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'"` � CITY OF DIAMOND BAR PRESS
DEPARTAAENT OF BUILDING AND SAFETY F�RMLY
BUILDING PERMIT
JOBSITE APPUCAl10N PERMIT 1 /_ � E
ADDRESS ffi�' 41300 S. Valley Vista D �E NTYUM�BER�COD
� A P N L O T T R A C T DATE � CONST.�GROUP�
o CROSS STREET V311Qy Vicra Dr Gtwy Ctr Dr ��NING SETBACKS "�►+�'"E"'S
•°—' OWNER P K T}iamnn� Rc�r VE�IItL1L'E� I1TG3 1 L P FRONT -----FiW ❑
� ADDRESS 818 W. 7th St. Suite #7Q0 REqp ❑
� GTY � �� ZIP�17 TE�13 623-1038 SI STREET RW ❑
o APPLICANT TEL. SIDE ❑
a:
e CONTRACTOR �� ���;��,� SEWAGE � PUBLIC PMT�`
o ADDRESS 13350 Ector St. DISPOSAL
„� CITY Industrv ZIP��TEL818/3G4�444 ❑ PRIVATE SC�.FT./100 GAL
g STATE GRADING ❑ CU.YDS.EXC. CU YDS FILL
o. LIC.NUMBER
y ARCH/ENG/ tn Np� SQ FT FAC€OR pS A�J. AREAI�/ALUATION
� DESIGNER W �
� ADDRESS Li,. 2
0
= CITY ZIP TEL. (,,!� 3
� PROPOSED USE Z 4
� � GARAGE
� NO.DWEL. NO. NO. � PORCH • •
y UNITS STORIES BEDROOMS m '�
ee LOT DIMENSIONS VALUATION ADJ.AREA
o NO.OF BLDGS HOW QUANtITY D SCRIPT N� FEE
W ON LOT USED
s
� �
0 COMRACIONS OECtARATION I Aenhy dhrm thal I em Ikensed imder provisiom of CMD�r 91�mmencinp
Y with Secoan 7000�ol Omsion 7 of the Businesa md Profeesian:Cade,ud my licenae is in full Porce and eHect �
3 � 4Ll
� QNNER�BUILOER UECIAflATUN:I here6y eifirm Mat I am exmpt from tAe Contrecmi s Lwmx Lnv lor tlie tollo.vi� Wa,t�T �.+ic�c;L� � 7.� .�
reason�Sec 7031.5.Business�nd fiafessanc Code:Any ciry m county wtieh nquirea e permn lo consUis[, �
o eNer,impiove,demd�sh,a repair eM rt����e,pr'ror m i1s isewnte,�Iso iequires tlie ryplium kr weh permt
� to file a sipned ata�ement Mm hs is ittnsed purment m the provisions of the Contraetar'�L'serme law(Chapte� �
s 9 laanmencup with Secum 7000�01 pviaion 3 of�he Business ond Pmleuionc Cadel Q thet M is ammpt d�ndmm
� and the hasu Poi the aNeged arcmpfian.Airy vidatbn d Seclion J031.5 by airy appRcam lor�pamn whKcu
W the apphcant to a crvil penaNy af nm more then Irve Aundnd dallare(5500�.�, y1
4.
