HomeMy WebLinkAbout1197 '"� CITY OF DIAMON� BA� PRESS
'-�" ' DEPARTMENT OF BUILDING A�ID SAFETY
�� BUILDING PERMIT FIRMLY
JOBSITE APPUCATION�_CL�PERMIT USE
ADDRESS �'���� ���n -�-��°�i SSUE � +� � N�ER�_�CODE
� APN LOT TRACT DATE �J 1� C�CONST. GROUP
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o CROSS STREET ZONING SETBACKS �"�
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LL ADDRESS Z3�3'�l „�j1'C'�n -e C�.rtc, �7� REAR ❑
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a CONTRACTOR� S�r� � �?����`i t`rC SEWAGE
o ADDRESS`�'�-i\ �', �"`t'� -.`'�-+}~ ❑ PUBUC PMT�
DISPOSAL ❑ pF;�VATE SQ.FT/100 GAL
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y LIC.NUMBER ���SC1 S C--^� GRADING �CU.YDS�.EXC. CU YDS FILL
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`=' DESIGNER W 1
� ADDRESS iL 2
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Z CITY ZIP �"'°��- TEL. � 3
� PROP�Q�SE.D USE � { � 4
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o NO. DWEL. �` NO. NO. j G � pORCH
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e L O T D I M E N S I O N S V A L U A T I O N �U f � A D J.A R E A
o NO.OF BLDGS HOW �UAN1'tTY D�SCRI IQN ��E
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UCENSE�CONTRACTORS OECLARATIUN.I herehy aflirm Ihat 1 am Iicensed under provisions of CAapRr 9 fcommencmg �
� wrth Ser,mn 70001 0l Oiwsion 3 af�he Business anA Professmns Cade.and my liceree is in f�AI torce and eHect �
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LL 04VNER�BJIL�Efl�ECLAPATION i here6y aH�rm Ihat I am exempt Irom the Contracmr's License Law la the folbwing
Z reason iSec 70315,8usiness and P:aSessions Cade�Any ury oi county whch rcquues a permn 10 cunstrucl, (}
o al�ei.impmve,demohsh,s repau arty slrucNre,D�ior to rts issuance,alsa reqwres the applicam lar such permi� �
Y- to h!e a signed statement tha[he is!icensed pursuant m the pia�isions ot ihe Cantiacror's Licence Law iChapter m
� 9lcommenung wah Section 7000�of Orv�sion 3 0l the Business and Pratessions Code)or Iha[he is exempt therelmm ,�
a and the hasis iar the alleged exempaon Any violauon ot Section 70315 br any appllcam!oi a pe�mil sub�ects �
x ihe aUDI¢ant ro a�rvil penalh•of r.ot mare thar.hve hnndred dollars(f5001;: a
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F ❑I,as nwne�oi the propeny,a my employees with wages as thev sda compensalion,wil�do the work,and --
[he stmc;ure is no�m;ended or olfered foi sale�Sec 7044 Busness arvl P�otessions Cade:7he Contracloi's License d
� law Aoes nol ap01y to an awner at O�aOerty who builds oi improves Ihe�eon,and who dces Sueh work himself, U
' or Ihmu9h hs ewn tmployees,pomded that sucF impravements are not mtended or olfered loi sale II,Aowever, Z
m the buildmg rn�nprovemem is sold withm one yea of campletion.ihe owner-hmide�will have Ihe hwden of pwvmg sG
� thai he did noi ouihi ar improve for�he Ourpose af sale 1 �
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�a ❑I as owr.er ot the pmperty,am eMclusively contracfiny witM1 IicenseC coninclors ro consiruct ihe pro�ect ISec ��yy
0 7IW4,Business and Piofessions Code:The Cantracmr's L�cense Law daes not applV to an awner af pmpenV who �
x bmlds ar�mpwves thereon,and who contrans lar such pm�ects wrth a contracmrls)licensed pursuam to ihe Comranor's K
Q Licer.se Law.� CONSTAUCTIQN � F.
