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CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY PRESS
1 1H III nlfJe.' PFRUIT FIRMLY
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APN LOT TRACT��'�
APPLICATION PERMIT J ; USE
DATE {, NUMBER OCC. 1 �. t.-&
DATE t' �f�` TCONST GROUP
CROSS STREET
OWNER 73Z8Re7].^Zi Cai1.f Inc.
ADDRESS 092 Par S PIe #1100
SETBACKS adwiowwwm
ZONING'FRONT RW ❑
REAR ❑
CITY Irvino,-, IP 714 TEL. 5 -?
SIDE/SIDE STREET RW ❑
APPLICANTr / 'r t ��"k = �- TEL.-2W_I %f;
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CONTRACTOR a �'
ADDRESS _t7 Box 1111
CITY C' P - , ZIP=TEL �0
SEWAGE El PUBLIC PMT #'
DISPOSAL ❑ PRIVATE SO. FT,/ 100 GAL
STATE 490083
LIC. NUMBER
GRADING ❑ CU. YDS. EXC. CU YDS FILL
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TYPE SO FT FACTOR PS ADJ. AREWALUATION `.
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DESIGNER
ADDRESS
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PROPOSED USE e;- ( f`C-�.'_((' tt t; (C.L--;
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GARAGE
NO. DWEL. NO. NO.
UNI.TS - STORIES BEDROOMS
LOT -DIMENSIONS
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PORCH
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VALUATION ADJ. AREA
0UANTrrY DES RIPTION : FEE
NO:.IOF BLDGS HOW
ON LOT USED
LICENSED CONTRA.CMRS DECLARATION: I hereby affirm that I am kensed wdr provisions of Chapter 9 (commencing
with Section IBM) of Division 3 of the Business and Professions Code, and my license is n bill face and effect
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OWNER-BOILCER DECLARATION I hereby affirm that 1 am ea rrii From the Contractor's License Lon lar IM following
reason (Sec 70315. Business and Professions Code Any city or county which «pnirts a puma to construct.
improve, demoksh, a repair any structure, prior to as isawrice, also repuiles the Indicant to aitch prmh
to fele a signed statement that he is licensed Pursuant 10 the Provisions of the Contractor's License Law (ChaPrer
9 Icammttilri g with Section 1000) of Division 3 d the Business and Protessnns Code) a Mat he a tempt threfrom
and the basis for the alleged esempdon Any violation of Section 1071.5 by any applicant fix a Flemish subjects
the applicanl to a civil penalty of not more than five hundred dollars (f500)1:
❑I, as owner of the property a my employees with wages as their sole Compernstian- will do the Werk, and
the slrature is not intended or offered for fair (Sec. 7044. Business and Professions Code The Contractor 3 license
Law does not apply Io in owner o1 property Who builds or inproves thereon, and who dos such wart himself,
or Orough his own employees, provided drat such improvements are era intended or offered for ask It, however,
IN building or improvement is sold within one year of eomplemon. IM owner builder will haw the burden of proving
that he did not build or improve for the purpose of sok)
❑I, as owner of the property. am deCklsnwtl' eontrxtmk With licensed contractors to Construct the prW [Sec.
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7044. Business and Professions Code: The Conaactoi s License Law does not apply to an owner of property who
builds or improves thereon, and wbo Wnlracts for LCI( Projects With 1 Cantraeta(a) lKentid pwmant to the Contrwar s
License Lawn -
CONSTRUCTION
❑ 1 am eampt under Sec. , B 6 P.C. (Attach Certificate)-
rale owner
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BAN REVIEW Jr J
ELECTRIC.— I -tvt ``I`
PLUMBING
MECHANICAL
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WORKERS COMPENSATION DECLARATION. I hereby affirm that I hen a Certificate of Correll to alf nsw r, or
A cerhhcam of W4rkeri Compensation Insaarce, or a cnWied copy thereof (Sac. 3900, tic Cl _..
0 CneLed copy, isknitlyfurnished .
U Certified copy is IAM will the Building Inspection Department a Building dpatrtant.
affrifICATE OF EXEMPTION FROM WORKERS' COMPENSA70 INSURANCE: This faction need rut be completed
il.ahe point is fa otic hundred ($1001 a fall. 1 artily tut in the Performance of the work for wwchf t�ris
permit is issued, 1 fh not empl any person in any mailer so�P.aebjcome subject to the Walwi DpriipeiYieih
Cal
Date T - Appkamr"7 (�;iE�s��.
NOTICE TO APP( If. after making this Certificate of Eaaepaon. ype shuck became su4acl a the ywkar-ir
Compensation proraioii of Ot Lahti Code, you must fw#iwdh comply with such provision or (his Permit slhA
be deemed revoked.
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SMIP
PARK FEE
SCHOOL FEES
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OMSION OF INDUSTRIAL SAFETY PERMIT CE ICA11Ob1 e"
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❑I hereby cntty thin no excavation five 151 Of'noT! toe death whish a pawn is raeimd to ipecwd r
wit be nide in connection with work aalhaitdrty 04famift.14 tilt pe IwAs iy "we, salkkpg• falsawak,
"demolition or it—." Orml. will be move Ow thin
ttysia 138) Net hipli. (D.9, 31. Grp 3. An t. Sac
341. LM 8. CA C ).
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0As awns builder, 1 will nor employ 1 1 p p�q�qxaea, Whi�(r1; , newt a prmh hen this OWW" d
kdustri it Safety. as retail above. unless on le} a joenwt to da ivic h work hon the dwiaim.
Ooms. IF ladvo d Safefv Perr I Ne
TOTAL FEES
CONSTRUCTION UNOW AGENCM-I kuJeki' tnat'thn h s caut¢eonn�ledW atmq for to Mformahce
of the wdk Ia WNtin vcF piml'a ja lned`$ee'3091 L 1 I
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Lender's Name ..
'COMMENTS -
Lender's Address
CIRTIFCAfE OF COMPLIANCE ANO ALITICIWATt1N OF ENTITY. I w* I have rad to Micheal ad star
that this information given is carted. 1 crepe to icomplp with sit sass, Was and city w6rasn relawiff a midi g
cwnniclhen, ad authwin ! nmPmpemtmove of ell Doprlwnl of 8d1i s ad Sahry to. laser am this pdperty
far vhlwh �apPhed (a tens prmh Int the prptr If eaatag mpesleM. r�
9ipnatwe d s a Apem Car
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RECPT NO. PATO BY VAUDA
WHITE—Department Copy, YELLOW—Finance Copy, PINK—AsAwntrtr r"- int nF:Nann—ear r..._,.n — .
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