Loading...
HomeMy WebLinkAbout12-700 �� _ CITY f)�I]IA,M�NU BAR F I7F..PAXtTMENT QF Cf]1'f1�1L1NI'E'Y&DEVEL[]PMEN'�SERVIC�:S 21$1�Copley Uri�e,Diamanri l3ar,C:A 91765 �f {yp9y 839-702D Fax{9pg)861-3ll7 S�ildi�g�nspectinn H�tiine(9i�9)839-7f)27 PRE55 ���� 13UII.IlING PERMIT'APPLICA'i'IUN FiRMLY � JOSSITE • •_- `. ` ; +�` APPLICATIOH �'ERMfT PIC d ARpFi�55 G r'�Z ��� _� ie���[['Y i S��,{r 7 i' �' -�-} NlJMB�R #�`,O� q � Gi. _r��-T�,� Ok7E T �- � �e�+ � ISSUE l'YPE p�� APIV ��7 , TRAC7 �ATE CRNST. GRQUP � awr�E� a '� _fJ -��r xDra�r�� 5�rsACKs q A{]QRESS J 5���l�yy7[�:��-'c-r' i, � CITY':•__.��^. ZIP��� TEL. FRdNT p}�y �� � APPL€CAN7 TEL. ��AR C] � SI�EJSit)�STRE�" Ryry1 ❑ m CON7RACTaR ` ' - - [' c':;:- � t ^ r...- SIDE � � CDDRE85 " ' c ZEP� 1`EL� f_, PROi�QS�D LISE _ t �������� . � ARC fVG! ti• .. —.: .,. _ ..._.._�� w ❑EsiGn��� Ha.DWEL. Id�. �{0. r� AE]QRE55 � C1TY �1P TEL. UN}TS 53RFilE5 BEOR[3DM5 � � DESCRIPT1pN Sf}.F7. FAC7Qfi PSF AOJ.AR�ANRLLI,0.TTC}N � OWNEFt-BLJILQER�ECLARATI�A! SFLUA�plREM � p I HEA=9Y A�FIFy.i 11NpEfi PEHALTY OF'ERILLRY FiiFT 3�5F�yEh!Pi FROM THE COI:T;?ACFOfiS LI- �aCd B/�a {� LLI CFYSELAWFORFt�EFOLiaWINGiiFA5Oh'[SEC.7L15F,5131151hE55AH.7?ROfESSIONSC.(}7E:ANYCITYOR (� � � C-� CaJN11'Wi1C]1HE0111RESAPEfLUITTOCOM1STHUCT,ALiER,IYAPROVE,OLA1�L15�!,ORREPR'RAN75TfillC. � � TUHE,PH�OH TO ITS ISSI}AKCE,lUSf]HEC7JIRE5 THE A'PLICAAfT Fpq S�CH PEAMITTO rI:E A513HE� � �atlp���f{ w� STATEAiEHT THAT liE DA SHE la 110E'JSEO?J�SL'AhT i0 TH�pppy15:0'JS OF TNf CCh4THA�7OR5�]- � CENSE LAW ZCVixP7fA B{CAi41MENCINC WITH 5[Ci'Ary T.�np�pF fl.'ViSrOh's OF Th?E 6USINE55 AN�PRQ � POOVSjY3 Q FESSbHS q[�E)OR THAT HE OR SH�IS E1fE.41PT T1{ER�FROM AN�T7i"c 8A5�5 F�H THE.�LLGE�E10EµF• � U TION.F.VY VIOLATIOPJ O�S�CTIn�17�]1.!�Y IWY APPLIC.WT FOf�q p�RMIT Sll&IECTS TF�p,?A[I�/,yY Y� � �g.��f r ACM�PEKALTY OF ryOT hIGHc TfLN3 FNE H111JORE6 DIX l ARS�5506�.): Q i:]R.4 i DWVEP.OFTHE BROPER'fY,n4j FAY EMpLQYEES WIiH WAG[5 nS TIIEfR 50LE WNPENSATI�.y, ❑ Commercial � WILL�O THE WOR+�AVO TV!E STAUCTk1RE IS�Ih:�40��6q OFFFq��FCR SRLE�5�'C.7�a1,61i51- J � HE55 AN6 PROFE551UM15 CL76E:THc CONTRACTORS GiCEHSE L4W DOES NCT AP?LY TO!,ry pW,y�R OF � PROPERTY YJHO gU'LOS OA 1MPHOVESTH[R[GH,RN6 W.'10�OES SIJ�H WOnK H�lASELFaR IiERSELFafy � T}iRq1JGH�115 OR HEROIVM EAIALOVFFS,VilnvlpE�THAT Sl1CN I?A7ROVFIJEN"5 ASiE NOT I.YTEN�=p pp m � �FFERE�FCRSALEIF,HOWE+I�Ft,TV�EFllll'.DiNG�R1U�ROVE!/fM155nt�W�7HI1rONEYERflOFLY}LI��- � 71Q.'1,T}{E C'JJNER-BUI�7[�i Ly��HJ�yE THE BliRSEH OF FROVlYG ill�.i�1E aR 5.HE�IO Nni yl�l[D OR � tMPRDVE FOR THF.1'i1HPO5EOF SALE�. � �i!,ASOWV�HaFTHEPIiOPERTl;A.UE%CLLSIVEtYCONTRACT:'N3WITHLIC[k5E000N[RACiOR$ - , [� 70 CO�:STR�JCT THE PftA7�CT[S',C,�pqJ,pV5!HE55 Ak�FROFE551pp5 Cppe:TFiE CONTRACTOqs��. V3II73IIOR � � A�.].AAEA � CENSELAW�OESNOTAPpLYTaRNOWHEROFAPROP�R7YWH06LIL�750RIMPAOV�STHER��I,RN➢ � WHO�QMfiAGT5FOR5lJCHP3iQ1€CTSWfRiA�p1�TMCTOR{S�LICENS��PIIRSL�NTT6THECUYTRqC- [jUANT�TY OESCRIPTIQN �� � 7QR5 LICEHSE LSW.). � CI I AAI.f�7[EA[PY F}Hp�R S�C., __ _ _B.b P.C.FpH[Nh5 ftEASOPJ d � C.7 W OA7E qWNEA F-- � '—' U d¢ L]C�PfSED C�NTRACTORS D�ClARA73�N � �C I}�R@SY ISFIAhi I1HdER P�NALTY pF P�RJlJqY T}�A71 A3.1 LtCE+J5E9 t1Nfl�R AApYI$]p�{S OF Ci1AAT�R � � Y ICdlAMEHCINCi WIFH SECTIOH 7o00J OF ONISIpl.rS OF 7HE 6USINFSS+�NP PFipF£SSIQ'JS CO��,F.4O � !].I �i�HSE�5 fN Fi1LL FQAC�AHp�FFECT. � � LICE135E CLASS �IC.Np. „ � � �ATE 4, CDHFRACYOR 0. U [11 � WDfZlCERS'G41riPEN5A710N OECLAPRTlph1 ¢ � 4 Si�ApBYAfFIiiM UM1DEFk PENALTY OF PE��IJRY ON[OF�31E FOLEOFVIh'G O�CL,AFiATp7J$; � � I HAVE P7J�WILL IAA1h7n1H A CERTIFICdTE�F CONSENT70 S��F-WS1J5��FflF WORKERS � _ CC4IPFHSRT1DIr',A5 P{Zp1/p�O 6Y SECTIOH 37W OFTli��.�yype��:p�FOFiTi1E Pf�RFORAUryL� � 4 OF771E 4L'Oi1K ZO.�WN:CH7N�5 PERMITIS ISS�E�. � � ikAVEPND WILLlAhiH:AiH WOHHfiGS'Cx1MPE1:5AFBONfAPSLiRAH�,RS!{EpJ�p�BYSfCT101J � � 37f16OF 7HE U96R C.�]OE,Fnfi 7HE PERFOR6WJC�pF THE WbRiC F097 WNiCII i}f15 PEFVAR I$ 3SSVE6.41YWORICERS'CAMP�IJSATION INSIJR,RKCE C+1r�RIERMI�POLICYNl1A19ERARE- CQnPS7FIIJCTION � � � cuaRi� __`�•-�_ �. � ,] __ ��.atd Rev�ew Ir.�� . 1 � Pa�cr wuMaen_r. ;� = r � �E��'�. a 4��•� ELECTRlG _ � [E];t4sc"�rcNNE�NCYiBE�pAiSETFflCFnfPEfi�,rrtsri7R4NEfa1DORE[SWELVS�ItooyClvLESSJ PL11M81FFG lJ_f � 1 CERTI:1'Tl1A:IN 7HE PERFORiANiCE OF T3iE YlORH FOR sYF[ICH f}u$p��T i5 IS5i1�0,i M1dECfiANiCAL G} S11AlL Nh1'EM1<pLQYANY PERSOiJ AY ANY FIMlN�f�$U.LS Ta 6ECAME SUBIECT TOTHE � 1VpRKrHS'COMPENSATI0.YLAW5[7FCnLIFtlf1HI,1pJ:pAGREETHRTiFISNOu��Q£C�b.`dF, INSPECTI6NFE� � SU6JE:TTO TNE N'O�il(ERS'COFAPfNSA:IOH PROV{S101GS OF SECT1OF137n6UF Tli$�Qq �' �� � CW[,1 ShfAl.�,FORTYM'ITI{COIApLY W�1 T�ipSC Prf�VIS10N5� ISS�JANCE �r, , � � �j DATE: APF'LICANT: _._� SAA3P _,.._'_"_"_.!� ,�jQ Lil � WkRN3H6:FAILUR[TC15'[JJi1E WnFEKERS'�A'.1�PENSA710.Y Lt7VEMGE 35 IJNLAWFU�,RNp SIi.4�LElE ENER�Y PIG .� � SFl&]�C7AN EMP!tlYk17 In CRIM:NAL PENALTiESRfJ�CNIi FINES uP TO ONE HUNpp�7 TlM7l15Ah1� ENEFiGY PERM17 09ClhR°�Sioo,9na],IN A�)iJl7:['�y i�'HE CDST OF{'AMPENSATIOH,DAAlqi,i�y AS PpbVIF1EO fOR Ik J SECTION 3709 OF THE LABOA CADE,ui7�qE$T.AHtl AT'Y�AHEYS FEES. � RETENTIdiJ FE�: -- (r]_ C30 4 CatJ57FEUC7ipN LEN�lNG AG�IJGY p-�RE-A.LTSFE�: � I HfRESYAFFlf�.l FINBER P�33W,j'(pF PEiLIIyF{y pH,4T THERE i5 ACOtiSTRlfCT10N�HO�NG AGEHCY �j� � d FUR�H�pERFOR3.NNCE QF THE WC3RlC FOR WH1C}iTHlS N�H!A�713 tS5VE0{SEC.3C�T,G7V.GJ � 11-F � �EkAE17S HRME F" LEh97Ep'SnpdpE55 � i C�RTIFYTHAT 1 VinYE H��n Tlil:APPLICAT=.]NAN�J S:AT�TWLi THE A90yE WFpqpF.