HomeMy WebLinkAbout117 ''� ClTY OF DIANiOND BAR
�.� ',�" ' DEPAF�TMEN7 OF BUILDING ANQ SAFETY PRESS
BUILDING PERMIT FIRMLY
JOBSITE APPUCATION / / / C� PERMIT l USE
ADDRESSI.� Zt7 GL.�'tiTyv�Pr DATE 1 I - G2 �` NUMBER / � CODE
iSSUE TYPE OGC.
`�' ` APN LOT , TRAGT DATE CONST. GROUP
• o CROSS STREET -Q�.Cp CA�v yvt✓ SETBACKS ""�'"E"'s
OD OWNER G.E'�P�I�d OSr�o�,.e� z�NING �ONT R'W CI
o ADDRESS_ REAR ❑
W CITY ZIP TEL. SIDE/SIDE STREET RW �
o APPLICANT TEL. SIDE �
x.
� GONTRACTOR A��'� �' c���S' SEWAGE
+� o ADDRESS�i�' �S- /10�'�r .�'�L r, DISPOSAL � PUBLIC PMT#
W GITY
p�Am a/�.D ��'ZiP41 7 d S" TELrrG/-vu Z � �IVATE SQ.FT./100 GAL
� z STATE
y LIC.NUMBER�y�OO� GRADING � CU.YQS.EXC. CU YDS FILL
� ARCH/ENG/ .t13 T'�!�'E ;SQ FT:F'ACTUR P5 : ALkJ:AREi�VALU)4'I'1{11+{
=' DESIGNER �� �
� ADQRESS `U 2
0
= CITY ZIP TEL 3
�' _
� PROPOSED USE � � 4
� --s�� �' GARAGE
.l:
o NO.DWEL. NO. N�. �, PORCH
y UNITS STORIES BEDROOMS
, � LOT DIMENSIONS � VALUATION ADJ.AREA
o: N0.OF BLDGS HOW ounrrtmr I,'� SCFtfiP7'[�!'+1 ' FEE ; :' I
W ON LOT USED �, � � �� _ �} I
: � ,
�u � U�
�,
- . LI ENSEO COMflACTORS OECLARATMN:I hem6y atfirm that�am Rcensed under pmvisions ol CMpter 9ltommennnY � . . . .. .. ._ __.... - � - - -
. - - �- wrcM1 Secuon 700D)ol pivision 301 Me 8usmess-and Prokssiuns-Code,and my licrose is M lull lorce a�effat :�� �-
3 � 1'�i�i
. � OWNER-BUIL�ER OECIARAT�N:I hereby affirm that I�m e 2mpt imm ihe Contntmi s Luense Law ta Me Idbw ng � --
reason�Sec 70375.Rnsiness and Pmlessinns Goee�Any cey or camry whith requl�u a permit lo cantVu[i �i
o. ahe�.impmve.tlemdish M repair ar.y MructUre.privr ta�,U rs;,;a�at.o�.��e��ims ifie awik�m tor wcn perma ":;4��
�- 4�_to file s.aigned statement ffiat he is IlcenuG purauant to tAe prmisions ot th¢Contratlois License law IChepta ;m�.
- �, 9�rommennng with Section 100�1 of Oivision 3 of the 8usmess and Professions Code1 or th�t he is exempt therefrom '�;
� p„ and�he basis lor the atkged eremp�ion Any violatian ot SecOon 703L5 6y any ap{dicam fa a permii wb�ecls "',_,�•
W� �he apD��cam tu a crvil penalty of not moie ihan five huMred dotiars(550�1.6 �,'�'
� � o QI,as owner ol rhe praperty,or rtry employees with wages as their sd¢compenp0on,will da tlre woh,md `-��
� the strucwre is not mteneeA or MtereA im sale(Sec.7044,Busmess ant Pmhssians tade:The Lomractor s Gcense .�[.
