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HomeMy WebLinkAbout15813 � CITY OF DIAMOND BAbt DEPARTMENT QF CQMMUNITY dt.DEVELOFMENT SERVICES � 21b60 E.Copley Drive Suite 190 � � � (9Q9)860-3195 F�(904)861-3117 PRES$ , �''""� BUQ,DING PERMIT APP'LICATION FIRMLY �r J09SITE ��S Q� f������C 7,�_ APPLICAr10 PERMR ��P/C o ADDRESS u N U DATE I t`� - O� NUMBER # � APN LOT TRACT ��VE NPE �C DATE CONST. GROUP p OWNE�iu-�'�— o ADDRESS �- F7-A - (.L- ZONING SETBACKS � � CITY �.�� - ZIP__ TEL. Io t" I�3� REART RW pp � APPLICANT TEL. SIDFJSIDE STREET RW ❑ � CONTRACTOR �Pt S1DE ❑ ! r� ADDRESS ' ' ` Q CITY(' rvn H....�GAc ZIP ("Io TEL. � � PROPOSED USE �GAR- ��Z � ARCHIENG/ �� ADDRESS NO.DWEL. 3� NO. NO. g a C�TY ZIP TEL. UNITS STORfES �_BEDROOMS J � y DESCRiPT10N SQ.FT. FACTOR PSF ADJ.AREANALUATION Q ONMER-BUILDEH D£CIARATION SFPJApDlftEM O � ��x�r�cFiw�umeA nEuulr nc vsnuAr nur i ua oc�avT Faou tHE corrc�ucroas u- Gerage/Carpon CENSELAWFOR7MEFOLLOWM'[ipEA00M(SEG.7031.5BUSME59ANOPqpFE5510NSCOUE:ANYCiTYOR (J� WIMRYW/RCHAE01APE9APE'fLMTOCONSTpUCf,ALTERtlAPNOVE.DEM10L1SH.ORHEPAiRANYSTRUC- W Patio/Dedc 7UHE,PHDR TO ITS ISSUMdCE,ALSp ilEpU1AE5 iHE APPIICANT FOR SUCH PERIAIT TO FILE A SIGNEp W .�, 37AlE4EM 11MT HE Op SHE IS LICENSEO PUq3UM1T TO THE PPOYISVONS OF TNE CONfMCTORS LI• � (�NSE UW�OUPTEq Y(COMMENCNICi W17H SECTpN 7000)OF DIVISION 3 0F TFiE BUSINE55 AND PH0- � POOVSPB FESSqfl4CODE)ORTMATMEaiSHEISE%EYPTTHENEFROA1MJ01HEBASISFORTHEAIIEG�E%EAIP- (!� TIOW./HYVIOlAT10NDF5EC7WN7W1.6BYMiYAPPLICANTFOR�PEPouIT&118JECT5THEAPP�iCM1TT0 Z qaRoof � ACIVIL PENALTY OF NO7 MOflEhWi FlVE HU4WqED DOLURS(�1.1: p ❑4��NEROFTHEPFIQPERIY,ORMYEMPLOYEES`M7HWAOESASTHEIRSOLECOMPEN3ATqN, O COMm8ICi01 � Z MIRL 00 7NE WORK,A!A THE STRUCTURE IS NOi INTEND6D OR OFFEP.ED FOp SALE(SEC.70H,&1S4 J � IESS IYID VNOFESSION.4 CODE:iVE CONiMCTOR3 LICENSE UM/DOES NOT�PPLY TO AN OYRIER OF ? PAOPERTYYIFp BULDSOR YPRONES TXEREON.AND MM1IO OOES SUCM YAqK H WSELF OR HERSELG Oq � THROUGHM80RMEROWNEYPIOYEE5.Pi1DYlOEDTHATSUCHWPROVENEMSAIiENOTMTENUEDOR � t�l aFFENEDFYKSALEIF,FqNEVE0.THEBU1lOWGOR�WROVEMENTI9SOLD'M7HWONEVEMOFCOYGIE Z TK7N,THE OWNEfl-BUq,pER MVILL HAVE TME BURDEN Oi PROVINQ THAT NE Oq SME D�NOT BUIID pq � YPRDVE FOR T1E R)RPOSE OF 31LLE} w i]1.7�40Yq�ROFINEPROPERfY,AYE][CIUSIYElVCONTRAGTINGWI7HlICEN5EDCONfR/.CTOHS ¢ 1CI CONSTRUCf TI/E PROJECT(SEC.loN,BUSINESS ANO PliOFES510N5 CODE THE CONiFACTOqS 1J. V81U9I10t1 A�J.AREA W CENSEINMDOESNOTAPPLYTOMI�WNEPOfAVROPEfl'iVVA1DWR.D90Rp1PApVESTMENEON.AND � 4MiOCDN�RACTS F0116Up1 PROJECTS N7THACONTMCTOR(5)LICENSED PURBUMITTOTHE CONiMG QUANTITY DESCRIPTION � roAsuc�seuw.). �E ❑IMIIXEYPTlMIUEflSEG B.6P.C.FOqTHI5REA50N a U � � w� awNEA U � w LiCENSED CONTRACTORS DECLARATION —� � w I HE1i�BY AFKIRM 11/DEq PENAIiV OF PERIURV TH�T 1 AM LICENSED UNDER PqOVIS1�NS Of CHAPTEq � �,[ 9�COYYENCINO WIM SECTION 70W)OF�NISpH]�THE