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HomeMy WebLinkAbout12621 (11) � �\ CITY OF DIAMOND BA� � -- " DEPARTMENT OF COMMUI�TITY&DEVELOPMENT SERVICBS � _ � 21660 8.Copley Drive Suite 190 ,,, (909)860-3195 Fax(909)861-3117 PRESS - aun�nvG r�aT nr�cn�oN FIFtM�Y __ ¢ ADDRESS �f""'�� ���� t i{'�� ��< APPLICATION .. PERMIT �/„� �/C p DATE NUMBER �S� � � ISSUE TYPE OCC APN lOT TRACT DATE CONST. GROUP � OWNER o ADDRESS t � ZONING SETBACKS � CITY � � ` FRONT RW ❑ APPLICANT TEL. REAR ❑ � SIDE/SIOESTREET RW O CONTRACTOR �'--� SIDE ADDRESS �p � CITY �� ZIP TEL ROPOSEO USE � 1� / U w ARCFVENG/ �� g DESIGNER NO.DWEL. NO. NO. � ADDRESS �----� UNITS STORIES BEDRQOMS � CITY ZIP TEL. � cn DESCRIPTlON SQ.FT. FACTOR P5F ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION &Fq/AOD/liEM O 1 HEREBY AFFlAN UNDER PENAL7Y OF PENURY THAT I AM EXEMPT FPOM THE CONTRACTORS LI- GaIB e/C.B• K W CENSEIAWFORTHEPDLIOWIN(3(iEASON(SEC.70.37.6BUSWESSANOPROFESSIONSCODE:ANYCITVOfl (n g � WUNfYMl111WREqlAqESAVEWpTTOIX]NBTpUCT.ALTERIAIPROVE.DEAIOLISH.OR9EAAIHANY3T4UG W P0110(OBd( � 711NE.PIiN.M TO ITS RSUANC�AL&O l�OU WES THE MPLICANT fOfl SUqI PERMIT TO flLE A 91OHED � � STATENENT THAT ME OR SNE IS LICfiN6Ep WASU,WT Tp 7HE PROVI570NS OF 7ME COA'TRACTON6 Ll• � CFlSE UW(CHAP7ER 9(COAIMENCWq NtlTH SECTI�J 7000)OF D11I�SION 3 OK THE BUSINE55 AND Pp0- Pp01/Sp8 � FESSpNSCOD�O1111MTHEORSHEISE%EYPTTMEREFROMAN�T7EBA516FORTHEAUEQEDE7(F1AP• (� � iION.MiVVIOLATI0NOF5ECTiON743t.6BYANYAPPLIG�NTiORAPERMITSU&IECTSTMEAPRLICJNTTO ���Rpp� �„_ A CNIL VENALTY OF NOT hqRE 7M(�N FNE NUhqItED DOLURS(f5oo)J: O ❑4��M�NEFOF7NEPROPERIV,OAMYEYPLOV6ESWITHWAGESAST!#IR60LECOAIPENSATpN, ❑ (',pmmBfClBI Z W0.L DO 1HE W,WYC,AND THE STRUCTUpE IS NOT IDITENDED OR OFFERED FOH SRLE(SEC.7oY,BU51- J � t#SS M0 PROFES&KY18 WDE:TNE fbA{TMCTOR6 LICENSE LAW�OES NOT�PPLY 70 N!OYfIER OF � PROPEAiY WNO BUtl.D4 OR W Pq04ES TMEREdJ,MID NMOOOES SUCH NpNI(HIIdSELFOR HERSELF Oq � T}Y1017qN WS OR FI�R ONM HVL�Y�ES,P90VIDED THAT 9UCH IMPROVEMEMS ARE NOT INTEd�ED OH � L� OffEREDFORSALEIF,HOWEVER�BIdILOW�ONWPRovEUEN71S50tDNRTHINONEYEAROFCOYPLE- � i70N.AIE OWN6R�I.1IL�ER WILL HIN�E THE BURDEN OF PROVINO 7HAT HE OR SHE�IO NOT 6UtlD OR YPNDVE fGiTNE PURPdSE OF SALE). W ❑1,AS OiM�R OF TME PROPERfY,AN E%ClUS1YELY CQNTMC7IN(i N'fTH UCENSED CONTRACTORS � TO CONSTRUCT 7NE PRO.IECT(SEC.70N,BUSINESS AN�PROFESSIqJS CODE'1HE CONTfL1CTOHS LI� ."� V011/BtiOf1 - ADJ.AREA CENSEUIM/ NOTAPPIVTOM10V/hIFROFAPROPERiYWl108UILDSORIMPROVESTHEREON,ANO MMO FORSUCMVRO.lECT5VATIACONTRACTOR(5)LICENSEDWfLSUMlTTOTMEWN7W�G QUANTITY DESCRIPTION FEE � T00.4 IAW.). . I AM IXEMPf UNDEfl SEC. 8.6 P.C.iOR THIS REASON a � U � . � DATE ONMER �- W � UCENSED CONTRACTORS DECLARATION W � I FiEHEBY AFF/W UMOER PElULTY OF PERq1RY 7HAT 1�M LICFNSED UNDfR PRONSNINS OF CHAVTER � � Y�fbYYGflCttY3 WITH SECTION 7mo)OF DNI610N]OF THE BUSINESSAND PROFESSIONS CODE.AND � �j MY IICENSE IS Wi il1Ll FORCE ANp EFFECT. ui