� ❑I,as owner ol the praper[y.w my hnployees witl�wagea�s tl�eir wle eompensatian,will do ihe rrork,uid
� the structure is nat mtended a oilered for sale(Sec.7044.Buam�as ond Profeseions Cude.TAe Contractar'e License
v lew does mt epOh m an ownu of propeny who bullds o�imprares Merem,and wha dces such work himseM,
�++ or[hraugh his own emplorees,qwded that such impravemenu�re not inrcnded a oHered 1m aak.II,however, �
= tM 6mltlmp a improvement is sold within one year of cvnplenon,die owner�6uilder wBl have tAe buMen pf pmvinp
y that he did nm huild ar mprove for Me purDase ol aale.l �
H ❑I,rs vx�er ol the praperry,am azclunvely cam'actiny wi�lieensed�ontnctois m mnatrutt Ihe pm�ecl(Sec
O
1044,Business arid Prafesaons Code�The Contnclar'z License lew doa nm apply to m owner of property who
= Ouilds or imprwes t6erem,end who contracts lar su[h pm�ects witA�rnmrxmrls�hcensed pursuant W Ihe Can[ractar'�
6 �°°""°��w� CONSTRUCTION
0
•.• ❑ I am exempt under Sec .B 5 PL.IAnsh Grtifican) PLAN REVIEW
�
0 oa� Ownar ELECTRIC
� MOHKERS'LOMPENSATION OECLARATION I here6y eNrtm thn I heve e urofiate of con�ent m edt-name,a �/� �
a urtrt¢xte al YVorkeis'Compensa�wn Insuance.or a cxuhed ww tnerw�Isec.3eoo,��b.C.I. PLUMBING l�CJ� ,�.��
0
a ❑Certilkd copy a herehy lurmshed � MECHANICAL
G Certilied copy is Fikd with Ihe Building In�pxeon Department a Oepxenenl. � (',RADING
W
Z CERTIFICATE Of EXEMP710H FflOM WONKERS'COMPENSATION INSURANCE:Thia�ctian nxd nat he complerod ISSUANCE
�= rf the permrt is lor one nundretl�i10111 a kss I cendy thal m the pedormmce N Ufe work fa wh¢h au
y rcnn rs�swed,1 shall nat em o a
pe pl Y iry person in eny mamer so as Eo hetome subject la Ihe N6rkeri Compenaefion $MIP
o �•W5��ca������ W PARK FEE
� �1e �DII�an' u- SCHOOL FEES �
W NOTICE TO APPLICANT N,elter m�king�h�s Grtiiioete ol Faempuon,you ahauld hecome subpct m Ihe VNoiker'a
J
—� Compenaatwn prwis�ms N fAe ls6or Cade,you must lat�wi�h mmply wrth wch qwisioni a Mis parmrt thMl
W 6e deemed revoked
� .
¢ pVIS OF INUUSTHIAL SAFETY PERMIT CEpi1FICATqN y�: r
o �here6y cn�dy Ihat rw auwuon fiva(51 or more Iro�in dapth nPo whkA�penon ia�epuired b Mscend, �,`I n_ i���B,�
wnl Oe m�0e m eamectm wiM work wtlmr¢M Oy Ma pimn,nd Ma[iro buildinp ovutturo,wNobmq,fNsework, �*►1��
m demohnon a drsmantirq thermt,wip M more thm lhirry�tix 136)bet hqh.(Ch�D�7.2.Gry 2.Art 2.Su �
W 7M11.TiMe 8.C.A.0 I
S
3 ❑A:owner-Euilder.I wil not�mploy rryane to da wrork whicA wauld tpuin�permit fiom Ihe 6vuion d
� Industnel SaFny,u mted a6ow,mleas�ueh perton hn�permrt m b wch work hom tlr diuition.::
�
W ❑�,.'��,��6„'.�s.,.ty�.����. TOTAL FEES � .L/�/ ��-J•-!V �
d
CWSTRUCfUN LENOING AGENp:1 Mrahy sffirm lhat IMro p a eonetration Mndinp prrzy Ix!�e perMmma
= ot the work ta wAch this perme is usued(Sx.3097,Crv.C.�.
� lmder's wme COMMENTS
m 4nder's Address
'S CERfIFICpTE OF COMPIIANCE AND AUTIIOAIZATION OF EN7F1Y.1 artify 1 Mve a�d Mis appliutian nd��h
v.f Mat Ue iMamstian pven is carect I qee Io comply with tll fiete 4we pM ciry aOinMw.n nhtinp ro OwNinp
y mnsvucnon d wtlwrue�reprty atrve ot tlr penment d Buddinp md S�fety Y rih�upon tlr praperry
= Ip whK appls br d�ia fr n for the pu d m�kinp tqns
�
�J /—
� RECPT NO. � RAID B�����VAIJDATlO�
Sg�auxe oi ApplKant a Aqent " Me
--��----, —.._.�.;�,+_n�i„�ooy.YELLOW—Finance Copy.PINK—Assessor Copy.OOLDENROD—FYe Copy.GFlEF�,�,'_,_-- —�„��
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