DIXONCITY OF LA OUIMTA 78-106 Calle Estac
z P.O. Box 1604
HOME OCCUPATION PERMIT Le Oulnta, CA tit,
(t) 19)664-2246
APPLICATION
cad eacn condition listed on tte attachment to this form to see if the
-roposed- activity -can -comply -with -the -City's -Home -Occupation -Regulations.
-------
�1 (TYPE OR PRINT 1N INK)
APPLICANT'S NAME C"U"CCCy �) X 0t\J PHONEZ--
JPROPERTY OWNER `S P1 M E n PHONE
\ PROPERTY ADDRESS fJ 7- `(O 5 '1 / �/ L'- HEARER);
TYPE OF RESIDENCE (single, multiple, mobile home, etc.) S
TYPE OF BUSINESS AdA i L c'61JG IkSE•121, ice 0,
BRIEF DESCRIPTION OF HOW THE BUSINESS WILL OPERATE lL'RC/iiAA 1)(9E= / C
NUMBER OF PERSONS INVOLVED IN BUSINESS �—
LIST NAY.ES OF PERSONS EMPLOYED M) AJ2F
FAID SM
SQUARE FOOTAGE OF USABLE FLOOR AREA IN —"•'^
HOUSE (EXCLUDE GARAGE) Z h � ki r VALIDATION ST;A P"
LOCATION AND SQUARE FOOTAGE OF AREA OF JUN 2 S 1991
BUSINESS ACTIVITY IN HOME (EXAMPLE,
"BEDROOM - 125 SQUARE FEET") 011
C
E=ST
DESCRIPTION OF MACHINERY, EQUIPMFI:T, AND SUPPLIES EING USED IN THE BUSINESS
OPERATION — — 0.F - i CV
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCUPATION .,i,S ALLOWED ( CONDITIONS ATTACHED) .
IF APPLICANT IS OTHER THAN PROPERTY OWNER, AUTHORIZATION OF OWNER OR AGENT
REQUIRED.
OWNER/AGENT SIGNATURE DATE
IMPORTANT: False or misleading information shall be grounds for denying your
Home Occupation; failure to comply with conditions listed on the attached page
shall be grounds for revocation of permit.
BUILDING i SAFETY DEPARTMENT
OVED BY DATE CONDITIONS ATTACHED
DEN:ED BY DATE
I IIIIII VIII II'I I' I
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Pursuant to Chapter 9 of Division 3 of the Business and Profession, Code
and the Rules and Regulations of the Contractors State License Board,
the Registrar of Contractors does hereby issue this license to:
13L-24 (REV. 4-91)
DIXON ENTERPRISES
to engage in the business 6r act in the capacity of a contractor
in the following classification(s):
CIO - ELECTRICAL (GENERAL)
Witness my hand and seal this day,
September 11" 1991
Issued July 1, 1976
Signature of Licensee REPLACEMENT
1111S licenst- is the property of (lit- Registrar of Contractors, is not
Signatur of Li rise, Q itfier transit-Frable.. and shall be returned to the R"istraj upon demand
when suspen(lt:cl, revoked, or invali(tite(l for any reason. it becomes
void if not renewed.
S18;e 011.ta
111.
Depan�Al 01
CA)msur rw.r
Midi-,
Registrar of Contractors
321389
License Number
•
Building
Address
Owner
Mailing
Address
54o 55
}}t ^^ I
Zlp
Contracto
T4tyl 4 ZP "
P.O. BOX 1504 APPLICATION ONLY
� 7�8-105 CALLE ESTADO
LA�'6i111NTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC. GRP
0 C 0 aAKms" r / A.P. Number
el.
5
TT 56 y - 2-902' Legal Description
OWNS ✓
Address
ty lZip
State Lic. City
& Classif. Lic. ff
Arch., Engr.,
Designer
Address Tel.
City I Zip I State
Lic. q
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the pro vi ons of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division of the Business and Professions Code, or that. he Is exempt therefrom, and the basis
for t alleged exemp(ion. Any violation o/ Section 7031.5 Dy 'any �pf'can'
for a permit
sub' ccs the applicant to a civil penalty of not more than live hundred dollars (5500).
I, as owner of the property, or my employees with wages as their sole compensation, will
o the work, and the structure is not intended or offered for sale. (Sec. 7044, Bufsness and
Professions Code: The Contractor's License Law does not apply to an owner o/ property who
builds or inproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for safe. If, however, the building
or improvement is sold within one year of completion, the owner-Dulider. will have the burden
of proving that he did not build or improve for the purpose of sale.)
I II'
as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
17 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
etpploy any person in any manner so as to become subject to the Workers' Compensation
Yaws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of .the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address '
This is a building permit when properly filled out, signed and validated, and is subject to
piration if work thereunder iss
suspended for 180 days.
certify that I have read this application and state that the above information is correct.
Tree to comply with all city and county ordinances and state laws relating to building
y.struction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Project Description
FINANCE '
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft.
Size
No.
Stories l
No. Dw.
Units
New 0
Add jj�
Alter IIS Repair.X Demolition O
U-)IR6
1�J CUL1,V6- f�ys
/,N -)- 113& -
_Rooms
4- L1
V1A)6-oZ M b
Ab J) 1Nsy4'CRo&7
¢- b R y
WALL
M CE10A)&S
- *2-- 13W AM S,
LIIV tk)&-R,
M..
4- K tTr-4+
y. ACPl-^C6
. /M P 0
i��1 sys�
Es ima V
C,0/
J�r 2,0
FINANCE '
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation: