Loading...
HomeMy WebLinkAbout11826 � . . i�'!� _�'�' .: .� CITY OF DIAM014I?BAR; ; : .:. -'• � . � �., , , COMMUNITY DEVEI:OPMENT I3EPA�tTMEN�' ` '�' PRESS � __A_^_21660 E.Copley Drive Surte k94 . ,;. . -� ___.._.. ._..�..,...,.� �W : �9os�s6o-3t9s��"t���r-3rr�_, � �..- _�_� �.��.�_�.��_T_��._m_—_._.____s_.,�__.T __�_..,_. . ,_. ._,_�a-- '""' BUILDING PERMIT APPLICATION FIRMLY �' JOBSITE ; -: ' •. ' : ARPUCATiON _ PERMIt P(C.-, t ' ,.Q •ppDf}ES3 ��.5�����_�� ' 4A�E`- �, __NUMBER it ` � +-- -iSSUE ; . ` TYPE OCC r � ; ` � .- APN . .. . L�T _ .. _..�..._..7RACT _-- - - -_, _ �dATE ___� -, _ _._ CONST.. . +._ .. �,ROUP s °C OWNER - . � � . . . p_ ____ .. . _. _... _.. �� _ . . ; APDRESS ` ' `, � ZONING SETHACKS , , a � . ' u'� CITY ZIP TEL,: -___ - FRONT _._... __ _ _, , . ._..._ RW-__�___,--fl�— f t 7 i ;.,_ _ REAR. �_ , O-----�-�'T° _ _� APPLICANT __ _—_ - ____.�...._. .__, __�E4_, {__..._ -�__ ... , , SIDElSIDE STREET 'RW {7�� �-� —_. _.. _�__ ___.. _�_. . ._._ -- - -:--- -SIDE_ _._..,�_�.._v._ __...__ __� CONTRACTO __ . �. � - AQDRESS_. _ _:__. _._ . �_.. ... . �_ ._ . ._. . _ ; ac _.. � � ; � G1Taf.._ _ .ZIP. .IEL. , PH�'OSEDUSE T . . , z a . w ARCFUENG✓ r - � b , '` -- - - - �,., z -DESIGNER- -___.__ . _._____ ...- _.. ._. ' . _._ --- � NQ OWEL . NO ' . Nt3.. nw. ADDSESS Up(}�g. -- - - --S7'�IFS ' 86DH00lJ5` ; .... �. ., :- , _..._, .__. ._ _. ..' � CITY ZIP TEL. _ ... . i � i _ _ _N. ..._ _.__ __..,---- _ ____ ___�._ __.._._.._ --:: " _ . , , � , .. :DES�fIIF'Tf�N _ 5Q.FT -FACTOR"PSF .ADJ.AREANALUATION � ._ �. ..:_..._...�..,.�---.,:_._..DINMER-Bl7t.nE6.nFrtiswsr�nni ; ---- �..: .. � � ' .. ''_._._ . _ _.. - ; - SFRlA00lREM _. .._ .._ . .:.. __,._._.._ ' ; p 4 ... . p . .�He�sr,�Ewu uem�xvFnwn oe-e�vurtr 7twr i�w.oc�a��r�.rt��arita�cToas u - ` ` '���._ ; ._ y 4 ; : W CENSELAWF'ORTHEFOILON'INGIiE0.40NlSEG7031.68USWESSANUPN�FESSKJN500D&Al1YGTYOFi. __ _ . . ._._..__ . _.. —.-._,� . ._. .,. _ € U c�urmwHrca�aEwikEsarauerrrocaasrHucr.arERwrnovE.o�aou�r.onr�krtstra� W .`_Pat�Qadc ---- ' _ u r�me:P�To��ssu�xc�uso acacnnEs�aaPc��w*wrrs�vea�rr m�r�swNEo t ° `., PPL �- � _=.,.-s ,., .. .