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HomeMy WebLinkAbout15318 _ _� _ CITY OF DIAMOND BAB .� DEPARTMENT OF COMMUNITY d'c DEVELOPMENT SERVICES • �; 21660 E.Copley Drive Suitc 190 (909)660-3195 Fax(909)6613t t7 PRESS '��'" BUII.DING PERI�IIT APPLICATIUN FIRMLY � JOBSITE � APPIICATION PERMff /L P/C o ADDRESSj�15"1 *�D�S�Z, :7AIF��T� SN'A�I�NU/J DATE_ � ' ,�,/ NUMBER `S�I � � APN LOT TRACT �SSUE �� Yv CONST. GFiOUP DATE p OWIYER TArLL�V�/►IC�,� J' -0,�. " ADDRESS ZONING SETSACKS B CITY ZIP TEL. REAR RW ❑ � APPLICANT TEL. SIDE/SIQE STREET RW O CONTRACTf�R �/ SIDE ❑ AQDRESS G'� Z h[ Ei2C� !�E � g CITY�115Sian I�IL:c� ZIP� TE .44�i)�/ �i"!40 PR�POSED USE e ARCWENG/ r � DESIGNER NO.DWEL � • NO. NO. ADDRESS UNITS STORIES �_ BEDpOOMS yCfTY ZIP TEL. DESCRIPTIfJN SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLAAATION SFR/AD[NREFI! O � i�Aeer�ron uemea vewun oF rerumr naT i u��Mrr fnon�n+e connn�croRs u• Garape/Carport CENSEUWFON7NEfOlLCWINGREASON(SEC.709t.68USI1fE35ANDPROFESS10N500DE:ANYCI7YOR (n COIRfiYMMIq1RE0U1RESAPERMITTO(�ONSTRUGT.ALTER.IMPRDYE,DEMOLI9FSOXHEPAIRANY97RUC• W �ti0/DBCk TIME.VRqR M RS ISSUANCE.ALSO REWMES TIiE A7VLMXfT WN BUCH PERMIT TO qLE�SIONEO W STATEMEM TFIhT HE OIl SHE 19 LICEI'SED PUR6UMlT TO THE PROVIulON9 OF TNE CONTMCTd19 V• � CDISE UW(fii�VTER�(L17MMENCM�NRfH SECiION 7000)OF OMSION 9 0f TME BlJ51NE55 AND VR0• LL PODUSp9 FESSIONS COD�OATNT NE OR SHE IS EXEMPT THEREFROM AND 7HE BABIS FOR 1HE ALlE�EO EXEMP- TqM.N1YV10LAT10NOF�CCT10N7081.69YANYAVR.ICANTFORIIPERMITSUBJECTSTHEAPVLICMR70 Z RB-HOOT � ACMLPENALT'OFNOTMOfiFTHANFIVENUNDR6DDOLLARS�i5o0J.y: � 04�01MNEROF7TIEPROPER7Y.OqMYEMPLOYEE5WI7MMM0E5A5TMEIR60lECOMPENSATqN, 0 COmmefCifll � MALL DO 1}IE WORK MA ME STRUCTURE IS N�T IMENOED OR OFFEREO FOR SALF(6EC.1M�.BU54 J NESS Ml�PlqFE3510NS CODE:TME CONTRACTOfl3 LIGENBE UW DOES NOT MPLY TO AN OWNER OF j � VRDPERTYWFqBUtl.D50q6iPRDVEBTHEREON.MI�WHO00E38UCHWOtiKHIMSELFORHERSELFOR � ilYIOUGHHSORHEROVYNEYPIAYEES,VFqVIDEDTNATSUCHIMPROVEMEMSMENOTWTENDEDOR CO OFFHiED fORBALE IF,FIOY/EVER'IXE 9UMNKiOfi MPHDVEMEM IS SOLU WII'MIN ONE YEAHOF COMPLE- TIDN,TFE OWNER-0UIIDER VALL 1UVE 7HE BURDEN OF PROVWG 1W�7 NE OR 6HE OIO NOT BULD OR MPRDVE FOR 7NE PUfiPOSE OF BN.E} w OI.ASOWNEROFTNEVROVERIV.AMO(CLUSNELYCON�RACTINaWRXLICENSEDCONTMCTOq9 � TO OONSTIIIIGT TNE iROJECT(SEG 70N,BUSINESS ANO PROfE5910N5 CODE:THE OONTMGTONS ll- V81118t1011 Z• ADJ.AREA CENSE UW DDES NO7MPLY TO AN OVMER OF A PROPERTY WFq BUILDS OR MOROVE9IMEREd{AND NSqOONTMCTBFORSIK]fiR0.1ECTSWfTHACqffFUCTOR(5)IICENSEpPUFiSUM1T70T1ECONTMG