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HomeMy WebLinkAbout1548 (20) - - _..._.. . �� '"` � CIZ'Y OF DIAMOND BAR PRESS� �' DEPARTMENT OF BUtLDING AND SAFETY F�RMLY BUILDING PERMI7 JOBSITE APPUCATIO�2 PERMIT SE AooaeSs _ DATE v � NUMBER CODE ISSUE TYPE Of',.C. � APN LOT TRACT DATE G` �- � CONST. GROUP e a CROSS STiiiEET ZONING �TBACKS '�"°'�''E'"5 � OWNER FRONT R1N ❑ o ADDRESS � REAR ❑ W GITY�����; ;5''�-� ZIF�_�.L�(�s�� � ' ' _ SIDE/SIDE STREET RW ❑ o APPLICANTa1��_�-IC.�-!=[.'���� E . SIDE ❑ z ` CONTRACTOR SEWAGE ❑ PUBUC PMT� o ADDRE�$�ZI 6+.1 ���� '�'T DISPOSAL ❑ pFiNATE 9Q.FT./100 GAL W CITY ���Cl ��.L_ZIP a,�EL. r ' z STATE N LIC.NUMBER 3�I �3�� GRADING ❑CU.YDS.EXC. CU YDS FlLL y ARCH/ENG/ � N�E SQ FT FAC7'l�R PS ADJ. AREANALUATiON = DESIGNER _1 �(�L �Q,:"^���-�-� � 1 o ADDR SS u. 2 = CITY�'�f.���,�ly��"�ZI TEL • (r} 3 �u Z 4 � PROPOSED USE ���>>+�"�= � • Q GARAGE ' ,n "� ..� NO.DWEL. NO. . ..NO. • � PORCH r� � UNITS :STORIES�-�"' ��EDRbO�f/IS '',•� �' �, ��!i: �; ,� :'• ,�" m VACUATION"` :` ADJ.AREA LOT DIMENSI0�1 " -'.�: NO.OF BLDG �^ �� : J-IOW�' ,• �;� '� 4 �: ' ' � �?t�Tf1'Y (;1,1�$ RI • ON � FEE � ON LOT � `�USED.,;:.;��,�: � t� � W ❑ ; , � r.. . � Y S r: f � f ~ IICENSE�CONTRACTOIi,�UECIqMTpN�I here6y��fhrm IA�t I mt�tensed uider ponHons M C6opM 8�[om1wKinp x nnh Saaan i00�1 Yf Giv�sian'3 a1 the Busm�¢s end Pmhssi�a fah.ond m�tceme n in lull Inrie W diect ;w , � c � ❑ ? � � , �. • � ;;:•: �.. • ,..� � � QMNfR�9UIL0ER DECLARATION I herehy allidA t�et I�m uempt from dN�NNclor's LklAsB tew 1or tlie lollawinp roson ISsc 70315.8uamess md PraleeeMns Code lny nry n c%imty wM�A�puin��prml b canslRcL � O aher.�mprove,d�mdish,p rpart�M s�ruelure,p�a�D ils iiswnn,daD reyu�rs Ilt app�iinl�oi Wch yMmil � � to I�k�s�pned statement M�t Ae is Ikensed pursuant ta Ihe pfovHims Of d�!Cantritk�'S GKense l�w(Ch�pter , � Q 9 S�ommennng wiM Section 70001 of Drvnqn 3 ot tAe&uinesi md Protnsons Cadd a tNr Ir K�mnpt Metrem � a. ane Me hosis lor tl�e aleped e�empuon Mry wdatwn d Sec�ion 7D31 6 bv�ny apphnnt hr�permrt tubKcts � W tAe app6nm�o�ervd penaltY ol not more Ihan li�n hwdnd ddlas�f50011: ^� Q � ❑1.as aw�re�of ihe praperry.a my emDloyees with wages n Nair�ok eDmpensat�m.vnll do tAe xark.md . r t0e sliatw��s not mtended ai dtered ta tile ISec.)04t.Buvnu snd�a4uiens tade TAe Camncia"f lrceroe s[ v Lew does nat sDDly 10 en wvner of propeny who 6uilds a impravcs thareon.end wAo dotc wc�worM Mmsdf, � � W a�I�rough his awn emp�oYees.porided Ihat such imprwemenli u�roi inUMM or MpfM Im i�k 11.Iqwwer. � = Me hwkmg or unOrovemem rs wld witM1m one yer of eMnDlena+.the awnn-buiber Mdl hns tlie hu�den al ywmp ,� y IA71 he did mt 6uild Or imD�ow iar Me purpose o1 sa4J � Va ❑I,�s owner ol the D�W�r1Y.