Loading...
HomeMy WebLinkAbout13291 . � .��� � CITY OF DIAMOND�3AR � COb1b1UNITY DEVELOI�h1ENT DEYARTAfE�iT <'�pt�,�....� '� 21G60E.Coplcy Drivc Suite 190' i pRESS (909)8G0-3I95 Fax(909)861-3117 '�"' • BUILDINGPER:1fITAPPLICATION FiRMLY o� JOBSITE ��L� �� ����f � . APPLICATION ���--C! PERMIT�3�y� P!C ADDRESS � DATE 1 NUMBE tt • � APN LOT_ TRACT ,��j �SSUE �/� TYPE OCC �;— �,j DATE�L,�CONST. GROUP p OWNER �11��1 o ADDRESS ZONING SETE3ACK5 Z CITY ZIP TEL. FRONT RW - ❑ 0 APPLICANT TEI. REAR ❑ S�DE/SIDE STREET RW ❑ • � CONTRACID � p� I'L SIDE ❑_�_ � A�DRESS L PflOPOSED U�, ' � � CITY ZIP��.3TEL� . �� w ARCH/ENG! z DESIGNER " NO.DWEL NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER•BCILOER DECLARATION � - - � SFFUADDlRE�M � � � � O ' ' . 0 1 MEpEBY AFFIHM UY�ER PENALTY OF PEfU1RY TMAT 1 AM C%EMPT FROM TME CONTMCT0�5 LI- � Garaga/CarpoA W CENSELAWPoRTHEFOLLOWINGHEASONISEG70.77.SOUSINESSI�NDPFIOPESSIOHSCO�E:ANYCITYOq U OWNTYWHICHREOUTAESAPERMITTOCONSTFUCT.ALTER�MPROV'c,DC�.�OLISH.CRPL'PAIFAVYSTRL'C. - W P3:�O�DBLk . u� TUH�DFIOR TO ITS ISSUMICE.LL50 R[WIRCS THE APPLICANT FOa SUCM PER'Ali TO fllE A SIGtiCD W � STATEMCNT TIAT HE OR SnE IS UCCNSE�Pl:RSUakT TO THE PRCYIS�ONS OF TME CONTHAC70HS U- L CENSE LAW(��TER Y(CO�.��ENCING WITH SCCTION 70ao)CF C1VISiON J OF TNE O�SI4E55 aN�Pf?O• � PDOUSp3 O FESSqN5CO0E)ORTMATHEOq5HE15EXEMPTTMERCFROMAK�7NE8�S�5FORTHEALLECEDCXEUP•�, , (r] V TqN.ANYNOLATIONOFSCGTION7C71,SBYA4VAPPLICANTFORA�CRMITSUBJECT5IHEADVLICANTTO Z Re-Rool � ACINLPG�ALTYOFNOTMORE7HANFIVEHUNDREDOOWi�S(SSao)_�: � ❑I,ASOYINEROfTHEPROGERTY,ONMYCMVIOYCCSWITHY/ACESASTHEiR50LECOMP�tiS�T10N, ❑ COmmBfCi�l Z W1lL DO TME WORKµD THE S7RUCTU�7E iS NOT IN7ENOCD 09 OFFERED F4R SAIE(SEG 70�I,PUSI- J NCSS AND DROFESSIONS OOOE:THE CANTHAGTORS LIGFNSE LAW DOES NOiAiPLY TO A4 OY7YEq OF � VROPCflTYYAIOBUILO50RIMPRpVE37HEREON,ANDWHO�0E55UCHWORKH�MSEIFORHEflSF.IFOR = � � Q THFlOUCHH750RHEflOWNEMPLOYEES,��OViDEDTNATSUCHIM7qpVEMENTS�RENOTINTENDC�Oa m , W OFFCREDFORSALEIF,HOWEVER7NEBl14D:NGOR'�MPROVEMEYi1550LD1MTNINONEYFAqOFOOMV�E- � TION,TME OWNER�OUILDEH WILL HAVE THE BUFlDEN OF PqONNO 7F�Ai HE OA SME DIO NOT�URD 04 L IMPROVEFORTHEPUf770SEOF5ALE). _ ❑tASOWNEROFTHEPROPERTY.