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HomeMy WebLinkAbout1623 , '� CITY OF DfAMOND BAR pRESS `-�� '�" ' DEPARIMENT OF BUILDING AND SAFETY � BUILDING PERMIT F{RMLY JOBSITE � � j �q �) "�,� APPUCATIO J �/' PERMIT �/� USE ADDRESS �� ✓" �•�- � �-�e:% � �,� DATE �l�` �`�IUMBER�.`��r CODE ISSUE ✓� /� TYPE OCC. � APN ., LOT TRACT DAl'E �`" �•-� CONST. GROUP o CROSS STREET_ ZONING SE7BACKS '.�'�°"E""E"'S = OWNER"Y��+� ' � � FRONT RW � o ADDRESS '-.J.�" �`.3 • '�``� �Z'f /__�a REAR _ � ,�; CITY �+ �':�` ZIP TELt�"�r%� ��'� SIDE/SiDE S7REET— RW ❑ oAPPLICANT ���� �`�..u-r-=- TEL. SIDE. _________ � z 6 ¢ CON7RAC70R �--a.-��';�...-�'ci'r1 � %�'�.s`u'e" — SEWAGE o ADDRESS.x.���: �--�Jc�t�-�% 0 PU8L1C PMT#E a � . DISPO�AL [] PRIVATE SQ.FT.f-�f80-�AE. �'-ti• ' �' W CITY i�J"'"- "'� ZIP TEL� `%�`�' ��t _ Z STATE -�-� ��, C f ��--� GRADING �CU.YDS.EXC. CU YDS FILL y LIG.NUMBER TYPE`: �'1'::F�cC'�F� P (}J::AR A/tili4LUATIC�N y ARCH/ENG/ w y =' DESIGNER p ADDRESS � 2 a = CITY ZfP �TEL. _— '(�. 3 ua � #� �: 4 � PROPOSED USE �-�- ��%�-��' ��•'� '°=�' � ..�.G-"v''zy: .-I'rS�.a{ ,���.. GARAGE o N0.DWEL. NO. NO. j pORCH y UNITS STORIES BEDROOMS m., � LOT DIMENSIONS ' VALUATION - �s - ; o NO.OF BLDGS HOW �auA�-riYv "1�ESGR1�'7'I.bN ;, FEE :.::. W O�LOT USED Q. = c>: _ ❑ ;�. �" I ICkNSEO CONTItACTOBS OELLARATION:1 urehy affirm ihai I am 6censed under Dmvisions of Chapter 9 Icoinmencinp . Y wiih Secimn 10U0)of Drvision 3 of Rie Business anA Pmlessions Cotle an�my license is in full}mce and effect. °�'�� 3 � �. �- OWNEIPNi1RpER DCCLARATION�I heidry allirm�hat I em exempl fram the Conhxiar's L¢ense Law Mr Me fdbwing � � masnn ISec 7031.:i dusmess and Pmlessimis Code-AnY atY or county which iequires a perma ta an3trucL ����' O� ahai.impave.Jemulish,�a repau any simciwe.prior ta 0s isruance,also requires the appticsm br such penm� ��Z� 4 to lile a syred s�atement ihai he is IicenseA pursuam to the prov�smns ul the Contradoi's lKense taw(Chapter `.;:.��� , � e� 5 fcomniencing wi�h Sectiun 70001 of[�nsinn 3 of Ihe 6usmess and Pmfessions Code1 oi Ihal he�s eveinpl iherefrom ;;�'�..i. d� nnd thr.has�s hii tlie alleged etempGon.Aiy violat:on of Section 7031a`hy any applicanl for a armn sunn��s :;;�r � W thr.appllcanl m a civd penalty ul not more Ihan live hundred dellars 15500;.1. :0.� ��� ❑I,as avner nf the�ropeny,or mY�+��P�%ses with wages as their sole compensation,will do ihe worM,and .�� -- ~. Ihe svur.�we is r.at iu!endeG ni nitereJ lor sale�Sec 7044,Business and Fioles'siuns f.ode The Coniracto�'s l¢ense ���.�,Q: ��. Law dne.v rtot aOUly in an nwner af praperry w�m 6uilJs or!mD�oves th¢rean,and whn dces such work himulf, .^1J '-'� m Ilnuuyn his n.vn emylayees,provided tl�et such improvemenis aie nat intended a�aflered lor sa�e.If,however. .,•2. = iM huildmg oi imPmvement�s mld wilhin o�e year ol complelion,the ownerbuilder will have ihe bwden al pmvmA "7s(� y ihat he JiJ nut huild oi nnUmve lar ihe purpoae o�sale.l �°Z ! ❑I.es ownr.r nt ihr poRerry,am r.rGusively conuacuny witl�licen:ed comracturs to canstmet rta U�aleat(Sec. >V�W', Q.: 70A4,Rnrness anJ Pmfessions CoJe:Thc Cantracror'S Li[ense Law does nat apply ro an owner af propeny wM1a '��.