HomeMy WebLinkAbout151 (64) . ,;� �� , �� .._.. ' .�.. i � � � . . � . :..+.. Ci
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'"� CITY OF DIAMOND BAR PRESS
`4M1" ' DEPARTMENT OF BUILDING AND SAFETY
'� BUILDING PERMIT FIRMLY
JOBSlTE �- APPUCATION F�RMIT U E
ADDRESS S . �(J`N`��00� DATE J J -l3—S'`� NUMBER ,��CODE
�' APN 1SSUE -- TYPE OCC.
LOT�,�.TRACT DATE CONST GROUP
`� CROSS STREET C I�AND�G� � I9SA,�no,�D !3A SETBACKS
°.°; OWNER FADf/�L f$/'?2N zONING FRONT RW ' ❑ �
LL' ADDRESS_2`3�G � l' GI�A���LL Ot REAR �
W GITY�I��r''D t3�}12.Zip ql7LSTEL SIDE/SIDE STREET RW C]
a1` APPLICANT��o���Ko TEL.��� 'SIDE Q
_;
Q GONTRACTOR �;2L��� SEWAGE •
o: ADDRESS DiSPQSAL � �BLIC PMT#
,� CITY ZiP TEL. � PRIVATE SQ.FT./100 GAL
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x STATE " GRADING �'CU.YDS.EXC. CU YDS FILI
y LIC.NUMBER
, P�';: ��1'::�'" �C��:�+� :�t��`11€��1N{.tLlJ�7'K}N: :. ..,
y ARCH/ENG/ Ci�.
= DESIGNER��ND//9 .l°!C F/✓G. W` 1 t�, -
Q: ADDRESS l,?.oL2 UALGG_y V',Z'_Fc*/��,� ��.,.: 2 .�, �
z. CITY (��d;POF..v' CnPol/k ZIP��TEL$9!_22�L � ' 3
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� PROPOSED US � L.Z%►r.TN� c� F�1'L1.2`L/ ✓�o� "�'• 4
�! ��5. —� �,�„�: GARAGE
� x� NO.DWEL NO. NO. � PORCH ��},
y UNITS j STORIES �- BEDROOMS� �;.
�; LOT DIMENSIONS OX. VALUATION `' ADJ AREA
, Q�NO.OF BLDGS /� � �HOW � .- ��� �- �;G�EJAt��r�Y C���Fil��� � �, :�.�
` ' �`��<" �
,Wt�ON LOT� � � . USED ����. � • �
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�: �;W � � � � . . � . .
H' ❑ . .. . . . . ��"v .. . . . . . � .
�, UCENSED CONTRACTORS DECLAflATION:I Mre6y aHirm that I am hcensed uMer pmmsions of�Chapter 9�commenc ng �
+�� with Section 7000)ef Oivisian 3 of ihe Business and P�uhssions Code:and my Ikense is in(ull force�and�efittt ��_- ���. � T��. � 1 � �
�,
3� ❑ , �� .�C.1
�-' OWNER��BUIIDER DEC�pRATION I herebY affirm that I am e�empt(ram�tM1e Contrattor's license Law for ihe Jdlowmg � . -� .. .
x( reason�.�Sea�70315.Business antl.Professnns Code.�pny.Gry.or�counry�which.requires�S permrt�.W.cansVucf ,�f � . �
O; alte�,improve,demolish;or repair any stmctue Dna��to its issuance,also�requires the apphcant Por sucM1 permrt .H,.i�; . '
-i-1 to hle�a SigneO siacement��hat he�is licensed pu�suanl ro.tic D���sians�ol'the�Cantractor's Lice�e.taw'�Chepter '���: � � � � � �
�' 9(commencmg with�SactionJ0001 oi Division$af the 8usin¢ss and Proleufons EOdel or that he�ia exempt tAerehom ,�� .
d; and the 6asis far the allegetl¢xemption.Any violation of SecGon 70315�6y any applicani�tor a permi[suh�ec4s ,�; .�
w; ihe appiMant m a crvl penalty al nm�more ihan fve hu�red.dollars(250061i. 3�:�� .
�. .. : .��. : :. �. ' . ,L1:.: � � � � � �. . .
<�? 01,�as�ou�ner of ihe properlY a my�em0loVeas with weges u their s�e compensa4on.'wdl do the wo�k,arA � . .
���the atmcture is nm intended or oHered ior sale(Sec.1044,8usiness and Pmfesslons Code:The Conirecto�'s Lcense c[- � � ' �
��v law tloes not aODW ta an owner of properry who 6uilds��or imC�oves thereon anA wM1o:dces su[h work himseH "(,)� �
�� ar thmugh.his own�.employees,proviEed Mat sueb imprmemenis aie npt intended:a offered tor sak.�f,howeve Y'�Y,�; . � � � . � ; ,5< �. . , � .
m= rhe hwitling�or improvemem is sold wnhinpne year ol complenon the'avner-6wldsr will.have Me 6uMen af O�ovmg �;.
�� that he did,:not 6mN1 or impwve ta the puryose ol sale.J .� . �� .�.. �: � � ,p. ' .
