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HomeMy WebLinkAbout14108 �� CITY OF DIAMOND BA& '�"''`�� � DEPARTMENT OF COMMUNITY&bEVELOPMENT SERVICES �i� :'``� � 21660 E.Copley Drive Suite 190 (909)86Q3195 Fax(909)861-31 t7 �,.�•••'`�� PRESS ��•��°� BUQ�DIIVG PERMIT APPLICATIUN FIRMLY � JOBSITE ��� �$ ,, �9 ° � , . �� APPUCATION •• {'��% PERMIT '' P/C ¢ ADDRESS '- . �.+�1,..-V 'i i- dd'�"�.f �.: ,�• � I � l� p a.—=�----�.� DATE ,'f�_NUMBER �- � # � ISSUE TYPE OCC APN LOT TRACT ._ DATE CONST._ GROUP � ��, � . p OWNER ��s'?. ,' =',/ l.'�f;' , i ^ "' ,� �;��,�1 � � ZONING SETBACKS o ADDRESS .� .,d �i �' t.>` 6, W CITY I���')�V 1,� ��-�✓� ZIP ti>711:,_ TEL.�Yj,. 4� `-�; )��% FRONT RW ❑ � APPLICAN7 TEL. REAR ❑_ � SIDE/SIQE STREET — RW_= ❑ CONTRACTOR SIDE __ ❑____ ADDRESS ,� � r% p "— - PROPOSED USE � •, __ �- �,_.;G, r.� CITY ZIP TEL._ � --�r � I'' ��,�, ��;;" ^ wo ARCH/ENG/ W DESIGNER _ NO.DWEL. NO. N0. � ADDRESS UNITS_ S70RIES BEDROOMS CITY ZIP TEL._ - N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION pOWNER-BUILDER DECLARATION SFR/ADD/REM 0 I HEREBY AFFlRM UNDER PENPLN OF PERIURV THAT�AM EXEMPT FROM THE COYTRACTORS LI� G8IdQ0/CBfPOfI W CEYSELAWWRTMEFOIIOWiNGRER50N(SEC.To31.5BUSINESSIWDPROFESSIONSCOOE:ANYCITYOH (n C�7 COUNTYWHICHRE�UIfiESAPERMiT7000NSTRUC7,AL7ER.IMPROVE.DEMOLISH.OPPEVAIRANY5TV7UC- W Pat10/DBCk W TUflE,PRIOR TO ITS ISSUPNCE,AlSO REQUIRES THE APPLICANT Pofl SUCH PEflM1T TO FILE A SIGNED W .� STA7EMENT hiRT HE OF SHE IS IICENSED PUFSUMIT TO THF PHOVISIONS OF Ttl[GONTFiACTOflSIb � CENSE LAW(CHAPTEP9(COMAIENCINO WITH SECTION 7000)OF�IVISION 30F THE BUSINESS M1�PRO� � PooVSpa . FESSpNSCOUE)ORTH�THEOqSHE1SEXEMPTTMEREFROMANOTHEBASISFOPTHLAl1.EGEDEXEMP- � TION./WYYIOLFTIONOF5ECilON7037.6BYAMYpPPLIGANTFORRPERMITSUBJECTSTHEAPPLIGANTTO Z Re-Raof _ � � J �y � � �rF � ACIViLPENALTVOFNOTMOAETHANFIVEHUNDREODOLLARS(E500).�: - � ❑I,ASOWNEROFTHEPROPER7Y,ORMVEMPLOYEESWITHWAGFSASTNEIRSOLECAMP[NSA710N, � COfll(I1BfC18I WILL DO THE WORK,AND THE STflUCTURE IS NOT INTENDED OR OFFEfiEO FOH SALE�SEC.7066,8U51- _1 � 1�55 AN�PROFESSIONG CODE:THE CAN7iiACTORS LICENSE LAW UUES NOT APPLY TO AN OWNER OF � PROPEKTYNM1iO BURDS OR IMPROVES THEfiEON,AND NT/O DOE5 SUCN WORK HIMSELF OR