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HomeMy WebLinkAbout13177 � �.�����=. . ' �� _ CITY OF DIA.MOI�ID BAR .�...� I ` I DEPA.RTMENT OF COMMUNITY Bc DEVELOPMENT SERVICES i E �w . 216b0 E.Copley Drive Suite 190 ��',�Ir � i l�Ul� � (909)860-3195 Fax(909)861-3117 P�E$$ � � ��'9�'� BUILDING PERMTT APPLICATION FIRMI.Y ' � JOBSITE �% /� +� APPLICATION � �,� " PERMIT �j P1C I o ADDRESS °�S� Z`)C.l'� � I:'C'IC. DATE � NUMBE� �'� � � # � c� ISSUE TYPE OCC APN. L07 TRACT___ DATE CONST. GROUP _ p OWNER � ��- I. I />C o ADDR SS S—� O�K 7 �' ��— ZONING SETBACKS Z CITY �"�v` �:)�'� ZIP__ TEL. r��' t FRONT RW ❑ � g � REAR Li APPLICANT TEL._ ' SIDE/SIUE STREET_._ RW r� i � y 1 SIDE ' l�-.---, -- CONTRACTOR�,f � �:f� �- � � ADDRESS s'' � J � �- I o CITY �')Cn.i 3`'/l1C (� ZIP � TEL. Q PROPOSEu USE �'"`i'��%-�--:Q� L'� t-I ���R�L_ I o ARCH/ENG/ � �V�� �_ t.�, . p�ti. .v �y. ' �us-A•}-- —. DESIGNER ---- – i � ADDRESS_ NO.D�NEL. — NO. � NO. � ~ UNITS__� STORIES __�BEDRQOMS � CITY ZIP TEL._,_, � y ' DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREMVALUATtON � � OWNER-BUILDER D[ClARA710N SFR/ADD/REM O — a � I HEpEBY AFFlRM UNDER PENALTV OK PERIUHV THAi I AM EXEMPT FHOM TNE CONTNACTORS LI. � Garage/Carport � W CENSELA'NFORTMEFOLLOWMGREASON(SEC.7031.SOUSIfiFSSANUPflOF[SSIONSWDE:ANYqTYOq _ U COUNfYWHICHRE4UIPESAPERMiTTOCANSTRUCT,ALTER,IMPqOVE.�E!AOLISH,ORRFAAIRANYSTRUG W pat10JD9Ck � � 7URE,PRIOR TO ITS ISSUANCE,IL50 RE�UIRES 1HE APPLICANr fOfl SLICH PEFMIT TO FILE A SIGNEU q � STATEMENT THAT HE OR SHe IS LICENSED PURSUANT TO TNF�ROVISIONS OF THE CONTRACTORS LI� W ' • CENSE LAW(CHAPTEF B�COMMENCING WITH SLCTION 7aoo)OP DIVISION 3 OF YHE B1151NE55 AND PRO� u' POOUSp2 FESSIONSCOOE�ORTHATHEORSHEISEXEMP7THGREFROMANDTHE�ASISFOATHEALL[GEDEXFMP� , ( x � I �V TION.ANYVIOLAiIONOFSECTION7oa1.58Y0.HYAPPLICANTFORAPEflMIT5U3Jf-GT�THEAPPLICRNTTO Re-RooP � ACIVIL PENAI.iY O�NOT MORE THAN FIVE HUNOREb DOLLARS(SSoOj.�: � ❑I.ASOWNEROFTNEPROPERiY,ORMYEMPLOYEESWITHWAGESASTNEIRSOLECAMPENSATION, ❑ Commercial_ _ WILI DO THE WORK,AND THE STRUC7UHE IS NOT INTENDED OR OFFEREO FOH SALL(SEC.70M,BUSI� ,J NESS AN�PflOFES5ICNS COOE:THE CANTRACI'ORS I.�GENSE I.AW�OES YOT APPLY TO AN OWNER OF 'N DqOPERNWFIOBUILD50RMAPROVESTHEREON,ANDWHO00E55UCHWORKHIMSELFORHERSELFOR � � iNii�IJGH HIS OF HER OWN EMPLOYEES.PHOVIDE�THAT SUCN IMPROYEMENTS ARE NQT INTEH�ED Ofl m W OFFERFAfORSALE.IF,HOWEVERTMEBUIL0INGORIMPROVEMEN�ISSOLOWITHINONEYEAROF('qMPIE- I Z TION,THE OWNER-BUILOER WILL HAYE TME HIJROEtt OF PROVING THAT HC OR SHC UIO NOT BUILD OR -� IMPROVE FOfl THE PIIRPOSE OF SALE). � uj ❑I./SONMEHOFTHLPROPEHfY,AAIEXCLUSIVELYC011RAC71YGWfTHLi^ENSFDCONTHACTORS ..