HomeMy WebLinkAbout1239CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY FIRMLY
BUILDING PERMIT
JOBSE
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ADDRESS 1
APPLICATION�
�use
TJER *DE
TYPE
LOT _iTRACT
DATE CONST GROUPAPN
CROSS ST ET W I a LOA RF -AT T -S'r
SETBACKS ""°'Ea"E'"5
OWNER adlArt " M, SA n��
ZONING
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
ADDRESS
CITY S�'7 sz J
APPLICANT 4 L 1 do -0141' TEL413
SIDE ❑
CONTRACT
SEWAGE 13 PUBLIC PMT TrP
ADDRESS TEL.
CITY ZIP
DISPOSAL ❑ PRIVATE SO FT/ 100 GAL
GRADING ❑ CU. YDS. EXC. CU YDS FILL
STATE 4LJ
LIC. NUMBER
W
TYPE SO AD3. EWALUATION
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ARCH/ENG/
DESIGNER E C
ADDR SS k. A.
ZIPs�, V TEL
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2 ICITY`
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3 +lPROPOSEDUSE
Z4
IrACTOR_
GARAGE
NO. DWEL. NO. NO.
STORIES Z BEDROOMS
DIMENSIONS
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PORCHUNITS
rDLOT
VALUATIONaUQ ADJ. AREA
OUANTrryl DESCRIPTInN FEE. :
NO. OFBLDPS HOW L!
ON LOT USED
LCENSED CONfRACTOAS DECLARATM I hereby afhra dot I as Isanwd welar proris as of chaps 9 (carawcim
wrh Seem Mill d D.— 3 of the Buskess and Professions Code. and my Imam, is in fall force and dfcL
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OWNER-BMDER DECLARATION: I hereby affirm that I an e*W Iwo the Contacmr's License law la the folewdg
mason ISec. 70315, &sirens and Prohsime s Code. Any city a eaMy which raµes a print fu conehuct
aim meow. denmGsh. a wait any shucim, prior to 0. issuance, aim w4uira the ydipnt for such Amit
to We a sgred mtement net he s hcensd pawmt Ca the awrnans d the Censactor's Lkeys eme law K
Ows- 3 e B"he" and ons ProfessiCode) a Mat he s antro dmehem
9 koinowrcirg with Section 7000) d d M
and Me ham h e Hon obeyed ewmption. Any vaktion of Section 70315 by arty mo ant is a permit subjects
the a�a aato a dad penalty d net awe than fide hondrad dinars (35001.1.
Cl I, as owner of the property. a " employees with wap" a Emr mB con enutim, wN do the work. and
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21.
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the areture a not intended or offered fw sok (sec 7044, business and Pro essiau Code. The CmuKrr i Liume
Law does ant apdr man owner of property who h" a atoms Eermn. and who do" saeb wart hand.
a tirargh hs awn emdaees. oraided that wch mpamments we not intended or dfewd fur sale. B. howso.
the bwbam or morowmea s :oaf within err yw of co mbetwo. the awrcr-brNa will hual
e the balm d pori"Q-
dat he dd rw build or imaow let ve prase of sak,l
C31. " owner at the property. Can eedisrvady coaramN with aeraad mmacas m cause ct the punct (SK.
7044. go' inisn and Profession Cod* The Comraora's Lenore law tlns rot apply o an amen Of property who
bends a improves thereon- and who contmic to mch pmncte with a c (sl Ptosed pante a the Cmtralctpr's
Lee—lawn
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CONSTRUCTIO
PLAN REVIEW
�h an must sK B P.c. which camicaael.
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ELECTRIC
PLUMBING
MECHANICAL
WORKERS' CUMNS,41M DECLARAI11111: I Imebr off— Chetaw a caducas d COMM to self -inion. a
a Certificate of Ltyorkm:ri Compensation Insurance, a a catifid copy teed (Ser. 3800- Lab. C.1.
❑ Certified copy a hereby furnished
❑ ce" copy s hied with Me imahmg fuspauan 0a cerwan t or Oa wra mre.
.Q
G ING
CEWnWATE OF EXEMPTI N (TION WORKERS' COINE14SATM RISMIOU: This saran mme0 set be collptesd
d Ee panne s lar ane hmrN ISM a 1"s I wady that r Me Pafaa 0 d the work fee wniN� Ewe
remit s weed. I shah ant emww any palm in my norma m as to boar whet a Ee Vkd s co p"mil ,
Laws d Wifiena.
won rods
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ISSUAN V
SMTP ��
PARK FEE
SCHOOL FEES
Ch. Came of Eametim. pmt shadd Income :abject o Me W-la•s
NUM TO AMICANT: B. aim mebwp Edle
Coanmaem Iavemers of the Lda code. was man Ion—Ptlpty n aaafl�el or Ems parch sMA
be diedw. r'_�'wi Y k ":�
OMShOIl OF P O WMAL SAFETY PERM CERTMPet7fpf:
1:31 hereby rattily Mat an aea+amn Tae ISI a Coma had in dmM km which a Amann ammeal le dorsad.
wd be nude in conewc im with wok ashsad by dos a�pryt�d Em r fai *% sawaia. aea4iddam. hlmawk.
■ drroktwm a dwnntbnnranwitwitf, be were dsn•hM ix ( k:l�aam. 32. Grp 2. 2. SK
p d
I ]tt. Tide 8. C AL.1. a tp 4 aj - vd M
❑As aww-hatilda. I will no mm* alryone a do wait which wand repro a penis ham Ee Diysi e ef
Indumol S*tv. a m" urban. mi"s each p•swT !-&pae Oda k fema Ma/iriaiaw- ,
❑IlwmwdhAnarwSafety%wNe. ...:,- ... :'-• - ��--.
TOTAL FEES
Cl1N5fAll M LEPMRNO AGENCY: I fewb'/ afRrs M Ewe s a maabaepon Mdnp apenry lar M pabmana
: of tie work fa which ter part s saved (Sec. 3097. fin. C).
i Leader's Name
COMMENTS
I Lader's Ad*aw
CE MICAft OF ANn AUTHM OF ENtRY: I ewady I haat mrd to anile lian and some
I this de ad paw ' mratl 1 emery rash a1 sae lows and eKy adaaaa shoo a faidirlp
tmnetncew. a a rrpraol the DepaEran at &"a ad Salasp a Carr apt ds pea"
which Ca n e m e
1. wpm d meld" agaetier.
3 a
7 P" /s
xA
Apphcan w Owe
RECpr NO. b 3 � 8Y 13-
,a e WY.;E—Departrrtend Copy, YELLOW—Finance Copy PINK—Assessor Copy, GOLDENROD --File Copy, GREEN— Applicants Coq
8 51 0 6-1 1 /129
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DFV. FEES PAID
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UNDER c�LC)0,1
PiRE'- LACE BOND BEAN4
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