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HomeMy WebLinkAbout1490CITY OF DIAMOND BAR PRESS DEPARTMENT OF BUILDING AND SAFETY BUILDING PERMIT FIRMLY JOSSITE ADDRESS APN LOT I -TRACT .30Acil APPLJCA71 9�7_ Q�_C�' PERMI n DAT E---L•�-r� �sLT= TMUPMEBER l v l CODE DATE t CONST. GROUP CROSS STaEET OWNER _ til? h r P t3 -G .�� ADDRESS / I Sedrr d rp e— Ila. a SETBACKS �EKWNM ZONING FRONT RW ❑ REAR ❑ CITY ..KrbriZ 964 ZIP 471145 TEL SIDE/SIDE STREET RW El - SIDE ❑ APPLICANT APPLICANT TEL CONTRACTOR "�%7• 9: e; 141 ADDRESS Ae'/`eza CITY ZIP�J TEL 35%r/ry� SEWAGE DISPOSAL © PUBLIC PMT # ❑ PRIVATE SO. FT/100 GAL GRADING ❑ CU. YDS. EXC. CU YDS FILL STATE LIC. NUMBER W TYPE SO FT FACTOR PSF ADkt, AREMAWAT ON ARCH/ENG/ DESIGNER ADDRESS Ili LU 1 2 CITY ZIPS_ TE g PROPOSED USE _ _� NO. DWEL. NO. NO. UNITS STORIES BEDROOMS LOT DIMENSIONS `a a � GARAGE CH �. VALUATION ADJ. AREA NO. OF BLDGS HOW ON LOT USED QUANTITY DESCRIPTION FEE k� LICENSED CONTRACTORS DECLARATION. I hereby warm that I am Ecrosed wider praeelims of Chapter 9 kwseneNing with Section 70001 of Diuuion 3 of the Business and Professions Cads, and sty Ecerew is in WB bra ad affect ❑ OWNER BUILDER DECLARATION I hereby affirm Mt I am exempt freer she Cmtncteri Lesion law W site kllownp mason ISc 7031.5, Business and Preessbm Code Any cay a county which requires a perm's a canstrucl. War, onprave, demolish, a repair any structure. pro w a waeence, aha requests ire gpBcant for with What to fife a signed statement that he is licensed passant to to provisions of the Cmtranw's Leenee law (Chapter 9 (camrneecing with Section 700M of Division 3 of ter Business and Profession Corel or that we it exempt thrNmm W dim bass for the alleged exemption. Any violation of Scrim 7031.5 by wry applicant ft a perms aabjecw the applicant to a cmd proudly of nus owe than flim hundred dollars 135001.1: W ' 01. as owner of the property. at mfr employees with wages be their side eompenaton, will do fee work. and the structure a not intended w offered W ale (Sac. 7004. Business and Professions Gds The Cmtrctor's Ltxea Lew fees not apply to an owner of property who builds t improma Merxen, sod who does such Irak hanN w through his awn ernployees. provided that such imprwmnmw we not ktwnda or tlferM ffr Nil. R, the building nor improvement a and within all vow af completion. Use wxw•fedlder will have dim burden of for no that he did ret build or improve for ane purpose of soh.} e a ju ❑I, as owner of the property. am arskiswN contrclny with himand corrections as construct the F"Kl se 7044, Business and Prefirmims Coda The Carrlratai s Liana Lata data nowt apply to we aynxe at prlpeny budds w nmprwrs dwrem, and who contracts tui such projects with a cmlrectwltl sictuad pursuant a the Cmtrecsor Lunn Law) v LA , � ,Co ONSTRUCTION ❑ 1 am awmpi wrier See. a h P.C. (Attach CerMus) PLAN REVIEW OB1. Owner -:: Cf ELECTRIC PLUMBING HANICAL WARNERS' COMPENSATION OECLARATICAL: 1 hrebv eNkm the I hew a owtr5cah of cameos a Iasi-uuve, be a ce olicir a of NMkws' ConrpenNlmvr Insurance, w a elrtifed copy sixewd ISI. 3600, Lab. C).;^ ❑ Grhfied copy a hereby lormshed, ❑ Classifiedspy is filed with So Buddnq wm O ypectiapttwnt ar fdrptawnt CERTIFICATE OF EXEN1PTINd FROM MWERS' CDIAPENSATION IFlSIIRANCE. Tlds With and nus be wnpletedSUANC d tlw pammn is fen erne hundred IS 100) t fess. 1 arafy Mat in cow performanceofair week for Which' his Permit a issued. I shelf not aofdoy my paw in any summer a a a become abject to air gWhte' Cwopenatim Laws of California to Appliant a - ' GRADI O SMTP PARK FEE SCHOOL FEES fDTICE TO APPLICANT. R, eter making Mia Certificate of Exemption, you meek 6ecaa eokject w ter WlWkw's CampeaNteon proWamm at ted Labor Coda. vwt-armt,91!?tlmn�Bn �nyly with wth provisions a *a pnnit duh he deemed revoked ,n :: DIVISION OF INDUSTRIAL SAFETY PERENT CERTIFICATION, ... ' .... Of hmhy ewtdy Meta seawoon Rus (51 OF seam lea in depth km which a poser a 04" a disclosed, was be oeds is carectm with week. ,Wflwy. aNWUCMeshwork,Wrk, hid.st6Cap. 3.1. rP Z. Air Z. Sec 1, Tris B. C.A.C1. ,.w36dneldmn wa. m ❑As ower-buddef. I will 004 employ frmyale Is do work which would roan a permit ban 0a Dinner M Industrial Safety. N rated ehoue,-likeraodlpmxen his a pumm a do path work jmra the division. ❑Qwsion of fedusbial Seery hrmrr iro. TOTAL FEES © U CONSTRUCTION (ENDING AGENCY: I Moly drum But sire m a a atrte: on hood" "my IN air paftexenxe of her Week for which side perms is Wind fSac. 3097. M. C.). Lerdei a were COMMENTS Ltdei s Address, CERTIFICATE OF COBWLWCE AMC WTHORIDITION OF ENTRY: 1 sadly I hew fwd !h application ad dace the ter udwwtnon tion is street. I apo to wooply with d whenlwer wood way, amsirvxcxe solowng all hiding cmatmclrm, wd authorize a mpreaatatiw of as Bantams W Building aid Secy re tear span dim pmpwry fa which I hoses ep�wmd wkkg isgtcdom. 7 RECPT NO. PAID BY / �7 O VALIDATION A ,,may,.., -le t wAgent �& �= WHITE—oepartmenl GDpy YELLOW—Finanee Copy I- PIN—Assessor Copy, GOLDENROD—Fib Copy, GREEN— Appokartts Copy 83106.11!89