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"'` ''�` CITIf OF DIAMOND BAR PRESS
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`� '���' DEPARTMENT OF BUILDING AND SAFETY
-� BUILDING PERMIT FIRMLY
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JOBSITE � APPLJCATION i�_C?_('�l� NUMBER '�CODE
ADDRESS �--b����'�a-�'k��'�' � S UE cb TYPE occ.
� APN LOT TRACT DATE ��- �'`��Z� CONSt GROUP
o CROSS S EET � ZONING SETBACKS "'°"�'"E"''E"'S
OD OWNER FRONT RW ❑
o ADDF�ESS � � �° c' �" REAR 0
,� CITY C��n,��-v{' ZIP TEL. '�� . SIDE/SIDE STREET RW 0
�o APPLICANT TEL. SIDE �
x
a CONTRAC70R � -- SEWAGE O PUBLIC PMT#
,
o ADDRESS �' � DISPOSAL [] pRIVATE SQ.FT./100 GAL
W CITY ��ZIP TEL.
z STATE J � <�
y LIC.NUMBER GRADING � CU.YDS.EXC. CU YDS FILL `
y ARCH/ENG/ �V .'�,��` W, TYPE. SG?F"1'' 'FACTCaR'F�S . : d4DJ::ARER1VALUAtION 1
DESIGNER ,W; -
� ADDRESS •.a ..."-�°..� tt 2 �
�. CITY ZIP TEL""�-- (�; 3 �
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� PROPOSED USE � ' ��" 4 �
� � � :,�,� GARA6E °
;
a NO.t�WEL. NO. NO. "'" '
y UNITS STORIES_. BEDROOMS � �'ORCH �
m.. VALUATION ADJ AREA ?
� LOT DIMENSIONS '
a NO.OF BLDGS HOW ouaeuT�rY .D.E�aCF31FxTIC3N.: :: : FE� �
� ON LOT USED_
a"'c U`
W ^ Y "y
� � .`.�,'.. 1�,4����.A...+E..� Y_/ �•-
LICENSE�CON7flACTORS OFCLAflAT10N:I hereEy aflirm that 1 am IicenseA under pmvisions ol Chapter 9 Immmencing ��..��;. ,
Y wn6 Sxnnn 711[I01 ol�ivisian 3 al ihe Busmess anA PmMssions Cade,and my license�s in full imce and cifecl. - �
� 'W` -
3 �.11.!. �•
� NEB�HUIL�ER UEC.LARATION.I herehy alliim�hat I am eaempt imm�he Conlractor's Licenx Law Por ihe fdlowing � ���-
Z reason�Sec.7031.5.Husiness and Pmfessions Cale:Any city m cnunry wh¢h requires a permit!o tunSUUCt, �--C3: �
o eliei,impmve,tle.moiish,ur�epeii eny svucime,pnor to i�s issuance,also iaqui�es Ihe applicant kr such permil `+��Z>� p
/- to file a signeJ s�atement that he is licensed pursuaut lo the prauisions n1 the Contraclor't Lirense LaW(ChaDier y�m.�.
� 9 Icammencinp with Seaion 70U0�of avismn 9 of the Business aud Pmlessioiu Cade)or that he is exempt lhereLom �-S`; �
y anJ Ihe bxsis�ni Ihe alleged exemylion.Any violatian ot Sectinn 7031.5 6y arry epplicant lo�a permii Subl�ts �-�,
W ihe applicant tu a civd Uenany ot nm mnre than five hmd�ed dullars(5500�p ::0.'
� ❑I,as nwner ol!he pmpeny,nr my employecs with wages as Iheir sale compensatian,will do Ihe work,and �-;
the simcmre is nnt mtended nr of(ereG lo�sale(Sec 7�44.Business and Pmtessions Code�The Contocmr's License �
V Law Jocs imt apply Io an mvnar nf D�opetly who uuilds m improves the�eon,and who dces such work himsell, �;�:���. —
W or�h�miph his nwn emDluyees.D�ovitled t�at such impmvements are no�mtended or oBered for sale.�I,however. :.�'Z�.;
m tLe bullJing nr impmvement is sold within one year ol campletion,the awne��6uilder will have the hurden of pmving �:iQ7
� tha�he did net huilJ or imD�ove tor ihe pwpase af sale.l �'_�- �
y .w.,�� _ " �
❑I,as nwnr.r nf ihe pmpeily,am excluxrvely coNrading with licensed contracmis m construct Ihe pwiec�ISec ;{�}=
� 7044.Business an�l Piofessions CoUe:The Cantracm�'s License�aw does not a�ply�o an owner ol property wha ?�.�y` �
¢ builAs nr imp�oves ihereo�.and wlw cantia[ts lor such prajecls with a contractor�s)li�msed puisuanl W Ih!COnlr2tt0(S
�icense�aw.l ;:`:C�NS7FiU�TIC�N
W �I am exempl unAer Sec .6.S P.C.IAt�ach Certiti[alel. � `��"�.PLAN I�EVIEW _ '
e Datu �ne1 '��"' LECTRIC� -- �T (��1��`)
� Vr9HKERS'COMPENSAiION OECLAHATION:I he�ehy allnm tha�I have a certifkate ol cansem to seu-insure,oi �;.;,..:PLUMBING _
a r.end¢ate nf Woikers'Cnmpensation Insuraxe.or a cenified copv�heieat ISec.3800,Lab.C.I.
