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HomeMy WebLinkAbout14164 (14) �/�� __ CITY OF DIAMOND BAB ���f -' �� • � �XJp fAr DEPARTMENT OF COMMUI�TY&bEVELO�ENT SERVICES `O _ - ,a� 21660 E.Copley Drive Suite 190 QCT (A09)860-3195 Fax(909)Sbl-3]17 �3 1�0o PRESS� "�"�� BUILDING PERMIT APPLICA�TIUN FIRMLYI o AD R'ESS 1 � � DATEICATION �S NUMBER/� �� `� (� / g ISSUE TYPE OCC APN LOT TflACT �� DATE CONST. GFiOUP p OWNER __S�lJ� l2�+1 p ADDRESS_�°,�y�Z ZOMING SETRACKS Z CITY ZIP TEI� FRONT qyy ❑ � g APPLICANT TEl REAR ❑ � ' � � ^ SIDElSIDE STREET flW ❑ j CONTRACT�R S SIDE ❑ � C'DTMORESS Z�Q '� TEL,��� PROPOSED USE /Y��_—`'�t')a�L `S—G S�C� Q�r�/n d �'i�rp�'I Q W ARCHlE ,91 � DESIGNER R+C- df(,r(� (' � y NO.DWEL. NO. NO. ADDRE55 ►r o�-z R r�a u a c+�+ � CIN Z�p 4��� TEI�•l,��Zf UNIT3 STORIES BEDROOMS � r�rrr���� t+- v� DESCHIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION d 01NNER-BUILDER DECLARATION �q{ADDlREM O 1 HEPEBY AFFIAN UMER VEN�LiV OF PERNRY THAT I M1 EXEMPT FROM 7HE CONiRRCTORS U- Gaf2gH!C8fPOl1 W CENSELAWFORTMEFOLLOWINOREASON�SEG703f.68USINFSS�NnpqpFES51045CODE:ANYqTYOR (() �� OOIplIf'NHICaIpCflIAqESAPEAtlfTTOCONS7RUCT.AITEFl.IMPflOVE.OEMOLISH.ORREVA1qAryYS7RUC. W Z TUAE.PRqq TO ITS ISSUANCE.AL50 REW IPES T11E APPLICPNT FOR SUCH PERMIT TO FILE A SIGPIEp P���k � STATpl1EM 7{UT HE Ofl 9HE IS UCENSED WRSUAHT�O TNE VROVISIONS OF TME CONiMC70R8 L4 w � C(N�lAW(CFUIPTER 9(COGIMENCMO N7TH SECTION 1000)OF DIYiS1ON 9 OF THE BUSINESS AN�Pfl0- � PooUSpa FESSpN500DE)ORTHATHEORSHEISEXEMPTTHEREfqOMANOTHE9ASISFORTHEALLEGE�EXEMP• (� 7YJII.ANYVIOLATIONOF3ECT10N7031.SBYANYAPPLICANTFOpAPEPA1175U&IECTSTHEAPPI.ICNlrTp � py_popf � ACMLGFN.LL7YOfNOTMOFEIMANFiVEHVNDREDDOLUIRS(fSOG�.�: � � ❑I,/SOWNEPOFh1EPPOVEFRV,ORMYEMP�0YEE5WITHWAOESASTHEIRSOLECOMVEN5AT10M, 0 CORIfIIBfCIdI MIILLDD TME WORK AND 71�E STRUCTURE IS NOT INTENOW Ofl OFfERED FOR SALE�SEC.7�u,&J5L J Nf33 ANU PFfOFESSlOfiS OODE:THE CONTMCTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � � PqOPEqiYWVip8U0.DSOpHIPpOVESTHERE�N,ANDWHO0DE5SUCHWORNHIMSELFOflMERSELFOR � TNf10UON MIS OR HEH OWN EA�LOYEES,PROVIOEO THAT SUCH OAP40VENEflTS ARE NOT WTENDED OR m 111 OFF(�0 WH3dLEIF,YqWEVEi�TMEBUILD�NOORMPqpVEMETITI550LDWfTMNONEVEAROiCOMPLE� 0 iION,TNE OWNEREUII�ER W1LL iUVE THE 9URDEN OF PFOVING 7HAT HE Oq SME 01��T BUILD OH j MPROVE TOR h1E W PPOSE OF SIlEI. W ❑I./SONRIFROFTHEPROP[�7TY,AME7(CLUSIYELY�ONiRACtiNGWITHLICENSEDGONTRALTpiS � ro ca+srrw�cr n�e rnaccr�sEc.�aa,aus+nEss um rraov�ssows cooc n+e coNrn�crons u. Veivation ADJ.AREA CEN$E UW DOES NOTAPPLY TO AN OXTIER OFA PROPERTY WHO 9UIL05 OR IMPROVES'lHEPEON.AND ' � YMqCONTMCTSFORSUWVRWECTSWI'fHACONTFUICCOR{S)UCENSEDPURSUNtfTOTHECONTRAG pUANT�TY DESCRIPTION �E � roqs ucENSE uw.