{71DH 15 COAR�C7. t O�AL Fl��� �� ' �1 � i FE1Rf E T[7�64PLY W1TH ALL CITY RN�CALNTV ORpI.VAYCEs A.Yp 57RiE GWS AEUTIiJ�70 911i�p1NR � CQNS7RllCTION,FN�HEREBY Al1TFiU'i12E RF.PFESENIAYNES�F i�L15�CIXINTYTO�N[FA!]POH THE � A6OVE�MENTtONEOPROPERTYFp.qINSPfL'7ipHP�pp5E5. . �����T$ � N J �. � ! � PEW�F1iI�E� ` �RiNly-` - Q �- � � 1.� � � U7 5[4HA7ilAi:OF ERhSI E PA7E R�CPT.NCI. �i a QC1 Pp3p BY ���1 VALIUA7I�N � , VYHiTE-pegArtmer�t Copy,YELLnW--FinanCB Cs�y,pEtJK-Assessw Copy,GQLOEN}ipC1-f��a Copy,GA�N--Appllcan!'s Copy i � ���`� �� �33�,����i� ��� � � � �������'���� ����F��3 ? , ,.,,,:,, . - - ., ;�� . z � - �, �:.;�, - � � �,���� - M � - �;: fiz.s:, w..a�� �� -i�''- , -� - ''' � h.-' -£- �-,- ,�5;�:�,; W � zi= n�• �r. 9 � � �e'� � r =�Z _� ��" �� t•'M��. ...:'.,' t:�� �&� � 'c.. •.,: , ... � , � . , , ��`� a�:.T F�F1C� � ; !FLGC].i?Ji.3s�1 I ' �..._......................_..............._..............._....._.....�, � � ... - -- _....._.._.......--- • - - -----.....---._....._...- ---- •r __......_....._...___....i f ; j --...._._..._...--- s ......_......._........ ._................._......_._.. .. . �.€CsSir�'Fii��;`���.3:�_ ! ' � `F�iA'SF..��A E�J ; �V '""__'"_'""__....—._....""'""""""_"_____"�....._.....................;..._....w,�..�....._.-....... .�......................�..,...............�......-...._�.. :_............._....-_._.._...-...—'"'_'""_.....__.....__"...._......__ "'_"........_.............. ............�-...-,...f........,..Y....��..�.......-...-..-,-.._'_'" _ . �.�m.m..�..� . ! ..�. � �I_i=[��!�I�C�t�f�.i€�Q � � ll'���R�i.t7t�%��l}CS : M..r.....r...._..__........._.._._.._...mr..•-.•-..___+--_•--------i---..._.__..._...._---_......_._.�._.w._.._.�.� �...................__...�._....._...._...�_...��.-•-•.--�F_..____.—�1...---.��._�......�_.....___W_...r._..._..�.._ i.x�iCi€.rNi:)Pu�Jlvi�i3�,r.� € I ; 'l7{'dCaE'li FL�vi��.i]€�l�?F.J�� i I ,S r...._.mm............._..._.._...f._..._...�._...___--a-------•--—'.-..-_..__.___._......_.�.__..�.._..._....._w._._.._. i S�.a�e��r�����. -- --- --- --� -------__ .__..._._......._.._�...______...._...___ ;�t�G��Foc���ura��z�;c�� � � c� __.��....._.__�__..._______---------; r—_—_..-----�.__.�.._�.w__�._���..._�...__�....�..__.�.�....�__------------- ��,�r�t����^;��.r�:�.�.__..�.._._�._._.._ i_w.�...__...__ I _� �rt��P�.�r����c��a�_F{��:�t ...�_.. m_._.�._.�...!... __ _ --- ! `iN��I�t�af�i1�fC� W_.... _..._ ._�.