HomeMy WebLinkAbout4853 BOA VISTA CIR - Building Permits4PPLICATION FOR A BUILDING PER"IT
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Tract 6q
Block
iBUILDING
Lot 15 J
PERMIT NO.
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✓` 3
Electrical
Permit No.
Building Y,I..,{1I
Add ress ! 3
Plumbing
Permit No.
Cross
Mechanical
Area Street
Permit No. 1000
Owner /
Type of Project: ❑ New ❑ Alter Addition
Address
❑ Repair ❑ Convert ❑ Demo ❑ Occupancy Pmt.
City Zip PhoneInsp.
A.P.Sup.
Dist./
Area
Architect/
Designer License No.
Zone
SPI. Pmt. No.
Setbacks
P/L Front
C/L St.
Street Width
Atltlress
City Zip Phone
Yards
Lef
g
ear
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ave o).'Leftq
Engineer License No.
Engineer
ark ng Spa Cas
Required
rov ae
overe
Atltlress
Struct
No, of
No. of
City Zip Phone
He lg ht
Stories
Family
LICENSED CONTRACTOR'S DECLARATION
I herby affirm that I am licensed under provisions of Chapter 9
Park Fees Ves
Required No
C.T.
Fee
Receipt
Zoning Approved BY:
Date
(commencing with Section 7000 of Division 3 of the Business and
Professions Cord. an license is in full force an )
License las `,—� License Nu e O
Date 7JL1JY0 Cptract
Misc.
Proposed Use
of structure
Add ress�(� L
_
City and Zip f8ti—lA �,t• A Phoneq:5,
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097,
Civ. C.1. ^
Dec.
CId55
Type
COn St.
Code
Year
USE/OCCUPANCY
SIZE SO. FT.
Lender's Name 1 1
Lender's Address
1
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law
for the following reason:
[� 1, as owner of the property, or my employees with wages as their
2.
sole compensation, will do the work, and the structure is not
intended or offered for sale.
❑ I, as owner of the property, am exclusively contracting with
3
licensed contractors to construct the project.
❑ I am exempt under Sec. , B&PC for this reason_4.
Total Valuation
Dat, Owner
WORKERS' COMPENSATION DECLARATION
Encroachment Permit Required ❑ Yes ❑ No
1 hereby affirm that I have a certificate of consent to self -insure,
or acertificate of Workers'Compensation Insutance, or a certified
copy thereof. CompanyM C io^ JV Z A
Policy No.
tling Pmt.
Required Vos No
Grading
Pmt. No.
❑ Certified copy is hereby furnished.
Wled�lllfi cfiled with Or
Date LoApplicent
Rough Grading
Approved
Date
CERTIFICATE OF EXEMPTION
FROM WORKERS'COMPENSATION INSURANCE
(This section need not be completed if permit is for $100 or less).
I certify that in the performance of the work for which this permit is
Issued, I shall not employ any person in any manner so as to become
subject to the Workers' Compensation Laws of California.
PERMIT FEES
Date_ Applicant
NOTICE TO APPLICANT: If, after making this Certificate of
Structural $
Plan Check $
Exemption, you should become subject to the Workers' Compensation
$
Special $
Invest.
provisions of the Labor Code, you must forthwith comply with suchElectrical
provisions or this permit shall be deemed revoked.
plumbing $
1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
Mechanical $
RELATING TO BUILDING CONSTRUCTION, AND HEREBY RUTH-
ORIZE REPRES TATIVES OF THIS COUNTY TO ENTER UPON
THE TIONED PROPERTY FOR INSPEC 1 PUR-
POSE1 /1 -� i -(��
I C
Pre -Grade
Inspection $
Signat re ppli nt or Agan Date
Pre-Gratle
Rec. No. $
Permit
Issue $
PurrL.1
Applicant's/Agent's Nam
All spaces within this box must be completed to process
Plan
Check BY:
Issuance
Approved:
CMF 0335-46 (BU -28) rev. 6/80
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