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HomeMy WebLinkAbout14719 (20) E � � CITY OF DIAMOND BAx /--�'"'� � DEPARTA�IENT OF COMMLTNITY&D�VELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS BUIL.DING PERMIT APPLICAT[ON FIRMI.Y � JOBSITE . APPLiCATION�,��..,Ua PERMIT � PJC � ADDRESS 3l ! �ATE NUMBER # � ISSUE TYPE OCC APN LOT TRACT - DATE CONST. GROUP � p OWNER � o ADDAES� ZONING SETBACKS � CfTY ZIP TEL. �' REAR � ❑ APPLICANT TEL SIDE/SIUE STREET RW O � � CONTRACTO �� SIDE ❑ } p� ADDRESS PROPOSED USE i� � � CIN� Q� ZI�� TEL. - ��L a o ARCWENG/ � z DESIGNER NO.DWEL. NO. NO. k' ADDRESS UNITS STORIES BEDROOMS � y CIn Z!P TEL. � rn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAlUAT10N � OVJNER-BUILDER DECLARATION ����E� O p i�n�r��t urroEa reNtirr oF r�a.�unv nur i uu Ex�cr c�tt�=_courrucroAs u- Gerage/Cerport lJ,! f�LAWFOR'MEFOLLOWINOREI1fiON(SEC.T0.97.SBU5INESSANDPROFESSIONSCODEMIVCIT'Ofl (n GJ COlMRV1MitlIREOlWIF9APERWITTO00NStiWCT.ALTEFl�PF�YE.DEAqLl�M.ORREPNPANY3TRUG (L Z TIME,PRqR TO RS�BUAMCE,ALSO REp)NifS THE APPLICANT FOR SUq1 PERAIIT TO FILE A 51(il�D W Pa�'°/D�Ck S7ATEI�NT THAT!IE OR SHE IS llCENBED PURSUANT TO THE PFbYI310N8 Of iHE CONTRACTOfi8 LF � f.'�SE LAW ICNMiEA i(WYYFNCWO V/ITH SECTIOM 700C)OF DIVI$ION 9 OF TME BUS�NESS AND PH0. V' POOUSpe � FESSIDNRCOO�dtTHATHEOp5HE15EXENPTTHEREFiiOi/ANDTNE8A515WRTHEALLEOE�EXENP- � � V TION.MiYV10L�710NOFSECT10NN31.58YAMYAPPLICMfTFORAPERWT8U&IECTSTHEAPPLICANTTO Z �-Fjpp� � AGVIL PENAITY OF NDT IIOHE THAN FlVE HU�HED OOLLMS fS60n1.): ❑4��A�TMEPROPERTXORA1Y91PLOVEESWITHW4QESASTt�iR50LECO1lPENSATIOM, O (`,pmmBfC�&I MALI p0 THE WOq�AND THE STHUCTUNE IS NOT INTEND6D Oq OFFERED FOH SALE(SEC.7W1,BU51- ,..� 11fiSS NO PNOFESSIONS CODE:TNE OWTHACTWiS LIC8i5E UW DOES NOT PPPLY TO AN OWNER OF � g � P�PiYNRqBUN.D80RNlPRD1�EBii�q�1.Al�NAfODOESSUCNWORKHIIASELFORHEHSELFOR € Q TNROUWi MS�1 HEIi OVM El/PLOYfcFS,Pi1DV7�E0 THAT SUCH WPHOVEl1EMS ARE NOT INTEN�ED�i m ( Q .OFFBI�FORSKEIf,NOWEV6RME917�M100RMIPfiOYFIAENTISSOLDW17HiNONEYEAR�GOMPLE• � � TION,iHE OMMEA�BU0.DER WILL NAYE THE BUimEN OF PROVING THAT NE OR SHE D0 t�T BUILD Ofl E MIV/1DVEFORTlffPURRDSEOFBALE). P (1J ❑tA8aMR1EROFTIEPRDVEfff1'.MIEKCLUSNELYCONTRACTMOVMiNLICENSEDCONTRl1CTOR5 ('[ TO CONSTRICT THE PROJECT(SEC.70N,BUSINESS Mq P1iOFESSK.�N3 ODDE:THE CONTRACTORS LI• �(glu9tiOn ADJ,AREA W CF11SEtAWO0E8NOTAPp�,YTOiVlOVM&qOFAPPOPERTYNFiOeVILDSORIMPROVESTNEREON,AND � MMDWNfAACTBFOqSUCF1PRQ1ECT5WITMAODNTRACTOR{S)LICENSEUPURSUANTTOTI1EOOflTRAG OUMlTITY DESCRIPTION FEE � iOQ6 L1CB�ISE LAYIJ. ' . ❑i Mi E%EMVf U1AER SEC. 8.6 P.C.FOR THIS REASON Q � V LL H DATE OWNEH � W UCENSED CONTRACTORS DECLARATION � � W iliEq�Y 11FF%#/IMDER PENlLLTY OF PER0.IHY THAT 1 A11 UCENSEO UNDER PROVISIONS OF CHAPTER � s Y(Cp,tllE1lCYNi WRH SECTlON 70ao�OF DMS�ON 3 OL iHE BUSINESS ANO VROFESS�ONS CODE�ND Z LLJ �LICENSE 4S M FUl WRCE AND FFiECT. �� m � L.