Loading...
HomeMy WebLinkAbout14627 (20) � � � �'r' CITY OF DIAMOND BAx � - " �'�- DLPARTMEN7'OF COMMUNITY&DE'VELOYMENT SERVICES !� , 21660 E.Copley Drive Suite 190 (909)860-3195 Pax(909)861-311� PRESS '9�'� BUILDING PERMIT APPLICATION FIRM�Y � JOBSITE --���f�� /�,' APPLICATION PERMIT � P/C o ADDRESS uC t ��s� � + DATE_ NUMBER #_ � � ISSUE NPE OCC — APN LOT TRACT_ DATE CONST. GROUP °C OWNER � .�� 0 j o ADDRESS �� / iCl D � ZONING SETBACKS w FRONT RW Ll_,___ Z CITY "�3�lht�__ f!� ZIP �"'7se��TEI, /� �/tlf� REAR f 1-.--- S APPLICANT _ _ TEL. — SIDE/SIDE STREET RW___ [�7___ z � CONTRACTUR f° L:��__________ __ SIDE _ LI ADDRE � � CITY ZiP TEL. � PROPOSED USE___ _ � w ARCWENG/ — -- z DESIGNER � NO.DNlEL. NO. NO. A�DRESS_ � � UNlTS STORIES ______,____BEDROOMS � � CITY _ ZIP TEL. . tA DESCRIP710N SQ.FT. FACTUR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARA710N SFRlADD/REM � O p �HEflEBY AFFlRM UXDER PENALTY OF PERtt1RY THAT I PM EXEMPT FROM THE CONTIiACTORS LI� Gef2J8/Ca�pOff � W CENSEIAWfOHTHEFOI.LOWIPoGREASON(SEC.r031SBU5MES5ANDPROFES�lO4S(:OUEANYCIiVOR (J� - --_ C1 COUNTYVh11CHREWIRESAPERMI7TOCONSTflUCT,ILLTER.IMPflOVE,OEMOLISH,ORqEPAIRANVS'fRUC- W P01i0/DBCIc Z TURE,PFIOR TO ITS ISSUAkCE,ALSO RE�UIRES THE APPIICANT FOA SUCH PCRMIT TO FILE A SIGNED � STATEMENT THAT ME UR SHC IS LICENSEU Pl1H5LANT TO THF.PROVISIONS OF iHE CONTRACTOFS LI� � � CENSE LAW(CHAPTFR B(C�MMENCING WiTH SECTION 7000�OF DIVISION 3 0F THE BUSINFSS AN�PR0- LL Pool/Spa � FESSpN5LODE)ORiHATk1EON5HEISE%EMPTTHEREFROMRNbTMEBA515FqRTHLALLFGfUE%EMP- (� — V TION.RNYVIIX.AYIONOFSECTION70.715BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO � RB�ROOf � ACIVIL PENALTV OF NOT MORETHAN FIVE HUNDRED DOLLAPS(5500).): — � UI,ASOWNEflOFTHEPROPEflTI,ORMVCMPLOYEESWITHWAG[SASTHF.IRSOLFf.OlAPEIdSATION, 0 COmm8lCiel WILI DO iHE WORN,M!D THE STRUCTURE IS NOT INTEN�ED OR OFFEFlED FOH SALE(3EC.7a4,BUSI� J � NESSAND PROFESSIONC CODE:THE CANTPACTORS UCENSE lAW DOES 407 AFPLY TO AN 9WNER OF = PROPERTY NR108UILD5 OR IMPqOYESTNEREON,ANDY�MO DOES SUGH NYJflK NIMSELF OR HERSELF OR Q THROU(3HHISORHEFIOWNEMPLOYEES,PROVIDEDTHAT5UCHIMPROYEMENTSARENOTI�TENDEDOR � QOFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENfIS50L[1WITHINONEYEAROFCOMPLE- ____ J_ � TION,THE OWNER�BUILDEFl WILL HAVE ME BURDEN OF PROVIA70 THAT Mc OH SHE DID NOT BUILD OR � IMPROVEFORTMEPURPGdEOF5ALEJ. �y C71,ASONMEAOFPHEGRU:ERTY,A/RE%CW3IVELYCS7NTRACTIYGWITHLI:'ENSL�COY'NACfORS '— -- a TO fqNSTRUCT THE