HomeMy WebLinkAbout101 (5) , . �'"'"".
''�` �iTY OF DIAMOND BAR pRESS � �
`�; '•" � DEPARTMENT OF BUILDING AND SAF�TY
�� BUILDING PERMIT FIRMLY
JOBSITE r� ` / APPUCATION PERMIT USE
ADDRESS 1 �� �7 • ��=�/�1�,0 ��--� DATE _�.L�NUMBER � � � CODE
lSSUE t + � ONST. �-.; ROVP �-�
a APN _.._ LOT�RACT DATE
� CROSS ST ET SETBACKS ""P"o"E'"E"rs
� � zONING �ONT_..�_.� .-� ❑
OWNER
o ADDRESS_� L .� ,�_ REAR_ _ ❑
W CITY �o Z �� T�L�� �� SIDF/SIDE RW ❑
a APPLI�ANT '� TEL d — SID� ❑
� CONTRACTOR � � �� � ���— SEWAGE
o ADDR S ' 4 � .`����,r DiSPOSAL ❑ �BLIC PMT�
� CITY Zi� TE1:..�GC_.✓—CG ❑ PRIVATE SQ.FT./100 GAL
= STATE /,f;.,-� �
..+ GRADING ❑CLI.YDS.EXC. CU YDS FILL
� LIG NUMBER lU`"� ._
ARGHi ENG/ t13
TYP� Q FT FACTOR PS AbJ. AREANA�UA7lON
f/.1 ...r..� . ..
`=' DESIGNER_ � 1 __ _ ��'
� ADDRESS LL. 2 M
z CITY ZIP TEL. (� 3 '
� PROP05ED USE FYL '"" C�''�� `� tz-- � 4
� � GARA
o NO-DWEL Na. NO. � ?ORCN
y UNITS STORIES BEDROOMS_.__..—.
� LOT DIMENSIaNS m VALUATION ADJ.AREA
o NO.OF BLDGS HOW QUANTI7Y p�$(„�lPT UN ��
W ON LOT_ USED Q� t'j .L7 " I L-�- , �S
� . �
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~ L E. 7 CONTIiACTCRS OECIAflATION:I herehy aflirm that I am licensed unda provismns ol Chaptei 9 Icammencmg �
¢ nn'�Sec�mn'000)of;nision 3 c1 the Basiness anA Professions Cade and my IKense is�n full lo¢e anA eflacl W
3 � ( uJ _�
� RJVNEH BUILf]ER 7i�LARA710N I herehy atlnm Ihat i am exemo���am the CmVacmi s Lrtecse Law lor ihe lollowing
�� -r�Ser, ?OS�5.Busu�ess and Pmfessmrs Code any:ny ar r.ounP;wh¢h mqm�es a perme ta canstruct, (�
Oowr �mpiove :le,^�oLsh,r.r r¢par a�ry slrucN:e,pnor lo ils asuance,also:equi�es thr,dfDl¢an[far such permit Z� '
�- tu'de a signed siatei^ert ihat he is hcensetl pdrinant ro Ihe prwrsmns nf ILe Contractor'S Lirense law�Chapter ep si
� 9•r.mnmrnary.vtn Senicr 1GOOi ni 0!vision 3 el t�e Bosmess and Piofessions Codel o�thar he is wempt 7herelrmn �Y----
X ,r;c tl�r,havs!cr t'�r,alleged eaeinoeon Any vialation al Secnon 7031 5 by any app6cam!or a pnmit sub�ecls �� �
... the ao;hcan:to a rrva perally ol no�;nore tMn five bundred dollars IS5001 i� �
� ���i,rs mv�.er nr ihe pmpe�ry ci my emp:nyees with wages a:pieir sa!e cnmDPnsa!�on,w�ll du Ihe wark and �'
;he stnrtm�e a no*r•ten0ed cr oHe:eA lor sale;Sec'.d14.0i�smess and Pmfesvrons Code The Cunlractor�s License ¢ �
� :aw Joas+m a77'Y:C Bf�OW02f 01 710pY.f1V���CWIdS ar�mpioves Iherton,and whu dres such wmF hmuell (.1 •—�
••• �_; tl•c;uuh biy�w•+erplayees pmvided!ha:such impmvemen!s zre nat intended n oflereA Im sak.I',howevr.r �
m ihe Cinldinn o•�:nprnvemen;�s snid wahin one year r.l completmn.,he own=r�6nlder wil!have Ihe A�rden ol promr,p e(
y Ihat he A'il�ot hu�lA ur in0��ve'or:he pufUose o!5ale 1 �
h ❑I,a�owne-�,t r�e prepeiro,am eadusrve;y co!nmcUny xnA h[ensed i�ontractors to r.enstmn ihe pr¢ect ISea � ,
