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HomeMy WebLinkAbout17042 (42) /� �� CITY OF DIAMOND$AR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117• PRESS ���^� BUII.DING PERMIT APPLICATION /FlRMLY•.� 4 ADDRIESS I�Z 2 J/l,�D�(�xJ �/�1/�L{�, APPLICATION� PERMIT r11� P/C �)� I _ � DATE '�� NUMBER V It ) g ISSUE � � TYPE C � APN LOT TRAC • ' DATE � CONST.��/ GROl7P'--�.. -� � OWNER � " ADDRESS ILL7Q7_ M� _L�nDC7 ��► ZONING SEfBACKS --1--�-rr�'r s� W CITY�(fj�Q_,���ZIP�TEL. �'��3q3—l�j FROPfT pW ❑ � APPLICANT �� � TEL - y�7 SID�IDE STREET RW p � CONTRACTOF ` - SIDE ❑ � CTM ESS ZIP � TEL , PROPOSED USE !� � n� � — �� �` - r. � ARCH/ENG/ ' /-= f DESIGNER � A �(LS1/�1�� � ` AODRESS !' L �� / ,,pt �i— NO.DWEL. NO. NO. = C'TM -I�—�-►—�� ��7L T T���-�h�—� UNITS STORIES BEDROOMS �n �7�,..x � DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILD[RDECLARATION SFR/ADDlREM ' O p 1 MEREBY AFFlRAI UNOER PEN�LT/OF PERNRY h1AT 1 AM ExEMPT FHOu THE COHTAACTORS Ll� G0f�g0/CdfpOfi W CENSEUWfORTMEiOLLOWVI0RFA50N�SEG70]1.68USWESSIWOPROFESS�ONSCODE:ANVdTYOF (/J � COLNTYWIIMJ/PEODUiE4A0EiWRTOCONSTRUCT.ALTERVPROVEDELIOLISH,ORPEPAI0.ANVSTAUC• W PaI10lDBCk TURE,PRIOH TO RS ISSUANCE.AL50 NEWIRES iME APPUCANT FOFl SUGH VERMIT 70 i1LE A SIGNEp W � ETATEMENT iHAT HE OR SME IS UCENSED PURSUMlT TO iME PROVi5lON5 pF THE CONTMCTORS LI• . � CENSE UW��7UPTEN 0(COIAMENCINU WITH SECT70N 70007 OF DINSiON f Of THE BUSINE55IUD PRO� u' PooUSpa FESSqN5tO0C)ORTTUTMEORSMEI9EXEMPiTHEREFROM/�.YDTNEBA.',ISFORiHEhLLEGEDE%EMP• (!� TtlN.ANYV10lAT10NOFSECT10N70.71.6BV11NYMPlIGANTFORA7LRMIT5U61ECT57HEAi7LIG1NTT0 Z Fle-Poof � ACMI PENALTY OF NOT GOf1E TIIAN F1VE HUNDRFD OOLUNS(1500��• � O1�50NR1EROFIMEGROPE�R�',ORYYEM�'IOYEESWITTiWAGE5A5TME1R50LECOMPEN5AT10N, � COTRIBf�12I n � WILL DO THE WORK M10 TME Siia1CTUFE LS NOT IN7EPIDED OR OFFERED FOP SALE(SEG 7M�,B'J51. �J N HESS NO VROFESSIONS CODE iNE COHiMCTORS LILENSE UW 00[S 1:0T APPLV TO AN qVNER OF ? 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B.l P.C.FOqTMS REASON � l u' DATE OK'r,EH �` � UCENSED CONTRACTORS�ECUAATIOM � — / - OC IMERCBYAFFWYLl1DERPENFLTYOFPERIUR'�THATI/JAIICENSEDUNDER7R0'ASIONSOFp1APTER ` � •�COYMGNCWGNITHSECTqN7000)OFDMSION]OFTHCBL'$IhC55M10PpOFE55lONSCODE,AND z 7 X MY LICENSE i5 M FUII FORCE AN�E«ECT. m r� ' LLI � UCENSE CI,ASS�_LIC.NO. ,.,����� � ' .