HomeMy WebLinkAbout1328 '"` CITY OF DI.a411flOND �AR PRESS
�,� °•" ' DEPARTMENT OF BUILDING AldD SAFETY
.� BIJILDING PERMIT FIFiMLY
JOBSITE b���� ��j�,J��. ��"j�n DATE CATION i ,��".�'�� NUMBER '�_CODE -
ADDRESS T �� - ISSUE .����_C TYPE OCC.
� 6 APN .___ LOT TRACT DATE �� CQNST. GROUP
� p CROSS STF�EET SETBACKS "'°"c"E'"E"'S
°° OWNER � `��v'P�i� �L�A A s�"J'''" ZONING FRONT �RW ❑
� o ADDRESS �� • /`� } _ REAR ❑
! W CITY � � ZIP • TE SIDE/SIDE STREET__ RW ❑
; a I APPLICANT� ��'��f�' ������EL,j'� 1 SIDE-- --- ❑
! $ _ _
� a CONTRACTO •� � � �r� �'''� � -�
' �� � �� � " �� �,t �� SEWACaE ❑ PUBUC PMT#
� o ADDRESS _ DISPOSAL
W CITY�-���d�ZIP TE � ❑ PRIVATE SQ.FT./100 GAL
� = STA7E �s � ` GRADING � CU.YDS.EXC. CU YDS FILL
� d LIC.NUMBER � � ���
� = TYPE SQ Fl` �ACTOR�S AdJ. AREANALUA710N
�' ARCH/ENG/ •�_` W. �
� �' DESIGNER -
� ADDRESS ���`'` L� 2
� � CITY ZIP _TEL.�' (�. 3
� x _,
� PROPOSED USE •� �t'�� z 4
,� w � � GARAGE
3 o NO.uWEL. NO. NO. � PORCH
� y UNITS STORIES BEDROOMS
i � LOT DIMENSIONS � VALUATION 8 ��-� ADJ.AREA � � L'�'
' o NO.OF BLDGS HOW �UAN7ITY DES�RiPTtON FEE
; W OV LOT USED ;4
� W — U — -
� x .:�
~ LICENSED CUMBACTUHS�ECLANATION I here6y affirm that I am I¢ensed under p�ovuions of Chapter 9(tommencmg
i Y with Sr.cnon IQ001 of Orvision 3 uf the Busmnss anA Pmfessions Code,and my hcense is in full toae and effec� ,�
i O J �
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LL �WNEN�HWLCIER OfCLAflA710N,I hereLy alli�m�hat I am erempt fmm the Comracmr's Lrtense Law far the fdbv+ing
' z reason�Sec 70315.Busmets and Pmfessians Cade Any cny ur county which requues a peimn to ronstru�t. .�(}
Io altai,impmvr.,demolish,ur rcVau any sVucune.pno�to ns ssuan[e,also rcyuirzs the epp�ican�to�such pe�mn z
! 1= tu Lle a siyneJ statemem Ihat he rs!¢ensed pursuanl lu Ihe provisions M the Contractor's L¢ense Law(Chapter 'm
�� 9 Icnmmencing wilh$ecuon 7G001 nl Orvrsian 3 ot the Husmess and Pmlessions Code)or that he rs eKempl therefmm .,��
f � ann tf�e Lusa!ar the alleged^xempfion Any�idaum�nl Secimn ID31 5 W any appl¢an�tor a permit su6jects ::��
f W Ihc app6cani ta a crvd yxnalry nf mn morc than irve hundred dollars(3500)L �� """"
� F ❑I,as r.wnc�ul Ihe puperty m my employees wnh wages as thei�sole compensaUan,wdl do the wnrk,and.
� _ ihe suuume is nni mtenAed or affered foi sale(Sec 704A.Rusiness anA Pwtesswns Cade The Cantracta's l¢enm <,Q
� V� Law Jues nut apply to an rnvn¢�ol propetly who builJs or impmves Ihereon,and who dces sucA work himsell, �t.? —
... or Ihtoup�MS own employees,piauiUed Oia�such impmvemen[5 are not in�ended o�alitmd lo�sale il,hawever,
m ihe huddu:g nr imprnvemem is sold widiin ane yea�of completmn,tM ownerhuilder wdl have Ihe hurden ot pmvmp �. ---.