�ME%CLUSIY0.YCONiMCT�NGWITHUCENSCDCONTfiAGTORS � TO CONSTRVCT THE PRQIECT�SEQ 70�4,BUS�NESS AND PROFESSIONS�A7E:T/I�CONTRACiORS LI- V31UaIi0l1 ADJ..4REA W CENSEUWDOESNOTAGPIYTOANONN[fiOFAPR07ERTY1VMO0UIL�509iMPROVE57MEREON.A1:0 � � NTIOCONTMCTSFORSUp1�fiOJECTSW�TNACONTHACTOii(SJLICENS[DPU{iSUANTTOTHECOhTfLIP OUANTITY DESCRIPTION � �� � FEE Y TOASLICENSEUW.�. � � � J 0 ❑IAM E]cE�APT UNOER SEG &8 P.C.FORTH:S fi[ASON U � ¢ � DAiE OKNER F'�' U W �Q LICENSED CONTRACTORS DECLARATION ' W CC I NEHEBY AFFIR'A UM1DEH PENILLTY OF PEKIUAY THA7 I A4 LICENSED UNDER PfiOVISqNS OF CMAPTCR�- U. � ; � G(CW.�MENLiNG�v�TH SECTION 70CD�OF OIYi510N]Of T1E OUSINESS AN'J PRO�E551DN5 CO�E�.�� Z � uV UCENSE tS W f L FaaC�iF��i ']IC.NO.�� �,,� � �� / � LICENSE CU15S 3 �•t L v � ( I . ��n """ �I"" //,, J V pq{��_ CONTRACTOfl_�y-;L,r���L}y.� � a W /,�(d f��l� ['�= WORKERS'COMPENSATION DECLARATION a . � U � IHERCBY/�FFIHA111NDENPENALTYOFVEit1URYOhEOFTMEFOLIOWINGDECL/�ilATqNS: Z Q 0 _INAYEANDWILLMAINTAINACERTIFlCATEOFCONSCNTTOSELFdNSI.REFORNORNCRS' _ � CpMPENSATqN,AS VROVIDED BY SECTION 97W Of THE UBOH COC�LOR THE PERFORAIANCE w OF TNE WONK FOq WHICH TH15 PERA/1T I5155UEO. , _ � w _IHAVEANOWRLMAINTAINWORKLflS'COMPENSATqNINSU�WJCE.A5RE0UIPCDBYSECTION O J7o00FTNElABORCODE,FORTNEPERFORMANCEOFTHEwORKFOqWNICHTHIS7EfiMIT15 ISSUE0.MV WORKERS' � NSATION INSURANCE qaARfil[RAN�POUCY NUTACEHARE: CONSTRUCTION jWqq;Eq �� .��-�L-�I h[1' _ PLAN REVIEW . o aaicrrauueca_j_. (���� ELECTRIC _ _ y/�, _t/�� � (iFc55ECTKX��EmNOT(iECC+.���ocn+Ex�swaanE�ax��oaixrs�s,ar�aa�c.ss� PLUMBING �; �!�� �"'"�" W MECHANICAL Z I CEflTIFY TH11T IN TME PERFOfUAqNCE OF TNE Y.'OW(FOR NRiiG1 THIS PEFlMIT IS ISSUED,I �J' SNALL NOT CMPLOYMY PERSON lY 0.YT MASNEA SOAS TO GECOA!E SUBJELT'O'!�E . � W10RKER5'COIA7ENSAiqNLAW50FGALIFOflN1AAN0AGREETMATIF�5MOl1LD�ECAME INSPECTIONFEE 2� —� -� SU0.IEGT TO THE WOiiKERS'CAMVENSATION PROV15�ONS OF SECiION 77000F THE UEtOR � � � CODE,I SNALL GOHTM4ITHCOMP�Y WIM7HOSE PROVISIONS. �SSUMICE �� - � � O DAiE: APf'LICANT. S'AIP �'.'�,�, T''CY _ — — � LZT�, \ WWMNIN@FAq.UFETOSECUREWO(�KERS'COMPE�:SATqNCOVFRACEISUNUWFUL.ANDSHALLOE ENEF�Gi�7c,��Oy S y �„�� --- � SUBJECTANFMPLOYEi7TOCf71MIN�L7ENALTIESAN�GIVILFI\ESI:PTOONEHUKDREDTMOUSRND ENER�y(A'Y'' YI���• DIXIARS(S1a0.00D1.INADDITIONTOTMECOSTOFCOMPENSAiqN,ONMAGE5A5�ROY�DEDFORIN rjV'�� 'J SEGT�ON7TOEOFiNEU00RCADE,INTCFlEST,AN7AT'R)R�:EY5FEE5. � RETENTIONFEE: Q oCONSTRUCTION LENDING AGENCY pRE-ALT FEE: �- � � IMEREBYAfFiRMUKDERPENALTYOFVERJURYTHATTM�REiSACONSTl7UC710NLENDINCAGFN�V � FOq THE PERFORMMICE OF THE WORK FOH WHICN THiS PERMIT IS ISSUEO(SEG]C97,CIV.C.