HomeMy WebLinkAbout1513 (19) '"` CITY OF DIAMOND BAR pRESS
DEPARTMENT OF BUILDiNG AND SAFETY F�RMLY
BUILDING PERMtT
JOBSITE rI � S�,,A,f1y P� pqTE CA�N NUMB R ��CODE
ADDRESS �� Ti��
iSSUE TYPE OCC.
4 APN LOT TRACT4Z5 81 DATE � �� � CONST. GROUP
o CROSS STREET "���a ZONING SETBACKS "�"�"'�"E""s
m OWNER � FRONT' RW ❑
� ADDRESS REAR � ` ❑ � �
� CITY ZIP�11(PI�TEL. Z SIDE/SIOE STREET RW ❑
o APPLICANT TEL SIDE ❑
:
� CONTRACTOR SEWAGE ❑ PUBLIC PMT#
o ADDRESS DISPOSAL
„� GTY_ ZI TEL. ��ryATE SQ.FT./100 GAL
� STA7E � GRADING ❑CU.YDS.EXC. CU YDS FILL
N UC.NUMBER �ypE S� FT A P A . ARE1�i4tilATiON
y ARCH/ENG/ N
" DESIGNER w � ' d
� ADDRESS Lt 2
0
z CITY ZIP T L. (� 3
� PROPOSED USE Z 4
; R L� _ '�,.,,�' 6ARAGE
o NO.DWEL. NO. q NO. � pORCH
y UNITS�STORIES « BEDROOMS�
� LOT DIMENSIONS k m VALUATION ADJ.AREA
o N�.OF BLDGS ( HOW � flUANTYi'Y pESCRIPTION FEE
W ON LOT USED���
Wx ❑
~ LICENSEU CAhTflALTOflS UECLAHATpN I hereby afhrm Mrt 1�m 6censed under pnnron�e1 Chepur B leommmcinq �
Y wnh Sxuon TOOp�of Diviswn 3 d the Bu+mess md Protessiont Ca1e.md my Iranet q in tull lorte�n0 effect W
apc:
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�±- OWNEH BUIlOER OECIARATqN I here6V dfum MN I�m pemp�Imm Me Cannemr'�Lc�n¢law la N�lalbwmq
reamn�Sec.7031 5.Busmess md Profeuions Cado Any ony or eaunry whch nquiru�qrmn ro comVal, Z7 �
e alte� impiove,demWish,rc repeii ury nrucmr�,qior q its i�ewnce.Mw rpu'res the�pp6c�nt lol su[h pemn .'G
� ta hk a sqneG statemem Ihet he�s N[ensetl W�sumi m Ihe pwiswns a1 tAe Cantrxtor't L'eerse 4w�Ch�ptm �j
� 9 Icanme�xing with Sxtan 70001 of 6wsion 1 el tl�e Busins�md PmMssions Codel a tlut he ia�emp tlrrdrom '�
d anA t�e hazrs lor che�pegM eumplinn Any wdauan N Seenon 1031.5 6y�M�pWiwm fa�p�rmn wUpns �
w the appHcant co�cnii penah�ol mt hnre tAan five M1undred dollen�550011 �
0.
� �I,�s awnei ol�he prapeny,a�ny�mployees wiM wepea e�Mnr�de canpensoton.will M Ma wak.nd
Me srtucwre is nat immded or olfered for eale�Sec 7064,fiusinxss md HMrazbns CoOe TM Cmtonar's Ucrost
� law doe�wl aDV1Y b m anner a1 prppertY�o budds or mpwws Mm�on.�d wha don weh wark MmHN.
�±+ a through hia ewn employees.pw�ded lhet tuch�mprovaments ne not inlended y olhred for fYe If,Iqwwx. ,
� me�ud0inp a mpwement ia iuW withn me y�n d complenon.tle ewner�builder will Ana tlie 6urden of pwiip a
y ihat he die noi hwW a improvc lar Me puryose ol nle.)
va ❑I.�s owner ol�he pWerry am eaNsrvery canlrxuny w�Gi licenaed[mYitm�s lo wnatru[t Ihe pqecl�Sec
O
7(144.Business��Rolesaqns f�de The CanuxWr's LKmae Lcw dees not�pply b an owno ef NopertY who
7e Gudds a�impiwes tnaean.ond wha cantnctf for luc�0�1��fi�cmnxrorlil IKensed punwnl ro tlx Cmtnctm's
'Q Lcenu lew 1 f Q�
� m J�lAN REVIEW �•(o�
"'� ❑I�m exem unOer Sec .B 6 P.0 IAnah Cerlilrc�h).
