HomeMy WebLinkAbout15603 (22) ` 1,� CITY OP DIAMOND BAbt ( �J
� DEPARTMENT OF COMMU�iITY 8c DEVELOPMENT 5ERVICES U
�w 21660 E.Copley Drive Suite 190
�,,., (904)860-3195Faa(904)861-3117 PRESS
BUILDING PERMTT APPI,ICATIQN FIRML.Y'
N JOBSITE i�/�/7����� APPLICA PERMIT P/C {
�
ao ADDRESS J DATE v NUMBER � #
g ISSUE /� TYPE OCC j
APN LOT TRACT DATE� V CONST. GROUP
p OWNER �
o ADD ZaNING SETBACKS I
z CITY - „$ FRONT RW ❑
g APPLI ANT REAR p
� SIDEJSIDE STREET RW ❑
CONTRAC f�i SIUE ❑
� ADO
CI T PROPOSED USE
o ARCWENG/
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
N
�n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFRlADDlAEM
O
0 1 HEIIEBY AFFIRI/UNDER PETLILT'OF DE(W RY iHAT 1 M1 EXEAIPT FROM THE 0.�NrMCTORS LI. Ga�Bge/�.•afpOfl
W CENSEIAWPoRTHEFIXIOWWOPEA50N(SEC.70.11.58USWESSANOPflOFESSIONgCODEANYCITYOq (fj
L7 COUKiYYANCii�pncaAGEN/IT7000NS79UCT,�LTER�PROVE.�E40LISH.ORPERVRANYSTRUC• W
�L NflE,PRIDR TO IT9 13.4UµCE,ALSO REOUIRES THE APPIICMiT FOR SUCH PERMIT TO FI(,E A S1faNED W PatielDeck
� STATHAfNT THAT HE OR SNE IS UCENSED PURSUANT TO THE PF�VISIONS OF TME C001TPACTOpS��• �
r CFNSE UW(CFi/�7TER Y(COYMENCWO WIT1 SECiION 7000)OF DIVISION90F THE BUSINESS AND Pq0- PooUSpa
� FESSIDN.4CODE)OR7HA�HEORSHEISfXE4/PTSHEREFRdAANOlHEBA4ISFORTNEALLEpEDEXEYP- (�
V TION.ANYVI�LA'fIONOF3ECilON7031.5BVANVAPiIIGNTFOqAPEP.AMTSU&1ECTSTHEAPPLICIINr7p z �qpp�
� A CML VENALTY OF NOT 1AOHE 7HAN FrvE NUNOaED DOLLARS(S600).�:
� ❑I,ASOWNEqOFTHEPROVERT/,ORMYEMPLOVEESWiTMWA(}ESA5TMEIRSOLECOMPENSATqH, � Comm8fCi81 -
NMl DO 7NE WOiL(,AND THE STRUC7URE IS NDT IMEf�ED ON OFFERED W R SALE(SEC.7ou,BUSI- J
� N68S AND P7qFE55qN$090E:iNE COe1TR�CTORS LICENSE lAW DOES NOT APPLY TO AN OWNER OF �
Pi1OPfqTY WHO WNDS OR NiPqOVESTHEREON,AND WHO DOES 6UCH WOFN HIYSELF OR HER6ELF Oq
� TNfiO4JOMNIBOPNEHQYR�IEMPLOYEE3.PROVI�EDTM�T9UpiMiVROVEMENTSqRENOTINTENOEDOR m
l�1 ,OFF6�WRSALEIf,FqN1EVER7ME8UILDINOORMIPROVFJIEMISSOIDWffHWONEYEAROFOQ4PLE-
V TqH,THE OWNER�BUILDER VALL FU1VE THE BUHDEN OF PFOVIN(i THAT HE Oq SME DO NOT BUILD OR
� YPROVEFORTHEWRPDSEOFSAL�.
W ❑Lti40WNEqOFTHEPROPEHTY,NIIXCLUSNELYCONiR�CTMN3IM�HLI(�NSEDCON7H�CTOH3
Q TO OONSTRUCT 1TIE PRO.IECT(SEC.70M,BUSMESS M1D PROFESSIONS COOE THE CONTMCTORS LI• VeW8110f1 ADJ.AREA
� CENSEIAWDOESNOTAPYLY70ANONMEHOFAPflOPERTYWHOBUHD50RIMPPOVESTMEREON.AFID
WHOCOHfMci5Fofl8tlCHPtW.IECisvaiT/tACONTMc70n�5)licENSEDPURsuAM'io7tffcoNTMG QUpNTITY DESCRIPTION FEE
� 10N5 UCENSE UW.).
