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HomeMy WebLinkAbout16263 (23) � CITY OF DIAMOND BAB --- --— DEPARTMENT OF COMMUNITY d�DEVELOPMENT SERVICES � . Zi�o E.c��Y t��s�u iso PRESS '�'-•��� BUQ.DING PERMIT APPLICATION � FlRMLY o ADDRESS �7 �!� ����1. DATECATION i J �' NUMB R_L._� �� IS5UE ` -� TYPE OCC � APN LO TRACT DATE CONST. GR�UP � OWNER 8 ADDRESS L� .iw.au��" ZONING SETBACKS CfTY I��t�..�.�R ►Q C� ZIP 1'EL. O? FRONT RW ❑ � APPLICANT ��, REAR ❑ SIDE/SIDE STREET RW ❑ CONTRACTOR SIDE ❑ ADDRESS PROPOSED USE � CfTY ZIP TEL. � 2 � ARCH/ENG! DESIGNER NO.DWEL. NO. NO. ADDHESS UNITS STORIES �BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.Ff. FACTOR PSF AW.AREANALUATION � OWNER•BUILDER DECLARATION SFR/ADD/REM O 1 HEREBY AfFYW UNDER PENKTY OF�EiWRY THAT 1 AM E%EMPT fROM TNE CONfPIACTORS LI- Gef9g9lCefpOh CENSEUIWFORTMEFOLLOiN�NG11EllSON1SEGT0]�.68USINE93ANOVROFESSIONBCODE:ANYCRYOR (n COUNTYMIFtlpiREOUIRF9A0ERMRTOCONSTRUCT.AI.TER�'�E.DEIAOL1�i3ORREPAIRANYSTRIIG W pad0lDeGk iURE,IRqR TO IT8 163UMICE,IILSD RECUIRES THE APPIICANT FOR SUpi PERMIT TO FILE A BIONED STATFJ�IENT TNAT NE OR 8HE IS LICENSED PURSUMR TO 7NE PR�YISIONS OF THE COHiRAC70H5 LI• CENSE UW(CMAPTER�(COMMENdNO WI7FI 9ECTION 7000)OF DIV61ON a Di TXE BUSINESS AND VRO- � PoOUSp9' FESSqMS COOq Oit iMAT ME OR SHE IS E%EA1PTh1EHEFROM AND THE BASIS FOF THE ALLEOED EXEMP- 710N,MIYVIOLATIONOFBECTIONfo316BYANYMPLIC�NTFORAPERMITSU&IECTST1iE11PPLIGNTPO Z Re•Fiaat F ACML PElLLLTY Oi NOT A10RE 1}NN FNE MUNORED OOLURS f�GaO).p � OI,A501MIEROFTHEPROPERT`/.ORMYEMPLOYEESWI7NWAOESASTHEIRSOLECOMPENSA710N, 0 COTm8rCi91 � WILL DD hIE M/OHK.M70 TNE STRUC7UNE IS NOT MJTENO6D OR OFFERED FOR 311LE(SEG 70M.BUSI- J � NESS AND IiiOFE5S10N5 OODE:TiE COMTMC?GRS UCENBE LAW OOES NOT MttY TO MI OWNEH OF = ppOPEHTY NM1q BU[�SIXil.1PFIOVE67MEREON.AND WMO�OES SUpi YPORK HiM9ELF OR NEH3ELF OR ¢ TMROUGH MIS OR MEq ONM EMPLOVEES,PqOVIDEO TMA7 8�W7fiWEMENTS ARE NOT IHTENDEO OR � � OFFFRWPDRBAI.EIF.FION�EYERINEBULDINGOqMAPROVEMBJTl760LDWfiFtlNONEYEMOF00MPLE � TION,TME OWNER-0UILOEii WILL HAVE TIiE BUR�EN OF iiIOVINO 1W�7 ME OR BNE OID NOT BUM OR MPRDVE FOH TMF K1RP06EaF BALE} � O L�S OWWEN OF TI1E VROPE�AM IXCWSNELY CON7RACTINO WRFi LICEN9FA 00NTMCTOR3 . TO COM5T1K1CT7HE iRO.IECT(SEC.7GM.BUSINESS MA PROFESSIONS OD�E:7HE CONTfUGI'ON5 t,1• Y81U8110n �"�� ADJ.AREA CENSE lAW DDES NOTMPLV 70 AN C�NNER�A PROPERTY NIl10 BUILDS ON IRIPROVE!TXEREON,AN� WnoWri7w�cisFORs�Ja�PAaEcrsrnMACorrra�cionlsllaENSEDntnswu+iiornEcanTw�u QUANTITY DESCRIPTION FEE � TC7RS UCENSE IAW.). O I AA1 EXEMPf UNDER SEC. 8.t P.G FOR Tli15 REASON � n LL � ! / pATE OWNER V � J � LICENSED CONTRACTORS DECLAHATION W IMENE6YAFFlNNUNDERPEMALTYOFPEfUUHTTXATIAMUCENSEDUNOERPROVISI0N50FCNAPTER � �(001M/ENCINOYVITNSEC7�ON7000)OFDIVISION30F7HEBl131NE53AN�PNOFE5510NSC00E.AN� Z W LICFIVSE IB N fIA.L FOHCE AND EFFECi. m � 110EN5E CLA35 �✓� LIC.NO. � I� 1 � � pA� ca�nancroa a WORI�RS'COMPENSATION DECURATIDN � y IHEREBYAFFIiUIUNDERPENALTVOFPEIWRYONEOFTHEFOLLOWINODECUMTION3: U � � � _�IMAVEANDWILLUAMTIUNACEN7IFICATEOFWFISEMT06ELHNSIIREFONWDRKERS GpMpENBATION,A9 PROVIDEO BY BECT�ON 97000f T1E LABOR CODE,MR fNE PERFORMANCE W OF 7FIE WOHIC FOR WHIq17H15 PERMIT IS ISSUED. � G �I H1WE Ml�WILL LUINTAIN WOfiKERS'COMVENSATION INSURANCE.AS REWiRED BY SECTIDN Q4 ]700 OF THE LABdi ODDE,FOR THE VERFORM+WCE OF h1E WORK FOR NRIICH THIS PERM1716 ISSUED.W WORNERS' ?E �TIOii INSURANr�,c��c.,HRIERAND ICYNUMBEFME: CONSTRUCTION � CARRIER •� !� PLAN REVIEW � FOLICNMIYBEP � – ELECTAIC � (ry65[L�qNA�IDpqT9ECp1.�LET�pFhEpEqlNfBq)qqdEMUApq ppLLA0.s�S7aqOqlEss) PLUMBING Z ICER7IFVTIATIN7MEPERFONMANCEOFTHEWORKFORNM1��CWTHISVEiW1T6155UED,1 MECHANICAL � SHALL NOT EMPLOY ANY PERSON IN NN MANNER SO AS 70 BECOME 9UBJECT TO THE N WORKERS'CdAPENSATION UWS OF CALIFORNII�MIOMiREE TNAT IF 18F70ULD BECOME �NSPECTION FEE S SUBJEMTOTHEWORKERS'C0610ENSATIONPFlOVISqNSOFSECTIONJ7a00FTF/ElA00R caoe i sw�u wnn+wrn+coMrtir r�nn+nase rnovisar�s. ISSUANCE i...�� 0 5MIP – � _,\ l 1 p OATE: APPLICANT: � WAIWINO:iALURETOSECUREWOFKEN9'COMPENSATIONCOVEMOEISUNIAWFUL.ANDBHALLBE ENERGYP/C � SU&IECTANEMPLOYER70CHIMWALPENALTIE5M10CIYILFWESUPTOONEHUNDNE01MOU5AND ENERGYPERMIT i pOLL�NSµt0o,00oj,IN M�1110NTOTME COST OF COMPENSATIDN,DAMA(IES A3 PNOVIOED FOR IN � SECTION 770!OF 7NE LABOR CODE,NTEREST,ANO A7TORNEYS fEES. RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � � INEREBYAFFlHMUNOENPENALTYOFPEFLIURVTIRTTiERE19ACON5TRUCTIONLEN�INO/AFNCY FOR THE PERFORMANCE OF TME YVOFK FOq WHICH THIS VENA�T I5155UED�SEG JOW.CIV.C.). � � �ENOERSNIIME C LENOERSADDHE93 � iCEHTIFYTl1ATIWWEflE�D7M�BAPPL�CNTqNM109TATETMATTIIEABOVEWFOfiMATqN15CORRECL TOTAL FEES I � � O w IAOREETO PLVWITN/JACIP/ANOCOUMYORDWANCESAlDSTATELAWSRELATINOT06ULDING P'I � CONSTHUCT .AND HEHEBY AUTNORRE REPRESENUTIVES DF 7HI5 COUNTV TO ENTER UPON TNE � l�90YE•ME NEO VNDVERIY FOR INSPECTqN VURPOSES. CQMMENTS � � P " (PRIN7) -.I +r/ � � 61GNA F ERMITfE MTE � i7ECPT.NO. PAID BY VAUDAl10N WHITE—Depertment Copy.YELLOW�inflnca Copy,PINK—Aassssor Copy.GOLDEN D--Fila Capy,(iREEN—Nppllcent'a Copy � — --- - .� . . , . „ . .. .- . . ... . , . ., .. , .. ,. . . . . .. .. ., . . , ,,, .. . , .., ,. , . ,,:.. � ..�a . . , .., , CITY OF DIaNiOfVD BI�R � IFJSPECTIt)PrE RECC�RD ' �_.. ��� . . � ` . s , �" � `,��, ..,.M�.���`.,�`a�."�, �<��',�*e�i�. ... ";. , �, . . . � • :.... ... . . . . .... :'.: . ., . , SET BACK ' ! FLOOFi JOIST• " j --- --�. ._.._. 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