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HomeMy WebLinkAbout10647 C1TY OF DiAM�ND BAR E X P I R E D COMMUNTfY DEVELOPMENT DEPARTMENT • u�o s.coPi�y nri�sv,c��90 PRESS � (909)86Q3195 Fax(909)l61-3117 N 0 U 2 9 20D0 '""'� BUILUIIVCi PERMTT APPLICATION FIRMLY � J08SITE '1'¢ D 7 r O rL A�A LIC/iT1AN � g � NUMBER/�� / �� � � o ADDRESs�Y! � APN LOT TRAC D TEE � i �� CONSL GROUP � owN� ��r. ! U .G.. ADDRES�n R . I�L�(1 /�vt! D ZONING SETHACKS � CITY�f — � ZIP TEL. FRONT RW ❑ APPLICANT � - REAR ❑ '��E ' SIDFJSIDE STREET RW O � CONTRACTO � SIDE ❑ � � ADDRESS r.� CITY - 21 TEL. PROPOSED USE p ARCH/ENG/ DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS &TORIES BEDROQMS � CIIY ZIP TEL. N DESCRlPTION SQ.FT. FACTOR PSF ADJ.AREANILLUATION Q ONMER-BI:ILDER DECIJIRATION SFR/ADWREM O p I MEREBY hFFlR►1 UNOER PENALTY OF IHiWRV TIY1T 1 AM E%6�IM FAOIA TME CONTMCTORb 4• OBlOQB�CtIp011 LI.1 CENSELAWFON7NEfOLLOWIN6RE�50NfsEC.7Wf.eBU6WE3SIW0iROi655lONSCODE:ANYd1Y0R (/� ZCOUNfYMMIG1ilEWIRESAVERMRTOCON5711UCT.ALTERIAAPROYE.DEMOLISH.ORNEPAIRANY87RUC- uJ ?�t101aCk TURE,MIOR TO ITB 66UANCE,ALSO i1FGUIREe iNE MPLICANT FOR SUCFI�EAMIT M FlLE A BKiNEO �'� lTRTEMENT 1MI1T ME Ofi SNE IS LICENSED PURSUMIT 70 TME YROVIb10NS OF 1NE COI(iAACTOR6 t,F W � CEN6E UW(p1MTER 0(COMYENCNO WITH BECTION 7000)OF DM610N OOF iME BU6INESS AND PR0. 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J NESS ANO PNOFESSIONS COOE:THE CONTiIAC'fORS LICENSE lAW DOES NOTAYPLY TO AN OYVNER OF = � VMPERTVVYFIOWM.DSORWPRDVE87HEREON.M/DWNODOESSUpiWOqKHIMbELFdiHER6ELFOq � 7NNOlX3NWSORNEROWNEMVIOYEES,PNOVIDEOTMATBU(71WVHOVEIAENTSMENOTNTENOEUOii m OfFERED FOR BALE.F,IIOWEYER7ME BUILDINOOR IMPROVEMEM IBSdDVYIhEN ONEYFAROFCOYp,E- TION.IME OWNERBULLDER WILL MAVE THE WFi�EN OF VipVNO TFiAT ME OH WE pD MDT 8UM OR YPROVE FOR TFIE VURGOSE OF S�LE). � OI.A90NMEROFTMEPROPERiV,AMEXCIUBIYgVCONTMC�INGWITNLN,ENSEDCONTRACTq13 TO CONSTRUCT T1E P110JECT(SEG MM,BU81NE9S AND►IqfESBION9 CODE TiIE OON7qAC70q3 LL g�w(� � Ap,)AflEq � CENSEUWDOEfNOTAPPLYTOANOWNEROFAPROFER1VNM1pWILD90pYVPWE9Ti16REON,AND wn000rrtr�creconawx+r�cTsrnnucarrw�croMa���nseorunauu+rrornecar.�-rue O MiTiTY DESCRIPTION FEE � TOM1Sl1CFN5EtAW.