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HomeMy WebLinkAbout13486 (25) � CITY OF DIAMOND BA& � DEPARTMENT OF COMMUNITY dc DEVELOPMENT SERVICES 21660 E.Copky Drive 5uitc 190 (9Q9)86a3195 Fax(9p9)861-3117 PRESS ����� BUILDING PERMIT APPLICATION FIRMLY o AD R'ESS I S�V �'apph�re L.an e APPLICATION PERMIT Q P/C DATE NUMBER � V� x � APN L T Z TRACT z DAfE �� � / 1 CONST. GROUP � OWNER Ci ' ADDRESS Z�NING SETBACKS �'P' CITY • ZIP� TEL. REAR Rw ❑ APPLICANT TEL. SIDE/SIDE STREET RW ❑ CONTRACTOR � t. 510E ❑ g ADDRES . PROPOSED USE� C17Y ZIP�,(�2_ TE -f 0 � ARCHIEN(3/ DESIGNER NO.DWEL. NQ. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIP710N SQ.Ff. FACTOR PSF AW.AREANALUATION � OWNER-BUIt�ER DECLARATION SFR/ADD/REM O 1 MEI�BY I�FFlRM UNDEN PENALTY OF PEIWRY TNAT I IIA E%EMP7 FROM THE C�HTRACTORS Lb G8f8flB✓(iflfpOrt (�NSEUWFORTNEFOIL�NflNGREMN(9EG70.71.eBUSNE89ANOPqpFE3910NSCO0EANYCI7YOH (f) COIWTYWIUCHREd.JqESA/ER1AIflO00N9TRI1Cf.ALTER�MPROYE.OEMOl15M.ORREPAIR,\HYSTRUC• W p�[IOID6Ck � TURE lRqR TO ITB IBBUANCE.ALBO REOUIRES THE�PPLICM7T FOR SUCH PERMIT TO FILE A BIONE�. W 6TA7EMHiT TNl1T IiE OR 8HE IS LICENSW PURSUAM M THE PROVISIdJS OF TNE C�NTRACTOR3 ll� CENSE UW(CNAPTER�(C04A�ENCINO M7T5i SECTIDN 7000)OF dY1SION 90FTNElUSINESSAND PRO• ,� POOUSpB FESSIONS OOOE�OR h1AT ME OR SHE�EXEMPT THEREFi10M ANO 1NE BAS�S FOR THE ALLE�ED EkEAAP� 710N.ANYYqU1T10NOF8ECilON7W1.lBYMIYAPPLIf,ANTFORAPERMRSl1BJECT37HEMPLICANlTO Z Re-Roof � A CML PENALTV OF/q7 MORE TIAN FNE lq1NORED DOLLAq51R5ao).l: - ., 04��NRdEROFiNEPpOPERTKORMYEMPLOYEE9W17NYU(iE5A9TMEINSOIECOMPEN3ATf]N, 0 COTm9fClfll WY.L DO iME WORK AND lME STRUCTl1HE IS NDf IHTEND[D OH DFFERED FOR SALE(�C.70M.WSI� J � NESS ANG VROFESSIONS OODE 7ME CGRMCfONB UCEN66lAW OOEB NO7 APPLY TO AN OWNEq OF j PROPERTY NII10 BU0.D3 ON MPFiDVES 7MEREON,AIm VMD00E3 BIKH NfORK MIMSELF OF HERSELF Oq iXR0U6HWSORIIERONMEMPLOYEES.OROVIDEDiHATBUCMWPROVEUENTSARENOTMREN0E0OR m OFFEHEO PoFSALEIF�F10WEVER 7HEBULDINOOfl MJGROVEAtENT i8 SOtD WI7HIN OHE YEMOF GOMFLE . . �TpN.TME OWNER-0UILDEA N7LL WNE 7FIE 9UROEN OF VqOVM10 THAT NE OR SXE 00 ND7 BURD OR MPROVE PoR h1E PURMSE OF SALE� O�AS OYNrEROF7FIE VROPERTI;AM E7(CLl18NELY COMMCTWO W�117 LICEN5ED CONTMC70R5 1D CONSTRULT