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HomeMy WebLinkAbout1839 _ ��� �' '���.- ��U"�>� '"' CITY OF DIAMOND BAR ��,' � DEPARTNAENT OF BUILDING AND SAFETY PRESS ���I BUILDIIdC PERMIT FIRMLY JOBSITE --> rZ� APPLICATION � PERMlT ,� USE� ADDRESS.� �� � • '' . �--' L��' DATE p, U���'� NUMBER����CODE B APN �;��F�•��"� LOT�TRACT � � D TEE �, `� � % � ��(� CONST. CyROUP � CROSS ST EET SETBACKS "R'°"E',�"'S �° OWNER �F,�/N�-'7,G/ ;FS') �'i��e=�� ZONING �ONT RW ❑ o ADDRESS_ � �� y� ��-_�� •����� REAR ❑ ,o CITY ��`- ���R' ZIP�TEL.1�� � SIDE/SIDE STREET RW_._❑ `o APPLICANT��✓��1��r .�/ l�of� ��! G 37a SIDE d � CONTRACTOR • `' '��" pp�'' SEWAGE o ADDRE � � �'�� � DISP05AL � �BLIC PM7� W CITY - �% ZIP�TELd'� 'C ' �� Q �IVATE SO.FT./100 GAL z STATE i i'�'��i y LIC.NUMBER�I�a 6�,('r.-- ���5 �—/[� "1�.� �� GRADING �CU. S.EXC. CU YDS FILL y ARCH/ENG/ /�,� — t!) E S •FAC?C1P!pS A . A� ALUA7'E3M . " DESIGNER /`�%����� � � ' , . � ADDR SS� � C/�CL �e Gt� �. 2 � �' GITY C 2 �� ���ZIP�TE . �- ��' � 3 x W � � .+�; PROPOSED USELa9�-Sr�Lc._ c��r�u/r� � � "c�.�� /�ts CF L. t)N �ca� ,,;;� GARAGE � . a o'. NO.DWE�. NO. N - � PDRCH � y: UNITS STORIES BEDROOMS_ � LOT DIMENSIONS_ �' VALUATtON - �t-'�--' � �- ADJ.AREA e: NO.OF BLDGS HOW ` Qt1ANFRIF DES. . PTION `. f�� � W` ON LOT USED , ;t _ r,�.:q .� �1(�) � � ~ � � �. � �`Cr LICENSEO CONiflACTOflS DECLAflATION:I IreieEy affirm thet 1 am Gcensed uMq qovi�ipu of Ch�pter 9ltommencirp � Wlih SLC6011 7000�of�imsiw 3 of the 9usmess and Pmfessians Code,and my license is in tuU lorce aM effect W 3� � �. _• �WNER�BNLOfH OECIAflATpN.I herehy alfirm tM1at I am eumpt fmm tAe Comractor's Lkense law fa�the idbwug � �> . y ` ie.asnn�Sec 70315,Business and Profeszmns Code Any city or county which requires a permit to con�imt. "'(y ��,-� ��„sc-� � ��� � a Q k o al�ei,impmve.Uemolish,ar iepair any stninure,prior co ns usw�e,alw reymres tlre applicant(a such pem�it �� ,� � 1= to Iiie a s�gned sutemen[that ht is licensed purswm to the p�wisb�a ol the Cmvacmi s Licente L�w(CA�pter ;� T C �,� 3 fcommencmg wrth Secunn 7000�af avisian 3 af the Business a�P�ahssiom Cadel a ihat he is axempt therehom �� '�� and Ihe hasix ioi Me allegeA evemptpn.Any vidatnn of Sxtion 10315 6y anY applicant far a permit subjeck � � ���.f �f�„ � l'n,.., "� � �� � �,.W tlm applKant m a crvil penalty of nat more than live M1undied dodars�5500�.�: �� •o i ❑I,as owner ol Ihe DropeitY•a my employees wiN wages as their sde canpensation,wili do lhe work,end ~ il�e xtructure is nat mtenOed or oflered lor sale ISec 7044,Business aM Prolessions Coda.The Conttacror's licrose �q � j � �V taw does nnt apply to an owner al praperty who 6uilds or improves thNeon,snd wha dces suth wotk himself, V �'�� - ��`•' � `"� � W or ih�ough his own enployees,provided lhat such�mpravemenis aie not imended a offeied for sak.If,however, , .im� tM hudding w impravemem i:sold wehin one yca�af�ompietron,tM avmeo-hmlder will have Ihe drdm ol p�wirp :.�� �•� �that he did not 6mM or impmve far�he purpose uf sale.) '_ � y — ��t/J. ❑I.as nwner of ihe prooetly.am extlusrveN cantraeuny wim 6censtd conuactorf to wnaruct tl¢prqect(Sec. .