HomeMy WebLinkAbout1229 (51) k _ .. . . _ ... . , ._.
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'"` CITY OF DIAMOND BAR PRESS
� DEPARTMENT OF BUILDING AND SAFETY FIRMLY
� BUILDING PERMIT
JOBSITE t � 'p� APPUCATION���15 �n�MBER CO E
ADDRESS �l"��� �1��C�� T�• ISSIlE ` (�, � "�Y� �,"�p- .
c APN LOT3 TRACT DATE �--1�"l�CONST��I�ROUP
e CFiOSS STREE7 SETBACKS '"""°"�""E"'S
°-' OWNER K-� ZONING �0� � 0
o ADDRESS P � REAR �
� CITY C-O�I�N A , Zip�a TEL. -� SIDE/SIDE STREET RW ❑
o APPLICANT A (�A P�1A`�C � TELS SIDE ❑
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a CONTRACTOR SEWAGE
o ADDRESS 1'J� • DISPOSAL � �B� �#
W CITY ��� ZIP TEL. � PRNATE SQ.FT./100 GAL
z STATE n, 1
y LIC.NUMBER ��-``�C�� GRADING G-�J CU.YDS.EXC. CU YDS FILL •
y ARC �`T�(PE FT �G�R /4E�:i4R�R11C LUR1'!"QM'":�. ..:
`=' DESIGNER � �� W � 1 -�S��C� �!C Ga S � �o
o ADDRESS �� � � 2
= CIT � ZIP � TEL. (�, 3
� PROPOSED USE �R f' � 4
� �' � GARAGE
e NO.DWEL. NO. NO. � PORCH �
� UNITS STORIES BEDROOMS
� LOT DIMENSIONS � VALUATION �t���5���C % ADJ.AREA
o NO.OF BLDGS How auai�rrr,r DESCRiP�'�0l�F:: FEE :,.. ; ::. .
W ON LOT USED �+S�����
� � 4 yCOL ec �>.DC)
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IICE EO C�NTflALTONS CLAHATION�1 hrzEy atium ihet i am ticmxd unde rywiums of pupter 9lwmrrcirq �i� "���' ��" ��C
��if � wnh Secoan 70001 af O�v son 3 0l iha&uiness and Vrafrssiwrs Code,xN mr lir.mse u�fuN Iwce end etfect �W
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LL WJNEfl-BUIlOEH DECLA TpN:l hereLy atfirm that I am eaempt from ihe Contractnr's LKema Law Iw the fd'a.v�rq ' ,l-
J� Z reasan I�c 1031-5.B �nezs and Profesaans Code AnM tilY ar cwnry whrh requiret�pum�to tDnitru[t. ,'� 1 2�7�/' �t•E,•�. • ?•,,Cj v
o alter_improve,demdah a iepair aM 4rutiurE.pior N i¢uwan[e.alsa repuues C�t 7(qGcan[fw w[h pwmi� "�
f- ro 1ik a sgned s�ate nt IAaI he is Ixmsed purswnt m ihe prwitions of tlw Cono-actor's liurae lnw(CM1apm ��'� f C � Sys��oJy �,�c,�
� 9lcommencmg w�h S tion 70WI af dvisan 3 01 Me Business and Vrohaions Cade)a that M is enmpt tlrrefrom ,�.;
d and the hasis tor aYeged e+empeon_Arty vidafian d Secfinn 7031.5 hy airy applinnl(or�peimit wCjetu .� � �/p�si� ����'�P`, '3.�(_)
x the appluam ro a c"il penalry ol w�mae than five hundred dotlars(55001.1: �:� �
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fo„ ❑I.as avne�f the Praperry.or mv enplayees with wages as dxit sak cunpmaoon.wil do the wmk.rd � � ,
Os strucmre�s not mtended or olkred fa sak I�c.7094.&umess and Professiona Code:TAe Cmtrxtar's Licrose ','°� � �GC,` / � .rE, J�.L1C'�
v law does rot apply Io an owner af Oroperty wM hmNs ar�mproves Nvem.and wl+o dass such work himulf,
W cr Mrouyn his own empicKes.P�wided thaf suM impovemants xe nat intaMad a allertd fm tale If.howr�c. "�.y� .
