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'"� CITY OF DIAMOND BAR PRESS
�� �"`"' ' DEPARTMENT OF BUILDIWG AND SAF�TY
��^ BUILDING PERMIT FIRMLY �
JOBSITE APPLICATION PERMIT � USE �,; ,
ADDRESS Z4.3..�� K►,0 LL CT DATE ��-$�$q NUMBER.�._.CODE ;
ISSUE TYPE OCC. `,i
a APN , LOT TRACT _ DATE ,_ CONST. GROl1P
� CROSS STREET � �n.� 2-iC� e � 9��D83 SETBACKS """°"E"E"'s
� ZONING
°° OWNER �Bf�-vt� C�A1L 5,�(!LfFi� FRONT RW ❑
o ADDRESS_7-�'3,'i'� KVi bC.t� [�' REAR_ �
W CITY D��hMa�o d+�-+'L ZIP 9� TEI(7�.�L'�I79 SIDE/SIDE STREET RW �
o APPLICANT � � TEI�� SIDE �
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4 CONTRACTOR (v,p�La�'Of2-���i f s � SEWAGE
o ADDRESS S � � PUBLIC PMT� �,
W CITY �i�.� Aa,►r ZiP R176S T��.�f/f-OoqS DISPOSAL O PRIVATE SQ.FL/100GAL �
_; STATE
d.} LIC.NUMBER �$S!D Z C�53 GRADWG IO CU.YDS.EXC. CU YDS FILI — �
�, ARCH/ENG! f13 TYP.E . SQ FT �A�.R::RS: ;ADJ.:AREA/t/AGUATiOK! . : : �
= DESIGNER `.�< � SW�
� ADDRESS �W �
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z CITY ZiP TEL. � �.
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W. �
�: PRUPOSED USE �L►�.�•• ��C, f c� z'• 4
� � d' GARAGE
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' o NO.DWEL. NO. NO. �
z '�`; PORCH �
� y UNITS STORIES BEDROOMS
� LOT DIMENSIONS m' VALUATION ADJ.AREA
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o NO.OF BLDGS HOW QOAt�tiir ::D£SCF�I .•;ION FEE: _ i
� ON LUT_._ ��� USED SF VZ y�.. �D/� SLr!/M � �---
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. LICENSED CONTflACT(1RS�ECLAPAt10N�I hcre6y affirm Ihat I am�icensetl under provisions of Chapter 9�mmmencinp .'����:
Y wnL Ser,enn I000�af�ivisim�3 ot�he Bnsn:ess anA Pmfessions Code.and my license is in lull lorce and elfect
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3 ❑ pl.
� �+- [MlNER BUIWkH OECtANAT10N�.I here6V aflirm that I am erempt irom Ihe Conlractols license law Por Me lollowing • /* /� �J
Z reasun ISec 70:i1.h,Business anJ Pmlessions Cnde:Any�ny or counly which requiies a permit m cnnsUucl, :;�'(7;: (7 rT5 � ��� ! �� i
O aher,impm.e,ilr.innlish,nr repair any strucime,priur to its issuence,also requues the applicam tar sich permit "„2?: ySO I
Q m Poc a signed s�aiement�hat he rs htensed pursuant m the piauisions of the Comracmr's License Law iChaptw •;��'. W�-�d.'�Q � ��� / �— �
p� 9 ir.mnniNnnng with Se[tion 7000�uf Oivision 3 uf�he Ausiness ane P�otessions Code�o�that he x erempt therelmm ;�,}�,:.
� . d and Aie Uasis Ini the allegr.d e.�emOtian.Any violaiion ol Sr.ction 7031.5 6y any apphcam toi a permi�suhjeds :;;�'. �
W 7hc aDP���ant ro a civil yenal�y ol mi more ihan live hundred dullais 15500I.1: � '!'�': S�
!'� �.
� � UI,as owner ol Ile pmpeny,o�my emplr�yees with wages es Iheir snle compensatian,will do Ihe wnrk,antl �� �
~ the stnictwr.is nnt inlended oi ollered Ini sale�Sec.7044,Business anA P�otesa�ans Catle:The Cantractor's License '��,':j�
� Law dues nm al%nly to an nwner o(pmperty who 6ni41s nr improves Ihereon.and wLo dces s�rch work himself. �.;(3.�, � �
W ar tb�ruuph his own empinyees.nmviAed Ihal such impiovemenis are r.ot intended or affered foi sale If.Amvever, �
m ihr..�uddmp or imprcvzmein is snld withm ane year ol completion,ihe owneo-buiMer will have Ihe hurden ol proving '.ad:. #
� tha�hc Nd nnt AwIA ar impmve 10�Ihe pmpose ot sale.l �^.�. . p.
