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HomeMy WebLinkAbout14647 (20) CITY OF DIAMOND BA& �� -- — DEPARTMENT OF COMMUI�TITY&DEVELOPMENT SERVICES � � 21660 E.Gapley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ����� BUQ.DING PERMTT APPLICATION FlRMLY o AD R'SS23Y/9 f�1A��L 5urt��w,rv�. APPLICATIO PERMIT �� P/C DATE_ NUMBER 1� � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GR�UP � OWNER�PHVk ADDRESS O f0 �- IAM�� Er S ZONINCi SETBACKS CITY�_ ZIP �. 9S �7 FRONT RW ❑ APPLICANT TG)D YS h i y�•I f REAR ❑ � SIDElSIDE STREET RW ❑ CONTFACT�R MI��aOA�GFY�""�'WN+[a'ff'o�S SIDE ❑ c� ADDRESS 3 W ►-1 SU�''G Q CITY UQVk�� Z�p g]g� � PROPOSED USE � ARCHlENG/ � DESIGNER N�.DWEL NO. Nfl. ADDRESS UNITS STORIES BEDROOMS � CfTY 21P TEL � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION d OYVNER-BUILDER DECLARATION SFRMDDfREM O 1 XENEBY AFRRA UNDER PEHAITY OF PEiWRV THA7 I AM EXEMP7 FROM THE ODNTHACiOilb L4 GanpalCaiport CENSEUWFORTNEFOLLOWINOREA90N(SEG70]7.6BUSINESSANOPNOFESSIONSCOOE:M1YpTYOR (J� CqMYNMIC1111E0UIHESAPEIIMITMCONSTRUCT.ALTER,MAPROYE.OEMOLISF1,011REPAIPANY8iF1UG IW Patio/Deck TUpE,pppq Po R9 155UANCE,�1L90 REOUIRES THE MPLMJWT fOR BUpi PEiMrt TO FILE A 91�NE� lTATiMENT 7W�T NE OR&7E IS L1CBi5ED�INISWNT TO 7NE PqOVI310N5 OF 7HE CONTRACTORS LF CFNSE lAW(CMAPiER B(CCGAIENCWO VATI8ECTION 7ao0)�DMSION�OF THE BUSINEsS AN�PR0. LL POOVSpB FE63qN5��ORTNAT ME OR BHE IS EXEMPT TFIEREFROM AND TNE BASIS iOR TNEALLEGEO FJfEMR TpN.M1YVIttATqNOF6ECT10N7081.6BYANYAPVLICANTWNAPERMR8U8JECTSiHEAPPLICMRM Z f16-Fipp� � ACMLVEWLLT'OFNOTMONETWWFIVEHUNOREDOOI(ARS(5500).1: �4K+OWNEFiOFTHEPROPEqT'/,ORMYEMPLOYEE31NiTHWAf1E8A6THEIR6OLECOMPENSATICN. Q Commercial WILL DO TNE MIOqK,ANO THE 6TRlICfURE IS NOT IN70W ED OR OFFEFED FOR SN.E(6EG.7w�.BU61- J pE'.sBAt�iiqFES910NL OODE:hIE CONiRACTOR9 LICENSE I.AW DOES IJ�7MPLY TO AN OWNEfI OF j � VROVERTYNAIOBUILDSORNACilOVE6TNEpEON.ANDWHDUOESSUCHYAIiKMMSELFORNERSELFON Q 7MROlqN MS OR HEROWN EIAP�OYEE9,PROYIDEO THAT BUGi MPROVEMEMS AHE NOT INTENDED OR m �1 ,OFFERmWRMLEIF.FqN�EVE�{7HFBULdN00NWVROVEMENTIS60LDWIT11NdJEYFMOiCOMRE- '? •TqN,TFIE OWNER�BULDER N7LL YN1�E T/1E lURDEN OF PROVN�Id THAT Hf Oli SHE DI�NOT BURD 01i � IIAPIWYEiONTNEPUliPOSEOFfALE} � ❑I.ASOYMEflOFTHEPROPEN7r.AMFJ(CLUS�VEIYCONfMCTINON7TNLICENSEDODN�FACTORS TO CGISTFRICT7HE PAOJEC7(BEC.7uN.BU6INESS M!D PROFESSIONS CO�E:TME COHTNAC70R5 tJ- VBIU9110� ADJ.AREP. CEMSE UW OOES NOTAPPLY TOAN ONO/Efl OF APHOPERTY YV/IDBUR0.S OR NAPROVES TNEflEON,AND Mf11000HTMCfSPoR9UCH►RQlECTEWITIAWNIIIACTOH�B�LICENBEOPURSWWT70TNEOONTMG QUANTITY DESCRIPTION FEE � T00.5 LN'.EN6E lAW.1 t �7� OIAAIEIfBdPTl1NDERSEC. B.iV.GFORTHI5REA60N � 1 ��Y�'A L �— � �=' DATE OWNER U � UCENSEDCONTRACTORSDECIARATION � � - � W IHEREBYJIFFIN4UlDERPEWLLTYCFPER1LRiVT1U71AMUCENSEOUNDEHPNOVI5i0N50iCHAPTEN � � �(COAWENCIIKiWfiM3ECTION7000)OFOMSION70FTNEBUSINESSANDPROFE59tONSCOOE,MID Z �!