HomeMy WebLinkAbout104 ��. �
�, '`� CITY QF DIAMOND BAR� PRESS
`� '•" ' DEPARTMENT OF BUILDI�IG AND SAF�TY
•� BUILDING PERMIT FIRMLY
,lOBSITE / APPLJCATION PERMIT USE
ADDRESS � � - L��/�D •SS E ��� �TYPE R 1 O �CCODE
` APN ___ LOT�T�ACT E DATE �.�.�.��.Z�._ CONST. �� GROUP�
o �ROSS ST ET .�vnwer.�xrs
zONlNG �ETSRCKS
°�' OWNER - �� FRC]r1T�� RW ❑
� ADDRESS��-'�� �L. L_ �/��.�•�,. +�� � REAR ❑
w ,CITY_ 1�' /� Z �/!�`" T�L, •� ���.� , SIpEi,S{6�"� REE7 RW ❑
a APPLIvANT TE / F I�IDE ❑
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a � e,.., �. i!
a CONTRACTO ���- SEI,MAGE ❑ PUBLIC PMT#
o ADDRE S�• ' �--�;�� DiSPOSAL
y�j CITY Y�� ,ZIp >/ �E��.�✓Iu" t/` ❑ PRNATE SQ.FT./100 GAL
Z ST,4TE / j,G;i[y�� GRADING ❑ CU.YDS.EXC. CU YDS FILL
� LIC.NUMBER_�l _. _
� ARCHiENG/ � �P� SC� Fl" FAG"roR RS AOJ. AREANALUATI�N
`=' DESIGNER _ W �
` R ADDRESS --- � 2 � �
Z CITY Z!P TEL.J �+ 3
� PROP�SED USE ` -�Z —I�-�,z � 4
v . � GARAGE
a NO.DWEL. NO. NO. '�y PORCH
y UNITS STORIES _BEDROOMS..� —
s LOT DIMENSIONS � VALUATIflN ADJ.AREA
o NO.OF BLDGS HOW QUAN7ITY DI�SCRIPTION FEE
� ON LOT__ USED_ J -.:� . � L� � �
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~' UCEN. :f.Oti?BAC'.�RS DECL.lRAT10N I herehy affin�thal!am Irtensed under piovisions of Chapler 9�cammencinp
¢ .rnh Sacuar 7�OOi of Oivision 3 nf ihc Business ar.tl Prolesswns CoCe.and my 5cense rs fn full taae anA elfect �
3 ❑ w
u- �,,'1NNL7�BUILOER 7ECtAHATION i hereby affnm tha�I am e�emp�fmm the Contracmr's L¢ense Law lar ihe lollowing ` ,
rr.aun^•.Sec 7D315.6usiness antl Pmfes:ions Cotle Any nty or cwmy wh¢h reqmres a pernrt tn conrruct (;3�
oal�ei I'1•yfD•.P.,iIY.'11�Ii5I1,i)!repair any slriic!ure priai la ils issuance,also requnes Ihe aDalica�n lar si�ch pe�mn � I
¢ �e�d�a silP�eA s�aiemem 11at 1e s Ircense�punuant to the pmvisions of the Cantia[ror's Laense Law IChapter (� �
pp 9�i�nionr.n�irG�.wih Szr.ncr 7�00;ca Onismr 3 af the 8�siness aud Pmfessions Cadel or Ihal hx is e+empt thereirom �
� nrr.rie h,sis'nr P•,e alleged a.emption.Arry violaimr.ol$ectinn 7D315 6y any appl¢am�or a permrt su6�ecls ^�
� �hr.u7pmact tn a crv�l penal6•ol nai mo�e than irvx hundred tlallais 1350011 a —
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� ❑.,xs mx�er n'ihe prnGer.y o�mv em0%oYPes wuh wages as iheir�ole comDensaimn,will do ihe woik,an0 �
fic sLe.r.urr.is ro:i^lendr.A cr oHe..r.d for sal¢;Sr.c 7094,Busness and I'roless.ans Cade Thx Contrarwr's IICP.IISC c(
vLaw ilas n1 appiy tn an own¢r of pwper.y x•ho 6wlds or im�mves Ihereon anA who dres such work himsell C: ----
w c, io;cuyn his twr emplayees promded that such imp:ovements are am miended m of1¢reu for saie If,hwaever Z
m tl•,r.�::Gdmr sr impmvenenl rs sold N•ithin one year nF completmn,Ihe owrer 6wlder will hav¢th>6urAen nf 0���9 d --
� tlia7�e O�U�inl�u�ld Cr imD�o�e'�r Ihe O���Oose ol Sale i :L ^ I
ri' (.) __.� J
�n ❑I az uwn..�d�he prope�h am eeclusrveH r.omracnny w�ih I:r.r.nsed�omracmrs to consvuc��he pio�ect jSe[ W
0 7��G4 Bi,smess antl Pr�tess�ons�uJe The Cantracmr's Lcense!aw does not apply tn ar.m�mer ol praperly whn �
_,tutlds or:mFmves therr.o�,znd who comrans Icr such prn�ects wilh a contractor�sl��censed pursuanl!o the Contractor's "
"j`"�"'°`a" CONSTFIUCTION I
0
� ❑ ���n e�e�i�;urder Sec B 6 PC iAnarA Crru!icaiel PLAN REVlE�/V
c oaie Owner E�E(�TRIL•
aYJORKERS'COMPENSATION�ECLAMTION i herehy aNirm that I have a certrficak o(cansm�ro self-insure ar p�UMBING
2 cenihr.a�e r 6Wr4e�s'Compensatmn Insurance or a cnuf�ed capy me�eol iSec.3800,Lab C�
Q v � MECFlANICAL
❑"en.rfir,�mpy�s hereC iwmsheA.
