HomeMy WebLinkAbout1572 '('� CITY OF DIAIUIOND BAR
� �,, �"" '' DEPARTMEN UIOD NG PE'RMITND SAFETY F RMLY
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DDRIESS �' � �! S �CJ�o � �'�...� D�E C��ON 1� '�� NUMBER�� CODE
y AP� ISSUE �������TYPE OCC.
� OT TRACT�_ DATE � CONST. GROUP
o CROSS STREET� ..s �Q . C..t�=�S I•�vx •�
°� OWNER�� 4,z� ��c� � cs� � � f%T ZONING SETBACKS •���
Z,� � � �� FRONT qy�/ ❑
� ADDRESS �.v"""'-r. " �1�1 REAR ❑
,� CITY � ZIP TEL.�� SIDE/SIDE STREET RW ❑
o APPLICANT �' �' TEL. SIDE ❑
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a CONTRACTOR �� ' �l` SEWAGE
o ADDRESS '" a - � "- ' F�°�• - ❑ PUBLIC PMT�
DISPOSAL ❑ pRIVATE SQ.FT./100 GAL
W GTY ZIP '�I/�TEL. � �
z STATE R.� ���
y LIC.NUMBER ! 7_�$''f��� GRADING ❑ CU. YDS.EXC. CU YDS FILL
y ARCH/ENG/ � TYPE 5Q F1' FACTi��t P5 14t�J. I4REANALUATiON
�' DESIGNER W 1
o ADDRESS „�_ LL 2
= CITY ZIP TE . � Vr 3
� PROPOSED USE �-� � . �� Q 4
� -i.�� � "'- �,�- ,,,,J GARA�iE
o NO.DVVEL. NO. � � PORCH
y UNITS STORIES BEDROOMS
s LOT DIMENSIONS m VALUATION ADJ.AREA
o NO.OF BLDGS HOw QUA1J71TY DESCRIPTION FEE .
W ON LOT USED ? � �G
� V ta+•:� �e 12.C.t�• /
� °C � C.�
�" LICENSEb;,ONTRALTOHS DECLAflATION I hereEY affirm t�at 1 am hcensed under provisions of Chapter 9([ommencing i�- — ~'
Y wrth Secuon 70001 of�ivision 3 0l!he Businesa and Pmlessiont Cnde,and my Irzense is m lull force anA elfect. ��
°c W L
3
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� �IVNEH�BUIL�ER OECI ARATION�I he�ehy aliirm that I am exempt(rom�he Coniracmr's L¢enae Law for the fdlowmg � 6.> '`�
Z reasac jSFc 7031 5,8us�ness and Pmfessions Code Any nly or counly which requires a permil ro cons[ruct \.• �.
o aher miprove,demolish or repair any structure prmr to its�ssuance,also requires IM aDUhcant Mr such permn Z
Q lo!:le a si9ned starement that he is 6censed W�s�nt lo the pmvisions of the Conttacmr's Li[e�r Law IChapie� �
� 9;mmmencmg wch SecLon 70001 at Division 3 of the Busmess anA Pmfessions Cade�or Ihat he�s eaempt Iherefrom �
Xare iGr.6asis for�he alle9ed exempunn A;ry noHtian at Sec�ion 70715 by any applicam toi a permn su6jetts �
Ihr.apph�art�e a crvd penalry of not more ihan hve hundred dallars 155001 i -3
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0 ❑I as nu�ne�of!he pmperry,or my employeet wrth wages as thert sole compensaum will do the work,and -
the+tructure�s nm icrended or olferd for ule�Sec lOC4 Busmess and Pmlesswns Code�The Cwnacta's Laense
v taw Aoes no�a00W to an mvner ot pmpeitV wha builAs or impmves ihe�em,and who dces such work himselF. (�j —
' ar Ihiou9n hu own emVloYees.orovided Ihat such impmvements are nat intended o�ollere0 for sale II,however, z
m ihe hui.dmg or�mprwemenl rs sold wnhm one year al completion,Ihe ownerv6ulde�wdl have ihe burden ol Orwing ;c(
y that he di�imt 7wIA or impmve lor the purpose of sale� �
y ❑I,as uwnx:01 Ihe properry,ain eaclusrvely com�acliny wnh I¢ensed convanors to consuuc�I�e pm�ett ISec �
D ]044,9usiness ard Prolessions Code Tbe Comracmr's License Law Aoes not apDly to an owner ol properry wha �
4 liwlds m�mproves diereon,and who camracts lor such pu�etts wnh a contrxlor(s�licensed purawnl to the Convactoi s
0
�"°"5e`a"'; CONSTRUCTION __
6 ❑I am eremp[under$e� ,8 6 PC�n,�un ce���i��arei. � PLAN REVIEW
0 oaie �+�� ` ELECTR� I`"G`�� �' �L�}
� WORKERS'COMPENSATIIXJ�ECLABATIW I herehy aflirm that I have a cerLficate of consent to seN�insure,or
a certihcare af NbrKers'Canpensauon insurance,or a certilied copy themM ISec.3800,lah C) PLT1N�fSfR'���
� ❑ce�t�i�ea�aoY�:n��enr i���sned. � MECHANICAL
o I n Certi6ed cnpy�s 5�ee wnh ir.e smmug�nspectmn uepximert or •Oepariment. Q GRADING
W r.-
= CERTIFlCATE OF EREMPTION FROM WOHKEflS'COMPENSATI(BJ INSUflANC This secuon need n he como�eteA ISSUANCE „ {�,",`� �
� d Ihe permn is lo�me hundred IS1001 a�less I[ertfy ihal m the loanante ol the w for wAich this �
y e �t is issueA,I shall mt em� a
� p rn i p oy rry p¢rmn in any manner so as to om su6�ect to ihe as'Campensa n
= Laws n�Califorma
0 o�te �• / 7 �' �� �.'� A���am PARK FEE
� nqTICE TO APPLICANT It afur makmg this CertilKate of fxemp�ioa,you slwuld ume suU�ttt to.'e WorNers SCHOOL FEES _
_+ CamDensatmn pmwsmns ol 1he Lahor Code,you must fonhwrth cynply wnh S M1 pfMISq115 a M�s ce�md shall
� be deemed re�oked , �:.; __.___
Y .,,.,. , = ,+
¢ pVIS10N OG INWSfBIAL SAFETY PEflMIT CEftT�FICA�IAN��;�',�'::�''�
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o UI nerehy�endY�hat nu ev�avatian five 151�or more het m dept�imo whkh a person is repmrd ta tles[mtl,
� wdl 6e made m cannectwn with work amha¢ed 6y Mis permit.and that im huJding swetwe.s��l(ddiny.Nsework.
ar demolnion m d¢mmtlmg IM�eof,wdt Ee mpe 11ran Ihifty�siw�'�H�'Ie�t high (Chap 7.2,Gry 2,Art 2.Sec
= aa i Title B,C A C 1 ��,�� n� � ��„���
3 ❑As ownen6uddei,I will mt empby'airyane to do work which wouk raqwre a permit hom Ihe 6vispn of
�— Indushial SatelY.as noted a6ove,unless such persan has a permit to do such wwY irom the diuision.
'� - � ... ' � �
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W ❑Dmsmn ot Indusbial Salety Permit No.�" ���� /���� --�� `'�� ' TOTAL FE ES ��
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CONSTFlUCTqN LENDING AGENC!I�her¢qy'aHirin.ihet iheh a a conmuc�ian kndirg pency ior Me perb�manm L ��
Z of Mx work far whxh tlns permit is issu6d I�.3097,Gv.G)
� lender's Name COMMENTS �� � �"' l
mLender's Address
� CEPTIFM'.A7E OF PLIANCE AND AIJ� IZATIpi OF ENTflY I certity I have read the�pl'tation ad s�ale
�s [ha7 Ne�nfa ion�prven is[mect I ee ro cemply wrth ail slate laws ard ciN a�a�e reh�rq to 6uildinp
yconstruction. nd a tharire a represent rve of the Depsrtment a1 Buildinp aM Sahry m eooer upon the property
= for whxh I ve plced for thu perm or the purpose pi ' inspecuons.
� X V __
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� lL � � � RECPT NO. �
Sqn e of np��ent or paoe PAID BY y,�_VAIJDATIO
WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOIDENROD—File Copy,CaREEN—Applicanls Copy
BS706-11l89
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