HomeMy WebLinkAbout1143 (10) �"� � CITY 4F DIAMOND BAR PRESS �
�, - DEPARTMENT OF BUILDING AND SAFETY F�RMLY
-� BUILDING PERMIT
JOBSI7E DATE CATION�_�._A-D NUMB R ��CODE
ADORESS ��� ' �
4 APN�#'TO(v"d/6-d3 / LOTLse TRACT2• DATEE �-��� CON3T. GROUP
o CROSS STREET ��6/a G'a/7.. SETBACKS '•"'a'E'"E"'s
°� OWNER �t/<c�..s.-, �: ��•�7=F.�-r/A'E.� ZONING ��NT RW C�
� ADDRESS //r 3 i./ �'/ -r%,�i� REAFi CO
,� CITYp��`��-s�t3�'�� ZIP, =�'i��r TEL.�D-�lSiZ " SIDE/SIDE STREET RW ❑
o APPLICANT -�*'"> � TEL. SIDE C�
Z
a CONTRACTOR C�c.vi✓E.c �i9t��tr7E'� SEWAGE [) pUguC PMT�
o ADDRESS DISPOSAL � pRNATE SQ.FT.l100 GAL
W CITY ZIP TEL.
z STATE GRADING ❑CU.YDS.EXC. CU YDS FILL
y LIC,NUMBER
y ARCH/ENG/ �/ ��TYFE SG3 FT-FAGIUR PS ;.:<;ADJ'AREANALUATIO.: ', :;;
y DESIGNER �•`�•-�'� � ��h'���'� '� � -1 S�D,-T� - �l S
� ADDRESS �/S.3/✓ d+�.%s� '�''r IjV p
= CITY��d--��� ZIP �� TEI.� •-I (�j 3
� PROPOSED USE - � � 4
w •l � GARAGE
o NO.DWEL. NO. NO. �. PORCH
y UNI7S�STORIES-2 BEDROOMS�_ m ;
s LOT DIMENSIONS /fi�- S K /// �`i � VALUATION � ADJ.AREA
o NO.OF BLDGS HOW QUANTITY DESCRIPTiO�t `.-- ` .: FEE: . '
� ON LOT USED �^r+�- FN/s �'Fs.
� n
_ ❑ � � ._ _
~' UCENSEO COYTflACfOP$DEGIARATION:I herehy alhrm that I am licensed undn pmvisims of Ch�pM 9�comme'uwng �'
�' �.snh Sttnon 70001 a(�ivision 3 af the Busmeys and Professions Cade,and my leense is�n full Porce and ellect. ,.�. Z.(� � �� � ,�O
Q3 � �C. laf� �2�_ tQ�
� Y R-BUILUEN OECLABATqN�1 he�eby affirm that I am eumpt Imm the Conirxmr's L¢ense Laxr lo�tlx fdlvni�g -�- .
;j rtason�Scc 7037 5.Business antl Pmfessions Code�Any cily ar camty whKh iequires a pe�mn ro wnstruci. (�}�. �
o alte� impmva,demolish,w iepaii aM�rxlure,O�KK���rstuanrt.also nquues me appYc�m Por sucA petmit �-2� � �
t= m��le a signed staiement ihai ne�s i�censeA pursuam m me pwisioni ol Me Convacmi s lkeme Law Ithapur .:Q7
� 9 Icanmenci�q wdh Section;OWI ol avision 3 af the gusiness and Prafessions Laee�rc ma he is exemp�Nsrehum ,��� �f
� d antl the basis�or the alleged e�mpnon.Arry uidation ot Sx[ion 7031 5 Oy+ny appliranl!o��pe�mn suhjects :�� 1 (;�� I � �
W ihe appleant lo a civd penalty of not non Ihan In•e hurdreE tlollars�5500�.1. �a-
� � ❑i.as mvirer nl me mo�ertv.a mv employees with wages as�iMir sole compensation.w�l do the work.and . �
� � ilie s�mcture is not mtenaed oi ollered(a ule ISec.7044.Bus�ness and Pmlessions Code:ihe Cm7rxlw's licrose �
ed Q.
v !=_w tloes ngt?pplY�a an vrvne�c!p�ope�ty who d:i!ds a:ir.:G��'+xs Mneo�.and w5o dces:uch wa�A himisM. ,�()'
•++ cr mmugn hrs awn en:Clnrees.C�o�idetl tAat sua"impran:mems are nat inhndeA m aNered M:sak.I!.hv.vewr. �•Z�
= tne 6uildng nr improvemem�s mld w�min one year af camP�enat Ihe nwnerbuilder will have tM hwdm oF pwing ';Q',�.
