HomeMy WebLinkAbout165 (1112) '"� CITY OF DtAMOND BAR
� x�` ' DEPAR'TMENT OF BUILDING AND SAFETY PRESS
BUILDING PERMIT FIRMLY
JOBSITE APPLJCATION PERMIT ' , -� USE
ADDRESS ��' 3 1300 S. Vallev Vista `��UE - ' `�—TYP�ER�CODE
! APN LOT TRACT DATE _.I��`�9 CpNST.�,�_GROU�
� CROSS STREET • SETBACKS �E*��
`:° OWNER P_K_ Ibaimnd V�t�e No. 1 L.P. ZONING �� � �
� ADDRESS g18 W. 7th St. Suite #700 REAR �
W CITY Tnc ng 1�_ZIP�_TEL2 SIDE/SIDE STREET RW �
o APPUCANT TEL. „ SIDE ,�_ ❑
: .
6 CONTRACTOR ��e ��� CO. , ... '
13350 F�tor St. SEWAGE , ' •C� PUBLIC PMT�
o ADDRESS DISPOSAL = '
„� CITY ���TS' ZIP 91746 ��818 369-�440 .'. ..b PRIVATE SO.FT./100 GAL
z STATE GRADING ❑ CU.YDS.EXC. CU YDS FlLL
y LIC.NUMBER NpE SQ Ft FACTOR P5 AD.I. AREAIVALUATION
y ARCH/ENG! i/]
� DESIGNER W 1
e ADDRESS LL 2
= CITY ZIP TEL. (� 3
� PROPOSED USE Z 4
w � GARAGE
� NO.DWEL. NO. �• � PORCH
y UNITS STORIES BEDROOMS m
m LOT DIMENSIONS VALUATION ADJ.AREA
o NO.OF BLDGS HOW CwaN't'ITY DESCRIPTION FEE
W ON LOT USED �
�
W �
�
IC SEO COMRACiDflS DECUIRATION 1 here6y dfirm Iha�I am licensed unda proviaions o1 Chapur 8(wmmencinp �
� with Saaan 70D01 of Oiwsan 3 oF the Business and Profeasnna Code,tnd my Ikenae rs in IuN krce rd dfxt �
�3 � W
�- OWNEF-BUILDER OE0.ARATpN I hercW Mfirm tha�I�m aMempt from Ne Cmtnaor'�tcense Lew br�he fdlowinp Q T_�� /1 7�� � �M
Z reason�Sec 7031.5,9usinesa and Professiona Cade:Airy cMy or county whch nquirm�permit ro canrlruc�, .(� [7 LYt L W
O �Iter,imprave,demohsh,a repair nry pructme,ymr io it�isswnce,4sa nquirn the�pplinnt(ai wcM1 permrt Z
1= ro file a sipned�tttement tha[Ae is YcensEd purauant�o the D�wiciona o1 Ne Cantncmr's Lkeme Vw(Ch�Dter � 7 = �„�
¢ 9(comme�ing with Secvon 7000�oi Oiviaion 3 of the 8usines��nd Proks�iaio Codel Q Mn Ae n exempt tlmafrom
Kend Me 6asia kr the�Ileged eKemptian.Airy vid�hon oi Swtion 7031.5 by any opphcam Po��pemn w6�etls �� �
W tlie eppliaant m e eNA penalry M not more than five hun0red ddlars Ii5001.1. *�
O.
