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HomeMy WebLinkAbout14251 � � _!� CITY OF DIAMOND BAI� � DEPARTMENT OF COMMUMTY&DEVELOPMENT SERVICES � 2i�o E.coPiey nri�e s�ic�i90 PRESS (909)8G0-3195 Fac(909)861-3117 �'A�'� � SUILDING PERMTr APPLICATION FIRMLY a AODRIESS .��6" (_�A PiIfV�// DATE CATION �� � � NUMBER. '� #`C c� ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER ZONING SETBACKS 0 ADDRESS �,Q,�,L�� �J�� FRONT RW ❑ g CITY �� ZIP TEL. APPUCANT t TEL. REAR ❑ SIDE/SIDE STREET RW O � CONTRACTOR._�_ Df=- l SIDE ❑ � ADDRESS � CITY Z P TEL PROPOSED USE �� � t �•-a (.� / o ARCtUENG! — � � 6 � � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS �� CITY ZIP TEL. DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM �� O Q i HEREBY AFFlRM UNDER PENALTY Of PERIUAY THAT 1 PA1 EXQAPT FROM THE CONTRACTOR5 ll- GefH90/CflfpOR W- CENSEUWFDRTHEFOIIOWINpREASON(SEC.7031.6BUSINESSAN�PROFESSIONSCODE:PNYCINOR �_ (f� � COUNTYWHtCHRE0U1RE5APERMflTOCIXYSTRUCT,ALTER,IMPROVE.DEMOLISH,OHREPAIqANYSTRUG : W pgI10/DBCIC . TURE.PRpP TO ITS ISSUANCE.ALSO REQt11RE5 iHE APPLICANT FOR SI1CH PERMIT T�FILE A SIGNFD _ W STATEMENT THAT HE OR SHE IS 110ENSEO PURSUANT TO THE PROVISIONS OF THE CONTMCTOflS LI- CENSELAW(CXRPiER9(COAIMENCINGWITHSECTpN7ao0}OFDIVISION30FTHEBUSINESSANOPRO- �� PooUSpa - FESSIONSCODE)ORTHATNEORSHEISEXEMPTTNEPEFfl01AANDTHEBASISFOflTHEALLEGEDEXEMP- . (� /� V. TION.AM/VIOLATIONOFSECTION7031.SBYANYAPPUCANiFOflAPERMITSUBJECTSTHEAPPUCANTTO - Z Re-Roof � Od(/ � �. ACIYIIVENAL7YOFNOTNqRETHIWFIVEMUNDAEDDOLLARS(SSOJ).): �_ ❑1,11SOWNEROF7HEPROPEHTXORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, - 0 Commercial � WILL 00 THE WORK,AND 7HE STflUCTURE IS NOT INTENDED OR OFFEflEO�OR SALE(SEC.7046,0U51- - J NE55 PND PflOFE5510NS CODE:T1E CONTftAGTOHS IICEN3E lAW DOES NOT APPLY TO AN OY{NER OF N- PROPEHiYWHOBUiLOSORBAPROVE57HEREON.MlOWHODOESSUCNWORKHIMSELFORHERSELPOR ---� :�.: 7HROUGHHISOflHERONMEMPLOYEE8,PROVIDEDTHATSUCNIMPROVEMENYSARENOTINTEKOEDOR � m _Q_ OFFEREOFOfi501EiF,NOWEYERTIIEBUILDINGORIMPhOVEMENTI3SOLDWRHINONEYEAROFCAMPLE .Z- -�iION,THE OWNENAUILDER WILL HAVE THE BURDEN OF PROVING 7HAT ME OR SHE OID NOT BUIlO OR �_ IMPfiOVEFORTHEPURPOSEOFSALE�. ��j--_ ❑I,A80WNEROPTHEPROPEHTY.NAEXCLUSIVELYCONTRACTINGWITHLICENS'eDCOMRACTORS :(= TO CONSTR�CT THE PRQIECT(SEG 70I4,OUSINE55 Af6D PROFESSIONS GOOE:THE CANTMCTOqS ll- .V8IU3110f1 ADJ.AREA 'W' CENSELAWDOESNOTMPLYTOPNOWNEAOFAPROPEH7YWHOBUILDSOflIMPqOVESTNEPEON.AND �� WFiOCONTRRCTSFORSUCHPflO.lECTSWIiNACON(flACTOR(S)LICEN3EDPUflBUANTTOTHECONTRAG QUANT�TY DESCRIPTION FEE _Y_ TORSUCENSELAW.). ._o; ❑1 NA EXEMPTlRiDER SEC. 8.8 P.C.FOq THIS REASON � Q - � � U_ �. ¢ : DATE OWNER ' F' U � -���` UCENSED CONTRACTORS DECLAfiATION t W � � � -.