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HomeMy WebLinkAbout1338� 2 s' CITY OF DIAMOND BAR PRESS A-12 DEPARTME BUILD NGPERMIT BUILDING PEND SAFETY FIRMLY JOBSITE 1 / � ADDRESS 13�l D `/ �►PP T10N MIT 1 SE DATISSUE 1' ]_ _ �J'"� NUMBER- `CODE APN L TRACT DATE r c J CONST. GROUP CROSS STREET OWNER ADDRESS ZONING SETBACKS serovekwwvs FRONT _ RW ❑ REAR ❑ CITY ZIP TEL. SIDElSI STREET RW ❑ APPLICANT TEL. SIDE ❑ CONTRACTOR "� 9 ADDRESS y3'l 1'^ �%� STRl3l�I%�7 a CITY (MAle 7Lr v WZK5 TEl7.= x SEWAGE ❑ PUBLIC PMT DISPOSAL ❑ PRIVATE Std. FT.! 100 GAL STATE 1�,,rp��--•.--�� ,,, LIC. NUMB;z� QER ZQ GRADING ❑ CU. YDS. EXC. CU YDS FILL ARCH/ENG/ DESIGNER ADDRESS W LWL TYPE SO FT FACTOR PS ADJ• AREANALUATION I 2 3 CITY ZIP TEL. PROPOSED USE Z 4 0- j GARAGE NO, DWEL. NO. NO. UNITS STORIES BEDROOMS LOT DIMENSIONS F) PORCH M VALUATION ADJ. AREA qRuANTffYJ DESCRIPTION FEE NO. OF BLDGS HOW ON LOT USED LLIl CONTRACTORS DECLARATION: I hereby dfirm that I am licensed under provisions d Chaps B kommomi with Section 70001 of DIwsion 3 of she Bus= and Professions Cade. and my (case is in full Ince and a a ©d 1 ./ oat E]wi o OWNER -&ALDER DECLARATION 1 hereby dfirm that 1 am Bumps Brom the CmtrKtor's License Law ha to hMlwr reason ISec 70315. Business and Professions Code Any city o county which requires a per. so -.4 alter. apim, ddmalish, or repair may structure, prior to as issanest. elm requires the applicant hr each panni 10 file a signed etatrmem dui he rslicensed pursuant to the provisions d isionthe CORNKI t s Licome Law Matter 9 Icommencing with Sabo T0001 of Division 3 at the Business and Professions Coda;) a that to is exempt tMrdrom and the basis for the alleged esempoon. Any violation of Section 7031.5 by Cry applicant to a permit mhpcts the applicant to o Car penalty of not more than fwe hu dmd dollars (S500)) L [!• ❑I, os wane, of the property, a my anploym with wages as drat ads eompematron, wit do h work, and h dnuctufa Is red (mended or offered for sale (SK 7044, Business lead Piolosams Code The Cadra�la•e L ,a L" does net apply m an own. of property who builds a onprows frmon. and who des such work Nmadf, a IMagh his own employees. pwded Mat such apro events ate not intended or offend her ode If, however, h budding or improvement is mid within ane ties, of Completion. the owner -builder will have h kodm of proving that he Md not build a improve for the purpose of take) dK ❑I, as owner of the property, an exclusively mnlreetmy with licensed contractors to construct to project (See 1044. Business and Profusions Code The Contractor's Liews# taw does not apply to an Came, of Property who builds or imptwes thereon. and who contracts to such protects with a cirommehil licensed pursuant to h Cmuator's uce^a Lew.l CONS TION ❑ I ism exempt ands sat . B. 6 P.C. IAnah GrlifrceN)- N REVIEW Oi 00 — are Owns J Q G MECHANICAL WORKERS- COMPENSATION DECLARATION I berobv affirm Mat I how a