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HomeMy WebLinkAbout16756 (37) 1 � CITY OF DIAM0�1D BAR r � +` ` J� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �y , 21825 E.Copley Drive '� (909)860-3195 Fax(909)86l•3117 PRESS 1 ��:� BUILDING PERMIT APPLICATION FIRMLY y JOBSITE � O�� �/_ ,_� � APPLICATION ��_�1 t PEflMIT I 1 �<I P/C a ADDFESS f-�� DATE V NUMBER� k � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER �1Q�f''�.1 QY�'Cl � ' ADDRESS �S iL �� ZONING SETEiACKS gCITY ZIP TEL � � FFiONT qyy p APPLICANT 7� TEL –D REAFi p � SIDEJSIDE STREET RW ❑ � CONTAACTOR SIDE p O CDDRESS ZIP TEL PROPOSED USE��'t-'- D P'C" , I.J���� ��'� ("D� !�I S o ARCWENG/ �L�i1�—F'LIL C<� � DESIGNER � ` ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFWApDlREM O p I HEREBY IIFFlRM UNOER VENALTI'OF 7ER7URY TMAT I AM EXEMPT FNOM TME CONTMCTORS ll- G3rdg8/C2rpOR W CENSEUWFORTNEFOIIOwINCPEASON(SEC.7o]t.58U51NE55FNDPROFE5510N5CODE:MIYCITYOq (n U �qJNryWHIp/REpUipESAPERMRTOCONSTRUCT,ALTERMPFqVE.DEMOLISH.OflREPAIRANYSTRUC• W Fylip/�Bd( Z TURE,DRqR TO RS ISSUMICE,/�150 REd11f1E5 TME�PVLICANT FOR SUpI PER41T TO FILE A SIG�FD �W STATEMENT THAT HE OR SHE IS LICENSED pURSUANT TD TME GHOV�SIOh4 OF THE CONTMCTORS LI. W CENSE UW(QIAPTER Y(COMMENCINO WITH SECTION 7000�OF DIVISION f OF TNE BUSINE55 AW VRO• �" PooUSpa VFESSIONSCODE)OitTHATNEORSHEISE%EMP7TIEREFROMMlOTHEBASISFORTHEALLECEDEXEMP• (� T1DN.AN1'VqLAT10NOF5ELTqN70]1.SBVANYIIVPLICANTiOHAVERMIT5l1B7EC75TMEAPPLICANTTO Z Re-Roof A CML PENALTY OF NO7 MORE TMM!FNE HUNDREO DOlURS(t5o0))� � �I,ASOMMEROFTHEVROPERTY.ORMYEMFLOVEESWITMWAGESASTHEIRSOLECOM7ENSATIDN. O Commerciat WILL DO THE WOf1K,AND THE STRUCTURE IS NOT NTENDED OR OFFEFED FOR SALE 15EC.7W�,BU56 J � NE55 M1D VROFESSIONS CODE:TNE CON7MC70R5 LICENSE UW DOCS NOi APPIY TO AN OWNEF OF � 7ROCEHTY NIl10 BUILOS OR IMGROVES TNERCON.ANO NMO DOES SJp1 VJORN NIYSFLF OR MFFSELF OR [r iHROUCHHI50RHEROWNEMP�0YEE5,OROVIDE07HAT5ULNMPROVEMCMSAR[NOTCfTENOEDOR m � OFFEREOiORSALEIF,IqWEVER7MEBl11LDINCORIYPROVEYCNTISSOtDW1T1aNOAEYEAROFCOMGLE• Z TION.TME OwNER�BUILDER VnLL HAVE TME BUH:7EN OF PROhN4 THAT ME OR SHE DID NOT BUILD OR � IMPROVEfOflTHEPURPOSC-OFSALEI. w �4ASOWNEROFTHEPROPERTV,AME%CLUSNEIYCONTHACTIkCNRT1ILICENSEDCONTMCiORS Q TO CONSTRUC'T 7HE GRQIECT(SEG 70N,BUSINE55 AND VHOFESS�ONS CODE:TXE CONTMCTORS LI• V�IU2110f1 -� ADJAFEJI W CENSEUWDOESNOTMPIYTOANOWNEROFAvqOiERTVWNOBURDSOAi�PROVE57MEA[ON.AND NM110 COMMCTS FOq SUCH PppJECTS WITH A CONTRAGTOA(5)L�LENSEO FURSUAHi TO THE GONTMG �E toasucEusEuw�. QUANTITY DESCRIPTION � J ❑IiUdE%EIAPTUNDERSEC. .BPGiORTM15R[ASON Q O V LL �j � DATE—!