HomeMy WebLinkAbout4216CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT FIRMLY
JOBSITEUSE-- J 7
ADDRESS ' jADDRESS
APN LOT TRACT
DAPS
CATION
NUMBER CODE
ISSUE TYPE n /
DATE CONST. V GROUP_
CROSS S,7>f; ET
OWNER I -VA—
ADDR I
ZONING SETBACKS &VFKMP*MM
RW
REAR
CITY
FRONT
SIDE/SIDE STREET RW
APPLICANT I A J^ TEL. SIDE
CONTRACTOR
ADORES
Y ZIP TEL. Cl-
C3PRIVATE'
SEWAGE
ISPOSAL
El PUBLIC PMT #
SO. FT/100 GAL
GRADING CU. YDS. EXC. CU YDS FILL
STATE n
LIC. NUMBER Z( O
TYPE SO FT FACTOR PS ADJ. AREWALUATIONARCH/ENG/
DESIGNER
ADDRESS
W 1
LLL 2
CITY ZIP TEL. 3
P RQpO$ED U `
4 f(X'./ dYL Zt
Z 4
GARAGEJ-
NO. DWEL NO. a
UNITS STORIES DROOMSBE m
PORCH
LOT DIMENSIONS VALUATION ADJ. AREA
OuAw"I DESCRIPTION FEENO. OF BLDGS HOW
ON LOT USED
71. CONTRACTORS OECLARATgNI waby affirm the I m kcahed Iesdr peennnrhs of Cnapr 9lcsmeeanp
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WwithSam, 70001 of Utvtao 3 of the Bteess and Profession C.A. sed any keeps is in fell force sof offset.
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LWWReehy &MBUILOERDECIARAYMIfaloneaIamMVIfonIMCaritrar/w ItoslowLaw I I
reason ISec 70315. Btinesn and Prdeswru Cges Any trey a carry, whets retpera a pane to caaeeet
nisi '.prove. demoksh. or repmer any rrt[bee, print to its entries. also rNuess the applicant for such pane
ra Ice a signed staemos that M e ktensed piesuant to tin pweans of the Contract's Licase taw Ones
9 ,canmonng with Satin 70M) of Division 3 of the amus and Prtolessom Cob) or that her as eanat therdram
ark 1. bests la the alleged eampton Any _Wbon of Sector, 70315 by awry ep*mt w a period ableds
the applicant to a Crvd Penalty of not one that lit hunlnd dopers 1!5001.1
7
In
e6•
D as owner of the property or my emoolvef with wager a den sale annambm. will do tM week. aid
U
The struttne s not intended or offered w 8 --sale ISa. 10" 8and Profesnam Cath: TM Comraw esmesLi
ty wer mnprerva threlle eepees. wM dsuch work hmadl. law does rot appy 10 a ager of property bwdl
I. shougn rets own emofwees. proutdad that sorb mpoyermer s ere not mteedtd or offered w sob If, howit
the auddng a ,nw--.m a sed with. ere yaa d Cam Vk .t. ftawmC 4eIMr W; hem Yee halon of prawn
mas he did not butt or weroue for IN pp. at sent
I as owner of the property. am eakmwly contrataty with ke, cmtratios to meeruct the poets 1Sa.
70aa lkmreu and I§dassnt Code- The ConoatsaS License Law does nm apply r an owner of property who
builds or r proves Merve. end who Coh ptmetsheSuch with a CantraeW SI kearha I pwwre to the Cohn I
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ul
g
Lcerm Law I CONSTRUCTION
lam e—of wan, Sr, a b PC amah Cermlicaal PLAN REVIEW
a 0— ELECTRIC
WMERS COMPENSATION DECLARATION I hereby eft m do I haw a arahcete of Cared to saN•.sae. or
a mathcate of Winners Contentment Insurance or a Cpdid copy Moved (Sec_ 3800. Lab_ C.I.
w is honest6arsheathonestWishedJ
PLUMBING
MECHANICAL
ICJ Cabled Cagy is fiW with de atuNnrg bsPcwt Dsprtamin a Osprtmre. B GR G
CERTIFICATE OF EXEMPTION FROM LM3RK IIS' COMPENSATION a61)RABCE: Thb sada meed rid be comites
d to Prime a fa ane tartan (21001 a Ian, 1 termly die m the pawon¢e d la web w which sods
permit a issued. I she not employ app Peron in airy manic m a m harm abPct a de Nwkri Canpemaae
Laws of Caltwme.
toteApplicant L
LJ.
S AN
SMIPr'
PARIEFEE
SCH&L FEES, , : , r, r. -=.i. e' "
i ;h E. I
NOTICE T3 APPLICAIET d. aft making the Crhlicm d Eaampdan, you shrine hrem seaPa to da waMr•s
Compenmtmn prwiainns of The Law Code. you oto w*md prroh with emeachpre,ese this prete erp
deemed•
r„
be revoked
OYISIM DE INWSTRIAL SAFETY PERMR CERTIFICARK
I hereby term, that m .—I- fine 151 or ata nee n dept( rib when a prtt S ager, a deseard.
@. P`S _.1 z: siovabemadencsnrarfmwithworkaeMotNbeOnpernw, eel the m MMYg meter,. aed1 11 1 1 - 1.
dty-m 130) feet high 10". 3.2. Cep 2, An 2. Sam... a demohltm a dismissed" thereof, we be tontt thr
341 Tide 8, C A.0 1
As ower kA* I will rot molt falling to de atak which wail maim a peed he fhe DvM of
lesssl, (less such peso hu a partner ands salt mark tram sod GemaheumwSONY. as teslaw
y C' ,r•i rTG; T S
ewaio of hakisew Seery porno w. TOTAL FEESCOdSTRUMM (EMM AGENCY-. I hereby ohm M Item a a eanaeae ImmYg ago" he h prwnrn
d tM work la which this prml S Sure (Sr,. 3097. Car. Q.
Lomas Kane COMMENTS
leader's Adding;
Aib AUTHDINZATOI OF FXW I termly I Aar and fhb apptintiea and stnIiRTUCATEO
97. ma Me idamaa. I opt to amply with ape sea Ian and dry er6tere ram" to bw6np
Comuctm, sited de Deprt mitt d 8wiq ad Sddy a are ops dm Paply
w wwh I have a ase" tsepaeeas
RECPT NO. PAID BY VALIDATION
X
SrPe n d Applimt a Days
WHITE—Departmenl,,C, YELLOW—Finance Copy, PINK—Aameeor Copy, GOLDENROD—File Capt', GREEN— Applicaft Copy
BS106.11789 u
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