Loading...
HomeMy WebLinkAbout15418 CITY OF DIAMOND BAA '� -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ~• � . 21660 E.Copley Drive Suite 190 � , (909)860-3195 Fax(909)861-3117 l. PRESS ���9�'� � BUII:DING PERMIT APPLICATION FIRMLY a ODR'ESS :� )��� ���-�-r���l�h R�� DATECATION�` �i' (f� NUMBER� #/C U � ISSUE TYPE OCC � APN LOT TRACT DATE CONST. GROUP °C OWNER � 1 �/t'ss�7�e!-l��Y1J'J' o ADDRESS i n.d • - � ZONING SETBACKS Z CITY � i'. w � it� Gl � TEL. � _ �- � FRONT RW ❑ � APPLICANT TEL. e�v-.^ �uf: REAR ❑ � z-s�r-� SIDE/SIDE STREET RW ❑ CONTRACTOR � ,r�/' " SIDE d` Q ADDRESS �� � PROPOSED USE `L z � � CITY - ZIP� TEL. ���� ��J oARCWEN ! W DESIGNER NO.DWEL. NO . d ADDRESS UNITS ST RIES BEDROOMS � GITY Z!P TEI. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER•BUILDER�ECLAfiATION SFRIADDlREM O �- I HEREBYAFFlRN LINDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTMCTORS LF Garage/Carport W CENSELAWFORTHEFOIIOWINaREASON�SEC.T03t.6BUSINESSANDPROFE5510NSCODE:ANVCITYOR (n . U- COUNiVWHIpiRE�lAHE3APEAMtlTOCONSiRUC7.AL7Ep,IMPROYE,DEMOLISM,ORREPnIRANVSTRUG W PatlO/D9Ck - Z- 7URE,PflIOR TO IT$ISSUANCE.AL50 REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W . STATEMENT THAT HE OR SHE IS IJCENSED PURSUANT TO THE PFOVISIIXJS OF TFIE CANTfiACTORS LI- �- CENSELAW(CHAPTEN9(COMMENCINOWITHSECTION70W)OFDIVI910N30FTHEBUSINESSANDPRO- � PooUSpa - �� FESSqNSCODE)Oq7HATHEORSHEISEXEMPTTHEREFHOMAN0TNE8A515FORTHEALLEGEDE%EUP- C7 �- TpN.ANYVIOLATIONOFSECT10N7031.5BYANVAPPUCANTFOflAPERMITSU&IEGTSTHEAPPIICANiTO Z Re-Raof '1 � ACMLPENALTYOFNOTMORETHANFIVEHUNDREDDOLV.RS(f5ao).j: . ❑I,ASOWNEROFTHEPflOPERTY.ORMYEMPLOYEE5W1iHWAGESASTHEiRSOLECOMPEN5pT70N, � Commercial - �:� 'MLLOOIHE WOAK,AND THE STflUCTUqE IS NOT IMENOED OR OFFEflED FOq SALE(SEC.70b4,BU61- J NESS ANO PROFESSIONS CODE:THE CO4TRACTON3 liCENSE UW OOES NOT APPLY TO AN OWNER OF � �- PROPERTYWF108UItA50RIMPROVESTHEREON.ANDWHODOESSUCNWORKHIMSEIFORHEflSELFOR - � � iNHOUGHHISOAHEHONMEMPLOYEES,PROVIOEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m Q .OFfEflEDFOfi3ALE.IFNOWEVEFi,THEBUILDINOORIMPflOVEMEMIS50lDWITMINONEYEAFOFCOMPLE Z_ 'ipN,THE OWNER-BUIIDER YALL HAVE iHE BURDEN OF PROVING THAT NE OR SHE DID NOT BUILD OR _. IMPFpVE FOR iHE PUAPOSE OF S�l�. `yj OI,ASOWNEROF7HEPFiOPEflTY,AMEXCLUSNELYCONTRACTiNGWITHLICENSEDCONTRACTORS Q TO CONSTflUCT iHE PRQIECT(SEG 70N,BUSINE55 AND PflOFE5510N5 COCE:TNE CONTflACTOHS LI- V8IU8�IM ADJ.AREA W: CENSELAWDOESNOTMPLYTOANOWNEROFAPROPEflTYW1108UILDSOflIMPROVESiHEREON.AN6 �.Z-_ INfOCONTMCTSFORSllCHPRQIECTSWITHACONiFACTOA(5)LICENSEDPURSUANTTOTHECONTRAO - QUANTITY DESCRIPTION FEE � !y7�p TOflSUCENSEUW.). ! ❑I/M EXEMPT UNDER SEC. 8.A P.C.FOP TH:S flEASON . J O j 3' � �- DATE OYlNER � Z W Q-_ LICENSED CANTRACTORS DECLARATION W _ � 1HEqEBVAFFIRMUNOERPENALTYOFPEfL'Ufl�THATIPAILICENSEDUNDERPROVISIONSOFCHAPTER � d: e(COMMENCINOWITMSECTION7UW)OFDIVIS10N30FTNEBUSINESSNNDPROFESSIONSfADE,ANO Z � X� MYLICENSE IS IN FULI.FOtiCEAND EFfECT. �. IiCENSECLASS �j�� ` LIC.NO. �J 7s :� ✓ / � � J U:- DATE ���'��e'L L� CONTRACTOR a _ W- f�- WORKERS'COMPENSATION DECLRRATION -� _ . �_, V � I HEHEBYAFFlflM UNOER VENALTY OF VERIURV ONEOF THE FOLLOWiNR DECLARATIONS: - Vj. Z Q ��. INAVEANDWILIMAINTAINACEqTIFICATEOFCONSENTTOSELF-M5UREFORWOPKERS' y �. C6MP SATIDN,ASPROVIOEDBYSECTIGN37fAOFTHELRHORCODE.FORTtiEPERFORMANCE �U E WORK FOh WHICM TNIS PERMIT IS ISSUED. � W � IHAVEANDWILLMAIHTAINWORNERS'COMPE�SATIONINSURANCE,ASREOUIREDSYSECTION Q. 37000FTNELABOPWOE.FORiHEPERWRMANGEOFiHEWORKFORWHICHTHISPEHM1T15 ���� _ 139UED.MYKbFiK AP SATIONI RANCECARRIER DPOLICYNUMBERARE: CONSTRUCTION � Q` CARRIER ,e�{�r PLAN FEVIEW - �ZZ� POLICY NUMBER ��I/ Hfe=�_ ELECTflIC Q- (1}AS5[L'lIOHNL�Mo7sem.w.ErEooFiHEaEfiMR19FIXioNEMXS7REo0oL7aR5(btao)oRLEssI. �. PLUM8ING ---- Z: I CERTiFV THAT INTHE PEflFORMANCE OF THE WORK FOR WHICH THIS PER�.!�T IS ISSUED,I MECHANICAL � �I3� �j. SFiALLNOTEMPLOVANYGERSIXJINANYMANNEftSOASTOBEGOMESU&IECTTO7HE _ . . ..�: . .WORKERS'CDMPENSATIONUWSOFCWJWRNIA�DAGREETHATIFISHOU:D8EC6ME INSPECTIONFEE " SU&IECT TO THE WORKENS'COMPENSATION PROVISIONS OF SECiIOY 770o OF TNE LABOR � � CODE.ISHALLFORTF1WfrHCOMPlYW1THTH$EPROVI310N3. ISSUANCE _,3.uy,�� 79fiP1f! � ��- L'� SMIP i�iiLi v � lUUU � ; - . p' DATE:� AVPLICANT: � K � - � � W ENERGY P/C �����p��piv�Ba� J. WRRNIN6:FAILURETO SECUqE WOF7KERS'COMPENSATION COVEfl IS UNLAWFUL,AND SHALL BE � SU&IECTPNEMPLOYEf7TOCRIMINALPENALTIESANOCIVILFMESU TOONEHUNDRE�TMOUSAND ENERGYPERMIf s'�raY'A 1������_. - DOLLARS(5100.0OO�.INADOITIONTOTHECOSTOFCOMPENSATION,DAMAOESASPROVIDEDFORIN BPp���q � �_ SECTION37oeOFTiELA80RCODE,MiEREST,ANDATTORNEV'SFEES. RETENTIONFEE: a-. CONSTRUCTION LENOING AGENCY PRE-ALT FEE: O �- IHEREBVAFFIRMUNOERPENALTVOFPERJURYTHAThIEflFISACON5Tql1CTIONLENDINGAGENCY - �- FORTHEPERFOflMMlCEOFTHEWORKFORWHICHTHISPEqMITI5155UED�SEC.3097,CIV.C.). - . - Z- W - �ENDEWSNAME - �. - I_ LENDER'SAODRE55 `� � ICERTIf`/THATIHAVEREADTHISAPPLICATIONANOSTATETHAiTHEA80VEINFORMATIONISCORRECT. TOTAL FEES ��-�� :- d- tAGREETOCOMPLYWITHALICINANDCAUNiYORDINANCESANOSTATEUWSRELATIN�T08UILDING . � CONSTRUCTION,ANDHEREBYAUTkiOHIZEHEPRESENTATIVESOFTHISCOUNTVTOENTE{111PONTHE - . - Z AeOVE�MEN(IONEDPflOPERTYFORINSPECTIONPURPOSES. COMMENTS -- � f�v�-� �i �' _ - m PEflMiTTEE NqM � Q � � ���� ►/ �l _ N - y-. SIONANRE. EE OATE = flECPT.N0. PAID BY VALIDATION_, _, ~ WHI7E epaAmentCapy,YELLOW--Fina�CeCopy,PINK—AssessorCopy,GOLDENROD—FileCopy,GREEN—Applicant'sCopy �; ��. � �.. i - - , .