� ❑I,a.v ewne�ot�M roperty,am exdusive comrachn with 6censed con�iacmrs ta constru[t the roett Sec �"�� �
P �' s v I I '-JL�:
' d 70M.8usiness and Pmfession:f.oee.TM Condacmr's License Law Aoes not apO�V ro an rnvner M pmperty who �.��. �
_ z hwlds or im0�aves theieen,and whu convacLs lor such pmieds with a convxeror�s)licensed pursuani ro the.Cnmractar's E
d '�°"nse1o`", z"r';CONSTRUCTION + � f
� ❑��m�.emm endcr Sea &fi P.0(Anach Cartihtate�. V ,;; PLAN F�EVIEW � � � __ ;
o uac�_ �+�e� �:° ELECTRIC k
� � WiIANEHS'CUMPENSATION OfCIAAATI(IN I heieW allirm Ihat I have a eertificaie af consem tu sell-insure,or �.;"'���`i�� � K
. a ceruticate ot Wprker5 f.nmpensalion Inswarice,ar a r.ertified mpy�eaol(Sec.3800,1a6.C.�. �� PLUMBING � �
z 0 ce�er �,�y�:neren�+���snen �•MECHANICAL ___ �
�
o f,enified copy is filed wilh the Building Inspeclimi Oepartment or o�Pa��mQ��. :�Q�:GRADING �
� �
x CEflTIFICATE OF E%f.M7TIUN FR(IM 1NllNNERS'COMPENSATION iNSUMNCE 7his seenon nreA nm he�amP���a �i�: ISSUANCE � �
� rf t�e permn is fnr one hunAred(fID01 m iess.I cenify ihat m�he perlorman[e ai�he work far whkh�Ihis —'
G/J �;
yennil Is issued,I shall not em0�oy a�ry persm�in any manner so as lo Irecame sub�ttt to the Nbikers'Compensaiion . S`M�P
� Larvs ul Califunia. •
7W:
o umP �1-g- 8°I aoou�am _ LJ:I PARK FEE
•.� NOTIf.E TIl FPPIICANT:If.aher maNing Ihis Cerolicate nf Exemption,you s uld came subject to the w�kers =�=-SCHOQL FEES.
� Compensation provisions n�Ihp�ahor Code,yau musl fathwitM1 camply with such pronsians w this permB shell g`! ��[y{
�� he.deemed revaked. — �"" ��--�--��"q.�
J
Q DIVISION Of INOUSTPIAI SAFETY PEflMIT CEflTIFICATION�.
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� � ❑I herehy aenily Ihxi iw e�cavauon Irve(5�or moie leet in deD�h imo wM1ich a person is rat�uired to descend, � -
au `
e�e wdl be made in connection with wa�k aWhaved 6y ehiz pe�mii,anA I�al no hwlAinp suu[ture,scallaWinp,falsewark. ' � �
- d ur ilemnlmm�or drsmamling Ihereof.will�e more than thiny�a�z 136)feet high IChaD 32,Gry 1.Art 2,Sec � bl iil R'a16i� /���q �A�p�p V —
_. —�1i�TTh�iTY'�i'�T�Y"�l'�i'�G�f
W 391.Title 8,C A.0 I. �
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3 ❑n,owne�6uilder,I will not ertqby anyone la da work which wqdd require a permil fmm ihe Uvuion af
�-- InAustna!Safely,es noteJ a6ov8.unless such person has�De�mit ta da suCh wark fmm the division.
� Y�Orvis�or.of Indusuial Salety Pormit No � �s TOTAL FEES Z �
a
� CONSINUf.TION LEN�ING AuENCY�I Aere6y aHirm Ihai there is a mnsnuclion IBndi�ageircY�o�the plrlo�man�e �
Z ot OW wmk foi wh¢h Ihis peimn is issued(Sec.309).Civ.C.L I
� le�der's Name COMMENTS 5`��}'+�p �' XT�.I� ���pL/��
_ �ender's Add�etc
m 1'l �i- � �
� Q CEIffIF�CATE OF C� LIANCE AND FpF11ZRT10N OF EN7flY:I aenity I have rtad Mis applicalion and stale � i
fn thal�he nrtormatio given is care I aprte ta amply with all stete laws and ciry ordirunces reqting to 6uiki�p � �
. y wnsirucUnn.and Iho�i�e a r¢pr utive o1 tk Oe�wrtment u1 BuiNiny wd Selely fn mter upon the poperry � �.•�
_ �or whirh a lied for this it 1or�he pYpose of inekmg inspections. T I
� y �� g �� t '�('�Q�
� RECPT NO. PAID BY��L VALIDATIO�
-� Signa e plinm or Agem Deta
WHITE—DepaRment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
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