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HomeMy WebLinkAbout15500 (23) � �� CITY OF DIAMOND BAB � � �r -- — DEPARTMENT OF COMMUNITY&DEVELOPMENT SERYICES �Y � 21660 E.Copley Drive Suite 190 (409)860-3195 F�(909)$61-3117 PRESS � ��+'� BUII.DIDIG PERMIT APPLICATION FIRMLY' � D R'E5S ��J 3 J(:��S � � APPL1CATfON PERMR � f� P/C DATE NUMBER � v # I $ ISSUE TYPE OCC j � APN LOT ,���. TRACT DATE CONST. GROUP p OWNER YJ(Cri cl.C�C_ �l N ADDRESS ZONING SETBACKS � CITY ZIP TEL. � Z�� REART Rw p APPLICANT TEL. SIDE/SIL)E STREEf RW ❑ ( � CONTRACTOR � l� (ZQn,��� SIDE ❑ ADORESS S '� fo T��rC � CITY 'Q 1 ✓�� ZIP tEL.��J�����_ PROPOSED USE� ff l� f�'L,L � � �� w� ARCH/ENG/ ' � DESIGNER NO.DWEL. NO. NO. '�"� CIT' E� ZIP TEL. UNITS STORIES BEDROOMS ` v� DESCRIPTION SQ.FT FACTOR PSF ADJ.AREANALUATION Q ONMER-9UILDER DECLARATION gFpJADD/REM O 1 HFRFAV AFFWI UTAER PEN.LLN OF PEILA:RY THAT 1 AM EXEMPT FROMI THE CONiRAC70R5�I- Ge�yBBJCBlPOR 8 CENSEIAWFON7HEF011OM7NOP6lSON�SEG7031.58USINESSANOP�ES510NSCODEANYGTYOR (n �] COUNTYWI4CHREdNiESAPERMffTOCONSTRUCf,AL7ERMPROYE.DFJ10LI5M.ORNEPAIRANYSTRUC- W Z iUNfi,PIiOq TO R8188UMICE,A150 REWIpES iNE APPLICMR fOR SUCH PERYIT TO FILE A SIQI�D Patio/Dadc ��j� STAIEMEHT TNAT NE�I SHE IS LICENSEO PUi35UNIT TO TNE PfiOVI510N5 OF THE CONTRAC70R4 LI- W CEN6E UW(CH�PTER Y(CONYENCWO NATH SECTIOH 7000�OF DIVISION 3 OF THE BUSMIESS ANO PRO- � PooUSpa FE3.4pNSCODE)ONTHATHEORSHEISE%ENPTTHEf1EFROYANDiHEBASISFORTHEALIEOEDEXENP• (' V TION.NtYVlOIATqNOF5ECT10N7031.6BYANYMPLICANTFORAPEFlI1TSU&IECTSTHE�PPIICANTTO Z qg-Rpp} � � A CM�VFNM.IY OF NOT AIOpE THMI FIVE HINJDHED DOt1AqS(;5a0).): � ❑4��ENOFTHEPROPERTY,ORMYEMVIOYEESWITHWAOE5A5T}1EIRSpLECOYPEN5A710N, � COR7111BfC18I WILI DO THE WOPI�MD THE STRUCTURE IS NOT INTENDE�OR OFFEREO FOq SALE(SEC.7ou,8U51- J y ME55 M$1 PIqFE551ON3 COOE:TY1E CONfMCTORS LILENSE UYV DOES NOT APPLV TO AN OWNER OF ? PADPERTY WF1094J6DSOf1 NFPROVES THEqEON,AND WHO pOES SUW WORK HIMSEIF Oq HEpSELF Ofl Q iW�0U0NNI50qMEROWNFdIVLQYEES,PRDVIOEU7H�TSUCFIIMPROVENENTSARENOTINTEN�EDOR � Cl ���E'IF,FIOWEVER�Bl9lDWdORM1PROVEMEMI550IDWITHINDNEYFAROFCOMPLE- � iION,iHE OWNER-9URDEF WILL HAVE iHE BUflDEN OF PROVN6 7H11T HE�q SHE OID!qT BUItD OR tlAPAOVE FOq THE PUIIPOSE OF S/J.E). � ❑4ASONMEROFTHEPPOPENTY./iMEXC1t13IVElVCONTMCT�NOWITHLICENSEDCOM�MCTOR9 �-7 TO CON^+TRUCT il¢PROJECT(SEG 70M,BUSINESS�NO PROFESSIOMS CODE:TME WNTRACTOf#S ll- V8lueti0(1 !� � ADJ.AREA f�M4E LAW OOES NO'f APPLY TO AN OWNER pF A PPOPERTY WFiO BUILDS OR NAP{�yES 7HEAEON,AND � WlqCONTRACT5FOR5UpiPROJECT5NA7H�00NTRACTOR(5]LICENSEDPURSUNltTOTNEGOHTqAG OUAN7ITY DESCRIPTION �� � TORS LICENSE U1W.). ❑I AM EXE4IPT UNOER SEC. B.6 v.C.FOR 7Hi5 REASON a U � � C�h OWNEH V 2 W � IICENSED CONTRACTORS�ECLARA710N W INEREBYAFFIflMItt�tlERPENlI�TYOFPEfUURVTHATIAMLICENSEDUNDERPROVISIONSOFCN�VTER V. � �(CdWENCMI(3Y/ITHSECTKINIC00)OFOIVISION30FTHEBUSINESSANDPROFESSIONSCOOE,AND Z �� MY LICENSE f5 M FUl FORCE M1D EFFECT. J� �L � LICENSE CLA53 � LIC.NO. {L'��� / � � wDATE � �� CONTMCTOR��'l.