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HomeMy WebLinkAbout1238 (13) ' '�� CITY OF DIAMOND BAR PRESS ��;,Y'�'�' �' DEPi4RTMENT OF BUILDING AND SAFETY F�RMLY � BUILDING PERMIT JOBSITE ��� � � APPUCATION � PERMIT � USE ADOfiESS DATE � NUMBER CODE ISSUE TYPE OCC. r APN L 3'� TFIACT ZS DATE �."-' - � CONST. GROUP � CROSS STREET Sw�n�j� �%� e- .�,,�� °-' OWNER � �- � L / 20NING SETBACKS FRONT RW ❑ a ADDRESS �� -S. 1� G�M(]r r REAR ❑ � CITY D i G it1C'�� RAT-' Z�p GA J9dS��fii�396 .$ SIDE/SIDE STREET RW ❑ o�APPUCANT cl��"'�—YEA� ,L/i{/ 7EL?f�39� S SIDE ❑ x Q CONTRACTOR SEWAGE o ADDRESS DISPOSAL � �BLIC PMT� ,�; CITY ZiP TEL. ❑ PRIVATE SQ.FT./100 GAL = STATE y �IC.NUMBER GRADING ❑ CU.YDS.EXC. CU YDS FILL y ARCH/ENG/ � N�� SQ � ��� �'S. - AD�l. AREWFJALUAtl01� � DESIGNER � � 1 I �� Jr,S� � ADDRESS Li� 2 0 = CITY ZIP �L._ (� 3 � PROPOSED USE z 4 � � 6ARAGE = NO.DWEL. NO. NO. j ppRCH ^ UNITS STORIES BEDROOMS ,= LOT DIMENSIONS m VALUATION � � ADJ.AREA c NO.OF BLDGS HOW QUANTITY DESCRIPTION FEE W ON�OT USED Q .Q C� JJ ❑ � S ~ L�CENSEO�ONTHh.,"70H5 OECIANATION I herehY alfirm Ihat I am licensed imdei prwiaor.s of Chaptar 9 Icammaicmq � wn�Stti�on IQpp1 0l Ci•+�s�on 3 af the Business and Prafes�ons Code,and my license is in tu�l lorce and elFect W 3 .� W LL OWNiF�Bl11l0ER CECLA^nAT10N I here6y afiirm thai I am eeemp�hom tAe Conttacmr's L¢enu Law for!he idlowmg � reasor.;Sac 7031 5 9usrcss antl Professans Catle�Any cny or county wh¢F reVmru a perm0 ro cans[rucc (} o aher �npwve.�emahsC,or repau airy strunure.C��ar m itt isswnce.also repwres�he applicant for such permn Z �= ta Ir.e a signeo sia�ert:arc thai he is hcensed pursuant ta[he Frovimons at the Canvacmr's Liceme law�Chaptn p] � 9 Iccnmenc:ng wiih Secr.on iC00V oi�rvis:on 3 0l ihn Busmess and Prclesvons Codq a�thm he is exempt�herefrom '� d md;�e Casis'or[he alle5eu edenpuon Airy violaaon o�Secuan 7071 5 6y any ap9�icam Im a permrt subpcts � � x ;he aFpLcan;to a cv�l p¢na�ty nf no�more than iive h�ndred dallars(5500i i. a W o ❑I a nurne��I the property.or mv em0�a/ees wnh wages az their saie compenution wtll Go tAe wurk.and ~I ne suuc�::rc•s na��n!e.nded or a!le�ed lo�sale ISec 7D64,flus�ness anA Praleasans Cade The Cmvx�or's L•unse s( �;Law ares nnt aCpv�a 9n awner of pmpertv wno 6wM5 n:momves merzon and who Oces sucA woh himseif. C� �+-� o�throug:hrs awn empioyees,Gmvided that suoh impmvemerls are noi mtuMM o��11erzd!or sak If.Aoweve�. Z ' m �hz hinid�ng or;mF�a�emer.l�5 sald wilhin one yea�af camplelim.Ibe ownerhwlder will have Ihe EurEen ol pronng Q � :ha�5e tlid no�::uJd s impmve lor;he purpose af eale i ' 2 y (/� �� d5 iM'�E:0�[hE QIOOe�IV.dfn t%LIUSI�liY=0!IlfdCtllly WIIM1 I:CEI!SP�COIfVdCI01S:0:A�SifUCf I�E Df01lL1 I$2C �jj � %044 Busir.ess and Prclessioiu Code The Conira�tar's license Law does nm apply m an own6r a�O���tY'H�o S� ¢ hwds or ir..Groves:herean,and who contrac:s Por such ONIeGs wnh a[onlracforisllicPnsed G�su3n1 ro tAe Contra[tar's �+ —7 Q�t�-r��.aw� C`.