HomeMy WebLinkAbout15029 (1098) J,�� CITY OF DIAMOND BA8
DEPARTT�IENT OF COMMiJNITY&DEVELOPMENT SERVICES
�� . 21660 E.Copley Drive Suice 190
� (909)86a3195Fax(909)662-31t7 PRESS
����� evII.unvc rE�rr a�rr.tcnriorr --- FIRMLY
� JOBSITE APPLIC Tl PEAMIT J�/�7(�P�
ADDRESS ,
DATE�,- IYUMBER t_��J s
APN dr T A� lSSUE
'/�f TYPE ^ �t OCC
� OWNER AATE �� V _ CONST GROUP
� ADDRE ZONING SETBACKS
AP LICANT ZIP TEL. - REAR Rw �
� TEL. SIDE/SIQE STREET �
RW ❑ \
CONTHAG7 SIDE �
� ADDRE S
C Z�p TE� ; PROPOSED USE +
ARCFUENG/
DESIGNER NO,DWEL. Np, �
ADDRESS —
CI7Y �p ' �� �' UNITS STORIES BEOROOMS
��1�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
CC OWNER-BUILDER OECLARATION SFp�qpp�pEM
O
111ERFBr AFRFM UNDEfl PENKTY OF►ERAIRY iM�1i 1 AG EXEMaT iRG1'IHE COPRMCTOqS ll• (�gfR99fCttpDrt
CENSEUWFORTNEFOLLOWNpqEA9pN(SEC.70.71,i8USINESSMIDGROGE5S10N5C00E:AIWCIiYOp (n
OdMfYWl4OIREOUIqESAVENNITibCpiSTiiUCf.KTERM�iPqpyE,pEAAplISH.OPFIERVPANI'8Tf1UG W Patla�/Deck
1URE.MpR 7C R8 IS.4UANCE.ALSO REOUIRES TIiE APPLIC.WT fOk BUCM PEFW IT 70 FILE A&ONED , �
SiATBABl�TNAT NE OR 8HE l5 UCENSEO RJR6UANT Ti]7HE PRDNSIONS OF TME OOMMCfppS LI.
CENSE LAW(piAPiER i�CCMMENC�NO N7TH BECTqN 7aoo�OF pMS10N o OF 7HE 9USINE45 AND PFl6 � � POOVSp81
iE65�ONSLbDE�ORFMATHEOqBHEISIXEMPT7NEREFROMM/DiNE&{515FpRTNEALLE0E0EXEMP• � (�
TIDN•MI'fVIOLAT10NOf0ECTION7C0t.O8YANYAPPIICANTFOHAPENAITBUBJECTST£MPIICAHfTp . Z Re-Roo1
� ACNiLP6NALTYOfFpTA1pRETF1ANFNEHlN�10RFDOd.UlR3(�Saal-)' ...
04ASOWNEFOFTNFPROPEHTV,ORMYEMPtOYEE5N7THW�0E9A9T1E1R50LE0pMPEN3A710N, Q COTmBIC181
WIIA DO TNE WORK,AN�TM6 S'fqUC7UqE IS NOT INiB1pfiD OR OFFEPE�FOH SY.E(6EC.7oa�,BU54
� �ES4/MQ PROFE9510N3 OODE:TNE CONTMCfOq9 LIGEHSE UW GDES ND7 AiPLY TO/W pWry�R OF ; j
PqOPERIY WFiO BURDS Oq YPqOVE3 T51ERFqi.AND Wiq DOES 9ub1 NpqXfiMSELFOqHERSEIF OR
� MbU�FI NS OR NERONN BAPLpYEES.PR0111DED hUT 6UCM MPHOVEMFMS AHE NOT MTENOE�OII ' m
OFf61ED P�H BALE F,IRTNEVFs�THE BU0.pN0 Oq MIPtqVEMg1T I9 BO��NTIMN ONEYFAq OFCqAPLE
710N.7ifF OMlNE0.CUILlIEA WILL 11AYE Tl1E�EN OF PfiOVW13 TTIAT MF OR iNE 010 NOi BWI,p Oq
MPFIOVE FOR 1HE PIJRPOSE OF W.E). .
� ❑I,A40MMEROF1NEPi10PEHiV.A4E7(CLL151YELYf�WiTq,�CTr10YVITHLICENSE�00tlTRACfOqS �
TO CONS7PUCiT1E►RWECT�8E0.7aa,BU9INESS 11N0 PAOFESSIONS pOpE:tF7E OOHTMCTORS LI' V81U6110r1 ADJ.AREA
CENSE lAW OOES NOTAPYlYTO/W OWNEN OF APROPEH7Y WFq&11LpS OR MPROVE8 THEXEON,Mlp
M41000!'1i1NC7aiOHlUCHiRQJECT9W17HACONTRACTpq�S�LICENSE0PUR9UANTMTHEpOHTMF DUANTITV DESCRIPTION FEE
� 100.4 LIC6?�9E LAWJ. , ,
❑I�a�M��� B.iPGWNTlNSqEAs41 �
U
� DA7E ONNER F��-
C�
���ddd UCENSED CONTAACTORS DECLARATION W
j� I MERFBY�FF1RM UNOER VENAI,7y OF PERIUM 1FLR I M1 LlCENSEO UNOER PIqVISKKS OF CHApfER � ^
S •(001NAENCINO YATH SGCipN 100D�aF DMSqN 7OFTHE B1181NES51W0 PROFESSIOAIS CQOE.ANO Z
�X LIYUCENSE IS N WLL pCEAND EPFECT. m
� LIGENS 99 � LIC.NO. �
�� COMFiACTOR S pJ.
