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HomeMy WebLinkAbout1066 (27) ,�,�..w ,�C.e�-��c,.-ri�. �c-� a.•� s��C,.x.�.�� �o��.�► d�.�--w�..�, : -` � :.. ': ..�j . ^ CCTY OF DIAMOND BAR �"�`�^ �PR���"��a �., -� �'�..� T, %_ ��.��-� DEPARTME $UILDI G PEIRMI�D SAFETY FIRMLY C(� JOBSITE tr � J�� �P�� APPUCATION r„ 7_�� NUMBER �D�� CO E ADDRESS L��� � �v����"�+�1�� DATE .� ^' ! APN �` � ' LOT__TFiACT ATE S'� �"` �O CONST. GROUP � CROSS STREET I�YI/�r1-���F+ t���_ SETBACKS ���++� °� OWNER��l V i c�.. £•=_ lt3 I���. ZONING FRONT RVH ❑ � ADDRESS 1� 13 O `; �: ��;t�tix�cd f�ar "G« I REAR LD W CITY�t�' ZIP��le�_TE�D '�ZSi3 SIDE/SIDE STREET RW ❑ o APPLICANT�Ii�ar G•Gc?kc_cr. �"�EL��Od'31g3 SIDE ❑ _ a CCNTRACTOR SEWAGE 0 PUBLIC PMT� o ADDRESS_� DISPOSAL W CITY P , TEL. O PRIVATE S(�.FT./100 GAL z STATE ---� y LIC.NUMBER GRADING ❑ CU.YDS.EXC. CU YDS FlLL y ARCH/ENG/ � T1lP.E F,AG7�R PS. :: r:A[kt::AREAINACU�I�ION `—' DESIGNER W � = o ADDRESS L�L 2 /�1^ �l, � � z CITY ZIP TEL. (� 3 � PROPOSED USE � ' ..�.:-�-i'�-r r�::� 1 L:tLi.l Z 4 � GE,iii�' �! ��'#- "�c•<i L. � GARAGE o NO.DWEL. NO. NO. � PORCH y UNITS STORIES .BEDROOMS � LOT DIMENSIONS m VALUATfON d ADJ.AREA o NO.OF BLDGS HOW �uaNTmr DESGRIE�Ol+F. .- :'; ; �E� W .CN LOT USED_ Q �. s. s U W � � S+�:T' :ICENSEO CONTRACTORS�F.CLAHATION-I nereby affirm that I am iicensei untler provisons ol Chapim 9lcommencmg � wno Secuon 70G01 of Oivrsion 3 af tAe Business and Prafessions Cade.and my license•�s in full force and effecc W 3 '� W �i P1lNER�3WlDEB CECLFRATION�I herehy affirm that 1 am erempt trom rte Conaacror's Licensa Uv+fm me Idlowing � I reason ISec.7037 5.Busi�ett and Pralessmns Caae�Any city or mumy wnrth requires a pefmit to cantiruct. �(7 o Iler �mpmve.demo65h,or repair arry stmctwe,pior ta�i�s�ssuence.also repwres the applitaM far such permit Z Q I[°h:e a signea statement�hat ne is iicensetl pursuam co ine provismr:s of the Camracmr's license Law�Chap[er m � 9 iccmmencmg wuh Se[uon 1000i al Omsion 3 Busi a ppp���sions Codel or that he is exempt Ihnefmm _ �. � and t�e hasis!ar the allegeO exemptian.A�ry vi ti�a�1�0�}�3�by any�ppluam'a�a permif suh�ects .�� � ,.. �Te appucao�Ia a c:vil penaltY a�no�moie than fi�"tiui�a 1 Ci . a o �I as awr.er of�he 7m;,e�ry or my employees wiM wages as their mp com0e����oq wiil Go tAe work,and �he vmcmre�s no�intentled or otlered iar sale iSec.7(144,Butiness and Professions Cotle.T�e Cantratar'S�icense Q V Law]aes r.ol apply lo an owner cl pro n ho huAds�r improres therean,a�M whu doe5 s�eh xroa himulf, (� ' Ci tArOu n his awn em la ees.provitleA �/m m�s ai ey�r. noetl oi afteretl�a�uk.If,however, ... 9 D Y � � 0� '7S?�e,J� . ��Z _'�he�uddmg or impiovement is sold wilhin �y a�of c O�e�lan.;IRWWiItrAudder wdl hare Ihe hurden af pmving Q y• hat he Aid no:bmid or impwve 10�;he purpose of sale.j U . , _ ti CI.as awrer o1:he pmqerty.am eglusrvely eontractm wilh I¢ere:d cmtrecm�s Io cnrs[ruc�the pioiect iSec. W 0 iNW.9usness and Professians�jh!(�a�({r�'ter'��iFyi��}rl,v�tliie�in�t i��''��`dn owner ot praperty who � . 