�S �'O OWNER U Z W � LICENSED COrlTRACTORS DECLARATION W � IHEFEBYAFFIRMUNDEHPENALTYOFFEMIRYTNATIAMLICENSE�UNDERPROVi5qN50FCHAPTER � d i�COMMENCWOWRHSECTION7000)OFDIVISKKi�OFTHE9U57NE55ANDPFOFE5510NSCO�E,AND Z �G YV LICENSE IS N FUI.L FORCE AN�EFF[CT, m LLl � LICENSE CUSS LIC.NO. j V DATE CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION a - N IXEREBYAGFiRMUN�ERVEWILT'OFGERIURYONCOiTMEiDLLOW1NCDECUMTqNS. Z _ . , G _IIUVEANDWILLMAINTMIACERTIFICATEOF�pNSENTTOSELFdNSUR[FORWORKERS' _ Q Cq1APEN5ATION,ASPROV10ED8Y5ECTION�7aoOFTNEU1DO�iCODE.FOFTHEPERiORMANCE W OF iHE WORK FOR WMICH THIS PERMIT IS ISSUED. � G W _I HAVE ANO WILL IMINT�IN WORKERS'COMPEI:SA710N INSURANCE,AS REOU�qED BY SECTION r Q ]7000FTMELABORCODE,FORTHEPEFFORMANCEOF7NEWORKiORWMIGMiHI5PE�1T15 Y � ISSUED.MYWORNERS'CdAPFNSATIONINSURANCECARRIERIWDDOLiCYNV1A8ER�RE: CONSTRUCTION �l Q > GRiUER PLAN REVIEW � POLICYHUMBER ELECTRIC ¢ (Rt55ECf/JNALmN7T9EmM14iFTEDOFhEPEiMT6fORONEHI�RED00lUR5RI0D)OHLE55). PLUMBING � Z ICERTIFY iHAT NTHE DERFORAIANCE OFTME WDAK FOF WHt[M THIS DEpAAITlSISSUCD,I MECHANICAL (�} SHALLNOTEMVLOYANVPERSONINANYMANNERSO�STOBELOM[SUBJELT70THE (1 y YqRNERS'CdAPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFI511IXhOB[COME INSPECTIONFEE �� S SUBJECTTOTHEWOANERS'CaMCENSATqNPliOV151�N50F5ECTION]�ooOFTMEUBOR • COOE.1 SHALLFORTMYATH COAIPLV WITN TIpSE VROVISqNS. �SSUANCE � p DATE: ADRICANT. SMIP ��.�:.� ' � � WAFNINQ:FAA.URE705ECUREWORNERS'C0�.�7ENSATIONCOVERAGEISUNUM/FUL.ANOSHALLBE ENERGYP/C '' � SUBJECTANEMPLOYERTOCRIMINALPENAIiIESANOCMIiM[SUPTOONEHUNOREDTHOUSAV� ENERGYPERMIT OOLURS(!����.�N A�D1710N TO TM[COST OF COMPE45�'bN.DAAAACES AS PROVIOEO FOR IN � SECTION�1DeOFh1EU00HCOOE,IN7EREST.A4DATTORrvEY5FEE5. RETENTIONFEE: nw_. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IMEREBYAiFIqMUNDER7EN�ITYOFPEfWRYTMATTMEREIS�CONSTRUCTIONLEND:NGAGENCY I' _�_ _�� FOR TME DERGORIA.UJCE OF TME WORK FOR WHlp/MIS OERYIT IS ISSUED{SEG]DBI,CIV C). Z W �Z LEN�EiY3 WUAE S � LENDEfYS/JDRF55 � TOTAL FEES � IGEflTIFYTHATIMAYEREADTM�SAFPLICATIONAND5TA7ETIUTMEADOYEWFORMATIONISCORRECT. � w 1 AGHEE TO COMMY WITH ALL CRY ANO COUNTY OROINMlCES AND STATE LAY15 REUTW G TO BUIIDING � � CONSTRULTION,ANDHEREBY�UTqRIZEREFRESENTATIVE50FMISCOVMYTOENTERUPONiHE ZABOVE�MENTIONEOPROOERTYFORINSPECTIONVURPO5E5. COMAIENTS ' O „ � \ � m CERMITTEENAME�PRINT� ¢ �D ) � y SIGNAlUREOFPERMITfEE DATE � ' RECPT.NO. 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