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HomeMy WebLinkAbout16179 (17) �� CITYOFDIAMONDBAR EXPIRED DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� . � 21660 E.Copley Drive Suite 190 (909)860-3195 F�(909)861-3117 O C T 1; ��t�Z PRESS `���� BUQ.DING PERMIT APPLICATION FIR LY � JOBSITE ��Z'�7 C+��,f�y��;�� • APPLICATION PERMIT P/C o ADDRESS � �� DATE NUMBEFi if � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER " ADDRESS �6's L � : ZONING SETBACKS "' CITY � .1 ZIP R/7l TEL a � FRONT RW � � APPLICANT TEL . � � REAR p SIDE/SIDE STREET RW p � CONTRACTOR 1 ' �✓� .�-- CL� SIDE ❑ AODRESS �d PROPOSED USE �� �� A p�,U 1 ,�UY� g CITY ZIP ' TEL. ` , � � �, � �� �, � �ii ARCH/ENG/ � "��r'r-'RrC�- � DESIGNER NO.DWEL NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. N OESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � ONMER•BUILDER DECLARATION SFR/ADDfREM � p I HEREBY AFF60A UHDER PEWLLTY OF PERIURY TMAT I AA1 EXEMPT FROM TME CONTMCTOFiS tl• Gef998/CefpOR liJ CENSEUWFORTNEiOl10WfNOREA50N(SEC.70.71.6BUSINESSANOVROFESSqNSCODE:ANYqTYOR (n C.� WUNTYWlppIREqJIRESAVERJARTOCDNSTFlUCf.ALTERdAPROVEDEMOLISH,OfiRE7NHANYSTRUC• W P81i0/DBCk � TURE,iRiOR TO ITS 6SUANCE,ALSO REWIRES THE APPLICANf FOR SULH FERAIIT TO FlLE A SIGNED W 6TATEMENT 7HAT HE OR SHE IS LICENSEO iU0.5UAHT TO THE OROVISIONS OF THE CONTRACTO0.S LI• � CENSEUM��ONPTEq�(COI,IMENdHOW11HSECT10N7000)OFDIVISqN]OFTHEBUSINESSANDFRO• LL' Pool/Spa iE53qN5 COOE)OR TNT HE OR SHE 15 EXEMPT MEREFRdA AND THE BASIS FOR TNE/�1lE6ED EXEAIP• TqN.ANYVIOLATIONOFSECT10N70.'f1.6BYANYMPLiCANTiORl1PEPMITSUBJECTSTHEMPLICANTTO Z qo-Rool � �GML►ENALTYOFNOTMOfiETNM1MENUNDREDDOl1AR5(f5ool.k � O��QN'NEROFTMEPROPERTY,ORMYEMvIOYEESVIITMWAGESASiT�EIflSOIECOMPEN5A710N, Q ('q�7mBftlal � YALL 00 THE MfONC,ANO iHE STRUCNRE IS NOT IHTENDED OR OFFERED FOR SALE(SEG 7W�,BU51• J NESSANO ViqFE3510NS CODE THE CONTMCTORS LICENSE UW OOES NOTAPPLY TO MI ONTlER OF � CROPE1tiYMIFiOBURDSORMPROVESTHEREON,ANOMM11000E55UCHN'ORKHIMSELFORHERSELFOR = � � TNRUUGHHISORNEROYlNEMOIOYEES.VROY�OEOTHATSUCNUAVROVEIAENTSARENOTWiENOEDOR ,. m .. OfFEKED FOR SALE 6,Iq�YEVER7NE BU0.DIN0 OR MIDROV[MEM IS SqD WRIAN ONE YEAR OF COMVLE•� Z �TqN,TME