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Home My WebLink About14295 � CITY OF DIAMONT�BAR �� i ��---1�--- DEPAI2TMENT OF COMMUNITY&DEVELOP NT SERVICES ��p'R�� r 21660 E.Copley Drive Swte 190 0 C T 0 3 ZpQp PRESS � (909)860-3195 Faac(909)86]-3117 ��°�� BUILDIN PERMITAPP ICATIOIv FIRMLY r'•�(� 4 ADDRESS �«.J � C�__,, �� APPLICATION !',_. J Cb�,..1.�9 PERMIT /L �J P!C p DATE / � / NUMBER # � , ISSUE TYPE OCC APN L T TRACT DATE CONST. GFtOUP p OWNE� R � "" ADDR SS O R�. )s�, a ?-'�( ZONING SETBACKS w _ FRONT RW ❑__ ' gCITY � ZIP TEL. APPLICANT TEL. REAR !1__ � SIDE/SIDE STREET RW f-]____ CONTRACTOR�—� . �E�o �-� SIDE U ADDRE �1..�r� i r-� T � CITY 1N:� _ ZIPr IC� TEL.1<-'i � PROPOSED.US� C:�"� (� '�' (^�� ' _ w ARCWENG! � z DESIGNER � E � ADDRESS_ — NO.DWEL. NO. �.)'L/J NO. UNITS STORIES _1°��--� BEDROOMS � CITY ZIP TEL. � en DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUIL�ER DECLARATION SFR/ADD/AEM O Q I MEHEBY AFFIRM UNDEfl PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTHACTORS L6 G8Id9B/C31pOfP �{J CENSELAWFQRiHEWILOWINGREA50N�SEC.7o91.58USWESSANOPROFE55lON3CODE:lUlYCITYOR (n C� CIXINTYMMICHNEqUIRESAPEHMiiTOCANSTRl1C7,ALTER,IMPROVE,DFMOLISH,OPPEPAIRANYSTiiUG � W pati0/DeCk Z TUflE,PRIOR N ITS ISSUANCE.AlSO REOUIRE9 THE APPLICANT FOR Sl1CH PERMIT TO FILE A SIGNED W STATEAIENT THqi HE OR SHE IS UCENSED PURSUANi TO 7HE PROVISIONS OF THE CONTNAC70R5 LI- W � CENSE LAW(CHAPTER B(COMMENCINO WITN SECTION 7000)OF DIYISION 90F TME BUSINE55 AND PRO- V' PooUSpa FESSIONS COOE)Ofl THAT HE ORSHE IS EXF_MPT THEREFHOM AND THE 8A515 FOR THE ALLEGED EXEMP- TION.ANYVIOLIITIONOFSECTIONIIXi1.56YANVAPPUCANiFOflAPEflMITSU&IECTSTHEPPPLICANTTO Z Re-Roof � 11CIVIlPENN.TYOFNOTMOqETHANFNEHUNDRED00LLARS(S50o).): ❑I,ASOWNEfiOFTNEPHOPEANORMYEMPLOYF.ESWiTHWAGE5A5YHEIRSOLECOMPENSATiON, � Commercial Wil�D�iHE WORI(AND THE STRUCTURE IS NOT IN7ENDE0 OR OFFE�E�FOR SALE(SEG 704a,BU51- J � NESfi ANO PROFESSIONS CO�E:YHE CONTRACTORS UCENSE LAW DQES NOTAPPIV TO AN OWNFR OF � PfiOPERTY'Mf0 BUILOS OR IMPROYES THEREON.AND WHO DOF.S SUCH WORK HIMSELF OR HERSELF Oq [C THpOUGHkI50RHEflOMMEMPLOVEES,PROVIDEDTHATSUqiiMPROVEMENTSARF.NOTINTENDEDOq m