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HomeMy WebLinkAbout1676 .�, _r_. t: � -.....-�....-�-_._;�..----� �--_--_.;.::,._�-� ..._ ;. _._ � . � '"` �I�lf �� DIAMOND BAR PRESS m DEt�ARTMEN�'OF BUILDING AND SAFE7Y F�RMLY � " BUILDING PERMIT JOBSITE APPLJCATION PERMIT � � �-�j USE ADDRESS � � � t ��M��� � fSSUE ��'��~�� TYPE ER_.1,�.P1��CODE CRl7SS STREET •�A � —�CKS� ,NST. GROUP �e APN LOT TRACT�` DATE CO ca �� ZOR!!NG --' OWNER �...,/�{',`L��'�� 1��'S�`sf.,� FRONT RW C❑ �? ADDRESS�.(��S`�G3 ��C O/��J,iir'� 5"0 R�AR O u� CITY�A��!J � ZlP��TELr�7/ S9DElSIIDE STREET RW CI ca APPUCANT�.�'M� TEL.S`�� SIDE C❑ �� � C�NTRR6�Q�2 SEWAGE �; ADDRESS �'`"'~�..� C❑ PUBUC PMT# DOSPOSAL C� PRIVATE SQ.FT./100 GAL 4; GTY �ZP"'"'^---- T� �: STATE C;RApINC C�CU.YDS.EXC. CU YDS FILL ue LIG NUMBER � �� ARCH/E �y �Y�'E S(� F�" FAG"�TQR P� ,A�1:,4F� ;' LUATI AI ' "'- DESIGNER W i �3 �' FiDDRESS 1f:kL' 2 � �, � CITY ZIP L. ,(�i 3 � PROPOSED USE /�i9//b ed t!,�,2 � 4 c�.'i �'iX/��//l.�� �/�.@T%/4la/ �,lJ�.�.� � GAflAC�E �; NO.�7WEL. NO. N�� �` p�RCN �� UNITS STORIES BEDROOMS �: LOT DIMENSIONS � VALUATION ADJ AREA c� NO.OF BLDGS HOW QCfAPd�"li'Y '���'�`y� #Q(�'; ��� ., p LL; ON LOT USED y _: v LLi ❑ �- �"' UCENSED CDNTflACTORS OECLARATION:I herehy affirm that I am licensed under pmvieions af Chap�cr 9�tommenoing �.�._ �� wifi Section 70001 oi Division 3 of the Business and Rofessions Code,and rm�license Is in full force and eFf¢ot. .,W; ci ...1: , . . 3� llj� r�r+fi;,,••,,�. �y-.:. :,�'r�.a«�a�,.i,:.,5:';� �±-; NER�BUILDEfl DECLARATION:I here6y affirm that I em exempt irom the Contracmi's Licensa law(or the loliowing reason(Sec.70315,8usiness and Professions Code:Airy utY or county which reqUires a permit to canshuct, (}-; c� alter,improve,Jemolish,or re0a�v any atrucNre,D�ior to ils asuance,also requiie5 1�e appliranl(or such permil �� f—� to file a sicned statement that he is Gcensed pursuant to ihe provisians M the Lontractoi s Llcense Law(Chap7er ,'.�.m- Q! 9(commenc:n9 with Section 7000�nt Oivisian 3 of the Business aM Pmfessipns f.odel or thai he is exempt therelrom .;.;5,�„+� a,; and ihe basis for the a�leqed exem0��on.Any violatiar af Seclion 7U31.5 by any applicani Mr a permh subjects i'�:^,,,5'r W'�i ihe apVlican[ro a civil penally o(not more than five hmdred dollars(SSOOIJ�. '-�� Q. � ❑I,as owner oi the property,or my empinyees wiM wages as iheir sole compensa�ion,will tlo Ihe work.and ' the svucmre is nat imended ar of!ered lor sale ISec.7044,Busmess and Protessions Cade:The Cwtractgr's Liunse �,Q.. ti Law does rol apD�Y�o an owner of proDe��V who hulids or improves thereon,and�who does such work himself, (� �++ or through his own emploYees,provided that such improvemenh are not intended ai ollered for sak.IL however. �- m tne huiding r,r improvement is sold within nne year of compl¢tian,the owneo-builder will haoe the burden of proving v�! .__. = that he tlid nat huild or Improae for Ihe purpose al saie.