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HomeMy WebLinkAbout1224 (13) � '('� � GlTY OF DIAMO�ID BAR '�"" ��' �`" '' �EPARTMENT OF BUILDtNG AND SAFET, PRESS '~' BUlLDING PERMIT FIRMLY JOBSITE ��.,(; �� ;� 1 APPLJCAl10N PERMIT y USE ADDRESS ���� �L•� ����'�r7 �-° SSUE TYPE ER 1 CODE 4 APN LOT Z- RACT DATE � � CONST. GROUP o CROSS ST ET—�— SETBACKS .�+�E��+rs `= OWNER � 1`�"� l�- ZONING �OM � ❑ � ADDRESS Z �— � -- REAR ❑ � CITY '"��liJi.{��{'�'Z�1 ZIP d� TEL.`� � StDE/SIDE STREET RYV ❑ o�APPLICANT TEL. R� SIDE ❑ z a CONTRACTOR ��r�(...��- "'��'"- ��� SEWAGE ❑ Pl,1BLiC PMT� o ADDRESS ,�� �O' � r �-�- DISPOSAL ❑ PRIVATE SQ.FT./100 GAL W CITY � ��l.�X... ZIP`� TEL. = STATE 1 � GRADING� ❑ CU.YDS.EXC. CU YDS FILL y LIC.NUMBER �����'t' y ARCH/ENG1 � {� TYPE $Q FT FACTL3F� PS A�J. AREANALlJA7tON — DESIGNER ��. �Ca� W 1 ��Q� r�� - '�(^��� � ADDR�.$�S ,�G �o t� t,WL 2 � '�� i�o� �b '1" <�O = CITYl��_�J2.#-t1l��}-- ZIP J� TEL. (� 3 °��t2 Z��IL �QC ocI � PROPOSED USE �'�.-. ? 4 � � GARAGE o NO.17WEL. NO. NO. � pORCH y UNITS � STORIES�BEDROOMS e LOT DIMENSIONS m VALUATION � ADJ.AREA o NO-OF BLDGS HOW � OUAN7r1'Y D�SCRIPTI�N ' FEE . : W ON LOT USE Q f�LG� L�( �v , � �� 5,��a 4�y O V ~ iICENSED i3ONTRACTOBS OECLAflATION I here6y affi�m thai I am Lcensetl untler provisiorts ot Chapur 9 Icommencing 1— — �} y0� � xnh Secimn 7000)m Oia�sion 3 of the Busmess ard Proless�ons Code.and my Lcense rs in full force and elfet� w 3 J ❑ W �,� � 3 � �±- OWNEN�BUIL[lEfl�ECLAflATION�I herehv alfirm ihal I am e�empt tmm�he CoMracmr's L¢ense law for ihe Idlowmg � ,�� 4 Z reasnr j$ec I031 5 Busmess and Pmlessions Code AnY cuy or county whith requires a permit to cunshuct, � �� ��O' o a4er �npmve,demahsh,m repmr any structure,prwr m ns rssuance alsa reqwres Ihe applimnt for sucA permit Z Qto f�le a signed statement that he is i¢ensed Oursuam�o the prwisions of the Canttactar's Lirense Law�Chapter p7 � � ,��� Z �' Q 9 icommencing w�rt�Secuon 700Di ol Orv�sian 3 of the Busmess and Pmfessioa Cada)or tAat he is eaempl iherelran S4 o. and the 6asis Ic�i5e allegeA exempUan Any v�dalion of Sectmn 7�315 hy any applicam fa�a pe�mi7 s��hrecls � �j ��G �'� �� �y�_ 1G1�+ "� rte appl¢ane m a civil penaltv a'nat no�e mar.Irve hundred dollars(55001j, J W a rn�I►�� � ❑I.as ow.^.er ui the prnperty or rtry er�ployeee with wa9es as thev sde compensaLon,wdl do ihe wort,and �- '`a' ���� ~ the stmctare is nm imendW m alfereu foi sale�Sec 7044 Busmess and Prolesswns Code The Cuntree�o�'s License ^7��,/ 1� � ��/y V Law dnes i�m appl��!o ar.mvnei o!pmperty who 6uilds a�imOmvet Ihereon,and who Cces suc�wmk himsell, (4,? ' ` �V�' .�� ��-IC... ' oi thmoyh his ewr emplayees.D��`+�aed Ihal such impmvemenis xe not mtended or oflered for sale If.however. z / �'y m �he hwmmg or impmvemem is saN wrthm one year ol compleuon.Ihe owner-buiWer wdl have the lmden oi provmg .t� �a�__��r' (C✓/�(...� y �hal he d:d nal hudd or improve ta�Ihe Dwpase af sak.