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HomeMy WebLinkAbout13311 (7) _�� CITY OF DIAMOND BA� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � . • ,; 21660 E.Copley Drive Suiee 19(? (909)550-3195 Fax(9(?9)861-3117 PRESS .`';�°. BUu,DnvG PE1tNdrr APPLICAaION . FIRMLY y JCBSITE APPLICATION � G PERMIT � � � P/C � ADDRESS�� _ DATE _�,� ' NUMBE�°-" `� # � ISSIIE TYPE OCC APN LOT�_� TRACT DATE_. CONST. GROUP p OWNER p ADDRESS_��h���]��__-��---� ZONING SE�BACKS � FRONT _ RW � z CITY ZIP�le7d-T TE�.��,Z�' I REAR APPLICANT I -- SIDEISIQE STREET RW ❑ � CONTRA�70R_�,_�� [�'��___ SIDE _ �- � ADDRESS ��A���x��- a CITY {��g[� I TEL ¢ PROPOSED USF.__ � ARCHlENG/ �� �`� ���� — DESIGNER L�ii - — NO.DWEL. NO. NO. a ADDRtSS � ----- - ISNITS____,_. STORIES BEDROOMS � CiTY ,_ ZIP_ TEL.--,-------- us DESCR!PTtON SQ.FT. FACTOR PSF ADJ.AREANALUATION � OVJhER-B�JIiAER D�CLARATION SFR/AD[YREFA � � ---- - Q !HEREBY AFFIRM UNDER PF.NAL7Y GF PEAJURY TWAT I MA FX�ldPT FROM TNE CONTP.NCTOFlS u� I Gat'd B/CBfpod W CENSEUWFORTkEFOILOWINGREASOM(SEC.7Cs75AUSMESSA4�PAOFESSIOUSCODE:ANVqTVOR (nt 9 C�.� COINfTYNHICHREIXlIRESRPERMITTOCONSTRUCT.ALTER.IMPROVE,DEMOL'S1+.ORRF.PAIRANVSTRUC- W I �g}IOIDBCI( L TURE,7RIOH TO ITS ISSUANCE,RLSO RF.DUiRES THE APPLICANT FCR SUCH PERMIT TO Fll.c'A SIGNED � STRTEMENT TiIAT HE OR SHE IS LICENSED PURSUANT TO THF PqOYb'IOYS OF THE CONTPACTORS U- � - � CENSE U1W(CHAPTER 9(CAMMENptiO WITH SECTION 7Mnj OF DIVISiOY 3 OF T'r•F gUSINE55 AND PRO� �OOI/S'�.7d _ _ FESSIONS�E)ORiHATHEOR5NEf5EXEMPT?HEREFROMANf:TY.E6ASI5FORTHcA!LE3EDEXEMP� (� TION.ANYVIOLATIONOFSECTION7031.SBVANYAP?LICANTFORAFER6lITSJ0.IFC'FTHEAPPL:CANTTO � Re-Rcof � ACIVILPENALT'OFNOTNORETHANFNEHUNDRED�OLLAaS;5,7o).�: — _ � ❑I.ASOWNEROFTHEPROPERTV,OAA1\'EAI7LDYEESLNI7ViP.AGESASTL+.EIRSC�Lr_�OUPENSA?ION, �� �OmmOfG�l 4ALL 00 THE WORK,AND THE STRUCTURE:S NOT INTEWED OR JFFERED FOR SA!e(5'cC.7046,BUSI- .J _ � � NESS ANO PROFESSIONS CODE:THE CONTRACTqnS LIC'eNSL'�RV ilOFS YO"APPI.T"O AIJ OWF!ER OF r PHOPERTY WFIO BULDS OF IMPROVES TiERECfr,AND NMO�ES SUCIi L'lORK HIMSF:F OR HER.SELF OP. L f7C TMROUGM HIS OR HER OVtlN EMPLOYEES,PiOVIOED THAT SUCH Ik7PROVEN�EMSARF:�OT INirN�ED OR �j � q OFFEFEDWRSALEIF,IIOWEVER7TiEBU!LOINGORIMPROVf-MFNTIS50LDWl?HiNOkEVt.AROFCOMPLE- Z TION,THE ONMER-BUILDER WIL HAVE 7HE BUFlDFN OF PRC��IING THA7 NF OR SuE nID NOT 9l�ILD OA �'-'--'--- = IMPROVEFORTNEPURPOSEOFSALE). W C71,AS�WNEROFTHrppOFERTVANEXCWS!4EL'/rp!;';apCT1�G�NITh;LCENSEC^C":';ACT0�75 I ------�- - Q[ TO CONSTRUCTTHE PP.O.:ECT(SEC 7044,BUSINESS AND PROFESSiOM;C.nDE:-4!''MN?FACTG95 LI ` �VBIU3ti01: ADJ.AREA W CENSEUWDOESNOTAPPLYTUA.40WNEROFAPROPEflT.V:•Jr�.:1SUIL:JSD?!ASPfl^NES?��.P,EOP'.AN� I ,_L_..__ -' -------'—" --"-- -- � W11000NTflACTSFORSUCHPROJECTSWITHAODNTAACTOP.(S;LI.^,F�l3FrPURSUAN?"O?>'!:A:N'RAG ' j �UAfvTIiY DESCRIPTiON FEE � TOflS LICENSE LAW.j. �_I___ _ �l :]IAM E%GSPT U12DER SEC.__"'____________ L'S F.0 FOR T��IS�FASO� 1'ov Q'�//� "� � o -------- ��--M-r-'�'�.-- --� � � r � 3 — ---- ----------- �����a �.�+���—�_ 2' ` DATE OWNER___.__ �' � � �� —� w �,� � LICEMSED CCNTRACTOFS DECL4HATION ,�� �" -� � � B _�.-�— -— . � IHEREBYAFFIRFIUNpERPeNRL7YOFPERJU�iV'iHATIFFAL'CEhSi_DI:IJ�[RFROVISIONSOFC4APiER d Y(COMMENCINOWITNSECTION7oC0)OFDN!ulON30FTH�BUSW'c55ANU7�Or�E55101SCJD'.n\D I __��Q�'� _ _ ' �'� + u� MY LICENSE IS IK FULL FORCE AND EFFECT. ; � LICENSE C 15�_��__ LIC.1d0 __y C_O,���6 y�---- -���� a • V DATE_ ��/, ��7-� CONTRACTGR__��JF�IR�J,y: � I ['---���- �—'-�- �-Z ��� 3 !? �''/ -_-_-- �a0 ��` .� �. i � WpRKERS'CUMPEhJSA-riOfV CE.^,LAAATlt�W�k� (N(�i �-��-� -- '^��p � � I HEREBY AFFIRM UNDER PENALT;OF PE^niUFl1'ONE OF�HC FOLI.C'NING DFC,ARF'i!GNS I � (I --_— - p � � f � � _____INAVEMlDWILLAiNNTMNA.^,ERTIFI�qTEOFCONSFNTTOSELF-IN�SiJAErGPiXOFKERS' 1 - --_ ---- C CnA1PENSATIUN.h5 PROVIOFD 0Y SECTION 3]0o f,F'He 1480R CODE,fOFl THL PLFFOFAIAkC � �� O�'ME V/ORK FOR WNICH TVi15?EPfJIT I5 1SSUEU. I � � W , � '_"_—'1"_ I � _iHAVEKJDWiLLMA1NfAINWOPKE9�CAMPF.�5A7�Cuiy51.�.UKCF.F.SR'cOU.F�f19"SF.:TION ; � 37000FYHELABORIXJDE.FORTHFP'cRFORiAANCEOFTHEWORi(FORWHh;47I1;cF'eRMfTIS _ ISSUED.1AYl�JORKEHS'COMPENSAl'IOPdINS..`RANCECAR?IeRPN�VOL'CYNJMB[Fll,RE � I CONSfRUC.TiOIV �j caRaiEa--���¢--f-u(�N-`--�---------------------- � � i PLAN NEVIEW =-- ',�n..�.`-..: - - � POLICV4UMBER__�.'1 d �,y�f_'-""__-"-'___"'_"'__ � � __ n' �� ¢ vr��..o ,CrRiC�.> ":� ��� � � ffliSSECTI0N4E�N0T8EO7MP�_E(EDOFh!"ePEPoATI':�(Y;ONEi-'I;AC2'cD;xi•.A�S1'X:I�RLESS) � I PLUh131ttiG _ _'_,�„� b���o °��y'• ,���� ____'_ i ,� ' ,�� "w'� 1 CERTIFI THAT IN 7NE PcFlFORMA�CE OF TNE WORK f-"CR WHICH T.ilt PFFiU.'