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HomeMy WebLinkAbout10618 (5) � �x t t'r EkP�R�b COMMUNITY EVELOPMENT DEPARTMENT� ��Tn n 21660 E.Copley Drive Suite L9Q U�luQ� PRESS� (909)860-3195 Faz(909)861-3117 �^M' BUILDING PERMIT APPLICATION FIRMLY � AJ DDRESS �►S �` 7 � ,S� � �'PLICATION � ' �� NUMBE � f�� DATE c� ISSUE TYPE OCC APN_,T,� LOT RACT DATE CONST. GROUP � dWNER � L1r�' ADDRESS vZ E ~ l2 ZONING SETBACKS � CffY Nt '� ZIP TEL.,��J'G TSJ FRONT RW ❑ g APPLICANT TEL. REAR p � SIOE/SIDE STREEf AW ❑ CONTRACTOR SIOE ❑T— � ADDRESS ' PROPOSED USE � CITY ZIP TEL w ARCH/E � � DESIGNER n, AODRESS NO.DWEL. NO, NO. � C1TY ZIP TEL. UN1TS STORIES BEDROOMS � DESCR4PTION SQ.FT. 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FES4IONS OOOE�dt THAT HE Ofl SHE IS E%EMPTTHEREFROM AND THE BASI6 fdi THEALLEf3ED EXEYR TION,�M'VIOLATIONOF6ECTION703i.5BVANVAPPLICANTFOR�PEflMIT5U8JECT9iHEMPIICMlTTO Z R9-ROO} � ACMLPENMIYOFNOTNORE7NANFNEHUNDREDDOLlM51f5oo1.1: � Ol1sOV91EtiOFTNEPROPEil7V.oRMVEMPLOYEESWITHWAaE8�9THE1R' ECdAPENSATItlN. ❑ COmR�BfCiHI NnLL UD TNE wOiYc,AND 1NE STHUCILRE IS NOT INTFNDED OH OFFERED fOR 9hlE(SEC.7oH.BU51- J NESS IWD VROFESSIONS GOOE:T1E�H�.CTORS LfCENSE LAW DOE5 NOT APPLY TO AN OWNER OF � VNOPF3RYIWIDBU&DSORWV(qVE57HEREON.M�DW/1000E55UCHYMDflKHWSELidiNE0.5EL�0R � � 1NflOVRHN450RMERdWNEA1PLOYEES,VRWpEDTM�TSUCHM/VROVE4ENTSAflENOTWTENDE�OA m WQ OFFEqEOfOR&YEIF,IIOWEVE0.TMEBULOINGO(iMIPROVEYEMA55pOMnTWNONEYEAR(`�COIIPLE � T10N,THE OWMEq-BUI/DEN Wk1.IUVE 7ME BURUEN OF PROVMlO THAT 1�Oli SHE DID NDT BUILD Oq � IMPHOVE WH TF�WaPoSE OF SALE4 � ❑I.,�OWNEFOFTHEPROPEATY,MIE%CLUSNELYCONTNACT�NaWf117L�C6N5E000NTMCTORB TO OONSTRUCT TME PROJECT(SEC.TM4,B1151NESS 1J1D PROFESSIONS COOE:7HE CdNTWCTOR3 U. 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B.8 P.G FOR THIS f�ASON � u" DA7E ONRIEP � � ! � LICENSEO CONTRACTOHS DECLARATION � I I NERE9YAFFlRM UNOEN PEN4LTY OF PERp1RY iHni I AM LICENSED UNOEN P1b1hS4N8 Of CM�PiEA Q„ i(COIpIEMCNIO Vl1TH SECTION 7000)OF DMSqN 9 0F TNE BUSWESS�Np PfYJFE9910N5(,UOE,M� � X MY LICENSE�3 N1 FUIL FORCE AND EF_F�CT. / � Lll � �C1 (/r � � i � tICENSECiASS LIC.NO. � j � �,� � ���� y � W - � WOHI(ER5'COMPENSATION DECLARATION � � � U 1 N 1 HERGBY IFFIiW U�AEN OENAITY�PE0.IUAY ONE OFTNE FaLlOWiNG�ECUR�TqNS: Q �� x J 0 _INAVEINDWM.LMANTAWACEflTiFlCATEOFCONSENTTO3ELHN5UPEWHN�01tl(EHS' Z � COyPENSATI0N.A5 PROVIL�EO 8Y SECTiON sloo Of TNE IIBOR LODE,FORT/1E PERFORMANCE 'U pF n{�y��pp1(fpq WF�Iq1 THIY PEiW IT 15159UE0. � � w _INIVEANOWIIlYAMTAINWONKER9'COYPENSATIONM9UMNCE,hSA[WIPEDBYSECTIDN O 9700 OF TNE IABDR CODE.iOR TNE PEHf'ON,IMIGE OF THE WORK FOR WMq1 Ti115 PEIWR IS I63VED.NVWORKER�3'C,dyAP�F,)1EATIONINSU CARR�ERANOPOLICYNVIBERARE: CONSTAUCTION yC�RRIER �/2.r�� PLAN REVIEW � POLICV Nlll/1FR��T<<i 7'T� e�Craic �L � (fMSs[�ITNHE�raTeE00AHtTEDOF7I+EPEMtfGPoRor1EFiYt%IEDDdlu�sf3��IMtES51. PLUMBING � I CERTIiY T/UT M 7HE PERFORMPNCE�THE WORK FOR WNItl1'fNiS PE�WIT 1S ISSUED,1 MECHANIGAL r SMi�LL NOT EMPIOV ANY PEPSON W�NY Y�NN�R 50 AS TO BECdAE SUBJECT TO THE � �wwcEns'COMPENSATqNUWS�FCAI.IFORNI�ANDAGREEiHATIGISHOVLDeECOME INSPECTIONFEE � SUB.IECTTOTiE4WRKERS'COIAPENSATIONPRpViSiON FSECTqN97a00FTNEIJ�HOR Ocooe, s m�+rnrHca.�xrwm�7rw�arrov� �s. :i� ISSUANCE ..d r p DATE APPLICANT.� . SMIP W ENERGY P!C WMMIINO:F�LUHE TO SEdIRE Y�'dSCERS CWPENSAiION COYEFUGE IS UNUMfFUI.NAISHKL BE � SUBIECTMI EYPLOYEN TU CRNIINAI VENN.TIES AND CML FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT �I I� J 'I �.4�I p(1�(ap5({iop,dp�W i1001TION To THE C0.470F COY9£HSATION,DAMAQES 1S PROVbED iOR IN � SECTION9)OIDiTHELA80NCO0E,WTERESi,MlDI1TTORNEYSFEE3. RETENTIQNFEE: ��* pW„ CONSTRUCTION LENDING AGENCY pRE-AlT FEE: O � IHEREBVAFfIRMUNDEFPENhLTYOFPERNR�'THATTMEREI5ACONSTRI)CTIONIEN�NlOAOENCV WR THE PERFOPIA WCF OF iHE WORI(WN M'M�CN 7M�5 PEPMIT IS ISSUED(SEC.]OiT,GIY.G.). 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