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HomeMy WebLinkAbout14797 (17) CITY OF DIAMOND BAK ��� `b � ' � --��-- DEPARTMENT OF COMMUNITY.&DEVELOPMENT SERVICES `'�.�•r` 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRE$� —' �"�' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE � � `- i n� APPLICATION PERMIT �P/C o ADDRESS ���-F'.,�� „�P�'..{� (]�i(� /C�L : DATE `:� "' C7 NUMBEfl # $ ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP °C OWNER ' ° �� 0 �'` ADDRESS P� t ZONING SETBACKS n oCITY �id.�SMe�:�-� I3dlY'ZIP TEL. I REOART RW ❑❑ d APPLICANT TEL. SIDE/SIOE STREET RW ❑ � CONTRACTOR � t��` i�� SIDE ❑ � ADDRESS "- - - ��3�, % : o CITY �(7� {�r,n p_a_ ZIP� TEL�� � ��;�� PROPOSED USE H � _ wo ARCH/ENG/ � , a DESIGNER w NO.DWEL. NO. / NO. � ADDRESS UNITS � STORIES _ = CITY ZIP TEL. / BEDROOMS � u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION . .� OWNER-BUILOER DECLARATION SFR/ADD/REM .O ,p 1 HEREBV AFFiiW UNDEH PBJALTY OF PERAIRY THAT 1 AM E%EMPT FROM THE CON7RACTORS LI- G8fdJ0/GBfpOR. �_ - -W CENSEUWFORTHEFOILOWINGREASON(SEC.7o31.5BUSINESSANDPROFESSIONSCODE:ANYCINOfl - (n C) COIINTYNMICFIREWIRESAPEFlM1T7000N5TflUCT,ALTER,IMPflOVE,�EN.OLISH,OHHEPAIqANYSTRUG -W pati0/DBCk -•z -7URE,PFIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE ASIGNED W STATEMEN7 THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONiRACTOflS L1- W -��- CENSE LAW(CHAPTER 9(COMMENCING WITM SECTION 7Wo)OF DIVISION 3 OF THE BUSINE55 ANO PHO- LL PooVSpa FE8SIONS�E)ORTHATHEORSHEISEXEMPTTHEREFflOMANDTHEBASiSFOFTHEALLEGEDEXEMP- � _V TION.ANYVIOlAT10NOFSECTIONT031.5BVANYAPPLICANTFORAPERMITSl10JLCTShIEAPPLICANTTO Z Re-Roof , � -�- ACMLPENALTYOFNOTMOREIHANFIVEHUN�REODOLUIRS(5500).): --� ❑I.ASOVJNEROFTHEPROPEFiY.OHMYEMPIAYEESWITHWAOESASTHEIRSOLECOMPEN5A7�ON� COmmeftial -- WILL DO THE WOHIC,AND THE STHUCTUqE IS NOT INTENDE�OR OFfEREO FOR SALE(SEC.7004,8U51- � -� NESS AND PHOFESSIONS COOE:THE fAMRAGT00.5 UGENSE LAW DOES NOT APPLY TO AN OWYEfl OF ? PflOPERTY WHO BUIlD50R IMPROVES THERC-0N.AN�WHODOES SUCH WORK HIMSELF OR HERSELF OR � -0[ THA(%JGHHISOqHEqONMEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSALiENOTINTENDEDOR m �n OFFEREDFORSALEIF,HOWEVERTMEBUIIDINGORIMPROVEMBJTI550LDWITHINONEYEAROPCAMPLE- __� TIOPI,TME OWNEH-9UtlDEii WILL MAVE THE 6URDHi 6F PflOVING 7HAT HE OR SME 010 NOT BUILD Ofl . .� IMP(iOVEWATHENRPOSEOFSALE�. - � . �.�yy �I.ASOWNEROFTHEPflOPERiY,AMEXCLU5IVELYCOMPACTIN6WRHLICEN9EDCOMRACTOflS �_� TO CONSTAUCT THE PROJECT(SEC.IOa,BUSMESS AND PROFE5510NS CODE TNE CONTflACTOHS LI. Valuation Cl � ADJ.AREA CENSE LAW DOE3 NOT APPLV TOAN OV.MEN OFAPqOPERTV WHO BUiLDS Oq IMPROVES THEREON.AND _F- WliOCONTMCTSFORSUCHPROJECTSWITHACPNiRACTOR(5)LICENSEDPURSUANTTOTHECONTRAP QUANTITY DESCRIPTION FEE - -� TORS UCENSE UW.). -� ❑i AM EXEMPT UJDER SEC. B.8 P.Q FOR THIS flEASOY . Q :� V Ll.. � DATE OWNER - � �. w :�_ LIGENSE�CONTRACTORS DFC�AFATION W . �,� IHEREBYAFFIRMUN�ERPENALTYOFPERIUflYTMATIAMLICENSEDUNOERPROVI510N50rCHAPTER �� ,_��- 8(COMMENCIN(3N7THSECTIOtd7000)OFDNIS�ON30FTHE8l/51NESSANDPROFESSIONSCADE,AND Z �X� MY UCENSE IS IN NLl FOflCEAND EFFECT. m W . �-0: UCENSE CtASS f�.