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HomeMy WebLinkAbout173 (23) �� i '''� ' CITY OF DIAMOND BAR PRESS DEPARTMENT OF BUILDING AND SAFETY p�pMLY BUILDING PERMIT JOBSITE /���.` APPl1CAT10N PERMR USE ADDRESS ��� �✓�"��� � PL, DATE '��y 5 Wl1MBER 12�CODE ISSUE TYPE OCC. � APN LOT T Tf1ACT DATE CONST. GROUP � CR05S T EET SETBACKS ""'a'E"E''"S �° OWNER ZONING ��� � � o ADORESS • REAR ❑ ,� CITY P TEL. " SIDE/51DE STREET RW ❑ ��� o APPLICA SIDE ❑ : � a CONTRACTOR SEWAGE � PUBtJC PMT# o ADDRESS DISPOSAL W CITY Z{P TEL. ❑ �NAT� �.�/100 GAL = STATE GRqDING 0 CU.YDS.EXC. CU YDS FILL y UC.NUMBER TYP� ��t P�_ /�1F��iN�14. A1 y ARCH/ENG! � � � 1 3� E � � DESIGNER � � a ADDRESS t1. 2 = CITY ZIP TEL � 3 � PROPOSED USE � 4 � � GARAGE x NO.DWEL. NO. NO. � p��H ; y UNITS�-STORIES � BEDROOMS � � LOT DIMENSIONS m VALUATtON ""'f ADJ.AREA o NO.OF BLDGS HOW QIUiRN�'[rY � F�O � W ON LOT � USED ,E � W a � H LICENSE�CONTHACTORS�ECLAHAiION�1 herehy afhrm Mat I am Gcenzed unda provitions of ChapRr 9lcwnmencinY _ Y wah Sanon 1pp01 of pnuion 3 ot Me Business a�Prokas�onx Cade,and my license u in fuY faru ud eflat � � � W � ER�BUILUEH OECLAPATION:I Mreby atNm Ihm I am nempt frwn ihe CoMrxmr's lcrose Lsa Im the IoYwvirp ieason(Sec T0375.Busi�ss an0 P�ofessions GoOe�.Any cn�m county wAich reqw�es a prrmd to cun:tr�ct, �� Oalur improve,demdish,or repaii airy stru�twe,priw to its issuance,alw requues tice applcanl b`wch permil f— ro fde a signN stmment Ihat he is licensed pufswn�to tFz piwisqns ot drc Contrutor's lkemt lew(C�np�er �j � 9 Icnmmencing wnh Secnan 701M11 oi 6vision 3 0l Me Busiriess and Rnhssom Cade�rc Mat le iz eYmpt tlrrefram .-'� d and the 6asis la the alleged eiertpuon.Airy vida4on of Section 1U31.5 hy any appliunt tar a permu suhqecis ^, � the apdkant ro a crvd pmalty af ml mare than liue hmdred�ifars(5500�.�. � W � ❑1.as anrer of�he propertY,p my emplarees wi�h wages as their sda compensanm.wi��tlb rvo6.aid � the strucwre is nm mtended or olkred fw sale�Sea lOM,Busiiws and Rohuans Cde�.TM Cmtru�a's license r[- Vtaw tices rot apply tv an owne�oi property wM huiltls w mpraves iherean,md wla daes sah work himrtq, (� W w throuyh hrs axn empbyees.prmided that sucA improvemenu a�e not interdM a otferttl for cak.N.YmweWer. � - � - d�o ihe 6ulding or imp�wertrtnl is wN within one�er ot com�le�ion.tM mmer�6uii0er wdl Mw Ne MrOen ol pwvq . � that he did not hwMl ol�mprove lar the puryose ol sak.i � y ,. � . e/J ❑I.as owner_of the praperty.am ettWsively.wmrcuny wilh�¢mmd wniractws W construct IAe prapcf I�C. � - - � 7f14A,8usiross and RoiessWnt Cade�ihe Cqnvxtor's LKenu Lxv Gaes nol�pqy�n an ovrtkr d mWMr wIW � - 4 huilds or imprwes Ihtteai,�nd wtro contracU 1a wch pmjects wiM�cwttranor�s�Iiunsed purswnl b the Cmtrx�r's ��cense uw.