� MY LIGENSE IS IN Ml FORCE AND EFFECT. m � LICENSErC�USS�_��.No. �3y�+���+,�rt� �,�1 ��tjl DATE 1�Z�� O� CONiRACTORW'P�V�►`�5 PA�M' a = WORKERS'COMPENSATION OECLARATION � N IMEFEBYIIFFIRMUNDERPENN.TYOFVEIWMONEOFTHEFOLLOWINO�ECLAqATION3; V H � � __INAYEANDWILLMABJTMNACERTIfIG1EOFCONSENTTOBEIFdNSUREFOHYYORKERS' S COMPEfiSATpN.ASPROVIDECBYSECTONJ70oOFTFIEUIB�RCODE,FORTHEGEAFORMANCE W OF THE WORK FOR NRildl THI6 PEPMR IS 186UFD. � _I MAVE ANO WILLMAINTNN WORKERS'GOM9ENSATION INSURIINGE,A9 REW�NED BY SECTpN � 97000F THE LABOR COD�FOR THE PERFORMMICE OF TME N�DRK FOR NRIICH iHIS PEq1AT 15 IBSUFD.MV WORKERS'Cd10EN5ATd!J,IN.,Sl1NANCE CARRIER AND POIICY NUA6ER ME: CONSTRUCTION 7 CIINRIER—��N A� �iS�W PLAY REVIEW � paicYrrt�uBEn W"'-1- If6�I�{ _ � ELECTRIC �_ Q (�fi6sECIloNWE�rrnBEod+RE'I�OFnEPF3i.afsFDaanElaR�damOalAasW+�Matl.65S1 PLUMBING Z I CERTIFY THAT N THE PERPDHMANCE OF TNE WORK FOR WHICH THIS PERMIT I6155UED,I MECHANICAL `�"' '`� (� 5�{�L��p7 EMPLOY ANY VEA�N W M1Y MANNER SO AS TO BECOME 5l1&IECT TO TNE (n 1MDRNERS'GOMPENSATqNlAW90FCALIFORNIqIWOAOREE7FIAT�IS110UlOBE00ME �NSPECTIONFEE S BUB.IECT TO THE WORKERS'COIAOENSATION PROVISIONS OF SECTION 9700 OF THE UBOR �] �'�� CaOE.I SI1ALL FOR"�MM7HCOMPLY N7TF17HOSE PXOVISIONS. ISSUANCE c�� � o�rE: 1•Z. ��1 �G+ �� �p '�6''� � � APPLICANT. SMIP � ;"'R�T�� �'a,..^.� ENERGY P/C �!\ i�j�„�-`t.i...•J-`�,r,.�, . K WARNING iA0.UHE T06ECURE NfON1�R3'OOMPENSATION COVERAOE IS UNLANFUI.AND SH/LL BE `T-�-p�� a�J „� �y 9UBJECTINEMPIAYERTOCRMpULPENALTIESANOCNLFMESUPTOONENUNDREDTNOU&W� ENERGYPEHMIT y t ' �"��� .r DOLIMS(i10G,OD0�,INADDITIONTOMECOSTOFCOMPEN5A7pN,OM1AOESA9FROVIDEOFORIN � BECTI�N a7oe OF THE LA60F OODE,IN7EREST,ANDATfORNEY'S FEES. RETENTION FEE: � CONSTRUGTION LENDINO AGENCY PRE•ALT FEE: � II/EREHYAFFlRMI1NUEflVENALTYOFPERJUpYTW�TTHEREIBACONSTRUGTIONLENDINOl10ENCY Z FORT/1E PERFORMANCE OF TNE WOHK(OR WHIOI TFNS PENMI715ISSUm(SEC.90Y7.CIV.C.). W � LENDEH'S NANE h— LENOER'SADDREss � 10ER71FYTHA7IHAVEREADhIISAPPLICIITIDNAND8TIITETNATTiEABOVEMViOFMA7qNISCORRECT. TOTAL FEES �� pW, IA(iREETOCOMPLYWITHI4LLCRYANOCWHIYORDIWWCESANObTATEUW3REUTINOTOpUMIN6 OpP16TAUCiION,AND HEflEBVAUTFiORIZE REPRESEMATNES OF 1HI5 COUMV TO ENTER UVON 7HE S�' �eoveaiExrpr�EovnonERrrroanurccTiowruarosEs. COMMENTS 9 l R W�S'C aS �m � E(yq� V"^ �"�[! � y pATE � RECPT.NO. 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