HomeMy WebLinkAbout044 (4),OF, CITY OF DIAMOND BARPRESS i �
DEPARTMENT OF BUILDING AND SAFETY FIRMLY
BUILDING PERMIT r, ,
JOBSITE
ADDRESS AJWHUh1)1JkR
APPLICATION PERMIT U E.
DATE �. NUMBER CODE
ISSUE TYPE OCC.
DATE CONST. GROUP
APN L T TRACT
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OWNER
ADDR SS
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APPLICANT TEL.
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CONTRACTOR
ADDRESS
CITY ZIP TEL,
SEWAGE
DISPOSAL - ;D PUBLIC '. ��•PMT.��
PRIVATE SO. FT./ 100 GAL
STATE•.
LIC. NUMBER
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GRADING ❑ CU. YDS: EX& .. CU YDS FILL `
TYPE: D FT :F S AW. . EANALUATION
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DESIGNER
ADDRESS
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CITY ZIP TEL.
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PROPOSED USE
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GARAGE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
Ca
VALUATION ADJ. AREA
cauANTlrr DESCRIPTION
NO. OF BLDGS HOW
ON LOT USED
LICENSED CUNTRAMURS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter G Icomfmwing
wnh Section 70001 of Owision 3 of the Business end Professions Code, and my license is in full lures and @Nett.
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06WNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License law hor the fallowing
reason (Sec. 7031.5. Business and Professions Code, Any city or county which requires a permit to construct,
°her. improve, demolish, or repair any structure. Prior m its issuance, also requires the applicant lar such permit
to file a signed statement that he is licensed pinsuant ID the prnvimons of the Contractor's License Low (Chapter
B Icommencing with Section 7000) of Division 3 of the Business end Professions Corel or that he is mampt therefrorn
and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).1:
❑I, as owner of the property, or ary employees with wages as their sole compensation, will do the work, and
thestrature is not intended or offered tar sake (Sec. 7044• Business and Professions Code: The Cimtractor's license
Law does not apply to an owner of property who builds or improves thereon, and who does such wad himself,
or through his awn employees, provided that such improvements are not intended or uttered for sale. If, however,
the building or an vemvns is cold within one year of completion, ten owner -builder will have the burden of proving.
that he did not blind or improve for the purpose of sale.)
❑l. as owner of the property, am exclusively contrectmg with licensed contractors to construct the proton (Sec.
7044. Business and Professions Code: The Contraclor's license Law dome at apply to an owner of property who
builds or improves thereon, and who contracts fent such projects with a contractors) licensed pursuant to the Cecractim s
License Law.)
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CITY OF DIAMOND BA 3
LDING AND SAFET
173
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CONSTRUCTION
❑ Ia m roan c. B. P. C.IAttachC@mOcatel.
PLAN REVIEW
Dot° °"M`
ELECTRIC
PLUMBING
MECHANICAL
WORKERS' COMPENSATION DECLARATION. I hereby affirm that I havea certificate of consent to self -insure, e
a certificate of Workers' Compensation Insurance, or a certified cap, thereof (Sea 7800, Lab. C.I.
❑ Certified spy is hereby furnished
❑ Certified copy is filed with the Building Inspection Department or D°partment.
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GRADING
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need net be completed
it the permit is for one hundred (81001 or less. I certify that in the performance of The work for which' this
permit is isswd. I ship net employ any person in marry manner so as to became subject to the Workers' Compensation
Laws of Californa.
nt
Dora Appate
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ISSUANCE
SMIP
PARK FEE
SCHOOL FEES
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of
NOTICE TO APPLICANT: N, after making this Cpetifcate of Exemption, yco thodd became anbjttt to the Worker's
Compensation provisions of the Labor Code. you must forthwith comply with such provisions or this permit shag
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
1111 hereby certify that no sacavation five 15) or we fent in depth into which a person is required to descend,
will be made in connection with work authorized by this permit, and that ne building structee, scaffolding, falserwork.
cr demolition or dismantling thereof, will be more than therly-sur 135) feet high. (Chap 3.2. Grp 2. An 2. Sec
341. Tide B. C.A.C.I_
[]As owner -builder. I will not employ anyone to do work which would require a perms from the Division of
Industrial Safety, as noted shove, unless inch person has a ppemn to do such work from the division.
❑Division of Induslriel Ssety Permit No,
FEES 76 q1L
CMSTRWr[ N LENDING AGENCY. I hereby affirm shot then is a construction lending agency for the performanceTOTAL
of the work for which thus permit is issued (Sec. 3097, 6v. C.).
Lender's Name
COMMENTS
Lender's Address
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I specify I haw sad this application ad sem
that the information given is correct. I stripe to comply with an stme lows cid city ordmancn redcing to building
construction, and authorize a representative of the Department of Building and Safety to enter now the property
ler which I ha apphed b thus,permt kr the purpose s meklp inspectpns.
RECPT NO.� PAID BY� VAUDAT
X A
gnatur@ of p icant or Agent gam
WHITE—Department Copy, YELLOW—Finance Coo PINK—Assessor Copy, GOLDENROD—Fie Copy, GREEN— Applicants Copy ��
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