HomeMy WebLinkAbout1343 (17) , '`� CITY OF DIAMOND �AR pRESS
�-"'" ' DEPARTMENT OF BUILDING AND SAFE7Y
��^ BUILDING PERMIT FIRMLY
JOBSITE ;L:7t.�r�1� �'jr,s ,i..t��cS �►%• APPLJCATIO PEFtMiT � USE
ADDRESS �t��fi�'��' , C:.� `�%�'C:�.9� Fi'���a� DATE _NUMBER CODE
- ISSUE TYPE OCC.
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�� APN _ LOT TRACT _ DATE CONST. GROUP
o; CROSS STREET SETB CKS �E��
°�°� OWNER C''HA��.�.5. i✓• !�f�"��°I5: ZONING FRONT RW ❑
o; ADDRESS_�.�.e'�"� RI� �.�'C��`.S R�'�� REAR ❑
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o' APPLICANTC'•��f1�d.�.i ��"• .�'I��ri��� TELF ��°�.a S�DE ❑
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a� CONTRACTOR fl'N � �--17�J
�� SEWAGE ❑ PUBLIC PMT�
o ADDRESS� DISPOSAL
„�� CiTY TEL ❑ PRIVATE SG1 FT./100 GAI.
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y; LIC.NUMBER GRADING ❑CU.YDS.EXC. CU YDS FILI
y} ARCH/ENG/ tn. 7YPE SG� FT FAL�R F' ADJ. REAN LUA710N
�, DESIGNER � � � m
� ADDRESS 1,� 2 • �r�. �
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o;' PROPOSED USE l �I Z" 4 � �
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o; NO.GWEL. NO. N0. � pORCH '
N? UNITS___ � STORIES ! BEDROOMS� � ° A
�. LOT DIMENSIONS � m VALUATION � ADJ.AREA�
; o'.• NO.OF BLDGS HOW QURNTtTY p�$CRIPT40N, ' ' FEE.:�. �.�, "
= ON LOT ' USED � �''�S
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' �' IICFNSfO COMFACTf1RS DECI.ARATION I he�eby aflinn Ihat I am licensed under piovisions ol Chapler 9lmmmencing '� "
t Q. wnh Secunn 7000�of�rvisinn 3 of ihe Busmess and Pmlessions C.ode,and my hcense�s in�ull fUr[e and eBect ,W
� 3° � .:� —
LL, fJvVNFN HUif Ukfi 06CLARAl10N:i hr,iehy afM1rm IhaP I am e.empt Irom ihe Coniraaofs L¢ense law lor tAe Idlvnmg ' —"-'-'-
i � iensm:ISec 70315.Busn�e�s and Pmlessions Cale Any uly m caunly wnidi requires a permit ta mnsfruct, ��(} � �- 9 -
o aher,impmve,demolish or repart any slmcture,prior to its issuanoe,also reqwres the app6r.ant fo�such permit '"� ----�-- i
h lo Ide�si9neA smtemem ihat he is hcenseA Oursuant lo the pmvisions ul the Canuac�or's L¢ense Law�Chaptei 'm t
�� 9 I�mnmenciny witli Seclion 70001 0l Divisian 3 ul Ihe Business and Pmfessions Cade�or 1M1at M1c is exempt therehom .�
' a� and�he basis for the alleped erempVon Any v�olallon of Sectian IU31 5 6V any applicant fm a permit wh�ects ;�� �
� x the epplicant Io a crvd penahy o�not maie than live hundmd dollars(3500)I �-�� -
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i �' I,as wvnei ul the proVerty,ur my employees w�lh wayes as lheir sole mmpenutian,wdl da the work,and
' the shucmre�s not mtendr,d nr nl�ered tnr sale ISec 7044,Busmess anA Pmlesswns Code�The ContractoYs LicenSe Q /t • ! �
�• I.aw Aoes not apyly lu an uwne�ul yroperly wla 6uilds or improves Ihereon.and whn dces such work M1imself, .(,)' a�L�� _ �
•.• or�hmugh hrs uwn emUluyxes,pmvNeJ Ihat such enpmvemems arc not mlended a otfered for sak.II,however, ����Z' �
� m� �he AutlAir.g nr�mprovement is sold wuhm ene y¢ar of cempletmn,ihe ownerhutlder wAI Aave the hurden nf preving "�rj;
y �tha1l he did noi Lmid ur�nipiove tor flre pwpo5e ol sale� .�' �
y ul as owner uf Ihe praDerty.am exdusrvery conhact�ny with hcensed caitrectors ta cmishuct the prulect lSec. [�j��,----- — --
0 7f144,Business and Prnlessions f.nde�The Comracror's license law does not apply to an owner ot property who g
