HomeMy WebLinkAbout12140 (11) i
� CIfiY OF DIAMOND BA& j�,
DBPARTR4ENT OF COMMUNITY&DEVELOPMENT'SERVICES
� 22660 E.Copley Drivo Suite 190 c
(909)860-3145 Fa�c(909)g6t-31t7 PRE$$
'"'- B�DING P'81tM1T APPLICATION FIRMLY'
r J06SITE �- , c �:• DATE CATION� �� � PERMIT � P/C
o ADDRESS � NUMBER,�_ �
� aPn' OT TRACT ISSUE e�l,� L� TyPE pCC
p OWNER _�r�� �ATE CONST. GROUP
p ADDFt�SS � � 1�� ZONING SETBACKS �
� CfTY � r ZIP TEL.Q'y��r,4}-�'�G.� FRONT pW p I�
APPLICANT TEL. REAR �
� SIOFJStQE STREET qyy p
CONIRACTOR C SIDE �
� ADDRE � \+ t�
C� �'� ZIp ' TEL. PROPOSED USE
� � ARCFUENG/
DESIGNEfl
� a ADORESS NO.DWEL. NO. NO.
� C� Z�P TEL. UNfTS STORIES BEOROOMS
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAll1A710N
O OWNER-BUILDER DECLAFATION SFRJADD/REM
� 1 NEHEHV AfFlf W(NOER PEN�LTY pF PEf W AY THAT 1 AA1 E%EMPT FROM THE CONiqACTOpS Ll- G9fg9p/L81pOR
CfllSELAMfOMTMEFOLIOWINOREASWIS8EC.709f.68U5WE55INOPROFES51�f�SCODEAN'lGTYOR (n
CGINRYMR9qIRE0UIf�8APEIWRTO�ON67Rl1CT.KTERtiP1�VE,DEMOIJSH.OqpE1MIRpNY57AUC- W PatiolDeck
NR�.PNOR TO fT3�SSIIANCE,AI.SO NEOIIWES TXE APRIGNT FOR SUCN PERMIT TO FILE�516NED w
S7AlH1EN7 7ru1T NE oR SHE t3 L1C�NSEp pUpgVAM TC7 711E PA(rvI570N5 Of THE LOHiRACTORS t1-
� CB15E LAW(CHMfER Y(COMMENCWO NOTii SFCi�OPI 7600)Of DMSq119 OF 7HE BUSINE55 ANp PRo- �'�' POOUSQd
FE881DNSCO�EjORY/iATHEORSNEISEXEI.IPTTIfREFAOMAND7HEBASISFOPTHEALLEOEDE%EYP- �
�T701'1..W�VIOLATK7NOF6ECT10N7677.6BYANY4PRN:AHTFpqAPEFA11T5lS.lECT57NEAPPLICAh(7T0 , �g,ppp�
F �qV1LPElUL7YOFNOTMURE71ilWFNEIiUNDRWD011AF3(i5W).�;
� ❑l�aM1ER0i7HEPROPEqTY,OqMYE4PLOVFFSWl7}iWA�E3A9THEIR50lECOMPENSATIDN,
M�1100 THE WOh(.Af�TME StFlUCTUUqE IS Pqi Rt1ENDED pp OFFERED FpR SILE(SEC."1011.9USI- O C�
y �&G MI�PNOFE85WNS CODE 7HE WMfMCTOR6 UCEN6E LAW�OES NOT AVPLY TO Ml OMMEp OF =
PMDiERTY MM09ULD30R YPSIDYES tNEREON,lJb VMOUDES SUCH WOqI(NULSE�FOq HEASELF Oq
2 7Wi0flIi114&ONIIEAOWNEMPLOYEFB.MWVl1EDTNATSUpiIYPPOVHIENI'S�NOTINTEN�EOOR m
G] .o�neo�s�.�.tar�vEan�eeu+towconn�vwovEua+rissanwirHn+assveAaoccou�te-
2 T10N.Tlff ONNER-dIIIPFR M7LL FW�E 1HE BiADEN OF PROyINp T}(;i ME OR SNE DID NOT BU1(p Oq
� YVRDVE FOR 7FIE PUNVOSF oF S�LE4
�y O 1 AB OYN�P Oi7HE PROPENfY.AM IXGLUSlVELY CONtMGTNO WI7H LICEM.SEO CONTR�CTORS
¢ TOCMtS7AUCiTHEPAQlECT(SfG744.6USWESSAtNPRqFE$SIpN3CO0E:THECONTRACTOASU' VOIUBHOl1 �
= CEtLSEWYD�68NOiMPIYTO+WONMENOFAPROPEpTYWF10BU1LD50RWPqOVE3TiERFON.Aryp ADJ.AREA
f_ Mwcartn�c7sr-0qsucHVHaEcrsNnn��carrn,�cTOR�sy��cENseotvr�sunrrtrornecatip�u pUANTITY DESCRIPTIOM �E
� roqs ucasE uw.}
D IM1 E%EA1Pf IN�DEA SEG B.t n C.FOp 7HI5 REASqJ q � � � y
U �
� ah OWNER �
� U
1lCEN8ED CONTHACTORS D£CUlAAT10N W �- � �
� I HEqEBV AFipW UPOER PEN�iLTY OF PE0.N1M TNAT I MA IICFAlSED UNDER PROVISIONS OF CH�PTEA � .
