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HomeMy WebLinkAbout15090 (39) ,...-.. , . - , , __, . . . . . � ..- zr . . . _ . . , . . _. ., . . . , _ . ,. . . . _ . , . +s..:�:�;:;- P+ � - � . . . � . . . 4 � CITY OF DIAMOND BA� . " .-_- - - .,��� - "'� � DEPARTMENT OF COrlMUrTITY d�DEVELOPMENT SERVICES r' 21660�.Coptey Drive S�rite i90 (909)860-3195 Fax(909)861-3117 pRE�$ ��^�*'� ` BLTII,i)ING PERMiT APPLICATION FIRMLY 4 DD ESS �(r'7� �a�a�WOUD ( 'OV� �p�ATION r � NUMB R �� o *� 0 � ISSUE 7YPE DCC APN LOT TRA�J DATE CpNST GROUP � � OWNER �.LL�.�_�� .AL...-�/ ADORESS ZONING 3ETBACKS CITY ZIP- TEL. �ONT RW ❑ APPLICAh1T TEL. REAR ❑ SIDElSIDE STREEF RW D CONTRACT R �/ SIDE p g *CRY S$ � Z1�I7'Sa TEL. PROPQSEUUSE "� � ARCFIlENGt DESi4NEH NO.OWEL. NO. NO. ADDRESS UNITS . STORIES BEDFi00MS � CI7Y� ZIP TEL. y DESCAIPTION S�.FT. FACTOR PSF ADJ.AREIWALUATIOiV Q OWNER-BUILDER DECLAAATION 5���� ^ �Q Q . i NERE9Y AFFl(W UI�ER PfeNl1L7T OF PERIURY 7wR c M1 FJIEAAPT FpoM lHE CONfRACiOP5 lF GarnpelCarport - � CB15EL11WP�RTNEFOLLOWINfiliEA60N(SEC.7097.68USINE98MIOVROFESSIONSODDE:ANYCIiYOR (/� COIM1fYYl71iL11RE0UWESAPERAVfTOCQISTRUCT.114TERIMPROVE.OHAOLISH.ORREPAiRANYBTRI]G .w P6tl0/DOCk - - TURE.7WA'Kt 70 tB ISSVANCE.ALSO itEW�RES 7XE MPLICANT FOH BUCM PEIMIIT 70 FIIE A SICiNW - - STATEMEN7 T1q7 NE OR SNE IS LICENSEU PUiiSUANT TO TME PpOVIS10N5 OF iH6 CONfPACTpR51,1- . - . - CENSE IAw�OU�PTER i�00111AENGR�10 WITH�S£C710N 7Wo)OF OiVISION 30F lT1E BUSMESS ARO P� � P��Ga - �- - FE6SIONGCODk)OFitHhTHEORBHEIBE%EMMTHEREFROMANDIHEBASISFOF�tlIEALlE6EDEXE4IP� -(ry TqN.ANY V10LIR1OM OF�ECT10N 7031.6 9Y MP/1PPWC7INT FOR A PENMIT$1B.fECTB TNE APPl1C/�M TO Z .R8-ROO� . . . !'� ACM.PENKIYOFNOTMAORE7HANFlVEHUNDREDDOLW19li6o01�Y : � . 04M:G�NNEROFTNEPROPERTY,ORMYF/A%.OYEE6WITNWAOESASTNEIRSOLEWMPENSATION, 0 �mmercial - - - WILL DO THE YlORK.AND T11E STRUCfUHE IS NOT INTENDED Oit OFFERED FOR SALE(SEC.96N,8u51� J y "-.NE86 AN�PROFEBSIDN6 COOE:IHE WN7MCTOR3lICENSE lAW ODES!pT MPLY TO AN OWlJER OF - ? .- . �_PiqVENT71NF10 BULDS OR MPRDVES THEREON.NiD M'HO DOES SUCN914FK MIMSELF OR NERSELF OR - G[ ?1MIOUGH HIS Op NEH ONM EMGLONEES.PFlOYIDED 7HAT BUCH MVROVEMEN(8 AAE NOT INTEMIEDOR m - � OFFERWPDR6ALEIF,MONIEVE0.7Y1FBURDIN�ORIMPROVEMBdTIHSOIOM7TFBNONEYFAROFCONRE� . � �TqN.TfE OVMER-0UIIDER 1NLL MAVE T+E BUF�EN OF P�VIN�TNAT HE OR SHE DID NOT BUdD OR . IMVRDVEPoR151EPURPOSEOFSALE). - - y,� ❑1A50YMEROFTH€iHOP6iiY.NAEXCLUSNELYCONTMCTNKiWI7MLICENSEOCONTHAC70R3 . � TO C0176TRUCT 7HE TFpJECT�BEC.9oN.BU8INESS ANO PROFESSIONS COOE:TME CONTRACTOR9 ll- V811161b�1 ADJ.AREA- . - -CENSE UW OOE9 NOTMPLY TO AN OMMER OG APROPEHTY YVHD BUIL�0111MPROVESlXEREON,AN� WIIOOONTMCTBFKNiSUCHPpOJECT3WfTF1ACONTMCTOf1(S�LICENSEDPUI�UMfTTOTNECONTMG pUANT17V DESCRIPTION �� . � 100.5 LICENSE tAW.