HomeMy WebLinkAbout11434 (5) C1TY OF DIANIOND BAR '
COMMUNffY DEVELOPMENT DEPARTMENT
;...0 21660 E.Copley Dme Suite 190
(909)860-3195 Fax(909)861-3117 PRE.SS
."""� BUILDiNGPERMITAPPLICATION FIRMLY '
Q DDRESS �� r `0 �/lO�-��L�I.N DATECATION 3 Zy � PERMR J � P1C -�
/ /�� NUMBER 1 I Y� A� I
� APN LOT TRACT ISSUE •--••` ., pyp :TYpE•• ,' � OCC
DATE • �'L—!p�' CONST �• � GROUP
°C OWNER _r N L�N , T�D
p ADDRESS ^� ZONING_ SETBACKS ..;i� ,' -`;;'! .'-:
�"' CITY DIMIO�U9 �fl� ZIP �17bSTEL " 7 - --REAR` • � . e ._�` .,' RW ❑
APPUCANT TEL, - . ; ` ❑
3 SIOE/SIDE STREET •''-'� c-�� pW ❑
a� CONTRACT R A? Cl1S SIDE � p
� ADDRESS O " � �
� CITY_LL/LhiUA ZIP,�,t,s TEL `7f Z•2/I.S PROPOSEOUSE L�I 1U �- S A
o ARCWENG/ n- "
� ADDR SS ROi� Lf�Ci4�12— YVOI �JC tJC��R�V4 NO.DWEL NO. NO. • ,.
? �� Z�P 7— UNITS STORIES BEDROOMS
� �— �L—
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.ARE/1NALUATION
p� OWNER-BI:ILDER DECLMATION SFAlADD/REM
O
i r+�aEer�mw umEa o�n oF rEaAmv nut�w excuvr rnora n+E corrtn,�croas u Geraga+�Carport
W CEHSEUWFqiTHEFOLLOWIN6REA30N(SEG7m1.bBU5WE551u�OPROFES5lON3C00EANYp7YOq (n �
C2 COI.NftWHIQiREOU1HE3A�ER�MiOCONSTRUCT,AITERMGtqVE.DEUOl19LORRE7AIRINY3iqUG w
LLI �onaa ro rts asuN+cE uso aEoumEe n+e�rr��wr Fon suw vEaurt to��s�cr+eo w PalidDeck
� STATEMEM THA7 HE OR 3lIE iS L�CENSED iVHSUNfT TO 7ME PROVISIONS OF 7NE Q7fTRACTOR3 LI- SJ O
� CENBE UW(G/MTEN f 1[pMUENCNO WfTH SECTqN 7000)Of DMSION]OF TNE BI/5tt�E55 J1M1 iR0. � PooVSpa
FESS�ONSCOOE�ORTHATHEORSMEI4E%EMPTTNEREiR�MIJ1pTHEBA51gFORTMEALLEGEDEXEMG- (�
T�ON.NIYVIOIATqNOFSECTqN70�1.6BYM1YAiPL1C�MFOqAPERA11T5U61ECTSTHEMVLIGWTTO Z p�qpp�
� A GV0.PENALTY Of NOi MORE TNMI FlVE HIMDRED DOl11lR3 f25001 k
� ,' �OI��M�NENNOilMEVR0VEq7Y,ONMYE4PLOVEFSVn7HWA6E3A3THFIRSOLECWAPENSATpN, (`,pmmBtGisl - . �
'MLL D�7NE MIONC MA THE STRUCMIE IS HOT x/TElAEO OR OfFERED FOq SµE(SEG 7W,BUSti O
� NE53 M7D PROfE5510N9 COOE TME CON7MCTOR.7 UCENSE UW DOES NOT APPIV TO IW ONMEq OF j
GROVEHTY WVIO BUtD9 OR IY7ROVE3 THEREdl,IND Mnq pOES SUC11 N9RK MUSEIFOq MENSEIF Oq
2 ?HROUCNltlSORNEROVIHE11GlOYEE9.PROYlOEOTHATSUCHYVROVEMEMSARENOTMENDEDOR C�
Q OiFEREDFORSALEIF,FqM�EVERIHEBU1.URqOF�Mvfip�'E�EMISSOIDWRMNONEYFAROFCOYPLE- .
