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Home My WebLink About1350 (32) ,_._ .._._– ._ _ . _.._ __ __. –-._._. . —__" __.____._ __.____"_ .__' __ . ..__ .... ._ .... � � ky:.` -� � CITY OF DIAflAC�IUD �AR PF�E�S � -� D�PARTMEFOT C)F BUILDING AND SAFETY F��MLY :�' BUILDING P�RMIT JOBSITE � " � � . APPUCATION ,�� PERMIT � USE ADDRESS DATE ��NUMBER � CODE ° ISSU� TYPE OCC. > APN lOT TRACT DATE �'�� CONST. GROUP o CROSS STREET Z��p�G SETBACKS "�"°'E'"E"'S °� OWNER ��j �°�'S� ��✓� - FRONT RW � � ADDRESS R�� ,= GITY ZIP EL. SIDE/SIDE STREET RW ❑ , o I APPLICANT_ ,S�°�`�� L. SIDE - 0 z 6 CONTRACTOR SEWAGE IO PUBLIC PMT� o A�DRESS DfSPQSAL ❑ pRiVATE SQ.FT./100 GAL W CITY ZIP TEL. z STATE y LIC.NUMBER - � � GRADING � CU YDS.EXC CU YDS FILL � ARCH/ENG/' �, TY�� .�'C.� �'1 .;:FAw�'f�3f� ��` : �!)J:::':l�Fl��A�UAI'#�I�- : ' " � DESIGNER �~~-'"'---- �` � � ADDRESS � �-' 2 � CITY ZIP TEt. �, 3 W � 4 oPROPOSED USE �, �-� ,�, GARAGE o NO.DWEL. O. N�� , pORCH y UNITS STORIES�BEDROOMS � 0o LOT DIMENSIONS VALUATIOi�I � ADJ AREA c NO.OF BLDGS HOW CIt3At�lT�rv :T39E�`u�"rF�IF�' �I �EE = ON LOT USED W � �''. � - �u. LICENSEO CONTRAL'TORS DECLARATION:I herehy affirm that I am licensed under pmvisians ot Chapter 9 Icommencing �; � with SeCtion 7000)oi Division 3 01 tlie Business and Pmfessians Code,and my license is in full force and eHect �. C 3 � �.. � QWNEH�BUILDEfl�ECLARATION:I herehy a�firm that i am exempt fmm the Coniracmr's Littnse iaw for tFe follaxing ��: ` �z reason iSec.70315 Business and Professians Code:Any city or couity which requires a permit ta[onsfruct {3; � �,o elter,impmve,demolish,o�repair any stmcture,prior to R5 issuance,also requires the applicanl for such permlt �2�; ��1= [0 file a signed sta�emen�that he is licensed pursuam to the pravisions of[he Coniractor's licensa Law(Chapter yCy�; � � 9 Icommencing with Section 700�I of Division 3 of the Business and Pmfessions Ladel m thar he is exempt[herefrum ��I � ��,p„ and ihe hasis tor the alleged esemp[ian.Any vialation oF Section 1031.5 hV any aDDlicant for a permft suqeus ��. 'W the npplicant to a:ivil penalty of not mare than iive hundred dollars IS5W�.1: �;_ � ❑I,as owner of ihe praper[y,or my emplayees with wages as theii sole compensation,will do the wnrk,and the structure is not intended or offered ior sale�Seu 7044,8usiness and Professions Cade:The Contraetor's License �Q-_ .V� Law does not apply to an owner of pmperry wha 6alds or improves therton,and who dces sucM1 work himself (,.�_ " ��W� or thmugh his awn emplayees,pmuided that such imprmements are not iMended or afhred Por sale,II,however �! m the huilding or impmvement is sold within one year of canpletian,the ownerhuilder will have ihe bnrden of proving 'Q�, , y, ihat he did nat 6uBd or impmve for the puryose nf sale.j � ��„ �!i ❑I,as owner of ihe pmperty,am exclusiaely[ontractiny with�icensed conlractors N construct the Or6ject(Set �{]J� 7[144,Busiress and Proiessions Code:The Canvacror's License Law does nm apply m an ownai of pmperty who �-��. �''� 6uilds ar impmves thereon,and who contraau for such pmject3 with a cantractar�s)Iicensed pursuani tu ik Cantracmr s !