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HomeMy WebLinkAbout16227 /-' CITY OF DIAMOND BAx � ' - 1�� DEPARTMENT OF COMMUNITY&D$VELOPMENT SERVICES / 0 �� . 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)Bb1-3117 � PRESS � "�'�� BUII.DING PERMIT APPLICATION FIRMLY 6 ADDRE5S �3�I3 TK�S�LT U�LC�I L1�I(/ APPLICATION (� PERMIT P/C o DATE �" 1'� ` NUMBER � � X � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP � OWNER �.il L ADDR SS� ! ROSP�C G£ ZONING SETBACKS � CITY ZIP�� TE Y ^ �" REART RW p APPUCANT � TE .3�1�s'��^,5�3 SIDE/SIDE STREET RW ❑ CONTRACTOR C�w/� SIDE ❑ � CITY�WE+L�C!]^l ZIP �t�Z-?2 TEL " �� PROPOSED USE C�a).riEO[['(` �?O C B7"�Fs�'GG � AACH/ENd! X�,� DESIGNER NO.DWEL. NO. NO. ADDFESS UNITS STORIES BEDROOMS � CfTY ZIP TEL. v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFWADO/REM O 1 XEREBV AFFlqM UNOER PENALTY OF PERRIRV THAT I Mt EXEMPT FHOM TME COMMCIIDRS LF G8fflQ8lC91p011 CENSEUWFORTlIEiOLLAWINOREA,.ON�SEC.7031.6DUSINESSANDiAOFESSION9CODE:ANYCRYOfi (n COUMTYWHICHREGUTAESAPFJWRTOCONSiRUGT,ALTER6APROVE.DEMOLISM,ORREP/�IRANV6T�UG W PatfolDeck TURE,PRqR TU I75 I63UANCE,ALSO REdUIRE3 THE APPLICANr FOR BUCH PEPMIT TD FILE�61�NED W tT11TEA1ENT TW�7 ME OR 6NE IS LICENSED PURSUANf 70 7HE PqOY1310N5 OF TXF CONTRACiOR3 ll- CENSE LAW(CHMTER i(COMMENCINQ WITH BECiION 7000�OF OINSION 9 OF THE BUSMESS APA PRO- �'L' PO�USpB FE�'.,SIONSCODEJOq7HATNEOR6NE19IXEMPTTHEREFROYMDTHEBASISFORTHEALLEOEOpCEMP- C7 TION.ANYVqLATIOqOFBECTION70.A1.68YANVAPVUCANTPORR0ENYIT&U&IECTSTHEAPVUCANTTO Z Re-Rooi � A CML PENALTY OF NOT MORE TXAN FNE HUNDRED DOLURS(t6ao�.): � OI,ASOY�R7EROFTFIEPROPEH7Y,ORMYEM�LOYEESWIhIWAGESA9THEINSOLECOMPENSRTION, (',ORI1IIBfC181 VYILC DO 7HE WORK,ANO THE 6TRUCTUFE IS NOT INTQI�ED OH OFFERED FOR SALE(SEC.70N,81151• Q NE85 AND PROFESSqhS COOE THE CONiRACTOR3 LICENSE lAW DOES NOT APPI�70 Ml OriNER OF � PROPENTYWFplUND90RMPqpYEfiTMEREON,AN01VNO00E56UCHYVORKHIM5ELFORHER6ELFOR � � 1HROVOMItl50RMEROWNElAA10VEE5,VROVIOE�THATSUCHMFNOVEGENTSAHENOTINT6NDE00R m OFFERED FORSKE IF F10WEVERTNE BULOIN(i OR MIPROVEMENT 6 SOIO WIiHIN ONE YFAROFCOdPLE- Z TION,THE OWNEH�9l11LDER VALL MAVE TME 9URDEN OF PROVIN6 THJ1T HE OR SHE OW NOT BIIqD pR � NAP110VE FOR 7HE PURPOSE OF SALE} O l�SOMMER OF iHE PROPERTY,AM EXCLUSIVELY CONTRhCTMICi WITH LICEHSE�OONTRACTOq! � TO CONSTRUCT 7F1E PqO.IECT(SEC.7oM,BUSINESS MIC P110FESSqNS CODE:7HE COMMCTOR9 LI• VelUfltlIXl ApJ,ApEA CkT19E UW OOES NOTMPIY TOAN OWNER OF A PROPERT'riR10 9U6AS OH IMPROVE7 7MEREON,AND MIFqCONTRACfeFOf18UCNPFOJECi9WIlHACONfRnCTOP�S)IICENSEDVlIRSUANT7OTH6COHfFUG pUANTTTY DESCRIPTION FEE � 70115 LICENSE LAW.