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HomeMy WebLinkAbout1162 '"` CITY OF DIAMOND BAR PRESS �� '�' ' DEPARTMENT OF BUII.DING AND SAFETY BUIIDING PERMIT FIRMLY JOBSITE � • APPUCATION PERMtT , t } � USE ADDRESS ��E TYPE�R��CODE � APN LOT TRACT DA7E CONST. GROUP o CROSS STR T ��,�A' ZONING ��CKS � Q'�"15 � O° OWNER � o ADDRESS REAR ❑ ' W CI7Y � ZIP TEL. SIDE/SIDE STREET RW ❑ 1 o APPLICANT/�C�M+'�lnc- �,rllf`T• TEI. SIDE 0 I � CONTRACTOR � � SEWAGE o ADDRESS � d DISPOSAL � �SUC PMT#� W CITY r ZI � . �— B ❑ PRIVATE SQ.FT./100 GAL = STATE y LiC.NUMBER � "— �$o Qb P GRADING �CU.YDS.EXC. CU YDS FILL , � ARCH/ENG/ � NPE SQ FT A PS AflJ: RE1�1/ IA QN � ¢ DESIGNER � � �� • � j o ADDRESS LL 2 � ? CITY ZIP TEL. � 3 J o PROPOSED USE � 4 � � � GARAGE o NO.DWEL. NO. N�. � p�GH y UNITS STORIES BEDROOMS s LOT D4MENSIONS m VALUATION ADJ.AREA o NO.OF BLDGS HOW aun►�irmr t3ES�CFliPd�f�N �� W ON LOT USED 4 � W ❑ � N IICENSE�C(1MBACTOHS DECLAMATION�.I hert6v affiim Ihat i am liemud wda prow�ians ol CM1wter 9(roiecwncing U ¢ wim Secuon 700D1 0l Drviswn 3 of the Business and Pmhssiona Code.and mY Icmx ia in IuN kr[e arid efkcL w 3 � W LL OWNEfl-BUItDER DCCIAFAT10N�I hereby allirm thnt�am erompt irom Ik Contrxtor's lke�u tm lor the Idlowing reason(Se�.7031.5.Busmess aM Pmfess�0�t Cade�Any ciry or c0unty whkh�ryuires�permn to conthuct (� oaltei imprwe.Aemohsh,a repa�r arry structwe,pr�ror ta its issunnce,alw requircs Me appl¢am lor wch pnmit � i— to lile a signed sta�emenf Nat he is Fcensep purwam ro If�e prwisions a�Me Contracmr's li[e�ne Uw�Chaptr {� � 9 Icommencing with Se�tion 70W)ol Uviaian 3 af Ihe Butiness a�d Prohssions Code�a fiat he is emmpt I6NNrom "� � antl t�e 6asis lor the alleyed exemption Am violauon ol 5¢tun 70315 6y aM applicant fa a permit wbleck ' W ±he ap0�'r.am m a crvil per.alry of nm moa Ihan five huidrtd dollars IS50011. a � ❑I,as owrttr of ihe pmperry,m my emplayees wiM wagrs as Mnr sok compensauon,wAI do Ihe wark.aN ~ the sructme�s irot intmAM or offercd la ule(�.104A.8usiness and Holessrons Code The Contrxta's l�cense Q V law does�wt avo�v�o an owner ot Droperty wha Wdds or improves Mereo�.and who does such woA himssl( j,a W m ihrough his mvn enylpyees.D�ordeA Mat such�mpovemmtS x�not inte�ded a o11ercA for sak.11,hoWeLet. � � t�e 6mlding a impravemem is sold within oM yem oi canWehnn,lhe o+merbuitder wdi have tk birden al pavng Q � �ha�ne did not emtl a im0�ove lor ihe purpose oi sak.1 U tif ❑I.as owner of rM prope�ty,am eKcluvvely ronua[nny w�tli IuensM tmvanars m canstruct t0e Dmleci ISa (U 704d Busness and Prolesswns CoOe�.T/e Comrxror s L¢ense Law Aas ipt apply ro an aw�r of prtqerty who ',� � hudds oi imprwee thereon,anA wno contraca fa swh O�IHtt wim a convxmrlsl��censM purtuam to Me Lontrxta's � ���^u�aw.