HomeMy WebLinkAbout1323 (14) . ..,...� .... .-.: '..,-....a� �.I.- .. .- ...._...._.�_.. :.....:. .....�.. . ..... .... ... ._ _.. t . . ...
'"` CITY �OF DIAMOND BAR PRESS
'••" ' DEF�ARTMEIdT OF BUILDfNG AND SAFETY
-� BUILDING PERMIT FIRMLY
JOBSITE �.. �. . t r� APPLJCATION �, _. �� RMIT (-�'.. � SE
ADDRESS• �- ' ��-��'• �'1?L•�' DATE NUMBER ` - � CODE
ISBUE t' ,� TYPE OCC.
�'- APN L � TR T DATE � ' W' CONST. GROUP
" CROSS STREET :'�t',?�y�-f7�--`�•'"%�� ' ,'� — SET�ACKS ' "s�°ae""e'."s
� ,�,t� . ZONING
a� OWNER � i,. �,... ,r 2 t ( ,'. ��',z'�._ FRONT RW ❑
ac �, <��E;;C%�r ' ti _b`�. _�1 „ REAR ❑
�� ADDRESS -
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�; GTY -� � IP��'�TEL. .� SIDE/SIDE S7REET RW ❑
C f APPLICANT TEL.� � L ,% SIDE ❑
�� CONTRACTOR '�'' C�"L `,y�"�"L`<�.�.. _ wr�.�X'Y3�"-
�,� �— SEWAGE ❑ PUBLIC PMT�
�; ADDRESS "rt���� •'�'�`-' DiSPOSAL ❑ pRIVATE SC].FT./100 GAL
�, CITY ��}-�' ZIP�;1_l��.TEL.� `"
�= S7ATE GRADING � CU.YDS.EXC. CU YDS FILL
�y LIC.NUMBER
V' ARCH/ENG/ {(y TYpE Q FT' �AGT�R P AL�J. R UATtON
a'- DESIGNER w�.�1.�L'-�� W� 1 .�' . '� �;•• - � .2��Gc.��.L.,�
�' �DDRESS It 2
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�a CITY ZIP TEL. (�} 3
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s: PROPOSED 11sE�,.$:a�xs . 4 _
� � GARAGE
� NO.GWEL. NO. NO. � PORCH
°" UNITS STORIES BEDROOMS .
=" m VALUAT60N � ' � 'r�'� ' --� ADJ.AREA
o� LOT DIMENSIOIVS
�� NO.OF BLDGS HOW y QUANl'ITY p�^,�CRIP7"IOI�I FE�
�� ON LOT USED Q
ae CT
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F'- LICENSED CONTflACTOflS DECLANATION I here6y allinn that I am Irtenacd undei piovis�ons ot Chaptei 9 Icommennng U --
y= nrth Sec;:on 7000j nf Oirismn 3 0l Ihe Busmess and Pmlessions Code,and my fcense 3 m lull Imce and effect I W
C:l � _�
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u_ q4VNEN�BUII�EP.�ECLARATION�I he�ebv alhrm Ihat 1 am exem0��rom ihe Contraciar's L¢ense Law for�he!dbwing -
rensar(Sr.c 1031 5 Business and Professians Code Anp nry or counry which reqmres a pnmit m cunalrucl, (!}
Ca a,ter,�mp�oue.demol�eh,or repau any 5lmnure,priar ta ds issuance,also rzpwres ihe appLaam(or such permit Z — —
�� tn hle a signed sta�ement Ihat he is lice�¢ed pursuam ro the{aavizians af the Com�acmr's L¢ense law IChapld �m
Q. 9 I�ni-men�in9 wnh Sauon 70001 al Oivismn 3 M the Businass anA Prolessions Cadel ar Ihat he is exemp�therefmm „S
p: anA ihc hasis fai Ihe allegetl°xempuon Any riolavon o1 Satian 10315 hY any apphcant!a�a permit su67ects �
�:i th�apUirenm io a uv�l penally of no!moa ihar live hurdred dallars(25�01 I Q
C�' ❑I ns mvncr of the orooertv or mv emoloyees wrth wages as iheir sok rompenaa6on,wdl do iM1e work,and —
~ �he snucurte is nm mrended or afhretl for sale ISec 7a74,Business and Professions Code:The Controcmr's License I s[
vp Law mes�nt apply m an owner at OraOerry who 6uilAs or improves thaeon,and w6o does such wark himsel( i (,� —.
