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HomeMy WebLinkAbout121 (25) �''� �; ClTY OF QIAMOND BAR PRESS `�: '•" �'j' DEPARTMENT OF BUIIDING AND SAFETY `t -� �,'t 6UILDING PERM17 FIRMIY JOBSITE �' �. . APPLICATION PERMIT � ' ' U3E � ' '��'-" '• ` ' DATE NUMBER�CODE ADDRESS~` ;_-/'" .:�.���.�l��" ��.�-. 155UE TYPE OCC. r APN LOT�Z-TRAC �ATE �1 I 1 I�� CONST.�—GROUP�_ o CROSS S7REET L�� ��P �titi 5 zONING SE BT ACKS °'i''E""s °r'- OWNER' I:r' s°'�'ir.C�ef��+`• FRONT� �RW ❑ ' REAR ❑ e ADDRESS_'='� ' i! .%'�:Y�+ti'/.(� F,��-- � . .. . ,� CITY/„�?(!.'"/�:L��i fti! ZIP��/�_,r TEL.;*�;:(-�"�4�:f SI� STREET RW ❑ „� o APPUCANT ��1� TEL. OE ❑ : 4 CONTRACTOR � • SEWAGE 0 PUBLIC PMT#� o ADDRESS ��� �f ��' -� �� DISPOSAL w C�TY ZfP TEL. C� PRIVATE SQ.FT./100 GAL ;e STATE GRADING ❑ CU.YDS.EXC. CU YDS FILL y LIC.NUMBER y nRCH�EN�� cn TYPE SQ Fi' �GT�R:PS ` .AD,i:AREN�/iAL /kTfON = DESIGNER •� � � ADDRESS � ' '� � �� '""" LL. 2 o � . � CI7Y ZIP TEL. {;�,. 3 ��PROP05ED USE.�,�_rf""C.,-�,��I �`� Z 4 � �• GARAGE o NO.DWEL. NO. NO. � pp y UNITS�STORIES BEDROOMS s L�T DIMENSIONS m VALUATION ADJ.AREA c NO.OF BLDGS How a�arrr�zv :.DESCR1PTt0i�t ` . .:,; ..:..:. FEE: `.: . .: . ... = ON LOT I USED �-�� a. s U =`o � �"'�I LICE45F0 f,ON�flACTORS OEf.IAflATION.I here6y aflimi Ihal�am Gcensed wdu pmvisions of Chapw 9 Icammmcinq 'F'_ � +�� wnn sttuo�70001 or qwisian 3 of the dusiness und Pratessmns Cade,a�d my I¢ense is in lull fo¢a aM tH¢I. ,�; 3 W � UNNEH�yWIllER C[CLAflAT10N:I M1ereEy atfirm that 1 am erem0��rom�he Canttacmr's L:[ense Law!or Me�dlawi� ' I reasnn t5ec '0315.8uvness ana P�Messions CaAe�any cny or coamy wh¢h requ�rzs a pnmit to cunstru[t. '�O���. Oaltei anp�ove.demoli5�,ur repan arrv slruclurc pno�ro its�ssuance.alw repmres ihe applicant tor such permn `�z` � ro fde�signcA s!�iement rta±ne is§censeG pu�suenl[o�he�ravii�ans ul!he Cunpacmr's Licrosz Law ICSa�ter •m. _ � 9 irommencmg w�th Sxuan]0001 of Oivismn 3 u�I�e Business anC Pmtesnans Codel or Ihat M is e�emp��herefram :;g: d� ar•n me basrs!or;Ce alleged zxempnon pny vidation et Secuon 7031.5 6y any appheant fo�a permn whiec�s "��' Wihe aDU����n�!n a a�v�l penalty ot ro�na�e Ihan live nuntlied dollars 12500)i: )'a: �� 0 CI,as ovvner nt Ihz pmperry,or mY empioyees wdn wages az Iheir sde compensavan.wdl do me wod,and � . rlrt stmnu:e�s not mrentled or a��e�eo lor sale jSec 7044,2us!ness anU Protasswns 6ade:The Contractar s License a. �,~j= law aor.s m�ae0!v�o an owmr of prapenY wuo builds ar�mOroves insreon.and wlw Aces such woA himsell, -.()' W or Mmnyn ins vnn xmplovees.O�onOed that:uch imprwemrnts are�ot�ntended ar othreE Poi sale.If,howevtt, � _ ;9e'mdAin9 or��mcrovement is sold wnhin cne year af camphnon,the owne��huilda wdl have!he 6urden nf pmmng `��� y �het he tlid nm hmiA ar�mprore for ihe vurpase�f sele.l .