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HomeMy WebLinkAbout14518 (17) _._--- . �-.. � CITY OF DIAMOND SAx DEPARTI��[ENT OF CUMMUNITY 8c DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 � � PRESS (909)660-3]95 Fax(909)861-3117 '��`� svII.nnvc��r,Ar�.ic�TTox FIRMLY o AJ DDR�ESS rS! � A�RGRDSS/N� DATE A710N ��,� —O� NtA1A8ER /`� SI «'� , � ISSUE TYPE OCC � APN LQT TRACT DATE CONST. GFOUP � OWNER p ADDRESS ZONING SETBACKS CITY ZIP TEL. FRONT RW ❑ APPIICANT TEL. REAR ❑ 51DElSIDE STREET RW ❑ CONTRACTOA �"u GtrJ• SIDE ❑ g ADDRESS ' CfTY ZIP�d QL TELJ'�� 7 Z� PROPOSEDUSE s � �I]- G G . � ARCHfENG/ DESIGNEH r NO.DWEL. NO. NO. ADDRESS 'UNITS STORIES II`Z BEDROOMS yCITY ZIP TEL : DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION Q OWNEFi-BUILDER DECLARATION SFR/ADD/REM O I IIEREBV AfFlR1A IADFA FENALTV OF VERIURY THAT 1 AM IXEMPT FNOM THE CqJrRACTORS LI•� �- ('aeRe9/CBlpOA CENS6IAWFOR7MEFOLLOWINOi1FA90N(SEC.7031.68USINESSAN07ROFESSIONSCOOE:ANYCRYOR (f� COlM1TYYRUdIRE0UIRESAPERM�[TOOONS7AUC7KTFRMPROVE.DEMOLISH.ORREMIRANYSTRUC- W P9tbJD9d( MIE,PitqR TO R6 ISSUANCE.ALSO RECUIRES TIE MPLICANT FOR 8UG11 PERMIT TO flLE A tKiNED BTATEMQlT TXAT NE OR SME IS UCENSm►URSUANT TO TNE PNWISIONS OF THE CONTR�CTORS ll• CENSE 1AW�C141VTER i(WMMENqN�WITM BECfpN 7000)OF DIVISIDN 70F7HE WSINESSAND PR0- �- P��$Pe FESSpNS CODEI OR T4lT NE ORSHE 18IXEMPTTNEREFROM AND7HE MSIS FWiTHE ALLEOED E%EAIP- TqN.ANYNOLATIONOFSCLTION70.11.6BYANYMPLICIWTFORAiENMR6U&IECTSiHEMPLIGNiTO �j R6-ROOf � ACIV9L►ENi1LT10FNOTMOREINANFNEMINDREDO�UAHSlt6ao�.�: L - p1,ASONAiEROFTNEPROPERTY,ORMYEMPIAYEE5N1hIWMiESASTHE1R90lECOAAPENSATION, Q �mmerciel N7t100 hE WORK,M70 hIE 97RUC7URE IS Ndf INfENOED OR OFFENEU FOR 6ALE(6EC.7ou,BUSI-- J NE&;A!�ifiOFE58qN5 OO�E iNE CONTRACTORS IICENSE LAY/DOES NOT MPLY Tp AN OWI�Eq OF- _ � PRDPEpTY YYF1O BUIlDSOH IUFROVESTlIEREON,NVDYYIp DDEB SUqi 1M�li1f NMSELFOR NERBELF Ofl iMiY0U0H YNS OR IffX ONM�APLOYEES,PHOVIDm TNAT SUCH wIPROVEMEN7SME NOTN7ENOED 01i C� OFFEHmFORBALE F.HOYVENERtF1E BUIDINOOR IMPROVEMB�R I9SOlDNATHIN ONEYEM OFCOMPIE-. �-710N.TNE OWNER�UILOEH VALL NAVE 7ME BUADEN OF pRONNO THAT HE OR 6HE DID NOT BIAID Ofi WPROVE FOi17ME PURPOSEOF bALE� - OI.AS�M�NENOFTME�ROPERIY.AW IXCLUSNELYCONfMCTWG WI7HLICENSEO CONTRACTORS �O CON^uTqUCT T}�PNWECT�BEG 70M.WSINES8 AN�PROFESSIOHS COOE:Tt1E MNfRACTOHS U�. VBIU8tI011 ADJ.AREA CEN9E lAW OOES NOTAFPLY70AN OYYNER�A PROPERTY WIiO BUMDS OR pAPROVES THERE9N.N10 Wl1OOOHTRAGTSPORBUCMPNWECfSWfTMACOMMCTOR(S)LICENBEOPUR9UNffTO�FiEOONTRAC � (�}UANTITY OESCRIPTION FEE � lONS LICENSE WA[1• _ . ❑IMIE)miWilkmERBEC 8.8P.GFORTH6REA90N � U �= pATE OYYNER r � LICENSE�CONTRACTORS DECLARATION � 1 NER�YAPFIRM UiOER PENALTY OF PERIURY i}iAT IAM LICENSED IMIDER PROYISIDNS OF CHAGiEH � ►(CONMEN[7N(iWRX8ECT10N700D�OFON�SIONaOFTMEBIISINE5SMYIVROFE5510l1SCODE,AND z W UCENSE IS IN FlILL PDRCE AND EFfECT. m o ��E�,s ��.No. 3�9�6 a � � o�h � cor�rw,cro a WORKERS'COMPENSATION DECLARATION Q N 1 REBY AFflR1A INVDER PENAL7Y OF PENURY ONE OFTME fOLLOVANa DECLAAA710N5: � � 2 � _IiUVEAlmMALLAWM/MIACERTIFlCATEOFCONSEMTOBELF-INSUREFORWORKEHS' 2 SATION,ASPROVIDm9Y8ECTIONJ7ooOFTNELA80RCO0E,FOR7HEPERi'OqMANCE � THE WORK PDR NM1IICH THIB PERMIT IS ISSVE0. � � I HAVE ANO YALL IMNJfAW WORKERS'OOMPENSATION INSURANCE.119 REWIRED BY SECfiON ` � Q 37W OF 711E LABOR COOE,FOR THE PERPDNW WCE OF THE WOfN(PDR NMICH 1N4S GERMR IS �[J ISSUW.NYWORKERS' P SATIONMIS CECARFUERANOPOLICYNUMBERME: CONSTRUCTION �v— � c�qqiEq - � � _ PLAN REVIEW � IGYNUMBER��7���gf/ �- �.�� ELECTAIC 0 sEcnoNr�rureEoowaFr�oFnfvQwr�swaar+eHrnr+moounas�siao�oa�ess� PLUMBING � FtTIFY7W�TNTIEPERFORMIWCEOFiMEWORKFOAriMPCMTFI15PERM1T13159UE0,1 MECHANICAL (y7 NOTEMVLOYIWYPE1150NMANYMMINERW/15708ECAME91$lECT70TME y PoCERS'COMP�15ATpN UNfS OF CAL�FORNIA ANO A(3REE THAT IF 1 SHOULO 8[OOIAE INSPECTION FEE S SUBJECT TOTHE MKIRICERS'COMFBiSATqN S OF 9700�F T1f UBOH o��/�u�µFoanrv�nnr caaa�r wm� E ISSUANCE O / � _+ �� � Ou�7E � /lf!!d1 APPLICAM: SMIP I_■ WAHNING:FAdUHE TO SECl1RE WDti1�N9'COIdPENSATION RA(iE IS UNLAWFUL.AND SHALLBE ENERGY P/C � BUBJECTMIEMPLOYER70CNIMINALPENALTIESANOGVILFlNESUPTOONEMftAREDT110U5AN0 ENERGYPERMIT } DOLLARS(ttoo,0o0).N AODITON 70THE COST OF COMPENSATqN,DAMAGES AS VRDW E7 FOR IN .:, sJ BECTION JTaO OF hff UBOH OODE.INTEREST,ANOATTORNEYS FEES p�►�pN FEE: � pL CONSTRLJCTION LENDING AGENCY PRE-ALT FEE: 0 �L IHEREBYAFFIW.IUNOEi1PENALTVOFVEKJUi1YTFiATTNERE13ACONSTRUCTIONLENDWGAOENCY FOq iHE PERFORMANCE OF THE NfORK FOR WHICH TNIS PERAIR IS ISSUED(SEC.30Y�,CIV.CJ. � � LENDERSNhME � LENDERSADURESS ICEIITIFYTMATIiNVEREADtH16AVPLIGIT10NANDSTATEIHATTHEA80VENIFORMATpNISOWiqECT. �TOTAL FEES � IMfREE TO WRWLY IMTII ALLCRY AND COUNTY ORDWNlCES ANO 8TATE UWS REUTMIO TO BUNDINO � CONSTRUGTION,MlO HEREBY A{1TpRQE REPflEBENTATNE9 DF THIS COUNTY TO ENTEfl I1PON THE , ABOVE�M EO PpOPERTY WR IMSVEGTqN PURPOSES. � �, � �� COMMENTS � m PERM P Q � � 116W1iVP.EOFP6WRTEE DATE � RECPT.NO. 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