HomeMy WebLinkAbout1412 (17) P
'� CITY OF DIAMOND BAR PRESS
� .,,.: .
�... DEPAR'TME�U�D NG PERMITND SAFETY FIRMLY
;�.
DDRIESS ��rt� �'' S%� S�`y�.. DATE CATION ��..('1 (� ��NU BER � CODE
6 APN LOT TRACT D TEE �'���r�� CONST. GROUP
'� CROSS STREET ' G �P��n 9 S
SETBACKS ���
�' OWNER S���i ��+ /� t'+�- � ZONING FRONT RW ❑
� ADDRESS � �� I�i J°n 5'I�+�--- REAR ❑
� CITY ����^<�-'� `9n- ZIP �l/' TEL. '� SIDE/SiDESTREET RW ❑
o APPLICANT ���ti�'1 f2-- �ta S c�r¢�L. TEL. `s'��� SIDE ❑
x
Q CONTRACTOR SEWAGE
o ADDRESS � ❑ PUBLIC PMT#
DISPOSAL ❑ PRIVATE SU.FT./100 GAL
W CITY TEL.
= STAT[ GRADING ❑CU.YDS.EXC. CU YDS FILI
a LIC.NUMBER
y ARCH/ENG/ � ZY�E SQ F� A.PS AO�. RR�AtVI�LUA71L3N
= DESIGNER W 1
v kDDRESS . (,�j_ 2
z CITY ZIP_ TEL. (� 3
� PROPOSED USE���-�� �._ P�d'�' C� ? 4
� 11/11 . �...11%1.e'/�ir�G� � �ARAGE
n NO.DWEL. � NO. NO. �� � � pORCH
y UNITS STORIES�_BEDROOMS
� LOT DIMENSIONS � VALUATION ADJ.AREA
� NO.OF BLDGS HOW QUANTfTY p��(`,,�� k()(1� �E�
W ON LOT USED a.
�
W ❑ �
1—
UCENSE�CONTNACTONS OECLARATION I Mrehv afhrm that I am licensed under provrs�ms of ChaD�9 Icommexi�q �,�
� with SaNnn 70U0�of Oivision 3 af the Business and Professions Code,and my I¢ense is in full lo¢e and ellect �W
3 � �y
�i� fhNNEH HUII(1ER�ECLApATION I herehy alfi�m that I am e¢empt from the Contractor'n Lirense Law lo�ihe fdbwing .
_. reeson ISec,70315.dusmess and Piafessions CMe�Any ary or coumy which reawies a ce�mit to wnstruct C�y
o alter,impmve,de.mdish.or ieyaii any stmciw¢.D��w Io i�s issuance,also rcqunes Ihe applicant for such permil � _ .
_ F-. in 61e a siyneJ statemem that ha is I¢ansed pursuant to�he proaisions of ihe Connacror'a titBnse Law(Chapter ; �'
�. 9 jcummennng wrth Secimn 7000�uf avismn 3 M the Busmess and Pmfessions Cade�a thal he is erempt Me�efmm '�-
p„ antl fie.6nsis!oi the alleged exemp0on Any viola�ian af Secllon 1031 5 trv arry appluam fw a cermi�subjects �
Y• tle apyl¢anl io a cnd penalty nf no!more Ihan hve hurdred dollars(5500�.�. a
W �t
�� LJI as owirer nf the proyerty,m my employces with wages as Iheir sale compensanon,wili do Ihe wmY,and
~�� Ihe sinature a not intended or ollered fw sale(Sec.7054,Business and Piofesswns Code.The Cantraclar's Licrose ;��
v- Law does rot apply!e an owner nt prope�ly who hudds or improves tAereon,aiM who Ace5 such wark himself, (�
', or[hmugh h�s own emyluyees.V�p+ided�hat such improvements are no�mtended oi otlerzd lor sale il,however, �
m ihr.tuildiny or impmvement is mtl wnhin one year ol campletian,the ownerbuilda�will have Ihe hurden af p�wng .Q
y rihalt he did not 6mld or impmve lor the pwyose ot sal¢.� (2�
y tJl.as ownzr nt ihe pioVenV.am ex[lusrveh canira[uny wnh licensed cantractors io consvu�t Ihe pm�ect ISec �Qj:
v 7(14a,dnsmess and Pmfessons Code�The Com�actar's limnse law dces not a{qly to an mvner of prapeny who �"
Q� hwlds ur improves thereon,and wlp comra[ts for s¢h pro�eMs wtth a[amrecmr�s)licensed pursuant lo Iha Cantractor's •O�
L¢en5e Law I
O �� ❑I am erenipt unJer Sec .8.&P.C.IAnxh Cendicatel P v�EW �
p' Date A''^r' EL
� WURKERS COMPENSATION DECtAqp710N�I heie6r affirm tha�I have a aenAuau of consem�o selbmsure,w
� e cernhcatr.nf Worke�s'Comp�nsatbn Insurance,or a arnfied copy iheieof�Sec.3800.La6 CI PLUMBING
6' ❑CerUhed copy is herehy fwmshed �,,,,,,,,,///� MECHA(1��CA�,
`p ❑C.erulied capy is fded with Ihe Bwidmg Inspectia�Oepailment a �epanmeni � GRADING _
�� CEflTIflCATE OF EXEMPTION FHOM WOHKERS'COMPENSATION INSUNANGE.This secuan need no�be mmpk�ed ANC - � �
y rf ihe peuna rs fm ane hundred IEf00�m less I rertify Ihat m the pedarmanoe of!he wak for whkh this
peimil is issued,I shall not empby airy per5on in any mannei so as ro 6ecome whje[t a tM Nb�kns'CanDenutim . ( �
= Laws of CalAomia
o - . �,J RK FEE
p Oate `.'.. ` :��• �;ApplicAnl.
