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HomeMy WebLinkAbout13778 �� CITY OF DIAMONI3 BAB DEPARTMENT OF COMMUNITY&D$VIELOPMENT SERVICES 216G(1 E.Copley Drve Suiie 190 O �� f (909)860-3195 Fax(909)861-3117 � PRESS �'��'� BUII..DING PEIt.NdTT APPLTCATION FIRMLY ��tt , y�, JOBSITE ��� APPLICATION• /�� EAMIT �'� �r P!C � ADDRESS TNN I, _ DATE � �`�6 UMBER� � # $ ISSUE ` TYPE OCC APN LOT TRACT � DATE_ _CONST. GROUP p OWN�R /L�L�F��-/� T�R/�— -- o ADDRESS LO t�! i ��1 ���3 ZONING SETBACKS z CI'Y / �IP y�_ TEI. D FRONT � RW � � APPLICAN7v2���t,a[�__ TcL.� REAR -7 SIDElSIDE STREEf FiW ;7 � CONTRACTOR DD�iitlfr-� .._ SfDE __ � ADDRESS !'� � PROPOSED USE � ClTY O ZIP� ^ TEL.9��-fjp�'j 0 ARCWENGi ° � � `--- ��,, DESlCNER NO.DWEL. ~ NO. NO. � ADDRESS _ -- — UNITS_ . _ STORIES __ BEDROOMS � CITY __ Zi�----' TEL.---- — cn -- � -- DESCRIPT{ON SC�.FT. 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Q (�oR1mP.r�iBi ___ WILL 00 TNE WORK,AND THE STRUCTURE I.S kOT INTENDED OR OFFERED FOR SALE(SEC.7044,AU51� J � NESS AND PpOFE5510N5 COCE�THE CON7AACTCRS�ICENSE LAW DOES NOT APPLV t0 AN OWNER DF � PppPEflTYWHOBUILD50fl1MPROVESiHEftEON,ANpYMOU0ES5UCHWORNHIhISElFORHERSELKOR m __ CC THHOUGHM950RHEROWNEMPLOYEES,PFlOVI�ED7FIATSUCFi1MPctOYEMEf:TSARENOT{NTEN�EOOR w OFFEPEOFORSPLEIF,NOWEVERTHEBUILDINGOf11MVPOVEkEk?;SSOLDWITHINONEYFARO�COMPLE� 0 TIOtd,7'r1E OWN£R•BUILDER'JNLL HAVE THE BURDEN OF^ROVNG T4qT ME Qfl SME DIC NOT BUILD OR ' -- � IFAPROVE FOR THE PURPOSE O�SALE). [y� ❑I.ASOYiNEROFTHEVqOPEi!TY.AA1EXCi•JSNELYCONTFiAGTI.'!GN'�hL•CE:�tiEOCV�ti�RRCTORS �- � Tp CONSTRUCT'H:PROJEC?(SEC.?oeq,BUSINE55 AND?ROFES.S!GI.'S CODF THE CONTflACTOR3 LI- �/��U3YiOft AQI.AREA W CENSEUWDDESNOT�PFLViOFiVOMMEROFAPROPEFTVN4i02Jt4.DSORIMFRO�/F.STNFFiECN,ANO �_'-- ' �— _ ----_ — Z WFpCONTMCTu`FORSUCHPRfi.iELTSWITHACtlh?�AGTOR(5)LICFNSECPUASUnNTTOTHFCONTRAG QUANTITY DESCR!PTION' FEE f� TORS UCENSE UW.�. Q o ❑IAMEXEMPTUIdOEPsEG__,____ ___._,__.9.6P[FORTnlSRF.ASCN I 'Q /�',1„ `�'_ � DATE '__�-�-O WNER�„4__'_' _'-__� u i . � /� � __-- __—_-____'_____ �•,-- ���� / � IICGtdSED CONT&ACTOFS OECLAS7ATION � �-}�--- -!!I.�� � Ii1EREBYAFfIRMUNDERPENALTYOF>ER'U�rYTr+AYIP1iJCE1tlSEi1uACER^ROV',�ION6CFCHA?`FR I � I/����� � 4(COMMENCING WITH cECTiCN 7npDl OFDNISION 90FTHE BUS:NF:S0.N7 PROFESS'Ck5 COCE A�p �I I'-77"f���'�__� �� YYLICENSE IS IN RJLL FOPCE AND�FFECT. �I--� "-1f � LICENSECLA55_x _'____LIL'.NO_ �,�l.J_���__ � --�---_I �"-' � U DA7 . � CCVTFlt,G7oR._.