❑1 A►1 EXEMPf IN�DER SEC. 9.3 P.C.KOqTIi15 FEASCN J
Q
3 �
� �
DA7E DWNER U
� �ICENSED CONTqACTORS DECLARATION W
� I HEiFPV AFFIpN UN�Eq PENV.tt OF VERHIM TNAT I AM LICENSED UNDER PPOVISIONS OF CHAPTEH � -
(_ •(COMMFNCMO WITH SECTqN 7000)OF DMSION 3 OF THE BUSINE55 M!D PROFESSIONS GODE,AND Z "
u' MY LICENSE IS W L FOR AND EFFECT m
� � S� LIC.NO. � ^ / g
�
�"� OA E� CONTMGTO � d
� WORKEfiS'COMIPENSATION DECLARA710N � �ciJ� Q I �
� � U
� IHEAEBYAFFIIWUNDEPPENALTYOFPERIUPVONEOFTHEFOLLOWINGDECUNATKKJS: z
0 1 MAVE M1D WrLL M10HTAtN A CENTIflCATE OF CWISENT TO SEIF-INSUflE FOR WORNERS' ¢
Z - S
COMPENSATION,A9PROVIDE08YSEC710N3'1000F7HEUBORCOOE,FORTHEPERFORMMICE U
d OFTHENbPK FOR WHICH TH�3 PERMIT IS ISSUEO. �
�
� _IHAVEMIDWILLMMNfAINN�ORKER4'COMVENSATIONINSIJRANCE.ASREWIREDBYSECTpN
� 37ooOFhIEU60RCOOE,FOR7HEPEHFORMIINGEOFTMEWORKFORWNICHTHISPEPMI7IS
ISSUED.MY N'ORKEFl3'OOYVEN3A[IQ�I7NSURA4lCE CAftRIER ANU POLiCY Ni7�EA AAE: CONSTA�JCTION
j y� c�wmEp PL4N REVIEW
� � POIICYTAIM9ER ELECTRIC
0 [n+s�r�rrort�aa�rEoovn+erew.rtswna+er�e000uAasry�m�oA�ssi PLUMBING /G.,LI v
Z I CEpTIFV THAT M7NE PERFORNANCE OF THE WOHK FOR IS Y . 515 ED.I MECHANICAL
� SNM.L NOT EMPLOY ANY PERSqJ IN ANY MANNER 50 AS E &1ECT T HE
� NORKERS'COYPENSATqNUW50FCALIFORNl0. AEE IFl ECOME INSPECTIONFEE
i � SUBJECT TO TM M'ORKERS'COMPENSAYION PROV �iN5 OFTHE UBOR
O ���CuL �rvnrH ca�.�v�r win�nas ao�s. ISSUANCE ��
/�
p OaTE�=�"" � APPIICANT: SMIP
W y ENERGY P!C
� WAIVtlNO:FALUflE TO SE/.l1RE WORKERS'WMPENS�TqN COVERAGE IS U ,M!D SHPLL BE
� SU0,IECTANfMPIOYFqTOCA1MIN,4LPENAITIESANDCIVILFME5UPT0 HUND UTHWSAND ENERGYPERMIT
OOLUi15(f140.000�.INlDDIiION TO THE COST OF WMPEfiSATpN.�MU 5 AS P EO FOR IN
J SELTpN 970!OF TNE 1A00R CODE.M7EREST,ANO RTTOHNEYS FEES. RETENTION FEE:
Q
d COMSTRl1CTION LENDING A6ENG PRE-ALT FEE:
O
� I HEREBV AFFlRM UNDEP PENALTV OF PER1l1RV THATTMERE IS ACQtJSTRUCTIOM�EN�IN(i A6ENCY
FOR TNE PERFORMANCE OF THE WORK iOR WHICH THS PERMIT IS ISSUED(SEC.�Ov1,CIV.C.),
Z
W
� LENOEFCS NUIE
1�S LENDER'S MORESS �/�,,,
"� ICERTIFYTHATIMAYEREADTi15APPLICpT1ONAND3TATETHATTHEABOVEINFORMAT10N15COHRECT. TOTAL FEES A "! 1 �G��
� IAOHEE TO WMPLV WITH ALLCITV INO COtINTV OROINANCESAND STATE LAWS REU�NO TO BUILDING t�1���
� CONSTRUCTIQM;�11��NEREBVAUiHORIZERE>FESENTATIVESOFTHISCOUNTVTOENTEHUPQPITHE
ABOVE�MEr�rWNEqPROPERTY FOR INSPECTION PURPOSES.
Q ��f COMMENTS
� v�
m PERMITTE E(P 1 �_� /f)7^�
a L%v
�
� SNi URE PEPM �ATE
� RECPT.NO. + PAID BY � YALIOATION_�__
HITE-0epartment Copy,YELLOW�inarae Copy,PINK—Assessor Cppy,GOLDENRO�File Copy,GREEN—Applicant's Copy
__��___._--�—_.—�—�- i � � � ,; � �� '�� �;,��,,� �;T„�� ,�� � �.�
�—___i �� � r � �� �
��7��� 3! 9 �+ � � ;� I�� � t �i �, ,�, iS,���C � .
