HomeMy WebLinkAbout121 '"� CITY QF DIAMOND BAR PRESS
�� `���"' DEPARTMENr OF BUILDING AND SAFETY
'� BUILDING PERMIT FIRMLY
JOBSITE APPLICATION PERMIT � � � U$E
�t_ �Y �'�'',���r��� `��'__ DATE NUMBER..!L`i__CODE
ADDRESyS„�^� �-'�/r �`-' .�` .-J�� �" �SSUE 1'YPE OCC.
a APN _ LOTZ�»TRAC DATE _._,�1 rT 8q CONST.�1��,_.._GROUP�_
� CROSS ST EET 1�1�!.1 S�?�4�""a" zONING SETBACKS °x�""E'"5
`=' OWNER�� e/�">—��'���'f'"t°'' FRONT RW ❑
� ADDRESS_�F�-='if l%�`J,�`.G=,��'�' ��� fi r REAR C�
,,o�, CITY� i�/'�.%�� ��I�9: ZIP�f�,�TEL.�'��''r �„�� SID STREET RW__C:�
o APPLICANT `���� TEL. DE� L�
a
� CONTRACTOR •��• SEWAGE 0 PUBLiC PMT�
o ADDRESS , � ' ��� �•/� � DISPOSAL
(� PRIVATE SQ.Fi:/100 GAL
W CITY ZfP TEI._
= STATE GRADING �CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER_
y ARCHiEN�i . tn ��'6 Q:Ff':�AC'�QR:�?5 ' : ADJ': AREA4lVRLlJATION :
�' DESIGNER w. 1
o ADDRESS % :'< l•` "s """� 2
� CITY � ' ZIP TEL _ `� 3
� PROPOSED USE�����.�1 L�.'DD � 4
�` Q 6ARAGE
o NO.DWEL. NO. NO.
y UNITS�STORIES BEDROOMS �� P�
�; LOT UIMENSIONS m' VALUATION ADJ.AREA
e NO.OF BLDGS HOW QUAhT17Y G��SC IP'KCOiK1 • FEE :
W¢ ON LOT I USED�--,.� _. Q
_� ;.;ty
W�.
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�. LILENSED CONTNAf.TORS OECLAHATION I herehy afM1nn ihat I am IxenseA unda pmnsions af ChaD�9 hommencing ::��^;. �
¢:.' �vth S linn i�D��af Dnisinn 3 nl�he Business and Pmlessions Code,and my license is in full Mrre and ettect. :;.�;
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3 V,�:,
W f.NJYGR BIIILi1FH I]f.CLAflATION:I hemAp af�irm that I em exempl fmm Ihe Cantrano�a Lrcense Law tor Me Inllowing �
reasun iSe.c 7f1,4I5,Ousiness and Pmhssions f,Me Any ary nr cuunly which requires a permit lo consiruct. ���'t}'�
o ahe.�,unyruve Jemolrsh.m reVair any suucmrc,prior tn ns issuance,also requires ihe app6cam lar such pamil ;�•�', �
Q �a filr,a sipr�ed statemeN lhat he is licensed pursuant m ihe provaions nf Ihe Canda[to�'s License Law(Chapter ;::m:
�p�; 9lcummen[iny wi�A Sec�ian 70001 0l�ivision 3��ihe&�siness antl Pralessions CoAel ar�hat he�s eremp�iherefram :;'�.��. —
p,.' ana Ihe hasrs�ur I�e allegeA esemption.AnV viWatioi�of Ser.non 7031.5 hy any applicam for a perme suh�ecis ?;:.�'
W'� tke appFoanl to a trvil penalty oi r.m mme tlian Irve huMreJ datlars 155001�1 . ;���!� „
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�„� Lll,nc owncr of?Ao�ope�ry.oi my employees with wayes ns theu sale cninpensanan,wdl do�he work,and .
�� the structure rs.nm.ime�ded er efferwl lor sale�Sec.7MA,8usmess and Professions Code The Canfractor's Lirense -�Q`
q,rj Law daec nm ayply ic an nwner ot yroperty w�ho builds ar improves Ihereaq anA who Jaes sucA wnrt himsel( �%�(��.