� o"' °ixne ` ELECTFIC
� NqiIlEFS'COMPENSATIqY pECLARATIqV I hereby�N�rm tha�I hrve�nrMicqe o1 toneent M�eN-nsme,a
a cerulKa�e ol Nbrkrs'Campensaum u�cur�me,or a ewn�ied�apr�naf�Sec 3aoo.�6.C I. � PLUMBING
� ❑ce�a�.a wuv a��enr i��a. � MECHANICAL
O LJ Cernlied capy��hkd rn[h Me Bwidnp InspecLm Oprtmenl or Depxtmenl �
� CERTIFIC0.TE OF E%EMPTqN fA067 WORKERS'COMPENSAiION W9IRANG4:TNa taeron nM rot 6�eo�kmd G'�� �,��j
y A��e permit it ta one huntlrod�i100�a Ins.I wrufy M��in Me perlamnce ol Ihe nv1 Im wlxch Mu _�
permit is issucd.I shaN nM empby�ny Mrwn in�m��orer w ai m becm�e w6�en u tlie 1W�kei CpnpensNim P .��
� Lnvs ol Cildom� �n. �'•�P�:.• ""``
00 �� C"'i' I,":..��`�'�� W PARK FEE
W NOTICE TO APPLIC0.M M,dpr in6kmg tlus Lernle��e al Eamo��.vw slould hewme sJqe«p ihe Wor4r'� u-�SCHOOL FEES
� Canpenunon prwrsians ol�M Li6or Cok.ysu mm�IarthwiM w+ylY wMi aeh ptoviaons a d�n permit Mdl
�e aeemea raakee ��
1
p� dVISION OF WUISTRIAL SIIF�,�7t��9T H ."t�
�++ 4AV�i
o ❑1 heretry certdy dut no ti favatm fiw I5)x roe het in dMh nw whkh a Osnan n�pwnd m Muend.
� wiY he m�de n ewNctm wnn waY wtlbrQea bY tlw pornn.Nd pq�.�o dyilNnY mrctun.pallok4np,IWewarl.
a demoAuon n dismm�inp tMrrol.,ynll k.nWe tl�in IhirtM-�(761.fie{Aiph.(ChW �.2.6r0 4.Arl 1.&c
W341. tleB.CAC1 �. !...;:' �..e� � . ; '.... .: _. ' :
z �'��;�S
� 0.s owner-buiWer.Ipp A pi',elnpby MYone ia do worY whieh wpAd npwn�pnni kpn/r Oivinan d
C Indstrd SdetY.��noh�'NuVe.unless`ucA GeRm Nf�7Km�O b Wch woAi Nan M dxilqn.
� ❑°"°'°"°"�"`"'S''°""`"'°"°. TOTAL FEES
� LOiSTNI1CTON LENOING RGENLY:I MrebY Nlirm rut M if�rymtruetlon Mndinp pincy ter/le�Irbnnme �
¢ pl tly rrork fp whith Mn�ermn N wWE(SK.3097.LN.C.�.
s �'"""''"""' COMMENTS
'��p' landx's Rdd�ese
s �ERfRCRTE DF COMPLW�CE AAD AIRlbItlUTOi�ENTRY:I aM'I 1 Ix�md tis�pplic�tim md�tee
VJ �hn Me+iMrmatm�iven k earnct I Wa m mnOh'wiM rl enn Mwi�nd eilv wdinmea/iunp ro hitlinp
y constructm.�nd riMnue�nD�eumwNe d!r O�OYtmm�d Builtlina�d SMMY b mor iqm Yr V�WR�1'
� for MA¢�1 Nw�ppNd lar tl�u R�mil b Me qrqfe d�nkiiq inpsoam.
Xl a7���V �` �I'W'�bl�'�+ � �M � RECPT NO._��2�PJUD BY V/WDATION
5pmtun d Appknt a� r i
WHITE—Department Copy,YELLOW—Finanee Copy,PINK—Asseaaor Copy,OOLDENROO—F�e Copy,GREEN—Applicants Copy
BS106-71189