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HomeMy WebLinkAbout1411 -- - .....--. - - . _. . .. ��ly� f`l ^--� �.�J '('� � �IT�( OF DIAMOND BAR PRESS DEPARTMENT OF BUfL�ING AND SAFETY F�RMLY '�^ BUILDING PERMtT JOBS�TE APPLICATION, ,�,.. ,,--�_ � PERMIT USE ADDRESS �-' � � • ' C„ DATE ��_ ��_NUMBER ��CODE ISSUE ���+ TYPE OCC. 4 APN LOT�� TRAG��:�`j� DATE �'���—`"L�_CONST. GROUP � CROSS ST EET �.�.-- � ZONING SETBACKS �� — OWNER _-���—�„_� �— FRONT �h/ ❑ o ADDRES � � '� ^ '�� > = REAR ❑ ,� CIT • �' � '�IP�`�,.. E�`C�5,�� SIDE/SlDE 57REE'•' RW ❑ �ii o APPLICANT � �- �. ` TEL�-{��� SID�__ ❑ Q CONTRACTOf�����'�.rc�:G�_ �C:��``_`a :.y"'<—� � •.''3'- DISPOSAL ❑ PI.iBLIC PMT� o AD�ESS -...`:...r L- ❑ PF;NATE SQ.FT./100 GAL .� CIT��.r.:- `��-'�i`�;s'.:�, Zip , .�:� TEL..�'�� � �� Z STATE � y LIC.NUIv1BER�5���`�}�-'' f~f S � GRADING � CU.YDS.EXC. CU YDS FILL y ARCH/ENG/-� � y TYP"E SQ F1� I� PS Af3J: i4REANAL ATfON, `=' DESIGNER • `�-���� W � r � �� ��'Y' ¢ � �. � l�DDRES � �ni'S �.c=-c�-"�.�sC3�-. IJ,. 2 Z CIT �..� ���_5�1P " `�"�•TEL.��.' 'a'S-: ` �r 3 � PROPOSED USE��� �=� � ��'4�-`�-� Z 4 _ � � GARAGE = NO.DWEL. O. NO. � pORCH , UNITS STORIES BEDROOMS � LOT DIMENSIONS m' VALUATION � f�- ADJ.AREA o NO.OF BLDGS HOW QUANTI'fY p�$��'ph'�Q� �� . . W ON LOT USED Q � � W _ ' � ~ LI EO CONTflACTORS DECLAAATIDN I heie6v alfirm ihat I am licensed undcr Dmvisions ol Chapter 9 I�ommencing � — � wnh Sxbon 7900)of O�oamn 3 0l ihe Business and Prolessrons Cade,and my Lcense is m tull iorce and elfect W � � W LL OWNER�BUILDEH�ECLAAA7qN I herehy afiirm thet 1 am ezemp�Imm the Connactor's L¢ense Law hr tAe fallowmg — reason ISec 7031 5 Business and Professians Cade Anp ury or county whah requires a pe�mit to cunsiruct, (� oxlre:.imOra�e.tlemoLsh.or repar any slructure.prior to ns rssuance.also reqwrzs the applicanl loi suoh ce�mit � F— io IiL a signed siatemem tha�he a I¢ensed pursuam w�he prwrsians of the Contnctor's License law(Chapter �j � 9��anmencing wRh Sectian 7000�of Oivision 3 at ihe 8usiness�nd Pmfessians Code)ar tha�he�s eremp[ther¢fwm '�„4 — � and;he Sasis tor!he alleged exempuon AnY vfolatwn al Secdon 7031.5 hy any aD01i[ant!or a Oermit su6leas � W 7he applicant in a c:vil penaliv ol not rtnre than five hundred doll�rs j5500�.1 a � ❑I,as uwner ct the propeny,or my employeex with wages as theu sole[ompensa[ion,will do Ihe wark,a� ~ 1he snucture�s not imen0ed or oNered tor sale�Sec 1094,Busmess and PrMeSsuns Code:The Can!racta's License Q � law tlaes rot apply to ar owner oi propertY who hwlds or imp�oves thereon,and who dces such wor4 h�mseN, L� � ' or;hmugh Fis own emDlayces provided that such impiavements are not m4nAed or oHered lor sale,if.however, � m me huilding or impravemen�is sold wilhin ane yeai of�ompleum tM mrmer6uilde�will have Ihe burden ot prwing Q � Ihat he ditl not bwld or xnOruve to�ihe Durpose ol sale.l ��� H e� ❑�,as ew�e�of ine o�uoe�w.am e.dusiveb contranmg wnh hcensed cantiactas to construet 7he pro�ect(Sec t(J 0 706C,Business and Prateumns Code The Contnctar's L¢ense law does not apply ro�n owrer ol pwperly wiw '� = uudds m'�mpro�es�herem and who wN�acls loi such pro�ects with a comroctor�a)d[msed purswm to the Can[roctor's a t"e�se�a"•� CONSTRUCTIO � �^ .