� '� i '[[ TO CONSTAUCTTHE PROJECT�SEC.�oAe,9USINESS AN9 PpqF[SSIONS COCE THE CO�TRACTORS ll�� glll0?IOf1 3�S _�__ADJ.AHEA____.___,_,.___ 1 '�W. CENSEUWDOESNOTAPPLYTONYOWNEHOPAPRUPENTYWHOBUILUSORIAIPROVE57HEflCON,AtJ� � -�-- - p � WMOCONTRACTSFORSULHPRCUECTSWI'MACON'fflACTOri(9jLICFN9EDPURSUANTT01'HECON7fiAG TQUANTITY DESCRIPTION FEE t .� TOFSLICENSELAW). ____ � C]IAME%EMPYUNDERSEC._,_ � O "'_____'_9.8P.C.FORTHISHEPSON U ' _�_-_—_ Z � _______ ___'-'_�_...__ '_ � � LL DATE ._OVJNER___ f'. ___� ,. .'__"_'.....____ �� � �' -- --- w i—�-� �� LICENS[Q GONTflACTO:iS DECLAHAI ION w i ----— ---'--^ �� 1 HERE6VFFFIRM UNDEH P'cNALTY OF PERIU.7Y TNFT I Afd IICCkSE�UNCGA.PRO`.�I510ti5 UF CH.4PTCR '!�� 'd, B(COMMENCIN(3 WIiN SECTIUN 7�lcro�OF DIYISION 3 OF TMF.[tIISIN'cSS AN�PROFESSIONS f:0'Jf,ANU z ___ MY LICF.NSE IS M FULL FOHCE M1D EFFEC7. � I C� '_' __.'—_. i � / v2� �' _ a � � UCENSECLASS_C UC N0._� ; J I �V� DATE__�_..,�� �CONTRACTOF�___.____ _ _- 0- i ___'"'- '�� 1YORKERS'CGMPENSATIOfJ OECLARA710N ���]D� _ � � _' U -- - i �! I HEREBY AFFIHM UNDER PENALTV OF PERIURY ONF OF THE FOLLOWING[1F.CLAiiAThTUS: �I — � � _IK�YEANDW�LLAIAINTAINPCERTIfICATFOFCONSEN?TOSF.LF�!NSURFFOHWGRKERS' �jI- �� COMPENSA710N,ASP�?OVIDEDB�5ECilON370D0�?NEI.ABOpCADE,FUNTHEPERcpRNANCf Wj __ OF1KE WOFK FOp WHICk THIS 7ERIAIT IS ISSUED. �1 � _ � W __IH�VEAND`MLLMAINTAINWORKERS'CAMPENSATIOMINSUNA4CE.ASRF.OUIPEDBYSECTION // � Q 37000FTHELABOACODE,FORTNEP[RFOHMAiJCeOFTHEWORKV"OAWHICIiTH!SPcRM1T75 \.l� 1 ISSUED.MY�W�OFlK�E�RS'WMPENSqT10t�y'�`SURANCECPRRIEHANDPOLICYNUMBERRRE. � .. CONSTRUCTIUN ___,___ __,_ `" � i_,_ CARRIER�,L:-� � �� •-' _ � PLANREVI[W _-.-_,— > t _, _ ---...-------�.------ � PaIICYNUAIBER c� CJ� '� TI _ l� L,.}�C ELECTRIC �' -�*�. � __ 7----�--- .._..---'--- ------- - ¢ ��ssEc�!orvNEFUNoreecau�erEooFn-xaeatiarsx�orternMa;;aFocbua�sryicaloa�ess) PLUMBING p' �--�--...__ .. . .. _�.,n` ,n . '_'__-_..._ W t'��.& Z ICERTIFVTHAT INT11E PF.RfORMANCEOF THE WORK FOR WHICH THIS PE!lAll i IS ISSUED,I MFCHANICAI ____...____..