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HomeMy WebLinkAbout15542 (34) � 1 CITY OF DIAMOND BAx � -- DEPARTMENT OF COMMUI�TI'FY dt DEVELOPMENT SERVICES �, Zi�o E.c��y�Y�s��i90 PRESS (909)860-3193 Fax(909)861-3117 ' '�,±� BUQ.DING PERMIT APPLICATION FIRMLY � JOBSITE � 'j} 1 �`� V��� APPtJCATION � /�� PERMIT, )�S�a P/C� � p ADDRESS v d� DATE NUMBER t R � APN LOT TRACT pA EE � � v v CONST. GROUP � OWNER T ADDRESS 1 n" y' o�- U� 20NING SETBACKS � CITY Ai.R r�a�.( L/�-R ZIP TEL: N JG•-/ I/ FRONT RW ❑ � APPiICANT ti w+- ' TEL. REAfl � SIDFISIDE STREET RW O CONTRACTOR SIDE O g ADDRESS PROPOSED U5E CfTY YIP TEL. � ARCFVENG! DESIONER NQ.DWEL. NO. NO. ADDRESS UN1TS STORIES BEDROOMS � CITY ZIP TEL. y OESCRIPTION S�.Fi. FACTOR PSF ADJ.AREANALUATION y � OWNER-BUILDER DECLARATION SFFilADDAiEM I HERE6Y AFFlRN UNDER PENALN OF PEFWRY THA7 I AM E7fEMOT FROM THE CONTMCTOH6 LI- Q8re99/CelpOn CENSELAWFORi}IEFOLIOWINafiEJ�BONI5EC.7a91.f8U51MES5MI�VHOFESSqNSCOUEANYCI7YOR (n COUNTYN4ACMREOUIRESAPFAEIRTOCONSTPUC7ALTERMIPROVE.DEMOUSH.ONREPAIRANVSTRUG ..W P81b/DBCk 7UqE YRIOR TO ITb IfiBVANGE,ALlO REOUIRES THE APPLiCNR FOR BUCN iERM1T TO FILE A SIaNEO lTATFYENT 71UT ME OP 9ME I6 LICBJSED PUHSUANf i0 7ME PNOVISIONS OF TME COHiRACTORSIF CENSE UW(CHAPTER�(COA1NENdNO MATX BECTION 7000�OF UIVISION]OF THE BUBINEBS ANO Oq0. u' PoaUSpe FESSIOIVS CODE)OR 1MATNE OR SHE IS D(EMPT TMEREFROM MID T/IE BASIS FOR TiEALlEOED IXEMP- TqN.ANYVI0LAT10NOFBECT10N7087.6BYANYAiPIM,ANTfOAAPEHMRBUBJECT6SHEAPPIIC�ANTTO Z Re-Roof ACML ENKTY CF NCf MOi1E TH/JI FNE INNDHED DOLLMS(i50o�.k ASOYYf�EAOFTHEiROPENTY.ORMYEMPLOYEESW�TXWApESASiY7EIR60LECOMYEN5A7qN, COITIRIBfCiBI WI 7NE WORK AN�TME STRUCTUqE 151bT INTENOED OR OFFERED FOR BALE(SEC.7W,&131- � - � NESS AND P(iOFESSION3 OODE:7ME CONiMCTORS LICENSE lAW DOES NOT MPLY TO�N OwNER OF y VRDPERT'WFqBL/k080RI�IPROVE87HEREON.MI�Yi11D00E5fUGiWORKNIMSEIFORMERSELFOR = /U� � 71MIOUGHMISOi1HERONMEMPLOVfES,PROVID�THIR9UCHM9pOVEMEMSMENOTI/1TENDE�OR m OFF61EpfOp0ALE1F,IpWEYEFLTHElVILqNOORNAPIpV6AEHT13801DWrt}IINONEYFAROi00MPLE h�S�l � TqN,1ME OVrt1ER�UItDER WILL HAVE 7fiE BUR�EN OF PRDVINO TlNT ME OR 7HE pID NOT BURD OR W GFiOYE FOR THE OUFPO6E OF 611LE�. � W ❑I,A60YMEqOF111EGROPEflTY,AYEXGU181VELrCONTRACfWC1N'ITMLICENSEOCONTRACTORS � � TO CONS7RUCTTME VHOAECT(BEC.7ou.BUSINESSAND VROFE931dV3 CO�E:THE aW1TiUCTORS U- V9h19t1011 ADJ.AREA CENSE lAW DOES NOTAPPLYTOAN OYlNER OF A PRDVEpTY WFq BUILDS Ofl IMPR�11E6 iFIEREON,AND � whpaornw,cTaFonsucHvnaEc'r5wirn�conrnncron(5)L�cENSeoPURsuurrro7riEoonTw�G p�JANTITY �ESCRIPTION FEE � iWLSIICENSEUWJ. - ❑I AAA plEIAPT UNOER SEC. B.i P.C.FOR TMIS REASON � U � � pA7E � �•: OWNER �' � �� W LICEN5ED CONTRACTORS DECLARATION W � INENEBVAFFIFWl1NDEAPEN�LTYOFVERri1RYTf1AT1AM4�CENSEOUNDERGROVIS10N50FCN11PTEH � •�COMMENCMKi�M�fIBECT10N7000)OFGIVISION70FiMEBU51NE5S1NDFROFE3310NSCO0E,AND Z MY IICENSE 18 W FULL FDNCE AND EFFECT. m � UCENSECLRSS LIC.NO. . j � pATE CONTqACTOR a � WORKERS'COMPENSATION OECLARATION a � 1 HEREBV AFFlRM UNOEH PENALT'OF 7E0.1URY ONE Oc TFIE WLLONnNO DECLARATIONS: U � � � __IIMVEJNDVYILLMAINTNNACENfIFICATEOFCONSENrT08ELF-INSUREG011WDRKERS' � OOLIPFNSATION,AS