�,�5�� yd hulllix III iinproVL's[ht.rtOn,alni wha contra[ts for SUCh p�ajecis Nith a conlr9ffatlsl llcenSEd pu�suanl ro tht Ca Iratlor s L¢enselawl �.:, CONSTFIUC�ION __ _ `�� d r � W LJ i am r..enry;under Ser.. ,B.6 PC iAUach Cerhhta[e�_ !; P�,A(� RE�/���/ F.. __�_ _'— � °ate °`""et '":t ELECTRIC � W�RKERS'COMPENSA710N IIECLABATION:I hereM altirm that 1 have a ceitificace o�consem m seif�insme.or :����'r• � a ceiiificate of�uvkers'Compensauan Insurance,or a cernfied wpy Ihereof ISec 3800.La6.C.�. �� PLUMB�N�i _ �� a ❑ce���ne�wov�s ne�en�nK��snea. ;;,,,� MECHANICAL ____ o . P�nr���Y��(ded with the BuilJmg Inspecuon Oepailment ar oepa�tmem 'CC GRADING tr� = CERIIFICAif Of EXEMPfNN FflOM WOPNEflS'COMPENSATION INSUAANCE:This seciion need�o�n���,�ok��e ;.�: ISSUANCE I"�•� � � ii the pe.rmn is foi une hundred IS100)or less,I cenity ihai�n i�e peJamance ol�he work far whKh�fhia - - � " ~' SMIP � permrt ig isnueJ,I shall mt ein0loy any persan in a�ry mancer so as�gbe�ome suh�eet to ihe N6rkns'Canpensauon , '�t' _ _ o �aw:o�t�ia //��� � :� f'� ��`/1 � �1.�;PAR}C FEE p �ate�_.�-'' ' �': AVplicant�(,i� �...�.Yr��I�'"�. `.W W NUTICE TO AVPLICANT.Il,�this Certili�a�e af Eremplion,you ehouW b¢come suhjeu to�he v,�kHS '�.��. SCHOOL FEES J -� CompensaUon piwisinns of the Lalai Code,ynu must Iwlhwith mmply wilh sUch pfovisnns o�Ihis pemiu shall � he deen�eJ ie�okeA. -- — � OrIV�ISIIXJ OF INIXISTBIAL SAfETY PEflMIT CERi1NCAT10N, ;�` o LJI he�ehy cenAy that no excavation fae(5)ar mar feaY�,in:dep�A inm whicn a persm is required to desoend '���t�s `a� i'��:..�'y'�'C-- - ��'i 'R.�""' � will hr.made�n conneclion with work authoritHd hy�u permit,and thal no builAfnp stmcture,s[eflolding lalsewnh, �_ � l or demolilion or dismamling fhereol,wdl he mwe than Ihirry�six�36)leel higA.IC6ap.3.1,Gry 2,Atl 1.Ste �}�'�� ��-� ��''�'�:-. �-�-��:�����"'T 1 x' 341.Tifk 8.C.AC1. � . 1 3 �g_;ry � n "�{ ❑As nwner-builder,I will not emp en�me to, �urN wM1¢h��k repuire a permn from tk Daisian of -�..���>�� �-���� f.. InAusuial Sahiy,as imted above,unlas such person has a permn ta do such wo�k Irom the di�iabn. � ;.:,:..; . W ❑a�9���af���5�„a�se�e�Y��m,�Na, TOTAL FEES Q � � CqVSTHtICrK1N IENUING AGENCY:`I Aerebv�aNirm tlit�thea.is�a[onitruction IflIYGng agmcy fo�the pnfonnenu },; 2 0l tlu worF lor wh¢h mis yermi�i5 itstipdiSei.3097,LYv..C.l..� �•-� ' " � ,��.'; � tender's Name COMMENTS � LenAer's Addresa Q CFRnFCATE OF COMPU�NCE ANO AUTIqRIZATIaI OF ENTflY�1 ieiity I have read�his application.�nd sta0e �� H that Ihe m(wmaLon giuP.n is carett.I aqr¢e lo Cortply with all 5tete laws aI1E ciry ordiNn[es fd�iXp to buildilp � ���� y conslr and au�hoiue a represemative ol thq Iment af BuiNinp and Sekty tn lnov ipm Ih properly � � lur rth I aue applied�fQr M� pormit�Rol`the p mak�np inspecfont_ !� L "'l) ��'� ��" Z '� w � RECPT NO. PAID BY VALIDATIO � Sipnature at pppl'sem oi AgerA �ah .. 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