HomeMy WebLinkAbout1511CITY OF DIAMONVj16AR PRESS
DEPARTMENT OF BUILDINr-. AND SAFETY/ lF-snaa� v
BUILDING
PE! ;MIT r�n�naw r
JOBSITE
ADDRESS
APPI JC% ;ION IrlPERMIT-USE
DATE r V NUMBER CODES
ISSUr TYPE OCC, [�
APN "-'+' LOT -- TRACT
DATA CONST GROU
CROSS S RE ET
OWNER
ADDR ESS
;ONING SETBACKS "
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
CITY IP TEL
APPI JCAN L
SIDE ❑
CONTRACTOR,-,
ADD
CITYRE ZIP L
SEWAGE
ISPOSAL
❑PUBLIC PMT
❑ PRIVATE. SO. Fu1oo GAL
STATE- 5U C�//� �j
LIC. NUMBER —
GRADING
❑ CU. YDS. EXC. CU YDS FILL
C0
w1
TYPE SO FT FACTOR PS ADJ. AREANALUATION
ARCH/ENG
DESIGNER f L
gig j,S
ADDRESS
2
CITY ZIP —6-12 TEL W&Z
3
PROPOSED USE
z
4
GARAGE
NO. DWEL. NO, NO.
UNITS STORIES 5— BEDROOMS
LOT DIMENSIONS
0
C11
PORCH
VALUATION ADJ. AREA
OUANMY DESCRIPTION FEE
NO. OF BLDGS HOW
ON LOT USED
Q
Fr
W
W—
LICENSED CONTRACTORS DECIARA113N I herehf affirm that I am Ycensed Wr provisions d Cbapar 9lcnnnvrcirq
web Section 7000) of Dvitim 3 d tea Business and Professions Cade, and my Iranse is it h8 bra aid Ntect
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MVNER RIIItDER DECLARATON- I hereby OFrm that I am exempt from IN Catracta•s License Law for the W—ing
reason (Sec. 70315. Business and Prefessions Code Any toy r [ouvy which repuires a Frmd to construct,
atter. mauve, demolish, or repair amf ttructre. Prior to ds asrunte. Iso requires the applcml fir such pmmt
to file a sinned statement that he a kensed pure nt m the pwisions d the Cattte•s alicense Law Disoer
9 (comarmrng with Srticin 70001 of DMson 3 of the Business and Profetgoes Code) r That he is weenpt thenfiaa
aid I" basis for the alleged eaemptsn- AM violation of Section 70315 by any appfi[mt for a permh subjects
ff. apprant to a ciud penahy of rot mat mat five hundred doers (150011
0I. is owr"n d the paorrty. or my empbyees with wages as Iry sage compensation, will do the wortand ,
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ED
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n
1.611
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the svucturt a net imeMed or offend for sale (Set 7044. Eusinefs and Professions Cade The Contractor's License
Law does rat appf to m owner of property who bums oe impaeex threw. and wee dos such wort lrhnalf
ce 0-0 has own armpoyecs. roeded thin such inprawmmts we nuc inm*d a offend fix sage I, bean n.
the building or inormnmem "wed wnthm a" nw of [arokna, the owner-bnkv wig haw the pada of proviq
that he did ine bmk or "Went fpr the purpow of saw I
OI. as owner of of the property, am eatanvety com"It p with licensed cmvactaf Is crier." the "M (SR.
7044, Business and Professions Cody TM Carmactar's License lin deet not appy to m owrrer of PoFtr'1' whir
builds r improves thereon. and who contracts be such pmleets wih a connacger(sl kented pregame to the Crtractor's
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license taw l
CONSTRUCT(
❑ 1 ve emmA under Sec. , 8. 6 P C (Attach Crtfcats).
Dare*
J
ELECTRIC
PLUMBING
MECHANICAL
YMKERS' COMPENSATE N DECLARATION I hereby afirtn that I bevy a citulicaR of consent to NO wrong. a
a ctndeate of WMYri Carpenxa,ion Intranet. or a cnbfed ropy thereof (Set 3800. Lab. Cl_
❑ Certified topyisheebrfurnished .
13 r .meed troy is fdtd with the Eudding 1espeetiar Dmvtmem or Deprtmem.
GRADING
CERTIFICATE OF EXEWTI N FROM WORKERS' COMPENSATM PMRANE: This section need ata be caole"d
i t the patrol is IN one hundred (11001 or less. I eerMy that in the prlamane of IM wart to which this
panic, is i=n"d, I shat not tmpby any Frvm in any roamer so as b become subject to thisvmvi Catgensatns
Lewitt caldaraa.
p
F
W PARK
ISSUANCE •J ,
SMIP
_
oilto
LL
FEE
SCHOOL FEES
NOTICE TO APPLCANT. I, after noting Iris trnbcate at Ermplion, You shod beta" subject to the Htriv's
Cvepemsaem prwisians of the Labe Code. You threat Irthawl WilgiN wilt such pwsiom r this permit shat
• be deemed reviled
MWM Of NaWMAL SAFETY PERMIT CERTIFICATION-
i ❑I hereby [reedy hal era ["avaoM fate (5) r rove feel is depth nm which a pencil is nMdngt Y dastard.
: wig be nude in connection with wart ai ffine d by this Pearl, and lay ro kn1dinp spatial. tMld6n t Iageewort.
A )
• or dereoltim or dismmdirq thereof• wig be erre than Iwry.sm (381 fast lriprt P". 32. Grp 2. An 2. Sec
„
341•Tell 8. CA C12.
❑Ai ownea builder. I Wil eat enpley sevens to do wilt which would nothing a pvnil Iron d" DFrisun d
InMnid Safety. as noted above. micro such persm has a Fannie b do such wet from the dbisiat
Dvision of 6dravlai Sefety Permit Ns.-•�
CONSTRI)CF11N LERVA AGENCY: I Mrebv error dal there is a constructionm6r8 leapvrY for dr Perfemmce
: of I" wort for which this perms is issued (Set 3097, Civ. CI.
TOTAL
�•-7
FEES - I 2
a Landn•s Name
I lerdn's Address
COMMENTS
CERTIICATE OF COMPLWCE AND IWfHONiATOI OF ENTRY: I "reify 1 have read dict sWeatism aid ttar
that the infienghm giwn is correct. I epee to cemplf with N stage Ing and ary advwces nlatirq n huM"
constructor, and authavt a repeumaeva of tM Department of &Akq and so" b ism" gas to pop 0
: for which I hew applied IN this permit fa ft pupose of matirq imsaaeuaa.
X
RECPT
NO. PAID BY VALIDATION
sgn,tue at Affteat a A¢m page
WHITE—Department Copy, YELLOW—Finance Cop)4 PINK—Assessor Copy, GOLDENROD—Rile Copy, GREEN— Applicants Copy
FISIM11189
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