�. ❑IMI EXEYPT UNOER SEC. &i P.C.FOp THIS RE/160N ` � pATE OWNER � Z � LICENSED CONTRNCTORS DECLARATION W � 1 MER[BY AFFIRM UNDER PENKTY OF YE0.IURY T11AT i M1 LICENSED UNDER MIONSIONS OF CHAPTEN � p„ �(�NCIHO NATH BECrWN 7oGo)OF DMSqN!OF 7HE BUSINESe AND PpOFE38WN5 CODE,IlW 2 X AiY UCENSE IS IN FULL FONCE MID EFFECT. O �' � � UGENSE 55 � LIC.N0. � �..,I �j pATE � COP(TRACTOE � a W � WORKER3'COMPENSATION DECI.ARATION � y1 HEREBY AFFlRM UNOER PENAL7Y OF PERRiM CNE OF THE FOLWNhNO DEGUMTION& Z � _IWIVEANDWILLMAMTAINACE11TiFIC/�TEOFCONSENTMOFIF-INSUREFONIWRKEIIS' � OOMPENSATION,AB PROVIDEO OY SECTION s7oa OF THE LABOF CaOE,FOR THE PEfiFOR►IM10E __, OF TNE W(MK FOR NM1IICH TMIS PENMIT L9185Um. 2 G � ��I I1AVE AND VALL YAMTMN WOAKEIIS'COMPBISATION RISUMNCE,�8 REOUIRED BY BEC1qN Q4 �7000FTNElABORO00E.WRiF1EVERfOIiAUNCEOFTNEWOftl(PORWMCNTIIISiENYR18 IBSVED.L11'M10RICER3'OONPENSIUIONINSUHANCECANNIERAN�POIICYMIAIBEFME: CON$TAlJC77ON � CAFRIER PLAN REVIEW � eaucr�xn�eEn ELECTAIC � (IMsBECIpNriE�NoteELULRE1�oF'nEVEA.Irsroaa+EHllNoqmoouxsp+mlp+LFS61 UMBING ��r I CERTIFY TMi N TIE PENFORMANCE OF THE NCRK FOR WIkq171M3 PERAIIT IS ISSIlE0,1 MECHAN�CAL 6HALL NOT EYP�.pYANY OERSON N MIY YANNER BO A!TO lECOME bUBJEC�TO tME � 1NORKERSCOMPENSATIONUWSOFCKIFOHNIA,ANOACfREEIHATIfIS/10ULDlECOME INSPECTIONFEE SUB.IECT TO TNE WONKEFS'C0IAPENSATION iqOVIStONS OF&ECTION J aa OF TMf IABOR , r„�.. s {'QOE.1 Poi17MMITNCOMPLYMfl11/ SEVXOVIS�O S UN'���, � �� ^ SMIP � DllTfi4 APPIICAN7:r, . i WANNNO:FALURE TO EEWNE WdIKERS COMPENSATpH COVERAOE 19 UNUWFU4 Af1D 6NµL BE ENERGY P/C ry BUBXCf AN EMPLOYGN 70 CRIIAtNAL Y6N�LTIES MD CML FWES UP TOONE H1N�RED 71i0USAND ENERGV PEHMiT .r DOLI.ARS({100.ou01,N WOIiWN TO i1fE 006TOF COMPEN3ATqN,DM1ACfE5 AS VRONDED POR N1 � 6ECTIDN 97a OF ME Wf/11 OOOE,IN7EREST,ANU ATTOHNEV'8 FEEB. RETENTIDN FEE: CONSTRUCT1pN LENpINO AGENCY pqE-ALT FEE: 1 HEREBYAFFl(W UIDER PENILLTY OF VERM1Rv TMAT iHEAE�B A OONS7Nl1CTION lFI1DWf1 KiENCY FOR TNE PEfiWRMMICE OF THE WORK PDR WHICFI MIS OERYIT 161SSUfA(SEC.�OC7.CV.Q�. b � �oexa ra�u,�e F— LENDER'BADORE33 � ICEi1TIFYTNTIWWEqEApTMISAVPLICATIONN/D6TATEIFMTTIIEABOVENFORMATpNOCORRECT. TOTALFEES � �� �� I AOpEE TO OOMPLY M7TH ALL CRY AND COUMY OH�INlWCES ANO BTATE UWS i1ELATWO TO BURDING CONSTIWCTION,AP�NENEBY AUt110R1ZE REPHESENTATIVE9 OF MIS COIAfTY 10 FNTEP UPON TNE � �eovE��EovAorEanwnwsrEcnor�runvosEs. COMMENTS ��, "���G• � . �7/t.c.. q PERM NMIEIVWM) � —�(�+/� Vj Q % � REOFP9WI7T� OATE aECPr.No. Pao av VALIDATION NMITE—Departmsnt Copy.YEILOW—Flrunem Copy.PINK—Assessor Capy,60LDENROp--Flle Cppy.GREEN—,�pplkaM's Copy . � - CITY QF DIAMOF�ID,B�4R : � • - � � . INSPECTIOI� RE!CC)RQ . `�. ` , ( � � � � ' . � . . �r��.;��.., . • � e � . � � - .. ... .... ... . ._ _ .. 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