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'� CITY UF DIAMOND BAR , .
�� '• ' ' DEPARTMENT OF BUILDING AND SAFETY PRESS
�� BUILDING PERMIT FIRMLY
ADDR'E5S ��� �� • L• � ' 7 DATE CATION , , � ���MBER��OS E
�,RrvD �i ,^_ ! -
�ssuE �” TYPE � �` � OCC
� APiV LOT��TRACT � DATE �� _�2��'�J CONST._.�L'�GROUP�,�
o CROSS ST ZONING SETBACKS "p°'��"'�'"5
�' aWNER G� FRONT_ _._ ❑
o(ADDRESS_`�� ? �-� .�^'�i�- REAR _ ❑
W I CITY� ' d __ � •a� TEL "�� SIDE/SIDE S RW ❑
Q�APPLICAN ,��_TEL-.���i?� -- SID ❑
s
4 CCNTRACTOR '�r"� �', ; T -��--�"'~�-���=�-= SEWAGE
a ADDRE I�� '. ❑ PUBLiC PMT�
�y, .�,a� DlSPOSAL ❑ pRIVATE SQ.Ff.1100 GAL
� CITY_���1/ ►1+(� ZIP �� TEI�,,�.id'� _ i
z STATE �''�
� LIC.NUMBER ����,3 GRADING � CU.YJS.EXC. CU YDS FILL
y ARCH/ENG/ � �p� C� FT FACTDf� PS AD,I. AREAN ATION
`-' DESIGNER � �
Q ADURESS p�y 2 �
i CITY ZiP TEL. _� � g �
� PROPOSED USE -'`���2-�_i�--- � 4 �
v � GARAGE
o NO.DWEL. NO. NO. ) � pORCH
y UNiTS ST�RIES BEDROOMS � � --s-
� LOT DIMENSIONS VALUATION! ADJ.AREA
o NO.OF BLDGS HOW � QURNtITY DESCRIPTIO FEE
W ON LOT_ USED Q ''' -�f�� f�� � 2. . i �
.°G.w I C.�
= I �
�" :ICEhS�C CONTRACTOflS DE�.ARATION I hereby afhrm Iha[�am licensed ander pmvisions af ChaU�er 9�cammmcinp� �
� acn S:r.u:�r 70^uG):il Drvisian 3�rhe 8usiness and ProFessions Code,and my licen;e is m full loice and eflect
3 � � .�.��
� OWN(N BJ!LIIEn":1f.CLAPATI�N�herekiy aflnm tliat I an eMempt fmm the Caniraclo�'s Lcense Law foi the following
rr.asnn�Se� N?15.Busmess ar0 PrWessmns CMe AnV atY or connly which repares a peimit to conslrutl G4 � � �
oetr.i im e dr.molish,nr repart any stmctua Pnor to its issuance also requires 16r,applaam for sikh permit Z
¢ m file aYsgned stairnent Ihat!�t�s Lcensed pursuant to rhe D�ouismns of the Contraclor's l¢ense Law jChapter m
p� nmennng w�:l-.Sec[m���7tl001 cf'Jwismn 3 uf;he Busmess and P:ofess�ms f,odel or tha;Lc�s e..e.mpt therefmm ,�
p_ �a�d the basis'm!he al:r,eA exernpuor.Any vialatian ol Sximn 7031 5 hy any applicanl!oe a permit tub�ecis �
W t"e appue.ari Ic a!��vil penalto nl�oi moie tl:an five hundred dollars�55001j � �
� �JI,as ow�e•r,l Ihe p:operry o�rrv employees wrth wages us the:r snle coTpensalion,�,nill An Ine wnrk,and —�
iM s�unue is i�m nterneC or nllzred fo�sale!Sec 7�44 Ausiness and Prelessmns�ade The Con[ractar's L¢ense Q
v iv tloes�int a�oq��r nn owne�nl property whn tuilds or•mC�oves IAereor• and wha dces such�nark^imself (J I
� �r tF.���ql nis a�.vn ar..ployees ;ro�ded thr,such impmaements are no1 inhnded n�otleied fur sale II howwer, `
m ice�ar.Cwc�r.inpro��zment is soltl wnhin one yrar ef cnmpleuon,the a+ner�butlder wtll havr the hurAen nf p�ovmg Q .
yIha1!re rvc noi hudn cr impmve!or the'puryose o!sale;• S �
v� Ci,as uwner W,se�roeenv.am ear.wsrve!v=a�vacnny wn�.i�cersea aomra:mrs to roncrc�ci�M pioien(Sec W
� 711A3,Rusne�s ard Prolessmrs Co�e The�om�aamr's License Law does not apply m an owne�ol properly whn ,4� __� �
Z h.ulr.s a�impraves Ihereon anA wha:on.�acts br suth plo�ecis d+ith.a cantrac�or�51 hcensed Uu�a.ant lo I�e Conita[toi�s — ---I
Q _cxrseLawl ' CONSTRUCTION
C .