QOFFEflFAFORSALEIF,MOWEVEfl7HE&/1LDINOOHIMPROVEMENTISSOIOWITHINONEYEAROFCOMPLE- � TION,THE OWNEP�BUIL�ER WiLL HAVE h1E BURDEN�F PflOVING THPT HE OR SHE DID NOT BUILO OR = IMPHOVE FOR 7HE PURPD5E OF SALE). ❑I,A90WNEROFTHEPROPERTY.AMEXCLUSI CONTMf,YINGWITHUCENSEDCONTRACTORS � � TO CONSTiiUCT THE PHOJECT(SEC.70�6,BUSINES A VROFESSIIXJS CADE:7HE CONTRACTOf75 LI• V'dIU0110f1 _ADJ.AREA __ ___ W CENSEUWDOE5NOTAPPIVTOANOWNEROFAPfl E WFiOBUILD30RIMPROYF:STHEREON,NJD �' �' NM1iDCONTMCTSFORSUCHPROJECTSWITHACONT CT (S)LICENSEDPURSUANTTOiHECONTflAG pUANTITY DESCflIPTION FEE TOflS LICENSE LAWJ. i �' �I EXEMrT I1NqEF S�C. ____B.d P.C.FORTHIS flEA50N Q f � _ � U � ay ¢ DATE 1—.�._oWNER —_"'_"'_.......__..."— � Z W � IICENSED CONTRAC ORS DECLARATION W � IHEflEBV�FFIPMUNOERPENALTYOFPERIURY7HATY�AMLICEkSEDUNDEHPROW510N50FCHAPTER � ^ �i G(COM4ENCINOWITHSECTION70D�)OFDIVISION90FTNE9USINESSANDPROFESSIONSCA�E,PN[1 z MY LICF.NSE IS IN FULI FORCE AND EFFECT. � ��f � � � UCENSE L.� LIC.NO. � � j� DATE � , CONTRACT _.______ d W � /� ��'��_ �OR�(ERS'COMPENSATIOND LAR ON � �- `�Y, ¢ � IHEREBYAFFlR �OEN NOFDERIIIRYONEOFTHEFOL WING ECLARATIONS: z 4 0 __IHAVEANDWILLMAINTAINACERTIFICATEOFCONSEN(70SELF-IN5UREfOPK'OFlKF.fiS' _ 4 �pA1PENSAT:DN,ASPROViDEDBVSECT70N37a0OFTNELABORCO�E,fORTHEPERFOHMANCE U Q OFTHE WDRK FOR WHICH THIS PEHMIT IS ISSUED. � � w __IHAVEANDWILLMAIMAINWORKERS'COMPENSATIONINSURANCE,ASRE�UIREDBYSFCTION � Q37000FTHELABOHCOOE,FORTNEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ` � �SSUED.MVWORKEFS'COMPENSATIONINSURANCECqqRIERRNDPO�ICVNUM�ERARF: CONSTRUCTION ._.___ _ ,____,,,_ _____ ____ ,� y cnRaiEw-- ------------ PLAN REVIEW _..----..._ .'� 0 POLICYNUMBEfl ELECTFIC � ;. Q _' "'—' "_ —' _'—_.. .—_"'__ � p (IHSSEC1pNNFIDNOTBEWbPLEimeF � SfO�iavEHUN%i&DDatnRS�S�w)aRLESS�. PWMBING ----- "---- --'--_'— '� Z �CEHTIFYTHATINTHEPERFOR CEOFTHE RKFORWHICHTf{�SPERMITISISSUED.I MECHANICAL ___.____,____ �� __ ' CS SHALLNOTEMPLOYANVPERS M1VAIANN OASTOB[CAM[SUBJECTTOTHE � � RKE 5'COMPENSATqN LAWS 'GpUFOFlN:, ND AGflEE THAT IF I SHOl1LU�ECOMI: INSPECTION FEE _ ._ '�'"�� ,a� � 5 BJE 70THEWORKERS'COMP ATIONPR SION SECTION37DOOF7HEtABOR 'y�,�[' � = ISSUANCE ' � € LLFORTHWITHCOMPLY HOSE 10 S. ,_. a.