HomeMy WebLinkAbout1236 (13) ���
CfTY OF DiAiUfOND BAR ��
`��.�_'-�'' ' PARTMENT OF BUILDING AND SAFETV PRESS
�� :,� �-- � FIRMLY
Q��� ; . BUILDING PERMIT
JOBSITE • �(� a APPLJCATION PERMIT _-�;� USE -
ADDRESS __ L� tC�n•�«��C:� ��1 �� �ATE NUMBER CODE I
- ISSUE % TYPE C.
a APN � LOT TRACT DATE � /� � CONST.—��- GROUP
o CR05S STREET��SET C"�IPIC� SETBACKS ""'�""�"15
0O OWNER P�N144G �E1")4W ZONING FRONT RW ❑
� ADDRESS S7Z OtAMONb 1?�R '�JWt7 REAR ❑
W CITY_���ND BA'R ZIP�(��TEL. r � SIDE/SIDE STREET RW ❑
; o APPLICANT TEL. - SIDE_ ❑
t � CONTRACTOR L�_�jirPl �iZOf�P SEWAGE ❑ pUBLIC PMT�
o ADDRESS 732 QI��OII�,l� �� �(,a(D'�'x.Z2 DISPOSAL ❑ pRIVATE SQ.FT./100 GAL
W CiTY Q���_ZIP�TEL�{�1
z STATE GRADING ❑CU.YDS.EXC. CU YDS FILL
y, LIC.NUMBER���� ""' g�� _
y ARCHfENG! � TYPE 5Q Fl" FACT�}R PS ADJ. AREANALUATIO
`—' DESIGNER �� G W 1 -'���. i 7-,G, �;C� �� � � •-
� ADDRESS �P3Z �I��ND �'T� �W—�—� � 2
Z CITY Q���W� �'� ZIP ��TEt��/el �r 3
� PROPOSED USE E -� " ,` �. t�C . Z 4
� "'`� 3 C,��;� ;.2`' Ca.. o GARAGE
; NO.DWEL. NO. t NO. �'- � pORCH c
= UNITS.�STORIES BEDRO�MS�_
� LOT DIMENSIONS_ m VALUATION '' ADJ.AREA
o NO.OF BLDGS HOW QUANTITV DESCRIPT OIV FEE
W ON LOT �USED �
� — —
W' ❑ �
� LICCNSf L'C[IA?fiACTORS OECLARAiION�I l�eiehy affrtm tAat I ain IreenseJ under pmv�sions at Chap�er 9 Icormnennny E-
-� a�n�Sncune 10�0)u!Oinxmn 3 nt±lix Busir,ess antl Piolessians Code and my 6eense is e�tull Porce nnA elfecl �
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�+- (M1YNFR BWLDEF OiCLAHFi i0N I hercLy slfum thal�am exempl Irom ihe Conirxcta�'s l¢ense Law far the fallmring
ienwn ISec 704 i 5,6usiness enJ Pmiessnns Code Any cny ar r.ounty which reqmres a pe�mu lo cunsduet, (�
oalter impmve,deinoLsh or repair any siruclme,O��o<<o ns�,ssunnce,a�so reqmres the applican;tor such permit Z
�-- ro tiic a si9und s�ateR�cm that he is hcensed Oursuant to tl�t Orovisans ol the Cauvacwi s Lirense taw ICheptt� (Q
2 9lccmmennng weh Seclmr 70001 0l Oinsmu 3 ut!he 6usiness and Pmfessmns Lode)or ihat he�s eaertipt lherdmm �
n_ ard ihe hasis im ihe alleged exempLon Any vwlation of Secuon 7031 5 6y any apph[am!or a Oermn suhreps �
x the aVW��unt w a uvtl penallV u�nat mare[har,irve hmplreJ dollars lS5001 I -�
W a
� ❑I,n>mv�rer ot the pwpenr m riy emp!ayees wnh wages as theu sole compensation,will do ihe wnrk,anJ
Ihe slmadre is not imerAed oi ulhred fa sa�e�Sec 7044,Dusiness anA Pioless�ons Cade.The Conrcacm(s LuenSe s(
� Law Anns nm�pply!u an nwne�ot pioyerty wl:o 6uJds or imprmes thereon,and who dces sucA warM himself, U
W m;Innngb his mvn empinrees,V���ided that such impmvemr.ms a�e r.at mtrndeA or o��e�ed for sak II.Mwever, �
m die hutldmq nr impmvainenl is sold wnhin nna yeai ol completmq the nwner�AmlAei wdl have the burden of provmg Q
= Ihai he.tlid no�hudd ur imO�Ove fnr�he F���O�sr.al sale 1 �
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� �I.a•uwner uf�he pmpeny.nm e�clusrvely cor.tiac�iny witA hcensed camracrors to corslmcl Ihe D�4�1 ISec �yy
0 7f1�'A Busu:tss ane YrMesainns Cotle ihe Camra�im's Ireense Law Joes nut apply io an owner af O�openy who �
4 hwlos or!mprrves�Lerea�aM w�o mntrar.�s fm aueh pmlects wrth a con[racior(sl Ilcensed purswni to�he.Cimira[lofs ..__..