\ �. � Law Uaes nm aOWY�o an owner of pmceny who 6uiMs or�mo�wes ihe�eon,a�wha dces such wark himself {�; . �-
j' - ' oi throu8����s own empioyees.prmided that such imDravements ere nut inhnded m aHered for sak.If,Aowever ;�i
� = the huildng or impmvemem Is sold within a�e year ot completion,the owner-builder will have the 6urden ot pmvmg _.�5(:;: ,
. � tha�he did not 6uild or impmve far the pu�pose ot sale) S,
y- ❑I,as owner ot the prapeny,am extlusrvely rontrectiny with lioensea cnnlraemrs to mnstruct the O�WK�ISec {�j!i �f^-i�t
p ]044.Busi�ss antl Vrofessions Cade:Ttce Coniractor's Liunse Law daes no�apDlv to an owne�of propertY who "'��. � " l�t
2 Wiltls or improves the�eon,and who cont2cta far such pmKets wiM a contranoqs)licrosed puuuant to Ihe Cantuctor s �/ �j'�
a ��re^u�w� �CONSTRUCTION
�-' � ❑�am e.�P,��e�s�. ,a.e r.c ianxn ee«au��ei ;�PLAN REVIEW
p �ate ��ef :�ELECTRIC
Y�� � WOflKERS'C�MPENSATION DECIABATION:I hereby afflrm that I M1a+e a teifificate ot cansent ro xli-insure a ��' -
a certrficate of Workers'Compensation Insum�rcc,or a rertNied cogv�hereot ISec.3600,La6.C.�. �PLUMBING
C
2 ❑certAied aovY is herz6y lurnished. �MECiHAN�Cip1�.
` _,jt
G ❑Cett�iietl topy is fifed wiih Ihe Buildi�Inspection Departtnent a Uepartmem d-.GRADING _�
u.t
� CERriFILA7E OF E%EMPTIpN FNOM VAflNERS'COMPENSATION INSUAANCE.This umm�need irot 6e compklM �.(SS{.�ANCE
�� i1 the permit is tor oire hundreE(S1W)m lesa I cetlily thet In 1ha perlwmance M the waM far wAkh fhis
" °'SMIP
� .� permit is issued,1 shail rot employ a�ry petwn in e�y manner so as to 6eco�wbjat b Ihe N6rkas'CpnpensMwn
laws of CalAornia. �
o PARK FEE L�SiV
� °ai `�`��� � SCHOOL FEES
••• �qTICE i0 APPLICANT:If,ahtt makim�Mis Certiliceie a�EKnnpiion,you should hecome subject to the Woikar s
- � Canpen5atian prwaions of Ihe Lebor Cade,you must lorthwith comply with suth prwisions m tl�is permrt shtll M�
� be deem�revoked. G D
J
- pC pYISION OF INOt15fflIAL SAFETY PERMR CEflTIfICATpIN:
W
d �I herehy rertBy Ihat no e�cavatim frve(5)o�mae leel in depth inro which a person u required to ducend
s will 6e rtade�n eonnectian w�ih work authw'ved 6y Nis permrt,and tiqt rp 6uildip itruct�,re.scaftaMinp.f�lsework. .
� �- a demolitiw or dismantFrg thneo[wAI be more ihan Miny-su 1361 teet�iph.(Lhap.3.2,Grp 1.An 2 Sec
�x' 341.71tle B.C.A.C.1.
S
3� QAs owner.Wilder,i wi�l�rot empbY airym're to do work which wou�d reQuire a pnrcuf frmn ihe Diruqn af
r. InWsi�ial Safety,as irond a6ove,unkss mch persnn M1es a permit fi do such xwk lrom the divi:ion
�
w ❑an5,�o����s����sa����m��No. ,TOTAL FEES � /�'�
� � CONSTflUCTqN LENDING AGENCY:i hereby affirm thet there u a co�utruction k� 1w die farmance ' � `-'
�B�Y R�
, z o�ihe work tw which thu perriut is iswM(Sec.3D97.Civ.C.�. - �
� lemer's Name COMMENTS
m �entler�s AtlAress
f '� CERiIFIGl�TE Of GOMPUANCE AN�AUTIpPoZAT10M OF ENTHY:1 wMy I Mve resG tlns epplinlian and rtate , �
g v� that Me infamation given is tarecl.1 agrce to Wmply wilh all sute Isws aM eiry ordinancaa tnlatuy to huildinp
, y consvuclion.and wthaae a representabve af ttce�eportmmt ol Buildiig aM$atety tn enW yqn Me popenY
= ta which I han aDd�d to�this pnmit tor the qrpose nt makinp insptiiont.
H
X igna�tu�e'at A�icanto�� '^� —pe� RECPT NO. ��� PAID BY ��� VAUDATION
WHITE—bepartment Copy.YELLOW—Finance Copy.PINK—l�ssessor Copy,GOLDENROD—File Copy,GiiEEN—AppGcartts Copy
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