�(�OIWGNCHO WffH SECTION 7omJOF OMSION30F TME 9USINESSANO PfbFE55pN5 CODE,M'D ��J
MY UCENSE IS N R1LL FOACE�EFFECT. z
o x• tDro3ti�J �
� � S5 ��.�. " ,�__ _
V �1� CONTMCTOR Q
lZl •, I
� WQR!(EqS'COMPENSAT70N DECLARATION ��3`�� � Q
� 1}iEAEBYAFFlP4UTAEAPENiV,TVOFPERRIRYONEOFTMEfoLLOMlNGDECLARIITION�: U
y 6
� �_IWlVEANpWRIMM�TAMACEMI'IFICATEOFCONSENTTOSELFINSt1REFORWORKER3'
COilAEM5AT1U1,AS PqOVIpEp BY SECTN7N 3]00 OF'ME LABpq�OpE,fOA7HE PERWRMANCE U
OF TNE YVORK FOR WMN7i Th113 pEqy�T Ig ISSUED. �
� ,�_IHAVEANDMnLLMVN{/�NIYOPoCEAB'CqIPENS�ITIOry1NSURANCE,ASREWIRED6VSECTION D U
Q a7000F7ryEU80RCODE,FOflTHEPERWRMANCEOFTHEWOpKFOqWHIC1{7F��gPEWA1T15
�, ISSUE�.MY1W CONVENSA�INSUMNCECARRIERANDAq�ICyHUMpERAAE: CONSTRUCnON
} c,�aA�a_��'Y Flx�\+ , � PL4NREV�Ew
� � Paecr��nEa— � \�`1 i�ti�, ; �. t��t , ELECTFIC
f d fn�s5cand+r�wrt�m�a.t�uccn+Ea�rsr�or�HurnnEooau�sa�m) PLUM8ING
I Z 10EPTIF/7HIITININEPEpipp�l/WC�OFRIEWORKFORWHICN7H15PEPM17151SS��� MECHANICNL
I SFWl NOT ENPLOY ANY PERSON IN ANY MANNEfl 50 AS TO BECOAIE SU&IECi TO i
� (�j� 'NJRKER5 COMPEN9A1fON L!N/S OF CJ.�IFOANIA,ANp AGAEE lHAT iF I SNOULp BECOME iNSPECTION FEE
� SUBJECT TO THE NbRKER5 NM�ENSA7IDN PRON510N5 OF SECTqN 37o00F THE UBOR
1 O CODE,�Sµ/dyFOR�NWIT�(%YdpIYYnMTi10SEPADViS10Ng, ISSUAIJCE
� p DATE: APRICANT. SMIP O
�' � EnE�cv P�c
WAIO/tNCY fl.�Uf1E TO SECURE Y/ORKEfl5 CONVENSATION COVEAAGE IS Ui1AWFlA,µD SHALL BE
" �y SUg1ECf AN EMP�OYER TO CR�MMIIL PEN�LT�S AND CML FMIES UP TO dJE HUNORED T/IIX15.Wp EryERGY PERM{T
JD�117�.0.S(5100.wp�,lµppplTfON TO�FIE CAST OF CaIIVENSATICN,�AMACES AS VROVIDED FOq�ry
SECTIDN 37oe OFTHELA80R ODDE.�NTEFESL MI�ATTORNEYS fEES.
