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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. 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