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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�. �.�. � .'��: �. 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. :;.�; O• 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 . ;���!� „ r^ �:a•. o - �„� 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� ���� d 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 � � r 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�'" / ����� �° � �� • � � ` � , �: �, � , � � � � � ��� _ � P �w,, vPJ� ���e. �. . . , . ' � �. ��_�'�,��,: / . �� . , � , _ ,, '. . .. ������ . 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