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HomeMy WebLinkAbout1170 (13) � Y`'�� `��--�-i l CITY OF DIAIIAQ ND BAR PRESS � � �� ��1i� DEPARTMENT OF BUIL[�ING AI�D SAFETY F�RMLY � a -l�u BUI ING PERMIT JOBSITE , ( ,n �� �n�N `�j—�'��'(�MBER � / CODE ADORESS w t'Tt5 � APN LOT TRACT�S ATE L�C���J �� �C � CROSS STREET �T��P��GLrrq-SE' '`��ST' GROUP °= OWNER O�>�rC,�G �'-� ZONING SETBACKS .�+a�►E"�s FRONT RW ❑ � A�DRESS ��Z�E� P.�OG7�.-�r7Z �'" 7/¢ REAR ❑ W CITY ��"�US'T•E'y Z�p TEL:� 397� SIDE/SIDE STREET RW ❑ o APPLICANT TEL. SIDE ❑ z a CONTRACTOR SEWAGE o ADDRESS DISPOSAL � �B� �# „� CITY Z1P TEL. � �ATE SQ.FT:/100 GAL z STATE GRADING �CU.YDS.EXC. CU YDS FILL y LIC.NUMBER T'YPE SQ F'S ° :�AQ,�.ARE�kN14t.tJA�'tdt� . y ARCH/ENG/ G!! p� `—' DESIGNER � 1 St�JD �! G a ADDRESS U�.. 2 a, �J� IZ" �f p a g ac = CITY ZIP TEL. (� 3 � PROPUSED USE Z 4 � � GAHAGE i NO.DWEL.N`� NO. N� NO, N � PORCH �„ UNITS STORIES � BEDROOMS ��' s LOT DIMENSIONS � VALUATION � ADJ.AREA o NO.�F BLQGS HOw �u,a�um�r :pE3aCRIP7�f+� , fEE. •. .: W ON LOT USED � . � W ❑ � H 110ENSEO CONrHACTOflS DECLAAATION:I here6y aflirm that I am GcrosM uda pmri�ims oF Cheptr 9�camm�r.inp � wnh Secmn 70001 of Oiv�sron 3 of�Im Bu.ainess and 7rohss�on Cad4 and my limiu it in 1uN force and eHact W 3 � IY �+ OWNER�BIIILDEF DECLAFAiqN I hereCy aHir.�tAat I am emmpt fmm Ihe ConCxta�s L'eeme Law M Ne falbixinp Z reasan I�u 1�315.8usiness and Prafeszana Cade:Any ciry or counry which requiret a permil W cons6uct, � O alter,improve,demd�sh,a rep+i�arry structure,p'm�m rts�swaMe,dm�equnea the app6iant for sueh perm� � F= to 1Ae a sgneA staiemenl Mat I�e rs IKensed pursuln(ro�he�prwisians of Me ConCxfar's L'[eme Uw IChtpM :ag � 9 jcammencmg wnh Sation 70�0)al Oiviswn 3 ai tle Busnmss ard Proleuiwq Code�n thal Ae i�eYempt 7Mrahom � a and Me 6esis for the alleged exempunn.A�ry vidation oF Su.tion 7031.5 hy my applinnl tor a parmit wbjaeu '� K �e applcant ta a crvil penalty M nat more tAan fiue hundred dollars(55001.1: . . :.a W . . . . . .., . � ❑I.as ownn o�ire paperey.a mv emdoyees with wages a Mei sak compensatlon.wA do ihe wark,aM the svucdre is not imended ar affer¢d fm sale l5e[.7064.Businns and Rafessions Code.The Cartrcmr s li�xme �e� �j law does mt aDPh�o an owner of property who huiids w mqroves thnem,and wlw does tuh work himaM, C.7 W a through hu uwn amployees.prwided�hat such impfovements an nol inteMed a Mfand for iaN,IF,howner, � . _ �he hwlAing or inorovemmt is soW wilhm oirc yeer ol compktion.Ihe aumerhuildn wil haye Ne NNen oF pwiip a y thai he d�d no�6mld u imprava fa�he purpase uf sak.) .