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�'�` ClTY OF DIAMOND BAR
'-� � DE€�ARTMENT OF BUILDING AND SAFETY PRESS
� -.� BUILDING PERMIT FIRMLY
JOBS�— D TE CATION ��; -�� �MBER -��CODE
ADDRESS � � � ��� ISSUE TYPE OCC.
� APN _ LOT TRACT DATE CONST. GROUP
o CROSS S ET C.--�. � �?Y'i t 1 �e SETBACKS "p"°"�'"E'"5
�-° OWNER ZONIIVG FRONT RW ❑
o ADDRE �%�� v-�s�^ C_c.. tn , REAR ❑
W CITY ' e• c Z�P TEL.��� I SIDC/SIDE STREET RW ❑
o�APPLICANT TEL. � SIDE_�� ❑
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Q rCONTRACTOR 1 ' � SEWAGE ❑ PUBLIC PMT�
o I ADDRE S t' � DISPOSAL
W CITY ' 4- P`��TEL.� Z b'6 � ❑ PRIVATE SQ.FT./100 GAL
y SC.NUMBER S� r t g t C �- ��, GRADING ❑CU.YDS.EXC. CU YDS FILL
y ARCH/ENG/ � �p� SQ Fi" FAGTC)ffi PS ADJ. AREANALUATION
� DESIGNER � �
� kDDRESS LL. 2
_�CITY ZIP TEL. (� 3
� PROPOSED USE � �_� n 4
� ,,,1 GARAGE
o NO.GWEL. NO. N� � PORCH
= UNITS STORIES BEDROOMS
� LOT DIMENSI�NS m. VALUATION � • C� ADJ.AREA
o NO.OF BLDGS HOW QUANTITY D�SCRIPTION FE� �
= OULOT USED Q
W
ac U
❑ �~ LICENSEO CONTRAGTOPS OECLAPATION I heie6y affirm thal I am hcensed under pmvismns of Chapkr 9 kammennng
Y wnh Ser.timi 10001 uf lvrsion 3 of ihe 8usmess and P:ofessnns Code and my hcense a in full farce antl effect �
3 � �
�+–�[?:VNF.��&UIi7EP DEfLdAATION!here6y afium that I um eaempl 6am the Contraclor's l[mse Law Im Me follmvmp —
Z renaun ISec 7031 5.8usmess and P:oiessions Cade Any cny ur county nhrth reqares a permrt m construtt, O
o altei impmae,demdish m repart airy strucmre.pnoi to M1s issuan�e,alw requnes the apD�icant lor such permn Z
Q ro 16e a siyned statenert ihat he is!¢.^nsr.d Cursuant to the pmvismns al the Connacmr s L¢ense taw!Lhapter �p
Q 3��unmerung wnh Seccon 7000)ni Orv�sian 3 0l the Business and Pwlessions Codei or tM1at he is eaemCl thereham �
a, antl the hasis fa� ire alleged exempnon Any vmlation of SecLon J0315 hy arY applicanl loi a permil suhle�is �
� inr.appncam•r.•a uml penal!y of no?nare!har.hve Cundred dallars 135001? —�
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� ❑I ac awrer nl the properiy or my employees�.v�th wagts as thev sole campensahm.wdl do ihe wmk and
Ilre slmcture�s nm�r.:endeC o�nlfered for sale jSec 7014 Busmess and Pmlesswns Cade:TFe Cmtiaatm's L¢ense Q
� Law dues net aCplv tc an ownr,r ol pmperty wM10 budtls or imprwes therenn,and who dces su[h vrork himself, fJ
� n�Lro•�Gr his ow�enyoyees provided that such�mD�ovemenu are nm�mended or olfered for sale.Ii,however Z
m��he 6wlding m ir.provemem is sold wilhin one yea�of rompleuon tM owner�6udder wdl have Ihe hwden of p�oving Q
� Cai na nC not hutln ci�mprave!or the purpose al sale.l �
rn I C�I,as ewrmr of ihe pmpenv am exdusnely contracL�.vith liceneed oontracrors lo construu the p�o�ect ISec. (}j
o ;044,Business ard Pmtessions Cotle The Contracmr�s lnense law does not apply ro an owner of pioperry wha S�,
� hudes a��mumves[hereon,ana who contraus lor such Orale[is wnh a contracrodsl hcenseJ Oursuanl 10 the Contrectar's � ` /+�T
i�cense law i COYVSTRUCTION �Y3 P 47�.)