�._. ___ ' ' ' - 57ATEMENT T}fAY HE QR SHE IS UCENSED PURSUMIf TO'ME PROV16bNb OF TME C�N�MC�OFiB LL � . . _ � � . . �� cetsE+.AVFtow'TERO�(EOMMEnsa+csvarNaEos�onaaoofocm+ns�oKsoerH66uswEssa�anxa, .s �'�' ��pa.._.--- . -- - --- . . . - . � 11P ._._.._�,. ..�_ - FESSIONSCODE)ORTHA7I�ORSHEISE7(EMPrTHEREFROMAMDTNEBA515FOR7HERl1EOEQEXEMP�- ; C�J , . , �� .. . i ... -.. ,. � U -riaw.�nvvauriavopsecriorrtan.serurv�ra�.�wrroaaaEaMiTst�rEcrstr�Yuae+muvrto ' � Re-Roaf , i - � � AqNL6ENALiY�N61'110RE7W1NFNEIBRtlDREDDOi1.Ai5S(i6WJ.j:�. . ... . .. ... . .. . ._.._- � ' ; � . . ❑LA3011MEROFYi�VAOPEHTY,OHMYEMROYEESNlITHWAGESA6TNEIRSOLECOA1Pft#�ibN.' - Q '(`,pmmg�C�l . ' , ,. - ' � -. -M7LL00'fHEW0aC1J�tfiNE-STRUCFkiHEL4t10iiMfHN3EDWi-E1FFE�WR�6M.E{SEC.304k81iS1-.. _ �j . .,. �.s � NES51�PlpFES510N5 WDES}�CONFMCTORS LICEN3ELAW WESN6TAPRYTO AlCQMMER.�,. .'. ;_-___. _.- -_ _---- . _ . � � . . ___ ____ _ � ,.-} _. "`.� , :.�. PAOPFHO[YIFiG@ULLASORMFAOVESTHERE4N./WD�M1909ESSUCNYYOHKHIMSELFOFtHEASEIR6H ., � ' � < : � �•; - . - W THHOU(',HMISORFIERCIWNENPLOYEES.PROVIDEDTWlT5lKF1YAYPOVEMEH79/WEt10TR([ENOFIIOft. �" � . . . . - . _ —' '' OFfEFiEDwR6M1lEIF,11��lEVER71�BlAlDPK10itYPROVHd@tTI550L�YiffIW10NEYEARCIF(`Ai10.6- •i , c. ' . .. . . .. . ._; � � � �. .Z "TION.`7HEOYMNEREUIlD9fYPAL1fAYET/tEWflQEIit�'PFNY6�1CiMAT1�OR8HBW01W4BtMDOR'._ ..: _ ' _'_._,._..... ._..... . .. .__....___..... ..a_.. _ __ .. . _ ...e,.. IfdPROVEFi�RTHEPURPO^uEOFSALE� .. .. � , " � � _ :_-��y} _..._.CSLASOWlffAOf-I)16PI30PEIiLKh4FXGl115tYELY�1tlfIT11.ICH15ED�lITNIGTIXtS� ,. � � �::' .. _' '.._...._ ........_. ..._.. .-._"_ _ .._...._. � ro oor�rrwcr n�aa�cr(sEa vow.eus�r�ss um P�rocssawNs coo�:n�cartw�croas u- y�qW� . AD.I.AREA � _ . . r...� CENSEUWDOESNDTAVPLYTOANDIARJEHC7FADROPERIYWIRBULDSIXiYAPlIDYE9Tl�f�ON.AND" " . ' � YhqCONTRACTSfOfiSilCNisi1CJECTS4tMTI�AOptlfR7VL'fOp(S�Gf�t6�PUAStM7RCTH�,CONTAAG `_ _" g �. QOAI�►tT}r_'_. _DE$CF�1('TiON��._ _ ' _.�E . _-� '.7WL4LICBlSEIAW.�. , . ::. ' .. � . _ , � �._� .._. ...e.._'__'.... .._._...,._.. ,..,._ �..._._,. ....�......._,._ .. __'_' ._. ... J. _.<.'. _ ,,_,...<._' _'_,..-,._.._—�'',' ' ' ' ' , 0 ❑IAN IXEMM LR.mEA SEC. ' . 8.l P.C.WH2FN53�ENSON j U _'.l._�. ...�• . ._ . . . . -' ,..._� . _ ._.__'_.__. _.___ _..._. ..,._. _.___.. ___ - ._ . __..