�NSTRI I('TICl r.J��• /� �I L' am e.emot umer c ,a.8 PS tixh Cernhcat LAN REVIEW �7 Ci�—� ����� 1 �,�•�rP � Caie � � �-� L Uw�er �^''�' —� ELECTRIC ' NASKER$' :OMPENSATIOFI OECLANATION I hereLy a���rm tha�1 ha�e a nndkate oi ocnse�t to sN��inaure,a a cenmcaie or uvarwers Gompensauon Insurarce,or a cxuUee coQY the�eallSec 3800.�ah C.1 PLUMBING Q ❑ v r ;x,-,� ,� ,m � MECHANICAL �enihed co y rs hereh furnshed ,�, ' �' �' <t GfiADING W ❑�endieA copY rs hled wnh!ne Bwld�ng Insqq't!�Jkparqnedt�m'� �Jepanment � ,Z�, CER?IFiCATE OF ENEMPT104 iAOM WOAKEflS'�DMPENSATIpJ INSUNANCE This secuon nred not he compkted A_N�("� , �,�1 y ii tne De�mn is lor one hundied;510�)or lets-i cemly tl�at m the pnlnrmante of�he ww4 for�vhich this � �._. pein;is rssued !snaN iw!employ any pe�wn m ar.y manner so as m�mame sub�ect Io Ihe Worters'Camcensauw S(N •�'j� o I Laws of�a!rfarma .�3 a� � q ,ry �;J� � ,� E���� W PARK FEE o�ca�e ''�o''°'^' u- SCHOOL FEES `L NOTICE TO�PW ICANT B after makmg m�s Lertrfica�e af Exemouon.vou shouM become sub�x�ro�he Nbrkefs � Compensa!�m pmv�sions a1�he.lahac Lode.,you.mpft�aMwith comply with sueA prmiswns a�his permn sAali �+- te deerned revoke.d . . - J • ' w p41SI0N^FINWSTRIALSAFEEV:GEIiMU;.GE�iJIFICATII]N:.;'. , ` - 0— ❑I hernhy cendy Ihat nn ercavaem lue(51 or more feet m depfi�into wh¢h a persm n reqmred to dacmd. s will he made m conneawn wnh wo�k authv¢ed 6y:hrs pelmn and thae no huJding srcucture,safloWing,faluwurk, � nr nerr.ol�unn o,d�smuntlug�hermf will he mwe than IhiriY's�i361 leet high �Chap 71.Gry t.An 2.See __ w 341 LHe3,CFC; 5 3 �,_,'As ownei�0udde�.I will no�empby anyairc io do wa�k wAKh xrou10 requrte�ptrm�from�he Oivisian af r Induso-�al Safety.as naied a6ove wless surh p�rson has a pazmil to do sueh wo�k 1mm Me dvision. � ❑arisinn ai Irousuial Safety Pcrmit No. TOTAL �EES � ) �� � CONSTHUCTtlIN LEN�ING AGENLY I herehy aHiem M�t tM1ere n a tonrnunion 4nAing�percy lu Me perlormantt zof the wo�k ior wmch ihis permn rs issued ISec 3097,Crv.C.) � imder'sName . C�MMENT$ m te��er:nddress Q CENTIFICAiE Of,:ONIPLIANLE�1N0 AIffNORIZATIOJ OF FNTRY I catity I Iw�e n�d this appiratm ad sts4 cn tl�al�he mformauon ryven is;nrect I agree ro comply wnh alt sta2 law:and eiry mdiwices rWup le huildiig ycons�nceon 3M auihome a�eDnsenbMe of the�epxtmeni af BmMi�g a�M Safery m mb upon Mie praperty = hx rxnKh I Aare appl'ied lor t�is,permR lor the pwpase oF inaki�p m ra. r )( �'L���.,� _�,� . ._.r �3/!0 , r �-(,D`� Siqna�we uf ycam o aqm� po4 RECPT NO._]S,_,��PAID BY 4ALlDATIO VVHITE—Departmec!Copy,YFLLOW—Financa Copy,PINK—Assessor Cooy,GOIDENRGD—File Cony.GRFEN—Applicants Cony �. 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