�� � • .7(144.Busrress and Prolessians Code The ConUecta's License Lew does not apply to an owner of poperly wtu � 'Y - � �x Luilds ui impmves theieon.antl w�o rontracis fw such O�lecls with a[anttacW�lsl li[ensed pu�suam to the Convecta s Q LKmu Lawl ni��t,�c.ri , _7 � � ❑i em r.��u���ae�s� .a e r.c.we�n c���a�rei. , PLAN REVIEW"��, :- '" nr.�l�-i C:��CG f(1 '~�- c• Date ow�e� .EL-•E�� .�J� ¢ _'y' WORKERS'COMPENSATION�ECLARATIW�I herehy affirm that 1 have a cerliliate of consail�o sdf�insue.a � ^g � a cerofi[ate nt N6ikers'Compensation Imwance,or a cert�tied eapy theieol(Sec.3800,Lah.G�. " �����'1 fA. rl �Y: o y 'I�/+ w rp� ��x Ce�tilied[opY is herehY Iumishe0 � �/�}T(��/;"��� �' IYSSwl�I..�Ia��Ci��»9 � .� ��✓v Q /L ['�� n � C CeiulieA wDY�s ided wrth the BuiMing InspeClion ,3�Im6nt Of� oepuimem. -'�L GRADING �^'W .� . ._. 'Z C FiCATE OF EI(EMPTION FROM NqHKENS'COMPENSATION IHSIINANLf:This secoon nee0 rol he campkte0 �.. �J�[.7 � �= it the permit is for one hunAied(S1IX1)a less I ttrufy Mnt in the perlormance of the wuk lor whkA'�his .,�,,:,:_--- .�y "� • � � permn is asued.I shall rot empluy atry permn in any manrer sa ai W 6etome w6ject W tM NbrYers"Canpensation S � •'� ��� Laws ol Caliloinia �2 ��� A �— • � /L! "�JCs""�J U npphnnt� +✓ . f � PARK FEE o uare � SCHOOL FEES W NOTICE i0 APPLICAM�11.alter makinp Ihis Cntilitaie of Exemption.yau aMuN rm�e subjett Me 4Wrker's � �_+ Compensa�an prmisiuns oi Me La6or Code,you must torthwilh cwnply wiM uch paunns a ia pnm�shdl "'� be deemed revoked. � 'L�"(�'r � �IVISION Of INWSTflIAI SAFETY PENNMT CEflTIFICATION. '�� ❑1 he�ehy cetlity th�t no expvatwn live�5)w more feet in deptK inlo W�i�a`per;$T�is rep�titrd to da[end, , •s wtll Ce made m cmnectian with vrork amM1u¢ed by thu ce�rt,a�thai iro huJdi�p�Vuclue:tcathl0inp.fWmwk, � -•d a demolrom or dismamling�he�eel,wJl be mere�han thi�ry�:ix 1�61 ftet hph.(CheD.'32.Grp Y.Art 2.5!t ' �W' 341.T�tle 8.C A.0�. S '3 ❑As owrer�6mbei.I wdi not empbY�Ya�la do workly�l'pd�;waui�iequire+permn hwn tl¢avison d �. Industrial Salery,as noted�6ow.unkss such person has a perij�i�b d'o weh wak Ir�lbi;d�i+i�on- 'E ' . : . �.',. 'y�,� ❑pvisim ol InMstrial Sa�ery Permil No. TOTAL FEES � f �t �� CONSTPUCfqN LENaAG AGENCY:I herehy aHirm thai ther9�is,a�c8nstrucAm,kndinp.apenty fa,tM pelamntt � .. �Z ot the wnrk Im whxh bis permil ia iasued�Sac.30B7.�Civ.C.1.. ' .. . � .. . .. � leiMer s xame COMMENTS � � �✓ (��✓ '"m LenAe�'s Atldass � Q CEpTIFICATE OF COMPIIANCE ISD AUIHptlZATIdJ Of ENT Y:I artily I luw rod this ippkatian rd auae va ihat the infamanon � is ren I �o comply w p apce laws and dry adinrsec rtl�pq to 4iNnp y �onstiuction.and a re0 auve Ik Deper t of Buidinp sd Sde1y m a�Yr Wm tle P�rt�Y F Iw whxh I h appied IAis pe��aupou kinp inspcc6mx ( (��� •/Sipnat, ot 4ppkm�apen J� ���G RECPT NO. ^ ""�� PAID BY �� `� VALIDATI �, WHITE—Department Copy,YELLOW—Finance Copy,PINIhl�ssessor Copy,GOLDENROD—File Copy,GREEN—Applkants Copy ,�. � i �BS7 06-7 1189 � � _ ___.____._ . . �`""�-,�'��� �,,� � �.c r � f _-�..� _ ����� �° -� �. �_ ` �. ( � �':. r �'`�k.��'�'���� y��.�•��• � j � � � — � . �e���"�� � �� '3 rg`" Y� ' , � � ,� �� �;���n+ ��:� j. �� ��;.���",� �z�������.��'� ' � � � �'.��`�r����h,-'�' � c._4 . ; � � ,., r�: ' . , _i� .n _ "� '.k���'s�`���;{�`����'°..1.'.�,8���:� , i . �, . . ' . . . -- . 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