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• , '"` � ' -� � - CiTY �F DIAM�ND BAR ' pRESS ,. .
- DEPARTMENT OF BU9LDtNG AND SAFETY F�R LY
BUILDING PERMIT '
JOBSITE ` 1 ` ' APPIJCATION PERMIT USE
ADDRESS �31� �/M-V� �/�4� �n-. DATE NUMBER CODE
ISSUE TYPE
� APN LOT TRACT DATE — CANST. GROUP
� CROSS STREET SF�ETBACKS � �
= ZONING �`�"`�
°D OWNER �Ar/bo�•G hY'vt' . f✓S .
�o�, ADDRE�X� �� �°�� ��ZiMr*li�.�i—��99I] LS�V REAR ❑
� CITY f'�V Ati44.lM�-- ZIP�It TELR�L•I�_ SIDE/SIOE STREET RW ❑
� APPLICANT TEL. SIDE ❑
$
� CONTRACTOR i SEWAGE ❑ PUBUC PMT�
o ADDRESS �2-33 Ft.1u'fS+UI.Ai't�4+�f.� Y. OISP05AL ❑ pRIVATE SQ.FT./100G14L
„� CITY ���A. - —ZIPQLt2 i TEL9q3•9.f0�
� STATE
N LIC.NUMBER �Ie��"1 � �Z— L� -' I Le GRADING � CU.YDS.EXC. CU YDS FILL
y ARCH/ENG/ � nP� Q FACTX? PS ADJ. R LUATION
� � DE5IGNER W 1 ' •
t '� ADDRESS i,�. 2
. o
• y CITY ZIP TEL. (� 3
�� PROPOSED USE �� u� �-- Z 4
� � � GARAGE
� NO.DWEL. NO. NO. � pORCH • � • • �
y UNITS STORIES BEDROOMS
m LOT DIMENSIONS � VAL:UATION ADJ.AREA
o NO.OF BLDGS HOW QUANFRY DESCRIPTIQN' FEE '° �
W ON LOT USED � �
� � .
_ � .. _ � ,
~ IICENSEO CONTflACfORS�ClARA710N.I Mre6y dhrm IAat I tm Lcensed under provisbns M Chapler B�mmmencinq
Y with Section 70001 of Gvision 3 af iFe Business anC Professions Code.end my litense ie in full face wid dhct �
� � �J k
�±- OWNEfl-BUILUER OECLARATION.I hereby afhrm that I am expnpt iram the Cmilmctor's licenae law to�Me fdlv.nnp
rtasan ISec 7031.5,Business end Pralessions Code My city or co�nly which requirea a permrt ro construct. (!1
O al[er,impiavu,demalish,or repau any rlructwe,pfar to ds rssuance,elw reqmies Ue appliunt for such permit �
F= m fiM a sipned�mtemem M�t he u kertTeA Dwwant ro Ihe D�ovisians ol IM1e Cona¢oor'a lcense lew�Ch�pter �
� 9(commeMing wnh Sectnn 7000)of Division 3 af the Businesa anA Pmfeaeiona Cade1 a mat he i��Kemp�tAvefrom
p� pnd Me haas iar Me elleged aempuon.Any violatian of Sxuon 7071.5 by eny apphcent for e perme sa6jecn
W the appLcam to�civtl penahy of nm mare than five hundred tlollaie(f5001) �
F ❑I,es owner ol[he puperry,or my emplayees wiM wages as I�eii cole CanOensatmn,will AD Me xrork,nd
�he evucmre is not imenEed rc allered fir sale(Sec.lOd4,Busineas and Pro�e:mons Code The Conhactor'e Lieeme d
v Law does mt app1Y 10 an ownei ot property who Wilds a improves Ihaeon,and who does such work himeeN. (�
W ar through his awn employees.prmided ihat auch�mprovements an not intended or oHered�m sale.I},hdxever, �
� the building or unprovemem is eold wnhin ane yeer of[anpletian,ihe owner�builUe�will�eve tAa bwden oi aownp e�
N that Ae did nat hudA oi improve for the wNose ol sale) �
N ❑I,85 owi�er o�the prapeny,em excWsively conliactiny with Lcensed convacwrs to constmct tM project(Sec y,�
O
