HomeMy WebLinkAbout1417 ., , �� ,
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CITY OF D.IAMOND �iAR PRESS
`'� �"" � DEPA�PAAENT OF BUILDING AND SAFETY
� ''"° �UILDING PERMIT F'IRMLY
JOBSITE RPPUCATION c:, PERMIT y j ( USE
ADDRESSh'�'-��i� .�C.'CJ�;r.i C1�/;� ��;�f��}•�'.�=_ DATE '�NUMBER � `�, I� CODE
1 ---- ISSUE � � c Q TYPE OCC.
;. ` APN ..____ LOT _1"RACT DATE `��_�_CONST. GROUP
' �' CR05S STREET_ SETBACKS ���+�s
� m 7bVNER f1'�'._c;�' "' �"`='.F�4='-;��,�i,'=�nl ZONING FRONT RW ❑
�.o �1DRESSX��'=�G' k�Csc�3i d��/�.+%�`,.�i 'Za'.`x.?�s�e'x�f"-. REAR __ ❑
,� CITY7���e�ra�`� r�:��"� ZIF�-i�. r"' TEL.'` ' -�`�- SIDEl�IDE STREET RW ❑
' o. Af'PLICANTi�'-r��'t..'/-�',?�)�--�;G:ae;✓�T'C�'`aTEL.rC � '.-°s=�1! SIDE ❑
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Q CON7RACT0��'�'".�1,°7�°'� c'""�Jr�i➢` G'`��. ttlJC -
SEWAGE
o ADDRESSI��CC�Y'�i �:���_���a��,,.-`�`�,.�.' f��='� DISPOSAL � PUBLIC , :PMT#
,� CIT`F=°'`+`�5•'��_�'�i��5'1�.S,�ZIP'!f 7��r� TELe`.=';+,,.. .. . � PRIVAT�' ` .SQ.FT./100 GAL
z STATE °�'�'�'�' .
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y LIC.NUMBER"��`"''=�.�!•'•��E..li GRADING 0 CU.YDS.EXC. CU YDS FILL
y ARCH/ENG/ � TYPE SQ FT FACIUR PS ADJ. AREANALUA710N
�' DESIGNER . ... .�_-_..�_�� W � :,> ��� _ e
� - �
� � ADDRESS _.___....--.�- � 2
� � CITY - -" ZIP TEL. � � 3
x „� � -�
!i � PROPOSED USE���t'�t���?"2 !''�, �,�e'ir�.�t"[..�'�'i7 �•'.�-�� Z 4 . a
0
� �'"�I��.�.-?c'a i:e•Y4,�'...ji�„j �. GARAGE �
z NO.DWEL. O. NO. � PORCH
y UNITS_�STORIES l BEDROOMS_� m
oe LOT DIMENSIONS VALUATION ADJ.AREA e
�,�, o NO.OF BLDGS HOW T QUANTITY pESCRIPTl�N ���
` W �N LOT USED -7 Z l "� •SC�
� a
x = U
~ LI_ 'EU;:(ININACTOHS UECI ARATqN I hercby aftum that I am I¢ensed under p�ov'uions of Chapter 9(commeneinp � � p -.� 4��
� wnh Secnnn 70001 0l Ov�smn 3 0l the Business anA Protessionx Code,and my I¢ense is in!ull lorce nnd efleu � ,� . � .e,�� � ' .Q�
3 o �
fM14NFN NUILDEH f]ECIARAT10N I herehy afhrm that I am exenip�liarti ihe Contractor's L¢ense Law lor ihe following W � � ' �� '"�i` ' ��
�r.asnn Itiac 7031 5 Busness and Pmiessmns CMe An cu or count whah re u ies a (} � C � +'""
x Y 4 Y q� pe�mrt to conslruct,
o eher imprme,tlemnlizh,or�epau any suucWre,pno�to ns issuance,alsa�equnes Ihe apphcan!lo�such permrt Z �^y
� lu fde a vqreA staier.�em Ihal he is licensed pursuant tn the pmaisians u�the Cantracmr's Lmense law(Chapter m �{- .t � r.J l S , �`1
�' oe 9 k���iimeu�iny wilh Secuon 700D)ol[lrvismn 3 ul Ine 6usiness and PrOf¢S5ion5 GOd¢�oi Ihat he rs esemp��herefrom �
' d 2nd!lie 6aas lor L^.e a!!egetl exempuan Anp cmlat;mi ol Secticr,?031 5 hy;ny ayylicain toi a permil suu�ttis � 'j �1 f'_ i e'� �
�•� W Ihc appl¢am m a r.iv:!yenahy ol iml mare ihun!rve hunAred dollars(55001.) -� �•� S �
a
�: � Ui.as nwner nl the pmpeny oi my employces wnA wa9es as O�eu sole compensauon will do the work,anA �t �
a;,;y � ihe smi;.ur,a�s nm mir.ndeJ oi oflerrtl(ar sale.(Sec.7094.Husniess antl Professions Cotle.�he Canirector's luense Q 3� ,
e� l'dw does nm apply Io an nwne�al pmpeny wlm 6wlds ar�mpmves ihe�ean,ard who dces such work�Nmself, `(� T �
� ' o:through his own enployeea pmvided that such improvemems are noi mtendeA or affered for sak If,however, �Z � ,`� y�y� ;
m Ihq huuNny m impmvement Is sald within nne year of compleuon,tl�e owneo-builder wtll have�he 6mden o1 pmving ,�- L� '
y Ihat he ditl net bmld or impmve for the pnrpose o1 sale I . Y �
t . U
t�-�� h UI as mvner nt tl�e pwpenV.nm esclusivery�'conlr2[Imy wit�I:censeO conttacims iu canslmcl Ihe pro;e[t(Se[� �y}
o IOG4,Busn:exs nnJ Professoi�s CuJe TM Contractor's Lmense law does not nyply to an owner al pruperry who �S i.�
�<`� � ;utltls ui nnproves thereon,ann who convaas br such prn�ecis with e aonUanoqsl hcense0 pursuam?o the Conuacmr's
l¢ense La�a•i �
I;' o .. CONSTRk7CTl0 �; '
'.�>' � U I am exempt nMer Sec � � ..B b P.G lattech Cerulicatel.� PLAN REVI�W 'o ' � '��� � .
