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HomeMy WebLinkAbout15417 (22) ` s CITY OF DIAMOND BA� � i ` __ DEPARTMENT OF COMML7NITY&DEVELOPMENT SERVTCES 2i�uo�.c�y n►�;,,�s��i90 PRESS, � '�pry BUQ.D�IG PERMIT APPLICATIOIV FIRMLYI � ,lOBSITE + f yf� 2��f ��� Q�� APPIICATiON p� � �UMBER I�`l�/ #� ' o AODRESS 4 �g �J �� DATE � ISSUE . � /�,� TYPE OCC APN LOT TRACT DATE (/� CONST. GROUP � OWNER �� � o ADDR S S G..'� ZOFIING SETBACKS � W CITY ZIP TEL. EA�T RW � i � APPUCAN7 TEL.� SIDE/SIUE STREET RW ❑ � CONTRACTOR � Y' t�`�-- SIOE t7 � CfIY IP TEL PROPOSED USE �O�ut.° S I�1}t�L�P M..DD /Z C DX I w 1 � ARCWENG/ DE3IGNER NO.DWEL. � NO. O. ADDRE �� e �i�.0 n�k .• - UNITS STORIES BEDROOMS � CITY. "� ZIP t�17ts o TEL. ,� y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATfON Q OWNER-BUILDER DECLARATION SFR/ADD/REM O Q i�a�v�mFw u�mea oarKn ox vEwum nuT�rv.��uaT F�n+E corvrnncroas u• GaragB/Ca�port W CENBEUWP�R7HEFOl,LOM�RNIREASON(SEC.)0.11.SBUSAIESSANDPPOFESSpNSCO�E:ANYGITYQX ((� � CGlN�R7WFqCHREOUHESAPERN�T7000N6TRUCT,ALTERIIAPROVE�EWIISi.OPRE9NHANY57aVG W Pet1o(DBC�C Tlp�pqqN TO rt3 68UANCE,AL50 REOUINES THE APPLICAM f-0R SUGi PEAIA�T TO FIIE A 518!!ED W � STAS�I4ENT TIMT HE O/i$NE IS LIC€NSEO pUpSll/M TO T11E PiqNSIONS OP THE CONTRACTONS ll- � C@15E UW(CNAP7ER Y(CWdMFNCINO N7h1 SECTqN 7aa0)OF OMSI�H 40F THE BUS�NE55 MI[i PR0. �- Pool/Spa FES.rOIt400�E�OR711ATHEONSHEl9E%EYPTiHEREFROM/JIDTHEBASISFOR7HEAlLEOEDIXENP- (�J TION.ANYYIOLATIOMOFSFCTIOf17Uft.68YAMYNPPIIGMiiFORf�PEflY1TSUBJECT5THE/�PVLICANTTO z RaRoof � A CML PENALTY OF NOT MONE iT4W f'NE NUNDRED D011ARS(f6ro).): � ❑L��MEROF7NEPRQPEittV,ORMYENPLOYEESNATHWAOESASTHE1RSOlEODYVENSAiION, � COmfilerCial � WKL DO TME M'ORK,A!A T1ff STRt1GiUNE 45 N071MEN�EO OII OFFEPEO fOR SAIE(SEC.7ou,BU51- � NE53 ANO PROFESSIOtL�Q�OE AIE CONTMCTORS LICENSE UW OOES NOT AVPLY TO AN OlYN6R OF � V110PENTYN7i08llIlD50NYPflDVESTNEREON,ANDNMO00ES5UCNNURKHiMSELFORMERSELFOR � Q TNppU0XIN80qNEqpWqEYVLOVEES,PROViDEDTNATSUtliWPflOYENEMSARENOTINTENOEDOR m � .OFFBiEDiORSALEIF�FiONIEYERTHEBULDIKKiORIMPf1oV6YEM�sS[x.oNnn11NONEYFJ.ROFCAYPLE- T10N,iHE OMRiFAAUtbEfi WILL WVE'INE BURDEN OF PROY/N0 THAT HE OR SME DID NDT WIID Oli = NFfqVEid1TNEPURPObE�SAIE�. W 06ASOVVI�OFTNEWiOPEKT'/,AME%GLUSNELYCONTR�CTMK3N7TNLICENSEDCDNiMCTON3 � TO CONSTRUCT 7HE PRO,IECT(SEC.7oN.BUSINE55 I�NO 4ROFESSIONS CODE:TNE CON7RACTORB LI- V81u8ti0n ADJ.AflEA CB6EIAW WESNOTAPPLYTOANOwNEqpFAPROPERTYMRIOBUILDSORMPROVESTHEREON.AND 2� ywocqrtq�cTswFtsua+vaaEcrsvntNrcoar�ucloa�s>i�NseoruRsuu+rrort�cant�c- pUANTI7Y �ESCRIPTION FEE � NRS L10EN8E IAWJ. J O 1 AN E%EMPT IMDEN SEG B.8 P.G f-0R TH15 RFJ.50N U Q � wrE oNa+eq V � � UCENSED CQNTRACTORS DECLARATION W � I NENEBY AFFWAI UNDER PENKTY OF PEM1IURY hIAT 1 FM UCENSED UNDEfl PROVISIONS OF CHAPTER � �(00141ENCNOMrtiMSECTION7000�0iDM5lONaOCTNEBU51NES5M10PROFESSiONSCODE,ANO Z MY UCENSE 16 W FlA1 FORCE ANO EFFECT. m 0 LICEN5f CM55 ��3�LIC.NO. �V r � � H � o�h �S–Y o cornancroa �`�' G S