELF OH HERSEIF Oq � � TMppUONN19pqNEqpN7164PLOVEES,Of70VWE�7W1T511GINAVROVEYENTSAqENOTINTEN0E0�A m � OFFEREDPDH9ALElF,iK1WE�iL7WE�U4DMOORMIPPONE4ENTI55dDV/f719HOP7EYElIROFC0i1pLE � TIGI,THE ONM6q-9UttDER WILL H�VE THE BURDEN OF Pf10VMIG TNAT ME OR SNE DID NOT BUILD OR � WPtiDVE FOIR 7ME PUFPOSE OF SIiLEN . W ❑4+�OM�NER OF TNE P�PEHT1;MI E)(CiU5NELY CONiMCTINC WITM LICENSfD CONTRACTOR3 � TO CONSTRUC7 iHE iRQIECT(SEG loM,BU31NE55 ANO PFpfES510N5 CODE:THE COMRACTOflS Ll- V3IU8tIOfi A�J.AREA CFNSE LAW OOEBlpTAPPIY TO AN ONRJER OF A VROPEFTV VAiO BUMS OR IMVPOVES iNEREON.AND WIiOCWRAACTSFORSUCHPROJECTSWITHACON�MCIOR(5)UCENSEDPURSUANTTOTMECONTMG Q�JqrJ'(�'�'y DESCRIPTIDN FEE � •_ TOASLICENSELAW.). � ❑1 NAEI(EMPT IMDEH SEC. B.d P.C.fOA THIS REt50N U � Q � u' DATE OMINER f' ! � W ; UCENSED CANTRACTORS DECLARA710N -� � w IHENEBY�FFIRMINJDERPElU17VOFPERIURYTHAT1AMliCENS[DUN�ERPROVISqNS�FCFIAP7ER � S y(COYYENCWOVATHSECTIDNToOa)OFOMSION30FTHE@USINESSANOPROFESSKNJSCO�E.AND z X y1'LICENSE 45 W FULL FORCE AND EFfECT. m liJ � � UCEMSE CU LIC.NO.� � I � � J V pATE CONTRACTOR a � � WORKERS'COMPENSATION DECU1RA710N a i � U � �FfEREBY�FFlRM UNDER PENN.T'OF PERJURV ONEOFTNE fOLLON/NC DECLAMTqN6: � � O �IHAVEMIDWILLMAMiTAMACEflTIFlCA7EOFCONSEMTOSELHNSUREFORWOHKERS' _ � COMPENSATION,AS�ROV�DEDBVSECTION370oOFTHELA80R�DE,FORTHEPERFORMANCE W OF THE N�ORK fOR WNK:M TH�S PERAIR�S ISSUED. � � �!HAYEAND WILL MAxJTANI M'ONKEPS'COMPFNSA7b/J INSUMNCE,AS REW�PED BY SECTION (� n 37000Fh1EUBOAGWE.FOFTHE�EHFOfi�IANCEOFTHEWORNFORWHICHTHISPERMRIS y�y.� /) ISSIIED.iJY WORKERS CC�MPENS�TION SURANGE CARRIER Afm GIXJCY NUYBEP ARE CONSTRUCTION �1, 1 L 1 � v/ � `O '� PIANREVIEW �^ - CARRIER � � ro�aV Mn�aER �" ELECTRIC � � �MssecnoNUEIDNoiaems�ErEnocn�aEare7stz%i Haa�ooa�aas(sim)oR�ess? PLUMBING �`I1���� � � �7� i � I CERTIFY7HAT Ni THE PERFORAINJCE Of 1HE WORK FOR WHiCH THIS PERMIT IS ISSUED.I MECHANICAL _.�rnT��R:�1'l - (J SHALINOTEMPIOVANVPERSONMANYMNAdER50ASTOBEC0�.1ESl�AEGTTaTME n��.�j"11YYUi AtA . � WDPo(ERSCOMAENSAT�ONUWSOFCPLIFORNIA,ANDACREETMATIFISHWLDBECOME INSPECTIONFEE . � SU8IECTTOTHEIMDRNER3'COAIPENSATKKIPFlO�ISpN50F5ECTION3�0oOFTHELA80R �SSUANCE �� CODE,l i/i/pp R7FNY�TH COMPLY NnTH THOSE PHO�n IONS. �. t�/�^ SMIP I p DATE:��_17��� APPLICAM: � �� � � ENERGY P/C W/JklINO:F IX URE TO SEW PE WORKERS'COMPENSATION COVEHAGE IS UNLAWFUL,M1D SHN.L BE �y SU&1ECTMlEMPLOYERTOCflIMINALPENPLT�E5M70qYILFlNESUPTOONEHUNORED7F101)SANO ENEFGYPERMIT DOLLAR.4(f100.0001.IN IDDITION TO TNE COST Of COMPENSATION,DFAIROES J15 PROVI�EO W R IN J SECTIDN370lOF7MEUBORCODE,MITEREST,ANDA7TONNEV'SFEES. ({�ENTIQNFEE: Q � CANSTRUCTION LENDING AGENCY PRE-ALT FEE: 2� IHEREBYAFF#iMUNDEFFENALT�'�FPCAfUNYTWITTHENEISACONSTAUC7IONLEMDWGAGENCy FOR THE PEflFORMANCE OF THE WORK iOR WHICH THIS PERMIT IS ISSUW(SEC.3oe%,CN.C.�. Z W � LENDEH'S NAME_ F— LENUER'SADDPESS� [y_(�y� � ICEHTIFYTXATIHAVERE/�THISAPPLICATION11N0STATE7Xl1TTHE�BOVEWFORM�iIONISCORRECT. TOTAL FEES � 1 AGflEE TO COIAPLY WITM ALi.CITY ANO COUNTY ORD�NANCE6 AND S�ATE UK5 REUTING TO BUIL�ING - CONSTRUCTION.AND HEREBY AUTHORI2E REPRESENTATIVES OF THIS COUNTY TO ENTEfl UPON TME � /�BOVE-MEMfqNE�PipVERT'F, ON'NSP�PURPOJS�ES. � COMMENTS O J.� /dNB�C � c� m FERMITTEENi1ME(PRIM'j-t ,� � / Cn ���l�91 /� tJ ��// � � _ [n S�GNATUREOFPERMITTEE� D�TE � fiECPL N0. PAID BY VALIDATION WHITE—Departrnent Copy�YELLOW--Finence Copy,PiNK—Assessor Copy, OLD6NROD—File Copy,GREEN—Applicant's Copy �ITY (7F C�1 �.��i°�C� �A� . 1��������� ������ � 1 �� ,°. �`� �,�, � s - s� „ � ,�x'� ; .��� �i��iEf � � I ��Q{��5�{���� . 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