� - ...._, . .._� _ _ _ _ _ � __a LG ` , _ � _ s .; '_._ F+ : , . --� . Z o�re owri� . __ _, � p -- _ _. : _ ..�.__ _` _. �. _ _,_ _.__ ._ �' � 1JCEN&EP-�QNIFiAGZ9A�PEcuw�7►0N LL ,_._� ° � _ ; � . .._ ,._ __-_ w , -- � - � � . _ _. ---__, _ _ _ -� , 1 HENE9YAFFlRM UNDEp PENALtY OF PEfWNY TWAT IAN IiCEH9ED IRJDEII PRONSIONSbFCli4PTfiN... ` � � d, 'Y(C6MMENCAlQWRFiSECTpN700D)�OMSIONSOFTF$BUSB7ESSARDPROFES510NSWDE.MID Z -.�� _ ' _ ___ . . . X IAY[lCENSEIS W WLLfOHCEMIDEFFEGT , - ,—. _ . . �- � e . LLl :.__ ;. . "r : ; � m . . . .,., � . __ .._.______... .____. ' _ _._____' . . . � • O � _ .__ . . _ � IIGEN3ECLAss LIC No. .- � �.• ..� . � , ..� .. .. .. _. . ._.,.. _..... _ . . J .. -�. . ' . UATE ' CONTRNCTAR , - ;. �- . . - ._ ._ �. - .-. t,4 __ . ... ...._... .__. . ._....._...__.....a.>.a .�,� .:�. �.-.��;� "--t�,:', -.x , ._ � � _. . � � WORKERS CAMPENSATION DEClN9AT10N Q � !NEREBYAFFWA I%�ER GENALT/OF PERNNY ONE OF iHE FOLLOW W6 DEGAMT10N5: � U � Z _,M"`_i.` � .— - � . .._ . . _. . .. _._ � ,..m.-�,�..�-...,.a.�--... ._.-.�__...,,.�... - . ._G __—._.�IFYIYEMOMflILMAINTAINACERTIFICATEOFCOMS@lfTOSEIFJNSUREFORWOHKERS'__.,... ...�,.._.,..__.._.�._.__-__.>._.,._....__ � � i � Q couvents�rar�.�so�wo�ersEcnoHsrmacn���eaAcooE.wrcn�renPow�uwcE W `.._.Q. . _OF.7HEMPORICWRWFYGH7HI5PEWdIT64_ISSIIED. _._._.._�_.... g �/ . _�__._..__...__....____._ _ � . . ._..__'._ .. . ._ . . . - ..,-_.. _._ __..___ .__ .. < _ __. .._... _. . ,. . W Y �HAVE MY/N/ILL W�1TAW WOHKERS'COMPENSATION INSUWINCE.AS REIXIIRED 97 SECiqN - '_ � 97000FTHEU60flCO0E.FORTHEPEAWfU1ANCEOF7HEYYOFiKFORWHICHTHISPEHMRi3 �: _. ._ .._..._ . . - ' '_' ' ; J ISSUED.MY�WJq�E RS' P ISATONWSURANCECM IEAAlDPpJCVlANABEHAHE. . _ _.. ..... ,.CONSTii - -.— .. .a . . .._..... ._.... . ._.._. __ i � CARRIER. / � � . � - , PLAN REVIEW _ - -.. .__ .. . . _..__..._ - ____.. _..._.. ._..--- ----__ . �...�._. ,._. ._. .....__...___�.__ ____.___:_ -- - ---- _,... _- , Z ra.icr►ruMeEA ELEC7RIC Q IIIWRIN(: - k . .. ,.� --.—.{t}�gfiELT10NP�IDTBE�FDOFAEFB�IA'FISfARONFlLt�Ofi�001LWS�itO�ORL�6},. m. ,. ._P -..v......�. Z t CFRTIFY tHAi W 7HE PEfiFOANANCE 0F THE N�ORI!FOR 1MMIl�77HIS PEaWT I5155UED,1 MECHANICAL � --(•} . .....9W.LNOT.EMP.LAY.Ad1lPEASONri/WYMANNENSOASIQ9ECAkES41B1ECST,OTkIE.