o �\enine�copv s filea wnh me BuilJi�g InsC�cimn Ueoar.men�er_ Oeoarrmem I � GRADING
4JJ
� C.ER?IFILATf 9F E7iEM1iPT10N FROM19 WORKENS'COMPENSAi:ON INSURANCE This secuon neea iwt he compMtetl( ISSUIgNCE `—�:�_
� rf?hr permil s'nr one hundred ISID01 or less I ceruiy Ihat m Ihe�z formance ol the work lar whiah th�s i �..�
pe�mrt is�ssued s��all� employ airy person in anp manner so as lo e suh�e[t la IFx Nbr '�Compensaiion SM�Q
� laaao Clor � �
o ������� ,�/ " ~�i � PARK FEE
p liulf App6can �
�i NOTICE TO 0.PPLICANT If,ah:r makmg this Ceruficaie of EMempoon,you sMuld 6eca su6�ect to ihe lAbrker's i � SCHOOL FEES
—+I Coinpensallm provisions ol�hr Laaar Code,you must lon�with camply wilh suh pr is�ons or Ihis permil shall,
� Ee deerned revo4ed ---- s m�
�
� OIVISIOh Of INDUSfNIAL SAFETY PEI7MIT CEATIFICATIpJ.
W
� ❑I here6y ceroly tha;no escawtpn five�5)o�mure teet in deplh inm which a person is required to dxscend,�
swill he inadr.in ccnnection wnh work aulhw¢ed hy�his permit,and ihal no huiding sUuclwe,sca�klding,falseweuk,� �
a�or demnlnwn m drsmantling theraol,will he mo�e than thirry six 1361 leet high �Chafl 32.Gry 2.Ari 2,Sec� _Y_
z�u�,T�nea r.zc�
s
3 ❑ds owirer�hmitler 1 will not empby anyone to do wark which wau�d reqmre a permit hom�z 6vis�on o�: �_ _��� ������N 9 B�R
� Indusv�x SaFety,as nnted ahave,unless such person has a Oermit to Oo such work 6om the division. ---
y�j ❑D�vrsim;al Industrial Salety Permrt No TOTAL FEES 1 11����_�r����F�TY ��� I ��
� f.ONSTNUCT10N IENIkNf 0.5ENCY 1 here6y affirm bat tM1ere is a co�huebon lendi
Z nf the wurk tor which th�s ��M�b��D�lormen[e
permi rs issued fSm 3091.Civ C I.
0
iendei's Name COMMENTS
mLenAe:'s llddress
e CER'fIF�ATE 0(COMPLIANCE AND AU7lI�RIZATION OF ENTNY.I tn�ilY I hex reaE�his applkalian�nd staR 1
sn that ihe mtonnaaon grve s correct I ayee to comply wnh all stak laws end ciry ordiiuncea releung ta 6uikinp
� cans�mctmn.and authonn a representalrve al the Oepartment oF Bwldmg a�Sahry la yqn lM p�operry
= loi whah I have appiK Mis pe�mn �the purpa nspaiions _
�-- X � -- //
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Sipnatwe d Appliran ��nqem psn RECPT NO. PAID 9Y VAIIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
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