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'� CITY OF �IAMOND BAR PRESS
� � `""` DEPA�ENT OF BUII.DING AND SAFETY
��^ 9 BUILDING PERMIT ' �IRMLY
JOBSITE APPUCATION PERMIT �� USE
ADDRESS � DA7E ;NUMBER CODE
ISSUE ) ��TYPE OCC.
6 APN LOT � RACT DATE ��J~���1 CONST. GROUP
aCROSS STREET � .avsrae�ons
°.=' OWNER /� ZONING SETBACKS
, �'` FRONT RW �
o ADDRES 3-��+%I Bfe��'7"/� C�.i REAR ❑
W'CITY f"' �" """ ZIPC�TEL. SiDE/SIDE STREET RW ❑
o APPLICANT -'' -'TEI.. -�'-'-"'°"'" SIDE ❑
Q CONTRACTOR '�� �, � ~ � SEWAGE
. � �.
o, ADDRESS�.�'��9 �''���"��-"=_C"��tt�2, " -� 0 PUBUC PMT#
DISPOSAL � pRNATE SQ.FL/100 GAL
,�; CITY � y ���'�ZIP��/,�TEL .t`j�G?�
W;' STATE < < GRADING �CU.YDS.EXC. CU YDS FILI
y LIC.NUMBER '�/��� .�� � � �
y: ARCH/ENG/ t!} T1FP� SQ'FY•FA�� t�S,.. ..AE'?�f. FiEAIV' UATIQht '', :
�'' DESIGNER W �
�: ADDRESS �1�y� 2
o_
� CITY ZIP TEL ;(�` 3
x:
�'; PROPOSED USE '� � 4 �
�k � GARAGE
;a; NO.DN/EL. NO. NO. �` PORCH
� UNITS STORIES BEDROOMS
�` LOT DIMENSIONS m VALUATION ADJ.AREA
�, NO.OF BLDGS HOW QUANTtT:Y ��SGRIPT=14Ad: ` 'FEE,:. ,. "
�� ON LOT USED � � �
'� U
�~� IICENSEO CONTRACTOflS OECtARATiON:I herehy aSfirm ihat I am licensed under provisions of Chapter 9�eommennng �.n .
'.oi with Secnnn 7000)of�ivision 3 of the Business anA Professions Code,and my Ikense is in full force anA sftect �`- �
�;
,`�� � �...W.
���+-w- Ol^INER�BUIL�ER-0ECLAflATI0N:1 hereby eftirm Ihat I am exempt Irom ihe Conireebr's Licenu Law for the foliowmg -
`a}' �eason�Sec.7031.5,Busm¢st and Professions Cade�.Any ciry or couNy which requires a perm@ to comUuc[ (�}�.; - -
'Ot' alie��impruve,demoVsh,or rqpai�any.�imcture,prie�[o its issuance.also requiret tAe applicant tor cuch permtl �I.�
�/—'. m hle a siqneE statement�ha�he is licensed Dursuam m�he D�ovisions af the Canpacloi s tiCense Law-IChaDle� m'. �
-� '(�;: 'J(commencing with Section T000)of Dlvfsion.3 of the Business and Prolessions Code�or�hat he is exempt theretram �:!- ,
-,pw; and the 6asis fa�ihe a�leged exempoon.Any viWation of Smtion 7031.5 by any applicant for a permit su6�ecb .�:.
`�.K:: the aD0„�ant m a civil penalty of not mare ihan five huMretl tlollars IS5001.1: . �r .
��; ❑I.as owner at the property.or my em0loyees wiPo wages as theh saie compensation.will do the xrork,a� _. ' �
- ihe s�mcWre is not imended or offered for sale(Sec.7044.Busi�cess and Pmfessions Code:The Cantra[tor's Uceise v�':: ���
;V:taw docs not apply to an owrier of property who 6uilds or improves Ihereon,an0 who dces such work hunself' (,?: �
'_�-�.,ror ihrough his own e.nployees,piwided iha�auch improvements are not Intended or offered for sa�e.If,however ,�z." ,
_'oG;:the huilAing a impmvement is mid within one year of wmple�ion,the owrcerhuilder will hane�he burtlen ot provmg q,, � .
.-_) _yn.�Ihat he did not 6uild or impmve for ihe purpose of sale.) - � -U. �
-�?- ❑I,as owner of the propeny,am exclusivefy conlractmy with licensed comractors t0 eanshuct the project(Sec '�}.
