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HomeMy WebLinkAbout15870 (1103) � � �� CITY OF DIAMOND BA8 �� �- 1 DEPARTMENT OF COMMUNITY&DEVELOFMENT SERVICES � � 21660 E.Copley Ihive Sttite 190 (909)860-3193 Fax(909)861-3117 PRESS BUII.DING PERMTI'APPLICATION FIRMLY � JOBSITE APPLICATION PERMIT Q p� Qa ADDRESS 6 r w ���Q RA/JG�'D SdQ DATE �L � NUMBER �.��1� i� � D TEE �Z � TYPE OCC APN LOT TRACT CONST. GROUP p OWNER o ADDRESS I ZONING SETBACKS CITY � �O ��_ ZIP9�7�TEL. - L� FRONT pyy p APPiICANT � TEL. REAR• p SIDFISIDE STREET qW ❑ CONTRACT � SIDE p ADDRES�S � C ZIP���TEL. � PROPO_ S�D,U E �.�Be.[-' � ARCHIENG! , DESIGNER NO.DWEL NO. NO. � CITY E� ZIP TEL. UNITS STORIES BEDROOMS y DESCRIPTION SQ.FT. FACTOR PSF AW.AREANALUATION O OWNER-BUILDER DECLARATION SFR/ADD/REM I MEREBY AFFlRM IJNDER PENALiY OF PEiWRY THAT I MI EXEMPT FRORI hiE CONTRACTORS Lh Gan B��K GENSEtAWPORi/1EFOLLONIINOREA80N(SEC.7a31.69USINESSMIDPItOFE5S10NSCODE:ANVCI7YON (f� 9 CALNPTYWHICMREGNIIESAPERMR7000h5TRUCf,ALTEI�IMPROVE,DEMOLIBH,ORNEMIRANYSTRUC- W P8tiO/D6Ck TUi1E PRIOR TO rtS ISSUANCE.KSO REDUIRES iNE AVPLIGWT FOR SUCH PERMR TO FILE A SIONED w lTATE1IEM THl1T HE OR SHE IS LICENSm PUIiSUMlf TO TNE PilOVL5iON5 OF hE CONTMC70R5 LI- CENSE LAW�f71AP7Ep 0(COAdMENCINO WITH SEC710N 7000)OF OMSION�OF TME BUSINESS AN�PRO- LL PooVSpa FESSqN5000E�ORTFU.TNEOR3HE18E%EMPTTMEi1EFpOMANDif1EBA51SFORTHEALLEGE�EXEMP- (� TION.AN'IVIOU1TqNOFBECTION1031.68YANVMPLICANTfOiIAPERMIT8UBJECT9THEAPPIICANTTO Z Re-Roof � ACMI�ENALTY OF NOT MDRE 1YUN FNE/NNORED DOLIARB({5oD).): O�AROMMENOFTFIEPimPERTY,ORMYENPLOYEE6WIiHWA0E9A5TMEIRSOLECOMPENSATqN, COTTBfCl01 YYILL DO TFIE WORK,ANO TNE BTAUCiURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701�,BUSI• �J � NESS MIU PqOFESSIONS OODE:TNE CONTMCTORS LICENBE lAW DDES NOT AVPLY TO AN OWNER OF PRDPFRTYWFq8UlD50RMIPiqVE$iMEREON.ANDYYFiODOESSUCHNCIRKHIYSELFORNERSELFOq � � TXRC%IOHWSORNEROWNEYPWVEE&pNDVIOEDTNATBUCHIMPROyEYEHTSARENOTMiTEND6�OR m OFiEREO iOR&YE IF,NOWEVER iNE BUILDINOOR MDROVEMENT IS BOID WITFANONE YEAAOF OOMPLE- TION.TME OWNER�BUILDEH WILL WIVE 7HE BUHCQI OF PROVING 7HAT HE OR 8HE DD NOT BUIID OI1 MIPWDVE FOATHE PURPOSE OF BALE} y� ❑41�3 OMMER OF TIIE PROPER7Y,AM E7(CLUSNELY COMNACTpVO WRN UCEN5ED CONTMCTORS � TO OONSTNUCT hIE PHOJECT(SEG 7oM,BUSNIE851W0 PROFESSIONS CODE:7}£CONTRACTORS�4 V91Ueti0ll ADJ.AREA CENSE LAW COES NOTMYLY TO AN ONMER OFA PROPERiY WNO 9UX.p5 Oq w1PROVE6 TMEREON.IWD MM1�DCONTRACfBFOiiBUqiVRWECTSMATiACONTMCTOR�9)LICENSEDPURSl11WTTOTMECONTMG QUANTITY OESCRIPTION Y raisucEe+seuw.