o i044 Burnr..s artl Pmfessim;s;oCe�The Cantr�ctor s Lir.ense Law does nm apCly ro an owner u1 Cropertv who �
_ �vAds�i inpra�es Iherenr antl wna contracrs for si�c�proiocts wrth a canhauoqs)licensee pwsuanl to IAe CanvauoYs
Q L�cr.rsr.Law•I I CONSTRUCTION _ _
0
� ❑ �m exempt arua Sec ,3 8 PC.iAltach Certihca�e! �PLAN REVIEIN
p Ilatn� Owner ELECTRIC
� 1YDRNEflS'C7MPENSAiION DECLAflATION i herehy�Ihrm that I have a cerlihcate af consent to selbin:ure.w
a cern+care ot'Nnrkei<'Compensabnn Insmanoe,or a cendied ropy�hereo�ISec�80U,lah C I PLU MBIR7G _
0
Q C ce:eF�ea��Y isherebV�w��shed J MECHANICAL
o j�Cerul�eC;opy�s filed wnh tL•e Buddmg Inspe�eicn Oepartmem m OeDarlmenl d,_ GRADING
W — ��f�
Z CEH?iFI��TE OF E%EMPTION FFOM\NORKEPS'COMPENSATION iNStIRAN:E Th�s settion need nol he conpleted t7 ISSUANCE /�3�LIV
� il ne gena�! s Por one nunAreA i51001 nr less I cr.rtAY thai m�e DeiPormance ai the woik for w�K��h�s
�
� pern�i.s�ssued shall nat employ a�ry person m any manMr sa a ome xih�e�t to the Worker'C pensetian S`M��
� �a,vs°'r���o,� . __ � ' w pARK FEE
� ' Ll1
p Uate / � ��—anoi�:a�. • � .l1— SCHOUL FEES
� NOTICE TO 0.PP!ICANT If,after makmg Ihis Cer66cate ol Exemptior.,yw shauH kcame xuh;mt to the Wmker's �
f,mnpensalmn prwisions of Ihe Lahor Cnde,yau must IortM.wth cm�ply with such pmisions or th�s permil shall �
� Ee deemetl revaked -
J
� IHUISION OF INf]USfNIAt SAFETY PENMIT CENTIFICATION
W
� ❑I Pemlry�erufv ihat no escavalion live 151 or more feet�n tleD�h imo whrtA a cerson ii reyuireA io dacend U A U � � ��ll�
� will Se made in conneuion wnh wmk autlwmed Ly tliu permi�,end that r.o huilding slm[ture sca}falding,lalsework, _ �
a- cr demolnion or dismantlirg thereol,will he mme Man thirry-siK�36)�ee1 Aigh IChap.37.Gry 2.An 2.Sec
W 3411,tle9.CaC1
3 uAs owre��6wldm,I wdl nol employ airyofre�o do wark wAah woultl reqm�e a perm�t ham me Oiwsan ai � ��YY �f DIA 1 �
� Industnal Salety,as nmed above,unless such persan has a permit to do such worM iram M¢drvi�ion
� I � $UIL�ING A.ND
W L�Owsun nf Industriai Sahty Permit No TOTAL FEES �5 , q 5
� C[INSTRllfTION�EN[IMG AiENCY I herehy aHirm Iha�there is a comtruthon 4ndi�epe�Y�w�PKb���
= oi ihe.✓�ork fnr wh¢h ihis permn is rssued(Sec 3097,Civ C)
� Lendor�N°"'� COMMENTS
mLeMn 5 Adtlress
4 CE(ffIFICATE OF C.OMPlI0.FCE AND AUTIqqIZATIOM OF ENTRY:I c.nvfy 1 M1ave rwd ihis applicatqn and sbk I
w �hM the informatmn grvPn�s correct I agree ro comply w�fh all sbte laws and eiry ordinance�relatinp ta 6u�np ! �
� construcuon,and+ orire a represenlatrve ol the Qepartmeirt M BmWinp antl Sately 1n �qen Ihe p,o0erty
= for which 1 have red tor Mis pe m�t For ihe se makmg�nspectuns �� �N� �_, I _
�-- X ,� � ��
Sgnatme o� �Kam ngent pa I RECPT NO. PA�D BY VALIDATION
WHITE—Depattme py,YELLOW—Finance Copy.PINK-0.ssesscr Copy,GOLDENROD--File Copy.GREEN—Applicants Copy
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