HomeMy WebLinkAbout14855 (27)CITY OF DIAMOND SAB
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive S dte 190
909)860-3195 Fax(909)861-3117 PRESS
BUILDING PERMIT APPLICATION FlRMLY
o pDDRESS II 7 SL L r V• DATE
CRTiON
Y I hUMB A "
r N Uv 'I
APN LOT TRACT pATE CONS7 GR oU P
OWNER i -
p A DRESS ZONING SEfBACKS
CITY ZIP TE . 9 FR4NT RW
APPLICANT TE . REAR
SIDFISIDE 3TREEf RW
CONTRA s°' j J` , SIDE O
g CITY
E
ZIP TEL.
PROPO5EDUSE 1
ARC N , 1 4DESICiNERv
ADDRE S
NO.DWEL NO. NO.
UNRS STORIES BEDROOMS
CITY ZIP T
y DESCRIPTION S(.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUIIAER DECLARATION SFR/A DfREM `
O
I HEHEBY AFFlF0.A UNDER PEINLTV OF PEFW I1Y TMAT I AM EkEMPT FIIOM THE CONTHACTORS LL Garage/Carport
CQlSEUWPWi7F1EFOLLOYUINGREASqJ(8EC.7W1.68USINES9ANDPROFESSIONSCOOE:MIYpTYOH (/
COIMTYWFIIdIRE0UIPESAPERMRTO00fJ571tt1CT.ALTERMPROVE.EA10L15H.ORREPIJRANYSTRUC• W Peti01D6G1{
TIMIE,1{qR TO ITO q9U1WCE,AL80 RE U RE9 T1E APPLICANT FOR$UCH PERMI7 TO FILE A BIONED W
BTATEYEM TFIAT ME Ofl SME IS UCENSED PURSUNR TO 1T1E PXO'YISIONS OF THE CONTHIiCTORS U•
CQ15E lAW(GWTER Y(C AUENCNO WI7H 6FCTION 7ao0)OF pIN31dJ a pF 7HE BUSINE55 MI PR0. LL P
FESSpNS GODE)OR TNAT XE OR 3ME 16 E%EMPT TIIEREFfiOM ANO TiE 9AS16 PoN 7HEALLE4E EXEMP•
TION.AN1'VIOlAT10NOF8ECTIDN7n91.68VANYMPIICMf1'FONAPEHMITSU&IECTSTHEAPPLIC NTTO Z R6-ROOf
A CIVIL BJI1L1't OF NOT MOiIE 7HM1 FNE HUN RE DOUAFlS(l l•1:
4h60WNEROF7MERiOPEATI',ORMPEMPLOYEE9WIMWAOEBASTHEIRSOLEGaMPENSATION, COTT9fCl91
YYLLL DO TNE WOqI(AND TME STRIICiUfiE IS NOT INTENDEO CR OFFEREO FOR SALE(SEC.10u,BU54 J
NESS At PROFESSIONB CDDE:TME CONTRACTORS I,ICENSE LA1N DOES NOT AVPIY TO AN OWNEH OF
OROPERTYWFiOBULDSORRIPROVESTMEXEON.MWNfHDODE59UCHYYURKNIMSELFORMERSELFOR
TlY10UGHIHSORHERONRIEYPLAYEE9,P110VIDEDh1AT8UCHIMPROVEMRIT6ARENOiMTENDE00R CD
OFFEAmFpflSN.E F,fOWEVER ME BULDM1fi ON IYPROVEMENTIB SOI,D WfRiIN ONE YEAR OFCOMPLE-
iION,TiIE OWNERBURDER WILL rMVE iME BURDEN OF MOVINO THAT F1E OR BHE DO NDT BUILO OR
WPROVEFORTHE UflFOSEOFBALE}
y OLA40WNEROF1NEfROPERfY,AMElCGU1SIVELYCONTRhGTIN WITFfLICEMSEDCONTRAC701i5
YO CONSTpUCT TME VROIECT(SEG 7M4,BUSINESS ANO 7ROFESSION3 CDDE:THE CON 7tAC70R5 LI•VgIU.tIOn ADJ.AREA"
COi9E tAW DOE9 NO'TMPLY TO AN OYMNER OF A PNOPERTY WTqlUttD60q IMPROVEB THENEON,ANO
1MFIOCONTRACf8PDR8UGiVRQIECf WI1HACONTWICTOR(S UCENSEDPUflBUMRT07NE00NTMG pUANi1TY DESCAiP710N fEE
OR5l10EN6E W4.1•
O I AIA IXEMPT UIJDEN SEG 9.L P.G FOR THIS REASON
U
2
pIRE OWNER F
W
LICENSED CONTRACTORS DECU4RATION llJ
I MEREBYAGFIRY UNDER PENALTY OF PERRkI'/TNAT 1 AM LICENSED UNDEF PNONSIONS OF CNAPTER
OOMMFNCMN7 YYIM 3ECTqN 7000)OF DIVISION 8 0F THE BUSINE55 AND PPOFE55qNfi CODE,M1D Z
W LIGENSE IS IN FU.L FOHCENID EFFECT. m
LICENSE LIC.NO.
1
J
pATE CONTMCT
WORNERS'COMPENSATION DEC RAT10N
r U
IHEREBYAFFfWUNDERPENALTVOFVERRIRYONEOFTMEFOLL0ININOGECUM lONS:V Z4
IH/1YEAN WRl1MINTANACERTIFlGTEOFCONSEMiOBELFINSUREFORWORKEqS• 2
COYPENSATION.ASPRONDED9YBECTIONS70oOFTMEl11BORCODE.FORTHEPERFORMANCE W7!E Wpql(FOR WHICN THI6 PERM 716165UED.
