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'"'� CITY OF DIAMOND BA,R pRESS
��., �""' '` DEPARTMENT OF BUILDING AND SAF(�TY
•" ���'' rCUL�1:�'. " ;`' BUILDING PERMIT FIRMLY
JOBSITE ' " ' APPLJCATION PERMIT � USE
ADDRESS � � � � � "' �� � DATE NUMBER�CODE
" ' ISSUE TYPE OCC.
s APN ___ LOT TRACT r�� DATE __ CONST. GROUP�-�
o CROSS STREET /�rl�1�p��1�ij�l��f�iif�'.���,� zONING SETBACKS � `�'�"'E"'S
O° OWNER FRONT RW �
Q ADDRESS� REAR_ _� O
W CI7Y ZIP TEL. SIDF S EET RW CO
o APPLICANT �-� .� 1 TEL.�(�/��`t� ��E �
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4 CONTRACTOR — SEWAGE
o ADDRFSS___ � PUBLIC PMT fi�
DISPOSAL [] pa�VATE S�.FT./100 GAL
,� CITY ZIP TEI.
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a STATE GRADING �GU.YDS.EXC CU YDS FILL
y LIC.NUMBER
� T1�PE S4 F`T' FAG#`tOR F'�s � AD3. Xi�EAN�tLUA71UN ' : .:
y ARCH/ENG/ y t�;
" DESIGNER � ` " �� � 1
� ADDRESS ` �..C'� �.%(!�-- pl�j��-', �.� 2
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= CITY1✓t��„�.�L,�,�ZIP �• ,�'TEL., � 3
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� PROPOSED USE �-� • � � `�
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o •i �X •< . .,_. _�.....�,..�..� �, GARAGE
a NO.DWEL. N � N0.
x ��: PORCH
�, UNITS STORIES BEDROOMS
� LOT DIMENSIONS m' VALUATION ADJ.AREA
'� o NO.OF BLDGS HOW ,.QUANTirY -D�s(;R1 -. ION ;. �EE..
W ON LOT USED_ Q � ��
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. ~ LIC❑.ENSFO CONTRACTORS DECLAHATION:1 here6y effirm ihat I am licensed under pmvisions of Cheprer 9(commencinp .A�ttt}���'� �
� wi!li Stttion 7000�of Division 3 ni the 9usiness end Pmlessians f.ode,and mp ficense is in lull forte and effttt. '��:��, . ;
3 � <1,""�u:
� �±- iRYNf R�BUILOEfl�ECLAflATIIXJ:I here�V atfnm thal I am exempt From ihe Comrectnr's Lianse law for Me fdbwing '�� .�
� reawn�Sec.7Q31.5.Businesx antl Prnlessions Code.AnY ciry or�aunty which iequi�es a permit ta cansvuct. ��•-(,.�F:
o elte�,�mprmie,demali.sh,nr repei�any structure,O��o�to its issuvnce,nlso�equims Ihe apph[ant ia�such permil ���+��';
QIn hla a sipned etatemenl Ihat I�e is licensed pursuant W ihe provisions of Ihe Cantractar's license Law�Chepfer ;".�• �
ee 9 Icun�urcm�ing with S�clion i000)of Divisinn 3 of Ihe 8usiness and Protessions LOAeI o�Ihat he is e.empl IAerelrom ..;�• �
� u an^_Ihe Uasis!a:�hr.allegeC cxem�t:rr Airy r;olation uf Section 7031.5 by ary applicanl loi a permit suhjecis �•-�i, '
W the apphcant tn a crvil penalfy ol not ma�e ihan five hundred dollars�55001.1. ����<�::
� ' o ��,
ti ❑I,as nwuei nl the pmperty,ur mY employees with wages�as IAeir go�e[ompensalion will do Me work,and �
M1IIC SIII:f,1UiP,�S 1101 intendeJ or offered far sale�Se[.7044,Rusiness ar�d Professians Cod¢:The Ca¢rer.tor's Littnse �:�Q� —�
� v Law Jces nol apply to an nwner of p�operty who huilds or improves thereon,and wha Aces such wort himself, ;;.�Lr):
� ' ur Ihmuyh his own zmplryr,e.s,prwided iha�sach imp�memen�s are not inffinAed a ollered loi sak.if,however, ::.;:�;.
