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HomeMy WebLinkAbout13338 _ �� CITY OF DIAMOND BAx DEPARTMENT OF COMMUNITY dt DEVELOPMENT SERVICES �" Z�a6o E.copuY na��s�u i90 �' PRESS '`����� BUII,DINGgPERMIT APPLICATION ---. FIRMLY � JOBSITE APPLICATION �- 2�J�/ PERMIT� 3 P/C � ADDRESS '�62� �h� Vr er^i' DATE � �� { 6 NUMBE N � ISSUE TYPE ��' OCC �_C(;O APN LOT TRACT DATE CONST. + GROUP U CT G O � OWNER L7 r4A/1��t711'�QQ(,C�lnd�"L ADDRESS�','�,(2� Coun.�. l)'re��..��j�.'fT- ZONING SETBACKS W CiTy 0,�. ZIP 4l76f• TEL.C��`(�S'6/-�.�D� REAR RW ❑ APPLICANT l�r/ �v J"tu. •*�— TEL. a SIDElSIDESTREET RW ❑ j •v SIDE ❑ CANTRACTOR g ADURESS � PROPOSED US M o CITY �� r� ZIP q2/'z� TELj)JY�P'P1�/S.?4 w ARCHJENG/ � DESIGNER NO.DY�EL. NO. NO. ADDRE55 UNITS STORIES BEDROOMS CITY ZIP TEL y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER pECLARATION SFRlA�D/REM I HEREBY AFFlNM UNDER PENALTY OF 7EiWHY TNAT�AIJ E7�MPT FHdA THE CONTMCTORS L6 GflfOgB/CfiIPOA � CENSELAWiDNiHEFOl1D�M�NGREA50N(SEC.7031.lBUSINESSANDPROFESSIONSCOGE:ANYpTVOH (n COUNiYWlllqiHEGNRESAVERNRTOCONSTRUCT,ALTER.IMPROVE.DEMOLISM,ORREMIRpNYSTRUC- W pei10/DBCk 7UqE,Pqpp TO ITS ISSUMICE,/�L30 REW IRES THE APPLICANT FOR 8UCH PERMIT TO i1LE A SIONED 6TATEMENT TINT HE OFi SHE IS UCENSEU PUREUANT 10 THE PqOV1410N3 OF h1E CON7MCfOR9 LI• CENSE LAW�CFWTER 0(LOMMENCING WITN 8ECTION 7000)OF OIVISION 9 OF T/E BU51NES5 AND PRO� � PO�USpB FESSIONS WOE)OR TH+1T HE OH SHE 19 E%EMPT THEHEFHOM ANO THE BASIS FOA THE ALLEGEO EXEMP� p� ^ TpN.ANYVpLAT10NOF8ECTION709t.6BYANVAOPLICANTFORAPERMIT9U&IECTSTNEAPPLICANTTO Z Re-Root E OQOv � ACMLPENALTY OF NOTMIORE 754W fIVE IIUNDRED DClUR3(t5oo).)� 04�S�WNEROFTHEPfq7ERtY.ORMVEMPLOYEESYATHWAliESABTHEIRSOLECOMPENSATqN, C] COmillerC191 WILL 00 iNE WORK AND TME STRUCNRE IS NOT qJ7ENDED OR OFiERED FOR SALE(6EC.7w�,BU66 J � l�SS AND 7AOFESSIONS OODE:TME CONTMC1a15 UCENSE UW DOES NOT MPLY TO AN DWNER Df ? PqOPERTY NhiO BUROS OR ILIPflOVES THEREON,ANU M�NO DOES SUCM NOPK HIMSEIF OR NERSELF OR � TNRqYlFIWSOkNERDNMEMPLOVEES.PROYl0ED7NATSUGiMIPROVEMENTSARENOTIN7EN0EDOR m pFFEqEp Fpp 9/Y E IF./pWfVEi�71�BU0.DINOOR MIPROVEMENT I3 SOlO WITMN ONE YEAROF CAM0.E TION,THE CWNER-0UIIDER WILL XAVE iME BURDEN OF PROYINO TNAT XE OR SHE DIO HOT BUILD ON MPFpVE PoR THE PURPOSE OF BALE} O 1.AS OVMEH OF TNE PFlOPERTY.AM IXCLUSNELY CONTMCTINO WffH LiCENSED CONtRACTORS � M tlONSTAUCf iNE PRO.IECT(SEC.70M,BU91NE95 lilW PROiE6510N5 OOOE:THE CONTMCTpR6 LI- V8IU811011 A�J.AREA CENSE UW ODE6 NOTMPLY TO AN 01NNER OF A PROPERTY WMO BUILD9 OR NIPROVE3 T11ERF.ON.ANO WFIOCOMRACTBFORSU61iRDJECT9WITMACONTRACTOR�S)LICF.NSEDPURSWWTTOTHEOONTMG QUANTI7Y DESCRIPTION FEE � 7ORSLICENSEUW.1. . .. , O I MI F7(E1AVT IHrDER EEC. B.i P.C.FOR THIS REASON � , U � S 4' p�h Z OWNER '0 _ U � W LICENSED CONTRACTORS DECLARATION �j � 1 MEREBY AFFIRAI UNDEN PENALTY OF DERIUMTHAT IAM LICEN5ED UNDEH PROViSIONS OF CHAPTER � . ��COMIAENCRIOWRHSECTKKJ70001OFDIV1510N70F7NEBl1SINE35ANDPROFESSIONSCDDE.ANO Z MY IICENSE IS IN FUl PoRCE AND EFFECT. m � uc�sE cuss C;-1�_��c.No.