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HomeMy WebLinkAbout14285 � �. �� CITY OF DIAMOIdD BAR �' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 „ r , T (909)860-3195 Faz(909)861-3117 PRE'S`S ' T '��'�'��� BUILDING PERMIT APPLICATION FIRMLY o ADDR'E55 "'���� � �" � � ._ OATECATION( -���-' NUMBER� � #/C q� ISSUE TYPE OCC APN_ LO _ TRAC __ DATE __ _CONST._ GR�UP � OWNER O - _ o ADDRES _ _ y ZaNING SETBACKS Z CITY � � ZIP 7EL.r FRONT _�_ RW___ ❑ g APPLICANT - TEL._ p REAR _ !� � SIDEJSIDE S7FiEET___ RW___ i.I___ a� CONTRACTOR � ^ SIDE ____ ._ Cl__�___ � ADDRESS l5 � � CITY ZIP 7EL. pROPOSED USE----, --`---- ---- w ARCH/ENG/ -' ""-- WDESIGNER --- NO.DWEL. NO. NO. a ADDRE55 - UNITS__..__._.____ S70RIES _______�_BEDROOMS._ = CITY ZIP TEL. --- _ � � — — DESCRIPTION _ SQ.FT. FACTOR PSF ADJ.ARErWALUATION � OWt�IER-BUiLDEF7 DECLARATION SFR/ADD/REM O - Q 1 NEREBV�FFIRM UN�ER PENAL7V O�VERJURV THAT I AA1 EXEAIVT FROAA THE CO�TRACTORS LI. GBfdge/Ce�pOfl W CENSELAWFOHTHEFOLLOWINGREASON(SEC.703159USIIVFS5pNDPROFESSI0Y5WDLANVGITYOfl (/) __ U� COUNf'/WHIC.tiREQUIRESAPERMlTTOCQYSTRUCT,ALTER,IMPROVE,DEMULISH,pq1iEPAIHANYSTFUC� W pdI10/DECk TURE,Pfl10P TO ITS ISSUAFICE,ALSO RE�UIRES THE APPLICMT FOfl SUCH PERMIT TO FIL:A SIGNEII STAiEMEM THAT HE OR SHE IS LIC[NSED PURSUANT TO THE PROYISIONS OF THC CONTRACTORS ll- � CENSEUW(CHAPTEkB(CO!/,MENCINGWITHSECTION%o00jOFUIVISiON30FTliE8U51NES5ANi]PRO� u' PCOVSPd FESSIONSCODE)OflYHATHEOR3HL13E%EMP7THEREFROMANDTHEBASISFORTHEAI.LECEDEX[MP� (� -- TqN.pNYVIOLATIONOFSECTION7031.58YANYAPPLICANTFORAVF.RAAITSJiSJECTSTHEAPPLICANTTO � Rg-R001 r �dVILPENALTY OF NOT MORE iHAN FIVE hIUNORCD UOLIARS($50DJ.): — � C71,A50'NNF.qOGTHEPPOPERIY,ORMYEMPIOYEESWITHWAGESASTNEIRSOLECOMVE45AYlON, ❑ Commercial __, Yfil�DO THE WORK.AND THE SYRUCiUR[IS NO71N7 ENDEO OR OFFFREO FOfi SAL'c(SEC.7044,0W^I� J � NESS AND PFiOFESS10N8 CODS�.THE WN�RAC?OHS LICENSE LAYI DOES NOTAPPLV TJ AN UWNER OF ? 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O ❑IAUE%EAIPTl1NOEHSEC. _.__S hP.C''ORTHISREPSOfV U 't _ '_'_..."'""-____'....__ _.� U�_� ._. � � DATE _.UWNER.'_._,-_'.'_______ �d LICENSED CONTRAC70R6 DECLARATION � W �� ` 2 1 HERFBY AFfIRM UNDEH PFNAL'fY OF VEMIIpV THAT I AA1 LICENSF.D UNDER PFOVIS!ONS OF CHAPTEH � + - J°1� }' (�/', d 9(COAIMENCWCiWITMSECT1aM7oU'1�OFDNI510P430FTHEBUSiME55AYDPRO:ESSIONSCODf..AND � _�,�,___ ' � �� � AIYLICENSE IS IN FULL FONCEAND EFFECT. m y� � � /. �y _� GJL� � LIC,ENSE CLASS'_C-�=.7�'_,LIC.NO.._...._'_�: �� � � _ � ..-- - r J J V �ATE � �_ C6NTRf,CTOR.__'_..."_ __ �y --- —F-F____� �'._._ � - LNOFKERS'CO'�1PENSRTION�FCLARA7'IUU � '-� � ¢� '- � �t�,----- � IHEFEBV0.'FIRMUHDF.RPENAI.TVOFPI:FiJURY()NEOFTH'cFOLLOWING�F0.ARI+TN7NS. � '�-.^ — � �-- � Ll 1 NAV6AND'.4111 i/RN'i zIN hCClITIFICAfC OF.^.C:;lSENT TC:�EJ��YSI�HF I�Oq WOFn'r_R5' �, � C(NAPENSATIOY,ASAFlOV{DCDF.'/S'�CIIO`l]]LOOfT1fELA00HCO0F_,Uf1THFPERFnRM:1NCE + V ___...___ - — �OF TNE WORK FO�WNiCH TIi16^F.qMIT IB IESUFD � �I W � _ �—___ � _�HkVEANU'dYILlMAIfJiA1NWOAKERS'COMPENS.liIONINSUqRNCF,ASRF!%IIFEUB't5[Cl'ICN f � a�aoUFTHELA�:��CD�C-.i'OHTHF.PcflFO.IMANG�_OFTiIEWURK�OR`.4HIChi11115PERMITIS � ISSl1F,D.MV WORKE/R.^.'WrM�PEN^AYION INS�iANCE CANRIEFiAND PO ICY NJM3EFlARE. � CONSTRUCTION __.. _'__"' ______'-____......''__" � � Cr1RHIEfl�!=�'V�' � '_ r �.l y+ _"_'_' " � H��N REVIEW -------- �- ------�------- � � PaICY NUMB[R_-�/�-�1 7���L.�.�'�V_ ._. ._-__ f_LECTRIC ____ ..—__ __ - _ "-- � ..., . ....r �. ..� � (nussecnonr�mnoiee�Eroorrht�tr.ururoaauEvur�torpu�!s�w�oa�Ess} PLUtitBWG ----_ •�� �" ` . ..---, e}r �__ W —�-�- Z ICE(iTIFYTHATINYHEPERFORMANCEJF711FSVORKFUqWHIC�{THISPERMITISISSUE�,I MECHANICAL „_.,,.___ (} SHALL HO7 EM?LCYANY PERuON IN MY MANt::;R SO AS TC AFCOM�SU8![f:'i'()i!{E - (/� WORKEFS'CCNAPENS/TIONLAV/SOFCRLIFOFiNIA.AN[)ACREELIIFTIFISIiOi!I.OFECOM[ INSPECTIONFEE p,� ____,._._. � SUBJEC7'TOTHEWORKEFS'COMPENSATION VISIONSOFSECTIOV97000FTHELABOH -141�d ! 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