��5�,�� - - d --+— � W ` 2 [� O I�7l WORKGRS'^�MPENSATIOP!DECLARATION Q ��- � ' � IH[REB4AFFIFRIUNCER°ENRL:Y�f-PCRnJRVG:tiF_O'rT'�EFOLI��WI!JfCr.�Wq,q7!Gh'S zj'—`." I d IHA�'EANDWIILAIAINTpINACE?PFiC4�F.AFGONScNI'TO.SELF-INSU�E�URWORKER� _ _-- I � —_CR.`ApENSATION,ASPROYIqECOYSECT'CP3%COOFTtiF..LAB7:IGODF.,�ONT1irPEFFOP.MANCE � U _____.�___ , OFTNEWORKrORWHICHTti!SGER:AITIS!SSUr7 � � -'i O __IHAVEANOWI�Lo1A:NTRINNK7PKERS'COMPFIJSqfIONINSUFUP:CS,AuRcOtPF.�DB4'SECT,ON E 4 �� � Q a7naOFTHFLACOR^A�£,GOR71-EFERFpRKAiJG:OFTI1FNGfiR;OAWFI'�^.4TFilc?�H`,11T1S 4 � � ISSUED.MYWO:M'cRS'COAIi�'eN5RT10NIM5U^4?�CCCARA7=NA!'[)Pl1LICYNUFA9'RARE� � �ONSTR�iCTION ______,__,___ _ ,_�_�c�_ j— �n m�I� '__ `�� cnaaiEr;_��..yL � , _ -- - — i PLANRcVIEW �- � {����-r--(�- ��./ - - -------------'-- -------------- � � 70lICVNUTAeEF.��^� � FLECTRIC __.__,r.,�_'���@. ,�-�+"f--'t-D-�'--b- -----'------- ------- � � �r��ssEc�ne�worae��+.ErrnoFiiE7Eflfl�7bFG41:1kEHUK)REO'v'.K.1.4i�S�S'.�iORLESSG PIUMBING ICER?IfY-HKi INiHE�EflFORNANCE::`-tYEYY:::iKFOP.WHICHIH:SP:R+A';ISIS?JE0,1 MECH.4NICAL � � I '_""_—"'___"__'______ � SY.Af.L!�C1F.M7lOYAiuVGEqSOtiINANYMANNeR57A5T08EC0�7C5J13JFCrT�TViF I — -'_""---q—.°..r,f^� —"'—"-'---" . FWORKERS'COhiPENS'hTIONLAW50FCAliFpqNlA,AtiDAGAEETHATiFI5M0'JLDdFCONE I 1NSPECTIONFEE J ,r �� _ /��1�� � SU&IECTTOT�{EWOPKERS'COMP'cNeATIG4PfiOV1510h50FGEC1l0\3'oo0:T4�!ABCR ' � � CODE,�SHAl.I FOR'FMATH COMPLY W:TH THOSE PRO'iISIOkS ISSUANCE�`�� , � (� O �L��_LLF AFPLICANT. '_'_'_'�5..!.___'_'_'_'_"_ SMIP . -__"""" ` ` J r� DATE:_ J WAqNING:FAI�l•RE?O SEC FE Y.ORKEPS'COMPENSATiU�fOVERAGE i5 UN:.'•WFUL,ANO Sw���gE ENERG�(!��C ,_______._______,.__________,_______ _ �y„ SU&IECTANEMPi.0YEft10CRIMiN�LPENALTIESA!JOCCVILFIUESi.PTCONEHUNDREOTHCU5A.N0 ENESaYPERMIT DOLUAS�f1aC,0ao),INhJDITIONTCTHECOSTOFCOMP�N5qT10NDAMAGESAuPROV'DEDFO�IN i --�-��-�---------- ------�— — � SECYION 3lOe0FT}{��gpRCODE,INTEREST.ANDATTOA\EV'S FEES RETENTIO(J FEE: __,___.___.___________ _ _ d CCNSTRUCTION LE�DItdG AGENCY PRE-ALT FEE: p -..---'----'-------------------- � I41'cREBV AFFIqM VYDER PE�IALiY OG Pc'RJUFlY THAT TMERF IS A CONSiR�CTION LENDING AGENCY � FORTM7ER:-0RMANGEOFTMEWOPKFORWhIICHTHiSP°AA�ITISISSUFp(SF.C.307l,CIVC). `--- — -- • � . W I ' ,(J��� '__'"___''_"___"'__ � LENDEHSNAME_'_'�S_�v��I�'"'_�l'� ��__—'__—__ _ ___ _ 4_- LENDEfl'9ADDA�SS��� �'�"�:__�.����_. '� _ . �.. � ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTAiFTHATTHEA90VEINFORMAT�ONISCORRECT. 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