' nr rtnengh his own empluyee.e,prwiGed that xnch impmuements aie not imentled oi offered for sa@ I(,however, ;�7Z:
m. �hp huild�ny or;mpmvnm¢nt is sald with�n oue year af canplation,the avune�-6nilder will Aave the 6wden nf prwing ',.Q..
y�. trhn'�i he did nm hnild ur improve 1nr�he purpase ol sale.l �:���._; .
h LJI,a5 n'.vnP.r U�IIIC Of0(If.fly.d111 lJICIIIbIVlIY tlfllif8[IIIIy W1�A II�P.I158A C011Ifd[fOfS f0 COtI51fYt�1IY p10�C[I�SEC. -�(J�'�
0� l044.Nusiness 811J VfOrP.390!IS CoJe.The Comiactor's License Law does not applY lo an owner of O�Werry who �.��
Z� hmhis ai impmves therean.xnd who r.onVar.is for such pmjecls with a conttapadsl licensed pursuani m[he Contracta's -
Q�. 6cense Law.l A�,.-^��j+ ���:�CONSTRUCTION _ _____
W� ��lem e�ee^+�ptu�,r�, "�•j " -�. �';�e.ePc.(nuxnc�uteaiel ��i PLAN REVIEW _
p' Cate �� `��� Gxnei '����' ;;: ELECTRIC ���— �
'd, N�URKERS'f,OMYENSATIIXJ OEClAPATI ':I hereW al� ai 1 hav� certilicate of consem ro self�insure.ar
. a cemhcate of IMnke�s Compensa�ion Inswa�e,nr a c ed copY�hereol ISec.3800,laU.C I ������,`PI.UMBING ___
_
Q O c9�i�rea«wY�:n�«nv��.��:nea. ;� MECHANIC,AL __
� C' L�CeniheA copy is�iled with tl:e BuilJinq Inspecunn Oepaqment m o�va«me��. �Q'�GRADING
W� 1 �yr�
�� CERTIFICATE OF ENEM1IPT104 FAOM WOHKERS'COMPENSATION INSUflANCE:This section need nol be campkted ?:��SSUANCE i .W
y� if Ihe De�mit u lor nne hundred�5100�ur IesS.I¢nify ihul in Ihe peda�mance of Ihe wak la which'this � f '
. cermrt rs issur.d,i simll imt empby anY�eison in any manne�so as to became sublut to ibe Nb�kns'Canpensatim ;��' SMIP � • ��1" �
�" Laws oi Calilnrnia. —'--`
o:' �'PARK FEE
p �ate APPLram ."�; 1f�i—�R�
�. NOTICE TU APPUCANT:H,aher making this ee�r�icatx ot e�emption.you snoub nemrre sutjen to tne wmter's :��SCHOOL FEES _
--�'.� Cmnp¢nsatian prawsians nf Iha Labar Code,yuu musl fmlhwiM cortply wi(h wch pwvisions or this permil shall .
��� Ae deemed revokeA. — .
J:
. pq,; lMVISIIXJ OF INDUSTflIAL SAFETY PEflMIT CEAiIFICATION.
� d� ❑I heie6y izr�Ay that no excavation hve I51 or mae feet iu depth inla whiah a person is rc7uireA to descend, �
�"� will he made in wnnecucn wi�h work authaued 6y Mis Oermil.and that na huildi�suuclure,scaffddinA.f�lse�rork --���� �� ������� �� �
m demalmm�a tlismantliig�he�eol.will he mac Man�hirryaix 1361 fret hi9h.(Chap.3.2.G�p 2.An 2.Sec
_� 341.7iile8.CAC.I. �'.�,�`5Jt�1111�f��1� Il(��'-ti1�1�
� 3 ❑As ownerhuilder,I will not empby anyone lo do work which would rEquite a pnmif from Ihe�ivisqn af � �
�— Indistria!Salety,as roted above,unless such cersan has a peimit to do such work hom tk divieion. ,
�� . .�:�.��':. .
y�j ❑IArisior al Industnal Sa�ety Permil No. ��OI w� ����
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v f.ONSTflUCfIDN LENNNG AGENCY:I here6y atlirm tl�st Ihere ia a tonstruction lendiiry agorcy Por iht perfoimm[e r{ �
Z al ihc wnrk tur whkh�his pe�mn is issued ISec.J097.Civ.C.).
�. Lender's Name COM NTS ��� �-�fl� '��—'�M��
p�p Lentlei s Add�ess
�
'a f,ER'fIFICATE OF COMPLIANCE ANO Al1THOflIZATl0.4 Of ENTHY-.I certily I have road 16u applicatian enl shte
va �hai tlie mforma��on 9iven�s cwrect I agree to�omply wnh all s�ak laws a�M oiry o�diixMa releG�p to 6uiNiig
y cunsiriKiw oritt a rco«s�ntativc oi the�e�wunent ol Buikinq ad Sahry tu mtm won the prapmtv �
= fw w have app 'a�this rmi�}oi iM purpose ol making Inspec�ions
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d[ 0� �
s �We Apo�wam or pyem , pa�e REGPT NO. PAID 8Y
� ' WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOIDENROD—File Copy.GREEN—Ap�'"
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