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HomeMy WebLinkAbout13917 _ c �,�_� GITY OF DIAMOND BAA DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 �� (�v>a�o-3 i9s F���>a6i-3ii� PRESS �'�M° WI • BUII.DING PERMTT APPLICATION < FIRMLY � JOBSITE -� APPLICA710 �,' PERMIT ��J PIC Q ADORESS aI�7�S �1°�/Z�R'FF (<-�_ DATE ��1� � NUMBER � / # ISSUE TYPE OCC i � APN LOT 7RACT DATE CONST. GROUP � �_ OWNER �Gs7�1 r7d �' �al.�-�a� ' " ADDRESS ZONING SETBACKS ' W. CITY Z!P TEL. REART � �W ❑ APPLICAN7 7El. i SIDEJSIQE STREE7 RW ❑ ' �: CONTRACTOR SIDE ❑ i �: ADDRESS _ �- CITY ZiP TEL. PROPOSED USE .L -��. 2� � ,f rZ'' u�i ARCH/ENGJ � � � z< bESIGNER NO.DWEI. NO. NO. ` �' ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. �' � cn DESCRIPTION SQ.FL FACTOR PSF ADJ.ARE�1/VALUATION d OWNER-BUILOER DECLARATION SFR/ADa/REM i � � 1 HEREBY AFfIRAI U40ER PENILLN OF PERNflY t}IqT I pM.F%E!1.PT fpOM TME CIXJiMCRJRS LI- ('jdf29E/(�.dfP011 - W CENSEIAWWR1HEf-0lLOW11�PEA50N(SEC.�03tS&151NESSANOPqOFcS51OYSCODE'AUYCITVOR -: {/� _ � :U� CIX)MYYMIq/REWIRESAPEHMITTOCOM1SiNUCi,AL7Eft,IMAFOVE,DEMOLlSH,OflREPAIRANYSTRUG � W patio/Deck � :� TUNE,AflIOfl TO ITS ISSUANCE,qLSO ftEIXJiFES THE APPLICRN�FOR SVCH VERMIT TO FlLE A SIGNED- �_ � - STA'fFA1ENT TfiAT HE OR SHE�5��CENSEO WRSUMR TO THE PROVIgIONS OF TNE CONTPACTORS LI- -�_ CENSEIAW(CHAPTERB�COMMENCMGWITHSECTION7G00)OFO:YISION30FTHEBUSINESSA4DPR0- - � POoUSpP � FES310NSCOOE)ORTIiATHEGRSHEISE%EMPTTHEqEFqOMRNDTHE8A415FORhIEALLEGEDEXEMP-- -:-._(� � V._ TqN.ANYVIOUTIONOF5ECT10N7031.58YANYAPPLICRNiFORApERMiTSU&;ECTSTHEAPPLICANTTO -�.Z Re-Roof �: A CIVIL PBdNXV OF NOT M00.E THAN FIVE HUNURED DOLLARS(SSoo).): � -��: ❑I,ASOWNEROFTHEPROPEqTY,OFIMYEMPLAYEESWITHWAGESASTHE1R50LECOMPENSATION,� -: C]� COtt1R18(Ciyl � - - � - -VALL DO THE WOAK,AN�1'HE STfiUCTl1RE IS NOT INTENDED GR OFF�fiED FOR SALE(SEC,704q W51 - J` � N. NE53 ANO PROFESSIOTkS CWE:TFiE CON7RACTORS L�CENSE LAW OOES NOT APPiY TO AN OWNER OF �__� . -PpOPEAiVW1108U�DSORIMPROYESTHEREON.ANOWHODOESSUC4iWOFKHiM3�LfORHEflSELFOR - Q: THFIOUOFiHISORHEROYNEMPLOYEES,PROV�DEOTHATSUGiIMPR0YEh1EhTSARENOTiNTENOE�OR . m --.