__� ;�� O ' ` �ti" SMIP �� .—� p DATE: `� APPLICANT: _._"_'—_'___ �.��j._.. _�._— W ENERGY P/C ' " � '�y J WARNINGFIIURETOSECUREWORKERS'GOMP SATIONCOVERAGEISUNLAWFUL,AKDSHAILBE —'---��.,--- ?iy— J SU&IECTANEMPLOYERTOCRIMINALPENAITIES DCIVILF�NESUPTOONEHUN�REDTHOUSAND ��-� `�.�_"�.:,:�`. ��'Y - ti ENERGY PERMIT ,4y,. ��. OOLLARS(f100.W0�.INPDUITIONTOTNECOSTOF MPENSATI�I,DAMIIGESASPROYIDEDFORIN -- �--�--� ��+C.;,-�—��'."r.�fi� �------ J SECTION37080FhIELABORCAOE,INTF(7EST,AND rTORr+ErsFEEs. RETENTIONFEE: ��-y �af+�-'��' W —"'_"'—"' r',a_..}�i,��,__ _" O CONSTRUCTION LENDINC AGENCY pRE-ALT FEE: ,___,___ �_;,..�'J� 'y/�� IHEREBYAFFlRMUNDERP[NALTVOfPLRJURYTHATTHERfiISACONSTRUCTIONLENDINGAGENCY __ _ ` �� t _ FOfl THE PEHFOflMANCE OF THE WONK K]R WHICH TMIS PERMIT IS ISSUE�(SEC.3�87,CIV.C.). W —.____ ___.' r' _ _-- �i, � LENDEWSNAME ___.--___ �� F-- LEN SAD�RE55_ '____'_"_ '"'_--" ---- — w ICER ATIHAVEREADTHISAPPUCATIONANDSTATETHATTHEA�OVEINFORMATKKJISCORRECT. T07,4L FEES � IAGRE TO�OMPLMWITMALLCITYPNUCAUN7YOROINFNCESANOSTATELAWSRELATINGTOBUILDING CONST C ON,AND HEREBYAUTHORIZE REPFESENTATIVES OF THIS COUNTYTO[NTEH UPON THE " Z OV MYONED PPOGERTY FOR INSPECTION PURPOSES. COMMENTS ___ _, `�;� � �� ,y�_Y_� . —�- ----- - - — ��'' m RMITTEE E�.. —�� C C.� �'y cn 1 �— --- � ��/ /l/ -- � S iUREDFPERM EE DATE - ' = HECP7.N0.__,___PAIO B ____VALIDATION__ �� WHITE—Departmant Copy,YELLOW—Finance Copy,PINN—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicanfs Copy F 1. j I .._ - i - s_x . #'rs .. .. � _�.... �..� ..�,... G I � k4 ' � t ..j "' y #� ��fi��y { �� ' i , � ` t � I , ;t � �' �� i� i 4 ��;' -f . � i � r � � t i� ' �. � : � �� x � .,� ; �i . I ' � I � �,' �'! � _ � i.��I i -�� .�i .. � rr ' � � � i I i �� .t��. S M2�.�.c�� - .�� - , � t � I ' s �s , I ,. �� # :r,, ; � � i � ; .�f I � I ; � �.. R4ir� � :1 , I : i �. � i , I i , � . � - �' � �n ! � i :-.I � ,r' - � . { � F ; 3 . I . , i , � � I i i � a s��t. � § ��' I ; � j ` � y i ' � � � ( � � � ' � I ��'^�� . � x � 9 „�� ''f i ' � ; _ I - - � - :_� ,-` �- i `- � ��Fi � _ i .. � I I , j - � . � ' F . � � � � f � -�. . , �� I �`�''�.. , , i , , ' ; � i , , f , � . 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