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�� CITY OF DIAMOND BAI� DEPARTA�4ENT OF COMMUNITY&DEVELOPMENT SERVICES '�� � : � . 21650 E.('.opley Drive Suite 190 � q (9d9)860-3195 Fax(I09)861-3117 / PRESS ,...�....:.. '�' BUILDING.PERMIT APPI.ICATION FIRMLY QJOBSITE _ DATEICATION �^� •..RD NUMB R I 2��- / #,C Q D—2-� I, Q ADDRESS G� L � � � � ISSUE a� q�,/TYPE OC� APn LOT TRACT �ATE__S'" � !' 1 D CONST. GROUP p OWNER — j�� - ADD ESS . E�:. ZONING SETBACKS O CI�?+L ,�2 pwl{� ZIP_�_ TEL�'�Z.�_ FRONT RW '7 RFAR _ ;� �� APPLICANT TEL. S!DE/SIDE STREET RW O z � CONTRACTOR ��T�Tr_�QL_� SIDE ❑ � ADDRESS ���-1A�1� pROPOSED USE_ � CI7Y�, _ � ZIP�__ TEL. _.�,�_�_ �-- w ARCWENG/ r z DESIGNER • e, ��;S��O��s (� ' a ADDRESS ��Gu'-'�-�" f��" O.DWEL. NO. NO. � UNITS STORIES BEDROOMS � CETY ZIP TEL. — v� , DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDEH DECLARATION SFR/ADD/REM O I HEPEBY AFFlRM UNDER PENALTY OF PEFiIURY THAT I AM E%EMPT FROM TPIE CONTRACTORS LI- Gale9e/Cefport W CENSEUWN0.7HEFOLLOWINGREASON�SEC.7037.59USMESSANDPROFESSIDNSCADE:ANYCINOR ((� __ C.) COUNfYWHICHRE0UIHESAGERMYiTOCONSTRUCT,ALTER,IMPROVE,DEIAOLISM,OqPEGAIqANVSTRUC� W TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICMl�FOR SUCH PERMIT TO FILE A SIGNED U Patio/Deck STATEMENT 7HAT HE OR SHE IS LICENSEO PURSUANT TO 7HE PROVISIONS OF TNE CONTRACTORS U- � CENSELAW(CI111PTER8(COMMENCINOWIiMSECTION700o)OFDIYISION30FTHEBUSINESSANDPRO� u' POOVSpa FESSpNSOO�E�ORTHATHEORSMEISEKEMPTTMEREFROMANDTHEBASI5FOR7HEALLEGEDE%E1AP- (j TION.ANYVIOUTIONOFSECTION7037.SBYANYAPPLICANTFORAPERMI75U&IF.CTSTriEAPPLICANTTO z Re-Roaf � ACINL PENALT'OF NOT MORETHAN FNE HUNDRED DOLLARS(SSao�.�: � ❑LASOWNEROFTHEPROPEtiN,ORA7VEAIPLOYEESWITHWAGESASTHEIFS�LECOMPENSATIDN, 0 CommerGial WILI DO hiE YVORK,IWD hiE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC,70a4,BUSI- J � NESE ANO PROFESSIONS WOE:THE CONTRACTGRS LICENSE LAW DOES NOT APPLV TO AN OWNC-R OF = PflOPEflTY WF10 BUILDS OR IMPROVESTHEREON,AND WHO�OES 3UCH WORK HIMSELF ON HERSELF OR � THRd1OHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEUOR m ' QOFFEHEOFORS/LLEIF,HOVYEVER7NEBUILDINGORIMPROVEMINiIS50lDWRHINONEYEAROFCAMPIE- � TION,THE OWNER�UILDER WILL HAVE THE BURDEN OP PROVING THAT HE OR SNE DIO NOT BUILD Ofi � IMPROVEFORTH�PURPOSEOFSALE). �� ' ❑I,AS ONMEH OF THE PROPERTY,AM EXC W SIVd.Y CONTRRCTING IYITFI LICENSE�CONTRACTORS Q TO CONSTRUCT TVE PRQIECT(SEC.7o4a,BUSINESS MID PROFESSI04S COOE:THF.CONTHACTORS U- VeIUaS�Ofl _�_ O O D ADJ.AREA W CENSELAYIOOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMFROVEfiTHEREON,ANO � WFIOCOMAACTSFCRSUCHPRQIECTSWIhIACONTRACTOR(5)LICENSEDPl1p5UANTTqTHECOMFAC� QUANTITY �ESCRIPTION FEE Y TORS LIGENSE LAW.I. ... O ❑I AM EXEARPT UN�ER SEC, B 8?.0 FOR T,H'S RF.ASON q .?