HomeMy WebLinkAbout1282 I � �� -���
, clTY OF DtAMOND eAFt PREss
'i ` ���. " DEPARTMENT OF'BUILDING ANl�SAFETY p�pMLY
�, BUILDING PERMIT
! JOBSITE hPPUCATION " �' PERMI7 USE
I ADDRESS ��� ���- --����- ��'�'��' � SSUE �� � � � TYPEER ��CODE
, � APN _ LOT�TRACT�7 .�.5 DATE CONST.�GROUP
o CROSS STREET ��r�rs
eD OWNER i`�r/�e.�'==i'� ,(�✓3f.�a�•� ZONING FR�NACKS RW ❑
� � ADDRESS .sr'l�.�s' �'-��C- .-5��'t% �-r%�c: REAR_ O
I W GITY �_ �� ZIP TEL���' ��5'Q SIDE/SIDE STREET RW C�
I o�APPLICANT �>.r9 i.'.r.'. 5 >�'L�'--� 7EL.��'-��"� SIDF__ �.
� GON7RACTOR ��� %''��-�� �''�y'�'' — SEWAGE
o ADORESS_,��;��, r'.'/�.�-�.7�°x;,yy..5' ✓9'/J�.:. � PUBLIC PMT�Y
o �,�r C��� C, - DISPOSAL CJ PRIVAYE SQ.Fl:/100 GAL
,,, C1TY ___ZIP�r;�/�'' TEL.a::��-��'lJ ,.�..._._._
= STATE �/' (�RADING 0 C11.YUS.EXC. CU YDS FILL
a LIC.NUMBER_ �� -�✓_���� .�.
y ARGH/ENG1 .. � �. T.YP� :SQ�T R" S ADJ .REAIt/Ai.U/41'IQI'�I ,
y DESIGNER ��`�� �-' =���� W �
� ADDRESS � i� 2
n —
z CITY ZIP__ TEL. 3
ts.
� PROPOSED USE �,� ✓��� �.�.+�'J�':t:.�,:,y:�.r��: � 4
� [�Y�[/��:�.�1%Yt•� + :O GARAGE
o. NO.DWEL. NO. NO. �;. PORCH
� UNI7S STORIES BEDROOMS—
� LOT DIMENSlONS � VALUATION ' ADJ.AREA
- o NO.OF BLDGS How �unriTirY:;t3ESC ,iPT"t�)N'. ;:: �� -
W ON LOT USED a
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W
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Lif.NSE�f.ON�RACTOflS(IECLAPA710N:I herehy afiinn Ihal I am licrosed under prwisinns of Chapter 9 fcommmcinq '�:��}-'•_
� witl�Secnnn 7000�ol Oivision 3 of�he Busmr.ss and Pmfessions Cade,and my Irense Is n lull torce anC elimt. ,d,w..
o ,_l
3 ❑ :u�: �:°:
�- OWNEH�BII1LOEfl DECLAflATION:I herehy elhrm Ihat I am erempt Irnm Ihe Conlrxior's Liceree Law for Me Mbwm9 � �' �
Z reasnu(Sec.)031.5,Business and Professions f,ode.Fny nty or county whi[h requ�res a peimit tu cunsnuc�, `��-(7'.
o alter,�mpiuve,demolish,ar repan any slmciwe.v��o�to rts issuanre.also iepmres Ihe apDlicant for such permil :i 2'�
�— lo fda a si4��stateir,enl that h2 is licensed pu�suart to the provisions af Ihe Conuacror"a liunse Law(Ch�pter ;;.�:
¢ 9(eammen�ir:��vilh Senim�7000�af Oivision 3 nf ihe Busines and Prolessions Cade1 or ihat he is enmpt therehorn — -
:.�..
d anJ ihe 6esis for the allegeJ eMenrytion.AnY violaGon of Stttion 1P31.5 6y any ayql¢anl fo:a permil subpc9s ;-.�; �
��.; W� �he apylicant m a civil penahy ol no�more ihan iNe hunJred dolla�s(5500).h �`�:a
� ❑I,as mvnxr uf ihe pm{�enY.e!mv employe¢s with wages as that sole compensalim.will do ihe work,and
h Ile simcnxr,is not inlanAed or oHered fm sale(5ec.9044.8usiness and 7mfassions Code�.The Canr�ctaYs license ;;;.�,.
V �Law does mt apply Ia an nwrnr ot pmperry who huilds or im0ioves ih¢reon.and who Aces such wrork himself. F;'{�- r
W� or tlaough his own empinyees,prnvidatl thal suth improvemenrs n�e not rnt¢n�0 oi olle�e0 fa�sale.II,however, ..;'.�'-
m �he hniltlmg or inprouement is sold wi�hin one year ol rompletion,the awnerhmlde�wiA haae the 6urden ol pmuing ':;'s[
� Ihnt he did nnt build or improve fa Ihe purDase ol sale.l -��:T;:
y
H �1.as nwr.e�ul the pruperly.am exr.lusiveM aontiecling wiPo�icensed canlractoa to canslruct the O�ajzct ISec. ';�',
o '7044,Business snA Pmfesaons Lude.Thc Conveomr's Licnnse Law does no�apply w an ownei ol pmperry wha -:�•`�`�
�� _'� hmlds or impmves�hereon.aud wha caNracis lor such projetls wi�a contracmrl3)licensed Dursuanl to Ihe Conimctor's � � s —
Q L¢ense�,w.i .. CQNS fRUCTION t �y
C] y l
F ❑I zin exemp:unner Sec. e.B PC.IAtixh Ceniti�a�el. 3`::. PLAN REV�E /�j s�������4rr
n o��e �^E1 ` ELECTFiIC
� Ih9NKfBS'COMNENSATION OECLAflATION�.�heuM alLrm Iha1 I havu a tttlifical¢al consem to self-inswe,a �'.�;-`:�
a certilir.ate of Wurker.s'Cmnpensation Insmance,or a cenifie0 mpy ihe�eol�Set 3800,LaM1 C.I. �`PLUMBING
� �ce�urea�onr�s��e�env r����r�a '��ra-MECHANICAL ,
C ❑Cr,rtilied capy is fAed wilh ihe Buiiding Inspec4on Depanmem or Depa�imem. �Q�;GR
tl z .�^ — _
J � CFHTIFICAfE OF f%EMPiI�N FAOM W08RFBS�COMYENSAiION INSUHANLE:ihis se�tion need�o�n��a�n���a � AN • C�C---
� �j A die peunit,is lor one hundmA 13100)or less.1�erlify thal in ihe pnlo�manc¢ f Ihe wak tor which Ihis ; :,' �
peuni�rs issued.1 shall no1 empiny am Person in�any manrei so as to become su6�e to the WwkNs'Canpensatiq� ��- ���
= L�ws af CaliPornia. � . �y�'J 'W: ---
:,�"r : ._'.�'r`-� �„".
0 o��e �'7/ C." �w�=�� .�. -�-� :kt;i: PARK FEE
� � NOTICE TO APPIILANF II,after making ihis Cenilicate ol Eremp ,Xyp`should 6erome suhjec�ro�h� �:SCHOOL FEES
y -_-� Compensalian pmvisiona af the le6o�Cade.you��'iprth(v( ctl:l�y�i��fh sah porisrons or Ihfs pe�mil shall �
� � � be deemetl ieuaked. -r.:'� �,' — ..
�
� fMVISION OF INWSfBIAt SAFETY PEflMIT CEHTIFICA pV
W
o ❑�herehp cenAy tha�nu e�cavatbn INp�S�0 mme lee�m depih mm which a persm rs aQuire�to desomd
-� �- wdl he made in ronneclion wilh wark aulha¢M bYtyu ue�it.and Ihaj;Ia.,Bqi,�tljng slructure,sWifalding,faisewaiM, .
w demolflfnn nndismantling thereal,wiH Oe mor��han t�pty��136i;f4S,rybfgh(Chap.31.Gry 2.An 7.Sec �
Z� :{41.LHeN.CAL.1. �
S
3 �As owner4uilder.I will not empbp anyane to do wo�M whkh wauid iequirz a permit hom the Oivisbn af '
f- Indusuial Sa�eiy,as nmed ahove,unlesssuch person'has�a permit N dn su[A wo�k han the divisbn � .
�
W oa.�=,�o����,���a�s��e����m,�� , . . TOTAL FEES �
�- � •��1 J
v CONSTRUCTION LEN�ING pGENCY�I he�e6y affi�m ihat ihere ia a construc�pn kndmp apency tor ihe pnfom�mtt .
Z M IAe work lor whicA Ihis permit is issued�Sec.3087,Civ.C.).
� tend�r's Name C�MME(��$_
m LenAer's A�tlress
a CERIIFIC�TE OF f,OMPLIANCE ANO AIRNOHIZA7NI!OF ENIqY:I certify I ha�e ieaA this appl�atim anE starc
va that the inlpmatian pven is cnrect I agire m compiy whh all state laws aid cih ordirwices retedp to huildiip
y rnnstructan,aid amlroiiee a�ipmsemetrve of the pepartment of Buildinq end Sahry ro mtn ipon tlie paprry _
_ �w whkh 1 Aave applied for Ks permit far iM1e pupou of ons. �
r /
}ti--�!�.y+�t.�..�� �/�����' -
Signature af Applicant or Apent �.,. pym RECPT NO. PAID BY_� VALIOATION
WHITE—Department Copy.YELLOW—Finance Copy;PINK—Assessor Copy,GOLOENROD—File Copy.GREEN—Applicants Capy
85106-11/89
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