7044,Busness a�+d Profess�ons Code The Cantrecmi's L¢ense lew does nm epply�o an owner o1 pmperry wAo '�
� 6uids or impraves thereon,a�who contracts for wch pm�ecte with o[anereuor(Sl litmsed Ounuam m the Connouor's
i �cense Ww I CONSTRUCTION
0
W ❑I am eaemp[wder Sec .8 5 PC.IAnech Cerufrafel PLAI� REVIEW
H
0 oaie Owner ELECTRIC
a Y�A]RNERS�COMPENSATIOPi OECLARATION,I henM dhrm Ihat I heve a cerliF¢rte al ronsent to seH-ineure,a
y a ierufiwte at Nbrkas'Compensatm msve�e,ar a cero�ied�opy thereo�ISec.3800,lah C I. PLUMSING
a �Cenifi¢d cupy o here6y Iwmahed „�j MECHANICAL
�G ❑Certified coDY is fied wilh Me Bwldmp Inspecaon Oepartmem or OaDartmem. � GRADING
�� CEHTIFICATE OF EXEMPTION FROW YVORRERS'COMPENSATION INSUAANCE This achon need not he tompleted 15SUANCE �
y d the permn rs kr one hundred(51001 m less.I aruly thal in Me performance of t�e wak for which thi5
_ permn is issued,1 sAall not emplW airy persm in my manne�so is to 6ecome whjai W the N6rkns'Compens�tion SMIP
�o laws of Californ�a W PARK FEE
� Oate Appl�[ent W
NOTILE TO 0.PPLIC0.1�fr X,ofter makiip IAis CMilicats M fxemp�on,you should 6ecame sub'iett b ihe Nbrkei's u- SCH�OL FEES �
-� Canpensatian prawsiws at lhe labur Code,you must forihwith campN wi�h auch prwrsbna w tlxs permrt shdl n��
�+— he deemed revoked — �
� qY1510N OF INWSTNIAL SAFETY PERMIT CEPTIFICATqN: . '
d �
� ❑I here6Y certily tAa1 m excawUan five�5)a more het in deptA inta which�persan n requved!o destend,
ee will be made m emnecua+wrtA worl auMortred hy tl�n permrt,md Mn no Eu1Ei�ttrutture,suftoltlup.fdsework, . .
�- a OertaYtan a d�smantling thereal.will be mae then Mirry-an(381 fee�hph IChW 3.2.6ry 2,Art 2.Sec
w 341,Title B,C A C� y � ��'—
x
� ❑As owner-huild�r.I wAI not�mploy myone to do vqrk which wwld r�qwrt�permit Irom the Oivaion of
� Indurnml Salety,es noted o�mre,wless sueh person hes a D��t m Oo such wp�k Irom tlw Iivisiun
�
W ❑Qhsim ol Inlusuiel Safery Pormii No.
� CONSTHUCfION LENOING AGENCY.I Iwr TOTAL FEES
e6y dhrm tlut there is�wnstruction Nndinp pe^q for tlie perlammco +
= oF�he xrorY For whch thu permn u iesued(S�c.3097,Gv.C.).
� �e�de�s�ueme COMMENTS ��� ��M'���" ��-'
m Lende' drtsa "� • /1
•
� IFICATE OF COMP ANCE AND AIRNpUZATKN E Y�1 ifdy 1 luve nM tliis�pplrefan r+d ttm w— `� .� .�p��,�� �y,,
H �t�lie informavon p n�s runett I apret Ia to V �N aY I�'Mi a11d Clty MdIM11GeS MOlilp 10 blllldnp /CL��I� i"��.a� -';�" � �� 1
constrvctwn,and w rue i ^nu6ve al� Oep� ent d ildi�p md Ssfety b am�upon tlie praperry
fa wAich I have e0 �s �m 1 ha pu : inp' lion:
� �^ � /d �j - R ., _
�� e �r � a„ RE.CPT NO. Y _VALIDATI
WHITE—Department Copy,YELLOW—FinanCe Copy,PINK—Ilsaes8or Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
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