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CITY OF DIAMOND BAR
DEPARTMENT OF BUILDING AND SAFETY
BUILDING PERMIT
PRESS --
FIRMLY
., e
JOBSITE
ADDRESStDSAT
APN LOT TRACT
APPLIC IT J /
CODE
NNUM1 ER OCC
TYPE
DATE � r CONST.- GROUP
ZONING SETBACKS `ll"nDaEWNTIS
FROM RW ❑
REAR ❑
SIDE/SIDE STREET RW
rl
CROSS STREET \ ` F ^ I.
OWNER I
ADDRESS 2- b
CITY -Z2 J _]-�-! TEL. L
APPLICANT K�� '
CONTRACTOR
ADDR S5;-;-SROSAL
CITY �I Z1P�(Mt
E ❑ PUBLIC PMT #
off` ❑ PRIVATE SO. FT/100 GAL
STATE
LIC. NUMBER
ARCH/ENG/
DESIGNER
ADDRESS
GRADING ❑ CU. YDS. EXC. CU YDS RLL
W
TYPE SQ FT RPS A AREANA UATiON
1
LLL
2 ) j5/ ,-3D
3
CITY ZIP TEL.
PROPOSED U
-
Z
4
O
GARAGE
NO. DWEL. O. NU.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
NO.OF BLDGS HOW
:5
PARCH
CO
VALUATION ADJ. AREA
OUANUTY DESCRIPTION FEE
ON LOT USED
LICENSED CONTRACTORS DMILRATIpN I herby affirm that I am Ecemed ander Movisnw d Doper E Itaomawcnq
wnh Sanction 70001 of Owlon 3 of Me Pau mazz wed Professems Code, and any hone is in too fors. and Nfact
Lu
�•
❑
W
OWNER BUEDER OECLARATON: I It ..by ofhm Mat I not camp ham the Cmsocror s License Law lir the kauwing
mason (See. 703 .5. Business and Professions Cade Any tiny r carry whch rapuira a Palmer to conwact,
ssce, site M mount So applicant such Word
slow npreve. damoarmature, or mpar any eture, pilot to m un
e I'll,a squad statement that M is Wnstl statement to the ywmons of the ContrKer's Lie.me Law (Chapror
9 Ieonnmennng with Seebon 7000) of Om— 3 N the Busnuss all Professions Cedeiw Wr a is awhW dwahom
and the bass mar Me ofaW twrpecor Aly variation d 3moon 7031.5 ay am applcant lir a panart Retrace
1. epofcant to ■ mil penalty al her Rewe Mm from hurdrod doll (85001.1
n
aZ
' 01, as owner of the property, ar my a pnyaes wrm wages a Meir sok compmstroan, will do Eta work. sed
Er a nature a not intended or offered for ae (Sec 7D44. Budness and Professions Code The Comuactm's L evem
i law does mat apply to an owner of property who buds w wnprows Ewswh, and who does such work hnnadf.
i a o wh his own emproyas. prarded ton such wonweam
rts we trot mmM �ded w offered tato R. flown"',
LMmw.np a dwrosenten he add whMm am war of eanpinam
n. Er ewr.nxdar will hEsu aw We" dPP—"Mat he did not hwk a npmve for the purpose Of sale l
h ❑I. as owner of the property, am atlwwely mntswew wnh keamd ennraeurt to clnsulat Er Impact (eK
anse Law s plat apply on amu .1 property chew
7044. Business and Profession Code The Contractor's LcPak
: bhakls or.:prows throw. and who mntrace b such pwPcts wnh a camracerlal IwsmN P'aa'rarie a da Compactor's
UNnae Low l
❑ I wn toe of mew SK B. t P.C. IAtmch Corsham)
W
�O ..a • lr.� f O
CONSTRUCTION s r? 1 s
PLAN REVIEW a Z 1 1 1 a
mak °
ELECTRIC
PLUMBING
MECHANICAL
i WORKERSCOMPENSATIW OEMARATION 1 hereby alfem that I haw a edrofcou of convert to waN•imwe, w
' a cordacak of Workers' Connownam Immolate, w a carotwd copy, tharedf (Soc 9800. LW. C.),
❑ Grafrd copy w ministry I emeMd
i ❑ Cerafwd map, a Idad with Esu Buddng nspKshon Department r Daarpplan.
` IiRTIFCATE OF EKEMPTMTN FROM WORKERS' COMPENSATION IhiS11R4NLE. This moon masa nm M co plewd
0 ds p rnut aha ane hundred (8100) w lass 1 scaly not in saw performance of Er work Mr whch EJs
�t.1 CoroedMull not employ wny Paloma kf'T�.mw?111I dorremr� _ sone aufrpKt a it fAbrtan' Coaapmwtien:
a mate =�` i"'
GRADING
ISSUANCE •Qa
PSMIP
ARK FEE
SCHOOL FEES
� NO110E TO APPLCAt7T. M. speer awkrnp Via Laetifrste N Exemption. you fallenhtume aWyKt m she Waker'a
± CemPanawan foremasts of she Labor Woof brown"comply will ash proyisom an Ills pemhit WsM
- he devoted nyaked
WLSIM OF NDUSTRLLL SAFETY PERMIT CIERTIFICATIOla.
� ❑1 IwebY artery wt m aacavofton lis. I81 or awn Imo M depth nm wdtdh I pelma is maattl a dw[wd.
wall M raeda at cenneofen eerlA �iiih'�' Wq� E9 v�It�omdk atdthat' kustM'q smith" RdEdQu'p, labwsrk.
- or deroenwn K tsomerb,p therot. wdI M�Tsb�. !0n%*4 X301 E6e1 IP-ECMap. 92. &P 2. An 2. &e
7a1, TNe..CACI is:.v( i L` �. i i re '*i''eD r`rA TY
C DA, owrir-0ader. 1 sun w wpby wpm w do work which wader wows I Prem from r &itlm of
tammm Safety. n NOW Wore. wdwa such Parker W a now for do web work tour w *As=
❑°"'mn of hdurow sale" power No.
cohi UCi1DN U101110 WAI0 I herby dfinn all severe r I mnmucom hualm ap eal w Ere P96n ar+o
of the work fa wkth IBA swam a ions" rm. 9097. Cir. W.
TOTAL FEES
a la der's 14ne
Leder'. Address
COMMENTS 614
c CENTIFEATE OF COMPLWNCE AND ARWWATTM N ENTRY. I eniy, I Maw and this apowatum sad war
g Ear ow nstwtwwn esu is Moret I aeon a ra spir sews ao am Mwm and dry, red Wp g lis iap
2 womb.. sed amMwn a sPtuaptevra N M Deowmwm of EluMmp osier Ser anon Pan Me�lslpny
Inn wta:h I d war aloe pareek to Ea propaw of prfw MWWMs. \1
E N
. t/ s�7L
04-1
L
�2G Q 0
- me r Ape:
RECPT NO.: PAID BY �. 1d►l�A
WHITE—Depattmawn Copy, YELLOW—Finance Copy. PINK—Assessor Copy. GOLDENROD—File Copy. GREEN— Applicants Copy
CITY OF DIAMOND BtAl
RISPECTIOW RECORI)
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