HomeMy WebLinkAbout1170 (15) � � � ... �; �I� �10-� 1 CITY OF DIAAAOND' BAR� PRESS � ' ����J � DEPARTMENT OF BUIL[�ING At�1D SAFETY FIRMLY �^ �TZlJ BUI DING PERMlT JOBSI7E �n� ,n� CATION �_�r�_��E B� l 1��DE ADDRESS i�� Y.�'Tl /_ �'�V ` APN lOT TRACT�' STEE �'r�U��`� CONST G�ROCUP e CROSS STREET �Tc�1'L-�'!'LfA��' SETBACKS �° OWNER �.�e+2�Cr� uy ZONING FRONT RW ❑ � � ADDRESS ��2�GS ��DC?'e.='72 T ?i� REAR ❑ W CITY /�'°``%��j'T�Y ZIP TEL:� �`�a� SIDE/SIDE STREET RW ❑ o APPLICANT _TEL. SIDE ❑ z — a CONTRACTOR SEWAGE o ADDRESS DISPOSAL � �BLIC PMT# ,� CITY ZIP TEL. _ 0 PRIVATE S().F�./100 GAL = STATE GRADINC 0 CU.YDS.EXC. CU YD5 FILL y LIC.NUMBER y ARCH/ENG/ t!A TYPE SQ F� PS AL)J. AFfiEl�ll� ION : oC `=' DESIGNER W 1 ��J� ��G a o ADDRESS �,Wj., 2 a, ar�J' D �2�' ��(Q � g ac Z CI7Y ZIP TEL. � 3 � PROPOSED USE � � 4 � ` � GARAGE o NO.DWEL. NO, � NO. � PORCH y UN(TS 'uf� STORIES ��' BEDROOMS �°`�� s LOT DIMENSIONS m VALUATION � ADJ.AREA o NO.OF BLDGS HOW aunNTrTy p�$CFiIPTtOI�f FEE W ON LOT USED ,� � W ❑ � N LICENSED CONTflACTJHS DECLAR0.TION 1 herebY alh�m thal I am 4censed under pmrisims o�Chapin 9 Irommendnp � wnh SecLon 700�1 at�ivision 3 0l ihe Business an0 Pmtess�ans CoAe,and rtry I¢pnse�s in full fprte anA ettecl � 3 � i'Ajl � �NNEH�BUIlOEH OECLAHATION�,I herehy athrm thal I am e�emD�Imm the Contracror's Utenu Law 10�1Ae Mlavinp reasan iSec 70315,Ausiness and Proleasiuns Code Any cily or counry wM1ich requi�es�pe�mit m aon:truet C� oalter imp�ove,demohsh,ar repai�any slmcture,prmr Ia its rssuance,alw rpuirzs Ihe appXcam lor such pmrtnl � r— ro f�le a signeA staiemem that he is IicenseU pursuam ro the p�ovimons ol�he Convacar's laense Law(Chapte p3 � 9(cammencinp wrth Satinn 70001 0l�rvision 3 of Ihe 9usiness and Pmlestians Cade1 a Ihat he is eYempt tMefram � d, and the hasis tar ihe alleged exemplian Airy�violalion ol Seclion 7031 5 6y my appliwnt far a parmrt w6jects '� K the app6car�m a civil penalty of noi nore than Me hundad dollars 15500�.�: a W � ❑I as owner ot ihe propertY.a�my empluyees with wages as t�en sole compenulqn will Ao fhe work,anA �he stmcture a no!inter.Aed or otfercd tor sale ISec 70d4,8usiness and Professions Code�TM1e Contracmr's Licerme d V Law tlaes nnt aOPH to an owner ol pmperty who huilds or�mpmves the�eon,and who does sueh worM Mmstlf, � '+� or[hrouyF Ns awr.employees,provided Ihat such m�prwemems a'e not intendeE a ofkred kr sak.If,howeVer, � = the.6udArog or imorovemenl is sald wnhin one year of can0lenon,the awneo-6uilCer wfll haue tAe burOen of provinp y Ihal�e tliJ rot hwld or im0�aue far the pwpase af sak.l � y ❑I,as nwr.e�of�he poperty,am eHclusrvely com�amxiy wiM Ikensed