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`+� ❑ i��i e.emP�n�e�Sec d.6 PC iA�ucn Cernikarel PLAf�I F�EVIEW
�
0 0�« �^ef E�ECTRIC ___
¢ WORKERS �OMPENSATION OECLAflATION I heiehy afhrm Ihat I have a ce�uhcale af cansml to selbmsure,m PLUMBiNG
� z mnd¢aie n!Wa:kers'ComDensation Insurance,ar a[enAied copy�hereM I��3800,La!GI
O
z ❑cen�t�ea�o�Y rs he�eAy(urmshed � MECHANICAL
c —
G :.J Certi6e0:c0y�s hleA vnlh Ihe Bwitlmg Inspttnan Oepanmem or Department Q GRADING __
W r�
Z CERiIF!f.RTE OF El1EMPT10N iFOM 4VORKERS�LOMPENSATION INSUflANCE This secuon need nm he oampletea [� ISSUANCE ��✓'
� �.I the pernw;s for ane Imndred 131001 or less I cen�lv ihat rti the perfmmaxe of the wwt far w�ich tA�s �,
y permit is issueA,:shall nol employ airy perwn m any mannei so as lo became suh�ec�lo IF.e Nbrkers'Compensauon SMIP
�" laws n�Califnrnia W
� PARK FEE
� W
o nai� Agohcael CL SCHOOL FEES
••• NOTICE TO APPLICANT II,a%e�making tArs CeiLlicate ol Eamption,ya should hecame sub�ect to the Worlar's —
� ComOersauan Orovisians of the La6or CoOe.you must tarthwith camply wnh such p�ovisnns a this permi�shall
� he Aeeired reuakeA. —
� qVI510N OF INUUSfNIAL SAFETY PERMIT CEHTIFICATION
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� ❑I hereby certify that no eMcavation Ine I5)or more leet in depth inla wh¢h a persm is ieyui�ed to deseend,
p�C will I�e ina0e�n conne[tqn with wort aut�Wved by Ih�s permil,and Iha[na Wildinp s[ructure,scalfolding,fdsewa�k, °
d or demolitmn ar drsmant6ng ihneoF,will he mae than�hirry six 136}Ieet high 1Ch80 3.Z.Gry 2,An 2.Sa
W 3C1 TitleB.CACI
S —
3 ❑As nwner�6uAder I wdl nol employ aMane ro do work wNCA would repwre a permn hom tl�e Divsion af
� Industnal Safety.as mted above,unkss such person has a Oe�mn b do zu[h wor4 fmm tk drviamn — �
�
W ❑0.nsmn of tnAustnal Sakty Rermn No — f>
� CONSTRUCTIWJ LENOING AGENCV:I Mreby atfi�m Ma1 tlKre�s a tonslrucUon lend��agency ior tlu perfortnance TOTAL FEES _ +�V
z of tIK work ta whch ihis permit is rssued I��3097,Ciu.C.) � • � � -
� Lender's Name COIv1MENTS
mLender's Address
Q CENTIFICATE PIIANCE A IIOR12ATqN�ENiNY I cntily I have read Miz appkcation a�d su�e
v) that Ihe inf matian 'ven a carrec I ee ta canply with aN stah laws aM ciry ord�nances�a4ting ro 6mldnp
croslruc n aM auN rize a r re oF the Oepaitment d Building end S+hty ro mter iqm 1M1e paperry ���� �� � �� '��'�'
y ta� I ve a I�e 1or Mis rmit o the
= OD PW��ol melvng n�eelions ,
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` � 1��%�4� 8 /,�p��
Siqnat�xe o�npdcant m nqent RECPT N�.��.PAID BY Y " /s,�VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Agsessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy � � � �
BS106-11l89
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