HomeMy WebLinkAbout1091 ,�� ����� �
t '`' CITY OF DIAMOND BAR pRESS
`'�� '�" ' DEPARTWfENT OF BUtLDING AND SAFE7Y
~ '� BUILDING PERMIT F'IRMLY
JOBSITE � APPUCATION�_,_ I �.��,i��RMIT USE
� � ADDRESS ��-�+� EO `�_��I_ DATE yMBER � � I CODE
ISSUE (� TYPE OCC.
4' APN _ _ LOT�TRACT DATE �v,\ �`"1� CONST. GR�UP
o CRO�S STREET � SETBACKS ""iON�'"E"�
'-° OWNER ZONING FRONT RW ❑
� ADDRESS '� ��` S � REAR ❑
W CITY ZIP TEL SIDE/SIDE STREET RW ❑ �.;
o APPLICANT L�}���„°- ��(CI�TEL.�L l� — SIDE ❑
x
� CON�7'RTCf� SEWAGE
o ADDRESS �-.._ ❑ PUBLIC PMT�
DISPOSAL ❑ pRIVATE SQ.FT./100 GAL
W CITY ZIP ��`""�..,�.�_
= STATE ..�,,
y LIC.NUMBER _ '' GRADING ❑CU.YDS.EXC. CU YDS FILL
y AR�i-I Gi � TYPE SQ Ft" FAGTC?R PS ADJ. AAEANALUATION
"' DESIGNE�� .� 1 _.� ' �.��� � F�'f�� J�' 3.C�
o AUDRESS - ,_._ LL 2
� CITY ZIP _�-T�L'�-•�--�_ � 3
� PROPOSED USE '''��� - '� ? 4 -
� A GARAGE
o NO.DWEL. NO. NO. � pORCH
y UNITS STORIES � BEDROOMS_� —
� LOT DIMENSIONS m VALUATION �` -�•E` ADJ.AREA
o NO.OF BLDGS HOW QUANTITY b�$GRIPi"lC)(V FEE
W ON LOT USED �
¢ — U
� n �
LICENSI[1 CIINTFACTUHS[JECLARATION,I i�re6y alhrm that I am licensed unde�pmvuions ol Chapter 9 Icammencmp �
Y wnh Secunn 7C00)of Omsiou 3 0l the ftusiness and Prolessions Cude.and my IKense is in lull luice and elittt '
2
3 [] w
� fIlVREii�BUILDER�ECLAFqTION:I here"y aNr,m��et I am eaenpt fron�he Coniracmr's lrtense law fm Ihe Idlmving "
= ir.nsnn ISec 70J�h Business and Pwfessions Code Any city ar county wh¢h�eqmres a pennit la cunsiruc�. (�.�
o aher improve,dr.moLsh,ur ieDa�r any sir�cture,pnor to ns issuance,dso�equnes the app6canf tor such pe�mrt ��
M— m file a siynnl slatemenl Ihal hc is hcenseA pnrsuam m Ihe provisions uf ihe Conincmr's l¢ense l�w IChapler �p]�
� 3 icummennng�h�nh Secunn 70001 o�����sion 3 of Ihe Bunness and Professmns Co�e�or Ihat he is exempt therefmm TZ
d an0 t�e hasis fo�ihe alte9ed eKe�nUllon.AnV vialatmn of Secnon 70315 hy any applicant Im a permrt su6�ens ��
x the ayphram lu a crvd penaNy nt not mou ihan hve hunJmd dollars�55001.I. �
W
� ❑I,ns uwne�uf�he F�operry,nr my employees mih wa9es as Iherc sole campensatmr�will do ihe work,and
the stmnure is nat iNenAed ur nflered fm sale(Sec 1044,Business and Prolessions Cade The Canirecloi s l¢ense Q
� Law docs nm apply�o an owne�uf pruperty who hmlds or improves thneon,end who dces such work h�msel( (>
W m thmupu his own employces.piaaiAe�that su[�impiavemems are nnt incended or affered to�sale If.however. �z
m �lir,hudd�ng ur improvement is solA with�n one yeai o�compleuon,ihe awner�builder wi0 have the bmden ol Dioving Q
y thal he Oid nol hmld nr imprm�e(or Ihe purpose al sale� �
� �JI ax nwne�ot ihe pope�iy,am exdumveN mntraamy witA licensed mm�xlors tu canstmct iha pmiecl(Se[ �{j}
0 7[1SC,5uwxss end Professions Cotle_Thc Canvactor s laanse Law tlnes not ayply to an ewner af p�operly who '�
2 bmltls ui imOmves�hereon.antl whn cnnvar.is fo�s�k6 Dmlecls wnh a wntracmr�s)i¢ensed pursuam to the Conira[Im's - -�—.�,.,9�-
Q L:cense Law 1 �, r,�i�N.TR 1['TJ� ��5 _
� U I am exr.mpt unAr.;Sec .B 6 NC(Auxh Cerldicate�. F'L,AN REVIE�� I �
c Dale_ Owne� .;� 'ELECiTR�Ci __
� Wf1RKfHti'COMPfNSATION�ECIARATION I hereby al6rm tha�I hare a cerirf¢ate nl consent to selt�msure,a '
a r.r.mLr;�ie ul Ykikeii Cumpensauon Ineurance,or a rerufitA copy ihereo�(Sec 3A0�,L'd6.C.�. PLUMBING , ,____
� U cen�nea cnpv�s��»�xbY i�Kmsi�ze �,�j MECHANICAL _
p ❑CertiheJ copy is hled wnA t�e Bmldmg Inspeclmn Oepertment oi �epartmem d GRADING
W
Z CEATIFICATC OF EXFMPTNN FROM WUHNERS'COMPENSATION INSUAANCE ihis seatnn need na�6e compkted �SS�AN�.� ' .l
� d ihe perinn is�m one hundreJ(f100)o��ess I cerllfy that m the pedarmante n�rtie wqk lor whKh iNs ' -'�--
� pr.rmrt is issued I shaV rat employ any Oerson m mry mam�e�su as m hecane su6lect m tk Nhrkers'Compensauon
� iaws or e�i�ro���a W SMIP .��[� --
o W PARK FEE
p f]ate ADPhcant �
� NUTIC[TO APPLICANI�If,aMer makmg 7�s'�.p�u c!i�P�i�n���.YW should hecame su6�ect to the Woiker's SCHOOL FEES
�--� Cmnoensanon n�nvisions ol qir.Labni f.o .p'Ai�kUS�ttM(t��41tli COmpIY w��h sah provrswns oi tha permit shall
LL hr.tleeine.A revoked �, �•�.,.'a.L Er,::-i�
a
. �� pVIS10N Ilf M[IUSiAIAI SAFETY PEHMIT CEflTIFICATION . . . _
w
�I he�eGy certity iha�no e�r.ava io 1 m mo�4(ee� Qeq�((hhp mto wh¢h a person�s requued to descend,
e�e wtll 6e mnde in connecuon wnh wa��§�d�thrs�erm�a�8��no huddmg slruqwe,acaftolding,f�isework,
� m Aemulnion ur dism�ming there 4a ma IhaB ihrtf}�f��� �fee�nigh.�ChaO 32.Gry 2,Art 1.Sec ___
W �ai t�nee.caei
a
3 ❑As owner6wlder,I wdI�m.oremykyraoypie;'to'J6,$pk wM1ichiqod�d,�Zq�e a permrt hom tl�e Uvuion ot
f— Indostnal Safery,as noted eUovE,nnidss s12r'pe�1�Ss'3 yermif lo d"o suih u»ik Irom Me drviaion . —
- • �
� ?�:�._'ii_t;�:��.,�.: :_,"... ..=.i f_:': 1
� ❑��,,,a����„��s„�a�Sa�e����m,�No _ ' .'. TOTAL FEES � . pg
� CONSTRUC.lWN IENDING AGENCY I here6y alfirm that•theie is a consnuctwn lendinp agency for ttrz periamante N � �'
2 ul Ihe wurk for wni[�Mis permit is issuetl ISet 3097_CN C I.
� Lender's Name COMMENTS � �' � _�
mlenAe�'s AJdress
¢ CERIIFICATk OF COMPLIANCE ANO AUTfqNRATI�!OF ENTflY I ceruty I ha�x read Ih¢applicalion and state
va thai�he nitamaUon given is ca�ec�I ayree ta compN wrth all sute laws aM�iry ordironces relet1p ta 6uiNi�
y cnnstrncuon,and authon:e a reprexntatrve of the Depanment af Buiidinq and Sahry m mter upon the prapeny
= tm wlii�h I h DPlied tnr this permit Por the pose ol makin�inspe�Wns.
� ~ '��.�
/ �� � ���— RECPT NO.��PAID BY VALJDATIO
Sgna u" I oi Ayen Dale
WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assessor Copy,�OLDENROD—Fi�e Copy,aREEN—Applicanfs Copy
� 6S706-11I89
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