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CITY Q�' DIAMOND BAR pRESS
\ ''�� DEPARTME BUODlNG PERMITND SAFE7'Y FIRMLY
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dOBSITE APPIJCATION FERMIT ,����,1 _._._-USE
ADDRESS ,l/d ii.�=C���� � �„ ,�»� DATE _��NUMBER CODE
' �ssu� rY� ' occ.
> APN L07 TRACT DATE �' ` ��� �
a — CONST. '� GROUP
„ o CROSS STREET _ �
� �° QWNER "" ' - �12 ia!' 4��> - OIVING FRONTCKS � ��Nrs
� � ADDRESS /f�.�^r� c�C j� /�','c.. �/L REAR �' �
!� ,� CITY�'i'r+e.°,a�6�'r!gi�u: ZIP - '�G=� TEL. --�/� �,SiDE/C�IDE.�STREET �(y ❑
; o APPLICANT __ TEL. --- SIDE � ... --- ❑
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Q CONTRACTOR + .,
y' SEWi4GE C�.,.PIIBLiC�-�; PMT+� .
o ADDRESS� DISPOSAL
; o CITY IP TEL. �-_PRI4/ATE SQ.FT./100 GAL
� = STA7E ----
y LIC.NUM6ER GRADING ❑CU.YDS.EXC. CU YDS FI�L
� y ARCH/ENG`/�, � TYPE $CP �1' FA�� PS. A�J..AREANALUATtON
� `=' DESIGNER �W�, y
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p ADDRESS �y 2
� � CITY .ZIP .__ --- �.3e 3
� � PROPOSED U5E ,�� ,��,,L;f-' •'"" z 4
" l.�[/K��r'� .�• ��.� ' � . a GARAGE _'_._
z NO.DWEL. N����,/ NO. L5`�� a PORCH —
�, UNITS STORIES.,,�_BEDRUOMS�_ �
+ �� LOT DIMENSIONS VALUATION� ` � 7 C��C. ADJ.AREA
� _; �O. OO7BLDGS UQ n � GtuAN7rrY DESG`iRl (C1N FE�
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i w -as ,� ❑ '
� : LICENSEU CUMNACTOBS OECLARATION I hereby alL�m that 1 am lirensed under pmvisions of Chapter 9(commmcinp ���� ---
�� wrth Secuun 70001 0l Oiwsion 3 of the Busmess and Prulesslans Cnde.and my IKense�s in full lorce and effect. �
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� •�+-' � NER QAL�ER D�C lAfll�i70N-1 h�re5y at�irm Ihat I am ezempl fiom ihe Canbacmr's Lrcente Law far the Idlawm�
i ,Z. rcasnu�Sec 70315,Busmess and P�otessions f,oAe Airy nty or touMy which re0uims a permil to cunslrucL �(�
O� aliei impiove,Jemohsh,or r¢pair any structure,prior to ils issuance.aiso iequ�ns tAe ayyhcant lor soch yermit �
!� i—� in tde a signed statemem thai he is I¢znseA Wauam ro the pmvisians ot the Camranor's ticense Law lLhapter �m
�.. 9lmmmencmq wnh S�v:uon 1 W0�of avision 3 0l the Business and Professions Code�a�tha�he iz eKempl there6om ,�
�X: anG�he hasis(or tlie alleqed esempuon pny umlatmn al Satron 70315 by any apphcam fo�a permit su6�ec�s ��
� :.�.� Ihe ayyhr.ani m a srvd penahy ot nol mare Omn hve nuudied dollars�5500�j J _
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0 ❑I,as nwirer nf the pmperty.ar mV emyloyees with wa9es as IAeu sole tompensa�on will do�he woh.and
33 �,�' ihe strucNre is nut intended or offeietl fa sale�Sec 7044,B�siness and Piolessans Code The Contractor's Ucense '�,Q
{ V� Law dor.s rot apply m an owner ul VruOerty wlio 6wldi or impmves 7hereon,and wha dae5 such wo�k himself. �(�_ _
a �'� or�hrou4h his uwn emyloyees,piovidal 7hat such impmvements aie noi m�ended oi olhred for sale.II,however, �
,� m the M��Mir,g or enpruvemem s tatd wrthin ont year ol complehon,lk wmeo-hmlder wiU Aave tna 6oreen ol pirning Q
�{ ��y Ihdl he did nm hudtl or impraae inr the purpox UI sale.) �'
