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HomeMy WebLinkAbout14751 (19) � � , CITY OF DIAMOND BAIt � --i� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 (909)860-3195 Fa�c(909)861-3117 PRESS �'`'+�"��\� BUII.DING PERIVIIT APPLICATION FlRMlY = __ .�- Q A DRIESS � I O �O G{��--/�J�'jR,pOIG �IZ DATEICATION� �"� �NUMB R � � S/C c� ISSUE /� TYPE OCC APN LOT TRACT DATE / CONST. GROUP p �WNER /''Z/Z�IZ lc � p ADDRESS �-)� I U C�(��/✓ T3I�UK;..- b I�- ZONING SETBACKS �"' CITY �D 1 � ZIP TEL. REAAT RW o ' APPUCANT �Pr�A_ ��6`] TEL.�j,C'A,r�(") SIDE/SIDESTREET RW ❑ �` CQNTRACTOR ���1 ���� SIDE ❑ �a. - �� ADDRESS I 3+lv �aX ( D PROPOSEDUSE �a � � NR�! ��S F�� � L � - � CI7Y !"�({� ZIP TEL.gpg f��=7f'7 o p ARCWENG/ : It � /�a ( � C. t`'. � DESIQNER NO.DWEL. NO. NO. �-. ADDRESS UNITS STORIES BEDROOMS �r CITY ZIP TEl. ,, "�'-`— y� ,= . DESCRIPTtON SQ.FT. FACTOR PSF ADJ.AREANALUATION ... _ ¢ OWNER-BUILOEF DECLARATION � SFRfA�D/REM � O�. Q � I HENEBV AFF7RM UNDER PENALTY OF PEPJUHY THAT 1 AM EXEMPT FROM THE CONTPACTORS Li GaragelCarport . W; ;-�CENSELdWFORTHEFOIt�`NINGflFASON(SEC.70.91.68USINESS/WDPROFE5SIONSCA�EANYCIIYOR '.,'(J�. , - U'. '(�NTYWXIqIREOUIRESAVERA/RTOCO�NS7RUCT.AL7ERIMPROYE,�EMOUSH,ORFEPAIRANVSTRUC `-'W� PdI10/DBCk - Zx 'NRE,PRIDN TO ITS ISSUANCE,ALSO fiEQUIRES THE APVLICANT FOR SUCH VERMITTO FILE A 51qNE0- ^'-�W- - W S7ATENENT THAT NE OR SHE IS LICENSED PURSUANT TO TNE PRO4ISIIXJ3 OF THE CONTRACTOqS LI � �` "CENS£LAW(CHAPTEflB(COMMENCiNQWi7H6ECTION7000JOF�IVISION30FTHE8USINESSIWDPRO --V' POOUSpe ' �� FE3SIONS��OR THAT HEOPSHE IS EXEMPTTNEHEFROMANDiHE BAS�S fOR THE AI.IEGED EXEAIP , :TION.ANYVKKATKKIOf$ECTION7Wi.50YANYAPPLICANTFORAPEfiMITSU&IECTSTHEAPPLICANTTO +-��Z. 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Q;.iHR0U0HHISORHEROWNEMPLOYEES,PflOVIpEOTMATSUCHIMPflOVEMENTSAFlENOTINTENDFDOR ' � , -� LU'� OFFEREDFORSALE.IF,HOWEVERTMEBURDINGORiMPROVEMENTIS50LDVWTHINONEYEAROFCOMPLE- ' - 0����TION,THE OWNER-BUILAER WILL HAVE THE BUpDEN OF PROVW�THAT HE OR&HE�ID NOT BUIID OR ��� IMPROYEFOR4HEPURPOSEOFSALE). � -- ❑I,AB OWNEROf THE PROPERTY.M1 IXCI.USIVEIY CONTRACTINO WI7H LICENSED CONTRACTORS ��' TO CON5T0.UCT THE PROJECT(SEC,i014,BU31NE99 AND PROFESSIONS CODE:THE CONTRpCTORS U� � V81U8fi0li ADJ.AREA W• CENSEUWWESNOTAPPIYTOANOWNFROFAPflOPEflTYWMOBUILDSORIMPflOVESTHEREON,AND - �-.. WFpCONTRACfSFORSUCHPqOJEC7SWiTHACONiRAGTOR(5)LICENSEDPl1R5l1ANTTOTHECONTRAG � Q�j/WTITY DESCRIPTION FEE �- iORSUCENSEUW.). ��. ��AMp(EMPTUNOFAS�C. 6.HP.GFOfi7HISREASON � � �'-_ d �. V' ' - �!: '__ — CL ' �. u" �ATE