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HomeMy WebLinkAbout14688 (19) � � CITY OF DIAMOND BAbi . DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � : � 2I660 E.Copley Drive Suite 190 (909)8C�(1-3195 Fax(909)861-3117 PRESS B�,FII.DING PERMIT ARPLICATION FIRMLY � JOBSITE � APPLICATION ` PERMIT / P!C � AODRESS 7ATE NUMBER��# c� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP g OWNEfl " ADDRESS ZONING SETBACKS Z C � ` „�� ZIP�TEL� � FRONT RW ❑ g APPL CANT TEL. REAR ❑ � SI�E/SIDE STREET RW ❑ CONTRACTOR � SIDE ❑ � ADDRESS i _ ��P _ CITY ZIP TEL � Pv-it,l��E � ARCWENG/ MO/S�j�- z pESIGNER NO.DWEL NO. , NO. St' ADDRESS UIVITS STORIES BEDFtOb � CITY ZIP TEL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUILDER DECU1RATiON �w��E� O � 1 FiEREBY AFFliM UNDEN PEN�ILTY OF PERJURY 7HAT I AM E%EMPT FROM T1E COMTMCTORS LI� (�`aBgO/CarpO�t YJ CENSEWMFORTHEfqlOWNOREASGW(SEC.)o31.68USINESSANOPROFESSIONSCODE:ANVCINOR (n V OIXWfYM4MQ1REOlARESAPEIWRTOIXYiSTRUCT.AL7E�tMVRDVE.DEMOl1SH.ORPE9M�IANVSTAUG `W P3tio/DBCk WTUqE PqqR 70 RS ISSUMlCE,ALSO pEf#WWEB TME AVPLICANT FOR SUCiI PERMIT TO FIIE/151GNED � STAiE1AENT TMAT HE OR SNE IS IICEDLSEO PURSUANT TO TNE PRWISIONS OF THE CMITRACTOHS Lb � GENSF WY(CHAPTE9 9(Cq1YEtlCWC1 YATH SECTqN 7QODi OF DIVIS�ON 9 0f 7HE BU5M1E55 AND PR0 LL P��Pa FESRqNS 009E)Ofi iHAT ME OR SME IS E%C-4lPT 7HEREFROM AHD TNE BASIS F057HE ALLEREO EXEMP• TqN.ANYVqU1170NOF5ECT10N7071.68YANYAPPLMAHTFORA7EPo/ITSU9JECTS7NEI.PPLICANTTO � Rp.Rpp+ � � A CIYR PEtNL7Y OF NOT MONE THAN FIVE HUNUHED DOLURS(is0o).): � OA��MMENOFTIiEPPOPERTY.ORMYE1WlOYEESWITHNMGESASiHEiflSOLECOMPEN5A710N, � COT1I1BfCiel - 1M.L p0 T!ff WORI(MD THE STPUCTURE 45 NOT MfT6DS1E0 OR OFFERE�FtlH SALE(SEG 704,B1154 J I�Sg A!D 7qOFESSpHB OODE:THE COHfRACTORB LICENSE UW DOES NOT APPLV TO N7 OWNER OF N pqppAiT`(Wlq9UILpSOqO/PqOYFS7NEREON,MIDMMDDOESSUQIWOAKH�N3ELFORHEN6ELFOH = `�. � THq011fL1 H180R{�R OMM ElIPLO`/6E5,PROVIOED lHA7 SUCFI 14PHOVEMFNTS ARE NOT dfTEN0E0 OR m � OFFEPEDFORSKE6.HONk�ERTNEBUILDINGORIYVROVEMRlTISSOLDWITMiNONEYEAROFCOYPLE- � �TION,il�OYq�Pobl14DER NML If�YE TiE BVNDEN OF PROVUH3 TMAi ME OR SHE DW NOT BUItD OR 111PAOME FOR TlIE PUPVO5E OF S�LE� � O I,A6 QYMEP�F TNE PROPGR7Y,A116%CLUSNEIY LDNTMCTINU WRH IICENSED CONTRACTORS 7C1 OONSTRUGT THE PRO.IECT(SEG.7041.BUSMESS HID PROFE9SIONS CODE:THE COHTRACTOFS lF VelUel1011 AQI.AREA CEtLSE UW DOES NOT APPLV TO FN OWNEH OF A PROPERTY WN09U0.D5 OR IMPROYES TMEiiEOM,AND � MlIpOONTMe78GONSlJCHOROJECT4WIlHACONfRACTOR(S)L�ENSEOPU0.SU11HTTOTMEmIfT�iAG p�q�ITY DESCRIPTION FEE � mns uc�uw.�. O I MI O(E/APT tNAEA SEC. B.6 P.C_FOR THIS NEASON a Q � p/�h OkMER U � LICENSED CONTRACTORS DECLARATION W J � W I NEREBY 11FFWM ld1DER PENALTY OF PER%/RY TFMT IAM LICENSEO UNOER PFIOYISIONS DF CHAP7ER � � 0(OOIIiENCl10 WlTH SECTqN 70(N1)OF DMSpN 3 OF 7HE 9USINE55 AND PROFESSIONS CADE,11ND � X MY UCENSE IS BI ML FORCE AND EFFECT. m `p IJCENSE a �.� L�c.ldo. ��.�L� j J � pA7E CONTRACTO a W � WORKERS'COMPENSATION OECLARATION Q � IHEREBYAFFlRMUNDERPENALTYOFPERRIHYONEOFTHEFOUDWINGDEClAMT10NS: � � z � _�HNVEAMD W1LL MARVTAM��HfIFIC+RE OF CaNSEM TO SELF.IN3l1RE FOR WORKERS' _ C0IIPEMSATION,�SFROVIDEDBYSECTION770�OFT/IEI/�AORCODE,FORiNEPERFORNANCE W OF THE WOFlK iOR WHICH THIS OERMIi IS ISSUE�. g � _I HFVE AND WILLMAINTNN WORKEPS'ODMPENSI1ilON INSURANCE,AS RC-0UIRED BY SECTION �O r � Q 81oD OF tHE UBOR CODE,(-0R 7ME PERFOMAANCE OF THE WORK FOR WHIG1 THIS PERMIT IS ISSUE0.MYWORKERS'C0�/PBi5�R10NINSUPoINCEC�RRiERANDPOLICYNUMBERARE CONSTRUCTION ? 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