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�. _..____..._._.._ , ,.�._.. _. .., .., ,..._m_ .. , -- , ._„ _. �.. _ _ _ . ., _ _. ; . . ..:,:, . , . . . . .. . - . .,k....;<:. . .,...� ., .. .. . ..:.:, � . , ..'� .., ��-',-' - E �� ' �ifT� oF D�I�M�N� �A� PRESS - oEpaarhn�NT n� �ur��iNG nn�o snF�TY FIRM � Bl1lLDlNG PERMIT JOBSITE APPIJCATION PERMIT USE ADDRESS �a�- �' DATE � NUMBER CODE � ISSUE TYPE OCC. > APN LOT TRACT DATE � CONST. GROUP 6 o CROSS STREET � � ���IN� SETBA KS ��� r° OWNER e- �L'_1l�._ FFiONT RW ❑ a ADDRESS ��� � ' � REAR � W CITY�J_LG1:./a7�-s1�.�2�__ ZIP_��ZF��TEL. �'� SIDE/SfDE STF?EET RW ❑ Q APPLICANT TE�. SI�E ❑ �� . a CONTRACTOR e��i++rS�='u' t�z 'C'..�d"a`�'�- ����,� �,,� SEWAGE D PIJBUC PMT� c; ADDRE� -'�-�`�i DISPOSAL LL; CITY ,� a�°►=w�'��•� ZIP �t s"�-� TEL.�.�`� ❑ PRIVATE SQ.FT./100 GAL = STATE �� LIC.NUMBER���� �r�� � GRADItJG ❑ CU.YDS.EXC. CU YDS FI�L � ARCH/ENG/ � TYF�� �� �'T �i4#�DFi' p'.� .; �•ADJ. A14EA�Jl��..UiA'�'�CIF+I: .` "• DESIGNER �' 1 � � ADDRESS �' 2 �; CITY ZIP TEL. � 3 � PROPOSED USE C''��� �%�-- � 4 c�.�i �_ d GARAGE �; NO.DWEL. NO. � NO. � pORCH �; UNITS STORIES^_BEDROOMS_ a: LOT DIMENSIONS ' � VALUATIOt� ADJ.AREA �� NO.OF BLDGS HOW CtuAht'�`IrV 'p�$,��1P"�`#OItiE ` �� ,: 43 ON T USED _ ,�. � �,, c Q' �: cy. LLY 'S.'. CCv �"� LICENSE�COMRACTORS DECtARATION:I here6y atfirm that I am licrnaed under provisians of Chapter 9 lwmme�ing �.-Y�- � �: with Section]D00)of Oivision 3 ot the Business and Professions Cade,an0 my bcense is in full iorte and eflecl. � - � 3.; � ��: �� . . �+- OWNEF�BUIL�ER�ECLARATION�I herety alfirm that i am exemDl hom the Cantmctor's License Law loi ffie tollowing reason ISec 7031.5.Business and Pmfessions Code:Any city or county which requires a permit tn cnnsiruct (}_� c� alte�,impioue,demo6ah,or repair any stmclure,D�ior ta i�s i5suance,alw requires Ihe applicant for such permil �- �� . �,�„ �� to lile a signed statement ihat he is Ifcensed pursuant to the prwisions of tAe Controctors LicEnse Law�Chapter m� � • �� '!*{I �*;�' � ��� 9(commencing wrth Secticn 700D)ol�ivision 3 of the Business aml Pmfeuions Caie)or Ihat he is exempl iherefrom .�{ . p;; and the basis ior�he alleged ezemption.Any violation ai Section 7031.5 by any applicam}oi a permi�su6jecLs �.�- �"°� fie applicant to a civil penahy of rot more ihan five hu�red dollars(5500)J: ,,�I, u.i C�� ❑I,as owner nf tte propeny.or my employees with wages as their sole canpensation will do Me work and . --..-- ~�� the strucwre is not intendod or ofkred for sale(Sec.704A,Business and Pro{essibns Codel TAe ContrAdWr's License .�_ L;i Law tloes not applV io an�wner o�pmperry who builds or improves Ihereon,and who dces sucA work himsel!. (,)��; �+:� or thmugh his own employees,provided that such improvemenls are not intended m offe2d for sale.If,however, -���` ca �he huilding or Improvement is soltl wilhin one year oF cwnpletion,the owaeo-buiMw will have ihe burden of pioving ,,y��: �.� thai he did nm 6uild«improve ior the purpose of sale.� ��:�. ua ❑I,as owner ot the pmperty,am exdusively contractlny with licemed coMractors m constmct ihe pro�ecl($ea '�,��- �� 7044,Business and Professians Code:The Contractor's license law does nn1 apply m an owner ni p�openy who ��4,,,5'- 7![ 6uilds or impmves therem.and who coniracis tar such pmlects with a cantractor(sl licensed Oursuant to the Contracta's -- '« License law.i � -��� �`QNCv"�'RU'�+`T��N ._ C:1 �•� ❑I am exempt under Sec. .6.