HomeMy WebLinkAbout1715 ,�. �'�`� ��_��� CITY OF DIAMOND �AR pRESS � �," ' DE�AR'TMENT OF BUILDING AND SA�ETY �^� BUILDING PERMI7 FIRMLY JOBSITE APPUCATION J r,, r� a � PERM�T USE ADDRES��/ � . DATE L � 7� S'Z._NUMBER���CODE � APN LOT y TRACT ATE ���—� �� TYPE OCC. ! - � —CONST GROUP o CROSS STRE T SETBACKS ��� °� OWNER �N�I/�I/�/���1 / ZJNING �ONT qW ❑ � ADDRESS�S�J�Ldf°� �'/ �f- REAR '1 ❑ W CITY�/� �`` v X-� �'IP TEL.S � SIDE/ RW ❑ o�APPLICANT �-� ��� �'���TEL�� SIDE ❑ Q CONTRACTOR � ''� '� � ���'f'` �','`� `�--•� SEWAGE o ADDRESS � �P.C.� C'�"9��'�C'v G� DISPOSAL � p��BLiC PMT# W CITY ��L�•�`�l°�9 /J�-' ZIP c� k�TEL.��✓X�r. :,-- ❑ PftIVATE SQ.FT./100 GAL = STATE -� ,, --ti � y LIC.NUMBER �f���S� _ GRADING ❑ CU.YDS.EXC. CU YDS FILL y ARCH/ENG/ ,,�/ .�I tn ��E �'� � ���'�R p�" ���• AA�ALUATIOIV = DESIGNER T��/� � S ��r'�� W 1 . '� � ��� � ADDRESS /'4`� / L�5 ec~'% c� n=- � Z CITY /l�� �✓ `��� ZIP TEL ��?��/ �r 3 � PROPOSED USE � C ���Z 1;L Z 4 � �� �3<.� �r?')[-�..G . � GARAGE o NO.IiWEL. NO. NO. j PORCH y UNITS STORIES BEDROOMS , � LOT DIMENSIONS � VALUATIOfV - �,p ' ADJ.AREA o NO.OF BLDGS HOW auaturrTr p�SCR1PTI�N FE� W O�J LOT USED � U r . �� = ac ,• �, ��� � , s.. ~ SE�CONTHACTOPS OFCLApATION I here�y alfirm thai I am I¢ensed under pmwaons at Chapter 9(cammencing � � � , `f � �3 wnh Secoon 7000�of Orvismn 3 oi ihe Business and Pmfessmns Code,and my hcense is m full fo�ce and effect � 3 � {j u- TNNEA-BUILUER OE0.ARATION�I herebv afhrm tha�1 am e�empt Irom the Contraclor�s Lrtense taw(a Me tdlowing x reasen ISec 7031.5 Busiress and Professions Code�Any city or county wh[h requires a perrnit to tunslruct, �!} o aher improve,demoiish,m repair any stmcture prior ta its rssuance,also requires the apDL[am for suh permn 2 � to f�le a agnetl scaiemenc ihal he is hcersed pursuam m che prowswns of�he Convaaor's LaenEe Law IGhapier �j � 9 icommencin9 with Section;0001 0l Dinsion 3 of the Business and Pmfessions Codel ar that he is exempt therefrom � � and the has�s lor the alleged=xemption 0.ny aiolatpn of Seclwn 7031 5 by airy applicant!ar a permit wh�eeR � � �he appL�ant ta a cnJ penalry of not nore�har five hmdred dollars(55001)' -J W � � ❑I,as�wner�f•Ae Gropertv,or my employees With wages az their Sole CanDensa�ion will do 1he work.and the srmcture is nm m!erided or olfered for sale�Sec 7044,Busmess and P�oless�ons Code.The Contncmr's Ucense ,( �,~j Law does rm apDly to an awner ol propeny who builds or�mproves thereon,and who dces such work himsell, (,) ' cr tl�muy,;his awn employees,provided�hat such improrements are nol mtended or allereC Por sale It,howevei, `7,� = the fw�dmg or�m0�ovement is sold wrthm one Vear al camplelian,the mvner�huiNe will have the 6urden ol praving at _ y •hai he A�d no�nudc or improaz lor the purpose o1 sale.� � �a ❑I as owner of the properry,am ezclusrvely cantra[uny wtlh I¢ereed contracta�s ro wnstruct th¢pmject IS�. � µ�j 0 7pq4 Busmess and Professwns Cade The Contracmr's License Law daes not apply to an owne�oi property who g ¢ 6ufltls or imOroves therean,and who cantracts for such Dro�ects with a cantraztOrlsl licensed Dmsuanl to Ihe Contraclor's ---..