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HomeMy WebLinkAbout14072 (14) . ..._ .,.. ..m._ __.... �------._�. ...... . ,..., .._._...,� _._.......�.�._ .,. . . ..___�._"_.. •...,.�..� . �.. _ CITY OF DIAMQND BA8 �hP�J��D - DEPARTMENT OF COMMUNIT',�di DEVEIA�'MENT SERVICES 2tvo��s��s����s6i 3ii� aCr 1 p 1000 PRESS .��^,.`, 'BLTILDING PERMTT APPLICATiON " ' FIRMLY p� JOBSITE c^ �` � �� �. A1PPLiCATIp �Q PERMfT P/CC�(� �j ADDRESS L�' KL�� L� DATE '��r ` ' NUMBER� * / / `-�S $ ISSUE_+'^�;�IYPE OCC PN L T TRACT DA,TE � CONST, aROUP �j WNER ' ADOR SS Zp�IING &ETBACKS CIN 21P TE Z- FHONT RW C] APPiICANT TEL: T R�' ❑�— S1DE/6ipE STREET RW� O,� CONTRACTOR SIDE'' ❑ g CIDTMDRESS �P TEI.. ROPOSED USE "'"��' 1 � ARCWENGI � DESIGNER NO.pWEL NO. NQ. A�DRESS ' UNIT6 STORIES BEDROOMS � CffY 21P�„�_ ;TEL.,�,,.�.� � DESCRIPTION SQ.F'T. FACTOR PSF ADJ.AREANALUATION � OWNER�BUIIDER DECLARATION gFq�ADp/REM 1 MEAEBY AFFlFW UNOER PENAITY OF PERJURY THI�T'1'/VA E%EMM RROM TNE GONTMCTOHS LL (a"gf8g9/C:9IpOfl�. . . . CENSEUWPORTNEFOLLOWWOREA80NI�G7091.BBUSINE98AlAPROFE9SqN3f%IDE:IINYCITYOR �'�.(j) . ' OGMiTWHIGII{�11RESA►ERMRT01.70N9TFRlLT.lVITER.MPFI0YE.0E4�l0USH.ORREWURANYiTRUP. ��'W P t�0/DBCk�.' , . . .. . TUpE,VqiOR TO 1T8�I.IANCE.ILSO IiEWIRE6 TNE APPIMCANIT i�IR SUGI PERMIT TO FlLE A 310NE0 .,; � P . t7ATElAENT THAT NE OR!HE IS UCENSED PURSUANT TO THE�PFqVi81pJ9 OF iHE CONTRAC70R5 ll- � OENSE 1AW(QiMTER�(COAiMENCING WI7H BECTKN 7000)k)F DIN810N 7 pF TH6 OUSINE85 N�PViq• ' u' PpOIISpA � � FE89qN5COOFJOR7FIATHEORSHEIBIXEMPTTHEREFFIOMIN�THE8A919FORTHEALIEGED&%EMP- . TqN.ANYVIOL11T10NOF8EGTION7o81�6B�NVYAPPIICANTFOflAPFJiMIT8U8JfiC70TNQAGPLIGANTI9 �� .I,I� qe-Roof - � A CIVtL P6NN.iY�NQT MQRE TMAN FrvE MUNOPEO OOLlAR6 R�IJ� ' . O OI.ASOWNERDFIHEPFqPEHTY.Oi1MYEMPLOYEEBWITHWAfiEBASTHE1R80LEdOMPENSATIDN, �� �I,Q �mmerdal � -� Z W&L OD TNE WOFiK,MI�TNE STRUCTIIRE IS NOT INTEnOE01 QR OFFEHEO FOR SALE(9EG 7MI,BU81• �,�J - NESS AIJ�PROFESSIONS CODE:7ME CONTRACTORS UCEN9E I;AW COES NO'�'M0.Y TO AM OWNER OF � ����I� { � . � VROPEFRYNM1IOBU1.D60RN1PibVEBTHEREON.ANOMMOpDE49tICHM/ORNNIM8ELFORNERSELFOR � TNROUGHHISORHEHOWNEMPLOYEES.PROVIDEDTIIATBUpIIMPHOVEMENTSARENqTNtlTENt1ED�1 'li m o�s�ot�r+s,u.e.�How�Rmesu�.oa+oon w�rnoveMaHr�y sa.owrtrawa�v�r+aFcour�• �'T1R1.THE RTNNER-0UKDER WILL HAVE'TFIE BUR�N OF PRPVMCi 1HAT NE Ofl 5N6 DID N9T dUTA OR �� MPROVEPoRTNEPUFiP08E�6ALE). - ����I - OI,ASPNrtJEROFTHEPROPERTY.AMFXCUIBNELYQONTMCTMfiW17HUCENSEDC01iTRACTORS ��� ro mNsrw.icr'n+e ranffcr�aEa�au,eusiNEss uao naoFessioros 000e:��rMcrOas u• , "; Vpiwtfon ' AW.AREA C6q5E LAW DOES N01'MPlYTO AN[1WNFR OFAGflQPERTY�MIMD BUILD9 Qfl IMPAOYES THEREON.AND lVFqppNTRhCfSWR8Up10qO,lECT9WRWACOIJTRAC79R(9)IICENSEDPUpBUANTl10THECONTMO pUANTIN�, D�SCFitPTION FEE � 10R8 UCENSE IAW.�. , ; .'