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'� � CITY OF DIAMOND BAR PRESS �� C%��
�� a����rM�n�r oF�ui�.�:r�� �ND s��E�v FIRMLY
^� �UILDING PERMIT
JOBSITE .,,� J,� „�, �. APPLJCATION �,d1 �NU BER_�ODE--
ADDRESS ��`"� �•� �����1�� �1�1 ��,`l��- DATE �LJ '
_ ISSUE � TYPE OCC.
� APN LOT� TRAC-�� DATE � � '-`��CONSL GROUP
p CROSS STREET�+��'�=��*�' ���'"`- �-•-�<� SETBACKS "�"�"'Er"5
°-�' OWNER - ��'G'y��c`�f?-�l ZONING FRONT RW ❑
o ADDR S ��`'�' ._� '.;`�y_��>.��`�,c=���-,�,�a'�'.'�'- - REAR - .� �
;� CITY ���c1-.�''(� � �-�ZIP��� TEL. ( `-�:�"�� ` SIDE/� ST ET_ RW ❑
o APPLICANT_ TEL. L- _ CI
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Q CONTRACTOR�' �����' �=�i''°-�
SEWAGE ❑ PUBLIC PMT#
o ADDRE S�"d'� 'c���-�,'=-'1 `�'�� `k�-�+ �'� �` DISPOSAL
„� CITY ��'�:` "�" �ZIP`?M�'�'�� •;` ' c . ❑ PRIVATE SQ.f-�T./100 GAL
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= STATE
y LIC.NUMBER �'��~'��� ""��% GRADING ❑ CU.YDS.EXG. CU YDS FILL
y ARCH/ENG/-�. � � �'�E SQ �T FACTOR PS ADJ. aREANAI.I„IATIQIV
y DESIGNER ��'-•��"'Z��
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O ADD�/R�ESS`tc�'Z.;Z, �.a¢=a,('.x ' .:.+„��� �
� � CITv`G�1c�-�`� w���as'�' ZIP TEL.E:"j,c�uZ.`i'•/ �r g
� PROPOSED USE �+�9aws�.-•,y.i�, (�c:�`'a. a-�',a"F'� Q 4
� ��'�•6 a`="� � � GARAGE
Q NO.DWEL. NO. NO. � pORCH
� UNITS STORIES BEDROOMS
� �OT DIMENSIONS m VALUA710N ADJ.AREA
o NO.OF BLDGS HOW 4UAh1TI�Y D�S�RIPTIC3N FE�
W ON LOT _USED Q
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I ICENSED CWTItACT(INS UFCLANATION I Irerelry affum that I am hcensed under pmwtions ot Chapte�9(commenung �F'
� wnh Sr.r.uun]000)ul Divaion 7 of ihn Busmess and Pmhssions CnAe,and my liCense:s m htll fmce nnd ellecl. �w'
3 � ll3
µ- UJJNER[3Ul IIEN UiCI AHATIUN I hereLy affirm th,t I ain exempt imm ihe f.ontracmr's Lreen�Law for ihe tdlowin9
� reasou(Sec.7031.5,6usmess anA Piofessions Cude.Any cny nr r,mmry which reqmies a pr.rmit to conslmct, (3 —
� altcr,inpmve,tlamo6sh,ur iepau any nrudure,prior lu es issuance,alm reqnires Ihe applicant tor snr.h periml Z � /�
� to hle a signed statemr.nt�hat he is 6censed Dursuant ro ihe prnvrsiuns ol fie Contra[mr s License Law(Chaptei ��m �, �1 � (,{ ��—
� � 9 Icnmmair.m9 wilii Sec�imi 100D�nf�rvisinn 3 0��he Business and Pmfessmns CuJe)or Ihal he is e.aempt�herelwm '`
�y nnd tl,e uasis for thr.nllepeJ e�emptimi Any vialation nt 6er.imn 70315 hy any apphcant Im a yermit su6�ects '�
W 7hc applicnnt io a crvil penzity nl nM mnre�han irve hunJreJ uallars(5h0U1 I a
� p ❑I,as uwner nf th:Dropr.rry,or my employces with wages as thert sole wmpe.nsatinn,wdl Ju the work,and �j
the siruclwM u not in�ended or nflereil Inr sale(Sec 7pA4,Business ar.d Pmfessmns CuJe_T�e Contrar.lm"x L�cPuse Q
v Law uees nm xpply tn an nwnei ol Urup2nv Who hutlAs or imprmes theieon,and whn dnas such wo�k himself, �(,}
Au nr ihrnu9h h�s a�.vn enployccs,pmvided ihat such impwvements are nnt intended or oflereJ for sale If,however, Z
m ihe builJing ar improveme.nt ie sold wrtiiin one ycar nf tnmplenan.ILe uwirerhuildcr wtll have.thp burden o�pmwnc� �c(
� ihat he diJ nul bu�IJ ur impinve for Ihe�iryose uf sale.� ���
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H ❑I,as owner nf the proVerry.am exclusively r.nnr,acimg wnh hcenseJ�ontractors tn r.onsimct the pmject�Sr.e � �
o l044.Busir.ess ur,d Pmlessmns f,nde Thr.Cnnuacm!'s L¢ense Lav�•Aoes not apply w an owncr nf pmpeny w6o �
a 6uilJs nr impm�es theiean,aud who cunlracts fnr such pm�ecis with a contrai9orls�licensed pwsuant to tliu Cuntrar.mr's
"� ''°"^SeLdw1 CONSTRUCTION _ _ --�}
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U I ain rxr.mpt unAr.r Sec .8 h Pf,(Atta[li CerGficate.�. PLf{(� �E�/�EW _
0 oa�e o,.��E� '. ELECTfiIC
J _ _- _'
� WOpKERS'f.qMNENSATIUN OECLAFATI�N.I herehy afL•rm that I have n certificate nf ton5em�o selftinsure,ar
a ce.rtd�cate of Workeis'Compensation Insuranr.e,or a ceruhed cupy Iherr.of(Sec 3so0.�a�tl. ' � PLUMBING ._
� ❑Centlietl cnpy is hereby fmnished. � M�C�"�AN��'iF��. _ _
o U CeililwA nryy is fileJ Wi�h the Ilwldmg Inspecumi flPparinient or Oepanment � GRADING � �
W � —_"__
^Z LERTIFILATt UF EXEMPTIUN FROM WOflNFRS'COMVENSNIUN INSURANCE This sr.r.�mn nr.ed imt 6e comDleted ISSUANCE
� rf�he Ue�nni�s fur one hundred�51U0)o�less I cerlily lhal in Ihe pertonnance o!Ihe wnrk for wlnch Ihis �,,,., — —
y
permn�s issued,I shall no�employ any persnn m any manner so as tu Lecome suh�r.ct to the N6rkers'Compensation SMIP
�' Laws ol C ifomia (�"'� "' —��- '-�-
o t � � � � PARK FEE.
p flate �4 r/:' .± 1 - -Appli[anl .e.—.r — '—
� NOTICE i APPLIC,NT.H,after making�his Ceruhcate of E� ptio yau shauld 6ecnme sub�eol to the Wnrkr.r's u" cJ � .S
-� Canipensaunn povismns of Il�e Labor CaJe,ynu must fnrth Rh cou ly wnh such pmvismns a Ihis pennit shall
'i be deemed�ewkeJ.
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� OIVISIUN OF INOIISTAIAI SAFETY PENMIT CERTIFICATION. 4i —_.___
W r, �IPdts �
d IJI hemhy cenAy tlial nu eacava6nn live�5)or mnre feet m deptli mlu which a person is iequired[u descend,
� will Le inaJe in connectnn wrth work aWhmued by ihis pennil,and thai no buAAin9 slmciwe,uatPolding.falsework,
n' ur demo6llnn m Jrsmantliry Iherea�,will he morr.Ihan Ihirty-six�86)lee�high (Chap 32.Grp 2.Art 2,Sec __.
= 341.TiHe 8,C.A.CJ.
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� IJAs owner huJder,I wi11 nu!employ anyone tn do wnrM which woulJ iequue a permrt Imm Ihe auision of
�--. Industrial SaIMy,as nntetl a6ove,unless sucL penon has a permrt tn Ao such work fmm ihe dnrsion --
�
�,¢y �Onision of InJustrial Safety Veimit Nn TOTAL FEES
G.
�y CONSTBI1f,fI0N ItNUING AGENCY.I herehy afhrm that iheie is a cansirucaon lending ayeixy for ihe performance
Z nf the wmk(o�whidi this peimtl is issced(Ser 3097,C�v CJ.
� lmAei's Name COMMENTS
m LenAer's AdJress
d CEflTINCATk UF COMPUhNCE ANO AUTNOBIZATION OF ENTHY.I cer�ity I have read tl�is applkaam and state
en thai thr,infarmanon grven is ennect I a9ree lo comply wrth all state laws and crty ordinances reWtinp to huiMing
� canstrucuan,anJ euthoiiie a representahve o1 Ihe Ueparin�enl ul Buildmg and Safety Io t�iler upon ihe property
_ �W have apphetl o Ns penmi for 11 yuryose af making mspections
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�awrc ol Apphcanf or Agem pa�e RECPT NO.��P 10 BY / VALIDATIO
WHI�—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
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