HomeMy WebLinkAbout123 '''� CITY OF DIAMOND BA,R PRESS
�� .� '••"' ' DEPARTMElV7 OF BUILDIPIG AND SAF�TY FIRMLY
�� @UILDING PERMIT
JOBSITE �7 � /�� /� 'pj� DATE CATION NUMBER��__CODE i
ADDRESS ��� f v" �'�'�� p��''` - ISSUE TYPE OCC. �
a APN LOT TRACT DATE CONS�GROUP
o CROSS STREET D �Pf'iv"l.�f ...+���,s
zONING SE BACKS
°= OWNER���i"��7dt�s�- - �-. — FRONT - ❑
o ADDRESS •t� �'�` " Z'�� REAR � ❑
W CITY�I"� �+�ZIP�'Z.k�S�TEL. �7�"��Q SIDE/ ET RW ❑ �
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o APPLICANT �%r'c.��-f.��� Si�r9 3'ix_TEL.9"5f,�'~3�5:5 E 0
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m CONTRACTOR -�-" ''��- � ���25 �
a �. �..���- ��s SEWAGE ❑ PUBLIC PMT� '
o ADDRESS���_ '� �'� � DISPpSAL ❑ pRIVATE SO.FT./100 GAL
W CITY�i�C�ia �[•tc-r:,__, ZIP_�17.`3'f� TEL.9`15's'S
x STAT
a LIC.NUMBER ���� ��!�0�7��5^ GRADING 0 CU.YDS.EXC. CU YDS FILL
y ARCH/ENG/ — � �'P� SQ FT FACTOFi PS: AbJ. REANAL ATIdN �
y DESIGNER "` "� � � � �
' p ADDRESS t,Wl. 2 7 � .CPD �
a CIT ZIP TEL. (,� 3 �
� PROPOSED USE ��' �� � C lc��� Z 4 `
� �-- i,FJL�/f S'r i�i � GARAGE �
o NO.DWEL. NO. NO. :� PORCH �
y UNITS STORIES BEDROOMS
� LOT UIMENSIONS � VALUATION • ADJ.AREA
o NU.OF BLDGS HOW Gr QUAN7Rv D�SCRIPTION . F�E j
W ON LOT � USED �tC,2�� Q ��j� �
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� �I IC NSEf]f.ONTRACTORS OECLARATION.I hereby aHirm�hat I am Ilcensed unde�piov�aons of Chaytei 9�camm¢nn(q
¢ wnh Sxtiou 7.�'i`.10)�if L'iwsmn 3 nf!ha Business and Profesvons Cade.and mV�i�ense fs in futl fame and effecl. � . �
3 ❑ ► I
�±- UJJKFN�Hi11L[IFR OFCLARAi�1N�I�ereCy a16rm that I am exempt Irum tlie Cantractor's License 1aw im the tWlmvmg — "
x reason ISec 10315,9usu�ess and Professmns CMe�Any�ty or ccunty wh¢h reqwres a permil to tanslruct, �(} i
O ahe� impmve,Jeinu6sh,oi repau any srucw�e,pnur�o its�ssuance,aiso reqmres the appimam far such peimrt ��Z
- 1— to file a signed slatement iha�he is I¢ensed pursuant to the piovisions ol the Contractui s l¢ense Law IChapter .� �
s 3 Icommencing wnh Seaion IOU01 oi Orvrsmn 3 of ihe 6usiness and Pmhssmn5 Code)or Ihat he�s eaempt Iherehom �g
y and Ihc hasis lo�1he elfeged exemption Any vmluiou of Sxoon 7031 5 6y any appl¢ant for a permrt subjecl5 �
W tne apD����m m a crvil penally at wt more�han fiva hwdred dollars(55001 P .� �
� ❑I,a�nwner nl the property,ur nry empluyees wiih wages a.s theii sole campnnsatron,will da the wark,and �
the stmctwe is nm imr.naetl or otMre�tm sale�Sec.7044,6usness an0 Pwfessions Code The Cwmaaor's t¢ense• q �
f,~j Law Jues i:ol apply iu an owne�of pmDerty v.hn Gudds or imOraves Ihereon,and who dces such�rark himsell. ¢(,} :
W ar throuqP his ewn em0�oyees,V�ovideJ that such imp�memems are nm m�ended n offered�or sak.If,hawever.' \� . �
' _ '�h�6wldinn oo imprnvement is sold willun one year al completion.the ownei�Wilder will have the hurden nf pioving •
y Uia�lie did nm�mIA or mipmve Por 7he purPose ol sale.� .:� t
� ❑1 as uwner uf the propeny.am exclusrveN�ontrartmg wilh hcenseJ comtacto�s to canstruc��he pio�ect(Sec� `:yJ,{ �� �
0 7094,6usmess and Proiessiuns Code The CnmieMor's licensc law Aces nol apply ta an awner o1 piope�ly who `� � � :
� hutlds oi improv c iherean.and wha cunhacts tor such pro�ects wnh a cantractoqsl l¢ensed pwsuant ta ihe Cantracim's �r��/ /�j f�
L¢ense Law 1 CONSTRUCTION ✓�-/' �+'�
C �
� L.J 1 ain aKrn�pt undr.r s�� ,s a rc im��n c.«�,��a�e�. � PLAN REVIEW � •��
� na'" °wne1 ELECTRIC I �
.e NAFlKERS'CUMVFNSaiIUN I1EClAPATION I heretry alfum iha�I have a cerahcate nf consent to selbinsure,w � �
. � a ceruficate of N4rkeis'Comper�satmn InsnroMe,nr a ceru6ed copy iAe�eol(Sec 380D.Lab C� ' PLUMBING A
O t
_ �ce�i���aa��uv�snP«nv+���snea J MECHANICAL
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`p �,erufreU cooV is liled wnh thr.Rudding Inspectmn�epaitmenl ur Ogparlmem .� GRADING —_ �
_ ,p� 1 c�
� f.FNiIFICATE OF E%EMPTION FHOM WOFKERS'COMPENSATION INSONANCE.This seclion need nm Ae compkte�l 15SUANCE , •
y d Ihe permq is�a one hunJred(SI00)ai less 1 ctrlify that m ihe perPormance af Ihe work far whkh ihis • � r Y
permit ix issued,I shall rot employ any peiwn in any mam�er su as la become 5u0�¢cl to Ihe N6rke�s'Canpensation SMIP � `Y 7 _
olaws nf f.a61;���a �W PARK FEE _ �
�
p Oete I1DPhr.anl � 4
W NOTICE TO APPtICANT II,after making Ihis Ce�uLcaie ol Fxemp�ion.you shoulA h¢come su6�¢ct�o ihe N1orMer's SCHOOL FEES �
� C.mnpensanan provisions ol ihe laMr Code.You must fmthw�comply wilh suth piwieions ar this permn ahall ��\i 1°f ���� ,
� he deemed revnkM - � � �
� [NVISION OF INDUSTflIAL SAFE7Y PEflMIT CEfliIFICATION: - �
W �d ❑I hercby cendy that no e.cavatwn frve(5�or more feet m tlepth inta which a person rs�eqmrfld to descend,
� wdl be ma0e.m mnn¢[ucn wi�h wmk aulhqved hy th�s peimit,and that re hui�diig structure.scaftoldinp,tdsework, �
or demulnnin nr dismani6ng thereal.will 6e more ihan ihrtry-six 13GI tee�hph.IChap.32.Gry 2.Art 2.Set
W� 341.Ltic8.CA.C1 4
_ €
3 Uns owner-�uildei.�win not empky anyane�o du work wh¢h wauld ieqw�e a permn Imm tirc Oivuian ol �
r Imlustna:Safery,as nated above.unless such person has a permit to do such woik from the diveiun
�
w ❑Drrisiar of Industrwl Safeiy Permit No TOTAL FEES s
d �
ta
CONSTN�CTHIN LENOING AGENCY 1 heieby aflirm Nat there is a cunstructian lendig ageircY tor tlie performance
Z ol IIW wnrk lor wh¢h M�s permn is issued�Sec 3097,Cn.C.1. �
� Lender's Name COMMENTS � f
m lender's AdAivas � � �
t
a CERTIFICATE OF COMPIIANCE AN�AU7FIOPo2Ai1W OF EN7RY.1 crtily I haue read thie applration and snte �
tn that the mtormahon grven is correct 1 agree to compFy wrtA alt slate laws a�[iry ordinanca retaiirq to huilM�
y consuupmn,and authonxe a�epresematiue al the Depariment of BuiNmq aiM Salety Oo mhr upan ihe qaperty �
= for which I have a p��etl for Ihis permrt for the pmpose makinq i�rspectians.
rs
~ � r� ji 7 �
X ` l`� RECPT NO. PAID BY VALJDATION ;
� Signature ol Applcant oi Agent Da
WHITE—Department Copy,YELLOW—Financa Copy,PIMK—Assessor Copy,GOLDENROD—File Copy,GREEN—Appticants Copy �
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