HomeMy WebLinkAbout182 (26) '"� CITY OF DIAMOND BAR ,-�, PRESS
� �� ' ' ��DEPARTMENT �OF BUIIDING AND SAF� � FIRMLY �
�� BUIL.DING PERMtT � � "
JOBSITE APPLJCATION /' � �PERMIT USE
�D�RESS �35 S. Leyland Drive 25 DATE �! ' � � NUMBER� CODE
!SSUE TYPE OCC.
e;� A�N LOT�TRACT 4� DATE CONST. GROUP
" CROSS STREET_ Grand & Di_amoncl Rar
SETBACKS ����
="- OWNER___ _Rrama 1 Pa T.imj,teLj ZONING FRONT RW _❑
�� ADDRESS �ne Park Plaza ��11d0 REAR ❑
" C!TY Irvine ZIP 92714 TEL. R S1-3� 1 SICE/S{DE STREET RW ❑
�'•� APPLICRNT New Plumbing TEL937-��7� -- SIDE []
�•�
:�-
;� i3ONTRACTOR New Plurnbing Cnntrartnrc_ SuC_, SEWAGE
�'� ADDRESS 2300 F.. Orar.gPwnnr� AvP_ DISPOSAL � PUBLIC PMT #
.; CITY Anahpim ZIP328D.6—TEL937-3972
❑ PRIVATE SQ.FT./100 GAL
`-� STATE 426109 GRADING � CU.YDS.EXC. CU YDS FILL
ii: LIC.NUMBER
��� ARCH/ENG/ � NP� SQ FT �'ACTOR PS ADJ. AREANALUATiUN
`•'•'- DESIGNER W 1
�:�
�� ADDRESS
�„ 2
,� CITY ZIP TEL. � 3
6.L1
;� PROPOSED USE c= � 4
���� � GARAGE
���NO.DWEL. NO. NO. � PORCH
,;, UNITS�STORIES BEDROOMS _
�:�I t_OT DIMENSIONS � VALUATION ADJ.AREA _
�� NO.OF BLDGS HOW QUANTITY p�SCRlPTION ���
�� ON L07 USED � �
!� `'� .� Tp,TER GT,QSF.T
i.0 U
�° a �; ��rx TL'B F
I f.NSE�COhTRAC70R5�ECLAflATI�N:I herehy affirm ih;i I am licensed ur,tler pmvisions of Lhapter 9lcnmmencing 1—
�?� with Secucn'/U00i�t Civisir,n 3 m!he Business and Prolessions Code,anC my license is m tull force ard eNeci � � SHOWER
�° ❑ W �� L�IVATORY � „ '�'�
;� InNNER BUIL�ER CECLAR.:710N I herehy alfirm ihat I am exempi Imm the Cuntractai's Lannsa law fur the lallawing - ,1 7 ��.`
.�C reasnn�Sec. /C315.Busness an,',P:ofes5iors Cade:Any cny or county which requires a permit m construc( (} ,��. SI�lK �� i�
i:o :Jlei,icipinve ur.mol�sn,or repair airy stmcture.pnor to its issuance,also reqmres the a�licaitt for such permil z DTSHWASHER •��� J1
�� ro lile a si9red stalenent�at he rs licensed pursuar.t t�the pmvaions of the Cmrtra[tar's Lrter.se La•n�jChapter � ,�
�;� 9(coinnrnr.inp wnl��Secimn'000;.of Cinsinn 3 of�hr.Busm?ss anA Pmfessicns Codei or thai he is exempt!herefrnm � CLOTHES WASHER I
i[� and;n�Aasis br t�e a'IegeA ea=mp�ior Any violatmn at Section 70315:y ary applican!!or a permrt suhiects �
�'� the dPP��-���''n�,^.r�d pr.nalty nl�to!nare Ihan five hundred dollara 155001� -� �� a
�.y °' G S Y M � `� �` I
�?�L�I xs owner i'Ihe pmpeny nr my employees with wages as the��snlz compensanon,will do thc wark,and . •
�_I'he s��nnu�e is rot m[ended cr oifere0 for xalr,�Sec 7045,nusiress and Pro"tessions Ccoe�?ha Contracror"s L¢ense � r HOSE BIBS
�_�i LaH�does nr.•xDu!v tu an nu�ner o`pro,env wha tuiids er impmves thmeur.and who does such wn:k himself, (.3 �
!;V or ri u h h s owr.em rovees,�rewceJ that such im rcvemenis are r.ot intended ni ofkred fr,r sale If,hawever, 7
�i. '°y � ° z [�ATER HEAT�R
���,hr.�uiiciry nr�npr�vemr.r.�is soiA�.vrthm one year oi canpletion �he�wner-huilder will ha�e thz burden nf proving Q _ ������
,;',rial re A�d�n[Cu��ld or inOrove�or tne auryose cl sale.; S
!;��I—I.as uw�er u(ire Urcperty,am erc:usively cnnttactir.�•Hrth:�cens�vf contractois to construct Ihe p�a�eu($ec �
�� '�Mt,6usiress artl Pmfessons Cude The Cantractor's L¢ense Law Aoes r:ot upply to ar.nwnr.r of property wha '�
