HomeMy WebLinkAbout096 (10) ''�` �` �I�'Y OF DIAMOND BAR "��'' pRESS
� x-�"/' Cr��ARTMENT OF BUILDING AND SAFETY � F�RMLY
-� BUILDING PERMlT
JOBSITE -� ,� � APPLICATION PERMIT � USE�
ADDRESS ,�� .��.k ; C.�� DATE ,,,.,� NUMBER �'' '' CODE
ISSilE ` � '��} TYPE OCC.
?� APN LOT � TRACT DATE r��_..1�CONST. GROUP
�� CROS REET �`- "'� SETBACKS ��"15
Z�NIN�
� OWNER —i �RONT RW ❑
�'..�` ADDRES '�' `� c3�, � � REAR�� ❑
;� CIT�+ZJ +��_ZIP TEL. �-3/3� I I SIDEfSIDE 5T'REET _RW ❑
�� APPLICANT TEL. �--� 8lDE ❑
:ae —
K CONTRACTOR SFWAGE
❑ PUBUC PMT�
;� ADDRESS DISPOSAL ❑ PRIVATE S�.FT./100 GAL
�u CITY ZIP TEL.
'r STATE
�:� LIC.NUMBER_ GRADING ❑ CU.YDS.EXC. CU YDS FILL
n ARCH/ENG/ � N�'E �� � FACTUR F'S ADJ. AREANALUATION
•"' DESIGNER ' W 1— .!
'� ADORESS LL 2
��
� CITY ZIP _TEL. (� 3 _
� PROPOSED USE + � ��� � � -k� ''.�- Z a
� � ' � 1=F� _ �` � GARRGE
;� NO GWEL. NO. Np� � PORGH
� UNITS STORIES BEDROOINS
�:� LOT DIMENSIONS m VAL'JATfOfV�. ADJ.AREA
1� NO.OF BLDGS HOW c�UAPlttTY p�$(,',RIPT1ONi FEE
�y ON LOT USED Q
� � �� �
�;� i � _ x,�`Si:�A- Si ��i(!� :/�.`"C(�_.1^ ,.
!ICENSED 30NTflACTORS OECI.AflAT;ON I hereW alhrm ihat I am Lcr,nsed under pmv�sions of Chap;er 9 kammennng ��
�;_ �9 SecLun i000;�!Oiwson 3 ut the Business aM Pruless�ons Code,and nry hcense is in 1u11}orre and eHect W i''
'� � W _��_
�_ fhVNER L+JILUER CE0.APFTIOk I herehy aflirm ihat I am exempt hom ihe CoMracior's Lrtense Law lor Me followmg �
2 rasor:Set 7031 3 6osiness antl°mfe55ians Cade Any uty m eoumY whRh reqmres a permt�o wr.strxt (��
b n:mr npiove,:Ir.mclish,or repau anY slmctwe,pnor lo rts rssuance,also repwres Ihe uppLcant(or such pe�md I .2` —�
t- to fde a siynr.J s�.r.ement that he:s I¢ensed pmsuan�to the prnuisions e�the Cantractor's L¢ensc Law IChaptc� [(y
��?¢mm�encing Hr.h Sectron;p001��Onision 3 ot the 8usiness anA Pmfesvans Codel or IhM hr.�s eeempl�hemirom� '�
i:t�un][�e 6asis�or ihe a�le,etl ewempuan Any violatmn of Section 70315 6y anv app6ca�u foi a permil su6jects� �
�� '�ie ap;�n,-.ant-r.a cnil penahy ol nm mare Ihan five hundred dollars�S5D0)I -�`# -
��� �II rs o�.vre�nl�se prnpertv m mv employees wnh wages as thert sole compensa6on,will da ihe work and�� ��-i---
�� Ih¢svuc�wo�s nnt mtendetl ar nHnmd far sa�e�Sec 7044,Business and Prolesswns Cade The Contraclo�'s Lcense i eZ I
j;� Law does rai apO�Y�o nr owrei nf property who 6wlds or imp�oves tAx�eo�,�nd wha Ace<SUCh yyo�k h�m5�lf �� (.)�__
!;� a�:YrnutA�lis cwr rmpinYr.es,U�o�+ided[hat sucF�mD�nvemems are not mlended or ofhred fcr sal2 II however � �
Co�ire Cmir.inc cr imprerenem is sold��vrthm one year ol complenon.the owner-6uilder wdl have fie 6urden a1 pmring �Q�. --�
�?�tl�n1^,e A:d nm hmid nr impmva for Ihe purpose af sale 1 �� �, Y�
r�7 i�.�1 a�owner�it iEe propeny am euluvvely coNracnn�wrth�icensed ecnvacNrs�o consnuci 7ne pml�:�ISec ��
e:�
I:ISG,Bnsiness antl Prntessions;ude The Conlracmr's Lmense law does not apply to an owner ol paper:y who S�
.iC bwlJs ar�mprovev therean,and who contracts for such pro�ecfs wrth a comractorlsl�i.ensed pwsua�t to the Cantreetai's .
