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�('`' � ��j CITY AF DfAMOND BAR� � pRESS
� '•" ' DEPARTMENT OF BUILDING AN�SAFE7Y
�M @UILDING PERIVIIT FIRMLY
APPUCATION PERMIT ,,w� USE
DDR�ESS ��� S, L�"j,�+ [_f�/�d� DATE _LL���2� NUMBERC-��� CODE
- - lSSUE �� � TYPE OCC. �
$ APN __ �.__..— LOT c�Jlz_TRACT.� DATE � CONSL�GROUP�
o CROSS ST ET zO��N� SE�SACKS �.--- �""E"'S
`.' OWNER FRONT �'` --r RW ❑
� ADDRESS �/ �' _���r'c�' REAR�' �� ❑
a CITY - C�- _7JP ���7 TEL�/""<-' SIQ�-l�16� TREET RW ❑
o APPLICANT � ..�L_.TEL:��� SIDE_. ❑
� CC31�!?RACTOR '� � �� �' f �.-` -��-1_L. SEWAGE �
o ADD'FiE°S •� • � 4 � ISPOSlZ�. � PUBLIC PMT#
w GITY _ 11�-(.7 ZIP /� TE�� ' � ❑ PRIVATE SQ.FT./100 GAL
x STATE � /��,.,�'�� GF?ADING ❑ CU.Y'DS.EXC._ CU YDS FILL
� LIC.NUMBER ""T __
y ARCH/ENG/ � NPE St� �'T' �aCTC)�t i'$ AOJ. ARERNALUATfON
� DESIGNER � � � � _ .--�'
' �' AGDRESS LL. 2 =!
��CITY ZIP �TEL�. _ (,� 3 _ -"�
� PROPOSED USE �--� " Z 4� -���
U o GARAGE �- '
o NO.DWEL. NO. NO. '� PCRCH �
� UNITS STORIES BEDROOMS_ !
� LOT DIMENSIONS m VALUATION ADJ.AREA_
o NO.OF BLDGS H�W � �UANTITY DESCR�PTIO FEE
w ON LOT USED � %� � ,, p�
W �
S �
�"" I ICE.EG CG�iTRACTORS f]E�LARATION I here�athrm iha�!am licensed under pmvisians af Chap�er 9 Icommencinq U
� APF S�cuor�orr.i�i o�•r�s�a�9 n!�he Busmess anl Pmhssions Code and my I¢ense is m lull}orce and eHer.t �
3 � w ---
�+- ;RUYNF+RUILI7ER 7EC�ABATI04 I he�eh�•nff:m:Ihat I am eaempt!rom the Camraclm's U�ensr.Law!o:Ihe fdlowmq
x;reason�Src 7�?�5,Busineu and�rofess�ons Cade Any aiy or:nump wh¢h requires a permii m cans[ruct (;) `
O i nliei i�nG'�•4 Jr.mu6sh m repau arY 5lnrcture C��ar ta its issuance,alxo rr.qmros Ihe auphcan�Ir.r such permu � '
F--'�o L:e n si9nW sinte^ient!hat he�s Lce srtl pursuant ro the provwo�s of I�e Cnntraem�'e lceiBt Law�Chapler y�
��9{n;nne.+nrig��.�dh s"ertinr;Op01+�Uivision 7 n�;he B��siness and P:ofess�ons Codcl o�lhat^e�s eHempt iherr.6om g ---'
d,I and�h�basu'or�4e allrgetl xeemption Amy vioiatmn uf Secuon 7031 5 6y any applicanl!a�a pfrmn s�ih�ects �_
oI no apylir,a�tt m a nnl penzlry u'nm mme 1�an live hundreC dallars 12500i;� ��---
~I�I as^wner�d v�r.FroDerry,o�i�y emFleytes wilh wages as ihe�r sale compensaeor,will do�he�Hnrk,anJ
�;Ire x�mn�,ur is�ml,rtcndeC oi o�fereo loi sale iSec 7Ca4.B��smess ar.tl Prafesowns Cade?he Co�trxtor s Lrcense Q
p~j�Laa 9c=s nc;appl�to an owrer nl properlr x'ha coilAs nr�mproves Merean.and wAo Siks 5urh wark himself (� —.