�� tn ❑I.as awcer o}��e prcqeny,am e�dusve'ry centraenny wdA Me:aed�onvxtors m tonatruct tM pojeel ISa. {jj Q 70a4.Buaness aM Professions Code�The Cantracmr's Licenae Law daes nm appW m m on�er oi p�opertY who �','� � Z huilds or imp�wes tlie�eon and who camracu la sixh pro�ecu wifi a connactwls)licmfedpursw�t m fhe Cmtncmr i _ Q t¢enu law I Q Qnj '�� C � �i I am erempt unaer See .B.6 P.L.IAnx�Ce�rikatel. � � S� • `�=�_ 0 oere �"'�` , ELECTRIC � WOXKENS'COMPENSATpN OECIARATION�I he�ehy affum lha�1 Mve t artifintl of cm�em m vn-+�sue.a . pLUM81NG a certifica�e af NbrMas'Compensaton Inwance.or a rntl1iM copy�heeoi ISec 3600.LaA.C.1� 0 � ❑ce���m�o�Y�ne«nY i����e. J MECHANICAL `O L.�Cercdrtd[opy is fded wi�6 ffie BuiHing Impxtion Deprmie�i v o��,.��. �<t GRADWG..., � CERTIFICAYE Of E%ENPTION FflOM YWNKERS'C�MIPENSATION INSURANCE:Thia ue4on need nol M tampleted S`(�A ���� y d the Dermn is b�one hundred IS700�a less.1 urtily tlut in iM performr¢e of tlrc work fa whih"Mu � � permn is issued,�shaY not emplay any peison in any mamer 50 as m hCame wh7ect b ihe 4Ybrtti e�...n� SMIP � o �w'��c'������ W PARK FEE e o�ce A°"��°` � SCHOOL FEES � hqTICE TO APPLICAM:If.aher mating this CerWicau af EnmMan.Yau shoWd becone aWj[ct m tlie Waker's � Lampensanon provisons o(th la6ar Code.yau must taMwilM1 camply witli su[h povisionc or thia permE fhM � 6e deemed reioked. � ¢ qYI510N OF INWSfRIAI S0.FETY PERMR CERTFICA� .` a �i I herebv certily rhat nn e�wvatpn Frve(5�rc�ee; ��q �pvsm n repmed m dezrard, � will 6e mede�n cannecUm wiM uwrk wthor¢N hy Ihu q�.��a�d Gtl i�sb�elua.sr.�kldii0.faliewak. a eemalmon ar dismantling thcrmf,wBl k more than Mirry-so(38)het hiph.Ipap.32,Gry 2.Art 2.See � W' %1 iitle B,C A.CI ��� ���� 3 ❑As owne-6udder.I will not enpbY wo w n a prml ham tlr Oivnim d � IiMustnal Satery,as roted�bm,unbs wcA perfon a a do f'an IM diuilian. � W ❑�nnm o1 Ind�stnal SahN�!rmit � , .. TOTAL FEES I�I .S^ LdVSRi11Cf10ti LENOING AGENCY.I rm tl�S!i'� �1 V far tlr perlMmma 2 al IM1e wark far wn[M1 th¢pttmit n¢���yG(r�.yC.�:1!v� rf'i��l i � leiMer's Name 4 = COMMENTS m Lender's Address a CEIifIFILATE OF COMPIIAAtE ANO AUfIptlZATIr!OF ENil1Y:I ttt%y 1 Mie nd tlo�ppl'e�um and thle w Mal�he inlamaeon gven n r�rreR.1 fpree m mnply weA atl riee Iws rd ciry erdinrw`Wlinp ta hiltip W y conmatwo.ana amhm¢e� s d tle Oqa�mnt d BuiYiq ad S�YtN m nr iqw tls pqxry � = la whch 1 applr s mif 1or tAe d mdinp inspecum'. 9W � � � X� _ � -����o ��`}�� 5qnenre d nppNc�t n p� RECPT NO. T"S.L/��—_PAID BY�D�_VALJDATION WHITE—Dep�itment C py.YELLOW—Finance Capy,PINK—A�sessor Copy,GOLDENROD—File Copy,GREEN—Applicanb Copy ' - BS1D6-71/89 �„` - ---�- ------- �—�----�`^+nsuµ� ., �wi'""r'p�w'�W.,.n��..-.._..__.. -,-'-•. . ' . . � . . � �ai��4J�A.w�..._�i LL..� � � "_r�.- ,.. .. .. .;. . . " . . . . .. . , . i . . , - . . .. 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