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CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY
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BUILDING PERMIT FIRMLY
JOBSITE
ADDRESS S �%/C�ODD
APPLICATION PERMIT USE
SSUE u —/ 3—R °j TYPE ER CODE
DATE CONST GROUP
APN LOT �-r TRACT
CROSS STREET
OWNER FAvel ur %A1,74ty
ADDRESS 2-244 9 F OL -4,411041Z P1
SETBACKS patokEaEhrrs
ZONING FRONT RW - ❑
REAR ❑
CITY ah •ZIP E1I7GSTEL 9Z
SIDE/SIDE STREET RW ❑
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APPLICANT2aW_ft :7-kn TEL Eby ,_' -I
SIDE ❑
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CONTRACTOR �Nr/�
ADDRESS
CITY ZIP TEL
SEWAGE
DISPOSAL
PUBS PUT #
❑ PRIVATE SO. FT./ 100 GAL
STATE
LIC. NUMBER
GRADING
❑ CU. YDS. EXC. CU YDS FILL
(1)
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TYPE SO FT FACTOR PS ;,.ADJ. AREMALUATION
ARCH/ENG/
DESIGNER 6461,96/},PK 5^✓&
ADDRESS_ 1;2,042 IrA�3 �r-, r
GLy VZE� �-�
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CITY raj OF n&LIA ZIP 1 TEL $`U -221L
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PROPOSED US 1� [�vSn�G `i Fig � tit" n'
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GARAGE
NO. DWEL NO. NO.
UNITS I STORIES Z- BEDROOMS,
LOT DIMENSIONS OX .
m
PORCH =7a;
VALUATION - ADJ. AREA
DESCRIPTION =>: - FEE
NO. OF BLDGS / HOW .
ON LOT • USED kms
LICENSED CONTRACTORS DECLARATION I hereby affirm that l am keened Isar famaims of CMpa 9 [commencing with Section 70001 at awswn 3 d the Business and Professions Code. and my Iceme a in tug Nm1 and effectIf
DQUANTIrY
S❑
OWNER BULOER OCCLARA71DN I hmeby affirm Nat 1 am eeenpt tram the Contractors License Law for Ne followingmamn (Sec. 70315, Bwmess and Profusions Cade Any city a camly which hol-11 a pima to construct.altar mprwe. demolish, a repar arty stratne. pip to as Issuance, also Musty Ne eppsicanl tot such pinetofile a spned statement dist he a bemsed paluant to N! prwipam at the Canvocud ILicense Law (Chapter
9 leammencing with Section 7000) at Olwsw 3 0l the Buseess and Prohsswns Code) a that by w eempt drNrom
and the basis lot the alleged eampbon Amy vWabon d Section 7031.5 h arty applicant la a Wind wbocu
the appheam to a cod oanmy of nor more Nan Bre hwdmd dolve IESOO) I
❑I. n owner of the property. a my ampkyets with veegrs as Nnr oak ebmppoanan wiB da the vert. iced
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the soocture is not imposed to offered In sale (Sec 7O•LA. Business and Professions Cade The Contractor Lormse
Law does tat &My to at dymer of progeny who ands a Impro as Opinion, and who dee$ such was hmsnt.
ho.
a through his own ainploras. provided dui sixth impartments we not intended a offered IIs oak Ifwever
the buiWuq a Impavnment is sod wrNm ane you of Campletai, the oomor-builds will hat the bird" of prwmg
Nat he did not build a mprow for the rwxu of 331..1
I ❑I. a3 ower of the paper N. anti laYIsmN anIlaCIUIMJ with hCnaed Lm111tlpti to CmitrpCt Ih Ilrq+tt ISee
i7044. Business ard Professions Code The Conuactor a Lamm Law dos not Apply to an dere at property who
aalds a mpore3 thereon, And who contrecu M such forests with a cmtionor(s) licensed p«suanl m the Contractor 9
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CONSTRUCTION � f1 -Z- . y 3
❑ I am aeempf under Set . B B P.C. 1ANach Cardcami.
PLAN REVIEW
I °a` Own"
ELECTRIC
WORTS' COMPENSATION DECLARATION I hereby alfem that 1 hart a « n caw of eonspot to sed inwe, a
a certificate of Warner' Compensation asaance, a a centra copy thereof ISee. 3800. tae C.I.
❑ Cabtwd copy is bmtrr handed
J
PLUMBING % S�
MECHANICAL
i ❑ Crofpd copy a hied with the Budding Nspcam Oapahmenl a DeAsenent
I CERTIFICATE OF EXEMPTION FROM %PORKERS' COMPENSATION INSURANCE Tics what two rot be Completed
� B the pnmt is hp am hundred If 1001 a less I caofr that in the palamatce of M real for winch this
- petmrt n uslred. I sham not employ dry person in any mann to 13 to become sow to it. vilarkri Com"eutan
Laws of Cahftina
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GRADING '
ISSUANCE
SM IP pain
b
' Dale at
W
W
PARK FEE
SCHOOL FEES
sit 's
NOTtF TO APPLICANT. N, altn mumg all Catdcne of al Emmptm, pay3heudd becomesukrcl m Wor4r
E
Copensabon provisions of the hoar Code, you mot forthwith comply with tech pe ens a Its perms sham
• be domed tevaked
'- DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
0114 CIE C i A MC" 3 R
❑1 hereby Cerldy that no lossmm two 151 a more Not in depth into wash 1 palm is mmwad ho dwcaid,
this pan. And n we I I- - Muctaesnlhw6fq laueevarl,
node in conith wore thrdN by aedra
will he mcfm wsu
a demuBran a snmwthq thereat. will be mice Nan Ihery site 1381 feet high (Chop 32. Ory 2. An 2. Sac
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RI II(•,DIP if; A�yt' C �v �'E g Y
KI• Tide 8. CA.CI
C ❑As owner balder. I will not employ anyone to do wall which would rgwm 3 Print haw the Owen d
• Induftnd Safety. as wind above, unless such pitman kiss a parent to dA slch week ham ice dpwImm
00w1m of ltdntrul Safety P"t No
TOTAL
FEES
IN
CONSTRUCTIONLEN ING A;ENLY 1 hetebe affirm shot acre is a caasuctim knd+q ager" la die 11
of It. ask to witch fns Wrist is oared Mac. 3097. Cit. Q.
Lad" a Name
Lender's Address
COMMENTS
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c CERTIFICATE OF COMPLIAKE AND AUTNOR12ATIO1 Of ENTRY. I snarly I Mrs mad this » sad Star
thio the Wrmaram poen ns Correct I affirm to comob an ad sale laws and on oramom ea rebaq to hi"
nst-bon. aauthaue a mpeumatae of the Oniatnrne d &Wd.M and Stony a Oma spm mfr perry
and
1« which I harp ap ed to s he FMM d maaeq imaectans.
Xrl«iymr
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RECPTNO.
'f!' PAIDBY '? VALIDATION'����L
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INSPECTION RECORD
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