caMraemrs to tonsirucl the po�ttf(Sec W 0 7046,Business aM Pmlesvons Code,The Conlnclar's L�reree Lew dces mt apply to an owner ol pruperty who "�. = hutltls oi imprwes iherean,and who conrtacts Mr such pm�ecis w�a comrxmr�s)hcensM pmsuan[m the Contrxtor's Q LeeeseLawl 0 �N __ '�� � ❑i am e�em0�under Sec. ,B.b P C,IAttxA Cenit�wRL LA �E _ a CJ • � oa" °""" ELECTRIC � WORKERS'COMPENSATIqJ DECLAflAT10N�I herehy affirm that I have�certificate of cansent to ull-insu1e,w a ceruficate al Workers Lompensatwn inwrance,oi a cei6fieC rnpy Maeaf ISec 3800,laD C�. � PLUMBING _ _ � ❑Cerllhetl coOV�s hereby fwmsheA MECHANICAL o ❑Cernhed c�y is filed wrth tM1E B�ildmg Inspecuon Oepanment a� neau�ma��. �d„ GRADWG� W � � CEATIFICATE OF E1(EMPTION FRp�7 VJORKERS'COMPENSATION INSUMNCE�TMs ucipn need not 6e compkted SUA ' l 3�� y d the permu is lor ane hundmd�SI00)a less I cerufy that in Ihe pnlormance of tM1e wak lo�which thu �,r„ -- permrt is issue0.I shall rot employ any person m arry manrer zo as b betom2 suEjeet t0 Ihe WD�Mers"Cpnpenselion S`��P e � QLaws nl Caldrcnia � PA�K �EE p [late App6cam � � NOTICE TO APPLiCANT:If,after mekinA tl�is Ce�UlHale of EmnD�ion,you should become subKct to die YAaker's SCHOOI FEES —� Campensauon piovisions at the Labor Code,you must forlhwiM comply wilh wth prwirnns ar th�s pemiit shall � be deemed revolred a W INYISION OF INOUSfRIAL SAFETY PEAMIT CEHTIFICAi1dPn � R�p,e.^., _. {�.u� ta��7 d ❑I nereoy cendV that no e�cauatwn irvx(5�or "'�ee�ieXbpt`��i�tu., h a peraan ic required ro desceM, 0 � wdl he made m conrcctwn wrth wnrk autFmied hy�pe�anA''tli�t fiiP'I�Aip siructure.ltaflddinp,IYsewak. nr Aemolemn o�d�smantling theieof,wdl be mwe than thiny-siz(36�het hi�.(CAap.3.2.Gry 4.Art 2.Sec W 341.TiNe 8,C A C.1 S !� �y� fp� 3 ❑0.s awner�6mldei I will not employ a�� wa�F wp�+� { �}/qre a permt Irom tlr Owi�on of r Industnal Safety,as nmed a6ove,uNess such person�a��p�hiitl6da s I�OPoiClrom tAe divi�ion. . f W ❑Unsion of Indusvml Safery Pormn < TOTAL FEES ��� .s d � CIXJSTRUCfqN LEN�ING AGENCY�1 hgre6y�al�irm th�T�53�0'cM�tit6nn i�md�iig'YpVeuly ler Ihe perlamsKe 2 af Ihe wark frc whi�h tAis pe�mit is isEye�I�G[�9�T:;�L.1:�:•::��'.�.s f.i'yi�L:i ! � leritler's Name � COMMENTS mlender's Address Q CERTIFICATE OF COA�LIANCE AND AUfFqPoZATIqI OF ENTRY.I cartity 1 heve ieM Mis oppliplim a�d s44 vJ Ihat the n�amatwn grven is cmect I agrce m wmply with all s1aR lews aM ciry ordi�w¢es�tip m 6uitlinp y construcuon,and authortre a rep tetrve of Me�putmmt of Buddinp end Sately ro eMa upon Ihe papnry ' = lor whKh I appl �i t� �m lor the p�pose d maki�g infpee4oet. 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