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HomeMy WebLinkAbout13565 � CITYOFDIAhiONDBAR EXPIRED DEPARTMENT OF COMMUNITY dc DEVELOPMENT SERVICES a , 21660 E.Capky Drive Suite 190 (909)860-3193 Fau(909)861-3117 N�� � � 2��� PRESS �^M`�� $UII.DING PERMIT APPLICATION FIRMLY oy JOBSITE 'f/� APPLICATION 2 PERMR � P/C ADDFIESS ��� DATE NUMBER �i � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER ,�h Ka �L o ADDRESS 7/en G52�� s �����/- ZONING SETBACKS W CITY 5 TG�1n't'b�q ZIP�,�TEL.7/� �Z6��S FRONT RW ❑ APPLICANT TEL. REAR ❑ SIDFJSIDE STREET RW ❑ CONTRACTOR SIDE ❑ ADDRESS g CITY ZIP TEL. PROPOSED USE �N Pu ARCH/ENG/ � �,., DESIGNER NO.OWEL. r�a� NO. Np, y AODFiESS UNITS � CITY Z�p T��, .�-- STORIES Z BEDROOMS�_ y u,3 DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OVYNER-BUILDER DECLARATION SFRIADWREM O 1 NEREBY AFFlRM UNDER PENALTY OF PERAIRY TH0.T 1 AM E%EMPT FIiOM iME CONTMCTORS LI- GBI9QB/C81pOfI CENSEUWFORTHEFOLLOWWOREASON(SEC.70.91.6BUSINESSANDPHOFESSIONSCOOE:ANYCITYOR (n WUMYWMCHIIEOURESAPEFiMRTO00N5TiR/CT,µTERIMPROVE,CEMOU9H2ORREPA10.M1YSTRUC• W P8110/D9Ck TURE,PRIOA TO 1T6�SUMlCE,/�LSO REWIRES 7HE APPLICANT FOR SV01 PERM�T TO FILE/181aNm � SiATEMENT T1MT ME Ofi 8ME IS UCENSED PUIiSUANT TO THE YROYISIONS OF TXE OONTIUCTpRB U• COiSEUW�CFIAGTERO(COMAIENCWOVRIIi9ECTION7000)OFDIVISION30FTHEBUSINESSANUPRO• LL' P�USpB FES910NSOO�E)ORIIUTMEOfiSHEISEXEYPT711EREFROAtANUTHEBASISfORTHEALLE4EDEXEMP• C7 TION.ANVVIOlA7qNOF8ECT10N7091.6BVANYAPPIICANTFORAOERMITSUBJECTSTHEA7P�ICANTTO Z Re-Raof � ACML PENAL7V OF NOT MORE 7MAN FNE HUNORED DOLLARS(isoD�.): �j A60MMEROFTHEPf10PERTY,ORMVEMPIOYEE6WITHWACiESA5THEIRSO�ECOMPENSA7qN, � CORIrtIBfC191 M10.000 THE NfORiC ANO h1E BTHUCTURE 19 NDT INfEtOE�OR OFFERED FOH 9ALE(9EC,70M.BUSI• J NESS AND VIqFE6510N5 CODE:7HE CONTRACTORS LIGENSE LAW OOES XOT MPLY TO AN OWNER OF � PROPEFlfYMIFiOBULD50iiIMPROVE57ME(iEDN,ANDVRi000E55UCHYYOfiKYNMSELFORHER6ELFpR � � 7Wi0UGNF1ISORHEROWNEM%AYEES,PlqVIDmTHATSUCNMAPROVEMEMSARENO�MTENOEDOR m OFFERED FOR&1LE IF HOWEVERlf1E BUIL�MQOR IMPR01fEMB�1T IS SOID WITHIN ONE YFAROFCOUPLE- T10N,THE OIMNER�BUIL�ER WILL HAVE TFiE BURDEN OF PROW�(i THAT HE OR SHE 01�NDT BUILD OR IAIPROYE FOR 711E PURPOSE OF&1LE} � OI.MOMMEROFh1EPROPEHfY,AME%CLUSIVELYCONTRACTIN04NfXLICENSEDCONTMCTOR9 10 CON6TRUCT THE PROJECT(SEC.7oK BUS�NESS AND PROFESSION9 CODE:TNE CANTMCTORS tl� V811l81iOf1 ADJ.AREA CENSE tAW DOES NOT MPLY TO AN OriNEH OF APROPERTY YNiD BUN.p8 ON MIPROVES MEREON,AND WlpCONfMCTSWRBUCMPROJECTSNI7HACONTMCTOR�8ILICENBEDPURSWWTTOTHEGONTMF �UANTITY DESCRIPTION �E � TORS 110EN8E UW.} O IAM OfEIAPT UNDER lEC. B.