�. ❑1 AM O(FLPT UI�ER tEC. B.i P.0 FOq THIS qEASON � - r U LL � �r. . OATE 01VNER - � . . �` LICENSED CONTRACTORS DECLARATIOM � ¢ w IFIERE6Y AFFlNM lAl0FF1 PENALTY OF PENUfl`I TMAT i AM UCENSED UNDEfl PROY1310N8 OF CH�PTER - � s f{COA4AFdJCINCi MM17M BECTION 7ooa)OF DMSION 3 OF iNE BUSINESS MID OHOFESSIONS CCOE,AND Z � MY IIGFNSE 15 N R0.L FORCE MI�EFFECT. mm � LICEFISE "'- ,Q IIC.NO. � fs-�G���"/� . - � . . � J DATE . . CONTMCTOR WORKEAS'COMPENSATION OEC N ^ _ y rL�+l . N IH��ER�E,jB/YAFFIRMUNDERPENALTVOFPEPJURYONEOFTME N7NOOECU : �ti� -� .�-I �ANDNALLMANiTAIN�CEHfiFICATEOFCON NTTO50.HNSUHE WOPK R6' 2 . - - - PEHB,{iiON.AS PROVIDED BY SECTION S1o0 F TME I.ABOR CODE.FOR THE PEH RMANCE . TIffWORKFORWHfCHTHISPERY1T14156UE � . � . IIMYEANDWItLMNNfAiNWORKER3'COMPENSATION , WIREDev � � -aT000FT1ElABOFOODE,WRINEPERFORMFNCEOFTHEWpi1(iORWNMkIhISP ITIB - � � 1S9UED.AIYVpR1(ER500M�ENSATIONIN6U9AN/C�CARq1ENANDPOUCYfJ11MBERM CANSTRUCTION- j cMruEq���Jk-E r .LiS Sb�. _ PLAN FEVIEW . � POIICYNNABER L-i/f_'/l.! � o��!� "" / ELECTR�C - - ��- T l . � (�ressecrcr+rf�noraeooe.ptE7IDOFn+erE1#nl6waor+Er�R�REuoaL�itsls+oolanlEss) PLUMt81NG � . - Z ICER71FY7)WTW7F7EPERF�RMANCEOFTHEWORKFOR N PERMR151SSUE0.1 MECHANICA� - � . (•J 811N1 NOT EMPLOY N1Y PERSON�M ANY MMINER SOA3 ^E ECTTO7HE ' y � MbRKEFS'CO�IDENSATIONLAWSOFCALIfORN1A.ANo REE7 IF NOUtDBECOME INSPEC7IDNFEE ._ . - `.� SUBJECT TO T/tE WOliKER$'OO/APENSATION PflOYI S OF S ]g000F TFIE IABOR . - S cao �sr+�tL rH cour�r v wr+S ISSUANCE �� MPL . O . ��L1�.1�OHTHW� �_.-. �".�,_-...,�f".�� . p DATE: �-APPLICANT: SMIP i s1 1 .r � ENERGY P1C WAi�IMN3:FALUREi09ECUREWORKERS'C06�PENSATIpNCOVER ISUNIAWFUI,ANOBHALLBE � - } �SUB.IECTANEMPIAYERTOClUMMALPENILTIESANDCMLFAVEBUPTOpNEHUNOREbTF10lJ9AHO ENERGVPERMIT �j iuY]�`' J � - DOLLARSIttao�WoFM1AD011WN70THECASTOFCOAIPENSATI0N.0AMA0ESA9PilOV1UEDFORMI . ��ls�� �V77 � SECTqN770lOF7HELABORRO�6:IN7ERESLANOATTORNEV'9fEE5. RETENTIONFEE: �`+zrs TI�N � p. - '-CONSTRUCTIONLENOINGAGENCY pRE-ALTFEE: 1� O � INEHEBYAFFViMUNDENPEN�LNOFPE1WflY7HATh1ERE15AEONSTRUCTqNLEt/DINpAfIENCV � ' - ' FOii THE PERFORIdMICE OF 7NE YroRK FOR WHICH iNIS GERM�T IS tSSUED(��ou7,dY.C-1. . . . . - � LERDER`SWWE- - � . . . � J . C rCENDEWSADDAE59 � -� i cEn�r nuT��nEnorns wruc.�TaN�rin suh nutnrs�eovE iucoaM�raN�s coaaEct TOTAL F�ES �"� CJ _ - p� I�(iREE TO WMPLY tMTH ALt CfiY AND Cq/NTl'Offfi]INMICESNIO STATE LAWS 1ElATINO N BU9AINO - _ . _ . . - � � CON6TRUCTION,AND 1iERE8Y RIZE REPRESENT�71VE5 OF THIS COUNTY TO EHTEq UPON TFIE - - - ._ � - . Z 1180VE-M,ENTIONEOVROPE WSPECT�ONPURPOSES. COMMENTS - - - � t� 3� w�uEl � r6i� —" "'e".r'�``.�_w' /„ O p I � BNiNA7VREDFPERUITTEE - - - W�TE RECPT,M0. PAID BY VALIOATION � ;-_.��. -WHITE—DepartmaM Copy,YELLOW—Flnance Copy.PINK—Atsacsa Copy,GOLDENRD[}--FiW Copy.GREEN--ApplicanTs Copy . - . .,