OWNER-BURDER VALLIIAVE THE BUPDEN OF PROYNO THAT HE Oil 6ME OiD NOT BURD pR = MIVROVE Poq THE PURPOSE OF S/LEJ. ,y� OI,/SOMMEROFTTIEVROPERf'l,M1E%LLUSNELYCANTRACTNC+YrtTNLICENSEDCONTMCTOR3 � TO CONSTitl1�T TME PRO.IECT(SEC.70N,BUSINE55/NJ PROFESSIONS CODE THE GONiMC70R3 L4 V81U8110f1 ADJ.AREA = CENSEUWDOESNOTAVPLVTOANOVMEROFAVNOPERTYriHD9URO50NMPpOYE3TMEREON.ANO F_ YAq00NTRACfSi0R5UCHPROJECT5WITIACONiWICTOft(S)LILENSEDRIRSUANfTOTYIECONTMG OUANTITY DESCRIPTION FEE � TO(L4LICENSELAW.).. O 1 AA1 EXEIAPT UNDER SEC B.l O.C.FOR TNIS REASON Q � U t�.. H DATE OWNEN V . � UCENSED CONTRACTORS DECIARATION –� � w INEREBYAFFIHYUNDERPENALttOFPE0.RIRYTF1A71AMUCENSEDUNDERVROVISION50FCHAPTEF V. , s i(C04YENCNOWIi/15ECT10N70oD)OFDMSION�OFiHLEU51NE5SANDVROFE5510NSC0�[,M1D Z LL� W LJCENSE i5 M FUl FOFCE M1D EFFECi. m � LICENSE CLASS LIC.N0. j V �l1TE cONTRACTOa a W � WORKERS'COMPENSATION DECLARATION a � INEREBVAFiWMUNDEAPENN.TYOFGE��ONEOFTNCF01101VINGDECIARATqNS: U [� Q � _IHAVEANOWILIMANTAIt1ACEFTiFICATEOFCONSEMTOSELF•INSUREFORNqRKERS' _ � C0110EHSATIDN,ASOROVIOE�BYSECTION]7ooOFTNELABORC00E.FOqTHEPERFOMAANCE W OFTHE VVOR`C FOR WHICN THIS PER611T IS ISSUED. � � Q �_IHAYEANOWILLMNMAMWOR1cER5'COMPEN5�T10NINSUMNCE.ASFEW!REDBYSECTION �O,U� ]700 0F 7HE UBOq OODE,FOR TNC PERFORMANCE OF THE WORN FOR WHICH THIS VE0.MR 15 � B4UEO.WWORICEl15'COuOENSATIONIN5UFMICEGp HIERMIDPOLICYNUAIBERME: CONSTFlUCTION � CMPoER ���P %c.�-•c�'t • Pu+N a�n�rr � POLICYMIYBER ����' ' ELECTRIC � (fF65EcrcNrEmrooteEoor.RErEooPnEF[w.�'6r�F7oNEruaiEooatAns�i�mloaLEss�, PLUM�ING . _.. Z IGERTIFYTNATWTNEVERFONUA.YCEOFTHEWOHKFORNMICFfiHISPERMRI5t55UED.1 MECHAnICAL (�} 6�iILLLNOTEMP�OVJWYVER50NINANYM�NNERSOA3TOBECd.lESUBJECTiOTHE Vj WORKERS'C06�PENSATqNIAWSOFCKIFORN�AANDAGREETHATIFISNOULDB[COME INSPECTIONFEE ll S SUBJECTTOTHEWOAKERS'CWAPENSATqMPROVISION50F5ECTqN77000FTHEU�BOR �SSUANCE .v CODE,I SHML FOifTFiWITH COMPLV N1T1 T/q5E PROVISIONS. ��I� � � � SMIP I •W p CATE: - APPLICANT. . � ENERGY P/C WARNnM:FAILURE TO SECURE W'ORKER5 COMVEN5A7qN COVERAGE IS UNUwFUL,AND 51u1L BE � SUBJECTINEMPLOYERTOCRIMWALPENKTIESMACMLFIKESUPTOONEHUNDNFDTIKK/SAND ENERGYPERMIT DOLUiiS(iloo,000),IN ADDRION TO TME CO31 OF COMGENSATION,DAMAOES AS PROVIDED FOR W 1 � SEGiION 77a!OF ME UBOR COOE,INTEREST,AND�TfORNEY'S FEES. RETENTION FEE: •�1 O a CONSTFUCTION LENDING AGENCY PRE•ALT FEE: � IHEREBYAFFlRMUNDERGENALTYOFFENURVTIUTTHEREISACONSTRUC'f10NLENDW6ACENCY fOR TME PERfOHMANCE OF THE WORK FOR VMICH TNIS PERMIT IS ISSUED(SEC.9007,CIV.C.