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HomeMy WebLinkAbout1055 (7) � -('� GITY OF DIAM�ND BAR pRESS �, DEPAR'TM�NT OF BUILDING AND SAFETY ��RMLY BUILDING PERMIT APPUCATION PERMIT r U E ADDR'ESS �� Q�S ��/C�� ��' DATE `�O TYPE ER � L�-� �CODE ISSUE �� � APN LOT TRACT DATE � L)�1 CONST. GROUP o CROSS STREET ZON{NG SETBACKS •p"°"�"'E'"5 �' OWNER �'Nf S � SS/f� FROM' RW ❑ � ADDRESS -2� a SS"' i'C�' U L� �' REAR ❑ W CITY ��� '��- ZIP 9/'1 CS TEL. SIDE/SIDE STREET RW ❑ o APPLJCANT L tEL. SIDE ❑ z � CONTRACTOR p�7c�S�W -Ta�� SEWAGE � pUg�.l� pM'T# o ADDRESS 3 I 90 E�.�//�J DISPOSA� ❑ pR�yATE SC].FL/100 GAL ,� CITY�'��'.�1� ����� ZIP�,�Q.�TEU/s 9�da = STATE Q GRADING �CU.YDS.EXC. CU YDS FILL y LIC.NUMBER -��- � 5 � y ARCH/ENG/ � TYPE SQ FT FACTOR PS ADJ. AREANALUATION � DESIGNER W � � ADDRESS LL. 2 0 � CITY Z1P TEL. (� 3 � PROPOSED USE ��'`.' z 4 � � Gl. � 1 � GARAGE o NO.DWEL. NO. NO. += P�� y UNITS STORIES BEDROOMS s LOT DIMENSIONS � VALUATION ADJ.AREA o NO.OF BLDGS HOW QUANTITY RESCRIPTION FEE W ON LOT USED ,� � �W ❑ L "� ❑CENSEO COMRACfOFtS OECIAPATION:I hm6y allirm tlut I�m kanod udar provqions eF GupW 9 Iwmmaicnq � wrth Secnon T0001 ot Gvicion 9 al t�e Business ind Proles�iont Code,and my Irmse is n full lorca�nd Nfect. .,W � � W W OVlNEN�BIAIDER DECLARATqN I heiehy alhrm that I am�umpt hom the Contnqofs 4cenu l+w im the ialbnmg _ �easan ISec.7031 5.Bugness and Praless�ons Cade�Any u�v or eoumY w�ch rpwrp�q�mit q cans6at. O mer imp�we,dertwLsA,a re0+��any rt�ucture,piiar to its issuence,deo requWs the aypYnnt Poi such pdmn �.� .,�` 1 � io hk a ugned rta�emem tha�Ae is licrosed Wnuanl to ihe pwisians of Me Cenvaror't lmense l�w(Chap�n 9 icanmeming witn Secuan 700D1 a1 pvision 3 M iM Businese md Professions Lotlel a dut Ae is enmpt Ma�ham � �nA Me hasis Im the aAeged eKemD�pn Any v�dalwn ol Settion 1031 5 by uiy pphcant fw�permn w6Aaa K the cpplrtont m�crvil pen�lty ol mt�wn Ihan ive huMred dollns(f5001.1 —� �++ '4 M ❑I.�s owner of 1M pro{mrtY.w mr employees with w�gn es Ihnr sde tompensatqn.xnll lo the work.�M ihe strucwie is not�MenAetl m ofkretl la sale(Sec.1044.Bus�ness mtl Rohsswns Cotle TAe Cmtruua's l¢enae i�Q v lew does ml�pp1y m an owner of propnry who Wilda o�impmves M�reon.�M who das suth worh himsdl. :�U ' m tArough�is own�mD�Weas.prmided tAet Suah�mprovem�nts ere nol inunded n olhnd hr uk If,Mw�wr. ��Z m i0e Euiluinp a improvemem w�ald wifiin ane ya�ot canplelion,th ow�wrhuiNn wdl A�re the huAen d awmp .iq � �hee he did nat 6wN a improve ki the pu�pose of sNe 1 �u H H ❑1.as owner ot Ihe popetlM.am ez[lusnety rontracuny w�[A IeeroeO comriclms N conttrucl tl�po�t(Sec, uJ 0 7061.BusiiYss�nd Prolessions