PFQIEC7(SEC.]nea.NUSINESS AND PROFESSIONS CAUF.:1 HF CONiqqCTOflS LI� V21UailOn _, _ ADJ.AREA lLl CEkSEUWOOES�O7RPPLYTOANOWNEFOFAPROPERTYYlNOBUiLO50RIfnPflOYE3ih!ERI:ON,.5N0 ��-�-��-- --'---�"---�-----�" ---'-- F MAIOCONfRACTSF00.SL1CHPPQIECTSWITHACDMIRAC?DP(5)LICENSfD�IlR5l1ANTTOTNECO,ViRAG pUAN71TY DESCRIPTIOFI FEE Y TOHSLICENSELAW.). _ __ ____ OLI I AM EXEMPT UN�ER SEC._,_________.,.______B.8 P.C.FON THIS ReASON Q 3 ------ --- �� _ ��H" � . DATE___ OWNER__ �� o ----__ ----------- w _ ' �' �..�d � LICENSEU COfJTRAC�ORS U[ClAflA710� W � I NEHEBYAFFIRM UMDEP PENPLTY Of PERI'JRY 7NAT IP.M I.ICEN.S'EO UNOEfl PROVISiCNS OF CHdPTLR � � . ,� B�COMMENCING WITlf SECT70N 70au�OF OIVISILW 3 0F;HE(iUS14ESS AN��RUFE55K).\�:i GOJ[,A\U _ _ W LICENfiE IS IN FULL FCRCE AND EFFECL ��i O LICENSECLAS5/�� • IIC.NO.___/ �DC� /C� _ . — ---� �~ �(E'�'i���/'—_�_ �i�� J __ V DATE CUNTRAGiOF / I1 — w �. WORKGRS'COMPENSA710N DECLARATIUN �/ � '-� ---- '- i �� � �� IHEFEBYAFFIRMUNDERPENAL'IYOFPERIURVONEOF1HEeOLIAWINGDECL ATIONS — � I � C] IHAVFM!OWIII.MAWTAINACERTIFICATeDFWNSENTT05'eLF-INSUHF WOHKFRS' � � COMPENSATIOR,RSPFiOViDEDBVSECTIOH3�u00FTNE1.R00RIX7�C,FOR7 - ___ ____ _ FIR h OF THE WOHK FOFlVJHiCH THIS?ERMI7IS I55UED, LL� w _IHpVEANUWILLMAIMAl4WORKEHS'CO�dPENSlQIONINSURFNCE,ASHEOUiRE� SECTIO� � � Q 3�aoOFTHELFBOACODS,FOR7HEPERWR�!ANCEOFTHEYlORKFORWHIf.F .ISAFRMIiI — — --_ ISSUEU.MY WOHKF.R5':AMPENSATION INSURANCECARFIERAN�POLICY� 6ERAflE: . NS7RU TION ' j cnRRiER ���.���°'�-- — P N VIEW __._—.__.—'_'.._.._— Z POLICYNUMBEH � ____.__ __._ _ _ . t � .�....j��.�.�-�-���— --- .._....._.. TRIC e `7 _� (iH�5ECf10NNEFDM:7fi�(XIMiEiFDOFTP�PERNYfISi-0RONEHI}, DDCLlARS(57C0)ORLESSy. PLUMBING _ Y. ... ...___._'���___ �_"' w Z I CERTIFY THAT IN THE VEHFORMh\CE OFTHL WORY.FOR WHICH THIS P , MECHANICAL _.___ _._____________, __ ,-(J SHALLNOTEMFLOYANVPEHSONINANYMMIN[HSOf.5T08[COMF.SVAJF.CTTOTHL " �? �� WORKERS'COMPENSA7IGNLAWSUFCALIFOH\IA,ANOAOREEiIiRTIfI51101;LUBEECOME INSPECI�IONFEE � �'•��" _ _ .__, _ = SUBJECTTOTHF.WORKERS'(:OMPLNSATIONPFiO'JIS:ONSOFSECTION37000FlHELA00R v'�'�" �• � -�'— CO�E.I SHRLLFOffTHWITH GWAPLY WiT}I THOSE PP.OVISIONS. ISSUANCE ______._�'��'', +.�' � � " � ,.....'�,-"' . o --- SMIP � -.�'� ;.. ' _.----- --.._..-._-..-- ---- - ;.y.. ,� ., .: ��� . _.,. w WARN�ING.FAILURETOSECUREWORKCRS'COMPENSATIONCAVERAC7615UNLAWFUL,ANDSHALLBE y'�Y' Y, E_. I o: � _ _ ENERGY P/C ' ..-----..- . ,---. �, SU&IECTANEMPLOYERTOCRIMINALPENAl71E5ANOGIVILFiNESU?700NEHUf6DREDTHOU3AN0 ENERGYPERMIT r OOLURS(S1ao.000),INMDITIONTO7HECOSTOFCUMPENSATION.