+�+eaclusneM comr¢ony wrth Icensed wntrxtms m wnmu��M pqttt I&c {�,� O �IIAA,B119M5!�nd Proleanons CoM Tk Camractor's Lianse Lnv does not app�Y�+��r�1 praperty wha � � bmlds ar imprmes iherem.md who con�n[I�la reh prv�ects wilA a[oMritlpflfl iCMsed puriuinl ID Ilx C��nClor'1 � Licensetawl W r ❑I�m exempt undn S�c 8.B P.0 IAnkh CerUfiUhl L�1N REVIEW 0 0.,� o�.. a NORKERS'COR7PENSATqN OECLARATqN I Mrtby dtrm Ih�t I h�ve�prfifiph ol cmm�1 to�Il�imwe.M Q�!1/'1 � �arl�fiole of NMkni Wmpensauon lnsurance,w�ta�Nied topy Mneoi(Srt.�BOD.LeO.C.) QL ��• 1 ISL_ " MECH � � �a � ❑CenAed ropy�s Mre6y IumaheA WCerofbd eopy n IAed witl�Me BwNinp Nep¢um Depu�mem a Oepsmrnt 'Q (� � �IFIGATE OF El(FMPibW FROM WWiKENS'LOMPEHSATION INSURANCE:Thn pcbon necd ro�b complewd � U J � � � N d the pamn�t lar ane hw�Med�f 1001 a M» I eerofy M�t in tM perfammce A tlw lor w�ieh d�is � _ permi�is nsued.I �A mi nnpby pry pe�wn in�M m�nier�D�s lo htome iu0'ct to a C nsRion S` 1 s �,:m cw+ro�� , PARK FEE � o��. �w ' "' t�i.. �++ �ar�c PLICA tl.�Iter mitnp IN�Cntds�u o1 EmmDtio.wu�M e< <e a.w��•, SCHOOL FEES � Carqenu n provrs s al IM L�6er Code.you m�Iaihwil��iply with reb ia a Nu prma�hYl �► hr d[eind nvaYed � n , .,., � _ 111¢���...��� pVISION OF INOUSTPIAL SAFETY PfBMiT GEflTIFILATpY;T F�'�•,('r•.-, . , ` -'�� � ❑I Mreb�rnfdy IMI iro�vaW�nn fidR 151 W rtda'1e[19R M!n!}n1a.w11KA�Oatan'a ppuind b ieumd. � ro will pe mtle m connection wilh worY wlMeed hy/ur jnm���nd bR�o luibinp nncluro.wMddiiy,I�ItMrork. L/�.� a' w demolnm a drsmantNiq Ikrwl.will h�mae Mn�nryaie(381 Ir1 Aiph_ICA+i.31.4'ry Y.An t.�c � P LLJ 9E� 311.Tiqe B.C.A.0 I , . �"p� �')1iI�1 3 QAs owner�Euade�.1 will m�emplaY rMona4s�u�vGorY�Aie�weu��.Yaq�IM�PKmI hom Ye avoion d �.- Induatrul Sohty.�s mW aEors.unins�uch per)on ItlY�yer�pt b da a�eh worN ham tl7e Nui�iM � , . � ❑a�„���,h������,�� � TOTAL FEES g . fAJSfRUCfOAI IENDNG AGENCY:1 MretiM.AMm htilw�'s�lamtrucoonlwdinp ap�ncy ip M pfa�nnce 7�C N th waF la wMcM1 tl�is pmit s i�sud;liec.7097:'W;CZ. :=. .._ • . •. r � � �.�,•�w.� ...,. ... CO M �l/ miMd.,•�ada..� � CEFfIiCA7E OF COMPLIAhCE AAD MfiptlUTO1 OF ENTRY:I v61y 1 Mve rpC his�piicrtim md Nk v� iM tlr nloruwtm}wn m m�a I pree wiN N f4u 1w�Md r+qt�wKn ri�m Midinp ycrosvunm.mE�u naen � M m�f�iW+q nd S�MY Y mmr iqon Y paperM fa whKh 1,lhw ¢pm d xp in�psums. � ,r^ _ ,, 1 ( � ! {�a ���� ��c -. .. 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