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HomeMy WebLinkAbout13916 (14) i ---.._.__.� ___..._ �� CITY OF DIAMOND BAht i DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PR E$S • '��� BUII.DING PERMIT APPLICATION FIRMLY o� JOBSITE -��./��f�f�,A�� APPLICATION e/�, /�tr� , NUMBER �13�1� �'�95 3� ADpRESS /v /U ( -/� DATE� � ISSUE , TYPE ' OCC APN LOT TRACT DATE ' CONST. � GROUP p OWNER " ADDRESS ZONING SETHACKS � CITY ZIP TEL � E/-567(, FRONT RW ❑ APPLICANT TEL REAR ❑ � SIDE/SIDE STREET RW ❑ CONTRACT R SIDE O g ADDRESS ` _ CITY ZIP� TEL�1 PROPOSED USE o AFiCFUENG/ : 1 �- � DESIGNER NO.DWEL " NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. N DESCRIPTION S�.FT. FACTOR PSF AOJ.ARE.WALUATION � � OWNER-BUILDER DECLARATION ' SFFL'ADD.'REM p 1 HEREBY AFFlItlA UHDER PENALTY OF VE0.AIRY THA7I/UA ExE1AVT FRO�A THE CplTRACTOi1S L4 GaragelCamort W CENSFUWFORiMEFOIlOwINOREA50NI5EG70.71.68U51NE551WDifiOFE5510NSLO0E:ANYCITYOR (n � COUNTYWIiIpIREOUIRE3APERMRTOCON57RUCT.AITERM�PpOV�OEMOl.ISH.qiREPA:RANYSTRUC- � . 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B.l P.G FOR iHIS FlFASON Q ^•S 3 � �" V" DATE OYI!!ER V - - � UCENSED CONTRACTORS DECUlRA710N W w � IMERCBYAFFlitlJUNOEHFENKTYOFVERR1flTTNATIMILILENSEDUNDERPROV1510N50FCHA7iEq Vr � Y(CdIMENGHOYATMSECilON70oo)OFDIV�SqN70FTH[BVSIhE55ANDVNOiE55iON5CCCE,AUD Z X W LICENSE 61N FUII FOqCE AND EFFECL - m � LICENSE/Cy1AS/$f /1 UC.N0.���,�d�y,,7'� J �� S'� p,�7E�/� ��CONTMCTOR�t��:I��� a . _ tZ�l ✓( � T '.�1 i � WORKEqS'COMPENSATIONDECLARATION U _ • .;� *T �" N IMEREBYIIFFWAIUNDERPENALTYOFiERR1AY0MEOFTMEFOILOWINOCECIAaATIONS: • ' • � ZQ i C ��IIIAVEANDW0.IMA►7TA:NACERT�FICATEOFCONSENT705ELFaHSUREfONWdiKERS' S •-� � �'d- CVMPfN5AT10N.IlSPROV�DE08YSECTIONf7000F}HEU90RGOOF.iORTHEPERFORMANCE W /OFTHE WOR'(fOii YMIp1TMLS GERM:71S ISSUED. � � r �I HAVE/iN�1MLL MAN•'NN N'ORKERS COA�PENS�TpN INSURANCE,AS REONRED B Y SECTqN �� Q 97ooOF7HLUl'�ORCOOEiOAMEDERFORMANLEOFTHEwOPRFORVM1u[117NISPERuiT15 ISSUEI7.4YY�DN(EHS'NFIPENSATIQp�IN�SU��^:ECANRiERMVPCLICVNl1A10EpME CONSTRUCTION � �r-�.?-��i111I�_ '? � I � uqaeq / PLAN REVIEVJ � vq.�cr r+uaAEn�� T�Q.�I�����J' ��— ELECTRIC � ` 1 p (n�ssccrce+Ncmrmre[aM�ocnEarf+r.rtswaa+EM.wr�oaiuismro)rn�l PLUMBING Z ICERTIFYTMATNTMEPERFORIAMICEOFiNEWOP.KFORWMICHiH15PERMITI5155UED.l MECHANICAI (,�' SMALLNOTEMPIOYANYPER50N NINYM.wN[RSOASTOBECOMESU&1ECT70THf Uj WOHKERS'C0IIPEHSATpNUW50FCALILORM��NOACREET1uT61SFquLO9[COME INSPECTIONFEE S Sl1B1ECf7OTH[NKNL(ERS'LOM7ENS�TqNYROVISION50FSELTION770oOFTHEIAIiOR 3 UL� cooE. s vonr�+winicouv�rvn sevaowsb s. ISSUANCE � i ��� SMIA b p DATE: . � APPLICANT: - � . W EN£RGY P/C WMNIIJa iMUR[TO SEGLRE K9RKEF5'CONPENSATION COVERAGE IS UNLAWFUL.AND SN/U.LBE [—y EU&IECTANEA!PLOYEH70CRIMWALPENALTIESINDCMLFNESUPTOONENUND0.EDTHOUS�.W ENERGYPERMIT DOLAAFlS p100,000),IN�DDITION TO iHE COST OF C040ENSQION,DAA110E5 AS YRO`nOED FOR IN J S[CTqN770lOF1NELMOHCOOE,PlTEPE57,IWDATTOFNEY5FEE5. ' FjETENTIONFEE: � OCONSTRUCTION LENDING AGENCY PRE•ALT FEE: , � IHERCBYAFFIPMUNDERPENALTYOFPCRM1IHYTIUTTHEREISACONSTRIJCiIONLENDINGAGENCY ���� FOR iME FERPDRMANCE OF 7ME WORK FOR WHIpI THIS FERMIT IS ISSUED(SEC.]OY1,GV.C.7. J��J�^� � tE'IDE115N�A�F L�' � � LFNOEf�5Il70RE55 � ' � IGERTIFYTHAi111�YEREADiMISAPP�IGATqNANOSTATEiHATTiE.�BOYEINfORAIATqNISODRf1ECL TOTAL FEES " ' � , � � IAGREEiOCOMPLVWITHALLCT'ANDCOUNTYONDWANCES�NOSTATEUWSREUTNOTOBIIL�ING ^ (�,/� CONSTNUCTION,ANOHERE9YAUf/1OWZEREPRESENTATIVE50FiM�5COUNTYiOEN�ERUPONTNE � �y X X , S� ►BUVE�M EDii10VEH7YFW11N5PECT10NiVRP65E5. 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