�T I.^:ISSUF�,I PAEC4ANICAL 4.^�t t f } � "�ti C,�S SHALL NOT EASPLOY ANY PERSON IM ANY MANNER SG,aS'U eECOME SVOJCCT T�T-{[ I ' ,. y;`L-=', - , � (q YVORKERS'C(?MPENSA?IONLAYJSOFCALIFOR:JIA�ihDAGRF.Ei�1ATIF�sr+c.,ino�rp!,ir; i !NSPEC.TIONFEF �_ ;�,�_�i�. + ! � S U&I E C T i 0 T H E W O fl N F.R S'C O M P F.N S A T I O N 7 i O Y I S�O N S OF'i C-f,T I O N 3'O n O f TN E!.A�O^, ��^� <� ,x�^.'� = CO�E.I SHAC FORTHYATH COM?Ly WITH THO£E PF.UVi �on5. � ISSUANCE .,�3°` -,'•�. „_ _ _ �L-' L p DATE:��f-J'.�. AFPLICAN7: .'__'__k��"' � SMIF ,..�'yya;�'�. '.—�-.. - ---- ,. . _ _��"V Y.... ----- ..�L � WARNING.FAILL'RETOSECL'flE`NOHKERS'COMPENSATIO�'COVFISAGE::SU+�IAWrUL.a�D:.HALL6E FNERGYP/C ____.___._____,____________ �y SUBJECTANEMPLOYERTOCRIMINALP[NAL7IESANDCIV:LFINESIiPTODNEHUN�FlEDTNOUSAYD ; ENERGYPERNIT DOL.LARS;f10o,o00),IN AO�ITION TO THE COST OF CAM7ENSA'fl0?l,OAMAGES AS PROVI[l[J FOR IN J SECTIOfJ 3)OB OF 7HE LABOR CADE,IN7ERE5T,ANC ATTOP.NE`f5�EFS. ' p� . RETENTiON FEE: __ d CONSTftUC?ION LENDiNG AGENCY ' i � PRE��ALT FEE: � IHEREBYAFFIRMUNOERPF.�iA.TYO�PcFlJ;1R�Y'rAiTHEREISA(:O'JSTAi:CiION'_E?:DiNGAGENCY n- FOR THE P[Rf-0FIAANC[OFTHE WORK FOR W�.ICH THIS Pcqy;7151SSl:ED(SEC.309],C'V C.j. -"-----"----"--"- - � � ___-----"_'__ _ � � LENDER'SNAME_.___ � F-' � LEN�ER'SADORE55______ "_____-__--_ _"__" "_ _--'-_�"-- W [ ICERTIFYTMATIHAVEREADT;-0SAPPLICATIONANDS7ATETHATT>I[AECVr.IMFOV.MATIONI;CORFlECi TQI/yLF�CS � � �� � d E I AGREE TO COMPLV WiTH ALL CITV ANO COI:NT'ORDI.VANCES AN7 STATE LAWS R'cLATING TO BUILOING � � CONSTRUCTION,AAD HERE�Y AUTHCRIZF REPR'cSEUTAT:VES OF THIS COUNTY TO ENTFR UPON THE Z � AB04EMENTIONEDPROPERTYFOFINSPc'CTIUNPURPOSES. � � COMPAENTS_____,__________ _ > > ---���_�1R�t�_�(J.------�—.._ — � - —---- - - d PERMITTEENAME�PWM) ¢ '_""_ ___ - � � �//� Uj SIGNATtIqE OF PER 'f'c " --- ---'- � �N� ""-"'"'-' t �jj /r-� _ � �� FECPT.!JO. �_ �PAlD BY � _ VALIDAT70N ��iV ~ tNHITE-De Rment Co � p« py,YELLOYd--Finarca Copy,PINh-Aseessor Copy,GOLDENROQ-File Copy,GREEN-ApplicenYs Copy . , � . � . , . . _� .. .. . � . . .at.. c. .r. •� . , _..,. ... .. ..... .... . .. . ....�.., .... ... . 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