�AM.AGESASPROVIDFDFORIN - � --------� ---- J; 3ECTpN37a80FTHLLABOftCODE,IN7Ffi[Si,ANUAT70RNEY'SFEES. RETENTIONFEE: '(.� �_ -._._—...."—_""_--__' �. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ ,_ .__ p�; �------�-- �� IHERE6VAFFIFlMUN�ERPENALTVOFPERJUFVTHATTHEHEISACONSTNl1CTIbN1ENUINGAGENCY a- FOFiTHLPLRFORMANCEOFTHEWORKFORWHICi�lHicp[F;��'(ISISSU[D(SLC.]Du�,CIV.C.�. —"��-�"'-------��"'��-'�-�--�-���'-'��"----�� Z W .__—_____- ___.—____.._— � LEN�FR'SNAME ____ ____. F-� LENOEH'SAOORE55___._.__.— _'_____.__--.._._._._...'__'__.._.....'.. — — '� ICERTIFVTHATIHAVEREADTHISAPPI.ICATIDNANDSiATETFNTTHEABOVEINFORMATtONISCOHFECT. T�T,4L FEES �w I AGFEE TO COA9PlV WITII ALLCITV AND C-0UNTY OR�INANCES ANU STATE LAWS RfLATING 1'O el11LDING � � CONSTRUCTIIXJ,ANDMEREBYAUTIiDflIZEREPRESENTATNE50FTHISCQUNTYTOF.NTERUPONTHE � A[30VE-MENTIONED PROPERN FOH INSPECTION PUf7P05ES. Z COMMENTS------------ ------------ �� �a�la�'.�`-�' �`"�.4i'f_'���•�,��_/_-�-�- --� '� ----------------._.._...------------- � m PERMITTEEN E P ,Q "_'_'_'_'___'_""'_ _ — _' �' .��� --.� `'yy'�,c2 — — -- � --------- � SIGNATURE OF P[RA9ITTEE DAT[ � �� � RECPT.NO. _ _ PAID BY ._____ __VALIDATION WHI7E—Deparlment Copy,YELLOW—Finence Copy,PINK—Assessor CopY,GOLDENRO File Copy,GREEN—Applicanfs Copy .. _ . . . . . . . . .. .. .. .��� � 4 , I ' : ' . . , ��' .. �' � . � ' � . .. — �.. _ a I , I i . - � t: :. . � " i _ � � � . � , '�' � � : , � . � - � � ; �. � � i . . , � � . � � � �. . , ; � i'� ,... , �... ': I Y � � F . . . '. . . , f I � �! ��,Q� , _ � '. � �'. , � ' i � � . � . � , . � .. . . ._..... . _ ...._ . . .. , , c ,�, _ j � ; , � � '� � � ���� � � � �� � � � ; � , `� i � , ; �� . � � � ' � � � . � �� ,; ; , i ; � - � , , , i � ; , , � ' N;� „ ; ; , . � � � � � ` � � �J =� � � � , � _ - � ��r' ,. ' I� I - I - :r � �; �.�� . �� � , I � � � � � � � �� � , � � �� � �i �� � - � . . � . : _ � � � � � i ; , ( I � I � I vn � �� . . . . � � �� . .. 3 i i . , ' � �. I � � � . i {*:xt , , ; . � . ' � ; ; � , � .' � . �.. i I , �. : � � >, ..... , . �. : '_,. . � i � � � '- I ' . _ � - •. . . ' ' . . . �: � � '� I I . '"".. ._.i �' . � � �� ' � . � i . - � . � � � . j . .. - �.7 iI , I ' I I i '' . I a I � ' � � _ . ' ,_ z ' ..> , , • � � `� ' ( � � + i I i �,� � ' . ' , i . ' � ,� . . ! I 1 i ' i , i I � .� I k .�� .H, y .1 , t i I i ' ' ' - I _ i � . I . _ 4 ' .. . � � ( I � � ' 'I , i ` j � i i � . I .. ��