Wofieate of consent a on-insae• o a ceraficete of Warkei Compensation Insurance. or a Cariboo copy toast (Sae 3800. Lab. C.). ❑ Certified copy 'ehereby, fumish.d ❑ Cortland Copy at tied with that BuddmB Inspection apatnent v Department Q GRADING CERTIFICATE O EXEMPTIDN FROM WORKERS' COMPENSATION LUURAUME This anion mail rot be completed A the permit w for oat Rudred (B IDO) a lose. I early that in the palormacdrat work o of fa which this , , permit is owed, 1 shag not employ any person in any name so as tobecame subject to h Vibrators' CompensationWiT Lames of Cddame Dare AppY1y z �u., ".'s :.tU W ^ ; PARK FEE SCHOOL FEES ApTICJU E TO APPLICANT: V, after mal Vis Cdkfitde el':E ion,;�na: ft dE Eamre edgect Of the lip bon's Ctmpem bon provisions of the Labe Code. you most falhwith comply, with each provisions or they permit shag be deemed revoked. DIVISION OF INDUSTRIAL SAFETY PERMITCERTIFN:�1` e] �N� Ell hereby cortily the no atevotion Iwo IBI a m h a fah'a+ aeon a wquhred lo descend. Carp be nude hh dconreeton Wath work witimem by this pemul, ane dist a lo�kg Wwtae. atilotling, tdewvak. er d ma a mantkng Heraathant, wig be ne n thirty -ter 138) be high. (Chs. 3.2, Grp t, Art i. Sat 341. Talk B. C A.C.I C: Ty C F EIAs owrwr soida, I Cap rot upM pip. to Division d Irdusmd Safety. as noted slave. unless such person hes a permit to do each work tan the division o0msan d Induatifel s.te,y nrmil Na. TOTAL FEES nn coNSTRwrim umm AGENCY: I he,* off. suitfen n is a mntneton londhg agsary M h performance of the work Its which das permit is iaued (SK. 3097. M. Cl. Lemi Name COMMENTS lender's Address C FIFFCATE O AND AUFNINUZATION OF ENTRY. I cafity I Mw wed this ppliratiw and oda dm h ¢nn a dire.. 1 pme co amply wine am mw lows and per Williamson nketing a I odeing const . ed train a rapesmaVn d h Department d Building said Sddy to Amor ow h pop V ler Kh hew for the permit for tie purpose d nuking iapaclou. RECPT NO. PAJD BYVALIDATION .. Sgnnm d Aper ate WHITE—DeparKent Copy, YELLOW—Finance Copy. PINK—As®essor Copy, GOLDENROD—File Copy, GREEN— Applicants Copy 9E10B-t 1189 :mmhnnr..w�Ree^w-w.man•mm� rvaueaen.�:.x.�-wC:ana::mwnwha•�.eva.:awuovwyhwrrmm,wae.�....ave..m�+r>...rrrwvww�nnw�r...wrw....���..«.x.�.,�...........,r..._-�_�.____�_----.- -•'�..�+--•_"- �' � EKY {�•.'��'„-�::� �`.: +a•,•�,apy,ys�-e,e..rr..•«e;p. r•w..,-wrwx, case e-:«,�o,;snpws.3 i1 ({ ww�Y6 (b �`� f �”' > T ,�s� .... �� xx �Ve Yi W'°rV 5 bl d ��% •(S(S � f��ii��ww..kk{{jj Rpt pg �e � t § � '�: p t to t:>, d>� �-�n �� xKdY��k H ... f'A,h, i{ i p i I _ _ .... .... _.. ._..._. ...... ,. . ... __. _.,.. ....... .. .,...... ... ..._. :-:€:,_ f�..f. r35A ....... ... ..... ....... .. .... ..... ...... .. .... a-- e3' ,.)i �iJ�{„.�Pwi'-' _<�. .... �. , ff { ... ,.; , .-, y?-� ,.;..i1 , ,i:: < f',,"✓ �2 ��q ...tifl.'r• a. i i D: €>: n, i I p , i -i p^ i Sl -?,Tl;, -4 TANK SIZE __._..._.__....__, .... SEE F5 PITT S17F _T._.............