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HomeMy WebLinkAbout10640 EXPIRED COMMUNITY DEVELOPMENT DEPARTMENT MAY 3 O �OOY ;.,c Zit�o�.coP��y DriY�s��c��so . PRESS (909)860-3195 Fax(909)861•3117 ""'", BUILDINGPERMITAPPLICATION FIRMLY o ADDRESS �� 1 W/AI1J I.JD o.� �1Q- SSUE ATF M. I/S /1 TY EB R �O(p ����c � APN LOT RACT �,� DATE CONST. GROUP � OWNER vre�F�b e ADDRESS 9 'nc U'pOc ZONING SETBACKS Z C�7y p�UW►OHu 4d' 21P ?B TEL R�R RW O � APPLICANT 7EL. � � SIDFJSIDE STREEf RW O ' CONTRACTOR � SIDfi ❑ g CfTY E�I N� P_�✓''1 IiP_�, TEL. 7 L�L,Z/j PROPOSED USE �^� u— �!�d r`� o ARCFUENG/ DESIGNER �7 NO.DWEL NO. NO. n. AODRESS � CITY tIP TEL UNITS STORIES BEDROdMS � �n DESCRIPTION SO.Ff. FACTOR PSF ADJ.AREANALUATION � Q OWNER-Bl:ILOER DECLARATION � SFR/ADOlREM O 1 HEREBV AFFIRM UNDER VENALTY OF 7fIWRY THAT I/JA fXEMPi FRdA iHE CONTRACTORS L4 G8MQ9/C!lpOR W CENSEUWiOR7HEFOlIOWwOREASON(SEC.7Wt.68U5WE53N10PROFE45qN4CODE:ANYCrtYOR (n C7 COUNTYWHICHREOUIRESAiEfU1ITTOCONSiRUCT.ALTERIMPFiOVE.DEM0U5N.ORREPIdRANVSTRUG � W P8110IDBCk � 7URE,PRqN TO RS ISSW WCE,PLSO PEWIqE$THE 110PUC+WT FOR SUCH PEtUAIT TO FlLE A E1�NE0 W ETATEMENT T11AT ME Oq SME IS t10EN5ED fURSUANT TO T11E iROV1510N5 OF TNE COHTMCfORe lF � CENSE LAW(CMADTEN i(COYYENCMIO WITH SECTION 7oDo)DF DIVI9qN 1 OF TNE BUSN/ESSANO ViIO. � POOVSp9 � � FESSIONSCODE)ORTHATNEORSMEISEXEMPTMEREFROM/NDTHEBASISFOqTMEFLLE0E0EXEMP• (� TION.ANYVqU7lONOFSEGTION70]1.6BYANYIIVPLIC/XiFORAVEpMITSUBJECTSTHEMRIGWiTp Z q�q� F A GVIL VENA�T/OF HOT AbRE THAN iNE HUNDRED�Ol1AHS(f5m)�: � OlA50wNEROFiHE7ROPEqiY,OflMVEMPLOYEES1vi7HWAOESASiMEIRSOLECOMPEN5AT10N, 0 COmR16fN8I WILL DO TNE MpRK.AND THE STRUCfURE IS NOT INTElWEO OR OFiERED iOR SAIE(SEC.7oU,BU54 J N NESSJWDVROFESSIONSOODE:THECONTMMORSLICENSEUWDOESNOTAPPLYTOAHOWNEROF ? . GROiERTY WNO BUl�3OR IMGROVES THEREON,MID MAq OOES SUCH WORK NIMSEIF OR NEfiSELF OR � THROUGHNISORNERqMNEYGLOYEES.VROVIOEDTHATSUtl1lA1PROVEI,IENTSMENOTWTENDEDOq m , � OFFEHEDfOqSn1E.F/10WEVERTNEBU0.DwQONMP�WVEMEMISSOIDNrtTHNONEYEAROFCOYPLE• Z TION,THE OWNERAUILDEH'MLL MpVE TME BVf10EN OF VROV►10 TFUT HE OR 6ME DID NOT BUILD Oq = MVROVEFOqTHE%1RPOSEOFSA�E). � _ . y� OL�OWNEROFMEVROPERTY,A/AEXCLUSNEIYCOMRACTIN�WITHIICENSEDCONTRACTOR3 Q TO CDNSTRUCT THE PRO,IECT(SEC.70a�,BUSINE55 MA PROFESSIONS COOE:TME COH7RACTOR6 U• VlIUY110n AQI.AREJ1 W CENSEUWDOE4NOTAVPLYTOAHONMEROFAPRO0ER7YMnqBUILDSOR�IPROVE4THEREON.N10 � W4qCOMMCTSFORSUCFI7HOJECTSWITMAGONTHAC'TOR(3)LICENSEDiURSUAMTOTNECONTMC� QUMITITY DESCRIPTION � ��E � � TORS UCENSE UW.). - Q O I MI E%EMPTUNDER SEC. 8.t P.C.FOR TWS pEA50N � - 3 �' �=" DA7E ONTIER U Z W F UCENSED CONTRACTORS DECURATION W � INER£BYAFFIqMUNOEqPENALTYOFOEfLri/RYT1uTIAMLICEH5E0UN0ERPROV15lOHSOFCIMPTER Vr . �� i�CO1�MAENCINOWITHSECT10N70oDIOFDIVI510N]OfTMEBUSiNES9M1DiiqFE5510NSW�EAND Z X W LICENSE IS N FULL FORCE AND EFFECT. m . � LICENSE C S ` �� LIC.N0. �O����� � V DATE ��S��J l �CTOit � W � WOFiKERS'COMPE ATION DECLAAATION � � IHEREBYIIFFIRMUNDERPEW�LTYOGVERRINYONEOF7HEfOLLAWNIUDECLAMT10N5: Z L/I � �.