"=i��tzf5e�^�� � ;CONSTRUCTld�t�)
;��C��a���,�mp���oe�Sec B E P.G IAttach Ceruf¢etel ���,i.PLAN REVIEIN � "�),��
gp�I:atc Owner j �r
�L�C�I V...__-..��-
:i� 'MIRKERS'COMPENSATION OECLpflATION I here6y a11i�m thai I haue a cerUf¢�te al tonsen� �o sell-msue,m #
�0 a cerdficale nl Nqrkeis�ComDensation Insuran[e,or a certihea copY�hereof(Sec.3800.La6.C.I � PLUAABING _._
e:� I s
� ❑f.end�ea copy is herehy IWnrshed. I � MECi�"�p1N�Ci/4L
.'L
a7 I❑f.eruhen capV is hleA.vnh tnz Bwl�mg Inspecuon Departmem or Oepanmem � d GRADING _
,.0�
�2 CEHTIFICATE Oi E%EMP710N FPGM WORNEflS'COMPENSATION IRSUflANCE This se[non need not he:ampkttd Q��SSUANCE
�a if;he permrt rs lor one hund�ed(EI00)a iess I wruly f6a1 in Ihe pedormanee of Ihe wo�k M�whah tMs —
t.o
permit a¢sued.I shall nat employ any person in anV mannr so as m 6v.come suh�ecl la thz NbrFers"Compensaton gM�p
F� Laws M CaliMmia � W
�� �. : .. �.:.. ��PRRK FEE
c� Dam Applxant' • '. • : ...�
�� NUTICE TO APPLICANT II.after making ihis Wnifiwie'.,qf�EMemptwn,you��s6ou�1 hecame sub�Ec!m ihe Worker's �"'t.S�i�"���.L FEES
-.J_+ Compensae�m provisions of the LaCor CaGe.you musl(6rthwith coinDN�vJrt��such Rdyisions er ihis permn shall
��-I he deemed revokal ------
a'�
i'y- pViS10N OF INDUSfBIAL SAFETY PEAMIT CERTIfICA71IMl.,, � ��;,.;,,. ---- —
�� C.I�ereby�e��dy thal no excavatmn Irve(Sj diwR•�(�el m deptf�mto�wAmh'�a'person is mpmred to descrnd,
�� will be mede m con�ctpn wnh wo�k aulhor¢ed by iliis permrt,and Ihal no huddng euuaure,scilfddinp,(a�sework, �
��- w Aemoitlion rn dismanthrg thereoF,will he more than thirty-sir(3fi�leef high (pnp 3.2.Grp 2.Art 2.Se� ___
:ie 3C1.T�neB.CAL1
��
_c :.' ' � i� �.. .�.' . - - � '� _,
?iG ❑As owner�bwlde�,I will ro1 emplay arryV�e�to do work which waM rEqhun'a pernlii'hom Ihe P��sion of
�•.- InGrsi�ial Sxlety.as nohd above,unlesa sucF�person h6a a pamii lo dG such'work'Iruin Nie�7i+�swn —
•.F
_; ❑pnsim of Indusvial Sakry Rermrt Na TOTAL FEES
��_ �.-�.
CONSTRUCfION LENUMG AGENLY�I heehy aHirm that theie is a cansrtucWn IeMmp apox.y iw th pe�fermence
�r ul the woiM tor whrth mu permit ie�saued�Sec.3097.Crv C.) .
°� I.ender's Name COMMENTS =�� �-�� r - 4� ���_
� Lender's Add�ess ' '
d] - .
�� CEflTIFICATE OF CqNPLtANCE ANO AUiHORIZATIW OF ENTRY�I cerrily I have read Mis applitotion and stan �
u� thal�he inlormahan�pven is�areq I agree tn camply wtlM1 all stao?Iaws anA nty aidimnees rel�liiq to huitlinp �/� �;,•' ..�k-(� ~v..r�. ��� �-•.=� "��'r �-.�� � �
�,� can a rue a rePresenWtive al the Deprtmenl ai Buildinp md$a}�r 7o p�q���e p�r1Y �-' �,J .
_�_ lo which I have applie ihrs permn r iryose o�makmg inspeawns, � -::���
�.� .:
�J
yg��'�e a'�o�� ��� 3 �rc� � RECPT NO.---.�-����PAIO BY ��.�J �� �'VRE_IbATiOM
_�
WHtTE—Department Copy,YELLOW—Finance Copy,?INK—ASsessor Copy,GOLDENROD—File Copy,GREEN—Applicants Copy
85106-11/89
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