HomeMy WebLinkAbout1564 (22) , '`� CITY OF DIAMONa �AI� PRESS
'-" ` DEPdRT11AENT QF BUILDING IlND SISFETY
�� BUiLDING PERMIT FIRMLY
JOBSITE APPIJCATION ��d'�' �� PERMIT USE �
ADDRESS �Q�+' 'rJ' . �'JUm�i7�2.iD(� DATE �.� „�NUMBER � CODE
IS�UE ��'?"�' _ �� �i.%��j TYPE OCC.
� APN LOT �'7 TRACT 2 "1 DATE ��1 �' � _CONST GROUP
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o CROSS STREET �s+2RN n ZD�I�� SETBACKS �""E"'S
°' OWNER �+.��� m�a7r�ntz�- mr�H FRONT RW ❑
� ADDRESS q�� �- 5�+� iS�-° +��" REAR ❑
W CITY �j`�-�+��+D �� ZfP ►�b� TEL.'�!'� �'� SIDE/SIDE STREE'f RW ❑
o I APPLICANT �'ra��- M�n�t'�--tv]a-� TEL.g��4�� SIDE._� ❑
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a CCNTRACTOR ��.��nS � SEWAGE ❑ PUBLIC PMT�
o ADDRESS �(7(c t.-arnf�q�fr-D�/ DISPOSAL
W CITY ���ht� ZIP�.L�1S�TEL.n�� ��-�i � PFtIVATE SQ.FT./100 GAL
= STATE GRADiNG ❑ CU. YDS.EXC. CU YDS FILL
y L{C.NUMSER_ �P� gq �-�q�R PS �AD�1. AREANALUAI'ION
ARCHlEf�1Cz/ . � �
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� DESIGNER -'""---,_� „�� W __ ,^
Q ADDRESS `"--�4----- � 1.3,. 2 _
a CITY ZIP TEL._ (►j 3
� PROPOSED USE_ Z 4
� � GARAGE
o NO.DWEL. NO. NO. � PORCH
y UNITS f STORIES�BEDROOMS�_ --
� LOT DIMENSIONS m VALUATION ADJ.AREA
o NO.OF BLDGS HOW QUANttTY DESCRI IOI�I FEE
W ON LOT USED �ES��t��=� Q
�
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~ LICENSE��ONTRACTOFS OEC:AflAT10N�I he�ehy alfirm that I am fcensed under p�ovisions al Chaptw 9 leommencmg s; •^—
� nnh See�100C;•oi[Hvision 3 al the Busmess antl Prafessions Cnde,and rtry hcense is ir.full inrce anC elfect �
3 111
LL aNNER�BWLOEfl�ECLAflAT10N:I hereGy atfirm that I am eyempt from the Contracloi s L¢ense Law!or the lollowmq ..
reasan�Sec.70315 Business and Pmfessrons Code:Any uty or caumV which reqm�es a permit ro contiruct. (} . � � .
o alter �i�Uruve.Uemolis",or reDau any strucmre,o�io�to its�ssuance,alm requires�he applicam for such permit 2 —
F- Ic f�le a signed statement that he rs licensed pursuam to the pmvrsions oh the Camractoi's L¢ense law IChapler py
� 3 irnmmencing witli Seclion 700�1 al Dimsion 3 of the Busness aM Pmfessions Cade�ar Iha[he is exempt Iherefrom �
d antl ihe hasis lor che allegeC^xempoon Any violaiian of Section 1031 5 hy airy applicant loi a perme su6�ects �
W thet a�phr.an!�o e aivA penalty of mm�cre than Irve hundred dollars(550011 a
� LJI as.wrei ai the proper4,oi my emplayees with wagss as their sole campensalion,will do tlie work,antl `
~ the slmtmre�s not��'.tended ar offered'or sale�Sec 70C4.Business and Pmlestions Cade The Cm7racl0i s LiCense �q � ��,�� ^ '+ �t '��, .i(�� j
� Law Jaes nr.�apPly to an awner ol property who builds or improves thereon,and who dces such wark himselt. (� �Y=�.,-�= u ,
,•� cr rtmugn h�s own:mpluYees,pmvided Ihat such impmvements are nM mtendeG ar aflared tor sale If,however, Z
m �he ewidinq or�nomvemem is sold wnhm one year of completmn,Ihe owner�wlde�wtll hav¢Ihe bmden af O�ovmp Q __
� thai he A�0�et hud0 ar�m0�ove fur the purpose of sale.� �
y
en ❑i as owne�of:6e prapeny,am eMCWsrvely comnumy wnh Ixensed canu�ciors m canstrwt the prqect ISea �,{�
oi044.Busir.ess anJ Pmfessians Cade The Contracmrs Lirense Law does nol app1Y to xn ownn uf Oioperty who �
Z bwids or�mpmves thseen,and wnu canba[ts for such Orolects wah a comractorlsl Ikensed Oursuani to the Camracta's
Q Lcense law i CONSTRUCTION
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�++ ❑i am ere�o�unner sec B,B P.t IAltath Cendicatel PLAN REVIEW
�
� oa`� °`"^°' ELECTRIC
� Vr9RKER5'C�MPENSATION OECLARATIpY I here6y affnm I�at I�ave a ceruficate o1 consent Io se�4insure,ar
z cernt¢ale ni Workers'Compensa�ion Insuranre,ar a rertil�ed copy ihe�eof�Set.3800.Lah C 1 PLU MBING __
C �''!
