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HomeMy WebLinkAbout13334 • CITY OF DIAM4ND BAE - - DEPAR'TMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Capley Drive Suite 19� (909)860-3145 Faa(904)Sb1-3117 PRESS BUILDING PTRMTF APPLICATION FIRMlr o� JOBSITE 'IQSS (��N7L� Y APPLICATION �� HUMB R �I �3� #'� ADDRESS a�/ DATE � APN LOT�_ TRACT �7 Y � DATE r' • CONST. GROUP p OWNE�ElN p ADDRESS �J�}r�7� 20NING SETBACKS W CITY ZIP TEL. FRONT RW ❑ � APPLICANT fell/tLN�_T,(ZO L,� TEL. —/L/! REAR ❑ � SIOElSl4ESTREET RW ❑ C�NTAACTO _ �-N✓T �V� SIOE ❑ � ADDRESS G�LD �K CITY l✓ L41 U ZIP / � TEL. S-�2 PROPOSED USE �� ARCHlENG/ �dN ���� �� OESIGNER NO.DWEL. NO. NO. ADDRESS ' UNITS STORIES BEDROOMS � CITY,�-��/ ZIP j���TEL. y DESCRIPTION SQ.Fi: FACTOR PSF ADJ.AREA/VALUATION Q ONMEA-BUIIDER DECLARATION SFR/ADDlREM O p I IfEf�Y AFFIPM UNDER 4Et1Al7Y�PERF]RV 1HAT i Ni EXEMPT FAON TNE CONTRpCT0175�I- �'jdfeQB/CdtpO([ lll CENSEtAWFORTHEFOILOWNHiNEASON(SEC.Ta31.5BU51NE55ANDPROFE5510N5CODE:ANI/CITVOR (,� C� WlY[fYWMCNq[-01I1F1E3�PEq11fTTO00N5TRUCT.ILLTER.IMPROVE.DEfqL1SH,ORREMIqAWYS7RUC- W Z TUfiE,ONOPtlO lT8 t53UANCE,AL90 q[W WES i/1E APPIICANT FOR SUCFI PFFWIT TO iILE A SIGNED P��O� � STA7BIEM 7M�T XE OFl SHE IS IICENSE�PURSUMIT Ta THE PROVISIONS OF THE COl1T9,1GTWiffi LI- � � �UW(p1AiTER Y(OOM4ENCINO NIITH SECIION 7000)OF OIVISKKi 3 OF THE BUSINESS ANI]PRa- LL POOUSPB fES510N3COBE)ORTH�TIEOi19HE15EXEMMIHEREFROMANDTHEBA315FORTHEAILEGEOEXENP- (� TION.AM'VIOtAiIQNOF86CT10N7a71.5BYAMVMPLIG�NiFORAPERMITSU&IECTSTNEAOPLICAHTTD � �-ROO( � ACMIPENAL7YOFNOTEqfiETNANFNEHUNDREDDOLURS(f5a0J.j: ^ ❑4��EROFTHEPNOPEflTV.ORMYE1lPLOYEG5W17NWAGES�STNEiR50LECOMPENSATION, (�`ORIIfiBfC�aI �'�' 'MLL DO 7}1E Y/OHK,M1D THE STRUCTUflE IS NOT INTENOEO OF OFFEREO FOR SALE(SEC.7ou,BUSI- � � NE59 At#)PROfE5510N9 OODE:7HE CONTRACTORS UGENSE L�W DOES NOT APPLY TO AN OWNER OF � PHOPERTY NR108U�.DS OR MIPHO�ES THEqEON,N�l�WHO DOES SUdi WDRK HIMSELF OR HERSELF Ofl Q TNNOUOMMSORHEPOWNEAPLOYEES,ORDVIOEDTHATSUCMIMPpOYEMENTSARENOTINTEN�FaOq m W OFFHimFORSKEff,HOWtVERSMEBIJKDiN60RMfPNDYFYIXfISSOI➢WRHINONEYEANOFCnYPIE- Z t10M,THE OVMEq-0UILDER VALL MAVE TME BUNDEII OF PROVING 7HAT HE Oq SNE DIO NDT BURD OR = IYPNOYE FOR THE PURPOSE OF SILE�. ? � OI.A4dY/�KHOFTNEPROPEiiTV.WE7tCLUSNEtYCONTRACTIN6WITN�i^EN5EDC0l1TRACTORS � 70 CON311M1CT7HE VRUIECT(SEC.7W4,BU31NE55 AND PPOfES510N5 COC E:THE CM17R4C70HS LI- VBIUPIIOfI ADJ.AREA G6NSE UW DOE3 NOTAPR�TO AN OWNER OF A VROPERTY WHO BUILDS OR NVPROVES TNEAEON,Ad0 Yh7000MMCT3FORSUCliPRQ1ECTSN/ITHACONTRACTOR(S)UCENSEDPUFSU�NTTOiMECONTMG QUANTITY DESCRIPTIOM FEE , � TdNS LICENSE WY.). — O I IW EXEMPT IAiDER