HomeMy WebLinkAbout1346 '�'� CITY OF Dl.�MOND �AR PRESS
� � " ' �EPA�TMENT OF BUILDING AND SAFETY
��^ BUILDING PERMI7 FIRMLY
JOBSITE APPUCATION, PERMIT 2 U E
ADDRESS ��`�o Cti ��-l�__� � DATE ������ NUMBER �J�� CODE
� APN . LOT TRACT D TEE ���` � LO CONST. G OUP
� GROSS STR T ��►7�' i��r�.���� SETBACKS ���
ZONING � �
=' OWNER C� � ` FRONT
o I ADDRESS ��' �C7 Ln � ' REAR ❑
W CITY �-ZIP�-'a '��'� TEL. SIDE/SIDE STFtEET RW ❑
o I APPLICANT a-h! C-�'l�"/�i�l!�9TEL. SlDE ❑
s
a CONTRACTOR � ` ' s.r
� SEWAGE ❑ PUBLIC PMT�
o ADDRE f�_ CPGI I` ��-�e�� DISPOSAL ❑ pRIVATE SQ.FT./100 GAL
„� CITY i'" ZIP��TEII�''�"�q��
z STATE � 2 7 � � �
y LIC.NUMBER��G� GRADING ❑ CU.YDS.EXC. CU YDS FILL
y ARCH/€NG/ � N�� �� � �p�� ps �.DJ. AREANALUA710N
�' DESIGNE W 1
o kDDRESS � 2
? CITY ZIP TEL. (r) 3
� PROP05ED USE _ z d
� _ � GARAGE
o NO.GWEL. NO, NO. � pORCH �-�} ��
y UNITS STORIES BEDROOMS m
� LOT DIMENSIONS VP.LUATION • - ADJ.AREA
o NO. OF BLDGS HOW QUANTI7Y p�(;R�pT�p�y FEE
W OULOT_ USED Q
� � U
W �
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~ t IGENSEC LONTRALT[]FS OECLARATION�I herehy alfum�hat I am 6cense�untle�pmvisions nt C6apter 9�tommennnp F^
� +vrth Sec;.or 7000;ef Oivrsiar.3 0l 4ie Bus�ness and Prnlessions Code,and my htense rs m tul�lorce and efhti W
3 � ...i —
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LL �IVNFR-BUILOER 7ECLARA710k�herehy alhrm!hat I am eeempt frem the Coniracmr's L¢ense Law for ihe foliaxmg --
= reasnn ISrc 7091[.3usmess and Pralessions Code-Any cily or canty wh�ch requires a permit to cunslruct, (}
o alter imFmve.Jemoush,m repar any stmclure,Dnor to its rssuance also reqwres the appirtant for siKh permil Z
�— lo lile a s+gntd s�ater,ent Ihtt he is iicersed pursuant to thx pmwsuns of the Cenrcacinr's LKense Law�Chapte� m
� i�cnmmennne�.o.th Sectmn 7000'�of Dn�sian 3 of the Business anA P;olzssions Cade)or that he�s exempl Iherefrom �
a. anG ihe bass ici tne afk9eJ:xemptian Any vidation of SeUmn 7031 5 Iry any applicent to�a�ermil su6�ects �
"� ihe apphr.ant tn a rivu penaity d r.o�mare!har.live hu�red dolla�s iS5001� a
W
0 ❑� as ow.^.er�i�he propenu,or my employees wnh.�agcs aa ihmr sole compensauon will do Ihe wnrk,an! ,
tFe suuaur?is not iraended o�olfered kr sale�Sec 7044 Business and Profess�ons Cade�The Cmuac�oi s License Q
� :aw dnes�nl applv to an�wnr.r of OroOerty who ouilds nr imprwes Ihereon antl who dces such worK himse�F, O _
' a:I':reupli his�wn r.mployees.provideJ Iha:such�mprovements are not:ntended o�offereC lor sale II,however. 'Z
m tl�e cui:Nnr nr imp:r.venect a sold wnh�n one Veai af complatmr.,the owner6udde�wdl have ihe 6urden of provmg .�
� ihat he did nm 7udo or inpiove tor Ihe purpase of sak i Z �
y J
H ❑��,as awnx;ot�he pi�pe:;y,am e.cwsrvety coniractmy w�nh 6�ensea conira�tors to cor.stmct ihe pro�ect ISec �y} "
0 7005 8usiness and Pmfesvons Cade The ConUactor's License Law daes nm aOWY to an�wnei of DmDerty who � '