... Z T�ON.THE OMMEREURDER WILL NAVE THE BUqDEN OF OROVRM 1M4T HE Oq SHE DD NO(BVII.D Oq
� MVAOVE FOR TME PURPOSE OF SPLE}
�J O L�5 OWNEROF iHE PROPERfV,JJJ E%LIUSNEIY COHfMGTNp N7TN LICENSEp CONTqACTpqS
2 ro ca�sTaucr n�rr�aeer tsEa�ou.eusn�ess�rm vno�ssior+s moe�n+e mnrn�crons u- Valuat • ADJ.AREA
W CENSElAWD0E4NOTA7PLYTOANOVMEqOFAPROPERTYWFpeUMSORIAIPROVESTTIEHEOt{ANO
� ro�as��H EUW�3UCHiiqJECTSVnT1ACdrtRACTOR(SjLICENSEDPURSUMlTiOTMECONiMG �UAN7ITY �ESCRIPTION �E
� O IAIA EXEAIPT UNDER SEC. 8.i V.G fON THIS REASON Q 1 • "(/� -
3 �
LL" DATE OWNER � 1�-�
2 U -
� UCENSED CONTRACTORS DECI.ARATION W � e•
� •
��n¢eru�au u�en rEwun oc vcaum nur i w i�r+sm u�roen eWo�nsarrs oc auv�n
p, s(CpwEUC�+O vntM SEC7id7 f00M OF OMSION]OF TFfE BUSnaE55µ0 PROFESSqr�9 COOE AhD z . - a . " i`S-
� W LILEMSE IS N FU.L FORCE AND EFFECT. m �' • I f
� �E�, S G 3 �,�.,�. �t i ; d
� o�� � cartruera� A!`f C�tl s�/ a ` s ^^ , i '
� WORKERS'COMPENSATtON DECLARAiION � � �p_�00 ,f
Lp --_ ._. _ p -- - -
--c=i� _ -- -- _ . ..._._ __........ ... . . . ..._ _.__ --- __ - .._ U
� INEREBYI�FirtWUNDERiENAITYOFGERRIHYONEOiTHEFOLLOWY700ECUMTIDNS Z . . ,
� _INAVEMDW0.1►IMYTAMACERTIFIGITEOFCONSEHTTOSaF-MSUREFOHMOPo(EPS
COUPENSATION,/S CIpVpED BV SECTONl7oD OF iHE UeDq COOE,fOq T/E VEqFORMANCE U
Q Oi THE NOFK FOR WHICM TInS PERMIT IS ISSUED. �
�W �NAVE Mr0 WRL MARRAIN WORKER4'O�MPEN3ATION MSUtWKE,A3 REOUIRED BY SECTION
]700 OF TNE4BOR COOE FOq THE PERFORIAMICE Of THE N'OPo(PoR NTfKH 7iN4 VEPYRI9 /j
Rsum.i.n couPEwsAraN msuru�una�R u�o roucr r�n�eeq u�e CONSTAUCTION !1 n ��lr..O�
� unaien �TA7� FwVO PUWREVIEW `.��
Z vaicrM,.reEn /4y40� — h7 eLEcra�c _ - '�. �°
�C
0 (naSEcnowrE�woiBEoo�.f�ErEnoFn�r�RrBrnaa+E�t+rntD0alMSM�7ioRtBs1 PLUMBiNG _ 7�y. .S
W
Z iccnrarnuTr+n+Ec�r+�eovn+Ewvn�cca{w++�n+isv�rwrtrs�ssuEp,� MECHANICAL � (,p ;
(9 SHALLHOTE1APlOYANVPEHSONNANYMIwNERSOA3TO8ECOMESU&JECTTOTME
(n MOMER4COUGENSAiqNUW50iGLIFORMA�NDAGREETMATIF151qULDBECOYE INSPECTIONFEE - �
SUBJECTTO TME VK)RKERS'COUPENSATION VROVISqN4 OF SECTION 770o OF THE UBOR
