HomeMy WebLinkAbout095 (5) �'�` CITY QF DIAMOND BAR PRESS
� � `• " � DEPARTMElV7 OF BUILDING AND SAFETY
�� BUILDING PERMIT FIRMLY
,!OBSiTE APPLJCATION PERMIT ,�/�G USE
ADDRESS DATE �.�.�.�a.�.�._NUMBER_S,LJ--,LCODE
- ISSUE TYPE OCC
� APN ___ __ LOT�TRAC DATE �� ���CONST. ��_GROUP�
`� CROSS ST,F�EET SETBACK� "°°'�''+�"'E'"5
� ZONING �'
`-° OWNER ' FRONT,� --' _._RW ❑
o ADDFES��`-'/._• �- o_. .. /. Zz:.._ - �� � REA€i� v � ❑
w I CITY_–�L�hJ/ ZIP TEL��',1 � SIDE/SID�. �EET RW ❑
o APPLICANT "„�G°�_T�..���/f• � --- SI�i� ❑
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.� G�N,RAC�T,JO � � "
m T �' --" � - �-='���✓�"--��'. SEWAGE ❑ PUBLIC PMT#
o ADDR S L� ° � ' f% " r DISPOSAL ❑ PRNATE SQ.FT/100 GAL
W CITY�)�? Zi �� _(�TEL._.�°�'�' ___
W STATE 1 ��>,'�; -- � GRADING ❑ CU.YDS.EXC. CU YDS FILL
y LIC.NUMBER �%c-�"�'� r� ,�_ _.
y ARCH/ENGi I � �'�'� �Q FT �,ACT�7p pS AD.ii REAN9LUAtfON
� DESIGNER
� ADDRESS� � �2 '
zGITY ZIP TEL.. --- � 3 - - �/ '
� PROPOSED USE� --��� �`Z--- � 4 �
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� � GARA � I
� NO DWEL NO. NO. � ppRCN
�„ UNITS STORIES 3EDROOMS____—.. m
s LC i DIMENSIONS VAt.UATICJN ADJ.AREA �
o I NO OF BLDGS HaW QUANt!TY DESCRIPT►ON F�E �
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W Oj�l LOT_ USED__ „z
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,I.ICE,S:D�ONTRACT^flS�ECLAAATIO�i I neiehy alfirn ihat I am 6censed undx provrsions of f.hapte�9lccmmenarg F� ��� �� �� .
�1�.vith Secoor i^�UO�or avision 3 0l�he Busmest anC Proless�ons Ccde.anA my leense fs m lull tarce and e�fect W
3I� - - w . -
w fp'JNCi 3UIl0ER CECL'uflATION I heirCy alfirm that I am eRempl from the f,ontrocto:'s license law�ar Me fdlow�ng "—
�rea.=.e�i iSer. %L�315 Busmess and armessions Cooe Any ciiy oi r.nunev wh¢h repmres a permn to constr�t. ',(}� � ' � � • ��
oI nlie� �mp�c.e,r.emoli<h or re.pau zny slrucWre pr.or to::s�ssuanre,aL=o repwies the apphcant tor si¢h germit 'L
�--�m hit e sioned statement;nat he�s 6cer.srn pursaant m th=proeismns of ihe Camraclm's l¢ertce Law IGhaple� �
��9�r.cmnenr.inr,w�tli Sectior 7pC01 0l amsmr 3 af;he Busmess anA Pmtessions Cade�er Iha1 he:s eRempt therefmm � —
d�,anA!hN Lasis+m the aller,eG a empnnn Any molatior oi Se!uon 7p31.5 6y any ap�6aant!nr a pemrt suhjens �
W�Irr a7a��=am ia a avl OPraltv��1 nai more iran hve huMreC Ao�lars�55001 i �
o rJl,a>nwne�o!�he p�oPert�• m my emoloyees w�m wages as rhev sole comDensarior.wdl do iPe wnrk,and —
the sruni:r+�s nm rtertlee ar M!e.re.d fo�sale(Sec 7D44,Cusiness and Proless�ens Code Thr,CnnirartoYs Licr.nse Q
',�"j '.srv Aoas�o!a�p�y ir nn owcer ol prooeity who Cutlds ar•mp�oves ihcrean and who�oes mth svurk Aimselt (}
••• tt thia�nyh�is o�n�er•;:loyees p omdeA that sucE�mprmements aie am��tended or eflereA lor snle I! however �
m v��e tmlr.m?or impro,ement m so�d within one year ef[omplelion.'he owntr Awlder wil�have Ihe hurdvn.�l provinp � _
y ur��ai fx tliC nat hu•IA oi impmve fir;he D:��Fose at sale j r
V� �_l� as rvvnu rr ihe C��PQ��V,am exclusi.ely:o�vacfmy with LcenxeC contraciors m cannruct the pra�e��ISzc ��j,�j
o %044 Busiress aiv P�cfessions Cone TM Comracror s Laense:aw does nm aWly ia an oHner ol y:openv who �
z Luiiox or mo•mes diereon a:d who mnvacts!ar soah pm�er.ts w�th a contractor(sl I¢ensed pms�arn to Ihe Conuar.mr's
OI I i.^.ense Law l � CONSTRUCTION ___ _
W 1.=] I e,n eaenp;unde�Sec B F P C IAttxh Cerufiea�el PLAN REVIEW
f—
p Uale axnar ELECTRlC .