___ ' CJ" SHPLLNOTEMFIOYANYPcR50NIN,WYMANNEflS(�AS?UBECOMESUaJECfTnII+E vj' WORNERS'COMPeNSAT10NlAW50FCAl.i4-0FINIA.ANDAGREETHATIFISHOUL08ECAME � INSPECTIUNFEE ___.,,,___ _/ -�+� SU&IECTTOTHEWORNERS'C.'C:MPENSAT!UNPROYISIONSO CTION37ooOFTfiFIAdOR � y, /y � �. CO�EISHA FORTHWITHCOMPLYW1IH SEPROVISIOYS. ISSUANCE _. __ C� ° �_ _____ .7_\_�... �. ��' w � 1 p DATE:~���_ APPLICANT: -_�t '____._'___— SMIP p__ � •��.y_ 4---_-_._.—�_C�_ � WARNING�FAILURETOSECUHEWORKERS'COMPENSATIONCOYERHGEISUNIAWFIJL,ANDSHALLBE ENERGYPIC i J���:'__�y���j�.�,�55,3��`�iJ SrP'F.� _._______ � SU9JECTANEMPLOYER70CRIMINAIPENALTIESANDCIVIL�INESUPTOONEIIUNDRE�THOUSAfJO *�j T . . l'�,:i"+ i�/�x.;` 'Tr'�l _ DOLURS�if00.000�.INADDITIONTOTHECOSTOFCOMPENSATION.�AMAGE5A5PROViDEDFORIN ENERGYPERMIT7.,8���F��'9i.°���?_._� F .. , �'.1 n _ ¢ SECTION370BOFTiELABORCODE,INTEREST,ANDATTORMFV'SFEES. RETF_NTIONFEE: ______.____.,___ ._.__. � CONSTHUCTION LENDING AGENCY PRE•ALT FEE: ___.,.. ____..... __..—_.- O �� 1 HEREBY AFFIRM UNDEP PE�ALT'OF PEFlJUHY THATiHERE IS ACONSThUCTION LENDINO AGENCV � FOFlTHEPEFFORMANGEOFTHEWOHKfORWHICHTHISPEHMITISISSUED(SEC.9a97,CIV.C.). �-- -��� � —'-' Z W .__ ...____" _""_._-'___" --'.__ � LENDER'S NAME__ ..—. '_'_'..... '_'_ '_-"_'"._..."_ F- LEN�ER'SADDflES6.____ __.__ _._ ..-.--. � � I CERTIFY THAT 1 HAVE READ THIS APPI.ICpTION ANO STFTE THqT THEABOV�INFOHlAAI'ION IS CORRECT TOTAL FEES G Y W 1 AGFlEETO CAMPIV WI7H ALL CITY ANO(:OUNiY ORDINANCES ANO STAT[LAWS itELATING TO BUILDING � CONSTRUCTION,ANDHEHEBYAUTHORREPEPFl[SLN7ATIVESOFTHISGOUN'fYTOENTEflUPONTHE Z ABOVE��7ENTIONED PflOPE(iTY FOH INSPCCTION PURPOSES. COMMENTS ___ � �_e,,J � �1�� — ---- ------- --- � �------ — --- Q EE NAME(PRI -_--�-' �� n "— _-L__ "__-"_— "'__' � �'_. '_��/._._ ._.. '"�__ � SION TURF.OFPEHMITT � � AT[ f = RECPT.NO.�___ PAIp BY ,.__� VAIJDATION._.___ � F" WHITE-Department Copy,YELLOW--Finence Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy ._ , . _ • - i , � ` #� , � � - ;� � �� ' �, � , � ; � ,. .. , '. . , ; � + , � ,. � , I � ; i . � , f , � . ; 3 , � � . � � � �� � f� � � - �:.�. ... , . , � i � , , � . � i _�� ' " r a , � � � � , � � � � I s. , _ ; ; i . . � � �. � � 7 ; ! � � 3 ! . � . � � . ' � . � . ' - . - . j . . , - , � . � , ! . i ` ( - ' . � � ' � '' . ' , _ i , � , . ��� - � . � � ' � ' � I � � , � I ' I . f ' � � � � i a� i � � , � i ' � � i � , i , � , � � • , , , , , , . , ' ' . ( , ` �. ; _.. . ; _ i i _ � . i._ ,,,„ i , � � � � � .. ( � � � �. � ' � i I i:,, � "I: ; , i , I - i - � r , I � ' � . . 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