�_!�f- .�i DATE CONTRACTOR�.✓" a LZS ^ ' = WORKERS'COMPENSATION�ECLARATION ���v Y Q ��� U � IHEREBYAFFlRMUNDEHPENILLTYOFPERIURYONEOFhIEFOLLOWIrvGDECIAHATIONS: H Q � �INAVEMIOWILLMNNTAINACERTIFlCATEOFCONSEHTTOBELFaNSUHEFORWORKERS' S � CANPENSATION.A9PROVIDEDBYBECTION37aaOFTHELABOHCOOE.FOR7HEVER�ORMhNCE `U OF TIE WORK FOR WMICX 7W5 PEFNAIT 19 ISSUED. � � _I IU.VE AND WILL MA�MAIN WORKERS OOMPENSATION INSURANCE,AS REWIRED BY SECTION � ti/'\ /J` Q 97Do OF 7HE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WNiCH THIS DERMIT l5 // 1 ��L! 165Um.MYM10RKER3'O�YPEN9AT INSURANCECARRIERMDPOLICVNUMBEflARE: CONSTF�UCTION i� �CJ j c��wEa 1 PLAN REVIEW ��■ � PpLICYNUGBER Y,��''&�7 b • /� -� ELECTRIC o �;e�cnw�NoreEoo�tErEnpFnEpEw�xr�sxwauEHrnaEomuswspimica�ss) PIUMBING � I CERTIFVTHAT W TF1E PERFOHMPNCE OF 7HE WORK FOR wNICH TWS PERMIT IS ISSUEO,i MECHANICAL SHALL NOT EMPLAY ANY VERSON W ANY MANNEN 5o AS TO BE WME SUBJECT TO TIIE � y KORKERS'COMPEN9ATIONLAM50FCALIFORNIA,I1NOMiREE7HA71FI5MOULDeECOME INSPECTION S SlIBJECTTOTHEW'ONCERS'COYPENSATIDNPROYISIONSOFSECTqN77000FTHEUBOR ISSUANCE UI ,T • � � CODE,16HN1 FORTHVA7N COMPLY WITX THOSE PH/OVIS�ONS. { � "T'['rlYYt7 I"cC�'[oft�2r4� SMIP u O DATE: r( APRICAM: � - � � WARNING:FAILURET03ECUREWORKERS'COYPENSATiONCOVERAGEISUNIAWFUL,ANDSHAILBE ENEFiGYP/C �y 9UBJECTAN EYPLOYER Po CWMINAL PENALTIES AND qVIL FlNES Ui TOONE HUHDNED THOl15AND ENERGY PERMIT D011ARS(i10D,000),N ADDI710N TO THE COST OF COMPEN6ATION.DMMfiES AS PROVIDED FOR IN � BEGTOfiAOlOFTHELABOROO�E,INTEREST,ANDATfORNEY9FEES. RE7ENTIONFEE: d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEfiEBYAFFIRMUNDERPEN�LiYOFPERAIRYTHATTNEREISACONSTRUCTIONLENDINOA(3ENCY FOR THE PERWRMANCE OF THE WOF7K PDR WHICH THIS PERMIT IS ISSUED�SEC.90G],CIV.G�. � � LENDER'S NAME � LENOER'SADDNESS . /J 1 � ICERTIFYTHATIMMIEREADTHISAPPUCATIONMDSTAiEI}NTTHEABOVENfOR1AAT10NI5COWiECT. TOTAL FEES `� � �`�'� � IA(lFEETOCOMP4VWYfHALLCIfVANDGOUNTYORDNANCESANOSTATEUIWEREUTINGTOBULDINO J� � CONSTRUCTION,ANOHEREBYAUTHOHIZEREPPESENTATIVESOFTHISOOUN7YTOENTERUPONTNE �( � `�� v S�. /i80YE#IEMIONEO iROPERTY FON�NSPECr10N PURPOSES. COMMENTS V _� a�� � ='rr drn�r,.1�o t�. (2 l � CERMITTEE NAME(PRINfI � � ��:Lz.� 't�?,,�..��..�.`., y�7�q � BIONATURE OF PERMITTEE DATE � RECPT.NO. PAID BV VALIDATION WHITE-0epartment Copy,YELLOW—Fk+ance Copy,PINK—Asseasa Copy.GOIDENROD—File Copy,OREEN—Appicenfa Capy , . . .. „ � - . . .. � . . , .. . , . � .. � ;' �, ' . . . ci-�� o� oi�r�o�vo e�R . � - : it��PECT101'� RECi3F�L� � . . 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