�—31.� �
� RKERS'COMPENSA710N DECUIRATION �
IMEREBYAFiIRAIIMDERPENALTYOFpEFUURYqyEOFTNEFOLLOYVIHGDE0.AMT1C1N9: V
� Z
� _�IHAVEANDWILLMAINTAINACERTIFIC117EOFCONSENTT06ELF•IN5UHEFORWOqNERS'
C�011PD18A710N.AH VN01rtDED BY SECTIOH i7000i iNE UBOR COOE,FON THE PERFORMANCE U
OF 1FE WppK PDR WFi1Cry 7N19 pEflMIT IS 195UE0. W
�
_�t IUVE AN�NnLL WIRTAIN N+OWCENS'CORIPENSATION INSUFMIGE,AS REWIRED BY BECTION
0 9700 0F THE L�BOP 000E,FOR T1E PERFORMAN OF THE WORK PoR WHI 7HIS PERMIT 15 �n M•�O
� issu�.w»oa 'caun�,tr�\ysoau� qRl cr sen�we CONSTRUGTION _ „ � J
� CARRIER ��l _ PLANREVIEW
� POLICYMMBER � �`'l{..�� ��
ELECTRIC
p f���+�ID�'�T��`a�T�o�T�r�e�sPo�+ouE�una��oaunsRtmlai�ssa PLUMBING
w
� ICER7IFYTTlATNTFIEiERFORMANCEOFTIIEWOFIfFORWHICNTHISPERMIi191S5UED,1 MECHANICAL
BFIAIL NO7 EMPLpY Mn pENSdi IN ANY MANNER 80 AS TO BECOME SUBJECT TO THE
(n WOqKERS'COYIPENSATION IAWg OF(',AL�FORNUI,MID��REE TIAT IF I SFbUL�BECOME INSPECTION FEE
S Bl1BIECTTO FHE YYORKERS'OOLiPENSATqN PROVISIONS OF gECT10H9)Oo OF 7HE LABOA
caaE,i s�uu copnn�nn�couv�r vnrn nosE anovisias. ISSUANCE
O
Q ��: APPLICANF SMIP
�t{
J WARNING:F��URETOSECUREWOpKEH3'COMPENSATpNCOVEqAOE15UNU1NFUL.AND6HN.LBE ENERGYP/C MAV
� SUBJEC7ANEMIPLOVERiOCRIMWALPEWLLTESANDGVILFINE5UPTOONEHINONEDTIqUBµO �r—� �
Od.LAIiS R700.000).N ApD�TION TOhIE GOSTOF{701APENSIRqN,DAMAOE9 AS PROVIDED fOR M ENERGY PERMIT
J aEcnava)woa7x£ueoRcooE,wreREsr,,wpATroa�Er8cEf5. RETENTIONFEE: C�ITY U� � 1
��,�r
O CONSTRUCTION LENDING AGENCY PRE-RLT FEE: RI TTT.nT�� `����1`i �
� IHEREBYA�FIRMUNDERPEN11�T1/OFPERIURY71NTT17EREISACONSTRUCTIONLENDINOAGENCY
Z fG7 iNE GERFDRMNJCE OFTHE YYORN Pofl YVFIMJi 7HIS P�qWT IS iSSUED(SEC.f0Y'l,pV.C).
W
� LENDER5 WIME
C LEN�ER'S�DCfRESS
� 10ERTIFYTU1TIXq/ENEAO1M19AVPlIGTpNANDSTA7E7W�TTIfABOVEINFORMATpNISCORqECT. TOTAL F S � ` K��� J
IAtiREETOCOIACLYN7MALLCRYANDOOl1MYORDNANCE5M7D8TAlElAYVSRp/�TppTpBUILDING J �iv
� CONSTRULTIOfy A(ID HEHE9Yµ)7�fOqIZE PEPRESENTATIVES OF THIS COUNTY TO EMEH UPON 1NE
ABOVFMENTIONEDPIqYE T'FORIN FCTqNWpP06E5. �MMENTS
�
�
m PEfMI I
y 1.
fq E E MTE
� RECPT NO. PAID BY VALIDATION
YVHITE—Dopartment Gopy,YELLOW—Flnance Copy,PINK—Aasessor CoFry,GOLDENRO�File ,pqEE
�PY N—Md��n's Copy