� - W OiFEfiED(-0RSKEIFHOWEVEfl.7HE6UIlDi400RPAPROVEMENTlSSOLDWtTHINONEY'rAROFCOMPLE - �� �710N,THE OWNER�BUILDER'MLL NpVE THE BURDQJ OF PROY:N3 TI1AT HE OR SHE DID N0T OUII�Ofl. � -� ._�MPFbVEFORTtiEPUHPOSEOFSAIE). � -L'I.ASOYINEROFTHEPROPEflTY.RMEXCLUSI`,/ELYCOM�MCTiN4YtRiit'CE43ECCON'flACTOfl5 - (r_ -TO CONSTAUCTINE PflQIECT�SEC.7043.BUSINESB AND PFlOFESSIO't5 CODE:THE CONTp,ACTOfiS U � : Valuatl0n ADJ.AREA � ..W- .CENSEUWDDESN�TAPPIYTOANO�NJEROFAPftOPERT'IWHCBUILDS�flIMPWVESTNEHEOti.AN� — - � �,- -YAiOCONTRACTSFORSUCHPNbJECT5N1Tt1ACONTRACTOP,(5)�IGENSEDPUR5JM17TOTNECONTflAG QUF,NTITY DESCRIPTION FEE - -� : � _TORSLICENSEUWJ. _ � LJ 1 MA EXEMPT 11N0ER SEG 8.8 P.0 fOR THIS REASON� ; Q � � — U � " � DATE___'_-_�__OYRJER_ �__„'_ _ . :�U ..j �--o� l7CENSED CONTq CTORS CECiARRTIC�d - _. � .. - i -�-- IHEREBYAGFIRMUNDEPFEN.ALNOFDERUP.YTNATIAi44CENSE�UNUERPHOVI5ICY50FCHAPTER � - � - �-_ B�COMMENC{NGWITNSECT'Ah]000}OFONISYJN30FP.iE8U5�,N'tSSANOPROFr'SGIO;lSCG�E,AhC �- � �[ MY LICENSE�S IN FUII FCRCE ANO EFFECL ' 7 W, m �� -.0 LICENSE CUSS UC.ND. .;�-;j . --- - s.J .,� _V,-_ DATE CONTRACTOA '�- 0. _ .w . LG:. � ._ ,_� ... ..� 1NORKEfiS'CGMPENSATION OEC'J1RA?lpN - . ... .. -- Q . .. .,p-a f E i=�'3 _� � -�F+-��` - . . ��� � IFiEHEBYAFFlR0.1 Uk^ER P[NA:TY OF PER.:URY ONEOF THE FOLLO`NING tr_CLARATIqNS: - � - � . � ,Z �".' EF; + _. 111 i - LJ:. _It:AVEIWDW!LLMAINTRINACEFiTIFICATEOFCONS'eNYTOSELF-INSUREFORY.'Oqi(ERS' '-�_ "p 7 ' �.k`9 COMPENSATpk,ASPRO`dI�EDeY3ECT!OK3]o00F7HEUBOR:,ODE,FORTHEPERF�RMANCE - �U -'h --� � oFTNEWORKFOHYVHiCHiHISPERM!TISIsSIJE�. � �- - . � � _i HAVEMID WILLMA�MAIN WORKERS'COMPEN6ATi041NSURANCE,U AEQJIRED BY SECTIOt "d.� 37o00PTHELABOPCG%E.FORTHEPERFOFMANCEOFTHEWCPK�-0RWhGC�iTHISPERM1T15 � _� �- ISSUFp_.eAYWpPKERS'..wUPEYSAT!C�l(J_.URRNCECARRIERAIr'DPO�ICYNUMBEAnRE- _ CONSTRUCTION ' _ _,___._ _�_ ,_ . � -j- caaeiEa --- AIkN(�EVIEIN _�__ . -� -`_[]- ra�cv��uMSEa _ [IECTRIC --- --_ - --�j �� !iFflSS.�CIIOhNE�NDTBE�!fi'LETWOFTFfrPEL�.4T1o1-0RaVE4.U�DRF�LGJ.M�(31oo)OP.LESS} PLUMBING -.:_�i . .-�. --. ` . � .__W _ . _ . . . . �' . Z- ICEHTIPYTHATINTI1EPEfiFOF7i.ANCEOfSNE.