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HomeMy WebLinkAbout14257 �� CITY OF DIAMOND BAA � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � : � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax( )8 -3117 PRESS �'�'A�'� � BtJILDING PE APPLICATION FIRMLY � JOBSITE � APPLICATION � �� PERMIT � '��:,! PIC � o ADDRESS DATE NUMBER �-�� # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER ��i3.S�t �C�� " ADDRESS O ` ZONING SETBACKS Z CITY � ZI � TE � - � FRONT RW ❑ g APPLICANT � ' ' �TEL. � S DEJSIQE STREET RW ❑ a�4q CONTRACTO " '�� SIDE ❑ ADORE s � 0 CITY y/ ZIP TE . PROPOSED USE �Y�1j.V� $n � w ARCN/ENG/ � z a:� � Z DESIGNER�� NO.DWEL. NO. O. � � ADDRESS UNITS STORIES BEDROOMS � CI7Y ZIP TEL. � �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O �- I HER�V AFFlPM UNDEN PENRLN Of PE0.111RV THAT I0.0 EXEMPT FROM THE CONTRACTORS LI- Gdf&9B/CBffM(I W CENSELAWFORTHEFOILOWINGREA60N(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITYOR - (n COUNTVYYH�I1flEIX11RESAPERMITTOCONSTRUCT,ALTER,IMPROYE,DEMOLISH,oRFEPAIR.4NYSTRl1G �-W P9tiDIDBCk . TURE.PRqP TO ITS ISSUMlCE.QSO RE4UIRES THE APPLICANT FOF SUCH PERMIT TO fILE A SIGNED -W STATEAIEM THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTPACTORS LI� W �: CENSEUW(GHAVTEP9(CO�MMENCINGN7THSECTION�000)OFDIVISION3OFTHEBUSINE55pN�PRO- �'�' Poo�Spa �.- FESSIDNSCODE�ORINATHEOHSNEISEXEMPTTHEREFROMANDTHE8ASI5FORiHEALLEGEDEXEMP- V TION.ANYVKKATIONOFSECTION7o3t.68YANYRPPLJCANTWtiAPEHMITSUBJECTSTHEAPPUCANTTO �Z pe-Roof � A CML PENALT/OF NOT ASORE THAN FNE MUNORED DOLLAfiS(5590).): ❑I,ASOWNEROPTHEPROPEPTY.ORMVEMPLOYEESWTHWAOESASTHEIRSOLECOMPENSATION, -� CommefCial - � g� Wlll DO THE WOFi1C,AND THE STRUCTURE IS NOT INTENDED OR OFFERED fOR SALE(SEC.7o4a,BUSI- J � N NESSI,NDPROFESSIONSCODE:7HECONTfiACTORSLICENSELAW�0E5NOTAPPLYTOANOWNEHOF � .PROPERiY YhIOBUp.DSOR IMPROYES iHEflEQY,AND HRiO OOES SUCH WOflKHIMSELF OR HERSR.F OR (_- TF8i0UGHHISORHEROWNEMDLOVEES,PROVIDE�THATSUCHIMPROVEMENTSARENOTINTENDEDOR m- �{ _Q_ .OFFEHEDFORSALEIFFiOYVEVEFLiHE8U1LDINOORIMPROVEMENTI550LDWI7HINONEYEAROFCOMPLE ' _z- -TqN,TNE OWNEP-BURDER WILL HAVE THE BURUEN OF PROVING RIAT NE OR SXE 010 NOT BUIID ON- �. IAIPROVE FOR TNE PURVOSE OF SALE). � W_ ❑I,ASOWNEROFTHEPROPEHTY,AMEXCLUSIVELYCANTP.ACTI��OWITHLICENSEDCONTRACTORS (�- TO CQNSTRUCTTHE PROJEGT�3EC.7aN,BUSINE55 AND PflOFESSIONS CODE:THE COI�TRACTORS LI� VdIUdiIIN1 'ADJ.AREA Il!` CENSEUWOOESNOTAPPLYTOANOKNEROFAPROPEHTYWMOBUILDSORIMPROVES7HEREON.ANO Z: WFiOCONTRACT6FORSUCHPRQIECTSWI7HA00A7MCTOR(5)LICENSFAPURSUMlf707HEWN7MP - QUANTITY DESCRIPTION FEE Y- rons uc�se uw.�. �� - o- ❑IM7 EXEMPTUNDER SEC. � 8.8 P.C.FOR7HI5 REASON : Q � 3 U_ � � DATE OWNER k U W � .