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HomeMy WebLinkAbout1402 (654) „ ,, ,�, ,,� �1c-- `��'"3� CITY OF DIAMON� BAR PRESS � '-' � nEPARTAAENT OF BUILDiPIG AND SAFETY -� �UILDING PERMlT FIRMLY JOBSITE , 9� � ° APPUCATION �� PERMtT USE ADDRESS � ��, � w���� ���M SSUE � TYPE ER��CODE 6 APN . LOT�TRACT O�� DATE _ �”` l��C�� CONST. GROUP o CROSS ST EET W 1K'�D m�`-�- 3 S L�s��'=t€��' Z�I�i�NG SETBACKS "'"'u'"F'"�''"5 °.� aWNER � �' �� FRONT RW ❑ o ADDRES, �- � � � �'" � � REAR � ❑ � CITY '�'"-'a''�" ZIP ti��°� TEL. �����'�) SIDE/SIDE STREET RW ❑ g I APPLICANT_ TE - S!QE ❑ a — — a CONTRACTOR (��"'w�-�'---� ''�' SEWAGE ❑ pUBLIC PMT� o ADDRESS DISPOSAL ❑ pRNATE SQ.FT./100 GAL W CITY ZIP TEL. �_� = STATE GRADING � CU.YDS.EXC. CU YDS FILL y LIC.NUMBER � �yp� gQ �}- FACFOR PS /4C3J. AR�ANALUA'CION - ¢ DESGNER / ��'�v � � i-i� �S�'�� �� W t p � '�J � � ADURESS—���— ��' ' 1 LL 2 Z CITY��"�`ti`0 ;ZIP �lL, TEL.��'S � (� 3 _ ' � PROPOSED USE � �-�� '' �� Z `� � � � GARAGE o NO.uWEL. NO. NO. � PORCH y UNITS STORIES BEDROOMS — � LOT DIMENSIONS m VALUATION �-�� � � �� ADJ.AREA o NO. OF BLDGS HOW a�ar�rirv pESCRIPTION ° �EE W ONLOT_ USED_ a ee U � � i f�,. .�_ I ICC4SE�CDNTpACT �ECI.ARAT16N I herehy afL i at I am hce:ued under provisions of Chapter 9 Icommencing Y w�ih Secno�� 7 f Orv�s 3 o�!he B ss ofessinre Code,and my license�s in full torte and eHect � o J 3 -.s� � LL 7WNER�BUI 0 A ON I here�y at I am e¢emp�fmm�he Comrauoi's L¢ense law tar ihe lollowmg —' z •eason�Sr.c . 3�. 8•�s�ness and Prolessions Code�Anv nry or county wAich re0mres a perm0 to tonsvuct, (,S" _ _ o m:er �ripove Je usn,m iepan any struuurc.O�ior ta rts rswance,also requres Ihe appl¢ant for suth permu 2 Qt�'il?a signeC stntemem:hal he:s hcensed pursuart to the provisions of the Contractar's LKense Law IChapler py � 5 icommenr.:ng witn Se[liun i0001 0l G�ision 3 01 the Busness anA Pmfessions Lutle�x thal he K exempi�heretmm � y aca Ihe Sas�s�ci!he aL'eqea exemption Any vmlanan ol Src[icn 70315 hy a;ry a006cani!or a peimn sub�etts � ♦ x •he a�y6cam tn a r.rvd penaNr ol ao1 more�han five hundred daliars(5500!I � w � �il as mvner-f Ihe proGe�.ry m:nV em0�%'ees wnP wages as theu sale compensauor..wdl da ihe work,and ' -- -- the s�ner.u,rx is not mir.ntlr.d or oflered lor sale ISec 10C4.Business ano Professmr.s CoOe The Cmtractor�s L¢ense Q VLaw Aoes�m aOCly to an rnvner o�Dro0e�ly wha 6uilds or improves thereon.and wha dces xuch wark himsell. (� — W J':In9uGh 7�s uwr emEdorees provided iha�such improvemenls are not intended or oilerzd Mr sale If,however. � = th?swiEwa�r imprmemem�s sold wrthin one year af completion,�he owner�builder will have the burden of prwmg � y mai he d�d nci uwld or imo�ove lor the pmDose of sale I � y �= as m+�ner ol ihe properry am esclusively conlractiny wnh Icenseo comractors W wnstm[t iAe D�olect ISec W � p 7044,6usiress aud Prolessions Code The Contraclor's Lcense Law does nat applV to an owner ol Dmperty wna g ¢ 6wlns nr:mp�ob�es:herenn,antl whe ccntra�ts tor such pro�ecis with a[ortra[Mrlsl licensed pursusrt to the Confractoi's �� License law i �5'TR � •TJ�1--^ _.