HomeMy WebLinkAbout1511 (17)CITY 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
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LIC. NUMBER —
GRADING
❑ CU. YDS. EXC. CU YDS FILL
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TYPE SO FT FACTOR PS ADJ. AREANALUATION
ARCH/ENG
DESIGNER f L
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ADDRESS
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CITY ZIP —6-12 TEL W&Z
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PROPOSED USE
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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
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LICENSED CONTRACTORS DECEARA113N I hereby affirm that I am Ecensed under owisions d Cbapar 9 lctmnrtcirq
web Section 7000) of Dvitim 3 d IN Shrines sM Professions Cade, and my (censer is it h8 bra aM Ntrt
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MVNER RIIRDER DECLARATON- I hereby OF— that I am exempt from IN Cat,kw*s license law for the W—ing
reason (Sec. 70315. Busies and Preirssiom Coda Any toy ur couvy which requires a Pram to construct,
atter. mtoove, demolish, or repair surf structure, once to as ssrunte. dao requires the sp*ml fir such petmd
to file a snned statement that he a Iitensed pure nt m the owitions d the Cakcor•s alicense Law 0soer
That he is pt thenfioa
ng with Sn 70001 of DMsion 3 of the Business and Profession Code) r twm
9 (comaenrrtio
send tle basis for the adeget esemptione AM violation of Section 70315 by any appfitat for a permh subjects
deapprant to a ciud penahY of rot mat mar five hundred do8as (5500) I.
0I. is Owren d the property, or my empbyen with wages es thea sage compensation, *4do the wort, adn
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danall Whai"—
the situctgrt s net imenned or offend for sale (Set 7044. Euseess aid Pnuhssions Cade The Contractor'sContractor'sLicense
Law does ret stuffro m — of property who bums oe iaogees threw. and wee don such wort hiveself
a 0-0 has own amplvm3. greenlet that such iapnawmmts are not inm*d a offend fix sage 9, howewr.
the to ildmg or intceowmem r rod within ma nuc of con oktan. the rower-bofder wig haw the drden of proving
that he did rot hufd or "Weer fpr the purpose of saw
OI. as owner of of the property, am erunvety comst" with licensed cmvactaf is conmucl tM Mobs (See.
7044, Business and Professions Code TM Carmactar's Lcerta lee dcet not appy to m www of gropers who
builds r iffbe im thereon. and who contracts be such pmleets wih a connacger(sl kented pregame to the eavactr's
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License taw 1
CONSTRUCT(
❑ 1 am erempt under Sec. , 8. 6 P C (Attach Cietifcate).
Dane*
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ELECTRIC
PLUMBING
MECHANICAL
YMKERS' COMPENSATM DECLARATION I hereby afistn that I being a citulicaR of consent to NO nsun. a
a ctndeate of WMteri Carpenxa,ion Insurance, or a crbfed copy thereof (Set 3900. Lab. Cl.
❑ erEeed ropy is he* furnished
13 ferfoed troy is fled with the Buddinq lesp etion Depatmem or Deprtmeat.
GRADING
—�
CtFrnriCATE OF EXEMPTION FROM WORKERS' COMPENSATM PNSORANCE: This section need not be canpktM
i t the prwl is IN one hundred If 10O) or Ins. I arMy that in the palamane of tM waM1 to which this
by erin any es b brine subpe miters'ct to miters'Canpeosatim
panic, is issind, I shat not tmpany Pron roamer so
Lewitt caldarra.
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F
W PARK
ISSUANCE •J ,
S M I P
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oak
u-
FEE
SCHOOL FEES
NOTICE TO AtRCANT. I, after nuking his ternhcate at Ermplion, You stow brae subject to to Htrir's
Cnmpensanm prwsias of hf Labas Code. You must ltahwnh WilgiN with such pwsiom ce this permit shat
• be deemed reviled
lyVIS M Of IN M -MAL SAFETY PERMIT CERTIFICATM-
i ❑I hereby mtdy hal eco [wavaoon fate (5) a mere leer is depth nm which s Ponca is rrpdnd o deuced.
: wig be made in connection with wart suhorvN by this perml, and des ro pundit sbuatre, "fol6rq, faleework.
A )
• or drrichbon or dismaarq thereof. wig be arae than vwry.sm (391 feet lriprt (pup. 32. Grp 2. An 2. Sec
y �.
311,Tvk 8. C A C 1-„ , , . .
1 []Ai owner widder. I WE eat employ armee to do week which would nothing a permit from the 6vsun d
InMnid Safety, as noted above. mlew such person has a permit b do such wad from the division
Dvision of ktdnuvlaf Safety Prmil Ns.
CONSiRlILTCl1 aNDIdG AGENCY: I hereby arrmg that rhes is . tasgnctiat kriq aprrP Ia dr pafam a
: of Pe wart for which this permit is issued (Set 3097, Civ. CI.
TOTAL
FEES - I 2 -•� �•-7
' Landn•s Nae
I teMn's Adbess
COMMENTS
CERTITATE OF COMPLWU AND IWfHONiATOI OF ENTRY: 1 ratify 1 have brad dicer sWesdis rd star
that he infamofim tiw'm is correct. I ata to coeb* with N stage Ing mad ary admmces nserq n hr:fp
co ufteton, and authays s repeumseva d ft Department d Bnddveg and Safety so anger gat the pop 0
: for Mich I haw apo ed for this We it for ft prtery of mstirq inVaeEai.
X
RECPT
NO. PAID BY VALIDATION
Sq." of Awkwit a Agent page
WHITE—Department Copy, YELLOW—Finance Cop)4 PINK—Assessor Copy, GOLDENROD—Rile Copy, GREEN— Applicants Copy
BS10S-11189