� y ❑i as awner ul�he pmp¢ny.am ezch9velV mNraClmy wilh liaus¢S conira[to�s to cqnsfruct Ihe D�oIK�ISe[ -��
;��0 7054,6usmess and Pm(essions Code-TM CoMranor's License Law does npt apply to an ownei of piuperty wM �
� ''= LaiWs o���nprevec thereon,and who cnmracts Iw such Bro�ects wnh a mntra�m��s)lirense9 pursuaai to the Cw+uactoYs �• �
i ."Q' Licen:e Law 1 "�"--. - 'p�
� ri CONBTRUCIIII6L�'_ �,�,
� ��. ❑I am exempt under Sec ,B 6 P f.�qnxh Cend¢atel� . . PLAN R�\/��w
eo'. ua��___ a+�e� — ELECTRIC
• ,� NqRKERS'COMPENSATIOM DECIAPATION I here6y alLrm tha�I have a certificate ol consent ro sAf-insure.cr ' --"'
d 's a rert�hcale o!K4rkers'Com�nsauo�Mswarce,or a ce��if�ed ca�y thereot�Sec.380D,ta6.C.1. PLUMBING
! �x '_ —
� ,Q ❑Ceitdied r.npy is here6y fwmshed � MECHANICAL
;r ',Lo I n Cenihed copy it tded unlh the 6widmg Insp¢clion Oepanment ar pepanmem. <C GRADING
i .�
;� .;�; CEfliIFlCATE OF E%EMPTION FNOM WOqNERS'C1IMPENSATION INSUNANfE�ihis sect�on need not 6e tampkted � UA �+�' ���"'�[`'�y
; y d the permn is lar one hundred IS100)a less.I cenAy uhai�n�he peqormanre nf the wwk for wh¢h�this
,j .� yennl is iSsueC,1 sheli not r.mplay any pe�son in a�,yJpam�.so a,�ta:l�ceq�e suh�ect w the LWrkps'Campensahm S��P �' .^'""v
-��z -�_, Laws of Cahforma ;$ ,1�;+ �) �.✓
; •o ;,.,,.;.`• �-' ..;` PARK FEE
'� o Oaie �sAppl�Cant,..'�. �J.1 —
:� � NOTICt TO APPLICANT If,aftei makm9 this Certilicate ol E.remptwu'you�should 6ecnme subject to the Warker's �+- SCHOOL FEES
� ��� Canpensalmn pron5ims a(ihe Lahor Code.you must tathw��campl`wi�h suth qmisqns or ihis permit shdl
���� 6e decmed revoked � r•:�9
a� x'� .'4�'Z�.;g
��� qVISIUJ OP INDUSfHIAL SAFETY PERMIT CE i 'AAON�
W Yi ` _
'� .o� ❑1�ere�y certily ihat no ercaval�an frve�5�or rtpfe feet m CepM mro whi�h a perem is requrted to fasceM.
� ���. will he made m canneqpn wilh work amhorued by�hi�F,p���i4.and,ii�a�no 4xldinp;,nriktl've.scaffiWiny,fduwork.
� or demo6�ion or d�smantling ihe�eol.;W;O'be�`ihorE,.mm`�irty�t'u{38}Ieet�Mgh,,�Chap'3.2.6ry 2.An 4,S�c
Z 341.Ltle 8.C.A.CI . ''; /
_ � � .
�3 ❑As mvner6uAder.I will not empby anyone ta da,wark which vrouM rtqwie a permn fmm the Uvisian af
� � Indu:nial Safety.as noted above.unless such person�aa a permi�ta do su�h wo�k irom the dHision
� ,s
.� ❑a„s�o�o���s���a�Sa�����m�,No. TOTAL FEES
fy CONS1pUCTION LENOING AGENCY I here6y affum tAai ihme is a canstructwn Iendi�agency ta�Me perlo�mm�e � �
� _' ot thx work loi whreh this permit is issued(Sec 3097.Gv.CI.
����; Lenner's Name
m� lendeisAdGess COMMENTS
� Q; CEFR6ICATE OF COMPLIANCE ANO AUTN(pIZATIdV�F ENTflY.I certily I h�ee reaA Mis appleuian�nA sta�e
`� �� �hat�he inlpma�ian g�uen is carect I agee ro wmply wtlA atl sun lews aid cip ordimnca rNefiiy Io 6uiNiiq
� . �, canstructian,and aud�arue a representative o1 Ihe Deperiment of BuilOfnp aM Salety tp mter ipm pk prqierry
= tu whreh I�a�t applced lur Ihis ptrmil la tbe pirpase oF mskiry inspeeGonx
1-�
� � ���'j� RECPT NO.,� �
ue af p�cant o�/yent °�+ p� �,J�1.�.PAID BY VAUDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assassor Copy,GOIDENiiOD—File Copy,GREEN—Applicants Copy
astos-itres
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