�P.G FOR iH15 REASON J � U LL � DATE OWNER U � LICENSED CONTRACTORS DECLARATION � � w � I f1EREBY AFFIRM IMDEq PENlLLTY OF PEIUURY TiAT IAM LICENSED UN�ER PROVISIDNS OF CIiAPTER V. •ICqAMENCWl3WRH6ECT10N7000)OFOIVISION70FTHEBUSINESBANDPROFESSIONSCOOE.ANO Z W LICENSE IS Mt Fl1LL FORCE AN�EFFECT. m � LICENSE CUSS LIC.NO. j �j DATE CONTRACTOR � � WORKERS'COMPENSATION DECIARATION � � 1 HEREBY AFFIRM UNOER PENKTV OF GERA/RV ONE OFTIE WLLOWINO DECUMTqNG: Z � _IINVEANOWILLMNNfAINACEFiTIFICATEDFCONSENTTOSELF-INSUHEWNWl7RKEFiS' $ COYPEN&hT10N.A8PROVIDEDBYBECTION37000f7HEUBORCO�E.FOIITHEPERFORMMICE U OF 1ME WOfIK FOR WHICFI THIS VERMIT IB 45SUED. � �I HAVE ANU WILL MAIMAN WORKEftS'CONPENSATqN INSUfNNCE.�S HEOUIRED BY SECTION �J � �7000FTNE 1�100R OODE,FORTHE PERfOR1AANCE OF THE WORK FbR WXICH iHIS PERMIT 15 ` ti 1S5I1E�.WMIORXFA9'ODAAPEN9ATIONWSUFLWCECARRIERANOPOLICYNIIMBERAHE: CONSTHUCTIQN � CARRIER PLAN REVIEW �^ �� � POl'IC�NII►IBEp ELECTRIC �( Q (MSSEcrnNri�norBEou,��E7mOFn#rEAMrsFanor��a�waE000uAasp+aoloRlFss�. PLUMBING I +�i i ( �f I Ma�'1 2 I CEMIFYTHAT IN TNE PERFORMANCE OF TFIE WORK FOq WXICH tHIS PFRMIT 61SSUE0,I MECHANICAL ��,��5.� � BWILL NOT EMPLOY ANV VERSON W ANY MANNER 40 AS TO BECOME 9UBJECT TO THE r, .. �•r,t.•'-..:�,'... � ._. ,. ..� (q WOR7(ERS'CdAPENSATpNUWSOFCKIFORNItiFNDA6REETHATIFISMDUL�BECOME INSPECTIONFEE - S BUBJECT TO THE WORKEAS'COMPENSATION PROVI51aN5 OF SECTION a7oo Of THE LABOR " -� •��� . 000e,�sww.r•oxrriwiTM con+ar rnn+nrose rAov�swHs. ISSUANCE � O �p DA7E: AaPL1cANT SMIP � WMNINO:FAILUflE TO SECURE WDRKERS'C061PENSATpN CAVEMOE IS UNUWFIII.M�SHALL BE ENERGY P!C �y 6UBJECTANEMPLOYERTOCRIMwALPENALTIESANDCMLFINESUVTOONEHUNDREDTIKKISAND ENERGYPERMIT DOLLARS(itoo.000J,W AODITION TO THE COST OF COMiENSATION,�AMAGES AS PRONOED FOR IN J�= BECTqNl70lOFTMELABORCODE,MITEREST,AN�ATTOpNEYSFEE3, qETENTIONFEE: W � CONSTRUCTION LENDING AGENCY pqE-AlT FEE: g111EREBYAFFIRMUNDERPENALTYOFPERJURYTqAT7HERE15AGON5TRUCTIONLENUINaA[iENCY Z FOR TNE PERFOHMANCE OF iliE WOFK FOR WFi1CH 7MI5 PERM�T IS ISSUED(SEC.90W,GIV.G�. W � LEPIDEWSHWE �S LENDER'SAODRE55 W ICERTIFYiH�STINAVENEMTHISAVPLIC�TIONNJ09TATETHATT1EhBOVEMFOHGATIONISDOqRECT. TOTAL FEES ^� l� , � � IAtiHEETOCOMRYN7TH/LLCRYMIOCOUNTYOR�WANCESMIOST�TEIAWSREU71NOlOBU4DINfi /y 1 - � CONSiAUCf10N.AND NEHEBY AUI1100.12E REPRESENTATIVES OF THIS COVNfY TO ENTER UPON'fNE / !i, 7 IiBOYE-MEMqNED VROPERTY FOR INSPECTION PURPDSES. �y� � COMMENTS��-7 7 t '� _ �� 'J� � RAIITTEE �aai� � ti s � IO fiEOFP I E IITE � RECPT.NO. PAID BY VALIDATION WHITE—OepertmeM Copy,YELLOW-finance Copy,PINK—Asseasa Copy,GOLDENROD--File Copy,GREEN—Applicant'e Copy � . . .. . . , . , , .. ,< <� ..., , . . .. .. , . .�. . . , .. � � . . .. . ,. . ..., .., , . , .. . � . • :; � .. - CITY OF DI�I`,�C)t�lC3 B/�R tFd sPECTIAN F�ECOl�t3 �.....,._..�..�_..._.._,,.�....,.,. n . . _ �.. ��,��i�'.�r��'�?;����„�1!�'�- R�� ►��" . �. ��% . -r �.l. � `�u_ � � ���" � .�. .�< �.,r:��--��-...�., .. . _ _. 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