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CITY OF 'DIAMOND BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY49W FIRMLY
or 111Irnurn 0=0LAIT
JOBSITE
ADDRESS 20940 PASCO C'
APPLICATION PERMIT USE
DATE NUMBER CODE
ISSUE _ / _ TYPE OCC.
DATE CONST. GROUP
APN LOT — TRACT
CROSS STREET
OWNER ARMANnn 7AMnCANA
ZONING SETBACKS `WROYE'EtM
FRONT RW
REAR
SIDE/SIDE STREET RW
SIDE
ADDRESS -909 '0 PA qrn Cm_
CITY DIAMO B R ZIP 7 5 TEL. 9 —1079
�arrr__,<. unnT T*T19-06
APPLICANT ri�Y,� r- TEL
CONTRACTOR PETERSON JONES
ADDRESS 3190 E. WILLOW
SEWAGE ❑ PUBLIC PMT A
DISPOSAL
9 ❑ PRNATE SO. FT./100 GAL
CITY SIGNAL HILL Zip 90806 TEL 2/988-0
GRADING ❑ CU. YDS. EXC. CU YDS FILL
STATE
LIC.NUMBER 528710
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TYPE SG, -FACTOR, PS .., ADJ. AREANALUATION` $...
ARCH/ENG/
DESIGNER
W
1
ADDRESS
ilia
2
CITY ZIP TEL.
C
3
PROPOSED USE A
Z
4
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GARAGE
PORCH
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
NO. PF BLDGS HOW
m
VALUATION ADJ. AREA
auaNTrrY ;FDESCRIPTION ; t $ ; :FEE,,
ON OT 1 USED
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LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am kcenwd under provisions of Chapin 9 (tmrvrerrrtp
.ah Sema, 7000) of Division 3 of Vie B&ururess and PTohsskms Code, and my litems n in fug force and dt tt
� twJ,,
❑
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OWNER BUILDER DECLARATION: I hereby affirm that I am attempt Imm the Coatracun a Licerae Lay fair the trrllonang
reason (Sec. 7031.5. Business and Prolessiom Cad.: Any city or county which reopuirn a permit to construct
ala,, anprwe, demolish, or repair arty su.nce, Rion to am issuarce, son req -es this applicant far such permit
�:
to file a signed statement that he is licensed purauant to the provisions of the Contractor's LKMue Law 1Chapher
9 (commencing with Serb 70001 at Division 3 d the Ek—. and Prolesaioro Cada) or that he is emnpt thMehom
sad The basis for the alleged eamPtian. Any violation of Section 7031.5 by am +pplinm Tara puma su0lecb
the applicant to a civil Penalty of ml more that foe hundred dollars t550D11
❑I, as owner of the property, or my employees with wages n their soh compbut will do the work, and
the vr.twe is mol intended an altered for saie (Sec 7044, Business and Professions Cade: The Contractor's Ltmrse
Law does am appy m an owner of property who built or improve Me—. and who dons such work hmaalf
at though his awn employees. provided Chet such vnprwremann are not in4Med or othred for sale. It, however.
the building a improvement is sold within oro yt. of completion, the --bund. -0 have the burden at proving
that he did not build or improve for the purpose of sale.)
Ell, as owner of the property. am exclusively corruactiny with licensed contractus an construct the prolat (Sas.
7044, Business and Professions Code: The Conuxtor's License Law does ma apphy to an ovaat M property who
builds ea improves thereon, and who contracts hr such pmjetts with a comtacmt(s1 licensed pursuant to the Contractor's
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License Law.)
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CONSTRUCTION
❑ I am exempt under sea. , a b P.C. (Attach Certificate)
3:'
PLAN REVIEW
Date owns
:F
_PLUMB
ELEC le
a
WORKERS' COMPENSATION DECLARATION. I h.tby affirm that I have a certificate of consent m silt -.sure or
a urnlicate of NWkers Compensators Inaaanca. ea a serdfied copy thereof (Sac. 3800. Lab. C.).
❑ C.tded Curr is hereby furnished
MECHANICAL
❑ Certified copy is filed with the Building Inspection Department ea afeau em
.Q''..
GRADING
CERTIFICATE OF EXEMPTION FROM WOIKERS' COMPENSATION INSURANCE: This section need am be canceled
'
ISSUANCE
J it. permit is for one hundred (51001 or hes I wily that in the pieforn—ce of the work fa which the
- pe it is issued. I shall rot employ airy prion in any mom. to a m become subject to the Vibrkes' Compensation
Laws of Calitorua.
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SMIP
Date Avpat
W,
LIL
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PARK FEE
SCHOOL FEES
NOTICE TO APPLICANT. M, afterking matris Certificate of Exemption. you sfrordd hecorse subject b theNbiker s
Compensation prwisms of the Labor Cod.. You mint lorthwah comply with sieh provisions or this Permit shall
be peered revoked.
OVISIO/ OF INDUSTRIAL SAFETY PERMIT CERTIFICATION.-
i
❑I hereby artily that no exeavat on hoe (5) or moa hm in depth into pe son a niquared b daacoq
ri"'. un. ttalkdiag. feluwaIt
will be made in ro mectdn with work authaaed W this pnr6f:7�d
u demoldon or dismammng thereof, will be mere dun thit73m {36}`JerF tagh +D. 3.2. Grp 2, Art 2 Sae
341, Title B. CAC.). j, 4r •:
❑As trvmer-builder, 1 wig not empty anyone to do weak which would raw,. paint frac db Divisor of
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y.4
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Inoistrill Safety. as noted afnvc inlw such Derson has a penal to da stdy war j hoo QR divisor
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❑Division d Industrial Safety Permit No.
TOTAL FEES
CONSTRUCTION UENDING AGENCY: I hereby affirm that hien is a comtr¢mn 4relng.agmcy.fn dr tafamnu
d the work fa which this parent u asisd (Sec 3097, Gr. Cl: „ l !' ."
Lerdai Name f =
COMMENTS
.
i
i Laid.t Add—
CERTIFICATE OF COMPLLIICE AND AUTHOCZATIOI O ENTRY: I certify I haw and this apphotion aril sob
that the infommion giwn a cored. Ispat to c—* with erg stab laws and city odinarrraa retailing to buNrg
constructorl and autharue a represmtawe d de,t Bigg ad Safety to anter MM the property
to which l fa tea rnpecdont
Sigmetat of Applicant pen Agent / Dab
.
RECPT NO..PAID BY VAUDATIO 1�4—
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File GoOy, GREEN— AppliCantS L:opy
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HEALTH DEPT. FINAL
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