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HomeMy WebLinkAbout13488 (27) � -- �._ CITY QF DIAMQND BAB /�./ � DEPARTMENT OF CONSMLJNITY 8c D�VBLOPMENT SERVICBS ` �c aisso�.c�uy r�►YG s�c�i4o PRESS •:A�°'' RU�ILDING PERMTT APPLICATION FIRMLY 0 oeaa��ss lS�'� � �'t�re. tu n� DA�ICATION ��QE�)-��. ..���j ��c ISSUE TYPB OCC � APN Ld � TRACT �- �' DATE ��� CONST. GRdUP �j C}WNER p ADDRESS • 20NING SETBACKS � CtTY ZiP 1� TEL�i/�C .�:.�I FFtOP1T RW 17 � RPPLIGANT TEL. r REAR O SIDE/BIDE$TREET RW ❑ � CON'FRACTflR i �'�" Gt� SIDE ❑ � AD�RESS PROPOSEQ USE Cliy ZiP�TEL "' O � AftCHtENG( + � DESIGNER N0.DWEL. NO- NO. �R�� UNIT9 STORIES BEDROOMS G�7'y YIP TEL. � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER 4ECLARATION � SFWADDIREM 1 HEfl�Y AFFIRM tNK)ER PENALTY OF PERIUHY h1A7 I AM EXEMPT FROM THE CON7RACTCIRS ll� ���(^�g�rt GENSEtAWPOR7HEFOLIQViNitiRFJ150NiSEC.7IXit.b8U6iNE59AN[}AflOFESSIOtiSOJD6:AN5'CIIYOR (n QpUNTVWIn"FIREOI.IIFiESAPEAMITTOCONS7AUCT.N.TEfl,MAPROVEDEMOI.ISN.OpREMIRANY6TRUC- � Patlo/Deck . . 7UpE,pqpp'(Q ITS 15.4UANCE.A130 NEOU�RES THE AVPLkANT FCR SUqi PEHM17 TO FriE�4 W�NEp 6"{RT6,rENT THA7 ME OR BHE i5 LICBJSED W,/RSUANi TG'ME PROVl8�di3 CF THE CONiRJtC1'ORS 41• 4�NSE UW(CHA77'6R 0(COLiMpNCINO YATH BECTION 70RqJ OF DIVISIpN 7 OF TNE BUSINE33 ANO PRU- LL' POQUSp91 ffi5910tiSCa.1E70R7}UtXNEflR5tiEi8EXEMMTHEREFROMMI07tiE6A3{SFORTNEKtE��67[fMP• {�} 7pN.AMYVIIX,ATI0NOF8EC710N7a91�6BYAM'/APP4�CM11'FORAPERM�TSUBlECI'BTNEAPPLIC�ANT7p z F19-R001 � AGMI pENALTY OF NO7 MOFlE iMAN FIYE NUNDHEP DOLLAPS(t55a0�1: � D6A5{IMR7ERqFTi1EFf�EFfiY,ORMYEA�IOYEESNfiTHWA4ESJS'MEIRS�.EOOMPENSATCX�1. � �merCiat WILL DO TiE WOfIK,AND 111E 87RUCitIRE 19 NOT INTENDED OR OFFERED FOR SAJ.E IeEG 704�,BUSI� J NESSAND PFqFE$$IONS OWE:THE WNTRA4'TORS LICENSE 4AW OOES NOT A7PLY TO AN OMlNEH OF � � PIiOPENTYWFi68l1q.OSIXi7YRROVE9TtiEREQN.Jd48WFiODOE$SUCNNCFlittNM6AFdiHERS£LFOR � TFq10U01tMIS4R H6POWN EMOI.OYE6&.Pfq410ED 71Mi 6UC11 IMPROVEMENTSME NOT INTENOEDOfl m OFFERE4 f�F49KE ifi NCM�EVER.T!�9VhDINQOR MPfl04EMENT IS 9GLD WiTWNONE YEAR OF GONPIE 7qN,THE OYVtiER�UKDE1i WILL.W1VE TXE 6UR6EM OF VRONN6INAT NE OR 9HE DID NnT BUtID Qfl MAPHOVE WH 7HE PUHC08E OF BALE�. ' �,} okASOrit�HOFtnErfqPEH7t;AME7ccLUSIVE�rIX'�trtucniOwlMticENSEOCtONTMCi#iS �� Tp ppMgTWJGT TME►RpJECT(8EG 7dM,BUSMESS NiD PROFESSIQNS CO[7E:TNE CONTHACTORS LI• VBIU9�1011 AdJ.AREA LY CFTISEIAWDOESNO7MPLYTOANOWMERqFAPHOPEHTYNM1N78ULD50R11AMiG1NE5THEREON,AlO � Yy1pC�MSR/lCT$WqBUCFIPROJECTSWiTHA00NiflltCfqR(S}ItCENSEDVtlt#SU4Nl70tN5GONTR�C- O(JA{�j�'jTY DESCRIPTFON fEE � roAs ucasE uw.