�,'aftK`OFS4H�CHTt(ISPERMITIS!SSUED,� MECHANICAL - (J. SHALLNOT EMPLOY ANY VEflSOM IN At1Y MANNLR SOAS TO BECOME Sl1BJECT TO TH[ / �j� '{/)- WORKERS'WMPENSATIOt11,AW90FCALiFOP.NIA,ANOAGflEETHATIFISHOULDBECOM[ �NSPEt;TIONFEE 1 �;�� . � --�� 54B,lECTTOTHEWORKEH3'COMPENSATIIN:PROVISIDNSOFSECt10N3T0oOFT1i[LABOR __� GD�E,I SHALL FORTMWIiHCOMPLV W17H THCSE PROVI510N5. ISSUANCE �� ' O SMlP � :' p �A7E: APPLICANt _ �_� �-�- ENERGY P/C �. WARNING FAILURE TO SECURE YlORKEfl3'CAMPENSATION CAVERAGE IS UNLAWFU�,AND SFIALL BE �- �y SUBJECTnNEMPLOYEFTOCRIMtt�IALPENA�TIESAN�CiVILFINESUPTOONENl1NDRE0TH0USAN� ENEflGYPERMIT -- -� oalLAPS(Stao.000),INADOITIONTOTHECOSTOFCOMPENSATION.DAMAGESASPROVIpEUFOflIN ------ -�-- — , -_-� SECTI�N 3]08�F THE IABOR IX)�F,INTEPEST,FW�ATTOqNE1^5 FEES, RETENTION FEE: � d CONSTRUC710N LENDING AGENCY PRE-ALT FEE: --� IHEFEBVAFFIRMUNDEfifENALTYOFPERJUFYTHATiHEflEISACONSTflUCTIONLENDINGA6ENCY FOR TME PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3097,CIV.C.). Z W -- - � LENDEfl'S NAME � 1'_ LENbER'SADORE55 _._—_ . � /� /y/ C � w ICEATIF1'THATIHAVEREqDTHISAPPLICATIONANOSTATEiHATTHEABOVEINFORMATIONISCOftRECT. � TOT/-1L FEES j / l � � .p_ IAGREETOCOMPLYWITHALICITYANDCOUNTYORDINANC[SANO�ATELAWSRELATINGT06UILDING � CONSTHUCTION.AN�HEFIEBYAUfHORIZEqEPflE5EY7ATIVE50FTHISCOIIN(YTOENTERUPONTHE Z qeoVE-MENTIONEO PROPER7Y FOR INSPECTION PURPOSES. COMMENTS " �b�rJt � �i�c�� � J � m PERMITTEENAME(PRiNT) Q ir � ' � � SIGNNTUREOFPERMI E • OATE " _ Z J RECPT.NO. PAID BY VAUDATION ~ W E—�epartment opy,YELLO --Fin nce Copy,pINK—Assessor Copy,GOLOENROD--Fi1a Copy,GREEN—Applicant's Copy v � ,� `T" — - �-.. = _ _ �.. �„� ��5 � �� �� �� ' � ��' � �� � �' s� a c � � ` � � �� r 5 ; � { . u �" � a �� s i i � _ � �' � t ��`.,-. � €'' ; �� � ��� � �; � �� �r . ` � �5 � � �; �; � . � � f � � �at� _ � �s t _ ; � `� � � '�� � � . , �V i t- > �£ � t" � �' �" 6�. � - � - :� ,., � ��. . � �.� `' $ � �: c`- _ � � � � � ��� "� � ' € 9 r < -1 ` t � � � �� _, . .�..�3. . , �-=� .� _. . . � � ' — — � _ _ r.—� � , —F— _ : �__ __ � - I � !� , i � , • , � _ � i i , � � � � ' ,� �g � , � < i � ��i i , � ' � ' � � , � i i � ; € _ _ E �� i , i 4 1 i y ' . _' � F � i c � i , -- t j t � ( i �; i ' ' � r - � € ,: ? i � - j � �� �f . � 3 � .'. � � � . � � ... , i , �� � _ � . � i , , : a � ;