W NOTICE TO APPLIGANT It,afler making"lhj�'�Ce(uf�cite'ol plmn,you sMWtl hetome su6kct ro Mt WorMei's �-�.SCHOOL FEES
J
—+ Cmnpensanan pmnsions of�he La6ar�Code�you"moSt 1ort��w�ih tompiy wnh such prmuons a ihis pemiit shdl
LL he Jeemed revakM . !�
� f�NSION OF INWSTflIAL SAf Y PEqMIT CEHTIFICATION; �J�Y�1 J Z-t'P�I� .��G��� -r .!�,�'"L-, ' ' ��l-.�
�1 gE,.: � C
{j ..V—--
LJI herehy certrfy 16at no��I�Qd���5�d mor+�#(ii�depth imo whih a qrsan�s required to dncend,
� wdl 6e made in connectm with work author¢eA'tfy Ihu peimit,and Mat no hudaiiq slruclure,stalfoldinq,fYtewoh,
d w Aema6tmn m tlismantling thereot.will be mwe than Ihirty�mz(381 feet high.�Chap.3.2,Gry 2.Arl 2,Sei
W' 341,iiMeB.CAC1 _ _
x ?.;• i f �' ;..��.`�.`).': :,�: :�;,�',.�
3 ❑As uwnai�Dmldn.J�-w�ll.no�,a�ppy,anyo�to,do,�wk..whirh�wouN nquue a permi�hom the Dirieion al
H Intlustrial Safety,as naiedaheve:unkss•such pe(sarhaf a permi�do�da aucR wo�k ham the dNiswn �
�
W ❑avision M Ineustnal Sately Poimit No. �
� CONSipUCf10N LENOING AGENCY:I he� TOTAL FEES
� ehy afh�m�hai theie is a constru�tion kndiig agencY for tlK per(oima�e •
= ol ihx worM la wh¢h this pe�mit ia issued�Stt.3091,CN.C I.
•
� 4nder's Name CQM������ ���1 • �� .
m Lender's AEdiess /'• .
c �
CFRTIFICATE Of COMPLIANCE AND AU71qIMZATION OF ENfRY:I cntily I have read tl�is applicotian and stak
NJ Mal the nformat�on ryuen is cn�ect I agree�o wmply weh all sute lews aM ciry ardnwta roYtip to huilYnp
ycansvuctwn,and authorue a represenutive of ehe Department o(Buildinp ad SaMY Oo mhr�ywi the pnqeiry
= Iw wAkh I have epDl' e ihis permn 1or t pmpau of mHkinp inspettpns.
~ X r, __6�-��.�_.. �- �/" >�,
' sipnature of AnqKant ar npmt p� RECPT'NO. PAID BY VALIDATION
WHITE—Depanment Copy.YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy,(ipEEN—Applicants Copy
85106-11/89 ,
''� � _, � . +7��. . .. .... ._ . .. . , . .
� �_P �� ` . . _ . _ , . -. . ' . _
r. . . . � . . - . .. . .-. .. _ . . _
a-". �` ._ . . � .. � � s- . � ' _ . _ � - � . .
� � k � . � : , � � � � _ � � � � . . ' ......�.
HI ,
,� � .. - �,. . - . . � . . � � - - � .
r , , �. . � � ' . . . , _ . . . . � . �
.v :, ..M t. .
, .. . :. . . . . _. . .
.:>, ,�,�. :::. '. ,. . . . .... .. . .. . .. . . . ... :. . � _.,. ..:. ..
._.. . _ � , , . . �� ' . � . . . '
. ' .. ' . ' . . . . '. . � : , . , . . . ' .
. �" , ' �E , , ' � ; ; ; . . .� . : � � .
� _;.._ , � ' . ..: ., , . _:.`.
. . . . . . ... - , ' -. . ....
� .... .. ;.. ;. ; .:.. . .
, , ,:�
� -
J _ �
�
' � __.. .. . .
` �
, �C ; : ` ' . _.
Z
l 1 w.
by^
; '
� ,
. ', . . - . . ' E . . ' , � ' . .
. . i i � ' � . . - ' . . . � . ' � . - ' ,
I . . . � . . . . i . . . ' _ . . , .
. . '_.... .' . .. . .. .' .... .. . . ... . . .
._..�: „ ... ._ ..., .. . . .. .. _.
. . .._...... .... .... . . .....!... :.... ...... ........ . � _