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HomeMy WebLinkAbout13951 � CITY OP DIAMOND BAx -'��.. ~ ��'� � - �� —- DEPARTMENT OE COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS 'A^'� BIJII,DING PEItMIT APPI.ICATI�I�{ FtRMLY � JOBSITE �']�' � � APPI.ICATION L"+ �'l pERMIT � ��� P/C � A�DRESS�7 � }J •I��� : w . ���'P. pATE � � g�,NUMBER > �� n � ISSUE TYPE OCC APN LOT TRAC7_ DATE CONST. GROUP p OWNER _�, i v ADDRESS � �Y'� ��` � (.ltl ZONING SET8ACK5 � CI ZI TEL. r� ^tr � FRONT _ RW ❑__�__ b T�_���f l� �� =�`•'J�r' REAR , ❑__^ �� APP ANT TEL. SIDE/SIDE STREET__ AW,�U_ � CONTRACT�R �� , � ' _ SIDE _ L�__ _ ADDREKS„S� i ' � CITY�,`�1P.�1'�Gl.� �r��_t�, ZIP /' "'"7EI_." � -r- . _� PROPOSED USE _,._, _ � ARCHlENG/ _ _ W DESIGNER — NO.�WEL. NO. NO. � AODHESS — UNlTS _ S70RIE5 _BEDROOMS. � CITY ZIP TEL. � u� DESCRIPTIDN SQ.F7: FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDSR pECLARA710N SFR/ADDlREM O p I HEflEBYAFFIFMI UNDEq PENPiTY OF CERJURY 7HAi 1 MA FXF.MPT FRUM 7HE cONTaAC7op5 LI- � GafegelCerport W CENSEUWFORTHEFDLLAWIryQREASON(SEC.]031.5BUSMFS6AN�PRaFF5510NSCU0E:ANYCITYOfl U COUNTI'WHICHpFAUIRESAPEfiMRTOIX)NSTRUCT,aLTEfl,IMPROVE,DEMOLISN,opREPAIRANYSTRUG � pg�j0ID8C1( � �. 7IlAE,PRION TO ITS ISSUANCE,FL30 RC-0IlIRE3 Tf1E APPLICANT FOR Sl1CH PERMIT TO FILE A SIQNED W — .tr STATEMENT THAT NE OR SNE IS UCENS£0 P4IRSUNNT TO lHE PHOV!SICHS OF THE CONTRACTOPS LI- � CENSELAW�CHAPTEfl B(COMMFNCING WITi SECTION 7ao0)OF DIVISION 30F 7HE DUSINESSAN�PRO- LL' POOUSQ2 FESSIONSODDE)ORTMAiNEORSHEISEXEMFTTHEREFRQNANDTHEBA515WRTNEALLEG-OEYEMP- � � TION.ANYVpLAT10NOF3ECTION7091.58YANVAPVLICAMFORAPERMl75�&IECT5THEAFI'�ICANTTO � Re-Roof F ACIYILPENALTYOFNOTMORETHANFIVEHl1N�RED00:lRRS(5500).): --- � OI,ASOWNEROF7HEPqOPLRYY,ORMYEMPLOYEESI^/�THWAGESASTHEIfl50LEGbMPENSATiON, L� Commerclal ' NALL DO 7NE WOHK,AND TNE STqUCTURE IS NOT INTEUDGU OR OFFGflFD�Oq SALf.(SFC.70N,UU51- �„� N NESS r1N0 PFiOFESSfONS CO�E TNE CONTP�ACTORS LICEN9E LAW L10FS NOT APPLV N AN OWNE0.OF � PROPER�YN7i0 BUILDS OR IMPROVES TH[RE�N.M1D WHO WES SUCH WDIlK HIMSELF OR HF.RSEIF 09 � TNqq10NHI50RHEROWNEMPLOYEES,PRQVIDE01HA75UCFiIMPROVEMENTSARFNOiINTENOEaOR m W OFFEREDfOqS.�LEIF,MOWEVEq,i}1EBUIlDIN60RIMPROVEMEMISSOIpWIhIINOMEYEAROFGOMPIE- Z 'TION,TNE OWNEfl�B41LDEfl WILL HqYE THE BIIRDEN OF PROVING THAT NE OR SNE DID NOT AUIiD OR � IMPflOVE WR THE PVRPOSEOF SALE). �yj ❑41��'NEflOfTMEVHOPFRTY,AAIE%CLUSIVELYC/JhTpqCTINGWITHUCENSEDWI7PJ�CTORS � -- !--'- ¢ TO CON3TflUC7 THE PRQIECr(g�c.7:+c„gUSINESs aND PROFESSioN6 C(:LE THE CONTpACiOPS ll. �/glud�lafl ___ __ ADJ.AREA____,_._ � CENS£lAWOOESNOTAPPLY'fOANOYMEAOFAPR�PERTYWHOBU1tA50RiMPFOVESYkEREON.AN� - ----- -- WFIOCONTMCTSF7RSUCNPROJECTuWITHACO'�T'�iAC70R(5)LICF.NSEDt'URSUANT707HECONTRAF I q�jqNTITY DE5CfiIPTION FEE ^ Y TORSl10EN5ELAW.). ___ 0 L1IAY/EXEMPTUNDERSEC._____,______..___9.8G.C.F�RTHISfi'tASON Q � —_" '__ '_`._�.___'"__'_ U � —' � " �. - OATE "___OSY,VER__�_�._"'_"_-_�_'_ U W o LICENSEOCONTRACTOflSDECi.4RA(ION � � � � I HERE9YAFFIflM UNDEfl PEkAIPY OF GFFJURY THAi I AM LICENSF.�UN9ER PROvISI'JN&nF CHAPTEF �f�yq �/.j� y' d D�WMMENCINGWITHSEGTIONiGvO)OFONISION30F1'HEBl151NESSANJPftDFESSIOMSf,00E,AN0 ` ��/K�./r �JG.�J LL MY LICENSE IS IN FUI�FOFCE�'JJD EFFfCT. �} ` .r +++/��� r/ m � C^�f.: ��.i p � UCENSECLAS9�___�_LIC NO.���^�V � A � DATE -' _,__._.CONTRACTO� J - - v ��� a w � WORHERS'GOMPFNSATIDN pFCt. HATION '`� � I HEREBYpFFIRM UNOER PENAlTyO'r PERJVRY ONEOF 7MC-FULL0IVING DFGURA7'104��"�`-�'�` U � � Z _ _'._ f3 __IHAVEAN�VFILLMAM7AINACeiiTIFICATEOFCONSEYiTOSf:LFdNSIIP.E�ORYlORKER� ,Z COdAPEMSATION,AS PRGYIDED HY StC7!Of.13JaJ OF TNE LABUR WOE,FON TME PERFORMANCF: U Z OFTHtWORKFORV:WCHTNISPFR'.iITI5155UED. � S 0 i � __._IMAVENJ�WILLMANdTAINWORNC-RS'GG?�PEN54TIONIN5JFiANCE,A5RE0UIHEDBYSECtION Q 9]WOFTNEfABORCODG,FOR7HEPERWflMANCEOFTHEWORK�OFWIIICNTlIISPtRM1i1S ISSUED.MYWONKEflS'COMP2NSA71D4iN5URANCECAkN1ERANDPOIICYNUMBERARE� CONSTRUCTION ___.___,_,___.__,____.,_._.. ________ Q ) WRPIER- � � � PLANREVIEW ---.�._�..---'--...---�--��----------'- ���--�- � � � Pa.u;vNUMBER___.,__����� �,;,/' ELF.CTRIC �,. \ Z� -------�------�—'- Q (YHISSECI%riNiFbN07'BEdJMIPLERDOFTHi-PLFCA�G�OFi(N.EF+tNDflEDCQ1M5(51D�ICRLESSAi PLUMgING',,.. _'___'_.—_.___—'_'____'���-.L.___r. � l MECHANICAL ___,__, . __'_'.___'_,i_______ �CERTIFYTHAT W THE PERFOI7MPNC[OF iHE WORK�PF Wi{ICH THIS PERMIT IS ISSUE�,�J � (f 6HALLNOfEMPLOYANYPElISONINANYMANNEfi50A5TOBECGMESUBJECTTOTHE ��� { (� N/ORKEFS'COMP[NSATIONlAW50FG1fIFOflNIq,q,�'UAGREE7HA1'ffiSHUULOBFGOME INSPECTiONFEE _ __.,y __.