ti«o:P i�w� NSTRUCTIO�I _- .� �I�J•�s� __,__
ot � (� ��� --
� Ll i am r.xw��yi under Sec VC � h Ce�Uficatel 1C1,.E�p{-Q�W��..._•j�~C,�,:^�t� ✓ � �' �(��
o n.�e-_ -ow���, . �--
ELECTRIC T
� WS1HKfNS'COMPENSATIaJ OFCLANATION I herety alhrm lhat I have a reilif f tonsem m<eu���s��e,o� pLUMBiNG
, a n,rtdrcnie ul Nbrkus Cnmpensrvimn I�snranae,or�certd�eE anpy�heieaf ISec.3800,La6 C I —
¢ L!Cen�'ied coov is herr.6y hxnrsl�ed � MECi�"rAN�C•A�. __—
o �f'snd:ed coD1'�s ided with thr.8mldmg Inspection Depanm¢m oi Depmtment Q GRADING--� _._
� CEfiTIFIC4i! ;IF FNEMPTI�N FflOM WONKEAS COMYENSATION INSURANCE This seUion cttd not 6e comVkte�i ~� !�`�A��J � �J' �
y if ;ne pcimn is lur une hundred 15100)ar less I cetlifY ihat in the pedormm�ce o�ihe wak lor wh¢h Ihis �
pnnni��x�ssuetl,I shall no�employ any yeisan in airy manre�au as lo he[ame sublect to Ihe'Mnkers'Comucnsauon � S`M�P� � �.
olaws af Ca6Mmia �/� PARK FEE �
p Oatc �/ aPPlicant �1/_3l-�LP_ �
� NOiICE TD A IICANi II,aliei makmg lhis CenihWte n�;Eke�pptfari:,V�sMutl�ecome xub�ect lo the Nbrkers LL- SCHOOL FEES
Cunipensaunn prnvisious al ihe Lahor Code,you masl tarjhwilh camply,wiM�,such'prwivons ar ihis permn shall
LL hc dnened revukeJ � � � - - —
a
Q [NVISION Uf IN[]USTBIAt SAFE7Y PENMIT CEflTIFICATION _
w
a �I herr.hy rendy thal no excavaunn hve�51 ur mare I ut m depth m�o whlch�a�,pe�son rs requ��reE to descerd,
� will he inedr m cannenion wrth work;�ulh�xued 6y M�6 mrt.�nd�jhu Tq huilQinghlmFfure,xcaflalJrg,lals¢work, --
n- nr demolnwn or Aismantlmg ihaieof,wJl Le mo�e thari�-hiity�sa�l36��1ee1 high.IChap 32.G�p 2.An 7,Set .
W :iAl.TitleB.CAG1
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3 ❑As owner hwlder I will not emplaY anyvoe io-do�worf�which'.wnuM reVwre a yermrt�from ihe pnsqn o(
� hNustnal Salery.as nmetl ahove,unless such pkYsm has a pCrmit I,a"dn such worl�from the divdmn' � ,
_ .; -.. � �
� ':':''" :�`�•,'� �'�" ;
w ❑D�nann ul InJusinal Safety F�imn No. "�" �OT A� C�C� ,
a f'1 f C � '
CONSTRI1CfqN LENDINfi AGFNCY I here6y afhrm ihat ihere�a a eonshuctian IenNig agency for the perfartnantt i
= nf tl�e wcrk for wNdi Ons penml is issued(SeC.3097.Crv.C) p
� �r�a�r�N,��P COMMENTS � ��
'a�p leuAei's�ddress �
� CEflTIFICAIE OF COMPUANCE ANO AUTHOHRATION OF ENTqY.I cendy I have read Mis appiration and sta�e
� ihat the ndama6on grven is 1 aryee lo[ompN wrth all state lan�s arM ury ortli��[es relaling to huitlny
� cnnstrumm�,and authnree rep�es tal e ol Me Depa�lment of Builtling antl Salety ro enler upon�he property
� Por wh¢h I h e apphed lor 's per r ihe pmWse n�making inspcetpns
X �Sg atwe al Ikam nr Ayent � patc,D - RECPT NO.! � PAID BY �`�L �� '
WHITE—Department.Cnnu vc'•^'.. _ :> .,: .<:
BS106-17lRo ...
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