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HomeMy WebLinkAbout13514 (22) � CITY OF DIAMOND BA� �- -- DEPARTMENT OF COMMUNITY dz DEVELOPMENT SERVICES � � 21660 E.Copley Arivo Suite 190 (909)860-3195 Fex(909)861-3117 PRESS ��^��+ BUQ.DING PERMIT APPLICATION FIRMLY N JOBSITE Q / DATE CATION NUMB R I�� �!C o ADDRESS �S� _! S'a�h i re C�(h� � APN T � TRACT 00 D TEE �` ��� CONST. GROUP � OWNER CEN� ' ADDRESS . G N 1^ ZONING SETBACKS �� CITY ZIP TEL. REAR RW ❑ APPLICANT TEL. SIDF1SIaE STREET RW ❑ CONTRACTOR 4►� . SIDE ❑ ADDRESS PROPOSED USE � CITY r�t(� ZIP� '� TE `d � ARCFiIENG! ' DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORiES BEDROOMS N CITY ZIP^_ TEL. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNEFi�BUILDER DECLARATION SFR/ADDIREM O I HEREBY AFFlRM UNDER PENALTV OF OERIURY THAT 1 M1 E%EMPT FROM THE CON7RACTORS LI- Gflf80B/CBIp011 CENSEU1WPoRiMEFOLLOWWOREASON(SEC.7Wt.6BU51NESSNIOPROFES5lON5CODE:ANYCI7YOR (n COUNiTWIiN71REWIRESAVEAMRTOCONSIRUCT,AI,iER�MPFiOVE.DEMO�ISM,OHREPAIRANYSTRUC• W petldD6dc ` � � �� NRE,PR10R 701T9 IBSUMICE,ALSD REal11RE5 Tl1E APPUCANT fOR SU0/PEPMIT TO FILE�SIONED {TATEMEM iMAT HE OR SHE IS UCENSEO PURSUANT TO TiE PHOVIfilONS OF 7HE CONTRACTOIiS LI- CENSE LAW(CHAPTER 0(OOYIdENdNO N'ITH 6ECTION 700%OF DINSION�OF iHE BUSINESS M!D PRO- LL P�D�Ga FESSpNSCODE)ORTIUTXEORSHEISEXEMPTTiIEREFROUAN07HE8A515FOH7HEALLEOEOEXEMP• (ry TION.ANVVIOIATpNOFSECTION7031.69YFNYAPVLICANTFORAGERMIT5VBJECTSTHEAPPLIGUJTTO Z qe-qoo� F ACML YENKTY DF NOT MW1E TIAN FNE HUNORED UOLLARS({600).); � 04ti40WNENOF7HEPROPE1ifV.OflMYEMMAYEEBWITHWAOE5AS7HEIPSOL60DMPENSA710N, O CORIII1BfCl81 " YALL DD TNE WOR(M1D h�STRUClURE I6 NOT INiENDED OR OFFERED FOR SALE(SEC.7as1,BUSb J � NE65 Alm PROFESSIQNS CW E:TME CON7MGT01i5 LIGENSE 4AW DOES NOT MPLY TO AN OWNER OF � PIiDPEiRY Yh10 BULDS OR MAPROVES 7HEREON,AND MRi000E9 9UCH WORK W MSELFOfi MERSELF OR CL iHROUGFiMISORMEROWNFJAPLOYEE5.PR01MDEDTW1TeUC11MIPROVEMENTSMENOTINTENOEDOR m � OFFFRmRIRBALEIF,N�WEVER��1LUWdONIMPROV9AENTIBSOIDMATHINCNEYEAROFCOMPLE• � TION.TFIE QYYNERBUILDER N7LL HAVE THE&IRDEN OF PROVW�TN�T HE ON 8HE OID NOT BI11lD Ofi MPROVE POH iHE PURP06E OF LLLE). �y,� ❑I,A501N1EROFTHEPROPEi[fY.AMEXClU81V0.VCONTMCTINGW17HlICEN5E9CONTqACTORS � TO CONSTRUCT THE FRO.IECT(SEC.70M,BUSINESS MID P�IOFESSIQNS CODE:7HE CONTRACTOliS LI- V6IWSIOf1 ADJ.AREA CENSE UW DOES NOT MiLY 70 MI OWNER OF A iNOPERTY WFIO BUHD9 OR W VROVE9 TMEREON,AND � N71000NTMCiSFORSUCl1VROJECfSW17H1100N�RACTOR(9�LICEN8EDPVRSUAMNTHECONTMG pUANTITY DESCRIP710N FEE � 70R5 LICENSE LAW.