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CITY OF DIAMOND BAR pRESS
�- DEPARTMENT OF BUILDING AND SAFETY F�RM Y
BUILDING PERMIT
JOBSITE APPLICATIO _ PERMR E
ADDRESS� DATE � NUMBER CODE
� AP �� � LOT�TRA DATE �� � ONST. GROUP '
o CRO TREET �' ETBACKS �E� I
°-' OWNER — 1 ` — ZONING �ONT RW O I
a ADDRES � � REAR O (
W CITY ZIP TE ' SIDE/SIDE STREET RW ❑
1
o APPLICAN ' 1 � #EL � SIDE O
a CONTRACTO — � ` � SEWAGE �
o ADDRESS � DISPOSAL � �BUC PMT�
W CIT��f'.,�1'L"�' ZtP TEL ❑ PRNATE SQ.FT./100 GAL
Z STATE
N LIC.NUMBER ��- � GRADING ❑CU.YDS.EXC. CU YDS FILL
y ARCH/ENG/ � TYPE SGl F? FACTOR PS ADJ. AREANALUATION
� DESIG R W �
o ADDRESS tL 2 I
= CITY ZIP TEL (� 3
oW �Ci S u = Z 4 ,
PROPOSED USE
� � GARAGE
o NO.DWEL NO. NO. � pORCN
� UNITS STORIES�BEDROOMS
e LOT DIMENSIONS m VALUATION ADJ.AREA
o NO.OF BLDGS HOW ouawrtrv DESCRIPTION FEE
W ON LOT USED Q
/(7 �,
�
W }� �
� u
ICFNSFO CONfNACfONS�ELLAPATI�N�.1 M1rreby dfirm Mri 1 am RmttA ude p/ovisiant o)thpter 91mmmncinq
� wnh Sauon 77001 0l G��wn 3 0l tM&nix�t snd Aokssiau LoM.�nA rtry Irent�is n tu�force�nd eftect �W �O
o J
3 � W ` � , .'-1�_ . � `� •\•':'�
�±- 0.VNEN BtMDFR LKQAHA7qN�1 haeby dfinn Aa1 I�m eampt ham rt�ConVacmr's lienu Lw�la tM Idbninq
roson ISec 70315.BusiMss anC Proletsions Codr AM ntY a[eunry wAkh nQuirq�permi�ro tmftr�c�, (7 �
o alter,impeve.demd�sA.n rryri a�ry suutue.prwr ro us rswance.a'so rcpurt�C�e�ppM1nm lar wch pmm� 2
Qro hk�sgneA stattment that ne n RmuE purwm�ro rtrz pwisbns of ine CmeKta't lieme t�w�Lhipre m
� 9lcommercing w�M Section 70001 0�Drrisan 1 d Me Busineu anA Prolnsion Cade)a Ma he n e.empt tMehom �
d mE me Ws�s la the aneged sxmpoon.Airy vitlmon d Sxuon T031 S Eq ury�ppik�m ta�permn suqe�n 7
W Me opplicant ro�civl penalty d not mae tAan five hurdred doCars(55�11. a
o ❑I.as awm ol fAe preprrry.n my empleyen wiifi w�gn n Vieir sde campmsation vnA do 16e wort.e�d
~ the svume n no�intended a oHered la uk ISec.T0<4.&n�ness nd Roless�ens CoE��TN Cmtrxmr's Licens� a
� tiw Ann nx ippry to m avmer o1 property who bu�lds d enpovn M�eon.nd who eaet suh xvt himttH. U
,.• or ihough his own employees.pa�ded Tat wcA mpovemmb�r�not�nuMe!er offered fa stk M.howntr. Z
m me eu�e��q ar�mpmemm�is w�a wrthin one yex ot cu�d��.tM ovmer eu�row we nm me evem ol pwm0 <
� tnst Ae d�d not Eu�W a«^pa.e Irc the pmWu d nk I', \.- _ . f,
� �
y ❑I.es wv�rr ol Me popatY.�m�T.etaneti cmvctaiy wi�Ike�M conaxfa�m conmuct�he pojM I5� W �.j - - ..