�� o� di�ouyl•nis owr emplayees.prov�ded that fuch impravements arc not inlenGeO or Ofle�ed for Sak If.howerer. � �
�S tne UwIAinS nr impmvemeni is sald withm one year ol canpleuor.,Ik awnm6u:ldei will hart ihe hu�den of poving �
� nini he did not bu;ld nr impmve lai ihe Durpose af Sale j
�o V
a� CI as ewner ul tne properlY.am ealusrvely contracuny wi�h,I¢eris¢d conir�etors to[onstruct the pra�tt�(Se[. (y}
Cy JfIM16.Business and Prolesmoia Code The Conuaclar's License law does not a00�Y lo an awne�o�D�oDanP w�b '�S,
Ze Eudds o��mprrnes thweon and who camracls foi such Dro�ects with a oontranalsl licrosed pmsuam�o the Camracmr's --
�� Licensz Law I t„CONSTRUCTION
ui � /� _
h„ ❑ �an enempi unAer Sec .B fi P.0 I�'Itazh Ceruhcalel PLAN REVlEW •-�•�-�'"'"
c Oate Owner
ELECTRIC
�� KpRKEHS'C9MPENSATION DECLARATION�I here6y alfirm Cu�I have a cerLf¢ate of conxnt to xll-insuro,or pLUMBING
a.r.rbfi le nf Weekers'Compensetion Inswanee.or a cxtNied copy thaeol fSec.3800,lah C 1
e� endied capy�s he�eby famshed „�j MECHANICAL
ae
d:
Ci, ❑Cernhed nyY�s filed wnh ihe Bwidmg I�pe[lion Oepanmenl o� Oepartment � GRADING
ui (�
�� "EHTIRCATE OF E%EMPTION FROM WOflNEflS'CaMPENSAiION INSUflANCE This seclmn need nct be completed ��NCE ' -�='`'��
C4S� �I ihe pnmtl is lar ane hund�ed�5700)or less I cedify Lhal in Meµvlo�mance d the wwk for whKh!his
iii
permit is iswed.I shall nat employ any Derson in any mancer Sa a5 t0 6¢COmE wb�6ct iPlhe 1HRkers'Compensalwn �'M��_,,,.. •�
►" Laws of Caldorma � � �
c r�'r.�-•`� �'• ,,, l�y,(y�p,r,.. � PARK FEE
C� Dare Tl�� r 9.�J Appli�ant i � C-i'3L'- \
ui NOTICE TO APPLICANT II,af7er makmg ihis Cerhfkate oF E�emp ab.you sAoutl hecame slib�ew..te.ihZ tt6rker's �- SCHOOL FEES
-; Cunpensauon pmviswns ol the Lahor Code,you must talhwilh c O�V H'��h suC�prwisbns m Ihis permil shall
'+• be deemed rewked „i::.�-'.:
Y�
qV1510N OF INOIISTRUIL SAFETY PERMIT CERY�IFI�i4fI0N:'.` �•,:
oc: , . ,'"���..'
C� ❑I he�eny cenAy t6ai no ex�ava�an Irve 151�br mde 1eM m de0�h m1u which a perso�is ieqmred ta dxsand.
a: will be maEe in conne[tion with work authorued 6y Mis perm�t.and thal na 6uildmg�vuctwe,stalfddinp•taltewark,
d• or demolibon or dismantling ihermf,wdl be more M�n�hirty�su(7@I.feet hph.IChaO.32.Gry 2.An T.Sec
_� 3M11.TitleB.CAC1 r? '��`��^�t
3: �.A S St � `yE i..; ' �
3� ❑As owne�-hwldei.I wil not emploY dnWU�ta�da wark wnich wwld reqwre a permit hmm Ihe Oivision d
F.-. Indusinal Salety.as noted ahove,unhss�uch persan hes i permt to do such uvork Imm.Nrdvisian.
�� `. ..� ' �.:
LL; ❑Unsim of Indusvial Sahry Permit Ab " � ' � ' TOTAL FEES - '
d. >
CONSiRUCTION LENOING AGENCY:I hereby'plfirm.Mal��e is a ctlnshu�uan lendinp percy for Me perbrmrice
� ot tlx worY lor whuh tliis permit is issled IS�t.309I,Lrv C.1
�i �eneer's wame � COMMEN
� Lende's Addiess , ry -°d�'l� �
V
a� CENTIFICATE OF COMPLUINCE AN�AUiFqRIZATIdV OF fNTIiY 1 ceMy I luue reaA tAis�qiufim aiM s�m �� . �•. a 4,i
u.i !nai Ine infamaiian peen is carcn I agee 10 mmply with all staoe laws erd c�ry oidinarwes rWtinp ro hudd'nq "°�
�� construnwn,and authorae a repmsematrve o1 the Deqertmml 0)Buildinp and SaMV b mM�pm de WWerN ' � �
_; far wh�ch I haverpPdkd ro�Ihis perm�or tM pupose ot mekieg inspaelions, � � ` �
~� � c�e� tJ� .ef .r�
X �` �,- �-t�"'• �,��<�.._. f> �� '
i sionawre of Mditam or aqen� p�u — RECPT NO. PAID BY e � VALIDATI
�
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assossor Copy.GOLDENROO—File Copy,GREEN—Applicants Copy
B;S106-ti/89
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