� y Cll as r.wr:er ul;ne praoenv.am zaclusnery camranmy wiio ii;ensN camne�oro m aanslmn iM proitet�Sec. '.:{J�., .I 70C4 9usm:ss antl Pmtessons Catle:ihe Comraaor�s Li�mse Law Soes not appiy m an owner al pioperty wno '� Z-`:ml0s ui;;npraves iherqon.and wh�coniracis�or such projects wi�h a[ontrttmr(51 licensed pxsuam to Ihe Cantrecta's Q t��r�:e�a•N� CONSTRUCTION W I C�I amPxempi nnder, / d.h PC.IAttach f,eniliwlel. � PLAN REVIEW o I Oate owner l'�4 ELECTRIC ' y� NNNKEAS CUMPENS(+iION OECLAHAnpV.�heretry aNirm a�I havr�a�eref¢are m ccnsem ta seit�insure.a ���%�;: P(UMBING a rerufir.ate uf lMorkers�Camoensatwn insurance,or a c iM copY mNeof ISec 38041ah.C.I. _ ❑CertJieA copy is herehy fwmshed •�;MECiHAN�C+A�. Q o ❑CerUlied copy rs filed wilh!he�wldinq Inspxtion Oepanment ar oenartmene ;;Q�GRADING W �y� �': f.ENTIFICAT(OF EXEMPTqN FAOM`�YUHKEAS'COMPENS0.TION MSUHANCE:This secuon need�o�ne��ok�� :�' �SSUANCE I � •L.V y 'if ihe 9ermrt is�nr one AnnAred IS1001 or less.I cenily Ihat�in Ihe pef�orm9n[e ot Ihe work far which IMs permn is issued,I shall not e.mplpy any persnn in airy manner so as to hewme wGject lo lhe NhikMs'Cor.�pensafim .:� S'M�P � � • �� oi,w��i ca��m���a. PARK FEE p uale AOpicant �� �� NOTICE TO hPPLICANT il.alter ma�un9 Ihrs CartAica�e af Exempnon.you slauld become suqect to Ihe wakn5 ��- SCHOOL FEES -� CumOensanon pmvisims of the L'aboi Code.yw must�athwith camply with suth prwimns or thn pe�mit sha11 �- be tleemed ievaled. .� � (MNSION OF INOUSfRIAI SAfETY PEPMR CEFTIfICAT10N� w a ❑I hereAy cenAy that no ereavalion hve 15)ar more feel in depth mta.vM[h a person�s rcpuired to dacmd. 2: wnl N inatle in cannecnnn wilh work awhaved M1r ihis pe�mit.a�d that no dxidiig suu�lae.scallnl0ing,lalxwork, . ��� � ������L, ��p. � or demaliimn ar Aismantlinp iheieol.will he mae than thuryaix 1361 Iret high.�ChaO�7.Z.Gry 2,Art 2,Se� @�y�@ �; ='I341.TitleN.CAL1. �I„l��Fl�f7.1.i A��/ 1Y�F���� 3VI❑as nwner.ln�ilder,I will nat empky anyane ro do wort which waultl iepwre a pnmi�ham the arisiun of 1—I Indusina!Salety,as noted above,unless such persan has a DNmrt m Ao sueh wark lidn the drvi�iun. ¢ ❑a�,s�o�o���a�,�„a�sa�e�Y��m��No TOTAL FEES 3.9�-�' � f,ONSTRUI:TION I F.N�ING AuENLY�I nereny aflirm mai�hert is a consnucuon lendiig agency lor Me pnfaimance = nl ihe�aak for wiich;nis permn rs rss�ed ISec.7097.Ln.C.I. � tenAer's Name (`,QM NTS � , p=p Lende�'a Addrtss. .� � "�I CENTIFICATE OF f,OMPUANCE AND AUTHON1IATIOt!OF ENTFY:I cnnty I hove iead�Ae applkaum antl s�ate va thai me�ninrnunon qrven�s carect I aqree ro compry wnn all slaie laws aM nry o�0inances�eutmg m Cuitliiy � y I aonstnauogr.anA'amhuwe a represema�ne of ihe Oepartmem of 9uildmg and$alety b enrn u�on de anperry � N wrytl(I h3vP d�l�l;nf(a'rthis flllii IO!�h[qYry03L 0�III2YIIIIf ii15pQCIq115. ,.- � y-,�- ,. 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