�......w.M.. � ?�,��f.�h4T.'�C�i�s'3 E�ri�3 f � •-____..___.___ ._..�._._�..._m.._..�_�...__m...____.._., � �._ .._...._...�._..�.�.�__�.......�._...._....._._�._._. i E�{"`�`_.._._._._....w�._._..._....._...._._ I # ;S FT RC]ND wiAt+�1 RG�3F SHF�H7��lI�G: i __.._._�...__..._..._.__.__�_...._._.�.._. � —_ I ...�.� ...�._�.�....�__.�.....W.._ __.. .�_....._..�_--__-___.._.__.w. i�Fi,��11�lGiL+�fi1TIL�T1(3RI � ��"..�"...__._...._..._..___�._.__.__.� E . 3�'��f��.x������.�l�f�i� t ; ........_.._.__.'___.___.._...__._..._....__..._.._._........y..,_.'.._.._....,.�...._...�. _....._.............._...._........-.-...._.-...._--.....-._ � . Fk...__..._...__._..�........k_.................._...,..._.,_.._.................f_-....._._..._..-....._ �i��}�'�Q�fF� € � � �Fs�ti�-��i�i�5{�.�Ci..'.—_._—.._—__'_"__.� s€ i _._.......-_..._-..._.._...._......--�----�......-_._.--.—...-:- - �----�-----..__....w—.—_._..........._...._..._.._.... .__.._......_..................-..-.-.._..__........._-...-..._�......-.., ..r.._.....----�-----}.........._...---...---........__.............._..._..............._...-:. ! R[�IJG�€��A71€'�C �— ---- I ��EP�C€�f1L�C f F j ....:_...___.._.........__..____—.-------.-._...---.+--------- ._..___._______.._.....w.....___.__..__..�.� _w._...._.._.___;....._....�....__..__..._.._..__._...._...+..__---•..--..-.---. =`•.�l;.Z;�{���C'�t�1C i i �FtQt�GEi C�R�bl3•l.C; � s-._._.__..__......_.._........_...._.__.__._.....__ !�t71lG}3�[.f.1tv181�lG_....._.�..._._.....s...�..m.._. .�._.__.�._------ :� ��iIv15Fi GR,�C3ING �.._.. _.___...__ _r_._ —___. ��E.[��,'�'EFii i�!BTE.Si".____._._.�_...__ ----- ; !FC7�[�C��CTRiC ' �__.__ ._.�_.W_...W.±_w_.�...____._.._.._�..._.�.��___ �� ;________..._.__ _._...._ �.�.....�...} ._.._ �hT.l.IIT?-i;Si(]fNG i , F�'C3C3�..F�IV�€�E� �� :. _._....�.._�.___�.�._.�.......�..._..�._.�..___m__._..._.�._,________� ;�— w_. � � ___.m______...___ yv��.���;�i3�..��ic���.._.�... € ;��n������ __Y_.. __�.._..__.. __a_.______.w_._�____w_.w�_W....�.._.._.____._._.__..��; _ _.___.__._ c����€���ra�s.�t.��t��v ! � ;��-��t i���t�i��. W i --- ._�]__..�....____...�_�..�...�_.._�....__V_._{ �...�w�..._...______...._..._.__� __.._.. .__�...�..____._____m._.__-__.�.._..� _T— _ , � t� � 3 1' IJ T Ci�1S ;7Fi .Jf1�.L 3'!�i_iiVG 1 �� f_R f .....__.......-•..:...:.:....._�...._...__.__- - --____f—.._ ----- - ---... --------- -____._._...--- ---...� �.......__......_....._.....-•__..._.........••-............._.._..y..._._..--- --�_..._.....------W_........._..._............._...._..._ ; SC�VE€2 I i :F[IVA�E�iz:. ; _.....__..__._......_._..__._..._._�.._._...m....