,•Qp Dnte _Uwne� ELE�i
� WUNKEHS f.UMNFNSATIl1N OECLARATION I Ireretry affirm that I have a rzrnhcate nf cunsem to setl-insure,w � ` � .
a cendmaie ol Wo�keis'Compensalion Insurance,ur a cernlied copy Ihereot(�c 3900,Lab C I� � LUMBING { �j�.��
� Qp � � _
Cernhea cepy rs here,ry hKmshed � _ — '� � 1 G;1
'7V
'► o�+.F 'Certi6ed[opy�s�Aed with the dwldmg Inspecnnn�epanmenl m pepartmem Q, GRADING
� CEHIIFlGA�E OF EREMPTION FHUM WI]BKEflS'COMPENSATION INSUflANCE This sectmn nend nol he�ompleted . UANC � t('�[�� �
y h�he pe.nnn is lor one hundreJ(5100�ar less.I reruly that in ihe peilormance af Ihe wark for which'Ihis ��.,� _
yermu is issuetl.I shall nm employ any persnn in any mannei so as m hecome sub�ect to the Workers'Compensa�ion !�
= laws of Caldomia ,W M) � �
� 1/ �-"�/—' l'�� ��rl-s�� r�a�f. W RK FEE
p Oa�e Apphcanp
JNOTICC TO APPLICANT If.aher makmg ihis Cendmate al Exempbon,you sMuld hecame su6�oct ro iha Nb�ker's �-: SCHOOL FEES _
Campensauan pinvisions ol Ihe Labor Cade,yau musl�athvnth comply wnh sur.h qwiswns a Ihis peimd shall
� 6r.deemeJ ievoked. E;.•-, w`.,� � _
� ___
� qViSI1N�fIF IN�US�HNI SAFETY PEAMIT CEflTIFICATION:��" �
W :l ...,:.�...�..,.._��
� ❑I here6y remfy ihai nu ercavatmn live�5�ar more feet m depiM1 mto whicA a person is requi�ed�a descend,
� will Lr.made m cannechon wi�h work amhwved by th¢permii,and thal iro builAing SlruotUfe,5[a1hWmA.fysework, �
m Jemolmon or dismanthng iherenf,will he mme�han ihiny-s�v 17�6�lee(,bi�d�ap.32.Gry 2,Art 2,Sec �
� w' 741.iitle A.CA.C) �1 f°�4`S A �� e.�;,.,�y
= r.3 C 3�`� "e . ,�:+�s.�,s
3 ❑As ownr.��huAdnr,I wdl no�employ anyone�o do wurk which wwk re0uire a permn fmm tlie avisan ol �
N InJusinal Safety,as noted aMve.unless such person has a pe�mil ta do such work Irom Me drvismrt . ----
�.�.;...,� . . . . .
� y��j ❑IMnsion oi Indnsvial5efety Permil No, �:�. �•.�e�: :1�'��..:'�.:��,:�.-.<.: :�..,-`�:�; TOTAL F�ES
�
� CONSTHUCTION IENDING AGENCY:I herehy'•jf�iim,fhat.fhere is�a ionehati6n�lEnding agency lor the perlommenca
Z al ILe wark for wh¢h mis permit is iswed ISec.3097,Crv.C.)
� Lennafs Name COMM NTS� � �,j )
- m tendeYs Address � .
Q CENTIfICAtE Of f,OMPUANCE AND AUTFIOpIZA710N OF ENTfIY.i ceruly 1 heve reed Mu appfication and state
v� thai�hr.inlormatron�ven is aa�ect I agree m comply wnh all state laws aiM ofry ordinances relalinp to 6mNnry
y cunsUuclion,and aulhonee a represenutve al the Oepartment ol BuiWing and SaletY m mter�qan tAe poperry
= Iw wh¢h I have ap0��d fa this pe mrt for t purpose,oi makinp inspeciions �
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Sgn��we ol Applic o�� �nt a�e RECPT NO. PAID BY VAUDATION� %
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Gopy,GOLDENROD—File Copy,GREEN—Applicants Copy j
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