0 706b.Bu4rc:s md Prolessiane Code.The Contrxta't lieese iw dets nol�Odr ro!n ewner o1�paKnY wha -S' � � i �- r..l i� )~ •�._Lf .)1 1
� Mlds a�mpeves trxrton.mE wno mmn�n ta t�en pmiects wit��tentrKmrfsl Fcensed pvtwm ro M tontnttoi s
�K°^x�� CO�NS�,�_UCTION � 101e �
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� O��m�,�,��,Men s� ,e 6 r.c unnc��.k� PLAN REVI�W �a- � �/
� °ah °""" ECTR U
4 KqtKEAS'COMPENSATCIN DECIARGTkl7�1 hee6y�ftrm IhH 1 hiw i terDMtM ol tmeM to feM�mv�,a
� a ceM�cate o�Wa.ke.i c�xM,f�,u�:�„rc..«��Rerra�wr�+isK.�soo.i.e-c� P LU M B I N G
� ca��ke��K n�w i��e J MECHANICAL
� � GRADIN
C ❑CernfKd tapY is hkd witA tht Buiid�iq M�pictim DeDxmimt Oeprmem.
W
� CEtRIFICATE OF FI(E61P110N iROM WORKENS Cp.!PfNSATION MISURANCE:This xetion need rot Ea to�ekd SUAN �
N d me permn is lor vne m.drza Ist001 w kss.�aMr uhn m me pntormarcr o�ur woit far wn�n nrs � G
� permit u issueA.l sh�ll rot e�v/iM Person in nry mmner so is Germr w6�ct ro Ilr Nbrksi'Wnqeny+ion MIP - _ •:�l� _
l�ws ol LXAdnu.
o ��, �_f� ' ��p AST� W PARK FEE
� °'° � � 'A9��"�� u- SCHOOL FEES
W NOiILE TO APPLILANi:M.dkr mek�nq�s Ce*afuu d Fn^r000n.W!i shauid brcmn eubjKt ro the Worker'�
� Campens�Um D�avit�ons ot IM I�Ea Codt.'Nn musl IanhwMi'�mDN��n�h.prh pMisidq a�hi�Gen^�shY
�+- Ee deemed mroked. �;J„s;.;i,��i
J
� tmsror�a n+dtsrmu s,u[Tr r[x�+rr aRrrunar
W
o ❑I herehy cerid�that no eamian frv�(5)a mo't het in dep�h inro whkh�penan h repuirod b dnnnd.
oC wd h nah n eeixietron with woh�uMv¢ed 6y Ait pS,mIR1 WOt�tl�o IWd7lN�clr7.StalkKuq,fYfewart.
°' a dnmlmm u dnmmdry Mneal.wA Et mae tMntf3,.qb�36/ke('fiqhl�IJy1:�2.GrP 2.M 2.S�t
W� Sl1.T�XeB.CAC1. r'1v
x
3 ❑As eMm�b�xmn.I vn'N na rnqky a�a�e ro do�.elt whih weuld�rewin�pe�m 6e�n�a+t�a d
f.. InBistti�I S�h�Y.n rottd Mo�.u+kss suU pnso4Ns lqF�110 Ao�axh.+�ak han R�0'na+on'�
� � �, rt\��. i._���
W ❑R.::7andMd�idSahMP4r�No. l:!„� n��;,:� �,�_. _ TOTAL FEES � (�
`" casrm�crnw iE�xc ar�ecr:i n�ar.re�e�,�e�.n.c�n�000 rro.p.�r ro�e.o«ro�.�.
Z d tM work la whsh Ihif pennl il'uvrA(Set.3097,Gv.C1.
� t"""•�"'"" COMMENTS
m i�•�aa�K�
� fFlRIFGTF OF COMPIWCE ANO AUTMIRZA7l7V ff ENTRY:1[ertih I Mt mE IM�POk�tim m1 MM �
�1 tAst Bu idamatim Pren it eom�t.I qN ro ta^d/weA d stW 6we wd ciry admweq n6tiq b 6�Hn�
y cen:mc�en.rd r�tlw"ve�rtperznhMe d Ae Dwtment d 6n77ir9 ma SNery n�ner ypn h Orqnry
= lor vAKh 1 hr+r Dd'�A fa tAn pmM M the puyew d m�kiq in�peccan.
~ . �I S RECPT NO. �� PAID BY��VAUDA �
.ture d lbprm�n�qmt o�ee .
_WHITE—Department Copy,VELLOW-Finance Copy,PINi�Pssessor_Copx GOLDENROD—Fite Copy,GREEN—AppP�caMa Copy ___ __ __
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