HomeMy WebLinkAbout1542 ''�` CITY OF DIAMOND �AFi
� `-:..�`�" ' DEPARTMIENT'OF BUILDING AND SAFETY PRESS
� a -� BUILDING PERMiT FIRMLY _
JOBSITE APPLJCATION PERMIT w_ ,�_�,r• �_ USE
'� � �"� DATE � "�' � � ��NUMBER � '' `'� .�ODE
ADDRESS �� N �� Y - IS�UE r TYPE OCC.
� APN _ �OT TRACT DATE _ ��._ ��1�� CONST. GROUP
o CROSS ST�T •r-`'''�s��.�v'°" ��`��t✓ SETBACKS '�"E"TS
� m OWNER �rf.:�'�%P,��Sg !✓iY �-�f _ ZONING FRONT RW ❑
� o ADDRESS �`�_.5��� ��-'T"-' � REAR ❑
,� GTY.a�,��t� �•=1 � �� ZIP ���TEL.+���' a��'4� S�DE/SID�STREEl" RW ❑
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g APP CANl� �"� S�`_—_TEL.��o�`�`F SIDF_
4 CONTRACTOR '�-- �c'����` �� `�e$ � "T�"':�� SEWAGE
p ADDRESS �c� C...0 ����Yf,�'P e�� Su.fi R ❑ PUBUC PMT�
DIBPOSAL ❑ PRIVATE SQ.FT./1W GAL
'� W CiTY �.�.��'.��S�_. ZIP_ C'` •'-�- TEL��#'- �•-/ '
� = STATE C � —
y LIC.NUMBER �s�`J��' GRADING 0 CU.YDS.EXC. CU YDS FILL
TYPE SQ Ff FACTOR F'S AE}J. AFiEANALUATION
i ' ARCH/ENG/ t!3• ---- f
'� "' DESIGNER ___.___.._._� _. W 1 ; .�
� ADURESS !L 2
0
� z CITY __ZIP TEL._ (j. 3 _
! � PROPOSED USE—�� ' �rr,' " � ' 4 _
o i 1 �i.'.. -.Z�'�a C7. .-� �'� .� .GARAGE , „� '
o NO.GWEL. NO. N0. � pORCH � .; Y',` ' �
y UNITS / S'TORIES�BEDROOMS�— py `'� ���/'E�'' � � `� f��"7-1r''"`�"�•
� LOT DIMENSIONS_ VALUATION �%�-�•� ' ✓� �ADJ.AREA
� o iVO.OF BLDGS HOW AUAhITtTY DESC'r iPTlOt�l FEE
� W ON LOT_ _____USED �
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-� LICf.NSfll Cf1NTNAf.TORS OEf.LARAT10N.t here6y aliirm Ihat I am licensed unde�piovuions ol Chapter 9 Icommentug �.�� ,
;� � wnh Secuon 7000�ul�ivision 3 ul�he Birsiness and Pmfessians Code,and my Ixense is in full Imce and elfec� �
F 3 � �
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� ��+- iM1NNFN liU1L0ER DECLARATION I heieby ellum that I am exempt from ihe Comracmfs L¢ense law fai the foilowing
� Z �emm�ISec 1031 5 8usmess and Pmfessions CNe Any cily or coumy which iequiies e permrt ro cunsiruct, ,-(}
O al[er impm�e,JemuLsf�,u�repau any siructnre,pnnr to ils issuance,alm requiies ihe epplicani Por such permu Z
t� � m Ide.a�ignetl statement that he rs licensed pmsuam to Ihe pmvisinns nt tAe f.onVaclni s L¢ense Law ICha0ler .m
� 9(�mnmencmg wiih Secuon 7000�nf Ilvrs!nn 3 nl ihe 8usineat and Pmfessions Codel or Ihat he is esempt IM1erefrom ,,y.
� ;d, and:he 6as�s lor the alleg�l ereniptmn Any violatian af Srttmn 70;i1.5 W anV aDo6[ant Por a cermn suU�ecls :.'�
� !W �Ihe�applrtam in a r.nd penahy nt not more ihan live hmdmd 6ollan�550011 a _
,� L�JI as ov.�ner al ihe proparty,nr my employees witM1 wages as Iheu snle compensa�mrt will do�he worY,and
ihe snucture is nm imended oi offered for sale ISr.c 70a4.Bnsmess and Pmfessons Cade.The Cwtracmr's l¢ense q �
� �� law dues��m apply tn an awner of piuperty who bwhis or�mp�oves fiereon,and who dces such work himsell, C) '
-W a thruuyh I!rs uwn emyluyees,pm�aded ihat such impmvemenls aie not mtendHl or otlered for sak If,howe.ver, �,�,
'� :��m� the hmlding m�mpwveinem is sald witlnn ane year nl canplefian,the mvnerhuilder will have the hwden of pmving ��Q.