TFIE PHDIECT(BEC.7W4,BUSINEbe AND PpOFE5510N5 CODE:71iE CONTW�C70��9 LI� VelU6�iOn AD.1.ApEA CENSE U1W OOES N�TAPPLY TOi41 ONRaER OFAPROPERTV MM1�O BURDS OH IMPIqVES THENEON.AND w�+ocoerrrucrawnsuc�+nr+aecrs�+nn+�carrnr�croA(s)��c�seovuRau�wr�on+eoa+rn+c pUANTffY DESCRIPTION FEE � fD0.4l1CBJ5E UW.). �1 AA1 FXEMPT UNOER 8EG 8.i P.G FOR THIS REASON � U � H DAiE OWNEa V � LICENSED CONTRACTORS DECLARA710N � � w INEREBYAFFIRMUNDERPEW4LTYOFPEIiIURYTHATIAMLICENSEDUNDERVHOV1310HSOFCHAGTER � •(CLYYENCIN�VATM SECTION 700a)OF OMSION 7 OF 7HE BUSINESS MID PROFESSIONS D70E.AND YY 110ENSE IS N Fl/LL F'OHCE NVD EFFECL Z � 6g�)�- l °° e."� � UGENSE CLASS LIC.NO. � � � DATE "• � CONTMCTOR � WORKER5 COMPENSATION DECLARATION Q y INEREBYlIFFliWUNDERFEWLLTVOFVERN/RVONEOFiHEFOLL�WINO�ECLAMTI0N5: V � Z � � �IWNEMAWILLAWNTANACEiifIFIGTEOFCONSBJTT06ELFINSUREFORYARKERS' 2 Op1PENSATION,A9PFqYIDEDBYBECTIO�l870aOFTHELABORCOOE.FORTHEPERFORFUNCE W Q � OF iNE WORK FOR YVHICM THIS iERM1T IS ISSUEO. � [F� _I HAVE AND WILLIWMAN WOFiKER3'COMPENSATION�NSUHANCE,AS REWIRED BY SECTIOIY �6 a7o00FiHElABdi00DE,FOflTHEPERFORNANCEOFiHEVYOFIKFORWHICHi111SPERNITIS � ISSUED.YY WORKE/��s,,, JPrNSATION INSURMICE CARRIER ANU POIICY NUMBERAqE: CONSTRUCTION � cuuuER ✓���+�N Q PLANREVIEW � POLICYNUABER�_� � ELECTRIC o �g[cnwr��qorgEm�.�i�pFnEpgaar�Fapa�Mx�npmpaUasa�rolop�) PLUMBING Z I CERTIFV 7HAT W THE PERFOfUAANCE OF TNE YARK FOR Y/Hlqi THIS PERMIT IS 65UE0.I MECHANICAL BFIALL NOf EMPIAV ANY PEHSON N1 ANY AIMlNER 60 RS i0 BECOME SUBJEC7 TO ME y NRIPoCENS'COMPENSATpNL/1WSOFGWFORNIA,NiD�OREETMI�TFIS/101RD8ECqAE INSPECTIONFEE ��'� " SUBJECTTO7HE MIOAKERS'COAIPEN6ATIDN VNONSIDN9 OF SECTiON�70o OF 7HE UBON ocooe,�swuir�rmrnrnca�r�rvnni ernowsar�s. ISSUANCE � � �,�:�' /99 ,���� � ar�! • l�1 ef�e n SM(P e�I� • ��. WARNINO:PM.URETOSEWREWORKEP9'COMPENSATIONCOVERAOEISUMAWFUL,ANDSHALLBE ENERGYPlC F �y 9UBJECTANEMP�OYERTOCRIMINM.PENAL7IESAN�CMLFINESUP700NEMUNOREOTfpU9AND ENEFIGYPE T���-7'.��.,�^,•. • ��'�"�� i�ft�.,��• � DOLLAFi6(i100.0o0J,N ADDI7qN TO THE COST OF COAIVENSATqN,DAMAOES RS GRONDEO FOR IN .. , J SECTIDN 7108 OF TF7E UiBOR COOE,INTEREST,AND ATTORNEYS FEES. RETENTION E:•���'' ^4;".'•_. Q qW.. 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