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HomeMy WebLinkAbout13261 (27) � _��� CITY OF DIAMOND BAI� (��/ DEPAR.TMENT OF COMMUI�TITY 8c DEVELQPMENT SERVICES l �, . Zi6�oE.c�iey���s��i�o PRESS ,s�„� (4fl9)8b0-3195 Fax{�t09}Ei61-3Y1? � BUII.DING PERMIT Als'PLICATION _._— F1���Y Q� JOBSITE ��t�� �� ��,�i �.t ���f`��� DATE GATION NUMBER�_��G�� �lC. ADDRESS � ISSUE TYPE QGC APN L T FRACT DATE �� CONST. GROUP o� . ` ,� _ QWNER � O AC1D S 20h11NG SETBACKS Q ° . . ` FR4NT RW� , � �O . �, REAR C1 APPt1GANT TEL._� �, SIOE/SIdE STREET RW I� , � CCINTRACT R ' - �•- i ' SIDE �1 � ADDR , . -�' P OPOSED U5E � CITY ZI EL. ', C� � . � DES GNERt � , � NQ.DWEL. NQ.'' NO. � ADDRESS ' UNITS STORIES BEDROOMS - f1TION � Cy}'y ZIP TEL. � " DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALU �, NER-BUILDER DECIARATiON SFR/ADD/REM ' _ _ , O � p . �rtFF�ar tFF�F�a uwuER a�13Y taF PERluRr sHnr�nM�xEpdPr Ft�i TwE cdwTancroas u- tiaragelCarport IW �CENSELAWFORTHEFGI.LOWMGREASON(5EC.7031.SBUSINESSAN�PROFESSIONSCOpE:ANYCITVQR �.. (f) , , . _ .. 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'PHOpERiYWFiOBUILD30RIMP VESTHEREON,ANDWHODOESSUCHVdORKHIM5ELFORHERSELFOR . . . � � �� '�THROU�HHISORHER4WNEMP�OYEES:PflOYIOFATHAT5UCHIMPROYEMENTSARENOTINTENtlE�OR �m � � LL! OFFEREDF9RSW.EIFMOWEYE lHEBUtt.D1NGORiMPflOVEMENTISS6tDWiTHItJONEYEAR6FCOkPI�� - . Z��,���!TION,THE OWNEfl�BUIIDER WILL HAYE 4HE BURpEN OF PROVING THAT HE OR SHE DID N�T�BUIL�OR � � � � . � NAPfWYEWRMEPUFif�OSEOF�Ai.Ej. � ❑I,JS OWNEH OF THE PR6PERTY.AM EXCI.LISIVEIY CANTRACTING WITH L�CENSED CONTAACTORS . . � ����70�CDNS7RUCT THE PRQIECT(S�EC.7041,9USINESS P1VD PRQFES51qNS CfJDE:TNE CON7RAC70it5 LI- VaIl18S1011 � AD.�.AREA t13, ;CENSEUWDOESMQTM�YTCI�AMdkR�R6FAPfl4PGRTYWHOBUk.DS4RHdPROY647HEREi}N,AND �� iN'FIQCDNTRACTSFOHSUCHPRQJECT3WITHACQNTRACTOR(S)UCENSEDPURSUANTTqTHEWNTFi�4G QUqNTITY DESCRIPTION � FEE �, TORSIICENSELAW.}. I . .. - � . 0� ❑I AM EXEMPT UNDER SEC`_,,..--.. B.&P.G.FpP,PHIS REAS�N � �.� � l � �::. i - .� . . �'i' DASE � OWNER .� . . ��' .. . I . ._ . . .. � 4,I LICEN�ED CONTRACTORS DEGLARATlON � ¢ 1 HEREBYAfFlFM UNDEp PENAI.��PF PERJURY THAT IAM LICENSE�UhOER PROVISIONS OF CHAPTER �,.-�r � I � ��..�-9-(CqMMENCINOWIT SEGTfQN jOFD1Y1S10N90FTHE9U51NESSANDPR�FES510NSCODE,ANR Z LLI �UCENSERStfd .6ACE �D�CT. �{ � .� `}r� �i` tTGENS IIC.NO � �J - ��.�� �DATE . - CONTRACTOR �.� � . .a � . . i � W RVC€Fk5'��OMPENSATION�ECLARATION � � �;,. _- I U i . ...�.. ���� 1 HEFlEBYAFFIRM UNDER PENAL� C1F PERJURY CiNE dF 7HE FC/LLOYVING pECLARATIONS: C/�: Z � .�� P ; A � �'; _I�IAVEANDWILLMAINTA�ACERTIFICATEOFCCINSENTTOSELF-IPISUREFOAW4RKERS' 2 '� ,' K COMPEMSATlON,ASPFlO IDEDBY9ECTION37000F7NEl.ABORCQDE,FaflTHEPERFpRMANCE � � �. �� *�, ' OFTHE WOAK FOfl WHiC Thiffi PEflMtT iS BSSUED. c� � �'. �ttiAYEANDWiICF.dARdTA WaRKEASCQMPENSATbtdiN4URANCE,ASiiE9UiR£DBYSEC710N' . Q37W OFTHE LABO CC70�FPRTHE PERFORMANCE THE WORK FOR WHIC THIS PERMIT 15 � CARRIER EN T N U GE RRI o C. ' 6ERAR6: COPlSTRUCTIOI`1 , � issu�o.tnr owc P ,� PLANREVIEW a w�.tcrr�Ms� I ELECTRlC Q � Y •, � �sE<.�r��r�T�c��renoFrt�a�awr�s�aoraEra�moa�artssiaa}o�tEss} � P�UMBtNG _ ora I A7ECHANICAL ���Sa"''��� �', t CERTIFY THAT W THE PERFOFib9ANCE OP iHE WORK FOft WHICH THIS VERMIT IS ISSUER.f SHALLNOTEMPLOYANYPERSt3NiNANYMANNEP50AST06EC ESUBJECTTOTHE � INSPEC,TIONFEE �, WC} KERS' PENSATIQIN LAWS . 10.hNb AGRE T IF I SHOULD 6ECOME °" TTQ NE bYOFKE�iS' TN�N TIPY 370a GF THE° � . _� D,I SHA F T '�� OMPi. WI � RO O . I�SUANCE � - ���--�-- .o.. ' . � - . �$��� � . �+. . p: OATE:. , . _ .. . . _ . ENERCaY P/C .f't� v" "�a '�; , � . � W7FMIIN9:FA�URE7 9ECURE KERS' Tt COVEfiAGEtSUNLAWFU4A,^lDSFNLBE ��� SU&IECTANEMFLOVER�TOCRIMNAI:FEIJAL71E5AN IIFINESUPi00NEMUNDREDTHOUS ND ENERQYPEFiMIT - � ��%� ��`������ . �. 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