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''� � CITY OF DIAMOND BAR pRESS
`�..� ���"� DEPARTMEN7 OF BUILDING AND SAFETY
BUILDING PERMIT F'IRMLY
JOBSITE - � �(J APPIJCATION PERMIT USE
ADDRESS _ � ���"�I�`��C��/�- P DA7E NUMBER������� OC CODE
ISSUE � TYPE C.
a APN LOT TRACT DATE � CONST. GROUP
" GROSS STREET N ZONING SETBACKS "p"°'�F'"E'"5
aO OWNER L�Q I� r FRONT RW ❑
o ADDRESS g7�s �I�kMOND �R P.7W�7 REAR ❑
,� CITY��1� � ZIP��TEL� SIDE/SIDE STREET RW ❑
g APPLICANT TEL. SIDF ❑
z
4 CONTRACTOR N � SEWAGE
❑ PUBLIC PMT�
o ADDRESS��.�I �^ — DISPOSAL
,� CITY �i1�1�1_b �.7IP q 17G.�TEL. t A�GI � PRIVATE Sa.FT.I 100 GAL
= STATE� f GRADING ❑ CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER %D�'�J��S '" �,
� ARCH/ENG/ � TYPE 5Q FT FACTt�R PS ADJ. ARE/kIV/1LUATION
� DESIGNER � � �
� ADDRESS Lt„ 2 °
ZI� lall7 P�A�2.ZIP TEI�o�� (r� 3
� CITY � � '�2
� ; � � i/-?� � � Z q
� PROPOSED USE � _- � � •� �� �
� i ,--z� J GARAGE
o NO.DWEL. NO. � N . - �— � pORCH �
y UNITS__�STURIES BEDROOMS_ � �
� LOT DIMENSIONS VALUATION ADJ.AREA
o NO.OF BLDGS HOW UANTITY DESCRIPTIOIV FEE
W ONLOT USED -�
� — U
W s
_ ❑ a �'�.�'� ` .,�. , (•,_ GC.Y�. ��C: ��C``
~ :ICFNSEII C.ONIFACTURS�ECIARAiION.I Bereby aHir�n that I am licensed under prmuions nl Chaple�9 Icammencinp
� �n�nh$ernoii 7000)o(Un�sion 7 uf thx�siness ard Prufessians Cnda,and my license is in full fcrze and eMecr � ���_�',t,� �y��_,
o ^
3 LJ i"�'1 i:�..,
�+- OVJNCR��UI:�ER DECLA1tAf10N I heia5y nlhrm Iha1 I am ewempt from me Cwma;�ur�s Laense Law ioi me iWlowmg �.r' . �
x reasor ISec 7031 5 RuS�nPtt Bnll Pfo(P951�115 Cude Any nry or cocnly wh¢h iepmres a permit ro consirucC (�} �f,
O zlter nn�xuvr.deinoLsh,ur repau any strunure.qior m iIs rssuance.alsa requnes the apyhcant Po�such peimn Z •
F— tn hle e s�yr.ed sta�ement ihat he is hcensed pmsuanl lu Ihe pronsians of the Comractor's l¢ense Law(Chapter m �
s9�wmmencin9 wilh Seuio:i J0001 uf @vism�3 0l the Nnsmess aud Professions Codel ar ihat he is exen�p��herelrum j � �� �
d anri tAe M1asis fm t!ie allegeJ exemption pny vinlation n�Seclion 7031 5 by any applaant loi a pe�mn suL�ecis
✓
W !t�e epuhi.am io a uv,i nPnanv nt nm muro than(rve huMred dollars IS5001 I "a �
o �.• .
� nl,as unner of t:c prnpertµcr iny emgloYees wnh wages as Iheu tnle mmpensauon.will do ihe wark,an0 �
Ine stru:mie rs nni unenUwl ur uller�lor sale ISec.l044.Buai�ess and P�ofessiuns Code The Comracmr s Liaense Q
�'j I,w dnz���oi apply to nn owr.er of pmperty w�o 6uJds or imyroves Iheieon,and wha dces such work h�mself, O
,•• or Ilrtcugh his ewn emoloyees prnnJed that sr.th impravemems are rot imended nr ollered br sale If,howeve�, Z
m i�e hwlAmp v impmvemeut is sold w�thin une year af comMennq thc aHner���idtlw wdl have Ihe burtlen ol proaing Q
� t�ai lie dnl rut I��m'tl ur improve for the purpase af sale I U
h
V) ❑I as uwner uf the D�cpenY.am eRUusrvelv com acun�wnh 1¢ensed mntracmrs ro r.or�stmct Ihe D�alect(Sec. ,�yJ
� 70AC Busi�:ess antl Pmle.ssions f.ode. The Cummctar's License Law does r.ot apply ro an ownei of properly who ,�
x �wltls m imp�nve..ihr�eun,anJ whu cantracts ior such pm�ects wuh a cantramr�sl 6censeJ yursuant ro the Comiactor's
4 '�«^�F�^�� CONSTRUCTION
0
� ❑i ani�cenipt uneer Sec B& .ernhcarel _~ �E.� ��J \ __
p Uate--- �_Ov+ner �-�'�1=��`�'
Q Wf1RNkR5'COMPCNSATIQV OECLAHATION I herety afhrin Ihai I have a ce�lif consem ro seil�insme,or
� � �,er1dme�e uf Nkrkers'Cnmpensancn In.aurence,a�a ceiuhe��copy theieof ISe�_38�Q La�C 1 LUMBING� �� � �� __ _,,___
� � � MECHANICA�.
� U Cerutied arryp is herelry hxmshed �� ___
O �CrrulieA wpY is fileG wnh Ihe Bwldmg Ins�Unn oa�am��em�� nepanmem �� GRADING
W /- �(`'�
= CCRTIF�Aif OF EXFMPTIUN FAOM WORKEAS'CDMPENSATION INSUHANCE This+emm�nceJ not 6e mmpleteA � ISSUANCE CL� ��-�-" •-
� d the peinw is lor m�e huntlred ISI00�m less I renity��a�m�he Uerloiman[e ol the work tor which this -
h
perrun is issue4 I S�BII rwt employ any peison m any mannei so es to 6e�ome suh�eu m the N4rkers Comyensation SMIP
� Lews of Cahlnmia uj —' "—
� ��,���� PARK FEE
� W
o ua�� 3 np0imani re'1�N_ tl.. SCNOOL FEES
•.� NU71CC TO AVV�IC N7 II,a te�making ihis Cen�h�ate o�Exemption,you slrould hecome suh�ect m he Worker's
= CamCensanon provismns ol Ihe la6m Code.Wu musi fa�hwnh mrr-0ly wnh such qovisians or ihis pe�mn sha:l
LL hrt deamed rewked x'"";� --- .— --
� DIVISION UF INOUSTAIAL SAFElY PEAMIT CEfl71FICATION i,�.i'�+ �' ';;'. •
� ( t ,� �r�i�S:i.. :v:�,
o LJI�err.�y�endy nm�nu e��avauon�rve 15)or more feE�m de01h mro which a pe�san rs required to descend, ______
p� will he inaJe m cor.necuon wnh worY aulhomed Uy this permn,and thet na huilding stru[tu¢,seafMlding,te�tework,
� m demuliuun or dismam6ng theieo�,will M1e mae than tb�ny�srs 136)leet hiqA iClp�.32.Gry 2.An 2,Sec _
= Y11.TitleB.f.ACi �,+� K `� 6aF�.i'a _—
@!f,�, oo�.•`�1
� ❑QS roxner��utlAe�,i will IIO[PIII�IIO`/d��011P�0 v!L'rk"Wh¢ti woulC reqwre a yermn fiom ilu pvisqn ot
� Intlnstrial Safeiy,as no1eJ aEave.unless such persan has a De�mrt to dn such work imm the diyision.��.
� _ ..� .„�.-:, :.:.�":
W� ❑LwismnullndustnalSaletyPermnNo K'����� � �'� � ' � �� TOTAL FEES '
� - 1�J
CUNSTHUCTION LENDING AGENCY�I here6v afhan 3hr�'thF�k is a'consUuclitln�lEndiiig'�pency fa Me peifo�mmce � 1 C(�C./
Zul tlre work for wMCA this permil is issued�Stt.�89i,C'N�C�:
� lener.�sName - COMMENTS
m lender's AeOress
Q CkHTIFICAiF UF COMPLI �AUiHONIZATION OF ENTNY�i certify I Mve read th�s applKauon and�tate
v] ihat ihr,mtorrnalion give is carec4 I agree m enmply wnh all stete laws a�ury ordironces�elatirq to 6uitling
y cnnstrncuon.and authon=e representauve of ihe Department ol Bwiding and$atery N mter upon the propvry
= for whi[h I h e a LM fo t loi ihe u af making mspecuons
� � � 3 0 �. ����
eWie o�� m o�Avem �e RECPT NO. PAID BY--+.=���e r'�VALIDATION
WHITE—Depariment Copy.YE�LOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
6S10G-7 t189
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