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CITY OF DIAM�ND BAR pRESS
\� DEPARTMENT OF BUILDING AND SAFETY F�RMLY
Bl11LDING PERMIT
JOBSITE , APPLICATION PERMIT SE
ADDRESS . �UE � �'�� TM�ER�,��CODE
� APN �'` LOT TRACT DATE g ���v CQNST. GROIlP
� !�i�.��
o CROSS STREET � L SETBACKS '"'*'O�""EM15
°p OWNER ,Q, ZONING �OM � ❑
o ADDRESS L-� � REAR ❑
W CITY��/V U T`� Z�p TEL� SIDE/St�E STREET RW ❑
g APPLICANT�yY 9 � TEL �G SIDE �
� � CONTflACTOR �+ SEWAGE
o ADDRESS DISPOSAL ❑ �B� ��
W CITY ZIP TEL. � ��`� ��������
= STATE GRADING 0 CU.YD�.EXC. CU YQS FIl1
y LIC.NUMBER
y ARCH/ENG/ tn T1f�!� FACT�l� "f,3,1.A �A�V, TIQN ".
" DESIGNER W 1
o ADDRESS ��, y,wy, 2
� CITY ZIP TEL. (r} 3
� PROQOSED USE ��" FZd c� 'S� `� 4
� ..��i__"�I iJfa 41,��,�— � GARAGE
o NO.DWEL. NO. —�'— NO. � pORCH
y UNITS STORIES BEDROOMS
� � LOT DIMENSIONS m VALUATION ADJ.AREA
o NO.OF BLDGS HOW OUANTr�`r a F��!{� ��
W Oy LOT USED q
�
W ❑ �
H
110ENSE�CONTRACTORS�CIARATpN:I hereby aftirm ihat 1 am Gcrosed udn provisuns al Chapw 9�wim�encinp
�g with Seceon 7000)ot Oivisron 3 d the Busness and Prokssions Code,a�my Iicense is in tuN imce aM e/lect. W
3 Ill
�+- EH�BUiLDEfl DECIANATbN�I OneOy alfirm that 1 am erempt ham Me Lontrxtor's Lcmte Law far tlx idbwiiq
reaton ISec.7031 5.Busi�ss and Piofessians Code�.Any nty w counry which requirt+pimn lo conzvuc( (}
o aher imprwe,demolisA.a«psir a�ry prucMe,prror to ns iswe�cc,alm reqimet Me applice�t(a wcA permu �
` to file a signed natement Mat M is licen2d qrcwant Po the�wisanE of IM1e CMtrxtw's licu�se liW ICluptw -Q�
� 9(commenang with Section 701�)of Oivision 3 0/Me Busioeu and Prolestia�n Codel a ihat he is enmq Merehom �
d and the basis for the allepeA csemptinn.Airy vidation of Section 7031.5 Dy a'ry appli[an�tm�permil SuCpetz �
W the appUcam m a civd penahY a i+ot mme thm live hurdred doNars ISSQ91.1. a
� ❑I,as av�r ol tM1e property,a my mipbym with wa�s a tMr sde tompenetion.W�N�tlp!werk,and
Hie structurz�s nat immdM or otter�fre saM�Sec.7044,Business aM P�ahssim�s CaOe:TM Carcrumr i license q
c~j Law does iwt apply to m wma�of p�opnty wlro driWs a pnpoves 4rerapt and who dees sud�work Amsdl, L�
W ar through his own employees.pavided tlut sUch im�aovwron6 are not inteidd a aik�for sW.If,howe�er, �
0�0 the buiWing or imprwemmt is wld within mie yex oi ipnp4tian,ihe owner-builder will hm iM hwdm oi prwiip a
� Aat�e did nol hudd a improve for Me WNox d uk.) 2
y �
ti ❑I.as owner ol me praperry,am exch�srveiy comrxuny wim ii[ersN condacmrs ro wnrnun�he pojen�Se�. y,�
Q7044.Bu:imss a�Professwna Coae:The Conbx�oi s lwenu law does not appv m an owm ol praPrry who ��
� huilds or imprwes�hnem.and wla camra[Is fa wch projMs with a contnttmis)licrosd pKsu+M ta tlu Canlncta's
i��e^utew� ONSTFiUCT10N C�C�
� �
W ❑I am e�empt undtt Sa. .B.6 P.L.IAtt�ch Cxli&aie�.
H
r � °a1e �'"'�` ELECTRIC
yWOltNERS'C�9PENSATpN DE0.AHATI(Y!:1 here.BY aliim Iha1 I Iwe�ceMicah af crosml to sdi�insve,a �
�ceru�ica�e oi Wmtni c���r�i�s���a a,�nur�e�mMm is.�.�eoo,�,n.e.�. PLUMBING
0
6 ❑Cttnfietl capy�:n�«eY i�.�;sn�e � MECHANICAL
o ❑r.ertArca cwv�:tilee wim me eu�rg mspaum Dma�mxnta. oqpmmm. 'Q
� CEWl6CAtE OF EXEMWTION FROM NNRNEfl��C�EN$A7G�t WS11�.4NCE:This mtten�d�����,� �- ISSUANCE t `
y B�he permit is fw ane Awd�ed(5100)w MEs:I rudity�_..�Yt.ui..11ie prlumncs ai the work ior whch�thn ..