� Lrtense Law 1 `y CONSTRUCTION ... ;.�� 0 n � G I em exempt under Sec ,8_B PC IA,Iuh Cenilinte�. EVIEW ��1�'�� �Ss63" � p Date OWner ELECTRI � �. J �..�+�,,,,.�.�j �,nlJ � WVRKEFS�COMPENSATION OECLAFATION I hereby afhnn Ihat I have a ceiuficate of consem ta self-insure.a — a cer6ficate of N6rkeis'fnmpensa�ion Insurance,or a cerolied copy ihe�eol(Se[.3800,lah C) PLUM8ING ¢ ❑ce���s�es�oov rs hereby furmshed � MECFiANiCAL WC.erufred copy is filed wich�he Bu�ding Inspecnon Depmtmene oi oepartmem. '�Q� GRADING � CE IFICATE OF E%EMPTION FROM WOflKERS'COMPENSATION INSUflIINCE:This section neeA not 6e comple�ed / ��°��� y rf Ihe Oermn is for one hundred IS100�o�less.I cenrfy Ihat m the perfarmarce of the wwk for which'this �-� -- — � permit is is .I shal t empby any Oerwn in any manrer so as�a 6ecome suh�e to the rXes'Campensal�an � � ;aws nf Id i � � , ��' t�' A'TiK FEE , `� p �ate �` �. � Applicant S�� � � �z' � NOT E TO`APPLICANT li,aher making ih Cernlicate oi Exemptiqn,yw�lwuld,b,me sub�ett w[he Nbrker's �» SCHOOL FEES � CamOensatian pravisians of the Labor Code,you must tarthwtlh.COmDIy'+N11h`Eut¢pruyisb�or lhis pam¢shd� � he deemed reroked -ti L.. J � qVISIW Of INOUSfRIAL SAFETY PENMIT CERTIFICA710N: W � ❑I herehy ceruly�hat no ez�vauon frve(51 or mwe le in depth into w�kh a person is requireE to tlescen0, � wdi 6e maUe m connenion wffi work autha¢ed bv tM1is�rq��,a�nd tlqt npguildiBp•sVuel�re spfbldinp,falsewark w demo6tmn or dismanllinq Ihereol,will be mare IharcjtlNtlysu�36)feat hi¢i'•��Ciiap$32,Gry 2.An 2.See W 341.7�tle 8.C A.C.I S 3 ❑As owner-bmlder,I will no1 empby arrya�'•to do.,work wirirh,would requve a permrt hon Me Uivision al f— Industnal Sefety,es noted aEove,inless such pef5on Aas a permit�to�do'such.Work irOm 11�division.f':' � �;.': ; ' ��� '' r ' ',, ._, ,..._ ., � ❑avision ol lndusuial Salery Poimn No. � � " "��"�'-"' "'-� ,-i Y TOTAL FEES �y ` � CpJSTRUCfqN LENOING AGENCY�I here6y allirm that there is a conshuction iendiig�ency for Ihe pnfoimann ��' Z ol the work fo�wh¢A tl�rs petmrt is i55uM(Stt.J097,Civ.C I � Lender's Name COMMENTS mLmder's Add�ess d CERTIFICATE OF COMPUA AND AUfHORIZATI0P1�EN7RY:I cerlily I have�ead thi3 applit7tion and sute �n ihat the intamaaan qved rs recf.I pree to compy wM tale laws md ciry o�din�nus rehtip to 6uildinp y consvucuan,and au arue a e taive ol the t t &riNinp md Salety ro enw iqm tM pope�ty n = loi whch 1 ave d lor i rmif tM p of mspections. � � ,sgnewre a�upprcant ar 4gent �� � �� RECPT NO. �-��PAID BY L?c.�� � VAUDATIO WHITE—Department Copy,YELL0IN—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREE�'—Applicants Copy 8S106-11189 . . f.. •. . . . . .. ., . . _ _ ".,_ ':' _ . . __. .__ ...,.._ .. ...._. %._.. .. _.. . ., .. ,.. . . . . ._ . ..... . ... . ... _ . . __.. . ... .� p` . ,.., � .. .. .. .///���! . . . . . .... . . _ . . . _ �". . 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