@ Yt ^ �"�v/"�i ticense Law.) �-:CONSTRUCTI tl t �+✓��% ` W ,a.e P.c.�av�n ce�afma�ei ; PLAN REVIEW �;:, ❑I am exempt under Sec. �'�.p� Uate Owner ...ji.ELECTRIC . �','� W➢RKERS"COMPENSATIQJ�ECLARATION:I hereby�ffirm that I have a certificate of consent to selt-insure,or i .�PLUMBING a cenificate of Warkers'Compensation Insuran<e,or a certified capy thereot(Sea 3800,Lab.C.1. � . '�,Q ❑Certitied copy is he�eby furnished. - �'�MECHANICAL p Certified copy is liled with ihe Building Inspection Departmmt ar Departmem �C�_GRAD W G W. � �� CEflTiRCATE DF EAEMPTION FflOM WORKEFlS'COMPENSATION INSUflANCE�,This section need no[6e campleled ��ISSUANCE 1/ �,y if ihe permit is for one hwdred IS1001 or less.I ceriify that in[he pedormance ol the work tar w�ith"Ihis �,,,,: _� ., permit is issued,I shall nm employ airy permn in any manner so a:ta 6ecame suhject m!he Nbrkers'Compenution s M� � F" Laws ot California. j � � FEE 0 o,; oa,e APOl�wnt 3� gCHOOL FEES W�� NOTICE TO APPUCANT:N,after making this Certdc ol E ptoR,�e�t"s{�ould 6ecome suhjttt to ihe Workxs � �', CamPensa6on prwisions af the Lahar Code,qau m�t��pl�w�q such prwisions a this perm0 shall �� 6e deemed revoked. �" ,+'%�q�y,��.r;:- - , �/� J ~L ,� a^ W �� DIUISION OF INOUSfHIAL SAFETY PENMIT CERTIPICATION: ry I.i� � �^ �l � ❑I herehy cer�Ay[hat no eccavation five(5�ar more�teet in depth i _1 a person is required to descend E �� 6-#' '" �� "`�A i��. will be made m cannecton with work authu¢ed per a,��ga�,'at . � stmcture,swNaWing,lalsework � � � or demolRwn or dismantling iherant,will he�r�M1�n ih�-sn"cP136) �t i .(ChaO�32,6ry 2.M 2.Sec 3 �,�" 341,Title 8,C.A.C.I. _ _. 3 ❑ps owner.builder,I will nol empMy anyone to da�bprk�,rvhuh:woula�(eypyttg a�prkl�tifrom�hE Oivispn of r Industrial Safety,as noud abo�e,unless saeh p,e'fs�n hps;'permn+ttl do soch vrorkµfrR,m.H�e.4ry1siart . � .� M1, .; "R. _..'"�, � ' '�.. ��..�:"'k'y .iw i ::'. .� ❑�ivisian at Indurtrial Safety Peimrt Na `�� " 1 TOTAL FEES �� d � CONSTPUCfO]N 1EN011�Y'i AGENCY:I hereby afhrm Ihat tMre is a wnstructwn lendi�apenry 1ar Me perla�mamx Z of ihe work fw whicA ffiis peemit is issued(Sec.3097,Civ.C.�. � �ender's Name CCIMMENTS = tender's AdMass - � � �Q CERTIFICATE OF COMPLIANCE AND AUTHOHRATpN OF ENTRY:1 certify I lmve read 6is applie�tim and rtah - � . va [hat the inFarmatian given is carect.1 agree to wmply with all stale laws aM ciry ordirences rNaMg ta huiNi�p �y constmcban,and authaix a r sentalrve mf the Oepanmem itlinq and Satety m mta apon Ihe properly . � = for which I have ' for r � fie�puryou �spec� ' , . r X' Siyaature ot nou�wan r Agent �� RECPT NO. � � � PAIO BY ,,, ��VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—ldssessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy BS706-i t189 � � k�_ � �:v ..,:.. �;w:,�r, ., ::�:he- .,..r.:.v��:6� .r+,y"uRfi��„t,*."" .:s;�i�y;`�- - — . .. � '- �: :� :o-. 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