�ENSE � IIC.NO.T,_„� � U DATE COMRACT /Fr d t� WORKERS'COMQENSATION DECURATION a = U � IHEIiE9Yl�FFlPNUNOERPENALiVOFPERRIRYONEOPTHEFOLLOWM6DECUMT10N5: � Z Q � _�H/,YEµpyJ��{,MAIM�IN�CEATIflCATEOFWNSENTTOSELF-MSUREFOFWORKERS' $ COYPENGATpH.115VROVAE�BYSECT10N7/000FTHEUBORCODE.PoRTHEPERFORNANCE �U OF TkE WORK FOR WHIGI TH�S FERNIT IB ISSUm. � 0 _I HAVE ANO WILL MAfl7fAM VVOW(ERS'COMPENS�TION IN9UfUNCE,MS REWIRED BY SECfqN Q 7700 OF 1ME UFlOR COOE,FOR 1ME PERFORIA�NLE OF THE WORK FOflNTiICM THIS PERMIT IS � �/ 6 � ISBUE0.MYWORKERS'CCHA�FNSATIONINSl1R�NCEGRR1EilANOPOLICYNUYBERARE: CONSTRUCTION � � C�Rfl1ER ' — ._ PLAN REVIEW � aa�crra»ne���1/ � — ELECTRIC � (IlISSEC�ONNEIDNpTPEap,�lEfFnOFnfpEwdTSR7RONEFAf�DREDOa.WLS(Stm)OHL.Ess� PLUMBING Z I CERTIFY 7HAT IN THE PERFORM�NCE OF TME WORK FOR MlF4CH TMIS PERMIT IS iSSUED,1 MECHANICAL (J SHALL NOT EMPLOY NJV PERSON N ANY I.IANNER SO�5 TO PECAME SU&IECT TO THE � VKIRKEHS'COMPENSATIONlAYY50fCALIWRNIqANDAGREETIATIFISF70UlO8ECOME INSPECTIONFEE S SU&IECTT07HEVI0RKER5COMPEN51UlONPROVISiDNSOFSECTIDN37000FTHEU80R I �� cooE. sHw. ca.+aiv Nnn�nasE n� ISSUANCE � SMiP � � pA APRICANT: . . � ENERGY P/C WARNINO� l/RE SEWREWOPICERS'COMPENSA7KKJCOVEMGEISUNUWFUL,ANDSXIILLBE � SUBJECTANENPLO RTOCRIYINALVENAlT1E5ANDCIVILFWESUVTOaJEHUNDREDTHIX15AN0 �RGYPERMIT OOlLAR9({100,000),IN/�DDITION TO THE COST OF COMFENSATqN,�AMAGES AS PROVIDED FOR IN J SEC710N 97oe OF iHE LABOR CODE.MITEHEST.AND A770RNE1"5 FEES. RETENTION FEE: Cf+�` '4 p� _ OCONSTRUCTION LENDING AGENCY PRE-ALT FEE � f 1 Y �- � 1 HFHEBV AFFlRM UNDER PENALtY OF PERIUPY iHAT THERE IS A CONSTRUGTION LENOING AGENCY FORiHEPERFORMANCEOFTH WORKWRWHIpiTHISPERNITI5155UEO�5EC.3oB7,CIV.G). ����� Z ��� --=v � LElAERSNAME • �.y,/I��� �__,/' / 1— LENDER'SAOORESS�/VK-7JII�JLTmY��C� � ICEHfIFYTW�TIHAYEREADTN�9MPlICATIONIWD5IATEM�.TTHEABOVEMFORMATKKJISCORRECT. TOTAL FEES d IAOREETOCOIAPLYWITHILLICffYANOCWNiYORDINIWCES/JiDSTATEUWSREUTINOTOBUILDING CONSTPUCTION,AND HEREBV AU7VION�ZE REPAESENTATNES OF THIS COUNTY TO EHTEfl UPON THE S�. ABOVE•MENTIONEDPNOPERTYfORINSPECTpNWRPOSES. COMMENTS � � m PER1IfREE NAME(PR ^� N \ / _ — ��/� /�� �q SIONATUREOFPERMIITEE DATE � RECPT.NO � PAID BY VALIDAT1pN I WHITE—pepartmant Copy,YELLOW�inanee Cc�y,PINK—Aafassa Copy,GOIDENRO�Ie Copy,GREEN—ApplicenYs Cop� -- ��T'Y` �� �t����l� ��� ' ��� ����� ������ � � � �. � ; :� � i FTC FOiti �5lSTEcL i ' I� FLC}QR JC}IST �, . - ; S�T�AC6� , __._...�.��__. , � .._..-_.�.._........_. .� .�..e. '...�_ E '� r j F�-IA REGl1Vi i S _-- - ' ' € C��={;l�Ffi�;;G,�''sOiJ�'JD � ; ( UIW(7�Fi FLCiC7R(Jt1CTT__---._..'� ! ---.T__..r�.._ ___.. . ��OUt�J��'LUE���1�lC� i ' UNDEF� FLOQR CC)t�r�UIT . � T..-_ � , � _.�..__ ;.. - - i �L.r";�4,�?=i�;�� j FIRCPLt�CE�C3UivDAI'iORI � I �� . _ � i�;uEe�+'�`v�l��? ! F3R=PLfi�CE HC�ND BEAP�1 i �__�s �� ;f f,�T�F�S��Vd � � i � .._.�, ' f €v�ID HT. Bf�(UD BE��� .. ,, f ; � __ _____ . . �-- _.._ ._ '• c `�____I�1�.M _—.��,��µ'� � e.. '.E3 F`T°. 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