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CITY OF DIAMOND BAR (^1 PRESS
t~ " DEPARTMENT OF BUILDING AND SAFETT,
BUILDING PERMIT F{ MLY
JOBSITE
ADDRESS
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fil.V
APPLICATION PERMIT/ E
DATE 10 CODE -
ISSUEp TYPE ER ' OGG.
APN LOT 48 TRACT
DATE U '` CONST GROUP
CROSS STREETZONING
OWNER rams ea Calit. -Inc.
ADDRESS a P` P
SETBACKS
FRONT RW ❑
REAR ❑
CITY IzviZI 9 14 TEL
SIDE/SIDE STREET RW ❑
APPLICANT _ TE !s/
SIDE ❑
CONTRACTOR ,Pa F.IPt- rine Tne,_
SEWAGE ❑ PUBLIC PMT
ADDRESSno _
CITY Irvine ZIP ILI' - tiEL _ .. ~
DISPOSAL ❑ PRIVATE SO. FT./ 100 GAL
STATE 490083 F,)M, 4/92
LIC. NUMBER
GRADING ❑ CU. YDS. EXC. CU YDS FILL
TYPE SO FT FACTOR PS ADJ. AREAIVALUATION "
ARCH/ENG/
DESIGNER
ADDRESS
W
1
LL
2
(D
3
CITY ZIP TEL
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4
PROPOSED USE
D
GARAGE
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
=)
PORCH
m
VALUATION ADI. AREA
GUANTTrY DESCRIPTION FEE'
NO. OF BLDGS HOW
ON LOT USED
13
LCENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of CAapu 9 ICommrctng
with Section 7000) of Division 3 of the Business and Professors Code, and art kense is in hl bice and effect
CE:
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OWNER WILDER DECLARA71ON I hereby afGnm that I am eampt hour the Contractors License law for the following
reason ISec 70715. Business and Professors Code Any Cay or courtly which requires a pima to construtl.
alter. improve, demolish, in repair any structure, prior to as Issuance, Alm Sequels the Appkam lot such Permit
to file a signed statement Mal he is licensed Pursuant to the pravisans of tle Connacroi s License law (Chapter
9 (Commencing with Secbm 7000) of Dvision 3 of the Busmen and Professions Codel o Mat he is aeempt thaafmm
and the basis lot the alleged exemption Any vatalm of Section 70315 by any applicant for a p(ma subjects
the applicant m a civil Penalty of not more than hire hundred dolW s 11500) 1.
❑I, as owner of the property or my employees with wages as Mar sole Compensation, will do the work, lid
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to i nucture a not intended or offered la sake [Sec 10x4. Businca and Professions Code The Contracts a Leense
Law does not SPdv to an owner of property who builds or improves thereon, and who does such wak himuff-
s are not intended or offered ton she If, hon,
or enough his awn employees, provided that such mpnovcmemvmv
the boding or improwment a Cold *.thin one veer of completion, Ile mel build. vert have the burden at prwmg
that he did not bill m mprare for the Purpose of sale 1
❑l, as ower, of the Property, am enkaveh anlnacnng with licensed Contractors to Construct the project (Sec
7614. Business and Professions Code The Cmuactor's License Law does not aptly to an owner of property who
feeNs or improves throw. aid who contracts for such projects with a canuactor(s) licensed purswrt to the Contractor's
taense Law l
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hey
CONSTRUCTION
❑ 1 am teempl send. S. . S. fi PC (Attach Certificate).
PLAN REVIEW
i Date OwnerFtECTIVJ_T__�'
J
g
PL MBING
MECHANICAL
MIORKfRS' COMPENSATION DECLARATION I h.etry, affirm that I haw a cerlkSIC d Consent to 301 insure, a
' a Cerehute of Mikes'Compensation Insurance. or a ensiled copy Mneol (Sec 3800. Lab C 1.
❑ Certified copy a hereby Iwnislee
i Crated copy a filed with the &oldie hspettton Deprtment or Building Dolow int
Q
GRADING
i CERTIFICATE DE E%EMPTON FROM WORKERS' COMPENSATION INSURANCE Thn aeceon need rot he completed
i 4 the Permit is ler ere hundred 111DG) at less I testy dict perlamancS el IM work lot which ms
Perna is issued, shal rot employ any person in any As became s b.; .8 , Mbtldi Canpensalan
La
e "�i so / / '�--
19SUANCE
S
PARK FEE
it
'
' NOTICE TO APPLICANT B, afar making this Crnleate a Eerption, you SMtdd become +rhlrct in the Worker's
e
Crnpensanao provisimi of Ihe Labor Cade. Diu must Ivthweh coaply with rich pronsms or m+ Perms MA
SCHOOL FEES
• he deemed revoked
ONSION Of INDUSTRIAL SAFETY PERMIT cERT6GTmet
r 1
❑I hereby [rldy that ra ex[ivation Irve ISI it mmx^, e fees tn'deph into which a Person is tendo ed to descrrd.
wit be made n Connection wrathoth work avmaved by'Uha ps mkand 8u1t n faxldrq snuclue. salfd6n8 f -hunter ,
a demhmon a d�smanM1ry thereof, wed be norMn tShirty So (36) feet high. (Chap 3.2. Grp 2, An 2" Sec
341, Title 8, CA C 1
�S7nul SaAs fety, as rated above. mk yiuc bNldp ygmt�:lo do'— from Ihembrision. af
F'kV
❑ Gvisan of Industrial Safety Permit No. ..., '. �,r
TOTAL FEES 1 �
CONSTRI1CTIDN LENDING AGENCY I hereb(.AWrm lbaf'Une u•7tn:`ndepa
h tM wale la whCh ms parol a iSsd d (See.[3D9F; fiv jJ /`�l. j .
+ l.der'sName sl1 i�,`L1 i
COMMENTS
lender's Address
d CERTIFICATE OF COMPl1ANLE AND AOn CRIZATIOI OF ENTRY. I cenafy I hive read IN. application and Stale
I that the information given a Coined. I arm to cemplY with N State IMS .d City eedeuncee Rhone to buadrne
Can utherite A ni resem.ve of dr Department of Bud" and Sekly So O` upon lam prpPrry
act are eked kr s Pr th pupose ma Cup mrylCana /
J
� fS/(lvin a
XSignatures
)
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RECPT NO. PAID BY vL VALIDATION
h Apkanl in eat�
WHITE—Department Copy. YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy
ES106-111439