y that ne diA not hwltl a imu�We lar the pmpase of sale.l •_
�n ❑I.u owrzr ot ih¢pioperry.am eMch�srvery cannaeumj wim ii[msed aonlractors�o eonstru�t Ihe prq[et(SK. ���- �
71144.9usir.ess and Pmfesuons CoOe�TM Lomracroi s Limse Laxr dors nai+pply Io an owner ol property wM ����' � �
4 hudAs ai improvez therem,and who convacts fa euch pmlect%wiih a contracmilsl licensed pmsuanl m[he Cmuxta s
L¢ense law.l N U TION ���
� ❑�am�/ ne_ar��b � a���n c����n�,«�. PLAN REVIEW ' ���
p Oaie z� `.-���� ELECTRI '�. � . LoZ) �
� WUflKEAS'COMYENSATIpN OECLAflAT10N:I herchy aflirm tAa�1 hav a cer xax af oonsmi ro sell-insWe,a ��:�... !'�� „f'�F1
a cendi�aie of Workers Canpenzation Insunrce,or B teqilied capY thceoF(Sec.3800.�ah.C.1. f� �
O
Q ❑cemliee�opy�s nerehv turmshed 'J�� �N�E�i�"�AN�(N4�.
o ❑Cenilatl copv�s Ided wi�h the Buddinq Inspeuim Depanment a oeea«��,. ��<C��GRADING
w ,p�
= CEBTIFICATE UF E%EMPTION Ffl�M Wl%IKEflS'COMPENSATION INSURANCE�.This section need no�he camDkted �� ISSUAN �� . t J�
� d Ihe permil is mr one nunaree�staai a�ess.I cemfy tha�in�he perfa�ce of�e.work fa which iM1is '',.,
h
permit it issued,I shali rot employ a�V peiwn in arry manner so as m became whla���'�4rYds'ComDensation SM IP � •
� ��w��i��a����a. ;� �' t � PARK FEE
� �b��'a "rr" , �',�. _
W NOTICE i0 APP ICANT�.If,aller making this Cendip�te�ol E�emp�mn,yau me suhpe�m�he wawH= -�-� SCHOOL FEES
J
-� Compensa�ion piwisions af Me Lahor Cada.you must fatAwith comqy wiM sutn prni�nns a+his permu she0 �
LL 6e deemed rewked. �
J �� •
p� �IVISi[1N OF INWSfflIAL SAFETY PEAMIT CENTIFCATiON. ., .,, �r ���
d
❑I he�e6y cedMy ihat no excavatpn live I51 or more txt m depth into whic�a persm rs requireA to�eaeend.
s will be made in connecuon with wo�k aulMrued W dus pe�mit,a�d Ihat ia WiWmp stt�c�me,srilldtling,lalsework, �
. d w demo6non ai dismenlling thereol.wAI 6e�We(Iron•ihirq�sM:136L}eei A,qh�(l?�+P.:12,;.--6�p;:7�';Art 2,Sec �
tx.
x" 341.{eleB.CA.CL `..t i v� ,� . ., . � —
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z 3J,'(.t ,Y.-.,;: . ::�. ; ..::-� 'f-•`/ .
� Pt owner�huldn,I will not emplay anyone Va��work��w�ich�iraild repuvt+perm�han tl¢Divisqn af �
F— inUustrial5ale�y,as no�eC amue,unless such person Aaz a pe`mit ro do such wak from Me divaon.
�
w ❑a.�5��a�i�n��ai SaiBh���m��No. TOTAL FEES
a. . '�
LONSfqUCTbN LENIIING AGENLY:I he�e6y aHirm that ihe�e is a anstrucEon kndmg�gmcy kr tM pnfmnme
Z ol tM worY(w wnkh tl�is permit is rss ec.3097.Ciu.C.1. ,
� lender's Name y^�� COMMENTS
� ie�aers aaa�ess � �
't CEHTIFICATE OF COMMIANCE AND AUTHptlIATI�!OF ENiNY:I�eriify 1 hm nM tlQs aplia�ian md stm �
ti thal me inlamalion given is Carcct.1�yee to comply wuh�II stak laws and ciry atliimres rWrinp ro dnNinp
y [anstrucUon.and authar¢e a represemalive ol the Uepartment of&uidiiq ad Sahry tD enrr�qm Ihe poperty � .
9�^
= In which 1 hare applied lor this pe�mM1 Iw IM1e pupose of making inspe[w�s.
~ �.��/��..�'� 2 � � a-
— � ap RECPT NO. PAID BY VAUDATION
SSgn�tue af li i �
WHITE—Depanment Copy,YELLOW--Finance Copy.PINK—Pssessor Copy,GOIDENROD—File Copy,GREEN—Appticanis Copy "'
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