HERSELF OR � THIiOUGNHISORHEROWNEMPLOYEE9,PROYIDEDTHATSUCHIMPROVEMENTSASIENOTINTENDEDOR � Q ,OFFEREOFORSALE.iF,HOWEVER.THE0UILDINGOflIMPROVEMENTI550lDWITHINIXJEYEAHOFCOMRE- = TION,iHE OWNFA�BUILDER WILL HAVE THE 9URDEN OF PqOV1NG THRT NE OR SHE CID NOT BU:ID OR (�uss l^ � IMPROYE FOfl THE PUPP09E OFSALEJ. ❑I,q5 OWNER OF THE PROPEfiT7,AM E%GWSWELY CANTflACTING WITH LICENSED C04TMCiOR3 ��� W � � TO CUNSTRUCT THE PRQIECT(SEC.70�6,BUSME55 MlO PHOFESSIONS�UE:THE CONTRACTORS LI-. V2IU2SIOR ___�___l��l,•!dJ....__.__._ADJ.AREA,.._.,..__._„ W CENSELAWDOESNOTAPPLVTOANOWNEROFAPftOPERTYWHOBUtID50NIMPROVESTHEREON,AND � NTIACONTRACTSFORSUCHPROJECTSWfTH�C9NTRACTOR�S)LiCENSEDPURSUPNTTOTHECONTRAG Q�JANTITY DESCRIPTION FEE � TOASLICENSELAWJ. p C]IAMEXEMPTUNDERSEF__ ___..____B.&P.0 FORTHISftEASON Q � U �y — �— ��-�-------- � OATE��" �___"OWNER�"..�.1��1�i! s�, :_ �._ur.... V W � LICENSLD CUN'ffiACTOR5 DECLARATION uj �� � I HEREBY AFFIRM UNOER PF.NALI'Y OF PENJIIRY TNAT I AM LICENSE�UNDEH PROVISIONS OF CHAPTEei � I i p� s(COMMENqNO WITH SECTION 7000)OF DIVISION 30F THE BUSINF.SS AND FHOFESSI0U5 CO�F,AND Z X MY LICENSL IS IN FULI FORCEf YD EFFECT. �y , m p � F LICENSE CLASS_______.LIC.N0. " J � DATE_'_'___'_—CONTRACTOF _..."'__......__""_. a W � WORKERS'CO�vf+'ENSATION DECLARATiON -� Q U � IHEREBYAFiIqMUNDERPENALNOFPEft1UflYONEOFTHEFOL�OWINGDEC:AHATIDNS: Z � __T —__ 0 iF1�YEMlDWILIMAIIVTAINACERTIPiCATEOFCONSENTTOSF.LF-INSUREI=OHYIORKE(iS' Z I �� (bMPEN5FT10N,AS PROYIDCD 8'f SECTION 370D OF THE LAOOa CODE,FOR THE P[RFORMANCE W L- _ _ OF THE WORK FOfl WHICM TiIS PERMIT 19 ISSUED. �I � _ _ , IHAVEMlDWILLMAINTAINWOFKERS'COMPeNSATIONINSURANCE,RSRcqUIHE08YSECTlOY l � '"___ � �;/ ...._-...... O 37000FTHELABORCO�E,FCNiTHEPERFORMANCEOFTHEWORKFOHWHi(:11THISP[fiMIT15 C`-•qG. ISSUED.MY WORKEAS'COMPF.NSATION INSUFlMCE GARFlIER ANU POUCV NURIBEH ARD CONSTRUCTION _ ,_____,__d _-�___._._._. ' cnRaien � PLAN REVIEW — ------------------- ---------.--- � ro��cv NUMa[a __—.