m � IICENSE CLASS LIC.NO. j � DATE CONTRACTOR d WORKERS'COMPENSATION DECLARATION � Q � I MEREBV I�FFIRM UNOER PENNLTY OF PENURY ONE OF TME FOLLOWING DECLAM710N5: Z � �_IHAVEANDWILLNAINTAIXACERT�FlCATEOFCONSENTTOSEIF�INSUREFORWORNERS' _ COYPENfiATIDN,/S PROVIOm BY SECTIOW 37000F TNE IABOR CODE.F�i THE PERf-0RMANCE W O OF THE NbRN FOH WHICN?M19 VERMIi 15I5SUED. � w _I HAVE M1D YnLL 4�AttlTA1N WORI(ERS CCMPENSATION INSVRANCE.AS REWIRED BY SECTION . Q. 3700 OF 7HE LAPOR CODE,WFl THE PERFOAM�INCE OF THE YYORK FOR NR11CH THIS PERMIT IS � 0 ISSUm.MYYNDRKEHS CO/lPEN5AT10N INSURANCE CARRIER M!D POLICV NUAIBER RRE: CONSTRUCTION� ► jcAnniEn PLAN REVIEW � Pq.ICYNUMBER ELECTR�C 0 �ssEcnc�r�woreEm.a�oFnf�s.rrsroaaueM�aEnoou,ws�tiao�oA�ssy PLUMBING Z 1 CERTIFVTHAT INTHE PERFONYANCE OP THE WORN FOR WHICH THIS PERMIT IS ISSUE0.1 MECHANICAL (� SHALL NO�EMPLOV M!Y PERSON IN ANV M�NNER SO AS TO BECOAIE St1BJECT TO THE N WDRKERS'COMPENSATIONUW50fGLLiFORNiAANOAGFEETMATIFISMWL�6ECOME INSPECTIONFEE S SU9JECTTO THE N'ORKERS CQNPENSRTION PROVISIONS OF SECTION 37000F THE LABOR CWE,I SHALL FORTHWITH COEAPLY WITH TIiOSE PROVISIONS. ISSUANCE i � (] DATE: APPLICANT. 5MIP y � ENERGY P/C �A I! /���n nn W�RNINO:FAILURETOSECUREWORKERS'COMPENSATIOFlCOVERAOEISUNIAWFULANDSHALLBE }j�j LL SU&IECTANENPi.OVERTOCRIMMKPENPLiIESPNDCNILFINESUPTOOf�IEHUNDREDTMOUSAND ENERGYPERM�T DOLLAflS(S10D.00D�IN MDITION TO THE GOST OF COMPENSATIDN,OAM�GES AS PROVIDEO FOR IN /'1�r��^ � J SECTIDN 97De oF7HE LABOP CO�E.N7EREST,AND ATTORNEY'S FEES. RETENTION FEE:1►11 I l)F TT,�i {'_ '� :- � CC b*� i+i�i4�'T��t. _r_�. , d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: J74Lyy,��� - - � � r ,,:.��,•,. .._ . � 1 HEREBV 11iFIRM INiUER PENALT'OF PERIURY Ti1�T 7HERE IS A CONSTRUCTION IENOMG AGENCY FOR 1HE PERFORMANCE OFTHE WORN WR NMICH THIS PERMIT IS ISSUE�(SEC.3007,CIV,G�. Z i LLJ � lENOEWS NNAE f- lENOER'SADDRESS I � ICERTIFYTHATINMEREADTHISAPPl1CqTIONANDSTATEh1ATT1EABOVEINFORMATIONISCORRECT. TOTAL FEES ` , d IAGRE�TOCOMPIYWRHALLCfTYANDCOUNiYORDINPNCESMlOSTI1TEUWSHELA7INGTOBUILDINa � CONSTpUCT10N,ANDHEP.EBYAU7}qRIZEREPRESENTATNE50FTY1I5COUNTVTOEMERUPONIHE ABOVE•MEMIONED VROGERTY FOfl INSPECTqN PUAPOSES. o ��� ���� COMMENTS � m PERMITTEE(/��� .��p RIN�--� ,�p (p SIONANREOFPEflWTfEE� �AT�`��_ " � � RECPT.NO. PAID BY - VAL.IDATION WHITE—Depertment Copy,YELLOW--Finance Copy,PINK—Assessa Copy,GOLDENRO�File Copy,GREEN—Appiicant's Ccpy �iYY a�' L�1�1�VIt3P+i� B�#R It��l�ECTiC�N I�E���tD � i � � � � � � � p � S�T BACK � _ � ( FLO(7R JOIST " l FTGSiF£7Rt�S15TEEL FHA REGIMTS � I �L�CTRoC GRUUND UND�R FL(�OR DUC'f" • � GRt7l3ND PL�U��i�ENG , ' UNDER F�OQR CC1RlDUIT _ , . , SL�«B GRADE I _ ; f`IREPLACE�OUtdDATIQN -�-, ----- • : TEt�i'PC}rNER FIREPLACEBC7ND BEAM . - ( V'Vr*+TER SEf�VICE , 7 MID HT. BONd BEAP�i ( �oa�s���-r��ra� - r_��'tg� ��c:� s�r.�o�D eEAn� --_ i FRA�itvGfYEtvTILI'�TI{�i� . . . . 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