`�� J � ❑I am exempi under Sec ,B 5 PC IAtixh Cer[i}¢aleL PLAN REVIEW l.�� � / � °a1e °i""" ELECTRIC � � NARKERS'�OMPENSATION DECLANATION I herehy aftirm that I have a cernficate of cnnaem tn self�insure.oi a cemfica�e nf NqrMers'Compensauon Insurance,or a cerMieO capy t�ereof(Sec 7800,lab C 1 PLUMBING _ � r � MECHANICAL _ ❑Cer tl coD4�s here6 Iurn�she0 o :�ernf�ed coDY is filed with the Bwiduig Inspection Oeparlmenl ar o�PM�mB��. �Q,�, GRADING W /'� � CEFTIFICA7E Of E%EMPTION FROM VARRERS'COMPENSATION INSUNANCE�This seclion need nrt he wmD�� �- AN�,E�- _ ��j L.J y A ihe permrt is fo�ane hundred(5100)or less.I cerLfy Ihal m tAe per�mmance cf ihe work for which Ihu (� — pe�mC is isSueA.I shall not employ any person in any menner so as 10 bCcom¢su6�ect to Ihe Worke�s'Canpensation ~i SMIP i "J � � Laws ot Calilarnia � W o '����� �. � L- � PARK FEE Od1e . SCHOOL FEES � NOTICE TO APPIICANT II,after making th�s Cenilkate of pu you h tiec s jecl m the Worker's �"�" � Compensation pmisims ol tM Labor Code,you mu31 IathwiM with avs or ihis peimit sM1ell � he deemetl revoked � � DIYISIOY OF INOUSTRIAL SAFETY PEHMIT CERiIFICATI01Jr�; ,`: _ ' '; � � . .-, ': `.: ;. � ❑I herehy cenity ihat no eKca�alnn Irve(5�or mOji ieet�in deplbiatoiv`hich a person n repured to destmd, _ � wdl 6e made in connecum wrth worM autlivved 6y this permit,and U�a1 no huil6ep slmclur4 scaHolding,lalaework, � or demol;[mn ar dismantling ihereof,will he mae than tNrry�su(36�fee�Aigh �thap.3.2,Gry 2,Art 2,Set _ = 341.LtIe8.00.C1. W ir.i��f,�.ih _ �<��" 5 °a Q''���� 3 ❑As owner�hmlder,I wdl no�empby anyo�m dh�7wwk:whiM waul�'r�ere a pmm�hom me Drvisian o1 � Industrial Safety.as noted a6ove.unkss such person has a permit to do such wark ham Ihe di�isun. � � ❑awsion of IndustwlSa(eN��it Ne....;.. , ' . ... ." . ,. �..,:.�---� TOTAL FEES � ° �, c� CQJSfRUCfION LEN�ING AGENCY:I he[eby atlirm•thst there iz a mnrnuction iendinp apeiiEy fa ihe perlamunce • Z of ihe wark for wh¢h Mis peimit is issu¢d{Sec.3091,Civ.C.).� � � "'' � Lender's Name COMMENTS mLenAer's Address 'a CERTIFICATE OF COMPUdNCF ANO AUTFqIN2ATqN OF fNTRY:I artify I Aave rxaA IFiis appleHion and sta4 y that Me i�ormatwn gnen is correct I aryee to comply wrth all staR laws and ciry ord'aunces rdptinp to huildi�p � construciion,and autM1onze a rep�esentative ol�he Depanmenl a1 Bwltlinq and Sahty ro mta ypn tlm qope�ry = whrc6 I have aDC�k r Mis permn for the pivpose of malig inseattbns. ~ ,. 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