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HomeMy WebLinkAbout168 '!'� CITY OF DIA,MOND BAR PRESS ` ',�" ' DEPARTMENT OF BUILCiIING AND SAFI�TY ^� BUlL�ING PERMIT FIRMLY JOBSITE �, APPUCATION PERMIT USE ADDRES / DATE � NUMBER�_CODE fSSUE TYPE OCC. � APN LOT TRACT DATE �_ CONST. GROUP � CROSS STREET �t�Brrl� �.B�rr G�— ETBACKS "p"°"E'"E°°'S °� OWNER�� �y/G���-c-� r _ ZONING �ONT � RW ❑ � ADDRESS� 5.�4,�.� RE�i�y.. ❑ W CITY�i ��� .ZIFr�L�.`�'TE GiSIDF E STREET RW ❑ a APPLICANT TEL. �E L� a 4 CONTRACTOR 4' - � , SEWA�E ❑ PUBLIC PMT� o ADDRESS_„� -��' � DISPOSAL ❑ PRIVATE SQ.FT./100 GAL W CITY`�dd/'��� ZiP'��,��TEL. � W STATE �''�, , ���. GRADI�IG � CU.YDS.EXC. CU YDS FILL y LIC.NUMBER_�%��'1[G•� `� C� �d y ARCH1ENG/ � �p� �Q � ��� �S ADJ. AI�EAN UAT10N " DESIGNER � 1 _ ' o ADDRESS EL 2 z CITY ZIP TEL. (r} 3 � PROPOSED USE� � r Z 4 � � � GARAGE o NO.DWEL. NO. NO. � PORCN y UNITS STORIES BEDROOMS � LOT DIMENSfONS m VALUATION ADJ.AREA o NO.OF BLDGS HOW ,f� .. Qua�friTv pE5CRIP?iON • �EE W ON LOT � USED Y�«=•=� a � W ❑ � H LICENSE�CJN?NACTGRS OECLAflATION:I he:ehy afM1rm ihat I am licensed undei pmvisions ol Chaptei 9(commmnnA s. ¢ wrth Seciion 760C;of�rvis�on 3 ef'he Busmess and Pmfessions CoAe,and my�icense�s in full fa�ce and eFfeot � 3 � b"�u � f]WNER 3Wt 0EB DFCiA9AT10N-I herety aflum that�am exempt fwm the CoMraetar's Lreense Law!o�Nm fdlowing Z reosmi�Sec 70315 Busmess and P:ofesaiars Cade Any ctly or cwnty whrch!equi�es a permtl ro ronstruct, (!j o alte• •npro�e 9emousn oi re0art any slmnure O��or;o its issuan�e,alsa�eqwres the apyLcant(or such permil �.' 1— m hle e sig�ed s�a�ert�em ihat hc is�¢ers¢tl pursuant to the O���ismns al Me Contraclor's Lrcense 4aw(Chapter m � 9�cnmmertunq w�tl�Se�ner 70D0;of Owismn 3 M fie Business ane Prolessions Cotle)or that he rs e�rempt iheretmm � d anG mr hasis Im Ihe a:legetl=sempnon Any vwlanon of Sectron TD31.5 hy any a�purant to�a permil suh�etls � K the apphear.i fc a crv;l Denalty,t nni moie�har hve huMred ddlars!f5[101.1 � W F ❑I,a;o�,r•ei o��he pro0erty m ny employees witl:wa9es as then sole compensanon �xill da the work,and the s�mcture is��nti�tenaed or oflered for sale�Sea 7Dd4,Busm.ess and Professans Code The Contradw�s Ucense Q � V La�n dors nm up0!v ic an owr.er al praperty k�ho 0!nlds o�impoves thereon.anA wha Aces such work Aimselt (� W o�t�rcu9h hn wm enaloyees.DrwiEetl Iha��uch:mprovements are not�ore�aea o�oll¢rzA(or sale If however, z � m ih?hwlnmc or.nprmpment is soltl wnhm one year a/complenon.Ihe owner�huAdei wtll nave t�e 6urden of o�wmp Q � iha��e OiG nm huiltl a:�mprove loi ihe puraase ol sale 1 U H v� CI as ewrei�I me praoerty am eKtlusneN conrcacnny wuA hcensea mmractars io consttuci�Ae pro;en iSe� W � 7MC Bnsmess aiM Pra�essions Code The Cantracmr's license Law das nm aGOh�to ar.owner ot pmperty'n�ho '�S � 6mids o•�mprovex Ihere.on,and