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HomeMy WebLinkAbout16329 � '� � , . ` CITY OF DIAMOND BAht •'i,—"'� I ` --��" - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES T_� 21660 E.Copiey Drive Suite 190 Y---�'" � PRESS (909)86(�3195 Fax(909)861-3117 ������°� BULLDING PERMTT APPLICATION FIRMLY + } JOBSITE s� �a APPLICATION �> PERMI7 -d P/C, i o ADDRESS__��_ ��e� S� L�/'7<„_ DATE � " NUMBER �� � ��# c� 15SUE ��TYPE OCC APN_. LQT-y��—�--�- TRACT DATE ` � +CONST._ GROUP °C OWNER ��rl f`C.iCAC:i�_ � ADDRESS �I� � r�� ' i>f) �-Ut9� ZONING SETBACKS w t FRONT RW ❑ i Z CITY �'I tYlO.'! . :�PZIP.`�i7��h TEL. U �Cxl'�5���,J -- g APPLICANT u Ct�� C,'� rlSTEL. .1` .� � REAR ❑__ � ---_ SIDEISIDE STREET RW U _ � CONTRACTOR C IUY"1 "�'I'1'tZ.(,.(-�Y::� SIDE ❑ c� ADDRESS� 7 �' �� Y�Jt.2Cl4t:.�teJ I p CITY �'�llfC'f�.riC:A ZIP �C)2 � TEL�1�+4.51.`i`J I PROPOS[DUSE --------------- � p ARCH/ENG/ Z DESIGNER — NO.DWEL. NO. NO. j � ADDRESS _._ UNITS__ _ STORIES BEDROOMS � CITY ZIP___ TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION � OWNER-BUILDERDECLARA710N . SFR/ADD/REM O Q I HERE6Y AFFIIAI UNOEP PENRLTY OF PERNRY 7MAT I AM[X[MPT FROM THE CONTRACTORS LI� G8fe9BlCelpOfl W CEN5ELAWFORTHEF'OLLOWINOREASON(5EC.703t.5BU51NE55ANDPROFE5510N5CODE:ANVCITYOq � � C� CWNTYNMICHREWIflESAPERMRTOCANSYRUCT,ALTER,IM?ROYE,DEMOLISH.ORREPAIflANYSTpUC� W aIlO/DeCk W NRE,PRIOR TO ITS ISSUANCE.AL50 RE�UIRES THE APPLICANT FOR SUCH PEHMIT TO FlLE A SIGNED � P STATEMENT iHAi HE OR SHE IS LICENSED PUPSUANT TO THE PiiOVI510NS OF THE CONTFlACTORS LI- � CENSE UW(CHAPTER B(COMMENCING HIITH SECTION�Wo)OF DIVISION 30F THE BUSINESS AND PFO- �' PooUSpa FESSIONSCODE)ORTHATFiEOR5HEI5EXEMPTTHF.REFROMPNDTHEBA515FORTHEALIEGF.DEXEMP• (� TION.ANVVIOLRTIONOFSECTION7ai1.58YANVAPPLICANTFORAPERMlTSl1&IECTSTHEAPPUCANT70 � Re-Root F AqVIL PENAL1Y OF NOT MORE THAN FNE HUNDRFD OOlU1R5(ESoo).): ^ CII,�SOWNEROFTrIEPROPEfiTY,OflMYEMPLOYEESWITNWAGE5A5THEiftSOLECOMPENSATAN, C� Caf111flefCidl � WILL00 THE WORK,AND TNE STRUCTURE IS NOT INTENDEO OR OFF[FED FOR SALE(9EC.7044,BUSI� J NE55 AND PROFESSIONS CODE:THE CONTPACTOF75 UCENSE I.AW DOES NO(APPLY TO AN OWNEF OF �� 7ROPER7YMR108U1�[150RMAPROVESiNEFEON,Ml�YA10DOESSUGHWOHKHIMSELFOPMEHSELFOR � �� 7HROUONtIt50RHEHOYMEMPLOYEES.PROV1[IE�YIiATSUCHIAIPROVEMENTSARENOTINTEN�EDOR O; OfFEREDPJHSPLEIF,HOWEVERh1EBUILDINGORIMPROVE�fENTI550LDWITHINONEVEAfiOFCOMPLE- _ Z TION,TME OWNER-RUIIDER N7LL HAVE THE fiURDEN OF PROVING 7HAT HE OR SHE DID NOT BUILD OR _: IMPROVE FOR THE PUHPOSE OF SALE1. �y: f.11,ASOWNEROFTHEPAOPEFRV,MIE%CLUSIVkLYCONTiUCTINGWRHI.Ic:[NSEDCONTNACTORS ¢} TOCONSTRUCT TNE PRQIt:CT(9EG 70,4,BU9INESSAND PROFESSIOMS CWE:IYE COrlTHAC70R5 LI- V8I118f10l1 __ADJ.AREA __ ____ W^. CENSEUWDOESDbTAPPLYTOANOWNEROFAPROPEFlTYNIHOB111L�50RIMPROVESTHEREON,M'D -- WIiOCONTRACTSFOii5UCHARQIFCTSWIiHACQYTRACTOR(5}LICENSEOPUFiSUPNTTOTHECONTRAG QUANTITY DESCRIPI'ION FEE Y`. TORS LICENSE UWJ. - ._ — ��� LI I AM E%EM77'UNDER SEC. __U.fl P.G FOR TNIS R[A50Y U �� _—_- "—____ —_ � � .11.. DATE oNRiEN..____'___..__.'__....._._...'.___—_ �: U' .. � :�a�� LICENSEDGQNTRACTORSDECLARATION � y i :;C��. 1lfEit£BYAFF:RML'YDER^E:RITYOF9ERJURYTHR?!,1ASLICENSEDLNDERPROV!S:�NSOFCNP.P?EA ;— ��;�� �����L�� � 9(OOMMENCINGWITHSECTKK47000)OFOIVISiON20FTMEDUSiNE55ANOPFO`F.SSIONSGCf]EF,PND �. 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'""'/�� L�._ .�_ PLAN REVIEW .......--------- ----- '.�'. CAHHIFR__`�—'Y?�]t` _'_�'�"""_ ' '--""_--'—"""_ __"'___--_ � , (� !�,__C>���.1------------........ 0�. POI.ICY NUMBER� � _ � .... . .-� FLEC7RIC �. ---- -------------.. -- �- -- � .� �ni�sSEcnoriHeFnNoraecohtttFr�oo�n�p[avn�sronaaerura�E000tw3s�stao)al�Essi� PLUMRING ........---- �`� ttr -- ----- - '�,z 1 CEHI'IFY iNAT IN THE FtRFORMANCE OF THE WORN fOH WHICN TIiIS P[l1MIT IS ISSUED,1 MECHANICAL .,__..— ___,_..._.___..—__ `;;('};: SI�iALL NCi EM.PIOYANY PERSGN!Y ANY MFNNEF SO AS TO CEGOMC SI�BJFGI'SO TIiE ` "�� WOPNERS'(:OMPENSA710NI.AWSOFL'nLII�OfiN1A,ANOAGflFfTHATIFISHOULDBECOME INSPEC71ONfEE ...,_ _'_-_""__'...'-- ...__� �.�, 5UBlEC1'TO'fN[WORKF:fiS'COMPENS�TIONYROV15104SOFSFCTION:fIooOFTHELABOR ISSUANCF_ �� CA�[,I SNALI FUfiTHWITH COMPLY WITt l'I fOSF.PHOVISION5. — _"......_....._"- "� �p�� �ATE: � '"'.�___UJ_' APPLICAN7: �.J.�.1°L._�V1_11,G "^�� SMIP _-K n . J; ENERGY P/ � .J� W0.flNING FAILURE YO SLCUPE WORKERS'GOMPENSATION COVERAGE IS UNIAWFUL,AND SHALLDE —" """""'"--"'-"""""'- ' ' —""--'-""'-- , �� SUBJECTANEMPLOYERIOCRIMINALPENALTiESANDGVILFINFSUPTOONEIiU�DNLDTHOUSAND ENERGYPE MIT � �'�. � �(�f � OOLURS(S�W�oao)��N ADDITION TO THF.COSTOF COMPENSATION,DAMAGES AS PNOVIDED FOP IN ""f�""Q i'-', i?'�-"--- -'-"-""-'-' -"-'--'�— J SF.GTION�7080FT11ELPBORC00[,INTEHEST,ANDATTORNf:Y'SFF.ES, RETENTION EE: �� .�. ._----_'__"_—"_" -'_'_'____.___.__-' �a�, CONSTRUCTION LENDING AG[NCY PRE-ALT FE : _.___ ___ _ O: y� �' IHERF.BYAFFIRMUNDERPENALTYOFPGfiJURYTI{q�'7HEI7EISACONSTRUCTIONLEN�INGAGENCV rL • FOR THF PERf4RMM10E OF THE WOR1(FOR WHICH THIS PERMIT Ib ISSUED�SEC.3CB�,CIV.C.�. —�''� � �+����� '�'l'l-""""-" ." ._-"-- .�, __'_ __'-' -S7- LENDLR'SNPME__..__._-"_ ___.--__. '_'_ __"'..__._.._.-.__. _ ' S. ' ' -......._.. F� LEN�ER'SADDRESS_ ___—___.- -__-----.- — ¢ I CERTIFV THAT I HAVE NEAD THiS APPIICATION AND S7ATE Th1AT fHC ABOVE INFONMATION IS CORFECT. TOTAL FE ES { � W I AOqEE TO COMPLY WITH AlL CITY AND CUUNTY ORDINANCES AND STATE LAWS RELATING TO�UILDING � � CANSTRUCTIOY,ANUhIEfl[BVAUTHORIZEFiEVR[SEN7ATIVESOFTHISCOUNT'TOENTEFUPONTHE A " ENTIONEO PROPEHTY FOA INSP- TIO URPOSES. � Z COMMENTS_,_.____ � ---��--�--�� ------- � ' - - - - Q PEFlMITTE E NT) �/�' ' ��y° �-`�.�.(�.�...�� . - ------- --- � , — — ------ -- -- — _ I � eaF ir eE oniE qECPT.NO. �'PAID BY -- -.....-----VALIDATION--..--- - Z � ~ wFi1TE-Department Copy,YELLOW-Finenca Copy.PINK-Assessor Copy.GOLDENROD-File Copy,OREEN-AppliranYs Copy . . . ... .. _ . . ,. ; , � ., , _ . � _ . . - , ; > � z � - �p I - � � - } � - ` � : ,.- , , - _ , ,. 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