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� '"' � CiTY OF DIAMOND BAR
�"� � DEPARTMENT OF BUILDING AND SAFETY PRESS
' � BUILDING PERMIT FIRMLY
JOBSITE APPLJCATION F'ERMIL i 1/1t USE
ADDRESS o DATE ` NUMBER `'�"� CODE
ISSUE . � TYPE;` OCC.
� APN LOT + TRACT DATE � �CQNST ' GROUP
o CROSS STREET SETBACKS ���►�+s
= OWNER�, � �r��Ts�� - ONING �ONT Ryy ❑
o ADORESS�j�.�'-'✓y o C h� /Z�'G �C/L R�q(� �'" []
� CITY�,;�.v�✓.B�'u'? ZIP �� TEL.B��� t.. SIDE/y�iDE.'STREET F�W ❑
e APPLICANT TEL. SIDE \ - ---�-'�-�—'- ❑
x '
4 CONTRACTaR � � • '
�,: �,
� °° ADDRESS SEWAGE �J...PUBLJG�;: �PMT�
� DISPOSAL PRIVATE SQ.FT.!100 GAL.
� W CITY IP 7EL.
z STATE
y LIC.NUMBER GRADING ❑ CU.YDS.EXC. CU YDS FILL
� y ARCN/EN � TYPE. SQ FT �ACTOA P5 . ALU. Af[E�rlVi�tUAl'ION ,.:
`n DESIGNER EL( 1
+ o ADDRESS �
� 2
iZ CiTY ZIP � 3
� � PROPOSED USE� � ""' Z 4
� � �k��"'���, � GARAGE
� z NO.t�WEL. N NO. � i� ,� pORCH
y UNITS STORIES�_BEDROOMS� �
oc LOT DlMENSIONS VALUA710N ADJ.AREA
� o NO.OF BLOGS How ttua�u��rv p���� ��p� ��
i W ON LOT USEO � a
� w;u �
! ~ LICENSEO C�NfppCTORS OECLANATIDN:1 herebY alli�m�hat I am licensed wda pmv�ams of Chapur 9(commmnnq ����
i � wnh Secuon 7000)af Owision 3 a(�he Business and Pm(ess�ons Code,aid my lemse ia in full force and elfetl. �
� o
3 C�yG..� �.EL..�r/ :a j.
� �+- NFH�BUILOEN OECLARATqN:1 here y a16�m that I am erempt imm i�e Contraclor's lkente taw lor Me fdiawing
x �eason iSx.70315.Butmess and Pmfessions Cade�Any aily a ewnty whrrh mqurres a pa�mrt ro canttruct, .(�j
o ahei.impmve,demalish,a repair arry muctwe,prior ro fts issuanae.alw�eQuircs Ne apphcanl fa such pnma �
6 ta lile a Sign¢O S�a[e.ment Ihal he is IcenseG pursuant ro the qwiuonz af the Contratror's li[e�e Law(Chaptef �j
� � 9lmmmencing wilh Secuan 1000)af Oivision 3�the 9usiness and Professiam Codel or ihal ht is exemp�fiaefium 'S�
; X and�he�as�s lor the alleged eumpnon Airy vidatian ol Sectwn 7031.5 4y arry applicant far a parmn sub�¢cu ��
� �y the aoON�ant ro a civd penalty at mt maa ihan five hnnd�sd dclWs lSSQD�.1: �
+ a
� �� ❑I.as owrer nl the properN.u mV emp�vreei wim wages as ilmr sde compmution.will Uo the xvrk.md
� ihe structure¢nal imended or alhred tar uie(Sec )064,Business and P�olesspns Cade:The Conirxmi s ticen5e Q
V Lew tlaes nat aOCM Io an awner of property who 6u�10s ar impraves thereon,aM wha tlas such wo�k h�mself. (,)
' w�hrauyh nis awn emplayees.provded that such imprmements arr na.�npMaO d oflertd for sak I(,howerer. .Z
= the bwlding or imD��emem is mk within one year ol compleum.the ovmer�hm�wdl h�ve iM burden of piowry� �Q
� � �ha�Ae did noe buiN a�mprove kr tAe purpoae el sak.l �"'Z
ti ❑I,as awner ol Ihe pioperiy.am e.clusneH�a�«anmy wrth IKens�d[ontocm�s m construct Ilie pqect ISe[. ���
0 10d4.3us�iress and ProFesswns Code IM Contrxtor'S ticense Law doss noi aqply�a an ownn ol pope�ry wla �
! � huAds or imprwes thereun.a�who tanlrect�la zueh pruje,;is wiih a mMntter�s)licmud pwsuant m Vie Conlrxlvr'S �}i
j Lrtenu Law 1 CONSTR `rl��
� � PLAN REVIEW
j � ❑I ain erempt uMer Stt. .B 6 P.C.(Auach CernNcm).