'�r.r Ihwuq.�h�s r.,rvr znipinyees prnnded Ihai snch:mpwvemenis aie not niler.deC or Mhred for sale Il,hmwever, `
m I'ho hml0.n�rr imp�^�ener.t�s so�d•,orthir ene yeu of compleLm,the owner�oui!der•,vill ha�e the hurden nl piovmg Q
� lia'h�diA r^;"�dtl ur chP�nuo lar Ihe pur,xse nf,�Ir.l • I
tn��i as ox�na�ut the property am¢K�lusrvely amn:achny wnh hcensed cantnctors:a cornlmct Ihe pro;ect ISec W
� %nM Bi:siness amrn Protessrons�oUe The ConVacmr'i License Law AOPs nol apply io an oa�ner ot property who ',S; .,_
� I:e!•CS m inpmvrs therem and who connacts lar such pia�r.cts wrth a remrtnor�sl licensed Dwsuarl to tA.^Convacmr s -
��r.e�te.av�; �CON$TRUCTION _
�
r !�I am eremp��roer Sec 8 8?C IAttxh Ceruhoaul ' 6 PLAN REVIEW
o :lair. Owner j ELECTRiC
� WUNNEPS'C0YIYENSATI�Ni DECLARATIIXJ I herehy alhrm thal I hare a arulicate nf:onsent m self msare � pLUMBING
Q o r.emh�a�e nl YLb�kers'Campersanon Insu�axe or a ae�oLed copy therool(Ser 3800,La6 C;. �
Q �J Ce+ni�ed r.aov is hereny turnisnee � MECHANICAL �
G `�d�l:er!ihc0,:uuy a i�lptl wnn me BuAtling Inepecnon DeOartmer.t or_ OeOarfrnent �Q GRADING `�'�,
��_EPTI IFLaTE OF eREMPTION FflOM 1NOflKERS'COMPENSATION iNSUAANCE Th�s settmr.need nol he compkleU ('���SSUANCE ,S a(J�C.I
� r me pe��n�t is iar ane��unA:ed;37pD1 a��ess I tendV tha�m�Ice lormance af Ihe ork im wn¢h th�s �, -
pernm:s csaed I s"II not e loy any persnn in any mannei sa as to me s�ibject ro�he N6rN s•..o pensatron SMiP
o��,w�������a � � W PARK FEE
p L'ate �� � ApCLcan �
� NOTICF TO APPLICANT If al�er makmg this Ce��dicate of EiempLan,you sMuld hern subieq 70�he blbrker's SCHOOL FEES __��
--+ Compensauon pmvaione ol ihr.Laha�Code,yau must fonhwrth camvly wilh such pi imons ar thrs permit snall
�+- 6e Cecmea rewked --
1 —
� !MVISION OF INOU57PIAL SAFEiY?EPoNIT CEBTIfICCTON� —
u.e /'� AN
a �I�:erehy re�tily thzt no evcavauon Irve(5)ar more leet in Oepth into whKh a person is�epwrea to descend, a��,I R ��l7[�
� wAI�e matle in cocnechun wiih wnrt autha¢ed 6y this permn,antl thal na budAinp struciwe.scafklding.idtewart.� T�-''�—��
d m 1e;nnlinm•or Aismantlim�ihercof.will Ire mare man ihiny�sia 136)��I�igh (C�ap.3?.Grp 1.An 2.Stt _.__�
_ :Rt,'itleB.CACi _—
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3 ❑As ownerhudder I will na�emplay airyane�o da woik which would reQmre a permn 1mm ryir.pvispn of
�.-�Ind;slnai Safety.as nmed a6ove,uNess such person has a permit to do sucA xrork from Ihe drvifion —
�
W ❑aris�nr ef Inrlusmal Sately Permit No TOTAL FEES I� ��
d
CQJSfRUf.TION LENOING AuENCY I herebv affirm�hat tlere is a consaur.uon lendi�ry epency for ilm YnMimance
xnt ihe wurk Inr whic�this permn is issued�Sec.3097,Civ.CJ.
a lenAei s Name
COMMENTS
mlende:'s AdArPss
Q CFRTIFICATE Of f.OMPLIANCE AN�Al1THOF12ATI0N Of ENT(iY I eernly I have read the applcmian and shte �
�n �hai�hr�nfonnabon grven correcl 1 agree ta wmply wnh ail stau Ir.�s arM nry oiai�uMes relauna�a hu�Ning '
y conshurLm.ann aut� 'a representatrve nf the Oeper[ment of BuiNinp anE Sahry n enkr upan!he paperry
= fo�whch I haue a0 �� �this permn for the pur�usenl makinp inspeclwna �
r /{�p` 9
%� P�7
synawre m itam�� �m pa� — ' RECPT NO._� PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINIh0.ssessr,r Copy.GOLDENROD—File Copy.GAEEN—Applicants Copy
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