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HomeMy WebLinkAbout15527 (20) � �1 CITY OF DIAMOND BAB " r -��- ��� DEPARTMENT OF COMMUNITY dc DEVELOPMENT SERVICES � � 216b0 E.Copley Ihive Suite 190 PRESS ` �� BUII.DING PERMIT APPLICATION FIRMLY 0 DDRESS ��3 / ��L'V�� ���� � i DATECATION Q I` I� NUMB R��52� i� n � issuE p� �h�TrPe occ APN LOT TRACT DATE � CONST. GROUP S OWNER BILL � �� ADDRESS YONING SETBACKS � CfTY ZIP TEL. ' = R�RT RW ❑❑ APPLICANT TEL. SIDFJSIDE STAEET RW ❑ � CONTRACTOR Z0�1�1� SIDE ❑ ADDRESS �t' PROPOSED USE a - N �Z g CITY � ZIP TEL.�,�� N �, � ARCFUENG✓ � G � � DESIGNER NO.DWEL NO. NO. ADDRESS UNITS �STORIES BEDROOMS � CITY 21P TEL. y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUILDER�ECLARATION SFR/ADD/REM O 1 HER�Y AFFlRM UN�ER PENAL7Y Of PEMIHY TiIAT I MA EXEMPT FiIOM T11E CONTRACTORS LI- G8l8QB/CBfpOfl CENSEIAWFOFTFIEFIXIOWINOREAiON�SEC.�031.68U51NES9ANOPROFE9SqNSCODE:ANYCT'OR (n COUNfYYNiGIREOUIRESAiEfUArtTOCONS�RUCT,N.TER,IMPROVEDEMOL191,ORREWIIRANY9TRUp W p8N0/DBCk NHE,PRpR TO ITS ISSUANCE,ALSO REOUIRES THE APVLICANT FOR SUCH 7FIiM17 TO F0.E A BI�NED � lLITEMQIT 7HAT HE OR BNE IS UCENSED PUFiSUANT 70 TNE PipVISI0N3 OF 7ME CONfRACTOR3 U- CFNSE UW(Ci1MTER 0�CdJYENCINO YATH SECTION 7000�OF OMSION]OF THE BUSINESS M�PRO� LL POOVSpO FESSIONS CO�E)OR tHAT XE OR BHE IS E%EMPT TIEREFROM M�D THE BA513 FOR THEALlEOEO E%EMP- TpN.ANVVpLA710NOF8ECT10N7Wt.6BYANVMPLICANTFORAPERMRSUBJECTS7FIEAVPIICANTTO Z Re-Hoof 2. � �CMI.�ENALTI OF NOT MORE TIAN FNE HUNDRE�DOLLARS(t600�.): � ❑4�bOWl1EROFTNEPROPERT/,ORMYEMPLOYEESWITFIWAOESA9iHEIhSOLECOMFEN3ATqN, CORIRIBfCIflI tiYLL 00 iNE WOHIL AND TF1[9TRUCTURE IS NOT IMENDED ON OFFEREO FOR SALE(SEC.7oN,BU51- NE55�!ID PROFESSIONS CODE:THE CON'fRACTONS LICENSE LAW OOES NOT APPLY 70 AN OWNER OF = � PIIOPEHiYWf108U�D80RMIPROVE61YiEREON.ANDNR1000ESSUCHYYORKNIM5ElFORFiE0.5ELFOH � TFWOIIOHNI50RNEROWNFYPLOYE6,PNOYI�EDTHAT8UCJ11MPROVEMENTSARENOTIMEN�E00R m OFFERED POqBALE IF,/qWEYER TME BULDINGOiI MIPRO�E4EMI5 eOLD WITHIN ONE VEAR OFCaMPLE� TqN,TME OWNERiU1LDER WILL FIAVE THE BURDEN OF PROVIN6 TMAT HE OR SNE DID NOT BUIID OR MPROYE F061 THE PUHP�SE OF 6ALE1. O 4�aNNER OF TNE PiiOPEHf1:AM E%CLUSIYEIV CONTRIICTWO NAhi LICENSED GDHTMCTORS � TO CON57IR/CT TNE►RDJECT(SEC.70M,lUSINESS M70 PIqFES310NS WDE:THE CONTRACTORS LI- V8IIl0�I0f1 O b ADJ.AREA CENSE lAW ODE9 NOT APP�Y 701W OYMER OF A PROVEHTY WMO BUILDS ON MPpOVEB THEREaN,AND WFiOOONTpACfSFORSUCNFROJECT5WITNACONTMCTOR(5)UCENSEDPURSUMlfTOTME00NTMG OUANTITY DESCRIPTION FEE � TORSUCENSELAW.