�. ❑I AIA E%EYPT U/�ER SEG B.8 P.C,FOR THIS FEASON Q U = OATE OWNER � � W IICENSED CONTRACTORS DECUIRATION —i � w IFIEREBYAFFIRMUNDERPENAlTYOFPEtUUfIYTHATIAMUCENSE0UN0ERPROVIS10N90FCHAPiER � � �(001AMENCWC�WR/15EC710N700o)OFDIVISION30FTHEBUSINESSANOPROFESSIONSCOOE,AND Z IAY�ICENSE IS N FUl W(iCE AND EFFECT. +1 I �O li! � �t'W t 7 � LICENSE CUSS LIC.NO. Z J �j OA7E ` CONTMCTOR f a � WORKERS'COMPENSATION DECLARATION a � I HEREBYAFFiUA UIGIER PEN�LTY OF PERJURY ONE OFTHE PoLLON'ING OECLAMTqNS: U y Z � �I NAVEAND WILL MAIMAW A CERTIFICIITE OF ODNSENTTO BELHNSURE FOR WORNERS' � OOYDENSA710N.A6 PIqNDED BV 9ECTION 97000F THE LA80R CODE.FOR 1HE PERFORMRNCE W OF THE WORIf PDR WFi1CY17H13 PERMIT IS ISSUED. � � < �I NAVE AND YYILLMAIMNN WORKERS'COLIPENSATION INSURANCE,AS REOUIREO BV SECTION 87000FTHELABORCODE.FORTMEPERF7�RMANCEOFTHEWONKFORWHICH7HISPERMITIS � 159Um.W WORKE�i pEN5A710N INg{JOANCE C,ANRIER AND POLICY NUMBER ME: CONSTRUCTION � CARqIEH W�+�'� GKR le PLAN REVIEW � ����p—alti�r /� �O� ELECTRIC ' � f11965ECIqNNFIDND7eEooAFLFfEDOFnEaEfMrswRor+E11UrDHmGauws�i'w)aRtEss1 MBING �� l� � ICEqTIFV7NATNTHEVERfORMANCEDFTMEWd1KFON'MnCNTHISPERM�TI515SUED,I MECHANICAL , $HALL NOT EMV�AY ANV PER60N W ANV MANNER SO AS TO BECOIAE SUBJECT TO THE { (/� WONfERB'OOMVENS�110NUWSOFCALIFOHNIA,MIDAOREETHATIFIBVqULDBECOAAE INSPECTIONFEE `"•Y + � �z+�' S BUBJECT TO THE MIOR%ERS'CqAPENS�TION PROY1910N5 OF 9ECTpN 97W OF 7HE IABOP /� �� moE,isr+ulwrmrwmica�a�rNnninrosernovisioNs. yy� ISSUANCE `���' 6.�':,��.+ •,' , ;ty � Q � h� �r�, Y �° p DATE:�L APPLICANL• „��G � /I I P...I SMIP C't.!1�,,i..: � �. . ... ��' � � ENERGY P/C W!flNiN6:FALURE TO SECUflE WOF4(ERS'COMP�NSAiION COVERAOE I5l1NLAWFUI,AND SHALL BE �y 6U&IECTNlEMPWYEflTOCRIMIN/�LPENALTESANDqVILFINE3UPTOONEHUNDNEDTMOIISAND ENERGYPERMIT � OOLLARS(i100,OWJ,INA001TION70TNECOSTOFGOMFENSATION.DNMGE5A5PROYIDE�FOfi1N J SECTION�70lOFTNEIABORCODE,WTEREST,ANDAiTORNEY'SFEES. RETENTIONFEE: Q � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I NERE9Y AFFlRM UNOER PENALT'OF PERIURY THAT iHERE�S 11 CONSTRUCTION LENDING AOENCY FOR TME PERFORMpNCE OF TNE WORK fOR MRiICH 1T115 PERMIT IS ISSUEO�SEC.90Y7,qY.C.�. � LENOEflS NNAE � � LENDER'SAODRE53 � ICERTIF7TW�TIHIWEREADTMISAPPLICATqNMIDSTATETIUITTHEABOVE1NFOiUU1TqNISGORRECT. TUTAL FEES d 1 Al3REE TO COMPLY MA7N ALL CRY ANO COUHTY OROINANCES ANU 6TATE UWS REUITING TO BU0.DING � CONSTRUCTION.AND NEREBYAUTHORRE REPRESENTATIVES OF 7HS COUNTYM ENTER UPON THE ABOVEJAENTIONEO PROFEA7Y WH IMSPECTION PUNPOSES. COMMENTS ` �'►e l r�v� � PEFMfTTE (PRI � (� y ,+ �. .� N SqNANRE FPEHMITTEE �ATE � RECPT.NO. 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