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HomeMy WebLinkAbout13412 (17) '� J� CITY OF DIAMOND BAx L=1 , ' DEPARTMENT OF COMMUNTTY k.DEVELOPMENT SERVICES � _ 21660 E.Copley Ihive Suim 190 • (909)860-3195Fax(909)861-3117 . PRE$$ �'A�'. BUQ.DING PERMIT APPLICATION FIRMLY a ADDRESS IO�If' Ql��.�uJv{� �IO�� I �'�' (2, r APPLICATION PERMR P!C p DATE NUMBER M � APN LOT TRACT ISSUE I/� TYPE OCC DATE �� CONST. GRaUP � OWNER �711'���Z "' ADDRESS � ZONING SETBACKS w � � CfTY Z}R ` TEL U FRONT RW ❑ APPLICANT a ' , l,t> TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ CONTAACT . SIDE ❑ o CfTY S 1� ZIP , TEL � PROPOSED USE � C{. C�1S,S ! � A NG/ � . . , DESIGN NO.DWEL. NO. NO. ADDRESS UNITS STORIES . BEDROOMS � CITY ZIP TEL. N v� DESCRIPTION SQ.Ff. FACTOR PSF A0.1.AREANALUATION p� ONMER•BUILDER DECIARATION SFR/ADD/REM O �(((��] I HEREBY AFFliqI UIDER PENALTV OF iERA1RY iIUT I IW EJ(EMPT FR04 THE COHTMCTORS L4 Garage/Carport CENSEUWFOHTHEFOLLOWHfiRFA�ON(SEG76]1.SBUSPIESSMIOVROFESS�ONSCOOEANYCRYOR , (n COUNttNF1101RE0URE9AVEAWRTOCONSTRUCi.KTER�IPROVE.DEMOl15H.di11ERURAN`l57RUG W PatiolDeck 7URE,VRIOR TO R9 p9UMICE.AL50 REW IRES TME APPUCAFR iOR SUdI VERAHT TO F0.E A SIONED W STATEMENT 7MAT ME Ofi SME IS LICENSED PURSUFNT TO TNE PROVISIONS OF TME CONTRACTORS L4 � CEHSE UW(Q/APTER Y(CAMMENCNXI WTI SECiION 7W0)OF DMSION�OF THE BUSiNE55 AND FHO� LL' POOVSpB FESSqN4000E�ORiHATNEOR5ME13E%EMPTT/1EHEFNOMANDiNEBA515FOR7MEKLEGEDE%OAP- (' TION.ANYYIOUTIONOFSECT10N70J1.69YANYAPR�GNTFOHAGERAIITSUBJECiSTHEMPLICANTTO Z Re-Root . � A CML FENALTY OF NOT 4pRE THAN FIVE HUNDRED DOlUHS({600).1: � � 04�.401N1EROF1HEPilOPERTY.diYYEMPIAYEESWI7HWAGE5A5TMEIRSOIECUMPENSATION, � COrtIT0K4'fl - WNl DO TME WOfY(IUJD TNE STRUCTURE IS NO7IMENDED OH OFFERED FOR SALE(SEG 7oa1,BU54 J � NFSS/JO PiqfESS10N8 COOE:THE CONiMCTORS LICENSE UW DOES NOTAPPLY TO AN OWVER OF ? . PROPEMY WHO BUIl.D9 OFi MGROVES T/EREON,AND YI110DOES SUCFI YN(iK HIMSELF ORHEflSELF OR � h1ROUOMHI50(iHENOMMEM%AYEES,YHO'NDED7INTSUCHNIPROVEMEMSMENOTWTENDWOq m OFFEAm fORSALE IF Yq'NEVERiME BUIDINOOR IMVROVEMOlT4S SOLD WITHNONE YEAFi OF CQ1RE � 'TqN,THE dNNERbUII�ER YALL 11AVE THE BURDEN OF VROVNO 711AT NE Oii SHE DD NOT BUttD Oq YPRWE FORTME PURPOSE OF 9ALE1 �y �4��M�MFADF7MEVROVERfY,AYE%CLUSNELYGDNiMCTWOWRNLICENSEDCOHTMCTORS � TO CONSTRUCT 7HE VRO.IECT(SEC 7ou.BU51NE55 AHD iROFE35iON4 COCE:TME CONTMCTqiS U- V81U81iD11 � ADJ.AREA � CEN6EUWDOE4lqTMPLYTOANO�NIEROFAGNOPERTYMnqBUIlD50R�.1VRDVESTIEREON,NA 1MqCONiMCiSFORSUCHFROJECT5W1T1ACOMRACTOi1(S�LICENSEDOURSUAHTTOiNECONTMC• OUANTITY DESCRIPTION FEE � iORS UCENSE UW.