&PG�Attach Cerliticatel. �. � ��/�E� ci Date Owner �LEC���`� Q _r YJOPNERS'COMPENSATION OECLAAATION:I herehy affirm Ihat I have a certiiicare al cansenl to self-insure.or " a cerhlicate o}Workers'Compensation Insuranre,or a tntitied cnpy ihereof�Sec 3800.Lab.C�. � PL f�� �e ❑Certitled copy�5 n�anY,w��snea. ,��,,,�j MECHANICA� e:i ❑C.enified copy is filed with the Buiitling Inspection Department m Department. _;�,.;GRAOIIVG UJ -"-- �� CERTIFICATE OF E%EMPT�ON FROM YVOHKERS'GOMPENSf+TION INSUPANCE�.This seclion neetl nn�be[omplela] SU��CE , ��� 7 the permi[is for one hundrzd�5100)o�less.I certify that in ihe pedo�mance of the wark for w6ich�ihis ui _ permlt is issued,I shali not empby any person in any manner so as to d me subj¢ct l0 4�6rkers'Campensatim 1 �':' Laws af Calitornia c� ���_..�'('j' � ,,,,_ �`F'ARK FEE C;� Date Appllcan � v+ �.j NOTICE TO APPUCANT�.H,aher making mis Cerlificale of E�emplion,you slwuld became subject to Ihe Worker's SVH�O�. FEES —�± Compensahon Drwisians of the Lahor Code.you mutt fonhwith comply with such p�misio�oi ihis cermit shali - u�� be deemed re�oked. (.,n� .av," r9 rvs..q _______ �a pVISION OF INDUSTRIAL SAfETY PEflM1T CEH7q�F�N,`AT�I a�" ��.:y';� � 01 here6y certi�y tha�nv excaualion five(5)o�'mre feet�n depth inlo whith a persan b repuired to descwd, pce will be made in connection with work autharrzed hy mrs permit.and[hat no bul0ing strutlure,uaNddi�,islsewotk, �� ��- or demolition or dismant6rg thereat,wfipe�ore an thirry-sn(361 feet high.�Chap.32,Gry 2,Aro 2.Sa uii �1.iitle 8.C.A.GI. �$x "_�,"& � "� � �� �r ' G'` �.. f' �a�'wd"YS � ❑As owner-builder,I will not employ anyone in da work wM1ich wnuN requi�e a pnmi7 Irom Me Ovision of � �.- Induarial Satety,as nmed ahove.unless such person�es a permit ro da sucb work Irom the d'xision. OI. ( _a..i Y ( i' ',.: ._,.�,`...'e .. ��� ❑avision af Indusuial Sahry L'¢rmq l�a C� CONSfRUCT10N LEN�ING A6EN �1`Feeb�7 aNrin�that 1Ae!„�a�a�5��,� ������,��,�����,ce TOTAL FEES � .1: o�Uie wark fa which mis permi�is issued�Sec.3097,Crv.C.I� � ,�y C.�i Lender's Name — C� ME a � J)l� ap Lender's Address � �'= CERTIFICATE OF COMPLIANCE ANO AUTNORI2ATpN OF ENTPY:I certify I have reed this applicstion snd state � (✓a that the infwmation qiven is carect.I apiee to comply with aN>tate laws am1 ciry ortH�unces mlatinp Io huilding �,� construction,and authorize a repreunwuv ' Deoartment oi Buildinp azd Smhry m mtrr upon Mre proarry � _� for which I haue ap � tor Mis permi r purpose of making inapxtbns. M•- '} � �.G� �� r�" nature af Aopiicmt ar Agent — po� RECPT NO. ����PAID BY VAUDATION on WHITE—Department Copy,YE��UW—Finance Copy,PINK—AsSessn�G"opy,GO�DENROD—File Copy,GREEN-ApplicaMs Copy ., ,� 5 � ..< �, ,, •� . . � .. , , _ . � �,;, . , ,::. ,. > ;.. �;... ;<.. .,w..,., .., ,. ... .- , „ ;� .�. , , � . , . , ,; ,.. ... , w;ud.� �'..-Z�� ��� �..�����e����,�����:�`�� ���a���� . . . . �;i`'���� ��,� � ���.��"� �`��q i��� �,.�d��&�'.r � �,�p��z���������.*a��. ,� �� ������t�„p�� ���� ���`����,��r����r"��z.. : �, �t���,�e���?��`�-����� �� :�� �" ,�'�',����`I�.����?�����n=: ����-� �� .��.m t s., ' � '�.������ � h .���Rk� :�°� �tY'A '�`'�" f� d� �.� "� :�*��„ &'m r"� �.,..�:,�p 8p��,� � . a?x �"`� ,�,. -i:� ��a s��z � �� �; �� ����'��:, �, ' ���r.�,�s ��.��`� i� ����ta� , � � ��,� �����5�. �i��:. ��i.,.�'° ��,��, a� }� i° ���:,.,:: A��.��:�€st�::����'���€���e,.n1�_�&�sSa�1��a�,���'�a������"w. ����:��`.,E.�.,�t.;��..�s��na��.���a .'�,��,.s,.:.,�����.,��,.a«,us�;Fa�,'xa�.A�..:�.�v�.��:���.'. ���at�r€���������.���`�.�x��:�i,������ ' �.E `" R � I � J S,': <ti ..,� . .�..�..v..._... . .. ... ........ ............ . - ��_._ _.... . . ...� , i •, A';`�.. .. ..?� :. .,'. 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