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HomeMy WebLinkAbout15408 (17) p-� ,,, " � _ CITY OF DIAMOND BA� � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � zi�o�.c�uy n�;��s�u i90 PRESS ' '��°" BUII.DING P�ERMIT APPLICATION FIRMLY oJOBSffE � APPUCATIO VERMIT P/C ADORESS�D�J�' �A�/�/U �L�/�/� DATE NUMBER � �O �1 � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER u" ADDRE ZONING SETBACKS CITY ZI TEL. FRONT RW ❑ APPU ANT TEL. REAR ❑ SIDE/SIDE STREET RW ❑ CONTRACTO ' SIDE ❑ ADDRESS PROPOSED USE f g CITY ZIP TEL� Pu ARC NG/ DE3taNER NO.DWEL. NO. NO. ADDRES6 UNITS � STORIES BEDROOMS � CITY ZIP TEL. y DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION QOWNER-BUILDER DECLARATION SFRfADWHEM O I MEREBY AFFlRM UHDER PENALTY OF PERAIRY 7HAT 111M EXEMPT FfiOM THE ODNTRAC70R5 LI• G9f9Qk1/G81'pOII CENSEIAWi'ORhiEFOLLOMIINGR[A80N(SEC.7W7.6BUSINESSMIDi1tOFE5SIONSCODE:ANYCITYDR (n CQUMTYMMIpfitEQNRESAVERMRPOCONSTRUCf,K7E1tMFf1OVEOE�IOIJSH,DNREPAIHMIYSTRUG tW petiOlDOdc 7UNE.PRqN M ITS 16HUANCE,AL90 REW IRES THE APVLICMIT WR 8UCH PERMIT TO FlLE A SIONED STATEMFNf TNAT NE OR!FE IS IICENSED PURSUANT TO hiE PROVIS�ONS OF THE CONTRACTORB Lb • CENSE LAW(CNAPTEN Y(COMMENCING WI7H BECTION iao0)OF DNI3pN 3 OF THE BUSINE53 AND GRO- u" P��Pe FES910N6 000�ORTNAT ME OR SHE IS E%EMPTTMEREFN04 AND TlIE BASIS Fdi lHE ALLEOEO E%EMv- , TIqd,INYVIOLATpNOFiECT10NT091.6BYNlVAPPIICANTfONAPERMITSUBJECTBiHEMPIIGNTTO z Re-Roo1 � A CML PENALTY OF NOT AIORE 7iW�FNE HUNDRED DOLURS(tSoo�.): ' ❑I,/�SOVrtiEROFTiEPRDPERTY.ORMYEMPLOYEESWIiHWA6E9A9THEIRSOLECOMPEN5A710N, C �ommerclal MIILLDO TNE YfORK,MA iHE BTRUCfURE IS NOT MENDfiD OR OFFEREO FOR SAIE(SEC.701�.BUSI- J NESS AND i1qFESSI0N5 OOOE:THE CONiRACTOR6 110ENSE WN DOES NOT�PPLY TO MI OWNER OF ? � VROPERfNM7iOBU1LDSORMPAOVES7HENE0N.ANDYVh1000E9SUGiWORRNIYSELFORMENSELFOR � 7MROUGH MS OR IIER OWN EYPIOYEES,VHOVIDEO 7HAT BUCH 14PROVEMENTS�RE NOT INTENOED OR m OFFFRED PDR BALE IF,YiOWEYER iMFBULDWOOR MGFIOVEMEM�9 SOL�NIITFANONEYEAROF WMPLE TqN,iHE ONMER-0ULDER WILL NAVE THE BUROFN OF PPOVWO 7HA7 HE Oi1 SHE DID N�T BUIID OR MVRDVE FOR THE PURPOSE OF 8ALE1. ❑I,AS ONMER OF TIE PROPEMY,M1 E%CLW IVELV CONTRACTINO Nflhl LICENSEO CAPft'MCrORS � 10 WNSTRUCTTME ifiWECT(9EG 7oK BUSINESS AND PPOFE5310N9 ODDE:THE CONiMCTORS Lf Veluation •� ADJ.AREA CENSE UW�OES NOTIIPPLY TO Ml OWNER OFA►NOVEHTf WIiO BUttD3 OR NAPFfOYES TNEREON,AND WIiDCONTMCTBFORSUCHPROJECTSWITHACONfRACTOR(S�LICENSmPURSUM1T70iHEWNTfUG QLJANTI QESCRIPTION FEE � TORS UCENSEIAW.). 