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HomeMy WebLinkAbout105 (11) '"` � �` �lTY OF DIAM�9ND BAR v`�`'� �t�� �, '-�" ' L��ARTMENT OF BUILDING AND SAFETY PR�SS ��~ FIRMLY �� BUILDING PERM17 JOBSITE � Q� J r� , \ APPLICATION F'ERMIT USE ADDRESS ��,��— � - :��Li x��-' ` • ! .� DATE NUMBER =��'� CQDE . - ISSUE� ..., J� TYPE OCC. ;'= APN LOT�_ FiACT DATE r__,L.� �CONST. GROUP �X `:' CROSS EET�"�'= �. �'"'�-��y ZONING SETBf�CKS ""'a'E"'E"'S :' OWNER '� �'g"�� FRONT RW ❑ �a ADDRESSES�+g-�21� :�I-4 2�� �v ��''�`�-_�( 8 t� __ RERR ❑ u_ --��"—� ��� CITY �',_.,3 a 'c�.-� ZIP TEL. _ SiRE/SIGE STfiEET RW ❑ ���� �� APPLICANT _TEL. SIDE__._ _ ❑ :L "_ ;� CONTRACTOR SEWAGE ❑ PUBLiC PMT# ���ADDRESS DISPOSAL ❑ pRNATE SQ.FT./100 GAL °�'CITY 7_IP ._TEL. __��.._____� 3=�STATE �7 LLiG_hfUMBER GRADING ❑ CU.YDS.[XC. CU YDS FIL�_ �� ARCH/ENG/ � �pE SQ FT FAGTCpFt F'S ADJ. AREANALUATtON `-'—' DESIGNER W 1 .__ `� F�DDRESS €� 2 �� - -- �� CITY ZIP TEI.. (� 3 ::G _"— :� PROPOSED USE _ -t"�-• r' + :T•-3_ ,-�—`,�,—�^�� Z 4 `.' �Y�-�-'5:.�_��,,,,s— � GARAGE �:� ,:� NO. DWEL. �— NO. � PORCH "O UNITS STORIES BEDROOMS_ «�LOT DIMENSIONS � VALUATlON__ � ADJ.AfiEA �� NO. OF BLDGS HOW QUANtITY p����{1PT70N FEE := ON LOT USED_ ¢ " "' '"'���` �'� U �— • u -:� ❑ a .,(''�eC. ,)G+�> ` �� E?�.�� �'— ,!ICEM1SED�ON7RACT�NS OECIARATION I hereby aH�nn�hat 1 am bcensed under O�ovisions nf Chap�er 9 Icnmmencing F— - - " '� '�mrn Secunr?OOCI o±7rvision 3 0�ihe 8usiness and Pmfessmns Code.and my I¢ense is m fuL force nn3 effect V �� i'.'c� ..1 _____ :t � W �_ �]WNER-13;11LU(R OE;;LARATIDN I beieGy aflirm Ihat I am exempt hom the Cumracto�'s Lrtense Law for ihe�ollowing ieacor��Sec 7037 5 Busmess nnd Professians Cade Any uty nr[oumV which reqwres a permn!o cunsiruci, (;} i� al�r.i �mPmve dr.nnLsl�,nr repau anY slrucune,prmr lo ns issuence,also requires Ihe applicam far akh pennn Z' ---- �•— r:hh+a signeil stacemeN!hai he is!¢msed piirsuant la the pmv¢inns uF Ihe Comiactar's Lcense law IChapte p'� �c `�coir,mencin9 wnh Secuor 7DWi nt Owismn 3 of tle 3usiness anA Pmfesmons Cndel or tha�lie�s exemp��herefmm S —'—�'— �i xx1�hr hasis Ini chr.xllegetl exemp0on AnV v�olauon o1 Seclion 7031 5 6y ary apD�icznt Por a,�e,rmit sn6jects � "� tl;e a�yLcant ro a cvd penaltv ol nal mo�e:han ime AUMretl tlollars 1350011 a i �.0 1 ��� ❑i as-wner rl me prnpe�ry.m my employees wilh wages as tAeir sole camDensafion wd1 Oo iPe waik,anA — --- � ' iM 51 JGLIIC�5 99I�i11P.PJPL�Gf nflered loi sale iSec JO:A Business anA Prdr.ssions Code The Conlractor's license ' Law-0nes nn!a I�lo ari G�STE'f Of in en who uuilds or im mves Ihaeon dnd who dces such work h�msell, C7 � iu UD' 0 0 Y P —..---_'— !;�+ m iL•iou�^h�s oa���r.riployees p;omtleu tnal sucn impmremems are no�:ntended or off¢red fci sale If,however. � �� thr.6udding nr,npmvement�s so�d wuhm one year af completwn,ihe ownerinulOer wdl have Ihe Cwden ol Drm'ing Q _ .. � tlbt he dul nut haim n�improve br:he purpose of sale{ � — �:n ❑i as�rv^er��:ne�mpeny am exclusrvety comrauiny wtlh her.nsed contractors�o mnstruct ihe pm�ect�Sec W �� i'ISC 3usiress and Pw�essons�ode The Comra[tor's Lkense Law does not appiy Io an ownei ol Vrop¢rtY who 'y� �� hwlds or anproves ihereon and who cunhacls lor sieh pro�eats with a contractorlsl li[ensetl W�suaut io�he Cnnvacior's ��_�����a^� CONSTRUCTION .