HomeMy WebLinkAbout1229 (40)CITY OF DIAMOND. BAR PRESS
DEPARTMENT OF BUILDING AND SAFETY
RtJ1I nING PERUIT FIRMLY
JOBSITE �y 1�r^ r�
ADDRESS CLQ _\� ��1i- ��J
APPLICATION IT USE
_T ���E k5T��PEMBERIG CODE
SUE DATE I ~1 ,�v� ,U TYPE pO-CC.
DATE 2" �►o CONST `FROUP
APN LOT TRACT
CROSS STREET
OWNER �'K
ADDRESS Com iia �� A �-
1i°`£
SETBACKS "VMEN1S
ZONING FRONT RW 0
REAR ❑
CITY V ZIP' 02k TE
SIDE/SIDE STREET RW ❑
APPLICANT A diA \iA� ' 1� TEL
SIDE 13
CONTRACTORSEWAGE
ADDRESS
CITY GL��� Zip TEL,
❑ PUBLIC PMT
DISPOSAL D PRNATE SQ. FT./ 100 GAL
GRADING ❑ CU. YDS. EXC. CU YDS FILL
STATE p 1 1
LIC. NUMBER ��-\"C
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TYPE 80fT FflCii �i PS - AA " REAtV N
1 ,25.60 G 6 S er �O
ARC
DESIGNER `� �
ADDRESS
CIT ZIPXA0 TEL.IOWUM
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2
3
PROPOSED USE `J'TR t
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4
GARAGE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
LOT DIMENSIONS
PARCH
VALUATION 7UL.o `� t n r ADJ. AREA
NO. OF BLDGS HOW
P�S�^l�X
ON LOT USEDo
01JR?+< MY &Scs"PTION
, } pp L 7 ec'"-�• d C)
UCEN ED CONTRACTORS
with Secbon 7000) of IN
CLARATION, I hereby afhrm drat I am licensed under provisions of Chapter 9 (eouwne
stun 3 of the Business and Professions Cade, and my license is in full face and effete
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OWNER BUILDER DECL TqN: I hereby affirm that I am exempt fieri the Contractor's Lcenae Law fa 0u fallowing
reason ISec 70315, mess end Professions Cad Any city or county whish requires a permit to construct.
alter, improve, demolish a repay any structure, prim to as issmase. also mqukes the applicant for sash permit
m hh a signed stale ret that h n licensed paswnt to the provisions d the Cantrat:ta's lirrne law (CAapte
9 (commencing with S torn 70001 of Oidsron 3 of the Business and Profeaterx folies a that h if eaotpt drrefrom
and the basis for alleged empkon. Arty violator of Syrian 7031.5 by airy applicant has a permit suhjecb
uk applicant ro a c 4 penalty of not mare than lire hundred delete ($B00),I.
01, as owner t the property, a my empiayees with wages as tlrir sale camprWsadan, w4 do line wale, and
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tic structure enol inlnded or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's Litmse
Law does not aptly to m owner of property wlw builds or improves thereon, aid who does such work fiberfill.
or thuauuh his awn employees. prended that such enaevementl are not intended or offered fa sele. R. howlwr.
the building or improvement is old within one Vea of compferion, the owner-euld. wit haws the widen of pawing
that he did not build or impaw: for the Purpose of tele.)
01. as minter of the Proarty. am eacluawly tom trachny With licensed contreclat to construct the protect (Sts.
7044, Business and Prplesswna Code. The Contractor's License Law don not apply m an Owner at property who
builds of impmwet Whereon, and who contrui fa such projects with a =[,a wls) licand pesumt W dui Cantrastar's
dcose Law.)CTIO
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Ell
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El am -pt oder Ser . B. b P.0 (Attach CantAicare).
PLAN REVIEW
Date Owne
,
F�j, ('TRIC ��• (�
e /•�
MBING r-., 1
HANICA ! • Q
WURXERS' COMPENSATION DECLARATION I heeM allirm that I haw a cerifiicre of contest h self -port, or
a certified copy UfffN (Sec tLab. C.I.
a certificate of NbWkei Coppentarn Insurance, a I
❑ Certified copy n hereby famished. `l
4�1,Ceslifiad copy is bled with the Building inspecoon DepraM6t L Opiermumt.
CERTIFICATE OF EXEMPTION FROM MKERS' COMPENSATION IfpSIIRANLE This section need nr M completed
d the Permitd, (s one hundred (3 100) o Mas. I cerkiy du' w+gtq a� work 6r which this
permit a issued. I shelf not employ any person in airy matr}s} as eLe1e YlhsLetn' Catrtpensalim-
Laws of California • s
-
ziaiw �j�,��
Date Applicant
PARK FEE
SCHOOL FEES
NOTICE TO APPLICANT 1, at,,, making) this Crnl'yata,ot Eseppmn: yw,,h k be�nr"ai'tq tTr LV4rkr's
Compensatin unavisiws of the Labor Code. youti fptt6wdu lampN'with sufT pro"vaWons.,gr,tpps� permit shat
be domed revoked.
DIVISION OF INOUStRIAL SAFETY PERMIT CERTIFICATION'
01 hereby tertdy that ne excavation lice (5) or more feet in depth into which a union urea" to descend,
will he made in cnnectuun with work authaued by this permit. And that as beildktg stsuctre, ecaF akJft taUrsork.
ordemolition or drmanarg thereat. at be more den thirty fir 1361 feet high. (dap. 3.2, err 2. An 2, Sec
341. Tile 6. C A.C.)
❑As owner -builder, I will trot employ arryorr to do wok which wndd require a press from Phe Owision of
Industrial Safety, as noted show. nlns such perm. las as permit to do sash soak from ft division
❑D ion of lmdnrnial Safety Permit Na.
TOTAL FEES -
CONSTRUCTION LENDING AGEWY: I busbyaffirm tht there is a cartructsoa lending agency 1a tlr perlamruaIt
of the work fa which this permit is issued ISec 3097, Cr. C.).
Laeder's Name
p-��
COMMENTS � �' Q L-1 —. 3 o q
Lender's Address
CERTIFICATE OF C OF ENTRY: 1 cetily 1 hors rod lir apphattetW rd state
mal she mfamaian n I to W.11 slat lawn nil m7 rrlurp fr..
"instruction. as a .ten Oeprt q= rod Safely te M Ips preprty
lor wI.I d fa pen of king irrpece,
X 5yr,n e a t a yen,
RECPT NO. PAID BY WWDA
WHITE—Department Copy, YELLOW—Finance Copy. PINK—Aseeasor Copy, GOLDENROD—F)le Golly, GREEN— Appilcants copy
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