� CORI TRUCTIO 0 "'� 1 am eMemp�uNn Sec 6 .Attach Ceruiiaalt) PLAN REVIEW H � od1e -' � °v'"" ELECTR�C � WORKERS�L:IMWENSATILIN�ECLAflATIOM:I hereM ais�m m�i n�� «er�e��oi��,�i,o wi-.�:wa a PLUMBING a cenihcare n�Nbr�ai Campensaeion Insu�arce.oi a cntitied capv theieof ISec.3800.ta6.C.1. i ❑ce�nr�ea�xv�s��env r,����,�e J,/ MECHANICAL c ❑farMmd copy rs 1Aed wnh Me Bunding Inspectim Oepxmiem a DeAxmnm `i C.{� ��(',7 W Z CEflTIFICATE OF EMEMPTKNY FROM 4WNKEflS'COAWENSATION INSUIi4NGE�.Thia cettion nad rwt 6e camp4tM �S J�NL` � �� � d tne permu is foi one huntlred�5100)a ku.I certify Mai m tl�e pnlmmrKe ol the wwA lor whkh ihis H permn u usued.I shall mt emp�W aM P�rspn in anY manner so�s ro hecome wbKc�m�he Nbrkerf Canpensatian � S' F1 � laws al CatAomia. o .� t .-�. �;-,., W PARK FEE p Oate ^�r°a"';�J,".�'-�'`'' � �.:� � lt- SCHflOL FEE$ W NOTICE TO APPLICANT:tl,ahn makinq t�is Cerlificale oi faiaptrory;yip��h�pM•� e sub�ect ro t4e Wwker's J � C o m p ens�uon provrsions o�th lelnr Cak,you must fmlhwith canqly with SucT�pwisimrs a Mis prtmit shaN LL Ce deemed lBVOtetl. J p� dVISWN OF INWSfflIAI SAFETY PEMA�T CEflT�ICA711114[t= .� B�i., � i FS � 9 a.�' ❑I here6y urtily that no e:�wetron M1ue�51 a��fOn ImAep MR�wOir�,yp�n i�nquired ta Oacad. C�e wAI he made in cwwrectpn wiM wark aulhor¢eE by Mu pemmL uM tlut no AuiNinp tuuctue,ualfiMinp,�ritewarM. � a demdivan u drsmantlinq thereol.wdl De mae 1Mn thirry�nv(36)�t AgA.�Chap.3.1.Grp 2.An 2.Sec � W- 141.TiNe 8.C A.0 I 4:"�'"J ; _ _ � �.:,:', ;:.. �..-�: � ❑As ow�ur-0uilaer.1 wiP�w�empby rryoQe la ad wat`qMtA wa�ld rqurs+,pamt hom drt D�ivqqn d i �� / I F. Industnal Satpy,�s nonM i6ove,un4ss su�M1 person hai�i pemuf fa'da iUch wak fnM'1M1e�dw�, . � W ❑Gvrsron of t�usirial Sakh Pc�mi1 Nn. � ` �� 0. TOTAL FEES ""� � CONSTflIICTIIN LFNDNG AGE.NLY�.I here6v aRi�m tlut Mqe is�tansVuttbn 4n6M+A�Y lor tlr prbmrnce Z of Me wmk fa whr��hiz permn is is�ued ISec.3097.Civ.C.I. � Lerdtt's Name COMMENTS m LeMer's Address 4 CEFITIfICATE Of C[NWLI E AND AUTftlIMZATpI OF FWiNY:I cerMy I lure mA qNs ypGulwi rd f4Y Na lhat Me infrcmemn ' ia cwrtct.1 a�ee to tomply with aN su4 laws aM tiry adiwrx n4tinp ro O�q y conavuctnn.md �e o matrve ol tment d Buildi^7 ad SdeY to oM Wm Ihe pe0vy' = far wM1icA I Aare M � mi� Ik d mYiry intpoclonx � � ' �� RECPT NO. `O�" RAID BY `'���YALJDATION .a �n aq�m o.r WHITE—Departm�t Copy,YEILOW—Finance Copy,P�NK—Aaaessor Copy,GOIDENAOD—File Copy,GREEN—AppticaMs Copy � BS106•it/89 I _ . , . . . . , =� r �� ���� �� .. � _ ,. � ,�� m ��� �.� ,� ��� �j ��,� . ��„ .".�� , � � ��'� � ..��,������� .y�,w,-r"�,.�.,aw"�,"�r; .��-i � f�_.� �,""r".�'s �::. � ��-'k ,,. . 4.,.AfY�.,:� ; :!� � k �tt.�.P.i....w-., . .� . .s.. ^*;re. 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