__ �� -• -- �:y f � [� I am exeriC�under Sec B k PC�Attach Cx�ufrtatel. ._LA�_.�.EVIEVY.I� ��^�7- l�`�l�1 I� �� °ai° °""ef ELECTRIC . � WORKERS"COMPENSATION OECLAHATIpY I heretry affirm I�at I�ave a certihcace o(r.ansem�o self msure,ar pLUMBiN� '° a,:ertd¢ate of Wo�kers Compensation Insurance,o�a aeruhed caDY��reoi�Sec 3800.Lab C I -- �¢ ❑f.arntixd capv�s he�eey lurn�shed � MECHANICAL __� _ ,p i.� 'eruheA copv�s liled•.vnh�he Bmidmg Inspeceai Oepanmem ur o�o��m.��. �Q, GRADING i.� „ CEA7IFICI;(E�F EXEMPiION iROM l5'ORKEHS"COMPENSATION INSURANCE This secuon neetl nm he[omCletrd � �SSUANCE _ _ �.n d the permil is lor one hundmd iS1001 0��ess I cenrfy ihat m the perfarmance ol the vrork (or which;his r perme is issued,i zhall no1 emploV any Oerson m any manrer so as to becare tu6�ect ta Ihe Wnrters'Canpen5atfm SMIP _ � Laws ol Cahkrma ^ �J o . .... :, .., � PARK FEE " cale .'�0;���^� " LM.- SCHOOL FEES L �ATICE?0 APPLICIINT N,alter makmg this Cerp cate�6l�Expmptiou,you'should hewme sub�ect to Ihe Woiker's � Cmnpecsanen provisions ol ihe la6or Code,you musl ImMwilh comply wRh such prw!sans w this permrt shall �i !u dcemed revoked ----- 'ix pV190N OF INWSTNIAL SAFETY PE�MIT GERf61CpTl(IN: � a�••�^� —_ i1 -` ^ "' � t;';•J;. �� �JI�erehy cettAy that no excavauon Irie 15�ar'more 1eeP in depth�nla whrth a person is reqwred to dexcmd, i;c wdl�e made m mnnecnon with vwrk au�hwaed by Ihis permrt,and that no huAdinp svuclwe.anlPotdinp,f�lsework, 11 ur demaNtmn or drsmamh�p Iheieof wdl he more than th�rty-a*(36)feel high (ChaD 31 Gry 2.Art 2,Se[ _ '��= 341 Tule 8.C A C i � �- . . . . i.aa . , . . � . .. ' . . , L : '�; �'As owner-hwlder.1 will not empby'ahyon0 to.do wark�wM�h wou10 rapuue a 6erm�han�he Oinsion oi Inilustrial Salely as nohd abave,unless such persan has a permit to do such nrork lrom'11rc drvis�on ---- I:E r-� �'i,� ❑p•isun oi Indus�nal Sahty Permit No. TOTAL FEES ,_L /.�_ T�.( � CONSTflUCTqN IENDING AGENCY I haeby alfirm ehat there is a aMnuction kmd'mg agmcy tor tlie pnfaimmrce „_1 jz of:m:work fa�wh¢h thrs pe�mn is issued(Sm 3097,Civ.C) q . ,s ,.s��' '�' �7 y�:� �' t .� Lender's Name CQ�EN�.` �i' ��i .���; �F 11\��__ ;',>>p Lender's Address ���. - I �� t� � t--� � �" .¢ ! CEflTIFICATE OF COMPL�ANCE ANO AUTHON2ATqN Of ENTflY I cntily 1 hax reaA this apdc�tion and s�ak !jn ±hat tne ml qwn is eamct 1 agree to tomply wAh all sfah las aid ciry oldinancos re�tinq to huildnp �.� construcu ,and au arue a�epesem e ot ihe Dryarlment af BuiNinq and Sahty m mm ipm tAe praperry� , for whc I have appl d Mis per fa ihe purpax of m�kinp inspe�twns. i._ r ,F� / �� )� (f, 1 � � i REGPT NO.��PAID BY���� UAUDATION r Signature f Applwant or Agem O�te WHITE—Department Copy,YELLOW—Financa Copy,PINK—Pssessnr Copy,GOLDENROD—File Copy,GREEN—Applicants Copy ' 13S106-1 V89 , � - �. . , ,�_��,,., ,.�. � ;` .. ; . , .., .... ; , ....... , . .... R"L" , . . ,. �..- ' : � , ,...,. :r:.i�'`:; �� .'; .. . ...... ,.. . . . . .. . . ..... . - . . .. .. . . . . . � . . � ..� .. . . . , . p:'�• .. .. a . ... . . . .. .. . . _ . . . . . . . ... . ._ _ . 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