�' Ihat Ik tliU nul Owtl or impiovr.inr Ihe puqwse a�sale.) '�S'.
y
� e/� UI,as nwner of thx puDerty.am ettlusrvely contracliny with IKensed canlracrors Io conslru[t 71�¢pro7ect�Se[ .� -----'--�~
� 7046.Rua��ess and F'mfessmns CuJe TIk Cunhactnr's Lrcense Law does not apply�o an owner d y�openy wha 'g
c
Q hmlds oi impruves iheieun,and who contractt for such pmle�ls with a conl�actaqsl�icenseA pursuant to the Contraatw"s � ..-'�
� Licensclawl �`TRLlG7�(�, l l
� � ❑I am e�empt unAer Se�. .B 6 PC IAuxh Cendaate) pLAN REVIEW _____
� o �a1e �^ef ELECTRIC __ __
d � WORNEAS'COMPENSATIDN OECLAHATIIXJ I hereby aflirm�hai I have a ceridiwte nf consent to setl-insure,ar ' pLUMBING _
� , a cerohcate nf Worker5 Compensa�ion Insurance,or a�erohed copY iheieot ISec 3800.La6 C�
2
,Q, ❑Cerufied copy is Icere6y hxmshed „� MECHANICAL __
� o �'�TT.ertiLed cuyy is ided with ihe Bmldmg Inspecliai�eDaiiment a� Deparunem Q GRADING w _
w -
= CfHTIFICfTf OF EKEMPT�ON FBOM W9flNEflS'COMPENSATI�N INSURANCE Thrs seotmn neeA nm be compkted ISSUANCE
� il ihe pen�nt is for ane hunJreJ(51001 or less I certdy 15at m the pedoimance ol the wak Por which ihis t.,,, �
� �' SMIP -' �
permrt rs issued,I shall�at employ any persan in any mannei so as to become suh�ect to tM Nbrkns"Campensalion
�". Laws nt Caldnrma
' o � PARK FEE
0 oa� aDD�icanl CL SCHOOL FEES
W NOTICE 70 APPLICANT N,afler making ihu Cerufwate nt EMemption,yau shouW become sub�ect to the Waker's
� Cumpensa6on provmons ol Ihe Labor Code,yau must,fo,�ihwf�M1,[ompiy�_wlM,su[h prwiswns a ih�s pErmit shell
�+- he tleen�e�ieuoked S� .� ::'� t •' `:.; , —
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� qVISI0N�1EIN0USfNIAL SAfETY PEflMIT CEHiIFICA710M. •� '- `"` "�� ������ �n�'� ��� - �1)l�'l� ,_`� ��(1�1�'P _
d LLafhere�y cenily thal no eMcaw�an irve(5�ar more feet�in depih into,wh¢h a persm�s rrymred ro deumd. ,���(1I � " �Ch , L�����
e�e will Le madr.in canuecLon with wark authaaed by iha ye�mit,and Mat na hwldi stmctue,staflolding IaiseworN. `� � ��
t �' ur demol�ion ur J�Sinamlmg Ihereof,wdl 6e m�e!�a�IhirY�sidj,j361'�C�'M1�i�p.3.2,Gry Y,Art 2,Sec ��� � ��-i� rj� 1 y
q W' 341.Tule .CA.C.L � S., iR �. •:,. '_
1 =
� 3 As uwnerhnilder,I wtll not empby anyo�re to do vrork which would require a permn hom the tinsan af
� Indistral Safely,as nnteA aMve.unlese su�h peYsan has�Dermn�ro�do suU'worM;ho�ihddivi'sian. �
� .. ' E � .. . .. •'�.
W ❑a�,�����,���8�5a�e�Y�,m��No. �. .. •. , -. , : ' . TOTAL FEES °��1 . 'IC"
a
f f,ON$THUClKIN LENI]ING AGENCY I here6y aiLrm that there rs a mnrnuctan kndi�p apency fa the performance
� = af tl�work lo�wh�ch Ihis permit is issued(Sec.9097,Ciu.C I r �;��--
� lender'sNai� COMMENTS � '�• � 4 W�-�
m tenAer's 11Adiess
� Q CEHTIGICRTE OF COMPLIANCE AND AUfFIORIZATI(N OF ENTRY�I ceufy I have read 1Ms applsation and steh C -
N Ihat Ih¢mfamatian 9rven rs corrtct I agree la comply with a�l state laws ariE tiry ordnuntes rel'tiq to 6wNinp
y cunsuucuon,and aufhorixe a iepresemaine e1 the Oepartrtent of Bmldinp and Safety m enta�qon Ihe qOperry
� = lo�wMc I h appbe r this lor the p se ot making mspecuons. j„�
� � � �d �
� �� � RECPT NO.�1�.�PAID BY 1 � VALJDATIO
� $ipnalua ot Applkmt ar Agent lleh
WHITE—Department Copy,VELIOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
1 :�,BS106-11!&9
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