VflOVIDED BY SECi�ON 7700OF TNE LABOR GODE,FOR TFIE►ERfORMANCE W OF THE VYORK FOR WHICH THIS PERNR IS ISSUm. . � . � �_IHAVElNDWILLMAMNNWORKERSCOMDEN9AT�ONWSURANCE,ASREOUIREDBY9EC7qN - � 77000FTqE LAUOR COOE.PDR TNE PEPFORMMiCE OF THE WORK FOR WNIpi T1115►ERMR 19 � 186UED.W NIbIL(ERS'OOMPENSATqN INSUqANCE CARRIEANA OOLIC/MIMBER ME CONSTRUCTION � GpaEp PU1N REVIEW � POLICYNUYBER ELECTRIC � .. •��-�� , � (niss[crqNr�r+�reeoa�aEr�avnf�rnxt�eroaanE�ooauns6+aa�oa�ssl PLUMBWG �1�T�� —�—��-' 8 1 CERIIFYTHAT M7HE PERFURMANCE�FTHE WOPK FOR WHIW TMS PERMIT LS ISSUED,1 MECHANICAL (y7 9UIL1 NOT EMPIAY M1Y PERSON N ANY MANNER 90�45 7'O BECOME Sll&IEGT TO TME (n WORKERS'COMVENSATqNUWSOFGLLIFORNIAANDAGREEiMATIFIBNOUL�BECOAiE INSPECTIONFEE S SUBJECTTOTHENGRKEHS'COMPENSA710NPFIOVISIONSOFSECTqN37aoOFiHEtABOR 000E.i sNw.conrrmnrn caartr win+n+ose vnovisarrs. ISSUANCE � SMIP � �` � p DIITE: APPLICANT: . � WARN�NO:FAILURETOSECURENOfIKERS'COMPEN9AipNCqVEf{�OEISUMAWFUL,�108MALLBE ENERGYP/C ���TT� r����{��J I 7� S��' SIJBJECTANEMPLOYERTOCRIA11N�tLGENALTIESANUCMLFINESWPTOONElUNDREOTHIX)6AND ENERGYPERMIT }��JLL++'"'- �� DOLLAHS(i70o,000),IN AODITqN TO THE COST OF WMPENSATpN,DMMOES AS PFlOVIOED FOq IN � � SECiON9faeOFTMEU90RCa0E,R1TFRE5T,ANDA7TONNEY'SFEES. RETENTIONFEE: CONSTRUCTION LENDIN�AGENCY PRE-AL FEE: � I HEREBYAFFIpAI UNDER VENALTV OF PEFUURY TNAT TNERE IS ACONSTRl/CTION LENOWO AOENCY � FOR TME PERFORIAANCE OF TIiE WORN FOR WNICX TMIS VEFYIT IS ISSUE�(SEG 70Y7.CN.CJ. � � IENDER'S NAME CS IENDERSADOHE35 �7 '+ I CERTIFY TU71 MAVE REAU TiIS AOPL�CA710N AND 9TaTE TNAT THE ABOVE NFORMATION IS COMECT. TOTAL FE ES ' 1��` ,J O � IAOREETOCOMPLYWIT/ALLCf1YMDCOUMYORDINANCE4ANDBTREUWSREURINOTOBl9LDIN0 � CONSTRUCTION.AN�NEREBV AUTF70RIZE REVRESENTATIVES OF TFIIS OOUNTYTO ENTEH UPON TlIE � ABOVE-MEMIONEDPROP TVFORINSPECTIONVURP0.SES. COMMENTS 9 ( !'htih•H�. � m PERMIITEENAYEIPRINT� < r. �f"1 � � y Sq , REOF ERMITTEE E � .,�, RECPT.NO. PAlD BY VALIDATION WHITE—Dapertment Copy.YE Inence Copy,PINK—Asaesaor Copy,GOLDENRO�k Copy.GREEN—Applicant's Copy ., , ._..�. . .. . . . . ,.: . . ,.. ., . .; . ,.. .. _ , . . . , .. . , . . . ,... . . ... . .� . . . ._ . ., . . .. . .. . .. . . . . , . . : ,:Y-� .�� .... :. .. . .. .. ... � CITY OF DIAIVIUI'r!D B�►R I�'�lSPECTI4N RECORC? , � �-�s � _�.,��ru, a�; ,.. . : �. � � ������;,. : i �� . ` �aa� � , � .'.. ������. � . ` ` •,��E�'�_�A`�. �. �•:�� �.. ,.... , ..n..+.w �_.� � �.. SET BAGI: � � f FLOOR JQIST � � E ?,( �j-�_- __-_--- -- --- — _ . FTGS/FOF�MS/STEEL�� , � FHA REC�MTS _ � j � --- -- - ... ----�----------------- -.__ .. 'ELECTRiC GROUN� . ; UNDEFi FLOOR DUCT ' __-_._.--------_--j_----- ---.__....----- � �-�--- --- -�- _._..-�-------------._..._ __ � GROUND PI_4Jh�BlNG � ; �UNDER FLOOR CUt�IDtJIT i '� . � 1 -----.�_�.----------------------�------ --- ------ ------�----- _,___�..----.._.__.....__...._._s SLAB G�,ADE�_ ( __ � �IREPLACE FCJUNDAT{ON � � _�._._--- ,._:_.--------.--------�-----+------- --___--- .._.__............._......� TEMP POWER ' ' ! ? 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