� �•���- 0 /�^� ••• G I ar.�eaen0i artler Sec ,B 6 P.0 IAttach Cenficetel PLAfv REVIEW _�� �Li � 0 oa0. °i""ef ELECT�iIC � WOflKERS'COMPENSATIIXJ DECLAflA710R I hereby alirtm thal I have a r.ertifica�e af cansent to seN-inswe.m " (7LUMBING a c?rnlicate of Werkers"CompensaLon Insurance,or a cerUfietl copY tAeieol ISec 7800,Lab C 1 Q ❑Cer,Ax;J r.apv rs herehy hKnrshed J MECHANICAL _ o ❑ ."�erufied copy s IiieO wuh the BuJdrog Inspecuan OeOartment er Deparlmenl �„Q., GRAQll�1G , _ '��/�) a.� ..V� z CEflTIPICATE Of E%EMPTION FflOM WORKEBS'COMPENSATION INSURANCE:TAis secunn need no�6e compleietl �S'S`U � f i�e permrt u for one nundied;5100�m less I cerufy�ha�In the pedormance of ihc work lor which this "` y D Y i v� SM�F' �Z� permn is issued,I shall not em la any oerson in any mancer so as N hecome suh eot to Nn LWrkas�Lan nution r� = Laws ol CaLlnrma o � PARK FEE ,_ 0 o�,e ADPlicant LJ- SCH(�QL FEES � NOTICE TO APVLICANT If atter makm9 this Certihcate of Exempl�a�,,you sh0uld qetame su61����e�ker's —� Compensanon pmnsions at the Lahor Code,yau must fatljwith'cnmply w!1h�5utMerwuwns or Mia permn shall Oe Aecmea revoked � — J � � pVISION OF INW5TNIAL SAFETY PEHMIT CERi1FICAiION: -- . w a ❑I hereoy cenrfy�hal nn e¢cavalnn Irve(5�or mme feet m deDih m!o wArch a person is RpUtrEd to da[end, o�e will 6e made m connectwn with worl auihaued hy th�s permn;and Jfwl na huild�riQ ilru'�twe,ttalloldina.lalsework, � ` � � �� � � o� tlemolninn ar tlismamling lhereof,will 6e mae�hSn�Hirl�l�srt�36)„{'tet Nigli.�(CK80 32.�Gry 2, Art 2,Sec W 341.Title8.CACi. x — 3 ❑As awnerbwltler,I wtll not emplay anyoirc ta,da,waJk wh¢h.wDuN m4ulre a permn hom.,the Gviswn ol �— Intlustrial Salety,as nnled a6ave,unless such Qerson,hal a 6emllt to d¢sucA��wotk hom�the�dNision" • — - ,'� ._. . . �, : ..;. ; . ,.:r�:' ', W ❑U�ision af Industnal Safely Reimn No. �'� � "' ' ��'-' ' "� � � � u TOTA� f EES �� . s � CONSTPUCfION LENpNG AGENCY I heie6y aHirm Ihat t�ere is a canstrunion kndiig ap!ncY for tlie periaimance Zot mx work tor wh¢h Ui¢permn�s issued(Sec 3497.Crv_C I � �eiide�'s Name COMMEhfTS m LenAer's Address Q CERTIFICATE OF COMPLIANCE ANO AUTHOIpZATIaY EN�NY:I cer1Ay I Aaw reaG Mis appliutian aM sute � ' "�- ' �' - - ""' cia that tAe i�formauon grven rs carect 1 agree to co piy nh all stete laws aM ciH adiunces rtlsunp to huiMi�p yco authonze a re oi t mrnt o1 Buildinq and Salety m mter iqon tl+e pay�rry " �" ' �' ' � '"�" = wh¢h I ha appled i th�s rt for� makinq mspxowis � _ � 6�`� � ���,� ° �� �• '�i'� Q1a � Sgnatue ot rbv�kant o�uqent �p�h RECPT N�°J. v �v� PAID BY VALIDATION WHITE—Department Copy,YELLOW Finance Gcpy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy �� BS706-711B9 �. .. , ,., ,.:fr . .. .. . . , .,- n ' � � ' . . . . . „ . _ .. . .. . . 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