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CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY FIRMLY
BUILDING PERMIT
JOBSITEt I /
ADDRESS Zr 3 �' `1 U�l L`l n e
APPLICATION PERMIT
DATE NUMBER CODE
ISSUE TYPE OCC.
DATE CONST S_ GROUT}Z 3
APN LOT _�_ TRACT3�y
CROSS STREET_ Psi FindC,i
OWNER Elie_ :Ie L L SI c J< (off
� "rs
ZONING SETBACKS RNA FRRM �
FRONT RW ❑
ADDRESS_ 5 -IM
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CITY Dj•mo,%2 7jP'i(7LY TEL 5'/Ligig
/SIDE STREET RW ❑
APPLICANT !10-1 c TEL
SIDE ❑
CONTRACTOR j�) lot ACr
ADDRESS
CITY ZIP TEL
SEWAGE
DISPOSAL E) PUBLIC PMT
❑ PRIVATE. SO. FT./ 100 GAL
STATE
LIC. NUMBER
GRADING ❑ CU_ YDS, IXC. CU YDS FILL
U)
TYPE SO FT FACTOR PSF ADJ. AREMALUATION
ARCH/ENG/
DESIGNER 6 w n
ADDRESS
Icy„
2
CITY ZIP TEL
3
PROPOSED US
Z
4
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GARAGEPARCH
NO. DWEL, NO. NO,
UNITS STORIES Z BEDROOMS 2
LOT DIMENSIONS
m
VALUATION ADJ. AREA
QUANTITY DESCRIPTION FEE
NO. OF BLDGS HOW
ON LOT 1 USED d--c'S
❑
LLEhtSEO CONTRACTORS DECLARATION. I hueDY dtum tut l am kaued undo pr0ruims d Tdspw9 Icaaswcirp
with Section 70D01 of DWruon 3 d the Braaws tad Protestant ". and an kense is o Ia
U n W effect
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W
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OMER BUILDER DECLARATION- I hereby dhrn that 1 an en -pt ban ilia Contractor a License Law fa the folaw'.1
reason ISac 70315. Bunness and Prolessans Cala AnY Call a county whish ("IS a Pamd 10 taaabppt,
yar. mpan• demolish, a repro tory s muse, par to its arcane, aim nvwa IM 4p6wl at such pant
to tde a aped summons WI he a kansw par u l to the pnums It the Cmaractoi s license Law IChapa
9 (cornivntmq with Scorn 7000) of Uwsm 3 of the Busaess and Nolessnn Cade) or that h a sumps dwahom
ad the basis for, the ateped a"um Any wKdatm of Seaport 70315 by any, app6ml Ion a paint wCpcts
ty d rat nae than Ina hundred daeae IS500)-1
of the poverty, a tin ampar«s wits waves as than tole compmsaoon, w0 do tla wool. Wure a not ,carded a offered la Lata ISac. 7664. Buvnss W Ptolessans Coda The Cmtracta's L"Ise int app, a n owner of papery who Mads a mprha thaem. W who d«s gush woos hmaell,
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or tlaouvh his Own employees. prided that such avam mit as net inaMed a offered for safe It. howtw.
rla Muumv a unpovement a sold avitha aria Vim dan
cpletm. the ownrMnda .4 have the Mn d Maden pinup
that he did not WUd a Capon la the P.,Wse d sail
❑I, as owrcr at the popatY. an ealuunq tmvacuny w�N Mcentd tmtracmi a tmstrat Ilia gohect (Set.
7066, Bu nails aha PIDIOS ma Con: The Coatrx3o,'t lcanse Law does not appy a an owns, d pioDtnV who
brads a unprhet oweon, W Who cotrata la heli propos Wirth a tonttctor(a) kensd paura0t a ds CmtrYlal s
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CONSTRUCTION
❑Ian oma sae h . a b .c. An A eeakkaal.
Dat` °Win
PLAN REVIEW
ELECTRIC 2 • Z d
WORKERS' COMPENSATION DECLARATION. I haabr affum that I hen A caolKary consist to No as
a terolKata of NbLai Conpewtm Insaarce, a a Wiled cWY domed (See. 38 ._lab. CL
❑ Canted copy a hereby laattad.
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PLUMBING -
MECHANICAL 2 s
❑ LaOlsd copy u Idd with and, Buda.np W.Wuaw Depaasnl a Cspatrant.
GRADING
CERTIFICATE OF EXEWT04 FROM WORKERS* COMPENSATION WSURANCE: This sctan nod but be carpkad
d us pant a la iia hatred 111100) a less. I cubly Net a the patormace d the work fah" this
tory person In airy so as bscant subpct N ilia %lakes as
perm' Is named. I snood rpl rmpluy tonra■w a Canpenm
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F
ISSUANCE I • GAO
SMIP
Laws ot Cydoraa
1>in AgoK i
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u-
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PARK FEE
SCHOOL FEES
NOTICE TO APPLICANT. 8, alta making this coulcare all Eaemptm. Vora "M hsara subsist a the ykrta'.
Canpe"utiw phams al trs labor Co". you roust toadmar copy, with ueh pmonas a an psumA sFW
to d«ned «sled
OIYISM OF W WSTRIAL SAFETY PERMIT CERTIFCATION:
❑I hereby artily that so e... hit 151 a anis feet In depth nm which a palm o rmniisd W ducad,
tacaoe with nook audaud by that paint. and that m buddap Mutsu.. "leading. falsewak
oma b made nmr
a dembtm a cl—and q stored. wit be we Nisi thatty sa 1361 teat high ICI W. 31. Cup 2. Art 2. Soo
341. Title 8, CACI.
❑As owns budda, 1 wed rate &y any. to do nal wW win ld redme a penal baa do Oram d
Industrial Safety. as noted alons. WIM such Perim has A Pant a do ncA work hal Ria annuam.
❑oWtm of kdAtlw safe" liarml Not
TOTAL FEES
CONSTRUCTION UNCIPC WAWY: I hereby affum thatine is a taadaclrnt 1WnP sp ncy la h pafaarra
W In wok la wW this paw is used (Sac. 3097.4. 4
la ler,$k—
COMME
land.'& Addau
CERTIFICATE OF CMWLtANCE AND AUTHAZATRI OF ENTRY: I Warty I hen nail S. agi«tun and auto
out the ntamaum pnn a eorrut 1 ages to comply with W Stan taws and any aanaces rslalip to bm"
emsuml,ran W w0witt a rapnsentahe of sit Deparasnt of U&I W Safety b citta cpm the pa"
Ito which I han�and Paint fa th Pupose d mYup urspettan. 97
RECPT NO. 42092. PAID By � 1' 1 VAUDATION�
SNrutue d t a Agent Dafe
WHITE—Department COPY, YELLOW—Finance Copy, PWK—A5$GSsor Copy, GOLDENROD—Fdo Copy. GREEN— Applicants Copy
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