Loading...
HomeMy WebLinkAbout105 3 � N,h � 1 '"` �� CITY OF DIAIVIOND BAR � pRESS � ���� °�" ` DEPARTMENT OF BUILDING AND SAF�TY F1RMiLY ' -� �UlLDING PERMIT APPIJCATION PERMIT USE � � d soa��—��� 5 . L�i--�/��� f�e`. sSUE �"�'rr�ER � o�cO�E ADDRESS � ' `- \ /" ' �� � 6 APN .___ LOT , TFIAC7�-�� DATE �� � CONST.�GROUP.�.< � CROSS S EET` SETBACKS _ , zONING ���� a° OV1'NER R � FRONT RW .❑ o ADDRESS� �,� ���- ���"�^�I�2� REAR � ❑ � CITY-�t'i�lJ'� iP. �TM��� _ TE' r � `� SIC�E/SIDE S r RW ❑ w TM �`�APPLICAN� TEL .� ' --- SI[7E ❑ 0 o ... � COiVTRACTOR ��f '� r � '�"��-�-- SEWAGE� ❑ PUBLIC PMT� o�ADDR� ' • i7 - � DISPOSAL ❑ pRIVATE SQ.FT./100 GAL w�CITY � !�-� ZIP�� � �TEL� /�' $ STATE ? GRADiNG ❑CU.YDS.EXC.�CU YDS FILL � �IC.NUMBER_ ��;1 _ �_"ARCHi ENG! � T�`�'� �Q� �+��R PS ADJ, AREAIVALUATi�N `�I DESIGNER � 1 i,"� � ADDRESS _ 1� 2 ! -�� o, . z'CITY ZIP _TEL..� _ (� 3 � � PROPOSED USE _��---- "'"' .—__ � 4 •��' � � GARAGE� � ' o NO.DWEL. NO. NO. m PORCH� � � UNITS STORIES BEDRQOMS `='I VALUATION ADJ.AREA_ em LOT DIMENSIONS _ o NO.OF BLDGS HOW � QUANTITY DESCRIPTION F�E � ON�OT USED � � :�`L. � , IO .. L� � � — x ac �"" I ICL.F.f:CUNiPACTORS�ECLANATION I hcrehy afM1rm ihat I am lkensed�nder promsions of Chapler�kamme�nnp 1- �— � .w�li Srcvm�.�70��11 N O�v!sinn 3 n�the Pu ir:ess ann Pmfessions Cade.and nry hcense is ic lull Mrce anA¢ffrcl � �I�f.5 31iIL7ER CECLApt.TION I herelry alfirm ihat I am eaempt fium�hr Contranor's!rtense�aw'oc the fNlowing � ' rensm�ISr.: %`u315.B�s�ness anJ Pioiesvans Cade Any c�ry m counry Which requiies a permil m cans[ruct, (� oalie� ��np�ave,i:rmolish,ur iepart any stmcwre pnor ro its�ssmnce alsc reqm�es the aoChcam for s�ah permit 2 ' F^ �o h!e z smnetl s�n�r.mem ttal he is I¢ensrd parsuant ro the Orav,sinns of ihe Coneacim':L¢ense L.�•.v;Chap7e� p) ��9 U:�rimr.unn9 wnh Seclion i0001 nl Ji��sion 3 of the B�siness antl Fmfess�ons f.odel ci that he,s eaeino�iherr.iron S� Xand!he lasic fnr•hr.el:eye:exemptinn Airy vialation nl Seouon 70J15 hy any apphcani tai a permn w��ecis � �_� W ;hc apyl:cunt to a r.:vil penalty n�not more iF.an live hu�reC dollars 1250011 a o I�I ae ewner rl��e propen� or ny emploY¢es wnh evages as fieu mle compensalmn,will da tlie worX and — rte svustcre�x•r•,1 mtentlar.m otferM'w sale!Sec 7044,BusinFss nnA P�olessmr.s Cade Thz Contraatals license .S `„�'p law•'ces nn!zFply Ic an��nrer ol properta whn�mlds ar impmves Inxreon and u�ha tices sur.h weik himsell �CJ . ��cr tMwg^h�s nwn znD�nyees.prowded Ihat such imD�oaemr.n�s aie nc1 mte�ded or olleren for sale Ii however � 7 m�:Le nu.m���nr�mc¢��ement is sold w•�hin onr year nl complenon.the owner-budder wJl have the turden nf prwmg I Q ythat ha Cid re:�oi'E or�mprove Inr the pwpose ai sale I � U y!❑� a�:nvrr•o`the prnpe�!V am exclusrvely mnttacliny witli h[enseA contracto�s tu constt�ct ihe proK[t(Sec I �yJ ;i�G4 9usu";s antl°'olessio�s Lude The Conttactor's ikensr.Law does not apD�Y�o an owner ai U�apr.ny wha S,� Zi Cmldc or ivpiwe.=.fi=�er.�,and who cumrans lo�se�h piaects wrth a comraomrls�luensed purs�a��ro tAc Carliactor s ' "`;��_�^�:�a� COfVSTRUCTION �� n � PLAN REVIEW '�'��U I j�n e�r.m:mdrv Se� ,B 6?�IAnach f,eruficatel � " o flaic G.