2 NdGs a�imD�nves Ihereon,and wh [pptN}ys(q��yE.h pipRe��vi�h,�canqactor,j5�,6Eense9`puisuam ro tle Cantracmr�s a �L�ti+•,��;�: .-��I�:i.. ,;;`.�-�.; Y ONSTRUCTION S�� 2S� L:rerse Law.l '�'��' �1 n ,� LAN REVIEN� �2 : O 9 I am exem t undtt Sec. e P.C.iAtlaeh�eruficaiel. 1 c oaie 5- �/— � ov,ner , „;;,::.c:�.;�k.4�t� EL �7 . s�C'- � WORNERS COMPENSATION DEGLARA71IX�1:I herehy altum that I�av:a certificau of consem ia seibinsure.o� � : IX a^ce!ut¢aie of Woraeri Compensatia�Insurarce.or a ceriified cepV therm�ISx.3800.�ah.C.1. PLUMBING Q L:CeruM1ed copy�:ne«ev����:n:e. J: MECHANICAL G 1_i CanLea copy rs IileA with the Buildng Inspecuon Oepa�tment m_ �epa�tmem. L�. GRADING W � J � CEflTiFIL;�iE OF E%EMPTION fROM WORKENS'COMPENSAiION INSU�iANCE:This secLan need nm he campkred UANC �� � � 2.4�� �✓ U y it me pe�mit is tor ane hundred IS1001 ar less.I cenrfy ihat in ihe pntormance of Ne wak lor whictt��is �ermit is�ssued.I shall rot empby arry persnn in arry manner sa as to lietome subiett to tk`M�rhrs'c�ce���� ��. SM IP o �aws�i cai�m���a. W PARK FEE p Oate AppFcant_ ��� J NOTICE TO�PPLICANT:If,af�er making thrs Cttnika�e of Eaemptmn,yau should hecome subjett m tAe Waker's � SCHOOL FEES � Compensatmn provisions af!ne lahor Code,you must forlhw�N comply wnh suth p�arisqm a thi:pe�mn shNl �+ he deemed revoked. J � qVISION OF INOUSTflIAt SAFETY PEFiMIT CEfiTIFMATION� W � C'I nereEy cernfy�ha�na e.cavatron frve�51 m mae feet ir,depth inm whic�a person o reqmred ta dneend, o�C wdl be maGe in connecnan with wori amlmf¢etl Ey fhis perme,anO�ha:no hudGing siructure,swlloWing fy�ework, �- n femoiiucn or dismantling tAerzai,wdl he imre ihan thiny�sis�3fJ fea Aiph.IquO�32.Gry 2.Art 2.Set - �-'� 361,Title�,CAC.�. W S 3 ❑p$�wner�huddn.I will not empby anyaire ta da wan whrth would reqwre a qrmi�Irmn the 6visun al � Indusmal Safety,as noud ehove.unkss mch person hes a pe/mi1 m do such work fram tt�e dnisian. � '.. W ❑a.�s,�a,���=��,a�5a+ery��m�,No TOTAL FEES Q y a � CONSfNUCTIUN IENU�NG AGENCY:I hereEy aNirm Nat therc a a canmuction lendinp egmcy 1w tlro periu'mance Z al ine wark far whic�ihis permii is i:sued!Sec 3097.W.C.1. � �enders Name C�MMENT$ p=p ten�er's Address 4 CEBTPCATE OF CpMPIIAACE AND AUTHOPoZATId1 Of ENTRY:I ur�ify 1 luw re�d�his+qioum ad mm N! �hal Me mlmna�wn�pven is mr�ect.I agee m cnmply with all stm lawa and tiry ardin�ptt reY1nY io dMnlltiip y �onsttuttmn.aM autho�in a iepresMWtive al the DylrMknl af 8uidinq and$�fety m e�1K�qm Me p�aperry . = fnr w�Kh I ha appled la Mis permu fw the puposa ol making inapw.liorm. � y , �� j� r �, ,� /� t�'� ���'—�— 'S�T� 7o RECPT N0.7�� � PAID BY ��� VAUDATIO = Signatue af Apqicam m Agem O�b WHITE—Department Copy,Y£LLOW=Finance Capy.PINK—Assessor Copy,GOLDENROD—File Copy.CaREEN—App6cants Copy O C I(��_11/f10 . . . . _._..... . . ............. . __ ___..__. _____.. ._ . ......._ .. .... ... ........ ................. ... ......... . . ..._.._....___,._. . .. _ . ... ... - _ _.. .. .�.,_.... . . „ ., .. . ���V � � � } fi�������� ..� ._.._ . .. . ...... :... ,_ ....,, .,_.,.... 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