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HomeMy WebLinkAbout1123 ''�' CITY OF DIAMOND BAR �� �•' ' DEPAt�'TMENT OF BUILDING AND SAFETY PRESS � '�° BUILDING PERMIT FIRMLY ADDRIESS ��� ��� ��°'P�� DATE CATION NUMBER �� CODE y ISSUE TYPE OCC. � APN . LOT TRACT DATE � CONST. GROUP � CR05S STRE T��j �l�" SETBACKS �'E�� `D OWNER /�' Ll � ZONING �ONT RW ❑ o ADDRESs �a ti.s '�R- r� REAR ❑ � CITY �[��r�^3G�t' ZIP�TEL. ��� ! SIDE/SIDE STREET RW ❑ o APPLICANT �'�� ���� TEL.��� L— SIDE ❑ z g�,,� _ 4 CONTRACTOR �U°^'�L''"''�'�'� f+�' `�'�� SEWAGE o ADDRESS I�S C�'x..`7 DISPOSAL � PUBLIC PMT� � �' �� � � TEL. � PRIVATE SQ.Ff./100 GAL w GTY �a � ZIP�7 5u �� x STATE Z� Z�r 7�' ' ° d LIC.NUMBER � S�� � GRADING ❑ CU.YDS.EXC. CU YDS FILL y ARCH!ENG/ � TYPE SQ FT FACT�C}R PS AOJ. AREANALUAT�N V' DESIGNER W 1 p,ADURESS LL 2 Z CITY ZIP 7EL. (� 3 W � PROPOSED USE 4 � ,� GARAGE o NO.DWEL. NO. NO. m PORCH � UNITS STORIES BEDROOMS s LOT DIMENSIONS VALUATION ADJ.AREA o NO.OF BLDGS HOW QUANTITY DESCRIPTlON ,E FEE W ON LOT USED Q � U W 2 � ~ l'E'SEC CGNTRAC'ORS OECLABATION I here6y a!hrm iha!I am hcensed unaer Omvisions ot ChaOtei 9 Icommennny � � wa�Secu:n'000)=1 Orvsioo 3 of thr Business and Pmfessmns Code,and my hcense is In full lorce and eHect W 0 3 ❑ ij �+-�i(T+94EF EJIIDEF DeCLARAT!ON'he�e6y alnrn that I am eKempt Imn the Cq�aracioi s Lr.ense Law tai Me to�bwing 'reasec;Sec '0?�9 Business ar.tl Pmiess�ors Code AnV���Y�r counry xhich reqmres a pe�mit to construct. (!j o �he� nnpmve Jr.noiish,ur rr.part any su:icture pnor ro rts ssuance.also repuires the aGGI¢ant lor san permn Z F— +o'iia a sic�ee yiatenem ikat he is hcensee punuant lo the pramsions o(the Conrtactor's Ucense Law IChapter m � '�I.^.��nmenc:ng nrth Secuon 70J"ui o�'�rois�on 3 ot the Bus��ness and Prolessions Code)or that he is e�empt;herefrum '�S � anU me]as�s Inr the allege0 eMempuon Any am�a�ia.�o�Secuon 7G31 5 hy any aoDlicam !or a peimit sub�eas � W 'M1P,iUlllli'bfll IO�n�.il oenar,y o'not more ihan five hundred dallars IS5D011 a 0 ❑I,as e�.nui r��h:prcperly,or�ny empioy¢es a�ih wages as thar sole comper.sanan wdl do the work,and L`,e s:�ci.ie a�et in;r,ndeC n of�ereo foi sale ISec.1�A4,Basmess and Protessmns Code The Canaana:'s Lcense Q r,~j Lnw r.nr.�no?appiy Ic an ewner o'propeny who budds ar improves iherr.on,and who dces suc�wcrk himself. l,,,) � r• ;h�nrF hs mvn znronvees.F�%'�ded Iha1 such:mpmvemerts are na1 mterded or cffered Im sak II however, Z m ��e h�rdm�m imF�ovemem is sold w•�hir one year of com01e0on,the owner�binlder•.v�ll haee Ihe burden ol proving Q = irat^r n��;nm bwlr,m•mF�ove Icr ihe pur�ose ot sale.i � �a ❑�, , �el;ie p,r.peny em eRclusrvely aonvacvny wrth Imennn convacm�s�o constma�he pm�er�Sec W oifiCa�Basmess ar.0 Professors Catle The Comrocmrs I.irense Law does nct apply!o an owMr ot Dmperty wAo �S Z ':ailCs e�imarevrs ihereor.acd whe canir[Is Ier such G�o�ects wrth x mntracmr�sl I¢ensed pursuaN ta Ihe Cmtraclo�'s ¢ `"r""`�`"� CONSTRUCTION o ,� — ,.