�. �i �— Z W � LCNUER'SNnME _ _ � F— lEN0EfY5ADDRE55 ' � ICEHTIFYTNATIHAVEREADiH:SAP�UCATqNANDST�TETNATTME�BOVEWFORMATI0Y15COiiRECT. TOTAL FEES � IAGHEETOLOMPLYVATHALLGTYANOCOUNTYOqDI.VANCE5M+D5TATEUWSREUTINGTOOUILD'NG � CONSTRUCTION,ANDHEREBYAUTNORIZENEPqE£FNTATNCSOFTIIISWUNTYTOFNTERU?ONThE � ' ABOYE� TqNED PROPERTY FOR INSVECTION RIRPOSES. Z � � GOfJt�EN7S � �1 � 3 (jl�. � m - - Q PERMI E NAME f�' T) _ " � y � � _ — � SIG ' ' �fil^ E DaIE � Z RECPT,NO.��_ _ PAID�Y _ VALIDATION_ ~ WHI Depanment C VE W--Fu�ance Copy,FINK—Assessor Copy,GOIDENROD—F�le Copy,GREEN—Applicanfs Copy � . . . . _ .'t.- ' ' ' I . . ,\ � � ,\ .\ . _ • . _ . . . ��1. � � 1 �' . � ' �r.. � , ` . .\ •i� - .i -\,��`. � ... I {.i �_..=� - � � ' . ',./ / . !�. �zis niiia d�3s �ZIS�INt/1�Ild3S . 1 ��'r- �, ;�� � � � � � ,� �1�. i`��� '_,,� .y ;! I. 1 i ! 1 � � . . . . S1N3WW0� . ... - - �. - - -- • . - _.. . . . _, , ; r . .� �.• i� 1 , f.� � � i ' ' � " "' - ' ' � .IJa�N3 - � � . , I, KJ.NIawnZd.�t/Nl� alt/d S�3� 'A30 � � , �! ' . != � �I�l1�3.13 ltfNl� ldNi�'1d34 H1�t13H JNIld3�l lt/Ni� �b'NI�1d30�FJI� :LSNO�lt/NI� JNINOZ lbNl� 1S31�iltl St/J 'SdWI 311S NO 'l'lllld d3�S 'Jidall�dV�SaNdl �INdl�Ild3S 'JN3 lb'Nid �I�M�S SN011tf�la�a JNI"lit/N lltfMl��4 'SdWI�lIS��O NOIlt/�f1SNl JNlll�� �dNl��OOd NOI1�f1f1SNi lltfM JNI�N3��ODd CJNIOIS/Hlt(1 1X� �ibl�3��lOOd _ _ 15�1 efll/�i3MOHS rJMOdaJ HSINI� JN18W(lld HJfIOd JNIQddJ HJflOa �Idl�3l3 H�flOb • JNIH�N38 JNIlN3H HJf10Fi . JNIaV�JJ-3ad �l3A0��OOb Wb'38 dN08ltlNl� NOIldIIIlN�/VJNIW`db� . , Wt/39 aN08:J�8 JNIHl'd3HS d�Od _ • � - 'Wt/36 QNO�1H QIW ti. _ ; � •� a �- -3 IAF13S d�lt/M ' ��� , I 'I •.-, i' t� : Wtf�8,dN08��tfld��ll� � • �;, a3M�d'dW31 ' N011b'aNf10�3�tfld�dl� �atfaJ BdIS ll(101V0�a001�d�aNfl JN18W(lld aNflO�1J , �. l�(14 ki001��30Nf1 aNf10FiJ�Idl�3l3 � `.' `•� :' ' ' ' ': !."� .. S1W�3li b'H� .t , �� '1331S/SWdO�lSJ1� � •- ' `� 1S1�f'�00'l� ` � .� �� �,_ `� �1�tf8 l�S �'�,���_►�F`..,U�1 ' i 0 9 �� � � � • � • � at30�3a N011�3dSNl ada an�4wdia �o�i