who comraas tar such pmjec;s wnh a connanor(s)I¢ensed Ou�suart m ihe Lontaclar's t��.r�se�aw� CONSTRUCTION __ 0 � ��a��=.aemr unde�Sec B 5 PC iAuxh Cerfitrca�el PLAN REVIEW � ca" °`""" ELECTRIC � NARKEr�S'CCMPEN:ATION pECLARATIOM I heretry alli�m that I have a:ernfiwte ol consent to seM-insure o� 0 x renificate of Warkers Comp¢nsation Insurance,or e rertified copy fhereol ISec 3800,lah C� PLUMBING ¢ ce�,�����oPr�s ne�nY`urnished � MECHANICAL , � c ❑Cerniied yipy is f�led wnh me Buddug Inspecnan Deoa�tmem a �epartmem � GRADING W �+� � CEFTIFICATE OF E%Ef�PTION FROM IWRKERS'COM.PENSATION INSURANCE This sec�mn nred nm he compkteU � �SSUANCE � � •��.J � d the permn�s I�r one hund�ed�51001 ar iess I rerlify that in Ihe performa�ce aF�he wrck tor whKh Ihis perm�t:s!ssireE,I shall no-emD��V an pe.•mn in any manner so a5 Io betOme su6�ect a iM Nhrters'Compensatnn SMIP �� �� � �ws,,icai���,���a r` � PARK FEE � , � � oa Y A��'f�a�, VJ SCHOOL FEES � N ILE 0 w NT If,after makmg tA�s Ceaihcate ol pliaa.4a+shaup)6ecame sub�ect tl�e Wwke�'s ;in0er.sation p;ovisions of Ihe la6ar Cade,you musl fanhwah comply w�M such proviswn Mis pmmrt shall �MF{) � � /'.�`c'�`j�'� � be Aeemed revoMed ��T �—'�� � ¢ qVIS10N OF INOUSTRIAL SAFETY PERMIT CERTIFIG4TION 0. o ❑I here6y rertity that na ercavaLon iNe(5�ar more het m depth mto which a persan rs reqmreC to descr�d, _ 0� w�ll Ce maEe m ron�ection vnth worN authorued 6y 1�is permit and tl�al no huildinp sttucture,staffolCing,lalsewnrk, . ' 0. 0�tlemuhnon or A�smanthrg;hereof,will 6e mnre than thrry-six(361��h� I�ag 32.6�p 2.An 2.Sec _ W 341.TitleB.CAf.i S 3 ❑As owner�entltle:.I wdl not ertploy ampne to Ao wark whicA would rtqurte a pNmit Irom lRe Oivisim al H Indusma:Salery,as nated ahove,unless such persnn nas a permit m da such wark Irom ihe divisian, � . �.. '.. ...... ... .. .. W ❑Unswn of Industrial Safety Permit No, rO�A� C��^ � d !\ f � � CONSTHUCf10N LENDING AGENCY 1 herehy affirm Mat�here is a conshuctian Imdi�ap�n�y for the perlormanee 7e ol tle work fnr whah this permn�s issued{Sec.1W7,Ciu.C I. � �e��d��s Nam� COMMENT ��' � �� m Lentler's Address ��t 'C 'a CEKfIFILATE DF C�AAPLIANCF ANO AUTFMIRIZAiION OF ENTFIY 1 urtify I hare rad this app6w�ion wd stalc - � v� that the mlarmation given rs correct i apree ta mmp�Y wrth all state laws md ciry ordinan�es reietinp to 6mHi�p co�slrucoon,ard authorne a re serAaMe of che � , y Q!q Oepaziment al&rildinq md S�My m mte iqon tle poperry 2 tor whrth I have ap Kd fnr tl i(Erm�t 1a the purpose of making mspections. _^!� / . - . . .. . ., -.- . r � "� 7��--" / � RECPT NO.�.Lv_�PAID BY��_VALJDATIO� 55g ature ot pl�can m ilah WHITE—Department Copy.YELLOW—Finance Copy,PINK—l�ssessor Copy,GOLDENROD—Fi�e Copy.GREEN—AppliCants Copy � . - ` ' . ` i,l. ' .. . , . . . . '• r �k.ly . . . , .. 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