�. ❑I AM IXEIAPT UNDEN 8EG 6.t V.C.FORTHIS REASON � U � F�- �ATE OY�'NEH V � LICENSED COMTRACTORS DECLARATtON W � I XEREBYIIFFWAI UN�ER PENALTY OF PERIURV iWIT IAM LICENSED UNDER PROVISIONS OF CHAPTER � /(CdWENCIHG MATM SECTION 7000)OF UMSION 90F THE BUSINESS ANO PHOFESSIONS CADE,AND Z MY LICENSE 16 N FULL FORCE AND EFFECT. ��Q � ' m � LICENSE CLASS LIC.NO. � � � pATE CONTMCTOR � WORKER5'COMPENSATION DECLARATIDN � 3 �Z -� U � IMENEHYAFFlRMINVDEHPENALTYOFPERJURYONEOiT7EFOLlOHIINODECLAMT10N5: q� � � _I NAVE AND VMILL MJUNTAW ACERTIFICATE DF CONSENT TO BELFdNSURE FOR MK)HKERS' Cl.MAPENSAiqN.11SPROVIDED8V9ECT10N97ooOFTHEUBORCOOE,FOR7HEPERFORMANCE W OF THE WORK ipR WNICH 71118 PERMI7IE ISSUED. � _I HAVE AND Y17LL MMfUN WORKERS'COMPENSIUpN INSURNICE.A9 REWIRED BY SECTqN ��` � Ylun OF TME LABOH OODE,FOR THE PERPoRAMNGE OF THE WORK fOR WHICH THIS PERMR IS AX ISSUE0.MVWORNER4'COIAOENSATIOAIWSUfUNCECARRIERMJDPOLICYNUM9ERME: CONSTRUCTION /U �l� � CARRIER N � "�- PLAN REVIEW � POIICYMlY9ER f� �r7 � 0 ELECTRIC �Q � (iH56QCTqNN�Np7gE0p+RETmOFhEPEqMiSFORWEHII�aEDOa.LAfs�ita%ORtEss} PWMBING 1 CEATIFY TlMT W THE PERFORIAANCE OF TNE WORK FOF WHICH TIi1S PERAl1T IS ISSUE0,1 MECHANICAL � SYUL�NOT EMPLOY ANY PEIiSON N ANY MANNER 50 AS TO BECpAE BU&IECT TO THE '`) y WORKERS'COMVENSATqNlAW50FGLLIFOHNIq,ANDAOREETHATIFISNOULOBECOME INSPECTIONFEE S SUBJEGTTOh1EYKJFKERS'COMPENSATIOqPHOVI510N50FSECTIDN�7000FTNEUBOR •�� CODE,ISHIILLFONTlNATHCOMPLYWIlHTNOSEPflOVI510N5. �SSUANCE C�ITY nR f:iA 11+[(l.T� 0 onre: q ((,�(o°APPLICANT: ���� SMIP �Ljj7'.�r�� ��,T�yn rc�rv . h � ENERGY P/C WARNINO:FAILVRE TOSECURE MlOP10ER5'COMPENSATpN GOVERA�E IS UNIAWFUL,AND SHALLlE BUBJLCTANEMPLOYEflTOCRIM7NALPENALTIESANDCIVILFWESUPTOONEMUNORED1TibU5AND ENERGVPERMIT .r OOLLARS�itOQ000�N1AD01T10NTOiHECOSTOFCOMPENS�TION,OAMA(3ESASPqOYUEOFORIN .tJ SECTION970eOF7NEUBOROODE,INTEREST.AND117TORNEY'SFEES REfENT10NFEE: � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBVIFFIqM UN�EN PENALTYOF PE0.IURY�HlI7 THERE�5 A CONSTRUCTIpJ LENUWG MENCY FOR hIE PERFORMANCE OF THE WORK FOH WHICH THIS iERMIT IS IS6U�(SEC.70W,CIV.C.). � LENOERSNAME � I CRTIFY TW1T I H/NE READ THI5 APP�ICATION AN�STATE 11U7 THE ABOVE INFOnMATqN IS GORRECi � TOTAL FEES I rL�'1 � 1 hGREE TO COMPLV 4VITH l�LL CITY ANO COUNTY ORDINANCES AN�STAiE UWS REUTWa TO BIHIDINd fbNSTRUCTION,ANO MEREBYAlfi/10RRE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE S� ABOVE•YENTqNEOVROPERT'/FORINSPECTpNPUR005E5. 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