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'''` �ITY OF DIAMOND BAR
'•�' •' DEPARTMENT OF BUILDING AND SAFETY PRESS
�� BUlLDiNG PERMIT FIRMLY
JOBSITE �/�q S 1� / /� DATE CATION' „y , ��� �MBER�.._.CO E
ADDRESS / ` `—�-�/� '`��- - ISSUE
4 APN LOT c� TRACT DATE J���!� CO ST. ��� GROUP�_
`� CROSS ST��T SETBACKS
o�w�w,s
� ZONVNd�
°.° OWNER �1'�'% t' � �-- FRON7 �_ _❑
o ADDRE'' ��'� ' -� _,�'Z�� ^ REAR^ ❑
q�CITY ./ =�,'� TE ���� __ SIDE/ R ET RW ❑
F�PPLICANT�� �TE ��" E ❑
¢ CONTRAGTOR � �� �� �-1�=�1��— SEWAGE
❑ PUBLIC PMT�
o ADDRESS • , DISPOSAL ❑ PRIVATE SQ.FT./100 GAL '
W CITY n''L� ZiP 7� TEk, Jr1 +
z STATE ���i� �pAnING ❑ CU.YDS.EXC. CU YDS FILL_
y L1C.NUPABER � - -- —
� ARCHiENG! � �°�E �� � FAG`TOR PS AD.1. ARERNALUATION
V' DESIGNER � � _
� � ADDRESS._ LL 2
� —
a CITY ZIP TEL. � 3
� PROPOSEDUSE _��� y CT�� Z 4
� � GARAuE
o NO.DWEL. NO. �10. � PORCH
x UN�TS STORIES BEDROOMS
s LOT DIMENSIONS m VA�UATION AOJ.AREA
o NO.OF BLDGS HOW � OJAN7�Tv DESCRfPTION FEE
W ON LOT_, USED Q � ' �C� J � C�
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= a
}'" I ICENSh �Oh7R1.CTGRS f1E�LARAiION I herehy a�lum ibat I am licensed��ndei p�ov�sions of f.hapter 9�commenqnp 1-
Y NP�Seceon!OUOi=�Gvismr,3 n�•he 9usineas and Prulessions Cade,and my hr.ense is�n lull force and eilr.ct
3 [� w Y
_ :1WNEH RJII DE=DF,;,L?pATpN I LerebY afLrm ihal I an eMemD�<<om the Contrac�or's Lcense Law foi the lollawmg ' �
�easo� Sec :031 E,8usiness and Professm�s Code Any n1y or cnumy which requves a penmt to construcl, (}
O nl;e� np'rn.e.Ae:nulish,ar repair any siruct�re prb�!n its issuar.ce.aiso repmres tne apD�icanl la�Sur.h pt�mn .yYL
t- in tile a si,r,neA siate^�en1 ihai'ie s Ucersrtl Wrsuant to�h:prarisions ol t��e Cantiacmr s license law(Chapter p�
p¢C •1 Ir.ocme��ung w.ih Sc�iinr 70001 nf Oimxion 3 0l�he 9usmess anL Pro�esxiuns CoEe)ar thol he is exemp��herr,from �
a, an7�he 6asis�n thr.alleged:rempticn A�ry violatio-of Srcho�7031 5 hy;ny aCpLoar.t!or a permn subleas �
M the ap•r�icant m a cn•i�Denalty a�not mare lhan h�re huMmd dollars i5500:I �
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� ❑I as r.wner il the prnperty or ny emqayees wah wages as theu sole r.omoensanon will de thr.wrork and •
�!�e sr.aLue�s�int;ntPnnue ar ollereo fo�sale iSeo 7044,Busir.ess and Professions Cadc The Ca�7iacle:'s I.¢ense � ,q�
f„~j !aw?nes nc'aFDly tn an owrrr o!prnO��Y h'ho hunds or impraves thereon,aM who does su.h work lumsell. C,)
••• ur thmu„^.h:s oau?;rylnyees prm^.detl ihxt such imprOvemen•s a!e nat�ntendeA m nlfereu fm sale It.hawever,
m •le buJd,ng rr imGmvemer.t�s sald wnhin anr ycar�mmplenan,Ihe cwner6wlder wdl haw:ihe hwAen nl pwvin� Q'
� :hat he Aid rt^aod ur r�a•evc to•tEe purpnse al sale.i �
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eq u�,ns ov.•ier uf ihe.proper���,nrr exr.lusrvelY:ortrncnr.y wnh Iicr.nse0 rq»raclors�o conctru:t the pio�ect(Sec .�j
o �;d4 6uainess anu Prolessons:ode iM Comra�cor's Lcense Law does nol apply tu an owner al properly w�ho S,�
2 ��uiix oi nnpr�ues fiereon antl who r.nmra[:5 far su�h pro�ec[s with a conttar.IDr(sl li[ensetl pursiiant M IEe.Canliatl0r 5
¢ �•ceiit��.aw; CONSTRUCTION �.
