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HomeMy WebLinkAbout14229 CITY OF DIAMOND BA� '�/ ,,, - — � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � , 21660 E.Copley Diive Suite 190 (904)860-3195 Fax(909)661-3117 PRESS �"M f BUII DING PERMIT APPLICATION FIRMLY � JOBSfTE o ADDRESS 2���� �(����� DATE CATION r V p�NUMB R ii� � ISSUE TYPE " ppC APN LOT TRACT DATE CONST. GROUP � OWNER � ADDRESS L� ZONING SETBACKS CITY ZIP TE d FRONT RW ❑ APPL ANT TEL. REAR p 51DE/SIQE STREET RW ❑ CONTRACTO 0• 51DE p ADDRESS�� g C(TY _ 21P �L TEL./ PROPOSED USE �.� B ARCFiIE�� v L'�� � � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � OwNER-BUILDER DECt,ARATION DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION 0 SFR/ADD/REM 1 MEREBY AFFMW UNDER PENALTY OF iERA1RY THAT I AIA EXEMM FFIOM iHE CON7AACTORS U- Gafefle/CetpOrt CENSEUWFORTNEWILOWINGREA50N(SEC.70.t1.6&1SINESSAN�PROFESSIONSCODE:ANYpTYON (n OOUNTYWHICMREOJIRESAPERMriTOOONSTqUCT,ALTER,MPROVE,DEMOLISH,ORqEPAtRANYSIHUC- W p�t��ck TURE,PRIOR TO ITS KSUANCE,AL80 REW IRE9 THE MPLICMIT FOR SUCH PEAMIT TO FILE A 610NED 6TATEMEM THAT HE MI BHE IS UCENSED PURSUANT TO ME PRONSION9 OF THE CON7MCTOW3 ll• CENSE{MM(CFUPTEfI��COMMENCINO Wlhi lECTION 7aoo)OF OIYISqN]OF TT1E BUSINESS Ml�PHO- �'L' POOUSpfl FESSqNS OODE)OR THAT ME Oq SHE IS E%EMPT 7XENEFqOM AND lf1E BAS1S FOR THE ALLE�E�EXEMV• TIDN.ANYVIOlAT10NOF8ECTION70J1.68YMIYMPLICIJ-fiFORAPERMITBUBJECT9TNEAPPLIGUlTTO Z Re-Roof � A CML iQiALTY OF NOT MORE TNAN FNE HUN�RED DOLLARS(i500).]: O OtASONMEHOFTHEPROPERTY.ORLIVEMPLOY6ESVYliNWA(iESAS7ME1R50LECOMPENSATION, COmRIB(Ciel - Z YNLL DO TXE WORIC AMO TME STRUC7URE IS NOT IMEND6D OR OFFEREO FOR SALE(SEC.70iM.BU51- � NESS AND ViIOFESSiON3 COOE:1NE CONTMCTORS 4CENSE lAW CDES NOTAPPLYTO AN OWNER OF � PROPER[NYYFIOBUIIDBORNJPROVE6TNEREON,AN�VM1IODOE55UCHYlORKFNMSELFORHER6ELFOH � � ifYiOUdilUSDRHEHOWNEMPLOYEES,VHOVIDEO7WRBUCNNAPROVEMENfSAXENOTINTENOEDOR m OFFERm fOR bALE IF,IqYYEVER 1MEBULOW OOR MPHOVEMENT I8 60LU WRIUNONE YEAROFCOMPLE• TON.711E OWNEWBU4.DER WILL WIYE 7TIE&1RDEN OF PpOYNXa iNAT HE Ofl 6NE DID NOT BUIID Oq MPROVE FOR T11E RJXPOSE OF 81LLq. • � ❑LAS ONMER DF TME VROPENi`/.MI E%CLUSIVELY COMMCTINO WRH LICENSED COMMCTOFS TO CONSTRIICi TME VND.IECT(SEC.7oM��NES9 AND PROFESSIONS CODE:THE CONTMCTONS LI- V81lItSbn ADJ.AREA CENSE UW DOE9 NOTI➢PlV i0 AN qNNER OF A PROPERTY NM1IO BULDS Op W VROVES 7HEREOM,At�p MM1qCONTRAMeFOReUCHPi10JECT8NATHACONTMC7OR�S�LICENSEDPURSWV77TOT1ECON7FUC OUANTITY DESCRIPTION �E � lORS UCENSE IAW.