�m� tM Auiltlmg or u•�ipnNemr.m is sold within on¢year at canpletion,the owner�builder wi�l have Ihe 6urden nf pwving >5:4;
� y ttial he did nut 6uild o�nnpiove for Ihe Durpase of sale.l s�::=.
j� �%i ❑I,as uwirc�uf the pmpeity,am exclusrvely com�actiny wit6 licensed�antractnra ta mnstru�t�he pmject(Sec '���� -
7044,Business and Pmfessans Code�The Cam�aclo(5 Licentt Law does not apply In an mvne�01 pmperlY wha '-,�,5�
a Z hnilAs m nnpm�ez t6ere�m,xnd who coMrxas for such pm�eets wiih a comroctm�sllicensed pwsuam to�he Cnmractnr's
.{ �Q I.¢enselawl `:�;;' CONSTRUCTION �
! O "_—
i
~ n i am exempt mxlxr Sec. .B.6 P.C.IArtach Certilica�el: '� ":� P�1N RE�/�E�l�/
7 � u"`— °�""e1 s�ELECTRIC
�� �. W[WKERS�COMPENSATION�ECIAFATIIXJ:I heretry affiim tha�1 have a certi!icafe of consem ro seH-insure,a ;VF�^�
a certdicate of Woikers'Campensatinn Insuranee.nr a cenified ca04 ihereaf ISet.3800.Lah.C.1 '� PLUMB�NC.7 � r
� 4 ❑ce�����Pa«ur�s ne�ee�i�x���nea ��' MECHANICAL
— .�'
� o L�Ceni6etl eopy is filetl wnA tAe BuilEmg Inspeetim�Deparlment w Depanmem {t,�'GRADING . .;,
w
'= CEATIFlCATE OF EXEMPTION FflOM 1NOBKEFS'COMPENSATION INSU!iANCE:This set�ion need na�he camDkiN ���SSUANCE
� d tha pr.rmn is tor one hunAred�51�0)ar less.I cerufy that in Ihe performente o�Ihe work tar whKh this
y pemiit Is issued,I shall mt employ any Dersam m��ry manne�so as to hetome subjeat ta Ihe Nbrkers'Campen38tion ��"� �
,��. � � Laws af Calilmnia. SMIP __ '���
� �o °:� 'PARK FEE _
� ���„� AP°����� '�'.SCHOOL FEES
� NOTICE TO hPPUCANT:If,aher makmg thls Cenilica�e ol E�emption,you sMuW became suhject ro the 4Wrker's j
� --� Cumpensation provisians of the laho�Code,you must b�ihwith[omply with such pravispns a this permil shall �
� �e Aeei�reU reuoke0.
� . � qVISIIX�I OF INDIISTflIAI SAFETY PEHMIT CEflTIFICATION: _ .
W
°- UI�ere�y cenHy that no excavaiion tive 151 ar mme feet in deoth into which a ce�son is requiied to descmd ��
a�e will hr.inedr.in cwnecfiun with work authw¢ed 6Y m�9 Perme,and Mat no huilding suuc�we.scelloldinp,lalsework �y°�t��
' a nr dr.muf�inn oi dismanlling ihereol,will h¢mare than thirry�siK�36)1¢et Aigh.(ChaO�3.2,Gry 2,An 1,SeC F ,
Z� Yil.Title 8.CA.C.�. �r
����
3 — ��:
❑As owner6uilder.I will nm empMy anyme ta do work which wauM require a permit fmm IM1e Oivispn af : g�
1— Industna:Safety,as noted aMve,unless such pefson has a permit to do such xrork Irom the drvision. �
� '::. � �
y�j ❑IMrismr nl Indistrial Sefely Pomwt No. ��TOT w� �^� ,
d
� f.ONST1iIICfI�N LENf11NG AGENCY:I hae6y affirm Mat tM�e ia a consttuc6nn kndinB�MY la the pnformmce � f{ C ?;
Z ol Il�e work fa�whch Ihis permn is fssueA�See 309),fiv.C.�. %�•
.� Lender'sName �+�
COMMENTS >'�:
p�p I.enle�'s Mdress ;�f.
4 CEATIFICA�E OF COMPLIANCE ANO AlITH11111ZpTi[W OF ENTfl1E I cerMy I luve read this appliraiion end sule '�. t
y �hat the udnrmatinn given is correct.i aryee to camph/with aA s�re i�5 a�e arv omi�w�����ro m,�u��re � A � � ).'
y construction,anA eutha�ire�iepresenta�ive af the Depanment ol Building and$efety W m4r�pon tht propeity r -°`
= la which I have applied r.Mis permtl fai Ihe pixpose al makinp inspeclpns.
O � �
~ � "—' ` RECPT NO.�/I�PAID BY VALIDA �
- �na re N Apo�� or Agent Oaro�
W ITE—D art eM Copy.YELLOW—Fin nce Copy,PINK—Assessor Copy,GOLDENROD—File Copy.GREEN—Applicants Copy
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