d
� . �I am err.mpt unJer Sec ,B 5�.0�At[ar.h Cendicale; PLA� R�V��w
O Dam ��ef ELECTREG
� N�flKERS C�M�ENSATION DECLAFATIqJ.I here6y allirm that I have a certihcate nl consmt to sell�insure w
a ce�u!�.xtr nt NMike�s'Comper.sabnn Insurance,or a rertAietl co01'�hereof ISec 3800.La�LI PLUMBING
0
Q '�^J C.enihed copy�:r.e��r�r�.�.�:n�e J MECHANICAL _
p �Cerlrfier.'coPY�s hied w�th ihe Bwidmg Inspecunn OePartment oi_,_ Depanmem � GRADING
� CERTIGICaTE OF ENfR1PT10N FROM W'ONKEflS'COMPENSATION INSURAFICE Thrs secimn need not be como�dM ISSUANCE ' �
� rt:�m permd s in�one hunAred�5100)oi less I rertd��11!at in Ihe erlaimance oF the wak lar whKh[his
CP.Illli".iS�SSII¢U I 1'II:lOf pioy anv Peison in anv mancer so as� ome sub�ect iu the Nbik Comcenwtion � SMIP
_ ��W��:��I�n� �j� - � � PARK FEE
o . __. W
p Oate Appl¢a �
� NOTICf.TO APPUCANi.II.afier making th�s Cernlicate al Exemp�mn,you sMuld heco SIIE�CEI 10 IAP.Worke�'s SCHOOL FEES
-� Canp¢nsavnr.provrsinns af thr.La6or Cnde,you must falhwith[omoly wrth such provisionc or this permit shall
'+- �e tleeme�ievokeC_ --- --�-r�,
�
Q 71VISION OF INI7115TRIAL SdfETV PERMIT CERTIFICA7IUN
W
� GI herehy certdy that nn ex[avatmn frve 15)or mwe teel in depth inta wh¢h a persan i�reqmra.�d tn deue�d,
2 will IM maAe ir cmnec!ion with wwt authaved hy thrs permit,and that no huildmg st�uclme,scaffol�ing,faliework, ���
d oi CermNunn or dismantling,hereof w�ll he more�hm;hnry-six f361 Feet high (Chav 72.Gry 2.Art 2.Sec ._
_ �a� rai�s,car,� 3
_
3 i]A:owner bwidr.r.I will not empbY enya�e to do work whKh wnuld reqmrz a perm�t fmm Me 6vupn a1 �Iy" n� h�A�a
f-- Ind�istr.a!Salely,as naleJ ahove,unkss such pe�'wn has a Dermit fo do such work Imm the division � � v`-vTTq-�-�--- - -- - -
� •
W ❑a��s�e���,�a�,�,�a�sa�e�Y�,m�,No. TC3TAL F�ES . C��'
� CONSTRUf.TION LENOING ASENCV I here6y afli�m tliat there'is o conatrucLon lendiip�pen[y kr Me yerkrmance J
ZM�ne wo�t Ini whmh mx permn�s issued(Sec 309T.C�u C).
0
�enner s Nai�e COMMENTS
m ie�n�r�add�Pts I
4 CER71FIC0.TE OF COMPIIANCE ANO AUTIIO{tl2ATpN OF ENTitY I cxtily 1 have read Mis applitxion an1 r�le �
rn tha�the m�mmauon qi is rorreot I aBree m mmpry with all sta�e lews and oiry aminaMsx raennp ro omd��p '
y wnsvuclion antl aui �m a represematrve oi the Oepartment of Buildinp and S�fety m mtn upon the qopenr
= foi wh¢h I have ap d fw Mis permn tar the p maYinp inspections.
� �/ ,r°�_
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S�y�awrc ot pKsm or qem �e � � R EG P T N O. P A I D B Y V A U D A T I O N
WHITE—Department Copy,VELLOW—Financa Copy,PINK—Asses�r Copy,GOS.DENRpD—File Copy,GREEN—Appiicants Copy
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