� RETENTION FEE:
CONSTRUCTION LENDlNG AGENCY PRE-ALT FEE:
a IHEREBY/IFFIpMUNDEflPEN/1LTYOFPERIURYTHATiHEREISACONSTRIICtIONLENDMGAOENCY
FOR TNE PERFORMANCE OFT1E WORK FOR WHILH THIS PERNIT IS ISSUED�SEC.�oY1,CIV.G).
Z
W
� lR�E7S NAME
LENOERS MDRESS
W ICERTIFYTIiATIHA`/EREA�7HISAPPLICATIONANDStATETHATTHEABOVEWWRMATIONISCOqRECT. TOTAL FEES {
� IAOREf7000YPLYWl7H�(yCRV.1NDCOlMiYOpOINANCESl4YDSTATEUWSqEUTNK3�OBUILDING
CONSTNUCfqN,MIO MENEev AUT1qR2E REPRESENf�TNE3OF THIg CIX1NfY TO EMEq UPON THE �����'
A9DVE�AE EDPppPEflTYFOHINSPECTIONWRPdSES. COMM
� � y
� °E"w' `a'�, ``� '�.� � �
(q 810NATUPE E OATE
� AECPT.NO. PAIO BV � VAI,)DAT10W I
WliITE-0apartmqnt CoQy,YELLOW—Fina�ae Copy,pINK—Asaeasa Cnpy,6019ENHO�Fib ,GREE
Copy N--ApplicanYs Copy
C1TY C1F C►IAI�tOt�1D �A�t
li�i��'EC71t7N RI��C�f��
� � � , � - a � »
SET BACK � � F�OOR JOIBT
FfGSIFOF�PJISfB�'EEL ; FNA REQMTS -
Et�ECT�iC CaROUP3[� UNDER FLOOR DUCT -
GROUND PLUtv1�ING UNDER FLQQR CC}R4DUIT _ —
SLA�faftADE FIREPLAGE Ft3UNDATl4N - •
TE�P P{JWER �IREPLACE 8QN€�BEAM --- -
WATER SERVICE M1D HT. BOND BEAM - . _.. - f
RC3C?F SNEATHIIVG j 7' --I-8 FT.60ND BEAM � �
FRA9L11NGlVE�lTILiAT{C}N FIN,4L BONa BEAM �
FiL3CrF C(�VEF� PRE-GRADING �
Rt}U(aN FiEi�ilPdG BEPJCH9NG
ROUGH ELECTRIC � RCUGH GRAC7fNG I
ROUGH f'LU€�1�81t�;G FINISH GRADING j
SNOWEFi,'TU��TEST PQf7L ELECTRIC _ �
EXT. Lr�THI5IDING � __ ._ —.i�� POOL.�ENCING i
V`,dALL It�SUTATiCl�i I �i I ROOL FINAL �
CElL3ivG f�3S1��ATiC3N OFF SiTE l�v9PS.
DR'(4hJALE.tV�;RLl�1� DED1CATiONS �
S�Vr'�R ��- - FVNAL ENG. �-- -- --�- �
S�€�T{C TAi�i}: . LANL}SCAPE/IRRiG.� i
SE�:Y PiT/L..L. —�—��� C�N SITE 11,1PS. ____���____�._� ;
GRS�6�i TES�' � � Fi�l��ZONING `�
FiPd�C�CY[o�57. ��+ -�/ � �IRE DEI'T. �'1tJAt �
FINr1�.HEATIP�i� . }r .���_.�. HEAL.TH D�r T. FIPlAL ��" ! .—__ � ;
FINr�L E�LCTRIC _ .. i� � DEV.�EES P�IL? �^ I
�I�tAL F'LUPv�EiitvCa . ` - - � ENERC-�1° y i
___�___._______._ _�_. _____�___ �.. }
I � O O ,. ! y � 4
_ � �
�U$L�%���T..�'.� i �
,
I
� � �
t
� .._. _ __----— --_
S�F'Tf�T�N�S SIZ�
S�Ei'Pl�lU�lZ� � __
_ �_ _ ._ _. "I
�. y
� j
-.'....'.----n�e ..r�__..____ �
_ '�R�����. __`_.._..— ....... �
w� � -a��- .,