� L.I an:exrmG�untler Sa: .9 6 PC lalta[h CerufiCatei PLAN REVIEW
o Date Owner � ELECTRIC
yLMIRNEflS f.Oh:PENSATI(NJ�ECLARA710!J I here6y affiim thai I have a[mri!rtate al consem�o sel��insurc,or
�ril�rn�e o�'AMrkers Campensatinn Insunrr.e,o�a cendied mpy thereo(ISec 3600,La6 C� �QL��B��C7
`� y���.� ( ��MECHANICAL
Q f.ervf�r.e capY�s hereGy hKnished � _
o �(J Cerntred�oDY�s liietl wnh the Bwlding Inspecnon Deparimenl or p¢parimene i <L�GRADING
W 1/\ � •
x EP.TIFI'AiE OF E%E�dP710N FRO�d 11NRKERS'COMPENSATION INSUNANCE Tlxs sectmn need nol�e canpktnf! ISSUANCE �
� .f Ihe permn is�or one^urclreA{51001 ar less I rernly that m ihe �ormance nf Ihe waik loi which Ihis +,.,,
y permn:s issueA,I hall nei em la " J .SMIP
p y anp permn in any manner so as Io h� me snh�ect ro the�o kfis Canpensav�
_ :.aws nt C)Ill�m �. i� — �
f � � p,y� PARK FEE
o Ca�e !F � �ADD�Kanl �j Ls-lSCHOOL. FEES
JNp�ICE TO APPLICANT II aher makmg ihis Ce�tihca�e.ot ExemO��nn,yau slould he me sub�ect to Ihe WarMer's
ComDer.sauon prwisions of the�aMr Cnde,you must for7hwith comply wilh such prov�swns or th�s permrt shall !
� he deemeA rr,voked
Y ��
� OIVISION OF INOUSfRIAI SAFETY PERMIT CEHTIFICATION
� �
W
a- ❑I hereOy cerutp that nn ex�avation hve�5)o�more feel in deptM1 intc which a penon is requred io deecend,
� wiN Ar maae m cnnnectmn wrth work authaiuetl�y this perm4 and that ne Wil�np strucfure scafMldmp,falsewark, �
� m AermLnrni nr dismantlny thereol will he more Man thrtty-six(36)fee[hgh �Chap 3?.Gry 2.Arl 2,Sec �
W ;i41 Trtlr.B.C 1 L i !
x — 1�'�1 p
3 ❑As awnerbmlder,I will no±empby anyone�o do work whch would rep�ire a permit from me Gvisan al �`h� �'aM�'vy,� p
� InOustnal SaletY as rotetl ahove unipss such person hu a permrt ro da SucM1 wark Irom the dvisian. — —L w'p vAe
tv �
¢ ❑�„s,�����a�=��,a�sa�,Y��m��� TOTAL FEES L-I-U • i U
�
� CONSTHULTION LENOIN6 AGENCY I herehy alfirm Ihal there is a�ansnuctinn le�i��e�y tar the pe�foimmce
z ot the work fur wh�ch mis permn ic�uced ISx 3097,Crv.C)
� iendcr>Name
m lemler's Atldress i COMMENTS�__
'� CEfli1iICATE OF COMPLIANCE ANO AUTHORIZATION OF EN?qY 1 cntify I ha�e read this applkation and atme — �
h :tiat the iniprrt�aum quren is carren I ag�ee m compry wnA all sta�e lawx aiM nry oNimnces mrotinp ro huitlmg '
y consfrurnon,and a ho�¢e a rcOrtuntative of Ihe Department o1 BuiMinp and Sah�Y Injentei�yan Me praperry
f�whrch I nave IieU tor this qermit kr t " M makinp inspetnons. �
� X ,, f - � //��f! "
Sgnatwe ot� oiK��o�a�e�� p,re RECPT NO. PAID BY VqLIDATION
WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENSi00—File Copy,GREEN—Applican[s Copy
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