��' p �r, d J 0 _INAVEANDWILLYAINTAINACERTIFlCA7EOFCONSEMTDSELF•INSUREFOHNIORKERS � � COMPENSATION,A9GROWEOBVSECTIONS7ooOFTHELABORCOOE,FORTNEPER�OMIANCE U C�� 5 � ����''O O OFTHEWOHKFORWMIqITK9VERM�TISI55UED. � � �I HAVE AND WILL MNNTAPI WOPo(ERS'C0IAPENSATION INSURANCE,AS REQ/1RED BV SECTION 77ooOFTMELABORCOOE,FORTIEPEHFORMANCEOFTHEWOHKFORWHICHhI14PEiWITIS � ISSUED.MYWOW(ERS'WMPENSATIONWSUfLWCECARRIERANOPOIICYHU►IBERME: CONSTRUCTION � CMRIER C� P�{Ud a�/��Vl( � vaucrr�uMeER Z- ELECTRIC � (MSSFCroNHE�NDTaE0.MPLETEDOFiHEPEW.�tBfORONEH+f%iED00llI1�R��l��l. PLUM61N6 Z ICERTIFYTHATNiHEiERFORAIANCEOFTHEWORKFORWNIp1TH RMRLS�SSIIED,I MECHANICAL _ �'y ,�IW Cih �' 2�•�A C7 SMAIL NOT EAIPLOY INV PEiiSON N M1Y MANNER SO�S TO BE S ECT TO iME �'���� � WORKERSCOMVENSA7qNUw50FCAL1iORNi AGREET TI 51qULD8EDDYE INSPECTIONFEE � SURIECT70iHEWORKEPS'C0117ENSATION7 SOFS 7o OiiHEUBOR s cooe.iswu amnwn�coMv�vwm� aows�a+s ' ISSUANCE /S, �� � D�ie: ���� Apaic�Ni: �lv SMIP a � ENERGY P/C } '�� WAItllMfL fAILURE t0 SECUf4E WORKERS'WIAPENSATION COVEMOE IS UNUWFUL AND SHILLBE �'y SU&IECTANEMPLOYERTOCRNIlULiEtULTIESANDCMLfINE9UPTOONEMINDREDMMISMlD ENERGYPERMIT DOIUAS(lloa,000),W ADDITION TO iHE COST OF COMPENSATION.OAMAaES AS PROVIDEO FOR W ¢ SECTION]70eOFT11ElABOHCODE,INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: � 4 CONSTRUCTIONIENDINGAGENCY � � � 0 PRE-ALT FEE � INEREBYAFFIHMUNDEqiENALTYOfPEM1RYTNATTHEREISAQONSTPUCT10NlFNDIN6AGENCY � Fp{�TMEYERFORMANCEOFTMEYqRKFORWHI�H7NISGEpM�TI5155UE0�54C.7�1.GIV.G). � � LENDER'S NMIE � . � lEN0ER5ADORE55 � TOTAL FEES �� •� W ICERTIFYTTIATIWWERE/DTHISAPVLICATqNM1D5TATEiHATTNEIIBOVE!lFqWAiIONISCORRECT, � � I AOREE TO COYPLY WIiH ILLl dTY ANO COUNTV ORDINANCES ANO STATE UN�REU7NQ TO BUKDINp � CONSTPo.1CTqN,ANDHEREBYAUT4qi12EREPRESENTATIVE50FTHI5COUNT'ITOENTERUPONTHE � ABOVE•MEMIONEDVROPER OqWSPECTqHVUfiPOSES. d C�I' {�1�Q� /ubl�f COMMENTS � / ( � m CEiWt NAYEIF _/� / � �ZL � 8�ONATUREOFPEWMTfEE ._ _ . DATE t� � �� �� ' • . . . • RECPT.NO. L PAID BY VALIDATION WHITE-Oepartment Copy,YELLOW-Finence Copy,PINK-Ae�essa Copy,GOLDENftOD-Fib Copy,GHEEN-AppI1c�M's Copy . .. r� .. i.�.� riK•: � •� �c7.. �.i,` h. .�i1:�: � f� �.. � 1..�,M.. �. ,, a . i'e� •j�- ,. .. . , 'i::i:. ,- .'.Y:=:i. ."7�='. .. . .. � � . - � 11 .. ;} � � CITY.O.F. 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ON;SITE IMPS. _. :j._ GAS AIR TEST- ------ ---- --.. .- - -. _ _ _.__ _ _ .FIPJAL'ZOt�ING . , - - _ _ � i �; -- FINAL-CONST.'------- ---_. --- ---- - ---- --- __ FIRE pEPT. FINAL _ ; I - : FINAL-HEATING_ _ ____ --- --- --- ---- - ----.--; - - HEALTH DEPT:F�NAL .: _ . __ . _ _ --- --------- � FiNALELECTRiC -- -___ --------- --- --- --- --- DEV. FEES PAID -�,, ,. ,r. , , ,,,, ; : -- ' --- -- FIr1ACPLUMBING---- -- -- — -- -- - -- -----_- FNcRGY . _ , , , - - - , <' • • _ , . , ,. . 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