� cm�, suut roanrvnn+couvtr�/yy►(�,nq,se rr�(�s,i/aa' � ISSUANCE � �.0 0
� p O�tE:lw� APPilCAN7;"�!K`"` - �/� SMIP
� � ENERGY P/C
WARNRI@ FALURETO SENRE NtlRKER3'COudEN4ATION COVERAGE�5 UM�Y V F U L,IWD SHILL1 BE
� SUBJECTAN EMROYER TO CHMMA�PENAlTIES M!D CMl FINES UP TOONE MXARED TlqUSnNp ENERGY PERMIT
DOUAtIS(f t00,0001 INADD1710N TO THE CO4T Oi CdA0EN4ATI0N,DAt1ACE3 AS OROVIDED iqi M
� sceTion»aoFn+euea+cooE.rrtcnesTa+o�Troro+ererces. RETENTIONFEE: ��
4 CONSTRUCTION LENDINO AGENCY PRE•ALT FEE �
O
� �NEREBYAFFIRYUNDERPENALiVOCOEiWMTNATTMERE15�CONSTiiUGTIONIENDRIOACENC/ �
� FOHIHEFEHiCRMAHCEOFTHENGN(FORNTiIp/iN15VERMITISI55VED(SEG]oi7.CN.Gj. , ...
� IENDER9 WVAE-
f' � 1-� 'LEIAERS ADORES$''
`. � 'ICERTIiVTUTINMEREA�iHISAPPLICATIONANDSTATETUTTHEABOVENFOWAATqN1$CORpECT. TOTALFEES �� � �� �9S oS
` 4 1 AOREE TO COAIPLY N1�/1 KL CITY ANO OOUNTY ORD WANCES Mq S7ATE U�'15 REUTHO TO BUIp�NO
,,� CONS7lWCT10N,ANOMEREBY�UT/qqtZEREPRESENfATNE$pFTHIg00UNTyTpEMERUPONTNE ,
AlOVEd1EHTqNEO iMCERTY FON P15PECtION PURPOSE4
. 0 • � COMMENTS
-� , t c.� D: V'�4-at G�C.
, m
�, �; c rv �`:r ��.; �l���
� � �� �4�� `;� ; 3 2Y ��P
�y � NAEOFPENWTTEE DATE RECPT.NO. PAIOBY "U VALIDATION
Nh11TE—DepaRmant Copy,YELLOW--Finance Copy,pINK—Ausssor Copy,GOLDENROD—fikCopy,6REEN—�typllc�nCa Copy
. _. ` ; I I Oi .n � �n -n _ .a -imOc> r � vi � � � � � s� � � tnG� m � cn _ ;
' � � ��'m f�i1 � i, � I � Z Z z Z D m m m � m D S O O O D A O D m � 9 m � � �
�^� ��fn� � � ' D D D D (l� Rl fU � � r . O G C C O D O m � � O n � W �fl .. '
f �'O-I � � • ��,i �r r r r n 'o n � � Z ��� m S 2 2 � � � 31 � L�'z "'� �t n �i- -- .
� . v c�. ,' , �. i�--,m- m O � -� '-� r � � � v rn x O GZi = ln o � o A � n �};
+ I�-I I C n - icmazmr9 � zc = � rrmc� mm - d � nD .T1 i V'
� . � D'�' � � .n � Z Z m c m A � r G� � . �
`u, GZ . ! z 5' -i �' cn r � a � � O w ? � � � '-n = c � R' c � u; . � ^1�'
1 � ; . ;� ._I�Im� ! -i . ._� . � � L, --I �.. � � O � N Z � � I '� � � I Z Z m ��� , ` /', .
� a '� � � ,m i � �'' � z � -�+ � � , -�i i � � � � �
+ � �I'��i �i !i1 � - � i � i � �! i i �' � p ..
