HomeMy WebLinkAbout1680 (669) , -'�` CtTY OF DIAM�ND SAR PRESS
'- " DEPARTMENT OF BUILDING AND SAFETY
-M BUILDING PERMIT FIRMLY
,^..__ ; - �` ���- APPLJCATION � PERMIT USE
JOBSITE ' � � ��� _��"'"���NiJMBER�CODE
� , DATE
ADDRESS ISvUE i TYPE OCC.
Y APN T TRACT DATE '-�" 1 �0.�'-- GONST. GROUP
o CROSS STREET ZOhiING SETBACKS '�'�""s
°° aWNER � � FRONT RW ❑
o ADDRES�S ' � r � e� REAR ❑
W CITY ZIP , TE �`�� SlDE/SIDE STREET RW ❑
o APPLICANT _TEL. -- SIDE �
z
a GONTRACTOR SEWAGE
❑ PUBLIC PMT�
o ADDRESS_ — DISPOSAL ❑ pRIVATE SQ.FT./100 GAL
W CITY ��•
z STATE GRADING ❑ CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER � —
y ARCH/EN • � NP� �� � �AC�F� �S _; .ADd. AAE�/VALUA710N .
� DESIGNER� z_y W �
� ADDRESS "�-- 1� 2
Z CITY ZIP TE-L��"''_.=,— (� 3
.L Z
� PROPOSED USE '� "_��`4�'' d � �� 4
� �s - _ _ � GARAGE
o NO.DWEL. N0. NO. � PORChI
y UNITS STORIES BEDROOMS
� LOT DIMENSIONS m VALUATION ADJ.AREA
o NO. OF BLDGS HOW �1vAN7tTY DESCRfPT�ION : .FEE '
W ON LOT USED � c� ,, - • _ r
� ❑ `r� /�\
W �6J �G.�
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~ UCENSE7 COMRACTOFtS DECLANATION I herehy aflirm Ihat I am lirensed under Drowsiuns of ChaG��9lcommencinp
� •.vnh Secaon 70001 0l Omsan 3 u!the Business anA Professions Code.and mY��cense�s m fu:l fome and eNect �_�_
�
3 — i�' "�G'� . ••-
�- YN �BUILOEq DECIARAT10N I here6y affirm ihat I am erempt fmm the Comractar's Lcense law lor the Idlowmg , y'�
reasm:iSec 7031 5.Bus�ness and Pmlessmns CoCe Any cny or coumy wh¢h wqmres a pe�mn to wnsvuct. {} � ��!�
airer nnp�ove,demulrsh,ur repau any sirutWre.pnor to ns rssuanCe,also repmre5[he apphcan[tor sucC pamtl Z �^'
F- ro'ile a si9ned statement thai he is Lcensed pursuant ta the prwrsions of ihe Convactor's Lkense law IChapte� m. 1 e J�
� 3;c�mmennn9 wnh Secuor 70001 nf�ivismn 3 0�Ihe Busmess and Protessions Code�or that he�s erempt therehom '�^ � .