� WORKERS'COMPENSA7I�JM�ECLARATION I hemlry affum thal 1 have a cerM1ficate of cansenl ro self-�nsure ar
a cerD�icale af 4Ymkers�Compensat:on Insnrance ar a cernfied coCv��ereol(Seo 3800.Lab C I � PLUMBING ._
4 ��-/Ce.rrfieA ccpY�s hereGv furmshed � M�(�'�-{Anj����„
o I;CJQ Lendied cepv rs fiie.a wnh the Buddmg Inspectiou OeOartmmt or Depar!mem � GRADING
... •.�
�j CEHtJFICATE ilF ExEMPTION iROM INDAKENS'C�MPENSAT:ON INSIIRANC This ser.lion need nat he compkfed � �SSUANCE L� . �Y 7
y rt Ihe per.n�i br a e hundreA iS1001 or less I cer�dy that in�Ce formance o�[he work lor whi�h this
Ipermn��s issae I sh rql empiny arty Person m any manne�sa as lo me w6�ec1 In Ilw Ylbiker; pensation gM i P
� Laws n/r��� '�a � PARK FEE
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p oe,e r` W � APOLcan • _. U..
� NOTIf,E TO APPLICANT I�,alrer making t�is Gerid¢ate of Exe�npnan,yuu shwld beco�e.suCjecr m ih!SNnYer's SCHOOL FEES
ComCensa�mn prowsians al the Lahar Cnde.yiu must ImMwith co�ro�Y w��h such prmisians or th�a pr.rmd shall
� M tlee�ned revnk J
a
� pVISION OF IN�USTRIl+I SAFETY 7EflMlT CEfliIFILATION
w
d ❑1 he•e4y certdy;hai nn exr,avatmr•ine I51 or more feel m depth imo which a person u rtQuneC!o desemd,
p�e �,xiC Ar made m cmnet��on wnh work aulhaued hy this permit,and[hat iw huilding simcw�e scafMidmp,falsewort,
� n- a den��olninr� o�dismanlLrg iFereol,will 6z more than thirty�su(361 feet high �Chap 32,Gip 2,Art 2.Sec I
W�341.?itiv B.C A C 1 --
_ -- -- �ITY t�� ��A,I��CiI� ���
3 ❑As v+mer�6wlder I will nat emplay anyone to do wark whch woub require a perrtul hom ihe Oivrsun o( y1 1J����� w A�� C���y.� � .
t-- Indisuia!$alety as noted ahove,unleis such person has a permit to do such work from the droision -- -Q�i� �+ r1�1 V 1
�
°C ❑Divisrc of InUusviai Safety Pe�mrt No TUTAL FEES
a � . �
� COM1ISTRUCTION LFNOING 14iE�CY I here6y affirm thal tMre is a construcunn lendi'g egeMy ior tha perPormrrce
= nl ihe wurk lor whan this ce�mit�s issueG IStt.3091.Civ.C 1
� LenAcr s Name
= COMMENTS
m lenders Address
Q CER7IFICATE OF COMPLIANCE ANO AUTiqR1ZATld!OF ENfRY I m7ify I Mre read Mis appGntim and#a�e (
� fiat rhe ndormauon pwen s corrnct I agree to comDN wnh all s�ate laws anE ciry ord� �u rNatiny eo 6uitli�
y conshucnon,anA aut :e a npresentalrve of Ihe Deputment ol BmWing and Sately enler yion Ihe prnpeny
1w whmh I have ao I�e tor inis perme kr the D�Oo kng mspecirons. / !/'
� i� �}e�� {�.< �Y
$igna u�e ot ApD�K �or nymt pBre RECPT NO._. PAID BY VAlI0A710N
WHITE—D artment Copy,VE�LOW—�'inance Copy.PINK—Assessor Copy,GOLDENROD—File Capy,GREEN—Applican4s Copy
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