�.._• . . ______ _ ---------- --..--._� u--___.....��...�.___....�._.�__....__.�...__1....�_...___...__._J.._----------------- �._._....__..__. _.__.-__ r ��- � . � � � , � f � - 'LHNU.�C?�PElIRRIu. �:E E L� h!h_.. ._.._._......_...._._._...�.�.._.__..._....__..w.__._._..._.._._...._.......�..._..._.__:..._m..__._.........._.___� s--•---•-... ------..-•. ---._.._....._.._.__..._......._._.�._......_._�._..m.�.._.........�...._...�...._...__._.:_._.._.� `�EEF f�,E%L,t.. � � ;Gh SfTE 1��r5. � ----- — _..._ �_..__.._.__......�..__....._..._.......w....... �.�_...__.___m_._..�._____�.----- ------___._...._.._._.........._.....�.__..•- C?F��A6R'rEST � i ;�4#�iE1l_��1l�1€P.4i2 ------�- -- ------------.��___—_ ._____—_...�__._._.._.._...._w....._.__..._. � . � �..__�.M.___.......m.._�.__..�� FIP�Ai.�O.h:S�. �-----�t � f FERE E3�!'i.�[€�iAL -----.�`f._._._.��__._._.�__w.._.�.�.._ F1�IA1�F�FA1�1P3G ...�._______�---- _.__.__.._� :���ALTH�3E.P���I�'RI_ ._._._..._.__........�_ mm�� . ��.=___....�� ._.........__.._..._...._. _...._.�..._m__.......f�..�--_-_.___�.—�---_ — �___ __..._._..�_..M_�._.._�....._..._......._ : �._�._.__...�... Fti�lFlL�LtC'��1C � E � �G�V�F��S€�AI[7 i_,_.._ � - - m_____�...__._.�T--- -.�_._ _.. � ww _�..._ , -____�_....�.__ ��n�����.u���n��r��_...._._����..._ .___.�....m.._.�.._....._..____ � _����c��-- -----_.—_ � ' _�....�._�.m..�.___._m _ �.__�.. .�... _ __._.._�, ;T__— _ _�_. �i�1F1: �LRtd�N� ! � w � ._�w.. _ .._._ ____.�..._..._.�._ .�__._w.._._..�.... __.._..____ ...____ .- ------ --� : �_...._ ._..-�. ._._.___----__. ._.___ �i�VAI.���l�1NEERk�lG 3 � ' . '� � -. '• . _ ._....__...._.._..._._....1�....__............_._....._�.__.__..__.�._,...._....... -_..---...._._._..-.-.-•.---.----_..__..._.__..__....__1____._�........__._..i___�.._.___.._..._.....�......._......__.._..........�..L.. C��ltN]�.NTS ... _.__.._._.�_...._.___.._.._._.___...._._..___...___-----------=-------------...._.._.._.__.._._.�_........_..._��.__.��.�..__.__.._.�...�.._...__�------------------ 5EP7€C 7�i�iC 5#Z� .____._ SE�P P�7'I�J SEZE ----------_._.____._-_.�......._._.._._�.._�.._.M�._...._...._....._...._._.._.._._._.._._.._....-.----.--.--------.--.------.---_.w_...__..__._....____._.._.._.�...�_. '^,- . • - �' ----------.._...__.._._.._____..._.._._......_............_.._...._........._.___.._.......__........�._._._..__._..__----.__--=--------=--_-.�•-_..__�..�.__..�......._.._..._._ - ._...___.._M.�._�._......_...._..._._T__._..._.._.....------ -.._.__.._.......- - - -...- _........__.._.�..._...._..._......�..�....._.__.._..__......_._.�.._......__ _.._.....__.._.---•