�. ❑1 A4 E%FMPT UTAER SEC. 8.a P.G FOR TMIS REASON J U LL ¢ DATE ONTIER U � W IICENSED CONTRACTORS DECLAAATION -� � w IlIEHFBYAFFIRAIUMIERPENALTYOFPERIURViHATIAMIif�NSEDUN�EflPqOV:S1IXJ5ocCHA77ER � :-'� �.� � Y(COIWENCMWVlITHSECTIDN7D00)�DiV15�ON30FTHEBUSiNE55ANDPROFE5510NSCOCE,AND Z X W LICENSE IS IN fL/LL FCRCE NJD EFFECT. � � �LL1 [ C� ; ---� LICENSE C�U15�3 Q_��'�71_��1 LIC.NO. R � � � OR7E—:llJ�� COPfTRACTOR �n���• 6J. � __ t5 '�T?ll' W 7 I�7 —�� � �� WORKEflS'COMPENSATION DECLARATION ¢ y} - ' v -,rr.�A ry � INEAEBY RMUNDERPENALTYOFVFRIUPYONEOFTNFFOLIOWINCOECLAqATKJNS: Z - i �• ' ¢ "'t�r+J,_,'� !�'/ � ��,Ii4NEANDWILLAUINiAIN�CEFITIKICATEOFC(MISENTTOSELFdNSURFGORYNDqKERS' _ COIfPENSATION,AS OPOYIOEO 8Y BECTfON T.9q O<?H£UBOR CC�£,FOq THE PEAFOAMANCE W OF THE V/ORK FOR WHICH TXIS PERMR IS ISSUED. � � � __„IHAVEANOYVILLM�IMIINWORKERS'GOAIPENSATIONINSUMNCE,ASREOUIREDBVSECTION Q 37000F TIE LABOR OODE,FOR TiE CER:pRMANCE Oi TNE WOpK�P WHICH THIS PEPMIT/S �� ISSUE�.MY WORKEAB'CdAPENSATIpN�NS CE CARRIER AND POLICV NUMBERAqE CONSTRUCTION � � jCMPoEN ..5��"C.—._. �� PLAN REVIEW 0 � � Z va�crm�u9Ep �'� — ELECTRIC �[ � SECfpNNE�NDTBE�RPLEfmOFh�PEPAAT75FORONEHIx�pPfDCCl1AN.4(f�0�9R!ESS) PLUMBING w .IiY TH�T W THE PE{iFORMANCE OFTHE WORK FOH WHICH THIS PERMIT 151SSUED,1 MECHANICAL z � NOTEM7lOYMlYPERSONINANYMANNERSOA5T08ECAMESU9)ECTTOTF/E N RS'CQNPENS�TIONLAWSOFCAIIWRNIA,IW�RGREETHATIFISHOUtOBECAME WSPECTIONFEE Ci 70 THE WOfl%ERS COMPENSATION VROVISpNS OF SECTqN 3i 00 OF 7ME LA9pR � COOE,ISHALLWflTMW1TNCOMPLYWITTITMOSEPFOViSIONS. / ISSUANCE � � C � on�:-�/�-��lt— APPLICANT:_1`�'��fcs'-"-�'�-�-- SM�P G �__T)_ � , J WAfiNIN6:FMUPETOSECUflEN'ORNEflS'COMPENSATIONWVERAGEISUNUWFULANDSH�6E ENERGYP/C /� � SUSIECTANEMPLOVERTOCRiMRJPLPENALTIE3PNUCMLFINESUPTOONEFtUNDF1£�TFIOUSAND ENERGYPERM�T �I4!'/._ . __ �„ Dq.LARS(=fo0,000),INADDITONTOTMEWSTOFCOMPENSATION,DqMAGESASPROV10E0FORIN V f�- h J� SECTION 97080F TNE LABOR CODE.INTEREST,ANDATTOqNEY'S FEES. RETENTION FEE: l�� � �.-UV a CONSTRUCTION LENDING AGENCY PRE•AL7 FEE: O � I HEREBYAFFIRM UNDER PENALTY OF PERJUflV T4iAT THERE IS�CONSTRUCTION LENDINO pGENCV FOR h1E PERWRAAANCE OF THE WOAK FOR WNICN THIS PERAIIT IS ISSUED(SEC.3099,CIV.C.). Z W � LENDEA'S NAME + T F- IENDEF'SADDqE55 � ICERTIFY7NATIHAYEflEADTHISAPPLICATIONM'OSTATETHATTHE/1BOVEINFORMITIONISCOqRECT. TOTAL FEES d I AGREE 70 COMFLY WITH ALL GY1V ANU COUNTY ORDWANCES AND STATE UWS REUTINp TO BUN.OINp ' CONS(RUCTWN,AND F1EFIEBY AUTHOPIZE REPAE5ENTATIVES OF 7HIS COUNTV TO ENTER UPON THE � �BDVE-MEN710NED PROPEATY FOR INSPEC7ION VURVOSES. COMMENTS 6 ���Li� �P=i="�� m PERAdI7TEE NAME(PRINn a p «� :%��: ,_ '�r' " / � f' � SIONATUflEOFPEFMiTTEE �. DATE � , �_' RECPT.NO. 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