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HomeMy WebLinkAbout17496 CTi'Y OF DIAMOIVD BAR ------�"'�' — DEPAIt'TMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES I 21825 E.Copley Drive ' (904)860-3195 Fa2c(909)861-3117 PRESS """<c�"' BUII,IDINGPERMITAPPLICATION FIRMLY � JOBSITE f �� 7 �!'1S�� ���v�E.. � �`� /� �1 NUMBER � �� t # APPLICATION PERMIT P/C o ADDRESS_ p^ DATE am ISSUE TYPE OCC APN LOT TRACT._ pATE CONST. GROUP p OWNER ;niA}� o ADDRESS ZONING SETBACKS y CITY � �� ZIP TEL. FRONT RW ❑ o APPLICANT � TEL. SIDE/SIDE STREET RW ❑ z a CONTRACTO � t; �G � +� r�je� SIDE ❑ � ADDRESS r� �- �� '� PROP�U� � Yi P�'t'- �/���'�S � arv Jk2 zip� TEL. ����Ii�� r ,. �s� -P pARCH/ENG/ 7�- � �ar ��O z DESIGNER NO.DWEL. O. i NO. QW. ADDRESS UNITS r STORIES / BEDROOMS� � GITY 21P TEL. � DESCRIPTION SQ.FT. FACTaR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O , � I HEREBV AFFIHM UNDER PENALiV OF PERJLIRY 7HAT I AM EXEMPT FROM THE CONTRACiORS LI- � Garage/Carport � W CENSEUIWFORTHEFOLLOWINGREASON�SEC.7931.5BUSMESSANOPROFESSIONSCODE:ANYGITYOR � U� COUNTYWHICHFEQUIRESAPEflMITTOCONSTRUCi,ALTER,IMPROVE.DEMOL15H2ORREPAIflANVSiAUC- W Patio/Deck � Z� TUPE,PRIOR TO ITS ISSUANCE.AL50 REQLIIRES THE APPUCANT FOR SUCH PERMIT TO FILE A 51GNE0 �, �� STATEMENT 7HAT HE OR 8HE IS LICENSED PUflSUANi TO THE PROVISIONS OF THE CONTRACTORS Lt� W . �, 'CENSE LAW(CHAPTEF 9(CDMMENCING WITH SECTION 7oa0J Oi DIVISION 3 OF iHE BUSINESS A�D PRO- � POOI/Sp3 ' .FESSIONSCODE)OFTHATHEORSHEISEXEMPTTHEREFROMAN�iHE8A51SFORTHEpLLEGEOEXEMP� , � TION.ANYVIOLATIONOFSECTION�,7o31.5BVANYAPPLlCANTFORAPERMITSUBJECiSTHEAPPUCANTTO z �Re-Roof �.+'� �, � ACIVIL PENALTY OF NOT MORE TNpN FIVE HUNDRE�DOLLARS(55w)J: '� � ❑4ASOV✓NEROFTHEPFOPERTY,ORMVEMPLOYEESWI'HWAGESASTHEIRSOLECOMPENSATIDN, 0 �C0171ff1BfCIaI ' Z,� WILI DO THE WORK.AN�THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BU51� J ' NESS AND PROFESSIONS CA�E THE CONTRACTORS LICENSE lAW DOES NOT APPLY TO AN OVMER OF �' � PFiDPEflTYWHOBUILD50RIMPROVESTHEREON,ANDWHO00ESSUCHWORKHIMSELFORHERSELFOF � �'� ���. '�THfiOlIqHHISORHEROWNEMPLOYEES,PROVIDEDTHA75UCHIMPROVEMENTSARENOTtNTENDEDOR m ; Wn OFFERE�FORSALE.IF,HOWEVER,�THEBIIIL�P1GdRIMPROVEMEN�I550LDWITHINONEYEAROFCOMPLE- Z; '�,TION,7HE OWNER�Bl11L0Ef1 WILL HAVE�THE BUR�EN OF PROVING TI�IAT HE OR SHE�IO NOT BUILD OF �,, 'IMPROVEFORTHEPURPOSEDF$ALE). I71,ASOVvNEROFTHEPROPEPN,AME%CLUSIVELYCOPJiRACTINOWITHLICENSE�CONTRACTORS �� qDJ.AREA �, TO fANSTRUCT THE PFOJECT(SEC.7044,BUSWE55 AND PROFESSIONS CO�E:iHE CONTRACTDRS LI- VflIUetI0f7 W' �CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AN� � � WHOCONTqACTSFORSUCHPROJEC7SWITHACONTRAC70R(S)LICENSEDPUFSUAM CONTRAC- QUANTITY DESCRIPTION FEE � TOflS LIGENSE LAWJ. ' � ❑I AM EXEMPT UNOER SEG� B.