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HomeMy WebLinkAbout1249 (14) ( � '"' � CiTY OF DIAMOND BAR �"� � DEPARTMENT OF BUILDING AND SAFETY PRESS ' � BUILDING PERMIT FIRMLY JOBSITE APPLJCATION F'ERMIL i 1/1t USE ADDRESS o DATE ` NUMBER `'�"� CODE ISSUE . � TYPE;` OCC. � APN LOT + TRACT DATE � �CQNST ' GROUP o CROSS STREET SETBACKS ���►�+s = OWNER�, � �r��Ts�� - ONING �ONT Ryy ❑ o ADORESS�j�.�'-'✓y o C h� /Z�'G �C/L R�q(� �'" [] � CITY�,;�.v�✓.B�'u'? ZIP �� TEL.B��� t.. SIDE/y�iDE.'STREET F�W ❑ e APPLICANT TEL. SIDE \ - ---�-'�-�—'- ❑ x ' 4 CONTRACTaR � � • ' �,: �, � °° ADDRESS SEWAGE �J...PUBLJG�;: �PMT� � DISPOSAL PRIVATE SQ.FT.!100 GAL. � W CITY IP 7EL. z STATE y LIC.NUMBER GRADING ❑ CU.YDS.EXC. CU YDS FILL � y ARCN/EN � TYPE. SQ FT �ACTOA P5 . ALU. Af[E�rlVi�tUAl'ION ,.: `n DESIGNER EL( 1 + o ADDRESS � � 2 iZ CiTY ZIP � 3 � � PROPOSED USE� � ""' Z 4 � � �k��"'���, � GARAGE � z NO.t�WEL. N NO. � i� ,� pORCH y UNITS STORIES�_BEDROOMS� � oc LOT DlMENSIONS VALUA710N ADJ.AREA � o NO.OF BLOGS How ttua�u��rv p���� ��p� �� i W ON LOT USEO � a � w;u � ! ~ LICENSEO C�NfppCTORS OECLANATIDN:1 herebY alli�m�hat I am licensed wda pmv�ams of Chapur 9(commmnnq ���� i � wnh Secuon 7000)af Owision 3 a(�he Business and Pm(ess�ons Code,aid my lemse ia in full force and elfetl. � � o 3 C�yG..� �.EL..�r/ :a j. � �+- NFH�BUILOEN OECLARATqN:1 here y a16�m that I am erempt imm i�e Contraclor's lkente taw lor Me fdiawing x �eason iSx.70315.Butmess and Pmfessions Cade�Any aily a ewnty whrrh mqurres a pa�mrt ro canttruct, .(�j o ahei.impmve,demalish,a repair arry muctwe,prior ro fts issuanae.alw�eQuircs Ne apphcanl fa such pnma � 6 ta lile a Sign¢O S�a[e.ment Ihal he is IcenseG pursuant ro the qwiuonz af the Contratror's li[e�e Law(Chaptef �j � � 9lmmmencing wilh Secuan 1000)af Oivision 3�the 9usiness and Professiam Codel or ihal ht is exemp�fiaefium 'S� ; X and�he�as�s lor the alleged eumpnon Airy vidatian ol Sectwn 7031.5 4y arry applicant far a parmn sub�¢cu �� � �y the aoON�ant ro a civd penalty at mt maa ihan five hnnd�sd dclWs lSSQD�.1: � + a � �� ❑I.as owrer nl the properN.u mV emp�vreei wim wages as ilmr sde compmution.will Uo the xvrk.md � ihe structure¢nal imended or alhred tar uie(Sec )064,Business and P�olesspns Cade:The Conirxmi s ticen5e Q V Lew tlaes nat aOCM Io an awner of property who 6u�10s ar impraves thereon,aM wha tlas such wo�k h�mself. (,) ' w�hrauyh nis awn emplayees.provded that such imprmements arr na.�npMaO d oflertd for sak I(,howerer. .Z = the bwlding or imD��emem is mk within one year ol compleum.the ovmer�hm�wdl h�ve iM burden of piowry� �Q � � �ha�Ae did noe buiN a�mprove kr tAe purpoae el sak.l �"'Z ti ❑I,as awner ol Ihe pioperiy.am e.clusneH�a�«anmy wrth IKens�d[ontocm�s m construct Ilie pqect ISe[. ��� 0 10d4.3us�iress and ProFesswns Code IM Contrxtor'S ticense Law doss noi aqply�a an ownn ol pope�ry wla � ! � huAds or imprwes thereun.a�who tanlrect�la zueh pruje,;is wiih a mMntter�s)licmud pwsuant m Vie Conlrxlvr'S �}i j Lrtenu Law 1 CONSTR `rl�� � � PLAN REVIEW j � ❑I ain erempt uMer Stt. .B 6 P.C.