= the huilding or imprwemmt is sold withM une year of complenon.Ih mmer��ilM wN Aave Hw budm af proving
y ihat he d�d nat huild or�mprove lor the purpou M Sab.) ���,
Vi ❑I,as axner ol the propeny,am eve4wveH comractiny with licwed con�roctws ro mnslruct IFe prqect(Sx_ �
fl 7044.Buv�ss antl Piofessans LoAe:Tte CanirEclor's Litenu taw Aaes nol applY�����O�WK�Y wlp
� hmids or imWwes Iherem,and who cmliacts la wch pro�ecis Mnih a eontrxmrlsi d�sNpurswnt ta W Cmnxlor's
lwx"se law 1 . �`iT��
� ❑i,m ua��p�m,eH sec. .e�Pc�anxn ce�erearcl- ' pLAN REVIEW • --��-'
o Date Owner �� ��
�
} NOFlKEFS'COMPENSATqN DECLAflATIpJ I heraby allirm tha�I M1aue a calificau ol cmeml m sdl•m�un,a
a cenAitale ol N4rkni Compensation Insuance,ar a cceffed copy tlweQl ISK.��0 La�.C.I. MBING ��� �Q
= Y.'"z +':� K'�� '',1
❑Cnoliee copy is hereEy furnishe0 �;,,� •c ,-y CHANICAL � r���o
Q _:E�'�% 1 .
c Cernfred capy is filed with the Buildinq Inspec6m Uepxtmlhl ar�`.. _� OeDxmrm.
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CENTIFICATE OF EXEMPT�N FAOM WIXIKEflS"COMPENSIITION INSUPANCE�TAa seeron neM roI he ComNeted . 7 /'l/'1
� if ihe permrt rs tor oM huMred(S100�o kas I cerirfy ihal m��o�e�he work lar whicM1'Nis ' C�`—/�`�=
y pentit is iswed.i�all rot employ erry pe�son in s'ry ma���te�as auFdle� H6rteri Campewim �� SM� ."7 D
OLaws of CalBwnia. �3�'`' a' `'' ��'PARK FEE
� °at `�PD��'�� � SCHOOL FEES
� NO�ICE TO APPLICAHf if,aher meYing this Ce�tiica)B,oJ F;WiWtion,-ypr•sM�dd'6e�dne'aub�[ei'.m the NVxlru's
—� Cw'Wensauon prwrsiau al Me(a6or Cade.Ywf.miis(�rtthwAh.iamply w`nh'soeKpraiiwg.7,Elu'pemii�sh�ll
�'- be deemed rzvoked. .
. ... �.::�. ..:_'_� � �....._ . .
J
pc OINSION OF INWSfNIA�SAfETY PERMR RflT61CAilOM: �
�
o ❑�herehy cendy that na extavation Irte�51 a�e feet m depth inN whirL a pxsan K requrtl Io tlpCenO.
ee wiA 6e made in cmnection wiN�wrk aNirc¢ed hY this R�mn.md tlyt m WiNiq struclv�.xsilaldinp,irxxork. . •
d' rc demd"aion ar drsmantXng thcrmf.wAI he mde Mm thury-m 1361 hat high.�qyp.3.2.Gry 2.M 2,See '
W' 341.TitleB.CACI.
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3 ❑As awner�hwlder.I wiP not enplaY�nyon io da vwrk wltith vwuN requile�p�mit hpn tl11 O�n6ian d I
r—. Indisvul SalelY.as noled ahove.unkss su[h cersan h+s a perRit m do sieh warY hwn tle diri�ioa
f
W ❑�,�,a����Sr��e�sa�ery��m,��. �TOTAL FEES �
� CWSTRUCfIOH LENDING AGENCY�I
hne6r aflirm thet tlert i�a mmtrucnon 4�dinp pa¢y 1a iM prfammee I
= ol ih wwk(a wlxch thia pe+mi��a iiwd(Soe.3097.Civ.C.1. �n p,.�
� Lmder's Name COMMENTS ��/' � l-���.��� i
mlmder's Add�ea
'Q CEHfIFICNTE OF COMPLI E AtJf OF ENTNY:I e�ply 1 Mw md tlis�ad fhh I
rq ihat the nfrcm�mn rs .I to w i sdle hws Md dry � tWinp Wldp I
y crostrucron. ¢e� sm� Oep� t d&iHnp ad S�MY m r ya prapnry
= tor whKh 1 h d lor ' perm i se d ' iropecLoin. I
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' ������� �a�� RECPT NO. � PAID BY VALJDAT
WHiTE—Departmeni Copy,YE'I.OW—Finance Copy,PINfhAssesaor Copy.GOLDENROD—File Copy,GREEN—Applicants Copy I
BS106-17/8 `
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