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CITY OF DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT FIRMI ,Y -
JOBSITE% ” ! YI }
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APPLICATION PERMIT USE
DATE NUMBER CODE
ADDRESS- ' fL -I'
ISSUE %_` TYPE OCC.
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APN LOT :L TRACT / r
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DATE (' CONST. GROUP
CROSS STREET
ZONING SETBACKS kfwlowomwm
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OWNER >�.
FROG RW ❑
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APPUCANT,-"-2 1:-:-A �,+r1' TEL '' °'j /G
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CONTRACTOR n1, 14il Electric, Inc.
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F O. Box 1111
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PUBLIC PMT
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n0 91706 291_6461
CITY ZIP TEL.
PRIVATE SO. FT.l100 GAL
GRADING ❑ CU. YDS. EXC. CU YDS FILL
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STATE 490083 Ex3. 4/92
LIC. NUMBER
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TYPE SQ FT FACTOR PS ADJ. AREA/VALUATION::
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ARCH/ENG/ ,'
DESIGNER '
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ADDRESS
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CITY ZIP. TEL
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PROPOSED USE- C : C..: k-1 { l.L may( [.`-� -
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GARAGE
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NO. DWEL. NO. NO.
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PORCH
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UNITS 7 STORIES BEDROOMS
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VALUATION ADJ. AREA
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LOT DIMENSIONS
QUANwY DESCRIPTION .: FEE
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NO. OF BLDGS HOW
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ON LOT USED
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LICENSED CONTRACTORS DECLARATION thereby alfilm that Ism keened order provisions of Chapter 91commrKirp
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with Section 7000) of Division 3 of the 6usmess and Professions Code, and my license a in full force and effect
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OWNER BUILDER DECLARATION I hereby affirm that I am sampt lam the Contraceh license law Id the following
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reason (Sec. 7031.5. Business and Professions Conk Any city or county which repriree a permit to construct,
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alter. improve, demolish, or 1111,1 airy etruclue, ❑rid m es eluent, 1W repuxes the .p cans ea tach purmh
he is de Me Coneactor's Lkena Low
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in life a signed statement that kcensed pursuant 10 provisions Of (Chapter
9 (commencing with Section 7000) of Division 3 of the Business and Piobtsior s Cade) or that he is eampt therehove
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and the basis lot the alleged tamption Any violation of Section 7031.5 by any appisint for a permit sublrcts
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the applicant to a civil pmahy of not more than five hundred dollars (=500)1:
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DI, as owners of the property. or my employees with wages as Meir sok compensation, will do the work, and
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the:vuture is not intended or offered td sale ISec. 7044. Business and Professions Code The Contractor's license
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law does not apply to in owner of property who builds or improves thereon, and who does such work WWI
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of through hu own employees. provided that such onprmements are not intended d offend Mr sal. It, however.
have burden
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the building Or improvement is sold within one year of completion. the owr2r-builda will the of povuq
that he did not bold or improve for the purpose of Ii
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DI, as owner of the property. am exclusivity eontranmg with licensed contractors to construct the project (Sn
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7(IW, Business and Professions Code The Conhactoes license Law does rot apply to an owner of property who
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bolds ae impreves Iherrm, and who contracts ku such prefects with a contractor(s) hcensad pursuant to the Conlractre t
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CONSTRUCTION
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D 1 am eremp under Set B h P.C. IAna1h Croficale).
PLAN.,RE)(IE_W
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Date owner
ELECTRIC-.--..
COMPENSATION DECLARATION I hereby affirm that I have a cerbfo u of consent to sof-insort. of
a certificate of Worker; Compensation Insurance, or a ceufied copy thrral ISec 3800, lab. C.1.
aBORXERS'
PLUMBING -
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MECHANICAL
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l� Certified is bled with the Buri Inspection BuiMi •y
rapt p Dec Dprtinanl d ' Dinprtment.
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CERTIFICATE OF EXEMPTION FROM WORKERS• COMPENSATION INSURANCE, This section reed not be completed
ISSUANCE
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if the permit w for one hundred (S 1001 Or less. I eerldy that in to prfa mance at the work kyliwhich Mit
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Flow is issued. I shad not empley any person in any mover W 13 b Ilcdne wbpct to the Wukurs' C11ganYlipt
Laws of California!o.1 "" % 1J
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PARK FEE
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SCHOOL FEES
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hOTICE TD y1PPliLAM: 8, after making this Certificate al Enempbon, you slaty become s� 1 b the Wafer's
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Compensanum provisions of Me labor Code. you must fordwr� comply with surh povsre;or Iden prone shall
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be deemed rdvoked. n '1') Z4
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DIVISION OF INDUSTRIAL SAFETY PERMIT CERTfICA -1�n p, t�>d:•
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eery certify that no aswatan live I51 or rrnee Pat in depth into which s prnsen is required to Beaten/.
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will be nide n connection with work wtteroed by then Penn. ash Mat no Mddiq atrueteve. auFlddiq Nanvrt,
ordemoldron d =Mantling tlrreol, will be mare Own 611Y sur 36) IKll Q�•y8 p 12. Cep 2, Art 2. Sec
311. CACI
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TO. B. n
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❑As owner -builder, I will not employ anyone to do whichJJh would Isrpn a permit from de Division of
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ndusnial Solely, as noted above. unless such portion has a print In do such work here On p vuian.
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❑Division of InAetriN Safety permit ffaLl I Y C ----� r
TOTAL FEES Pf /
CONSTRUCTION LEMW AGENCY. 1 hrabiiatboWthei *—.wa'cim ilrao i WmMq apency her ow perwe�Fd
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of the work td which Mis pawl is issued (Sec. 3097. Civ. W.
Lander', Name41 I
COMMENTS
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Lernd„•a Address
•OFC IAACE AMAMMUATM OF MW truly I have mrd Yds booco m and rim
:CERTIFCATE
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Mat tte information porn it WK1 I apna to cwnply wish sl aura hnas O d city 06 r raletip W bddp
W111.1en, and oveh ix a """Mon of on DaprUret of BuNrq see Stay to ww W. to prapergr
he which I Mse *eked kr this prone for due perpnse of netting irwpca M
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RECPT NO. PA(n RV : c j a \M I ar %AT"` 1& i
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