�. ❑I AN EXEMPT tM+AER�C. 8.8 G.C,fOR THIS REfi50N � 2 V" DATE �NMER V � � UCENSED CONTRACTORS DECLARATIQN W � INEREBYAFFIRLttMDERRENALTYOFPE0.WiiYTMATiAMtiCENfrEDtklDEflPROVtSlONSC�CHMTER � � ��COMMENCINGVA7NSECTqN'7QWI�DIV1310N?OF7HEBUSINESSAHDPROFES610NSCODE,AND Z E1V L10EN6E 16 N FUt.11�itCEl4V�EFFEC7. � t�r� a LICENSE CIASS UC.NO. �� � j � pp7E ' CdJTMCTON � d � WORKERS'COMPENSATION D6CLARATiON a U � ��aEsr r�mwa uraosa v�nurr a pewuar a+E oc niE rournvx�a aEoururaws z ¢ Q _,,,{��ipapWlLt#1AY+ITAINACERTiFK.�`.T60FCONSENTTOSELFWSUtffiFORKCRKEPS' S �� COIAI>6NSA710N,AS PROVIDED!Y SECTION 8�004F THE UIBOP CADE,FOR'ME OEfiFORMANGE W OF TME NfORK Fqt NMKki THI.4 PERMIT IS 185UE0. � � �.�HAVEANDWILLIAAMNNWORKERS'OOMPENSATIONINSURANCE.ASREOUIREDBYSECTION � aTaaOF Tt�UBOR C006,FOR Tt�PEHP3HMti�ICE#TH£WORK FCR Wt@C1i FNiS PEHMtT IB � CONSTRUCTION -� � � . . _, > ��� �,�' ������� . 158UED.W WOPoSEflS' PENSA IN9URANG HRIER D POI.IGY ��e�� � w� ... ... Cl pp��`yry�IIBER, I ELECTRIC R �� �.._. (IW58EC110WWE�PD1'8Em9'�IEIEDiOF'7HEOEaM1fsRSi+dJEHl.�oarvIX7l.WlSGF+aolaiL6s5b P4UMBING .0 '_.'�..'�'yq' BI CE1171FY THAT IN 7fiE PENFORMMICE OF THE YK1RK FOR WMI{://TNIS PERMtT IS kSSUEG,� MECHANICAL ��,r i • M 4 �y BFW,1,NOT E�dPLOY N7Y PER9f}N IN ANY NINNER EO�5 TO BEGOME 5�&IECT TO THE y�x waaceas•�urr�vsaT�aa uuvs oF ou�anr��,uao xrtaEa�r a��srxxxo B�c� IN�ECtiON FEE,��' � tiUBJEGTTOTHEWOFlKERS'CCWGENSATItlNPROVIS10N80F&ECTKINe7DqOFTWElA80R � � '. i sP.°� �� CODE,lSHALLWR7MWlTMCdMP�YW4THMO5EPFtONSICINS. ISSUAhICE � :.1=�., •�`V}r ! f�� .�.1�-� /�.�lj..� �.[;,::-�-�.,� � pp7E:��� APRICANT: _C +I E. SMIP . F� ENERdY P/G WARNING:FAIUIXE TO SEGURE WOHNERS'CQMPEN5ATIO�N COVERAGE IS UMIAYYFIR.ANLIBHALL BE � 75U9JECTMIEMP�4YERTOCRIMINALPENKTIESANDCMLFINESU77QONEHUNDREOTHOl1SAND �ERGYPERMI7 � �,,, DOCIAfiSiStiqq.�DI�WK115�T10NTOTHEC03TtiFC�APENSATfON.OAMAGESlSARDVtUEOs�RW � ffiECTION97aB pF h1E UIEOR CQQE,INTERE57 ANDATTOpNFB FEES. RETEN7ION FEE: q, CQNSTRUCTION LENDING AGENCY PRE-ALT FEE: � t FiEREBYlrfFlfGd C1t�ER PEM/S.tY�PEP.1Uf1Y TW�T THEFE i9 A�tSTRt1CTi�N lENO WG A6EMCY FQR THE PERFOHMpNCE OF THE WORK FOR WlUG7i MIS PEAMI715 ISBUm(SEC,f0Y7,CIV.C.�. � LENDER'S NA.ME . � � 4P+oEfi'su�GRESS � lCERTtKYTNATiIiAVEHEM'tHiSAPPIlCrtTbMYdDBTATEtNATTHEAB�vEINFOWAA710N150041RECi: TOTAI.FEES � 1 AOREE TO CClMPLV NATH AlL QITV M�COIRRY OFIDINANCE3 AND STATE lAVl3 NE4.AnN0 TO BUILLINq CY7NSTRUCTqN.AN�MENEBY AU7HOR�2E REPRESENTATIVES OF 7H1$CAUNTY 1d ENT£H UPON THE � ABOVE�MENTIONE6AF�p�RTYFQRiN6PECTWNWFIPOSE& COMMENTS � ` }1'?�. e- � PERMITfEE � , t+ � � rr � SI�X+itURE OF i OATE RECP7:NO. 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