BUSINESS AND PROFESSIONS CODE,AND Z � M'LICENSE IS W FULL FORCE AND EFFECT. � � � LICENSE CLASS i-' J / LIC.NO. �� � j � V mlTE I' �D CONiRACTOR d � � �(� �`�'WORKERS'COMPENSATION DECLAFATION Q � EB RM UNDEN PENNTV OF PERfl/RV ONE OF THE PoLLOWING OECL�RqTIONS: z � _I HNJE ANO WILL MAMTAMi A CEIir�ICATE OF CONSEMTO SELFINSURE FOfl NCIPKER5 r i � COYPENS�TION,ASPROVIDEDBYBECTICN�137000FTMELABOPCOOE,Fai7NEPERFORMANCE �U � � �n+Ewoaic�vm�nnsa�mTisiss�o. � I �_I NMEANO YVILL MAMTAN W�7RKER3'CCMPENSATION iNSUFUNCE.AS REWIAED BY SELTIDN 'Q�'�� �. Q 37ooOFiMELABOqCODE,FORTHEPERPoRiNWCEOF7HEWORKFORwNICH7HI3PERMlT15 � t55UED.MY 1MDRKERS'COMPENSATION INSURANCE CARRIER MID PO�IGY NUMBER ARE'. CONSTFlUCTION �^ CARRtER PLAN REVIEW � PoLICYMIL6ER ELECTRIC 0 (rnssEcroNr&.�noreEm�rmovnfa�w.ttSro�ar�r�DoalAnstsimfditAsl PLUMBIN� Z ICFRTIfYTHh1R1h1EPERFORMANCEOFTHEWO FORWHICH7HISPERMR13133UE0.1 MECHANICAL � SHAGINOTEMPLOYANYPER50NINANYMANN[ ASTOBECOMESU9JECTTOTNE (Jj WORKEPS'C0�IPENSATIONUW40FCAt.lfO AGREE(HA�5ISHW�OBECOME INSPECTIONFEE S SUBJECTTOTHENVRKERS'COYVENS�TION O SOFSECTION]7000FTHEUBOR cooe.i srwt coArHvnn�cour�r xnn+ v�sror+s. ISSUANCE � �900 � p �ATE — 'A� APPL�cnNT: SMIP o �'S � � � ENERGY P/C �WARNIN(1:f�IUHE TO SEWRE YARKERS'COYPENSATION COVEMGE 1511NUWfUL,I1ND SHAtL BE ry SI�JECTANENPLOYERTOCNN11NAlPENALTIESANOCNLL,FINESUPTOONEHUNOR£DTFiOl15FND '" Dd.LARS(f10D.00o),INAOOITIONTOTNECOSTOFCOMPENSATION,DAMAGESASPflOV�DEDFOAIN ENERGYPERMIT ¢ SECTION a)u!OF THE UBON CODE,HJTEPEST,AND ATTORNt1"S FEES RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: QI HEREBY�FFIRM UNDEH FENALTY OF PERIURV THAiTNERE IS ACOFiSTRlICT10N LEN�ING A6ENCY Z �-0R THE VERlOflMANCE OF iHE WORK iOH WHICH THIS PERMR IS ISSUEO�SEC.w9T,GY.C.). W � LENDER'S NIYE 1S� LENDEp'SIIODRESS `� 1 CERTIFYTHAT 1 HAVE THIS APPIICqT�ON AND STATE THAT THE�180VE WFORMATION IS CORFECT. TOTAL i��ES � �5�v � �AGaEETOCWiPLY ALLCITYANDCOUNTVOR�INANCESANOSTATEIAWSHEU7INOTOBUiLDINO � CONSTPl1CTION, REBYAUTXOHIZEAEPPESENTATIVESOFTHI5CIXINTYTOENrERUVONTHE AAOVEMENTIONED ERiY FUR INSPECTqN PURPOSES. � COMMENTS � ut �jA/tc�R- m PERMITTEE (V Nn ¢ � �_ �a � (/� SIONA P� EE OATE � RECPT.NO. PAIO BY � VALIDATION WHITE—Department Copy,YELLOW—Finence Copy,PINK—Aasessa Copy,GOLDENROD—File Copy,GREEN—ApplicenYs Copy CI�'�' C�� �3���vii��@� ���� ���������a� ������� _ _ � . , �- g � :.� ; ;'- .��.�,:�.�d��„ - � . r„�;=� �...ys.`t �i e . . � ��T dpGK i : �� FLvC��,�Q��"JT ; i � ._ .T,_ -- ----_��.�.��— ----- f ...,._.`.._....._..._._._"_._.. _ �.._ ._........ . .._..,. .i ��.3������1�I�Jr..�-����� j ��'if\��Q���r'��'J � f } ELC�T«!G(�r,t�t}FdF� _�^..,__.._ � Ut�lD��i r=LC�O�'�:SC� �! 4_,--� _ ; .�� � " _ — _ — --_. _. _._.� G�C3l;ND P�U[�rt[�f�:G � i Ui�Ei��e FLOQF�CCJi�`C��i� � ; I �__. ,._ - -� �_ __- --_ _; — �. 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