'y` ;-y; rI�h-al he did nm�wIA nr impmve tor Ihe purpose at sale 1 %x� �
.�. UI,as uwner ol tha piopeny.xn exclusveh�onl�actmy wilh hcensed cOnUa[lors�o cnnstruct iM pro�ect ISec. �� , `''�
� 7044.Busness ai�d Professions CoJe The Comrnr.tnr's L¢ense Law does not apply to an ownei ol piopeny who 'g ,�,...--.---���-�...�„ _ __ �v � :�J
�o ' '�.—,i� .
'I�� hudds m unproves iherenn,and who can[racts(ur such Oro�ecls witli a contiaaorlSl I¢en5ed pursuan�to the Cmlracior'S ,:• .+�
L•�enseLawl '� (��N.�"r��(,�i��ON '
� Q --����
� 'rc Q, �e I am exenipt urvJer Sec pWner �B 5 Pc lanxn C.eruticatel �M. p[/�N {�E�/�E�l _____
� ` ELEC'fRIC _
yWDHKf.HS'COMPENSATION DECLAflATIIXJ,I heretry afhrm Ihat I ha�e a ce�td¢ate ol cansenl lo se���insme,oi PLUMBING ,
a eerufica�e ol NbrNers'f.nmpensaimn Ineurance,or s ce��i�ied capy�hereot�Sec 3800.Lah C 1 — —_
.-o
"z ❑r.enu�ea�ovv�5 n�«ny i���:n�a � MECHANICAL
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�o ❑Certdied capy is liled wi16 the 0midmg Inspechon Oepartment or �eDanmem K GRADING
w. /'y
,:�` CEATIFICATE UF E%EMPTION FflOM WOBKEflS'COMVENSATION INSURANCE 7his section need not be compkted �rs`'�`VAN�E ^ �y'�i��`�,l+
�y d the permit is fai une hundied I31001 ar less.I tertdy Ihat in the pedamance o�the wak kr which this �ti
� ye�mrt is issued.I s ha l l not emp loy a�ry perwn in anY manner so as to 6ecome su6�ect lo th N6rkers'Com p ensalim � S M I P � � � � _
'� Laws al Califamia �^'
;o; � �ARK�EE
o; oate npp�uam — �J�. SCHOOL FEES
��� NOTICE TO APPLICANT II.a0er makmg this Certi6cate of ExeAipribn,yGa'�sinidd�b'eiolne sub�ttt ro the Nbrker's
°'-�.� Compensanon provisians of the lahor Code,you must fathwitA�cul�{pry'w'iih such�p�wisbns a tAis permil shall . '
�� 6e JeemeJ revaked •• ���� " �
J ' ' .
.s pVISIqJ OF INDUSiflldl SAFETY PEflM1T CERTIFICA71pJ�
;,�; , ,/ /c' � j`�-}� /�� •�
Irere�y cenily ihai no ezravauon irve�5�or mae,JRe4u��Qepth�No„�Yih�[ha•puspS�s reqmred ta descmd, � �'� � (. _.�{JL..' �-a �,
• e�e will be made m connenron wilh work authaved hy th�s�eS�ih a�Ihat nn hGddinj��INc�u'.stalloldmp,talsewo�k, / �^ �
� m tlemohuun or tlismanthnp Ihereol,will 6e mae Man�tAuty�tiw�36�leet highr`�qi2p��.2.Gry 2.Art 2,Stt � ! (� !� �
W', 341.TitleB,CACI. -l�f�.�� i� '\��f1...Y/1.-"�� --`' IR.� J
_ 11�..
:3• C�As ownerbmlder,I wdl nol empbY anyoire�tn do��1!a�rk.which 1wuM requrte a pxmit irom Ihe�Uvition of
' 1— Industnal Safety,as noted ahove,unless such pefson ha5 a,permil to,tlu such work ham ihe divisian. �
..�. :.�.:.. �. . . . .
';W'� ❑Urisiw of Indislrial Sakty Permn No
�.� TOTAL FEES
��� LONSTRUCTION 1EN01NG AGENCY I here6y afli�m tAa�Ihere is a mnstrucl'an lendi�apency lor 1Fe perM�mma ' _
,'x nf�hx work fa whsA this permit is issued(Sec 3091.Cv_C� {, � � } /'�
'�� Lender's Name r' R (
� COMMENTS�YL� �rk, I:'1� ( .�i�._.. - l._-f f..=.
ep lemkr's Addiess —��y�.� �_� ! . ,�; e�
�4 CENiIFICA7�OF COMPLIANCE ANO AUTHOHIZAT�V OF EN�NY.I tMify I have read Ihis applieNian and�lale ���[
vJ tlia�Ih nfamalan 9rven is caiect I ag�ee to comply wrth all stare laws and ciry ordiwnca relalinp ao 6uilA� ``-�
y constr hon,and authorue a representatae nt Ihe Depertment inp and Safety ro enla upon Ihe pi0perty
lar reh �d for Ih�s rt for t wpose ot maY inspee s.
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� ��. � �rm '�� �.� �� � � RECPT NO. `--! +1`-? PAIO BY � �—VAUDATIO �
natwe of Applicant or Age OeM
WHI7E—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicaMs Copy
8S106-11/89
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