�ia;� ❑I,as owner�of the property,am e%clusireh�anhactmg wnh licensed rontractors m canstruct the project(Sec ;� . . .
'd� 7044,Business aM Pmteisions�Code�TM Contractor's lvense taw does n01 apply Io an owner of property who T:'�,:. � � � � �� � � �
�� 6uilds oYimpmves thereon;and who comracts tar sucA pr�jecis with�a coniractor�s)h�enSeO pursuml to thc Coniractm s . � . � . � �
ticeose�aw.� ,,;GONSTRUCTION ,:.� t/,.� e f+� j
�� ❑ram e.emp,��ae�s�. ,e.e r.c�an�n cena�eare� ; PLAN REVIEW �•�� � L�1�... �'_�
�� w�e o,V�� ��; ELECTRIC � e'J�
^c,,a� 1MIRKEBS'COMPENSATION OECIAflATION-I heiehy allirm that I have a ceraficate ot wnsent ro self�insure a '� x- � � � � �f�y /�9
:�`�a certifitale of Wo�kers Compensation Insuraixe,or a certified copy iheaoll�.380D,1aE.C.�. � � h��,'PLUMBING � � � /� S�14' �
;� ❑ce«n�ea�apY�s ne�enY+���sn�a �`MECHANICAL
,�,,.y3�;�
o,� ❑Certified mpy is filed with the Building Inspecuon Oepartment or � pepanmeM `+�V C,7R{�[��N�'j � "
W_ .. . . . . , . y : . , ?
� CEflitFICATE.OF E%EMPTI�N.FflOM W(MKERS'COMPENSATION iNSURANCE Th�s section;nced fq�Oe mmpktcd ���CJC,uANCE . .. . ... l,j r Q . t �
� * 1 thepermit it for one hundred(5100)ar�less I certify�that in the�performance af Me wwk for�whicA this . !�
� y4 rmn is issued,I shall rot em lo a �' � z
pe p Y rry perwn m any manner so as ta hecome wb�ect ro the Nbrkers'Canpenunan -----��� �w� �
`- - =��Laws afLaliMrma . _ .. . _��. _. ... .._ _. . ' �°.SM�P..�.._ . �. � ��/�.�. �- - F
� :�. PARK FEE . �
,.�a-oe,e '�ou�a"� lt=��SCHOQL FEES � �
NOTICE TO APPLICANT:If,afler making this Certifkau.of Exanption,you shoultl hemme sublett ro the Wakers , . ' � � �� �
-�- Canpensalion provisions of the Lahor Code,you must forthwrth�comply.with�sah prwisiuns or this pem�il shall ,:�,;-
`�"g. 6e deemed revoked. . . . � . . . � .
a-;
:� qVISION OF�N�USfAIAL SAFETY PENMIT CEHTIPICATION: . . � � . 5 ' � � � � � �
�o� ❑I hereDy centty�hat na excava�ion five�(5)or more tee�in de0�n inio which a petson is rep�gred to descmd �CJT� el' {.lil�el ga�+ti.� ts:�'�� �
-.�; will be mede in conneeiinn with work authwaed hy this permil,and thst no huilding simdure,scaitdding,fakewark � . '�� .
� oc demalitian or dismantling thereof,will 6e more than thirry-six 1361�eet high.�GAap.3.2.Gry T.�Art 2 Sec � RI Al��!11A1f'; A 4 C�f T
i��i� �+i'fa-f—Y 9
. 'Z^ 341.Title 6.C.A.CJ. .. „
43�` ❑As awnerhuilder,I will nat�emplay anyo�to do wod wAich wouW mquiro a permit iran Ne pvispn of � ' �. .. � � �
�1--. Indusvial Satety.as noted a0ove,unless such ce�'wn has a permit to do such wwk fmm the division. . � �
m
.E, .� . . . . . . . V, . . . '
'�, ❑Rvision oF Indusirial Satery Permi�Na � �0��� ���� , �
'.���. CONSfflUCf�N LENOING AGENCY:I heie6y atliim tl�at there is a con3trcetion lend'u�g egeircy tw dce pertormence ` , �„�. �
� ;Z;. af ihe work for which ihis permit is issued(Sx.3097,C'v.C.�. . .
':�s. leneer's Name COMMEN�. �� � � � � ��
;�m,E lender's Address � —- -. . . .. . . . ..
�4�; CER(IFICATF OF COMPLIANCE ANO RUTHOHIZATIa!�F ENTflY:I ter6ly I�have nad iM1is appliw�ion and xtah
-�v�� that the infamation given is cwrec�.I agree 10 wmply wilh a�l state laws aiM ciry ordiiunces rei�ting to huiki� � � �� � � � �., ��-
� ;y': constmc6an,anA authariEe a reDresentative of the Oepartment af BuiWi�ry mM Sefety m mter upon Ihe properry � � . .
�:�; lor whi�h I have ap ed to is pe il-I iM1e pwpose ot maYing in9pections. . . , . .. .
.1-rt � , � .. , � . . ' . .
-��T RECPT NO. ,t�� � ' PAID BY �� VALIDATION � ��
� Sign e Applicant or Agent te . �--- � -� .
` WHITE Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLOENROD—File Copy,GREEN—Applicants Copy �