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HomeMy WebLinkAbout107 (10) ''�` :� CITY OF DIAMOND �AR '�' PRESS - ��., �� L..�ARTMENT OF BUILDING AND SAFETY � FIRMLY �� BUILDING PERMST JOBSITE <J�� �� ` ,���_� DATE CATION �MBER j CQDE ADDRESS � ISSUE �,�- -J. , TYPE OCC. •." APN LOT � TRACT DATE �����CONST GROUF' � CROSS EET " � �'—>L�'-5� ZONtNG SETB�►CKS ���� �� :� OWNER ' , y" � FRONT RW ❑ `,'` f1DDRES.�'2�hi �— �:��-L_ >3 "•' il �Cs REliR ❑ ,L CITY�;,,c.—� '�----�.. ZI —�-% TEI�'�3s3�, 1 SIDE/SIDE STREET RW ❑ ;� APPUCANT_ �TEL._ 51DE ❑ :z = CONTRACTOR SEWAGE ❑ PUBL!C PMT� � ADDRESS DISPOSAL � CITY ZiP TEL. ❑ PRNATE SQ.FT./100 GAL�. «�LICAT UMBER �GRADING C� CU. YDS.EXC. CU YDS FILL �� ARCHlENG/ uy N�'E SQ_F1' FACFOR PS ADJ. AHEANALUATION `•'—' DESIGNER � � ' ADDRESS � tWL 2 �� -- .;� CITY ZIP TEL. (!3 3 ^ � ;��_"—_ PROPOSED USE ' � ��_ ��_ z 4 _ � �� ���_.!,') s��. ,. � GARA6E �g NO.DWEL. NO. NO. � � PORCH �' UNITS STORIES BEDROOMS m ---L--- �,_ LOT DIMENSIONS VALUATION_ ADJ.AREA �� NO.OF BLDGS HOW �UANTITY a�SCRIPTIQN FEE '-� ON LOT_ USED_ � '�" ci_ („t _._._. ��� ❑ ¢ ;'�C=- (._.'Fri `� : c,�� 'e�� LICENSE�CONTRACTOAS OECLARAiION I herehy affirm thai I am HcenseJ unde pmvmons nf Chapter 9 Icommenarg, �t--! �� �r�tl�Sectio�•70G01_d�rviaon 3 0l�Ae Business anu Prolessions Cade and my Iwense is in idl tmce and e!teci � c:� J — — ?I: � LL! �!_ ;TNYEH NUIL�ER�ECL•1HATION I hertGy aflirm Ihat I am e.empt irom the Coniracro/s Lirense law for Me lollawmg � '— ��. roasm�(Se.c i0315 9usiness erd Ralessm�Code�Any utY u�countY which requues a pe!mn ro tunstruct. (J C7 a��;er .mprnua .ienolah,or reUarc aiN slructure,pnor to ns rssuance,also ro-qwres the apphcam fm such penm� Z — N �r'�le a signed sta7emenl�ha�he�s 4censeA pursuanl to the piovisions ol Ihe f,anuacfor's litense Law If,hapter p] pi. 9�ioR.meixmy Nnn Secum�:O�C�cf Orvision 3 0l ihe Busmess anA Prolessians Cadel or�haf he rs exempi ihere�ram Sr„ I p_ a��i^F hasis lu ,hx alleged.^eempvon ArY vmlavon d Secnon 1Q31 5 by any applicani fo�a Dermit suhiec7s � ��� ihe ap;1¢ant�n�c:roil Oena�[y a!no!�nnre ihan`.rve hundred dollais(55001 i � a e� I_�I a mv^e���f the V�oper��,or inV employeex with wages as thert sole compens2Lon,will do 1M wrork ane -- �� �he stri,uurx is not utenAed a alferetl for sa�e I�c 7064,8usiness antl Pmfesswns Code The Lmvactoi's L�rense A[ �;j Law r,nei��.it aCFly to an aw�vr ol pra0erty wha hwlds or impraues therear.anG wha Gces sut�wmk himself J -- �� ar Peuugh�ua��um:emqoyeei.pmv:DeO Ihai such improvemems are r0�inlen�ed or oikred Por sale II,hcwr.ver,l Z _��!irv hudAir,or mprmemo�i i<scld�.rnhm one year ef comD�Pnon ihe ownerbiiider wdl have Me burden o�pmrmg d _ G,�.7ia1 h�tliA uat 6WId nr improYe lor Ihe purpo5e of Sa�e.i � o;��L i as:inrrr of;ne G�operN nm axclusw.ly conbactmy wrth Ikensed com�acmrs lo constmc�the pm�at ISec q��j I ~---'— � �� %'YK Busines:anc Professions Cude The Lamraclar s License Law daes not apply ta an owner ol prapeny who '� ^_ :6^ Cadds m�mprmes thereor.,aud�vha rontraus icr such pra�ects wiih a comracroqsl licensed pursuam m the Cantractor's "� ������s��iaw� CON�TF�UCTION _ _ �� ❑ dm e�eR�o���ee:se� e�P.c�n���n ce,��r�a�ei -- F�LAN REViEW..