�-. LICENSED CONTRACTOHS UECLARATIDN - W -�-:. IHEflEBYAFFIRMUNDERP'cNFLiYOFPERJUftYiHAT1AMLICENSEDUNDERPROVISION50FCHAPTEfl . � � -�� 9(COIAAtENCINO WITH SECTION 7nm)OF DIVISION 30FTFlE BUSINE55 ANO PROFESSIONS CADE,AND Z X__ MY LICENSE IS IN FlM1 FORCE AND EFFECT. - - m � .�- UCENSE CLASS �-_l � LIC.NO. � �^✓ �� p -. j _U� DATE ��� �_CONTRACT6R � C.S+��' a � � W -� WORKERS'COMPENSATION DECLARATICN � �� , -�- I HEflEBYAPFIRM UNOER PENNLT!OF PERJURY ONE OFTriE FOL�OWI`1G O[ RATKKJS: � ' Z � -C]: _IWIVEAND'MLLFIAINTNNACEflTIFiC,ATEOFCONSENTTOSEIF-W REFORWORKEHSti = . .�-' COAlPENSATION,ASPROYIDEUBYSEGTfONaiooOF'HElA80RCOD, RTXEFEPFORMANCE W: 1HE WORK FOR WHICN THIS PER411T IS ISSUED. � .: I HAVE ANO WILLMAIMAIN WORKERS'COMPENSATION 14SURAhCE.AS RE�UIRE�BY SECTlO �s ��` �� Q.' 37000fTHELABOflCODE,FORTHEPERf'ORMANCEDfiHEWORi(iORWHiCHTHISPEflMITIS -0` ISSUED.MY]aORKERS'COMPENSATIONMSUWq1NCECARRIERANOPOLICYNUMBER . CO THUCTION :'�-- �>>1/"' . _}: CARRIER � � +'� v PLA EVIEW Z_ POLICY NUMBEH - ` � � - � IC Q �: �.0. (fNISSECIXXJNE�NOTBE�LETIDOFh,�PEFWtt�SFLYi�NEMF�OliEO �Sioo) �Ess� PLU ING ��� W _Z.. I CERTIfYTMAT IN iNE PERFORMANCE OF hiE MlOHK FOR WHICH THIS PERMIT I i CHANICAL =(,ef�- SHALI NOT EMPLOY ANY PER5'J.4:4 ANY MAN4ER-SO O BECOM'e SUBJECT TO THE - :�- WDflKE(iS'COMPENSATIONLAWSOFCRIIFOPNIA,RN GHEETHATIFISNOULOBE ME INSPECTIDNFEE __� SU&IEGT TO THE WORKEflS'COMPENSRT PROV NS OF SECTiON 37o00F TFi OR ¢ ['� � �, CADE.I HALLFONTHWITHCOMPLVWITHT O ROVISIONS. ISSUANCE � � f t`�o � ���� DATE� � . APPLICANT: SMIP ��'�'�. a,- . - 0 w ENERGY P/C �� r �`��f� ,�a _�_ WARNING iAILURETO SECURE WOflKE COMPENSATION GOVERAGE IS UNIAWFUL,AND SHALL BE ���y�:� �� T i � -:�y,- SU&IEC7ANEMPLOYERTOCRIMINALPNALT�ESANDCIVILFINESUF700NEHUNDREDTHOUSAN� ENERGYPERMIT � �� !��-� �'�'�"- DOLLAFIS(S�W,000j,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN M�� --J�. SECTION97D8OFiHEL460RCODE,WTEREST,ANDATfOPNEY5FEES. RETENTIONFEE: �:�- CONSTRUCTION LENDING AGENCY PRE-ALT PEE: _..__ _________. O' -��- IMEREBYAFFIRMUNDEflPENALNOFPERJURYTHATTH[(i[ISACONSTRUCTIONLENDINGAGENCY `�-- fON THE PERWRMANCE OjFTHE W'^ORK FOR WHIGH THIS PERMIT IS ISSUEO(SEC.3097,CIV.C.�. - W: /�f �J :�; LENDER'S NAME ..FS—�. IENDEWSADURE55 -� /�j ;W:_ ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFOPMATKKJISCORRECT. TOTAL FEES 1 �� � `� :�� IAGPEETOCAMPIYWITHALLCITYANDCOUNTYORDINANCES/WDSTATELIWSREUTINGTOBUILDING �: CONSTRUCTION �HEHEBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE _Z_ ABOVE ED PROPER7V FOR INSPECTION PURPOSES. w COMMENTS `�` � J— �rS �. ' m PE 1 E (PRINT) �. � . ' ��- PEflMITTEE DATE - = RECPT.NO. PAID BY VAL�DATION - ~- WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy ,_ __... _ - ��. , �_ � , �� � � � � � � . � � �� � � = - ; � t � �• � € .��� q� 7 _ � �_ .�� , 3� q §. - ° � c:� � �� � . 9 �' � ��;€ ; �r . 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