__.._.. _ _._.,.�...� � N wormEAs•coe�Ews�riowuws�c�wrorwiti,woncn�nurc�sHaxneEcowe .. ' -1NSPECTIONFEE".""".._,_J��� .ea..R..._,_.___ ...n�___ _ ..__...__..._ , > � � SUBIECTTOTNEM/ORKERS'COMPENSATIONPPONSIONSOFSECTWN�Ta00F7HEtABOH ' _� __ .__cme,i TM canar vnn�n�s�rpv�sroNs. __ ISSUANCE 11�'trt. ___.__._�v O f �I��II�/'T> __.�_ __._. - .. SMIP —�� - . d DA7E:jrZ.I�APPLICANT. ..1�1JL V f� .,-„_ • -, '-.�. _ .� . . .-. _�ENEfdGY-P!G . . WAFWIN(i:FA&A1FlE T0 SECURE NlOi1KFA5'COMFENSATION COVERA6E IS ONLAWRI4 AIYI SHA[1 BE....... . .� .._ ..._ . . � SUBIECTANEMPLOYEPTOCHIMWALPENAL7IESM�CMLFWE3UVTOONEFKNIOREDTlqUSM1D FJdEHC�YPERMIT . ..�IIIA1 � C 'IQCIQ ppLLAAS(ttOn,000),p-0 ADOITION 70 THE COSTOF OOMPENSATION DAYA(iES/3 PNONOEO ADN NI .... � 5EtTI0N37080FTHECABC1Yi�mDEMEfiE51:AtAAT10FWE75�FEE8."`-___-___.__.__..`._.___. __ .,�. .. _ ����-� RET�M71dN PEE: _. _._. .�_ _._ _0 __ . _ ._.,_._ ..CONSTRUCTiON LENDING AGENCY`_.__ _-�.....__�_.. PREALT fEE: CTI�Y OF DLdI�C�NI��3A�w ^ ; x a ;' ,: . _ -----._�._w_._. _�.._.. . , � � IHERE9YAFFIRMUNUERPENALiYOFPEFWfiYTHATTHEHEISACONSTRUCTIONLEND�Nal1(iENGV BUILDING AND S�T�F3`�--��� '� . FORTHEPERFOHMANf:EOFiMEN10NCFOHWHICN7W30ERANTISI55UEDf5EG30i7.qV.G). . . , , ' Z _.._.__.._._"___..__..._.._.......___.__..__...._.._...-,__.-. .__..._..�..,___...... .. �..._._._,_...�._..._ i__... . . ...� . . ... W . _ _. _�.�.._.._.._...,_._ .......,. _...._.__. . . � LENDEWSNAME . �.. .�• � ..�i.�- . .°.;.. ' .` __ _".._._..__. ........__..�.._..,,._ _�.._-�-.._...._._____..�._,..__. .__...�_ . . H IENDER'SAOF1RE55 � . � TOTAL FEES - � JCERTIFYTHATIHAVERFN#TNISMPUCA710NAHDSTATE'�FiAThIEABOVEWfOFIMATqNISCORRECT. ��. .j� .,�` ,.. .W IAGREE70CdAPlYN7TNALLCfiYANDCOUNryOROWANCESAH�STATELAWSHELAi1N(iTOBUH.�IN(i_. ... . � .__.�..�_ ..__,...._.,,___ _.., ._.__"._...._.. , -.� � . � . � CONSTRUC7WN.ANDkENEBYAUTlWHIZEfiEPRESEMAME90FTHISCWNTYTOEMERUPONTHE - - � � ' q80VE�lAENT10NED7ROPFATYf00.1NSPEC�NPUHPOSES. ��.. ..- . . _z _ __ _ _ ___._. . ____ . _..__— ---_______._� __ . coMn�,zs- __ --. _� . ., , ,, <: � ���� . � . m f��--.. _ _ - PERMITfE�/1/ I�/ � , ....____.... '. .____. _—_. � - . Q : � �' ._ � SIONATUREOFI�� �ATE � -,_ ._- . ..._. _. .. ,._.._..