HomeMy WebLinkAbout1134 .,�.
� '"� CITY OF DIAl1AOtVD BAR pRESS
<�.h �- '� " DEPARTMENT OF BUILDING AND SAF�TY ��RMLY
BUILDING PERMIT
JOBSITE `'� �}/ `� �►� � �/ pATE CATION �`'�---�_(",� PERM�ITR ,3� USE
ADDRESS r.�f� �� �`"`+�f`�' ���'�_ C� �CODE
ISSUE TYPE OCC.
� APN LOT TRACT DATE _ �_,G�'`;��� CONST. GROUP
� CROSS ST E SETBACKS
OD OWNER lL,U ZONING �'�°"°"F''E"'s
FRONT RW ❑
LL ADDRESS � . � � �� I REAR ❑
� CITY_ L1'/U ZIP 3�L. � SIDE/SIDE STREET RW ❑
o APP�ICANT /� TEL. �--� 51DE ❑
� •
Q CONTRACTOR - = SEWAGE ❑ PUBLIC PMT�
o ADDRESS �' � � ���-�� DISPOSAL
W I CITY�L"Laq �..�1'hrR ZIP � � TEL.` __ ❑ PRIVATE SQ.FT./100 GAL
z STATE a
y L�C NUMBER �"�� 3 7d` �-�-� GRADING ❑ CU.YDS.EXC. CU YDS FILL
N ARCH/ENG/ � TYPE SQ Fi' FACTOF� PS AQJ. AREAN�tLUAl'ION
" DESIGNER W 1
p ADURESS � 2
Z CITY ZIP TEL. �I 3
� PROPOSED USE e3 � '� Z 4
� � GARAGE
Z�NO.DWEL. NO. NO. � PORCH
y I UNITS STORIES BEDROOMS
��LOT DIMENSIONS m VALUATION ADJ.AREA
o NO.OF BLDGS HOW QUANTITY DESCRfPTION FEE
W ON LOT USED Q
� U
W �� �
_ �
~ L'CEVSEO CON?NACTORS CECLARATION I here6y aHvm�hat I am Lcensed under provrsians of Chapter 9 Icammencmg h
� +vn�Sec:m��7�OOi u1 Di.is�on 3 0l the Busmess aid Prefessians Code,and my�cense a in iull force and elled � '\
3 � W
=i 7'NNER BUIIDEfi�ECLAflAiION I irerety alnrm!hat I am eumpi Imm:he'Lomracmr's license Law fa�Me fdlpvmg
x •oa•�r;$ec ;07�5 6usmess an9�rofessons CoOe dny uty or counry wrt¢h ieqwres a permn to ronstruot, O
O elie� r•pre�.e demolish ui repa��anv str:,_nwe,prmr!o�ts issuance also reqwres�he apUlicam tor tuch perm�l 2
�- m'�I�a sigryd siatenenl iha�he�s Lcensetl purwar.t io!he Urovismns of the Convacmr's License Law IChapie� �p
� 9::on•.mennnr nrh Sec:mn 70�C)oi)misior 7 of[he Busmess and omf¢ssioas Codel or ihat ne is evempi[herefrom �
d�ard iPr Sas�s Icr the alle9ed e�emouon Any nolatmn of Sec:ior.7C3I 5 by any appluant!a�a permit sub�ects �
Wthe appucar;:o a uvil pertauV ol�oi more Ihar trve n�ndred Mlurs�5500�i a
1-�-
CI as�wne�il the,�c�eity m;nv emplovees wrth�,vages as theu sole comcensauon Hill do the wark,and
me s:w::✓e•s�mt ir�!r.nUe�a o1l=rec for sele�Sec 704a,Busness antl Professrons Catle The Comroctor's Ucense Q
�i taw 9;es rct a,OM ta ar ew�er o!G�oper,v who 6w�ds m ime�oves IDereon and wh�dces such warM himself U
'�o� ihioay"lus ev:n eaplayees,provmetl;�at such:mpmvements are not imerded oi olfered'or sale I!,however, Z
m ne hudd�nn or inprwemert rs sold w:;h�n one rear ol mmpletion,the.awnerhuntler wdl hare the.burden of pmving Q —
� u�at r±Am not PuAO n�impim•e for Ihe purpose ol sale� 2
v� .�I ns�nrer;,f vhe p�cperry am exclus.eH rertract�np wuP I¢ersee car.ira:tms io carslriKt ihe pm�ect�Sec W
o !OC�:.I3asn:r.ss ard?mfesswns Code The Cartianor's i¢ense Law does not ap01y to an o�nner n1 pmp¢;ty whn '�
Z :u�lds o iinp�nves tna�eor,and wnu corirons lar such pro�ecis wilh a cartra�tnr{5�hcensed puisuart!o th¢Lontranar's
` '-"�s`�`a"; CONSTRUCTION
0
� ❑;a,�?.empi aroer Sec ,8 fr PC IAuaah Cerolaare� PLAN REVIEW ,/� �•' /�"�� (�� �
o ]aie Owner LtCTRI �/"sL C.f�'�' � L�. —�/
� WTIAKERS'COMPENg0TI0N�E�WRGTION I hereby aflirm that I have a cenAiwte ol consem m se�l-�nsure,or
a cerrhr.ate:!I Woiaers Cumpensauan Insurexe,nr a r.enifietl ceGY�he�eo�(Seo 3900.Lab C� PLUMBING , _
Q ❑ o r � MECHANICAL ____
:er,lieA oa v�s hereb f�m:nhed
=i❑C211ih?1.OD�i5'deA wnc!ne Bwltling MsC�������eDarlmem or oeputment � GRADING
�I CFRT.IFICGTC 7F E%EMPTION FNOM vVOFKERS'COMPENSATION INSURANCE This secimn nepd not be comD�eted SSUAN _ � . � � _
� r ihe�erma is for one hundreJ�S1001 or less I cervly ihal m me pedormance ol tAe wa�k tor whkh this
�pr.rmii is isxued I shall no�employ ary person m any man�r so as ro 6ecame sub�ect ro ihe NqrMers Compensanan 'P
oLaws d Ca!ilamia � PARK FEE
p �av AppLr.am•-.. .1'e� ��.",",, W
� N[;TICE TO APPLICANT If,aher.maKin9 thrs Ceruficate altE�ption;•yoS stlguld'4ecwne sub�ea ro ihe Woiker's u- SCHOOL FEES
—+ ComDensanan prov:swns of the Labai Code,vau must lor�vith,pn7iph�vyirtlr�ueh'provisons or Mis permrt sAal
� he deemed�ewkeJ
J
s 71VISION U�IN�USTaIAI SAFEIY PEHMIT CERTIfICATIqJ �7^ y�,
�- ❑:herehY=r.iif thal no exca�aUon 1rve�51 or�k��le. L w,�nc�'pS
r y � ��,m d�ap�h�to A•�x rson rs mawrM to descenC,
s will Ce matle in corneclqn wn�wark aut�orved�y1fiu�Qer�d,antl Ina{no Gu6tlihp��htiaurz,saalfoWing,talsework
� oi demuln.an nr d�smmtlmg t6eieof.will 6e more than thiny-si�i36�feet hiqh (ChaD 3 2.GN 2.An 2.Set
W 341.Trtle B �A C 4
_ .- .- . .'• r�. ..:. .... :.. .
3 ❑As nwnerhmldei.i wdl nm empby arrytlne lo`da itrork which would t¢quire a'petrtid�hom the Gviswn al
� inAus�nal Safety,az��oled ahove,unless suck'persori has o permfl'lo dC such�work froin Me diviaioh.
� :.. , .,,. , � .. :.. �
W ❑avisior,al Intlusuul Satety Permit No TOTAL FEES
d
a CWSTRUI:TION LE401NG AGENCY I herehy ailirm Mat IMre is a canshuclnn lendmg ape¢y fa Ihe performantt �
x nl ihe work Im whrtF.this perrtxl is issued(Stt 3p97,Cn.C)
� �`"a�`s N'"" - COMMENTS
mLender's Address
'Q CERTIFCA7E OF COMPUAACE AND 0.UTHOfpZATlp!OF ENTRY I�ntify I have read Mis appl�cation aiW suee '
h tha��he mformauon grven a conett i agr¢e to comply with aA slate lews a'd ciry ardinaMes�e�aunp to Wddilg
y mnsvunion,anJ auttwr¢e a re0�semanve ol ihe Departmmt ol&nldinp and Salety b mar upon Ihe prapenY
= for whkh I h e a pl�ed m M permR for the Durpose nf makfng inspeclqns
� �
������ RECPT N�. ��� PAID BY �� f VAIJDATION
Synatwe o App rcan or gent Dam
WHITE—Dapartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
BS10^o-11!89
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