�� . ��f �j DA7E���_��.__CONTMCTOR J'LT'���/�_ J 7—� " W � V � � WORKERS'COMPENSATIONDECLARATION� . . . - • • _ �C�� � IHEREBY AFFViAI UNDER PEKALTY OF pE0.A1RY ONE OF THE FOLLOW��NG DGCURATqNS: ` � � z d Gt'L z ��IMI�VEANDW%LIMA!NTAINACEMIFICATEOFCONSFMTOSRF-RISURCFOqNqR(FR.' T � � COMVENSA7pN.114VROV1�EDtlY5EC7ip177ooOF7MELA�ORCWE,FO�iT�EDElt�'OMUNCE U �! ' � � OF hIE WORI(FOR VM'dl TN15 PERMIT IS L.SUED, w • /•i Gf, . G Q �IHAVEANOWiLLMAtNTAWWORKFRS'COI.InENS�TI0NIN5UMNCE,ASREOUiRE�BY5ECT10N (� � /� r 970o OF TNE LA£OR CODE.FOq i/1E PEnFpItMFNCE Of THE WOFK FORw!iICH iHiS PERMR IS � I 1 1 � LSSUED.W NONCERS'COL+PENSATqN IN5U9ANC��ERAND COLICY NwBERIUiG: CONSTfiUCTION v 7 GiiiUER�� !� � �+--/-- PLANREVIEW ' � paierrrt�MO¢R_�Q���f��Jr.— ELECTAIC � � - - � G o m�scenx+numNoreaea.f{�rmancrenxr�sr+on �uonmoaU.u�s,xianuss� PLUM�IDJG � � ICERTIFYTMAThThEPFRFORMANCEOFh1EYlOM(FORWNiCNTMiSPERMTISI55UE0,1 MECHANICNL � ,G " �L H[1T E1APlOYANY VE0.SON IN M!Y 4ANNEN O AS ib BECOME SJBJCLT TO THE 0� � WORKERS'COMVENSATqNlAW50FCAl1FORN1 .�IDAGqEET IFISF101AOOECANE INSPEGTIONFEE / S SU0.IECTTOTMENfORNERS'COMPENSATqNFR '.'ii0^l50�5 iON71MOFiHEUBOR e.i s�uu Fonn�wn�ca+a�v Nnn. �wis � ISSUA4CE � ; � �/ �k�� SMIP �y� • W DATE: "' � . APPLICANT: iH —ti—ri[—Pry 1 ...� WMNINC:i11M1.URLTOSECUFeNUfUfER5COMPEN5AT10NCOVCNAGE15U4UYlFUL.ANOSHKLBE ENERGYP/C ��i j��•1 $UBJECfANEMPtOYEATOCNMINALPENALTIE4ANDCNILFNESU�TODNENUNDRL'DTHOUSAND ENERGYPERMIT � ' DOLURS lf f 00.000).N A�DITION TO ME COST OF�OMPENSATpN,D�AGES AS PROViDED FOH W ¢ 8ECT10N]10eOFTMEUBOi7CODE.M7ERE5T,ANDATTORNEY5FEE5. AETENTIONFEE'/��� O�� oCONSTRUCTION LEYDING AGENCY PRE-ALT FEE: y � INERFBVAFFlMIUNOERVCNALTVOFDERN11YfNATTNCRE151CON5TRUCTIONIENDWGACENCY FOR 7}�E GERFORMANCE OF THE Y/ORK iON VM�CN TMIS PEpMIT IS ISSUED�SFC 3aDl.CN.C.�. �^ � LFhJEii'S N.uIE '+[ 1 � LEMOERSIDDRE55 C w ICERTIfYTMATIMAVEREADT/15APPLICATiW1AN�STATETNATTM[ABOVENiORAUTqN15WRRECi TOTALFECS IO��� Q IIIGREETOCOIaPLYWI'MILLICT'ANDWVNTYORDINANCESANDSTATEUNSPEUTVMTDBUIDING CONSTPUCTi0/{ANUMEPEBYAlIP110RREREP0.ESENTATIVE$OF7TUSCOUNTY OEHTERUPONTN[ Z �swe-M�rrtan¢ovravEATvr�NSPECTIONWRP05[S. 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