HomeMy WebLinkAbout1272 (22) � . _ _. --- -__�. . (
'�'� CITY OF DIAMOND BAR pRESS
� �'" ' DEPARTHIE BUI�LD NG PE'RM TN�SAFETY p�RMLY
J�BSITE APPLICATlON PERMIT USE
ADDRESS ��.S �rAM0�17 2.��a� �� DATE �— (���v NUMB�R 1 a-��- CODE
4 APN LOT TRACT DA EE � `��� � CONS7: GROUP
� CROSS STREET, SETBACKS �E��
=-° OWNER f�4R �,''f7�� � N7[�c�A1r�i� ZONWG �ONT HW ❑
� ADDRESS%z��� '� r`��..' -� aZ REAR ❑
W CITY �!�(.^"lc7x,(��IP9e 71,a�'TEL�r S1DE/SIDESTREET RW ❑
o APPLICANTT�q�<<� C�aa�i7' Cc� TE��`��' '� SIDE ❑
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Q CONTRACTO���� ,�'/y�}�'%• �,/�� SEWAGE ❑ PUBUC PMT�
o ADDRESSl +� DISPOSAI..
,� GTY�'��`�oFi.'U�^v�-��°� ZIP %9 �f� TE�: — ❑ PRIVATE SQ.FT./100GAL
z STATE $�f�' GRADING ❑CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER''���"i 70 1�
y �� � TYPE Q Ff FACTt�f� PS AD.t. AREANALUATION �
" DESIGNER � 1 � i
Q ADDRESS � 2
= CITY ZIP T . �} 3 i
� PROPOSED USE���X")!.A lc�: .."lc7L� - _ Z 4 �
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w lN�falCx o:..t,i ,Z :.✓iiiJ.�Or.�J`i � 6ARAGE �
= NO DWEL NO. NO. � PORCN t
UNiTS STORIES BEDROOMS �p I
s LOT DIMENSIONS VALUATION � � % J� � At7J.AREA �
o NO.OF BLDGS HOW i _�UANTITY DESCRI ION FEE �
WON LOT USED I a .�/'• ;tialG� ' .'.+.t c.,1.s � Jv y
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~ .CENSEO CONTRACT�H$OECIABAT10N I Miehy atinm tl�at 1 am imenz 1 under pmnvans ot Clupm 91�ommmcup �,'�' ��� ��
¢ nnn Secucn 7U00�of amsion 7 of!Ae Busmess and Pmfesswns Code and my 1¢ense is in IWI forte ana effect W � •��3-� /� "O y
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� 'hVNER BUILOER OECLARAiqN I herehy alh�m tAat i am enmpt hom iM1e Camixtoi s lrcense Law fm the fdlawmq G
_ �eawn ISec 70315 Busmess and Profess�ans Gotle Any ury or counry wh¢li repmres�pamn ro canstruct, (}' � r(,�� �
o ahei impiave,JemaisM1 n repai airy rnxtum.prmr to i�s rssuance also rzqmres the applcam ta�suh pmm� Z
Qta hie a signM staument 1M1at he is 6�ensed purauant ro iM D�o+'�sions oi�he Connacmi s Leense law lChap�n �p �t} ,�
s 9 ieommeun�.g wi�h Secnon 7U00)ol O�vinon 3 of cAe 8us�ness and Pmfessions tode)a Mm he rs exempi merefrom � �
d and me has�a for Me a11ryM ezempuon Am��nan af Sectwn 70315 6y a�ry apphcam fot�permit suhiec�s � - �
x the apPhcant 1u a cNil pena�ty ol nat ma�e t�an fae M1uMred dollars�550011 -� !