QUANTITY DESCRIP710N FEE � NRS 110ENSE LAW.1. J ❑I IW E77�MP7 VlAER SEG B.i P.C.W R TMIS REI150N Q U � DATE OWNEH � � W LICENSED CONTRACTORS DECLARATION �j � I HEPEBY AFFlFM UNDER PENAl.7Y OF PERIURY 71UT IAM LICEN6EO UNDER PROVI610N3 OF CHAPTEF � � ��COMNENGNNiNATMSECTqN700070FOM5�ON70FTMEBUSINESSANDPROFESSIONSCO�E.ANO Z �� W LICENSE 6 N RCE D EF ECT. m d LICENSE CL�SS ~ LIC.NO. � � � on� 1�l G—OO eorirRacroR � a WORKERS'COMPENSATION DECLARATION � � U � INER�Y�FFIRAIUNDERPENAL7YOFPER1UtiVOt/EOFTNEFOLLOWIN60EGLAM710N5: Z C _I1111YEANDWILLMAINTAWACEfifIFICJI7EOFCONSEflTTOSELF•INSUREFOHWORKERS' _ � OdAPEN511TqN,A8 PIpVIDED 8Y SECTION J7000F TNE IIBOii OOOE,FOiI THE PERiORMM10E W Q \/ OF TNE MfOWC FOR VMIQI 1H13 PERMIT q IS8VED. � �� /� IIIAVEMIUMALLIWNTAINNIDRKERS'OOGIPENSATIONINSURANCE,ASNEWIREDBYSECTION .l K Y70o OF TXE WON OODE,FOR TNE PERRDRMMICE OF THE WOHK FOR WMICH THI9 PERMITIg // J ISSUED.YY WORKERS'OOYPENSATION WSURANCE CARfl�EP/QJD POLICY HUM6ERARE: CONSTRUCTION �/ Q STA'TF� l�L/�� PLANqEVIEW � raw�'Nu�ae�R � Z9d y ELECTRIC < � fi1�SEC1IWNEIDNDrBE00NPtEiIDOF7TEPEWdfsFORO1�ltlNqiEDWtURS(Stw10RLF551 PLUMBING � I CElRIFYIHAT N hiE PERFORYANCE OF TFiE WORK FOR WF11CH 1MIS PERMIT IS ISSUEO.1 MECHANICNL 81W,1IqT EMPLOY M1V PER60N NJ M1Y MANNER SO A6 TO BECOME SUBJEC7 TO tHE (p WORKERSC041PENSATIONUWSOFCl�L�FOIW0.IU10AaREETHATIFIihKK1LDBEGOME INSPECTION FEE S 8Ul.IECTTO THE 1MDRKERS'CONPENSIRION PRONSqNS OF SECTIONl7000F THE UBOR 000e.�sHru wanrmrn caun�r win�na/se+rRovisia+s. ISSUANCE .! pon7E: �-t 9"Oo �PPucani: (o SMIP �X� � WMNING:FAIIURE TO 8ECURE WORKER9'CAMPENSATION COVERMiE IS UNLAWFUL,AND SHALL9E ENERGY P/C J U� � � �O�O �y SUB.IECTMtEMPLOYER70CRIMMALPENALTIESANDGVRFINE5UP700NEHUNDREDTFfOVSAND ENEFGY�ERMIT y OOLLI1RS�if00.000),NII��I110NTOTNECOSTOFCOMPENSIUpN.DAM�0E5ASiliOYIDEDFOHIN .,J SECTION�70lOFTHEUIBOROODE,INTEHEST.lJ�DI1ITORNEMSFEES RETENTIONFEE: T7�i ' 4 CONSTRUCTION LENDIN6 AOENCY pRE-ALT FEE: �`� AND SA1�TY O � 1 NEREBYAFFIRM UNDER PEN�LTV OF PENJURY THATTHERE IS�CONSTRUCTpH IENDINO AOENCY FORTHE PEH�OAIJANCE OF1ME WORK FOR WHIp1THl5 PERMIT IS ISSl1E0�SEC.90q.qV.C.). � � LEN�ER'5 w1ME � LENDER'3AODRE35 � ICEMIFYTHATIIUVEREAOTMSAPP�ICATqNANDSTA7ETF1AT7NEl1BOVEINFORMATIONIBCORRECT. TOTAL FEES d 1 ACiREE 70 G011PL�YVITN ALL CRY M10 COIMTY ORDIW W CES ANO BTIRE LAWS REU71NCi TO BUILDING � OONSTqUCTION,ANDMEREBYAUT1/ORIZEHEPRESEMATIYE50F1NISCOUNIYTOFIfrERUPONTME , FBOVE-MEMqNED PRDPERTY FOR IN$PEC710N YURPOSES. 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