HomeMy WebLinkAbout4207.pdfCITY OF DIAMOND BAR PRESS
4.)
DEPARTMENT OF BUILDING AND SAFETY FIRMLYllit40"11 MlklrPQOUIT
WHITE—Department Copy, YELLOW—Finanee Copy, PINK—Assessor Copy. GOLDENROD—File copy. UHtr_n— ApgecariM t.opy L/
BS106.11189
APPLICATION PERMIT
JOBSITE
ADDRESS 12401 S r" DATE NUMBER O E
ISSUE . TYPE •
DATE CONST. GROUP
APN LOT TRACT
i CROSS SIRET D ZONING SETBACKS
OWNER 0.e %44 0.ri
ADDRESS REAR
CITY ZIP TEL SIDE/SIDE STREET RW
i APPLICANT • y,-irv TEL. SIDE
CONTRACTOR 4tI SEWAGE PUBLIC PMT #
ADDRESS DISPOSAL PRIVATE SO. FT./ 100 GAL
CITY ZIP !&
GRADING CU. YDS. EXC. CU YDS FILLSTATE
LIC. NUMBERli TYPE SO FT FACTOR PS ADJ. AREANALUATION
ARCH/ENG/
W 1
DESIGNER
ADDRESS LL 2
P} 3CITYIPTEL.
PROPOSED USE C Z q
J GARAGE
5 PORCHoNO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
VALUATION ADJ. AREA
LOT DIMENSIONS
N NO. OF BLDGS HOW OUANTTTY DESCRIPTION FEE
V
ON LOT USED
WsW y
ECJI
J• CE R CONTRACTORS DECLARAT[RI 1 Nreky Mhem that l am keeled t&de pons"+ Of ChapM 9 1ca•ene•cuq 1 • ..
he wan Sedan 70001 at Dwnm 3 of IN 9ullNfli +nd Pedefllmf Cod! did ON license is in h1 lace aN effect W
F ,. r a I .'
5 JW
W OkVNER ER DECLARATION 1 Nrtb,, afhern that I M m.np from the CnaftKam's License Low fa M tdleeWdE
ee+mn I$!W 15 Buurrss and Prokurm Cad[ Aery my r teensy what raouuq + prime m [lnfhtrt.
o eller enpbve. de sh. a repae eery a1rWN/ prior m es mitrroe. +Iso raaues the apkant to flWh print Z
m hk + Signed nn I that N q kensed puw+nt m M! pov.umf d pia Cmeacmr't Ltelae law ItNep"
N then
m
J
s 9 aommencrnq ..in Sa n ?DOD) d D...sm 3 d the Suswm ed Profevam Cool a that a mmol eko.n
Kand the hese la Mt + 11lrroban Arty .datron d $ecWn 10]1 5 by wry applwm M +Pena 4ehpcm
4. W IN aPpcanl to l [ad pn+ltY not mar! Dldn FM htetlrld dotes ISSOOl1
f I as Meer of the papert p empwlae with wswl la reme floe f&aglamtm WIN do tN Web and
1— et Stec tae ,s not intended ar .11, d h ISec 70" El"reas and PrdeSfmf Cc" the Cmteacmr 1 IKMse
e— Uw des not aooh to an Mner dl pdpert N antlf a r.tprovrs *raw. and wN des such wet hrnmN,
Q
SS
Ir
u W a Noup his Mn emdoyeet po.ded that rnporenrnls ee na 111 a offered to saw t. ho.wuer.
m the building o un lo.emant n mtl wl" an Yew -PWm, IN twlae ar.mrt we baa the hurdan of pevrlp
Z t •. (" L' .
that he did int Du.tl a tmD•on to the papse d uh 1rn UWto I as Mne of the pmpeety am 1""ll canbactey W. lcemed con racme m cmmuct IN protect (Sec
666 Ifaed Prdessans Code TheContta[tdr f L.. l not Iodine to an ower d property who
builds o. •mpro.ef IMeon and wN Wflaelf fa iWh PMWS with agar me let licensed hursue•l m 8r CmIllata'e
t License Law t CONSTRUCTION
1 am eenp aide Sac .8 6 PC. IAnach GrbN+"l PLAN REVIEVY:
o ate D+••m ELECTRIC ,s.
PLUMBINGVMKIRS' COMPENSATION OECLARATION I neatly aftrm nut I haus A Weeks" of cement m sW aside. a
a « rubcare of Wdtet Ccmpenutm Malec@ r a Wntded cost Meed (S+[ 3800. Led C.1 Q o
Cu fled copy is N.elry IWasNd I EC 1 AL •
4
C=; Laolyd copy q hhd Wnth IN 8udd.nq Inipechon Daprmwt a peprmw.t Q
W CFRTIECATF OF EYEMPTON FROM WORKERS CCMPENSATON INSlN1AleCE The moan meed not m ca.nlle"d N r 15. w
X3 d tN Peine q la ore hurdled 151001 r his I [eels thdI n IN Pailarmucl Of Pr Wk IM W"Ch IM
HH perm) .s issued 1 shall not Wise" eq PmW n en7 maim m +s to bendier e.gatt to rimps, EarapememlawsofCalAmnu
SMI
0 Det[ / Axles11.
W PARK FEE
cmW SCHOOL FEES Wit°/rr :• . 7
NOTICE TO APPLICANT t, alter mae.nq this Ceblule d E You tltondI hlaone Submit dr thhrte'a
you al fathWMSoleswin PAN Pewmrna a 1 pmla feelCompenmtmpea..umi d it*Lahar Carlaw r,.. e `i .
vs. be decd moll d
Cr_ OMSION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION e_1/, , . / ' Wa-• I hereby ctrtAy the N ertaMm IMISI a dive feet n del" nm wh.clt a parse.. " terlu•eM m dlacped. l j •'; :, •,. i= w.l he made in conerWtm with Wort suthaoed by Isla PaemA. Will the All Ae1dly Fe"It" ae. scdhNei IdaaWarl.
a de+roblm Or 6s ei.ng INreol, wdl be nae When dWtyla 1361 flat NO (CNP 3.2. firs 2. Art 2. Sac bl•'` r'• t•"a :. _ Z 311. Tine 8. CACI
F;:. ' •tomWS3AsMrr.bamn 1 wed not ampM neper to do elab wh[tI Would ewe 1 pend has M IAMr+n M
0.— Safety, as mad &bon. WWI allies Pemn has a PWnrt m b OWN twit Irue M dA—
SE
D.,sm all mduseW Safety Perms NO TOTAL FEESa. u A taeeWla Ie aft &llaecY M ar PedamerwCONSTRUCTDW. N LENOAGENCY I hereby &them " dere r
d the web to WheA dee peat r iaard ISec.. 3097. G., Cl.
of Leroere Name COMMENTS
mlender's Aad.esa
IC CEFITIFICATF OF COMMACE AND AUTIda2ATOf OF ENTRY. I e..My I bm lead 66 811limem W "M
y nYl IN nfantatnn 9Mn n mesa 1 agm to txn.pse wen a1 mad meq will city aeirlaas tsmary as hrdMl
H Winn Iuthatte & t+oee tabn d to apeb&ael at 6dd+M will sally he am yrs Pr papsery
a which 1 +eDhed b thq for Ile d ifiek" moww P
r— 6 RECPT NO. PAID BY VAUDATION
S.pNt.&a Of APµ[ent or
WHITE—Department Copy, YELLOW—Finanee Copy, PINK—Assessor Copy. GOLDENROD—File copy. UHtr_n— ApgecariM t.opy L/
BS106.11189