a, and the.6asis lor�he alle9ed exemption.Any vfolauan ol Secdon 7031.5 hy any aOF�icant!m a permrc wbjects �
W !!ie apphcrnt Io a c:ml penahy ol not more than five hundred dollars(55D0�.1 � • ��
O �i as�wr.er of tfe properry,or my employees with wages as theu sa@ rompmsatior.,wtll do the wark and 1
F— ^�
Ihe snectur>.is not m:ended or alfereA foi sale ISec 7044,Busmess antl Professions Cade The Cwincior's License Q j ,�f �"''� 4� J
� Law does��m apply ro ar.owner ol pmperty who huilds ar imD�oves Iheieon and who dceS such wark hfmself. (,} —.W � --f�
••� a:tlirow�h hs ev.r empl�ye¢s,proviaed iha�such impraaemen�are no�in4ndeA oi o�fered Mr sak II.however, z
G�O Ihe Cwidirq nr imprevemem rs sold wnhm one year at campletmn,the ownerhwlder will have ihe burden ol O�oving +,� -----
� that he did nol amla a improve lor lhe Ourpose of 5ale� �
H
rn ❑I as awnei of the C��Derry.am exclusrvely contracuny wrth licensed contra[rors to cor.uruci�he prqen(Sec W
� 7I144.Busmess and Professons Code The Cantracror's l¢ente Law does not a001y to an ownei at DrOpe�tV who � __
¢ builds m nnpmves theieon,and whe contncts loi such pro�ects wrth a camraomr(s)licensed pmsuam m the Conlroctor s
��ce�se�av.� CONSTRUCTION
� ❑I am esemD�under Sec B 6 PC�nt�xn ce��������.i. PLAN FIEViEW _
0 o81C °i""e' ELECTRIC _____
� WDRKERS'COMPENSATiON UECLANATION I here6y alhrm Ihat I hava a certificate of content to sell-insme,n p�U.M p_����� _ _—__— '
a�enihcate ol Nlorkers'Campensauan Insumnce,or a mofieJ copy ihaeof(Sa 3900,leh C I .- !-�-i'��C�
G
--__. z ❑CeriiSetl copy is heieAY��mshetl MECHANICA� � L
¢
o I�".ernlied cnpy�s filed wnh the 8widing Inspectbn OeCatlmenl or __.DeDartmenl K GRADINt'a _
W
Z CEHTIFICATE OF EI(EMP710N FfiOM WORKENS'C�MPENS0.TION INSUAANCF This secuon need rm1 6e com0�eted ISSUANC
� d the perma is Inr one huMred 151001 a� less I cefp�Y�'�a4-m Ihe paPormanee ol the wwk for which ths �"'������ — C ��'
y
permtt is issued,I i�all not employ any peiwn in any manrer so as"�o hecOme wL�ec�lo tk Nbrkas'Campensaem � 5`M�P _
� Laws nf Caldamia � � ;• � -. -�� W
� � '" PAAK FEE
o (j,1
p I)ate A0�M0in� u- SCHOOL FEES
'y NO710E TO AP7lICANT If,aNer makmq this CerUfkate of Ewempt�on,you should hecome sub�at m the Worker's —
� Compensauon pwvisions al the La6or Code,you,mugt^�thw�complV wrth!sufli qw�sions a�hrs pE�mM Shall
he deemed�evoked �y`,��,�'j� —
J
� qVIS10N OF INDUSTRIAL SAFETY PERMIT CEflTIFILA710N ,
d
o ❑1 hereby ceruly that no ettavalian fiqe(51 a,�e leet in tlepth inw whch a person is repwred to descend,
ee wdl be made in connectwn with woik auHipr�ied by Ihis.peimit,aid that no EuYdinp 5VUClurl:itaHoldinp,Falsework,
� o� demolman ar d�smantli�ikreof,will he more tAan thi�ry-sa 176�Fe�t Aigh {ChaO 72:Gry 2,An 2,Sec _
W341.Title 8.C.ALI .., ....^. . ... . . .. r. . . i
x —� � . . .. ., .. .
3 ❑As ownerbwide�,I wdl not empby amrone to do work whx.h would roqmn a permn Irom Me D'iuisun ol
�— Intluslrial Safety,az noteU a6ove,unless such person has a peririt ro do such work Imm the division --- �
� /+��
W ❑Dnision ot Induslrial5alety Permn Na TOTAL FEES � �/
d.
LONSfHUCTqN LENOING AGENCY I hereby a1Lrm lhat thert is a canstructian lending igency'for tlie perlo�mmroe
z nf the work lor wh¢h this permn n rssueA ISec 3097.Gv.GI. ... ... ... . "
� Lender's Name COMMENTS
m LenAer's AUCress
� (FR�IFICATE OF COMPLIANCf�.�1NU AUTFpiqj0.T E �J certily I hm read lhis epplicmion and suoe ' '
sn mat the mlamatwn grven i c .I aqx ta w wn all bte laws antl nry ertlinances rW�inp w buitlinp
construct�on.anA r' �trve ol the t e/BuiNinp and SafetY m mo-1 ipm the praperM ... ..". .. `"'. . .'....,_
y fw wh�ch I have ap� Oiis pe� Iw Ih u .i7aspecUmt _
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S�emt a�n p�cant o�6 q em p�n RECPT NO.--��(—'—'--�—PND 8Y � VAUDATIO
WHITE—DepartmeM Copy,YEL�OW—Finance Copy,PINK-0.ssessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
BS10611J89
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