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C\ �ITY OF DIAMOND BAR PRESS
�;, �� �� DEPARTMENT OF BUILDING AND SAFETY
��° BUlLDING PERMIT FIRMLY
DDRIESS "1 ��.�{1 DATE�pn�N ��- ���� NMBER p���_CO E
ISSUE G TYPE OCC.
6 APN __ LO TRACT DATE � ' �� 1 � CONST. GROUP
� CROSS STREET ZONWG SETBACKS ��
� OWNER � FRONT RW ❑
� ADORESS � •i'"� ��� � � 1 ' REAR ❑
W CITY �� � �` IP TEL � SlDE/SIDE STREET RW ❑ �
o�APPLICANT �?�-� _ �A7�_TEL. - SIDE ❑
z
c
a CONTRACTOR - SEWAGE ❑ PUBLIC PMT#
o ADDRESS -.._ - DISPOSAL
❑ PRIVATE SQ.FT.1100 GAL
W CITY_ � ZI �TEL.
z STATE GRADING ❑ CU. YDS.EXC. CU YDS FILL
y LIC.NUMBER
y ARCH/ENG/ � �PE SQ FT FACTC}R �S ADJ. AREI4NALUATIOPF
�' DESIGNER � W 1 �S �k�.� ��-�j �1.�3• [�: .C-U
p ADDRESS �~'`--- �„�j. 2 01 (?�'�D �"p-� . 'DCe .�p
Z CI7Y ZIP ^_��'Ft�-- (� 3 �'1� . .�-�(� - �T� 1 U�.(..Q��
� PROPOSED USE � � 4 ' ��iC•� `7.�O ���� )� `oZ g�i�]�
� -�-. r.- .� � "17� �.��'� ' S� '� p K c :�4�I.50
o NO. DWEL. NO. NO. � �
y UNITS STORIES BEDROOMS 1 "�'�-' � � � - C c�
o�'LOT DIMENSIONS m VALUATION L� � ADJ.AREA
o NO.OF BLDGS HOW I OUANtiTY DESCRIPTIO FEE
W ON LOT USED Q
°c�❑ U
W
~i IICENSED C7NTAFC?OBS CECLARA,TiON I herehy affirm!hal I am hcersed under Orovisions ol Chaptei 9�commenting � -.
��•.v:th Secunn 7^Opi o`Oimsmr 3 al:he 3usmess anA P:olessions f.o�e,and my licerse is in lull lorce and eflect �
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�+- GWNEH 3UILDER OEC!ARATION!hereoy aff:rm thal I am e�empt 4om the Contmcmr s L¢ense Law iar the lollowing
2 reasen iSec %0315 Rusiness arA Prolessions Lode AnY city or canry wh¢h requi�es a permn Io cansirucl. (�
o ehei rnp•mz,aemchs",or reCau am simcture,prmr m¢s rssuance alsa re0wres tlie apOhcant fnr such permit 2
/— to 6!e a si9ned statefrer.�that he is ncenseA:ursuant m the provisiors ot the Contnclor's Ucense Law�Chapter �j
Q5¢ann��ercny w�tn Svnro:�7GOOi uf�rv�s�on 3 0l Ihe Business and Pmlessions Codei ar 1ha1 hc�s exemp�iherzimm 'iS
d anr,c�e I;asis ior!Iv allegetl exempuon Acy moWvon af Se[tion;0315^y ar,y apph�am!or a permit su6lecis �
x ihe a�o�¢ant Ic a:.�i:pena�ty a!r.m more than Sve hundied dodars 155001 i -�
,.. a
C+ '�I,xs owne:r.l!he poperty nr ny enCloyces wnh.vages as Ihert scle compensauo^. wdl uo Ihe work anA
~ ihe sir�nmr:•s nol;mendec ar alfemc im sale ISec 7044,9uaness and Pmtessmns Cotle The Comranor's Li[ense Q
v Law noes nu[app�y tc an owrer al proDerly who hutlds er,mproves lhereon,and who dces such work himsell, U
' m 1!iaugh h¢avn enFloyees provided Ihat s�h imprm•emen!s a�e not intended ar oilered lor sale If,hcweuer, Z
m rte bndpwr or mprmemeM is soitl wrthm one year nf complener.,�he owner-buddu wdl have ihe Eurder.ot o�onng Q
y �rh�a�he 9�n�m 6wld or impmve tor the purpose of sak� 2
y I LJ; e:nwner ut:"e Frc�er!y.ar evtlusNery coniractiny wah�¢ensetl comranors ta consttn,!ihe praiect ISec ��jJ
o�%OC4 6usmess and Professiors Catle,The Contractar's!¢e'rsc Law dces rrol aDDly ro an ownei ot Dropeny who ,�
Z I����rns m��,p�rn�s ihereo�and wnc cantratls!ar such pro;ecls wrth a mntracmr�si I¢enseil purcuant to Ihe Conlrao�or's --�
� L1e"�"a." ,`CONSTRUCT�C�DJ� � �llp���-
�!❑ ��.��.os.���e�se: � �a�a rc�n: n ce� aa,a� PLAN REVIEW
o ,n�e /�—Gi — i� Owrer t �LECTRIC� —
¢ JJPR:(ERS �OMPFNSATION 7ECEARAT!ON I herehy alhrm that I have a cerlrficale n`tonsem ta sell-insure,or
��e rereti�:aie ol drorkers CoinFensanor Inxurance,or a cx�idied copy!hereo�ISec 3800,�a6 CI PLUMBING _
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¢ ❑Ceirlied:apy�s harehy Iwrisned � MECHANICAL
o ❑f,er.:hr.i:opv is'�led with the Bwlding Mspecimn Depanme�t or Department � GRADING
. . C � .C�O
� CEHTIFIf.ATE OF E%ENPTION FflOM YWRKERS"L�MPENSATION INSl1HANLE This s¢rtion nee�nnt be camD�elea
y j r, Ine�erm�t is for one hundred IS1001 nr less I ceruly Ihat in tlie pedormance nf the wo�k tor whKh this t� — /^�
� permii is nsual 1 shall nol employ ary peisan in anY manner so as to 6ecome suh�at ro the Warkers'Compensaban r S`M -,/ _ �.� .v'�
= LaWS ti Ca:ilnmla (F-. ��.�:,�
� �"`�: .�:r ''`- �� PARK FEE
W NCTICE TG APPIICANT N,aher mak�ng ihis CerbUca9erofn�xenpuon�you should 6ecwne suh�ea ro ihe Woiker's u- SCHOOL FEES _
Lwnpeisanon promsmns o�the:aha�Code,yau mus�tanhwnh compty wrth such prowsons ar this perm�l shatl
he deeiaed remked
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� �IVISION OF INIIUSTRIAL SAFETY PEHMIT CEHT616 EIN� �� g����
o- ❑1 i•.erehy a�idy thal ro excavation frve 151 or more teet in deplh nto which a persan is reqwred l0 0escend,
p�e mll Je matlr:r cannechon with wmk auttwrhed by thrs permrt,and iha�no hutlding suucture,swfloldmg,falsewark,
� nr aemolit•un r.r Aismmlhng Iheieaf,wdl he mo�e 1paq,th�qy-siz�36J Jeet O�gh 1Chap.7�z.Gry 2,Art 2.Sec
W �ai r�nea caci r,;._.... L. . . ,. _., ,_. . .:,
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3 [�As ownei�owide�.I will nnl ertploy-%Ayone��b�da worY' whrch'°wo'uld'7equ1rE�7'p�rmh hom Me Gvition of
1— Indusirial Salety,as nnled ahove.enless such person has a Oe`m�to do such work I�om Me drv�sion
�
W ❑Onixwn of Indusinal Salety.�'ermn No.
�- TOTAL FEES
� CONSTRUCiIqN LENIIING AGENLY I herehy affirm thai there is a cons(ruc4an lending apency lor the perfo1mance � �,� i�
Z of tne werk for whreh Mis pe�mn i:issuetl ISec 3D97,Crv C.)
� iender's Name COMMENTS
m lenAr,r's Address
¢ CERTIFICATE OF COMGLIANCE ANO AUTHORRATI�N OF ENTRY I certiry I have iead Mis applintian and state
rn mat the mlormauon grven is correct I agree ro comply wnh all stah laws and ciry wdinanoes�elatmg ta huiMi�p
y const:uc a authorize a representetive ol�he Depanment al Buildinq and SatetY���Wo��W��h
= lur w h I ha�OUlied tor ihis per n for the pury�e M i2Ming inspx➢ons.
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�a�-' Nv 7'(.� i'f� �' ��--1,
yg�at���o�pp�a�t o�qqs�� peh RECPT NO. PAID BY VALJDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Capy
esios-ivas
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