} ❑i/1M DfEM?T UNDER BEC. B.l P.G FOR THI9 REASON � �i � WiE ONMEH U � UCENSED CONTRACTORS DECLARATION W � IHEREBYAFFIIWUNDERPENALTYOFFERl1/RYTWRIAMLICEN9EDUNDERPROYISIONSOFqi�PTER � •(OOMMENCMIO WITN SECTqN 7000)OF DiV15qN 8 0F TXE 8U31NE55 AN�PROFE5510NS CODE,M/0 Z MY 4CENSE IS W FULL FOHCE AND EFFECi. m � LICENSE S LIC.NO. � � o�'re torrrrueron�' _ a W RKERS'COMPENSATION OECLARATION � I NEREBV AFFlRM UNDER VENALTY OF PEIl1UM ONE OF iHE FOLLONIINO DECLIIMTION3: � V C� , Z � �lHAVEANDWILLMAINTNNACENTIFICATEOFCONSENTTOSELFINSUREFORNCIRKERS' _ „ • , , 001APENSATION,AS PHOVIDEO BY SEGTIqV 7T00 OF TME IABOR CODE.FOq 1}IE PERFORMANC� �U O OF THE M/ORK FOR MMICII TNIS PERMIT 19 ISSUEO. � �I iUNE AND WILL MNNTNN WORI(ERS'COAIPENSATION INSIIRANCE,AS REOUIRED BY SECTIDN � Q 77000FiHElA60RCODE,FORTHEPEHFOHMANCEOFTMEWORKFOHNMICHTXISPERM1715 � I66UE�.MYXpWC PENSATIONI CE IENAfYDPOLICINUM9ERME: CONSTRUCTION >^ CARPoER��� �/� .�1, �f PLAN REVIEW � POLIC�NUMBER J,[��C �7 � � v ELECTRIC �' � (IHseECfqlaNE�rqTeEaa.RE7IDOf'n€r'ER1.at6waorEFiUf�ORE�DaWts�ita�ontEss) PLUMBING Z 1 CERTIFY TMAT W iHE PERFORMANCE OFiHE WORK FOp WMIC71 TNIS PERMIT IS ISSUED,1 MECHANICAL SWLLL NOT EMPIAY ANY PERSON IN ANY GANNEfi SO TO BECOME SU&lECT TO THE y WORKERS'COMPENSATION UNfS OF CALIFORNIAMID OREE TMA71F 1 SHOULD BECOME IN5PECTION FEE S SU6IECTTOTHEWORI(ERS'CdAPENSAqNPROVIS ]7000FTNElABOR 000e, rHca.�n�rwi s. ISSUANCE � - O p OA7E: v APPLICANT: SMIP � WARNINO: AILURE E REWOHKEHS' A710NCOVERAOEISUNUWF INOSHALIBE ENEfiGYP/C � Sll&IECT MI EMPLDYER CPIMINAL PENALT S ANO CNIL FINES UP TO ONE H EO TFqU3Mq ✓ DOLLARS(f70o,00aJ.W T10NTOTHECOS70FCOMPENSATqN,DM1AOESA6PROVIDEDfOHIN ENERGYPERMIT � BECTqNlTO!OF 7HE LABOq CODE,MTERE3T.ANDATTDIiNEY'8 FEES. RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 NEREBV AFFIRIA UNDEH PENALTV OF PERIURY THATTXERE I6 ACON6TRUCTION LEN�ING At3ENCY PDR iHE PERFORMANCE OF THE WORK FOR NfHICH THIS PERMIT 16155UED(SEC.9oW,GV.C.). � � LENDERS NAME � LENDERSADDRE55 � ICERTIFYTMIITINAVEREADTHISMPLICATqNAND9TA7E7FI�Th1EABOVEWFORMATpNISCORRECT. TOTAL FEES � IAGREE TO CqAPIV N7fli ALL CT'AND ODUNTV OROINANCES ANO STATE UWS NELATINO 70 BUILDINO � � CON9TRUCTON,ANDHEFiEBYAUhqRIZEREPflESEMATNE3OFTNISCOUNTYTOEMERUPONTHE ABOYEdAENTqN W PflOiEflTY PoR INSPEGTION PURPOSES. COMMENTS � 1 ¢ PERMITfEENAME � y 81GHATUNE OF iE ITfEE DA7E � — � RECPT.NO. 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