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HomeMy WebLinkAbout1044 (10) , , .. r: '"� CITY 4F DIAMOND BAR � PRESS `.., -� DEPARTMENT OF BUILDING AND 5AFETY �� BUILDING PERMIT F�IRMLY' JOBSITE /� � APPUCATION ` �_ �PERMIT. �/'� USE ADDRESS C—.��• ,SSUE ,�T �,N�UM�BER�CODE 6 APN � TRA ✓�� CONS"C GROUP � CROSS S ET � SETBACKS ��� °= OWNER � ZONING FRONT RW ' ❑ o ADDRE Q� REAR ❑ W CITY ` ZIP TEL. SiDE1SIDE$TREET RW EI g APPLICANT TEL. SIDE-:,, _ . ❑ _ 4 CONTRACTOR -�— SEWAGE o ADDRESS ___ CI PUBI.IG PMT� DISPOSAL ❑ pq�/ATE SQ.FT./100 GAL W CITY TEL. z STATE GRADING C�CU.YDB.EXC. CU YDS FiLL y LIC.NUMBER y ARCH/ENG/ �, TYRE SQ'FT- R;P� > 'AD.i:AR�RNJ1l�UA'TIO�f` • . . y DE5IGNER � � ���� o ADDRESS � 2 = CiTY ZIP TEL. � 3 ,. _ _�.._ __ _ _._. __ a PROPOSED USE `� 4 � � 6ARAGE � = NO.DWEL. NO. NO. >� PpRCH �, UNITS STORIES BEDROOMS � LOT DIMENSIONS m VALUATtON ADJ.AREA o NO.OF BLDGS HOW QUANTmr �E5GR1P''T'[�f3N ��� W ON LOT USED ,� � W ❑ � S �"' IICEtJSEO COMRACTORS�ECLARATION:I herehy aflirm that I am licenmd vidn pmvisians ot ChapMr 9(wmmencinp �. � Y wnh Secuon 70001 d Oivisan 3 of the Business and Prufessians Code,a�d my license rs ia lull fu¢p and eHect. ..,W. c 3 � fj � PJ✓NEfl�BUILDER OECLAflATION:I hereby a�fiim thal 1 am emmpt from the Comtaclor's Licmu Law far the Idbwing = reason�Sec.703L5.Business and Prolessront Cade:Any cfry or county which requires a permit ta toatiruet, � V' o al�er �mpmu¢,demnlish.a repair any slrueture,yiw m it�fs:uarce,alm requues the appiicme tor such permit ��Z� Q m hle a sgned statemem ihat he is licensed pursuant to the prwisions of the ConaaCmr's lie6iue Ww(Chapter �,m pp 9 Icommencing with Seaian 70001 of Oivision 9 of the Busine�s and Pmtesiiom Cadel or that he is exempt merehom �g� y and me 6as�s fo�the allegad e�em0oun,Aay vnlaaan of Satian 7a31.5 Ey any applicant tor a permit suhje[4 �� K ��aOD���ant to a ciud penally of no1 muie than fiae hmdred dollars�5500).1. ! Q� W � ❑1,as owner oi�he properry,a my employees wiN+wages as ther ide compensetion,will do Me wwk.aiW . aW Ihe scrucmre a not imended or oNered fm sale ISec.7044.8usiness antl Professpns Code:The Contnemr"s UtenSe ���"-�-���'-`""�j Law tloes nal applY to an owner of propmry wlia Euiitls or imOroves thaeon,a�M-who does sucA work himse�f. .����V� � or Mrau9h his own emnloyees.provided thai mtA imprwemenh art nat Inttnded ar offered for sak.lf,however, :.��Z = the DuAding or improvement is sold within one yaer al camp7etian,tNe owner-6uilder wiA have Ihe hwdtn ol proring ;�.Q�. y iha�he did nat 6uild ar improve for the purpose af sak.l -�,� � ❑I,as owrer vl the properry,am exclusiveh wmmcnng witA licensed cantracmrs m aanstruct the projeet�Sec, ����:w . o I04t,Busines3 aiM Professions Cotle:The Gantrector's License Law does not apply ro an awner at property wAa ' �� ¢ hwids a�imywes tM1eieon,and who wntracts lor such pmjects with a com�actor�sl licensedµvsuant 10 the Cmtruta's Ucense law.1 -. CONSrRUL•T��N 0 ¢ ❑I am emnpt ur�der Sec. ,B.