Q C Cerirt�ed copy is herahy fwmshed MEC.k�A�U�AL�- �f'r ti-�
o ❑feruLed copY rs filetl with the 8wldmg Inspecua��eDanment or Uepartmem. '� GRADING
W AIr
� CERTIFIC.ITE OF E%EMPTION FqOM Vvl]HNENS'CU7PENS0.TION INSUHANCE This section nceG nst he comqeted �SSUA'�v`�,�.--' +��
y tl Ihe peimit is far one hundred 15100)or less I certify that in the pedormance of ih¢woh loi which this �,,,,, .
yermil is issue4 I shall not emplay a�y person m anV manner so as W bacome sub�xt ro tM Nkrkers'Campenution SMIP
= Laws nl Cahtorn�a_ ,,, ,-•.-�-.. �
� ;. .,;, ,;�.� - LJ„1 PARK FEE
0 oa�r >"';,aeai�e^�'" , tJ., SCHOOL FEES
"-� N0710E TO APPLICANT If,afler mating this CecLficaie af Eicemption,you ShWW LCCOIIIE SII�Ki M(IIC Worker's
J -
� Camper.sauon promsqns of��e La6or Code,you must lar�hwith wmply with s�eh pmviswns or this perme shall
LL 6e deemed ieuoked.
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¢ qVISION OF INUUSfNIAL SAFETY PEAMIT<EE�ITIPR�iI� �? 4���'�j�
� r-1 ��e- ti.�
o L:I har�y cerufy thal no excavalwn hS!(5�"or more feet m deplh into whicM1 a persm is required to descend,
ae will he made fn cannecum wnh work wlYareM 6V this permtt,and lhet no hilding structure,scatfoldmg,talsewaM,
� or demolainn or dismantli�tkreot.wdl he mme then thir)y-si��36h feet�high.�Ehap.32.Gry 2,An 2,Sec
w 341.TnIeB.CACI. - , , . ... •� -
_ :.,�'t �� � ' � . .... . '::. :
3 ❑As awner6wlde�,I will nm empbj�'anyone`to.�do worE'whieh�would�eqmre a permit Imm Me Oivisron of
H Indusirial Salety.as nated ahove,unleS's such person has a pnmit to do wch work fram the drvispn
� �
� ❑6msmn of Ivlustrul Sahry R¢rmit No. TOTAL f EES �''
� CONSTRUCfION LEN�ING AGENCY:I here6y affirm that there is a construc�im lendi�aper¢y Fa!k patoimance I
2 oF the work for wh��h Mis permn is issued(Stt 3091,Crv.C.�.
� Lender's Name COMMENTS
mLender's Address
Q CEHrIFICA7E OF CONPLIANCE ANo AIRNORZATOV OF ENTNY:I rsrtily I tave�eaa�his applk�tian aiM suk
fn thal the�nformauon g�ven is care�t 1 agree io comply wtln all stMe laws a�d ciry ordironces rcNWp M huildi�ry
y construmm�,and authouze a repesematrve ol the Oepwtmenl of Buddinp and S�fety ro entn yan lM1e woperry
= for wh¢h I have aoGlied for Ih�s permtt fo�the pwpou of makinp inspe[tians.
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X ��.t.� �9 N�l.�r'USl[. ���, •� _l /'��- �� .� / l^l.` ��f\�-
sqnatixe ai Mp��cant or aqen�T'—"' mte RECPT NO. PAID:3Y VqLIOATION�,�.
WHITE—D�partment Copy.YELLOW—Finance Coqy,PINK—Assessor Copy,GOLDENROD—File�Copy,GREE�—Applicants Copy
BS106-11l89
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