Cade The Cnnuacmr's Lkense lxx does aot�pply to m ownu of papenY Who F � hmMs or impiwes thereon,end wM tommcu Fa such pmpcts wnh a comrx�aUl linnsed Wrsuant lo Ms Lonlrxtu'a " L1Le^���+w� CONSTRUCTION 0 4+ ❑I am exempt under Sec .8.6 V.0 IAttzh Grohute� P�AN REVIEW r- p Oale o„��� E � WMIKENS'COMPENSATq6 OECl/IPATIW 1 hneby allum Mat I h�ve a oerohute ol cansmt�o al4n�ue.a . a ceruLc�te af WorNeis'Compensation Insuran[e,o�a cntilied eapy thaeal ISet 3800,Lab.C.I� PLU�B�N ` ❑c�m+�a�or����env+�.m�n�e. � MECHANICAL W ❑GemfieG copy rs hktl wit�Me BmWing Inspectm Oepu�mem a Deparmwm � GRADlNG � CEHfIFICATE OF EKENIPTIOW FAOM WORKERS'COMPENSAiION INSURANCE.iAic wnon neetl m�6e compk�ed ISSUANCE y A tne oKmrt is tor oM hundred ift001 a less.I certity tlwt m Ihe oerfamrice M IAe wat fw wheh�Nis permn u�ssued.I sh�ll rot�mploy rry person in airy manner w is lo hecpne wb�ect 10 Ik N6rYvs'c�.,.��«� � SMIP o �.w.a�c.��m���e. W PARK FEE p Oate ioopiom �Ll. SCHOOL FEES W NOlICE TU APPtICANi M.Nter m�king dl ol n.you shouM hcarc sWpct lo Me 1Norkm'f � Canpens�uan pransiam ol Ilx LMor���far��wiM Ndi prow�or�a IAi�permu�hMl �+ he deemed re�okN. �°+.���,_. � � ONISION Of INWSfRIAI SAFEiY PERMIT CERTIFICATION� � ❑I herebvi ce��Ar����o e�cawton fne(61 0�nioie ket m d/e�ptA nto whch�pnm a rpui�d q Mxwd. � wdl he mede m iwnectian wnh�.4u�i�d�ulJr.�m 14ii.�Y,f no huildinp�trve7ue.ualfoWiny,IM�ewarY, q OemoNtion ar dsTmtlinp iM�ea,W(II�OF M�r,�m�r �hee Agn,�Iwp 3.7.Gr�3.An 2,S�e � 361.Ltle 8.t a.0 1. 3 ❑As owror�hudCer. I wilI�na•�9pkY�n WM-m,d9 Waf�..wbKh-CYO��Q!J7uin a pmn hom tlw Wuim d � Induslri�l S�Mv.�s noRd�5u�e.1nl�sa MrtKyMm l�i�.��e1ioil:tcdWmLh rylrjram tlr Iiri�ion. � . � ��,� r,,•,,., ,._. ,. , ..._...� ' � � � � C� � �'r" 4�..,��, f��,� ��;� :.;. TOTAL FEES W ❑Urisim c1lMustriN Sah Y��m� d � GONSfIiIICf10N IFNqNG AGENCY I qereEY Wirm M�tlrre it�wnmrtmn YnOinp pmcy la b prfamrict sof th worM Iw wluch firs prmit u i�wed ISet.309T.Ov.C.1. -' L1nd�"N'"" COMMENTS p�p Lentln"s AAtlresa '� CEfiTIFILpTE OF COMPLIANLE�NO pUflnlpZA7rM!Oi EN7RY:I pruly I Mvt md liif�ppiwtqn rd Wb VJ Mil IIIE IIMf111 8 11 0 11 O�q COfRR.I IQfE!10 WIODN WIN M 7UR IN/5 NIA�IIY Ofaf1�11CM IW4110 b Ylldlll0 y COn6Lu[40n.Md LIwI1[a�HpleYnUhv!01 IM a urit d Buildinp rd S�MY Y Mrr�qon tlr MpMNY = tor whch I h Ird fq�u pma fw tM makiry nspstions ~ Y /�//' � n '''�L��/� �� !�� �^� �" RECPT NO.��,�RAIO BY�_YALJOAT � $qnatue ol Applcml er Aqent lMq WHITE—Department Capy.YELLOW—Finance Copy.PINK-0.sses9or Copy,GOLDENROD—F�e Copy,OREEN—ltppliCants COpy Bsios-i irsa .„ •„., ::.,.. . �,: � .� .npr�a .,,.;:�:�..}:'*. 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