&P.C.FOR iH15 REASON U �' 4._ � �AiE OWNER. V Z W � LICENSED CONTRACTORS DECLARATION W � 1 HEREBV AFFIflM UN�ER PENALTY�OF PERJURY THAT I AM LIC�NSE�UN�ER PROVISIONS OF CHAPTER � . � 9(COMMENCIN�WITHSECTIONiqOo)OFDIVISION30FTHEBUSI�ESSANOPROFESSIONSCODE,AND Z X� MY LICENSE IS IN FULI FORCE ANq EFFECT. ' {✓@/�y ( m � LICENSE CLA55 �V�f'�`I!�� LIC.NO._ __""��� — � F— ! �,/y WDATE r z !_I',Y P f9-� d COMRACTOR d � WORKERS'COMPENSATION DECLA TION � � ¢ � I HEREBY A ,.IRM UNOER PENALTY OF P�RJURY ONE OFTH6 FOLLDWING DECLARATIONS: � � Z , C1 HAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWOflKEflS' _ ' ' ¢ COlAPENSATION,ASPROVIDEDBYSECTION37GOOFTHELAeORCODE,F�RTHEPERFORMANCE �U ' OF THE WORK FOR WHICHTHIS PERMIT IS ISSUED, � 0 W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRE�BV SECTIDN � /9{q a 37�OOFTHELABORCODt.FORTHEPERFORMAN�OFTHEWORKFORWHICHTHISPERMITIS �:/, � ISSUEO.MY WORKEAS'COMP NSATION INSUq i1SCE CARRIER AND PO NUMBEfl ARE: CONSTRUCT70N d .�9,,� ] CARR�EF ��,,y �''�`'� �� PLAN REVIEW Z PDLICVNUMBEF (S"�- �����b "L ELECTRIC ¢ � � (I}iISSECTiONNEmNOTBEOJMPLETEDOFh1=PEflMITISFORONEF'UNDREDDJlLARS($100)ORLE55). PLUMBING I � ICERTIFYTHATINTHEPERFORM1IANCEOFTHEWORKFORWHICHTHISPERMIiI5155UE�,l MECHANICAL Z (,'} SHAILNOTEMPLOYANYP�ERSON�NANYMANNERSOASTOBECOMESUBJECTTOTHE '� � WORKERS'COMPENSATI�N��AW�OFCA�JFORN�A,ANDAGREEiHATIFISHOl1L�BECOME INSPECTIONFEE F- SUBJECTT07HEWORKEFIS'COMPENSATIONPROVISIONSOFSECilON37ooOFTHELA60R � CO�E,I SH LL FORTHV✓ITH COMPLY WITH THOSE PRO ISIOWS. ISSUANCE p DATE: �x' 'APPLICANT. - _ SMIP ,',� J '� ENERC�Y P/C ._ J WARNING.FAILURETOSECUREWbRKERS'COMPENSATI OVERA EISUNLAWFUL,ANOSHALLBE W SU�JECTANEMPIOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSANO ENERGYPERMIT OOlLARS(5100.000),IN A�DITION TO THE COST OF COMPEN5ATION,DAMNGES AS PROVIDE�FOR IN � SECTION3�080FTHELABORCOD�,INT�REST,ANDATTORNEY'SFEES. RETENTIONFEE: �I O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEPE6VAFFIflMUNDERPENALTY,OFPERJURVTHATTHER ACONSTWJCiIONLENDiNGAGENCY n' FOR THE PERFORMANCE OF iHE WORK FOR WHICH THl RMIT IS ISSUED(SEC.3097,GIV.C.). � Z W T LENDER'SNAME � _ � I_- LENOER'SAD�RESS _ ` � I GERTIF1'THAT I HAVE PEAD THIS A PLICATION AND STATE THATTHE ABOVE MFORMATION IS OJRaECT. TOTAL FE ES / ��� � w IAGFEETOCOMPLYWITHALLCITYAN�COU�iYORDiNANCESANDSTATEL4W5FELATINGTOBUILDING � CDNSTRUCTION,ANDHEREBYAUTHOflIZEREPRESENTATIVESOFTHiSCGUNTYTOcNTERUPONTHE ZA80VE-MEN�TIONE�PqOPERTY FOR INSPECTION Pl1RPOSES. COMMENTS -- � �° •/�1��+j "1 � 5 1- �.(�� �f"�Id _ �1 m PERMITTEE NAME(VJTJ Q � ���__,.----� ,� ra�—r�, Vy SIGNATU 'RMI� DNT� ` _ � RECPT.NO. PAID BY � . . 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