Z ❑Certitied mpy is hereby I�xnished '� MEGHAN�C��-
6 ""'�-
o ❑CsniLed mpy is fileA with the Building Inspeclimi�artmenl ar oepanment. �.�.'GRAL7ING —
W ........ .,....""'C_..� — . i
= CERTIFICATE OF EAEMPTION fflOM WORKEFS'COMPENSATIbN INSl1MNCE:This sealion need noi he compkted �� � ISSUANC4.—•��••" � ..� �'^�7 L� E
� d tl�e enmt is fnr one hundred(5100)oi less.I tertdy iSat in Ihe perlormance of Ihe wak far which�this �
y r ��:...�•.....—.�..
_ permii is issued,I shall ip�employ any permn in any mannei so as to 6ecome su6jecl lo IAe 1Wrkers'Carpensation - S`M�P !
= Laws al California. `.W' �
o ... ,.,:,.... LLJ:PARK FEE �
oa�e '`7idol!�'d"�- ` tr� SCHDOL F�FS
W NUTILE TO APPLICANT:tl,afier making this Certilkate•a1::Ek,emptipn,you shouH hecome subject m the NMker's ���!!!^� �
J
-� Cumpensaliai yrovisinns nf the Lahor Cade,yai inus��'ia�hivith��camplp�with such p�ovisdns w this cermit shall
�+- he deemed revoked. �
�
� qVISION OF INDl15fHIAL SAfETV PENM�T,f�E�AFICATION�
W j:'3 r (� i^a,.�:'4 !
d ❑1 here6y certrfy Ihat ip ertavatwn fine(5)d'ma'e�feyi�xin d¢PtH'mtu?which a person ia required to des[e�.
0
s will he made in cm��ecuon with wark author¢ed by Ihis permit,and'SlizFnO�uilding stmcture,scaltoMing,IdseworN. �
d ar demoliuon oi dismantlirg tM�rof.will he more than thirtr-sia�36)leet high.�Chap.32,Gry 2.An 2,See _ i
W� 341.TitleB.CA.C.1. ,..,;..-... . ... .... .. . . . '
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3 ❑As owrerbuAder,I vrill noti�empfo�'ahryre.tq da woik,whlc6 xrould_require'a'permit from the Oivrsan of
r InJustriaf Safety,as noted a6oue.`unk'ss siich`person�hesa Oerinil:Io do Sucfi�worN;lrom the divisioa ,..�
� ,
W ❑Qy�s��o����r,�e�sa�e�Y��mn No. TOTAL FEES 1`�- �.-,C._�
� f.WSTAl1CIqN LENOI�IX'i AGENCY:I h¢rehy atlirm Ma�theie is a constructqn kndinp apenry fa ehe perlomunce
�IX
= ol tiw work for wh�ch Mis permit is issued(Sec.7097.Civ.C.�.
� lender's Name C�MMENTS —
m Lender's Addiess
Q CERTIFICATE Of PLIANCE D AUfHONIZATION OF ENfRY_I urtity 1 have read 1Ms applkmfon and stah
Vi ihat Ihe intm q � rect.1 a tu comply wilh all srote laws aM ciry adi'wica relrtiiyg ro 6uikinp
y ennstrucuon, �: � r re ative the Oepr�mem ot BuiWin and Safety Oo ente iprn ihe poperty
= Iw wn¢�I 'd thi rmu lor t pupox ol a. —
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u� of npp�k /�gent pon RECPT NO. PAID BY_ VALIDATI ��__
r e en Co y, LOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
BS106-71/89 ,
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