� CONSTRUCTfON �- Q `S � ❑� .emp��m ' a .� cKur�r�. ; PLAN REVIEW �.� e °7e °u"'"` ELECTRiC � NDRNENS'COMPENSATION OECLARATIf1N.I here6y�Ilam tAat 1 hwe�cenificate d cmrent ro stlf�insure.a ',: , a urnhca�e af Wnrkni em�pens�twn�nsuranoe.w�aaMied topv inemd ISec.3800,uo.C.l �- PLUMBING Q ❑Ceitd�ee aopy rs herehy fmnukd. � MECHAN�CAL o ❑Ce�tiiKd copy is f�kd wi�h tM BuJMnp Inspec6m Depxtmem a o��� -�+`C GRADfNG 7 � _' CEflTIFICATE OF E%EMPTqN FHOM Y`9NKENS'COMPENSATION HSIINANCE:This xctpn rcsd not he io�npkted �j �SSUANCE �> '� � il the pe�mrt is lor du hundreA(5100)a kss.I cerofy Mat n Ne pertwmnce al the wark tar which tfas �.�, y petmit i5 i33ued,(Sh�l ro�employ alry pet3Dl1 in 81ry m8nnE1 50 i5 IO 6KMM SuE�CC�b IYM WMkYi Cartpentstian SMIP � vw:o�c�no�oa � PARK FEE � p Oate - Applwnt � � W NOT�E TO APPLCANT:M,atur making Mis Cerafiwte d Eump�ion,you sha�tl Mcmr wbjat ro Ik Nblar's � SCHOOL FEES � Cmryensation ryrnisims ot ihe lnhar Cade.yau must FaMWiM tomply wilh weA prwsiam a Mi�pemM�lul �OND RAR � bedeemedrewktd. ...rv !TC Cll�fw! — WOIVIS�NOFINOUS7NIALSAFETVPENMITCERTIFCATIQI: �*�+w:r: dN� SAFETY � . � ❑I herebr ceildy Ihat re e&avatpn Me(5f a�e ket in depth inb wM1ich�pliaan u nquirN b deaceM, - s wiq he made in cmnection wilA work autlinized hy tlxs R�mR.md tlwt no bWlOxq structue.fCaft0l�i�p,�WnvaAe. ' d «dmwldan a dismantlinp�hereot.wi M mae tlun Nwry-siy 1361�M1qh.(�aP.�.2.Gq 4.!ut 2.Ss W� 341.Title 8.C A.GI. _ 3 ❑At owner-huildx,I wiN not empbY���m�k whirL wroWd nquin�p/rmt Imm IM Uvitian d - 1.- Industru!Safety,as rodd abo�e,w4ss wch persen hu a pamit m do wch wak han IM Inision. � � W ❑°'"''�,a''�'="°'S'h""°`""'�. TOTAL FE ES �S �- d � ca+srxucr��rw�acencr:i n�rtev�+��uuf u.�.u,�..uw�r�a�e w�r�*�.ram«�. 2 at the wark fa whKh IAis perml u iswd(Sec.309T,fiv.C.1. � �'s N� COMMENTS mLender's Addrzss s fEfli1FLATE OF LONWLINCE AND AUTFq4IA ENTpY:1 ra4Fy 1 Mw rad 1ht ippiumi rd shY � rn that tM inl grven u mrM.1 aprte ro wiN tll stri hwt rd eiry ahM[n�Wlnp fo aY�q � y consvuc .a�d mwue uwe Dq�rtimimt d B�IdMq+nd Sile�y ro rrr yion un prayn�y = lor h I � 1 prrtil d mdap uspxUa�s. / ~ /tJL�I �� Sy�uwe 1 a Aqpit � RECPT NO. 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