&P.C.IAnxh Cerufieaxl. � �:. P�N (�E�/���/1/ � p �a�e_ Owner _ � � /' �J � N9RNEBS'COMPENSA710N DECLARATION:1 heiebv affi�m that.l hare a cerfifiaate ai cans.nt m sNf-in:ure,ar a certdica�e ot Worke�i Compensatian�nsma�e,or a aeruiied rnpy tfiereai�ISec.3900,tbO.�C.1. "' � -P � � � c - _ ❑Cer�itie�rApyiFhereby�furnis"Fed. . ... ..... . . .� . ... -.'.. . , , 3 - 6 .. . � - � .. ' �: . W ❑Cerphed copy is filed witA the Budding Inspectian Oepartmem m pepartment �:��GRAD�NG - � CERTIFICATE OF E%EMPAON fROM WONKEHS'COMPENSATION INSURANCE:This sectiun need imt 6e comple�eC D ��f the Dermil is tor one hundred 157001 or less.1 certiFy that in the performance ot tAe wak rac WnKn��n�: ��;a` ISSUANCE CA . � ,�ermu is�ss�eu.I shall not employ any person in any manner so a:to-6ecame wbject m 1he Workxi Canpensation M� � _ '.aws af Califorme. . � - W,�, o ��e � . p��� � PARK FEE � �TICE TO APPLICAM:if,at�er meNing Mi e«urj� � � ,,�„,n�,�,,��„�;�,�„��,b,�,,, .�-�SCHOOL FEES � - CmmDemadon pravisian of ihe Le6or Cade,yau mmt farthwith conply wipr saA pravispm a thia pemiit sh� � 4' �2 Ct211kA f8Y0�tEd. � � �INSION OF INDUSTRIAI SAFETY PER T f �� 1 �' W ��,�� ���Q o ❑�here6y certAy that iro BNC3V81 e or e t i yEp111�to whieh a pusm is nqwred to da�mid, � � wiil he made rn connectpn with work euthaaed by ihis permit and Ihnt nu huildip struetura,sGfhlEiag,fil�wvork, _ w demolition or ai:mamm�q�nereot. waree marc tlwn thirry�six I�)feet high.(�V.9.1.Gry 2.Art 2.Sec 2- 341,TiMe 8,CA.C.i. � A k:s�}" 'I `) W GIT'� Ci- C,�:",�vi-,;t�.J ..,�:� S 3 ❑As awner-6uilder.I wili�.v�tb��d�14p,fp�ylfrT,��a permit flom i�e DiVispn of • �—. inUustrial Satety,as notM ahove,unlas such'oers`en has a Oermu t`o'Jo�utA mm the divisqn. � W ❑a�,s,�m���„���sa�ry��„� TOTAL FEES � � CWSTPUCfIpN IENDING At�NCY:�Aerehy�Mro rtwt�here is a mnsauction labinp aqency for Me pqkmunte f Z of tne work ta wA¢A this permit is iswed ISe�.3097.Civ.C.1. � r � �e��r's Name COMMENTS �� mLender's Add�ess "= CEHTIFICATE OF COMPLIAhCE ANO AUtFqIpZAild1 OF EMAY:I cuMy I have rwd Mis appGqtion arW sute va that t�e mFame�ion grven is�arect.I agree ta coeply weh atl xtah�aws�M eity adinanee=reBung�m 6uildiiq � construc�m aulAorize a repns�nutrve o � of Building ad Sahty Lp pner tqun(he preppty . = la w� ve a�ied tar this yermit tor pupox at mak' i tqna. , � � . , y--3c� -�� + ,' tue ot em ar �� RECPT NO._'� PAID BY f� VAU ION WHITE—DepartmeM Copy,YELLOW—Finance Copy,PlNK—Assessor Copy,GOLDENROO—File Copy,GREEN--Applicants Copy :,r` >: — ._ _._ ����� , � , ' � ; :� ���� ������������ ������ � ����. 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