.� ; t I � : ;, - � � .,-' 1_ -� i �•-1 �r �'�" —z � �
—C �-� i i i ( i � �C � - i ;. � �v 7 ��"j E ,` �� ��S- � { ��.,�� ,
( � - i � i t � � � �E ( �,_ r � t i � I �f i, � '� �
� yi � � � � ! � ; I � � _� f � c I i ,�� c_�i � rr� € i. � ' �
� i , � I� � � � I r" I� � � 3� c�
� �, i � ! � r E �� � � ��, � _�— r>� � !�
� F� � � � � � � .��� :'� �iU> �,=�a"3 1 ���' d �i —�`�,f—�
�
,tE � � I
' � ., � � �, __� ���..� , � � � I I � � � I �
� � � � � � I �_ � � .�.._. � �,�-- • _._
� i � I I �,
. b � ' I
�.� � �-� __. .- � � i ` � � � � i ? � � � ' � � , i �, 1 � �
� � � � ' , f 1 6 � 7 I �, � �
� � ' �� � `' ' i i � � � � ( '�a
e
� ,
� �
, , I � � � � i f
� ` ; � ' , � � ' --� '$_ _ � —, — — — ---! , i.._
; , �
� l i � , i! j i i i , F...i ( � ; � '' � _ . ; ' i i_
� , �
� � I i E �
Z � � � � � I � � i 1 I � j ? � ( i � � � ! � I s , If I .. � vC.
j i i I i I i � i i I i j � � I I i I � ,` ( ( i i � ( i i . I a
�) i � { i
� � � , , , 'j � i ; � , � ; , , � , � i ; ( i � � , � �
�
� ,' ; � f + � '� , � { , � � � ; � � , � ' � , , ; � ; , �, � �
, 3 �
� �
� ;
i , , , r � , I � � � ; ; j "
� ' i � 4 � � � �`
� � � a I � ' � � � � � ; � -� !_ � � i � � _ � �.,�P
� :, i i � ._ __ j i . ... �--( � - � i �'Ili'T'� � '"�
� ; �, � ; � � � � IYT � Izt � _9 ' ` � Ti�� �� �Iti� �l� �� I -�, -, �i �
� ' � E � i i ' � r�; -� I , ����, Ir
�� { ��r� c�a�c� c� a � �;:� �,� �x c _ ;
rr . x � C7 �r � m � �z �c, � �
'. I s � : � ( � !� i� r' � -�) � I� �r�i� � ��z��_ `�L ��� � _� ��� � '
- � � ( , � f r7 I S � r t i
E E i � � I : � ( ,-i r 7 r� r� f i -� i -u y� �, �t �
, ; ', s i ' r t;= -r� ,� t� :..� iitrlq.�� rr ��. '���,'���i��C', c�j' c7�"� �ir-' � - 9S' �
� � � i � � � � � E ! { ��I u� n��' �� �=i��r-iC,Is-t,c- �, , i`;I� � a, � QIC��� � $F �.a
; � ` � j ( i i , { l�, �� =i i � I�a,� .��Ii t, iai e- �I r" ( �4 �I (� � f"
� I � ( -� � �I I � i I�' �'�Gyl :'� �n�o; ���`. � � r�
; ��I i { � i I � I � � ' _'y� ii � ;�., � y 14:� '` :z �C �r :�
i � `� � . � i I� � : r � i i � � Ei � I �i i I ` 1 ��--+ cw. �
� 1 �� � � : . � � . � � 1 � �� _ � I � � . � � i , i I �(
�
; � �
i i � i � � I 1 � � � �
� i
� ( � � i � � � � � _I I —'t--� -- � � — =--
i I
� ; � � : � j � , , � � _—f- __— I
� ; � , , � � ' ' � i { i , �' j + , I 4 '.
� � , � � I � � �� � ' � � � � � ', � � � � � ' � �
F ; � � � !, � I '� , ; '� ; , I I, � ' ' � ; . , i �
� � , , � 1 , , � , �.
f
s � � , , � � ; , � , ' � � ' � � �-- -- —
; ; i
, ' ,' � i , ,._ ,. i �
� � , � , 3 a �� �� ; j � , � �
! � I � '; I � ; j j � I � � � � � , i � ; � ; � ; , ,
� , , j ' � ' � � � � G i � � � �.
E � � ' � I i � ` � i � � I i ' �
� '
: � i ' i �` i I ( i ' � I � I ; I l � � 's, � , � � i ( ( i °"
, � I I � I ; �, i { i ` � ; I I i 3 �
i ; j ' I j � ; : I E ` % ; � f i ��
� � � , � � ; , � � � I �� � � j : l � � �
� ; � � �
, � � , , , �; ; ` ; � � ; '� , � � C � � � � ��. il �_� � � �
, ; i ' � , u_�_._�_� w_���__.� _ ._�___-__._ __ __.. _._,_._.._
�.__..�_ ----�- ___ _..p__�_.:��__�______i__�.��__ .�_ __ ___._ �