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,:w CITY OF DtAMOND BAR PRESS� ,
DEPARTMENT OF BUILDIi�G AND SAFETY �� — �-�
� BUILDING PERMIT FIRMLY
JOBSITE ` J PPLJCATION PERMIT U E
ADDRESS ���� �1���1Sti4 �D1'Z_. � ATE NUMBER CODE
ISSUE fj TYPE OCC.
� APN LOT TRACT DATE v � — CONST. GROUP
� CROSS STREET ZONING SETBACKS ��"EN3
�— OWNER FRONT RW ❑
S ADDRESS �Z2.G t7 6tLh�►.3G4.�w.11.1�� �'� REAR ❑
W CITY ����'�►—• ZIP�Q�TEL • � SIDE/SIDE STREET RW ❑
o APPLICANT TEL. SIDE �
6 CONTRACTOR L SP cs� C�► SEWAGE ❑ PUBLIC PMT�
o ADDRESS 32�3 fz.�lu'CLt�l�ll.a 6�.. S C. p�SPOSAL
W CITY QCL�i.A+� . ZIP Z 2 TEL.q°►3•9S � PRIVATE SQ.FT./100GAL
= STATE
y L1C.NUMBER � t+��'�Z—� C-1 L. GRADING � CU.YDS.EXC. CU YDS FILL
y ARCH/ENG/ � TYPE SQ FT FACTQR PS ADJ. AREANALUATION
`=' DESIGNER W �
o ADDRESS � 2
a CITY ZIP TEL. (� 3
o PROPOSED USE L ' Z 4
� a GARAGE
o NO.DWEL. NO. NO. � pORCH
y UNITS STORIES BEDROOMS
ec LOT DIMENSIONS � VALUATION ADJ.AREA
o NO.OF BLDGS HOW QUANTITY QES IPTIQN FEE
W ON LOT USED ,�
W V
� �
LICENSED CANTRACTOflS DECLANATDJN I kreby etfirm that I am qceneed undm praviaione of Chepter 9(cammencing
� with Scctwn 7000�oF Gvismn 3 at the Business and Prohssmna Code,ond my license ia in tutl face�nd dfect. W
� ❑ LLI
LL OWNEH-BlIILOEH OECLAflATION I here6y afhrm tha�I am ezempt Imm the Contncror's LKenu law lar Me lollowmg
reason�Sec T031.5,Busmess md Pmfessions Code�Any oitY or caunry whKh nqunes i parmn m construct, {,�} "
O allm,imprwe,demtlish.d repau eny�ructure,prwr ta ns usuance,dso requires the�pplWont Mr euch permrt ��
� Ia Fk�agned netement lhat he ia Aceneed purwant m the p�owspns ol Me Cantrec�ar'a Lkenee law µ7upler m
� 9 Icommenang wnh Seclion 70001 of Oiviaian 3 0l�he Busineas antl Piofessions Codel a thet he a exempt tharefrom �
d end Me hasis tor the�Ikg�exempeon 4ny vmlrtion af Sanon 7031.5 6y�ny eppl¢am fa��permi��uhjec�s �
K 1he ipDlitanl lo a[inl penilly of not mors Hron Irve hundrod dnllars(5500)) a
W
� ❑I,as owner ot the propeny,a mv emplayees wiM wapes as their ade tampensauon,wdl do the wmk,rd
the suucture is nat imended o�ofkrtl la eela(Sec 704A,Business aM Pralesawns Cade TAe Connacfwl l�anse .�
�j Law does nm apply to m owner af prapenY who hudds or imprmes Iheaon,and who dces�uch work himsell, U
' m tl�rouyh his awn employees,prmided that such�mpmemenn a�e nnt intenkd or ollered iar sak-II.hmxever, �
= the bmldmg ar improvemeM is sold within ane Y��of cqnplelioq ihe owner-budder will have the 6urden ol provrtq d
y tM1a�he CiA nat Ouiltl o�imp�uve for the purpaee of sale.l �
eq ❑I.as owner of the Iraperty,�n exclueively contradmy with IkenseA eontncmrs m eonstruct tM prqect(Sec. w