a ❑I.�s awner af tAe praperry.a my empbyees wiM w�pes u theu tole compens�nan,wil do the work.�nd
�he svucture rs nm inronded ar dlsnd la sde�Su.7p94,Bus�Mas end Pmfesaioru Code:The Lontnetor's Ucense 'q
v Lev does not opply ro m owner oi property wlro huilds p improves thereon,�nd who does w�h werY himedl. �,y
�++ a ihrough his ann emqoyees.provitletl thet iuch imOmvemenls rte not imended or oHered lar tele N,ho�eoer, Z
m Mie�uibinq or improvement is aald within one yeer al eomplevm,tM owner-6uilder witl ha�e tlw hurden of prmiop q
� ih�l he did not budd a imprme kr iLe purpaee of sak-� x
y �.2
v� ❑I,es owner af tAe propeny,am eaclusrvety[ontra[uny wnh liaemed cmnacbrs to conatrucl 1M pro�ec��Sx {��
0
7D44,Business md P�ofessions Lade�The Contmctar't License Low daes ro��pply to m owner ol prapntp wha
= 6mlde or imprwes thereo4 and who conVaets lor such pm�eots wit�a tantru1aq�)Icensed pvauant to Me Contpctd'i
t �Ke�:�taw� CONSTRUCTION
F ❑I am BMemD1 under s� ,e.e v.c ianKn u��;�,roi. ' PLAN REVIEW
� °ie °in"" ELECTRIC
� V40HNERS'COMPENSATIWJ DECIARATI�J 1 hereby etiirm that I hwe�eertil¢ate ol emaent b sell�insve,a
a rertiUcete of Nbrkers'Campensatian Iniurarce,or�cxtitieA eapy tl�ereof(Sx�eoo.�.n.c.i. PLUMBING � O•
� � MECHANICAL
_ ❑Cernf�ed copy i�he�e6y lurnished. �
Q www���
�p Certif�eA copy is hled wilh the Build�nq Inspecuon Oepartment or DeOuunent. � GRADING
� CEATIFICATE OF E%EMPTION FROM WOHKERS'COMPENSATION INSUflANCE:TAis xctian nxd no�be eomplead ISSUANCE .�
� d Me pamn rs lar ux hund�e0�f100)a k:s.1 urofy Mat m Ihe perfmmince d tl�e worM far whicH thia
permi�is issueA.I thall ml empluy iny person in eir/menner so�s to Dcpne suCjecl to the Nbrkerb'Compenae�ion SMIP
o ��W$`�c�;����a W PARK FEE
e oare ���^� LL• SCHOOL FEES
W NOTICE TO APPLICANT:tl,dur mekinp this Certihc�te o1 Emmptun,yau should 6ecome�uh�e�t to Me WmYer'�
—�+ Compensanan prwisions of the L�bor Cade,you must faMwrth eomply wiM wch prwiswiu a IMs p�rmu diell
� he deemed revaked '
J
� WISIQAI OF INIXISfRIAL SAFETY PEHMIT CERTIFICATION
W
� lerehy�ertrtv mat rm e¢evauon frve(51 or imre het in depth�nro wAkh�penon u rpuired to descmd.
s will be made n eonneetm wah woh w�hn¢ed bY tlYo pe1mit,eid IMt no huddinp�tructun.sealloldinq,lalsewarR �
d d tlemolNon v dismantprq tAeieol,w�ll Ge mde Man m.n���(381 het Fiph.ICM�p.3.2.Grp 2.M 2.Sec � C� OF DIAMOND
W 361.TitleB.CA.C) gt11LD11VG AND A�
_
3 ❑AE bynx-6udde�,I wiN no1�mploy myone to do work wAich wauld roquin�permt Irom tlie D'witian d
� InAistnal Satety,as noled�bove.unless such ponon ha�a oamt m do such work ham Eie�vi�ion.
f
W ❑Orimm d Indumial Sakty Poimit No.
�. TOTAL FEES ,�
� CONSTftUCTIOW 1EN01NG AGENLY.1 Mreby�Hirm tlwt tlpn if�canstruNion 4ndinp peircY M IM Mrbimann
Z d�he worM for whkh this pemMt it�sauetl(See.3097.CiV.C.1.
� lander'a Name COMMENT$
m 4nEer's Addreaa
t fFRTIFICATE OF COMPLIANCF AND AUlHORI2ATWN OF EMRY�I mti(y I hw ned Ihis KpYcnian�nd MNe
_ m�i�Fe nt«mauan piven u mrnn i apree te mmpW weh�o nan hws+M ciry udiiunces rWnnp b 6u�np
y constru�t and wnhoiue� senuwa ol tlw Oepertmem al BwWinp rid$de��ro�mr ywn tlx qapary
� for wh" ve applud for rme lar the p se ol makin ' tions
� f< S' 8
�
�a�We d n�v�KM�a�t�e p�m RECPT NO PAID BY VALJDA
WHITE—Department Copy,YELL0IN—Finance Copy,PINK—Atsessor Copy,GOLDENROD—Fpe Copy,GREEN—Applicants Copy
, ., . , , . , �� .-, . ,- . - . . . . . ., . , .. , „ „ �-. •� . . , , •- .. .. „ . � ,� . � ,
� - ..' t ' � _ � . .. . ( ; •
, '' •; � , . .
�J ' . ,
. • . , �.''�,�1' . � _...� ` . 1 � ! .
Qt, �.vn8 �n�6 F�Na� >o�-3r-4�
,; ; � ~����
, -
:- - _ . ; , �
- �,�,����.�u�:,;�
�:;?� � � t-tlr�� ..
f��,L� ,1:�i1;.. �•ii) -'t(.) �Y I?�
�7�i:i:.�%:•, i1 y� ` ; •. �i�
f: 1ii.L1J�v�.�
� . , _
.+�`._.._. � r:-r _.. _..... . _.. , ./ , � . . :' . ' . .' , _ � �'