� _
;
� . , . , i ��. . , �i . , � ' i, .
.�.
d � .
i -
P I)} � � � � � � Z �'� � =��� p.
� � � ; ���� 7 �' � - i � � �i ' i r � i i r i o Ili .
- i i I i 11 I i � : r'I�`'T.' �� �l
- � �; ��: i i � � i j, ; .i�v
� � I ����
i:
�� ,
r ,'i '_s. '�.a ;+�
� i I -Sj� �; ..a
- uK
� ���
u i �I
i I��
i I 1 �
bc ��_
i c. I i i ' I'i �i ` i i i' i i
� i h �.
, I
� � � � I .
I
�� J I-� -
Ii ' tv - ,� �
;� � �. � i I
�r
� � I
. :�:I � � •
�� �
. i
:i- �. _ �
__ _ ,� � _ , �� � i 3�r��� n
_ � " i - ` - �� j - - �I I � �'� cn
_ ,�, . , E i ,t• �
J: - � � � ��) . •
�
;.
, i
_ _ .t t . ',,�' .�" � ���- ( _' � �' �;� -•
�r � , - ,� '� � � — � � � .
__- __I __ '.I I �� � !',- �.�.T O T.T 'fl Q �f' 'it � fJ ��� � T D I W � T7 O� � 'fl T C C �'t i T �"0 ._
�.__ �. �� �' ' '. ' 1- �� �' ` ,4___(__j.�_�_ .Ve ' m m - D CZf7 D _ O � D -��C:fn 7J��Z -.3J 37.Z Z 2ir �.: Q.
� _. _
.. .'. '__ _ _ __�.__ii--I - i + � - �- m < v � � Z Z p T O O O��O z m D.� O m m O CJ D � , � �.
� �--- � -..' --.J7 �I c � r (n r r-.r �:G7 � r � 2�'o U�fr1 FR �7 O � ' �:.� ..
_ _ _'_ ___t . . _ _'__ -+__ __ .7 L� m S fafl N � [n m D -� 'sl 'n m = S = � m�p � r � 37 m 7l
.. I , r'+, -G rtt. � p m n Z -1 m z .,m, r G� � Z y p I aj D � Tj �'p � � _ .�S -�
I � � i _ _ ;J, cn � -{ z � � c� � — a 'T' � A c� ❑ z]`o o'm m r r- S o �} .:'(Til:-�
i � i, m s � n n r O,O -a cn Y
�• � � , � � ,i,, � � � zvn ' .z � -i � D Z �`mzm -nQ Otr � � C).p
� � :� { � ., � T : r;- j o T y � �" 9 �" a' � � � z �.�miF n c o ���c c2 0 � � 7G,�
�. I .,�I i �I� � Z r � . G� � �1� ym 4'.p Q C ' � � �
�^ � i` �' ( � � j 7,m � � � �� .'�
I (' I � ' � ' . ( 1 D � C I "- ..
I � Z �
. - -�. - �'j .
: ��' `�� � � ; "' � ' : ' �: �- ���� ,�
; _5,� � I �: ,�L � .`j �- � a;Vi� �: �; _ � -
� � i ; i I I i, �� . .._
` '� �' i ��o r '.f,
! � - � i ;I v � i �� i i
� r � ,� ,i� , �.�� � ' _ �(�', , + � � �
�C� ���� _ =I -- ,� �-�--�= � �� � ,
� i � ;, `
�-! , , �.: � II` , �, _f
- � - —
< �
- - � 1 ,,, ,
� � �
c � , , - _ , I I �, iI .I' � �
� a� I
�.`v "� � _ - I � " � _ �
� �- I �
.�.,� � a _ ' - ' ,�: i ` � ! ��"
� ' -��� � � , �' . _ ! I�: � � � ; �
� � i i � � k� �, _ � � �
��:�-W;� �i ' - ' - - / ' I , „ �;
� �����I-at �- � - - �� - - �- � -- �- ��, , - ���;
1 �:�;��� _ , _ �.- � - . . - -� � I _� -t�- ��- �,
,