>. FEE � ❑I MI i7�MPT UI�ER BEC. B.�P.C.FOR THIS RFJ�SON ¢ U ZOATE OWNER U � LICENSED CONTRACTORS OECLARATION W � 1 NEREBY AFFIiW UNDER VENALTV OF PERIURV THAT I AM LICENSE�UN�EH PROVISION6 OF CFiHPTER � •(OOMMENCWOWfTHSECTION)000�OF01N610N90FTF1E0USINESSMIDPROFE54qNSCODE.AND Z NY LICENSE 16 N FULL FORCEANO EFFECL � m � LK:ENSE CUSS LIC.NO.���` � �j o�tE�� corirw�c a � WORKERS'COMPENSATION DECLARATION a y1 MEi1E8Y AFFIRM UNDER PENALT'OF PERIURV ONE OFTNE PoLLOWWG DECLAMTIONS: Z � �I NAVE AND NALL AWNTAIN A CERfIFICATE OF CONSEM TO BELF-INSUFE FOR NqRKEHS' a tqAPENSATION,A9PROVIDE0BY8ECTIONA000F7HELABORCODE,PoRTHEPERFORMANCE U O OF T/IE WORK PoR VIMqi Tf115 PERMIT 18{65UED. � _I NAVE AND WILL AWMAM WORKERS'COYPEN9A710N INSUqANCE,AS REOUIRED BY SEC710N Q 770D Of 111E IABOR OO�E,FOR THE PERFORMANCE OF TNE WORK iOR WHICH THI9 PERMIT IS �59Um•W WO RS'COMPENSATION INSURMICE CIIRRIEq IWD POLIC`!NUMBERApE: CONSTRUCTION �iq I � � CMRIER � e�--I � (�� PLAN REVIEW � vo�wY Hu+eER�B—' D L�h� ELECTRIC p ������Tm����T������R+�IOAtEss4 PLUMBING LL � 1 CEiiTIF1'TFNT IN THE PERFORMANCE OF 7HE WqiK FOR M}IICM iH15 PERMIT IS ISSUEO,I MECHANICAL SHFLI NOT EMPLAY ANY PENSON IN ANY YANNER SO AS TO BEOOME SUBJECT TO THE fn N'ORKERS'COMPENSATIONIAWSOFCALIFORNI�,ANDAdiEETHATIFIBHO4ILOBECOME INSPECTIONFEE S SUBJECTTOiHEWORKERS'CdAPEN3ATIONPROVISION50F5EC710N77000FTHEUBOR caoE.i swui aoan�wmr ca.��v rnrH nasc vArnnsar+s, ISSUANCE O 'p OATE: APPLICANP. SMIP i JJ � � WMNINO:PAILURETO6ECl1REWORKERS'COMVBtlSAT10HOOVEqAOEISUNLAWFIA,AND9HALLBE ENERGYP/C � SIIBJECfANEA1qAYERTOCRIMINALV9JALTIESANDCNILFNVESUVTOqJEXUNDHEDTHIXIBANU ENERGYPERMIT � OOLLAqS(3100,000).IN ApDITqN TO TNE COST OF COMPENSATqN,�AMAOES AS PqOVtpED FOR IN SECTION 7700 OF THE 1A80R CODE,IMEREST,ANO ATTORNEY'3 FEE9. qE7ENTION FEE: OCONSTRUCTION LENDING AGENCY pRE-ALT FEE: � 1 HEREBY AFFIRM UNDER PENALTV OF PERIUHY THAT THERE IS A CONSTRUCTION LENDINO AOENCY FOR THE PERPoRMANCE OF THE WO,K R WHICH THIS i IT I51�($EC.80�,GY.C.�. � LENDER'SNAAIE_ � IENDEN'SI�RE55 / � 1 CEIITIFY TIMT 1 HAVE READ T11S MPLICATION IND BTATE TFNT THE ABOYE NFONMATpN IS OOXqECT. TOTAL FE ES �o ��U � 1 AGiREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES ANO 6T�TE LAW9 REIATIN(1 Tp BUROINO '^ CONSTRUCTION,MlOMEREBYAUf}pRQEREPRESENTATIVE50FTHI5COUNTYTOENiEHUPONtHE '�. ABOVEMENTqNEO YRDPEflTY a wsvecrwn w sEs. COMMENTS G r� � U m VEIWITTEENAMEIPW � � � � SIONATUREOFPERIAfTTEE OAT � RECPT.NO. 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