� permit i:issued.I sh�M mt empNy airy pm�M eiry'mriai so as m hecome wbjett ro fhe NMters'Cmqensalion �S' �P .t� h
taws of Ceiifomia.
o � PARK FEE
` �``�° "' u- SCHOOL FEES
p Oah C"
� NOiICE TO APRCANl:M.alter mrci�qi ' fi[ak ol�„�mpWap.:iY�SM�iA bxdne a�[�ta tlie Waker's
� Lp11D��3i11d1 M��SW�S OI 111!LLIIEI C�Al.'yWL11N51 ThfHM'ilil[OAy1M WNI S11LT P0IASWIS R I�NS p�ll i� .
�+- 6e deemed fevoYM. /J
J
p� DIVISIOi OF INDIISffl1AL SAFETY P€967T:CERAE�'+A7NN- .' ' �� : :...�..�: LY� ` y /C�Q
W 1 . . , . .. . ...,, � /+ /+�,� + , /�,
� ❑I herdry�enAy Ihet no excMLoa 7N¢(51«more fml in Qqth-nN W�b�ierma o mpi�ti dticeoi. �� !_�yl,.A (ii.�7G].f�/�L,[.L("�(
� w�A he mMe in caxecuon wiM xdrl}�pa[�ad 91'tlnc Wmit.lnd tlW ro hwbiq strutut.sc�poldnA.�abwat. �T
n demolaim a diunmtWg tlrnot.wiN be mero tlwn AwM�A�(381 leet Aph.I�P.32.GT 2.An 1.Sac �.�I'C1-C�x�
W' 341.Title S.C.A.C.I. (�
s
� ❑As awnn�builder.1 witl not�nploY xryont to do work wtith wdiA nqwn a pnnl hai M Rvision d � .
H I�ustrial Sahty,as nm�d ahma.unfns such Pe�^Ms�permit 10 do su�A wat frein Mt Groioa_
Wo°'"'�"'"w'�"'s''°"°"m°"° TOTAL FEES `
� �Q�$����f�i�if�'.�Atl�'iMR�I Ib1 1�1U!1i��YC11011�lY�11�pp1�Y�0f 1�!�/�M
2 0l Ihe wwk ter WMt�NiS�Ixmt 4 nslld(SeG 3097.Gu.C.�.
� �"^^E1S"� COMMENTS
� i��a�
� c�nnc�can o�ca�iwcE an wnn�uznmi a Ewrav:i u.rik i n.w m�a:��e.�o�.r.ar
tn Mat tM infamotim guen u emM.I qee M comqy wilh a1 shr Wn rN ary ntlpwice nYYq ro 6uiNYp
y �anskxctim.ond wNaue a�eymernata el Or Oyrurom d&ddYp d S�firy lo wr�on 1M Mqrp
� fa w1icA I lu ppi�d 1ar tl�is pr�sl hr tke w d m�kinY i�cBons.
X �a� t5 Q'
�� �a � RECPT NO, � u PAID BY VALIDA
WHI7E—Department Copy,YELLOW—Financa Copy,PINK—l�ssessor Copy,GOl0E1JA00—File Copy,C3REEN-AppGcaMs Copy
BS106-11/89
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� CITY OF DIAMOND 8AR �
OMNER-BUILDER APPLICANT
J� ADDRESS:
. - _ r
Attentian Property Owner: � �
An 'or+ner-builde�' building permit has been appiied for in your
n�ee and bearing your s�gnatare.
Pieas+e camplete and reta��n this informatian at your esrliest
oppertunity to avoid unnecessary delay in processing and issu9ng
your buildi�g pennit. No t�uiiding permit will be issued until this
verification is recaived.
1 . I pe�sanaiiy R�an to Drovide the ma3or labor and mate�ials fcr
canstruction of the propose+d property in�rovement (yes o� no) .
2. I (havejt�) si9ned an application for a
building perntit fcr the proposed work.
3. I have contractad N�th the fb 11 owi ng pe rs+on (f i rm 1 ta p rov i de
. N�ne . � Address City
Phone Contracto�s License No.
4. I plan to provide portions cf the Mo�k, but I have hired the
�a_ ersan to caafdi�ate, supec-vise, a provide the ma�,ivr
work:
_. ,. _ _
_ _ , _ _-_------
. . Naene -. . - - _ ... .. Ad __ - - - _ . . Ci ty ----- --- _ __ . .
pho�e Contracto cense No.
5. I w�11 provide same of the work but I have c ctsd (hired)
the following persans to provide the work indica .
Name Address Phv�e TyRe of No
Si9��:
operty ner
Social Seturity Number v/4 - �y ` ���� .
i
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