~ (.,,�.7;J� _ �; o��Y� a��ef �. �EtE�TR1C '— :i WDflKERS'COMPENSATION�ECLARATIIXJ I hereM1y aftirm that 1 have a cenficate of consem to self-msure or i � �LLMBlNG - s ar;�fir.a�e ol WorMeis'Gompensa�ion Irsurance,ar a cer4fied copy ihereal(Sec 38UD,LaG C 1 c� i� ❑Ce�nlied rapy is hereby furmshed � � MECHANIGAL _ e:i '� 'end:ar,mDY�s 6ietl wnh the 8wlding Inspttlmn�epanmem ar Oepaitment � GRAJING : � �a i;FRTIFICAIE Of E%EtdPTION FROM WOBNERS'COMPENSATION INSUNANCE This secuon need not he completM ISSUANCE ,_ _ u�i 'I �he permii�s ior me hundred i51001 0�Irss.I cerbfy:hat in the perfoimanre ol Ihe wo���or wAMh this perm:t:5 iasued.�shall nol employ anV Oe«n m any manrer sa as�o�ecome su6�ett lo Iht IM1brkers'Canpensa�ion SM I P �:' laws�I CaLfon��a � ' PARK FcE a� 11J -- e:� ua�e "��''�"' L� SCHOOL FEES "� NOTICE TO APPLILAN� If,after makmg[his Certihcaee af Exemp�ian.you shauld 6ecomc suh�xt m the YWrNds - Cmnpensalmn provisions of�he Labor Cvde.you must forlhwith comply•�vnh su[h D�aviswns cr this perm�shafl 6e dr.emed�r.voked ---- �.. �� pVISIOH OF INDUSfFIAt SAFETY PEBNIIT CEflTIFICATIpJ� _—_—_� LLI ' '.�.. 1'•o, '. __ C� ❑I he�e.hy ceiuly thet no excavatron fve�SCa��lfre lee�'m'dep�h�mlo wh¢h a parsm a reqmred Io desce�d, __ pe: rvdl 6e made in connecuon with worM authorved hy Uns pe�mn,and ihal na 6uil3inq strudure.scalMidng falsework, �^ ar demolnian or dismamhrg�he2of,will be mwe�han ih�ny-air 1361 lee�h�gh (Chap 3.2,Gry 2.0.rt 2,Sec � 3c 341.TitIeB.CACi ,',.`3:...; � � ��:,,`..;� 3�� �;As owner-hwldei,i will not empby�airyone to Uo work whYch�iudiAd�eqmre a permn from Ihe 6vision af � f--. Induslrial Safety,as noled ahoae,unless such persoe has a permrt to do such work imm the Axuion �; I u'{ �O�nsion o(Industrial Safny�Peimit No, ' � ' .- '`. .' , .. '...=-- — —--- ,..�!�� n:. � TOTAL FE�S � q�� � � CONSTRIICTION LENUING AGENCY:I.6ere6y af8lm��hat�1��e is a�iamhlietion�kndi�p ageM.y for ihe perMrmence �� � Zy al!he wmY for wh¢h Ihis perm�t is issued�l�.3097.�Gv C.I.: �.: .. .• , 1 _ �+ Lender'x Narnr CdMMENTS_�..� !/� � �+ _y (��� ..��-��-- ' � LenAer's Address o� CERTIFICA PLIANCE AND AUTNORI2AilON OF ENfRY.1 caiily�luue ruad this applration anE sma ,{ r � 'i j�y, u� tAat �nlnma�ion gi is carrtct I apree m camply with all state laus aiM ary ardiwncn reletinp ro 6uitlng 'F/�r'�1`l_'�.� " '� I�/ � � ��L'�� L-+' � � v� ro vucuon.a�d authoii e rzp2u e ot Ihe Oepanment ol Buildinp aiM Salety m mier;�on the poperh " � � _: f whrth I,have a001Ktl i rs ii lar prpos¢af makmg mspaclions. r• � � �siq�na�e n�np o�aqm�t s ��mre�� RECPT NO. _�PAID BY�_��.VALJDATION��, �..__ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GQLDENROD—File Copy,GREEN—Applicants Copy asios-i vee _ . •�t:�::�r: . �.. ... .,.. , . - ,. ,. . . . , . , . . ..- „ :. .. .... . . �. . .�,. .. .. -- � . . . . 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