__ � = RECPi.NO. PAID BY VALIDAT .-�WHI7'[-�DepenmeM EoDY:YELkOW-Fk�arwe CoPY�FINK.-AscoccaCopy,CaOLDENf30DFFiIa.Capy,GREEN-Applic�nt'sCoPY �.-,:`.... .. �;�. : f- �__._. __,_....__ .._ . �.:. �' , �: ., _..: , _ _ � __ _ , �:� . � . � ; � ,. . - : � � � � � i ; I ; , . . . . . ,,, ; , , - , _ . . , � ., , , . : . ., ; , , .., - : ' ,, � i r � ; _ ;`.� i • I ! �. �� . I � i � ' ' i � i i - �: �''' - . • � v! I� � i i r J ' �, I I I .� I � �= pF � � � � ' Iy ( ��� .Q'.� � 'V,� �G'm';� 'i = �. . a . . , 3!. 9� � , e �, .�,.� Q Q � . ,. , , � ; � , ��. : � � � o:.oQ °mnwmc�' � ? � z - a �, � �, � z � Q �J^ � I ; � V - � � o owWz `° � z. � ¢ UU -� gz u� a � �iaQ , • � �, i ' z-ltl . , O � � c> cU � � R ��� ¢ w z a O c� a � z �n � ' O_�. :7 '� LLILQQ CII�ZOQ.Z �. �r JWZ�111FZQ — O ��OW � . �. � _. : . C ¢ W fL CC J�...] H O CO 2 = S W LL lL � 4 W V W.N W 2 W } ..,. • _ . �.... __ _._.... o .. � ' � ✓�. 'G:'� ._ O �.� .p W..W = m}`�� Q lt1 2�� N-O V O � W Z ZQ 2'.Z � � '��� � _. .... . , I�� ��. � W W a a. J C7 ' , ... . ��} a�O LL�. LL.�.7, � ll. ,�L +� W.IL a ft1 2 LL 4 a n. O Q LL. J O�ti. LL 2 C i1J . '_. ..._ � '� .. .��U.%U I — ; _ � �I— f� � ' ' i I - � � i �. - k�rU z_ ' !� � � ` i ' ' I i I '._ I i _ t ' � �' � ' i I � � � � � � G ,i',. ' � i i i _ i = i �' • � T�? ;'� ; � ; � '' �y ' ;4 i , ^� �i I i;. . �, i j � I i � I I � I` � I j i� . � T\ j ! ;� � i + "�, I � II . J: � I � I . � _ . . ._ , ', w , i I 'i � I � I :�I '' I �. I, � I � �� s� ��4 i �i� j : ''.�: . i � � � � i i � � � i � I i z I � � � i I � a`S � Q � �I i � O ' ! �';__ Z � � � j � j i I � I � � t, • �, � Z � wllz -a-' t7v �W t� Z ° z f i � i � I � � . �O � � U Z � � � � h:? � � .� i �i � ,�, U ,Z _ �� ! . p � US N� �.. t� � � W�W �,F.- w W:F- �"� j;0 �.Q , Y „� �j f: 2 F '.pp - '.f+ i . .�. i ���, . Y � vaQ3 �'u4i ?� � = �'ia �d � m � �, ' ta-, � �' Ou`� 1�3 'LL1 � ►'¢-�' `",r ' ¢ � F z � 4 ¢Icq, z, x 2 w g z Z;<.aC U a. ¢ U 2 w a i�2 � ' ' � i U a. m U � maw.u: g � i� c7t7 � � W ¢ � ;.� _r � _ . �" wo � � aQ�o » 5a � � � � aw �naaaa � - ; Fa' �iH J � � W "tOS`O4OOS `'r W ¢' QZ2Z Z O ; I W � , , � ..' "-, �...�': (A W W U' (p t- '�s�� lL Cr S 2 'Q fA � '�Y U�.O,(4 � y (7 tL �L lL IJ.. . �U ; �� �- [A fA .I