�ner ELECTRIC � VfJRHERS :OMPENSA7FJN�ECLAHATION I herehy afhrrn Ihat I have x certificate ni consenl m sel6msure,or a ceruficate�I PJnrkers Coinpensat�on Insurance,m a r,erldieA roDY�hereo�ISec 3800,I.a�.C I � PLUtvfBiNG o (� Q ❑Cerlifietl�opV�s heiehV�wmthed �� MECHANICAL o� �enifieG cnpv�s 6lad with�Fe Buiiding Inapecuan Oepartment nr Departmem If� (`,,qADING ' —/��y,.{/+—) CERT�FICFfE 7F C%Eh1PTI0N FFON 1NORKEPS'C�MPENSATiGN INSIIFANCE This seufan neea nol he mmpleten �(�y ISSUANCE /•�-� �"�--o � il t1e pern!�is Por nne hunAreA II10DI or 1¢ss I ceru�y tha�m�he�erlormance uf ihe work fnr whkh Ihis F,,,. � Cermit is issueC I �ali not.emo-'oy any person�n any manner sa as Io t suh�ect lo the Wo aryenvUon S`�1f7 _ � �,„,s�r e �,��� �,�'"'g( . ' � PARK FEE Da�e ����� =� ' Mo�¢ ��� � � R� uW.,. W ND71LE TO APPLICANT N af�er mak�nq this�erv6eate of E�mption,yau shaulE hece suClect ro the 1Norler's�f SCHOOL FEES _ f,am0ensaarn�9rovisiane al Ihe lahor Cade.yau musl farthwnlh compl�wtlh suh pra iswns w�hn peima shall� "– he deemed mvdced �—__' � ��IVi510N OF INOUSTflIAL SAFETY PEBMIT CERTIFICATION ! W i d LI Lc�eCy rerlrfy fiat no e�wvauon Irve(5�ar ma�e het in de01h mla whrth a person rs:eqwred to Jescend,: e�e i wN be made�n connenwn wlth woh amhaaed 6y th�s permiL md that no huilding suutture scaliclding,lalsewul,� ' ^ a�or Aa��ula�en nr dismarlimp Iherml will 6r mare tnan ihirty�sn�36�leel�iph �Gap 32.Gqi 2.Iln 2.Sec! ____ ?�:ia 1.Ltle 8.C A C i f"i7V 11,�–'��t�r�Atf'f O A i.h 2 r ---s�rTv� T Y�1�"'07'[T 3 �Jas owneo-bu:lder I will no�¢mploy anyone 7o du wark wh¢h wvulE requue a 9ermn Imm Me Divispn af �yl jll P1 A RIlY �'+�C�V �. Ind,slria!Safety,as nofed a6ove,unleu euch person has a permit to do such work hom Phe AvMmn r � W ❑av,,,a�.������.=,�,a�sa,���,m„�o TOTAL FEES � . 2 a � COM1ISTRIICTION LENOIkG RuENCY I her � e6y affirm that there is a conmucuon lend� epeixy lor Ilm perlam�mct i Znl ihe wnrk lui whKP th:s permrt�5 ISSIICE�S¢C,3II9I,CN C� I '+'— � �P�ncrs Name � C�MMENTS '' m lende�'s AAAress Q CER"fIFK,'ATE OF f,OMPLIANCE AN[1 AI1THOqRATpN OF ENTiiY.I certify I Mve resd tM1is epplicetian wd swt + en �hat the mlonna�mn yrven rs corrvct�aqree to camply wrth al slate lawx and�iry ord�names rel�ting eo hw16�g � wnslrucoon,and authon a representatrve al the Oepa�tmem M Bwltlinp�nd Salely l0 mler n qopeny lor wM1¢h 1 ha�e aGU��ed or Ihis pe�mit ta�Ihe D�W �hskm9�nspeclwns x — � � . — "� 7 - �' 1� �� E� Synature nf Ap cs�t oi nge ��� � RECPT IVO. PAID BY VALIDATION WHITE—�epartment Copy,YELLOW—Flnance Copy.PlNK—Assessor Copy,GOLDENii00—Fila Copy,GREEN—Applicants Copy _ , .;. .., .. ,.,...:. �. . . . .,,. . .:,, , . .- ..... . ,. , . . . . . . ,. ,..r„ , . .. , , /'� , �`i, .i , ' . . I ' . . . . . . � . . . . . . . . .. . . . . .. . . . ... ... ... ... ,.. . . ... . .. .. ... . . . .. . . .. .. ... . � .. ... .. .. .. . . l��. /O "��"�la _ _ . . . .. . . , �� � .:� �4�. . . . . ., . . { ; . �.. ;.: , ,�,. . . . . . . ... . .,; . ,. s ,, .n:. . .. . .. . . ... . . .. . . . . . . . . . .... . . , . .. . ,. ... . ... ._ .,.. . .. _ . . ... . - . .. �t'���, . �.F '�.i r`'; .. . . ... . ... . .. . .. � .. :'"s,",,:.� �� - . . . .�.. ... '' , ... . .. ... . . . . .. ., . . .... . . . .. . .. _ �.. ' .. � � . .. '. - . ._,+ .. ��V'': .. ' t' ... ..E. . . . .. ,... . .. . . . ... . . ... .. . . . .. . ... .. . . . . . . . ... ... .. ..... ... .......... ................ . . ... .. . . . . ... .... . ........ .. . ....... .. ... . . ... .. .