HomeMy WebLinkAbout1395 (17) i
'"` C17Y OF DIAMOND BAR PRESS
�•� -' DE6�ARTMENT OF BUILDING AND SAFETY F{RMLY
-� BUILDING PERMIT
JOBSITE � � • ,\ APPUCATION (� � �� F'ERMIT �. .i USE
ADORESS ���',>� � .1 .1C~ ,h�' .{.�1-� ;1--�1 , bATE �,�1�NUMBER�CQDE
- ISSUE �r_/� TYPE OCC.
� APN LOT RACT DATE �"" `��`"�{u CONST. GROUP
� CROSS STREET G�`-''��' S�''���'�5�C./a 2(��o Z�N��G .SETBACKS ""�"'E"'S
=' OWNER��-'� � Cn�`-s mo2�'t,�S Fi�OWT RW �
o ADDRESS�-�'�3►� ��22�'-' YJft' aREAR� ' �
?' W CITY���y"�`^'� �p� ZIPr1l�1 'y�'_TEL�b� clkfr3 SIDE/SIDE STREET RW ❑
f o APPLICANT ��---� -TEL. SIDE�. O
� x J""'--
� CONTRACTOR �G �� SEWAGE
C) PUBLiC PMT�
o ADDRESS DISPOSAL � pRIVATE SQ.�T./100 GAI..
W CITY ZIP TEL.
` = STATE GRADING ❑ CU.YDS.EXC CU YDS FILL
; y LfC.NUMBER
y ARCH/ENG/ �, .T.X{�E SQ Fid1GT�.R fj�`r. : AQ.1:::I�REAIVALUA71f?N
�' DESIGNER 5• �- '�SS 16�"� LiJ' 1 �� ,, �'
� ADURESS7AR5 o r�.ran,�,nosA (��4-ZS� c� �'
(1;, 2
i w LI',K.aS tSLSI•.+e ft .._
2 CITY ZIP TEL. ;.(�; 3
- � PROPOSED USE Y%1!Y1`'�. £- r}'1� � Z= 4
� -' �•. GARAGE
a NO.uWEL. NO. NO. �;. ppRGH
y UNITS STORIES_�__BEDROOMS '�-
s LOT DIMENSIONS m VACUATION ' �� � '� ADJ AREA
i. o NO.OF BLDGS HOW QUANT"tiY DESF�✓R#PTI�. F„EE,` ,
W ON LOT USED Q i � . s �
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s �; � 5. (� �
~ ICE ED C[1MFAf.ID1NS OECLAHATION�.I herehy aNinn Ihat I am IicenseA wdn pmvisans of Chapter 9(�ommen[mg �
Y w�lh Section 7000�nt flivisinu 3 ot Ihe Business anA Pmlessfons Cade,anA my laense is in fu�l forre ana ellett "��
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3 [� y'u
! fR�VNEfl�UUILUEF OECLARATION I heieby aflirm that I am erem0������Comraclar's License Laxr�oi�h�e idlowing ����� , ,
� reasnn�Sec 7(1315.Busiiress antl Professinns Cade.Any tiry ar caunry which requires a permit to consUuc�. .%:(�':
O alrei,iarymve,demu�ah,or repau any slmdme,pnor m its rssuance,also requi�es Ihe applicam Por such p¢unii ��:';2��� ,
Q to file a siqnai siaiament that he is licensetl pnrsuam m the prwivans of ihe Cantracror's litense taw(Chapter :���m.� � �
� 9 I�nmmennng with$ectian 7000�ol Oivision 3 0l Ihe Business anA Profeasions Cade�or that he is exempt thecefwm �,��:'��.: ..
y anJ the Lasis for ihe allegeA:iemytion.Any violation al Sttlion 7031.5 6y any appliwnt for a permi�subKus .?.�'- � � ��
� Ihe apphcam m a cicil penahy o1 r.at mare Ihnn live hundied dollars(5500Lh �:'0.
�:�� � LJI,as nwnr,r ol!he propenY.nr my employees weh wages as IAeii so�e compensation,wll do Ihe wnrk,and �
~ Iht ShutW�C i5�IOt I��PnAEd Di o��ered lor sale ISec 7044,Busness aM Piotessrons Cade.The Canintror�s License �
�4�
V Law does nnt aDUly In an mvne�of praperry w6o builds ar impmves therean,a�d wha dor.s such work himself, .j-(,��: -
W or tlimigh liis uwn emqayces,provided that tuch impiovemenis are not intended oi oifered�ar sale.It,however, �:�:�
= ihr.Ixiilding or inpro�tment rs sold hin one year of complelinn,the owner�6vilder will have�he hurden ol pro��ng :t.;;Q�
y i6ai he did not hutltl ur impmre f th D���Dose at sak.) '�r2•-
ua ❑I.as nwne�uf the pmpeny a IusrveN mraatiny wnh licensed minracmrs to consiruct Ihe v�o;mt(Sea �;:��{��.
o. 7044,Busmess and Vmfassioi � he Cnn cmr s C ense taw aes not apply ro an owner af propeny who ��5�
�- LwIJs ar mproves theieon,an a irar.ts�o A p�o i a mrac�m�s)licensed P�Suam io ihe Conuanor s �- —�-�
lv.enselanl _ G'I�NSTRUCTION~i -"`�`,�� ��"�t"��-'--'---
- ----------"--" ;,.