O �.I '
� Ci I am exenpt under Sec .B.&P.C.�AttaCh Cendicate) PLAN ICYY
� `�`e °"""e1 ELECTRIC
� WOHNEAS'COMPENSATION OECtARATION I herehy afUrm�hat I have a certih[ate ol cansent to self-msure,or
a cerohcate ni Workers'Compensatmn�nsurance,o�a cerused wpy ihereot ISec 3800,lah C I. � PLUMBING _
a �''cera�ied capy is hereey fu�msned. � MECHANICAL
`p ❑Cernl�eA capy�s filed wilh ihe Buildmg Inspeclian DeD�lment oi Oepanmem Q GRADING _ _�i ,,, �•
Z�„ ",.ERTIFICATE Of EXEMPTION FROM WDHKERS'COMPENSATION�NSUHANCE This section nred not be campkud SSUAN l �
y d the permit is for me hundred ISI001 ar less I ceroly thal m ihe perlormance ol the worA fo�whkh"th�s �� —
permrt is issuetl.I shall not employ any permn in any manner so as to�etome su6�ect to tbe Vlbrkers'Canpen5ation S`M .�
� Laws ol C f r a
o ����� c'�� ,��'_ uJ PARK FEE _
p �ate � AppliCd��-` �
� NOTICE TO APPLICANT If,after makmg this CerelKate al ' U t_:Yw;shaild•Ii�come suh�¢ct ro�he WorMer's SCHOOL FEES
� Campensal�an p�ov�sions ol the Lahor Code,you must krtl4Lith -�lji�.ur�th:sueKprmnans ar tlns permn shall
� 6e deemed revoked
J
� pVISIOM1I OF INOU5TAIAL SAFETY PEAMI7 CERTIFICATI�H: y� ,+�
� ❑I herehy cerhfy that nn eycauaUon live(5)or md������depth inm w�'s?p�sm is reqmrM m descend,
� will 6e made m cwnection witM1 work autha¢ed by t}lis�Brrt1P,and�Mat ip hui�dM'p"iiid�tue,staMolding,talsework.
d a deno6tmn or disnamling thereof,wtll he mae Ihan thmy-six(36)teet high �Lhap 32,Gry 2.An 2,Sec
W� 341.Tme8.CA.CI
_ ��;...,,. ,...,. ..,,. . .....�. '. ::' '�,'.:;
3 ❑ps ownerhmlAer.I will na[empby anyonei�o,do wurk'^whil6�wouW.requiie�a�pnina:�liom Me Oivisian of
� Industnal Salery,as na�ed a6ove unless such�e,1mn has a'Oerr�ii iq do qycA qro�k;fiam UieErvtiqp:
�
¢ ❑Qvision ul lndustrial Safety Perm�t No ��;7 .���
� TOTAL FEES �
� CONSfRUCfION LENOING AGENCY:I h¢reby aFfirm thaf tlere is a construction le�inp agmcY 1or the pnbrmante �i,�
= af thx work far wnrth Mis permil is iswed ISx.3097,Crv.C)
� lc�der's Name COMMENTS
m Le�'s Address
Q CENTIFICATE�F Cqy1PLIAACE AND AUTtpPoZATIdJ OF EHiI1Y I cerrily 1 have rtm�6iis a�pliatim and�tYe
eA that Ihe inlormatian gnen rs mrect I agree m wmply wrth ail sWle laxrs aM cily or0i�wnces rdalinp lo buitli�
y constructan,and autlmnie a iepresentatNe al the Departmem ot Buildinp and Safety m enm upm tlx properry
= for which I have a001rd for Mis permrt for iM qppou af makinp i�upeclians.
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� � �— RECPT N0.1 l/�,�_PAID BY�,��VAUDATIO
Signature M Apqeam a Agem Dot
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,C9REE'V—Applicants Copy
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