�'�; IHEflEBYAFFIfiMUN�ERPENAL-fYOFPEiUl1RYTHATIAMIICENSEDUN�ERPFOVISION50FCIiAFTER -: � � :p�; B(COMMENCiNGW17HSECTKKJ�000)OLDIVISION30FTHE9USMESSANOPROFESS!ONSCOCE,AND - � _X� MY LICENSE IS IN FU.I FORCE AM1D EFFECT. p /� � m �; UCENSE GL4SS C�� LIQ NO. if! / �-� ` `� € j :�- DATE Z CONTRACTOR �EFLJ C((� j. � -.W .TT n . . . . . -�- --WORKERS'COMPENSATION DECLARATlON L��� � . -�; tJ Q '�'�� IHEflEBYAFFIRMUNpERPENAINOFPERJURYpNEOFTHEFOLIOWINGD[C"�ARATIONS:y U � uj• Z � �-0��� _IHAVEANDVdiLLMAINtAINACERTIFICATEOFC0.LSENTTOSE4-WSfIREFORWORKEflS' = i � -�i� COMPEkSATION.ASPROVI0ED6Y5EC�lON3�ooU`THELABORCOOE,FORTHEPEflf-0flMANCE �U _ Of THE WORK FOR WNICX THIS PEflMIT IS ISSUEO. � y' _�: � �'W� __I MAVEAND WILLAIAINTAIiJ WORKERS'COMPENSATICN INSURANCE.AS flEQJIREO BY SECTION E j� � � ':-�;� 97000FTHELABORCOOE,FORTHEPERWRMANCEOFTHEWORKFORWHIGH7HISP'eRMITIS � �-�'- LSSUED.MY WOHKfAS'COMPENSATION IN5URANCE CARRIER AND POLIC/YN�UM�eEHARE: CONSTRUCTION � �l�- GAflRIEN � � �—"' PLAN REVIEW � . . -0,, voucrrouMaEa � ELECTR�C _____ �,.t a ���_ __ -- P� Z: �-q= (iF96SECIIQVNE�NOTBEO�HffiLEfEDOFTIEPEPoWfISFORONEFAN�ORED0Ol11�RSIS�Oo)ORLESS} PLUMBING 0_ _�_. . .I CEflTIFYTNAT INTHE PERFORMANCE 0'r THE WORK FOR WHICN THIS PERMIT I5155UED,1 MECHANICAL ���- �'�j�' . ,:�... - `�" -_(�=: - SHA.LNOTEMPLOYAfJYPERS�JNINANYMANNERS�ASTOBECOMESUBJECTTOTHE - y�'� � '-!�< ��ti'i3•. . :��-- WOqNEflS'COMPENSATIOMIAWSOFCAIIf-OPh1AANDAGREETNATIFISHOULDBECAME INSPECTIONFEE _ _____..__ .-__ SU&IECT70THEWORKEHS'COMPENSATtONPROVIS10hSOF5ECTION37o00FT1{EUBOR �SSUANCE ����� �t -„_ ;RT'-'���_�� CODE,I H FORTNwIhI CONPIY WITH THOSE PROVISIONS. " - _. � .-.Q" �� _� K-L SMIP r�T��i 9 1 r '�' ---r d (� 0 on�: � 2 APPLICANP. ._.__ � s>--t -�� ENERGY P/C -JLL .W A R N I NG.F A�LUflE TO SECURE WORKERS'CAMPENSATION COV RAGE IS UNtAWFUL,AN�3HALL eE � LL. SU&IECTMIEMPLOYERTOCFIMINPLPENALTIESANUCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(1700,000),IN PDDI iION TO THE COS70F COMPENSATION,DAMAGES AS PROVIDED FOR IN -�� SECTI�N 370B OFTHE L460R WDE,INTEREST,AND ATTORNEYS FEES. . RETENTION FEE: d= CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ,Or' . ._�' I HEREBVAFFlRM UNOER PENALTY OF PERJUFY THATTNERE IS ACONSTRUCTION LENDING AGENCY FOflTHE PERFORMANCE OF THE WORK FOF WHICH TMIS PENMIT IS ISSUW(SEC.3o97,CIV.C.�. Z( ;w: — LENOE(1'S NAME �. --1_-- LENDER'SADDRESS �-�W ICERTIFYTHATIHAVEREADTHISAPPIICATIONANDSTATETHATTHEPHOYEINFORMATIONISCARRECT. TOTAL FEES /�'y�r �� :,�;. I AGREE TO GOMPLY WITM FLL GITYAND CAUNTY OFiDINANCES AND STATE LAWS RELATING TO BUILOING CANSTPUCTION,AN�HERE6V AUTNORRE REPFESENTATIVES UF l HIS COUNTV TO ENTER UPON THE -Z� A80yE-MENTIONEU PROPERTY FCR INSPECTION PURPOSES. COMMENTS �• �: � -- m' PENMITTEE N E �� ll2 �— — - �-� SIGNPTUR O Tf E DATE -:_ � RECPT.N0. PAID BY VAUDATION -F'- WHITE—Department Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENiiOD—File CoDY.GREEN—ApplicanYs Copy 3 . E " �,�: ' .-_,. _ .. _- - - rt ��_: �� I r � � • '-� � ` �� � � � $ �� � � ��'�� ' � W � } � z- - �•�s '� e�. � � r � - � - ' � � .�' €` � � �� i _ ; � ,*: � .� — � � c: � " � `� �= _ - ' �i l ! � � t g ; c '� � — _ � � � � i i , � � �E � �� � � `t � � _ � t�< j : ,, I . � , _- .�—+ . .. . _ . ' �.� - �; � � r , __ . , . 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