Z �wltls nr inpioves therean,and wno caniracts far such pm�ects wrth a canvacror�sl h[ensed pirsuam ta�he Centnctar's
OLicense law I �N�•TR�� �� � J
� ❑�am exempt unAer Sec ,8 6 P.0(Allxh Cr.rnllcataj PLAN REVIEW
0 od`e_ °`""ef - ELECTRIC
� NORKERS'COMPENSATION�ECLAflATION I here6y affum Ihat I have a cen�Awte of consent to sell-insure,ar
a cerL•Lcate ef Nbrkers'Compensauon Ir.surante,or a certd'ed copy Ihertol f�[3800 Lah C.I I PLUMBING ___
� �--�/ r �j/��-� � MECHANICAL
❑Cer.rfied copy�s hereh lurmshed
p �F7:erL•fieA mpy�s hied with the Bmldmg Ins�ectian�epartment R i7epar�ment �
W ____
Z CERrIiICl+TE OF EKEMPTION FROM WOHKERS'COMPENSATION INSUflANCE:This s¢ttmr need not he�ompklM �S'S`VA1yy.E„� , �'�O
� d the Vermn is for one hundred iS100)or less I cerufp Iaat m the per(ormance of Ihe wwk for which this �
y e t is issued.I shall not em b an erson m an manner so as l0 6ecome su6 ect to tk W6rkers'Can S`M �
� p rmi P Y Y 0 Y I pensatwn
= Laws of California
o � ARK FEE
p Ua1e .{�liea�rt� �'.._....
JNUTICE TO APPLICANT I�,aher making fiis Cend��)'al,�Exemp�n^you:Fhould be[ome su6�e[t to the Nbrker's �- SCHO�L FEES
Cainoer.saUon Urovisions of the�abor Code,ynu mksl foit(�Wil[[.cAinp{Y.�th such O�ovisbns a this permi�shall
� 6e deeined revoked __
� OIVISION OF INOUSfPIAL SAFETY PEBMIT CERTIFICATION-
s .^!," —_
o ❑I herehy�eruty[ha�no excavauon hve(al!o��ore 4@t m,.�epth�pm�ijl�c�a persm rs reqwred ro descend __
� will 6e made m connection wilh work authorald�l�tlus pd'nnd.4nd th�kaU•Bmdinp strucWre.stalfddi�,faluwork.
or demoLtion o� dismaniLng tMreof,will he mwe Ihm th�rty-six(361���M1igh(Chap 32.Gry 2,An?,Sec _
W 341.TitleA,CAC1
S �,r-. .. ..... .. . . . .�+ : . . .
3 ❑As owner bwlder.I wdl nol emyby"�fiycne to`da wdr4�wln[h would'ie9uiie'i permn Irmm 16e Divisqn ol
r Indusvial Satety,as noted ahove,unle3£�suth perswi he1 5 permrt`W do;3uih work from th�E drvision
� •_� . . ..,-. . .,.. . .� .� �.
� ❑0.nswn of Industnal Salery Permn No TOTAL �EES � � S
o.
CONSiR�LTION LENOING AGENCY�I hereby atfirm Mat there is a conso-ation kndi�agerty for tl�e perfoimmce
Z ol ihe wark�or wh¢h�h's permit is issued(Sec.3097,Civ L�. `�
� tenaei s Name 'OMMEN v � /
m 4ndei s Address •
Q �'
CERfIFICATE OF COMPLIANCE ANO AUfIqR1ZATla7 DF ENfflY I cetify 1 have read tl�is applicalian and staR _ �
w �lut�he mfamauon grven is caren.I agree to comply w�h all state laws anA ciry adifwn[es reYteg to Euiltlinp '�
� canstrucnm.and aufiariie a repreuntatrve at the Oyanment ol BuiWinq a'd Seiety ro entx iqm the paperry
= la whrt 'a appl�ed for this par tor tM se mekirg inspxlions.
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�e°.� �.�%' +/ '� � �'�-_'
5guatwe of Applcant or nqem m RECPT IJO.��-PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Gopy,?INK—Assessor Copy,GOLDENROD—File Copy.GREEN—Applicants Coov
85 7 06-1 1/89
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