HomeMy WebLinkAbout1635 (22) :.� F ^,� ��c_. ��-� �� 1 �
CfTY OF DiAMOND BAR pRESS
`<,.. '�=" ' ' DEPARTMENT OF BUILDING AND SAFETY
'�^ BUILDING PERMIT FIRMLY
JOBSITE `�.;��_ ��,�0� DATE CATION _. i �GJ("'� �MBER ��� CODE
ADDRESS ISSUE TYPE OCC.
:� APN . LOT TRACT DATE �.,�'��� '�� CONST.�.GROUP�
�
p CROSS ST..�,wEET G-t�?�r,�_I J1.�+•`9 'f3e,+�- SETBACKS ���
^° OWNER wYG• , � �'�1�13. (�SIF1..im� ZONING FRONT RW ❑
� ADDRESS��0'�� '- �� �� REAR ❑
,� CITY �� ZIP TEL. SIDE/SIDE STREET RW ❑
g APPLICANT TEL. SIDE ❑
� GONTRAC7DR �'�� SEWAGE
o ADDRESS �I, S S�I�-i?.iZA ^-� DISPOSAL � ��C PMT#
W CITY_S,�p�� ZIP �1 TEL.�� � � PRIVATE SQ.FT.!100 GAL
x STATE � �6� GRADING C�CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER � 7 _
y ARGH/ENG/ �. TYPE SC.1 FT F R PS AC?J. AftF..fWALUA710N
� DESIGNER �"r.�.MP �•-+� �,J,-,�✓t+,j�- LU 1 � ( �
�p ADDRESS (W�, 2
CITY �ZIP TEL. � 3 _
� PROPOSED USE '�a ''- ��1"' �-C Z 4
� GARAGE
� NO.�WEL. NO. l NO. � pORGkI
UNITS 1 STORIES ` BEDROOMS
LOT DIMENSIONS m VALUATION I _c?' -�' ADJ.AREA
NO.OF BLDGS HOW QUANTITY DESCFi) (ON �EE
ON LOT_ USED a � s �� �t� v-- '7 , . >
U
¢
LICLNSEO CONTHACTORS DECLARAiI[IN I hereOY������n that I am heensed under pmvisiont ol Chaprei 9(commencing F
wAA Ser.tmn 10U01 of D�vis�o��3 0�the Busine9s and PrMessions Code,anA rtry Ltense is m tull imre and effeet W
� �
� (hYNfR�fiUIL�ER UECLAFATION I here6y alfirm Na1 I am exemp�trom�he ComrocWr's L¢ense lew(w the fdlowmg t--� .
rensor.(J'ec /031 5.Business and P�ofessions C�e Any nty ar counry which requiias a permn to cunsfruct, �.!,}� � , (h�� � I-
O aher unprnve,Jemolish,or�epair any strunme,qimr to ns osuarrce,also mqmres the app6[ant foi suah penmt �,ZC
F- to�de a siyncd siatemenl ihat he�s hcenyed pursuant�o tlie pronsmns ol the Canfractnr's Lieense Law(Chepter �(,rj� � �V{/L, � ��j
s 9(cammencnig wi(h Setlion 70001 oi Drvison 3 nf Ihe Ousiress and Piolessione Code)a that he is eawnpt�kiefrom � � ,,.,,�
a and the hnsis far ihe alle9eJ:xempuon Rny viola0an ol Section 1031 5�y any app6wm foi a permrt su6�eCis � ��. � S � y
x tlie aD�litant in e crvil penalty nf nnt more ihan Irve hwdred dalla�s�5500�1 'a
W
� ❑I.ax mvner�f Ihe p�operry.M my empinyees with wages as theu sole compensation.w�ill Ao th¢work,mE t
the,sanclwe is nat mtended ai olleied fnr sale(Sec.7094.9usiness and Piofessmns Code:The Cmiracloi s L¢ense ¢ t � �
_ �„� ,L�w daes nat apply lu an owner ol D�operty who bmlds nr improves iherem,and who Does sueh wo�k Aim:ell. .•V �
�' n tlnouyh his own empluyees.DmwtleU Ihat such improvements are nol mlended or offere0 fo�taie.I(Aowever, ;� j
m the huANng rn unyruvemem is sald within one yeai nl[omplellon,�M mwner�huiltltt will have the Umden of pmvmg �Q
� Ihat ne Aid nu!hmld or iniprove�ar the pwpose af rdle.� •�
`n U
� ❑I as owner of Ihe piaperly,am escl�isrveN�o���acbny with licensed comr�aors la cansimct Ihe pm�ttt�Sec (g�
0 7044,6usiness and Rnfess�ans Code.ihe Coniradar's Licensr.Law Aoes not apP�Y ro an owner of pitpeny who g
Z hwlds nr nnpraves therenn,aud who contracts lor sah pm�e�h wtlh a aonlraclor�s�licensed pmsuant lo Ihe Contractar's .---...—
a �'°r"��aw� CONS7RUCTI�I ���c�y,���
�; ❑I am r.xempt wder Sx. .B&PG IAtlaeh CeruLcale) PLAN REVIEIAfx� _�_I�„ �r ���"' � �"'�`-
o: ua�e (Avnei � � TRI '� S ��P�„(`,r
�' N9RKER$'�OM11F'FNSAT101V�EilAFAT111N�I here6y affirm that I h�ve a aeru6cate of conmm to sdFmsure,w �`�V �
a ceihhea4 of Wark¢�s'Cnmpensauon Insurarce,or a cerofied Ihemol Sec 3800,La6'C(�.7`r�/"�, PI.UM �• —�t-��
Q ❑Ccru6nA copY is here0y furnisheJ. ��� I 0�v� ECHAN,I�C,�{G.. i l�1,��Yr_.__
p �Ce�tdied coDY�s hled wtlh Ihe dwidmg Inspecuon DeDa�mrtnl or Oeparlmen� d GRADING ,
W. y
x CENTIFlCATE�f E%EMPTI�N fROM YJOFKERS'COMPENSATIDN UR4NCE:This,ction nred Ae[ompkiM ��UA��',�,,. r .- �
yrf ihe permn rt for one hundree(S100J nr less.1 cendy�1 m the pedorma ai e k r whwh�his ;f,7,� _
permn is issi�ed,I shall mi employ any person m anY mancer s as ta beeome s t s'Cwnpensalion P�T-.-^ � � ��_
oLaws nl Caldornia PARK FEE
p �a�e �`,� •� APPIi[a � ?
� N[ITICE TO APPLICAN7 II,after makmg�his Cerdficate at emD n,yw sMulA come suh�e[I ro�he VJorker's �+�- SCHOOL FEES r
� Canpensatmn provfsions af the Labor Code,you must falh tomplp wiPo such pravuqns a Mu permil shall
�+ he dmmed revoked � —
—' qVISION OF INWSTRIAL SAFETY PENMt�CEHTIFICA710N: � ' i
� L :, �: 3 �
❑1 heiehy rertdy thal no excav�tan irve(5)ar mde leel m depih mW wMcn a persm�s reqwrN to deumd.
� will I�e made m connection wnh work authwued 6y 1h�t permit,aM ihat�ro OuilUing stru�tu�e,atalfdAing,falsewar¢, t
d ur demalamn ur dismamhng thereo(will 6e mae�harv,tpKry;eiy 136�I�r.�Ai�A �Cpap 32.Gry 2,An 1.SK ' �
w� 741.Tine 8.C.A.C.I i , ` .. �.fi;.�?�� � '.
_ :., .� : :
3 ❑As uwner-hwlder.I will nm empby snyone to da wark whieh wouW�eqmie a permA from Me Divisian of �
�.- Indusmal Safety,es nohd a6ave,unless such persan,haa a pe[mi�ro do such wor4 1rom the division. . ; �
� '... . � ,, . . .,. � . - :
W ❑pnsmn of Indush�ai Sakly Permrt No � " � �� � , '
� C[INSIRUCfION LENDING AGENCY:I herehy alfirm that there ia a�onstruction lendinq zgency ia`1M pertarmanta TOTAL FEES � ��i, n�
= nt ihe work fd whMh Ihis permit is wsued(Sec 3097,Civ.C.1. � ` �
� Leneei s Nar�e CO MEN7$ � C--
p�p tender's AAdress '
t `�
d CENTIfICATE OF C IANCE AND HORIZ EMNY:I wtiiy I heve read thia�{qkalion�nd ate4
v� ihet ihe mfamam i n u car w with all srate lawa end ciry ordinma reh�iip to 6uifdinp
y construct n,end ve a of DepartmeM ol&tildinp and Safely ta mhr upon the pmperry
$ lor whi� I have P ryrpou of inekinp inspecGms.
� Xg_��..� ,,.
Sqna��e ot nyqcant o�aqent p,h RECPT NO. .� • -f� PAID BY q v� _VALJDATI
WHITE—Department Copy,YELLOW—Finance Copy,PINK—ftssessor Copy,GOIDENROD—File Copy,GREEN—Applicants Copy (
BS106-11/89 �
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