• i e,n=ennp;wder Sec B h P C IAttath Cerelicate� PLAN REVIEW f— p L'aie �+'��� ELECTRIC � 'JvDFlKERS COMPENSATI�JM�JECLARATION I hereCr athrm that I have a cerUhcate of mnsent m seif�insure,ar PL e�e•t 4_ate�f J.brvers .^.ompensa:mo Insurance,or a cerUhed copv theieof lSec 3800,La6 C) Qo � ^� �er:iheJ ccpy a hereoy furmsheA ��F(�H41��(�-A1 � +�/ p ❑ :.enrfied copv�s:iled wnh ihe Bwltling Inspectmn Deparlmenl ar Oepanmem d GR �Q�.l—•-....� _ y��F, ��CiRTIFIC4TC��EXEM17PTION FflOM VJCflNEAS'COMPENSATIDN INSUNANCE This sernan need no canpletN �S`S`(��yy , C� •CJ'V y'r." In=oermd is for one hundreJ IS10D1 or less I cenrfy thal�n!he performance of ine work w whKh ths � — �urme is asued,I s�all nc1 employ any pe�son m a�manner so as eo beco sub�ect ro:M Nbiker C mpensanon SMIP Laws i'Colilomia o (���� ..�y "� ' . � PARK FEE e oa�e ADO��:ant lL SCHOOL FEES � NO�ICi iJ i.P�IICANT II,alter making fMs Cenificaie ol Exempnon,you shuu 6eeome s t io the VJerMer's Campensaum�prwrsmns r.t thr:ahor Code,you must tathwnh comply�xrth sueh prwiswns or thu permn shall I:e tleer�ed�evokea — a 71VISIOh OF IN�U,S'fNIAL SAFETY PERMIT��jfFIC�nUI;,t; � i�,�_:� -- d ❑i herehy ce�tAy Uiai no ercavavon 6vt'�5�'�opj�wE!laZt�in'depth into whlch a persa+is requ�red ro descend, o�e wJl te rnade m rom�ectnn wilh wurk aulhotYed tl�M�c peimif'ar7d that iro buildmg simctum,scatfoldmy,idsework. � o�aenmlmnn or Aismar.tlug theieoi,will Ae mve Man thiny�sir�361 feet Aig� (Chap 3 2,Grp 2.An 2.Sa _ W 311 T�ieB�ACI x {,� — 3 ❑As awner�eutltler.I wdl not em�lmyya�ne 1�d�y��aik q,�CpeVyould reqmre a peimu irom tht avi5qn ol 1— InA�isuial Safety as r.uted above,unleSs'Yiic�'6erse'xhad 2 ON 5"dM'such work From tAe dnis�on. � w ❑I�vismn of Inuustnal Sefety Permil No �• � � CONSIRUfTqN LENOING A[`iEN�'!i I�{�ere6y aflirin-ihef�there iY e�toiRhuctWn'16ndinp apency lor the perfomiance TOTAL FEES = nf�he warY loi wh¢h tl��s pwnul�s issaed(Sa 3097:Crv C'1. �. - -.'.ti"+' ]` � Lewer'sName `,�.`,�.�_, ..�� � .,�.� •... •� �.• • OMMENTS � ` mlender'<_qCdress � 4 CERTIfICATE OF COMPIIANCE AND AUTfiORIZATqN Of ENTflY I cntily I have read tMs applcation and state � e� ;ha1�he�cfurmano qven is earect I agree to compiy wilh all suk laws arid ciry ordinaMes relerinp to huiNup y construcuan,and oi'¢e a represemetrve ol Ihe tment of BuiWiig and Sekry m enter upon the pmperty = inr which ve a tl toi tla's,�rd for the purpo�makrg mspectpns ~ X Y� lA. `'i„�''�� ��-"�����p Sg ture of Applrcant ar � pa�� RECPT NO. —�"`�`T PAID BY � �� VALJDATION WHITE—Department Copy,VELLOW—Finance Copy, PINK—Assessor Copy,GOLDENROD—File Copy, GREEN—ApplicaMs Copy B5106-11l89 ,�..:,..... . ... : . ,..-.:....., ... .... . . , , . ..,.. ... , , . - . ,. : . 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