HomeMy WebLinkAbout153 'r'� CITY OF DIAMOND BAR PRESS
�� '"" � DEPARTMENT OF BUILDING AND SAFETY
~ '�' BUILDING PERMIT FIRMLY
JOBSITE j�,� APPLICATION � PERMIT USE
ADDRESS �$�r�•D�piMO�taD J�R �U� DATE NUMBER �- %' GODE
ISSUE �;. TYPE OCC.
4 APN LOT . TFtACT DATE _ ->'%�� CONSt GROIlP
� CROSS STREET SETBACKS
m OWNER N � L� b ZONWG ��"15 j
o ADDRESSL�P O � ���- � J � �+ REART � ❑ +
� w CITY�J�V��I'�. ZIP �5 TE��'k� 1 3n3o SIDE/SIDE STREET RW ❑ �
o APPLICANT��F-�iP�, T�I�°r$ SIDE ❑ �
z �Q CONTRACTOR �� L SEWAGE 0 P�BLIC PMT#
o ADDRESS�� Q'� �'4M�'E.l�'Cs DISPOSAL
W CITY[a2�h1A ZiP � O' TEL, 73 1?� ❑ PRIVATE SQ.FT./100 GAL
= STATE ��+�$� GRADING 0 CU.YDS.EXC. CU YDS FILL
y LIC.NUME3EP,
y ARCH/ENG/ �. TYP� SQ FT ACTOR P AQJ..AF�EAN/CLUATf01+1
= DESIGNER � � �.� .� � `� 8�- � ' �
p ADDRESS �� 2 `
z, GTY ZIP TEL. �, 3 �i
o PROPOSED USE � Z 4 � �
� � GARAGE �`
= NO.DWEL. NO. NO. � POACH f
u, UNITS STORIES BEDROOMS m '
� �OT DIMEN510N5 VALUATIOPI � ' '' ADJ.AREA �
o NO.OF BLDGS HOW �UANTITY p�$��1p'('((,�� ��E �
W ON LOT__ USED U,
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W ❑ � �
2
~ UCCNSEO COR7kACTUAS DECLARATION�I hereAY ailiim iha�I am heensed under pmvisions ot CheDter 9(commencing
Y wnl•�$ecuon Ipp01'+1 Orvismn 3 ct!Le Nusmess and Pralessions f.ode,and my IKense is in lull tmce and eNect � _�_ 4_ `b.�ii,.. �� Y---
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�+- OWYCH�RIIILIIFH DEl2ARAT10P�I lieiehV ath�m mat I am e�empi ham;he f,ontractar';License law fo�the folluxing �
Z reason(Sec ro:;i 5 Busness enJ Pialesvans f.nde_Any ciry ar counry wh¢h requi�es a permit io canstrucl, �'(�}' '
o aher impmve tlemuush.ur iepav any stmcwre.prim to rts issuance.alsa�eqwres tAe appi¢am la�sucM1 permn tZ
F- to f�le n si9nr.0 stalement Ihal he is I¢r.nsed pursuam to�he prnv�sinns of Ihe Conrtactor'i Lrtenze law(Chaptei �m
� 9 Icommennng wah Scr.unn 700D)oi�iviaion 3 of the 6usiness and Pmlessions Code�oi ihai Ae�s e�emp�tAereFrom '�S
d antl�hr 6asrs fw ihe alle9etl exemD��on Any viola�mn M Sectinn 7031 5 Ay anV applicam for a pemv�su6;ecis �
x Cie npV��������o a r.rvil penalty ol noi more ihan iive tmMred tlollars IS500�.�. �J '
W �
� ❑I nr n,nner af ihe properry,or my empluyees wnh wapes as iheir sole compensanon,will do Ihe wark.aM
tk shuctme is nm imendeJ ui otleied fni sale(Sea 7044,Rusiness anC Prafessians Code The Contrac�ar s Umnse Q '�`�
� Lnw Aocs nut apply tn an ownu of yropeity H�ho 6udds oi impmves IAereon,and whu does such wor4 himself, .(,)
W w�hmugh his cwn empinyv.e;,piovided Ihal such imp:ovemenis a�e not imended or oHered�oi sale II,hpwever, G
m the Luddmu nr miprovement is sold wid�m ane yea�a�completion,tM1e mmer6widei will have ihe 6urden of pavi�g �
y �hat he Jitl nm twld nr�mpmve 1or ihe qirpose of sale.l �y
�y' ❑I,as owrr nl'�Ihe�pmDerty,3m exdusrvelY�oniractiny wiN 1¢e�ed caNractWs to conslruct.ihe 4�q�1 ISec. "� , � • .