v'— a WORKERS'COMPENS0.TION DECLARATION Q N 1NERE9YIFFIPoAUNDERPENAL7YOFP�RNFiYONEOFTHEFOLL0INNG�ECL�RATIONS: U '�' a O ���NAVEMqYw��MANlTAq1ACElinFlCATEOFCONSEMTOSELF-INSUflEFORWORKERS' Y Z OOWENSATION,A4PAO�DfO6YSECT10N31000FTNE�A80RLO0E,FONTHE7ERPoRM�NCE U Q OF7MEIWRKPOHMMIdiTHIS7ERM1T191S5UED. � w � �l�r{,�yE/WWILLy�URAMNbPoCER9'Gl�AtpENSATqNM3URAACE„WREOIJIR£DBVSECT�7 / l� �Q � 97000FTiEL�BOACO�E.fORTMEPER(-0RM�NCEOFTHEN�ORKFORWNICNTHISPERMITIS Q£ A^>gUEp.LryypqKEAS'OOYPEN9AT10NINBUAM7CECAflMERM1DPOLICYNUMBEflME: CONSTFUCTION � ��p� PLAN REVIEW � � � pa�cvNt�uaEn ELECTRlC Q �SECfqn�l�ryp7pEaptiq,E'I�pF�F#p6q�1fI5FOqp�EFUW(i�pCllAqS�stooJoqt.E55) PLUMBING � W ICERTP`/THATMTMEPEPFORYMICEOFTHE'NOPo(FORWHIpiTHISPEPM�TISISSUED,1 MECHANICAL � S1ULL NOT EMPLOY/�NY DERSON RJ ANY MANNEN SO A4 TO BECOME SU&IECT TO THE {9���} � NK1�EH5'COMPENSATION LAYVS OF CAI.IPoRN ��CREE TN F 1 SHOULO 9ECOME iNSPECTlON FEE p` t�_, 1�. /1 SUBJEGTTOTMEWDRXEA3'CAMPENSAT P Y IONSOfS J70oOFTHEUBOP �SSUANCE !1j,13 ` �]�1. Ca0E.I5FiALLFOHIHNnn�cwv�rwin� E Vi5nN5 ^� . -��,-�.� oare: nrauc.wr: W� � ____ SM�P ��Orr.D1�M �.-.rv o � ENERGY P/C a' J� WMNlNO:iACUqETO SEGUAE'�ARKERS'COAIVENSA1bN COVENAGE IS UNI.�WRri,AND 5HALL BE T � SUeJEC7ANEMPLOVEpTOCR1MINALPENAl71E5ANDCM�FiNESUPTOONEHUNOHEDTN0U5AN0 ENERGVPERMIT }3` - pp�uq$(�lup,pppj,pV/�pDIT10NTOTHE COST OF COAI7ENSATION.DAMAGES AS PROV��ED FOR IN J 9ECTION970lOFTHELABORCODE,�NTEAEST,ANOAT'fOPNEY'SiEES. RETENT�ONFEE: Q � CANSTRUCTION LENDIN6 AGEMCY pRE-AlT FEE: � INER�YAFFIAMUN�ERPENALTYOFPbRR1RViF1ATTMEREISACONSTPUCTIDNLENDINGAGENGY fOq TIiE YERFORAIANCE OF iHE WORK FOR MM1iICH THIS PERMIi IS ISSUEO(SEC.3087,CIV,C.�. Z W � L£NDER'SNAM£ F_ LEfbERSADORE55 C � �CERTIGYTHATIXAVENEAD7H�SAPPLIGITIONANDST�TETNATTMEABOVEINFORIAIITIONISOORNECi TOTAL FCES � �ApqEE7pCpA%,yyry7NlJ1Cf7YMiDCOl1NTYORD�NiWCESAN�ST�TfLAWSflEUTINOTOBUIIAING � � � CONSTRUCTIDN,ANDHEREBYAUTiORiYEqEPfiESEN7ATfVE50FTHI4LWNTYTOENTERUPONTNE ABoyE.MEMf10NED PROPERTY FOR INSPECTqN PURPOSES. COMMENTS o 'P� e+e�Soti✓ m PEWIITTEEN [ IHf� � � � ���n y SIGNATUp_OKOER1AITfEE UATE � RECPT.N0. PAID BY VAUDATION WMI7E--DeAartment Copy,YELL0IN—Firtance Copy,PINK—Assassw Copy,GOLDENROD--File Copy,GREEN—Appikant's Capy m� ! i � __� �� i ,T I� v� v, t���.Imlcnxv � �.l-n -�I�� rnln �m, � � t,n c+� .-, , -ri� n I ___.,_._��.,._ nt r+�"j"�" � � � � � � � �I s�i u��������;-'�O ��C�c�c E UU -'�C -,n � �n p rn Gy 1-� � � ) �r� v 'm '� �1 f � � , . 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COUNTY OF LOS ANGEI.ES DEPARTMENT OF �OtTi3TY �fiGINEER-FAC�LITIES , ; AIVISION OF BUILDING AND SAFETY { � ` " STATEMENT TO BE SIGNID BY.OWNER`PRIDR TQ ZSSUANCE OF SWi2�tING POOL PERMIT. : •- i jWater dra3ned from swimming pools must not eacroach on abutting property. ' The fol.lowing are legal methads of swimming pool waste water disposal: � � le To a sanitary sewer through a 3" P-trap legally installed under permit from the Building and Safety Div3sion of the County of i.oe Angeles. This applies only to property which is connected to a public sewer. Swimming pool waste water shall not dis- charge to a private sewage disposal system. � ' 2. To a storm sewer or established storm channel �rhich abuts the ; property if permission can be obtained from Che County Flood - Control District. The general information telephone number there is (213) 226-4111. 