�. O I MI E%EMPT 1MDER BEC. B.i P.C.FOR THIS REASON Q U �= OATE ONMER r � � UCENSED CONTRACTORS DECIARATION W � I XEREBY AFFIRAI UNDER PENAL7Y OF PEiUUpY TFMT Il1M IICENSED UNUER VROVISIONS OF CNAPTEFl � � �(OOIAAIENCYN3 YATH SECTpN 700D)OF OMSION 70FTME BUSINESS�VlD PROFESSIWIS COOE,AND Z W LICENSE IS N fUll FORCE AND EFFECT. �1'�'T!7O � � ��E CZo ��.�. � ~ DATEs�� � CONTRACTOR � WOFKERS'COMPENSATION DECLARATION ¢ O � � I HEREBY�FFlWA UNDER PENALTV OF PERIURY ONEOf TiE FOLLOWINQ DEIXAMTIONS: Z � _IMAVEA610WILLWNJ7AINACERfIFICATEOFCONSENTTOBELFdNSUREFORWORKERS' _ OOAIPENSATION.AS PROVI�ED BY SECTION 97000F THE LABOfi COOE,FOR THE PEHFORYANCE U Q OF TFIE WORI(FOR MMICH TNIS PENAl1T IS ISSUEO. � ''�u �I HAVEAND 1MLL MAINTAIN WORKEfl9'COMPENSATION INSURANCE,AS REWIREO BV BECTION � 3700 OFTNE UBOR CODE,FOR THE VERFORMANCE OF THE WORN FOR MMICH THIS PERMRIS LSSIIm.W WORKERS'CONPENSATqN INStIRANCE CApRIER AN�POLICV NUMBERME: CONSTRUCTION � CMRIER �� �� PLAIJ REVIEW Q POLICYNIAmEH_�-�Z 7'�0� ELECTRIC � C Q (niseEcnorrr��r�oTaEoo�w�rrEooFnEPEw.�rsfaaonE�ooaur+sR��1�L�5s1 PLUMBING Z 1 CERTIFV TNAT N THE PERFORMANCE OF TNE NKJHN FOR WHlpl hIIS VERMIT IS ISSl1ED.l MECHANICAL �.�,� � SHIll NOT FAIPLOY ANV PERSON IN ANV MAHNER SO�8 TO BECOME SU&IECT TO TXE (q WORNENS'COMVENSATqNUW50FCALIFOPNIAMIDAGREETNATIFIBHOUI,OBECOME INSPECTIONFEE S SU6IECT TO THE MIONKERS'COMPENSATqN PROV19�ON3Oi$ECTqN a70o DF TME LABOR CAOE,I SNALL FOfiRIW ITN COMRY WITH TNOSE PROVISIONS. ISSUANCE .0 O . .. . p ppTE: A,pp�IC,WT: SMIP -- � WARNINO:FAILURE TO$ECUflE WORKERS'COMPENSATION COVEM�E IS UNLAriFUL,AND 6FUllDE ENERGY P/C �y SUBJEGTAp EMPLOYEH i0 CRIMINAL PEWILTIES ANO CIVI�FINES UV TOONE NUN�PEO 7FIOUSMID ENERGV PERMIT DOLURS(ilUO,OW),MI ADOI7ION TO 7HE COST OF COMPENSIITIDN.OIJdA�E5 AS PHOYIOE�WFl IN ¢ SECTpN�7D!OFTHE LABOR CODE,MTEREST,ANDATTORNEYS fEES. RETENTION FEE: 4 CONSTRUCTION LENDING AGENCY 0 PRE•ALT FEE: � I NEREBY/1FFIRM UNOER PENALTV OF PERJIRiY TH11T 7HEHE IS ACONSTRUCTION LENDING AQENCY Z FOR THE PERFORIMNCE OF Tl1E WOflK FOq WHIQI TIIS PEHMR IS ISSUED(SEC.]OY7,CIV.C J. W � LENDEWSNAME � LENDER'SAD�RE55 � I KlREE TO COMPLY N7TN ALL CIN AND COUNTY OADINMICES ANO BTATE LAWS RELA71N0 TO BUILDING TOTA L F EES ��f�� � CONSTNUCTION,ANDHEREBYAUi110RIZEREPRESENTATIVE50F1HI5COUN7YTOENTERUPONTHE � ABOVE-MEHTIONE�iROPEpTV FOR INSPECTION VURPOSES. COMMENTS � 2l C�-d , tF.w�s � osrunmc (a i � 37a N &GNATU �OF R EE D117E � RECPT.NO. 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