HomeMy WebLinkAbout1602 V' / . ""Gr
''�` . CITY OF DIAMOfVD BAR �
��.. '- "� DE3�ARTMENT OF BUILDING AND SAFE�Y
�� BUILDING PERMIT FIRMLY
JOBSITE L � 1 i�- � �,,,r, �",ti,P� �, APPLICATION �^ PERMIT �'�, � USE
ADDRESS �. DATE ��� �� NUMBER�,� r�, CODE
� APN LOT TRACT ATE ��� CONST. GOUP
o CROSS STREET I 'y.t.--r�.,.tv� �. SETBACKS ���
°= OWNER �''�!Z , � '�/:L . t,� c.L ZON�IJG FRONT qW ❑
o ADDRESS 2� a- � � 4� � � RE/!R ❑
W ClTY ��.� TEL. SIDE/SiDE ST�tEET RW ❑
o�APPLICANT _TEL. 51DE ❑
a CONTRACTOR ' � � N • �-% �'"�'
- , z � SEVIrAG ❑ PUBL�C PMT�
o ADDRES ' DISPOSAL ❑ pRIVATE SQ.FT./100 GAL
W CITY '� ZIP � ( =� TEL. u"r�
z STATE —
� LIC.NUMBER 5 � � �' 7 7 �. � " ��'' � GRADING ❑ CU.YDS.EXC. CU YDS FILL
y ARCH/ENG/ � TYPE SQ FT FACTOF� P5 ADJ. AREANAIUAtiON ::•
V' DESIGNER �� W 1
� F�DDRESS �`` � 2
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= CITY ZIP TEL. � 3
� PROPOSED USE ' �` 4
� _� �` — � � GARAGE
z NO.l7WEL. NO. NO. � pORCH
y UNffS STORIES BEDROOtviS m
� LOT DIMENSIONS VALUATION ADJ.AREA
o NO.OF BLDGS HOW ouaN7rrv p��R�p-�'�p�y � FEE ' �
� GN LOT USED _ Q � z ��� . ��,, , ,J ��
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�'" LICENSE.CUNTflAtTOftS 7c�LARAT10N�I�ere�y atfirm that I am I�censeA miaer pmvismns at Chapter 9 Icommencmg 1'�
Y Hith Se�!ier'0001 0l f)rvision 3 cf!he Busmess and Vrolessionx Code,and mV laense rs m full lorce and ellen V � " '
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3 LJ w � .C'�--
LL JIVNER BuIL�ER,�E�LAFATIOk i herehy allirm that I am exemp�hrom�F.e Contrac�or's Lcense law for fhe fdlowmg
_ �Pd50�1 jSE[ '091^.4usmess nnd Pmlessions Code Any cny cr caunly whwh requires a permn ro cunslruct, ('y
o a:tei unpmce,demoush,or renau any stmcluce pnor ro its issuance,also reqwres the apD���ant for such penml Z
Q I�(tle a s�qneJ staterer,t Ihat Ce is�icecsed Gursuant lo the provisnns of the Cnmractor's Lxense Law�Chapte� ffj
s 5�cort,menun;�.vith$ecbon 7000�ul Div�sion 3 01;he Business and Piofessions Cade)or Ihat he is exenpt iheiefrom � —
a, m�,tl ihr basis ir.�the efkged�xemption Any violauan of Seumn 7031 5 hy a�ry applicam fm a permn su��eCu �
°"� ihe nppl¢am•o a uvd penaRy M r.ot more ttiar hve hi�red Aulla�s 155001� �
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� ❑I as:nuner il�he pmyertv,or my employees wdh wages as thert sole cortpensauon will do 1he worM and
~ tlr�i�uccir•��s not u:tenAr,d o:olfered!ar sale!Sec 7044.8usness and Pmfesswns Catle 7he Conira[mr's Laense Q
� Law 9aes�N apply to an�wner of pmperty wha huilds or imprwes thereon and who dces such work himseif, U -
' o�v.mugh his uwn emvlr,yecs.V�a��ded Iha!such unpmvements are aot�niended or alfereC lor sale If_however Z
m �hv haldmg r.r impraverient u sold wrthin one year af complatmn,Ihe owner-huddei wdl have Ihe 6urden ol pmvmg Q
= Ihat he did re�6ailtl or impmve lor IF.e pwpose o�sak.J �
N
y �I xs owner ot Ihe pr�per,y am eacWsrvety comrac[my wilh I:cr.nseo comracmrs to cvr.stmct�he proiect(Sec W
0 70u1,8usmess and orofess�ons Code.The Com:aamr's License Law daes nol apDlY ta an awner of propeny who ]�
6 ';udtls er inproves rhnean,and who cantracts for such pm�ects wnh a canvactor�sl hcensed pursuant ta the Comractor's
`"`"s``a'"' CONSTRUCTION _
� ❑;
W ,.��esemp:unAer s� a�Pc iAttach CernFicate) PLAN,�EVIEW �
H
o Oale Owner ELECTR! ...�-=' �
� K9RKEHS'�OMPENSATION DECLARATION i herehy affvm IAat I have a cernficate at consem io sNl-insure,or �+
a cerbficate ef�lbrke�s'Cnmpensalian Insura�e,or a cernfied:opy the�eol ISec 38CD,lah G) PLU MBING
� � � MECHANICAL
= Cert�fied copy�s herehy lurnished
¢ ..�
o ❑:ertdietl cepY is hled with the Bwiding Inspecuon�epanment ar oepanment d GRADING
W
Z �EHTIFICl��E OF ErEMPT10N FROM WOHKERS�COMPENSATION INSUflANCE This secuan need not be completed UANC
� d tAe permn is for one hundred jS100�oi less I rsrhfy Ihat m thr perfamance ai Ihe wak lor whKh this '„�
y e t is asued,1 shah not em lo an �
� D�m� D Y Y pe�sor,ro any manner w as 1a hecome su6�ect to Ih Nh�Mers'Cmmpensatian S`
= Laws of California ¢ \ W
� �.'�1 / f"� � '= C/'�v�,e.. G-'��.,.•w.a� � PARK FEE
p [la�e � � 4pp6.�nt � �
� NO?ICE TO APPLICANT II,afYer meking 7his Ceruhcate of E�emppon,you shouW become su6�e[t to the Worker'S BCHOOL FEES
-� Camper.salion provisians of the Lahor Code.ynu musl lorthwrth camgly with such qwisions or this permil shall
� he deemed revoked _
�
UNISION OF INUUSfRIAL SAFETY PEflMIT CENTIFICATION
W ti'.� ',Q.y T':.�.:+. _—
d ❑I he�eny cerufy tha�no acaralron Irve(51 ar moie,�feei 1n depthi�in4i wMih a pe�sm is required ta desceM.
� will he maUe m conneclian with work aNhw¢etl by 1hif�be�mA"znd�that no building svucture,soalPolding,fWsework.
or demolitmn m dismantlim�thereaf,wdl he mae thm thiny-si:(361 IeM high.IChap 32.Gry 2,An 2.Sec _
= 341.TitleB,CAC;
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S
3 ❑ps owner-huilder I wdl na empby anyor�l�"��rl�''wAi'ch wo6idtl�QJ��',' a permn frdn!he Oivisan of
�— Indusinal Satety,as naled ahove,unless such peYsarKp4`a perfii�to.2o suAr.�wrk��om Ihe droision.
�
W ❑a�„���o����_��'�Sa�eN��m��No TOTAL IFEES , �+�
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CONSTRUCfIOi!�ENDING AGENCV:1 M1erE6y�alfiini tliat there,is a constructan Imdi��ag'tncy'kr 1M perForman�e
x ol tlx work fw which this permit is�swed.IS�-309T.Civ C).
: . .: ir /-.
mtender's Name °'" ..... ...•." . .. ..�. . •- CONIMENTS l./�,��/�_-C/' s�-��.� , �T__
Lender'sAEdress �"�(;r- `�� •i^. �;ry � ,�! � � ��r} r �
L'1C Y L L•— I.J •.p
Q CEIiTIfCATE OF COMPLIANCE ANO AUTHOMZATIpV DF ENfHY I�atity I hare read this applianon rid su2 �'� "''"
vs that the mformauan qrven is carect I ag�ee to camply wilh all;pte iaws and ciry ordiiun[es relating Io buitlinp
ycanstrucnm,and aulhame a repRsentalrve at Ihe Ueqarimem al BuiWinp xd Sahty m entx�yon Me properry
= fa wh¢h 1 have ppl for th�s permn 1 k purpose ot maNing mspecUons..., �
� �� � '� f .� � �l � r'! �
X `�" ,'' s+�� �RECPT NO.-����PAlD BY VALIDATION•
9gnat�xe of cant w Apem i �ate' '
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
esios-ivae
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