SEC. 6.6 P.C.FOR THIS REISON Q � , � U t� ¢ o►� owr+Eq V � � UCENSE�CONTAACTORS DECUFiATION � � w IHEqEBYAfFtPoAUt1ERPENIITYOFPE0.1UqYTNATIAMLICENSEDVNDERPROVISION50FCHAP7ER V. �(OOYYENCNM3 W11H SECTION 700D�OF�IVISION 30F THE 6USINESS ANO PPOFESSIONS COCE,AN0 Z YC MY LICEMSE I5 M FUl FOflCE MIO EFFECT. � ' • LLl 0 LACEN&E CUSS LIC.NO. � � � J V pATE CONTRACTOR � � WORKEHS'COMPENSATION DECLARATION ¢ � � � fHEHEBYAFftAML1Nt1EAFENALT/OFPEAJUAVONEOF'HEFOLL0IVNGDF.CLAPA710N5: Z � _IHAVEMID�MLLMAMTAINACERTIFlCATBOFCONSENTTQSEIFINSUP.EGORMMJRKERS' $ CONVENSATpN,ASPFlOVIDEDBYSECTIONT/000FTNELAeORC06E,FGRTHEPERFOqAIANCE �U � OFT4E WOPN FOq WHIC{I TNIS PERMIT IS ISSUF.D. � 0 � W IHAVEM/OWILLYARlTNNWOftKERS'COMGENSATIONINSUflANCE,A5RE0UIRE0BY5ECTION d 37(IOOFTMElA90RCq)E,WR7NEPER�ORMANCEOFTHEWORKWRWHICHTHISPERMITIS dJ ISSUED.MSNOFRFAS'CONPENSATIONlNSVIiANCECAPP.!ERANOPOLICY4UMBERARE: CONSTRUCTION I'S � } CARq1ER PIAN REVtEW _ ��,�� '+ � POLICYNUM6ER ELECTAIC _ ..m ���p,_� :4� 1 Q (nYss[LipNMEIDra7BFod.rLETE�oFnErEF.rrISroRONEIUMREnoaLVtsR�aolorlLtSs1 PLUMBING �''il�'�.�-'�'� 1 � W ,E'� /� Z ICERTIFYTHAT W hiE PEPFOAMANCE Of�FiE WORK FOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL �� � � ) (i SHALt.NOT fMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SU&IECT TD THE --���� (� M�1�EA5'COMPENSATKKIUWSOFC/LIFORNItiAN�AGREETNATIFISHWIABECOME INSPECTtONFEE �� "�i + SI/BJECTTO7XEv10iacENSCOMIPENSATqNPROVISpN50F5ECT�ON]7ooOFTMEIABOR 1 )A s CWE.ISWLLLFORTHWI7NCOMP�YWIhiiHOSEPflOVI5lON5. ISSUANCE r�+� ..�..y�'3 '-_*t,�l -�t�� � SMIP �`� �� �- p DATE: APPLICANT: w ENERGY P/C !"`"�� ,`� � J W�ANINO:FAIWRETOSEWAEWORKERS'CO�MPENSATIONCOVEMGEISUNUWFUL,ANOSHAL�BE ('���y(� � SUBJECTNIEAP�DYERTOCRINiNAIPENALTIESANDCIV�LFlNESUPTOONEHUNDREDTHWSAND ENERGYPE'Fi74(�1.t+ ���� � DqLARS(j100,000).Ml AODITION TO1HE COST OF COMPENSRTqN,�AMAGES i15 PqpVIDED FOH IN J SEC�ION 370!OF 7HE LABOR CODE,INTEREST.ANDIITTORNEYS FEES. RETENTION��y O CONSTRUCTVON LEtJDiNG AGENCY pqE-ALT FEE: � 1 4 1 HEREBV AFFIHAI IINOEN PENAL7V OF PE0.IURV THAT TlIERE IS R GONSTRUCT�ON�ENDINO AGENCV FOA THE PEAFORMANCE OF 7HE WORK FOR WHICHTHIS PERMIT IS ISSUE�(SEC,3oW,qV.C.). � Z � R } i u� � �EN�ER'S NAME 1S— LEN�ER'SADORE55 '+ IGERTIfYTMATIHAVEREADTM�SAPPLICATIONANDSTA7ETHATTHEABOVEINFOPoAA710NI5CORRECL TOTAL FEES Q IA6REE TO COMPLV WIiH AlL CiTY ANO COUNTY ORDMANCES AND S�ATE V.WS REIATINO i0 BUILDING � CONSTRUCTION,AN�NEREBYAU7FIORIZEREVRESENTATIVESOiTHiSCaUNTYTpEMERUVONTHE ABOVE�MEHfqNED PROPERTY WN INSPECTION PURPoSES. COMMENTS � f�L L�w m PERMIiTEE N HI Q � � N SIGNANNE i E ATE � RECPT.N0. .. 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