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� ' �ITY OF DIAMOND BAR PRE S
; '�,.,. �' ' ' DEPAF�'fMENT OF BUILDING ANt�SAIFETY S
r ! BUILDING PERMIT F'IRML
JOBSITE ���; n V y���l,� S DATE CAT�ON i� �� PERMIT - USE
ADDRESS ~ �"��"' ! NUMBER CODE
ISSUE TYPE C.
Q APN .__ LQT TRACT DATE � � CONST. GROUP
o caass sTRE r q rax�a SETBACKS ���
=-° OWNER �.2�hPtaL►C-��! ZONING �RONT RW ❑
o ADDRESS ��2-� 3�l ��� l-i%�� �C� . � REAR ❑
W CITY ZIP�TEL. =•11 '� SIDE/SIDE STREET RW ❑_
o APPLICANT � !�V'" '�-' TEL. � � SIDE ❑
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a CONTRAC70R_ ��� ����-� "�'�` � SEWAGE
o ADDRESS �3Gi ll ' � -OSi,�.3�-,l1 P•�-�, • DISPOSAL � PUBLIC PMT�
„� CITY ' �-''f`-�` ZIP ��Q TEL� ❑ PRIVATE SQ.FT./100 GAL
°z STATE c�
y LIC.NUMBER ���a� r� GRADING ❑ CU.YDS.EXC. CU YDS FILL
y ARCH/ENG/ ,�. � T'�PE SQ IFT �AGTOf� PS ADJ ARE AL ATtON
� DESIGNER �I� � v(k�k��c✓'� c�-� m�.y tW 1 -� � " L •J� _ . �?. _.
o ADDRESS ^ � � 2
= CITY_ Z.IP TEL. Ur 3
�� PROPOSED USE �---�--� . �.•�� '• T z 4
�' � GARAGE �
� ;z NO.DWEL. NO. NO. � pORCH
y UNITS STQRIES BEDROOMS
� s LOT DIMEN510NS m VALUATION � r<�f�.`- .�'` ADJ.AREA
o NO.OF BLDGS HOW QUANTI7Y DESGRIPTlON FEE
'.W ON LOT USED _ Q
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W. � �
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'~ I ILFNSEU CONTHACTORS Ok,^.LAHATION I herehy a1M1rm ihat I am hexnud unde�O�ovisions ol ChaD�er 9 Immmencmy 1-,
� anh$ecUnn 70001 uf Owismn 3 of the Business and Prufessions Cade.and my luense is in full forae and elfect � �
3 � �j ,
.�+- (4VNER�BJILOER OECLABATION I he�e6V a1Lrm thel I am exempt Imm the Cantracmr's Lmense Law far�he followmg
x rezson ISec '031 5.Busin:ss and Pmfessions Cade Any nty ar county wh¢h reqwres a permn to consVuct, ('}
O altr.r i!�pm:r..dr.mdish.or repair any slntWre.pnm m ns issuance.also reqmres We ayylicanl lur such permil Z'
�H to file a si9ned stateme.nl dini he rs Lcensed pursuaut to ihe piovrsions ul the Cm�Raclo�'s License Law(Chapter ,m
� 9(cummenring wilh Seclmn 700��oi Orvismn 3 nf the Hnsmess and Pr�essm�s CoAel or ihal he is eienryi tho�¢from '�
d and ihe 5ass for thc alleyed r.mmptmn.Any ndatmn al Se[tion 70715 by'any upplicant tor a permi�sub�eals '��
"�� the aVulvant m a crvil Oenaltv of noi mo�e tlia�i frve hundred ddlars(550��I J
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.�.�; L�I,a�n�,vnr.i o�ihr,prupeny,ar�r,y employees witl;wages as theu sole comper,saimn,wtll do�he wnik,anA � -- —
= ih�e snacmre rs�wt inlendtd o�al%ered for ta!t�Sec 70G4,Bucinesc and Prolessians Code.fhe Con:ocmr's l�wnse Q �
j�:, Law tlnes roi apply in an nwnr.r ot pmpeny who hudds or impmves thereon,and whn Aces sur.h work himself, U
�W' n tlnum�h hn uwn enployees,prn�ided Ihal snch nnpmvemen75 aie not inknded or olle�ed for sale 11,however, Z
;m� �he hudJ�ny or impmvement is suld wi�hin one year ol completmn �he owner6uilder wdl have[he hurden of pmving
_' thal hc diA r.et Cwld or improve tor ihe purpose af sale) �� �
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'.�?.� ��I,av nw�r of ihe pwp¢ny,am eicp�srvely r.nntiar.iiny wnh lir.ensed eontraciois to wnstrun tM1e pro�etl ISec. .pJ
�n+' 7U44,tlus�ress arA Piofessmrs,oAe The Cumia�:tor�s U�ense!aw does not apply to an owner of Drocertv who �
•x� LuAJs ar impmvas the�eon and who mmraots hr such Dro�eats with a comranoqs�Irtensed pursuant ro the Contrector's � •„
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a`, �icensr.taw� CONSTRU�TLOAI---' .—���1 i �>
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(�.� ❑I am exem�t under Sec ,6 h PC IAttach Ceruhca�e) PLAN REVIEW� _ �—��._-
'p� Catc_ �l4ncr --_
ELECTRIC
�¢�� WOflKFHS CUMPFNSATION f)F.IXARATION I herelry afhrm Ihat I have a cerLhca�e nf consem�o self�inswe,o� �-�—
'3, a cerldrcnte o�Nbikeis'cnmpr.n.unon�nsuiance.m a r.e�u�iee copy iheiea�Isec 3ea4 tae c� PLUMBING _
'�{ L ce«,��ea�a,Y is heretr furmshed � MECHANICAL
�,` �
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,G L�f.enihed cuyy is LIeJ wiih IM1e 8mld�ng Inspection Oeparunent m r ��LDe � � GRADING
W / _� `
::�,, CEATIFlCATC Of EXEMPTIDN FflOM WOAKEAS'COMPENSATION IN is sernnn .A not wrnpki � IS 1vv�-..� ' ..--� .`',� ` �
_y� J thr.peimit is fnr nne hundreA IS1001 or less I rnnrfy tA n rMr nce nl� wo�k wMch t s -----
pr.rmi�is ixsueJ,I shall irot emyluy any perwn in any manner as 6ec e sd6�ect ta t Ykrk ' pr�ns S`M� 1 � �
�"+- lews uf Califmnia. — --�-
o� u,i� �U�`i 1'l7. r9�t�aovi����'• � + , s�% �ARK FEE
� NOTICE TO APPUCANi If,nher making�his Ce��ilkate ol Exempiion become su6�ec�m rker's SCHOOL FEES
`J Compensatmn piovrsions of ihe La6or Cade,you must tonhwrth ao h�nyi`ons ar thi nnn shall
u+," M1r,dee.med ievnNM r;,!';�1 ? —
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�� aVISION(lF INI]IISTAIAI SAFETV PEflMII CEATIFICA710N " n"\";`.',�-�-'
..�.. �4- � i,...;
�� UI Oere6y wndy that nn r.Mcavauon trve @I nr mare leet m,deplh mm wh¢h a person is requued lo tlesrenq
��. wiN Ue inade in connectmn wnh wwk authoi¢ed by this peimiL and thai no bmldmg slwctwe,zcafPolding,falsework,
oi denio!man oi J�smantlny tl�eieol,will 6e moie than�hiny�s��136)feet 1�9h. �Gip 2,Art 2.Se�
'W' 7M11.TitleA CAC.) ���N�. 7 � �h .
M1
•3 <, i,� evwd• __ —
UAs awner budder,i will nm emD�'anyone ro do wark wh¢h wauld reqmre a peimn Irom the Unswn ol
�F- In�N�suial Safe�y,as notetl a�ove,nnless such person�as a permn ro do such wurk Irom,ihe drviswn�.i. �
� i':':_`,! i �: :�`':.' �:�„.:�-. .:..".;�.
W ❑U��=,o�o���M.s��,a����e�Y��m,�No .: . :. - � .�. ._ .�.: TOTAL FEES r ti
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� CONSTBUCIION LCNOMG AGENCY I herehy afli�m ihSl'+i4Eie�is�a can3euiuon lending ageircy lor�he perfa�mance
2 ul Ihe work far whrth this permn a rssued ISx 3097,Crv.CJ.
� Lender's Name COMMENTCy
� lender's Address v7//" �-�.__ ..-�� �(^�
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� f.FNTIFICATE OF f.pNIPL AN0 UTfNINIZpTIRI TN� ¢rlity I hav¢read Mk apphnlion and state �r �✓ C7
h �hat�he�nlon 's earect ag�ee to co witM1 sta laws a�ciry ordinances�elatinp ta 6uildiip
y wnstmcuon, M au orize a re0resentatrve at Oepar nt af Ninq and SaM1ety m en�er upon the piapeity
� lo�wh¢h I�ve a �ed thrs permn lor the p e oi ng i Wns
� +` �'�—� ,J ���� RECPT NO.� AID BY �` VALJDATION
ican r Agem O+te
WHIT — partment Copy,YELLOW—Finance Copy,PINIhAssessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
BS106-11/69
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