(Auach CernNcm). i � oB1r °i""B1 ELECTRIC � a WORKENS'COMPENSATIOW 6EClAflAT10N I Anety al!'um Owt 1�m a mufinte vl toncem to sd6insue,n � 0 a cerohcate af Wa�keri Compensaum�nsmance.ar a caMue cwv iheieo�ISec 3800,La6 CI ' PLUMBING 1 Q ❑Cenifiedcapy u berehy lumished J MECNANICAL o ❑f.anirp copy a IiIM wnh the BuJding Inspecum Depvtment a peoxtment. Q GRADING W i � CERTIFICAIE OF EREMPTIpN FROM WORKEflS'COMPENSf�7lON INSIIfiANCE.7his satnn nred not he campkted CJ`UA ` _�� y d�M perm�[u Iw one Awlred�f10U)a ksr I eerufy Mat m me yrlamanee�f IAe wnt for which lhix /''� � � permit is issueE.I s�aN mt empby any persun�n a�Qann�.�,6o a,�ta4ecy�re wh�ec�to fhe Nh�kxa'ca�x�sa��, . $MIP ..�(_� � Laws ol Cai'rfwnia. j:u�"1 �s j �, O ��`S`�'-���#`��% PARK FEE � �1e ���^'�. ~� �- SCHO�L FEES � NOTiCE i0 APPIICqNT:If,alter making�his LernfKale uf 6rempuoR You should hewme su8�at ta Ihe M4rkx'a � Campensauon provisions al tk Lahor Code,you mua�faihwnh camply w�m s�n�w�:a„s a m�:v�e�n� ' �' be deemed revaktd. 4 . r I s qVISION OF INWSTRIAL SAFETY PERMIT CEAT ,J "" W I o ❑I herehy certify ihat no eytavatnn live(5)a mae leel in EeptA inm which a prsm is required to dacad. � wN he made m[mnecnon wnh work wthor¢d M�!f.V�IR,�ndtpatno hyldiny_YPl'ktul.snllddinp.I�Isawak. w demdnion ar d�smantlinp ihe1cal.(Qi8'6e`ihw(.ilian tpirry'Li{JBF I!n Mqh.^(Chz'p;'J.2,Gry 2.An 2.See . � W 34�.TitkB.GAC1. � �.�..:, ,� �°.�...� ". �„-J.; i = r.`,,:::_.._.'.`. 3 ❑As owner�Duilder.I wili nat emplaY anWna m do wwk whwh wouW rcquire a permA kan tM Divuian d I 1— 7nAurrid Sakry,as norcd abcve.u�kaa such persan!us a prmrt ta do turh hak trom Ne Eivifian. � � W ❑°"`'�m�'�'��,s�"�`�°,�. TOTAL FEES a � CONSfpOCTIpN LfN01NG 4GENC't�i herehy alli�m m��tnen is a consttaoan le�q q�r�cy lor tlr perfam.nee ►� � = af�ht vrorM fa+rhrh this penrct�a isawd(Sa.9D9T.Civ.C). I � lmdei s Name COMMENTS m lmder's Add�ess I � CERTIFICAiE Of COhiPL1ANCE ANO AUiNOfpZA771fNN!7F EN}AY:1 taMy 1 h+e read llq appinlion aM iUtr . y tM1at the infamanon grven is corrett.I aqree ro comply wi�h aY su2 law�aid dry adinraa reaup to Md6np ' y wn�buctwn.md anMr¢e�ieprtsenfative d tlr Oyrtm[M of Buildinp ad S�kry m nW�qm if�paOM�Y I = kr whKh 1 tuue appl'rd lor Ihis ppmit fut Ih p�pnse d m�kinq inspecuqn Y�— � —�s�- � ��dS�i p�'�— � �an�� RECPT NO.�_PAID BY—I�=��—VALIDATION � ��.,,�..,�„ WHITE—�epartment CoDY,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROO—File Copy.GREEN—Appticanis Copy , _. _ j� r � r 4 j � - � ,� r�'� � ;er r�. � i , , � - i , r �� j ��� ,� I � � � I � � '» r ,`��€x 4 i � �i . � � ;r e t �-q±�a . 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