OWNER . W . � � _ LICENSED CONTRACTORS DECLARATION ; W �. �� 'IHEREBYAFFIR�l1NUERPENALTYOfPERJURVTNRTIAMLICENSEDUNOERPROVI510NfiOFCHAPTER ,� (i, �9(COAIM6NCR:SiWRHSECT10N7000)OfOMSqN30FTHEBUSINESSANDVROFE5510N5CODE,AND Z: - X�: -MyUCENSEI6iNfULIPoNCEANOEFFECT. . m . li1 �c�3 0 9 Z' � � UCENSE CLqSS C 39 U0.NO. - �;: � �j�: _DATE �'Z�� O D cat�tiwiCTOR��_ lG(t� � a w � WORKERS'COMPENSATION DECLAFIATION a . . �� 1HEHEBYAfFIRMUNDERPENALTYOFPERJUflYONEOFTHE'ALLOWING�ECLARA71oN5: - U - � Z Q . � ___IHAVEM1DN9llMA1NTAINACERlIFlCATEOfCONSEMTOSELF-INSUREFONWORKEflS' _ - CqMpENSq7�pN,qSPqOVIDEPOVSECT10N37000FTHELABORCODE,FOflTHEPERFaRMANCE U Q OFT7EWORKFOHWHICHTHI9PERMITISISSUEO. � Q __,I HAVE M1D WILL MA�NTaN WORKERS'COMPENSATION INSUflANCE,AS RE�UIRED BY SECTIDN � Q 37ooOfTHELA80RC0�E.fORhIEPBHW�AANCE�FTHEWORKWAWHICH7HI5PERMI7IS --- / ISSUED.MVWORKEAS'COMGENSATIONIN5t1RANCECARRIEHANDPOLICVNUMBERAflE: CONSTRUCTION j c/�RtEa F�nLT���(��., �–a __— PLAN REVIEW _ � POLICYNUMBER���On I O�"v C/L � �Q� ELECTRIC ._ � � � (iHA55EGRpNNE�NJTBE07MffM.EfmOFhEPER�Nf/SR]R�NEIRN�7EDDOlVJ1S15100)oRl-ES51 PLUMBING Z I CERTIF�'THAT INTHE PERFOFMANCE OFTHE WORK FOR WHICH THIS PERMR IS ISSUED,1 MECHANICAL (� 6HALLNOTEMPLOYANYPERSONINANYMANNEflS�AST09E�ME51J&IEC7TOTHE �q WORNER$'COMPENSATIONLAWSOFCA4�FOflN1A,qN0AGREETHATIFiSHOULOBECOM� INSPECTIONFEE _ SUBJEGTTOTHEWdRKERS'COMPENSATIONPROVISIONSOFSECTION370oOFTHEIAeOR ISSUANCE �� E 5 CODE,ISHALLfORTNWITHCOMPLYW17NT110SEPROVI510NS. � �lA ttt�AAA - p DATE:- �Z �n APPLICANT: �� LLI�'f SMIP - - � ENERGY �r+'6T���� � WAPNINO:FAILURETO8EGUREWORKEqS'COMPENSATIONCOVERAGEISUNtAWFUL,ANDSHALLBE �a, �� . �y SUBIECTANEMPLOVEqTOCqIMINALPENALTIESAN�CIVILFMESUPTOONEHUNOREDTHOUSAN� ENEpGV 7��� � DOLIAfiS�5100,000),IN AOO�TION TO THE COST OF COMPENSATION,DAMAOEu AS PPOVIDEO FOR IN A�� � ,, � SECTION37UBOFIHELA90RCO�E,iNTEREST,AN�nT'foRNEY'SFEES. RETENTI EE: __ __ ___ W CONSTRUCTION LEN�INO AGENCY PRE-ALT FEE: 0. — O 0. I HEREBY AFFIHM UNDER PENAl7Y OF PERJURV TMATTHERE IS A CONSTRUCTION 4EN�ING AGENCY FORTHE PEFf-0RMANCE OFTHE WORK FOR WHICH THIS GENMIT IS ISSUED(SEC.3os�,CIV.G}. W — . � IEN�ER'S NAME -_.-. - F- LENOER'SA�DRE33 ^ C /J W IGERTIFlTHATIMAVEflEf�TNISAPPLICATIONANDSTA7ETF�ATTHEABOVEINFORMATKKVISWRRECT. TVTALFELS � �. 'In�� d IApREETOCOMPLYWITHAIICiTYANDCOUNNOR�INANCESANOSTATEUWSRELATINQTOBUILOMG - � ���� C � 0.�NSTHUCTION.ANDHEREBYAUTHORIZEREPREBENTATIVE50FTHISCOUNTVTOENTEFIUPONTHE , � A00VEMENTIONEDVfloGERTVf-0RINSPECTIONPURPOSE5. 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