� - , ,I L ' z----�� (� � � ���"� � '��� �€���" ' ;s a � s a � � � � ' I ` f � � r � i�� -� � � � �-t���t��f`�-�'.:3��r�3 � i ' a r- � � �C �,��� - - � a��'�� ���a�� i • � , ; ������ � � `- r � e� �' . 3 s ��. ';� ���� ��� i�"��" � �,.� ; j � ; . j � '�� _ � �'° _ 3 as ��� ��� ��� �� � . � ( � _ � .�� �� € >� - �� �� � � .. � "�,�`� ��,� 'g� � i ` � � t _ � - -� � � ; . � rf � ,�+� � � � '- i : � . '. � � . 3 ,.. . i � � � .. � �° �� �� � � � � � � i ' � j � � �� � �'�� � � €aa � a � � A �_� _� � - �-��T -- 1 — � �� .-�*x�._�� _.�:'�f� ; �, i .. � i � �� � ` i , vs i ' � �""�s � ' � ° 4 ; � �� � � � t ; � 1 „� �.� ; f� � � I E j [ t i '�(� ( �R� ��z� r } ' � t � O: � i i � _ \a _ _ '� € ',�- I 7 s � ( � i � t � � I'_�. T�' �t . � � I { ��� � � � i f I � �*., � i i t ` i i � � ' � ; E ��« 3 � : , � , ' ( � . i .. � I i € i � � ; � I � E � i � - .� �3 ( � i ' y I ' 1 I k � � i � � � T , . � i ; � i � % z i � � � � , ; G ` , '. , , � i , ; k E � � . � � .-�- -� � - -r- f � E ' � �� _ ' � - ; ' �T �A � , �; i - - � '� � .� �- ���� �=� i ' � ' � � ' { _ = , , � � �; � � ��� � > � E � � � �r r � '�'; ' � -� c � � I � � � k i y � � � £ � � � �"� '� r � I i ' - , , : � - � a'd �. >� '� �.• �' ' 7,� � � � � , � i ; �� v i .� i ) "� � t �._� rF`; ! I � �� � �1 5 1 j '; ( � "1 �i � �� 7x4 � � � �� � �� I I `� i � I �`i i � �t 1 �� ! � � i � 1 i� � - - ,� � � � ' ��� ! , ) _ _ � ' . ; � i 1 _ i - . � ; � i j - i. � � - 1�' j � I I ' : I � , � € � I , , � _ _- I i i . ` � - --Y--;— - �_'� ' � _ —_ ' i "�.. € i. I E , i t i ; . (. ;� � . � I I 3': `_ ; ( � ': f�� .� � ��"`q�� . ' � i � 1 � I , �� � � E � , � , - � ��. : .. _ _ _ _ '"'' - - • . � , i , . ( . }. � _ 6 i . . . , , ; • ;- - : , �.�. , i t ! . { � -- . . i � , ' ;_� � i i : .I �. . : ��,, ( i �- , . .. t � ','�, i i ! . . i � � E i � , � < � •, � j . I i � [� I' q n'3 a , � . � - - F � 1 � ' I -� �:� � ��y.='�. 1 ( I ' ;� I � � �� - , � I- : -� � �,:�' . •. , ,, �. i ' 3 ' . � � � � f ;. � f� . . � 4 I f. � f � ..+ ` �� � � � . � � ; , j : , . , 3 . ,� _r . � : � . . , � , _ _ _""_ .-,. ...- s,_ _..� _ __.._�_a _ _ .__... ' � .......:_, __�.._�__...._ .... .._... , _..._. << <... . �...._<._._ _..._ ._.... _ ........_._ .. :.. . ........ .. . �_._.. . ___.... .._,._.. .._ �K