} � OIAMEXEM7TUAERSEG B.iV.C.FOHTHISHEASON U � � DA7E OWNER U � UCENSED CONTRACTORS DECLARATION � � w 111ENEBYAFFIWAVNDERPENILLTYOf7E0.JURYTMATIAAILICENSEDUNDERVROV1510NSOFCHMTER V. s �(OOYYENCNO VrtTH SECTId/f000)OF DMSqN 7 OFTHE BUSINESSAND VROFESSIONS WOE.ANO Z �( W LICENSE 6 N ML FORCE AND EFFECT. m � LICENSE CUSS `� � LIC.N0. �' ��� j a�� eorrra�eTon a •f a i ^ WORKERS'COMPENSATION OECLARATIO�� ^,1�(./ ¢ � IMEREBYAFFIRMUNOERVEWLLTYOFpER1URY0NEOFh1EfOLLOW7IODECLAMT10N5: 1" Y , 2 � _IHAVEMqYNLLM/UNTANACEHTIFlCATEOFOONSEMTOSfLF•INSUREFORM/011KER5' _ OONPQ/6ATION,ASVRONDEDBYSECTION17000FTHEt1B011CODE,FORTMEPERFOM6WCE U � OF T/E WOR1(FOR WM1CM iMIS VEIIMIT q I55UED. � 0 Q _I HAVE/ND WILL WRRAIN NIOiiKE0.S'COLIPENSATIDN MSUfUNCE,AS REOUIRED BY 6EC71ON 97ooOFh1ELABOqCOOE,FOqTHEPERFORMANCE0FIHEWOpKFORWHidITMISPERMITIS � ISSUEO.MYNOR%ERS'Cy���\PQHSATIONINSURA/1LEGAARIERM1DPOlILYM1M8ERME: CONSTRUCTION �. � � CARPoER � ✓•" PLAN REVIEW � va�crNu�e�R LT ELECTRIC � (MSSEC110Nr�EIDHoiBEod.�IF�EDOFl1E1'EiiAf610ROrE1#JN71�ED R+�) �ssl PLUMBING Z ICERTIFYTHATNTMEPERFORMANCEOiIHEY+ORKiDRWNICMiHISGERMiTR65UED,l MECHANICAL --•� SIIALLNOT EMPLOYINV VERSON NANY►UWNEF SOASTOBECDY[SU&IECTiOTHE � . �. WOFNE0.5'COYPENSATtlNUwSOFCALIFORNIAANOAGREETNATffISH�IADBECOME �NSPECTIONFEE '� �'S,;'v SUBJECT TO TNE Wdi1cER5'COMPENSATqN PROV1510N5 OF SECTION]70o OF TNE UBOR 1- -�' s '-r" coo�i� Q�{nm�nica�virwini asEaao�nsqy/rys_��//� ISSUANCE pDA7E� APPLICANT: i`-u�Y l.O♦ SMIP !� ��J �l�t_ . _ WApNINO:iALURETO6EWREWOFL(ERS'COAIPENSA COVERACEISUhUWFUI„MA511ALLBE �''`` ENERGY P/C �*� , "•�p��� ,_<'•`�'i ry SU&IECTANEMP�OYEqTOCRIMINALPENALTIESN�DCMIFNESUPTOONEMJNDREDiHOUSAND ENERGYPERMIT `,T, ,r1" ,+`��r� DOLURS(i10o.Doo�N ADOITION TO TME LOST OF GOYPENSIRqN,DAMAGES AS PROYIDED FOFi IN J SECTqN170tOFTHELABORCOOE.N7ERE5T,ANDATTORNEVSFEE4. RETENTIONFEE: �� �' �"� '� a Q d CON5TRUCTION LENDING AGENCY PRE-ALT FEE: C ••� �1��� O �v•• � IXEREBYAFFl T/OFPERIURYTMATTMEREISACONSTPVCTIONLENDINOAGENCY Z FOR THE VERFORM�INCE OF T vEHA�R IS ISSUED(SEG 7on,pV.GI. W � LENDER'S NAME C IENOER'SADORE55 � ICERTIFYT4VIHAVEREADTHISMPLICATIONANDSTATETHATTHEABOVENFORA1�710NISCORRECT. 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