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CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY FIRMLY
BUILDING PERMIT
JOBSITE
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ADDRESS
APPLICATION 11,, 3 PERM
DATE _.11
APN LOT TRACT
TYPE _CODE
DTE ISSUE �� �� CONST. ���L GROUP
CROSS S EES
ZONING SETBACKS
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OWNER
ADO ESS �
CIT IP TE
FRONT RW
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SIDE/SI EET RW ❑
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APPL1'CA*N
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c CONTRACTOR
SEWAGE-------[:]
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ADDRESS
DISPOSAL.
❑ PRNATE SQ. FT./ 100 GAL
CITY ZIP --'.TEL
GRADING
❑ CU. YDS. EXC. CU YDS FILL
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n UC. NUMBER
TYPE SQ FT FACTOR PS ADJ. AREWALUATION
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DESIGNER
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ADDRES
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CITY ZIP TEL
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PROPOSED USE
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GARAGE � • I i
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PORCH �"' ,
y UNITS STORIES BEDROOMS
VALUATION ` bJ. EA
r= LOT DIMENSIONS
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ON LOTBUSE
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~ LICENSED CONTRACTORS DECLARATION I Mreby all.. that 1 am licensed inch Piro ms of cMwa 9 kammlcuq
ale well Sxbm 7000) of Division 3 of d1c dates and hWctsw a Cod@. and an ktnst a n hell lace and aftocL
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a_ (AVNER 6MUR DECLARATION 1 herety !Item thel 1 am wanpt Ease the Cwtrwlw's teenst Law la the k wrmp
maw" (Sec 70315. 6saaas and Proles"s Code Any mY a "wit, whe:h reRuua A Panyl m 4mmuct.
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O1111111 onpare. demolish. a replar un stimus. pea a da assume. also apuats tM rypkant such Wine
to Ile a speed statement Nat he a licensed pursuant to this povawls of the Cmaaaar i Lam Law (Chawa
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sac 9 (coaawicaq with Section 1000) d Diwsm 3 d the &ismss and Pnolus" Codec a Mat be a !iota dwlhom
ii 114 de bass la - apeped laemptwn AM mawson d S@cuon 70315 by Ory atpkaat fa a Axed wdteca
at de appkam to a cnd Pesely of not awe dart Im dmdad doWs 1150016
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a' ❑L a aw11t1 of dr Props" a Ory -Mass wrth wages as tMx sok CCmPenaasm, well do 1M wok, acid
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one strunwe A not intended a olfued Ea sale (Sec 7044. &caress 114 Proleuens Code The Cmbxta's Lxense
desam. does wok hmsell.
Q
w Law does rot apply to an awnet of popaty who kdG a anpmts and Who sorb
W a no4h Ms own rnme@s. padW teat such mpa+emarts ale not handed a olkrad la saw- R. howowr,
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m IM bulking a unpovement a sold wahm ons Yea of eanpatmn, the pane kadr wd1 bars Me Was of povm9
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IA that M did rot Wild a anPrcve la Me purpose al sak.)
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a'_ ❑I, as owner of ME Property. am inklu"ll, tdetlxtmp with lienal cmuactors to caWrmt the pojat (Sec.
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7044. Business sl Rofesswns Code. The Cmvxta's Lranda Law does not apply m an owsw d PraPaty oho
6 dulls a uW.a dweon, and who contrxis la sucb projects with a embxta(s) kunsed pies—1 b de Canaxm'f
License Law)
CONSTRUCTION
1:11 am now user sec & 6 P.0 LAW abfuto6
PLAN REVIEW
g ate Dons
.
ELECTRIC
PLUMBING
yYAIRMERS' COMPENSATION DECLARATION. I bugW aflam Mat 1 haw a ursfaato of co0sad to stlf issue, a
a cerWaata of Ydskei Corlptniata» ksualce, a a cabled copy Mored (Sec 3800, Lab. C)
4 ❑ abted Copy a Ii fWashad
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MECHANICAL
E=; ❑ aofed copy a fled with the Budang Inspeewn Department a Depatm@ c
ns
GRADING
OF EXEMPTION FROM WORMERS' COMPENSATION WSURANCE. TM sections nel no be coeplewd
ISSUANCE
U-1CERTIfCATE
A de, peml 1s la one burdntd (S IDG) a less 1 carafedist m Me pafamnce d 04 oak fa whose fit
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h
Pant a Wood. l sha rot alpky IM palm^ in aM ulama so as to becarc sv6jat to IN fAtxkai Canpensatm
SMIP
S Laws d Caldana.
PARK FEE a
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C "'ao1
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SCHOOL FEES
NOTICE TO APPLICANT: M. afua nulunM tds aufasw d Eamptim, vol :hall berme, 31Apct a tle Ykrka'a
Conpensswo Prrne,mns of de Labe COG. ru must todiweh corply with such ppaams or Mss Panels ahaa
NOV ��
N O
�- be detml rtvokd
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eL pYLSION O WWSTRIAL SAFETY PERMIT LERTFCATIIN.
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c ❑I baeby tally that 110 ecawuon Im 151 a rax! Lal m depth ate wdrA a pasaa a I@4inl b dascmd,
CITY BAR
I= wig be maG m caawuon with walk anlaauad by Mia prat, rad Mat as te-&q suscuat, "Wd,% lasewak,
a' a demok o or dsin.&% thataol, ori be we t- dety.sa 136) last hqA (CaP. 32. Gp 2. M 1. Sae
BUILDING
W 341. Title 9. CA C).
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3 []As oonea-daka. I w1F amt art* anions to m wok wfah wail a4l a Paad flue de Divanon d
bdusvat solely. as mud angio..kat such Perm has A pard m G tush oak Iter Me, dnrkmn
u; ❑Division dkaaoalSafety Twain No
TOTAL
FEES itj Is 2
d tordaq M Mr
k
La CONSTRUCTION LEW" AGENCY: 1 ba shy dorm las iia a wwbucboa agency pe6lmraA
of dr wok la wWch Mus Pam a kml 15%M 3091, Gr. c6
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o Lader'sName
COMMENTS�j
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m tach•, Addnau
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< CERTRCAtE OF AND AUTHORIZATION OF ENTRY. I [atdy I Mw read *4 spoutim rad stair
H tat de elf van a a I rya to wepply.with AA auto Iowa ad city abnaaa rdataq to keldirq
y [alabuas ., t n m d Md D"seeat d BudanM arld SoM to Ona Ipm tie, papacy
fa ,laic!! d mak.q .aP.chons.
-
RECPT NO_�.� PAID BY VALIDATIONSis
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sgnetWa d t a Agent
RITE—Department Copy, YELLOW—Finance Copy. PINK—Assessot Copy, GOLDENROD—Fila Copy, GREEN— Applicants Copy