�. � � LENOERS MM�E C LENDER511DDRE55 �/` � ICERTIFYTHATIIUVEREADMISMPLICATIONANDSTATFTNATiMEA80VE1NFDR61AT10NISCORRECT. TOTAL FEES ��'W . d IAGREETOCOM7LYWITIALICfT'IANDCOIMTYORDWIWCESANDSTATEUWSREUTINOTOBU0.DIN0 CONSTRUCTION.M1D HEREBYAUTIqRIZE REORESENTATNES OF THIS COUN7Y TO ENTEfl UPON 7ME � ABOVE�MEIYf10NEDPROVERTYFORINSPECTbNVUNPO3E4. COMMENTS _ .��i�t�t— L�-1 Z�i�f ' m FE TfEE HM1E �/���1 /� ¢ \ /�{��/1 / � � � � iau F mEe o�re RECPT.NO. � PAID 6Y VALIDATION .� I WHITE—Oepartmenl Copy,YELLOW--Finence Copy.PINK—Assessor Capy.GOLDENROD—File Capy.GREEN—ApplicanCs Copy � , . ., ,.., _ , . . . , . . . . , _�.. _ �• , .. , . , CITY OF DIAMOtdD.BAR ; - _., . � It�lSPECTIOP�E�RECOR� � , jf �l+'k-�li?�,��+�'j��� ��R�.�.� 1��.�!��.°�..���seil�!������4�+ .r�.r���'�C-^ ,. 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" , ., ' ; ROUGH GRAD�NG -- -- � �ROUGH PLUMBING - - - -- - -- -I- -- FINISH GRADING �SHOVVER�7UBTEST- -- - --- - - POOLEI:ECTRIC � icX�LATH/5101NG- __ . _ __ _ _ POOL,FENCING � � IWALL tNSULATION ' --- POOL FINAL - ' ;CE1LiNG 1NSULATION OFF SITE(MPS. � ' ;DFYNlALL NAILING - DEDICATIONS fSEVJcR FINAL'EtdG. ' . iSEPTIC TAF:K j LANDSCAPE/IRRIG. SEEr_PIT/L.L. .' � ON SITE Ih4PS. �G��.S AIR TEST ' � FINAL ZONI�JG j - _ . 'F1C•IAL CrJNST. ' FIR�DEPT. FMF,L � �Fli'1AL HE�,TIP�IG ._._ . _ _ HEALTH DEPT FINAL - � ;�1N�`,�ELEGTRIC -- - - - DEV. FEES PAId . 1�..--- —- -- ' �~:;:+`•,}_PLUt�',BIhG - - � ENrRGY '� '--•--- � ' - -- - _ _ _... __ ___ _ _ _ , � i� .,�,,.�,..,,�.,-��,..�.�.....-- I � . . . . _ _ _.. _ . . . . �^yu {�.r,.-.]�-� ° c ........�_�. ._.....� .. . ,.. � ' _ _:crc�n �,al.c. ..._..+: ' . j1. ..._._. __ _ . . ._ . . _ � � ; ��Oi^MENTS — - ;- �_---- -_ __ _ _ . _ _ , , '-'�1 r� ,= , ,. � . , , , . . � ` —. . . . . ; . c�= %�;. :". ; � .. . , — i--- ' .. . .. . _ . ' � � . ., � . 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