— ELECTRIC _ � (fHISSEClYJNNEC-0�TAEC�x�+PLETEUOFTI�PERAtlTISWFiONEHINIXiEDD01L1RS(510010RLES5� PLUMBING �g _ z� I CEHTIFY THAT IN 7HE PERFORNANCE OF THE WORK FOR WHICH THIS PERMI715155UED,1 MECHANICAL NIIA ________________,_,_ '(�j', SF�LLNOif.MPLOYANYPERSIXJINANYI.IANNERSOASTUBECOMESUOJECTTOTHE ���� WOFKEHS'COMVENSATfON IAWS OF C/�LIFOANIA�ND AGHEE THAi IF I SHOULO BECOMF. INSPECTION FEE � Su&lEC7 TO THe WORKEflS'CAMPENSATI04 PflOVISIONS OF SEC710N 37000F THE LAHOR _„� - � CODE,ISHh1FORTHWITHCOMV�YWITHTHOSEPHOVISiONS. �SSUANCE l� _ � � �i O' SMIP . _ C�_Aj p; DATE:.__"---- APPLICANT: _..._.— ' ___.....__.._. J '__' _.—_' '_""' W' ENFRGY P/C � J' WARNING FAILUflE TO SECURE WORK[RS'COMPENSATiON COVERAGE IS UNLAWFUL,AN�SHALL BE Q`�������'��""--'--"-'---'--"'-'--'-"'-'-- LL� SU&IECTANEMPLOYERTOCRIMINALPENALTIESAN�CIVILFINESUPTOONEHUN�REDTHOUSAND ' ENERGYPERMI'('��'{�7��9�r y�7�p DOLLARS(ft00,00D),INADOITIONTOTHECOSTOFCOMPENSRTION,DAMAGESASPROVIDEOFORIN A.T�JjJ�jJuyG�D��/'][`L'1 A � �`� SECTION370BOFTHELABORCADE,INlEREST,ANUATTORNEY'SFEES. RETENTIONFEE: ___,_ pW„ CONSTRUCTION LENDING AGENCY ppE•ALT FEE: O; CL`' I HEREBYAiFIRM UN�EH VENALTY oF PERJURY THRT THERE�5 A CONSTHUCTION LENDING AGENCY 0- FORTHE PERWRMANCE OF 1HE WORK FOR WHICH THIS VERMIT IS ISSUED(SEC.7U97,CIV.C.). w _' '__ ��± LENOER'SNAME___' __""—'__._... ---'-"" . _'_....' '_ '--____'_ '_"_ �,. LEN�Efl5ADDHESS___,___ .___--.-.__...__ �'. ICERTIFVTNATIMAVEAEADTHISAPPLIGTTIONANDSTAIETHATTHEABOVEINFORMATIONISCARRfCT. TOTAL FEES Ji���� ' w' IAGREETDCOMPLYWII'HAILCIIYAN�CAUNTYORDINANCE5AND5TFIELAWSRELATINGTOeUIL01NG � CONSTRUCTION,AND HEPEBY AUTHORIZE RGPRESENTATIVES OF THIS CDUNTV TO[NTER UPON THE Z' ABOVE�MENTpNEDPROPC-RT'FORINSPECTIONPUflPO5F5, COMMENTS O' � � �i+-�,�__ _! _— —'—.—_ _—._ — �- m PEq�r EE, E(PRINT) /,/ (� - �' '�..^ .r .f���� {/I/.–�. � _ !ri) ` �., "7 C /�_'--' '' '' \ —"'" SIG fi OFPER1dIT7EE .," OATE = RECPT.��_PAID6Y ..�_�VALIDATION 'j� � ~ WHITE—DepaAment Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy ,1 � _ _ � , i _ - � , .. _ � I ` i � - " , , � . ' , � � , , ' ; � ; � � � � �� � '� � �� � ; � �� � � � � �. • . � � � �. ; � � � � i , � — i � � ' , ! �. ' , � i : �� � � �� . i 1 � ` �, � � ' �� ,' ' �%'. � v , ; � , � ' � ! � ' i , � I I �i . . ' � I . , 4 � � , ' . . � , , � 1�. i , � �\ . . _ , � ,. . � �, �' � � ; � s � � , � � . � : . . , `c, I i , � , � . . _ ; �,� i ' , . 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