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HomeMy WebLinkAbout16055 � F�� �_ CITY OF DIAMOND SAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Capley Drivc Suite 140 � PRESS ' ''��'�' sc�n.�n�resi��Arpiic��rtox FIRMLY pJOBSITE / /APPUCATION PERMIT p/C ADDRESS ,I 0�Z FL-��!+-�C� QATE � NUMBER R � ISSUE TYPE OCC i4PN kOT TRACT pATE CONST. C3ROUP � f�WNER ADDRESS LC XONING SETBACKS CtTY ZIP �i S 'fEL. FRQNT RW � APPLICANT TEL. R�p ❑ 61D�/SIDE STREET� RW 0 �CONTRACTOR Gf"r � SIDE ` ' ❑ � ADDRES CITY ZiP " TfL. ��y�^Pl'.f PROPOSED USE':�'�+C.' .1FGG Wv � ARC NG! " ��' � DESlGNER �IQ.DVVEL. � . ...' ;� ^ Np. , NO. iADDRESS tINITS, ' STORIES BEDROOMS CITY ZIP TEL. � i dESCRIP710N SQ.FT. FACTOR PSF ADJ.AREANAl.UATION � OWNER-BUIL.�ER OECLARATION SFR/ADp/REM I HEIIEBY AfFIpA WJDER PENAL7V OF PERJURV TNA7 I AM E%EMPT fqOM THE CONTMCMRS Lb . ' ',(iBbQB/Ce1�70K , ., '.CENSEUWFOH7XEFOlLOW�NOREASONISE47p9/.6BUSWE59ANORHOFESSI0N500DE:ANYCRYqR I(/) , � :OOUNTYWMCt1RE0U1REBAPffRA1RT01�lY5TRUCT.ILLTE0.MIPROVE.DEMOIISN.ORREPAIRAMf6THUC- W �'.PBtIOIDBCk' � .. . .. ��tTATFlAENT TFIAT H6 Oii SHE IS LICENSED'PIIRSUMIT TO TNE PROM191dJ3 OF THE TCd1T�RACTORB LD !CQISE U1W(GIAPTER�(OOMMENCIN6 NiTH BECTION 7000)C�DINSION 9 OF THE BU91NE39 ANO PqG u' !POOU$p81 '- �FE59qN5�ODE)ORTNATME OR SHE 18 EXEAIPf 7YIENEFROM AW THE BASIS i4R T1fE IILLEQED EXEMP• '� , �TION.ANYVIOI.ATWNOFBECT10N7977.6BYANYMPUCANTFpHAPERMITSUBJECTBTHEAPPIJCANT�O - � i,Rg¢�pp� � '�11CML YENKTY OF NOT MORE THMI FIVE FIUHORFA OalLMB(ibaol.l: � J 04�"+��EpOF1HEPqOPERTV,ORMYEMPLOYEE9WITNVMOESASTHE1RSOlECOMGENSATION, � ':COIIIfItBfC181 �i WRL DO THE WORK ANO 1HE STRUCTURE 16 NOT INTENO6�pR OFFEREO FOp SALE(SEG.7M4,BUSI• - � jNPFlOiERTYWFpBUKD80NN1P�WOVE9mEREON,AND�WFlO$OOE58UGiYK)RKFMM96L�FORIIERSNEtF011 � �� •.TIi�UGH NIS OR NER ONM EA1PlOVEHS,PIbVIDEO THAT BUtli MPROVBAENTS ARE NpT MBJDED OR �Ca � �'OFfERED POIiBALE IF.HpWEVER,iHE BUILOMOON MAPROVEMBI'f IB 60LpVATHINONEYEAR OiODMPIE- �+i1pN,TIE GWNEf4BUIlDER YfILL MAVF TNE BURUEN�F PROVINQ THA7 HE Qfl BME DID NOT&J4D Oq �MCRDVE PoR 1HE PUHP06E OF SALEI. � . O L A!OWNER OF1WE PROPERTY,�M EXCLVSIVELY CONTR�GT1N01MffH UCENSED CONfMCTOR3 �TO CONSTRUCT THE PpOJECT(BEC.7W�,W91NES4 N!0 PHOFE5910N9 CODE:TNE WNTiUCTOR6 L4� atiOrt ADJ.AAEA .CENSE LI�W OOES NOTMPLYTOAN ONMEH OF A PPOPERTY WH9 6U1A3 OR IMPROVEB THEREQN.AND !1NFIDCONtRACT8FOR8Uf�iPHO.IES;TBMATHACONTMG'TOR(9)LICENSEDPURBUANTTOTMECaNTRJIP QVANTITY DESCFi1PTION FEE -I �TORS l�E LAWJ. � I � Y O I AM IXEIAPT UNDEH SEC. B.4 P.C.FOR 7HI3 RFJ�59N � S �u" �.WTE OWNER . � � UCENSED CONTRACTORS DEGLARATIqN w � ',IMEREBY/JFNW4NDERPEIMlT10FPF•fUURVTMATIANUCEN5E0UNDERPROV18WN90FCHAPTER Lye , ��:!(CCMMENCWG WI7H SECTION 9000)OF OMSqN s OF THE BUSINE53 AND PPpFE9810NS CO�E,AN� � :MYUGENSE IS N KULL WRCEANO EFFECt p � .L,ICENSE CU C LIC.NO. S-/ . �'��� . pATE GONTMCTUR � WOFiKERS'COMPENSATION DECU+RATION ;� � V � 1 MEREBY KFRUA UNDER PENALTY OF PEFiNRY ONE OF TNE FOLIOWINQ DEIX,AHATIONS: � ,� _IHAVEANDWILIM/JMAJNACERT�FM•ATEDFCONSENTTOBELF-INSUREWRNUHKFR6' S COMPENSATqN,A8 PROVIDED BV BEC710N 3700 OF THE LA90R CODE,FOFih1E iERFORMANCE �- OF THE WqfiK fDR WHICH TiS PERMIT 18136UED. � � Q _IHAVEAHOWILLMAM(TAINWOqKERS'COAIPENSA710NINSURANCE,IlSRE0UIREDBYBECTqN /'1 w,w /J � b70o Ci T11E WBON COOE.FQFt TME PERFOAMINCE OF THE WORK PoR WMIp1 THIS PERMIT IS \,�1�1' '�'7l� � ISSUW.MY WORK�E.R�+S' P�NSATIO�N IN^S-Uw�pr E CARRIER AfJO PO�ICY 1�0.1MBEflME: CONSTRUCTION I � ,��� �j. CARRIER 7� �T13�✓A PLANREVIEW � wx�cY�.eER_`.��"Q(ZO Z ELEGTRIC � �ssccrnNrEmnpreeaa�er�oFirrepr�crswaar+�runo�ooaw+5p7w1oAlEss1. 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