�� UG NO. Q� • j -, - '�-~- DATE �'-�.J�°�Gd CONTRACTOR � � U w > � � WORKERS'COMPENSATION D LA ATIO � -:� � ���� U . '� IHEflEBYAFFIRNUNDEftPENPLTVOFPERIl1RVONEOFTHEF-0LLOWINGD LAflAT� _ _ -� _lHAYEAM6WILlMAMTAINACEHTIFlCATEOFCONSEMTOSELF-IN6 EFOAN/OR7(ERS' - � � - — COMPENSATION,ASPROVIOEDBYSECilON3'1ooOF'iMELABOflcODE, HTHEVERFO W �. � `OFTHFWORKFORWNIq/7HI5PERMITIS�SSUED. - -���W� _I HRVFAND WILL MAIMAIN WORKEHS'CAA/FENSATION INSl1RANCE,AS RE(]UIRED AY SEC ON - - � �} �q ; -~Q 37000FTHELABORCODE.FORTHEPEflFORMANCEOFTHEWORKFORWHICHTHIS.VEflMITIS -� �f-t��6 �- ISSUED.MY WORK S'COMPENSATION INSURPNCE CARAIER AND POLICY NUMB°A�ARE: ONST CTION � �3 :�.- CARRIER �- 5 t � L�Sry V�EW _.Z_ POLICY NUMBER '�L � +�� � � / LE IC - �-0 (IHISSECftJPJNE�t�TBE�E�EDOFhEPEFi�Af�ISFOHONEIM\ORE➢ (Si a UMBING . � �Z 'ICERTIF1'THATIN7HEPERFORM�VICEOFTHEWORKFORWHICHTNISPERMI ISSUED.1� MECHANICAL - . :(�-_ SHALLNOTEMPLOVANYPERSONiNANYMANNERSOASTOBECOMESU&IECT - - "(/j� WORKERS'COMPE45ATIONLAWSOFCAL�fOPN1R�DAGREETHATIfISHOULDBECOME -INSPECTIONFEE _�- -SUBJECTTOiHEWORKER5'COMPENSATIONPROVISIONSOFSEC710N37000FTHELA00 , CODE,ISHALLFOflTHWIiHCOMPLYWITHTNOSEPfl VISIONS. ISSUANCE �J¢( n �� �RP�� �1 1\ � :� '.p- DATE: � 'd� APPLICANT: . . ��! i SMIP . �,(�'yyy � �� � -J- WARNIN6:FAILURETOSEWflEWORKEflS'GOMPENSN71 NGOYERA ISUNIAWFUL,ANDSHALLBE ENERGYP/C �YT���,�L���'SVL-D�+[j _ .. _ :_:LL_ SUflIECTANEMVIOYERTOCRIMINALPENALTIESANOC ILFINESUP700NEHUN�flEDTHOUSAND ENERGYPERMIT rarrm Y14ATlti ATl1T��h1C°L'ii d- ' �y- OOl1.AR5(S70o.00o),IN ADDITION TOTHE COSTOF COMPENSATION,OAMAGE'a AS PROVIDED FOR IN s�-��y{QTg,i���^ -- -._I SECTION37080FTHELABORCOOE,INTEflEST,FNDATfORNE1"SFEES. � RETENTIONFEE: -��� CONSTflUCTION LENDING AGENCY PRE-ALT FEE: O �--- ---�-� IHEREBYpFFIRMUNDEHPENALTYOFPEflJl1RVTHATTHEREISACONSTRl1CTIONLEN�INGAGENCY -d FORTHE PEflFORMANCE OF THE WORK Wfl WHICH THIS PEflMIT IS ISSUED(SEC.3097,CIY.C.). . --"- - Z. W - '^�� LENDER'S NAME � I—:- LENDER'SADORESS ������� ICEflTIF1'THATIHAVEREADhIISAPPLICATIONANOSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES - � . W- IA6flEETOCOMPLYWITMALLCIT'ANDCOUNT/OR�INANCESANOSTATEIAWSRELATMGT09U1LDING V ��� CONSTRUCTION.ANDHEflEBYAUTHORIZEFlEPRESENTA71VE50FTHI5CDUNTY70ENTERUPON7HE - �-�_Z ABOVE-MENTIONED PROPENT'FOP INSPECTION PURPOSES. COMMENTS -�,� �-��ZR �'- f���• -_a PE ENAME RI / ��� � ,.p �� � . r � r'f'� % r/f ! A .� IG NEOfPEHMiTTEE D E - ���� - .__ - RECPT.NO. .�/� PAID BY _____VALI�ATION ' '~ WHITE—�epartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�—File Copy,GREEN—ApplicanPs Copy —� [ ^^�� + � �'� ��� ���8�� .s ff . . 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