. ... . i . !, /� � . �] CI I AM IXEMPf UNDER BEC. '� 8.d p.G.hbR tMIS RFA9CN '` U v W � ✓ I � Q DATE OriHEFt �� ���[[ LICENSED CONTRACTORS p�GLARATION II � LL 1 MEREBYAFFlRAf UNDER PENALTY OF PERJURY 7MAT tNA LICENSEq UNOER PROVISIDNS OF CHAPTER ,,'., Z . �� C � O S •(00►II�ENCIIW YATN 9ECTION 7000)C1F DIV�514N�OF THE dU61NESS ANO PPOFfiSS10N'S COOE,AND ' ..y) WJ YY UCENSE 16 Ml Ml FOFCE AFD EFFECT. � '; ' . /", � LICENSE CLASS UC.NO. � �I � !.. . . � ;�II � �� ., t /� DATE CONTRAC70R . , 7 V WORKERS'COMPENSATION DECLARATION � � ✓ � � IHEHEBV�FFIRMUNOERPEWILTYOFPERJUqYONEOFTHEFOL44WINQ0ECLAMTIONS: � z ',� . � . �i lC0110EN AS 710N.AB PROVIDEO 8Y 8'FECTIOH AOOOF'ME IABOR CO�E,FOFOR NK1fiKEFOHMANCE��:. � � Y .� , . . Y � � . __ _ ,. � �.,.,-� , s. jt r.. :c� . ..,. ' '�.. \ ti..., � �•, 0 N 8► ., . ._. _ . ,� .. a OFTHEWORKFORWHICMTHIBVERMIT18186VED. - . I��, � . � _I HAVE MDYYILL MAIHTIUN WOAKERS C9MVENSA710N INSURANCE,AB flE0U1REp BY BECTION /+ J7000Fh1E LABOR CODE.FOF THE iERFORMIWCE tlF THE WORK WR WHICH THIS PEWAITIB ��. { � �a �DVED.I/VWORKERS'001APENSATIONINSUMNCEGRRIERANDPDIIG"INUMBERME� CONSTRUCTION ��f,� __.._ � cNw,or _ _ ; . PLaNREV1EW > �' ���EA ELECTRIC � � S �C � �rt+�s�ur�rqTgEoor�.E�nocnEpEp.rrswpa+�r�4ollusis+ao�qa�ssF PLUMBING 1 CERTIFY TIAT IN iHE PERfORMMlCE OF TME MlQRK fOR WHICH Tf113 PEPMIT If ISSVEU.1 MECHANICAL , . ��6 &W.L NOT EMPLOY ANY PERSfx!IN�M'MANNER SO AS TO BEGOAIE SU&1HCT TO TNE y� WOAKER&'COMPENSATIONUWSOFCAL�QRNIh,AM�AQREE7XAT1i15HC7ULD8EGOME IMSPECTIONFEE � S1181ECTTO THE WORKERS'COMPENSATqN PRQVI910NS OF SECTNX4 97000F TFIE LABOR - �,/ CQOE.1 SHALL FORTMWI7H CQMPLY WITN THOSE VROVISIDNS. ISSUANCE ��: �pp��p� SMIP a � WMMNO:fMLRETO6EGUREMIOfiKER3'COMPENSA710NCDYEMOEISUt$AWFUL,ANDSHALLBE ENERGYP/C �� ��C�I SUB.IBCTMIEMPLOYERTOCRIiA1NP1VBJALTIESMIOCIVILFRIE9UPTOONEXlIK1FlE�THd15AN� ENERdYPERMIT � DOI.tMS(i100,000).Rl AOqTION TO THE COST OF COMPENSATION,OAMAOES AS P140VIDE0 WN IH � aecnon aroe oF n�e u�eon oa�e,arceassT,�rw��rot+NErs Faes. qETENTION FEE: r.��..._ r i�UP°IwL}I���y �i C!� � CONSTRUCTION LENDINO A6ENCY � �� pRE-ALT FEE: ���w�.i�`tl+_�Yt��'' 1 HEREBV AFFIFM UNDER PEN.�LTY OF PERJURV THAT THERE 19 A CbJSTpUCTION IENDNtl AOENCY FOR THE PERFOFlMANCE OFTIE WORK FOR WHICH 1HI5 PERMIT IS ISSUED�&EG 7oa7.CIV.GI. . . � tENDER'S NAME �. � � . � 4ENOER'SADDRE58 ICEHTIFYTiATiHAVEREIOTFpSMPLIC/RIONAND6TATETIiATTHEABOVEWFORMAT10NISCOf'�iECT. � TO�IAL FEGS � � � 1 MiREE i0 WMPLY N7TM ALL GTY M1D f�UN�Y ORDINANCES ANO STA7E lAWB qELATINf1 TO BULDINO [[[���fff CONSTRUCTqN,ANUNEREBYAUTFqRREHEPRESENTA17VE90FTHI5COUNT`/TqENTERUPONIHE � � . � , � ABOVE�AIENTIONEO PROPEfliY FON INSPEGTION PURPQSES. ., � COMMENTS . . .. r r, M� 4 PERM NAME(V . . � � SKiNA DAT ... . , , . -... , � � RECPT.NO. � PAID VALIpAT10N WHITE-0apartment Copy,YELLOVJ--Finanae Copy.PINK—Aseeawr Copy,R04DENROD--File Copy,OREEN—ApplicanYs Copy ����,�;,�;=! 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