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
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� .+�; 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
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