O __I IiAVE AND VYILL AUMTAM WORKERS'ODMPENSA710N INSURANCE,AS REWIRED Bv SECiION
9700 OF TNE 1A80R COOE.FOR TME PENfORNANCE OF THE WOHK FOR WMICH T115 PERMIT IS f. L
ISSVE0.NY WORKEH9'COMPEN9ATION RISURANCE CAHRIER AND POLICY NUMBEAARE: GONSTHUCTION f L Ui_
CMRIER PLAN REVIEW
POLICY NUMBER ELECTRIC i
0 (n Ssecronr woreeoa E DaFtffr w.r atnaorietixanmDa asRtm an ssF PLUM6ING
Z I CERiIFY iMAT W iNE PERFOHMANGE OF T11E VNRK FOR WMICH IS PERMIT IS ISSUED,I AAECHANICAL
SHALL NOT EMPLOV ANY VERSON NI ANV WINNER SO AS TO BE ' CT TO iHE
WONKER500/dPENSATqNLAW80FCALIFORtJI YDM3 I ECOME INSPECTIONFEE
S
SUBJECTTO THE WORKERS'CO APENSATION O 5 S . S7Do OF LABOR
mMnnn oor a r wrn s ISSUANCE cir..... .._
SMIP
AND SAFETY
OATE: APPLICANT.
WARNINO:FLLU TO SEd1RE VNDRKERS'CONOEN ION COVERAGE IS UNIAWfUI,M1D SNALL BE ENERGY P!C
SUBJECTANEMPLOYERTOCRIMW LPENAL77E8M1DdVI FINESUPTOONEHUNOPEDhKK15AND ENERGYPEF MIT
OOLLARS(!f 00.000),NI ADDITONTO TFIE COS OF WMPEN3ATION,OANAOE5 AS PROVIOED FOR pl
OJCL6ECTqN970!OF h1E LABDR CODE,NTEREST,AND ATTOMIEY'9 FEES. flETENTI ON FEE:
CONSTRUCTION LENDINQ AGENCY PRE-ALT FEE:
r '
I HFREBYAFF1141 UIDER PENALT/OF OE0.IURY THATTHEPE ISACONSTRUCTION LENDWO AOENCY
Z FOfl TME PERFORMANCE OF THE WORK WR WHIdiTHIS VERMITIS ISSUED(SEF 9071,CIV.G.
W I,ENUER'S NAME
LENOER'SADDRESS
1 CERTIFYhYR I W WE READ THI9 M7LICATION N1D 9TATETNT TIE ABOVE INFORAAATqN IS COqREM. TOTAL FCC
d IAOREETOOOMVLYNATHALLCR7ANDOOUMr1'OFiONANCESANOS7A7EUYV5REUTINaMBUILD NO
GONSTWCiION,ANOHEHEBVAU'1FK)NREREPRESEIYTATNESOFIWSCOIINTYTDENTERI/PONiHE w[
S EHTIONED PROPERTY PoR INSVECT ON WRPOfiES. COMMENTS
V
c?
Q
PE E 1
H
y DATE
RECFT.NO. PIUD BY VALIOATION
WHffE—Dopartment Capy,VELLOW Inance Copy,PINK—Aseassor Capy,QOLDENROD—File Copy,OREEN-1pplioaM'a Capy
m.ro......-...
CtTY OF DI I'SI OND Ei R
ir P cTron coRo
E E + t ' E + i
sEr B,cK F oaR oisT
Fl"CaS/FORMSISTEEI. FMA REQMTS
ELECTRiC GROUND ,. UNDER FLODR DUCT
GRC7UND PLl.tMBCNG 11NDER FL0C3R CGiRIDtJIT '`
SI.AB RADE F1RE'CA E FOUIV6}1 TIC)N •. . '
LL..- , -.–. . .
1"EMP POWER FIREI?AGE'BL?tll€7"BEAM '`' ' , ' `
WATER SERV{CE°-MED HT.B{3N}E;4M "
RQCJF SFfEATI-lIN+G F 8C!!lU 8 AM ' .
RAMING/VENTILIATlON I FINAI.BCEND BEAM
R(JC7F COVER . PRE-GRADI JG
R011GH HERTING BEN HING _• , '` ,
ROilGH ELEGTRIC ROUGH GRADWG
FiOt1G!-fi PLUMB(NG 'F(NiSH CaRADiNG
SFiQ1NERCi'U8 TESi" Pt Ca.ELEC7RlC
EX7'. I tTFI1SIL}IN£ t . PC3C3l.FENCINC.-
1 1tALL INSIlLATICtN Pt OL FiIUAL
CEILING lNSULATROh! j OFF SlTE IMPB.
DRYWALL NAILING DEDICA710NS
SEWER j I ; FINAL ENG.
SEP71C TANK i, ( LANDSCAPE/fRRIG.
SE P PITf,.L.–j;'.p p N 51TE lMPS.
CaAS AIR TEST; FiiVA ZC3M13iM11G
FINAE CQN81: I I FtRE C7EPT. FENAL
FINA 4-{EATING H ALTH[3EPT. FINA --
FlNAL ELEGTRIG I DEV, FEES PAlD --
INA PlUMBlNG
t ENER Y
i i-_..Y
ti •t, ..
caM nErv-rs - --c, 5. . ....-___ _
S Z, t, 1 n.t T
c .
1.`.
s. ,
r1.. •f \ . ..
4
4..,,,,._.._'
S F'T#G TA VK SIZE
SE P PITJU SlZE
i . - , . `i,':"T--r----
ti,