� � � 1044,Nusiness and Prole.svons Cada The Cnnlrectnr's�cense law does nol apply to an owne�of property who �'g. .
x 6wids m mipm��es thereon.and who comracts lor such pm�ects with a mniracPo��s1��censeC pursuanl Iothe Cnnuactor's � ,
4 °`�"'e�"'"� `� CONSTRUCT'ION „� �r.b� '
o / r.
F L�I am ezenipi under Sec .B 6 P.C.IA1ixh CertA¢ate�- �+ PLAN REVIEW �Cil r t,� t� �us-T"�O"' �
o Deie [}wner ' ELECTRIC • � b� "� �'
� W9RNFR5 f.UMVENSAiIIXJ OECLARNTION.I here�y alhim t�at t have e tertilicate nf[ansenl Ia sel4mswe.or . �� �
a�eruh�ate oi Wnrkers f.ompensauou InSurance.or a aerutre0 copy fherzof(Su 3eoo,tan t I- � PLUMBING _ �
� _�—
a 9r�/�cerni��a�vv�s heie6y Iwn�s�eil �•MECHANICAL _
o R!1 Cendied mpV is filed wnh ihe Bwidmg Inspection�epanment ar o�a,���e��. ��GRADING �
W �q J
� CERTIFlCATE OF ExEMPTION FROM\NOHKEHS�CO�M,FA'SAHBMtqS0/et is setuun neeA not Ae campkled (�� ISSUANCE �m1 _ � /_3y "� �
y rt��e permit is lor one hundred�5100)ur less aenAy ihat n e d te af IAe wo�k toi whuh this ,��, ��
permn is isxueA,I shall mt employ any perwn in any manrer so a to w6� o the Nbrkns"GanpensaLm SMIP �
� lsNs al Cnhimma W —
o PARK FEE �
o n,�e�_��_$� Applxam LLW. SCHOUL FEES �;�'��� '��19.� �
� NOTICE TO APVLICANT N.alier makmg this Ceru(kate of E�emp4an,ya stwu0 hecome subject to Ihe Nbrker's
� Campensation provrsfons ol Ihe lahar Code,yau must torlhw�th romply with such prwisqns m this peimil shall �
LL 6e deemed revokad �
J
qVISION Of INWSTflIAL SAFETY PEflMIT CENTIFICATION �
W � •
�- UI herehy cendy thal no emavatron trva�5�m mcre feet in Aepth mto whKh a pwsnn rs required 10 deacend. �
2 will he made m r.nm�ecuun wrth wark aWhmeed 6y M�s pe�mit,and th�t no huildinp sUutiwe.statfolding,lalsewark, . .J !
d o�Oemnlmm�ur dismantling iheiro(will M more man ihirly�six I�)�ael high.�Chap 32,Gry 2.Art 2,Sec �
W' 341.Title 8,f.A.0 I�
S
3 ❑!�nwner bwWer,I will�wt empbY anyorrc to da work whuh wouM rzquire a perm0 irom tM1e Uvuia�al
w
H Induslria:Selety,as noted a6ove,unless suth person has a permit to do mch vroik Irom the dniaion
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W ❑a�,5,�:�����:,��a�sa�e�y����,��No TOTAL FEES
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� f.ONSTqUCTtON LENIIING ACiENCY I he�ehy aNirm that there is a wnahuctwn lendinp apeixy�or the pnlormana ,/� � +.
• Z ot the work iar whkh tAis p¢rmit�x issued�Sec.3f197,Crv C.1.
� tenee�'s Name COMMENTS
mlenAer's Address
� a CE" 0 AllillqilZATqN OF EN7flY:I cntily I Mva reed tMs appliwtian and s�a¢ �
t/� at Ihe m�mm ron grve ca�e agree to mmDN wtth ell x�ate laws a�ciry o�diiunus reletnp to AmNi�g
y cansl�ucUun,a� authon reunf 'e ot tAe OepartmeM aF 6uildinq and Sn}ety to enia ywn the properry
= tnr whrth I ha or ffi peimit lo� pupose d making inspee6ans. �
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X 1 ti — �3—"� '"�< '� '�/�' �_,,�.
sqnature at npp�xant or Ayent �� RECPT NO. � � 6%� PAID BY �x. G VAUDATION
WHITE—DepaAment Copy,YELLOW—Fina�ce Copy,PINIG—Avsessar Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
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