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B.tP.CFORTHiSRFJ�SON � U � � OATE OWNER V �� J UCENSEO CONTRACTORS DECLARATION W � 1 NEREBYAFF�NY UNOEp PEWLL7Y OF PE0.NlIY hIATIJJA IECENSED UH�ER PHOVISIDN9 OF CHAPTER Vr s ��CO►IMENCWGWITlISECTION70oo)OFD�VISION70FTNE9l1SINESSANDPNOFE5510N5C00E.AND �i� W UCENSE 161N FLLI FORCE AND EFFECT. m O + o uc�sE cuss LIC.N0. � Cj D S , � pnte eoriTaacToa a BU WORKERS'COMPENSAT N IRRA ION Q � 1 NEREBY�FFlRM UNDER PENALTY OF iER1URY ONE O E FOLLOWINO DECLAMTpN3: U f� Q � _IMMEMYJWILLNAMTAINACERTIfICATEOFCONSENTTOBELFdNSUREFORWDfiKERS' 2 OOIl0EN3AT10N,AS PROVIDED BY SECTION 47ao OF TFIE UBON CODE.FOR iHE PEPFORMANCE f� pFTHE WORK FORNTfICH THIS PEHMIT IS I68UED. u! 0 � _I MAVE AND WILL LWNfAN NKMIKERS'COAIPENSATION INSUMNCE AS HEOU�RED BY SEGTION //�''�t�/�.y� Q l7mOFTNEIABOROODE,FOR7NEPERFORMANCEOF?FIEWORNWRWHICHTFIISPERMITIS � %�V— 165UED.MY WORKERS' PENSATION INSURANCE CARRIEq ANO POLICY NUMBERARE: ONSTRU � CARHIER�C� PLAN REVIEW � POlIC7M1Y6ER SL�-14 3 ZQ.� e�Ecraic � (iF165ECIpNIV�NpTgEpp�¢LE1EppF7FEpEW.1iBFOqpJEMJ1�UREp00uAFis�i�oqoqLFsS} PLUMBING Z ICERTIFYTHATINTiEPERFOf1MMlCEOFTHEWORKFORWHICHTNISVERMI71515SUED.1 MECHANICAL �'} 9t4W.NOTEMPLOYAHYPER50NWM7YNANNER80A5TOBECOMESUBJEMTOTHE E N WONKERS'COIdPEH9ATpNUW90FCALIFORNIA,MIOACREETHATIFI5�KKILDBEOOME S SUB.IECTTOTMEYYOf1KER5'GOh�PENSATqNPqOV1S10N90FSECTqN97000FTHElABOR — CODE,I SHALL FORT}IWITH COMPIY WI7M TM0.5E PROYISiONS. I � � p pRTE: APPLICAMi: WApWIq:FNLURETOSEQ/RE1NOiiKEflS'GOMPENSATIONCOVERMiEISUNIAVhUL,ANOBHALLBE ENERGYPIC � M18JECTANEMPLOYEfllOCRIMINPLPENALT1E5M1DCMLFINESUYTOONEMUNDREDTHOUSAND ENERGYPERMiT � OO11M31S700.000).WAUDI710NTOTHECDS70FCOMPENSIUION,DNMGESIIBPROVIDEDFONIN � SECTIONatoeOF711EUBOROODE.IN7ERESLANDATTOHNEY3FEE5. RE7ENTIONFEE: CONSTRUCTION LENDiNG AGENCY PRE-ALT FEE: � IHEREBYAFFlRMUNDERPENALTYOFPERIURYTYIATTHERE45�CONS7RUCTIONLENDWUAGENCY WR THE PERFOfIMANCE OF iNE WORK FORNM1iICH 1FIIS GEHMIT IS ISSUED�SEC.e0A/,CIK G�. � LENDER'S NAME_____'^v/V� � LENDERSADDNE88 � ICERTIFYTHATINAVEREADTH4SAPPLICATIONANDSTATETNATi17E1180VEWFOR1MTqNISCORRECT. TOTAL FEES ��I �.� � IAnREETOCOMPLYIMTMALLCf1YANDCOUN7YORDNANCESANOBTATELAWSREUT1N0106ULDINr3 CONSTRUC71oN,AND MEREBY AUTqRIZE REPRESENTATNES OF 7HIS COUHTY TO EMER UPON THE S� ABOVE�MENTqNEDVH07ENT/iORINSPECTION� � /� COMMENTS o �' 1 r� _ m PERMITTEE N I Q � N � N RE 1 EE �TE � RECPT.NO. 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