° 71194 Businecs ard Pmfessions Code�TAe Contracror's license law daes nat apply m an owner ot propeny who �'
.:! - :�Z; bwWs o�impmaes ihereon,and who conlrac�s fa�s'uch pmjects with a conlracIDr(s)licensed pursuant to the Convaemr's , .
�-6`���License law.1 �.����,L`�N5^TRU'L`T��N
`p^;
-W'� ❑1 am eKempt uMer Sx. ,8.6 P.C.(Atta[h CerGf cate) ";PLAN REVIEW
'N.
i o° oa�e u.v�e� : ELECTRI
:
:,_�``� WUAKER$'COMPENSATI�N�ECIAflATION�.I her , - .
eby atfi�m Iha1 I have a certlficate o(consent ta sHf-insure a
.. a cenAir.ate ef Warkers'Cnmpensation Inswance,or a ctttified mpy ihereof(Sec 3604 Lah.GI. :� P�-UMB�NG
�����¢,. ❑Certifietl copy is herehy turnished. ;�,- CHANICAL r �
'-a.' ❑Cenified copy is filed with the Bui�din9lnspecDnn fkpartment or �Oeparhnent d-:GRADIN �
W �;: �/ p�,
.,�; GEATIFICATE Of EXEMPTION FAOM WORKEflS'COMPENSATIINJ INSUBANCE This fection need not be cumv�e�� Q��. ISSUANCE JC �`�4 d
,y� if the permit is for one hundred IS700)o�less.�urfify�hat in Ihe pedorm of the wark for which ths .. ..
_ _ � permi�is issued,I sha I not employ arry Person in any manner so as to beeome � t ro_Ihe N��keri Canpenution �"'` SMIP
- =� iaws o�caia���a r `
o- - > �, �;PARK FEE
p= �ate � � ApPlicanl� /g � "
�;�g NOTICE TO PPLICANT:II,atter making this Certiikafe of Exwnplmn,you shouW become s ject to the Nbrker s �'��SCH00�FEES .
�-�'Compensation provisians nf the laMr Code,yuu must im��co��ly wiM such proviswns or ihis permn shel� ,,,�
;�+-���he deemetl re�aked. S'�t.. t�;'` y��'�'"� �.
�;
��;� d�VISION�F INDUSTRIAL SAFETY PEBMIT CERTIFICAT101J: � -�'v�:� :... - -
,W ...�r Y .,: _.
'�- �I hereby cerlify thal no ezcavauan five(5)o�mme leet m deD�h inlo whicM1 a person is requiad�a descend
���p�e;� will he made m cannection with work eulhw¢ed 6y this permiL and that na building structwe,scafkWinp,falsework
'� oi demolition or dismantli�ihereaf,will be mwe}}i��t&�y�sjY,l3fj�,tetl��p.32,Gry 2,Art 2 Sec
.::_: 341.Title 8.CA.C.I. 61� n� � �y -
n�
�`"3 ❑As owna-builder,I will not empbY anyoice to do wod which xroWd rryuire a pttmi��mm Ue Urawn of
;� induslrial SaMty,as noted above,unless sucppn�rsot�hps dp�Jtnt�o�da such work hom tAe d�vision.
,.-.�,. . �. 6 v�i� :...+� �d ...�p �� ':;�-:
'W� ❑avision of Industrial SafeN�rmit Na. '';� ".` ��.ill f:� �
�- CONSiHUCf�N LEN�ING AGENCY:I herehy afl m I�at�tAere s a construcLon fendi TOTAL FEES
��ntv�1«me pntormance b��a.
�:.Z:� ol the work for which ihis permit is issued(Stt.3091,Civ.C.1.
`�'��� LeiMer"sName �M� � �
-;m� le�er's Address
��-6. CERTIFICATE OF COMPLIANCE AND AUTFIOHRA710N Oi ENTflY:I catily I hava read Ihis applitatbn and sta4 . -
��a ihal the�nformation given is eaiect.�agree ro comply weh all state laws a�k ciry ordinairces«latlng ro buiNiry
� -�`-y constmction,and authonzB• represenWtive af the Deputmenl ot Bu�ldinq aiM ety to mter�qon tlm properry
� . ,:.,= Por which I have aDPlie RO tAis peimn for the purpose of making inspections.
�r � Signalu�e oiW �ar A����� Osre RECPT NO.-=:r��PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
'8 51 06-1 1189
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