3. To the street if a permit is first obtained from the County Road . Department (213) 226-8188. � - 4. On the property if the property is large enough to insure that � runoff will not encroach on abutting property. ;,, S. In the case where none of the above can be accomplished, the pool � contents must be removed by tank truck. This is to certify that I have read and undersCand the foregoing and agree to pass this information sheet on to the nexC subsequent owner. �%����- ��/- ��� �s Signature Date Subsequent Owner's Signature Date Subaeqvent Owner's Signature Date Subsequent Ownerts Signature Date EL�Ll:�a 53 Form G - Twc► capies required. Owner retains one. _ - . . -_� � � r,czixv.?_c,vau.'�isaas 4. �iST.OfF. TP• COUNTY 0�'�,OS ANGELES DEFkAPIvl�NT OF COUNTY ENGINEER Date �/.� —,Y�" CLAIHf fOR REFUN� C1oia:for refund oF permit and otherfees paid, as��provided by applicable ordinances establishing Building, Code;plumb;ng Code;S�itary Sewer sid Industrlal Waste Ordinance; Electricc]Code;Mechanical Code. � a�� Claim is hereby made for the refund of$ I.1`f• s�V ,which is eighty percent(80%)of the fee paid(S__j�� �!) )for the permit or other service shown 6elow. (Check one only.).,. � BUILDING � ELECTRICAL O REGISTRATiC)N FEE, PERMIT PERMIT COFETFtACTOR � PERMITG 0 BLDG.&SAFETY � J�OURNEYMACd��EE, � PLUMBING � SEWER-5E'h'AGE � PERh1IT DISPOSAL PERMIT � FEE FOR INSPECTIONS FEE FOR SPECTAL &RECORD PLANS � STUDY � FEE FOR PROCESSING PLAN CHECK FEE, SEWER EASEMENT � SANIT'�RYSEWERS � PLAN CHECK FEE,INDUSTRIAL � FEE FOR PROCESS- WASTE FACTLITIES ' ING REIMBURSE- MENT IaBS Permit No. �_%''�� Receipt No � Date Issued �w/�—�'"..�- , Job Number or . � ��� � � �} � ,� �Job Address �G'= f-in�"'`^tl/ ,�.�,� �..*Q- �}'s==�-,x,,�,� ,�i.f✓J I herehy certify that no rovork was commenced or-dane under the permit or receipt issued and that the infor- natio❑ written above is tr and con�pct to y best knowledge and beliaf, and that this cluim is justly due "and h¢s n 4-6�en paid. � r� � Cl:AIM T ; ��.#^: ; '� �!'Y��.l.r.s t ���E��L �M��r—r^--�.�"-i�� - 'Address lLei� G�''a1;�::� 1���' k"�� /)��l1.17;,,....;> ea.A�r`d ��7F_„5 Sf pEEf Claimant to fill in a11 necessary spaces above this line Z��E I hereby certify that a11 the terms�id conditions of the applicable ordin�ces qoveming refunds have been strictly and fully complied with, �d this refund is APPROVED. RPPROVED BY— � DIS1'ftICT � ��IAis[rlct Engineer-pr-Oihar Supprvinotr�,;: , . J �._ � q � .� . , The original copy of the germif or ieceipi issaed musf he attached to and t»ede a parf of this claim ti �