0 704t.Bus�ress and Rolesswns CoUe:The Contractor'n license L�w does nm�pply Oo an owner ol prupertY wM �
= huilds o�impmves�hereon,end who conneo�s for wch pm�ects wi[h a comrecror�sl licensetl pursuam m Ne Cmvkta'e
6 LrenseLaw) CONSTRUCTION
•
0
6 ❑I am eKempt under Sec. ,6.6 PC.�Attuh Cerofiurol- P�N RE�/�EW
0 oo�e ��� ELECTRIC
� NAHNEAS'COMPENS0.TIqY pECIAFAT10h I h��e6y iHirm lhat I have e tertihcate of crosent ta sNl-mswe.or
a certihcate ol Warkers'Campensa�ion mauonce,or a cerefied copy ihemof I�38oD,lab.C I. PLUM BING
c �
_ �Cer6lied copy ie here0y furnisheA � MECHANICAL
t ,,,���
o ❑CerUlKd capy is�ded with the BuiNuig Inape�tion Deperemem ar �epartment � GRADING
W
� CEIITIFICATE OF E%EMPTION FPOM WORKEAS'COMPENSATIqV INSURANCE This aechon need not be campkted ISSUANCE
y rf the permit is for one hmdred IS100)w less I cn6fy thal in Ihe perfarmance ol the wark Mi whkh Mis w
permrt is rssued,1 shal not employ ony person m anY manner so as to hecome suh�ett to the fWurter�Compensetim SMIP �1 e 1
� Lews ol Californw (L
o W PARK FEE �
0 o��e Applicam �i. SCHOOL FEES
� NO710E TO APPLICAM tf,athr makmp IAis Certilkate of E�emotian,yau sAould become auDlect fi tl�e V46rker's
Compensatwn provitwna d 1M labor Code,you must Iqlhwilh comply wnh such pronsians a th�s permit ehall
� be deemed�evo4ed R r T ' /' ��QQ
r
� OMSION OF INWSTAIAL SAFETY PERMIT CERTIFICAiION:
d
o ❑I herohy certily that no e�cavauan tNe 15�er rtore he�in depth inm whsh�person ia rpmred b desaend,
�¢ wdl he made m cmnectwn wnh worM au�lqr'ved hy Mis pamtt,eM tliei na hudEinp ftrutture,wffalEinp.IWsewort,
u demolmon m drsmanllinp tlereaf,will h mare than Mirry-am(36)hn hiph �tlyp 3.Y,Gry 2.Art 2.Sec
W 341.T�tle B,C A C�
S
� ❑As owne�-bmlder.I nnll rot empby mynne ta do warM which would nQu��e�permrt Irom tlrc pivision d
F— Intlusaul Safeey,es noced�6ove,unless�uch permn hes a Dermit ro Ao wch work Irom IM Ini�ion.
�
�;; ❑a�,5,�a M�Sn�e�S���N��m,�No. TOTAL FEES
.
� C�SIRUCTUN LElIDING AGENLY:I herehy dhrm Mat tlrre is�tonshuttion kndinp pencY lor�he perfomi�nn
= M Me worM fn whch Ih�s perml u isiued�Sec 3097,Ciu.C.)
� Lmder'e COMMENTS ^i �P���� r �
m ar'a Addrcss 2'� �N4�r'�O. ��L�� �R.�l�l3 LL'�
CERTIFICATE OF C IIANCE AND AUT� ENiflY artify I hove nad fhis pplkrtian md tud `
M�t IAe nFamatpn ven u tar�ct I proe m wrth al nrc hwa wd uty ndirercn Mafinp N EuiNinp '3'� {�� . G 3!w Z�
canstiucuon.�nd �proumafi of!h partment BuiMmp and S�ktY Oo rnhr upm 11N properry
— ta wh ve ed . it lor nf m�' n�pnwns
1--
sqneiwe o� a nt � p� RECPT NO. � Y c1�QL VAUDATIO
� � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Pssessor Copy,OOLOENROD—File Copy,GREEN—Applicants Copy
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