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HomeMy WebLinkAbout15843 . __�� CITY OF DIAMOND BAI� EXPI R ED � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 ��t4��� � ' (909)8603195 Fax(909)8b1-3117 PRESS �'�^'� BUILDING PERMfI'APPLICATION FIRMLY y JOBSITE ��� � c� APPUCATION D I- ��ERMR (� p/� o AO�RESS �� OATE NUMBER b �► � APN LOT TRACT �SSUE 7YPE �C � OWNER DATE CONST. GROUP o ADDRESS ZONING SETBACKS � CIT1' Zlp TEL FRONT RW p APPUCANT TE�, REAR � � SIbE/SIDE STAEET RW ❑ CONTRACTO � �D SIDE � � ADDRESS GC C� �' ZIP � TEL ' PROPOSED USE � d � ARC NG/ DESIGNER NO.DWEL NO. AODHESS NO. c�i C� ZIP TEL. 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LlCENSE CLASS � �� IIC.NO. � �0 � ..'_.—.� OATE � CONTRACTOR a = WORKERS'COMPENSATION DECLAFiATION Q N 1 HEREBY 11FFlqM UNpER VEW1lTY OF iERIUM ONE OFTME FOLLOWw6 DECUMTqNS: V � Z • � �HA NnUMAMTANALEifTIFIGTEOfCONSENTTOSELfdN5Ui1EFOqVpRKERS' Q � , EHSATION.AS PROVIDED BV SEC710N 770o OF T1E UeOq CODE,FOR iHE PERFOFiM,WCE U Q �RI(FORN}IICMTM,.pERMiTI5155UE0. W � �1 HAVE AND NALL 4AdlfA1N WORKENS'COM7ENSATION INSUqAHCE,AS qEOUiRED BY SECTqN � ���r �� 770o OFTNE UIBOR OOOE,fOH THE PERFOMIMICE OFT�E W011K FON WNICFITHIS VER4R IS tSSUED.W WONjEII�P(NS�TqN INS ANCE f.MRIER AND VOUCY NUAIBERME: CONSTRUCTION l /i // � GAHPoER G� ��-C„ /l✓�rr PLAN REVIEW � POL�CYNUMBER a ELECTRtC q (����ID�TBE o�nEv�»�Tsra�on��oot�R�a�a9�ess] PLUMBING � W � ICERTIFYTHATNhIEPERFOfU1N10EOf7HEWORNFOqNMICN7H15VER1AITI5�SSUED,I MECHANICAL SHALL NOT EMPLOY AM'PEii50N N AM'M.WNEH 50 AS TO BECOUE SUBJECT TO THE (� N'ORKERSCOMPENSATIONUriSOFCALIFORNI.�MlDACREETXATIFIS OUIOBECOA/6 INSPECTIONFEE SUBJECTTOTMEwORKERS'COMPENSATIONPROWS �N90FSECTIO„ ooOLTHEUBOR O ;e, s FOAnrvmHwrav�rw�n�n�osEv �saNs. tSSUANCE � p Os.TE:1�(�� Aaatrc.�.rlT: �SMIP � � WAANIN�:FA4URETOSECUREWOiiKERS'COMPENSATqNtO �HACEISUM/�WFUI,IWD6MALL0E ENERGYP/C � �y SIRJECTAN EMPLOYEN 10 CRMINN.VENAL71E5 ANO CM�fINES UP TOONE 1K1NDqED hqU^ML7 ENERGY PERMIT O011AflS({100,000�,IN ADDRION TO THE CDST OF COIAPENSATqN,DAMAGES AS PROVIDED FOR IN —��1 SECTIONl70lOFTNEUBORCODE,MEREST.ANDATTOPI1EYSfEES. RETEM1ONfEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � IMEREBYAFFlpAIUt�IpERVENALTYOFPERNMiNAiTMENEISACONSiRUCTIONLFNCWOAOENCY � Z FOR TME CERFORA/ANCE OF TNE WORK FOR WMIGH TMIS PERMiT IS ISSUED(SEC.JOY7,qV.C.} 4J � LENOERS WME � LENDER'SAOORE53 � da ICERTIFYI/MTIYUYEREADTNISAPPLICAT10f1/JASTATET/ATTIEIBOVERIF01iMATqNISCOfiRECT. TOTAL FEES � IAOREETOCOMPLYWITMILLLGTYANDLOIiNTYORDINANCESANDSTATELl1WSPEUTINUTOBU4DIN6 /�� � CaNS7HUCT10N,ANpNEREBYAIff/q(UZEREPPESENfATNE50FiY115COVNlYTOEMERUPONTHE �� y/)�j� � �` � AUOVEJdENTqNEODROPEFTYFOHIN' FURP0.5E5. l i1'N '/ 9 COMMENT w ! fZ � m OERAAIt7EE NAM ry ) Q CA �' (n SWNAIUREOF �� � DA � RECPT.NO. PAID BY VALIDATION WHITE-0epartment Copy,YELLOW—Fnence Copy,PINK—,Assessor Copy,GOLDENRO�File Capy,GREEN—ApplicanCs Copy .. � ,. ' . . . .. • ��-l:r ,.-� -.... . �. , - ... , • . . � . . :o-. �. . ... _ . ._ . ... _....... , .,���t � ... 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' ;;",��1LL-INSULATfON - - - POOL FIPJAL � ;ccILtP1G irJSULATI�N -, _ oFF SITE Ir�IPS. �DRti'1'JALL P�IA1LIiJG - , � - �EDICATtOfdS 5;l^.'ER _ _.. _ _ FINAL ENG. _-' . . ;SEPTIC'iF�Nn UINDSCAPE/IRRIG. � '��E�P1TlL.L. --- ' ,:;'c:.. ON SITE 1��1PS. - _�_ _ '�AS AIR TEST FINAL Z�P11NG _. rl;�!-,C.CONST. _ _ ___ FIRE DEP7". FINAL �—�� '�i^��' HEATIilG _ ____ _ _ _ _ HEALTH DEPT. FINAL - �: ....� � ------- —._ ' � �d^,l_f�LECTRIC - _ _ DEV. FEES PAID - �:.: ` _ � i -l..+,,`,' cLU"�i5lNG � ENERGY . � , 1' T— . � _ --'---- j'_ _ _ . "` ' 'm . � y ' • ��,; C��i I" I� . , .. ._..:.�_ �...� .n•axi��i ��.__. _ _ . . . . . ._.. . `..` .\� - , P�' . . ' __ .. . i �.;� . •�4` . � �:��i;%i<<11E��!'C5 ___-- __ _ _ - - - , �;-- _ -_ (�—�( ^�--f M � � , �� '_ � � �'� � � � � i (� -i - . . ., � , _ _ – _ – ii _. � . , ' � ...__. + _- . 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