�= Lwlds nr miprmr.s tlrerw�,and whu conlrac:s lor such pm�er.*s wrth a canr.anmisl licensed pursuant ro the Cartracta�'s �
" Lreense I.aw i CONSTRUCTION '
r.�
i`—'i� '3,i ewer.�pt uimer sec s e PC;anach certi�i�ate; PLAN R EVIENJ
i� Oaie Owner ELECTRIC —i
�� N^JRKERS�COMPENSATION OECWflAT10N I hereAy af!irm thal i Lave a iernficale ul cor•sent Ic self-insure,o:
' d r.cr!�'ir.atr nf Y�Urkers'Coi�pensa:�an Icsurance,or a cerufied copy tl�erenf ISec 3000.la6 C; PLUMBING .�__
�7 r
•� LJ �eni!ied cupy rs here6y f�xnished � MECHANICAL I
n=
i u I �erli`ieA caFY s lileu wi�h Ihe Bu�ldmg Inspectim�,Depanment m Depariment � GRADING
' �C,BTIFIC+.*E OF EKEM�TI�N FaOM'NOflKERS':OMPENSaTI�N INSJRANCE This se�tior need not br cnm pleted a 1 5 S U A N C E � (
;;n I I th.=ue•mit,s`or cr.e hunered;51001 or less.I cerhiy that m the perlormance af the vuork ior which Ihis ti
�7en�in is issued I sh;nl not employ any peison in any manner so as 1a hecomx su6�ec!ta the Worke�s'Compensalion gM�p I
�. 'aws of CaLforr�a
i:7
:� i o��r ADDlreant W PARK FEE
!;� i"107'ICE TO APPLICANT II,after riaking�his Certificaie of Exemption,yau should hecome sub�ect to the Nbrke's LL SCHOOL FEES
�•-� I Compensation Crnvisions a1�he labor Code,you must forthwilh camply wrth such prwisians or Mis pe�mit shall
�•� �he deemed revoked �
� �
�;C i[11VISIUN O4 INOUSTRIAL SAFETY°EflMIT CERTIF�CA710N
i� • �1
�9��I�I hr.rr,hy r.ernfy�hat no e�cavauon five 151 or more Feet�n depth mto which a oersan is repmred m des�end. _ st�f1\�� l.
i=�•e�ill he made m cornecuon witli work authar¢ed hY this permit,and thal na huddmg sVutture,snHoldinq.falxework,
�t`ur demnlinor.nr d�smanUing!hereof,w�ll he morr. then thirly-sir�361 fee�high �Gfiap.32,Gry 2,Art 2,Stt ____
�j3GI,TitIeB.CFCi �`r•, ��
�.
:� LAs ownerhwlder I will nut employ anyone lo do work which would reqmre a permd fmm�he Orvisian ol C1� � �1' �`�e]`��„ I
p—I Indusmal Sa�ety,as noted a6ave,unless such person has a permi!lo do such�hrork fram the divisfon � - � �
1.� � � I
i.0 I L Owision of Industnul Safety Permit Na. �+�,� � I
�t �I TOTAL FEES �� �
�.' f,INJSTRUCTION LENDING A6ENCY I hereby afiirm that there is a conshuction lenbng apency for Ihe perFormance �
;� nf the�vark for which this Vermil is asued�Sec 309T.CN C.)
:°� Lender's Name COMMENTS
�p lender'sAtltlress �
"= CERIIFICATE OF COMPIIANCE AND AUTHOAIZATIDN�F EMRY:I certity I have read mis aOP�uation and st�h
c!� tha��he ir.formalion grven is correct I a9ree lo canplY wnh all slale laws and city ordinanca relating ta hwlding
��I wnstmctmn,anA authonze a reprzsentalive of the�epartment of Bwlding and Safety ta eikr upon Me qtperty
:_�tcr whrth�eep or thrs permit for Ihe purpom of maNi�q inspectmns �
�'— �� % ... � .
; °" �����- � .. s �j
� �%� �-��, - �
i Signatmr.af 'plicsni ar Agent • pa�y RECPT NO.� 1 PAID BY� / ��<-�'�S VALIDATION '�
WHITE—Department Copy,YELLOW—Finance Copy, PINK—P.Ssessor Copy,GOLDENROD—File Copy, GREEN—Appiicants Copy
. .�'� ^ . ' ' ' �"'. .e .
.. ...._ . ; . `"
' I
�/U.�� ,�•— ! �- �9 g�
_ � �;�....�.�...1
:�: -�7i ���� �.� ,
.i �. R� ..� _
- -�'`:f� '�. �'a;�'` �
F
' ' . N ...�` V i 1± ���' . . . . . . � � ..