� �. h v ❑I,aa owner of the propertV,am exclusrvely ronlractiny with licenaed r.nntrar.Nrs la constmtt the project ISec u}� 7(I4d.Busineas and Pmtessions Cade�ihe Comraclor's Gcense Law does not apON to an owner oi Droperry wha ,��. 4 hmids or improves thereon,and who conirans for such pm;ects wilh a contrac7ar�s1�icensed pwsuant 1a the Contractar's ,�,,,,.-^" � : � �`^.q License law.l �-%°" ��.,�� o / ` �� "'� ❑I am ezemp�under Sec. ,B.6 P.0(Attach Cenifiw�el. („P_I.AAiI.-F��I�^U�^•-"� � p Date Owner ;:..:E�.E(�.rTAO�i � WDRKERS'COMPENSATIIXJ DECLARATION:I here6y aff rm that 1 have a certiFicate ot ronsent ro sel4insure,or � a reriifica!e of Nbrkers'Compensation Insur�ance o�RGen�@d Eqiy thereot(Sec 3800,La6.C.). �-P�-V M���G _ -- 6 ❑Certitiedcopyisherehytumished `r�(�'. �' '�z _,�;1 � � � � -�- �:MECif'{AN�CiAL o ❑Cer[ified copV is fikd with the Bu Mmg�lnspection DeDartment a Oepartmem d_�GRADING W ^-� �'1�, CEflTIFICATE OF EXEMPTION fflOM IMJRKERS'COMPENSATION INSURANCE:Yhis section need not be com leted ..�/ yif Ihe permit ia for one hundred IS.1Q0 �r•$less I cgrtify t1�3g:�.Inj�1"j,e periormance al�he work�or which"this �,.�,: � ����` � �`� �/��'yJ, �"f'�� permit�s�issued,I snall no2 employ a�y�p�r�ore m aSP�'m��Iner s�;0 i#5,1u�,Uetome sudject to the N6�ker5'Compensetion ' S M I ^ 6 . ( /.y�1 __ otaws ot Cali�amia. ::PARK�EE p Date 0.pp''°�^t - `� �.�SCHOOL FEES W NOTICf TO APPLIGANT It af2r,ma�109��Ler7�fica�e bf EsEmpUon qou shauld 6ecome subla��me Worker's � � Campensauon provisians a�th�tatior Code Koulnust larthunih compiv�`�,"snclf provisians a tAis�perma shall -��: T���ps�i�,��`,�;�,� ���5 1�"'T�r,l��,.��� W he deemed revoked. t ` .•.-, - -. . ...�- e / '1 J p� qViSIpN OF INOI157flIAl SAFETY PEfiMIT CERTIFICATION� � y� � o ❑I hereby certMy that na evcavaton frve 151 w mGe fRet n;dep h inS`o�iy�ich a persm is required tn deSCBnE, ee will be made in connectmn wrth worY aumor¢ed ny tha peir�iCaNtl di3t�Io 6y,dding strucnre.scaifoWing.�alsework. 0. or demolition or dismamliiq thereot.will 6e more tKan IhiYty�syi^136�1eN�-hgh.IChao�3.2,6ry 2,Art 7,Sec W 341,ii8e 8.C.A.GI. � 3 ❑As ownerbuilder,I wiA not empby anya tad'mwark whkA wayld,�(equire a parmit hom 11rc Division of r— Induurial Safely,as nofed abo�e,unless such�e��a,�a p�me�do��W3�r�imm the divuan. '� w ❑Uvision of Induslrial Sakry Permit Na T�TAL FEES � COM1ISTflUCfpN LENOING AGENCY:I hrtehy'xHjrm;•ffia[ihp2 is.a-�canstructwn-i�ndmg.epmcy ta�he pertarmence 0 = of iAe wort for which Ifiis permit is�ssdetl(Sei.3U97 Crv CI�''�� -� � '"i f 1 - � Lerider's Name r 3 i�:� ����ty`j COMM�NT y �� p�p LeMer's Address � 5 � '0� CEHTIFICATE OF COMPLIANCE AND AUTIqPoZATpN OF EHTflY:i certity I luve read this aqdicalion ad st�te � � � v� that the�i�ormation gi�rcn is wrzn.I ag�ee 10 comply witA all staa laws aid usy a�diro�es relat'pp ro huiMinp ��� � y coretruction.a�d autlarize a repaxntawe of the Depvtment of Buddinp and Safery m enror upm 1M p�arry 3 . = for which I Aave applied for Mis cermd fa,r%th�e pirynse af making mspatioaf. - �- ~ X.���o.a�Q (.�� /��"�—'� C,� f r�� signature o�npplKam ar nqam p� REGPT NO. 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