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CITY OF DIAMOND BAR PRESS
i. DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT FIRMLY
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JOBSITEa �j� , f +• tVr�C
ADDRESS + `E'6011,��J �C -�� ��: ✓
APN LOT TRACT Z
APPLICATION PERMIT cr $E
DATE NUMBER � ! CODE
TYPE OCC.
DATE f +`'� ! / CONST. GROUP
CROSS STREET
OWNER Bram- lea Cftif ha Inc.
ADDRESS One Park Ple, 41100
SETBACKS ..YadiEhlceets
ZONING FRONT RW ❑
REAR '` ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
CITY Ir'vinO ZIP 92714 TELS51-3131
APPLICANT 1(:'P ' ✓�,� . AI TEL
CONTRACTORha7rZ=+actriC, Inc.
ADDRESS
CITY Mina, Ql— ZIP (01703 TEL ".21-64 t
SEWAGE
DISPOSAL
El PUBLc PMT #
❑ PRIVATE SO. FT/100 GAL
STATE 490083
LIC. NUMBER
GRADING
❑ CU. YDS. IXC. CU YDS FILL
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TYPE SO FT FACTOR PSF ADJ. AREWALUATION
ARCH/ENG/
DESIGNER
ADDRESS .1
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CITY ZIP TEL
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PROPQXD USE t:: t< 1 ,1e- {"[� -=. (-2y
GARAGE
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
La
PORCH
VALUATION ADJ. AREA
aUANTm DESCRIPTION - - FEE
NO. OF BLDGS HOW
ON LOT USED
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LICENSED CONTRACTORS DECLARATION I hereby affirm that I am Lcensd under prwisions of Chapter 8lcaermrcihq
with Section 70001 of Division 3 of the (lemmas and professions Code. and my licsnu is it full as and effect
❑
OWNER BUILDER DECLARATgN I hereby alfirm that 1 am teeept Irom tie Covectat's lsense Law for the following
reason (Sec. 7031.5, Business and Prolossuns Cods AM city a counly which re"ira a Permit to withuct
alter, improve• demolish, or repair any nructwe, pia to its asarlte, also requires to applicant for tach parents
to file a signed statement Mat he is licensed pursuant m the prwitiers of ate Conaeclel's tKree Law (ChyM
9 lcomme" ing with Section 7000) of Division 3 of the Blithe sod Professions Cool as that he is swept thaevrn
and the bags for the alle ed exemption. Airy violation of Section 70315 by any applicant fu a permi whjects
the split tint so s Civil penalty of not more than five hundred doors (E5001.1:
❑I, is ewmr of the property, or my employes with wapes as Mar eels compen icim. will do the work, and
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the nructure a not intended or offered for sale (Sec. 7044, &ainess and Ftefessiom Code The Contractor's License
law does rot appy to an owner of property who builds of inproum aurone, d who does seek work himself,
of through his own employees. prwdd that such anrwrmnu we not ntndid or offered ham sale If, howoer,
the briding or Imp i r[ment Is sell within one yah of Connotation, the Olwlel.WUldw will bat the brdM of prohnd
that he did not build or improw for the purpose of sale l
❑I, as owner of the Properly. am eahnur&* centlatlmy with hetmtd Contratters to construct the project IS*c
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7044, Business and Professions Code The Comn i Liam Law does that appy to an owner of property who
Wilds ate informs thereon, and who contracts for such projects with s crnvacterls) aconssd prruent to the Cemrector's
License law)
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CONSTRUCTION
111' am eaynp under Sec. , a b P.C. IAnach Certificate)
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WORKERS' COMPENSATION DECLARATIM I hereby affirm aw that I ha crbficae of content ot stall-thm"'.a
a «mdrahi of warbri Co.peeeetol beararne, or a c&WW copy thereof (Sae 380, Lab C.O. ..
❑ Certified Copy is Kersey Irnahed. ldingMECHANICAL
MCsrnfgd copy a fled with the B."ref Inspection Datnant or Deprmhaot.
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PLUMBING - -- ... �.'"`....--•-"-.:::. _:�-.. -"._: "� _ _.,.,_ ._...:..--.�-:..-: _.
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11MRAPIM. This section d oat be completed
CERTIFICATE OF EXEMPTION FRI7M WORKERS' COh1PEfISSATION a
d the print is for one hu" 151001 or less, I cattily that it at Prlarrae of the irk for WOKA this
permit is issud; I slid net employ any Arson in try intact 7h sin becrns mbpm $a the kMrhri nwion
laws of Caldor,
ate "`/ "'�f ` Applin,,;""" '4t>-."� 1rr � �.� '
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UANCE~-di
SM IP
PARK FEE
SCHOOL FEES
NOTICE 30 APPLCAQf;:B, da making the Certificate of Exemption, veu shedd bee«m sahject te;ae werlar's
Compensithan pa t of tie tabor Cob. you neat Forthwith conpb r,M soh prwsiera a this prnl Mal
be deenlid rervekael -
MSION OF MdI OR1AL SAFETY PERMIT CERTFOTilya; '_� C; a J
Of hereby Cattily Mat m n tutints fie 151 o%nareffe.t M d ipllisc which a person is raetrired to duurd.
wild be reader in nreetion wrat week audharsad ter gees phra, aN *9 the ledbp Mucci. aafMterha Ialsworh,
or dereeken a dneuethp thereof, weer he rare tear tlrty.m (381 feet feel. Past. 32, Grp 2. An i. Sec
341. Tide 8, CA C1. '
7+� 0 �rc�
OA, owir-buildr. 1 the int septet, anomie to b that which vweYd roue a pram from Ile Division of
Industrial Safety, as noted above, u las such person tea a penew to do uch wan (hese aha div:rsn.
i ❑Cursion of Idharsl Safery PtereA No. -.. , ; .. d (., r. ^
TOTAL
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FEES lyo,to
CMSTNUCTIDN LEWM9C AGENCY: I hwdry allime that teen is he amsoctsn, hake apway a the peraawn
of the week for who pre prma is Issued ISR: 3497, Cta. C.O.'
Lrdar's Nemo
ldr's Alreat
COMMENTS
CERTMCATE OF CMWL1AACE AM AUTIKIRIZA7MM1 OF ENTRY- I ewofl' 1 levee ofd this appfuaalT d asste
h Mat the infwnekon,tn" is Carat. I gee is Cady Web d a" pen and c" ahiinructl refalip,e pail►y
caatreclnn, rrd piMain a npearavn of do Dywvrrd of Brilbp sed Safety te amt epos ti paperty
a which I him yyphd fair cels pmt b/dr perpeee of ieepeawa.
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RECPT
CJ
NO. - ' i— PND BY y VAUDATION '
Sitimort of Assistant he Aged Dom
WHITE—Department Copy. YELLOW=Finance Copy, PINK—AMssasor Copy, GOLDENROD—Fate Copy, GREEN— Applicants Copy
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