___,_ -{-��� SUBJEL'1'TOTNEWOHKERS'COMPENSATIONPRDVISIONSUF 10 I DOFTI 'LA H ` � —� y " j COGE,I'/SIVALL�aRTHWITHCOMFLY`NITHTHOSFP �SSUAPJCE _, _/1._d�_ __.__�.________,__._ 0 fi/�4/ � �..,., SMIP Lr� p DATE:�'!��_ APPLICANT.�_ . ' . ' -- '-- ----- --- ---'------- J t �� ' [NERGY P/C ,.-� - - -.-- � WARNING:FAILURE TO SECURE WORKERS'COMPENSA710N WVERAGE IS U WfU 0 SNALL BE ,{ �-------------- � SUBJECTpNEMPLDYEflTOCRIMINALPENALTiESANOCIVII.FINESl1PT0 U EOTHOUSRND ENERGYPERMIT ' � �{ OD:IARS(fi00.o00).UVPDDRIONTOTHECOSTOfCOMPEN�/;TION,DAMAOESASPAOVIOEDFORIN ---- - - ----i--�------------ J SECTIDN3]aeDFTh1ELABOAWUE.INTEREST,ANCATTORNF.1"SfEES. �ETENTIONFEE: � � ¢ _'_' .: __"�"_"__` "'_ d GONSTt�UCYIONLENDiNGRGENCY PRE-AI.TFEE: _____,._.____________.____ O � IHEREBVAFFIqMUNDEqVENAL7YDFPF.RJJRVTIIATTHEf1E73ACONSTPIJCTIONLENI7INGAGENCY d FOR TH[P[HFORMANCE OFTN[WORK fOR WHIGH TNIS PERMI715ISSUED(SEC.3UW,CIV.C.). —���— —' —��--l-- -------- --- Z W _. __.__ _—�_—_________ — � LENDEW5NAME_____._...__.._"'__�_—__'__"_ _'_._'___ _._...____'__' ___—___` H IENDEfl'SADONE55_____,_________.�._.___._ � ICERTIF/THATIHAYEREA�THISAPPLICATIONM1�SiATETHATTHEA80VLINWPMATIONISCOpfiECT. TOTAL FEES '�y���, � IAGflEETOCOMPLYN7THALLCITYANDCOUNTYORDINANCESANUSTATELAWSREIATMGTODUILDING � GONSTjiUCTION,ANDMENEBYAUTHOFIZEREPHESENTATNE50FTHISCOUNTYTOENTERUPONTH[ Z ABOVE�MENTIONEDVROPER1YFOflINSPECTIONPUHPOSES. COMMENTS___.—.___________ ____._ O J �y�, �,/�/� � i "+��✓�Ger...+aG_��.-'S�a����.0 _—_ "'__.' '_'_'_ r.. � PERMIT7EEN _. _ _ � ��-� ����= ------ �= �1 -f�� "_y} �----_�-f,F—/— � SIGNATUREOFPFM7ITTEE TL �� - G 1 I+�`� �^-- V (�:. = iiECPT.N0.__�� _ �AID BY_�____VALIDATION_____._ ~ WHITE epanment Copy,YELLOW--Finence Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GfiEEN-Applicanfs Copy , .. , .� _. ; ,.. , . ,;, , . . _ �.. . . .. . , , . �. .. _ , � „ , ,, � . ., _ � . - , , t , : � __, _ i . . � . . ' '�� : . _ , . ' � , . . ' r � � � � ' � . � ..,. ''I � � . ._ n � ` . ' , � � G � - , , �� , + , } , '`� ; ' ' , x , , ; , r . . , . . . � � . . � . . ,.� . ., . - . . - �}l �. , , , . , , . . � . - _ , , . . �, . ,. ... .,, - . . : , . .. �. �. , .�., �.,. . - . 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