� U . , . . . . . l±- � -- DATE OWNER___'_____"_"_ U Z W � UCENSED CONTRAGTORS DECLARATION W � I HEREBYAFFIRM UNOER PENAL7V OF PERJURY 7HA71AM LICENSED UNDER PROVISIONS OF CHAPTER � � I �R.LT� b(�J �rt'�iI]�-'� C��9� � Y ICOMMENCNO WITH SECTION 7000�OF DIVISION 3 OF THE BUSINFSSAND PROFESS!ONS CO�E.AND Z ��yy MYLICENSEISINFlJLLFOFCEANDEFFECT. � �' b, U S j �O 4E Q m � LICENSECLASS�_�q ,LIQ NO._��L , � J `�J� �`p r q/1 S.6 U DATE_D'- � I C�y�_ CDNTRACTOR ���� n. � ��� �y,� [l ' / - ! ¢� WORKERS'COMPENSATION DECLARATION -� � _ d � I HFREBYAFFlRM UNDER PENALTY OF PE0.IUHY ONE OF THE FOL_OW:NG�EC�ARA'IONS: Z � �I HAVE AND WRL MAIN7AIN A CERTIFICATE OF CANSENT i0 SELF-INSIIRE FOR WOHKEHS' ¢ 2 COMPENSATIDN,AS PROV!OED 9Y SECTIWd 3)�OOFTNE L ABOR CODE,FOR THE PEaFORMANCF. �U o OF THE WORK FOH WHICN THIS PFRMIT IS ISSUED. � W _1 HAVE AND WILL IAAINTAIN WORKERS'COMPENSATION INSURANCE,AS REC:/1RED BY SFCTI�?l Q 370o OF iHE LABOH CO�E.F-0R THE PERFORMANCE OF TFIE WORK FOR WNICH THIS PERMIT IS ` ISSUEO.MY W RNERS'COMPF_NSATION INSURANCECARRIER PN�PO:JCV NUMB�R ARF: CONSTRUCTION �V_�19 D � CARRIER � �/�.L._r__�__,..rwli _�_._,� PLAN REVIEW __ ___„ _��'o��7 � POLICYNJMBER___�_,i����_ __ ___' ELECTRIC _ _ __ _� p. 0 (MSSECfI0Nt3EDNOT8E0CiuPETEDOFh1EPERMJ�ISFORCY.'EHUNORED�.APSI�100�ORLESS). PLUM9ING _____ _ S O W z ICEATIFYTHATINTHEPERFORMANCEOFTHEWORKFOfiWHICH7HI5PERMITISI55UED.l MECHANICAL .,_,_,_._,__ ___ ___, _ Z}' SHALLNOTEMPLOYANYPERSONINANVMANNERSOASTOBECOMESUBJF.CT'O�HE I � WORNERS'GOMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISMOULDBF.COME � INSPECTIONFEE ____._ __ SI/B,lECT TO THE WORKERS'COMPFNSATION PRDVISIONS OF SECTION 37Co OF TNE LA90R � CADE.ISHALLFOflTHWfTHCOMPLYWIiHT SEPqOVIS10NS. I � ISSUANCE ____ __ ___ ,2S�DD � DATE:����/3,�;, APPLICAN7: ' _ __ I SMIP _ _1�..0 JJ- �--- ENERG`f P/C �----- �— ------ -�---- WARNINO:FAILURETOS'eCUREWORKERS'C PF.MSATIONCAVFRAGEISUNLAYlFL1L,ANDSWAL.LBE � � yL SU&lEC7ANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINE5UP700NEHUt.DREDTHOUSAN� ENERGYPERMIT DOLLARS(E7 oD,000),IN ADOITION TO THE COST OF COMPFNSATIOK.DAMAGES AS FROVIDE�FOR M --------- J SECTION 37ae OF THE LA60R CODE,INTEREST,AND ATTOFlNEV'S�EFS. i FETFNTION FEE: � — — d CONSTRUCTION LFNDING f,GENCY I PRE-ALT FEE: O - - gIHEREBVAFFIRMUNDERPENALTYOFPE0.IL'i7YTHATTHEREISACONSTRUCTIOYLEN0INGAGENCY ' FOH THE PERFORMANCE OF THE WORK FOR WMICH THIS PERMIT IS ISSUED(SEC.3097.CIV.C.j. I Z i w _—_—_ _— � LENOER'S NAME _ ________--.-- � _'___"'_ __ F— LF.N�ER'S.W�RESS __'__'__'__"'_... —'__ __ � ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTAiETHATTHEA90VEINFORMATiONISCORRECT. TVTAL rEES //''''''�� � (((��r// � 1 AGREE TO COMPLV W1TH ALl CITV AND COUNTY ORDINANCES AI.��STATF U1WS PELATING TO BLIILDING ��( /r / " / � CONSTRUCTION,AND NEREBV AUTHORIZE REPRESENTATIVES OF T41S COUNTV TO FNTER�1PON THE � V � 1 ZA90VEMENTKN-0ED PROPERTY FOR INSPECTION PURPOSES 0 ^ COMMENTS J ��` � �.�.�. � Z�/2n�i1C -�------------ --__�' m PERMITTE E(PRI � ¢ --��-�-=9-8-- �Y�� � � sicr�ni O P RMI DATE RECPT.NO._,_ ,_12L�-_PAID B �S VALIDATION_ � _ � WHITE ertmena Co YELLOW-Finenca Co PItJK-Assessar Co GOLDENROD-File Co GREEN- p py, py, py, py. ApplicanPsCopy �. ,,,..:�, r_. ., �....� F-. «.u,..� •�. �. � .r ' . ��.an s..>c;x�,�"��"s`,r'���:.,s �'�:.�: t'�a�C�:in;�:;�e."w�+r"'�;; ��s'��?'���i-i�'��� . • � .,,.. . . r�E,.. .. 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