= limlds m impioves Iheieun,and wlw coNroct3 for sich pm7ecis with a conlrxNrlsl I¢enseG DwSuani 10 ihe Caiiiacta�s
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a �"�"4tLd1V� CON57RUCTION �0 d �
, F ❑1 am ezempt under Sec .8� PC IAtlach Cernhw�e) � P EVIEW ��� � �
o w�e 3' ts � �• 3 ow�� L�-�_IC' � c�
� � WJHKFHS'COMPkN5Af10N I7EClAflAT10N I herelry athrm Ihat I,have ayreruf¢ate af crosent'to self�insure,w -;�
a ceruhcate af Nbrkers'Compensation Insurance,or a cenified copy ihe`eaf ISec 3800,lab C I �� LU �.�"� !��
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� _ ❑Ceiuf�eJ copy is he�eAy Iwmshed �. f{�... ���
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G I.�C.ertdien cnpy rs filetl wM the Bwitlmg Inspecuon DeOarlmen[a oepartment. Q' GR NG ��
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� CERTIFICATE OF EKEMPTION FHOM WORKEH$'COMPENSATION INSURANCf:This secuon neeA not 6e compkteA ANCE�_ b _
y rf me Dermrt is far one huneretl�510D�ar less.I cenify tlat m�he pnMimmce ol the work tor whKh this �,,, —
� yennit�s issued,�shall mt employ any parson m any manner so as m 6ecome su6�eot to the Nbrkars'Canpensatim
� Laws ot CalAomw. g � •w. (� � l
" �"�L-`7 »2 I ��� �" %s , - �.. W PARK FEE �--�
p Oa�e u Apphcam�' -i . • + �.• • —
� NOTICE TO APPLICANT If, Ier making Ihis CmULcaie of Exempuon,ya,slwuld become sub�ect Nbrker's �- SCHOOL FEES � ^<
-� Campensaumi pionsions of ine Lahor CoAe,you must fa,t6�q�c�7pry iV��i;'suCA,pravrsrons a permit shall
LL be Jeemed revoked .
s �IVISION OF Ml1USTfliAt SAFETY PEFMIT CERTIFICATION�'�}��` ������ ___ _
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� d I herehy ce�Ofy thnt no ucaval�an five(5)o�mae feet m depih imo wh¢h a person�s requued to desrend,
� will made m mnnectwn with wor4 autlwaed hy Ih�isy�i9mit,a�Ihat no hu�diuly stru�cture.tqlPoldinq,falaework,
nr dr.mnl�inn or dismantling thervaf,will Ee more'tFahb1qrVty-�i��36�fat�nglr{f�ip 3.1,Gry 2,Art 2,Stt
' z 341.TifIeB.CAC1 .;Qd'P t � . .
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3 As awnerbwlder,I will nat empby anyone to do work which wauW reqmre a parmit Irom Ihe Gvisian M
�.- neu ial Saleiy,as nmeA above,unless such pe�son�has a mt to�do suoh wurk�rum 1he;divuiU�.',
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W ❑pvismn af InAustrial Safaly Permn No '-� ,: -..,.�, �.� . ..•. . - ' �0��� ����
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� CONSTRUCTqN LENDING AGENCY:I here6y aflirm�hat there is a constru�tion kndi�g apency la tice pelfomiarwx )
Z of tl�x work br whxh Ihis permit is issued�Stt.3097,Civ.C.�.
� Lender's Name (',�MMENT$����`� ��'K � �
p=p Lender's Address
e CEII�IFICIITE OF COMPLIANCE AND Ail�IUFdZATION OF ENTflY I certAy I Aave read IMs application aM state
Va that tM1e iniarmatron grven is correct.I agree to compFy witF all sla@ laws and ciry ordinances rchhMp to buJdi�
ycunstructwn,and auihorize a represemame of�he Depanmem ot BmNiiq xtl Saiety m enm upm Ihe gapeiry
fw which I have a Kd lor Mis permn lo�tM ae of makiig inspectans.
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, 9qnaiwe ot auWKant or Agen p+� RECPT NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,C+AEEN—Applicants Copy
BS106-17l89 .
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