� U . y � �^ � �� t.J � y �il,as aw�r of t6e properly,am exclusvely contractiny mm�rtensed contrecmrs ro constmu the pro�ect�Sec U} 0 7044,9usiness anA Prolessions Cotle The Lontractar's L¢ense Law tloes not apply ro an owner ol Droperty wha � ,,S %'�`� � � a Q(� 6 hutlds or imo�oves thereon.and wla comrans tor such pro�eois with a comraum�sl h�ensed pursuam m the Contractor's Lcense law I O f p , e l � G 1 am e�empt urder Sec ,B 6 P C 1Anxh Cendicahl A ��N( � � �� c oate pwner LECTR � � VJORNENS'COMPENSATIWJ�ECLANATION:I herehy alfirm thal I hrve a cenificate nf mnsent to selt�msure.or � � a cernhcate nf NJo�kers'Compensatan Insurance,or a rertiLed capy ihereol(Sec 3800,lab C�. �UIIIEBIN _ p Q ❑Cernliea capy is here6y lumuhed � ECHANICAL r� _.r-----� p :.J Cernlied mDY�s filed wnh Ihe Bmitlmg Inspe[tion Depmlmem oi Oeparimeni Q C,7 )�_��� W ��T— �� � CERTIFICATE OF EXEMPTION FROM WOPKERS'COMPENSATION INSUAANCE TAis secuon neeU not he completed � V �Y' _ i'� y d the permn is lor ane hunAred iS1001 ar less I cerof�rwth�,is,in the perlarmance ol�he wmY Mr wh¢h'�his �,,,, /A�--f--- permrt rs issued I thall not employ arty perspp'4¢.an�f�dnnep sa,as�tp hecome sub�ect to the Nbrkers'Canpensauon = Laws of Cnlifnima �,,,,;:: ;;:` i'.. :. - — � o �„ yy::.:.,,a��;;�.v. W PARK FEE p �ah � AppLnnt � ND710E TO APMICANT N,alter makmg thrs Cerulma�c of Exemp�bq you should 6emme su6�ect ro ihe NNr4er's �- SCHOOL FEES � Cmnpensauon Orowsio�re al Ihe l2hpr LOde,you m�sst forl�wi L WIM 511Lh pfpVISp115 p 11115 pEf11111 ShNI � be deeme0 re�oked � 6 '��A� __ _ J � qVIS1IXJ OF INWSTflIAL SAFETY PE IT E IFICA ON ___ W 0 ❑I hereby cenily Ihat no ex�avanan five(51 or more ket m depih�nro yrhgh.a.pe�son is raqmrd to descmd. � will he matle�n conntt�wn w�rty work�ay�hor¢e4 dY;mis qrmP;anC�ire[�a pUilEinq itructu�e.sc�lfoWing.fWsework, o�demalnion or dismantlug thereo{.wtll be more"ihan ifiirty-s�_�38j teet high��Gap_32.G�y 2.Art 2,Sec W341.T�M¢fl.C.A C I "° `•' ``�� ...... ..... .. _.e 'r —_— _ ;�'..a::...:.ai.�•.�,.: ,`!:�• : _.. , . � 3 ❑As awneo-6wlde�.I will iwt emplay anVone m do warM wh¢h wnuM requi�e a permit fran the 6vism d H- Industrial Salely,as noled ahave,unless such person has a permit to do such wwk Irom Me dvision. — W� � ❑dvisian ol industrul Safery Permit No TOTAL FEES d � CONSTRl1CTION LENDING AGENCY:1 herehy alfi�m that tMre is a conmucLon lendmg agmcy fo�tlie pn(ortnarwe �•�� = of tlu wark fm whkh[his permil is�ssued(Stt.3097,Crv.C.) � Lender's Name a + m Lender's Address COMMENTS (• '�L� T '� � � � CERTIfICATF OF C ANCE ANO A ZATIp�!Df EMIIY 1 cntily I have red 1Fit�ppli��tion eid s1Ne n � � sn that the�nformaV rven is camtl. gree to camply wnh ali slate laws aed city vdirunces M�tinp W 6uiltlinp " � y canstrucuon, �h - a rep ma�rve ol�he Dpxtment o1 Buddinq�d Safety m enter upon Ihe yaperry = fa wh�th I f Ihi mrt lor iM pvpoje of�ki'g mspctions. 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