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�,n,,, ❑I as owner al ihe piapeny ar my empipyees wiN wzgps as then sok tompensa0on wdl do the woh,and �
� Ihe sln�c�we rs rro�mimded or oftered lor sale ISec 7044,Buwneas and Piafessrons Cade The Controcta's lrcense q �
y Law nnes mt apGM�e an owner ol p�openy who�wlds m�mpmves thnean,and wno tlnes sucn wait nm�self (� �
ni Ihrou9h his own emA��a prmidM Ua�such nnpovemenu are nol imended a atlaed Mr sele If Fowever, Z �
m n�e nudCing nr imprwemrnt�s sold wnhin ona ynr af compleuan Ik owner�Omltler wdl Aaw Ihe Maden af piwing Q
= that he di0 not hudd or�mprove 1or�he purpose ol vk� 2 I
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v� ❑I as owre�nt me pmpeny,am excWnvety comracuny wnh hcen5ed cam�acmu to wnstruct�M➢�o�eot(Sec ��jy i
q 7074 Busi�ss a�Pmlessiona L4tle The Conlmclar s L¢ense law does not apply lo an awnn oi 0����Y who �
Z hudas or nrryvoves;hxeo�and whu canvacu lo�such pro�ec�s wnh a conpxro�U)I¢ensetl pmsuam Io�he Coniranor's �—�-�� �
¢ li�nse law 1 G`O CT �� .O� �
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� ❑I am e:empt uMer Stt B S PG IAllxh CerufKatcl V�E �
o �,e �M� `r —
� Wi]RKEqS LOMPENSAtqN OELLAPATION I M1eretry allnm that�nave a ce�uhcate at consent to self inm�e « pLUMBI G L`? l Jl_/ �
a aerulrzale ol Workers Campensauw Insurairce oi a ceidied copy IhneM(Sec 3800.La�C) -
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Q ❑u�ni�ea�oP���n��ew�w��:nea � MECHANICAL _,,.
o �Cernhed c�py iz filed wrth the Bmlding Inspecnan Deparimem o� �epaimunt � GRADING `
� CEHTIFN:ATE OF EXEMP710N fPOM WOHKEflS'COMPFN34TION INSUH4NCE Th�s secnon need nol 6e compktrd UA � '� �O �
y h 1he Damn is IDr one hu�d�e0(5100)p less 1 cerofY�ha�in tFe perfoimence at the work toi wluch qxs �,,, + �
� yrmu�rs issua0 I shall ro�employ any pe�aon in airy manrer sa as w Eecome su6�tt1 to the NUrkns'Compensanm
laws nf Califumia
o aa,e i 7Ju�'� 19.� ,�a,�a�, t� SCHOOE FEES
NfITICE TO APPLICANT M after maNmg this Ce�nlrtate o�f puon,yw sMuN 6ecame ub�at m the NMker's
= Cm�pensanon Prwisims a(1he LaCor Co0¢ ynu must farthw comply_v���prwisn w m�s pe�n s�a4
� he deemed reuokeJ *,�.5`-'.� ;,r� 3
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s pVI5111N pF INOUSf HIAI SAiETY PEPMIT CEq71FILAT10fl;� �^';;.,,'�W'�.J�
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❑1 hereby cenrty ih�i ro exqveunn trve 151 0�more hei m deq�A mm whKh a pe�sm is iequ�md�o aexmd
� wdl be maEe�n conne[tnn with watk au�aued 6y thu pmm�a�that no hwlding structurc seafiWAm9.I�Issewaik.
o�demolmm�or d�smanuing Ihereol wdi Ee maq��tiarty�n,�1,6�IEi�Chap 32,Gry 7,An 2 Sei
W 7a1 TrtleB CAC1 � � ;�,.a
= 3 5. �
� ❑As aw�e�-hmWe� I wiA nal emqby aMoire lo do wurY whuA wau'd�epmte a permn han ttrt Ovqqn al
ti IniWsmal Sale�y as noteC ahove,unless surh person h�s a pe�mtt lo do auch wa4 irom the drvis�n
S / ^^ i":.t.,.' . .'; R_�_`���
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W LIOms�m u(Ind�m�al Sa1ery Petmit No�- '- �. ' , . ,� ... TOTAL FEES ` � l�L�. 5D
� CONSTNUCfpN LEN�ING AGENCY I harehpaM4m�M1at ttten��s a cdnsmicuon IenWig aqeMy lor the perlortnann
2 0l the wo�k Inr wnch tM1rs permn is rssued(Se�7097.Gv C)
� Le"""`Ndine COM,�v1ENT�` �
mLender s M1ddress ' � �
'� CEFTIFCAtE OF COMPIIANCE AN�AIITIqHTATIaI�EN1NY I catrty I have rtaA tlxs applaatian and nau ��' �,,"�' " " —�" ' —"' � �
rn tnal me mfama�wn grven n earect i agree to wmply wrth all sbte laws and uty adNMes nhtlnp M�wldinq ,. „_,_ ,_, „ ,�,„
w
yconsvuc�m and auihome a represenuwe oF Me Opy�ment of&uldmq aM Sahry to enm Wm�paperry '
S �a whch I Mve appled fm thia pttm�for k qrpox oi matvp mepstais
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� '�a��e� i � u�m ��— RECPT NO ,� `-� / PAID BY �3G� VAUDATiON
WHITE—Department CoDY.YELLOW—Finance Copy,PINK-0.ssessor Copy,GOLDENROD—File Copy,GREEN—Appllcants Capy
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