i � oB1r °i""B1 ELECTRIC
� a WORKENS'COMPENSATIOW 6EClAflAT10N I Anety al!'um Owt 1�m a mufinte vl toncem to sd6insue,n �
0
a cerohcate af Wa�keri Compensaum�nsmance.ar a caMue cwv iheieo�ISec 3800,La6 CI ' PLUMBING
1 Q ❑Cenifiedcapy u berehy lumished J MECNANICAL
o ❑f.anirp copy a IiIM wnh the BuJding Inspecum Depvtment a peoxtment. Q GRADING
W
i � CERTIFICAIE OF EREMPTIpN FROM WORKEflS'COMPENSf�7lON INSIIfiANCE.7his satnn nred not he campkted CJ`UA ` _��
y d�M perm�[u Iw one Awlred�f10U)a ksr I eerufy Mat m me yrlamanee�f IAe wnt for which lhix /''�
� � permit is issueE.I s�aN mt empby any persun�n a�Qann�.�,6o a,�ta4ecy�re wh�ec�to fhe Nh�kxa'ca�x�sa��, . $MIP ..�(_�
� Laws ol Cai'rfwnia. j:u�"1 �s j �,
O ��`S`�'-���#`��% PARK FEE
� �1e ���^'�. ~� �- SCHO�L FEES
� NOTiCE i0 APPIICqNT:If,alter making�his LernfKale uf 6rempuoR You should hewme su8�at ta Ihe M4rkx'a
� Campensauon provisions al tk Lahor Code,you mua�faihwnh camply w�m s�n�w�:a„s a m�:v�e�n� '
�' be deemed revaktd. 4 .
r
I s qVISION OF INWSTRIAL SAFETY PERMIT CEAT ,J ""
W
I o ❑I herehy certify ihat no eytavatnn live(5)a mae leel in EeptA inm which a prsm is required to dacad.
� wN he made m[mnecnon wnh work wthor¢d M�!f.V�IR,�ndtpatno hyldiny_YPl'ktul.snllddinp.I�Isawak.
w demdnion ar d�smantlinp ihe1cal.(Qi8'6e`ihw(.ilian tpirry'Li{JBF I!n Mqh.^(Chz'p;'J.2,Gry 2.An 2.See .
� W 34�.TitkB.GAC1. � �.�..:, ,� �°.�...� ". �„-J.; i
= r.`,,:::_.._.'.`.
3 ❑As owner�Duilder.I wili nat emplaY anWna m do wwk whwh wouW rcquire a permA kan tM Divuian d
I 1— 7nAurrid Sakry,as norcd abcve.u�kaa such persan!us a prmrt ta do turh hak trom Ne Eivifian.
�
� W ❑°"`'�m�'�'��,s�"�`�°,�. TOTAL FEES
a
� CONSfpOCTIpN LfN01NG 4GENC't�i herehy alli�m m��tnen is a consttaoan le�q q�r�cy lor tlr perfam.nee ►� �
= af�ht vrorM fa+rhrh this penrct�a isawd(Sa.9D9T.Civ.C).
I � lmdei s Name COMMENTS
m lmder's Add�ess
I � CERTIFICAiE Of COhiPL1ANCE ANO AUiNOfpZA771fNN!7F EN}AY:1 taMy 1 h+e read llq appinlion aM iUtr .
y tM1at the infamanon grven is corrett.I aqree ro comply wi�h aY su2 law�aid dry adinraa reaup to Md6np
' y wn�buctwn.md anMr¢e�ieprtsenfative d tlr Oyrtm[M of Buildinp ad S�kry m nW�qm if�paOM�Y
I = kr whKh 1 tuue appl'rd lor Ihis ppmit fut Ih p�pnse d m�kinq inspecuqn
Y�—
�
—�s�- � ��dS�i p�'�— � �an�� RECPT NO.�_PAID BY—I�=��—VALIDATION
� ��.,,�..,�„
WHITE—�epartment CoDY,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROO—File Copy.GREEN—Appticanis Copy
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