� ❑�am exempt under Se , e&PC.�Auach Cerofiearol ;: PLAN REVIEW ""�=�' __,_
� Q Oam Owner
= E f _-� �
�' � W9RKERS'COMYE45A71UN�ECLANA710N:I here6y alliim that I haae a ceni�iCa�e ul cansem�n self�insme or -,�� �
a r.e.nAicate ol Workers'Compensaiion Insunnce,or a cxtitietl mpp ihereol ISec.3800,Lah.C� �Pt-UMB�NG
¢ O ce�or�a�oov�5 i�e�enr r��;snea. =�; MECHANICAL
p. ❑Cenilied capY is Ided whh the Buildiny Inspecho��e0ertmenl ar Uepxlment d: GRADING _---�-�—
W ~ SUANCE� :'7`lp ���
Z CERTIFICAIE OF E7(EMPTION FflOM WOIiKEHS'COMPENSATION INSIIRANCE:This section need not he mmplettd
" � if the pennit fs Inr nne hundreU I5100)or less_I cenil �5a�in the . ( —
y y performance o�the wwk}or which thrs '����
�:.�- permit is issued.1 shall ibt employ�ny person m any manner so as W became su6�eci m tAe N6he�s'Lompensauan t �� �� "�l(3
o� L�ws ot California, f`, ���• PARK FEE \
ti �.
o: o"` `�"`�'t ' �` SCHOOL FEES
W� NOTIf.F i0 APPLICANT:N,aher maNin9 Ihis CeildKate af fxemDnan,yw shouW hewme subl��to Me Nfxker s
�� ComDensanon provisiuns oi the Lahar Code,yw must lonhwith coiryh with such prwisiairs a tMs permil shdl
".` iu deemeA revaked.
2: Y .. "
.�; �� qNSION OF IN�tISfflIAL SAFETY PEflMITy'�.,jl',sATION: � . ..�,:S,�
,�C. �� 5: � — —
�' ❑I here6y cer1AV ihal no evcawlron frve�5)or mae leet m aeplh nlo wAKh a pertm is reQured to descenA
�. wdl he inade in conneciron wnh wo k authar'ved hy this ye�mrt,md Na1 na huilGng guueture,swlfddinp.IYsework
w demalitinn nr dismanthng thereof w!p,b¢more thqn thirrysuv 1781�1eit hiqb'IChap 32,Gry Y.Ari],Sec
I,,"-:. = 741,iineB,C,ACI ., . �'
���: _ . .,. , '.'.. �:. ' ...'-: . i �:.
��.'° 3 ❑As owner-huAUer.I will no1 empbµairyoce to dd'wa�Y wh¢h wdAd reqmre a permit hom dx G�uion ol ��;
�--. InNsVial Safely,as noted above,uMess:u��per'son has a permrc ro do such work fram ihe division. +;�:�
� � ,.
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I�..,� � ❑a�5,o„o��„�.����sa�ry��m,��. TOTAL FEES � �k��
.� CpJSTRUCTpN LEN�ING AGENCY:1 herehy atfirm tl�a�theie is a mnrnuction iendinp apenq lor tM perfoimente
Z of the work fa wh¢h Ihis permit�s issued ISet.3097,Gv.GI. -��-'
� lenAer's Name � � �]�,� ��
COMMEN7S _��C C,��v �1� n r';
m Lender's Addrzs
�� Q CERTIFICATE F UANCE ANO AUTHOPoZATION OF ENTHY�1 teuly I heve rzad Hiis appliution md stau ��.��
: y that the inl me ven i cure[t.I agreo to co ph/witA all slate laws and ciry oidi�wttes rohtinp ro huiltlirq ��;�
y �onstructi ,a arue repre Mat Depulmem ol BuiHinp aM Salety m enter iqm tAe poperry
= for which e ied f �s pe� il sA of making inspectiona.
Ir. � � -�
'; /_ � �_ � RECPT NO. � �` PAID BY VALIDATIO
Signatue al Appisant or AgeM Drte . .
WHITE—Depanment Copy,YELIOW—Finance Copy,PINK—Assessor Capy,GOLDENROD—File Copy,GREEN—Applicants Copy
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