�„C_L��� d � WORKERS'COMPENSATION DECLARATION Q = U NI HEREBYAFFlPM IXdDER PENA�TY OF PERJURY ONE OFiHE FOLLOWING DECLAWITIONS: z � _IHAVE/✓AWILLMAtNTA1NACERTIFlCATEOFCONSEMTO3ELF-IMSUREFORWORKERS' r COMPEN4ATION,AS PPOVIOW BV SECTION 3700 OFTHE 1A80R CODE,FOR THE PERFORMPNCE W OFTHE WORK FO{i WHK)/THIS DERMIT IS ISSUE�- � � w 1 NAVE ANO WILl MAMTAM WOPo(fA5 COM?ENSAT70N iNSUMNCE.AS REW!RED 8Y SF.CTION Q 77a00F7HELABORCODE.FOHTMEPEqFORMeNCEOFTNEWORKFOFWHICHTHISVEHMITIS � f /�^ /�;1 � ISSIlED.MY WORKEFl�S-'-C�O�M�P�ENSATION Ifi5URM10E CARRIER M1D POLICY N'JMBEFARE: CONSTRUCTION (L�,�J jCAqq1EH rK-u���(:� C'� PLAN REVIEW '��.`�FT�'.�:�� � !'OLICVMMfBER lnJ��-O 0 b ELECTAIC �,i` . . � �� ���'����)l�.i4`��ii�t1 k::�;;� 0 (n+5s�cno�+n�raoTeEa�.er�oFn+�aEw,rtSroaaNE�noaEn PLUMBlNG t_ �3T���f..�A1N'" z <;�;�.�;-rn, � 1 CfRTfFY h1AT p7 TiE PERFORMPNCE DF THE WORX FOA WH1CH TH15 PERMiT IS 1SSUED,1 MECHANICAL E 5 ���--� (�7 SWLLLNOTEMPLOYANYPERSONINANYYANNF.RSOASTOPECd.�ESU&IECTTOTHE (n MKlRKERSLONFFNSATIONUWSOFGILIWRNIA,i1NDAGflEE7HATIFISMOUL�BECAME INSPECTIONFEE S SU&IECTT07HEWd1KER5'COAIPENS�TIONPROVISIONSOFSECTpN37000FTHELABOP sH cor+i'\m�nrNwMa�rvnnrnroserra/o�v,i.s,ior��s. ISSUANCE ��-�Q � �V �I Il.f ��[L� SMIP ` (�_ p DATE APPLICANT: wWMNINf3:FA0.UqE TO SECURE WDRKERS'GOMPEN9ATION COVEMGE IS UNLAWFUL AND SHN.L BE ENERGY P/C �y SUBJECTANEMPLOVERTOCRIMINPLPENALT�ESANDCIVILFiNESUPTOONEHUNDREDTHIX15AN0 ENERGYPERMIT Wl1/�pS({taa,oa0),IN ADOIt10N TO THE fAST OF COMPENSATqN,DAM�GES�S PROViDED FOR IN J SECfION370EOF7HEUBORCOOE,INTEPEST,ANDATTOFiNEY'SFEES. q�ENT1ONFEE: � a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � 1 HFAEBV AFF1M1 UNDEA CENAiTY OF PERlUFY THAT THEAE SS ACCYJ5TRUCTION IENDIN6 AGENCY Z FOR THE PERFORMANCE OFTME WORK FOfl WNICH iH15 VERM�T IS ISSUED(SEC.3o97,CIV.C). W � LEPIDEN'S NMIE � LENDEP'SMDHESS ( � ICERTIFYTHATIHAVEFEADTHISMPLICATIONANDSTATE7HIITTHEABOVEINFORMATIONISCORR TOTAL FEES � 1 AGqEE TO WMMV WITH ALL CITY AND COUNTY Ofl01NANCES ANO STATE UWS RELATING TO BUIL � CONSTRUCT�ON.M�0 HEREHY�UYNORIZE RECRESENrAT1VE5 Of tHIS CWMY TO ENTER UPONTH Z q@pyE•MENTIONEU PROPERTY FOR INSPECTION PURPOSES. COMMENTS o � � �T� � I m PERYITTEENMIElP IfT) �/ a - v v, ci � SIGIUNREOF DATE � RECPT.N0. PAID BY YAUOAT4pN WHITE—Department Copy,YELLOW—Fnanco Copy,PINK—Assessor Copy,GOLD NROD--File Copy,G EEN—ApplicanYs Copy .. � �.. , ____��._,..�.__�_ .. �--i--, , . �.. �4 -----,— j�--�� �;.���I r�_ � � � t��� 3 `� ` � `; �� �i';Ti F ; , �i t - i � a � n�t " C' s 1 7 tsE :; .., fr "Ci� . � � .� �� � � .. � , � �� � � � ,k'n 'i�� ��, �.' � �: c� c .� c �- ,� '� I� j ' ; , �. �t _ x p � r7 �' � �. � i � i � i � i i � �` "��") �! �G ��. �. � � E 9� � _ _ .'-. � �,[ "1 "T . ! � � � . �._ � � lt7 c� � _ r . ��Ci ' Y � ii � � ic3��� ri � � . 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